What predicts referrals to mental health services for fathers in a statewide home visiting program?: the role of home visitor social support

Fathers’ mental health needs are increasingly recognized in home visiting settings, and screening is one strategy that programs use to support identification and, if warranted, treatment. However, less is known about the day-to-day practices that home visitors use to move from screening to referrals and service connections for fathers. This evaluation offers a detailed description of how home visitors support fathers’ connections to mental health services within a large statewide home visiting program. The analysis included 84 fathers who enrolled in a statewide home visiting program over 24 months. It analyzed text data from fathers’ home visit records ( n = 1,195) to measure two aspects of home visitor social support, their provision of emotional support and instrumental support, as well as home visitor documentation of acute stressors and challenges present in fathers’ lives. Text data were coded using manual coding, with a machine-assisted consistency check to validate human coding and identify potential discrepancies. We then examined whether home visitors’ provision of emotional or instrumental support or the presence of acute stressors and challenges independently predicted the time to fathers’ first mental health referral using a Cox proportional hazards model, a type of survival analysis. Findings revealed that home visitors’ instrumental support and the presence of acute stressors and challenges were each associated with an increased rate of fathers’ referrals to mental health services. Findings suggest that screening alone may be insufficient to connect fathers to services and that action-oriented facilitation via instrumental support may be a key mechanism for increasing referrals in home visiting. Strengthening referral pathways for fathers may further support this pathway.