Examining Service Integration By Community Based Providers in New York State Offering Maternal and Infant Services

Background: Perinatal maternal depression, interpersonal violence, (IPV) substance use and poor sexual health are critical public health concerns with significant negative impacts on child development. Despite widespread calls for service integration at the systems/organizational level and well-documented benefits to children and families, predictors to service integration are not well understood. Our study examines organizational and individual level predictors to service integration by 159 community-based providers (CBPs) who identify as community health workers (CHWs) or home visitors (HVs). Service integration in this study is defined as the screening, delivery and referral-making of two or more services over the course of six months. Services of interest in this study include mental health, IPV, sexual health, mental health, and substance abuse services.

Methods: We analyzed cross-sectional survey data from 159 CBPs, who identify as CHWs or HVs, which was collected using the Qualtrics platform. Descriptive statistics were performed to characterize our sample and show the distribution of service types. Logistic regression was used to identify salient organizational (job satisfaction: communication, contingent rewards, fringe benefits, operating conditions, and coworker; and training helpfulness) and individual characteristics (self-efficacy) that are associated with service integration.

Results: The majority of participants (n=70, 44.03%) integrated all four of the services: mental health, IPV, sexual health and mental health services. Training helpfulness (b=-2.48, p=0.0089), self-efficacy (b=0.0682, p<0.001), and job satisfaction (b=-0.0361, p=0.0114) were significantly associated with provision of integrated services. Specifically, elements of job satisfaction that were associated with integrated service provision included satisfaction with communication (b=-0.2792, p=0.0047), and coworkers (b=-0.2929, p=0.0043).

Conclusion: For the first time, integrated service provision was conceptualized to include sexual health, substance use, IPV and mental health services, a formulation that is responsive to the well-established linkage between clients of home visiting services and vulnerability to these conditions. Having demonstrated empirically that there are specific levers within the scope of work conditions that can be activated to promote integrated services allows human services organization leadership (many of whom are social workers), workforce policy advocates, and legislators to consider strategies to invest in training and innovative supervisory tools that are responsive, tailored, and specific to the needs of this workforce, rather than a broad one-size-fits all approach.