Coordination and Integration of Providers Across Sectors Improves Referrals to and Connections With Services for Clients Engaged in Home Visiting.

Abstract

Objective: To examine the association between cross-sector collaboration among Nurse-Family Partnership (NFP) home visitors and service providers, and referrals to and use of services.

Study setting and design: An observational study of 264 local NFP agencies in 40 states, the US Virgin Islands, DC, and tribal communities was conducted. Random intercept probit regressions examined provider-specific collaboration measures and their relationship with referrals to and use of services with that provider-type, adjusting for client-, nurse-, and agency-level covariates.

Data sources and analytic sample: Secondary data from NFP implementation from 2015 to 2021 were matched to the 2018-2021 NFP Collaboration with Community Providers panel survey, 2010 Rural-Urban Commuting Area Codes, and the Index of Concentration at Extremes using 2010 census data. We included clients with their first NFP visit between January 2015 and December 2021 who completed visits through birth and did not cease program participation due to unaddressable reasons (n = 95,489).

Principal findings: Provider-specific coordination with Early Intervention, mental health, crisis intervention, substance use treatment, and child health care promoted service referrals by 1.67% points [CI:1.08, 2.27], 2.14% points [CI:1.22, 3.06], 1.13% points [CI:0.60, 1.65], 0.86% [0.52, 1.21], and 1.13% points [CI:0.13, 2.12] respectively. Provider-specific integration promoted referrals to nutrition and housing resources by 0.08% points [CI:0.03, 0.14] and 0.98% points [CI:0.46, 1.51] respectively. Provider-specific coordination and integration were associated with families' utilization of nutrition by 1.03% points [CI:0.42, 1.65] and 0.21% points [CI:0.08, 0.35], housing resources by 1.28% points [CI:0.05, 2.50] and 0.93% points [CI:0.27, 1.60], Early Intervention by 3.11% points [CI:1.28, 4.94] and 0.45% points [CI:0.02, 0.89], and mental health services by 2.85% points [CI:1.70, 4.01] and 0.24% points [CI:0.03, 0.46]. Provider-specific relational coordination was associated with the use of substance use treatment by 3.19% points [CI:1.06, 5.32] and child health care by 1.47% points [CI:0.70, 2.23].

Conclusions: Strong provider-specific collaboration is associated with increased referrals to and subsequent use of that service among families engaged in nurse home visiting, but this relationship varies by provider type.