DATE: April 25, 2023
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Retroactive Revenue Agreement Funding Application with California Department of Public Health
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Chairman to execute a retroactive revenue Agreement Funding Application with California Department of Public Health, for the California Home Visiting Program - State General Fund Expansion, effective July 1, 2022 through June 30, 2023 ($748,835); and
2. Adopt Budget Resolution increasing FY 2022-23 appropriations in the amount of $694,375 and estimated revenues in the amount of $748,835 for the Department of Public Health Org 5620 (4/5 vote).
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the first recommended action will provide the Fresno County Department of Public Health (Department) with California Department of Public Health (CDPH) funding for the California Home Visiting Program (CHVP) - State General Fund (SGF) Expansion Year 1. 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. Approval of the second recommended action will increase the Department’s appropriations and estimated revenues for FY 2022-23. 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 accept the CHVP SGF Expansion Year 1 grant funding to expand the program and provide important services to pregnant and parenting women and their families.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2022. The process for receiving the CHVP SGF Expansion Year 1 funding requires submittal of an Agreement Funding Application (AFA). The Department received the CHVP SGF Expansion AFA on December 22, 2022. The time required to prepare the budget and all documents in the AFA 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. CDPH is allocating additional funding ($748,835) to the Department’s CHVP SGF Expansion Program. The recommended agreement will provide funding to support salary and benefits, and operational costs to expand the NFP services provided by the Department for FY 2022-23. Approval of the second recommended action will increase the Department’s Org 5620 FY 2022-23 appropriations in the amount of $694,375 and estimated revenues in the amount of $748,835. The increase in appropriations will be $289,375 to Salary & Benefits and $405,000 to Services & Supplies, with the difference being the indirect cost ($54,460) budgeted into revenue.
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. The first recommended action is for additional CHVP SGF Expansion Year 1 funding that supplements the current award funding for FY 2022-23 to expand the NFP services.
The NFP program provides nurse home visitation services to low-income, first-time mothers and their families following an evidence-based model. From pregnancy through the child’s second birthday, Public Health Nurses with specialized training visit regularly with mothers, fathers, and extended family members to monitor the health of mother, child, and environment and provide information on pregnancy, parenting skills, healthy relationships, disease prevention, and appropriate community services. The nurses encourage positive health choices, such as:
• avoiding smoking, drinking and using drugs;
• seeking prenatal care;
• eating nutritious foods; and,
• increasing intervals between births.
Currently, the Department provides NFP services countywide through the County’s original NFP site in the City of Fresno. Approval of the first recommended actions would provide the Department with CDPH, CHVP SGF Expansion Year 1 funding to support salary and benefits, and operational costs to expand the NFP services provided by the Department. This will allow the program to fund additional staff and increase the number of clients served.
In FY 2021-22, the County’s NFP program:
• received 61 referrals and enrolled 60 families into program services;
• served 265 families;
• made 2,089 home visits and attempted an additional 364;
• 1,324 visits were in person and 765 were telehealth;
• 71 children were born including 3 sets of multiples;
• 90.4% of clients-initiated breastfeeding at birth;
• 87.5% of infants were up to date on immunizations at 12 months of age and 91.2% of toddlers were up to date at 24 months;
• provided infants 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; 78% were screened at 24 months and 25% were referred for early intervention; and
• 739 referrals were made for government assistance, crisis intervention, mental health, substance use, health care services, education programs and other services including transportation, housing, and job training.
The recommended agreement will provide funding for the NFP programs to continue working to:
• reduce infant mortality and emergency department visits;
• improve school readiness and family economic self-sufficiency; and,
• coordinate and refer to other community resources and supports.
REFERENCE MATERIAL:
BAI #45, November 16, 2021
BAI #29, June 9, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Agreement with CA Department of Public Health SGF Expansion Year 1
On file with Clerk - Resolution (Org 5620)
CAO ANALYST:
Ron Alexander