Goal and overall framework guiding the Title V needs assessment

 

Every five years, Louisiana’s Title V Program conducts a comprehensive assessment of the health needs of the state’s maternal and child health (MCH) populations including women, infants, children, adolescents, children and youth with special health care needs (CYSHCN), and families. The goal of the 2025 needs assessment was to identify 7 - 10 priority needs to be addressed in the 2026 - 2030 state action plan of the Title V Program.  The needs assessment utilized primary and secondary data to investigate:

1. The overall health and wellbeing of the state’s MCH populations
2. The Title V Program’s capacity to respond to the identified health needs of the state’s MCH populations, including through partnerships, collaboration and coordination with other federal, state, and local entities

 

Data sources and methods used to continuously monitor and assess the overall health and well-being of the state’s MCH populations

 

Louisiana’s Title V Program supports continuous monitoring of the overall health and wellbeing of the state’s MCH populations.  Data sources used to continuously monitor and assess the health of mothers and infants, including newborns and infants with special healthcare needs, include state vital records, newborn genetic screening data, newborn birth defects monitoring data, newborn and early childhood hearing screening data.   Act 17 of the 2023 Regular Session of the Louisiana Legislature required the Louisiana Department of Health to submit an annual report to the legislature of any condition added to the national Recommended Uniform Screening Panel (RUSP), and the status of the department's review and determination on implementing testing for the condition as a part of the state newborn screening panel. The first “Annual Report on the Louisiana Newborn Screening Program for Genetic and Other Congenital Conditions” was published in November 2024.  

 

Passive surveillance of hospital discharge and emergency department data supports monitoring of fatal and non-fatal injury (including sexual violence).  Maternal mortality review panels including the Pregnancy Associated Mortality Review (PAMR) and Domestic Abuse Fatality Review (DAFR) facilitate improved understanding of the preventable factors contributing to maternal mortality.  The most recent PAMR Report and DAFR Report were published in April 2024 and May2025, respectively.  The survey-based Pregnancy Risk Assessment Monitoring System (PRAMS) supports understanding of a range of factors influencing overall maternal and infant health outcomes. PRAMS findings will now be reflected as a live dashboard whereas previously existed as annual reports. The last PRAMS report was published in early 2025.  Maternal mortality review panels and the Pregnancy Risk Assessment Monitoring System provide evidence that can not be sourced from other national or state data collection instruments or systems.  They are critical for ensuring evidence-informed design, monitoring, and evaluation of maternal and infant health policies and services.  

 

Data sources used to continuously monitor and assess the health of children and adolescents, including children and youth with special healthcare needs, include state vital records, hospital discharge data, and emergency department data. Child Death Review (CDR) panels located in each of the state’s nine health regions facilitate improved understanding of the preventable factors contributing to child and adolescent injury and mortality.  The statewide Child Death Review report was most recently published in 2024. The National Survey of Children’s Health (NSCH) and the Behavioral Risk Factor Surveillance System (BRFSS) each contribute to an improved understanding of the social determinants and behaviors influencing overall child and adolescent health.  The NSCH is specifically valuable for understanding the health and wellbeing of children and youth with special healthcare needs.  Title V funding was used to support an oversample of the number of households included in the distribution of the 2021, 2023, and 2024 NSCH survey.  The combined dataset from these oversample years allowed for stratifications of data concerning children and youth with special healthcare needs where stratifications had previously not been possible due to the small population size (i.e. CYSHCN in rural areas). The National Survey of Children’s Health (NSCH) and the Behavioral Risk Factor Surveillance System (BRFSS) provide critical data informing the design, monitoring and evaluation of child and adolescent health policies and services.  The data provided by these instruments can not be sourced from other national or state data collection instruments or systems.  The National Survey of Children’s Health is particularly valuable for driving evidence-informed policies and services for children and youth with special healthcare needs.  

 

The Federally Available Data (FAD) Resource compiled by the federal Maternal and Child Health Bureau (MCHB) was specifically appreciated throughout the 2025 needs assessment process.  The resource facilitated improved communication between Title V program coordinators, who do not have epidemiology backgrounds, the Title V supported epidemiology workforce, and Title V funded program and project managers who are utilizing data to design, monitor and evaluate MCH interventions. Measures for data stratification were particularly valuable and contributed to important discussions concerning sub-population disparities in key MCH outcome and performance measures.  

 

The initial stage of the needs assessment included a mapping of state data products (i.e., reports, dashboards, factsheets, etc.) and their update/publication timelines.  This mapping allowed for anticipation of data updates expected to occur during the needs assessment time period.  A review of key MCH data indicators included review of most recently published data products, cross-checking with the federally published FAD resource.  Where stratifications were not available in published data products, the FAD data resource was utilized.  The data review process prioritized stratification by geography, race, income, and sex (where relevant and possible) for selected MCH indicators.   

 

Constituent involvement in continuous monitoring of the overall health and well-being of the state’s MCH populations

Key constituents including policymakers, providers, and representatives of the state’s MCH populations are systematically included in the continuous monitoring of MCH health outcomes, the definition of recommendations for MCH policies and services, and the dissemination of data products and/or recommendation reports.  Legislatively mandated Boards, Councils, and Commissions are routinely consulted in the design of data collection methods, in the contextualization of data findings and in the formulation of recommendations for MCH policy and service improvement.  The Louisiana Pregnancy Risk Assessment Monitoring System Steering Committee and two mortality review committees each include representation from six community based organizations.  Nine regional Child Death Review panels each include representation of community and family constituents.   Other statewide Boards, Councils, Commissions, and action bodies facilitating constituent involvement of continuous monitoring of the overall health and well-being of the state’s MCH populations include:

• Commission on Perinatal Care and Prevention of Infant Mortality
• Birth Defects Monitoring Network Advisory Board
• Commission for the Deaf
• Doula Registry Board
• Early Hearing Detection and Intervention Advisory Council
• Genetic Disease Program Advisory Committee
• Rare Disease Advisory Council
• Sickle Cell Commission
• Young Child Wellness Collaborative

 

Quantitative and qualitative methods used to assess the strengths and needs of the MCH population

 

In addition to the continuous efforts to monitor and assess the health and wellbeing of the state’s MCH populations described in the previous section, numerous studies and collaborative strategic planning processes have been undertaken in recent years to support further understanding of the underlying factors influencing the overall health and wellbeing of the state’s MCH populations.  Specific studies examined the strengths, assets, and gaps within the systems of care charged with assuring MCH populations in the state are able to achieve their full health potential.  This section describes the most relevant studies completed within the past five years.  The description of each study highlights the qualitative and quantitative methods used as well as the level and extent of the involvement of key constituent groups including policymakers, providers, and MCH populations from around the state.  Key findings of these studies are integrated into the Needs Assessment Findings section of this application.  

 

Louisiana State Health Assessment

Implementation of the 2021-2022 State Health Assessment (SHA) provided significant insights into the overall health and well-being of the state’s MCH populations. The state health assessment utilized a mixed methods approach including community listening sessions (N: 600), a statewide survey (N: 4,551), and key constituent interviews with community leaders (N: 34) and public health system constituents (N: 11).

 

Disseminated in July 2022, the State Health Assessment identified four priority needs:

1. Behavioral Health
2. Chronic Diseases
3. Community Safety
4. Maternal and Child Health

 

Maternal and Infant Health

 

Assessment of Louisiana Department of Health activities impacting women’s health (2021-2022)

Act 210 of the 2021 Regular Session of the Louisiana Legislature directed the Louisiana Department of Health (LDH) to assess “…all activities engaged in or services provided by the Department that may specifically impact the health or quality of life of women.” The assessment included analysis of traditional indicators of physical and mental wellbeing, as well as measures of the social determinants of health, and factors from a Life Course perspective.  A key constituent survey was disseminated to all offices and sections of the Department of Health to collect data and information on current programs, services, or initiatives. 83 responses were received from six offices and sections including: Bureau of Health Services Financing (Medicaid), Office of Public Health, Office of Aging and Adult Services, Office for Citizens with Developmental Disabilities, Office of Behavioral Health, and Health Standards Section.  Key constituents from outside the Department of Health were also invited to participate in semi-structured interviews which aimed to identify policies, programs and services that were observed to be particularly noteworthy or beneficial from an external perspective. The women’s health assessment report was released to the legislature in February 2022. 

 

Louisiana Perinatal Mental Health Task Force Policy Brief (2022)

House Concurrent Resolution No. 105 (HCR 105), passed on June 9, 2021, enacted the formation of the Louisiana Maternal Mental Health Task Force to identify strategies, research, and make recommendations to improve care for pregnant and postpartum individuals experiencing mental health conditions. The Task Force’s 43 members included physicians, public health practitioners, social service providers, birth workers, persons with lived experience, and representatives from community-based organizations supporting pregnant and parenting Black and Brown families.  Data was collected during Task Force Meetings, which began on September 27, 2021 and continued to January 2022, as well as via semi-structured interviews with Task Force members. The policy brief was released in February 2022. 

 

Study on the Potential Feasibility and Benefits of a “Baby Bonds” Program in the State of Louisiana (2022-2023)

House Concurrent Resolution No. 94 (HCR 94) of the 2022 Regular Session of the Louisiana

Legislature directed the Department of Children and Family Services (DCFS) and the Louisiana

Department of Health (LDH) to jointly “study the feasibility, best structure, and potential return on

investment of a program to provide children born in Louisiana whose birth was covered or eligible for

coverage by Medicaid with a trust that, at maturity, can be used to fund the child's postsecondary

education in this state, the purchase of a home in this state, or formation of a business in this state.” The approach included a review of current literature, policy, and data; semi-structured interviews with individuals and entities named in the study’s authorizing legislation; and, formal and informal consultation with individuals with knowledge or expertise related to the charge of the legislation. Team members used the information from these activities to: 1) assess the current policy landscape; 2) identify existing programs and services with similar goals; 3) characterize the need and identify potential eligible populations in the state; and 4) describe considerations in the potential design and implementation of a Baby Bonds program in Louisiana. The study report was published in March 2023.  

 

Qualitative study of caregiver depression screening in pediatric practices in Louisiana (2023)

The study investigated pediatric providers' experiences screening caregivers for depression at pediatric well-child visits, as well as barriers to implementing universal screenings at those visits. Semi-structured interviews were conducted with 18 pediatric providers across Louisiana.

 

Study Commission on Maternal Health and Wellbeing (2023)

Senate Resolution 131 of the 2022 Regular Session of the Louisiana Legislature (SR 131) established the Study Commission on Maternal Health and Wellbeing “to research and make recommendations on connecting pregnant women and new mothers, particularly in rural and underserved areas, with resources for the health and wellbeing of mother and child.” SR 131 charged this Commission with identifying and assessing the functions and activities of existing state efforts and service systems focused on the health and wellbeing of women before, during, and after childbirth, as well as seeking ways to address a reduction of adverse maternal-health behaviors during pregnancy, dysfunctional infant caregiving, and stressful environmental conditions that interfere with parental and family functioning with a focus on maternal substance use.

 

Postpartum Newborn Nurse Home Visiting Task Force (2024-2025)

In response to House Concurrent Resolution 113 (HCR 113) of the 2024 Regular Legislative Session, the Postpartum Newborn Nurse Home Visiting Task Force was created to:

• Study the implementation and impact of the Family Connects model of postpartum newborn
• Nurse home visiting in Louisiana and other states
• Develop policy and funding recommendations to implement postpartum newborn nurse home
• visiting services, such as those provided through the Family Connects model in this state,
• Provide for the composition and duties of the task force
• Report findings to the Louisiana Legislature. House Concurrent Resolution 113 of the 2024 Regular Legislative Session

 

The Task Force reviewed national data from the Family Connects model as well as preliminary data from a pilot program implemented in New Orleans.  The Task Force completed a comparative analysis of Medicaid and private insurance models in states such as Oregon, New Jersey, Colorado and North Carolina, where Family Connects has been integrated into the state’s healthcare delivery system. The Task Force also reviewed published academic evaluations of Family Connects from other states, including randomized control trials (RCTs) and cost-benefit studies.

 

The Task Force also completed a series of constituent consultations with healthcare providers, various state agencies, and community based organizations.  Lastly, the Task Force reviewed participant satisfaction and health outcomes data collected via past surveys conducted with New Orleans families who participated in the Family Connects pilot program. Cost-per-family estimates and Medicaid savings were calculated using cost models from other states and data from New Orleans.  The Task Force report was submitted to the state Legislature on January 24th, 2025.  

 

Child and Adolescent Health, including Children and Youth with Special Healthcare Needs (CYSHCN) 

 

Development of the Whole Health Louisiana State Plan of Action to address childhood trauma and adversity (2021-2023)

The mission of the Title V supported Whole Health Louisiana (WHL) initiative is to “transform Louisiana’s cross-system collaboration and community-specific care, so that together we can effectively prevent, recognize, and treat childhood adversity and its effects, allowing the people of Louisiana to access their full potential”.  From December 2021 to November 2023, the initiative carried out a multi-phased, community engaged process to define a statewide plan to systematically address the widespread issue of childhood adversity and trauma.  In an initial discovery phase, more than 100 people were engaged through interviews and focus groups, and almost 700 people were reached via a statewide survey. The discovery process targeted subject matter experts, service providers, parents, and community leaders across the state in order to capture insights from those who were well versed in the ACEs ecosystem and/or could speak to the impact of ACEs and ACEs initiatives on their communities.  In the subsequent planning phase, the WHL initiative supported a series of “Community Conversations” throughout Louisiana to hear direct feedback from community members, particularly those who have been historically left out of conversations about health and healthcare. In total, more than 450 community members participated in at least one of the nine community conversations, which were organized in each of the state’s nine health districts. The State Action Plan was released in November 2023. 

 

Pediatric Specialist Provider Landscape Assessment (2022)

A landscape assessment was carried out to improve understanding of geographic access to sub-specialty healthcare services for children with complex medical needs. The assessment utilized a Pediatric Medical Complexity Algorithm and Medicaid claims data to complete geo-mapping of specialist health service needs. The landscape assessment then identified all pediatric providers that accepted Medicaid patients and had available appointments within the next two months.  A survey was disseminated to 1,615 pediatric providers. 1,112 pediatric providers completed the survey and 394 met the criteria. The findings showed the distribution of providers by specialty in each region and their availability to serve patients covered by Medicaid. Additionally, the analysis gave a clearer picture of the geographic areas where residents had inadequate access to specific specialties. 

 

Assessment of Early Hearing Detection and Intervention (2023)

An analysis of 2015 to 2020 Early Hearing Detection and Intervention (EHDI) system data was completed to improve understanding of key indicators including (1) percent of newborns receiving a hearing screening prior to hospital discharge, or by 1 month of age; (2) percent of children completing the audiological diagnostic process by 3 months of age; and (3) percent of children identified as D/HH and enrolled in intervention services before 6 months of age.  The analysis led to the development of a series of recommendations to assure all newborns and young children enjoyed access to desired early intervention services.  

 

Child Health and Community Services Parent Survey (2023)

A family survey instrument was developed to query families around their most valued services, barriers to services, and recommendations for system improvements. The survey was implemented in partnership with a statewide network of 10 Families Helping Families organizations. 177 families responded to the survey, including families from all nine health regions of the state.  

 

Assessment of Graduate Education Programs for Pediatric Providers (2023)

Semi-structured interviews were conducted with leaders from 16 graduate education and training programs, including programs for Family and Pediatric Nurse Practitioners, Pediatric Residency, Osteopathic Medicine and Physician Assistants.  The interviews examined the extent to which medical home competencies existed in each of the current academic curriculums or training programs.  Questions were developed using American Academy of Pediatric (AAP) recommendations and the previous work of the Medical Home Resident Education Initiative Work Group.  The assessment used a 1-5 scale to measure the degree to which the following topics were rooted into the curriculum:  Care Coordination, Community Resources, Developmental Screening, Accessible Care, Continuity of Care, Family Centeredness and Partnership, and Youth Health Transition. 

 

Pediatric Medical Home Provider Survey (2024-2025)

The Pediatric Medical Home Provider Survey includes 25 questions investigating the medical home practices of pediatric healthcare providers in Louisiana. The survey specifically focused on developmental screening and care coordination practices.  In 2024, the survey was disseminated to over 1400 pediatric healthcare professionals via email blasts, newsletters, social media promotion by the Louisiana Chapter of the American Academy of Pediatrics (AAP), Louisiana Primary Care Association (LPCA), Louisiana Medicaid and the Louisiana Academy of Family Physicians (LAFP).  The survey was also disseminated via direct mail-outs to pediatric healthcare provider offices throughout the state. Of the 53 total respondents, 46% identified as pediatricians and 23% identified as clinic managers.  

 

Development of a Strategic Plan for Louisiana’s Early Childhood Systems of Care (2023-2025)

Initially created in 2015, the Louisiana Young Child Wellness Collaborative (YCWC) is a state-level early childhood advisory body providing leadership for shared priority setting and strategic planning across the continuum of supports and services within Louisiana’s Early Childhood System.  In 2023, the YCWC launched a multi-phased and community engaged process to develop a strategic plan for the state’s early childhood systems of care.  To inform development of the strategic plan, a family/caregiver survey was conducted to capture family experiences within the early childhood developmental health system and recommendations around the systems’ strengths and opportunities for improvement. 769 persons from across the state responded to the survey, including 717 parents / caregivers and 52 providers. Nine semi-structured key informant interviews and one virtual ground-truthing session were conducted with parents from underserved areas of the state to collect additional data concerning the unique barriers and facilitators affecting access to quality early childhood healthcare systems in their regions of the state. A strategic planning workshop was organized in October 2024 to define the goals and objectives of the strategic plan. In 2025, work groups were created to define concrete activities required for the achievement of the defined goals and objectives.  

 

Methods used to assess the Title V Program’s capacity to respond to the identified health needs of the state’s MCH populations, including through partnerships, collaboration and coordination with other federal, state, and local entities

 

Louisiana’s Title V Program places significant emphasis on leveraging strategic partnerships to achieve sustainable quality improvements within the state’s MCH systems of care.  As discussed in the above description of the “Purpose and Design of the State Title V Program”, Louisiana’s Title V program identifies three key constituent groups within each of the state’s MCH systems of care: Policymakers, Providers, and People (or MCH populations).  

 

Policymakers (Federal, State, and Local)	State legislative bodies, State executive bodies, other state agencies, C-level executives from private provider or insurer organizations (nonprofit and for profit), regional and municipal authorities, foundations / philanthropy, etc.
Providers (Public and Private)	Hospitals, clinical networks, individual clinics / providers, doula networks, professional associations (i.e., American College of Obstetricians and Gynecologists, American Academy of Pediatrics, etc.), service providing community based organizations, etc.
People (Individuals, Families, CBOs)	Family-led community based organizations, community based organizations with a mission or stated mandate to represent MCH populations, individual advocates including family leaders, etc.

 

Internal Assessment of Title V organizational strategies (2024-2025)

In addition to being subject-matter experts in their respective health fields, Title V supported program and project managers are increasingly expected to work across key constituent groups and to facilitate complex engagement processes to support the development of MCH policies and services.  Within these constituent engagement processes, managers are expected to ensure that all groups, including representatives of the state’s MCH populations, are meaningfully participating in the design, monitoring, and evaluation of MCH policies and services. The modernized expectation of the management level of the MCH workforce represents a significant departure from the traditional competencies required for the management of direct, gap-filling service delivery programs.1  

 

Within this evolving context for public health management, the 2025 needs assessment carried out an internal assessment to explore the strengths, assets, and gaps related to how Title V supported program teams ensure meaningful participation of, and collaborate with,  ALL internal and external constituents for the implementation of the following five organizational strategies:

1. Identify and Diagnose Challenges
2. Identify and Align Resources and Efforts 
3. Build Coordinated Partnerships
4. Develop and Test Solutions
5. Spread and Scale Solutions

 

The assessment explored the relevance, effectiveness, efficiency, and sustainability of the tactics utilized for each of the five organizational strategies. A key constituent survey was responded to by 51 Title V supported program staff and 109 partners and key constituents of Title V supported programs. Persons invited to respond to the survey included staff of state agencies and community based organizations partnering with Title V supported programs, members of Title V supported Boards, Councils, Commissions and other advisory bodies; and members of nine regional Community Action and Advisory Teams.  Survey respondents included 6 senior management staff and 42 other personnel of Title V supported programs, 20 persons self-identified as “CBO leaders or Advocates”, 35 “Healthcare providers”, 10 “Hospital Administrators”, 1 “Medicaid/MCO representative”, 17 “Member of a state Board, Council, or Commission”, and 24 “Other”. 8 semi-structured interviews were conducted, with 6 interviews involving Title V supported program staff and 2 interviews with program partners. Additionally, 5 focus group discussions were organized with (1) regional MCH coordinators, (2) regional home visiting teams, (3) LA Perinatal Quality Collaborative quality improvement teams, (4) persons from partnering state agencies and (5) persons from other partnering clinical systems and community based organizations.

 

Interface between the collection of needs assessment data, the finalization of the state’s Title V priority needs, and the development of the state’s Action Plan.

 

The 2025 needs assessment was led by a collaboration of the Bureau of Family Health’s Data to Action Team and Strategy and Operations Team.  Initial meetings were organized in the first quarter of 2024 to discuss the overall approach of the needs assessment, to identify key data indicators, and to identify data sources and data years to be utilized to inform the needs assessment. Throughout the data and literature review stage of the assessment, updates were periodically shared with management level personnel of the Bureau of Family Health via monthly Collective Development and Alignment meetings.  Presentations shared the methods being used to inform the assessment as well as key findings for each milestone of the process.  Collective Development and Alignment meetings allowed a space for questions, answers, and discussion about methodology and/or data interpretation.  

 

From 11 - 14 March 2025, a workshop was organized with participation of all Title V supported programs.  The workshop was the first time since the onset of the 2020 COVID-19 pandemic for all Title V supported programs to be physically present in a shared space. The workshop facilitated discussions on organizational strategies and implementation approaches.  Throughout the four day workshop, specific sessions focused on themes related to the 10 essential public health services including evidence informed practices, community and family engagement, program monitoring and evaluation, and emerging issues of importance for Louisiana’s MCH populations.  

 

A draft 2026 - 2030 framework, including priority needs, was defined in April 2025.  A series of four information sessions was organized in May to give space for all Title V supported program teams to orient their understanding of the new priority needs as well as to allow for feedback and sharing of concerns.  The internal Title V application process was launched in May 2025.  From May to June, discussions with partner organizations and key constituents were led by individual Title V supported program teams to define plans of action and strategy measures aligned with the new priority needs framework.