To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Jennifer Solito, 707-565-4774
Vote Requirement: 4/5th
Supervisorial District(s): Countywide
Title:
Title
Department of Health Services Staffing Allocations
End
Recommended Action:
Recommended action
A) Adopt a personnel Resolution amending the Department of Health Services Department Allocation List to add 2.0 full-time equivalent position allocations to support the Nurse-Family Partnership and Trauma Informed Approach to Public Health programs in the Community and Family Health section, effective September 24, 2024.
B) Adopt a budget Resolution, authorizing budgetary adjustments to the fiscal year 2024-2025 adopted budget to reflect additional revenues and expenditures in the amount of $427,194 associated with the requested addition of 2.0 full-time allocations equivalent to 9-months of the fiscal year.
(4/5th Vote Required)
end
Executive Summary:
Due to the demand surge in the Nurse-Family Partnership program following the COVID-19 pandemic, resulting in a consistent waiting list of 10-14 low-income, first-time pregnant individuals, management is requesting to add within the Public Health division a 1.0 full time equivalent (FTE) Public Health Nurse (PHN) II, and a 1.0 FTE Senior Public Health Nurse to the Community and Family Health Section in the Field Nursing program which provides community services through the home visiting programs. If approved, the total annual ongoing cost of $557,712 will be funded from reallocated 1991 Public Health Realignment funding and the California Home Visiting Program grant.
Discussion:
The Department of Health Services, Community and Family Health Section is requesting to add a 1.0 FTE Public Health Nurse (PHN) II in the Nurse-Family Partnership (NFP) program and a 1.0 FTE Senior Public Health Nurse in the Trauma-Informed Approach in Public Health Nursing (TIA-PHN) Field Nursing program to increase community services through the home visiting programs.
Public Health Nurse
The Nurse-Family Partnership (NFP) is an evidence-based program that provides nurse home visiting services to first-time pregnant individuals who enroll early in their pregnancy (before the 28th week) and continues to support them until the child’s second birthday. Currently, NFP employs 5 full-time Public Health Nurses (PHNs). This staffing request proposes adding 1.0 FTE additional PHN, bringing the total to 6 full-time equivalent (FTE) nurses. According to the model, each nurse manages a caseload of up to 25 clients, currently allowing a maximum caseload capacity of 125 clients. Due to the length of service and the program's high retention rates, turnover is minimal. Expanding capacity by adding an additional nurse home visitor would accommodate the individuals on the wait list entering the program. Additionally, the Supervising PHN, who oversees the program, can handle 3-5 clients and is primarily responsible for fostering and maintaining relationships with referral partners.
The demand for NFP has surged following the COVID-19 pandemic, resulting in a consistent waiting list of 10-14 low-income, first-time pregnant individuals. Between 2021 and 2022, NFP conducted extensive outreach to clinics and other perinatal service providers to boost program referrals, resulting in a large increase in incoming referrals. The surge in referrals quickly led to a growing wait list, as program enrollment capacity is constrained by the number of case managers. Proactive outreach was paused based on the growing waiting list, with the understanding that expanded grant funding would soon allow NFP to add a case managing Public Health Nurse to address the growing need. If the addition of the PHN is approved, outreach efforts will resume and full caseload of 25 clients per home visitor, as required by the NFP model, will be maintained. The provision of home visiting services to low-income families is included in our annual mandated Scope of Work for California Department of Public Health Maternal Child and Adolescent Health.
In 2022, home visiting programs across California received a significant increase in State funding through the California Home Visiting Program (CHVP), including a 25% increase in the Maternal, Infant, and Early Childhood Home Visiting allocation and a new State General Fund grant for Evidence-Based Home Visiting, both of which Sonoma County can only use to fund NFP due to its status as an evidence-based program. CHVP funding for the County of Sonoma increased from $352,736 in FY21-22 to $1,068,098 and $1,067,000 in FY24-25, representing a 200% increase or $715,362. This additional funding will support the NFP program, including the addition of a new PHN II position, thereby restoring the program to its pre-pandemic staffing level of 6.0 FTE PHN II positions. CDPH has established 5-year funding cycles for CHVP funding and expects this investment to continue.
The CHVP remains a prioritized initiative due to its proven effectiveness in supporting family well-being and child development. Its funding trajectory reflects a sustained commitment by the state to invest in early intervention and support services, with continued financial and legislative backing ensuring its ongoing success and stability. The five-year, long-term agreements provide a stable funding framework, allowing for sustained program operations and the ability to plan for continued improvements and outreach over an extended period. We are currently in year 2 of a 5-year cycle, and that funding is anticipated to renew.
Senior Public Health Nurse
Trauma Informed Approach in Public Health Nursing (TIA-PHN) consistently carries a waiting list of 40+ high-risk, low-income pregnant and parenting people with children under age 5. Demand for field nursing services has remained consistently high post-pandemic, and the acuity of clients has increased in recent years, with a higher proportion of referred clients experiencing housing insecurity and mental health challenges. The Department is requesting 1.0 Senior Public Health Nurse to serve as a lead for the TIA-PHN model, including the role of Master Adverse Childhood Experiences Trainer, tracking fidelity to the TIA-PHN model, and serving as a lead staff overseeing the coordination of Community Health Worker and Social Service Worker tasks. These duties are not currently being performed, and the program anticipates the addition of these duties will provide better adherence to the TIA-PHN model as well as improving the provision of support services to enrolled clients. The Senior PHN will carry a decreased caseload of 15 clients (rather than 25) to accommodate these new duties. The addition of a Senior Public Health Nurse will increase the capacity of the Supervising Public Health Nurse to carry a small caseload of 5 clients, while also providing oversight and supervision to 6.0 PHNs.
Funding for the Senior Public Health Nurse will be supported by the continued increase in CHVP grant funding flowing to NFP, and by transferring subsequent Public Health Realignment savings and Targeted Case Management revenues to TIA-PHN.
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 October 3, 2023, Board item 2023-1070 for California Home Visiting Program State General Fund Innovation authorized grant agreement execution with the City and County of San Francisco, fiscal agent for the California Home Visiting Program's Trauma-Informed Approach in Public Health Nursing model, to receive up to $1,396,920 to implement the Trauma-Informed Approach in Public Health Nursing model through June 30, 2026. The funding will be used over multiple fiscal years to implement and sustain the trauma-informed practices in public health nursing.
On September 12, 2023, A) Adopted a personnel resolution to add a 1.0 full-time equivalent Community Health Worker Specialist; convert 3.0 full-time equivalent time-limited Social Service Worker III position allocations to ongoing; and extend a 1.0 full-time equivalent time-limited Assistant Public Health Laboratory Director position allocation through June 30, 2025; and B) Adopted a resolution authorizing budgetary adjustments to fiscal year 2023-2024 adopted budget, programming $688,000 from a combination of state and federal grants and public health realignment to finance 5.0 FTE requested position allocations
On February 8, 2022, adopted a resolution amending Staffing Allocation to extend 3.0 FTE time-limited Social Service Worker III allocations through October 2, 2023. These positions were to support the Teen Parent Connections home visiting program, serving low-income pregnant and parenting youth under age 21.
On June 8, 2021, adopted a resolution amending staff allocation to extend 3.0 FTE time-limited Social Service Worker III allocations, through October 3, 2022, to support the Department’s Teen Parent Connections program.
On June 2, 2020, adopted a personnel resolution amending, to 1) add 8.1 FTE positions and delete 1.0 FTE position as detailed in the attached resolution; 2) extend the term of a 1.0 FTE time-limited Health Program Manager position through June 30, 2022; and 3) extend the term of 3.0 FTE time-limited Social Service Worker III positions through June 30, 2021. The Social Service Worker III staffing changes were to support Teen Parent Connections.
Fiscal Summary
|
Expenditures |
FY 24-25 Adopted |
FY 25-26 Projected |
FY 26-27 Projected |
|
Budgeted Expenses |
|
$557,712 |
$572,944 |
|
Additional Appropriation Requested |
$427,194 |
|
|
|
Total Expenditures |
$427,194 |
$557,712 |
$572,944 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$427,194 |
$557,712 |
$572,944 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
|
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$427,194 |
$557,712 |
$572,944 |
Narrative Explanation of Fiscal Impacts:
The requested increase to FY 24-25 appropriations is equivalent to 9 months of staffing costs for 2 FTEs is $427,194. Year 1 costs include one-time and overhead costs of $28,750 per FTE.
Per the California Home Visiting Program Grant eligibility requirements, the increased funding can fully offset the cost of the Public Health Nurse II allocation and allows availability of current year budgeted 1991 Public Health Realignment to offset the addition of the Senior Public Health Nurse allocation costs.
FY 25-26 represents the full ongoing cost of the requested 2 FTE allocations. Future year funding will be included in the appropriate year budgets. The increase in costs for the full 12 months in FY 25-26 would be $130,518 and $15,232 for FY 26-27, both assuming a 3% COLA.
Upon Board approval, additional appropriations to increase the FY 24-25 adopted budget will be processed by a budgetary adjustment as referenced in Recommended Action B.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Public Health Nurse II |
$10,082.53 - $12,256.61 |
1.0 |
0.0 |
|
Senior Public Health Nurse |
$10,800.85 - $13,127.98 |
1.0 |
0.0 |
|
|
|
|
|
Narrative Explanation of Staffing Impacts (If Required):
If approved, these allocations will support additional cases, expanding the capacity of this program to serve community members in need and alleviate high workloads from existing staff.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None