Ethnic Variations in Service Use Among New Mothers Participating in Home Visitation

Background

Healthy Families Arizona (HFAz) targets new parents who are identified at risk for child abuse and neglect and poor child developmental outcomes. HFAz attempts to reduce risk and build resilience by influencing parent child interaction, improving safety practices, and mobilizing service utilization through frequent home visitation. Previous studies of service utilization have noted a significant race effect, and significant subgroup variations by ethnicity. Typically, minority mothers have lower formal service utilization, including financial services (Daro, 2007; Radey & Padilla, 2009). Among Latino families there are mixed findings with some studies reporting greater service use for foreign-born parents (Dettlaff & Cardoso, 2010), and other studies reporting lower service use for undocumented individuals (Pérez & Fortuna, 2005).

Research Questions

This paper compares service utilization data from a randomized controlled trial of HFAz over a one-year period. Three groups of new mothers (N = 188) were compared: white, Latina- English-speaking, and Latina-Spanish-speaking. The research questions were: 1) Does service utilization differ by ethnicity and language preference? 2) Does participation in HFAz increase service utilization regardless of ethnicity and language preference? 3) Is there a dosage effect and does it vary by ethnicity and primary language? The researchers hypothesized that minority mothers would have lower service use at baseline compared to their white counterparts, that participation in HFAz would significantly increase service utilization for all new mothers, and program exposure would be positively correlated with service utilization.

Methods

Secondary, self-report data from semi-structured interviews with mothers at baseline, 6, and 12 months were analyzed. Mothers were consistently asked about their use of financial services such as TANF and also their use of other formal resources. An open-ended question was asked to capture any services not surveyed. A Poisson regression, appropriate for count data, was used to test the hypotheses.

Findings

Results indicate that the mothers in HFAz had a 27% higher rate of formal service use over the 12-month period than mothers in the control group, and a 22% higher rate of financial service use. Although ethnicity did not significantly affect service use, language preference did, with Spanish-speaking mothers reporting lower financial service utilization. A 3% increase in service utilization was observed for each additional month participants were in the program, indicating a significant dosage effect. Although ethnicity was not significant, language preference was, with lower financial service utilization among Spanish-speaking families, despite their exposure to the program.

Implications

This research supports the notion that home visitation can help at risk families overcome the effects of minority status on service utilization in high risk communities. Specific subgroup characteristics such as Spanish language preference, however, remain a barrier to the utilization of financial services, despite participation in HFAz and program exposure. This research supports a model of home visitation that is tailored to participant diversity and that strategically targets program retention. The financial support of all children regardless of the generational status of their parents is an issue that extends beyond program design and that requires other forms of policy practice.