Title
a. Receive an oral report update to Board Referral No. 2022.06 (referring Supervisor, Wendy Root Askew), which sought an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) to maintain operations through June 30, 2023; and
b. Provide further direction, as appropriate.
Report
RECOMMENDATION:
It is recommended that the County of Monterey Board of Supervisors:
a. Receive an oral report update to Board Referral No. 2022.06 (referring Supervisor, Wendy Root Askew), which sought an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) to maintain operations through June 30, 2023; and
b. Provide further direction, as appropriate.
SUMMARY:
This staff summary is an update to Board Referral No 2022.06, VIDA Project Extension, which sought an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) Project to maintain operations through June 30, 2023. The VIDA Project, formerly known as the Community Outreach and Education Pilot Project (“Pilot Project”) is a partnership between the County of Monterey and the Community Foundation for Monterey County focused on addressing the disparate impact of the COVID-19 pandemic in low-income and Communities of Color. VIDA is implemented in collaboration between Monterey County, the Community Foundation for Monterey County and with community-based organizations (CBO’s) to deploy Community Health Workers to ZIP Codes and/or census tracts of the lowest quartile of the Healthy Places Index. VIDA CHWs have provided education, system navigation to help community members access resources for adequate isolation and quarantine, and COVID-19 testing and vaccine registration and clinic supports. VIDA began in December 2020 and has continued through various funding allocations from the County and federal and philanthropic grants. Efforts have progressed through several phases and right-sizing of staffing to address new and emerging needs associated with the pandemic as well as other emergency responses.
BACKGROUND/DISCUSSION:
Community Health Worker models to address the disparate impacts of COVID-19 were launched in several California counties during the first year of the pandemic. VIDA has been a successful model in Monterey County, contributing since the start in December 2020 and continuing to present to reduced COVID-19 case rates, community testing availability, and increased vaccination rates in the county. In addition, having CHWs associated with a county-wide program and several Community Based Organizations has added to community capacity to respond at the grass-roots level during emergency efforts such as during the 2023 storm and flood events in Monterey County.
VIDA has had several phases as approved by the Board of Supervisors and in response to the COVID-19 pandemic and community needs, generally responding to the community needs resulting from changes in the pandemic. These included several right-sizing approaches, obtaining various grants to support continued work, and pivoting efforts to support COVID-19 testing, vaccination clinics, and access to services through efforts such as helping residents with Medi-Cal applications. The current VIDA staffing includes 51 part and full-time CHWs across seven Community Based Organizations (CBOs), with funding coming from a combination of county American Rescue Plan Act (ARPA) funds and a Health and Human Services grant to County of Monterey Health Department.
VIDA has developed a holistic and culturally relevant approach to support health equity and social justice needs in lower quartile healthy places index ZIP Codes in Monterey County. This has included ensuring deep and hyperlocalized community engagement for whatever issue the CHWs are working on. Administrative staffing support is shared by County of Monterey Health Department (MCHD) and Community Foundation for Monterey County (CFMC). This work includes decision processes, financial management, overseeing data collection and quality assurance, training for CHWs, and coordinating activities across the CBOs. The CBOs ensure daily CHW supervision and data collection by them, CBO administrative processes, as well as scheduling and problem-solving with their CHW teams. All participating organizations work collaboratively on communications and relationship building with other partners. Community outreach and engagement strategies and communication tools support culturally relevant and linguistically appropriate outreach to the focus communities.
The VIDA work from January through June 2023 included supporting COVID-19 rapid antigen testing services, addressing vaccine misinformation and conducting outreach in support of pop-up vaccination clinics offered in partnership with Visiting Nurses Association, promoting the expansion of Medi-Cal eligibility to those 50 years and older, supporting an Affordable Connectivity Program event in South County. The January and March 2023 Storm and Flooding emergency response efforts resulted in VIDA CHWs providing extensive supports in various parts of the county around immediate assistance needs and in particular as information conduits in Pajaro as part of the recovery from flooding in that community. Training for CHWs has including coaching in United Way Monterey County’s Smart Referral Network software, Medi-Cal application processes, a structured series of classes to obtain CHW certificates, FEMA application assistance, and classes in self-care and reflective practice. In addition, CBO Executive Directors were connected with Central California Alliance for Health (Alliance) to explore each organization’s interest in becoming approved by the Alliance to become Medi-Cal billing entities. The Alliance has since released a grant opportunity for organizations to apply for funds to develop CHW programs.
From December 2020 through April 2023, the VIDA Project had over 538,500 individual outreach interactions, providing COVID-19 prevention educational materials and resource connections. They also assisted over 11,800 people with vaccinations at VIDA partner clinics, conducted over 36,300 COVID-19 tests and distributed over 68,800 rapid antigen test kits, and supported over 3,600 individuals with unknown isolation or quarantine status with basic needs and resources. CHWs also supported over 660 individuals with Medi-Cal application assistance.
In addition, between January and April 2023, Monterey County experienced unforeseen challenges due to a series of extreme weather events. The VIDA CBOs pivoted strategies to continue to reduce potential equity gaps resulting from the storms. VIDA CHWs had over 16,000 interactions, providing over 25,000 information resources on disaster relief funds (9,764), health services (4,457), legal assistance (1,061), disaster cleanup (2,177), food distribution information (775) and disaster Calfresh (1,679) information. Over 100 direct referrals were made to United Way, Catholic Charities, and other organizations within the county. Over 12,700 individuals received direct economic support and basic need supplies (clothes, food, water, shoes, personal hygiene supplies). Door-to-door efforts also resulted in distribution to 325 households of FEMA/financial assistance information. Finally, messaging and communications were also embedded in CHW outreach efforts as over 1,550 individuals received messaging related to Monterey County Emergency Preparedness and Response and over 500 individuals received direct support signing up for Monterey County Text alerts to stay connected.
Expenditure Report
County ARPA Funds
The expenditures from April 1, 2022 through April 2023 were $1,570,012 which covered a range of total CHWs (a high of 21 to a current level of 17) FTE at five organizations, leaving a balance of $227,387 available for expenditures through June 30, 2023.
HHS Funds
The HHS grant funded expenditures from July 2021 through April 2023 total $2,413,950 which covered a range of CHWs (from 21 to a current high of 24) FTE CHWs at two different organizations, administrative staffing, and evaluation for the HHS grant, leaving a balance of $1,538,487 for expenditures through June 30, 2023.
The tables below show the allocation period and amount, expenditures-to-date, remaining balance and current number of CHW FTEs for each of the two Health Department project funding sources.
VIDA Project - County ARPA Funds
Allocation Period: April 1, 2022 - June 30, 2023
Expenditure Period: April 1, 2022 - April 30, 2023
|
Allocation Amount |
$1,797,399 |
|
Expenditures-to-Date (salaries, benefits, operational supplies) |
$1,570,012 |
|
Remaining Balance |
$227,387 |
|
Current Number of Funded CHWs FTEs |
17 |
VIDA Project - Federal Health Literacy Grant Award
Grant Period: July 1, 2021 - June 30, 2023 (2 Years)
Expenditure Period: July 1, 2021 - April 30, 2023
|
FY 2021-23 Grant Amount |
$3,952,437 |
|
Expenditures-to-Date (contracted services, County staff salaries, benefits, operational supplies) |
$2,413,950 |
|
Remaining Balance |
$1,538,487 |
|
Current Number of Funded CHWs FTEs |
24 |
VIDA’s two major funding sources (ARPA funds through the County and the federal Health and Human Services grant) are both set to be expended (ARPA) or end (federal grant) by June 30, 2023. However, VIDA has been able to leverage its successes to successfully apply for other philanthropy and grant funding that can be used to support continuation of some of the VIDA CHW efforts. These include: 1) obtaining the one year $1 million Farmworker Resource Center Grant to fund seven FTE CHWs across three VIDA organizations using the MCHD-CFMC co-management model; and 2) obtaining a three year $3 million grant from California’s Go-BIZ to fund up to 14 FTE CHWs and several administrative support staff in temporary 3 year positions as a repositioned VIDA model within MCHD. The job skills and certificates obtained by the VIDA CHWs also position them for ongoing career opportunities. For example, MCHD has current job openings for CHWs within it’s Clinic Services and other healthcare entities in the county are expanding their service delivery with CHW-type positions. All of these efforts will support and help grow the approach developed by VIDA to have a broader base of holistic and culturally relevant community supports both within agencies and organizations and collectively together to reduce health inequities and build community resilience through a community-centered approach.
CFMC estimates it will have $320,000 in unspent philanthropy funds after June 30, 2023 which could be used to continue to fund up to eight CHWs across the VIDA organizations for six more months. This funding along with the Farmworker Resource Center funding will result in a combined 18-20 FTE CHWs funded for the period July 1, 2023-December 31, 2023. VIDA CBOs are interested in continuing with VIDA-related work and have expressed understanding if staffing levels were to be decreased as part of another right-sizing effort. Currently available funding would result in a 51% reduction from current VIDA staffing levels.
VIDA CHWs are currently hearing from the community about significant challenges faced by residents due to ongoing financial burdens resulting from the winter storm events. Thus, having a skilled cohort of CHWs across several CBOs will enable the county to ensure that residents have opportunity for effective peer-to-peer, hyperlocalized community outreach, connecting all residents they find with social and healthcare access challenges with needed services from helping with Medi-Cal applications, to food pantries to help with food insecurity. And given prior experience around COVID-19 needs, they will also continue COVID-19 education outreach, testing, and vaccination supports to support residents.
This work supports County of Monterey Health Department’s (HD) 2018-2022 Strategic Plan Initiatives: 1. Empower the community to improve health; 2. Enhance community health and safety through prevention; 3. Ensure access to culturally and linguistically appropriate, customer-friendly, quality health services; and 4. Engage HD workforce and improve operational functions to meet current and developing population health needs. It also supports the following of the ten essential public health services, specifically: 1. Monitor health status to identify and solve community health problems; 3. Inform, educate, and empower people about health issues; 4. Mobilize community partnerships and action to identify and solve health problems; 7. Link people to needed personal health service and assure the provision of health care when otherwise unavailable; and 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services.
OTHER AGENCY INVOLVEMENT:
The VIDA Project is implemented in partnership with County of Monterey Health Department, Community Foundation for Monterey County, Building Healthy Communities (BHC), Mujeres en Acción, Center for Community Advocacy (CCA), Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO), City of Gonzales, CHISPA, Pajaro Valley Prevention and Student Assistance (PVPSA) and The Village Project. County Counsel reviewed and approved Board Report.
FINANCING:
There will be no impact to the General Fund from this action.
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 county 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, they 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.
Check the related Board of Supervisors Strategic Initiatives:
☒Economic Development:
• Through collaboration, strengthen economic development to ensure a diversified and healthy economy.
☒Administration:
• Promote an organization that practices efficient and effective resource management and is recognized for responsiveness, strong customer orientation, accountability and transparency.
☒Health & Human Services:
• Improve health and quality of life through County supported policies, programs, and services, promoting access to equitable opportunities for healthy choices and healthy environments in collaboration with communities.
☒Infrastructure:
• Plan and develop a sustainable, physical infrastructure that improves the quality of life for County residents and supports economic development results.
☒Public Safety:
• Create a safe environment for people to achieve their potential, leading businesses, and communities to thrive and grow by reducing violent crimes as well as crimes in general.
Prepared by: Krista Hanni, MS, PhD, Public Health Program Manager, II, 755-4586
Approved by:
_____________________________ Date_________________________
Joseph Macaluso, Assistant Director of Health, 809-4790
On behalf of Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Board Report
Board Referral No. 2022.06