Title
Health and Human Services Agency recommending the Board:
1) Adopt and authorize the Chair to sign Resolution 026-2021 to delete 5.0 full time equivalent (FTE) Community Health Advocate allocations (three vacant, two filled), and authorize the Human Resources Department to initiate the reduction in force process for the two filled positions; and
2) Approve a deviation from the order of layoff by retention points to allow the utilization of a remaining 1.0 FTE Community Health Advocate to support targeted Epidemiology and Laboratory Capacity grant activities, as retention points order alone would result in HHSA being unable to fulfill key program activities which support at risk populations related to COVID-19.
FUNDING: Public Health Realignment.
Body
DISCUSSION / BACKGROUND:
On June 5, 2015, the Board of Supervisors received a presentation from First 5 El Dorado Children and Families Commission and El Dorado Community Foundation identifying the community collaboration group “Legacy El Dorado” and proposing a systematic approach to addressing early childhood achievement gaps, including Community Hubs. Since its launch, the Community Hubs have offered a locally developed model for accessing service referrals and navigation through five (5) library locations located within the five supervisorial districts in El Dorado County. A number of Community Hub Board items and presentations have come before the Board of Supervisors to demonstrate the successful outcomes-driven activities and positive growth from the initial Hubs concept, up through the most recent presentation on March 9, 2021. With the target of serving families and children, the Community Hubs have achieved a number of accomplishments including but not limited to:
• Expanding the reach of health and social services navigation support;
• Ensuring increased access points are brought to the community through utilizing local libraries;
• Promoting equity through prioritizing isolated and vulnerable residents for navigation support;
• Establishing Community Advisory groups to design, monitor, and adjust services to continue to meet the needs of consumers, and;
• Leveraging external funding and resources to sustain the model.
The Community Hubs program has been collaboratively funded by the First 5 El Dorado Commission, the El Dorado County Office of Education (EDCOE), and the Health and Human Services Agency (HHSA). When first launching, the First 5 El Dorado Commission approved the Hub concept as a part of their FY 2016-2021 Strategic Plan, which aligned funding streams from the described partners for a five year period and was included across three different strategic plans: El Dorado County (Healthy Communities), Maternal Child Adolescent Health Plan and First 5. The remaining portion of funds came soon thereafter from Mental Health Services Act Innovation funding. As a result of delays in both the initial approval process by the State and a number of the subsequent contracts, the first year of the three-year funding was not fully expended. Upon approval, the funding for the Hubs program was incorporated into the El Dorado County three year MHSA plan, making it available to support years two through four of the Hubs program. As the three-year term was coming to a close, a request for a one-year extension for FY 2020-2021 was submitted and approved by the state, which extended the funding for the Hubs program for one final year, ending June 30, 2021.
The creativity and collaborative funding model from all involved partners ensured that the program could operate over that 5 year period, leading to a program that now is being recognized and considered a potential model for a statewide solution for increasing services access and navigation across all counties. The specificities around MHSA Innovation Funding have afforded El Dorado County the rare opportunity to launch this unique program, while at the same time it is also limiting in that the Innovation Funding can only be utilized for a short period of time. MHSA Innovation funds provide an opportunity for communities to launch a new and innovative program over a multi-year period, with the goal of communities then considering how to sustain the project thereafter should it have created a positive impact. With the Hubs program being widely recognized as an innovative model, coupled with the one-year extension period coming to an end June 30, 2021, HHSA has been actively collaborating with First 5 El Dorado, the El Dorado County Library, and EDCOE to plan for the necessary shift in the model to ensure its sustainability, and to potentially expand on the existing services. As a part of that transition planning process, opportunities to create more sustainable staffing models and enhance the Hubs with new services have been identified and were presented in part to the Board during the most recent Hubs presentation held on March 9, 2021 (Item# 20-1648)
Specific to staffing, as was discussed on March 9, 2021, there are currently three (3) Public Health Nurses (PHN) (2.8 filled FTE) and three (3) Community Health Advocates (CHA) (3.0 filled FTE) that are HHSA staff and actively working in the Community Hubs program. These positions have been funded with the described MHSA Innovation Funding and MCAH program dollars, supporting salaries and benefits for these six individuals. The following strategies are being considered and recommended to ensure a sustainable Hubs program model moving into FY 2021/2022:
Public Health Nurses:
HHSA will be transitioning the 2.8 FTE PHN allocations back into the Public Health Division, as there are currently vacant PHN positions that the PHN staff can be absorbed into. The value in taking this approach is that the Public Health Division can utilize its ongoing funding to maintain the staff, retaining their institutional knowledge and expertise to continue supporting the Hubs, all while also adding the depth of additional PHN staff to be able to cover for and enhance access to services through the Hubs, over time.
Community Health Advocates:
The primary purpose of this Board Item today is in regards to the three (3) CHA staff.
Reduction in Force: As HHSA is a super agency which provides administrative support to five large program divisions, with a staffing size equaling roughly one-third of all County staff, an indirect cost rate of approximately 25.53% is applied to all HHSA programs in order to pay for key administrative support. Through creative thinking in how to make the Hubs model more sustainable, and through considering that the CHA staff operate at the Hubs library locations already, a plan has been developed for the Library Department to go through the process of requesting 3.0 FTE CHA allocations during the upcoming FY 2021/2022 budget process. If approved during that process, this would result in the Library being responsible for the 3.0 FTE CHA positions, and as such, those same staff would cost the Hubs program 25.53% less than if those positions remain in HHSA. This was determined to be the most fiscally responsible approach to maintaining levels of services in the Hubs while reducing the cost. The ideal outcome associated with this recommended Reduction in Force for two (2) of the CHA staff would be that the Library’s request for 3.0 FTE CHA allocations is approved through the budget process and the two affected staff are thereby considered to fill the vacancies in the Library Department on July 1, 2021, and continuing to provide their services in the Hubs Program as staff of the Library Department.
Deviation from Retention Points: For the remaining filled 1.0 FTE CHA, HHSA is requesting approval from the Board to deviate from the order of layoff by retention points to strategically utilize this bilingual staff person for a targeted Epidemiology and Laboratory Capacity (ELC) program position. The ELC grant provides funding for Public Health Departments to (1) establish or enhance community-based surveillance of vulnerable populations; (2) conduct case investigation and exposure to COVID-19 in vulnerable and high-risk settings or within populations at increased risk of severe illness or death; (3) build local capacity for reporting, rapid containment and prevention of COVID-19 in vulnerable populations that reside in communities; and (4) ensure testing of populations at higher risk of becoming infected with COVID-19. To identify outreach target areas in the County, the El Dorado Public Health Division utilized the Healthy Places Index (HPI), a State approved data mapping tool used to visualize the social and economic conditions that shape health across our different neighborhoods. The process identified Census tracts on both the western slope and within the South Lake Take area as being priority areas for outreach, education, and engagement for the described ELC activities.
On the western slope, there is a staff person identified to fulfill these responsibilities. For the identified census tracts in the South Lake Tahoe area, HHSA’s recommendation through this Board item is intended to address the staffing needed for this service area. In the identified South Lake Tahoe census tracts, approximately 30% of residents identify as Latino/Hispanic, and COVID-19 studies continue to show how Latino/Hispanic populations are at higher risk of severe illness or death if exposed to COVID-19. It is also worth noting when comparing census tracts in El Dorado County, the identified census tracts within the South Lake Tahoe area continue to have disproportionately higher numbers of the County's Covid-19 cases. Lastly, California is allocating its available vaccine supply to Counties based upon each County’s ability to maintain equity in its distribution. As such, the Public Health Division is responsible for executing an equity plan which includes providing targeted outreach and services in the referenced census tract areas on both the Western Slope and South Lake Tahoe area. By the Board approving a deviation from the order of layoff by retention points to allow HHSA to utilize the bilingual CHA for this effort, the bilingual CHA can help Public Health to achieve key outcomes for El Dorado County while ensuring that the most effective and culturally appropriate services are provided in the community.
As being bilingual is a key qualification for the described effort, in advance of this Board item, HHSA Executive Management held meetings with the CHA staff to ensure that they understood and could anticipate the process being recommended to the Board through this item. On March 17, 2021, HHSA Executive Management met with the most senior CHA staff person to advise the individual of the intent of HHSA to request approval from the board to deviate from the order of layoff by retention points. This staff person is not bilingual, and they expressed that they understood and acknowledged that due to not speaking Spanish, the ELC position would not be appropriate for their consideration. A letter was provided to the staff person to offer a written overview of this process. Following that meeting, a second meeting was held with all three (3) CHA staff persons on March 22, 2021 to provide an overview of HHSA’s intent to request approval to deviate from the order of layoff by retention points. In that meeting, the bilingual staff person, who is the second most senior staff person of the three, expressed interest in considering this position. Following the meeting, a letter was then provided to the bilingual staff person to offer a written overview of this process.
Recommendation:
HHSA is requesting to delete 5.0 FTE (three vacant, two filled) Community Health Advocate allocations and subsequently requesting authorization from the Board to authorize HR to initiate the reduction in force process for the 2.0 FTE filled positions, with the incumbent’s last day in the positions within HHSA effective June 30, 2021. Lastly, HHSA is requesting that the Board approve a deviation from the order of layoff by retention points to allow HHSA to utilize the remaining 1.0 FTE Community Health Advocate to fulfill targeted ELC funded activities. By approving these actions, HR can quickly begin working with the CHA staff to explore alternate employment opportunities within the County between now and June 30, 2021 that they may be eligible for and interested in. Simultaneously, as the other piece to this process, the Library Department will move forward with their FY 2021/2022 budget requests for adding the 3.0 FTE CHA allocations. Should the Board of Supervisors ultimately approve the Library’s request to add 3.0 FTE CHA allocations during the upcoming budget process, and should those staff be interested in retaining their current positions within the Library Department, HR will work with those staff to accomplish their goals. Should the Board of Supervisors eventually deny the Library Department’s request as part of the FY 2021/2022 process, by authorizing the initiation of the reduction in force today, HR can provide the quickest and greatest opportunity to support the affected staff as they consider options and transition planning to other available employment opportunities within the County.
ALTERNATIVES:
The Board could decline to authorize the deletion of the 5.0 FTE CHA allocations and initiate the reduction in force process. If this occurs, HHSA would then be required to retain the staff and would come back to the Board of Supervisors as part of its FY 2021/2022 process to request funding to maintain the staff which would be at a 25.53% higher cost than it would if the positions were maintained in the Library Department.
The Board could decline to authorize deviation from the order of layoff by retention points to allow the utilization of a remaining 1.0 FTE Community Health Advocate to support targeted Epidemiology and Laboratory Capacity (ELC) grant activities. If this occurs, HHSA will be required to retain the staff member who has the most seniority, who does not possess bilingual skills which is a key qualification to ensuring that the most effective and culturally appropriate services are provided in the community.
PRIOR BOARD ACTION:
1) June 5, 2015 15-0524 V1, Agenda No. 46; “Receive and file Legacy El Dorado presentation”
2) October 6, 2015, 15-0524 V2, Agenda No. 12; “Receive and file update on Legacy El Dorado”
3) June 6, 2017, 16-0363, Agenda No. 47; “COB First 5 Appointment”
4) January 23, 2018, 18-0095, Agenda No. 36; “Five Proclamations recognizing Community Hubs”
5) July 17, 2018, 18-0622, Agenda No. 29; “Healthy Communities Update”
6) June 5, 2018, 18-0752, Agenda No. 42; “Supervisor Novasel First 5”
7) April 16, 2019, 19-0671, Agenda No. 3; “Community Hubs Program Presentation”
8) June 6, 2019, 19-0936, Agenda No. 44; “MHSA Plan Update”
9) November 19, 2019, 19-1498, Agenda No. 38; “Supervisor Novasel CSAC Challenge Awards”
10) March 25, 2020, 20-0407, Agenda No. 5; “MHSA Community Hubs Funding”
11) May 19, 2020, 20-0309 Agenda No. 27; “Supervisor Novasel First 5”
12) February 23, 2021, 21-0246; Agenda No. 27; “CAO Mid-Year Budget Report”
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Human Resources and Local One Bargaining Unit
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
Savings in Public Health Realignment in the amount of approximately $92,064.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Upon Board approval of the attached Resolution, Clerk of the Board to provide a certified copy of the fully executed Resolution to HHSA at 3057 Briw Road, Placerville, (Attn: Contracts Unit); and
2) Clerk of the Board to provide a certified copy of the fully executed Resolution to the Lauren Montalvo in Human Resources at 330 Fair Lane, Placerville.
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT
Don Semon, Director, Health and Human Services Agency