To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Tina Rivera, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Community Health Workers for COVID-19 Response and Resilient Communities Grant
End
Recommended Action:
Recommended action
A) Authorize the Director of Health Services, or designee, to execute an agreement with the San Francisco Community College District dba City College of San Francisco for community health worker training services related to the Community Health Workers for COVID Response and Resilient Communities grant in an amount not-to-exceed $733,447 through August 30, 2024, including $389,586 in fiscal year 2022-2023.
B) Authorize the Director of Health Services, or designee, to execute agreements for community health worker training and deployment services to fulfill the Community Health Workers for COVID Response and Resilient Communities grant program requirements, competitively procured during fiscal year 2022-2023, in a total amount not-to-exceed $1,663,479 through August 30, 2024.
C) Authorize the Director of Health Services, or designee, to execute the first amendment to an agreement with the Petaluma Health Care District for the continuation of Community Health Worker deployment and engagement services, increasing the amount by $21,971, resulting in a new, not-to-exceed amount of $133,971 for the period August 31, 2021 through December 31, 2022.
D) Adopt a resolution authorizing budgetary adjustments to the Department of Health Services fiscal year 2022-2023 adopted budget to increase Centers for Disease Control and Prevention grant revenues and expenditures in support of year-two Community Health Workers for COVID-19 Response and Resilient Communities grant activities in the amount of $2,132,125. (4/5th vote required)
(4/5th Vote Required)
end
Executive Summary:
In March 2021, the Centers for Disease Control and Prevention National Center for Chronic Disease Prevention and Health Promotion section solicited applications for the Community Health Workers (CHW) for COVID Response and Resilient Communities grant (CHW Grant). In July 2021 the Department of Health Services (hereinafter, DHS or the Department) was notified of a grant award of up to three years in the amount of $2,000,000 per year, beginning August 2021.
Consequently, on December 7, 2021, as part of the “COVID-19 Emergency Response Strategy, Appropriations and Delegated Authority Update” agenda item, the Board approved the Department’s plan for CHW Grant implementation that included hiring four time-limited (3-years) full-time equivalent staff to manage and coordinate the new program; increasing fiscal year 2021-2022 revenues and expenditures by $1,679,393 to support program efforts; and establishing the work of County partners with one-year agreements to City College of San Francisco, Alliance Medical Center, Santa Rosa Community Health Center, Petaluma Health Care District, and West County Health Center.
The CHW Grant project has three components: Train, Deploy, and Engage Community Health Workers. As part of the Train component of the grant plan, the Department plans to continue its partnership with City College of San Francisco to strengthen the enrollment of Sonoma County residents in the CHW Certificate Program and the stackable workshop modules, utilizing an innovative “from CHWs-by CHWs-to CHWs” training methodology. This item includes a request for approval of a new agreement with City College of San Francisco for training services through August 30, 2024.
In year 2 and 3 of the program, the Deploy and Engage components of the grant plan, the Department will assess activities currently performed by CHWs within the contracted organizations developing robust scopes of work that clearly incorporate activities to be performed by CHWs in the field that match the deliverables established by the grantor. The Department is in the process of competitively procuring services associated with the Deploy and Engage components of the grant plan, with vendor selection anticipated in January 2023 for the Year 2 and Year 3 funding available. This item requests approval to enter into agreements with vendors who merit an award as a result of this competitive procurement process through August 30, 2024.
To provide for the continuation of services during the competitive procurement process, the Department plans to extend the Year 1 agreements with Alliance Medical Center, Santa Rosa Community Health Center, Petaluma Health Care District, and West County Health Center through December 31, 2022. The Petaluma Health Care District has fully utilized the funding available in the current contract and will receive additional funding during this period. The other contractors spent less than anticipated during their contract terms and there is sufficient funding budgeted during fiscal year 2022-2023 for the continuation of services.
This item also requests approval of a fiscal year 2022-2023 budget adjustment to support Community Health Workers for COVID-19 Response and Resilient Communities grant activities in the amount of $2,132,125.
Discussion:
Sonoma County has an extensive system of community-based organizations, clinical agencies, and coalitions that employ CHWs, both paid and unpaid, doing positive and proactive work in the community to address health inequities. CHW Grant activities are part of local and national efforts to standardize the training that CHWs receive across all organizations to meet a core set of competencies; provide COVID-specific training to extend the reach of COVID-19 CHWs working for the County Public Health Division; support CHW hubs to improve coordination of CHW efforts across organizations to maximize impact; and professionalize the important roles CHWs can play in supporting the planning, implementation, documentation, and evaluation of public health interventions to improve health outcomes and reduce COVID-19 in our communities.
CHWs are members of our affected communities; they have deep knowledge of and are the bridges to the communities we seek to partner with to co-create solutions to the complex barriers that prevent community members from achieving health. CHW Grant efforts will in part address the underlying causes for the disproportionate impact of the COVID-19 pandemic upon the Latino, Native American, and unhoused communities in Sonoma County by training and funding new CHWs. The high burden of disease in these populations is rooted in systemic racism and resulting disparities in their social determinants of health. Furthermore, unrelenting fires followed by a pandemic further complicated access to needed services, have contributed to higher rates of comorbid conditions, lower rates of vaccinations, and greater financial and psychological impacts on these populations.
The pandemic has highlighted the need to reach people where they are in the community: in their homes, worksites, and the places they shop and go to relax. Community Health Workers know community preferences, speak their languages, relate to their cultures, and appreciate their needs are essential to providing the kind of support our communities have been asking for throughout the pandemic. The CHW Grant presents an important opportunity to expand and enhance this work in Sonoma County.
The CHW Grant project has three components: Train, Deploy, and Engage Community Health Workers. This project will train current and new CHWs to enhance and expand the existing local Sonoma County workforce. To effectively serve priority populations, the training provided to CHWs will teach and reinforce information on the social and political determinants of health, and service delivery using the lens of racial equity and trauma informed strategies. This will also include linguistic and culturally responsive messaging, designed to communicate health information most effectively to populations that are disproportionately impacted by COVID-19. For CHWs who are embedded in Federally Qualified Health Centers (FQHCs), there will be an emphasis on serving as a member of a care team that provides a comprehensive approach to addressing the social determinants of health.
The Department is partnering with the City College of San Francisco to deliver high-quality training to current and new CHWs in partner community-based organizations and community health clinics in the County. Training is based on the Community Health Worker Core Consensus (C3) Project, recognized by the Centers for Disease Control as the standard CHW model. A full CHW course is provided to participants with 17 units of college credit and will result in a certificate of completion. Training will include internships at participants’ current place of employment, and will offer an elective in healthcare interpreting, to support service delivery in languages other than English. There are 25 students from Sonoma County who have been enrolled since February 2022 in online classes and are on track to graduate in December 2022 or May 2023. The Department is recruiting a new cohort to enroll in December 2022.
To continue the training being provided by City College of San Francisco, the Department is requesting approval of a new agreement for training services through August 30, 2024. The Sonoma County Purchasing Agent approved a single source waiver for this agreement on November 2, 2022.
CHW trainees will have the opportunity for internships in agencies and communities to better understand the approach to supporting clients in managing chronic health conditions, while engaging in and learning about systems change in public health. This project will also elevate other local opportunities, workshops and training programs offered by subcontractors and partners designed for CHWs.
The CHW Grant project is implementing the “Deploy” strategy by partnering with key non-profit organizations, community health centers, and collaboratives that are committed to hiring and embedding CHWs into their operations to promote healthcare and advocacy services for community members. Grant funds are being used to maintain and fund CHW positions at partner organizations and strengthen management and supervision capacity within those organizations.
With the help of two community-based organizations (CBOs), the DHS team has begun mapping current employers of CHWs in Sonoma County, so far identifying 23 employers. A baseline survey will provide DHS with further details about their hiring practices, current CHWs hired, CHW integration, CHW career pipeline, data systems, and policy around CHW hiring and supervision. The surveys used to monitor progress and attitude changes around CHWs have integrated partner input as well as tested and previously utilized surveys. This data will be shared with community partners to inform on the current landscape and conditions of CHWs in Sonoma County, used to inform on sustainability practices after the end of this grant, and for the internal DHS team to monitor progress.
“Engage” strategies include the expansion and strengthening of a network of CHW employer organizations that will build capacity of partners to increase outreach and engagement of individuals from target communities in health and social services. Recognizing the current existing CHW networks in Sonoma County, that existed before and were reinforced during COVID-19, this grant aims to support the parties holding these networks to cultivate relationship building, relationship strengthening and supporting community building amongst CHWs engaged in our grant.
The CHW grant supports CHWs in hosting ongoing community events, aimed at engaging community members in their communities and in the health care system, including COVID-19 outreach, testing, vaccination, and prevention. We will also expand efforts to get messages out to the community through trusted sources, including our County bilingual, bicultural COVID-19 CHW staff, faith-based leaders, and formal and informal community leaders.
An advisory council comprised of subcontractors and community partners is in place to assist in identifying standards of practice for a continual quality improvement process among partners. The advisory council convenes regularly to receive updates, identify common barriers, share best practices, share community feedback on service improvements, and address data collection and reporting. Two subcommittees have been formed within the advisory council, one for this project’s evaluation and the second to plan a CHW Conference. There have been four meetings of the advisory council, with 21 community and subcontractor participants. The council has included participation from five CBOs, six CHWs, four subcontracting FQHCs, one subcontracting CBO, and DHS staff.
A key element of this strategy will be leveraging existing networks within the county, including: the Center for Well-Being, which trains and supports CHWs serving in the Latino community; the Health Equity Advisory Group, which advises DHS on COVID-related health disparities; Sonoma Connect, a project that seeks to build and strengthen a closed-loop referral network employing trauma informed strategies; the Community Outreach Collaborative, a group of CBOs that have been active in COVID response and CHW training and support; and key County departments, including DHS and Office of Equity.
CHW Grant Year 2 and 3 Activities
Year 2 of the CHW Grant began on August 30, 2022. The Department plans to issue a request for proposals (RFP) to solicit contractors to train and integrate new CHWs into their agencies. The Department also plans to solicit contractors who can support other features of the CHW Grant. CHW training in Spanish exists for skills training but is limited for core competency training. This funding can support the writing of a Spanish curriculum and core skills training that is not covered by the City College of San Francisco curriculum. This need is critical and will be addressed in Year 2. Because of different experiences and understanding of CHW roles and responsibilities, we will also seek a trainer for CHW supervisors and care teams.
This item requests approval to enter into agreements with organizations not to exceed a total combined value of $1,663,479 who receive an award to provide the needed services based on their exhibited ability to provide the needed services as detailed in their competitive procurement proposals. Existing providers are welcome to submit proposals to continue providing services. Agreements resulting from the competitive procurement solicitation will have a term through year three of the grant, which ends August 30, 2024. Evaluation of proposals is anticipated to begin in December 2023 and vendor selection is anticipated in January 2023. To minimize the lapse in the provision of services, the Department is planning to have new agreements in place soon after vendors are selected.
To provide for the continuation of services during the competitive procurement process, the Department plans to extend the agreements with Alliance Medical Center, Santa Rosa Community Health Center, Petaluma Health Care District, and West County Health Center through December 31, 2022. Only Petaluma Health Care District will receive additional funding in the amount of $21,971 during this period, as the other contractors spent less than anticipated during their contract terms.
CHW Grant Funding Summary - Attachment 4 provides a summary of grant expenditures, actual and planned, for years one through three of the CHW Grant. Note: Grant year one is August 31, 2021 to August 30, 2022, grant year two is August 31, 2022 to August 30, 2023, and grant year three is August 31, 2023 to August 30, 2024.
This item also requests approval of a fiscal year 2022-2023 budget adjustment to support Community Health Workers for COVID-19 Response and Resilient Communities grant activities in the amount of $2,132,682.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan and is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal: Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective: Objective 2: Identify gaps in the Safety Net system of services and identify areas where departments can address those gaps directly, and seek guidance from the Board when additional resources and/or policy direction is needed.
Prior Board Actions:
On December 7, 2021, the Board received a staff update on current COVID-19 response and enhanced strategy efforts which included fiscal and staffing impacts associated with the Community Health Workers for COVID-19 Response and Resilient Communities Grant activities for grant year one, which began August 31, 2021.
Fiscal Summary
|
Expenditures |
FY 22-23 Adopted |
FY 23-24 Projected |
FY 24-25 Projected |
|
Budgeted Expenses |
$401,313 |
$2,000,000 |
$333,333 |
|
Additional Appropriation Requested |
$1,730,812 |
|
|
|
Total Expenditures |
$2,132,125 |
$2,000,000 |
$333,333 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$2,132,125 |
$2,000,000 |
$333,333 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$2,132,125 |
$2,000,000 |
$333,333 |
Narrative Explanation of Fiscal Impacts:
The Department is requesting adjustments to the FY 22-23 budget via the attached budget resolution to increase expenditure appropriations totaling $1,730,812 from the Community Health Workers for COVID-19 Response and Resilient Communities grant. The FY 22-23 budget includes an encumbrance of $401,313 carried over from FY 21-22. Appropriations for FY 23-24 and FY 24-25 will be included in the appropriate year budgets.
A portion of the $2,798,792 FY 22-23 award, $666,667, was included in the FY 22-23 adopted budget, and DHS is requesting the addition of the balance of the award, $2,132,125.
|
Staffing Impacts: |
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|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
Attachment 1 - City College of San Francisco Agreement
Attachment 2 - Petaluma Health Care District Amendment
Attachment 3 - Budget Resolution
Attachment 4 - CHW Grant Funding Summary
Related Items “On File” with the Clerk of the Board:
None