Building Therapeutic Relationships Between Parents and Home Visitors from an Intersectionality Perspective

Overview: Drawing on an intersectionality perspective, this presentation will discuss significant factors associated with positive therapeutic relationships with parents in home visiting programs. The results suggest similar and different factors between fathers and mothers. In particular, US-born Hispanic fathers faced more challenges in building positive therapeutic relationships than immigrant Hispanic fathers.Proposal text: Background
Positive therapeutic relationships between parents and professionals have been well documented as a significant factor to enhance the effectiveness of home visiting programs (Sturley et al., 2022). The broader literature has shown that service users’ multiple identities, such as gender, ethnicity, and immigration status, intersect with one another in building positive therapeutic relationships (Pettyjohn et al., 2020; Roy & Walsh, 2020). However, the impacts of these complex intersections have not been fully examined in the context of home visiting programs. Drawing on an intersectionality perspective, this study examines and compares the dynamic effects of multiple identities on the therapeutic relationships of home visitors with fathers and mothers.

Methods
This study analyzed data collected from 180 fathers and 130 mothers who participated in the Dads Matter-Home Visiting program to optimize fathers’ roles in home visiting programs. Both parents’ perceptions of the therapeutic relationships were measured using the Relational Health Index (Liang et al., 2002). Ethnicity and immigration status were measured by binary variables (Hispanic = 1 and non-Hispanic = 0; US-born = 1 and non-US-born = 0). Other control variables included parents’ perceived quality of their relationship with their partner, co-residential status with partners, depression, low-income status, employment, education, age, and intervention group. Two separate multiple regression analyses were performed to identify significant factors of therapeutic relationships for fathers and mothers, respectively. The interaction effect between ethnicity and immigration status was tested using the PROCESS Macro in SPSS (Hayes, 2013).

Results
The analyses indicated similar and different factors to promote positive therapeutic relationships between fathers and mothers and their home visitors. Fathers reported a significantly lower level of the therapeutic relationship when they identified as Hispanic (B = -.21, p < .05) and were born in the US (B = -.36, p < .001). Furthermore, fathers’ ethnicity significantly interacted with their immigrant status (B = -.61, p < .05). A probing analysis provided a more detailed pattern, showing that the negative impact of being born in the US was only significant among Hispanic fathers, but not among non-Hispanic fathers. Similarly, US-born mothers were less likely than immigrant mothers to perceive positive therapeutic relationships (B = -.34, p < .05). However, mothers’ ethnicity and its interaction with immigration status were not statistically significant.

Conclusions
These findings provide useful insights into uncovering the complex nature of building parents’ positive therapeutic relationships in home visiting programs. Immigration status was an equally important factor for both parents, whereas ethnicity was a more important factor for fathers. Furthermore, US-born Hispanic fathers faced more challenges in building positive therapeutic relationships with home visitors as compared to immigrant Hispanic fathers. These findings point to strategies for promoting equality, diversity, and inclusion in home visiting programs. For example, it may be beneficial to increase the diversity of the workforce in home visiting programs to reflect the communities served. In addition, organizational efforts (e.g., training, supervision) are necessary to raise home visitors’ critical awareness about privilege and power inequality and promote their cultural humility within an intersectionality perspective.