Applying an equity lens to social prescribing.

BACKGROUND: Social prescribing is often described as an intervention that can help reduce health inequalities yet there is little evidence exploring this. This study aimed to assess the feasibility of accessing and analysing social prescribing (SP) service user data to demonstrate the impact of SP on health inequalities. METHODS: The sample size consisted of records for 276 individuals in Site 1 and 1644 in Site 2. Descriptive analyses were performed to assess the characteristics of people accessing SP, the consistency of data collected and the missingness across both sites. RESULTS: Both sites collected basic demographic data (age gender, ethnicity and deprivation). However, data collection was inconsistent; issues included poor recording of ethnicity in Site 2, and for both sites, referral source data and health and well-being outcome measures were missing. There was limited data on the wider determinants of health. These data gaps mean that impacts on health inequalities could not be fully explored. CONCLUSIONS: It is essential that SP data collection includes information on user demographics and the wider determinants of health in line with PROGRESS Plus factors. Considering equity around who is accessing SP, how they access it and the outcomes is essential to evidencing how SP affects health inequalities and ensuring equitable service delivery.

Varying Estimates of Social Workers in the United States: Which Data Source to Use?

Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs.

Sustentabilidade afetiva nos atendimentos do CREAS: as percepções das famílias / Affective support in the service of CREAS: the perceptions of families / Sostenibilidad afectiva en los servicios del CREAS: las percepciones de las familias

A Política de Assistência Social mantém a centralidade de suas intervenções na instituição familiar a fim de fortalecer a garantia de direitos à população em situação de desproteção social. Atento a esse cenário, o objetivo desta pesquisa consistiu em analisar a percepção das famílias sobre as intervenções realizadas pelos psicólogos em um Centro de Referência Especializado de Assistência Social (CREAS) situado em uma cidade do interior do estado do Paraná. Adotando uma perspectiva qualitativa, os seis participantes relataram a experiência desses atendimentos e seus impactos sobre a família. Como resultado, foi possível conhecer os receios e medos presentes nos primeiros contatos e como isso foi superado à medida que o vínculo afetivo era fortalecido, abrindo espaço para o relato das experiências difíceis de violência familiar. Ao final da pesquisa, foi possível compreender a relevância de construir uma sustentabilidade afetiva capaz de afirmar a vinculação e acolher as famílias. (AU)

Social Assistance Policy maintains the centrality of its interventions in the family institution in order to strengthen the guarantee of rights to the population in a situation of social unprotect. Aware of this scenario, the objective of this research was to analyze the perception of families on the interventions carried out by psychologists at a Specialized Social Assistance Reference Center (CREAS) located in a city in the interior of the state of Paraná. Adopting a qualitative perspective, the six participants reported the experience of these services and their impacts on the family. As a result, it was possible to know the fears and dreads present in the first contacts and how this was overcome as the affective bond was strengthened, opening space for reporting difficult family violence experiences. At the end of the research, it was possible to understand the relevance of building an affective sustainability capable of affirming the link and welcoming the families. (AU)

La Política de Asistencia Social mantiene la centralidad de sus intervenciones en la institución familiar para fortalecer la garantía de derechos a la población en situación de desprotección social. Conscientes de este escenario, el objetivo de esta investigación fue analizar la percepción de las familias sobre las intervenciones realizadas por psicólogos en un Centro de Referencia Especializado en Asistencia Social (CREAS) ubicado en una ciudad del interior del estado de Paraná. Adoptando una perspectiva cualitativa, los seis participantes relataron la experiencia de estos servicios y sus impactos en la familia. Como resultado, fue posible conocer los miedos y ansiedades presentes en los primeros contactos y cómo éstos fueron superados a medida que el vínculo afectivo se reforzó, abriendo un espacio para la denuncia de experiencias difíciles de violencia familiar. Al final de la investigación, se pudo comprender la relevancia de construir una sostenibilidad afectiva capaz de afirmar el vínculo y acoger a las familias. (AU)

Os quilombos e suas interfaces com o Sistema Único de Assistência Social / Quilombos and their interfaces with the Unified Social Assistance System

O artigo apresenta a discussão sobre os quilombos no estado do Rio Grande do Sul (RS) e as aproximações com as ofertas inscritas no Sistema Único de Assistência Social (SUAS), com objetivo de analisar as particularidades da questão étnico-racial acerca dos povos quilombolas no estado do Rio Grande do Sul, para a afirmação desta pauta na agenda do SUAS. Socializa os resultados de uma pesquisa documental de abordagem mista com ênfase qualitativa. Revela a potência e a complementaridade das informações encontradas nos instrumentos do SUAS, como nos dados do Censo SUAS (2019) do Centro de Referência de Assistência Social (CRAS) e do Centro de Referência Especializado de Assistência Social (CREAS) e os dados do Cadastro Único (2021), frente ao reconhecimento dos territórios quilombolas, embora ainda seja necessário ampliar as ações de educação permanente acerca do debate sobre a questão étnico-racial e os quilombos na agenda da política de assistência social

The article presents the discussion about the quilombos in the state of Rio Grande do Sul (RS) and the approximations with the offers registered in the Unified Social Assistance System (SUAS), with the objective of analyzing the particularities of the ethnic-racial issue concerning the quilombola peoples in the state of Rio Grande do Sul, for the affirmation of this agenda in the SUAS agenda. It socializes the results of a mixed approach documentary research with a qualitative emphasis. It reveals the power and complementarity of the information found in the SUAS instruments, as in the data from the SUAS Census (2019) from the Social Assistance Reference Center (CRAS) and the Specialized Reference Center for Social Assistance (CREAS) and data from the Single Registry (2021), in view of the recognition of quilombola territories, although it is still necessary to expand permanent education actions regarding the debate on the ethnic-racial issue and the quilombos in the social assistance policy agenda

Social Determinants of Health Needs and Pediatric Health Care Use.

OBJECTIVE: To examine the associations between family-reported social needs in primary care settings and pediatric health care use. STUDY DESIGN: Data were obtained for a sample of 56 253 children and youths (age 0-21 years) who received primary care at a large hospital-based pediatric institution between June 2018 and October 2019 to estimate a propensity score for the probability of being seen in a primary care clinic. Inverse probability weighted regression specifications were used to examine the associations between reported social needs and health care use. Families were asked about 4 social needs: housing, utilities, transportation, and food. Outcomes included the number of Emergency Department (ED), inpatient, social work, and well-child visits (only for those aged 0-2 years) in the 6 months before and after needs screening. RESULTS: Overall, 12.0% of the families reported a general social need, with 28% of those needs identified as urgent. Food and transportation needs were most common. Patients with needs were more likely to have an ED or inpatient visit at 6 months prescreening and 6 months postscreening compared with those without needs. Among children aged <2 years, those with a social need were less likely to have completed a well-child visit at 6 months postscreening compared with those without a need. CONCLUSIONS: Social needs are linked to less preventive care use and greater reliance on emergency care services. Understanding how to better assist families in need requires greater attention.

Use of social service counseling by cancer patients: an analysis of quality assurance data of 6339 breast cancer patients from 13 certified centers in Germany treated between 2015 and 2017.

BACKGROUND: Integrated social care may help to mitigate social risk factors in order to achieve more equitable health outcomes. In cancer centers certified according to the criteria set out by the German Cancer Society, every patient must be given low-threshold access to qualified social workers at the center for in-house social service counseling (SSC). Previous analyses have demonstrated large variation in the utilization of these services across individual centers. Therefore, this research aims at investigating whether SSC utilization varies regarding breast cancer patient characteristics and center characteristics presenting a unique approach of using routine data. METHODS: Multilevel modeling was performed using quality assurance data based on 6339 patients treated in 13 certified breast cancer centers in Germany in order to investigate whether SSC utilization varies with patient sex, age, and disease characteristics as well as over time and across centers. RESULTS: In the sample, 80.3% of the patients used SSC. SSC use varies substantially between centers for the unadjusted model (ICC = 0.24). Use was statistically significantly (P < .001) more likely in women, patients with invasive (in comparison to tumor in situ/ductal carcinoma in situ) diseases (P < .001), patients with both breasts affected (P = .03), patients who received a surgery (P < .001), patients who were diagnosed in 2015 or 2017 compared to 2016 (P < .001) and patients older than 84 years as compared to patients between 55 and 64 years old (P = .002). CONCLUSION: The analysis approach allows a unique insight into the reality of cancer care. Sociodemographic and disease-related patient characteristics were identified to explain SSC use to some extent.

Integrating human services and criminal justice data with claims data to predict risk of opioid overdose among Medicaid beneficiaries: A machine-learning approach.

Health system data incompletely capture the social risk factors for drug overdose. This study aimed to improve the accuracy of a machine-learning algorithm to predict opioid overdose risk by integrating human services and criminal justice data with health claims data to capture the social determinants of overdose risk. This prognostic study included Medicaid beneficiaries (n = 237,259) in Allegheny County, Pennsylvania enrolled between 2015 and 2018, randomly divided into training, testing, and validation samples. We measured 290 potential predictors (239 derived from Medicaid claims data) in 30-day periods, beginning with the first observed Medicaid enrollment date during the study period. Using a gradient boosting machine, we predicted a composite outcome (i.e., fatal or nonfatal opioid overdose constructed using medical examiner and claims data) in the subsequent month. We compared prediction performance between a Medicaid claims only model to one integrating human services and criminal justice data with Medicaid claims (i.e., integrated model) using several metrics (e.g., C-statistic, number needed to evaluate [NNE] to identify one overdose). Beneficiaries were stratified into risk-score decile subgroups. The samples (training = 79,087, testing = 79,086, validation = 79,086) had similar characteristics (age = 38±18 years, female = 56%, white = 48%, having at least one overdose = 1.7% during study period). Using the validation sample, the integrated model slightly improved on the Medicaid claims only model (C-statistic = 0.885; 95%CI = 0.877-0.892 vs. C-statistic = 0.871; 95%CI = 0.863-0.878), with small corresponding improvements in the NNE and positive predictive value. Nine of the top 30 most important predictors in the integrated model were human services and criminal justice variables. Using the integrated model, approximately 70% of individuals with overdoses were members of the top risk decile (overdose rates in the subsequent month = 47/10,000 beneficiaries). Few individuals in the bottom 9 deciles had overdose episodes (0-12/10,000). Machine-learning algorithms integrating claims and social service and criminal justice data modestly improved opioid overdose prediction among Medicaid beneficiaries for a large U.S. county heavily affected by the opioid crisis.

Six months in: COVID-19 and its impact on oncology social work practice.

The extent to which oncology social workers (OSWs) are available and adapting to disruptions in service delivery throughout the COVID-19 pandemic is unknown.Objectives: The purpose of this report is to outline the initial impact of COVID-19 on oncology social work practice during the first six months of the pandemic.Methods: As part of a nationwide investigation of workforce conditions for OSWs, three professional organizations surveyed their members to assess the effects of COVID-19 on changes to work hours, employment status, work setting, pay, and mode for patient contact (e.g., telephone or videoconference).Findings: Among 939 OSWs, 20% reported a reduction in work hours, and two-thirds indicated a temporary shift in work to home, with most patient contact occurring primarily via telephone or videoconference.Implications: Results speak to the essential nature of oncology social work and the need for evidence to inform OSW training and advocacy efforts for however long the pandemic continues.

Modelling the determinants of health and cancers as perceived by children: using imagery as a mediator of expression and narration.

OBJECTIVES: To model and analyse conceptions of determinants of health and cancer that are expressed and perceived by school children aged 6-11 based on a multiphase qualitative protocol. METHODOLOGY: This is a multicentric, qualitative study of human and social sciences conducted among school children aged 6-11 years old. Two different tools were used, e.Photoexpression and Photonarration, in four French schools. This innovative and exploratory method addresses global health during the first phase (e.Photoexpression) and the theme of cancer during the second phase (Photonarration). The children express themselves through photography and narration. RESULTS: 1498 qualitative productions were made by 381 children aged 6-11 years old. The analysis of these productions of expression and narration through images allowed modelling of determinants of health and cancer as perceived by children through 7 fields and 28 categories. The conceptions of determinants of health and child cancer refer to rationalities that are centred on individual determinants (76%), minimise environmental determinants (20%) and conceal the parameters of access to healthcare and social services (3%). DISCUSSION: These findings provide new data to the international literature on children's perceptions of determinants of health and cancer. These research findings, which can be applied to interventions and current practices, will enable prevention workers to act more effectively, closer to children's perceptions and needs.

Did COVID-19 change the interventions provided by oncology social workers in the epicenter of the pandemic? A natural experiment.

Background: Throughout history, the field of medical social work has been shaped by epidemics and pandemics. As COVID-19 rapidly overwhelmed the healthcare system in 2020, oncology departments found that space, staff, and funds were reallocated to address patient needs during the pandemic. Traditional outpatient services were required to operate with reduced resources, with special attention to additional measures to protect workers and patients from exposure to the virus. Little is known about how these changes affected the nature of the practice of oncology social work.Methods: We compared data on OSW interventions for three months (March-May) 2019 to the same period in 2020. Mount Sinai Downtown Cancer Center's Department of Social Work routinely collects data on services provided by social workers using a validated instrument. As NYC became the epicenter of the COVID-19 in March 2020, the comparison of these time periods creates a natural experiment to examine whether and how the presence of the virus impacted the services provided by OSWs.Findings: There was little difference in the number of encounters that took place between the two time periods (2186 encounters in 2019 and 2084 encounters in 2020); however, there were notable differences in the types of interventions. While interventions involving supportive counseling decreased in 2020, we identified a significant increase specific to bereavement counseling.Conclusion: The study shows a remarkable consistency in the volume and types of services provided by OSWs, in spite of the radical increase in stressors they experienced during the height of the COVID-19 pandemic. These findings suggest that the OSWs did not allow these stressors to interfere with their work with patients. This study demonstrates how routine use of an instrument to measure OSW interventions can be used to examine services provided over time and to evaluate potential influences of external factors.

Nursing Home Social Workers Perceptions of Preparedness and Coping for COVID-19.

OBJECTIVES: Social work has a long history of responding to the needs of vulnerable populations during times of crisis and disaster. Social workers are working at the front lines responding to the current COVID-19 pandemic in a variety of health care practice settings, including nursing homes; however, it is unclear how social workers perceive their preparedness during this time. METHODS: This study employed a cross-sectional survey to nursing home social workers via social media on feelings of preparedness for COVID-19, what has been most professionally helpful for social workers during these times in their role in COVID-19, as well as demographic questions. Demographic data were analyzed using SPSS and qualitative data were analyzed using the rigorous and accelerated data reduction technique. RESULTS: Data are based on a sample of 63 (N = 63) nursing home social workers. Findings revealed that while some social workers felt prepared for the coronavirus, many respondents stated that they were unprepared to meet the demands and challenges they were facing. Moreover, participants shared that professional support was critically important to get through COVID-19. DISCUSSION: These findings are important, as social workers are tasked with ensuring each resident attains their highest level of psychosocial well-being, which can be achieved only when nursing home staff are supported. Findings from the present study suggest that additional support for nursing home staff ought to include peer mentoring and mutual support. Additionally, improved leadership across health care settings is worth assessing.

Special educational needs, social care and health.

Better understanding of the proportion of children who ever receive special educational needs (SEN) provision or social care services during school years is highly relevant for healthcare as reductions in one or more of these services could impact on healthcare. Using the National Pupil Database linked to the all-of-England children looked after return and children in need census, we estimated the cumulative incidence of SEN status among (1) children ever in care during school, (2) children in need but not care, and (3) neither. We observed a very high proportion of children who were in care or need during school years had SEN provision at some point (83% and 65%, respectively), and that a high proportion of children in neither of these groups did so, too (37%). Healthcare, SEN provision and social care services focus on a similar population of children. Better integration of these services could lead to synergies and cost-efficiencies and better support for these children and their families.

Location Matters: Disparities in the Likelihood of Receiving Services in Late Life.

Moving beyond typical dichotomous rural-urban categorizations, this study examines older adults' likelihood of receiving home- and community-based services. Data from 1608 individuals aged 60+ who requested assistance from Area Agencies on Aging in Virginia in 2014-2015 were analyzed; 88% of individuals received at least one service. Receiving services was associated with geographic-based factors. Individuals living in completely rural areas were significantly less likely to receive any service compared to individuals in mostly rural (OR = 2.46, p = .003) and mostly urban (OR = 1.97, p = .024) areas. There were subtle but significant geographic-based differences in the likelihood of receiving specific services including food/meal, fresh food, information and referral, in-home care, utilities support, and transportation. Findings provide nuanced insights about geographic-based disparities in the receipt of services and suggest the need for new and modified service delivery strategies that maximize older adults' ability to live.

Hospitalization Trajectories in Home- and Community-Based Services Recipients: The Influence of Physician and Social Care Density.

OBJECTIVES: Repeated hospitalizations among older adults receiving Home- and Community-Based Services (HCBS) may indicate unmet medical and social needs. This study examined all-cause hospitalization trajectories and the association between area-level resource density for medical and social care and the trajectory group membership. METHODS: The study participants included 11,223 adults aged 60 years or older who were enrolled in public HCBS programs in Michigan between 2008 and 2012. Data sources included the Michigan interRAI-Home Care, Dartmouth Atlas of Health Care Data, the American Community Survey, and the County Business Patterns from the Census Bureau. The group-based trajectory modeling was used to identify trajectories of hospitalization over 15 months. Correlates of the trajectories were examined using multinomial logistic regression. RESULTS: Four distinct hospitalization trajectory groups emerged: "never" (43.1%)-individuals who were rarely hospitalized during the study period, "increasing" (19.9%)-individuals who experienced an increased risk of hospitalization, "decreasing" (21.6%)-individuals with a decreased risk, and "frequent" (15.8%)-individuals with frequent hospitalizations. Older adults living in areas with a higher number of social service organizations for older adults and persons with disability were less likely to be on the "frequent" trajectory relative to the "decreasing" trajectory. The density of primary care physicians was not associated with the trajectory group membership. DISCUSSION: Area-level social care resource density contributes to changes in 15-month hospitalization risks among older adult recipients of HCBS.

Who is in the revolving door? Policy and practice implications of recurrent reports to adult protective services.

Repeat referral to adult protective services APS (recurrence) is a much-discussed topic among APS agencies as it may indicate ongoing harm, yet there is limited research examining prevalence or causes. This paper provides a foundational investigation of recurrence within a California APS county program. Drawing from thirty-three months of de-identified reports, we used logistic regression to examine the impact of intake report characteristics on repeat referral within one year after baseline case closure. One-fifth of the sample was recurrent (19.9%, n=987/4,958), with self-neglect being the most common type of report to recur (14.3%, n=307/2,141). Overall recurrence was predicted by female gender, older age, living alone, and multiple elder abuse, neglect, and exploitation (ANE) types reported at baseline, and report placed by social service provider, friends, family, landlords, and victim self-reports. Reporters personally related to the victim and social service providers are potential partners in identifying ANE, and alternate intervention approaches may be necessary.

COVID-19 and social services in Spain.

During the state of alarm declared in Spain by COVID-19 due to the pandemic, the country's authorities declared Social Services and their workers to be essential, considering that the activity of these professionals with the vulnerable population was crucial and that services should continue to be provided to guarantee the well-being of users in this exceptionally serious situation. This article analyzes the impact that the COVID-19 and the state of alarm has had on Spanish social service professionals. An ad hoc questionnaire was used, administered on-line, individually, voluntarily and anonymously to 560 professionals working in social services, both in the public and private sectors, based throughout Spain. This questionnaire has five different parts: socio-demographic profiling, impact that the health crisis has had on the practice of professional functions, degree of knowledge of the measures imposed to guarantee the protection and safety of professionals and users, impact that it has had on the professional and personal development of social services professionals and, the fifth and last part, degree of adaptation of the measures aimed at the care of the vulnerable population. These results are discussed based on the situation in which professionals working in this sector find themselves in the face of the changes they are experiencing in the development of their work, and we are able to determine the profile of the workers who have felt most affected by the situation, with the consequent and foreseeable mental and emotional affectation that this implies. These professionals tend to value more negatively the set of measures developed to mitigate the impact of COVID-19 on Spanish social services.

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.

INTRODUCTION: Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. METHODOLOGY: Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. RESULTS: There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. CONCLUSIONS: The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

Higher Utilization of Social Services Is Associated with Higher Language Scores in Children from Deeply Impoverished Urban Families.

Language development has been consistently linked with socioeconomic status (SES), with children from lower SES backgrounds at higher risk for language delays. The objective of this study is to investigate the relationship between familial social service use and language development during the first year of life. Thirty-one low-income mothers and their infants were recruited from the New York metropolitan area. Mothers provided information about demographics and utilization of social services (Women, Infants, and Children (WIC), food stamps, Medicaid, and public housing). Infant language skills were assessed using the Preschool Language Scale. Multiple linear regressions were used to investigate the relationship between social service use and language skills. We found that the number of social services utilized was not an overall significant linear predictor of language skills. However, social service use interacted with poverty level to predict language skills. Specifically, for families living in deep poverty, higher service use significantly predicted higher infant language scores (ß = 3.4, p = 0.005). These results suggest that social services may be an appropriate target to help narrow socioeconomic disparities in language development.

Effect of COVID-19 lockdown on child protection medical assessments: a retrospective observational study in Birmingham, UK.

OBJECTIVES: To determine any change in referral patterns and outcomes in children (0-18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years. DESIGN: Retrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown. SETTING: Birmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children. PARTICIPANTS: Children aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018-2020. MAIN OUTCOME MEASURES: Numbers of referrals, source of disclosure and outcomes from CPME. RESULTS: There were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns. CONCLUSIONS: School closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

Programmatic determinants of successful referral to health and social services for orphans and vulnerable children: A longitudinal study in Tanzania.

BACKGROUND: Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. METHODS: Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. RESULTS: During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. CONCLUSION: CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.