Title
a. Receive a verbal report update to Board Referral No. 2022.06 which sought an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) to maintain operations through December 31, 2022; and
b. Provide further direction, as appropriate. (ADDED VIA ADDENDA)
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive a verbal report update to Board Referral No. 2022.06 which sought an increase in funding allocated to the Virus Integrated Distribution of Aid (VIDA) to maintain operations through December 31, 2022; and
b. Provide further direction, as appropriate.
SUMMARY/DISCUSSION:
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 December 31, 2022. 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. Using the community health worker (CHW) model, the VIDA Project is implemented in collaboration between Monterey County, the Community Foundation for Monterey County and community-based organizations (CBO’s) focused on specific census tracts of the lowest quartile of the Healthy Places Index (HPI Census Tracts). The purpose of the VIDA Project is to raise community awareness and education and provide system navigation to help community members access resources for adequate isolation and quarantine, and COVID-19 testing and vaccines. The VIDA project began in December 2021 through a funding allocation of $4,989,651 from General Fund Reserve, and Cannabis Tax fund accounts by the Board of Supervisors to the County Administrative Office and the project has continued through several phases and additional funding in response to community needs during the pandemic. The effort currently employs 58 part and full time CHWs or 44 Full-Time Equivalent (FTE) CHWs across 8 CBOs, with a recent expansion of their outreach efforts to include providing Medi-Cal application assistance to residents and a pop-up vaccination clinic effort with Visiting Nurses Association and United Way Monterey County.
BACKGROUND:
VIDA has had 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 already approved but unallocated funds ($957,344) with additional right-sizing; 4) acceptance on October 17th, 2021 of $3,952,437 in funding from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary for Health which allowed the project leads to fund approximately 18-20 CHWs from July 1st, 2021 through June 30th, 2023 with a focus on COVID-19 health literacy; and 5) a continuation through December 31st, 2022 approved by the Board on March 8th, 2022 to support the remaining portion of CHWS not funded by the HHS grant and enable the project to continue at the March capacity of approximately 50 CHWs by using funding support of $1,570,012 from unspent ARPA funds. Through March 2022, VIDA supported the work of the CHWs across nine organizations. After March 2022, one organization opted to return to pre-COVID-19 pandemic response activities. Some of their CHWs were subsequently hired by other VIDA organizations. As of the end of July 2022, there are 58 part and full-time CHWs or the equivalent of 44 FTE CHWs. The success of the VIDA project has resulted in additional funding from philanthropy sources which has supported various activities, such as developing and holding pop-up vaccination clinics, purchasing incentives, or printing materials for outreach efforts.
VIDA’s administrative structure consists of co-leads and coordinators, shared between the Monterey County Health Department (MCHD) and the Community Foundation of Monterey County. An MCHD Epidemiologist oversees data collection and quality assurance. CFMC and MCHD provide coordination of communications materials, ongoing training, and develop relations with the health systems and other organizations. The CBOs each have a CHW Coordinator and Data Analyst, who respectively supervise the CHWs and provide data quality assurance. VIDA CBOs also develop relations with health systems, other organizations, and communities.
The holistic and culturally relevant approach of the VIDA Project has been successful in its goal of addressing the health equity and social justice needs of the residents of Monterey County during the COVID-19 pandemic, with CHW effort hyper-localized in the lowest quartile Healthy Places Index ZIP Codes. In addition, VIDA has established process protocols; training modules and schedules for community outreach and engagement strategies; and communication tools and social media protocols to maximize reach to the populations of focus in the most culturally relevant and linguistically appropriate methods.
The VIDA work from September through November has focused on continuing 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. CHWs have widely promoted the expansion of Medi-Cal eligibility to those 50 years and older. VIDA also supported two Affordable Connectivity Program events to support digital access. Both of these latter efforts help connect individuals that are more vulnerable to COVID-19 to needed medical resources. All strategies are community-specific and guided by CBO grass-roots community knowledge and supported with coordinated social media messaging efforts. In addition, VIDA CHWs have received several training hours with United Way Monterey County’s Smart Referral Network software in preparation for future CHW work with licensed provider referrals and Medi-Cal reimbursement opportunities.
From January through October 2022, the VIDA Project had 140,453 individual outreach interactions, providing COVID-19 prevention educational materials and resource connections. They also assisted 1,836 people with vaccinations at VIDA partner clinics, conducted 21,238 and distributed over 38,089 rapid antigen test kits, and supported 1,150 individuals in isolation and quarantine and a further 828 individuals with unknown isolation or quarantine status with basic needs and resources. CHWs also supported 246 individuals with Medi-Cal application assistance.
Expenditure Report
County ARPA Funds
The expenditures from April 1 through September 30, 2022, were $872,229 which covered 23 CHWs at six organizations, leaving a balance of $697,783 available for expenditures through December 31, 2022.
HHS Funds
The HHS grant-funded expenditures from July 2021 through September 2022 total $1,465,871 which covered 21 FTE CHWs at two different organizations, administrative staffing, and evaluation for the HHS grant, leaving a balance of $2,486,566 for expenditures through June 30, 2023.
Below shows 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 - December 31, 2022
Expenditure Period: April 1, 2022 - September 30, 2022
Allocation Amount………………………………………………………$1,570,012
Expenditures-to-Date (salaries, benefits, operational supplies)…………$872,229
Remaining Balance……………………………………………………….$697,783
Current Number of Funded CHWs………………………………………23
VIDA Project - Federal Health Literacy Grant Award
Grant Period: July 1, 2021 - June 30, 2023 (2 Years)
Expenditure Period: July 1, 2021 - September 30, 2022
FY 2021-23 Grant Amount……………………………………………….$3,952,437
Expenditures-to-Date (contracted services, County staff salaries,
benefits, operational supplies)…………………………………………….$1,465,871
Remaining Balance………………………………………………………$2,486,566
Current Number of Funded CHWs………………………………………...21
As mentioned above, VIDA co-leads have also leveraged VIDA resources and continue to work to secure additional funding for VIDA-related efforts. CFMC has a total of $334,957 from philanthropy and other sources that can be used for funding VIDA CHWs from January through June of 2023. In addition, there were project savings of $363,764 in the first year of the HHS grant (due to contract delays leading to a September start-up for expenditures also available for use towards the costs for CHW services for the first six months of 2023. This leaves a gap of $227,387 needed to meet the $926,108 required to continue to fund 23 of the 44 FTE CHWs from January 1st, 2022, until June 30th, 2023. Staff is requesting an additional $227,387 from county ARPA funds to make up for the difference in projected staffing costs and available funding in order to continue at current capacity.
If funded at current capacity through June 30, 2023, VIDA CHWs will continue to provide extensive 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. They will also continue COVID-19 education outreach, testing, and vaccination supports which could be important if there is a January surge in cases. VIDA administrative staff will also continue to work with Central California Alliance for Health (Alliance) and their efforts to connect with local Community-Based Organizations interested in becoming Medi-Cal billing entities. This process is still in the development stages by the Alliance given DHCS didn’t release their All Plan Letter until early September 2022. VIDA co-leads are having discussions with Alliance staff to understand how to support VIDA CBOs connecting with licensed providers to receive referrals, discussing with the VIDA CBO Executive Directors their interest in being credentialed with the Alliance, investigating other counties’ development of CHW administrative hubs, and exploring the development of a similar hub or hubs in Monterey County.
In addition, if approved to do so by the Board of Supervisors, MCHD will be the applicant from the county to the California Department of Community Services and Development’s Notice of Funding Availability for a Farmworker Resource Center Grant. If successful, funds would be used to continue with VIDA community outreach and systems navigation specifically for farmworkers throughout Monterey County past June 30th, 2023. This grant would be an important mechanism to continue, through a state funding mechanism, the important three years of VIDA efforts to support holistic and culturally relevant community supports to reduce health inequities and build community resilience through a CHW program that is flexible and community-centered.
This work supports the 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 the 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 services and assure the provision of health care when otherwise unavailable; and 9. Evaluate the effectiveness, accessibility, and quality of personal and population-based health services.
OTHER AGENCY INVOLVEMENT:
The VIDA Project is implemented in partnership with the 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:
The potential financial impact could be $227,387 if the Board approves the request for additional ARPA funding.
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, Ph.D., Public Health Program Manager, II, 755-4586
Approved by:
______________________________Date:_________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Board Report
Board Referral No. 2022.06