Save This Lifesaving Program for Children from Budget Cuts

By David Caprio, Jennifer Fairbank, Benedict Lessing and Margaret Holland McDuff
Published in the Boston Globe March 15, 2024

A little-known but vitally important program could end this summer if the Rhode Island General Assembly doesn’t act.

The First Connections program, administered by the Department of Health, is Rhode Island’s emergency response and triage team for families with young children, as well as the federally required child find entity for Early Intervention services. The program provides free, voluntary home visiting services for approximately 3,000 families a year and costs the state only $1 million a year.

Families are referred to First Connections in a number of ways: the state’s birthing hospitals send referrals for families they have identified who may need extra support; the Department of Children, Youth & Families refers every family, and foster family, who has a child in their care under age 3, for supports and screenings; pediatricians make referrals to have First Connections connect their patients with resources and to find children who have not returned for medical care; and parents themselves who reach out to the Department of Health for help are directly referred. First Connections casts the widest net of any program for our youngest children at most risk. According to data presented at last month’s Children’s Cabinet, one in four (25 percent) of children under age 2 are enrolled in First Connections, more than any other program, except Medicaid.

Once referred, nurses, social workers, and community health workers visit families in their homes to ensure that babies are safe and that parents have the skills, resources, and connections they need so their children can thrive.

First Connections staff are tasked not only with child medical assessments and connecting families with a medical home, but they also conduct home safety checks, screen for social determinants of health, domestic violence, substance use, screening for depression and anxiety, as well as other behavioral health needs. Staff also perform developmental screenings for children in the home and are the gateway to connect families with longer term programs such as Early Intervention services, long-term home visiting, Head Start, and child outreach. Data has shown that families who engage with long-term program supports are less likely to have future DCYF involvement. The First Connections program also assists families with obtaining resources for food insecurity, diapers and clothing, job training, and housing instability.

First Connections is funded through Medicaid and the Department of Health and has not had a permanent rate increase in 23 years. For the last two years, the state has used American Rescue Plan Act funds to provide a temporary rate increase which allowed us providers to continue to offer the services to families this year. However, Governor McKee’s fiscal year 2025 budget proposal to implement only a third of the rate review amount recommended by the Office of Health Insurance Commissioner starting on Oct. 1 will mean that the reimbursement rates for this program will be cut by 70 percent on July 1. None of our four nonprofit agencies that administer these services can continue these vital services with such a low reimbursement.

This program not only saves lives, but it saves Rhode Island money: 100 percent of families who get a home visit learn about safe sleep and other lifesaving measures. The program reduces emergency room visits by reducing the likelihood of harm and increasing the likelihood of regular well-child visits and immunizations. And the program leads to less longer-term involvement with DCYF.

The state needs this program to meet its federal requirements and to serve the families it is required to serve. We need Rhode Island to continue the current reimbursement rates for First Connections, and not go back to the rates of 23 years ago. Legislation introduced by Representative Joshua J. Giraldo and Senator Bridget Valverde will keep the much-needed rates. First Connections saves lives; please save First Connections.

David Caprio is president and chief executive officer of Children’s Friend; Jennifer Fairbank is the chief executive officer of Visiting Nurses Home and Hospice; Benedict Lessing is the chief executive officer at Community Care Alliance; and Margaret Holland McDuff is the chief executive officer of Family Service of Rhode Island.

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