Louisiana should strongly consider expanding voluntary home-visiting programs for families with newborns, according to a new report released Wednesday that said just 6% of all families with newborns in the state have received such visits, despite their track record for improving outcomes.
The Louisiana Policy Institute for Children and the Build Initiative's Prenatal-to-Three Capacity Building Hub released a bevy of research Wednesday into Louisiana's approach toward home visiting, including ideas for how to expand the programs. Louisiana has some of the worst outcomes for infants the developed world, including high infant mortality rates driven by an abundance of preterm births and low birthweight babies.
“This biggest thing first is setting a direction and a vision for, what do we want to see in Louisiana and then how do we make that happen?" said Amy Zapata, the director of the Bureau of Family Health at the Louisiana Department of Health.
The state administers a handful of programs to help families with newborns who are on Medicaid, including Nurse-Family Partnership and Parents as Teachers. Both have been successful with keeping families enrolled and reported high satisfaction from the families involved, according to the report.
But those programs are not reaching most eligible families who could benefit from their help. Just 1 in 10 families with newborns who are covered by Medicaid are being served by the programs; the report found that 3,645 families received services through the programs last year.
Many people who could benefit still have never heard of them.
“Currently, we are at about 80% capacity and so in real terms, we could serve another 300 families tomorrow," said Susannah Boudreaux, the state's program manager for Maternal, Infant and Early Childhood Home Visiting. "We just need to continue to solidify those relationships and increase the awareness of this wonderful opportunity.”
An expectant mother holds onto an ultrasound photo of her baby while lying on a table at St. Francis Medical Center.
The New Orleans metro area had some of the lowest levels of home visiting for infants on Medicaid last year: Just 2% of those families were part of the state's programs. The region with the highest percentage of infants on Medicaid receiving home visits last year was the northwest corner of the state, including Shreveport, where participation reached 25%.
"The first question to be addressed is whether there is the intention to serve a higher percentage of families," the report says. "If so, then there is a need to set a target goal for the percentage to be served. Any goal to serve a larger percentage of newborns will take time to achieve due to the additional workforce, training, and funding, that are needed."
Louisiana's home visiting programs been hindered by lack of funding and staffing, plus stringent requirements for enrollment in some cases. The state also doesn't have enough home visitors, which both impact the program's capacity and affect the length of time that families stay enrolled, according to the report. Many families will leave if their home visitor leaves the program.
The vast majority of funding for the state's home visiting services comes from the federal government, with $23 million budgeted for the programs for the current fiscal year and $2.6 million coming from the state's general fund. It would cost around $48 million total annually to make home visiting available for all newborns across Louisiana through a program called Family Connects International, the report estimates.
The New Orleans Health Department is piloting such an approach with Family Connects — all families who live in Orleans Parish and who give birth at Touro Infirmary or Ochsner Baptist can opt into home visits. Libbie Sonnier, executive director of the Louisiana Policy Institute for Children, said they hope to use the city's program as a guide for how to approach home visiting across the rest of the state.
Moving forward, she said, she expects to have conversations with lawmakers and community members who are asking for more support for families.
"Oftentimes what happens to families and what happens to providers, too, is that things are done to them instead of with them," Sonnier said. “We know we want to grow, but we want to do that in a thoughtful, meaningful way, using data and community voices in the process.”
The report also found that community members believe there were many families who could benefit from home-visiting services, but who did not meet the narrow requirements for Nurse-Family Partnership. The program requires enrollees to be low-income first-time parents who enroll before their 29th week of pregnancy.
Other states might serve as useful examples for Louisiana.
Oregon, for example, has passed legislation to mandate the availability of universal home visiting for all families with newborns, and followed up by requiring health insurance plans to reimburse the costs of the programs. They're in the process of phasing in the program.
New Jersey passed similar legislation in 2021 for a universal nurse home visiting program. Officials there are still in the planning phase.
