© 2016 Informa UK Limited, trading as Taylor & Francis Group. Objective: The purpose of this study was to investigate retention and attrition in First Teacher, Alabama’s Maternal, Infant, and Early Childhood Home Visiting (MIECHV) programme. Methods: Secondary data analysis was used to identify families that were most likely to leave through attrition; focus groups were conducted to discuss potential reasons for choosing to leave or stay in the programme. Results: Participants who were pregnant and under the age of 21 years were nearly eight times more likely to leave the programme than their peers. Focus group participants confirmed that it was frequently the relationship with their home visitor that influenced their decision to stay in the programme rather than leave. Conclusion: Based on social exchange theory, investigators observed that home visitors who seemed most successful at building and maintaining relationships with their clientele were women who expanded participant networks through an exchange of information and access to community resources.