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Adopt a resolution amending the List of Numbers and Classifications of Positions to add 2.0 Limited-Term Health Assistants through June 30, 2020 and a 0.5 FTE Public Health Nurse position in Health and Social Services, Public Health Division to administer services in the California Work Opportunity and Responsibility to Kids Home Visiting Program; and Approve an Appropriation Transfer Request (ATR) for $458,383 for FY2019/20 to accept unanticipated revenue from the California Department of Social Services (4/5 vote required)
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Published Notice Required? Yes ___ No _x _
Public Hearing Required? Yes ___ No _x_
DEPARTMENTAL RECOMMENDATION:
The Department of Health & Social Services (H&SS) recommends that the Board Adopt a resolution amending the List of Numbers and Classifications of Positions to add 2.0 Limited Term Health Assistants through June 30, 2020 and a 0.5 FTE Public Health Nurse position in Health and Social Services, Public Health Division to administer services in the California Work Opportunity and Responsibility to Kids Home Visiting Program; and Approve an Appropriation Transfer Request (ATR) for $458,383 for FY2019/20 to accept unanticipated revenue from the California Department of Social Services (4/5 vote required).
SUMMARY:
In September 2018, H&SS Public Health and Employment & Eligibility Services Divisions collaborated to submit a Request for County Plan to the California Department of Social Services (CDSS) to implement the California Work Opportunity and Responsibility to Kids (CalWORKs) Home Visiting Program (HVP), known in Solano County as Healthy Families Solano. Solano County was granted funding for an eighteen-month term of January 1, 2019 through June 30, 2020.
The first allocation granted $252,652 for program start up and planning for the last six months of FY2018/19. CDSS indicated HVP counties could anticipate a FY2019/20 allocation approximately double the first six-month allocation amount; therefore, H&SS developed its budget for FY2019/20 in the amount of $505,304. In July 2019 CDSS released the approved FY2019/20 allocation for Solano County of $963,687, $458,383 more than budgeted. This Board Item is a request to accept the unanticipated revenue of $458,383 for FY2019/20.
Additionally, in July 2019, CDSS expanded eligibility criteria for the HVP, increasing significantly the number of eligible clients and increasing the need for staff. If approved by the Board, H&SS’s Maternal, Child and Adolescent Health Bureau will expand staffing by 2.0 FTE Limited-Term Health Assistants positions and by increasing a 0.5 FTE Public Health Nurse position to a 1.0 FTE position, to provide additional Healthy Families Solano case management services to high-risk pregnant and parenting families enrolled in the CalWORKs program.
FINANCIAL IMPACT:
For FY2019/20, the California Department of Social Services has allocated to Solano County $963,687 to implement the CalWORKs Home Visiting Program. The requested 2.0 FTE Limited term positions and the increased 0.5 FTE will be fully funded by the CDSS funds for FY2019/20. The current CDSS allocation is for FY2019/20 but the department expects the allocation to be renewed annually. There is no County General Fund cost associated with this request.
The costs associated with preparing the agenda item are nominal and absorbed by the department’s FY2019/20 adopted budget.
DISCUSSION:
The CalWORKs HVP was authorized by legislation in 2018 (Assembly Bill 1811 Human Services Omnibus, Chapter 35, Statutes of 2018) and established in 2019. HVP is a voluntary program overseen by the CDSS and administered by participating California counties. The HVP aims to support positive health, development and well-being outcomes for pregnant and parenting women, families, and infants born into poverty by expanding their future educational, economic and financial capabilities and opportunities, thereby improving the likelihood they will exit poverty.
In January 2018, the CDSS released a Request for County Plan (RFCP) to solicit plans from county governmental agencies for funding to administer the HVP program. The CDSS awarded funds for providing voluntary, high-quality, evidence-based and culturally responsive home visiting services. H&SS’s Public Health and Employment & Eligibility Services Divisions collaborated, planned, and jointly submitted the RFCP in September 2018. Solano County was granted two allocations for an eighteen-month funding period to implement the Healthy Families America home visitation model, known as Healthy Families Solano, in Solano County.
Per CDSS guidelines, ongoing funding is subject to an appropriation in the annual Budget Act, and CDSS has indicated it will continue to award funds to participating counties who apply biennially and meet the minimum requirements. H&SS anticipates this funding source will be long standing.
The Solano RFCP included a plan for H&SS’s Public Health Division, Maternal, Child and Adolescent Health Bureau to implement the Healthy Families America model for clients enrolled in the CalWORKs program. Healthy Families America is an evidence-based, national home visiting program designed to promote positive parent-child relationships and healthy attachment through interactions between home visitors and families. HFA provides intensive home visiting support to parents facing challenges such as single parenthood; low income; childhood history of abuse and other adverse child experiences; and current or previous issues related to substance abuse, mental health issues, and/or domestic violence. Home visitors/Family Support Specialists (FSS) utilize evidenced based practices and methods, curriculum, and conduct health, developmental, and social emotional assessments for both parent and child. In addition, FSS utilize techniques such as motivational interviewing and validated tools with families to set and accomplish goals and assists the family in accessing needed resources and services. Families are enrolled prenatally or within three months of birth and are served up to the child’s third birthday.
Healthy Families America has decades of data demonstrating outcomes that include reductions in low birth weight babies, pregnancy complications, emergency room visits, parenting stress and risky behaviors including abuse of alcohol and drugs, as well as less yelling, physical punishment and overall maltreatment of children. The data also demonstrate increased breastfeeding rates, rates of health insurance coverage and connections to medical homes. The model has demonstrated positive impacts on mental health, parent confidence and parent/child interactions.
Since January 1, 2013, the HFS program has served two hundred and eighty-six participants. Recent outcomes for the Healthy Families Solano program include the following: ninety-six percent (96%) of participants had up-to-date immunizations; one-hundred percent (100%) had both prenatal and postpartum depression screens; one-hundred percent of children (100%) of enrolled participants had up-to-date social, emotional and developmental screenings; and, ninety-seven percent (97%) of children were connected to a medical home. Birth outcomes for participants between January 2013 and September 2019 show a prematurity rate of 6.85%, less than the state average, and prematurity rates by race/ethnicity show that Black and Hispanic participants have lower rates than both County and state levels. Low birth weight rates by race/ethnicity show that Black, Asian/Asian Pacific Islander and White Healthy Family Solano participants all had rates below the County and state levels.
Initial CDSS guidelines for the HVP released in July 2018 mandated that participants served by the HVP must be first-time parents or caregivers. In July 2019, however, CDSS updated program requirements to include parents and caregivers who had other children at the time of enrollment. Expansion of program eligibility has increased significantly the number of participants eligible for home visitation services. As a condition of funding, CDSS requires that the allocation must not supplant existing funds. To adequately meet program expansion needs and needs of the community, H&SS is requesting to add 2.0 FTE Limited term Health Assistant positions to provide case management services for HVP clients including routine assessments, client education, assistance and technical support; conduct screenings, assessments and enrollments; and provide home visitation services to participants. The requested increase of 0.5 FTE Public Health Nurse will promote HVP client health maintenance by providing clinical health assessments, education and counseling related to detection, prevention and control of diseases and adverse health conditions.
ALTERNATIVES:
The Board may choose not to approve the ATR of $458,383 or approve the requested 2.0 FTE Limited-Term Health Assistant positions and the 0.5 FTE Public Health position. This is not recommended because the increased funds provide Solano County with the opportunity to increase services for high-risk pregnant and parenting families in Solano County and improve health outcomes for infants and families.
OTHER AGENCY INVOLVEMENT:
The CalWORKs HVP allocation is awarded directly to the Employment & Eligibility Services Division, which collaborates with the Public Health Division to administer the program.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION