DEPARTMENT: Health
DEPARTMENT HEAD: Colleen M. Bridger MPH, PhD
COUNCIL DISTRICTS IMPACTED: Citywide
SUBJECT:
Authorizing an amendment to an agreement with Communities in Schools of San Antonio and an agreement with Centro Por la Justicia associated with the San Antonio Metropolitan Health District’s FY 2019 1115 Waiver Project for a term ending September 30, 2019.
SUMMARY:
This Ordinance will authorize an amendment to an agreement with Communities in Schools of San Antonio (CISSA) for adolescent health services to provide in-school behavioral and mental health counseling for the Teen Pregnancy Prevention Program, funded by the Medicaid 1115 Waiver Program in an amount not to exceed $550,000.00 for a term ending September 30, 2020.
This Ordinance will also authorize an agreement with Centro Por La Justicia for the enhancement and maintenance of a community garden with equipment purchased by the Healthy Neighborhoods Program, funded by the Medicaid 1115 Waiver Program for a term ending September 30, 2019.
BACKGROUND INFORMATION:
On January 31, 2013, City Council authorized the submission of six project proposals by Metro Health through the Regional Healthcare Partnership Anchor entity, University Health System for consideration and funding in the amount of $43,392,942.00 through the new Delivery System Reform Incentive Payment (DSRIP) arm of the “Texas Healthcare Transformation and Quality Improvement Program” or “Transformation Waiver.” Metro Health carefully selected projects in the following areas: diabetes prevention, children’s oral health services, HIV and Syphilis prevention, breastfeeding promotion, teen pregnancy prevention and neighborhood health promotion. All six project proposals are in alignment with Metro Health’s strategic plan and many community goals set forth by SA2020 and have the overall goal of improving health outcomes. The initial demonstration period came to an end on September 30, 2016. The Centers for Medicare and Medicaid Services approved an initial 15 month extension period and an additional 21 month renewal of the program that extends the term of the 1115 Waiver through September 30, 2019. Metro Health will continue to earn incentive payments through the Waiver Program from October 2019 - September 2021 and has additional Waiver funds to support these projects through 2023.
In 2014, Metro Health reported 2,441 teen births. Of those 539 were repeat teen births. San Antonio’s birth rate for females ages 15-19 was 37.4 per 1,000 and was 55% higher than the national rate. According to the National Campaign to Prevent Teen and Unplanned Pregnancy, the 2014 cost of teen childbearing in San Antonio was $54.2 million in child welfare, healthcare, lost revenue and incarceration. By the year 2019, 111 kindergarten classes will be filled with the children of teen parents.
In September 2017, City Council Authorized an agreement with CISSA for adolescent health services to provide in-school behavioral and mental health counseling for Metro Health’s Teen Pregnancy Prevention Medicaid 1115 Waiver Program in an amount up to $216,000.00 for a term commencing October 1, 2017 through September 30, 2018, with options to renew for two, one-year terms. Furthermore, a one-year renewal was executed for the term October 1, 2018 through September 30, 2019. The proposed amendment with CISSA will increase the value of the current agreement, up to $550,000.00 and extend the term through September 30, 2020. The proposed amendment further expands the scope of work required by CISSA to include telephone sessions in addition to individual and group counseling to teenage parents and expands the target school districts to include a fifth district, Southwest Independent School District.
The Healthy Neighborhoods project is a childhood obesity prevention project which employs eleven Community Health Workers, one per each of the eleven targeted neighborhoods identified based on health indicator data as well as poverty levels. The Community Health Workers, with guidance from the Healthy Neighborhoods project leaders, coordinate the planning and implementation of childhood obesity prevention strategies in the neighborhoods. Community gardens is a recommended obesity prevention strategy as they have been shown to increase access to fruits and vegetables in food deserts, improve mental health of participants, increase physical activity, and improve a “sense of community” among neighborhood residents.
In FY 2018, the Community Health Worker in the Denver Heights neighborhood collaborated with Centro Por la Justicia’s Roots of Change Community Garden to increase residents’ tending of the garden and engagement in health-related activities. Through garden work days, vegetable cooking demos, and working closely with the area schools, the Community Health Worker became an asset to the community garden programming and outreach. Funds from the Healthy Neighborhoods budget were reserved for the purpose of enhancing community spaces for approved projects so that sustainable changes could be made to the environment that promotes health and wellness. The agreement between Centro Por la Justicia and Metro Health would continue this collaboration to improve the health of residents living in Denver Heights and the surrounding neighborhoods.
Authorization of the amendment with CISSA and the agreement with Centro Por la Justicia will allow Metro Health to fund partners for the expansion of adolescent mental health counseling services to teen parents and for the enhancement and maintenance of a community garden in the Denver Heights neighborhood.
ISSUE:
Metro Health is requesting City Council authorization of an amendment to an agreement with CISSA for adolescent health services to provide in-school behavioral and mental health counseling to teen parents. Parental/guardian consent will be required for teenagers ages 17 and younger to receive services.
Metro Health is also requesting Council authorization of an agreement with Centro Por la Justicia for the purchase of gardening equipment including soil, wood for garden beds, and electrical equipment that will enhance the community garden and improve functionality of its use as a teachinig space. Metro Health will continue to support the community garden with connecting residents in Denver Heights and the East Side to resources and providing nutrition programming to promote health in the community.
ALTERNATIVES:
Should these contracts not be authorized, Metro Health will be unable to move forward with plans for improving upon its adolescent health services project for the prevention of teen pregnancy in San Antonio and its childhood obesity prevention efforts and will be unable to meet deliverables set forth in the Medicaid 1115 Waiver Project.
FISCAL IMPACT:
This Ordinance authorizes two agreements related to the San Antonio Metropolitan Health District’s Medicaid 1115 Demonstration Waiver Project, one an amendment to an agreement with Communities in Schools of San Antonio to extend the term to September 30, 2020, and an agreement with Centro Por la Justicia for a term ending September 30, 2019. There will be no fiscal impact to Health's FY 2019 Adopted Budget.
RECOMMENDATION:
Staff recommends City Council authorize the amendment to the agreement with CISSA and the agreement with Centro Por la Justicia to support Metro Health’s teen pregnancy prevention and childhood obesity prevention efforts funded by the Medicaid 1115 Waiver Project.