Emergency room visits among infants cut in half during their first year. Mothers 28% less likely to report postpartum depression, and connections to family services increased 15%. More than $3 in emergency health costs saved for every $1 invested.

These are among the outcomes reported for new parents from public home visitation programs like the one Oregon adopted in 2019. New Jersey officials are hoping for similar results here under a nurse visitation program for newborns Gov. Phil Murphy signed into law on Thursday.

New Jersey’s universal, voluntary program — the nation’s second, after Oregon, to be available to new parents regardless of income, insurance coverage or legal status — will offer free home-based wellness checks for mom and baby within two weeks of birth, with two additional visits over three months. The law provides $2.75 million to help the Department of Children and Families (DCF) roll out the first phase of the initiative.

“Home visiting programs have tremendous benefits for mothers, infants, and families,” Murphy said. “Research has shown that these programs not only decrease infant and maternal mortality, but also improve mental health, increase child educational attainment, decrease abuse and neglect, and strengthen family success and economic growth.”

Maternal mortality rates

The program is the latest initiative of Nurture New Jersey, an effort led by first lady Tammy Murphy to improve the state’s abysmal birth safety statistics. New Jersey has one of the highest rates of maternal mortality in America — which has among the worst outcomes of any industrial nation — and the danger for Black women and babies is as much as four times what it is for white moms and babies.

The first lady, who joined her husband at the bill signing, said the first few weeks after birth are critical to the health of mom and baby. “Through this universal home visiting program, we are making clear to all New Jersey families that their health, wellness, and development are our highest priority, beginning with birth,” she said.

Nurture New Jersey released a plan in January that calls for reducing maternal mortality by 50% in five years and eliminating racial disparities in outcomes. Murphy’s administration, with assistance from lawmakers, took multiple steps in recent years to expand access to family planning services, prenatal care and birthing options. State officials have also moved to enhance training for providers and make it easier to access maternal health data.

Maternal health advocates — bolstered by Black and brown female legislators who have shared their own, often difficult birth stories — have continued to stress the importance of postpartum care, something they said is missing for roughly 40% of the new moms in this country. More than half the maternal fatalities nationwide occur after the mother gives birth, according to state Sen. Teresa Ruiz (D-Essex), a main sponsor, and two-thirds of these deaths can be prevented.

“Having a home visit will benefit both the caretaker and the newborn,” Ruiz said, recalling her own struggles to nurse her daughter, adding, “it is essential in diagnosing conditions before it is too late and connecting parents to the care and assistance they need.”

NJ second state with home nursing visits

Home visitation programs for new moms have been implemented in many localities, from New York City to Austin, Texas, to Santa Barbara, California. In Oregon — the only other statewide, universal effort — home visits have existed in some communities for nearly three decades, but the statewide rate of postpartum care has still lagged behind the national average, according to the program’s website. Oregon began rolling out statewide services in 2020, a process that will take six years but should eventually serve some 45,000 families annually.

Oregon’s program is based on the Family Connects model, developed by Duke University’s Center for Child and Family Policy, which is used in home-visitation initiatives in more than a dozen states. Ongoing randomized trials of these efforts indicate impressive health and welfare benefits, as well as savings. In addition to fewer emergency room visits and less postpartum depression, participants in the programs were more likely to hug their children and be patient with them, books and educational materials became more common in these households and homes became safer for kids, the center reports.

The New Jersey program will build on an existing, but limited, effort that provides postpartum home visits to certain first-time moms covered by Medicaid, or FamilyCare, which pays for roughly four in 10 births in the state. More than 6,000 families benefited from this service in 2020 at an estimated cost of $16 million, or nearly $2,600 per family, according to a fiscal analysis of the legislation.

Building statewide program

Under the expansion, the DCF would use the $2.75 million to create the statewide program, promote it to new parents, hire and dispatch licensed nurses, and analyze the results, according to the legislation. It is not entirely clear how and on what timeline it will be instituted in New Jersey, where nearly 100,000 babies are born each year.

While Oregon requires new moms be visited within three weeks, the New Jersey version calls for a home wellness check within two weeks of the mother leaving the hospital or birthing center. It allows for two more visits within three months, although additional services could also be arranged, the bill notes. The program is open to adoptive parents and those whose baby was stillborn and is designed to reduce the stigma sometimes associated with social service programs.

In addition to checking on the health of the mother and baby, nurses will be required to use an evidence-based process to screen for postpartum depression, child abuse or neglect, or other situations that could be dangerous for the family. They will also provide guidance on breastfeeding, infant care and development, and connections to other social services, like housing or economic assistance, according to the legislation.

The program also requires DCF to coordinate with the state Department of Banking and Insurance (DOBI) to create guidance for state-regulated health insurance plans to cover postpartum home visits, the bill states. If DOBI approves, insurance companies could eventually provide the service directly. This also applies to the public-worker health plans, which do not currently pay for these services.

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