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File #: 2021-0341   
Type: Consent Calendar Item Status: Agenda Ready
File created: 3/29/2021 In control: Health Services
On agenda: 6/8/2021 Final action:
Title: Department of Health Services Public Health Staffing Allocations
Department or Agency Name(s): Health Services
Attachments: 1. Summary Report, 2. Attachment 1 - Personnel Resolution
Date Action ByActionResultAction DetailsMeeting DetailsVideo
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To: Board of Supervisors of Sonoma County

Department or Agency Name(s): Department of Health Services

Staff Name and Phone Number: Kim Caldewey, 565-6671; Robert Gonzalez, 565-4416

Vote Requirement: Majority

Supervisorial District(s): Countywide

 

Title:

Title

Department of Health Services Public Health Staffing Allocations

End

 

Recommended Action:

Recommended action

Adopt a resolution amending the allocation list for the Department of Health Services, effective June 8, 2021, to extend 3.0 full-time equivalent time-limited Social Service Worker III allocations, through October 3, 2022, to support the Department’s Teen Parent Connections program.

end

 

Executive Summary:

During the June 2019 budget hearings, the Department of Health Services recommended that the Teen Parent Connections program be eliminated to balance the Department’s fiscal year 2019-2020 Budget. The Board of Supervisors directed staff to try to identify ongoing funding to restore the positions supporting this program before final layoff proceedings begin in October. This program leverages federal, state, and other funds to provide targeted home visiting and case management services to our county’s most vulnerable babies and families.

The Department requested to restore these positions through June 30, 2020, enabling the County to continue service delivery for one more year and providing the additional time to identify ongoing match funding. The Board of Supervisors approved the Department utilizing 1991 Health Realignment Fund Balance, along with other sources, for the funding requirements for fiscal year 2019-2020.

The following year, the program spent a significant period of time supporting COVID-19 efforts and providing telehealth services in the later part of the year. Due to these other priorities, funding was not identified. The Board of Supervisors allowed the Department to restore these positions through June 30, 2021, while the Department used the time to identify ongoing match funding. The Board of Supervisors provided $328,000 in one-time General Fund for the funding requirements for fiscal year 2020-2021.

As we approach the new budget cycle for fiscal year 2021-2022, staff is providing information on the program, the impact of the work to our community, and recommendations for the program for the upcoming fiscal year. An extension of the 3.0 FTE Social Service Worker III is requested through October 3, 2022 to be funded onetime with 1991 Realignment Fund Balance while the Department continues to seek ongoing funding.

 

Discussion:

Currently, the Department’s fiscal year 2021-2022 budget is balanced with the removal of the Teen Parent Connections program’s 3.0 full-time equivalent Social Service Worker III allocations. These allocations provide a significant impact on the underserved babies and families in the County.

Although the Teen Parent Connections program leverages federal, state, and other funds to provide targeted home visiting and case management services, it is the only program within the Family Health unit that is a non-mandated program.

Program Statistics and Impact

The Teen Parent Connections program supports approximately 209 pregnant or parenting teens who are 18 years and younger and 176 children of teen parents, through case management services, with the goal of maximizing their educational potential and self-sufficiency. Without the program, teen parents would be more likely to not graduate from high school, have a second teen pregnancy, become homeless, enter the child welfare system, enter the juvenile justice system, and require other County services that lead to increased long-term County costs for safety net services (including human services, behavioral health, criminal justice, child support, child protective services, etc.).

Teen Parent Connections was established in 1987 in response to the concern of teen pregnancy and its risks to the well-being of children. Utilizing a trauma-informed approach, Teen Parent Connections targets the complex health risks of pregnant and parenting teens which can lead to multi-generational health disparities when not effectively addressed. The program focuses on four interpersonal areas and goals shown to have the most positive and long-lasting impacts:

-                     Maximizing access to comprehensive health care and supportive services for teens and their children;

-                     Increasing educational and vocational obtainment;

-                     Reducing repeat adolescent births;

-                     Promoting positive relationships with self, children, and community.

The Teen Parent Connections team is predominantly bilingual, highly trained in child and adolescent development, and deeply rooted in the community. Through forming caring relationships and providing strengths-based case management, the program aims to increase personal and parenting competency, and comfort in navigating community resources.

Although programs such as Teen Parent Connections have shown tremendous success in reducing teen parenting rates, a snapshot of our program referrals for 2019-2020 still point to a highly vulnerable sector of our community. Over 50 percent of referred teens lack parental support due to a variety of factors, such as childhood neglect and abandonment, parental deportation and incarceration, parental drug abuse and mental health conditions, and a history of child abuse. Thirty-four percent (34%) are struggling with mental health conditions of their own, while 29 percent have a history of truancy. Twenty-one percent (21%) of teens report sexual abuse, although this number is generally under-reported at intake and tends to increase during the teen’s participation in the program, once a trusting rapport with their case manager has been established. Thirty-three percent (33%) of referrals just in this fiscal year have reported witnessing or being involved in domestic violence episodes, and 21 percent have had contact with Child Protective Services. Twenty-five percent (25%) are at high risk of homelessness or are homeless. On top of these numerous indicators of risk and inadequate support, 27 percent of these teens lack access to appropriate prenatal care.

In order to help buffer the impact of these traumatic childhood experiences, also referred to as ACEs (adverse childhood experiences), the team uses a research-based intervention approach called Positive Youth Development. It focuses on teaching self-regulation skills, exploring personal strengths, and goal setting. Through bi-monthly face-to-face encounters, the Teen Parent Connections staff provides on-going assessment and linkage to needed resources for teen parents and their children. Teen Parent Connections has a solid and well-documented history of producing positive health outcomes in the community such as decreased second pregnancies, and is included in Sonoma County’s Upstream Investments portfolio. The program has received an award from the American Medical Association for excellence in intervention and has been featured by the Press Democrat several times for their work in the community. In addition, the program has demonstrated success in decreasing health disparities for Latinx youth.

As described in the name, Teen Parent Connections’ focus is to support pregnant and parenting teens gain access and to coordinate a comprehensive network of resources for young parents. These interagency partnerships are critical to facilitating ease of access to resources for youth to meet basic needs, achieve optimal health, and attain educational goals.

-                     Teen Parent Connections has a long-standing and reciprocal partnership with Santa Rosa Community Health Centers and other health care providers in the community who are the main source of referrals to the program. There is a close collaboration with the Comprehensive Perinatal Services Program (CPSP) staff who are often the first to refer to the program and later collaborate with Teen Parent Connections to help address any barriers to health. As field visitors who develop long-term working partnerships with clients, Teen Parent Connections staff are often in an optimal position to assess the needs of the teen and child and support any needed access to care.

-                     Teen Parent Connections has a long-standing partnership with the Sonoma County Office of Education and the Santa Rosa School District in particular. Specialized academic and other supportive programs for teen parents and their children include on-site childcare centers and parenting education.

-                     Teen Parent Connections enjoys a long-standing MOU with Burbank Housing which sets aside 16 units at their Cypress Ridge complex to qualifying and deserving program participants to address the high risk of homelessness for this population and help set the foundation for self-reliance. Teen Parent Connections staff in turn provide essential support to these young families in gathering, securing, and navigating all necessary requirements for independent living and tenancy.

-                     Teen Parent Connections collaborates with Juvenile Probation to identify and connect incarcerated pregnant or parenting teens with Teen Parent Connections case managers. These referrals lead to greater support for positive parenting once released.

-                     Teen Parent Connections has a long-standing contract with the Human Services Department’s CalLearn program. Referred teens receive comprehensive case management and cash aid to fulfill the mandate of school attendance.

-                     Teen Parent Connections is fortunate to work with Santa Rosa Junior College’s opportunity, outreach, and retainment programs to provide support with every step of becoming a college student, including financial aid. There is a system of referral to the Dream Center to assist those youth who are Deferred Action for Childhood Arrivals (DACA) eligible to optimize their opportunities.

-                     Teen Parent Connections works closely with Family, Youth and Children’s Services (formerly CPS) to mitigate the risk factors for this vulnerable, two-generation population to stop the cycle of child abuse. Many young families are mandated to participate in Teen Parent Connections and many more continue to do it voluntarily in order to optimize the positive parenting of their own children.

-                     Teen Parent Connections enjoys a committed and enduring relationship with community programs, such as the Redwood Empire Auxiliary who staff and provide a baby supplies program for Teen Parent Connections clients, known as the Wee Wardrobe, and who provide continuous scholarships for clients enrolled in higher education. The programs have a successful trajectory of helping teen parents successfully complete Bachelor and Master’s level education, as illustrated by many current community professionals, including a Master’s level bilingual, bicultural program alumni who is now a very successful social worker for the Teen Parent Connections program.

Consequences of a Diminished Teen Parent Connections Program

With the 3.0 FTE supporting the Teen Parent Connections program, the staff that would remain would be unable to support the 200+ clients currently being seen. The program supervisor and one Social Service Worker III would be left to support the program. Without staffing, we foresee the following consequences to the clients and community.

-                     Decrease in graduation rates for teen parents

o                     90% of Teen Parent Connections clients who are not currently enrolled in school are planning to return to school. Teen Parent Connections case managers were instrumental in supporting teen parents to transition into virtual school settings, working with school staff and families.

o                     In FY 2019-2020, 79% of all Teen Parent Connections clients are in school or have graduated. Graduation rates of clients >= 19 years: at enrollment 11%, at follow-up 49%, an increase of 38%.

-                     Increase in second teen pregnancies

o                     Teen Parent Connections clients had zero repeat births in FY 2019-2020

-                     Increase in child abuse reports for the children of teens

Many Teen Parent Connections teens have experienced ACEs, such as witnessing domestic violence (33%) and/or experiencing emotional abuse (36%). Teen Parent Connections case managers are very experienced in addressing ACEs and providing trauma-informed interventions in order to decrease barriers to health access and to prevent continued child abuse.

-                     Increase in health discrepancy for Latina teens

o                     The teen birth rate has decreased for both white, non-Hispanic (decreased 75% since 2000-2002) and Latina (decreased 76% since 2000-2002) teens. However, Latina teens continue to have teen birth rates over five times higher than white teens.

In 2015-2017 about 12% of teen births in Sonoma County were repeat births. About 5% of white teen births were repeat births compared to 15% of Latina teen births.

Teen birth rates also vary by geography in Sonoma County. While about 12% of total births in Sonoma County (2014-2016) were to mothers who lived in zip code 95407, almost 40% of teen births were to mothers who lived in this zip code. More than 82% of teen births in zip codes 95403 and 95407 were to Latinas. Teen Parent Connections is currently serving 64 Latina teens in zip code 95407 and 30 in zip code 95403.

Program Fiscal Data

In 2019-2020, the Department was able to identify $428,826 in funding to support the Social Service Worker III positions through fiscal year 2019-2020 allowing additional time to identify a long-term funding solution for the program. The funding included $169,210 in 1991 Health Realignment from prior year fund balance and $259,616 in Targeted Case Management funding, which is an ongoing source of federal funding that requires match funding.

In 2020-2021, the Department was unable to identify funding sufficient to fund the positions through the fiscal year. Staff were providing telehealth services while balancing needs of support to the COVID efforts, and leadership was unable to identify a long-term funding solution for the program. The Board of Supervisors approved the use of one-time General Fund in the amount of $328,000 and $246,828 in Targeted Case Management funding prior to budget hearings.

For 2021-2022 fiscal year, the annual cost of the 3.0 full-time equivalent Social Service Worker III positions is $470,653.

Partnership and Outreach

During the last two years, the Department has met with various partners to try and identify funding to maintain the Teen Parent program.

-                     Compiled extensive data to demonstrate effectiveness of Teen Parent Connections program

-                     Department of Human Services, Family Youth & Children - discussed how to incorporate Teen Parent Connections into their programs and concluded it was not financially feasible for them.

-                     Behavioral Health, Mental Health Services Act (MHSA) - Presentation and discussion at a stakeholder meeting in January 2020, discussed the 3-year integrated plan recommendations, and it was determined that MHSA does not provide enough funding for additional programs. If Teen Parent Connections were to be funded, MHSA dollars would have to be withdrawn from another program.

-                     City of Santa Rosa, Community Program & Engagement - Grant applications were closed and only mini-grants were available. Nonetheless, more information about Teen Parent Connections was provided with them.

-                     Northern Sonoma County Healthcare Foundation - The Foundation had expressed an interest in expanding their services into Santa Rosa. With their focus on healthcare access, mental health and early childhood development, which are all areas Teen Parent Connections addresses with every client, they clarified their interested in expansion into Santa Rosa was for fire recovery related services.

-                     First 5 - A report prepared by Learning for Action titled: Assessing the Role, Impact, and Opportunities for Sustainability of the Teen Parent Connections Program in Sonoma County, in November 2019, had stakeholders expressing a strong interest in keeping Teen Parent Connections housed within DHS in order to keep the team’s level of expertise and effectiveness in providing the full spectrum of services teen parents need. At the same time, they are unable to provide financial assistance.

-                     School Based Medi-Cal Options - Local Educational Agency Medi-Cal Billing Option Program. Coordinators for this program stated this funding stream does not include Targeted Case Management programs and is for school districts.

-                     Sonoma County Office of Education - Sonoma County Office of Education Teen Parent programs had been reduced drastically barely drawing down any Medi-Cal.

Recommendations for Ongoing Funding

For the 2021-2022 fiscal year, the plan is to have staff meet with the partners identified in this report to see if there is any renewed interested in assisting with funding. A concerted effort will be made to secure ongoing funding this year with the use of partners or any outside grant opportunities.

Recommendation - Additional year of funding

The extension of the 3.0 FTE Social Service Worker III allocations for the upcoming 2021-2022 fiscal year will use onetime 1991 Health Realignment fund balance in the amount of $268,272 along with leveraging funding from Targeted Case Management $202,381 to cover total costs of $470,653. Unless ongoing funding is identified by your Board from County sources, staff will continue to search for and secure funding by April 2022 with the expectation the program will sunset in October 2022 if funding is not secured.

 

Prior Board Actions:

In June 2019, the Board approved the fiscal year 2019-2020 County budget.

 

Fiscal Summary

 Expenditures

FY 20-21 Adopted

FY 21-22 Projected

FY 22-23 Projected

Budgeted Expenses

574,828

 

 

Additional Appropriation Requested

 

470,653

 

Total Expenditures

574,828

470,653

0

Funding Sources

 

 

 

General Fund/WA GF

328,000

 

 

State/Federal

246,828

202,381

 

Fees/Other:

 

 

 

Use of Fund Balance:

 

268,272

 

Contingencies

 

 

 

Total Sources

574,828

470,653

0

 

Narrative Explanation of Fiscal Impacts:

Onetime funding from 1991 Health Realignment Fund Balance and matching funding from Targeted Case Management has been identified to restore the 3.00 full-time equivalent Social Service Workers III positions in the amount of $470,653. Extending the Social Service Worker III allocations will generate additional Targeted Case Management revenues by providing approved services to clients.

Appropriations for the Teen Parent Connections Staffing Allocations will be added to the FY 2021-2022 Budget during 1st Quarter Consolidated Budget Adjustments.

 

Staffing Impacts:

 

 

 

Position Title (Payroll Classification)

Monthly Salary Range (A-I Step)

Additions (Number)

Deletions (Number)

Social Service Worker III

5,308 - 6,453

3.00

0

 

Narrative Explanation of Staffing Impacts (If Required):

The Social Service Worker III positions are currently filled. Should the Board not approve extending the positions for the full year, authority to implement layoff procedures would be requested in June as part of the FY 2021-2022 budget adoption process.

 

Attachments:

Attachment 1 - Personnel Resolution

 

Related Items “On File” with the Clerk of the Board:

None