Title
a. Receive an update on the development of the Community Outreach and Education Pilot Project (“Pilot Project”), a County-wide project responding to the disparate impacts of the COVID-19 pandemic on Communities of Color residing in the census tracts of the lowest quartile of the Healthy Places Index (HPI Census Tracts); and
b. Approve an increase in appropriations of $2,296,952 in the County Administrative Office, Office of Community Engagement and Strategic Advocacy Budget Unit 001-1050-8440-CAO024, financed by a release of $2,296,952 from the Cannabis Tax Assignment, BSA 001-3132, to fund the Pilot Project for the three-month period from January 1, 2021 through March 31, 2021 (4/5ths vote required); and
c. Authorize and Direct the Auditor-Controller to amend the Fiscal Year 2020-21 Adopted Budget, Fund 001, Appropriation Unit CAO024, increasing appropriations by $2,296,952 funded by Cannabis Tax Assignment, BSA 001-3132 (4/5ths vote required); and
d. Approve and authorize the County Administrative Officer or Assistant County Administrative Officer to execute an Agreement with the Community Foundation for Monterey County, for implementation of the Pilot Project and disbursement of funding to the Community-Based Organizations (“CBOs”) identified in Attachment 1, for a total Agreement amount of $2,296,952, for a three-month term from January 1, 2021 to March 31, 2021 once approved by County Counsel/Risk Manager and Auditor Controller.
e. Provide direction to staff as appropriate.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an update on the development of the Community Outreach and Education Pilot Project (“Pilot Project”), a County-wide project responding to the disparate impacts of the COVID-19 pandemic on Communities of Color residing in the census tracts of the lowest quartile of the Healthy Places Index (HPI Census Tracts); and
b. Approve an increase in appropriations of $2,296,952 in the County Administrative Office, Office of Community Engagement and Strategic Advocacy Budget Unit 001-1050-8440-CAO024, financed by a release of $2,296,952 from the Cannabis Tax Assignment, BSA 001-3132, to fund the Pilot Project for the three-month period from January 1, 2021 through March 31, 2021 (4/5ths vote required); and
c. Authorize and Direct the Auditor-Controller to amend the Fiscal Year 2020-21 Adopted Budget, Fund 001, Appropriation Unit CAO024, increasing appropriations by $2,296,952 funded by Cannabis Tax Assignment, BSA 001-3132 (4/5ths vote required); and
d. Approve and authorize the County Administrative Officer or Assistant County Administrative Officer to execute an Agreement with the Community Foundation for Monterey County, for implementation of the Pilot Project and disbursement of funding to the Community-Based Organizations (“CBOs”) identified in Attachment C, for a total Agreement amount of $2,296,952, for a three-month term from January 1, 2021 to March 31, 2021 once approved by County Counsel/Risk Manager and Auditor Controller.
e. Provide direction to staff as appropriate.
SUMMARY:
The County Administrative Office in partnership with the Monterey County Health Department has been convening a collaborative of community-based organizations focused on the development and implementation of a COVID-19 Community Outreach and Education Pilot Project as a strategy of the COVID-19 Pandemic Disparate Impact Report. The Community Based Organizations (CBOs) currently involved include Communities Organized for Relational Power in Action (COPA), Building Healthy Communities (BHC), Mujeres en Acción, Center for Community Advocacy (CCA), Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO), California Rural Legal Assistance (CRLA), Bright Beginnings, Lideres Campesinas, City of Gonzales, Central California Alliance for Health, Action Council, and the Community Foundation for Monterey County.
The purpose of the Community Outreach and Education Pilot Project is to reach residents most impacted by the pandemic by implementing a public awareness campaign and community education efforts using strategies centered on culturally relevant messaging delivered by trusted messengers. Community Health Workers (CHWs) within the CBOs will work collaboratively across the participating organizations to conduct outreach and provide COVID-19 education and connections to resources for hard-to-reach disparately impacted communities through Spring 2021 to support reductions in COVID-19 transmission in Monterey County.
The Community Outreach and Education Pilot Project was developed with consultation from Fresno County and Building Healthy Communities-Fresno, Sonoma County and San Diego County. The Fresno County Equity Project community outreach and education training curriculum has been adapted to fit the needs of Monterey County.
BACKGROUND/DISCUSSION:
On December 8, 2020, the Board of Supervisors received a proposal from COPA to further expand and fully fund the Pilot Project. Their proposal includes two parts:
Fully Implement Fresno Community Engagement Model
1. Engage trusted community institutions - hire and train community health workers to do outreach, prevention education, promote testing, contact tracing, and navigation to support services, using a culturally and linguistically appropriate joint problem-solving approach.
2. Concentrate testing, tracing and supported isolation in high-risk communities (HPI Census Tracts).
Establish a Governance Team
1. Establish a collaborative governance team that includes County government (Administrative Office, Health Department, Public Health, Housing and all service providers) and the doctors, clinics, and hospitals to ensure that we can all pull in the same direction and quickly adapt to changes.
2. Charge this team with creating an over-arching plan and the metrics to track progress on that plan.
3. Create information systems to capture the entire patient journey from testing through contact tracing and the end of supported isolation. Track the timeliness of interventions (from patient presentation, exposure and/or symptom onset). Make this data publicly available so we all know how we are doing and where we need to adapt.
Implementation of the Pilot Project is currently underway and 45 Community Health Workers who will provide community outreach and education on the prevention of the spread of COVID-19, promote and assist the community with setting up appointments for testing, and assist with navigating access to resources needed for adequate isolation and recovery have been trained and are being deployed to communities in the HPI Census Tracts. The participating CBO’s intend to hire and train an additional 55 Community Health Workers, Data Analysts and Coordinators for the Pilot Project.
The proposed community-based contact tracing is not being considered as part of this first phase of the Pilot Project. To implement such endeavor would take considerable time in training individuals in conducting contact tracing efforts and development of additional agreements to ensure all state mandated reporting requirements are met. There is urgency in moving forward with elements of the Pilot Project now. The Health Department, as the lead for case investigations and contact tracing efforts, will continue to explore opportunities for expanding contact tracing efforts in partnership with CBOs as practicable and feasible.
Process metrics will be used to track the progress of the Pilot Project. The metrics include; a master calendar of site locations, staffing and hours designated to the outreach sites; tracking the number of contacts and the types of needs that arise as well as the ways in which the project meets those needs and challenges or barriers partners face in working to meet those needs; and tracking actual access to resources.
Sonoma and Fresno Counties have found it effective when the implementation of a community-driven approach is led by a community based organization that functions as a fiscal agent or grant maker to subcontracting community partners. This approach is recommended here. The Community Foundation of Monterey County served such a function for the 2020 Census initiative with close collaboration by the County Administrative Office. A similar close collaboration among the Community Foundation of Monterey County, the County Administrative Office and the Health Department easily can be implemented for the Pilot Project. As a philanthropic organization, the Community Foundation for Monterey County is poised to garner contributions from its philanthropic network and currently has the capacity to dedicate a staff member to assist in the coordination.
It is recommended that the County investment in the Pilot Project be managed in a written agreement with the Community Foundation for Monterey County. The agreement, which has not yet been negotiated but for which Board approval is sought at this time, would describe the structure of the collaboration between and among the County, the Community Foundation for Monterey County, and the participating CBOs as well as the terms and conditions by which the Community Foundation for Monterey County would receive, disperse, and manage the funds.
It is recommended that the Board of Supervisors fund the Pilot Project for a period of three months, from January 1 through March 31, 2021, financed by a one-time contribution from the Cannabis Tax Assignment. Alternatively, the Board may consider an investment of $4,989,651 for the period January 1, through June 30, 2021. A three-month investment in the Pilot Project would support the hiring by the CBOs of 100 Community Health Workers (CHWs), seven (7) Data Analysts for collection and compilation of data reports, seven (7) Coordinators whose scope of work would include the daily tasks and logistics of the Pilot Project, along with an operating costs and administrative costs associated with implementation. While the Pilot Project was already launched at a small scale earlier this month, a three-month period would allow for progressive expansion and demonstrate needs and lessons learned with both the methods of outreach and strategies for motivating behavioral change.
It is recommended that the Board fund for the next three months. Due solely to the impacts of Covid-19 Pandemic, the Monterey County residents who are the focus of the Pilot Project already are jobless, already are homeless or facing eviction, and already are facing hunger or near hunger. If lucky enough to have a roof over their heads, the residents already are living in high-density conditions and may not have access to consistent quality health care. Because of these disparate impacts, it is recommended that for the next critical three months, the County relentlessly connect these individuals to information and services and who, through no fault of their own, are more likely to become seriously ill or die during the next months, while housing, jobs, healthcare, and a vaccine remain out of reach for many.
The framework for the Pilot Project could potentially benefit other aspects of community-based health outreach, education and prevention that would remain in place beyond the COVID-19 pandemic, should long term sustainable measures continue to be developed and implemented.
OTHER AGENCY INVOLVEMENT:
The Pilot Project is developed in partnership with the County Administrative Office, Monterey County Health Department, Community Foundation for Monterey County, COPA, Building Healthy Communities (BHC), Mujeres en Acción, Center for Community Advocacy (CCA), Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO), California Rural Legal Assistance (CRLA), First 5 Monterey County Bright Beginnings, Lideres Campesinas, City of Gonzales, and Central California Alliance for Health. County Counsel reviewed and approved Board Report.
FINANCING:
Approval of one of the recommended options included in this report for either a three-month period’s project budget at $2,296,952 will result in an increase in General Fund Contribution from the cannabis assignment. An updated estimated cannabis assignment funds will be provided in the oral presentation.
BOARD OF SUPERVISORS STRATEGIC INITIATIVES:
Receipt of this report and authorization of the proposed letter supports the selected Board of Supervisors Strategic Initiatives:
X_ Economic Development
X_ Administration
X_ Health & Human Services
X_ Infrastructure
X_ Public Safety
Prepared by: Rosemary Soto, Management Analyst III
Approved by: Nick Chiulos, Assistant County Administrative Officer
December 18, 2020
___________________________________________ ____________________
Nicholas E. Chiulos, Assistant County Administrative Officer Date
Attachment A: Community Outreach Pilot Project Budget three-month period
Attachment B: Community Outreach Pilot Project Budget six-month period
Attachment C: List of Participating Community Based Organizations
Attachment D: Board Resolution