DATE: September 1, 2020
TO: Board of Supervisors
SUBMITTED BY: David Pomaville, 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 Chairman to execute a retroactive Amendment III to Agreement No. 16-683 with Children and Families Commission of Fresno County for the Nurse-Family Partnership program extending the term by one year from July 1, 2020 to June 30, 2021 and increasing the maximum by $210,249 to a total of $1,037,186.
2. Approve and authorize the Chairman to execute a retroactive Amendment III to Agreement No. 16-684 with Children and Families Commission of Fresno County for the Nurse Liaison program extending the term by one year from July 1, 2020 to June 30, 2021 and increasing the maximum by $394,361 to a total of $1,783,291.
REPORT
Approval of the recommended actions will provide the Department of Public Health with an additional year, for a total term of five 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. In addition, the recommended amendments will allow the County to use the funds as the local match to draw down approximately $670,194 of Federal Financial Participation (FFP). The First 5 and FFP funding will support salary and benefits, operational and indirect costs, with no increase in Net County Cost. 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 nor draw down FFP funding, which supports salary and benefits, operational, and indirect costs for both programs. Non-approval would also 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 amendments are retroactive to July 1, 2020 as both were received from First 5 on June 22, 2020. The time required to prepare and review the recommended amendments 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. Each of the recommended amendments provide additional funding and extend the agreements for an additional year, for a total term of five years. The NFP amendment will provide an additional $210,249. The Nurse Liaison amendment will provide an additional $394,361. The First 5 funds will support salary and benefits, operational, and indirect costs for the programs. The recommended amendments plus the FFP drawdown within the agreement with California Department of Public Health for the Maternal, Child and Adolescent Health program (NFP $176,277 and Nurse Liaison $493,917; total FFP $670,194) will provide a total of $1,274,804 of additional funding. Sufficient appropriations and estimated revenues are included in the Department Org 5620 FY 2020-21 Recommended Budget. The recommended amendments allow indirect cost recovery of 5% ($27,515) of total personnel costs; the Department’s indirect cost rate is 22.674%. The 17.674% ($97,260) difference will be covered by Health Realignment. There are no pending invoices associated with the recommended amendments.
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. Public Health Nurses (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 and September 10, 2019, the Board approved first and second amendments to extend the agreements with First 5 for a third and fourth year to receive additional funding supporting the NFP and Nurse Liaison programs. The recommended actions will extend the term of the agreements for one more year for a total term of five years and accept additional funding into the two programs.
First 5 funds two of the six PHNs in the NFP program. During FY 2019-20, the program:
• served 149 families who were having their first baby;
• completed 1,008 home visits;
• ensured 93% of infants served were current on immunizations at 12 months of age;
• provided 96.5% of infants served with developmental assessments using the Ages & Stages Questionnaires®, Third Edition (ASQ®-3) at 2, 4, 10, 12 and 18 months of age; and
• helped 97.83% of clients initiate breastfeeding at birth.
In FY 2019-20, the Nurse Liaison program:
• provided case management services to 179 pregnant/parenting teens, high-risk children, and their families;
• administered 164 developmental screenings to at-risk children;
• made 199 referrals for developmental, mental health, and other community agencies; and
• kept the re-hospitalization rate of children who received Nurse Liaison services to under 4%.
Approval of the recommended amendments will accept an additional year of funding from First 5, providing the local match to leverage federal funding further supporting the programs, and allow the NFP and Nurse Liaison programs to continue improving pregnancy outcomes, child health and development, and linkage to resources as needed.
REFERENCE MATERIAL:
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 III to Agreement No. 16-683 with First 5 for NFP
On file with Clerk - Amendment III to Agreement No. 16-684 with First 5 for Nurse Liaison
CAO ANALYST:
Raul Guerra