Getting to the Warm Hand-Off: A Study of Home Visitor Referral Activities

INTRODUCTION: Conducted as part of the Massachusetts MIECHV evaluation, this study examined the role of home visitors (HVs) in facilitating families’ connections to early childhood systems of care. The aims of this study were to document the full range of HV behaviors related to service coordination. METHODS: The study sample was 65 participant cases from five program sites, comprising two home visiting models (HFM and PAT). We coded and analyzed 11,096 home visiting records, focusing on identifying referrals, connections, disconnections, and supportive behaviors across 20 service areas. Qualitative pattern analyses were conducted on a subsample of records to identify unique pathways from referral to connection. RESULTS: HVs discussed an average of 30 different programs with each participant, and overall, only 21% of referrals resulted in a service connection. This rate varied, with some (e.g., housing) requiring much more intensive HV support and yielding far fewer connections. HVs also worked to keep participants engaged once they were connected to a service, often discovering challenges in need of attention through monitoring activities. DISCUSSION: Home visiting is often thought of as a key entry point into a system of care. Findings from this study confirm this premise, highlighting both the centrality of home visiting in helping families navigate local systems of care, and the insufficiency of these systems to meet family needs.