DEPARTMENT: San Antonio Metro Health Department
DEPARTMENT HEAD: Dr. Vincent Nathan, Interim Health Director
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
Budget revision to convert 16 full time temporary service personnel to full time Grant funded City of San Antonio (COSA) employees with the addition of one Administrative Assistant II position increasing the personnel complement to 28 to support the Healthy Start, U.S. Department of Health and Human Services (DHHS), Health Resources & Services Administration (HRSA); a 5 year Grant funded program.
SUMMARY:
This ordinance authorizes the conversion of 16 full time temporary service personnel to full time Grant funded City of San Antonio (COSA) employees, as temporary employees cannot be used for the length of a five year grant, with the addition of one Administrative Assistant II position increasing the personnel complement to 28 in support of the Healthy Start, U.S Department of Health and Human Services (DHHS), Health Resources & Services Administration (HRSA) Grant, of the San Antonio Metropolitan Health District (Metro Health) to successfully continue the Healthy Start Initiative for the period of April 1, 2016 to May 31, 2019.
In addition, this ordinance authorizes the Director of Metro Health to initiate, negotiate and execute any and all necessary documents and grant contracts to effectuate the management and acceptance of funds for the above referenced grant, and to execute any contract amendments pertaining to this grant in the following circumstances: a) carry-over funds, when ascertained and approved by the funding agency through a revised notice of award; b) line item budget revisions authorized by the funding agency; c) modifications to the performance measures authorized by the funding agency and listed in the contract so long as the terms of the amendment stay within the general parameters of the intent of the grant; d) no cost extensions; e) amendments which will provide supplemental grant funds to a grant by the funding agency in an amount up to 20% of the total amount initially awarded to the grant; f) reimbursement increases of administrative funds for each participant served; g) amendments funding one time equipment purchases or defined program services; and h) changes in federal regulations mandated by the funding agency.
Further, this ordinance adopts the revised program budget and approves the personnel complement of 28 positions.
BACKGROUND INFORMATION:
The San Antonio Healthy Start (SAHS) Initiative aims to reduce disparities in infant mortality and adverse perinatal outcomes by: 1) improving women’s health, 2) promoting quality services, 3) strengthening family resilience, 4) achieving collective impact, and 5) increasing accountability through quality improvement, performance monitoring, and evaluation. SAHS has a key role in strengthening families and creating the foundation for optimal infant and young child health and development, including early learning. The SAHS Initiative includes activities and components that will build a ladder of opportunity for all children and families. SAHS will be the first rung of that ladder beginning before, during, and after pregnancy and serving families for the first two years of a child’s life. The SAHS Initiative will conduct activities in conjunction with the Metro Health Neighborhood Engagement projects and other place-based initiatives and serve as the backbone organization for achieving collective impact. SAHS will participate in the development of local/state/ regional/ national programs and policies and serve as a resource site in support of other organizations working to improve perinatal outcomes.
The SAHS Initiative supports the following Health and Human Resources Administration Strategic Goals:
Goal # 1: Improve Access to Quality Health Care and Services: The SAHS program enhances access to care for women, infants and their families by facilitating linkages to ensure access to continuous, comprehensive health care. The program ensures that the care received is responsive to the needs of individuals in the community and is delivered or directed by well-trained providers.
Goal # 2: Strengthen the Health Workforce: The SAHS program helps to strengthen the health workforce, specifically those individuals responsible for providing direct services, and managing program components by requiring minimum educational and training levels for all staff.
Goal # 3: Build Healthy Communities: The SAHS program ensures communities have a perinatal system that is responsive to the health and social needs of the Maternal Child Health population, and is sustainable and robust in order to provide ongoing, coordinated, comprehensive services in the most efficient manner through effective service delivery.
Goal # 4: Improve Health Equity: The SAHS program promotes health equity by identifying health and social circumstances that place an individual at a disadvantage that does not allow them to achieve their full health potential. SAHS provides and facilitates connections and linkages with appropriate organizations to strengthen the Maternal Child Health system and promote community transformation.
In 2013, the San Antonio Healthy Start Initiative provided services to 119 pregnant and post-partum women and 170 children. Additionally, from 2002 to 2012, the infant mortality rate for program participants was 3.28 deaths per 1,000 live births, compared to the 2011 national average of 6.01 deaths per 1000 live births. Since 2008, San Antonio Healthy Start Initiative has reached over 40,000 individuals in the community through outreach, health education, and case management. Successful award of this grant will increase the number served, including pregnant and postpartum women, children and fathers with minimum of 600 participants for the first 9 months and then 800 participants annually thereafter.
ISSUE:
Metro Health requests City Council authorization to support this long-term (5 year) grant in its final 3 years by converting 16 full time temporary service personnel to full time Grant funded City of San Antonio (COSA) employees as temporary employees cannot be used for the length of a five year grantwith the addition of one Administrative Assistant II position thereby increasing the personnel complement to 28 positions. Additionally the department requests tosubmit a grant budget revision and accept total funds over the remaining 3 year project period in an amount not to exceed $5,400,000.00 from the U.S Department of Health and Human Services (DHSAHS), Health Resources & Services Administration (HRSA) to continue the Healthy Start Initiative grant. Authorization of this Ordinance will allow Metro Health to successfully continue the important work of providing outreach, case management, and health education to underserved pregnant and inter-conceptional women and families in San Antonio and Bexar County while realizing the benefits of internal COSA employment.
ALTERNATIVES:
If the conversion of current full time temporary staff to COSA employees does not occur, an impact to well-being, morale and control over direct supervision for the 16 full time long term temps is likely to occur. As a result, Metro Health and Healthy Start will have less than optimal job satisfaction from and oversight over 16 staff members who currently provide critical outreach, case management, and health education services to at-risk pregnant and inter-conceptional women and their families. Additionally, Temporary Services contracts are scheduled to increase in cost over the next 3 years, creating compelling case for conversion to Grant Funded COSA employee status for these 16 positions in question.
FISCAL IMPACT:
This HRSA grant contract will provide total funding in an amount up to $5,400,000.00, which represents 100% of the funding for the Healthy Start program within Metro Health. FY 2017 funding represents an decrease of $200,000.00 in funding from previous year awards from HRSA as reflected in the attached budget (see Attachment I). Acceptance of this grant will place no demand on the General Fund.
RECOMMENDATION:
Staff recommends approval of the conversion of 16 contractual full time temporary service personnel to become full time Grant funded City of San Antonio (COSA) employees. Staff additionally recommends approval of the addition of one Administrative Assistant II position thereby increasing the personnel complement to 28 positions in support of $5,400,000 U.S Department of Health and Human Services (DHSAHS), Health Resources & Services Administration (HRSA) Grant for the Healthy Start Initiative for the period April 1, 2016 to May 31, 2019.