Title
a. Receive an update on the development of metrics for 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. Provide direction to staff as appropriate.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an update on the development of metrics for 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. Provide direction to staff as appropriate.
SUMMARY:
The County Administrative Office in partnership with the Monterey County Health Department continues to convene a collaborative of community-based organizations focused on the development and implementation of a COVID-19 Community Outreach and Education Pilot Project.
The purpose of the Community Outreach and Education Pilot Project is to reach residents most impacted by the pandemic. Outreach and education strategies are implemented by Community Health Workers (CHWs) who are trusted messengers who live in, and are highly regarded by, their respective communities. The CHWs are trained and equipped to deliver culturally relevant messaging and assist community members with system navigation for access to resources. Community-based organizations employing the CHWs will work collaboratively to conduct outreach and provide COVID-19 education and connections to resources for hard-to-reach disparately impacted communities to support efforts to reduce COVID-19 transmission in Monterey County.
The Pilot Project’s community partners will assign CHWs to implement outreach strategies in census tracts with the lowest quartile Healthy Places Index (HPI). As of now, those census tracts are in the following communities:
• Salinas, 93906 and 93905
• North Monterey County: Castroville, Pajaro, Las Lomas, Moss Landing
• South Monterey County: Gonzales, Soledad, Greenfield, King City
• Peninsula: Seaside, Marina
The metrics for measuring the effectiveness of the Community Outreach and Education Pilot Project will continue to evolve in its development. Maintaining a certain degree of flexibility allows the opportunity to modify the metrics as the implementation process will inform lessons learned and the insights of any unanticipated challenges or opportunities with data collection. The domains and indicators for measuring the Pilot Project’s progress are outlined in Attachment A, the Community Health Worker Performance Measurement Framework (adapted from: Agarwal et al. 2019. Human Resources for Health, 17(86)).
The four primary domains of the Community Health Worker Performance Measurement Framework are:
• Inputs:
o Policies for the CHW selection and assignment of tasks/workload
o Governance/Stakeholders
o Logistics
o Funding and Information Management Systems
• Programmatic Success
o Supportive Systems: Supervision and performance appraisal
o Data use
o CHW development: recruitment, training and incentives
o Support from community-based organization
• Community Health Systems Performance Outputs
o CHW -Level Outputs: Service quality, CHW knowledge and CHW well-being
o Community-Level Outputs: Community access and community-centered care
• Outcomes
o Improved health outcomes
The Community Health Worker Performance Measurement Framework will include short-term (immediate implementation) indicators and long-term indicators to be implemented as the Pilot Project expands.
Short-term Indicators:
Inputs/Supportive Systems:
• Ratio of CHWs to supervisors/coordinators
Programmatic Success:
• # of CHWs who have been selected/recruited
• #/% of target communities/populations that have an assigned CHW
• #/% of CHWs who have received initial training
• # of planning/review meetings held at the level of the local government to discuss CHW program performance
Community Health Systems Performance Outputs
• #/% of CHWs who express that they feel confidence in their abilities to provide health education
• #/% of CHWs with all the key stock commodities in the last reporting period
• # of days CHW has performed at least one CHW responsibility in the last month
• In the last 3 months, #/% of CHWs who have reported on their activities
Equity, Gender, and Accountability: Each of the above indicators may be disaggregated by one or more of the following characteristics to assess possible equity gaps or disparities: education, ethnicity, family type, health risk-level, immigration/migrant status, language, marital status, occupation, refugee/asylee status, religion, sex, social capital, tribe, wealth.
Additional process metrics tools for coordination 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.
OTHER AGENCY INVOLVEMENT:
The Pilot Project and the process metrics are 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 the recommendation included in this report will not result in additional General Fund contributions.
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
January 7, 2021
___________________________________________ ____________________
Nicholas E. Chiulos, Assistant County Administrative Officer Date
Attachment A: CHW Performance Measurement Framework