Factors associated with self-reported family enrollment in community services after referral by First Born home visitors

  • Andrew Breidenbach
    Cradle to Career Policy Institute, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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  • Hailey Heinz
    Corresponding author: Hailey Heinz, MA, MSC02 1645 1 University of New Mexico, Albuquerque NM 87131, phone: (505) 277-0582; fax: (505) 277-0118
    Cradle to Career Policy Institute, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA
    Search for articles by this author
  • Elizabeth Yakes Jimenez
    Cradle to Career Policy Institute, University of New Mexico, 1 University of New Mexico, Albuquerque, NM, 87131, USA

    Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, 87131, USA
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Published:September 16, 2022DOI:



      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 1,049 families with 5,397 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 (OR: 1.69, 95% 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.

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        • Duffee JH
        • Mendelsohn AL
        • Kuo AA
        • et al.
        Early Childhood Home Visiting.
        Pediatrics. 2017; 140e20172150
      1. Home Visiting Evidence of Effectiveness - Linkages and Referrals. Accessed September 2, 2022.

        • Allen S
        Parents’ Perceptions of Intervention Practices in Home Visiting Programs.
        Infants Young Child. 2007; 20: 266-281
        • Wagner M
        • Spiker D
        • Gerlach-Downie S
        • Hernandez F.
        Parental Engagement in Home Visiting Programs – Findings from the Parents as Teachers Multisite Evaluation.
        SRI International, Menlo Park, CA2000
      2. Sama-Miller E, Lugo-Gil J, Harding J, Akers L, Coughlin R. Home Visiting Evidence of Effectiveness (HomVEE) Systematic Review: Handbook of Procedures and Evidence Standards - Version 2.1. Accessed September 2, 2022.

        • Dodge KA
        • Goodman WB
        • Murphy RA
        • O'Donnell K
        • Sato J
        • Guptill S
        Implementation and randomized controlled trial evaluation of universal postnatal nurse home visiting.
        Am J Public Health. 2014; 104: S136-S143
        • Lutenbacher M
        • Elkins T
        • Dietrich MS
        • Riggs A.
        The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial.
        Matern Child Health J. 2018; 22: 92-104
        • Lowell DI
        • Carter AS
        • Godoy L
        • Paulicin B
        • Briggs-Gowan MJ.
        A randomized controlled trial of Child FIRST: a comprehensive home-based intervention translating research into early childhood practice.
        Child Dev. 2011; 82: 193-208
        • LeCroy CW
        • Lopez D.
        A Randomized Controlled Trial of Healthy Families: 6-Month and 1-Year Follow-Up.
        Prev Sci. 2020; 21: 25-35
      3. Home Visiting Evidence of Effectiveness. Manuscript Detail - Healthy Families America. Accessed September 2, 2022.

        • Korfmacher J
        • Green B
        • Staerkel F
        • et al.
        Parent Involvement in Early Childhood Home Visiting.
        Child Youth Care Forum. 2008; 37: 171-196
        • Duggan A
        • Fuddy L
        • Burrell L
        • et al.
        Randomized trial of a statewide home visiting program to prevent child abuse: impact in reducing parental risk factors.
        Child Abuse Negl. 2004; 28: 623-643
        • Arbour M
        • Mackrain M
        • Cano C
        • Atwood S
        • Dworkin P.
        National Home Visiting Collaborative Improves Developmental Risk Detection and Service Linkage.
        Acad Pediatr. 2021; 21: 809-817
      4. Home Visiting Evidence of Effectiveness Review: Executive Summary September 2019. Accessed September 2, 2022.

      5. Home Visiting Applied Research Collaborative (HARC). Introduction to Precision Home Visiting. Accessed September 2, 2022.

        • Schwarz DF
        • O'Sullivan AL
        • Guinn J
        • et al.
        Promoting Early Intervention Referral Through a Randomized Controlled Home-Visiting Program.
        J Early Interv. 2012; 34: 20-39
        • Duggan AK
        • Bower KM
        • Spinosa CZ
        • et al.
        Changing the home visiting research paradigm: models’ perspectives on behavioral pathways and intervention techniques to promote good birth outcomes.
        BMC Public Health. 2022; 22: 1024
        • Goldberg J
        • Greenstone Winestone J
        • Fauth R
        • Colón M
        • Mingo MV
        Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities.
        Matern Child Health J. 2018; 22: 22-32
        • Kilburn MR
        • Cannon JS.
        Home Visiting and Use of Infant Health Care: A Randomized Clinical Trial.
        Pediatrics. 2017; 139e20161274
      6. Essential Program Elements - First Born Program. Accessed September 2, 2022.

        • von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        PLoS Med. 2007; 4: e296
        • Raudenbush SW
        • Bryk AS.
        Hierarchical Linear Models: Applications and Data Analysis Methods.
        Sage Publications, Thousand Oaks, CA2002
        • Rabe-Hesketh S
        • Skrondal A
        Multilevel and Longitudinal Modeling Using Stata, Second Edition.
        Stata Press, College Station, TX2008
        • Doering JJ
        • Maletta K
        • Laszewski A
        • Wichman CL
        • Hammel J.
        Needs and Challenges of Home Visitors Conducting Perinatal Depression Screening.
        Infant Ment Health J. 2017; 38: 523-535
        • Jones Harden B
        • Denmark N
        • Saul D
        Understanding the needs of staff in Head Start programs: The characteristics, perceptions, and experiences of home visitors.
        Child Youth Serv Rev. 2010; 32: 371-379
        • Tandon SD
        • Parillo KM
        • Jenkins C
        • Duggan AK.
        Formative evaluation of home visitors’ role in addressing poor mental health, domestic violence, and substance abuse among low-income pregnant and parenting women.
        Matern Child Health J. 2005; 9: 273-283
        • Dauber S
        • Ferayorni F
        • Henderson C
        • Hogue A
        • Nugent J
        • Alcantara J.
        Substance Use and Depression in Home Visiting Clients: Home Visitor Perspectives on Addressing Clients’ Needs.
        J Community Psychol. 2017; 45: 396-412
        • Gill S
        • Greenberg MT
        • Moon C
        • Margraf P.
        Home Visitor Competence, Burnout, Support, and Client Engagement.
        J Hum Behav Soc Environ. 2007; 15: 23-44
        • Tandon SD
        • Mercer CD
        • Saylor EL
        • Duggan AK.
        Paraprofessional home visitors’ perspectives on addressing poor mental health, substance abuse, and domestic violence: A qualitative study.
        Early Child Res Q. 2008; 23: 419-428
      7. Administration for Children and Families, U.S. Department of Health and Human Services. Resources and Strategies to Promote Anti-Bias Teaching and Home Visiting Practices. 2020. Accessed September 2, 2022.

        • Shen MJ
        • Peterson EB
        • Costas-Muñiz R
        • et al.
        The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature.
        J Racial Ethn Health Disparities. 2018; 5: 117-140
        • Burcher SA
        • Corey LA
        • Mentzer KM
        • et al.
        Family home visiting and fathers: A scoping review.
        Child Youth Serv Rev. 2021; 128106132
      8. Gearing ME, Peters HE, Sandstrom H, Heller C. Engaging Low-Income Fathers in Home Visiting: Approaches, Challenges, and Strategies. Accessed September 2, 2022.

        • Miller W
        • Rollnick S.
        Motivational Interviewing: Helping People Change.
        3rd ed. Guilford Press, New York, NY2013
        • Biggs J
        • Sprague-Jones J
        • Garstka T
        • Richardson D.
        Brief motivational interviewing training for home visitors: Results for caregiver retention and referral engagement.
        Child Youth Serv Rev. 2018; 94: 56-64
        • West A
        • Gagliardi L
        • Gatewood A
        • et al.
        Randomized Trial of a Training Program to Improve Home Visitor Communication around Sensitive Topics.
        Matern Child Health J. 2018; 22: 70-78