HJNO Jan/Feb 2023

LDH 2023 PLAN 22 JAN / FEB 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS  Initiative 1: Improve Health Outcomes in Pregnancy and through Childhood In FY22, LDH advanced substantial pol- icy and systems- level changes to improve health outcomes in pregnancy and through early childhood. For FY23, the Department will build on this momentum with a focus on two particular areas: maternal and child nu- trition in pregnancy and through early child- hood, and the development of a state action plan to address early experiences that affect lifelong health — Adverse Childhood Experi- ences (ACEs) and trauma. In pregnancy and through early childhood, malnutrition and diets lacking in key nutrients lead to poor health outcomes for mothers and children. WIC provides access to supplemen- tal foods, nutrition education, breastfeeding support, and social and healthcare referrals to at-risk women, infants, and children up to 5 years of age. Participation in WIC may also reduce nutrition-related health risks such as gestational diabetes, pregnancy-induced hy- pertension and preeclampsia, and maternal iron deficiency among women. According to 2019 data from the United States Department of Agriculture (USDA), WIC serves 94.7% of potentially eligible infants and 62.9% of poten- tially eligible women in the state of Louisiana. Additionally, based on August 2022 participa- tion data, 16% of Louisiana WIC participants are enrolled in the program, but are not ac- tively participating (i.e., not receiving WIC benefits). Strengthening the referral systems for Louisiana WIC and increasing participation will augment the work the Department is cur- rently doing to improve health outcomes. In addition, Louisiana’s breastfeeding rates are below national averages, with lower rates among Black and Medicaid-insured mothers. Therefore, as part of the FY22 business plan, Louisiana Medicaid and LSU Health Sciences Center New Orleans (LSUHSC-NO) conduct- ed research—including focus groups with beneficiaries, physicians, lactation consul- tants, and MCOs—to determine gaps in care experienced by Medicaid-insured breast- feeding women. Medicaid’s continued part- nership with breastfeeding mothers, lactation consultants, physicians, and MCO representa- tives will inform the next steps in making out- patient breastfeeding support a reality. Looking more broadly at child health, Loui- siana is seeking to develop a statewide trau- ma-informed plan to set priorities for the state, and inform action around addressing the driv- ers of ACEs and childhood trauma. Research shows that exposure to trauma and toxic stress in childhood increases the likelihood of developing emotional and behavioral disor- ders in childhood and chronic disease across the lifespan. Childhood trauma is when an event, series of events, or set of circumstanc- es is physically or emotionally harmful or life- threatening, and has lasting negative effects on a child’s functioning and mental, physical, social, or emotional well-being. In Louisiana, 23% of children (compared to 18.2% national- ly) are impacted by two or more ACEs. ACEs are potentially traumatic events that occur in childhood (0- 17 years). ACEs are common, with about 61% of adults in the United States reporting they have experienced at least one type of ACE before age 18, and nearly 1 in 6 reporting they had experienced four or more types of ACEs during childhood. Goal 1: Increase breastfeeding rates through implementation of two policy changes, and increased prenatal and infant participation in the Louisiana WIC program. Strategy: Knowledge gained from communi- ty-engaged focus groups to identify barriers to lactation support — conducted as part of the FY22 business plan — will be applied to operationalize policy options and calculate the fiscal analysis necessary for implementa- tion. Expanding coverage options for outpa- tient lactation consultations and decreased barriers to obtaining breast pumps will repre- sent the culmination of research, work group consultation, and MCO and internal meetings on feasible and effective options. The Bureau of Nutrition Services will in- crease prenatal and infant participation in the Louisiana WIC program by promoting the Louisiana WIC Pre-Screening Tool to poten- tially enroll eligible women and infants; imple- menting data sharing agreements with the Supplemental Nutrition Assistance Program (SNAP) and Medicaid to expedite and expand enrollment; and expanding access to poten- tially eligible participants by partnering with Louisiana birthing facilities. Additionally, the Bureau of Nutrition Ser- vices will continue to promote breast milk as an infant’s first food by improving outreach and referrals, specifically for prenatal women, to Louisiana WIC and the WIC Breastfeed- ing Peer Counselor programs by conducting targeted outreach to healthcare providers, MCOs, and community partners; improv- ing prenatal engagement through monthly Breastfeeding Peer Counselors contacts and enrollment in Pacify for lactation support; and implementing the WIC Breastfeeding Friend- ly Clinic initiative using USDA Loving Support guidelines and the National WIC Association’s Six Steps to Achieve Breastfeeding Goals for WIC Clinics to protect and promote breast- feeding initiation and duration amongst WIC participants. Goal 2: Develop a state plan across Louisiana’s child- and family-serving systems to prevent, recognize, and address the effects of ACEs and trauma. Strategy: Engage in a comprehensive, com- munity-informed, interagency collaborative to develop principles, strategies, and priori- ties for the state’s health, education, justice, and social services systems to recognize and address ACEs and trauma in their policies, ap- proaches, and services. The process will be guided by a steering committee comprising representatives from impacted state agen- cies, community leaders, and advocates, and will encompass statewide public listening sessions.