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VOLUME 2

chapter 8

HEALTH AND HUMAN SERVICES

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fact sheet

HEALTH AND HUMAN SERVICES

Health

• Louisiana ranked 50th in the nation in overall health in 2015
• Infant mortality rate in Louisiana in 2015: 8.4 deaths per 1,000 live births (3rd highest in the nation).
• Cancer death rate in Louisiana in 2015: 217.9 deaths per 100,000 people (4th highest in the nation).
• Leading cause of death in Louisiana in 2015: Cardiovascular disease
• Rate of binge drinking in Louisiana in 2015: 16 percent (25th highest in the nation)
• Prevalence of obesity in Louisiana in 2014: 34.9 percent (4th highest in the nation)
• Percentage of pregnant women in Louisiana who received adequate prenatal care in 2011: 77.1.
• Average number of sick days per month Louisiana in 2011: 4.2 (7th in the nation).
• Percentage of New Orleans adults without health insurance in 2011: 19 (down from 26 percent in 2006).
• Percentage of New Orleans residents reporting some type of chronic health condition in 2011: 56.
• Percentage of New Orleans residents reporting trouble accessing health care in 2008: 68.
• Percentage decrease in access to primary care for Louisiana residents from 2008 to 2013: 1.3 (from 119.4 to 117.9 primary care physicians per 100,000 residents).
• Increase in public health funding per resident in Louisiana from 2008 to 2013: $95 to $99.
• Number of hospitals open in New Orleans as of 2016: 14 (as compared to 23 before Hurricane Katrina).
• African Americans in New Orleans were significantly more likely than whites to have fair or poor general health (28 percent compared with 19 percent) and report having no personal doctor (31 percent compared with 22 percent) in 2014.
• African American residents of Louisiana had a significantly higher cardiovascular death rate than other races in 2015.
• Economically disadvantaged New Orleans residents in 2007 ranked their health as “fair” or “poor” more than twice as often as those with higher economic status (19 percent compared with 9 percent).
• Uninsured New Orleans residents in 2008 were 1.5 times more likely to report their health status as “fair” or “poor”.
• Before Hurricane Katrina, over two-thirds of healthcare for the uninsured in New Orleans was provided by the Medical Center of Louisiana at New Orleans (MCLNO/Charity Hospital).
• Patients at MCLNO/Charity before Katrina were about 75 percent African-American and about 85 percent very low-income

WHAT DOES IT MEAN?

New Orleans and Louisiana residents have very low overall health as compared to the rest of the country. They suffer from high rates of obesity, heart disease, cancer deaths, and chronic health problems. Residents who are African American, economically disadvantaged, and/or uninsured are more likely to have significant health issues.

More than half of New Orleans residents report difficulty accessing care. However, the majority of pregnant women in Louisiana receive adequate prenatal care, and Louisiana residents report roughly as many sick days as the national average. Statewide, per capital funding for public health and per capita access to primary care both increased from 2007 to 2008.

Mental Health

• Percentage of New Orleans adults who ranked their mental health as “fair” or “poor” in 2010: 14 (down from 20 percent in 2008).
• Percentage of New Orleans adults in 2010 who reported having been diagnosed with a serious mental illness: 16 (up from 15 percent in 2008).
• Average number of poor mental health days per month for Louisiana residents in 2013: 4 (10th lowest in the nation).

WHAT DOES IT MEAN?

New Orleans residents already have high rates of mental illnesses like depression and Post Traumatic Stress Disorder (PTSD) and the number of diagnoses continues to climb each year. However, Louisiana residents overall report relatively few poor mental health days as compared to the nation.

WWW.NOLAMASTERPLAN.ORG

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Children and Seniors

• In 2015, Louisiana ranked 48th in the nation for child well-being based on ten indicators.
• Percentage of children in New Orleans living in poverty in 2014: 43 percent.
• Percentage of pre-Katrina childcare centers open in New Orleans in January, 2016: 55 (150 out of 273).
• Median annual cost for one infant in a Class A child care center in New Orleans in 2014: $5,975 (12.8 percent of median household income).
• Percentage of qualified New Orleans families receiving child care assistance vouches in 2008: 38.
• Percentage of Louisiana children served by afterschool programs in 2016: 15.
• Percentage of New Orleans senior citizens in need of health and supportive care: 16
• The percentage of New Orleans citizens over 65 was 11.5% in 2014 and is projected to increase by

WHAT DOES IT MEAN?

Children in New Orleans have very poor overall health and wellness as compared to children in the rest of the nation. Over a third of New Orleans children live in poverty. While the average cost of child care is unaffordable for the average household, just over one-third of qualified households received childcare vouchers. Less than a quarter of children are served by afterschool programs.

While 16 percent of seniors are in need of health and supportive care, several area programs provide daytime programs and services for senior residents.

There is a need to plan for the inclusion of citizens over 65 years of age, an age group which is projected to dramatically increase by 5% by the year 2030.

Homelessness

• As of January, 2015, there were an estimated 1,700 homeless individuals in the City of New Orleans—less than half of a percent of the city’s total population.
• Number of emergency shelter beds in New Orleans as of 2015: 472.
• Percentage of homeless residents in 2012 who had some form of disability: 79.
• Percentage of homeless residents in 2008 who had more than one form of disability: 31.

WHAT DOES IT MEAN?

An estimated 0.43 percent of the total population of city was homeless as of January, 2015, the majority of whom had some form of disability. There are far fewer available emergency shelter beds than there are homeless residents.

Public Safety and Criminal Justice

• In 2013, Louisiana had the highest incarceration rate in the nation. (1,420 per 100,000 adults)
• In 2013, Louisiana had a higher rate of detained and committed youth as compared to the national average (180 per 100,000 youth, compared with 173 nationally).
• In 2013, the cost of detaining a juvenile offender in Louisiana was more than $141,000 annually—more than three times the cost in some other states.
• In 2006, the rate of detained and committed Louisiana youth in custody was 149 per 100,000 youth ages 10-15, in comparison to the national rate of 125.

WHAT DOES IT MEAN?

New Orleans has a higher rate of detained and committed youth and a higher overall crime rate than the national average.

Sources: United Health Foundation, 2015; Louisiana Public Health Institute, 2015; Kaiser Family Foundation, 2015; Brookings Institute/Greater New Orleans Community Data Center, 2015; Bring New Orleans Back Health and Human Services Commission, 2015; Kessler et al, 2008; Agenda for Children, 2008. Afterschool Alliance, 2016. New Orleans Community Health Improvement Report, 2013. The Sentencing Project 2016. Louisiana Housing Corporation, 2016.

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FINDINGS

• Louisiana ranks among the worst states in the nation for several metrics of overall health, including chronic conditions such as obesity and heart disease.
• Socioeconomic disparities in health outcomes continue to persist for New Orleans and Louisiana residents.
• Access to health care among New Orleans residents has increased since Hurricane Katrina due to the proliferation of community-based clinics. However, a lack of specialty and mental health care persists.
• The overall health and wellness of children in Louisiana is poor compared with national averages.
• A relatively high percentage of children in New Orleans live in poverty, but the vast majority of them have health insurance.
• The majority of New Orleans children are not served by out-of-school-hours programs.
• The average cost of child care for one child in New Orleans is prohibitively expensive for the average New Orleans household.
• Homeless rates in New Orleans continue to surpass most other U.S. cities. Supportive housing and increased services such case management, outreach, emergency shelters, and daytime centers are needed for homeless individuals.
• New Orleans senior citizens' highest-priority needs include low-cost medication assistance, transportation assistance, and daytime programming and care.
• New Orleans continues to rank very high in the nation in overall crime, but plans to transform the city's criminal justice system are being implemented by a coalition of criminal justice leaders.

CHALLENGES

• Sustaining and growing the network of neighborhood-based community health centers.
• Coordinating health care and human services in order to reduce redundancy, increase efficiency in service provision, and close service gaps.
• Providing adequate mental health and addiction treatment services, including transitional outpatient care.

a note on education

A note on education: This chapter includes discussion of lifelong educational opportunities outside of regular school hours, including early childhood and day care for youth, afterschool opportunities for all school-age children, and day care and services for seniors. Workforce development for adults is discussed in Chapter 9—Economic Development. A comprehensive plan for New Orleans public school facilities—the School Facilities Master Plan for Orleans Parish* - was adopted by the school districts in 2008. The implications of this plan for the physical development of the city are discussed in Chapter 14—Land Use Plan.

• See: www.sfmpop.org.

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• Providing adequate basic assistance services to underserved residents, including the estimated 21 percent of New Orleans residents living below the federal poverty line (2007).
• Continuing to implement reforms to the criminal justice system to improve its effectiveness and cost-efficiency.

Environmental quality and environmental determinants of health are discussed in Chapter 13—Environmental Quality.

Acronyms

To aid in reading this section, below is a list of acronyms used within the text:

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A Introduction

A robust and integrated system of health care and human services contributes to quality of life by promoting competitiveness, productivity and livability. While access to health care among New Orleans residents has increased since Hurricane Katrina with the proliferation of community-based clinics, new hospitals, and the expansion of Medicaid in Louisiana, and most New Orleans children have health insurance, Louisiana performs poorly on many measures of overall health, and socioeconomic disparities in health outcomes persist in New Orleans. The city suffers from inequitable health outcomes for a range of measures including infant mortality and chronic disease rates, which must be addressed through more equitable social, economic, and environmental conditions in addition to improved access to health care. Lack of affordable day care and insufficient after school programs affect children and youth, while at the other end of the age continuum the priority needs for senior citizens are affordable medications, transportation assistance

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IMAGE: GNO UNITED WAY Dozens of nonprofit organizations—many founded since Hurricane Katrina—offer a broad array of services.

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and daytime programming and care. The city has higher rates of homeless persons than most other U.S. cities. Criminal justice reform initiatives and police efforts are directed at the city’s high crime rate.

The Master Plan focuses on organizing the physical and spatial aspects of providing health care and human services to New Orleans residents, as well as coordinating programs and initiatives. Non-governmental agencies provide most of these services, but city government can shape and assist the provision of services by designating and promoting locations for facilities, as well as by convening agencies working toward similar outcomes and leveraging funding to promote program coordination, efficiency, and quality. Because of the influence of social, economic and environmental factors on health, City government can also promote “health in all policies;” namely, the consideration of how policies and decisions made across sectors can affect health equity.

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The Medical Center of Louisiana at New Orleans (MCLNO/Charity Hospital) was the region's primary safety-net provider of care for residents without insurance before Hurricane Katrina.

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IMAGES: ST. THOMAS COMMUNITY HEALTH CENTER. WWW.STTHOMASCHC.ORG.

St. Thomas Community Health Center in the St. Thomas/Lower Garden District area of New Orleans is among the largest and most comprehensive primary care facilities serving both insured and uninsured patients in the New Orleans area.

B Recommendations

A recommendations Summary linking goals, strategies and actions appears below and is followed by one or more early-action items under the heading Getting Started. The Narrative follows, providing a detailed description of how the strategies and actions further the goals. Background and existing conditions to inform understanding of the goals, policies, strategies and actions are included in Volume 3, Chapter 8.

Summary

FIRST FIVE YEARS: 2010–2014 MEDIUM TERM: 2015–2019 LONG TERM: 2020–2030

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FIRST FIVE YEARS: 2010–2014 | MEDIUM TERM: 2015–2019 | LONG TERM: 2020–2030

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| | | | | | | | | :--- | :--- | :--- | :--- | :--- | :--- | | 3.B. Support and enhance efforts to increase health insurance coverage for all residents. | 1. Advocate for increased funding and expanded eligibility for public insurance programs. | (See above) | First five years | (See above) | 8.23 |

FIRST FIVE YEARS: 2010–2014

MEDIUM TERM: 2015–2019

LONG TERM: 2020–2030

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FIRST FIVE YEARS: 2010–2014 | MEDIUM TERM: 2015–2019 | LONG TERM: 2020–2030

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[ ] FIRST FIVE YEARS: 2010–2014 [ ] MEDIUM TERM: 2015–2019 [ ] LONG TERM: 2020–2030

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FIRST FIVE YEARS: 2010–2014 MEDIUM TERM: 2015–2019 LONG TERM: 2020–2030

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Getting Started

These items are short-term actions that can be undertaken with relatively little expenditure and will help lay the groundwork for the longer-term actions that follow.

• Create and maintain a database of publicly-accessible facilities that could house health and human service providers.
• Facilitate partnerships to provide for the location of health and human service providers in existing community centers and other publicly-accessible facilities.
• Convene citywide consortia on health care and human services that meet regularly and include stakeholders from public, private and nonprofit sectors.
• Direct public health funding to expand outreach to and enrollment of eligible residents in low-cost or free insurance programs.
• Advocate for the Neighborhood Place at the Mahalia Jackson School to be fully implemented.
• Ensure that all available funds for child care are drawn down from state and federal sources.
• Expand outreach to all eligible families to receive Child Care Development Vouchers.

Narrative

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Below is a more detailed narrative of the various goals, strategies and actions highlighted in the "Summary" chart.

GOAL 1

Neighborhood-based centers that coordinate and deliver a broad range of health and human services tailored to the populations they serve and are accessible to all residents

The term “multi-service center” (MSC) is used here to describe neighborhood-based service centers that provide a range of coordinated health and human services across the continuum of care. This nomenclature is intended to reflect the broadest range of possibilities for collaboration across all health and human service sectors, and encompasses the multitude of forms that those collaborations may take as the concept of the MSC is implemented throughout New Orleans to reflect and meet the specific needs of individual communities. Although they do not go by this same term, there are several service providers in New Orleans that already successfully embody this model by providing a range of multiple, coordinated services, including health care, case management, behavioral health, and programming for children and youth

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IMAGE: B/H.M/W ARCHITECTS Multi-purpose community centers such as this Central City YMCA provide recreational, educational, and wellness programs for residents of all ages and serve as anchors of neighborhood revitalization.

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Services offered in any one location should be tailored to the specific population served. An MSC is likely to include multiple service providers within a single location, including public, private and nonprofit entities

By supporting and coordinating existing providers and facilitating partnerships and co-location in key locations, the City can ensure that all neighborhoods have access to an MSC that provides the services they desire and need. The range of services that can be provided through MSCs includes:

• A “medical home” for the coordination and delivery of primary health care and other health care services, including primary and preventative care, care for chronic diseases, and outpatient mental and behavioral health. (A “medical home” is not a residence, but rather a central point of coordination of care for all health-related services. See Volume 3, page 8.4–8.5 for more explanation of medical homes.)
• Case management, coordination and delivery of human and social services.
• Daytime programs and services such as day care and after school programs for youth, daytime programs for seniors, and literacy and workforce development programs for adults.
• Access to and information about publicly-sponsored services such as food stamps, unemployment, social security, disability assistance, transportation and day care vouchers, housing assistance, and literacy and workforce development programs.
• Resources, information, public education and outreach on public health and preventative health topics.
• A database of evacuation needs of residents within the service area, including special needs populations, and coordination of services to ensure continuous medical, mental health, and social service care in the event of an evacuation or other emergency.
• Access to centralized, up-to-date information on services and providers citywide to ensure a “no wrong door” approach to care and referrals that provides efficient and coordinated delivery of services across the continuum of care. The “no wrong door” approach ensures that a client requiring services that are not provided in a given location can be easily referred to the appropriate provider with confidence that system-wide coordination will prevent redundancy and expedite the referral and service delivery processes.

1.A Coordinate partnerships between health and human service providers and owners/tenants of publicly-accessible facilities to provide for the location of multiple health and human service providers in shared locations. MSCs should be centrally-located where they are most accessible to the population they serve. The long-term goal is for every resident to have easy access to an MSC. The model of co-location of health and human services with public and centrally-located facilities such as schools, libraries, places of worship, and community and recreational centers is widely regarded as a national best practice, and has been a central tenet of numerous plans since Hurricane Katrina, including the public school facilities master plan and the UNOP and Neighborhood Rebuilding (Lambert) plans. Co-location of multiple services is not only economical, it also encourages a

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Fit NOLA

In 2011, following the lead of First Lady Michelle Obama’s Let’s Move! Campaign, Mayor Landrieu challenged New Orleans to unite in an effort to combat the obesity rate of youth within the parish. As a result of the citywide call-to-action, Fit NOLA was developed to ensure all New Orleanians have access to community resources that promote nutritional foods and physical activity. The ultimate goal of the initiative is to increase physical activity and healthier eating.

Fit NOLA Projects include the implementation of the Smoke-Free Ordinance, the Fresh Food Retailer Initiative, the Lafitte Greenway, the continued expansion/creation of over 100 miles of bike lanes and the addition of more New Orleans Development Recreation Centers. These and other projects places our city on a path to becoming the future standard

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more robust sociocultural infrastructure that promotes greater coordination and community building.

Co-located services should include services that are compatible with one another and the surrounding neighborhood environment, and exclude incompatible services, such as emergency health care facilities within primarily residential areas, that could be disruptive to the surrounding neighborhood.

To create a citywide network of MSCs, NORA, the Department of Property Management, the Office of the CAO, City Planning, and other public agencies should facilitate public-private partnerships and shared-use agreements with existing publicly-accessible facilities to secure shared locations for health and human service providers. The City Planning Commission, through the Neighborhood Participation Program described in Chapter 15 of this plan, should work with neighborhood residents to ensure that MSCs are developed with community input at every stage and result in facilities that are an appropriate "fit"—in both physical and operational character— with the surrounding neighborhood context.

RECOMMENDED ACTIONS

1. Create and maintain a database of publicly-accessible facilities that could house health and human service providers. Who: Health Department; CAO; Property Management When: First five years Resources: OFICD 2009 budget provides $25 M for health institutions and hospitals

   Many cities and towns maintain a database of vacant commercial properties for the purpose of attracting businesses to locate there (often maintained by a local economic development agency). City Planning, in coordination with other city agencies (e.g., Health Department, NORA, CAO, and Property Management, as well as the Economic Development Council) and other public and nonprofit health initiatives, could develop and maintain a similar database of potential locations for MSCs and individual health and human service providers. The database should track owner and operator contact information, facility specifications, and cost, and should eventually be geocoded and mapped to include service needs by neighborhood. Maintaining the database would require regular and consistent outreach by City Planning staff to building owners and managers and other city agencies (e.g., schools, libraries, NORD, etc.) to keep the database up to date.

   Such a database could be part of a more comprehensive citywide Asset Management Program, as discussed in Chapter 16—Structures for Implementation.

2. Use current data on population and service needs to identify under served areas and locate new MSCs and other health and human service providers in areas of greatest need. Who: CPC; Health Department; LDH When: First five years Resources: LPHI; Greater New Orleans Community Data Center; LDH; DSS; college and university research institutes and others

   Several local and regional entities collect and make available data on health outcomes, population demographics, and other factors that should be used to identify under served and at-risk populations when locating new services and facilities. Relevant data is currently available from LPHI, the Greater New Orleans Community Data Center, DHH, DSS, college and university research institutes, and other sources.

   Developing new MSCs also presents an opportunity to target public investment in ways that

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contribute to neighborhood revitalization and quality of life. As such, reuse of existing vacant or under utilized publicly-owned facilities—including community centers and schools (both functioning schools and land banked buildings)—should be given strong consideration as

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potential locations for health and human service providers since these facilities are typically centrally-located within neighborhoods. Many also have historic value and could help achieve simultaneous goals of preserving neighborhoods’ historic character, as discussed elsewhere in this plan (see Chapter 5—Housing and Neighborhoods, and Chapter 6—Historic Preservation).

3. Offer incentives to property owners and tenants of potential shared use facilities to accommodate health and human service providers. Who: Health Department; Community Development When: Medium term Resources: OFICD 2009 budget provides $25 M for health institutions and hospitals

Incentives could include tenant improvements to facilities or contributions toward maintenance costs.

1.B Provide for the location of MSCs and other needed health and human service facilities—including supportive housing—in zoning and other land use regulations. Land use and zoning should support the development of health and human service facilities, including supportive housing and MSCs, in circumstances of both adaptive reuse of existing structures and new development, and should also ensure that these facilities are pedestrian- and transit-accessible and compatible with the existing physical character of their surroundings. Health and human service facilities and MSCs should be located in or near neighborhood commercial districts wherever feasible.

RECOMMENDED ACTION

1. Consult with homeless housing providers (UNITY and other advocacy groups) and other service delivery agencies in creating new regulations. Who: CPC When: First five years Resources: UNITY of Greater New Orleans can provide information on zoning conducive to supportive housing development

1.C Involve neighborhood and community groups and other stakeholders in decisions about the location and development of MSCs, and the type of services that should be provided. The development of the first Neighborhood Place in Sabine Parish involved successful collaboration among state and local service providers, community members, and other stakeholders. It will be governed by a board of consumers and community members to ensure that it continues to serve the unique needs of that community. In New Orleans, decisions about the location of new MSCs and the types of services they provide should be shaped by similar collaborative processes involving nearby residents, property owners, and others whom the new facility will serve. The Neighborhood Participation Program outlined in Chapter 15 of this plan provides an organized structure for this type of meaningful community input into decisions related to neighborhood development.

RECOMMENDED ACTION

1. Use the Neighborhood Participation Plan to ensure meaningful community input. Who: Capital Projects When: First five years Resources: Neighborhood Participation Plan (See Chapter 15)

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1.D. Ensure transportation linkages to established MSCs to ensure accessibility. Many individuals who would benefit from a MSC do not have adequate or reliable transportation to get there.

RECOMMENDED ACTION:

1. Coordinate or develop transportation services to/from nonemergency appointments for all Medicaid recipients. Who: RTA, LDH, Local rideshare companies When: First five years Resources: Medicaid expansion

GOAL 2

Coordination of health and human services delivery across the continuum of care

To fully embody a “no wrong door” approach to providing a comprehensive range of human services, significant coordination across all sectors and service providers is needed.

2.A Support and promote ongoing initiatives to convene a citywide health care consortium and a citywide human services consortium. Two citywide consortia—one for health care and one for human services—including providers, consumers, and other stakeholders from private, public and nonprofit sectors should convene regularly to ensure efficient and effective health care and human service delivery and increase the capacity of the network of providers throughout the region. These consortia should be based on principles such as:

• Truly shared, collaborative governance composed of stakeholders from various sectors.
• Informed by, built upon or built into existing relevant structures.

  Existing coalitions include Fit NOLA and the Behavioral Health Council, both convened by the City of New Orleans Health Department.

• Embodying a regional, systems approach to health and human service policy.
• Promoting best practices with evidence-basis, based on local and national experience.
• Active engagement of the community.
• A culture of openness, mutual respect and accountability.
• Cross-membership between the two consortia.

Goals and activities of the consortia should include:

• Convening meetings of committed members within which to present their problems and resources to the consortium and community at large.
• Implementing actions to create coordinated systems of care, diminishing duplication and promoting efficient and accessible delivery of services.
• Instilling transparency and accountability into the delivery of effective services.
• Promoting the development and sustainability of service capacity of area providers through analysis, planning, decision-making and advocacy around changes to policy, programming and

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• Developing, partnering in or otherwise advocating for requests for funding.

• Providing technical assistance to committed partners for implementation of initiatives.

Developing and periodically updating shared priorities through application of consensus prioritization principles to most recent, valid and reliable data such as those from current population estimates, vital data, risk and disease data, service utilization data and community assets assessment.

RECOMMENDED ACTION

1. Ensure full participation of all relevant public agencies in consortia meetings and initiatives. Who: Health Department; MHSD; DHH; DSS; private and non-profit providers When: First five years Resources: Build on existing coalitions including Fit NOLA and the Behavioral Health Council.

City health and human service agencies should be full and active participants in these consortia, and should contribute resources from meeting space to data to funding wherever appropriate to ensure their continued success. A representative from each relevant city and local public agency (e.g., DHH, MHSD, Health Department, DSS, etc.) should appoint at least one representative to serve as the liaison to the relevant consortia. Consistent representation will help promote collaborative relationships over time.

2. Coordinate partnership with the City Health Department and Fit NOLA to develop and implement a full range of strategies focused on reducing obesity among New Orleanians. These strategies should support and build upon existing Master Plan Goals, strategies and actions in five key areas:

   • Improve access to healthy foods

   • Address the surplus of unhealthy foods in our everyday environments

   • Raise awareness about the importance of healthy eating to prevent childhood obesity

   • Encourage physical activity

   • Raise awareness of the importance of physical activity.

   Who: Health Department; non-profit organizations When: First five years Resources: Grants, philanthropic resources

2.B Streamline City-administered grant funding processes for health and human services. Private and nonprofit service providers in New Orleans report that they are often deterred from applying for available city-administered grants because of cumbersome administrative burdens. Having a single source of city-administered funding and a common application process for multiple funding sources would increase the effectiveness of these funds by broadening the applicant pool and making the funds easier to use.

RECOMMENDED ACTION

1. Convene all grant administering offices to establish a more efficient application and granting process. Who: All City agencies that administer grants to health, human service and related local

ATTACHMENT A agencies When: First five years Resources: Consult with grant recipients to better understand their needs and realities

City offices who administer grant funding should convene and establish within 6 months a strategy for streamlining funding and granting processes. The city’s web site should be utilized and application materials made available in downloadable format. A single contact person should be identified and their contact information posted on the web site to field all initial inquiries about applying for city-administered funding. Once a streamlined process is established and implemented, the group of funders should continue to meet at least annually to ensure continued coordination.

2.C Support the development of a coordinated system of record-keeping, intakes and referrals throughout all levels of heath care service provision.

RECOMMENDED ACTIONS

1. Convene a task force to streamline citywide service referral and directory services. Who: CAO (3-1-1); United Way (2-1-1) When: First five years Resources: Health and Human Services consortia should be consulted to ensure that the system meets needs of all types of providers

In the spirit of fostering a seamless continuum of care, numerous organizations have developed in-house resource guides to locally-available services, but no two lists are the same, and all require significant effort to compile and keep up-to-date. This is not only time-consuming for providers, but it also puts consumers at risk of “falling through the cracks” because providers are not always aware of other services available or do not have a reliable means of communicating with providers in other service sectors. The health care and human services consortia described above can be utilized to form a single focus groups to investigate ways to streamline and/or consolidate the various service referral and directory resources throughout the city, including VIALINK (2-1-1),³ 3-1-1,³ 504HealthNet,⁴ and others to avoid duplication of efforts and make the most efficient use of collective resources.

As of 2009, United Way was working on legislation to develop a dedicated federal funding source for the development of 2-1-1 systems nationwide, and estimates that a fully realized 2-1-1 system that meets national standards will cost approximately $1.00–$1.50 per capita. The University of Nebraska’s Public Policy Center estimates that a fully realized 2-1-1 system in Nebraska will bring $7.4 million in benefits to the state of Nebraska with a population of 1.7 million.⁵ The City should support efforts to bolster the current 2-1-1 system to provide increased coordination among health and human service providers as well increased as consumer information, and consolidate other duplicative services.

2.D Prioritize support and funding for health and human services that provide comprehensive case management and/or coordinated care across disciplines and over time.

RECOMMENDED ACTIONS

1. Advocate for completion of the Neighborhood Place at Mahalia Jackson School. Who: Health Department; Mayor’s Office; School Board When: First five years Resources: Advocate at state level for implementation of planned Neighborhood Place

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2 A toll-free 24-hour call center funded by United Way, VIALINK (2-1-1) provides referral information for both providers and consumers of health care and human services, in addition to crisis counseling. 3 The City of New Orleans offers information and referral services through its 3-1-1 dial-up information line. 4 504HealthNet is a nonprofit organization in New Orleans that provides support for coordination of service delivery among primary care providers. 5 Louisiana Alliance of Information and Referral Systems: http://www.louisiana211.org/benefits.html. February, 2009.

In 2010, the state plans to open a Neighborhood Place at the Mahalia Jackson School. It would serve as a “one-stop shop” of state services—a single location housing representatives from DSS, LDH, the Department of Education, the Louisiana Workforce Commission, and the Office of Juvenile Justice. (For more information, see Volume 3, p. 8.13.)

2. Implement ACT teams and support other resources that increase the availability of comprehensive case management. Who: LDH; DSS; MHSD When: First five years Resources: CDBG; philanthropic funding

(For more information on ACT teams, see Volume 3, Chapter 8.)

GOAL 3

A robust continuum of health care and human services, including preventative care, that is accessible to all residents

3.A Ensure continued funding and support for community-based health clinics, including their certification as Patient-Centered Medical Homes. Community clinics funded by the LPHI-administered Primary Care Access Stabilization Grant (PCASG) and other community-based clinics throughout New Orleans have not only filled critical gaps in health care provision since Hurricane Katrina, they also embody the Medical Home model of care which has been a central tenet of health care reform initiatives in New Orleans and throughout the state for more than a decade. (For more information on the Medical Home model, see Volume 3, page 8.4–8.5.) Additionally, several have expanded the services they provide to include outpatient behavioral and social services in addition to primary care, and exemplify coordinated, patient-centered service delivery across the continuum of care. These clinics represent an opportunity to reform the city’s health care system according to national best practices, and should serve as a foundation for a citywide network of neighborhood-based MSCs.

RECOMMENDED ACTIONS To ensure the continuation and expansion of community clinics in New Orleans after the 2010 expiration of the PCASG, the City should pursue the following sources of funding:

1. Advocate for increased funding from Medicaid. Who: Public-private partnerships founded through health care consortium When: First five years Resources: Medicaid; Federally Qualified Health Centers; philanthropic funding

City health officials and other city leaders can advocate at the state and federal levels for expansion of Medicaid eligibility requirements to increase the number of people insured. Increased Medicaid coverage will provide more reimbursements to health clinic providers and decrease their reliance on city and private funding. Additionally, greater flexibility in the state’s ability to use Medicaid Disproportionate Share dollars for outpatient primary care (currently only available for inpatient hospital care) can provide a stable source of funding for community health clinics.

Note: Medicaid was expanded in Louisiana as of July 2016.

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2. Advocate for expanded funding for Federally Qualified Health Centers. Who: Mayor’s Office; Health Department When: First five years Resources: Federal funding (Health Care Financing Administration)

   City health officials and other city leaders can advocate for the expansion of the Federally Qualified Health Center (FQHC) program in the New Orleans Region and the state to bring it in line with levels of funding received by states and regions with similar needs. This would allow existing FQHCs to expand their service provision and would also provide resources for new grantees. For more information on FQHCs, see Volume 3, p. 8.3-8.4.

3. Seek private philanthropic funding. Who: Mayor’s Office; Health Department When: First five years Resources: Federal funding (Health Care Financing Administration)

   Support seeking grant funding for providing care for the uninsured. Public agencies such as the Health Department and local offices of MHSD and DHH should partner with existing networks of providers to secure private funding from foundations and other sources for health care initiatives.

3.B Support and enhance efforts to increase health insurance coverage for all residents. While there are several exemplary programs that work to increase insurance coverage for New Orleans residents (enumerated in Volume 3, chapter 8), none of them currently serves its target audience completely due to lack of funding or capacity or both. Surveys of uninsured residents indicate that many are low-income (see Volume 3, chapter 8), and are therefore likely to qualify for low-cost or free insurance programs like LaCHIP, Medicaid or Medicare. Expanding outreach programs to identify and enroll qualified residents in insurance programs is an early-action item the city can take that is likely to offer significant return on investment. Increasing insurance coverage is not only likely to improve the health outcomes of enrollees, but will also bring needed funding to providers in the form of reimbursements and reduce indigent residents’ dependence on emergency rooms for basic care.

RECOMMENDED ACTIONS

1. Advocate at the state level for increased funding and expanded eligibility for public insurance programs such as LaCHIP, Medicaid and Medicare. Who: Mayor’s Office; Health Department When: First five years Resources: Federal funding (Health Care Financing Administration)

   (See Strategy 3.A, above.)

2. Provide support and funding for local outreach programs to identify and enroll eligible residents in available insurance programs. Who: Health Department; City Budget When: First five years Resources: Kingsley House’s Health Care for All program

   Public health funding such as CDBG funds should be directed to organizations that already provide outreach to enroll residents in health insurance programs (such as Kingsley House’s Health Care for All program). Prioritizing programs that work to ensure all residents will provide significant return on investment and should be an early-action item.

3 Increase access to information about what Medicaid expansion means for local residents

ATTACHMENT A Who: Health Department, LDH, 504HealthNet, local Federally Qualified Health Centers

When: First five years

Resources: Grants

Navigating the world of health insurance is complicated, and information about insurance plans is not always easily accessible. Efforts should be made to not only inform individuals of their eligibility for insurance programs such as Medicaid, but to help them understand how to use their insurance and what it covers.

3.C Prioritize funding and support for programs that increase the health and developmental outcomes of children. Investing in the health and development of children—including prenatal care—is has been proven to provide significant return on investment in terms of the health, education, wellness and prosperity of children and their families for the rest of their lives.

RECOMMENDED ACTION

1. Direct public funding to expand programs such as the Nurse Family Partnership, Head Start, Healthy Start, and other programs that increase the health of children. Who: Health Department; City Budget When: Medium term Resources: philanthropic funding; CDBG

3.D Expand mental health and addiction treatment services and facilities to meet current and projected need. Mental health care and addiction treatment stand out as a significant unmet need in New Orleans, and while the rate of mental illness appears to be on the rise, local mental health providers have lost public funding in recent years. (NOAH, the only inpatient mental health facility for the uninsured in the city is scheduled to close in 2010). Advocates for increased mental health care in New Orleans include a range of interest groups, from health, housing and homeless assistance initiatives to public safety and criminal justice advocates to real estate and business interests, who recognize the connection between providing adequate care and nurturing an investment-friendly environment.

RECOMMENDED ACTIONS

1. Advocate for increased state funding for LDH and MHSD for mental health services, including expanded ACT teams and permanent supportive housing. Who: LDH; MHSD When: First five years Resources: CDBG

2. Coordinate with the Behavioral Health Council to identify and target areas of need in mental and behavioral health and addiction treatment. Who: Health Department, LDH, MHSD When: First five years Resources: Baptist Community Ministries, City general funds

The the Behavioral Health Council will gather data on service coverage and needs

ATTACHMENT A

in the New Orleans area. Future investments should make use of this data to target investment where it is needed most and where it will offer the highest returns.

3. Work with the Behavioral Health Council and other initiatives to facilitate partnerships between service providers to offer mental health services through existing community clinics and other health care facilities. Who: Community clinics; Behavioral Health Council; mental health service providers When: First five years Resources: MHSD; LDH; DSS

Since Hurricane Katrina, several community clinics have branched out to offer mental and behavioral health services through partnerships with other providers. (See Volume 3, pages 8.7–8.8.) The City can encourage other clinics to follow this example by offering incentives and facilitating partnerships and shared-use agreements between primary care clinics and behavioral health care providers.

HARLEM CHILDREN’S ZONE

Called “one of the most ambitious social-service experiments of our time” by The New York Times and recognized as a “best practice” nationally, the Harlem Children’s Zone (HCZ) project is a unique, holistic approach to ensuring that children stay on track through college and go on to the job market. The HCZ pipeline begins with Baby College, a series of workshops for parents of children ages 0–3, and goes on to include best-practice programs for children of every age through college. The network includes in-school, after-school, social-service, health and community-building programs. The two fundamental principles of The Zone Project are to help kids as early in their lives as possible and to create a critical mass of adults around them who understand what it takes to help children succeed. All services are provided free of charge. Recent evaluations showed that 100 percent of students in the HCZ pre-Kindergarten program were school-ready for six consecutive years and 97.4 percent of eighth graders were at or above grade level in math. The budget for the HCZ Project for fiscal year 2009 is more than $40 million, or an average of $3,500 spent annually per child. One-third of funding comes from a public sources and two-thirds comes from private and philanthropic sources.

In 2008, Louisiana state legislation SR122 requested the Department of Social Services, the Department of Health and Hospitals, and the Department of Education to conduct a joint study and develop a comprehensive continuum of support for Louisiana’s children using the Harlem Children’s Zone as a model.

3.E Support and enhance preventive and public health education and programs. Supporting preventative and public health initiatives is another cost-effective investment the city can make in the health and well-being of its residents. Facilitating partnerships with neighborhood, faith-based, and other community organizations to work with public health initiatives can increase the reach of these programs to serve a broader population.

RECOMMENDED ACTION

1. Identify priority strategies and resources to address health education and outreach needs through engaging in community health improvement assessments and planning. Who: New Orleans Community Health Improvement Steering Committee, Health Department When: First five years Resources: City general funds, grants This group should coordinate and collaborate on efforts to extend public

INTERGENERATIONAL DAYCARE

Combined daycare facilities for young children and seniors that give seniors the option to participate in structured intergenerational activities with children are gaining popularity around the country. Studies have shown that elderly adults who participate in structured activities with children on a regular basis are more focused and in better moods than when children are not involved. Compared to their peers in traditional preschools, children in intergenerational daycare programs are more patient, express more empathy, exhibit more self-control and have better manners.¹

ATTACHMENT A

health education and outreach by applying jointly for funding and otherwise collaborating.

3.F Review need for and effective use of hospital facilities and emergency health care services and infrastructure according to data on projected population and need.

Hospitals and other emergency health care services and infrastructure (e.g., EMS, fire and police) are critical to ensuring a robust continuum of health care services. The health care industry is also an important component of the future economic prosperity for New Orleans and the region. Development of new hospital and emergency infrastructure should be driven by data on population demographics and areas of need within the health care sector (e.g., types of specialties, etc.).

RECOMMENDED ACTION

1. Convene a hospital and emergency care advisory group within the citywide health care consortium (see above) to facilitate the aggregation and use of data in hospital and emergency health care planning.

Who: LDH; hospital and emergency care advisory group, Health Department, health care systems When: First five years Resources: OFICD Budget; City Budget

See also: Chapter 10—Community Facilities and Services for a discussion of emergency services and infrastructure.

3.G Support and enhance programs and partnerships that promote sexual and reproductive health and teen pregnancy prevention.

New Orleans experiences high rates of sexually transmitted infections and teen pregnancy. It is important to inform and educate residents on the availability of prevention and testing services and provide them with information on how to make healthy decisions around sexual and reproductive health.

RECOMMENDED ACTION

1. Increase awareness of services that provide screening, testing, and education for all ages, especially school-aged students

Who: LDH, Health Department, Schools, LPHI When: First five years Resources: LDH, LPHI, Grants

3.H Provide for emergency planning to ensure continuity of operations and services.

In light of New Orleans’ vulnerability to emergencies, it is critical for health and human service providers to engage in emergency preparedness planning and maintain continuity of operations plans.

RECOMMENDED ACTION

1. Identify and address gaps in continuity of operations plans for all health and human service providers.

Who: LDH, Health Department, Schools, LPHI When: First five years Resources: LDH, LPHI, Grants

GOAL 4

Access to fresh, healthy food choices for all residents

ATTACHMENT A

4.A Establish and promote fresh produce retail outlets within walking distance of all residents.

ATTACHMENT A

RECOMMENDED ACTIONS

1. Identify areas that are under served by fresh food access. Who: CPC; Community Development When: First five years Resources: Tulane Prevention Research Center

   Work with local partners, including the Tulane Prevention Research Center, to establish a walkability standard for access to fresh produce outlets for all residents (e.g., 80 percent of households within ½ mile of outlets) and identify geographic areas throughout the city that are under served by fresh food outlets according to this standard. An example of this type of study is the New York City Supermarket Need Index6, which determines areas in the city with the largest populations with limited opportunities to purchase fresh food.

2. Remove zoning and regulatory barriers to farmers’ markets and other temporary/mobile fresh food vending. Who: CPC When: First five years Resources: CZO under development

3. Explore incentives and provide technical assistance and training for small neighborhood food stores to stock fresh and local produce in under served areas. Who: OCD, Health Department When: First five years Resources: City can offer expediting permitting as an incentive; grants.

   Incentives might include: Financing (grants and loans) for capital improvements and equipment, inventory, and technical assistance; expedited permitting assistance with produce merchandising and promotion. See also: Chapter 5—Neighborhoods and Housing for strategies for attracting supermarkets and other neighborhood-serving retail.

4. Encourage and assist farmers’ markets to accept food stamps and Seniors/WIC Farmers’ Markets Nutrition Program coupons. Who: Health Department; local WIC administrators When: First five years Resources: Several area farmers’ markets already accept WIC and other food assistance coupons

5. Support urban agriculture and community gardens. See Chapter 13—Environmental Quality. Who: OFICD; CPC When: First five years Resources: Federal funding; bonds; philanthropic resources

6. Explore and implement incentives to encourage sale of fresh and local food. Who: City’s Economic Development Team When: First Five Years Resources: Grants

The 2009 OFICD budget provides $7 million in D-CDBG funds to establish a Fresh Food Retailers Grant/Loan Program, and an additional $2 million to establish a Community Markets Initiative and an Urban Food Gardens initiative. These funds—in addition to private and philanthropic funding—can be used for the above strategic actions. The City should work with stakeholders to assure that there is a business plan for the continuation of these initiatives after disaster fund. The CZO allows agriculture with products destined for commercial sale in most districts.

Initiatives to increase opportunities for participating in urban agriculture are discussed in Chapter

ATTACHMENT A

13—Environmental Quality.

6 For more information, see: http://home.nyc.gov/html/dcp/html/supermarket/index.shtml.

4.B Support access to healthy nutrition opportunities at government-run or supported facilities including (but not limited to healthy foods and beverages, availability of breastfeeding spaces, and availability of fresh water.

1. Amenities to be included (but are not limited to) healthy foods and beverages, availability of breastfeeding spaces, and availability of fresh water. Who: City, State, non-profit organizations When: First five years Resources: Federal, State and City funds / grants

4.C Explore avenues to address unhealthy food choices

RECOMMENDED STRATEGIES:

1. Explore land use and zoning policies that restrict fast food establishments near school grounds and public playgrounds. Who: City Planning Commission, City Council When: First five years Resources: Staff time

2. Explore local ordinances to restrict mobile vending of calorie-dense, nutrient-poor foods near school grounds and public playgrounds. Who: City Council When: First five years Resources: Staff time

3. Promote consumer education and programming to facilitate healthy eating habits and support demand for fresh and local produce. Who: Health Department, Fit NOLA Partners, Food Policy Advisory Council When: First five years Resources: Grants

4. Educate residents about and promote advocacy to limit proliferation of fast food and drive thru establishments. Who: Health Department, Fit NOLA Partners, Food Policy Advisory Council When: First five years Resources: Grants

4.D Promote business development for farmers and processors of locally grown food

RECOMMENDED STRATEGIES:

1. Reduce zoning and regulatory barriers to processing and distribution of “value added” local food products. Who: City Planning Commission, City Council When: First five years Resources: Staff time

Many local growers and producers could earn more income by selling value added products beyond raw produce, but face barriers. Reducing such barriers would enhance the local food industry and facilitate business development and improved livelihoods of local growers and producers.

ATTACHMENT A

2. Promote training and instruction in food and plant production and processing. Who: Local universities When: First five years Resources: Grants

3. Encourage and support urban agriculture and community gardens through linkages with land use, water management, and economic opportunity plans. Who: City Planning Commission, NORA, Sewerage and Water Board, Network for Economic Opportunity, Health Department When: First five years Resources: Staff time, grants

GOAL 5

High-quality child care and learning opportunities beyond basic education that are accessible to all children

5.A Expand after school and youth programs to serve all New Orleans children. As of 2007, only 25 percent of qualified school-aged children were served by after school programs. For more information, see Volume 3, pages 8.16–8.17.

RECOMMENDED ACTIONS

1. Pursue increased funding from state and federal sources for after school and youth programs. Who: City, with local private and non-profit providers and advocates When: First five years Resources: Twenty-first Century Learning Center Program; No Child Left Behind; Child Care Development Fund; CDBG; Temporary Assistance to Needy Families; Section 8(g) Grant Program

Investments in programs for children and youth have been show to provide dramatic returns in terms of both child and family wellness as well as cost savings to the municipalities in which they live. For instance, investments in high-quality pre-school education for low-income students show a $9 return for every $1 investment. Public funding is available for after school programs but has not been fully utilized by the city in recent years. Out of 33 discretionary federal programs identified as potentially funding after school programs, only 9 of them

ATTACHMENT A

currently have awardees in New Orleans. The city should partner with child care providers and local advocates (such as the Afterschool Partnership and Agenda for Children) to apply for funds and ensure that all available funding is drawn down and used each year. Sources of available funds include:

• 21st Century Community Learning Center Program (21st CCLC): Louisiana is eligible to receive over $20 million each year to support afterschool programs; however, since 2004, the state has not drawn down the maximum amount of money dedicated for 21st CCLC programming.
• No Child Left Behind
• Child Care Development Fund (CCDF): The CCDF is designed to help provide child care to low income parents who work and/or attend school.
• Community Development Block Grants (CDBG): Currently, the City of New Orleans allocates $115,617 of the $15.5 million in CDBG funds it receives to youth programs.¹
• Temporary Assistance to Needy Families (TANF): Louisiana dedicates $19–25 million each year in TANF funds to reimburse licensed child care centers.
• Section 8(g) Grant Program: Provides approximately $5.1 million in funds each year to exemplary or innovative programs designed to improve student academic achievement or skills.

THE CENTER FOR EMPLOYMENT OPPORTUNITIES (CEO), NEW YORK, NY

Eighty-nine percent of all probation or parole violators are unemployed at the time of violation. CEO is an nonprofit employment agency for people with criminal records in New York City based on the idea that if the employment needs of persons with criminal convictions are addressed at their most vulnerable point—when they are first released from incarceration or soon after conviction—they will be less likely to become reincarcerated and more likely to build a foundation for a stable, productive life. CEO's services include a highly structured program of pre-employment job readiness training, short-term paid transitional employment and full-time job placement and retention services. Findings from an independent evaluation show that program participants are 50 percent less likely to be reincarcerated after joining the program.[^p39-13]

2. Increase outreach to provide Child Care Development Fund vouchers to all who are eligible. Who: DSS; CDBG; philanthropic funds When: First five years Resources: Provide information through health clinics, Nurse Family Partnership and similar programs for expectant families and MSC

   As of 2008, only 38 percent of qualifying families received the voucher. (For more information, see Volume 3, Chapter 8) The City can assist in facilitating partnerships with community organizations such as neighborhoods, schools, places of worship, and others to perform outreach to families with children.

3. Provide for the location of needed child care and afterschool facilities in zoning and other land use regulations. Who: CPC When: First five years Resources: CZO under development

4. Provide support and incentives to child care service providers to become accredited through both national and state accreditation programs. Who: Non-profit organizations When: First five years Resources: Agenda for Children offers training and technical assistance to child care providers

ATTACHMENT A

As of 2009, only three child care facilities in New Orleans were nationally accredited. For more information, see Volume 3, Chapter 8.

5. Prioritize new program development in areas of greatest need. Who: Prioritize program development in areas of greatest need When: First five years Resources: Agenda for Children; Afterschool Partnership and others can provide data on service needs

The Agenda for Children, the Afterschool Partnership for Greater New Orleans, and other local and national advocacy organizations collect and make available data on service gaps in programs for youth. Partnering with these and other organizations to plan public investments in areas of greatest need will ensure the best return on investment.

6. Support workforce development programs that train professional childcare workers. Who: New Orleans Economic Development Council When: Medium term Resources: Local colleges and universities

There is currently a nationwide shortage of well-trained and experienced child care workers. For more information on programs that provide workforce development in child care, see Volume 3, page 8.16. See Chapter 9 for further discussion on workforce development programs.

GOAL 6

High-quality supportive services for the elderly that are accessible to all elderly residents

6.A Expand elder care facilities and services in areas of greatest need. To better serve all elderly residents with daytime care and activities, including social and recreational programs as well as health care services, additional facilities as well as expanded services in existing facilities should be developed according to data on service gaps and need. Priority should be given to development of services on or near transit routes and in or near other community and publicly-accessible facilities for maximum accessibility.

RECOMMENDED ACTION

1. Identify and expand elder care facilities and services in areas of greatest need. Who: DHH; MHSC When: First five years Resources: Council on Aging can provide data on service needs.

6.B Provide affordable paratransit service for seniors. In 2008, a survey of New Orleans-area seniors revealed that low-cost transportation assistance was among seniors' most important issues. For more information, see Volume 3, p. 8.17.

RECOMMENDED ACTIONS

1. Advocate for increased funding for paratransit from RTA. Who: RTA; Council on Aging When: First five years Resources: Council on Aging had a paratransit program in the past; requires additional funding to restart it

ATTACHMENT A

2. Provide public funding for taxi vouchers for low-income seniors. Who: Community Development Council on Aging When: Medium term Resources: Staff time; Federal grants See also: Chapter 5—Housing and Neighborhoods for a discussion of housing for the elderly.

6.C. Create an Age Friendly New Orleans Working Group to guide an age friendly strategy for the city to better support its seniors and allow for aging in place. By 2030 the share of residents over the age of 65 is projected to increase by 5%. To prepare for this increase and better serve residents of all ages a plan should be made to make the city more age friendly.

RECOMMENDED ACTIONS

1. Bring together people knowledgeable about senior needs as a working group charged with advising on Age Friendly policies for the city. Who: AARP Louisiana, New Orleans Council on Aging, with a diverse stakeholder group.

GOAL 7

A robust continuum of care for homeless individuals and families

7.A Provide additional funding and support for outreach and safety net services for homeless persons. With the extent of blight and vacancy in New Orleans, outreach workers for the homeless are stretched thin. Providing additional funding for outreach to the homeless is the only way to ensure that all homeless individuals have access to the network of services designed to move them into permanent housing and provide supportive services.

RECOMMENDED ACTION

1. Advocate for increased funding at state and federal levels. Who: LDH When: First five years Resources: Council on Aging can provide data on service needs.

7.B Provide for the location of permanent supportive housing, emergency shelters and daytime service centers for the homeless in land use and zoning.

RECOMMENDED ACTION

1. Incorporate into CZO. Who: CPC When: First five years Resources: CZO under development

2. Explore opportunities to use existing vacant buildings to house homeless individuals and provide wraparound services. Who: Community Development, Health Department When: First five years Resources: City and State resources

7.C Support programs and services that prevent homelessness through financial counseling

ATTACHMENT A and emergency assistance to at-risk households.

RECOMMENDED ACTION

1. City convening diverse working group to develop strategic plan to end homelessness. Who: City Administration, City Council, business community, faith-based community, Continuum of Care (Unity), HUD, DHH, DOJ, USICH When: First five years Resources: HUD, philanthropic community

2. Provide financial support to homeless-serving agencies so they can offer financial management and job sustainability classes to homeless individuals Who: Community Development When: First five years Resources: City, State, Federal, philanthropic resources

See Chapter 5—Housing and Neighborhoods for a discussion of permanent supportive housing.

GOAL 8

A criminal justice system that is effective, efficient, and just, and that emphasizes prevention and rehabilitation

In spring 2007, at the request of the New Orleans City Council, the Vera Institute of Justice proposed several initiatives to make the city's criminal justice system more fair and effective based on national best practices. These recommendations led to formation of the Criminal Justice Leadership Alliance (CJLA). CJLA, working in partnership with the Vera Institute, has already completed ground-breaking work on this issue, implementation of which began in 2009 and holds great promise for transforming the criminal justice system in New Orleans. (For more information, see Volume 3, pages 8.22–8.23.) In addition, NOPJF’s OPISIS information-sharing system promises to increase communication and efficiency within the New Orleans criminal justice system. The City should prioritize the continued implementation of these plans. The recommendations below are intended to emphasize and support these plans.

NOLA FOR LIFE: A Comprehensive Murder Reduction Strategy was developed by the Mayor’s Innovation Delivery Team, in collaboration with the Police Department, Health Department, other City departments, as well as agencies and community members across New Orleans. NOLA FOR LIFE has utilized a public health approach to reducing violence since its launch in 2012. While the murder rate remains unacceptable, since the implementation of many initiatives under NOLA FOR LIFE we have seen a reduction in the murder rate, as well as decreased recidivism among NOLA FOR LIFE program participants.¹

8.A Support and expand community-based crime prevention programs that target high-risk and vulnerable populations. Stopping the cycle of violence and learned criminal behavior starts with preventing criminal activity before it begins. Studies show that afterschool, youth mentorship, and recreational programs are effective deterrents to criminal activity in young at- risk populations. Nonetheless, criminal justice professionals in New Orleans cite the dearth of youth programs and mental health and addiction treatment services as major impediments to an effective criminal justice system.

ATTACHMENT A

RECOMMENDED ACTION

1. Implement and support evidence-based strategies and programs such as CeaseFire New Orleans and Group Violence Reduction Strategy. Who: Mayor's office, NOLA FOR LIFE When: First five years Resources: Advocate for increased public funding and apply for private funds.

   Contributors to strategy development should include members of the criminal justice system, representatives from youth advocates such as the Afterschool Partnership, NOPD, NORD, MHSD, and other stakeholders.

2. Address conflicts and trauma among youth through promotion of positive behavioral interventions and supports and trauma-informed approaches in schools. Who: Schools, Health Department, Center for Restorative Approaches, Behavioral Health Council When: First five years Resources: Grants

8.B Expand evidence-based alternative sentencing, diversion, and community corrections programs for nonviolent offenders that emphasize comprehensive rehabilitation. Alternative sentencing, also known as community corrections, is a strategy of serving low-level offenders such as first-time, nonviolent, and status offenders a sentence that can be served in a supervised community-based setting as opposed to in confinement. Community corrections have been shown to result in significant public savings. For example, while a day in detention in Cook County (IL) costs about $114, many young people are now supervised in the community by a youth advocate for $17 a day, or report nightly to a community center for intensive supervision and programming at a cost of $35 a day. Community corrections programs have also been shown to significantly reduce recidivism: Over 90 percent of the young people in Cook County's detention alternatives remained arrest-free

9 National Youth Violence Prevention Resource Center: http://www.safeyouth.org/scripts/index.asp

ATTACHMENT A

while in the programs.¹ The New Orleans criminal justice system offers some opportunities for community corrections for youth and adults, such as the successful Orleans Parish Drug Court and the District Attorney’s Diversion Program. However, criminal justice professionals suggest that these serve only a fraction of those eligible.

RECOMMENDED ACTIONS

1. Redirect criminal justice funding to support community corrections as opposed to incarceration. Who: Parish Criminal Sheriff When: First five years Resources: Juvenile Detention Alternatives Initiative program of the Annie E. Casey Foundation

   Louisiana State law explicitly allows the Orleans Parish Criminal Sheriff to establish and operate community rehabilitation centers within Orleans Parish for offenders who have “strong rehabilitation potential.”² Redirecting funds from incarceration facilities to community programs would increase the capacity of these programs to serve a higher percentage of eligible nonviolent offenders.

2. Expand workforce readiness opportunities for people with criminal records. Who: Economic Development Council; private service providers When: Medium term Resources: CDBG; private funding

   Prisoner re-entry programs that focus on employment and life skills have been shown to significantly reduce recidivism (see box above). Expanding such programs is a cost-effective means of reducing recidivism and reducing crime rates that could provide significant return on investment.

3. Investigate creation of a state Community Corrections Act or similar legislation to provide funding for community corrections programs. Who: State legislators When: Medium term Resources: 36 other states have similar legislation that can be used as precedent

   Thirty-six states have policies known as a Community Corrections Acts that provide funding to municipalities for community corrections programs.³ For example, California’s Probation Subsidy Act, enacted in 1965, provided counties up to $4,000 for each prison-eligible offender who was supervised, sanctioned and serviced in the community. Between 1969 and 1972, the state placed nearly all nonviolent property offenders under local supervision, cut its inmate population by 30 percent, closed eight prison facilities and drove recidivism (within two years of release) down from 40 percent to 25 percent.⁴ Louisiana currently has no such program, but city officials could collaborate with other municipalities in the state to investigate the potential cost savings and feasibility of implementing similar legislation.

4. Fund mental health and substance abuse diversion programs at courts. Who: City Council, Health Department When: First five years Resources: City funds, grants

   The Community Alternatives Program at Municipal Court, run by the Health Department, is a diversion program that diverts defendants with mental illness to treatment in lieu of incarceration. This program fosters collaboration between mental health and criminal justice stakeholders. Since its inception in 2014 through July 2016, the program has served 111 participants.

ATTACHMENT A

10 Annie E. Casey Foundation Juvenile Detention Alternatives Initiative. “Detention Reform: A Cost-Saving Approach.” www.aecf.org, Retrieved February, 2009. 11 Justia.com/Louisiana RS 15:1131. http://law.justia.com/louisiana/codes/145/78847.html. 12 www.ceoworks.com 13 The Pew Center on the States. Getting in Sync: State-Local Fiscal Partnerships for Public Safety. July, 2008. www.pewcenteronthestates.org, Retrieved June, 2009. 14 Tim Findley, “Story Behind the Decision—Dramatic Prison Reform,” San Francisco Chronicle, January 7, 1972, page 1. 15 Marcus Nieto, Community Corrections Punishments: An Alternative to Incarceration for Nonviolent Offenders, California Research Bureau (Sacramento, California: May 1996), www.library.ca.gov/crb/96/08/. Retrieved June, 2009.

8.C Support and expand Community Policing and neighborhood involvement in crime prevention.

RECOMMENDED ACTION

1. Work with neighborhoods to identify crime-related blight and call in enforcement. Who: NOPD; OFICD (Code Enforcement) When: First five years Resources: Neighborhood Participation Program can be used to organize system

2. Prioritize funding for community policing and new satellite police stations. Who: NOPD When: Medium term Resources: General funds

8.D Provide support for re-entry in accordance with best practices.

RECOMMENDED ACTION

1. Provide discharge planning and case management to link formerly incarcerated individuals with health and human service providers and ensure quality of care. Who: OPSO, Volunteers of America When: First five years Resources: Referrals and communication with service providers

2. Reduce barriers to opportunity for formerly incarcerated individuals, such as for housing and jobs Who: OPSO, Volunteers of America, HANO When: First five years Resources: Legislative advocacy

8.E Provide for other appropriate approaches to preventing and responding to violence.

RECOMMENDED ACTION

1. Promote a coordinated, victim-centered approach to respond to domestic violence and sexual assault. Who: Health Department, NOPD, New Orleans Family Justice Center When: First five years Resources: Grant funding

2. Promote prevention and education regarding the physical and sexual abuse of children. Who: Health Department, Children’s Advocacy Center, Children’s Bureau When: First five years Resources: Grant funding

3. Coordinate to prevent human trafficking, including labor and sex trafficking. Who: Covenant House, Human Trafficking Task Force of GNO, NOPD

ATTACHMENT A When: First five years Resources: Share resource manual, referral system.

Volume 3

chapter 8

HEALTH AND HUMAN SERVICES

A Context

1. Health Conditions and Health Care Access

According to the United Health Foundation, Louisiana ranked 50th in the nation in 2008 for overall health, and has been ranked either 49th or 50th since 1990. It ranks in the bottom five states on 10 of 22 measures of overall health, including a high prevalence of obesity, a high percentage of children in poverty, a high rate of uninsured population, a high incidence of infectious disease, a low rate of high school graduation, and a high rate of preventable hospitalization.¹ A poll of New Orleans residents in August, 2009 revealed that only 9 percent of respondents thought that the quality and availability of health care in New Orleans was better than before Hurricane Katrina, while 62 percent thought that it was worse.²

Socioeconomic disparities in health outcomes are prevalent in New Orleans and pose an additional challenge. In spring 2008, uninsured New Orleans residents were statistically more likely to be low-income, in fair or poor health, and/or African American. Nineteen percent of economically disadvantaged adults in New Orleans ranked their health as fair or poor, as compared to 9 percent of those with better economic status. Compared to those with private insurance, New Orleans residents covered by Medicare or Medicaid were more than three times as likely to report their health as fair or poor, and residents who were low-income, African-American, and/or elderly were significantly more likely to have severe and chronic health problems. Former patients of the Medical Center of Louisiana at New Orleans (MCLNO/Charity Hospital), New Orleans’ primary safety-net health care provider before Hurricane Katrina, were about 75% African-American and about 85% very low-income.³

Hurricane Katrina significantly damaged New Orleans’ health care infrastructure, and resulted in a loss of both facilities and of personnel in the health care professions, including thousands of physicians about a third

ATTACHMENT A

of whom were primary care providers.¹ In 2008, a majority of New Orleanians surveyed continued to have difficulties accessing health care.² However, as of 2008, the number of physicians per population for the New Orleans Metropolitan Area was greater than pre- Hurricane Katrina levels and greater than the national average, though area experts suggest that these numbers conceal a shortage of primary care physicians, psychiatrists, and certain subspecialties.[^p47-6] Projected future population growth should also be considered when evaluating per-population healthcare statistics to ensure that this ratio keeps pace with area population growth. (See Chapter 2 for a discussion of projected population growth in New Orleans.)

HOSPITALS

Before Hurricane Katrina, the New Orleans metropolitan area was served by 78 state-licensed hospitals— including 23 in Orleans Parish—and had more hospital beds per population than the average across the country.[^p47-8] Despite widespread hospital closures due to Hurricane Katrina, as of August, 2008, the total number of hospital beds per population in the New Orleans region had again surpassed the national average,[^p47-9] and from the first to the third quarters of 2008, average hospital wait times showed a 24 percent decrease.[^p47-10] By January 2009, there were 52 hospitals in operation throughout the region, including 13 in Orleans Parish.[^p47-11] However, future population growth will likely require additional capacity. One report estimates the projected additional demand in the region to be anywhere between around 760 to 1,400 beds by 2016, depending on a range of factors including health care reform and area population growth.[^p47-12]

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Ochsner Baptist Medical Center was among the first hospitals to re-open after Hurricane Katrina

As of 2009, the Southeastern Regional Veterans Administration (VA) Hospital and the Louisiana State University Health Sciences Center (LSU) in New Orleans both plan to open

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new hospital facilities in the city as part of an enhanced medical district and biosciences corridor. It is expected that the

completion of these plans would significantly increase the city’s ability to provide more inpatient and chronic care and increased emergency

services. The 2009 Office of Recovery and Development Administration (ORDA) budget allocates $75 million for site preparation for the VA Hospital site.[^p48-14] (See Chapter 9—Sustaining and Expanding New Orleans’ Economic Base for further discussion of the Medical District proposals.)

6 DeSalvo, Karen, et al. “Health Care Infrastructure in Post-Hurricane Katrina New Orleans: A Status Report.” The American Journal of the Medical Sciences. August, 2008. Volume 336, Number 2. 7 Ibid. 8 Brookings Institution and Greater New Orleans Community Data Center. “The New Orleans Index: Tracking the Recovery of New Orleans and the Metro Area.” January, 2009. www.gnocdc.org. 9 DeSalvo, Karen, et al. “Health Care Infrastructure in Post-Hurricane Katrina New Orleans: A Status Report.” The American Journal of the Medical Sciences. August, 2008. Volume 336, Number 2. 10 City of New Orleans Budget Report, Third Quarter 2008. Available at: http://www.cityofno.com/pg-45-6.aspx. Retrieved June, 2009. 11 Brookings Institution and Greater New Orleans Community Data Center. “The New Orleans Index: Tracking the Recovery of New Orleans and the Metro Area.” Appendix: Data Tables. January, 2009. www.gnocdc.org. 12 Health Planning Source. “Medical Center of Louisiana—New Orleans Business Plan Review.” Prepared for the Downtown Development District of New Orleans. 13 DeSalvo, Karen, et al. “Health Care Infrastructure in Post-Hurricane Katrina New Orleans: A Status Report.” The American Journal of the Medical Sciences. August, 2008. Volume 336, Number 2. 14 2009 New Orleans Office of Recovery and Development Administration budget.

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The Medical Center of Louisiana at New Orleans (MCLNO/Charity Hospital) was the region’s primary safety-net provider of care for residents without insurance as well as a major teaching facility before Hurricane Katrina. Through the LSU and Tulane Schools of Medicine, Charity Hospital trained an estimated 70 percent of the physician workforce in Louisiana,¹ and treated over two-thirds of the region’s uninsured residents, although the volume of patient visits to Charity had been declining before Hurricane Katrina.² As of June, 2009, Charity has not reopened, and LSU plans to eventually adapt its main hospital facility to another use.³

Methodist Hospital in New Orleans East has also not reopened as of 2009. The 2009 ORDA budget provides $30 million for land acquisition and planning for the former Methodist Hospital site.⁴

In the City of New Orleans, geographic areas lacking convenient access to hospitals and emergency care include New Orleans East, Gentilly, parts of the West Bank, and the Ninth Ward.

The city’s emergency medical service (EMS) and other emergency response infrastructure are discussed in Chapter 10—Community Facilities and Infrastructure.

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The Medical Center of Louisiana at New Orleans (MCLNO/Charity Hospital) was the region’s primary safety-net provider of care for residents without insurance before Hurricane Katrina.

COMMUNITY CLINICS

In response to the dearth of major hospitals and other health care infrastructure post-Hurricane Katrina, a substantial network of neighborhood-based primary care clinics developed in New Orleans and continues to expand. Community clinics are operated by a broad array of organizations—including academia, government, faith-based, and Federally Qualified Health Centers (FQHCs)⁵—and offer services to patients with varying abilities to pay, including the indigent and uninsured. As of May, 2009, there were 58 community-based health care centers in the New Orleans metropolitan area, including:

• 35 primary health care clinics (18 in Orleans Parish)
• 15 behavioral health clinics
• 4 dental clinics
• 4 school-based health clinics.⁶

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St. Thomas Community Health Center in the St. Thomas/Lower Garden District area of New Orleans is among the largest and most comprehensive primary care facilities serving both insured and uninsured patients in the New Orleans area.

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15 DeSalvo, Karen, et al. “Health Care Infrastructure in Post-Hurricane Katrina New Orleans: A Status Report.” The American Journal of the Medical Sciences. August, 2008. Volume 336, Number 2. 16 Annual report. 2005 [cited May 15, 2005]. Available at: http://www.lsuhospitals.org/AnnualReportsI2005/2005_AR.pdf. In DeSalvo, Karen, et al. “Health Care Infrastructure in Post-Hurricane Katrina New Orleans: A Status Report.” The American Journal of the Medical Sciences. August, 2008. Volume 336, Number 2. 17 Health Planning Source. “Medical Center of Louisiana—New Orleans Business Plan Review.” Prepared for the Downtown Development District of New Orelans. 18 2009 New Orleans Office of Recovery and Development Administration budget. 19 Federally Qualified Health Centers (FQHCs) are community-based organizations that provide care to all persons regardless of their ability to pay, and operate under supervision of the US Department of Health and Human Services. 20 Louisiana Public Health Institute, May 2009.

MAP 8.1: NEW ORLEANS PRIMARY CARE FACILITIES, C. SEPTEMBER, 2009

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IMAGE: www.GnoComMunity.orG, SEptEmbEr, 2009.

Additionally, the New Orleans Faith Health Alliance and Dillard University were each building a new clinic; both are expected to open in 2010. In March, 2009, the St. Thomas Community Health Center in New Orleans was one of seven community health centers in the state to receive a portion of the $8.6 million in federal stimulus funding for health care in Louisiana to expand the Center and provide services to more patients.¹

As of March, 2009, 37 community clinics in the New Orleans region had been certified by the National Committee for Quality Assurance (NCQA) as Patient-Centered Medical Homes. A Patient-Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when

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appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to ensure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. (A Patient- Centered Medical Home is not a residence.) NCQA provides certification of Patient-Centered Medical Homes throughout the United States. The Medical Home model of care is a nationally-recognized best practice that ensures coordination of services across the continuum of care, and has been a central tenet of health care reform initiatives in New Orleans and Louisiana since before Hurricane Katrina. The NCQA certification indicates that a provider meets certain standards of managed care, including demonstrating that patients have an ongoing relationship with a personal physician who is responsible for coordinating all of their health care needs. A grant administered by DHH and the Louisiana Public Health Institute (LPHI) provides funds for additional clinics to become certified by NCQA through 2010.

CHILDREN’S HEALTH

New Orleans has a high rate of poverty among children and a high rate of infant mortality —a common benchmark for children’s overall health. In 2008, 25 percent of families with children surveyed reported their child’s mental and emotional health was worse than before Hurricane Katrina, and 16 percent reported their child’s physical health was worse.[^p51-22]

A study comparing New Orleans children with blood lead before Katrina and ten years after showed a profound improvement. The blood lead reductions are associated with decreases in soil lead in the city. See the section on “Lead Poisoning” in the revised Chapter 12 – “Adapt to Thrive”

Several programs are working to improve the health of children in New Orleans. They include:

• Nurse Family Partnership: For over 25 years, the Louisiana Office of Public Health and the Department of Health and Hospitals has run the Nurse Family Partnership, which improves pregnancy and early childhood health outcomes by matching nurses with low-income first-time mothers.[^p51-23] The program has been shown to significantly improve pregnancy outcomes, child health and development, and family self-sufficiency, [^p51-24] and reaps an estimated $5.70 return on every dollar invested.[^p51-25] Due to limited capacity, the program currently serves less than 50 percent of eligible participants.[^p51-26]
• Healthy Start New Orleans is a federally-funded program that provides prenatal and neonatal care for low-income women and their babies. It will receive $10 million in funding between 2009 and 2014 through the Department of Health and Human Services.
• Head Start And Early Head Start are national school readiness programs that provide free education, health, nutrition, and parent involvement services to low-income children from birth through preschool and their families.[^p51-27] As of June 1, 2009, there were about 16 licensed child care facilities in New Orleans that offered Head Start programs.[^p51-28] Many are operated by the nonprofit Total Community Action.[^p51-29]
• The Women, Infants and Children Food Program (WIC) provides supplemental food, health care referrals, and nutrition education for low-income expectant mothers and parents of children up to age 5. In 2007, 3,922 women and children in New Orleans benefitted from WIC.
• The Greater New Orleans School Kids Immunization Program has been successful in increasing immunization rates of New Orleans school children by offering free immunizations through schools.

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• School Health Connection is a regional collaborative administered by LPHI that supports the expansion of school-based health centers in the New Orleans metropolitan area to improve the health of school-age children and their communities.¹

MENTAL HEALTH

As of January, 2008, the rate of mental health conditions like depressive disorders and post traumatic stress disorder among New Orleans residents was several times the national average.² In 2008, 31 percent of New Orleans residents surveyed reported having some mental health challenge, 15 percent reported having been diagnosed with a serious mental illness (three times the rate reported in 2006), and 17 percent reported having taken prescription medication for a mental health issue in the previous 6 months (more than twice the rate reported in 2006).³ However, the average number of poor mental health days for Louisiana residents was the