Title
a. Receive an oral 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 direction to staff.
Report
RECOMMENDATION:
It is recommended that the Board of Supervisors:
a. Receive an oral 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 direction to staff.
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 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 the County of Monterey, 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 eight (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 in partnership with Visiting Nurses Association and United Way Monterey County.
BACKGROUND/DISCUSSION:
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 17, 2021 of $3,952,437 in funding from the U.S. Department of Health and Human Services (HHS) Office of the Assistant Secretary to be administered by the County of Monterey Health Department, to fund approximately 18-20 CHWs from July 1, 2021 through June 30, 2023 with a focus on COVID-19 health literacy; and 5) a continuation through December 31, 2022 approved by the Board on March 8, 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 $1,570,011 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 44 FTE CHWs across eight (8) CBOs.
Since March 2022, VIDA CHWs continued to implement public awareness campaigns and community education strategies centered on culturally relevant messaging to influence social behaviors, normalizing and providing COVID-19 testing, use of face covering and social distancing, and addressing vaccine misinformation and supporting vaccine clinics in priority communities. In addition, CHWs were trained in and began supporting individuals with Medi-Cal applications as part of the state of California expansion of Medi-Cal eligibility to those 50 years old and older regardless of documentation status. This support will 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 by various sectors through the COVID-19 Collaborative of the Community Foundation of Monterey County.
From January through July 2022, the VIDA Project had 95,891 individual outreach interactions, providing COVID-19 prevention educational materials and resource connections. They also assisted 987 people with vaccinations at VIDA partner clinics, conducted 18,944 and distributed over 22,559 rapid antigen test kits, and supported 854 individuals with basic needs and resources through COVID-19 isolation and quarantine support. CHWs helped 407 individuals complete the county-wide Community Health Needs Assessment.
CHWs also conducted new outreach in the community around Medi-Cal expansion education and began offering Medi-Cal application assistance at VIDA rapid antigen testing sites. By the end of July 2022, VIDA CHWs had helped complete 64 Medi-Cal applications. In addition to additional advertising signage being developed, each VIDA organization developed new monthly Medi-Cal application targets and outreach plans during an August 4, 2022 VIDA CHW convening. VIDA CHWs also referred a number of individuals to MCHD’s Medi-Cal Outreach CHW who in turn completed 158 applications for the period of May through July 2022.
The holistic and culturally relevant approach of the VIDA Project has been successful in meeting its goal of addressing 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.
Expenditure Report
County ARPA Funds
The expenditures for April through June 2022 were $523,337 which covered 23 CHWs at six (6) organizations, leaving a balance of $1,046,675 available for expenditures through December 31, 2022.
HHS Funds
The HHS grant funded expenditures from July 2021 through June 2022 total $1,259,117 which covered 21 FTE CHWs at two (2) different organizations, administrative staffing, and evaluation for the HHS grant, leaving a balance of $2,693,320 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 VIDA Project funding sources being administered by the Health Department.
VIDA Project - County ARPA Funds
Allocation Period: April 1, 2022 - December 31, 2022
Expenditure Period: April 1, 2022 - June 30, 2022
|
Allocation Amount |
$1,570,012 |
|
Expenditures-to-Date (salaries, benefits, operational supplies) |
$523,337 |
|
Remaining Balance |
$1,046,675 |
|
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 - June 30, 2022
|
FY 2021-23 Grant Amount |
$3,952,437 |
|
Expenditures-to-Date (contracted services, County staff salaries, benefits, operational supplies) |
$1,258,185 |
|
Remaining Balance |
$2,694,252 |
|
Current Number of Funded CHWs |
21 |
VIDA co-leads have also leveraged the current County funding to secure additional funding for VIDA-related efforts. For pop-up vaccine clinics in partnership with Visiting Nurses Association, an additional combined total of $423,272 has been granted from the California Department of Public Health Epidemiology and Laboratory Capacity grant to the Health Department Public Health Bureau to the HD Administration Bureau and the Center at Sierra Health Foundation to United Way Monterey County. The Center at Sierra Health Foundation also invited VIDA partner, Mujeres en Accion, to apply for a COVID-19 outreach grant and the VIDA team provided grant-writing support for this successful application.
Efforts are currently underway to support mechanisms or avenues for VIDA CBOs to have sustainable CHW programs, including being ready to be Medi-Cal billing entities and/or partner with licensed Medi-Cal partners to accept and be reimbursed for preventive services for patients referred by a physician or other licensed practitioner of the healing arts. The Health Department held a CHW Stakeholder convening in June 2022 to inform VIDA partners and others about the new Medi-Cal CHW Service Plan Amendment. VIDA co-leads are having discussions with Central California Alliance for Health staff to understand how to support VIDA Project CBOs connect with licensed providers, investigating other counties development of CHW administrative hubs, and exploring the development of a similar hub or hubs in Monterey County. HD staff also collaborated with Cabrillo College on a HRSA CHW Workforce Training grant to support expanded local training and CHW apprenticeship programs in order to strategically meet upcoming state requirements for CHW certification processes. Upcoming national developments include the CDC’s proposed $3 billion grant program using American Rescue Plan-funds to strengthen the future public health workforce, including offering CHWs support to continue their careers as public health professionals beyond the pandemic.
This work supports County of Monterey Health Department’s (HD) 2018-2022 Strategic Plan Goals: 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), Lideres Campesinas, City of Gonzales, CHISPA, Pajaro Valley Prevention and Student Assistance (PVPSA) and The Village Project. County Counsel reviewed and approved the Board Report. This item was presented and approved at the Health, Housing, and Human Services Committee Meeting on September 12, 2022.
FINANCING:
There is no financial impact from receiving this report.
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.
Mark a check to 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:_____________
Elsa Mendoza Jimenez, Director of Health, 755-4526
Attachments:
Board Referral No. 2022.06