Factors Associated With Self-Reported Family Enrollment in Community Services After Referral by First Born Home Visitors.

Abstract

To examine factors associated with family enrollment in community services after receiving a referral from First Born home visiting staff in New Mexico. Analyses of program administrative data from August 2010 to January 2020 for 1049 families with 5397 referrals were conducted in Stata 15.1 using mixed effects logistic regression; missing data were imputed. We examined the likelihood of a referral outcome being coded as "client enrolled in services" based on family self-report as a function of program, referral type and initiator, and staff and referral recipient characteristics. About one fourth of referrals resulted in enrollment in services, with the highest enrollment rate for early intervention (39%) and lower enrollment rates for behavioral health (18%) and domestic violence (14%) services. Reported enrollment in the referred-to service was significantly higher for older caseholders versus teens (odds ratio [OR]: 1.69, 95% confidence interval [CI] 1.07-2.67) and for children (OR: 1.33, 95% CI 1.06-1.67) and pregnant mothers (OR: 1.45, 95% CI 1.04-2.01) versus non-pregnant mothers and significantly lower for referrals initiated by home visitors (in discussion with family - OR: 0.62, 95% CI 0.49-0.79; based on screening results - OR: 0.52, 95% CI 0.37-0.72) versus family initiated referrals, for fathers versus non-pregnant mothers (OR: 0.49, 95% CI 0.32-0.75) and for Asian, Black, and multi-racial/ethnic group caseholders versus white caseholders (OR: 0.53, 95% CI 0.30-0.97). Quality improvement efforts and home visitor training on making sensitive referrals, anti-racism, and motivational interviewing could potentially improve family engagement with community services via the First Born home visiting model.