DATE: June 30, 2026
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Director, Department of Public Health
SUBJECT: First Amendment to Agreements with Children and Families Commission of Fresno County
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute First Amendment to Agreement No. A-24-686 with Children and Families Commission of Fresno County, for the Nurse Liaison program, extending the term by one year from July 1, 2026 to June 30, 2027 and increasing the maximum by $524,610 to a total of $1,313,332; and
2. Approve and authorize the Chairman to execute First Amendment to Agreement No. A-24-687 with Children and Families Commission of Fresno County, for the Community Health Teams program, extending the term by one year from July 1, 2026 to June 30, 2027 and increasing the maximum by $975,390 to a total of $2,766,170.
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will provide the Fresno County Department of Public Health (Department) with one additional year of funding from Children and Families Commission of Fresno County (First 5) to support the existing Nurse Liaison (NL) and 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 (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 (CBO) 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 funds, which supports salary and benefits, as well as operational and indirect costs for both programs. Non-approval would also lead to a reduction in the Department’s NL and CHT staff and services that currently provide much needed assistance to children ages 0 - 5 and their families in Fresno County.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The First 5 amendment for the NL program will provide $524,610 for FY 2026-27. The First 5 amendment for the CHT program will provide $975,390 for FY 2026-27 and fund four CBOs providing home visitation services for the CHT program.
The recommended actions will also allow the County to use the funds as the local match to draw down Federal dollars under Title TXIX as FFP eligible services through the Maternal, Child and Adolescent Health (MCAH) grant.
Sufficient appropriations and estimated revenues will be included in the Department’s Org 5620 FY 2026-27 Recommended Budget.
DISCUSSION:
On December 17, 2024, the Board approved agreements with First 5 to receive funds to support the NL and CHT programs for two years. 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 2024-26, the NL program:
• Provided case management services to 286 children;
• Administered developmental screening for 212 children;
• Provided 374 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.
The CHT program pairs the 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. 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 program coordination.
In FY 2024-26, the CHT program:
• Provided case management services to 720 total clients which consists of 226 children ages 0 - 3, 127 children ages 3 - 5, and 367 parents/caregivers;
• Services were provided to Fresno County families living in rural (44.39%) and urban (55.61%) areas;
• Provided developmental screening to 420 children;
• Provided referrals for 427 children and family members for job assistance, Medi-Cal, health insurance, financial assistance and public benefits enrollment, primary care, dental, vision, mental health, diapers, food and food assistance programs, housing, parenting education/support groups, domestic violence and family safety resources, employment and job training services, child care and preschool programs, transportation assistance, special education services, and early intervention; and
• Provided depression screening to 306 parents/caregivers.
The Department has been receiving the First 5 fundings for the NL program since 2016 and for the CHT program since 2020. In FY 2023-24, there was a delay in receiving the First 5’s amendments to the NL and CHT agreements, resulting in the drafted amendments having to be converted into new agreements for FY 2024-26.
Approval of the recommended actions will approve one additional year of funding from First 5, provide the local match to leverage Federal funding, further support the programs, and allow the NL and CHT programs to continue improving pregnancy outcomes, child health and development, and linkages 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.
Vice Chairman Chavez currently sits as the Commission Chair for First 5.
REFERENCE MATERIAL:
BAI #60, December 17, 2024
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - First Amendment to Agreement with First 5 for NL
On file with Clerk - First Amendment to Agreement with First 5 for CHT
CAO ANALYST:
Ron Alexander