DEPARTMENT: Health
DEPARTMENT HEAD: Colleen M. Bridger, MPH, PhD
COUNCIL DISTRICTS IMPACTED: 1-5,7,9,& 10
SUBJECT:
Authorizing the submission of a competitive grant application and four grant continuation applications and the acceptance of funds from the U.S. Department of Health and Human Services (HHS), Health Resources & Services Administration (HRSA) Healthy Start Initiative grant.
SUMMARY:
This ordinance authorizes the submission of grant applications over a five year period and the acceptance of grant funds in an amount not to exceed $5,470,000.00 from the U.S. Department of Health and Human Services (HHS), Health Resources & Services Administration (HRSA), by the San Antonio Metropolitan Health District (Metro Health) to continue the Healthy Start Initiative for the period April 1, 2019 to March 31, 2024. The CFDA number for these funds is 93.926.
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 application and the acceptance of funds for the above referenced grant, and to execute any contract amendments pertaining to this grant in the following circumstances: a) line item budget revisions authorized by the funding agency; b) 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 grant’s intention; c) changes in state or federal regulations mandated by the funding agency; and d) carry-over funds, when ascertained and approved by the funding agency through a revised notice of award.
Further, this ordinance adopts the program budgets and approves the personnel complement of 12 full-time 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) improving family health and wellness, and 3) promoting systems change. SAHS plays 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. Healthy Start will be the first rung of that ladder beginning before, during, and after pregnancy, providing in home case management services to families for the first 18 months of a child’s life. The SAHS Initiative will conduct activities in conjunction with the Healthy Families Network coalition of community partners and serve as the backbone organization for achieving collective impact and health equity in maternal and child health. 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 following descriptions discuss how the SAHS Initiative supports the three (3) HRSA Strategic Goals:
Goal # 1: Improving Women’s Health
The SAHS program will promote activities to improve coverage, access to care, health promotion and prevention and health for women before, during and after pregnancy. 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: Improving Family Health and Wellness
The SAHS program will promote activities to improve infant health and development using a two-generation approach. Acknowledging the health of families are interrelated, SAHS will support the parental and community factors that promote family health and wellness, including system coordination/integration, health promotion and prevention and social support services that protect and advance parental and infant/child health and wellbeing.
Goal # 3: Promoting Systems Change
The SAHS program will support activities to maximize opportunities for community action to address social determinants of health, including systems coordination and integration among health and social services, other providers, and key leaders in the community. SAHS will provide regional and national leadership within the greater Healthy Start community and field of maternal and child health.
In 2018, the San Antonio Healthy Start Initiative provided services to 412 pregnant and post-partum women and 246 children. Additionally, from 2002 to 2012, the infant mortality rate for program participants was 3.28 deaths in 1,000 live births, compared to the 2011 national average of 6.01/1000 live births. Successful award of this grant allows continued service to pregnant and postpartum women and their children, and expands to include enrollment of fathers, with a minimum of 700 individuals served annually.
ISSUE:
Metro Health requests City Council authorization to submit a competitive grant application and four grant continuation applications over a five year period and acceptance of funds upon award in an amount not to exceed $5,470,000.00 from the U.S. Department of Health and Human Services (HHS), Health Resources & Services Administration (HRSA) to continue the San Antonio Healthy Start Initiative. Authorization of this ordinance will allow Metro Health to continue the important work of providing outreach, case management, and health education to underserved pregnant and interconceptional women and families in San Antonio and Bexar County.
On October 16, 2018, the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) released an updated competitive Request for Applications (RFA) for the next funding cycle April 1, 2019 to March 31, 2024. The new RFA reduces the funding amount from $1,898,600 million/year to $1,070,000 in year one, and $1,100,000 for years 2-5. The reduction in funds and revised project area qualification criteria will reduce the program’s staffing complement and change the service area starting April 1, 2019. Currently the Healthy Start Program offers services in parts of District 1-7. In the new proposed program, services will be offered in (13) zip codes that fall in Council Districts 1-5, 7, 9&10. This target area is based on where the average Infant Mortality Rate totals 8.8 or more, which is a HRSA requirement.
Under the current grant the City receives funding that supports 27 full time employees who, among other program requirements, case manage 1000 clients. The new grant will fund the program to case manage 700 clients utilizing 12 full time employees and will eliminate the Neighborhood Engagement Section, several administrative positions, consolidate from four office locations to two, and adopt a home visiting curricula that has less restrictive caseload limits and required visit frequency. The service period of pediatric participants has also been reduced to 18 months rather than two years, allowing for more rapid graduation of participants resulting in the ability to accommodate new participants in increased case management caseloads.
ALTERNATIVES:
Should City Council not authorize the proposed ordinance, the potential funding will be redistributed to other Healthy Start programs in the country. As a result, Metro Health will be reduced by 27 staff members who currently provide outreach, case management, and health education to at-risk pregnant and interconceptional women and their children and families in San Antonio and Bexar County.
FISCAL IMPACT:
This ordinance authorizes the submission of grant applications over a five year period and the acceptance of grant funds in an amount not to exceed $5,470,000.00 from the U.S. Department of Health and Human Services (HHS), Health Resources & Services Administration (HRSA), by the San Antonio Metropolitan Health District (Metro Health) to continue the Healthy Start Initiative for the period April 1, 2019 to March 31, 2024.
Funds for year one (April 1, 2019 to March 31, 2020 are estimated to be $1,070,000 and $1,100,000 annually for years two through five.
This grant does not require a cash match and will have no impact on the General Fund.
Further, this ordinance adopts the program budgets and approves the personnel complement of 12 full-time positions. This is a reduction of fifteen positions from the previous award and is a reflection of a reduced grant award, as grant employees are only funded by the availability of grant funds. The Human Resources Department will assist these employees with resume development and interview skills and will work closely with them to make sure they know of other positions throughout the city for which they are eligible to apply.
RECOMMENDATION:
Staff recommends City Council authorize the submission of grant applications over a five year period to the U.S. Department of Health and Human Services, Health Resources & Services Administration and the acceptance of grant funds upon award, in an amount up to $5,470,000.00 for the Healthy Start Initiative for the period April 1, 2019 to March 31, 2024 and authorize 12 full-time positions.