Title
Health and Human Services Agency (HHSA) recommending the Board:
1) Make findings in accordance with County Ordinance 3.13.030 that it is appropriate to contract with Colleen Bridger Consulting LLC for the provision of COVID-19 community recovery consulting services, provided under Agreement 6164, because the “limited timeframes, temporary or occasional nature, or schedule for the project or scope of work, the ongoing aggregate of work to be performed is not sufficient to warrant addition of permanent staff;”
2) Approve and authorize the Chair to sign Agreement for Services 6164 with Colleen Bridger Consulting LLC, in the amount of $248,864, for a term beginning upon execution through May 31, 2023; and
3) Authorize the HHSA Director, or designee, to execute further documents relating to Agreement for Services 6164, contingent upon approval by County Counsel and Risk Management, including amendments which do not increase the maximum dollar amount or term of the Agreement. (Cont. 1/25/2022, Item 13)
FUNDING: State Funding: County Coronavirus Response and Relief Supplemental Appropriations Act, 2021.
Body
DISCUSSION / BACKGROUND:
As part of the Fiscal Year 2021-22 state budget, the California Department of Public Health (CDPH) has provided funding allocations to the 58 Counties to enhance efforts aimed at supporting the statewide response and recovery from COVID-19. The overarching purpose of the funding goes far beyond the pandemic, with a goal of analyzing and providing an understanding as to why certain subgroups of our community experience poorer health outcomes than others, for all diseases. This information can then be used by community partners, the healthcare system, and other stakeholders to identify and implement strategies aimed at improving health outcomes for all residents of El Dorado County and will better position us to face future major health events.
When Public Health received word of the approved State allocation coming to El Dorado County, our management worked to understand the different options we had for meeting the objectives. Over the span of eight weeks, our Public Health leadership queried our statewide peer network, neighboring and peer counties, and CDPH. The responses we received focused on the following strategies:
1) Providing ongoing training to current staff over the two-year term to build their capacity and add it to their workload, indefinitely;
2) Creating a new county classification, to fulfill the requirements of the funding as their full-time job. These counties plan to hire a full-time staff person who would be funded beyond the two-year term through their County General Fund or other local dollars.
In our research, no other county expressed plans to hire a consultant to perform the entire scope of work. Through this process, Public Health learned that 55 of the 58 California counties have accepted this funding, most of whom will be hiring staff to accomplish the goals described above. For example, our neighboring counties of Alpine, Calaveras, Nevada, Placer, San Joaquin, Stanislaus, Sutter, Tuolumne and Yolo are either developing a Community Health Improvement Assessment/Plan through existing staffing who are already trained, hiring new staff to perform this work as their job, or they are contracting with outside organizations to provide training and development to existing staff who will eventually perform the work. It is worth noting that the three counties that didn’t accept the funding (Amador, Sierra and Yuba) chose to not accept more funds due to capacity issues within their administration. They are, however, still performing this work by using American Rescue Plan Act (ARPA) funding or other Public Health funding to accomplish the same objectives. As such, all 57 other counties are performing work to meet these objectives in some way, with nearly all accepting these funds to do so.
Public Health does not recommend using these funds to train current staff to perform the work needed to meet the specified objectives. Public Health has a current vacancy rate of approximately 26%, which is an incredibly high number of vacancies. In addition, we are experiencing a high number of staff who are leaving their positions or have indicated they are retiring over the coming months ahead. Of the 65 allocated positions by our Board, only 48 are filled. Considering the vacancies, current staff are at their workload capacity in ensuring that we meet Public Health mandates, on top of the additional work required to response to COVID.
Public Health does not recommend adding a position classification dedicated to this effort. This funding is short term and is only available through May 31, 2023. The only fiscally responsible type of recruitment would be for a limited term position, which significantly reduces the candidate pool, as our positions have been historically difficult to fill. In addition, there is no current County classification appropriate to the broad scope of work required of these funds. As such, a new County classification would need to be created within our Human Resources department. This would require a classification and compensation study, which takes many months. That, in addition to the time to recruit considering the current recruitment challenges we all face, would leave little to no time to complete the work by May 31, 2023.
Public Health suggests hiring a consultant to lead this important work, with Public Health staff playing a supportive role by providing data, guidance, and feedback/direction. Before we went through the process of drafting an RFP, Public Health queried CDPH, peer counties, and our peer Public Health statewide network to ask if any counties were contracting with a consultant, or if anyone was aware of any California organizations that conduct this type of work. We did not receive a single organization or firm in response, as counties and CDPH were not aware of any entity that could fulfill all areas of work required of this funding. Please note that specific to El Dorado Public Health, any firm that works with our department needs to meet strict accreditation criteria. This year, Public Health officially met standards to become an accredited Public Health agency. In order to retain this ‘gold standard,’ any consultant that we contract with has to meet specific accreditation criteria in order for us to retain this status. This goes for all work we do as a division.
During our initial unsuccessful efforts to locate a consultant in California, our Public Health statewide association provided a nationwide training on improving health outcomes for vulnerable populations. Colleen Bridger Consulting LLC (CBC) performed this training, and as our leadership participated, it became evident that Ms. Bridger’s firm seemed to have deep expertise in areas that would be applicable to this work. Following the training, discussions were held with CDPH and our statewide association to confirm if CBC was qualified to perform this work. Upon multiple discussions, they confirmed that CBC is uniquely qualified to fulfill the scope of work associated with the funds and she also meets our accreditation standards. For these reasons, we propose contracting with CBC as our consultant, through Agreement 6164.
In addition to Public Health staff involvement, CBC will involve local partners including hospitals, community health centers, and other healthcare-related stakeholders in a thorough assessment to understand the root cause of why certain subgroups are more vulnerable to poorer health outcomes than others, and then would work with our partners to implement targeted, appropriate strategies aimed at improving health outcomes for all El Dorado County residents.
Colleen Bridger, MHP, PhD, the founder and Chief Executive Officer of CBC, is professionally qualified in the following areas:
• Public health quantitative and qualitative research, including expertise in Patagonia Software;
• Root cause analysis to understand what makes some populations more vulnerable than others;
• Tailoring interventions to best suit rural underserved populations; and
• The requirements and standards set by Public Health Accreditation
Within the term of the Agreement, CBC will work with County Public Health leadership, health care partners, stakeholders and the community to:
1. Evaluate the feasibility of unifying efforts to provide a base community assessment that all partners can use.
2. Conduct a countywide assessment looking at the root cause of why some populations experience poorer health outcomes than others.
3. Conduct a Public Health specific assessment to identify gaps in service delivery.
4. Work with internal and external stakeholders to develop a Resiliency Plan to better position the County to respond to future health events.
5. Develop and deliver necessary training to ensure comprehensive service delivery across the county for division leadership, public health staff, and master trainers.
6. Oversee the implementation of the plan and troubleshoot any first-year challenges.
In accordance with Board of Supervisors Procurement Policy C-17, Section 7.11, the contractor selection process for service contracts in excess of $100,000 must include a review of the scope of services and contractor’s professional qualifications by a group of individuals (including at least one representative from outside the department requesting the services) qualified to judge the contractor’s ability to perform the services. Such a review was performed for Agreement 6164 with Colleen Bridger Consulting.
ALTERNATIVES:
Should the Board decline to approve this recommendation, it would be difficult for HHSA to use the funding received to accomplish the associated goals as the Public Health Division does not have internal capacity, does not wish to hire permanent staff with short term funds, and no other qualified contractors were located.
PRIOR BOARD ACTION:
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
Approved by County Counsel, Procurement and Contracts, Human Resources, and Risk Management. The Auditor-Controller has been notified.
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no Net County Cost associated with this agenda item. Sufficient appropriations were included in the Fiscal Year 2021-22 Budget, and will be included in future budgets for the term of the Agreement.
CLERK OF THE BOARD FOLLOW UP ACTIONS
1) Clerk of the Board to obtain signature of Chair on two (2) original Agreements for Services 6164.
2) Clerk of the Board to return one (1) fully executed Agreement to HHSA Contracts Unit at 3057 Briw Rd, Suite B.
STRATEGIC PLAN COMPONENT:
County Strategic Plan - Infrastructure: Provide, operate, and maintain our infrastructure, public facilities, and associated services that protect our community, environment and economic well-being.
County Strategic Plan - Healthy Communities: Improved health, well-being and self-sufficiency of El Dorado County communities, residents and visitors.
CONTACT
Don Semon, Director, Health and Human Services Agency