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
Department of Health Services Staffing Allocations - Public Health Division
End
Recommended Action:
Recommended action
A) Adopt a personnel resolution amending the Department of Health Services Department Allocation List, effective September 12, 2023, to add a 1.0 full-time equivalent Community Health Worker Specialist position allocation; 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.
B) Adopt a resolution authorizing budgetary adjustments to the Department of Health Services fiscal year 2023-2024 adopted budget, appropriating $688,000 to reflect revenue and expenditures associated with the 5.0 FTE requested position allocations.
(4/5th vote required)
end
Executive Summary:
The Department of Health Services (hereinafter “DHS” or “the Department”) is requesting to modify the Department Allocation List to support various programs in the Public Health Division. Program and requested position allocation information is provided in this report along with funding information for the positions.
In January 2023, Sonoma Works introduced to their Home Visiting clients a program through the California Department of Social Services (CDSS) Cell-Ed program, Laptops 4 Life, to help bridge digital gaps for clients to access employment and education opportunities, as well as other needed resources. The requested Community Health Worker Specialist (CHWS) will be a Home Visitor to deliver, set up, and provide initial technical support and education to the client. The estimated salary and benefits costs including indirect and one-time staff costs is $150,000 in fiscal year 2023-24.
The Teen Parent Connection program provides support services to pregnant and parenting teenagers aged 19 or younger. The program is currently staffed with 1.0 Social Service Worker (SSW) III and 3.0 time-limited Social Service Worker (SSW) III staff. These time-limited positions are due to expire on October 2, 2023. The program as staffed is at capacity with caseloads. To continue to meet the level of referrals and clients admitted to the program, and to sustain the program at its current service level, converting the three time-limited SSW III positions to ongoing allocations would allow for continued delivery of needed program services. Total costs for twelve months is estimated to be $585,000.
The DHS Public Health (PH) Laboratory provides testing services to Sonoma, Mendocino, Lake and Humboldt counties, training and reference testing to clinical laboratories and laboratory support for diagnosis and control of communicable diseases to medical providers. The Assistant Lab Director position supports the PH Lab Director with additional supervisory/management support to the laboratory. The Assistant PH Lab Director leads quality improvement efforts, efforts to maintain and improve technical excellence, day-to-day operational needs, and regulatory compliance. Currently, the Assistant PH Lab Director is slated to expire on September 30, 2023; however, the Department has grant funding to extend this position through fiscal year 2024-25. To further support the program DHS is requesting to extend a 1.0 FTE time-limited Assistant PH Laboratory Director position allocation through June 30, 2025 for $229,000 annually.
Appropriations of $688,000 are being requested with this Item for the costs associated with the addition of the new 1.0 Community Health Worker Specialist and the conversion to permanent for 3.0 Social workers and the extension of 1.0 Assistant Lab Director.
Discussion:
Community Health Worker Specialist (CHWS)
DHS is requesting to add one (1) FTE Community Health Worker Specialist (CHWS) allocation to the Trauma Informed Approach team in Public Health Nursing program in Family Health. The position will be funded by increased funding from California Department of Social Services (CDSS) which allows for the expansion of field nursing team to support a new Laptops for Life program through DHS’ Home Visiting Program, which will benefit the community and require significant staff time to implement.
The Trauma Informed Approach (TIA) in Public Health Nursing (Field Nursing) program is an interdisciplinary team that relies on collaboration between Public Health Nurses (PHN) and CHWSs allowing PHNs to prioritize medical needs and complex social issues while the CHWSs support clients with education, navigation of resources and practical support such as transportation. Over the last seven months there has been a significant increase of referrals to the Home Visiting Program, which utilizes the TIA model. The Home Visiting Program visits pregnant individuals and parents with children up to the age of 5 years old. In fiscal year 2021-22, from July to December, the average number of clients referred was 19 and in fiscal year 2022-23, the average was 27.
Due to the number of referrals compared to the caseload staff ratio, there is a waiting list of 42 (as of August 24, 2023). The type of referrals received have increased in acuity level with individuals having challenging medical conditions with significant needs, requiring a high degree of intervention. The number of clients referred to the program speaking Spanish is approximately 30%. Sonoma Works referrals have increased and been a contributor of the overall increase.
In July 2022, another increase in existing services available to families enrolled in Sonoma Works and TIA Field Nursing includes a Material Goods fund from $500 to $1000. This benefit helps equip families with health and safety items (e.g., a safe sleep environment to prevent SIDs, baby proofing to prevent injuries, car seat, breast pump, etc.). This worthwhile program requires significant staff time to educate the client on safety topics, collect a list, order the items then deliver them.
A CHWS is trained and has experience in providing education, navigation of resources, and practical support such as transportation. The addition of a CHWS would allow the program to prioritize higher acuity medical and social needs among clients to the PHN. With staff currently at capacity and with maximizing the benefits of the Laptops for Life program, the improvements to the delivery of services from the additional CHWS would be realized immediately. Many families are limited to using cell phones to access the internet and medical issues and/or multiple young children can make it difficult to use services at the library or Sonoma Works. The Laptop 4 Life would support the short-term benefit of increased self-sufficiency to access needed resources. Additionally, the long-term benefits of expanding the Trauma Informed Approach PHN team would result in an upstream investment by serving more families in need and preventing crisis-driven services that would impact other programs. The 9-month cost of adding the position in fiscal year 2023-24 is approximately $150,000 including one-time costs, and will be $185,000 annually.
Social Service Worker III (SSW III)
The Teen Parent Connections (TPC) program was established in 1987 in response to increased teen pregnancy and corresponding risks to the well-being of children. TPC targets the complex health risks of pregnant and parenting teens which can lead to multi-generational health disparities when not effectively addressed. The program goals focus on increasing high school graduation rates, reducing second pregnancies, increasing use of long-acting reversible contraceptives, increasing immunization and breastfeeding rates for infants, increasing child developmental screenings and referrals, conducting mental health screenings, and connecting clients to services.
Converting the three time-limited Social Service Worker III positions to ongoing allocations will sustain TPC services at the current level, providing needed services to most teen families. The program was prioritized by the Board of Supervisors during fiscal year 2019-20 budget hearings with the addition of the 3.0 time-limited Social Service Worker III positions, and remains a DHS priority due to the program’s unique value to the vulnerable at-risk population of pregnant and parenting teenagers. The estimated costs of 3.0 Social Service Worker III for nine months is $385,000, three months of costs are already included in the fiscal year 2023-24 Budget $130,000. The total annual cost is approximately $610,000.
Assistant PH Laboratory Director
The Assistant PH Laboratory Director provides increased additional supervisory/management support to the laboratory. Increased supervisory/management capacity supports the mitigation of risks by increasing quality improvement efforts, efforts to maintain and improve technical excellence, oversight of day-to-day operational needs, and regulatory compliance. This position is funded through the CDPH LabAspire program focusing on the training of qualified candidates to become public health lab directors in California. The LabAspire program is funded by California Future of Public Health HERO funds which have been extended through June 30, 2025.
This request would extend the Assistant PH Laboratory Director from its current end date of September 30, 2023 through the grant expiration date of June 30, 2025. The estimated cost for nine months is $153,000, three months of costs are already included in the fiscal year 2023-24 budget ($76,000). Total cost for twelve months is estimated to be $238,000.
Strategic Plan:
This item directly supports the County’s Five-year Strategic Plan by. It is aligned with the following pillar, goal, and objective.
Pillar: Healthy and Safe Communities
Goal 1: Expand integrated system of care to address gaps in services to the County’s most vulnerable.
Objective 1-2: 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.
Objective 1-3: Objective 3: Create a “no wrong door” approach where clients who need services across multiple departments and programs are able to access the array of services needed regardless of where they enter the system.
Goal 4: Reduce the County’s overall homelessness
Objective 4-3: Increase investment in programs that treat underlying causes of homelessness, including substance abuse, mental illness, poverty, and lack of affordable housing.
Objective 4-5: Continue to collaborate with local partners to advance planning and policies to address homelessness.
Prior Board Actions:
On February 8, 2022, this Board adopted a resolution amending the Department Allocation List for the Department of Health Services, effective February 8, 2022, to extend 3.0 FTE time-limited Social Service Worker III allocations through October 2, 2023.
On June 8, 2021, this Board adopted a resolution amending the allocation list for the Department of Health Services, effective June 8, 2021, 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 the Board adopted a personnel resolution amending the Department of Health Services allocation list, effective June 2, 2020, 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.
Fiscal Summary
|
Expenditures |
FY 23-24 Adopted |
FY 24-25 Projected |
FY 25-26 Projected |
|
Budgeted Expenses |
$206,000 |
$1,213,018 |
$1,010,371 |
|
Additional Appropriation Requested |
$688,000 |
|
|
|
Total Expenditures |
$894,000 |
$1,213,018 |
$1,010,370 |
|
Funding Sources |
|
|
|
|
General Fund/WA GF |
|
|
|
|
State/Federal |
$509,000 |
$1,213,018 |
$1,010,371 |
|
Fees/Other |
|
|
|
|
Use of Fund Balance |
$385,000 |
|
|
|
Contingencies |
|
|
|
|
Total Sources |
$894,000 |
$1,213,018 |
$1,010,371 |
Narrative Explanation of Fiscal Impacts:
Community Health Worker Specialist
Current grant funding is sufficient to cover the cost of adding a new staff person. Fiscal year 2023-24 estimated costs for the CHW position is $150,000. There is approximately $783,000 in grant funding through the California Department of Public Health (California Home Visiting Program (CHVP) State General Funds (SGF) Innovation) and the California Department of Social Services (CalWORKs Home Visiting Program) for the implementation of this specific home visiting program. CHVP SGF Innovation has been extended through State fiscal year 2026-27, providing consistent funding for this position. The department will utilize the current grant funding until it sunsets. As the sunsetting of the grant gets closer, the department will look at current grant program funding to support this position and will utilize ongoing 1991 Health Realignment dollars.
Social Service Worker III
The Teen Parent Connection program is currently funded by public health realignment, Medi-Cal Targeted Case Management and Cal-Learn funded by Sonoma County Human Services Department. The subject positions are currently filled and do not require one-time space needs and costs. For fiscal year 2023-24, the department will use $385,000 of 1991 Health Realignment’s fund balance and ongoing costs will be included in subsequent budgets, using the mix of funding sources identified above. Realignment fund balance estimate for June 30, 2024 is approximately $31 million including this requested use ongoing allocation.
Assistant PH Laboratory Director
The position is 100% grant-funded from the California Department of Public Health Lab ASPIRE program and is not anticipated to have additional fiscal impacts.
|
Staffing Impacts: |
|
|
|
|
Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
|
Assistant Public Health Laboratory Director |
$9,404.21 - $11,430.46 |
1.0 |
0.0 |
|
Community Health Worker Specialist |
$5,096.05 -$6,197.01 |
1.0 |
0.0 |
|
Social Service Worker III |
$6,583.12 - $8,002.37 |
1.0 |
0.0 |
Narrative Explanation of Staffing Impacts (If Required):
With the continued increase in referrals for services and the infusion of a new program benefit described, considering the time and type of tasks it will require to implement, the addition of this CHWS will relieve the workload of the Public Health Nurse to focus on primary duties and allow for the appropriate delivery of program services.
The three (3) Social Service Worker III positions are currently filled and converting them to an ongoing allocation status will not have an effect on any other existing positions.
The Assistant PH Laboratory Director relieves the workload of the Public Health Laboratory Director, allowing the Director additional capacity to focus on managerial tasks. The position also provides increased supervisory support to lab staff.
Attachments:
Attachment 1 - Personnel Resolution
Attachment 2 - Budget Resolution
Related Items “On File” with the Clerk of the Board:
None