SUBJECT
Title
AUTHORIZE COMPETITIVE SOLICITATION FOR EVIDENCE-BASED FAMILY HOME VISITING SUPPORT SERVICES (DISTRICTS: ALL)
Body
OVERVIEW
The County of San Diego (County) provides Evidence-Based Family Home Visiting Support Services for children and families following the Healthy Families America (HFA) evidence-based family-focused model. The HFA model is currently utilized for services provided by both the County Health and Human Services Agency (HHSA), Medical Care Services (MCS) department and the First 5 Commission of San Diego County (First 5) and employs a framework to strengthen the health and well-being of parents and children through a series of home visits. County Public Health Nurses (PHNs) conduct the home visits provided by MCS. The First 5 program is administered by contracted providers employing a trained, community-based, culturally responsive family support specialist.
Through a business re-engineering process, HHSA has determined that a more equitable and effective option would be to integrate these two programs to optimize the level of care provided to the families receiving home visitation services and maximize available revenue. If approved, today’s recommendation authorizes the Director, Department of Purchasing and Contracting to issue a competitive solicitation for Evidence-Based Family Home Visiting Support Services and award one or more contracts for the delivery of these services. Selected providers will coordinate service delivery with PHNs to ensure that each family is provided with the appropriate level of service based on need.
Today’s item supports the County vision of a just, sustainable, and resilient future for all, specifically those communities and populations in San Diego County that have historically been left behind, as well as our ongoing commitment to the regional Live Well San Diego vision of healthy, safe, and thriving communities by supporting families in making healthy lifestyle choices, developing resiliency, and enjoying the highest quality of life.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
In accordance with Section 401, Article XXIII of the County Administration Code, authorize the Director, Department of Purchasing and Contracting, to issue a Competitive Solicitation for Evidence-Based Family Home Visiting Support Services, and upon successful negotiations and determination of fair and reasonable price, award one or more contracts for a term of one year, with four option years and up to an additional six months if needed; and to amend contracts as needed to reflect changes to services and funding.
EQUITY IMPACT STATEMENT
The County of San Diego Health and Human Services Agency (HHSA) has been instrumental in supporting Home Visiting programs for over two decades, with the goal of improving the health and well-being of families and reducing health disparities by building and sustaining community partnerships. This includes engaging overburdened families through home visiting services, cultivating and strengthening nurturing parent-child relationships, promoting healthy childhood growth and development, and enhancing family functioning by reducing risk and building protective factors. Additional resources include referrals to the Women, Infants and Children (WIC) program, food assistance, diaper bank, housing, medical providers and behavioral health services.
The Home Visiting program is designed to support families who are particularly vulnerable to adverse childhood experiences, ensuring person-centered services are utilized to address their specific needs. The program emphasizes culturally responsive practices by tailoring services to the unique needs of diverse communities. Every effort is made to match eligible families with staff who speak their language and understand their culture and staff are trained in active listening and cultural humility.
The Home Visting program utilizes Parent Satisfaction surveys as an essential tool for collecting feedback from families, providing insights into their experiences. Participant feedback promotes program improvements and can further strengthen community engagement by demonstrating responsiveness and a commitment to meeting the evolving needs of families. In Fiscal Year 2023-24, the Medical Care Services (MCS) Home Visiting program provided services for 900 families and First 5 provided home visiting services to 632 families, countywide.
SUSTAINABILITY IMPACT STATEMENT
Today's proposed action supports the County of San Diego Sustainability Goal #1 to engage the community in meaningful ways; Sustainability Goal #2 to provide just and equitable access; and Sustainability Goal #4 to protect the health and well-being of everyone in the region. The home visiting approach creates fair and equitable access to services by meeting families where they are at and collaborating with the family to create service plans that support their well-being. Through the Healthy Families America evidence-based family-focused model, this approach fosters positive parenting, promotes child health and development, and helps prevent child maltreatment.
FISCAL IMPACT
Funds for this request are partially included in the Fiscal Year (FY) 2025-26 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this will result in estimated annual costs and revenue of up to $6.0 million in FY 2025-26 that would grow in subsequent years as integration of the home visiting disciplines occurs and additional revenue is realized. The funding source for the new, integrated Home Visiting program includes Proposition 10 approved by the First 5 Commission, Social Services Administrative Revenue, California Home Visiting Program State General Fund Expansion, Maternal, Infant, Early Childhood funding from the California Department of Public Health, and Realignment. Appropriations are currently partially included as part of HHSA’s FY 2025-26 CAO Recommended Operational Plan. Additional appropriation may be needed within HHSA depending on final program design to transfer Proposition 10 funding that is part of the budget under the First 5 commission. This would be requested as part of the FY 2025-26 CAO Recommended Operational Plan Change Letter or subsequent quarterly status adjustments. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
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Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board (HSAB) reviewed and approved this item at their meeting on April 1, 2025.
The First 5 Commission of San Diego County (Commission) is scheduled to review this item, as well as an extension of the existing Home Visiting Support Services contracts through December 31, 2025, at its April 16, 2025 meeting.
BACKGROUND
The County of San Diego (County) Health and Human Services Agency (HHSA) has delivered an evidence-based home visiting program since 1999. By building trusting relationships between provider and family, home visitation services improve both the health and life-course of children and families. These services nurture the development of healthy relationships between parent and child and enhance parental knowledge regarding their child’s growth and development. Services are customized based on an assessment of family strengths, needs, and desired outcomes. Families are equipped with the necessary tools and community referrals to achieve their personalized goal plans. A home visit can consist of a variety of activities including but not limited to providing education on child development, positive discipline, safe sleep practices, lactation support, and healthy diet and exercise. Additionally, they may include family goal planning, stress management techniques, and referrals or linkages to community resources.
HHSA utilized the Nurse Family Partnership (NFP) model of home visiting for over 25 years but re-procured the services per the San Diego County Board of Supervisors (Board) authority on October 25, 2022 (7). At this meeting, the Board authorized a competitive solicitation for an evidence-based home visiting model and approved the extension of the NFP contract through August 31, 2026, to allow for client transition. The procurement resulted in a contract with American Academy of Pediatrics using the Healthy Families America (HFA) model, which has been implemented by HHSA Medical Care Services (MCS) and the Public Health Nursing (PHN) staff. Additionally, the First 5 Commission (First 5) has been operating a home visiting program using the HFA model since 2013, which is administered through contracted providers employing a trained, community-based, culturally responsive family support specialist.
Evidence shows that parents following the HFA model gain knowledge regarding their child’s growth and development and interact more positively with their children. Expected outcomes include 48% fewer infants born at low birthweights, increased likelihood of infants being breastfed, increased likelihood of having health insurance, and being linked to a medical home leading to increased well-child visits and developmental screenings. In addition, HFA families are five times more likely to enroll and participate in school training programs, and 27% fewer families were homeless.
In Fiscal Year (FY) 2023-24, First 5 provided home visiting services to 632 families and MCS Home Visiting program provided services for 900 families, countywide. During this timeframe, First 5 continued enrolling families into the HFA model while MCS began the transition of enrolling new families into the HFA model. Due to this recent transition in Spring 2024, no families have completed the MCS HFA program to date. Outcomes will be available as families complete the program.
In FY 2023-24, First 5 outcomes using the HFA model demonstrated positive health trends, including 95% of children being born at or after 37 weeks of gestation, which significantly reduces health risks and supports healthy development. At 30 days postpartum, 97% of children and 95% of primary caregivers were linked to a medical home, ensuring consistent healthcare access and preventive care. Additionally, by 12 months, 97% of children were up-to-date with Well Baby checks, indicating strong adherence to healthcare guidelines and early detection of potential issues.
In FY 2023-24, Medical Care Services, using prior home visiting models, demonstrated several measurable outcomes. From an initial assessment, participants that pursued a higher level of education increased over 15%, and 14% of participants reported an improvement in their employment status contributing to increased economic self-sufficiency. In addition, 76% of participants were screened for maternal mental health concerns, including postpartum depression, resulting in 44% receiving services and support.
In 2024 a business process review was conducted to examine HHSA home visiting efforts and make recommendations to optimize the program. Recommendations included integrating the existing programs to streamline processes and maximize available revenue, ensure equitable utilization of both PHN and contracted family support specialist resources, and increase access to the program. To implement these recommendations, a new contract(s) must be established to integrate the expertise of both disciplines and provide a more comprehensive approach that is case specific and thus more efficient in assigning the appropriate level of staff required to meet the families’ needs.
The transdisciplinary approach to the Home Visiting program integrates County PHNs and contracted staff for day-to-day operations, and communication processes to enhance case management activities. Selected providers will coordinate service delivery with PHNs to ensure that each family is provided with the appropriate level of service based on need. The HFA model is designed to meet social and parenting needs, while a PHN focuses on important health needs such as reducing pre-term births and supporting clients with complex health issues.
Today’s action requests the Board authorize the Director, Department of Purchasing and Contracting to issue a competitive solicitation for Evidence-Based Home Visitation Services. If approved, this action will maximize enrollment efficiency, provide timely service, and centralize and streamline program access with the goal of increasing the number of families served over time.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed action supports the County of San Diego 2025-2030 Strategic Plan initiatives of Sustainability (Economy and Resiliency) and Community (Engagement, Quality of Life, Communications, and Partnership) as well as the regional Live Well San Diego vision of healthy, safe and thriving communities. This is accomplished by delivering resources to families who are at risk for adverse childhood experiences. These efforts empower our workforce by fostering innovation to implement best practices in home visiting services to increase the well-being of families and their children. Additionally, the transdisciplinary home visiting approach supports flexibility within the PHN workforce to ensure the capability to respond to urgent needs while home visiting services are maintained.
Respectfully submitted,
ebony n. shelton
Chief Administrative Officer
ATTACHMENT(S)
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