Title
Receive a preliminary analysis report in response to Board Referral No. 2022.06 seeking an increase in funding allocated to the VIDA Project to maintain operations through December 31, 2022.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a preliminary analysis report in response to Board Referral No. 2022.06 and:
1) Direct that staff proceed with completion of referral based on description in this report; or,
2) Direct that staff:
i. Proceed with completion of referral based on modifications by the Board; or,
ii. Return to Board with a more comprehensive analysis of referral and anticipated effort for completion; or,
iii. Rescind referral.
b. Provide further direction, as appropriate.
PRELIMINARY ANALYSIS:
Referral Summary & Background:
This staff summary is to Board Referral No 2022.06, VIDA Project Extension, seeking an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) Project to maintain operations through December 31, 2022. The VIDA project began in December 2020 through a funding allocation of $4,989,651 from General Fund Reserves, and Cannabis Tax fund accounts by the Board of Supervisors to the County Administrative Office to expand and implement a Community Health Worker (CHW) model for the County’s COVID-19 pandemic response. VIDA was a response to the need for a holistic and community grounded approach to the inequitable COVID-19 morbidity and mortality outcomes being experienced by the County’s vulnerable communities. The CAO’s Office and Monterey County Health Department (MCHD) partnered with the Community Foundation for Monterey County (CFMC) as the project’s backbone, to engage and oversee 10 Community Based Organizations (CBOs) to conduct a coordinated public health response effort around outreach and education, isolation and quarantine supports, testing and vaccinations. The CHW effort has focused primarily on ZIP Codes that are in the lowest quartile of the Healthy Places Index which correlate with the County’s most vulnerable communities and higher COVID-19 case rates.
The project has gone through several phases as approved by the Board of Supervisors and in response to the COVID-19 pandemic and community needs, including: 1) approval by the Board on June 22, 2021 for continuation past the original end date of June 30, 2021 using unspent allocated funds ($559,000) but with a right-sized approach; 2) a return to the Board July 27, 2021 with the right-sized approach and a 35% reduction in overall CHW numbers from 126 to 80 CHWs; 3) a second approval by the Board on September 28, 2021 to continue the project for an additional six months through March 31, 2022 using unallocated funds ($957,344) with additional right-sizing. County funding for the last approved continuation was augmented with funds from other sources. These other funding sources include a two-year federal grant from the Health and Human Services Agency’s Office of Minority Health (called the Health Literacy Grant) to MCHD with deliverables related to improving COVID-19 health literacy for vulnerable communities. In addition, CFMC was able to obtain several smaller grants from private philanthropy to support VIDA project backbone staffing and outreach materials.
Proposed Project Description:
VIDA CHWs implement public awareness campaigns and community education strategies centered on culturally relevant messaging to influence social behaviors, normalizing COVID-19 testing, use of face covering and social distancing, and addressing vaccine misinformation in priority communities. They offer and support COVID-19 positive individuals and families with isolation and/or quarantine supports, including contactless/front door food and diaper drop-offs and resource needs system navigation and warm hand-offs. Community-specific vaccination campaigns, clinics, and testing sites are also developed and implemented by the CBOs. They were particularly important during the Delta and Omicron surges, adding tens of thousands of observed rapid antigen tests across priority communities.
Strategies are community-specific and guided by CBO grass-roots community knowledge. In Latino communities where most of the residents are migrant farmworker families or hospitality workers, the VIDA Project partnered with agricultural companies, contractors, hotels, and labor unions and CHWs provided worksite COVID-19 education workshops and assistance. In densely populated communities, CHWs went door to door and positioned themselves at storefronts where individuals often returned seeking support after a member of their household tested positive for COVID-19. In African American communities, CHWs educated congregations during or after church services and bible studies. A language access line in several Indigenous languages to Oaxaca, Mexico such as Mixtec, Triqui and Zapotec languages, was launched to address language barriers to access for hundreds of community residents.
While the funding for seven of the VIDA organizations is expected to be expended by March 31, 2022, the COVID-19 pandemic is continuing. Expected upcoming community needs include the need to support community members who do test positive or who suffer from lingering effects of COVID-19, reducing inequities in booster and children (ages 6-11) vaccination rates, supporting roll out of vaccines for children under the age of 6 when that is approved, responding to any increase in positive case rates due to surges from new COVID-19 variants, and the need to continue to educate the community on state guidance and safety precautions. These activities will complement the Governor’s new COVID-19 SMARTER plan and allow Monterey County to move forward with COVID-19 recovery but be prepared for responding to changing pandemic outcomes. The availability of only the Health Literacy grant funding to support less than 20 CHWs from two organizations from April 1, 2022 forward will cause considerable capacity and response constraints on the project, and will necessitate extensive reduction in current outreach, testing, and vaccination support efforts in our hardest hit communities.
Estimated Project Cost:
The project at current CHW staffing levels can continue to respond to local COVID-19 pandemic community needs if additional funding is provided. It is estimated that for VIDA to continue at the current staffing levels and efforts, an additional $1,447,303 would be required to fund a nine-month period of VIDA operations for the unfunded seven CBOs through December 31, 2022. An allocation breakdown is outlined in Attachment A. If additional funding from the County is not available, VIDA efforts will have to be scaled down to match funding from the Health Literacy grant.
Staffing Level Estimate:
MCHD and CFMC staff time and costs for the VIDA project are covered in part by the Health Literacy grant. These include 0.25 FTE for a Public Health Program Manager II, 0.35 for a Chronic Disease Prevention Specialist II, and 0.38 FTE for a Community Service Aide III who are part of the project backbone team at MCHD. There are some CFMC backbone staff costs included in the current proposed nine-month extension budget including 0.10 FTE for the Project Manager and 0.40 FTE for the Project Coordinator, the latter of which is covered by the CFMC portion as shown in Attachment A.
Departmental Challenges:
The COVID-19 pandemic has been a very dynamic process and requiring constant pivoting to address new challenges, ranging from vaccine roll-out to new variants. Staff expect to be able to meet the timeline for referral completion but recognize that there could be some change to the pandemic that may strain staffing capacity and potentially delay the referral process. No such delay is anticipated at this time.
Proposed Response Date:
Staff is prepared to return to Board of Supervisors no later than March 22, 2022, with an Amendment to the County Agreement with CFMC, depending on Board direction and decisions on funding sources for the continuation at current levels for an additional nine months for the VIDA project.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
This recommendation supports all of the Board of Supervisors Strategic Initiatives. Community Health Workers are a critical and cost-effective, customer-responsive part of the workforce. They are trustworthy individuals who come from the community they serve and as such are important contributors in our County in emerging stronger from the COVID-19 pandemic and with a focus on reducing historic social and health inequities. They can bolster public health with their efforts, while also addressing broader social and economic needs within their communities. Their continued COVID-19 outreach and education efforts and expansion into social supports not only promotes equitable opportunities for healthy choices, but they also reduce community stressors that can contribute to improved community safety and a more sustainable infrastructure, contributing to an improved quality of life and economic development.
Mark a check to the related Board of Supervisors Strategic Initiatives
X Economic Development
X Administration
X Health & Human Services
X Infrastructure
X Public Safety
Prepared by: Krista Hanni, MS, PhD, Public Health Program Manager, II, 755-4586
Approved by:
______________________________Date:____________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Preliminary Analysis Report
Board Referral No. 2022.06
Attachment A