DATE: December 17, 2024
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Agreements with Children and Families Commission of Fresno County
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute retroactive revenue Agreement with Children and Families Commission of Fresno County, for the Nurse-Family Partnership program, effective July 1, 2024 to June 30, 2026 ($420,498);
2. Approve and authorize the Chairman to execute retroactive revenue Agreement with Children and Families Commission of Fresno County, for the Nurse Liaison program, effective July 1, 2024 to June 30, 2026 ($788,722); and
3. Approve and authorize the Chairman to execute retroactive revenue Agreement with Children and Families Commission of Fresno County, for the Community Health Teams program, effective July 1, 2024 to June 30, 2026 ($1,790,780).
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will provide the Department of Public Health (Department) with two years of funding from Children and Families Commission of Fresno County (First 5) to support the existing Nurse-Family Partnership (NFP), Nurse Liaison (NL), and Community Health Teams (CHT) programs. The recommended agreements with First 5 will also allow the County to use the funds as the local match to draw down Federal Financial Participation (FFP) at around fifty percent. The First 5 funding will continue to support salary and benefits for Public Health Nurses (PHN) and four subcontracts with local community-based organizations (CBOs) to provide direct home visitation services. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions. Should your Board not approve the recommended actions, the Department would not be able to accept the First 5 funds or draw down FFP funding, which supports salary and benefits, as well as operational and indirect costs for all three programs. Non-approval would also lead to a reduction in the Department’s NFP, NL, and CHT staff and services that currently provide much needed assistance to children ages 0 to 5 and their families in Fresno County.
RETROACTIVE AGREEMENT:
The recommended actions are retroactive to July 1, 2024. The First 5 agreements were initially received as amendments to the previous agreements. However, the amendments were not received in time to follow the board agenda item deadlines to be presented to your Board before the end of the fiscal year. All three amendments had to be converted into a new agreement with a new budget that excludes allowable carryover of unexpended funds from previous fiscal years. The item is now being brought to your Board in accordance with the agenda item processing deadline.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The First 5 agreement for the NFP program will provide $420,498 for the next two years. The First 5 agreement for the NL program will provide $788,722 for the next two years. The First 5 agreement for the CHT program will provide $1,790,780 for the next two years and fund four CBOs providing home visitation services for the CHT program.
The recommended actions will allow the County to use the funds as the local match to draw down Federal dollars under Title XIX as FFP for eligible services through the Maternal, Child and Adolescent Health (MCAH) grant. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2024-25 Adopted Budget and will be included in subsequent budget requests.
DISCUSSION:
On December 16, 2016, the Board approved agreements with First 5 to receive funding supporting the NFP and NL programs for two years. On August 7, 2018, September 10, 2019, September 1, 2020, September 7, 2021, and August 23, 2022, the Board approved first, second, third, fourth, and fifth amendments to extend the agreements with First 5 for an additional year with each amendment and receive additional funding supporting the NFP and NL programs. PHNs in the NFP program provide evidence-based nurse home visitation services to low-income, pregnant, or parenting first-time mothers in the County. PHNs in the NL program work with Valley Children’s Hospital and Community Regional Medical Center as well as the medical community outside these facilities to ensure that referred high-risk infants and children under six years of age living in the County receive medical care, resources, and support as needed.
In FY 2023-24, the NFP program:
• NFP PHNs served 193 pregnant and parenting women;
• Completed 1,889 visits with clients, of which 1,645 were in-person home visits and 244 were virtual telehealth visits;
• 96% of women served initiated breastfeeding after birth of infants;
• 93% of infants served were current on immunization at 6-months; and
• 255 referrals were completed for needed services including: mental health, dental services, Medi-Cal assistance, Women Infant and Children Nutritional Program, medical referrals, and referrals for developmental delays in children.
In FY 2023-24, the NL program:
• Provided case management services to 181 children;
• Administered developmental screening for 101 children;
• Provided 253 referrals to children and families including: mental health, dental, primary care, domestic violence assistance, early intervention, and immunizations; and
• Had a rehospitalization rate of less than 1% for children in the NL program .
On October 6, 2020, the Board approved the agreement with First 5 to receive funding supporting the creation of the CHT program and the agreements with the four contracted CBOs, which pairs a Department PHN with teams of paraprofessionals from local CBOs to provide research-based and evidence-informed home visitation services to underserved families in Fresno County communities. On October 19, 2021, June 21, 2022, and August 23, 2022, the Board approved first and second amendments to extend the agreement with First 5 and receive additional funding supporting the CHT program, as well as approved the first amendments for the four contracted CBOs to extend the agreement for an additional two years. These teams provide much needed assistance to children ages 0 to 5 and their families who otherwise would not qualify for existing nurse-based home visitation programs.
The PHN provides guidance and support on medically challenging cases to the CBO’s home visitors that provide direct home visitation services. Depending on the home visitation model used by each CBO, the home visitors provide social support, health information, referrals to community resources, family planning, and serve as a literacy teacher and parenting coach. This is a unique home visitation model that provides a team approach to provide wraparound case management services for families. The CHT meets on a regular basis for trainings provided by the PHN, case consultations, and other program issues.
In FY 2023-24, the CHT program:
• Provided case management services to 233 families;
• Provided developmental screening to 239 children;
• Provided referrals for 220 children and family members for job assistance, Medi-Cal, health insurance, financial assistance, primary care, dental, vision, mental health, diapers, food, housing, special education services, and early intervention.
Approval of the recommended actions will approve two years of funding from First 5, providing the local match to leverage Federal funding, further supporting the programs, and allowing the NFP and NL, and CHT programs to continue improving pregnancy outcomes, child health and development, and linkage to resources as needed. Approval will also allow the Department to continue using an integrated approach to enhance CBOs’ capacity to provide licensed medical support, strengthening the early childhood system of care, and promoting a “no-wrong-door” approach for families in the community.
REFERENCE MATERIAL:
BAI #33, August 23, 2022
BAI #71, June 21, 2022
BAI #30, October 19, 2021
BAI #50, September 7, 2021
BAI #42, October 6, 2020
BAI #33, September 1, 2020
BAI #46, September 10, 2019
BAI #47, August 7, 2018
BAI #35, December 6, 2016
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with First 5 for NFP
On file with Clerk - Agreement with First 5 for NL
On file with Clerk - Agreement with First 5 for CHT
CAO ANALYST:
Ron Alexander