DATE: August 23, 2022
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Amendments to Agreements with Children and Families Commission of Fresno County
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Vice Chairman to execute retroactive Amendment V to Agreement with Children and Families Commission of Fresno County, for the Nurse-Family Partnership program extending the term by two years from July 1, 2022 to June 30, 2024 and increasing the maximum by $420,498 to a total of $1,667,933.
2. Approve and authorize the Vice Chairman to execute retroactive Amendment V to Agreement with Children and Families Commission of Fresno County, for the Nurse Liaison program extending the term by two years from July 1, 2022 to June 30, 2024 and increasing the maximum by $788,722 to a total of $2,966,374.
3. Approve and authorize the Vice Chairman to execute retroactive Second Amendment to Agreement with Children and Families Commission of Fresno County, for the Community Health Teams program extending the term by two years from July 1, 2022 to June 30, 2024 and increasing the maximum by $1,790,780 to a total of $3,581,376.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first and second recommended actions will provide the Department of Public Health (Department) with two additional years, for a total term of eight years of funding from Children and Families Commission of Fresno County (First 5) to support the existing Nurse-Family Partnership (NFP) and Nurse Liaison programs. Approval of the third recommended action will provide the Department with two additional years, for a total term of four years of funding from First 5 to support the Community Health Teams (CHT) program. The recommended amendments will allow the County to use the funds as the local match to draw down Federal Financial Participation (FPP) at around approximately 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 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, Nurse Liaison, 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, 2022 as all amendments were received from First 5 in May 2022. The time required to prepare and review the recommended actions did not allow presentation to your Board at an earlier date.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The first and second recommended actions provide additional funding and extend the agreements for an additional two years, for a total term of eight years. The third recommended action provides additional funding and extends the agreement for an additional two years, for a total term of four years.
The NFP amendment will provide an additional $420,498. The Nurse Liaison amendment will provide an additional $788,722. The CHT amendment will provide an additional $1,790,780. The First 5 funds will support salary and benefits for PHNs and four subcontracts with local CBOs to provide direct home visitation services. In addition, the recommended amendments will allow the County to use the funds as the local match to draw down approximately $2.1 million of Federal dollars under Title XIX as FPP for eligible services.
All three agreements allow for recovery of indirect cost at a maximum of 15%, the Departments current indirect rate for FY 2022-23 is 18.816%, the difference will be offset with Health Realignment funds. Sufficient appropriations and estimated revenues are included in the Department Org 5620 FY 2022-23 Recommended Budget and will be included in FY 2023-24 Recommended Budget.
DISCUSSION:
On December 6, 2016, the Board approved agreements with First 5 to receive funding supporting the NFP and Nurse Liaison programs for two years. 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 Nurse Liaison 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. On August 7, 2018, September 10, 2019, September 1, 2020, and September 7, 2021, the Board approved first, second, third, and fourth amendments to extend the agreements with First 5 for an additional year with each amendment and receive additional funding supporting the NFP and Nurse Liaison programs.
In FY 2021-22, the NFP program:
• NFP PHNs served 149 pregnant and parenting women;
• Completed 1,011 visits with clients, 642 in-person home visits and 369 telehealth;
• 93% of women served initiated breastfeeding after birth of infants;
• 92% of infants served were current on immunizations at 6-months;
• 308 referrals 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;
• First 5 funded PHN position that had been vacated since December 2021 and was filled in April 2022.
In FY 2021-22, the Nurse Liaison program:
• Provided case management services to 182 children;
• Administered developmental screening for 94 children;
• Provided 220 referrals to children and families including mental health, dental, primary care, domestic violence assistance, early intervention and immunizations.
• The rehospitalization rate for children in the Nurse Liaison Program was less than two (2) percent.
On October 6, 2020, the Board approved the agreement with First 5 to receive funding supporting creation of CHT, 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, the Board approved the first amendment to extend the agreement with First 5 for an additional year and receive additional funding supporting the CHT program. 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.
In FY 2021-22, the CHT provided:
• Case management services to 240 families;
• Developmental screening to 223 children;
• Referrals for 227 children and family members for job assistance, Medi-Cal, primary care, mental health, diapers, food, housing, special education services and early intervention.
Approval of the first and second recommended actions will accept two additional years of funding from First 5, providing the local match to leverage federal funding, further supporting the programs and allowing the NFP and Nurse Liaison programs to continue improving pregnancy outcomes, child health and development, and linkage to resources as needed. Approval of the third recommended action will accept two additional years of funding from First 5, providing a local match to leverage federal funding supporting the CHT and allowing 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. Prior to the Agreements expiring, the Department and First 5 agreed that the Agreements was to continue for an additional 2-years.
The Chairman currently sits as the Commission Chair for First 5. Due to this reason, it is appropriate for the Vice Chairman to approve and execute the amendments.
REFERENCE MATERIAL:
BAI #50, September 7, 2021
BAI #30, October 19, 2021
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 - Amendment V to Agreement No. 16-683 with First 5 for NFP
On file with Clerk - Amendment V to Agreement No. 16-684 with First 5 for Nurse Liaison
On file with Clerk - Second Amendment to Agreement No. 21-427 with First 5 for CHT
CAO ANALYST:
Ron Alexander