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: Majority
Supervisorial District(s): Countywide
Title:
Title
California Home Visiting Program State General Fund Innovation Grant
End
Recommended Action:
Recommended action
Authorize the Director of Health Services, or designee, to execute a grant agreement with the City and County of San Francisco to receive up to $1,396,920 in revenue to implement the Trauma-Informed Approach in Public Health Nursing model through June 30, 2026, and any amendments that do not substantially change the scope of work or increase the funding amount.
end
Executive Summary:
In August 2023, the County of Sonoma Department of Health Services (hereinafter “DHS” or “the Department”) received an allocation letter from the San Francisco Department of Public Health allocating $1,247,250 over the next three fiscal years to the County of Sonoma for the implementation of the Trauma-Informed Approach in Public Health Nursing model (TIA-PHN).
The TIA-PHN model supports the unique needs of families where children are most likely to encounter toxic stress leading to suboptimal brain development and future poor health outcomes. This model design incorporates Adverse Childhood Experience (ACEs) education in a self-reflective approach with parents to increase family resilience and reduce the risk for future childhood trauma.
The grant agreement with the City and County of San Francisco includes a contingency of $149,670, the utilization of which requires a modification to the grant agreement or a revision to the grant budgets approved by the City and County of San Francisco.
The new allocation follows the June 8, 2021, the Board approval to execute a grant agreement for $1,199,979 to implement the model from May 15, 2021, through June 30, 2023. Information of what was accomplished during the first cycle is included below. New cycle funding will support existing staff costs, which in the FY 23/24 adopted assumed use of 1991 Health Realignment accumulated fund balance.
Discussion:
In August 2020, the California Department of Public Health/California Home Visiting Program (CDPH/CHVP) issued a request for supplemental information (RSI) to local health jurisdictions (LHJ) to solicit applications for implementing home visiting as a primary strategy for serving families from pregnancy through kindergarten entry, with a focus on innovative practices to meet local need; and for evaluating the innovation in order to assess continued or more wide-spread use.
CDPH/CHVP considered applications in response to the RSI for home visiting services that either employed an evidence-informed model or employed an evidence-based model implemented with an innovative approach or an add-on component.
The Sonoma County DHS Field Nursing program has developed and piloted an evidence-informed home visiting model, the Trauma Informed Public Health Nurse (TIA-PHN) model based on the US Substance Abuse and Mental Health Services Administration’s (SAMHSA) Trauma and Justice Strategic Initiative.
The TIA-PHN pilot model began in July 2018. SAMHSA operationalized a trauma-informed approach for the mental/behavioral health sector based on a set of six key principles that mitigate re-traumatization of both clients and staff.
1) Safety
2) Trustworthiness and transparency
3) Peer support and mutual self-help
4) Collaboration and mutuality
5) Empowerment/voice/choice
6) Cultural/historical/gender issues (SAMHSA, 2014)
The Sonoma County Field Nursing program joined Napa County’s Home Visiting Program and San Francisco County’s Home Visiting Programs to form the San Francisco Home Visiting Consortium for the purposes of implementing the TIA-PHN model across three counties. The CDPH/CHVP selected the Consortium’s request for supplemental information for a $3 million funding award beginning fiscal year 2020-2021 through fiscal year 2022-2023 to serve up to 300 families annually. The San Francisco Consortium implemented the TIA-PHN with eligible and enrolled clients and their families. By implementing this new model across the three counties, home visitors increased access and addressed the mental health, social and medical needs of high-risk families in urban, suburban, and rural settings, and reached a more demographically diverse population.
The TIA-PHN model supports the unique needs of families where children are most likely to encounter toxic stress leading to suboptimal brain development and future poor health outcomes. This model design incorporates Adverse Childhood Experience (ACEs) education in a self-reflective approach with parents to increase family resilience and reduce the risk for future childhood trauma. The average length of enrollment is 6 months.
During the first funding cycle of this grant, the TIA-PHN team:
• Had a reflective conversation about ACEs and administered an ACEs screening to 96 adult participants (82% of whom had not heard about ACEs before)
• Had a reflective conversation with 100 adult caregivers on the significance of ACEs and brain development
• Screened 163 adult caregivers for depression and referred 35 of those adults to mental health services
• Linked 27 adult individuals to MediCal, and 25 to a medical home
• Screened 184 children (ages 0-5) for developmental delays, and referred 28 of these children to early intervention services
The Sonoma County TIA PHN model has been shared with interested colleagues and community partners through:
• TIA-PHN Model Presentation to Western Region Public Health Training Center in February 2022 and to the California Directors of Public Health Nursing Conference in May 2022.
• TIA-PHN article published in a June 2022 issue of the American Journal of Public Health dedicated to Public Health Nursing.
• TIA-PHN Model Presentation to the Sonoma Connect/ Sonoma Unidos ACEs Clinical Action Team in July 2022.
• TIA-PHN presentation and information around substance use disorder and perinatal fentanyl use to the Sonoma County First 5 Advisory Council in August 2022.
• TIA-PHN Model presentation and training with neighboring counties interested in implementing the model in their Field Nursing programs in April 2023.
This item seeks Board authorization to execute a grant agreement with the City and County of San Francisco to receive the allocated revenue and to implement the model through June 30, 2026.
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 3: Increase investment in programs that treat underlying causes of homelessness, including substance abuse, mental illness, poverty, and lack of affordable housing.
Racial Equity:
Was this item identified as an opportunity to apply the Racial Equity Toolkit?
No
Prior Board Actions:
On June 8, 2021 the Board authorized the Director of Health Services, or designee, to execute a grant agreement with the City and County of San Francisco to receive $1,199,979 in revenue to implement the Trauma-Informed Approach in Public Health Nursing model for the period May 15, 2021 through June 30, 2023.
Fiscal Summary
|
Expenditures |
FY 23-24 Adopted |
FY 24-25 Projected |
FY 25-26 Projected |
|
Budgeted Expenses |
|
$415,750 |
$415,750 |
|
Additional Appropriation Requested |
$415,750 |
|
|
|
Total Expenditures |
$415,750 |
$415,750 |
$415,750 |
|
Funding Sources |
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|
|
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General Fund/WA GF |
|
|
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State/Federal |
$415,750 |
$415,750 |
$415,750 |
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Fees/Other |
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|
|
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Use of Fund Balance |
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|
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Contingencies |
|
|
|
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Total Sources |
$415,750 |
$415,750 |
$415,750 |
Narrative Explanation of Fiscal Impacts:
The Department did not include this funding in the requested budget as the allocation was not known until August of 2023. The Department will add appropriations via the Quarter 2 Consolidated Board Adjustments. As this funding will in part support existing staff, the Department will reduce the use of 1991 Health Realignment that was included in the adopted budget to support these positions. The contingency amount of $149,670, or portions thereof, will be added to the appropriate fiscal year budgets as necessary.
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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 - Grant Agreement
Related Items “On File” with the Clerk of the Board:
N/A