DATE: December 6, 2016
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement with Children and Families Commission of Fresno County for Nurse-Family Partnership and Nurse Liaison
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive revenue Agreement with Children and Families Commission of Fresno County for the Nurse-Family Partnership program, effective July 1, 2016 through June 30, 2018 ($848,677).
2. Approve and authorize the Chairman to execute a retroactive revenue Agreement with Children and Families Commission of Fresno County for the Nurse Liaison program, effective July 1, 2016 through June 30, 2018 ($1,614,728).
REPORT
Approval of the recommended actions will provide the Department of Public Health with two years of funding from the Children and Families Commission of Fresno County (First 5) to support the existing Nurse-Family Partnership (NFP) and Nurse Liaison programs. In addition, the recommended agreements will allow the County to draw down approximately $1,345,446 of Federal Financial Participation (FFP) annually. The First 5 and FFP funding will support NFP, an evidence based nurse-home visitation program for low income, first-time mothers, and Nurse Liaison, which utilizes Department nursing staff in partnership with the local medical community. Nurse Liaison identifies and provides services to high-risk infants and children ages 0 to 5, to ensure they have access to medical care, resources and support as needed. The First 5 and FFP funding will support salary and benefits, operational and indirect costs, with no increase in Net County Cost.
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 nor draw down Federal funding, which supports salary and benefits, operational and indirect costs for the NFP and Nurse Liaison Programs . Non-approval would lead to a reduction in the Department’s NFP and Nurse Liaison staff and services that currently provide much needed assistance to children ages 0 to 5 and their families in the County.
RETROACTIVE AGREEMENT:
The recommended revenue agreements are retroactive to July 1, 2016. The agreements were received from First 5 on October 6, 2016. The time required to prepare and review the recommended agreement 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 maximum amount of the two-year revenue agreement for NFP is $417,977 (FY 2016-17 $207,780; FY 2017-18 $210,197). The maximum amount of the two-year revenue agreement for Nurse Liaison is $699,982 (FY 2016-17 $348,218; FY 2017-18 $351,764). The First 5 funds will support salary and benefits, operational and indirect costs for the programs. The revenue agreements plus the FFP drawdown (NFP $430,700 and Nurse Liaison $914,746) will provide a total funding amount of $2,463,405 over the two-year term. Sufficient appropriations and estimated revenues are included in the Department Org 5620 FY 2016-17 Adopted Budget and will be included in the FY 2017-18 budget request. The recommended agreement allows indirect cost recovery of 14.676 percent of total direct costs; the Department’s indirect cost rate is 15.873 percent. The 1.197 percent difference ($25,714 two-year total for NFP $8,859 and Nurse Liaison $16,855) will be covered by Public Health Realignment.
DISCUSSION:
First 5 funding has helped support the NFP and Nurse Liaison programs provide care to underserved or special needs children ages 0 to 5 for the last ten years, providing the local match for FFP funding. The recommended revenue agreements will provide two years of funding from First 5 plus leveraged federal funding to support the programs.
Public Health Nurses (PHNs) in the NFP program provide primary prevention services to approximately 50 voluntarily enrolled pregnant or parenting first-time mothers in the County with the following goals to improve:
• pregnancy outcomes by helping women improve their health-related behaviors, including reducing use of cigarettes, alcohol and illegal drugs;
• child health and development by helping parents provide more responsible and competent care for their children; and,
• families’ economic self-sufficiency by helping parents develop a vision for their future, plan pregnancies, continue their education, and find employment.
In FY 2015-16, the NFP program:
• served 162 first time mothers, plus 35 newborns;
• ensured 85% of these first time mothers received prenatal care in the first trimester; and,
• made 1,111 referrals to local agencies, 68 for mental health services.
PHNs in the Nurse Liaison Program work with Valley Children’s Hospital (VCH) and Community Regional Medical Center (CRMC) 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. Nurse Liaison staff:
• attend CRMC and VCH Neonatal Intensive Care Unit discharge rounds weekly;
• provide case management services through home visitation; and,
• facilitate referrals and linkage to resources as needed.
In FY 2015-16, the Nurse Liaison Program provided services to 558 families whose infant or child had been referred for services.
With your Board’s approval, the Department will ensure the First 5 funds can be used as a local match to leverage state and federal funds further supporting the NFP and Nurse Liaison Programs. The recommended Agreement contains a mutual hold harmless clause and an attorney’s fees clause favoring the prevailing party.
REFERENCE MATERIAL:
BAI #35, August 25, 2015
BAI #50, September 10, 2013
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with First 5 for Nurse-Family Partnership Program
On file with Clerk - Agreement with First 5 for Nurse Liaison Program
CAO ANALYST:
Sonia De La Rosa