DATE: October 19, 2021
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Interim Director
SUBJECT: Retroactive Amendment to Agreement with Children and Families Commission of Fresno County
RECOMMENDED ACTION(S):
TITLE
Approve and authorize the Chairman to execute a retroactive First Amendment to Agreement No. 20-402 with Children and Families Commission of Fresno County for the Community Health Teams program extending the term by one year from July 1, 2021 to June 30, 2022 and increasing the maximum by $895,390 to a total of $1,790,596.
REPORT
There is no additional Net County Cost associated with the recommended action. Approval of the recommended action will provide the Department of Public Health with an additional year, for a total term of two years, of funding from Children and Families Commission of Fresno County (First 5) to support the Community Health Teams program. The First 5 funding will continue to support salary and benefits for one public health nurse (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 action, the agreement with First 5 would not be extended an additional year and the Department would not be able to accept the increased funding nor draw down additional Federal funding. The Department would also not be able to continue the Community Health Teams (CHT) program which provides home visitation services to underserved children ages 0 to 5 and their families in the County.
RETROACTIVE AGREEMENT:
The recommended agreement is retroactive to July 1, 2021, as the final version was received from First 5 on May 27, 2021. 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 action. The recommended amendment provides $895,390 of additional funding and extends the agreement for an additional year, for a total term of two years. The First 5 funds will support salary and benefits for one PHN and four subcontracts with local CBOs to provide the direct home visitation services. In addition, the recommended agreement will allow the County to use the funds as the local match to draw down approximately $414,720 of Federal dollars under Title XIX as Federal Financial Participation (FFP) for eligible services. The recommended agreement plus the FFP drawdown will provide total funds of $1,310,110. Sufficient appropriations and estimated revenues are included in the Department Org 5620 FY 2021-22 Adopted Budget. The recommended agreement allows indirect cost recovery of 15% ($12,442) of total personnel costs; the Department’s indirect cost rate is 22.579%. The 7.579% ($6,287) difference will be covered by 1991 Realignment-Public Health funds. There are no pending invoices associated with the recommended amendment at this time.
DISCUSSION:
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. 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 Proposition 10: California Children and Families Act of 1998 funds from First 5 will provide a local match to leverage Federal Title XIX funds (FFP funds) into the County to continue to support salary and benefits for one PHN and four subcontracts with local CBOs to provide the direct home visitation services. The CBO home visitors provide social support, health information, family planning, and act as a resource provider, literacy teacher, or parenting coach. The PHN provides guidance and support on medically challenging cases and completes joint home visits as needed. The CHT meets on a regular basis for trainings, case consultations, and other program issues.
In FY 2020-21, the CHT provided:
• intensive home visitation services using research-based models and curriculum to 185 families with children ages 0-5;
• developmental screenings to 215 children ages 0-5; and
• referrals to 140 children and family members for community resources such as mental health, primary care physicians, health insurance, early intervention and economic assistance.
Approval of the recommended agreement will accept an additional year of funding from First 5, providing the local match to leverage federal funding further 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.
REFERENCE MATERIAL:
BAI #42, October 6, 2020
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - Amendment I to Agreement No. 20-402 with First 5 for Community Health Teams
CAO ANALYST:
Ron Alexander