SUBJECT
Title
AUTHORIZATION TO ACCEPT PERINATAL EQUITY INITIATIVE FUNDING AND AUTHORIZATION TO PURSUE FUTURE FUNDING OPPORTUNTIES FOR PERINATAL HEALTH EQUITY (DISTRICTS: ALL)
Body
OVERVIEW
The San Diego County Board of Supervisors (Board) has authorized the acceptance of California Department of Public Health Maternal, Child, and Adolescent Health Division Title V Maternal and Child Health (MCH) Block Grant funding since 1998. MCH Block Grant funding addresses health disparities in African-American birth outcomes by implementing the Black Infant Health (BIH) Program in San Diego County. The 2018-19 California State Budget Act established the California Perinatal Equity Initiative (PEI) to expand the BIH program. Counties that implement BIH programs were eligible to receive PEI funding, and the County of San Diego received a PEI grant allocation of $968,620 on November 13, 2019, for the grant period of October 1, 2019 through June 30, 2021.
Today’s action requests the Board to approve and authorize the Clerk of the Board, upon receipt, to execute the anticipated PEI grant allocation for the grant period of July 1, 2021 through June 30, 2023, for $968,620. Authorization is also requested to apply for additional funds to help improve perinatal health equity for San Diego County residents. Today’s action supports the Live Well San Diego vision by enhancing services provided to families and increasing quality of services to mothers, children, and families, which will result in a healthy, safe, and thriving community.
RECOMMENDATION(S)
CHIEF ADMINISTRATIVE OFFICER
1. Authorize the acceptance of $968,620 in funds from the California Department of Public Health, Maternal, Child, and Adolescent Health Division for the period of July 1, 2021 through June 30, 2023, for the Perinatal Equity Initiative grant. Authorize the Clerk of the Board, upon receipt, to execute all required grant documents, including any annual extensions, amendments, and/or revisions thereto that do not materially impact or alter the services or funding level.
2. Authorize the Agency Director, Health and Human Services Agency, to apply for additional funding opportunity announcements, if available, that address improvement of perinatal health equity for San Diego County residents.
FISCAL IMPACT
Funds for this request are included in the Fiscal Year 2021-23 CAO Recommended Operational Plan in the Health and Human Services Agency. If approved, this request will result in costs and revenue of $484,310 in Fiscal Year 2021-22 and costs and revenue of $484,310 in Fiscal Year 2022-23. The funding source is the Perinatal Equity Initiative grant from the California Department of Public Health. There will be no change in net General Fund cost and no additional staff years.
BUSINESS IMPACT STATEMENT
N/A
Details
ADVISORY BOARD STATEMENT
The Health Services Advisory Board voted to support the recommendations at its meeting on May 4, 2021.
BACKGROUND
The health and well-being of mothers, infants, and children are important markers of the overall
health of a society. Inequities and disparities are serious public health concerns with social and
economic implications, such as poor health outcomes and increased healthcare costs. According
to the National Center for Health Statistics, African-American infants are more than twice as likely as white infants to die before reaching their first birthday. In San Diego County the statistics are as follows:
• Fetal mortality rates for African Americans are more than double that of whites (2016-
2018 fetal mortality rates: 7.0 vs. 3.4 deaths per 1,000 fetal deaths and live births),
• Infant mortality rates for African Americans are nearly triple that of whites (2016- 2018 infant mortality rates: 7.5 vs. 2.7 deaths per 1,000 live births),
• African-American infants are more than 50% more likely to be born preterm compared to white infants (11.2% vs. 7.2% in 2017- 2019), and
• African-American infants are nearly twice as likely to be born with low birthweight compared to white infants (10.1% vs. 5.4% in 2017- 2019).
Designed to address these and other inequities, the County of San Diego Health and Human Services Agency, Public Health Services implements the Black Infant Health (BIH) program. To improve the birth outcomes of African-American infants, the BIH program provides a group-based approach with client-centered management to help develop life skills, learn strategies for reducing stress and build social support among African-American pregnant women. Program outcomes in Fiscal Year 2019-20 included:
• 100% (104 of 104) of participants received information about the importance of not inducing deliveries before 39 weeks,
• 96% (54 of 56) of singleton infants (non-multiple births) born to women who participated in the BIH program for whom birthweight information was available were of normal birthweight (2,500 grams or more), and
• 93% (53 of 57) of infants-initiated breastfeeding at birth, and 82% (32 of 39) of infants assessed at three months of age were breastfeeding at that time.
The 2018-19 State of California Budget Act legislation established the California Perinatal Equity Initiative (PEI) to address the causes of persistent inequality and identify best practices to deal with disparities in infant mortality. The PEI promotes the use of specific interventions designed to fill gaps in current health departments to promote leadership and coordination for widespread and lasting change in public awareness and in public health and clinical practice. Counties that implement a BIH program were eligible to receive a PEI funding allocation. During Fiscal Years 2021-2023, the PEI program aims to achieve the following outcomes:
• Implementation of an evidence-informed fatherhood intervention that supports
engagement of 50 partners during pregnancy and childbearing;
• Implementation of an evidence-informed intervention providing implicit bias training in 60 healthcare provider offices to improve relationships among providers and their African-American pregnant clients, and improve birth outcomes;
• Maintenance of a Community Advisory Board to support the work activities of the PEI program; and
• Maintenance of a public awareness campaign that educates and engages the community in the inequities of birth outcomes and the importance of preconception health.
PEI media services included formative research with African-American women who are pregnant or of child-bearing age, fathers, and health care professionals, to determine campaign designs and messages. The Black Legacy Now media campaign was developed and included a website (<https://blacklegacynowsd.com/)>, a Facebook page, and an Instagram page. If funding is approved, the Black Legacy Now campaign, along with the Father2Child II fatherhood program, Implicit Bias Educational Trainings for peripartum healthcare providers and staff, and the active and vocal PEI community advisory board will continue. The PEI program aligns with the Board’s January 12, 2021 (8) resolution declaring racism a public health crisis by working to advance equity and raising awareness of poor birth outcomes and inequities among African Americans, and to address the role of bias and racism, particularly in health care settings, in contributing to these birth outcomes. These efforts help reduce disparities in African-American maternal and infant health outcomes and would be worthy of County funding if grant funding was not available.
Today’s action requests Board authority to accept $968,620 in PEI grant funding from the CDPH, Maternal, Child and Adolescent Health Division for the period of July 1, 2021 through June 30, 2023, and authorize the Clerk of the Board, upon receipt, to execute the new two-year grant documents. Authorization is also requested to apply for additional funds to help improve perinatal health equity for San Diego County residents.
LINKAGE TO THE COUNTY OF SAN DIEGO STRATEGIC PLAN
Today’s proposed actions support the Healthy Families Strategic Initiative in the County of San
Diego’s 2021-2026 Strategic Plan, as well as the County of San Diego’s Live Well San Diego
vision by ensuring that San Diego County has fully optimized its health service delivery system
for mothers, children, and families to be healthy, safe, and thriving.
Respectfully submitted,
HELEN N. ROBBINS-MEYER
Chief Administrative Officer
ATTACHMENT(S)
N/A
AGENDA ITEM INFORMATION SHEET
REQUIRES FOUR VOTES: ☐ Yes ☒ No
WRITTEN DISCLOSURE PER COUNTY CHARTER SECTION 1000.1 REQUIRED
☐ Yes ☒ No
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PREVIOUS RELEVANT BOARD ACTIONS: December 10, 2019 (12), Acceptance of Perinatal Equity Initiative Grant Allocation; August 6, 2019 (10), Authorize the acceptance of grant funds from the California Department of Public Health (CDPH) for the Title V Maternal Child Health (MCH) Block Grant Allocation, and authorize the Agency Director to apply for any additional funding opportunity announcements to address early intervention and treatment programs for at risk women; June 28, 2016 (11), Waive Board Policy B-29, approve, authorize and execute agreements for the Title V MCH Block Grant Allocation; September 10, 2013 (9), Authorize the Clerk of the Board to execute an agreement with CDPH for the MCH Title V Block Grant Allocation for Fiscal Year (FY) 2013-14 through FY 2015-16; December 8, 2009 (14), Authorize the Clerk of the Board to execute the MCH Title V Block Grant Allocation agreement for FY 2010-11 through FY 2012-13; February 12, 2002 (2), Authorize competitive procurement of a contract to provide Black Infant Health program services; June 16, 1998 (31), Approve an augmentation to the FY 1997-98 allocation, approve the FY 1998-99 State allocation and other actions to implement the programs; and June 3, 1997 (25), Approve the MCH Title V Block Grant Allocation to support the PCN and other Children, Youth and Families activities for FY 1997-98. |
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BOARD POLICIES APPLICABLE: B-29 Fees, Grants, Revenue Contracts - Department Responsibility for Cost Recovery |
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BOARD POLICY STATEMENTS: The Agency Director, Health and Human Services Agency, certifies that the perinatal equity activities funded by this grant would be worthy of funding with County resources if external financing were unavailable. |
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MANDATORY COMPLIANCE: N/A |
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ORACLE AWARD NUMBER(S) AND CONTRACT AND/OR REQUISITION NUMBER(S): N/A |
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ORIGINATING DEPARTMENT: Health and Human Services Agency |
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OTHER CONCURRENCE(S): |
N/A |
CONTACT PERSON(S):
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Wilma J. Wooten, M.D., M.P.H. |
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Adrienne Yancey, M.P.H. |
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Name |
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Name |
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(619) 542-4181 |
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(619) 692-8430 |
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Phone |
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Phone |
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Wilma.Wooten@sdcounty.ca.gov |
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Adrienne.Yancey@sdcounty.ca.gov |
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E-mail |
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E-mail |