DATE: December 3, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive California Home Visiting Program Agreement Funding Application with California Department of Public Health
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a retroactive Agreement Funding Application with California Department of Public Health, for the California Home Visiting Program - Maternal, Infant, and Early Childhood Home Visiting and the California Home Visiting Program - State General Fund - Evidence-Based Home Visiting programs, effective July 1, 2024 through June 30, 2025 ($2,531,711).
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will provide the Fresno County Department of Public Health (Department) with California Department of Public Health (CDPH) funding from the California Home Visiting Program (CHVP) - Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program and the CHVP State General Fund (SGF) - Evidence-Based Home Visiting (EBHV) program. The funding will support salary and benefits, and operational costs to expand the Nurse-Family Partnership (NFP) program services provided by the Department. The program provides outreach, home visitation, health education and linkage to community resources for Fresno County pregnant and parenting women and their families. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended action, the Department would not have sufficient funds to operate these critical programs and will be unable to provide MIECHV and EBHV services to pregnant and parenting women and their families.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2024. The process for receiving the CHVP MIECHV and CHVP SGF EBHV funding requires submittal of an Agreement Funding Application (AFA). The Department received the CHVP AFA on May 30, 2024. The AFA requires the State’s pre-approval of the budget and all documents before the item can be presented to your Board for approval. The Department received the necessary pre-approvals and is bringing this item in accordance to Agenda Item timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. CDPH is allocating $805,195 to the Department’s CHVP MIECHV program and $1,726,516 to the Department’s CHVP SGF program for FY 2024-25. Approval of the recommended action will provide funding to support salary and benefits, and operational costs to expand the NFP services provided by the Department for FY 2024-25. Both grants allow the Department’s indirect cost rate of 24.43%, however, the indirect cost rates were reduced to 7.20% for CHVP MIECHV and 2.39% for CHVP SGF EBHV in order to remain within the grant allocations. The 1st quarter invoice to the State is currently pending submittal, however, we are not allowed to submit the invoice until your Board approves the AFA. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2024-25 Adopted Budget.
DISCUSSION:
CDPH funding has supported the CHVP in Fresno County since 2012. On June 9, 2020, your Board accepted SGF from CDPH to expand the CHVP, increasing services in the City of Fresno and a CHVP site in the City of Selma. On November 16, 2021, your Board approved and accepted a retroactive award funding for the CHVP SGF Expansion for FY 2020-23. On April 25, 2023, your Board approved and signed the CHVP SGF Expansion Year 1 AFA, accepting $748,835 in additional allocation to support salary and benefits, and operational costs to expand the NFP program services provided by the Department for FY 2022-23. On October 10, 2023, your Board approved and signed the CHVP MIECHV and CHVP SGF EBHV AFA for FY 2023-24, accepting the $2,531,710 allocation to support salary and benefits, and operational costs of the two programs.
The Department provides NFP services countywide through the County’s original NFP site in the City of Fresno. The program provides nurse home visitation services to low-income, first-time mothers and their families following the evidence based NFP model. From pregnancy through the child’s second birthday, Public Health Nurses (PHN) with specialized training visit with mothers, fathers, and extended family members to monitor the health of both the mother and child, as well as the environment. PHNs also provide information on pregnancy, parenting skills, healthy relationships, disease prevention, and appropriate community services. During their visits, the PHNs encourage positive health choices, such as:
• Avoiding smoking, drinking, and using drugs;
• Seeking prenatal care;
• Eating nutritious foods;
• Increasing intervals between births; and,
• Setting achievable life goals.
In FY 2023-24, the County’s CHVP MIECHV program:
• received 23 referrals and enrolled 23 families into program services;
• served 82 families, 80 children, 27 new clients enrolled, 15 graduated the program;
• made 758 home visits in-person and 153 were telehealth;
• had 27 children born;
• had 100% of clients-initiate breastfeeding at birth;
• had 90% of infants up to date on immunizations at 6 months of age and 56.25% of toddlers up to date at 24 months;
• provided 80 infants/toddlers with developmental assessments using the ASQ3 at 4, 10, 18 and 24 months of age and ASQ-Social Emotional at 6, 12, 18 and 24 months of age; 100% were screened at 6 months; 100% were screened at 12 months; 95.45% were screened at 18 months, 100% were screened at 24 months, and 11 referrals were made for abnormal ASQ screening; and
• made 135 referrals for government assistance, crisis intervention, mental health, substance use, health care services, education programs and other services including transportation, housing, and job training.
In FY 2023-24, the County’s CHVP SGF EBHV program:
• received 30 referrals and enrolled 30 families into program services;
• served 61 families, 49 children, 28 new clients enrolled, 8 graduated the program;
• made 607 home visits in-person and 61 were telehealth;
• had 21 children born;
• had 90.48% of clients-initiate breastfeeding at birth;
• had 66.67% of infants up to date on immunizations at 6 months of age and 20% of toddlers up to date at 24 months;
• provided 49 infants/toddlers with developmental assessments using the ASQ3 at 4, 10, 18 and 24 months of age and ASQ-Social Emotional at 6, 12, 18 and 24 months of age; 100% were screened at 6 months; 100% were screened at 12 months; 100% were screened at 18 months, 100% were screened at 24 months, and 3 referrals were made for abnormal ASQ screening; and
• made 70 referrals for government assistance, crisis intervention, mental health, substance use, health care services, education programs and other services including transportation, housing, and job training.
CHVP provided clients linkage and health care services and other resources including childcare, job training, housing, transportation, injury prevention, childbirth and lactation classes/services, charitable and legal services, as well as early childhood intervention and dental services. Clients were also connected to crisis intervention services including intimate partner violence, mental health, and substance abuse cessations.
CDPH will issue the CHVP MIECHV and CHVP SGF EBHV award letter once the Agreement Funding Application is approved.
REFERENCE MATERIAL:
BAI #56, October 10, 2023
BAI #38, April 25, 2023
BAI #35, November 8, 2022
BAI #45, November 16, 2021
BAI #29, June 9, 2020
BAI #34, January 7, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - FY 2024-25 CHVP Agreement Funding Application with CDPH
CAO ANALYST:
Ron Alexander