Agenda Item AGENDA STAFF REPORT ASR Control 24-000167
MEETING DATE:	05/07/24
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Jennifer Sarin (714) 834-4099
	Veronica Kelley (714) 834-7024

Subject: Amendment No. 2 for Public Health Nursing Services

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: N/A

Staffing Impact:

No

# of Positions:

Sole Source: No

Current Fiscal Year Revenue: N/A

Funding Source: N/A	County Audit in last 3 years: No
Levine Act Review Completed: N/A

Prior Board Action: 5/23/2023 #32, 6/2/2020 #64

RECOMMENDED ACTION(S):

1.	Approve Amendment No. 2 to extend the Memorandum of Understanding with the Children and Families Commission of Orange County to receive revenue in the amount of $4,500,000 for the provision of Public Health Nursing Services for Bridges Prenatal-to-Three Network for three years, effective July 1, 2024, through June 30, 2027
2.	Authorize the County Procurement Officer or Deputized designee to execute the Amendment as referenced in the Recommended Action above.

SUMMARY:

Approval of Amendment No. 2 to the Memorandum of Understanding with the Children and Families Commission of Orange County for the provision of Health Care Agency Public Health Nursing Services for Bridges Prenatal-to-Three Network will allow Public Health Nursing Services to continue receiving revenue to support healthy birth outcomes and improve child health and development in the County of Orange for an additional three years.

BACKGROUND INFORMATION:

On June 2, 2020, your Honorable Board of Supervisors (Board) approved the Memorandum of Understanding (MOU) with the Children and Families Commission of Orange County (CFCOC) for the continued receipt of revenue supporting provision of Public Health Nursing services in partnership with the Bridges Maternal Child Health Network (Bridges Network).

Board Date	MOU/Amendment	Action	Term	Amount
June 2, 2020	MOU	Board approved MOU	July 1, 2020, through June 30, 2023	$5,057,670
May 23, 2023	Amendment No. 1	Board approved extension and increase	July 1, 2023, through June 30, 2024	$1,500,000 Cumulative amount not to exceed $6,557,670

The Bridges Network is comprised of hospitals, community-based programs, and Public Health Nursing services focused on developing strategic and responsive services that promote healthy early childhood development of young children from birth through age five. This MOU allows the Health Care Agency (HCA) to receive funding for the provision of services under the Children and Families Commission of Orange County scope of work, which includes supporting positive health, development, and well-being outcomes for pregnant and parenting women, families, and infants, expanding their future educational, economic, and financial capability opportunities.

Scope of Services:

This MOU allows funding of HCA Public Health Nurses that provide nurse home-visitation services through Nurse-Family Partnership® (NFP), Perinatal Assessment and Coordination Team (PACT), and Medically High-Risk Newborn (MHRN) programs. These public health programs provide services for high-risk maternal, infant, and pediatric populations delivered through comprehensive case management services, including home visits and telehealth services, which were incorporated to increase client retention and engagement. Services are tailored to address individual needs, including physical, psychosocial, developmental, and social determinants of health.

The NFP program is an evidenced-based nurse home visitation program that improves the health, well-being, and self-sufficiency of families. Public Health Nurses work with first-time mothers during their pregnancy, with services continuing until the child is two years of age. NFP is a proven program that improves the health, well-being, and self-sufficiency of families. Eligibility requirements include being a first-time mother, less than 28 weeks pregnant, low income, and a desire to be involved in the curriculum-based program.

PACT is a Public Health Nursing Program which provides home visitation to pregnant and parenting women. The PACT program focuses on women with current or history of substance use disorder, mental illness, women experiencing homelessness and women with high-risk perinatal conditions including those living with HIV.

The Medically High-Risk Newborn Program (MHRN) is a component of the PACT program. Public Health Nurses in the MHRN program provide case management services for up to 36 months to children and youth with special health care needs, for conditions such as prematurity, low birth rate, small for gestational age, failure to thrive, metabolic problems, respiratory distress syndrome, intracranial bleeding and/or congenital/genetic anomalies.

The Public Health Nurses in these programs provide home visitation, health education, promote parental bonding, child safety, and conduct health screenings including growth and developmental screenings, as well as address pregnancy concerns, provide education to help manage health conditions, assist with emotional, alcohol or substance use concerns, assist in understanding growth and development, pregnancy and post-partum conditions and complications and child safety and management of health conditions. Additionally, Public Health Nurses provide care coordination, case management, referrals, and linkages to services in the community.

Performance Outcomes:

The intended outcomes of the home visitation programs are to improve birth and health outcomes through nurse home visits. HCA's goal for the program is set at 125 to allow for implementation of best practices as recommended by NFP. HCA consistently reviews the program to determine expansion based on performance.

Outcome Measures	Fiscal Year 2021-2022		Fiscal Year 2022-2023		Fiscal Year 2023- Mar 31, 2024 (YTD)
	Goal	Outcome	Goal	Outcome	Goal	Outcome
Number of enrollments	125	125	125	125	125	125
Number of client visits	1,680	855	1,680	1,157	1,680	1,024
Number of children who received developmental screenings	105	105	105	105	105	105

The Public Health Nurse home visiting programs contribute to positive birth outcomes by helping to improve early access to prenatal care and postpartum care within three weeks after delivery to be followed with a comprehensive postpartum visit no later than 12 weeks after birth. Public Health Nurses address disparities and work to reduce preterm birth rates. Public Health Nurses identify and engage women at high-risk for poor birth outcomes, provide referrals for treatment of mental health disorders, substance use disorders, smoking cessation, HIV, Sexually Transmitted Diseases services during pregnancy, anticipatory guidance, and health education.

The American Academy of Pediatrics (AAP) states that developmental surveillance is an important way to identify children at risk for developmental delays. Public Health Nurses conduct developmental screenings and work with families to ensure children at risk for growth and developmental delays are referred and linked for comprehensive follow-up care. Public Health Nurses refer children to Early Start services and early learning programs.

HCA requests that the Board approve Amendment No. 2 to the MOU with the CFCOC for receipt of revenue to support provision of Public Health Nursing services in partnership with the Bridges Network, as referenced in the Recommended Actions.

HCA has verified there are no concerns that must be addressed with respect to CFCOC’s ownership/name, litigation status or conflicts with County interests.

FINANCIAL IMPACT:

Revenue received through this Amendment will be included in Budget Control 042 FY 2024-25 and will be included in the budgeting process for future years.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A - Amendment No. 2 to Memorandum of Understanding FCI-HCA-13 with Children and Families Commission of Orange County
Attachment B - Redline to Attachment A