Item 4

Monthly Financials and Detailed

breakdown of Program: Oral Health

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INITIATIVE SPENDING UPDATE Report to the Budget & Finance Committee

1. Initiative: Children’s Dental Care Program

* Children’s Dental Care Program is composed of three strategic partnerships with: • University of California, Los Angeles (UCLA) • Western University • University of Southern California (USC)

2. Financial status:

CDCP1 $ % Spent a. FY 2013-14 approved budget- TOTAL $9,789,879 57%

FY 2013-14 approved budget- UCLA $3,183,704 38% FY 2013-14 approved budget- Western $3,116,964 89%

FY 2013-14 approved budget- USC $3,489,211 46% b. Amount spent as reported in the June 2014

Monthly Financial report - TOTAL $5,578,738

Amount spent-UCLA $1,222,542 Amount spent -Western $2,763,971

Amount spent -USC $1,592,225 3. Brief purpose & history of the initiative: The Children's Dental Care Program (CDCP), approved by the Commission in June of 2012, is a partnership with three universities, UCLA, USC and Western University, to provide preventative and treatment services to 95,000 children from March 1, 2013 – March 31, 2018. CDCP was developed as a response to the great demand for children’s dental care needs in LA County, First 5 LA expanded existing dental care investments to provide children (ages 0 – 5) with continued dental care over the next 5 years. The program aims to serve these children through the following activities:

• Prevention: children’s education, screening and fluoride varnish • Treatment: emergency restorative, special needs, and sedation services • Parent services: appropriate education of parents and care takers, and assistance

linking to other services • Link to Dental Homes • Care coordination: ensure that children referred receive care • Professional development: for primary care physicians, general dentists, nurses and

hygienists • Use of emerging technologies to increase access • Residency and Post-Residency dental training • Capital Improvements

4. Implementation status/update of programs(s): UCLA-CDCP In Year 1, FY 13-14, the project established the infrastructure and staffing for implementation and provided capital funding to San Fernando Community Health Center to complete the expansion of its dental clinic from 4 to 10 operatories. This project was completed in July 2014 and the clinic is currently working toward acquiring FQHC status. A Request for Applications (RFA) to select the 10 1 The budget numbers included in this document represent 16 months (March 2013- June 2014) as this is the contracted project period for CDCP projects.

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clinics or community dental providers was also developed during FY 13-14 and released 3/25/14. A total of 6 clinics have been identified to date. Western- CDCP In Year 1, FY 13-14, the project established and maintained current partnerships with school districts and community sites to provide services to children and families. A partial list of community and school sites include Pomona Unified School District, El Monte City School District, Los Angeles Unified School District (Center for Oral Health), Mountain View School District, PHFE WICS, and the LA County Office of Education. As a result of the work completed in partnership with these sites, Western University served over 2,300 children through preventative and therapeutic services. In addition, Western provided parent education regarding early childhood oral health needs and milestones to over 2,300 parents/caregivers. Last, 285 dental providers received training on preventative screenings, assessment and pediatric dental services. USC- CDCP In Year 1, FY 13-14, the project established community outreach sites which include but are not limited to the Mexican American Opportunity Foundation, Los Angeles Child Guidance Center, Hawthorne Unified, Lynwood Unified, and South Bay Children’s Health Center. These sites provide a basis from which the USC CHAMP + Project case management team provides outreach and services to children and families. Through USC’s case management model, the project has served over 6,100 children through treatment and linkages to a dental home. In addition, 10,355 parents were provided parent education regarding early childhood oral health needs and milestones. Last, USC provided training to 244 providers on preventative screenings, assessment and pediatric dental services. 5. Reasons for the unanticipated rate of spending UCLA-CDCP The main reason for the unanticipated rate of spending was a delay in the clinic selection process due to UCLA staff turnover and challenges in identifying clinics that met the selection criteria. The FY 13-14 budget ($3,183,704) included administrative and subcontract expenses based on the implementation of the program at 10 sites for 6 months in FY 13-14. The 10 clinic subcontracts and related subcontractor costs of approximately $1.6 million comprised approximately 50% of the total budget. Since clinics were not selected by the end of FY 13-14, there were no expenditures for the clinic subcontracts. Associated UCLA personnel and other program costs for this component of the project were also not fully expended. These expenditures will begin to accrue in FY 14-15. The primary contributors to clinic selection delay were as follows:

• Selection Criteria and CDCP Geographic Focus: Criteria to select the clinics included high numbers of underserved children, ability to serve and expand dental services to 0-5 children, geographic location and distribution of the clinics. Because each of the three CDCP partners (USC, Western, UCLA) target specific regions of LA County and 12 Dental Home clinics have already been selected through the Dental Home Project, UCLA faced challenges in identifying a pool of providers who met their clinic selection criteria. UCLA has recommended six clinics that meet the criteria and is working with First 5 LA on the final recommendations to complete the selection process so the project can begin providing services in FY 14-15 to meet its goal of serving 6,000 children.

• UCLA Personnel Turnover: The Project Manager left early in FY 13-14 and the position was not filled until the end of the fiscal year. This impacted UCLA’s progress on clinic selection.

Another contributor to the unanticipated rate of spending was the completion of the San Fernando Community Health Center Capital Project in July 2014 after the end of the fiscal year. The Project expended approximately $200,000 in FY 13-14, and the final invoice for the remaining $250,000 of renovation costs will be expended FY 14-15.

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Western- CDCP Western University was on target for spending in Year 1 of the project. The agency spent about 89% of their budget for FY 13-14. The majority of under spending for the year can be attributed to staff turnover and unfilled positions in the Personnel and Contracted Services section of the budget. USC- CDCP The main reason for the unanticipated rate of under spending was a result of delayed program start-up/implementation. As a result, many personnel and sub-contracted positions went unfilled. For example, a majority of the unfilled positions were due to a delay in opening the VIP Dental Clinic at the Los Angeles County + USC Medical Center campus. This newly constructed clinic is a partnership between LA County, USC and VIP Community Mental Health Center (VIP). Through a grant with First 5 LA, VIP constructed a new pediatric clinic and USC would be responsible to operate and staff the clinic. Due to delays in construction, release of permits and securing a MOU between the county and USC, the clinic did not open during FY 13-14 as originally scheduled. The clinic is now estimated to open by June 2015. In addition, there was also a large amount of underspent funds in program supplies. Program supplies were budgeted based on full implementation however due to delays the need for program supplies was less than anticipated. Last, it is important to note, that while there were delays in hiring staff and operating at full capacity, the program was able to meet target goals, including number of children served and number of providers trained, for the year.

INITIATIVE SPENDING UPDATE

Report to the Budget & Finance Committee

1. Initiative: Oral Health and Nutrition-Dental Home 2. Financial status:

Dental Home $ % Spent a. FY 2013-14 Funding level $3,401,568 b. Amount spent as reported in the June 2014 Monthly

Financial report $2,084,784 61%

3. Brief purpose & history of the initiative: The UCLA 21st Century Dental Home Project (DHP) is a 3.5 year, $9,239,000 effort that began July 1, 2012 and will continue through December 31, 2015. The DHP seeks to increase access to dental care for 13,000 children ages 0-5 and perinatal women by establishing dental homes1 in 12 Federally Qualified Health Centers (FQHCs) countywide. In partnership with the 12 FQHCs, Safety Net Solutions/Dentaquest, and Childcare Alliance of LA County (CCALA), the program aims to be a comprehensive, sustainable model that uses integrated service delivery to link local healthcare providers, childcare providers and families of children ages 0-5. The FQHCs are implementing systems and capacity building/infrastructure improvements, and employing strategies to expand/modify existing dental operatories, improving the quality and efficiency of dental services and operations, and integrating medical and dental services within the clinic so children can receive more comprehensive services. Participating FQHCs are AltaMed Health Services Corporation (Bell, El Monte, and First Street), Antelope Valley Community Clinic (Palmdale and Lancaster), Arroyo Vista Family Health Foundation (Highland Park and Lincoln Heights), Clínica Monseñor Oscar A. Romero, Community Health Alliance of Pasadena (Fair Oaks), Comprehensive Community Health Centers (Glendale), El Proyecto del Barrio, and St John’s Well Child and Family Center (Louis C. Frayser Health Center). Clinic Enhancement Plans were developed through an intensive assessment and planning process in the initial project phase led by Safety Net Solutions (the DHP subcontractor responsible for strengthening clinics’ business practices), who will guide each clinic’s implementation of these plans in partnership with UCLA. As a part of the Enhancement Plans, clinics are scheduling 1-2 half-day sessions with a goal of serving 12-20 children ages 0-5 per week. All clinics will also hire a Community Dental Home Coordinator to help patients establish dental homes and facilitate referrals as needed, provide parent education, and serve as a liaison between dental and other pediatric medical practitioners, and early care and education providers. Additionally, clinics will aim to improve coordination of care between primary health care and dental professionals. The DHP is also working with subcontractor CCALA to provide training to 1,500 early care and education providers in the 12 FQHC geographic service areas to increase knowledge and awareness of the importance of oral health for young children. 4. Implementation status/update of programs(s): In Year 1 (FY 12-13) of the project, UCLA established staffing and project infrastructure,

completed selection of 12 FQHCs and initial site assessments in order to develop “Clinic Enhancement Plans,” which delineate specific operational and service delivery improvements that will occur through the project.

1 Dental Home is defined by the American Academy of Pediatric Dentistry as the ongoing relationship between the dentist and the patient, inclusive of all aspects of oral health care delivered in a comprehensive, continuously accessible, coordinated, and family-centered way. Establishment of a dental home begins no later than 12 months of age and includes referral to dental specialists when appropriate. http://www.aapd.org/.

In Year 2 (FY13-14), major accomplishments included: • Execution of 11 Clinic Subcontracts* – included the completion of individual Clinic

Enhancement Plans that delineate clinic capacity building activities/ training, staffing (ie. each clinic hired a Community Dental Home Coordinator and a pediatric dentist), and infrastructure improvements such as capital expansion, health information technology /dental equipment, and improvements that make clinic waiting rooms more child-friendly;

• Direct Services -15,960 children received oral health services from January – July 2014 at 11 participating FQHC’s;

• Clinical Provider Training - Over 100 clinic staff received basic and advanced training on pediatric dentistry, disease management, etc.

5. Reasons for the unanticipated rate of spending: The major reason for the unanticipated spending rate was due to delays in executing the 12 clinic subcontracts, which contributed to 67% of the FY 13-14 budget, or $2,296,854. Clinic subcontracts were finalized January 1, 2014 and direct services began in Q3 of FY 13-14; therefore, FY 13-14 costs reflect only 6 months of direct services and related program activities. The delays in subcontract execution and subsequent program implementation was due to additional time required to ensure the equity and appropriateness of the clinic enhancement plan budgets across the 11 FQHCs (which included developing an incentive pool for high performing clinics), and to address HIPPA and other legal issues with the FQHC’s. The delay also impacted individual clinics’ ability to expend funds in personnel areas such as the Pediatric Dentists and Community Dental Home Coordinators. Due to these reasons, $1,224,242, or just over half of the clinic subcontract costs and the associated direct services and other performance objective outcomes were carried over to the FY 14-15 budget and performance matrix.

*Subcontract with the 12th clinic will be executed in FY 14-15.

FISCAL YTDFY 2013-14 JUNE FISCAL YTD BALANCE EXPENDITURES/BUDGET* EXPENDITURES EXPENDITURES REMAINING BUDGET

%PLACE-BASED INITIATIVES

Best Start - Community Funding 9,370,507 2,110,325 5,626,067 3,744,440 60%Best Start - Family Strengthening 20,069,423 9,810,602 17,985,830 2,083,593 90%

COUNTYWIDE STRATEGIESData Systems Integration 1,436,150 295,494 1,038,809 397,341 72%Health Access (Healthy Kids) 4,692,219 1,621,625 6,155,279 (1,463,060) 131%Information Resource & Referral (211) 1,259,295 195,169 1,185,870 73,425 94%Policy Advocacy Fund (PAF) 3,662,057 980,057 2,909,919 752,138 79%Policy Agenda/Agency Advocacy 541,900 119,043 374,370 167,530 69%Public Education 2,309,500 565,128 1,300,559 1,008,941 56%Public Education - Conference Funding Grants 150,000 50,000 78,025 71,975 52%Resource Mobilization 2,491,402 605,588 700,422 1,790,980 28%Resource Mobilization - Early Head Start Matching Grants 670,810 197,001 645,813 24,997 96%Resource Mobilization - Challenge Grants/Social Enterprise Grants 1,420,000 49,233 1,402,528 17,472 99%Resource Mobilization - Donors Choose 112,500 12,469 112,500 - 100%Resource Mobilization - LA PECHI/Baby Futures Fund 550,000 52,477 389,029 160,971 71%Resource Mobilization - Matching Grant Program 1,294,796 313,979 1,264,039 30,757 98%Workforce Development - Cares Plus 2,000,000 1,290,013 1,993,828 6,172 100%Workforce Development - P-5 Core Competencies 520,000 161,330 358,243 161,757 69%

COUNTYWIDE INITIATIVESBlack Infant Health 1,161,986 509,317 1,158,961 3,025 100%Children's Dental Care 9,827,806 1,786,158 4,902,459 4,925,347 50%Children's Vision Care 876,000 165,637 957,208 (81,208) 109%Data Partnership with Funders 1,105,000 54,035 446,330 658,670 40%Early Identification and Intervention of Autism and Developmental Delays 550,000 99,707 136,252 413,748 25%ECE Environmental Scan 581,600 44,100 370,800 210,800 64%Healthy Food Access 1,653,326 344,305 1,337,016 316,310 81%Infant Safe Sleeping 35,435 - 23,034 12,401 65%Infant Safe Sleeping - Public Education 413,595 - 340,255 73,340 82%Infant Safe Surrender 271,686 - 270,484 1,202 100%Little by Little/One Step Ahead 2,887,728 729,807 1,627,444 1,260,284 56%Parent Child Interaction Therapy 4,464,855 2,733,621 3,912,661 552,194 88%Peer Support Groups for Parents 798,257 189,034 307,392 490,865 39%Permanent Supportive Housing 10,000,000 - 10,000,000 - 100%Reducing Childhood Obesity 10,776,128 4,414,919 7,376,464 3,399,664 68%Substance Abuse Services 5,314,768 2,669,248 5,198,877 115,891 98%Tot Parks and Trails 5,599,866 1,190,495 4,263,580 1,336,286 76%Universal Assessment of Newborns 6,253,127 144,895 2,179,260 4,073,867 35%Workforce Development - ECE Career Development Policy Project 949,490 257,663 950,509 (1,019) 100%Workforce Development - ECE Workforce Consortium 11,733,055 7,211,481 11,622,557 110,498 99%Workforce Development - Kindergarten Readiness 32,580 200 32,780 (200) 101%

PRIOR STRATEGIC PLAN INITIATIVESBaby Friendly Hospitals 2,737,605 795,048 2,078,925 658,680 76%Community Opportunities Fund 603,878 153,323 595,768 8,110 99%Family Friends and Neighbors (FFN) 1,000,000 283,682 934,339 65,661 93%Family Literacy 1,631,720 310,786 1,510,599 121,121 93%Family Place Libraries 265,945 20,524 208,209 57,736 78%Healthy Births 1,924,012 (60,124) 1,540,240 383,772 80%LAUP 52,191,683 11,091,599 58,330,374 (6,138,691) 112%Dental Home (OHN) - 1,654,684 2,084,784 - 0% (1)Oral Health & Nutrition - Safety Net Dental Care Infrastructure 498,502 87,005 339,941 158,561 68%Oral Health & Nutrition (OHN) 1,458,315 256,965 1,318,972 139,343 90%Oral Health Community Development 55,587 - 3,674 51,913 7%Partnerships for Families (PFF) 10,912,168 2,507,780 9,953,050 959,118 91%School Readiness Initiative 1,099,126 (9,673) 1,014,818 84,308 92%The Children's Council 1,873,722 465,267 1,911,692 (37,970) 102%

RESEARCH AND EVALUATION PROJECTSData Development 2,958,478 726,968 2,439,107 519,371 82%Program Evaluation 5,847,469 1,979,223 4,281,867 1,565,602 73%Research Partnerships 412,502 91,395 339,602 72,900 82%Results Dissemination 50,000 6,244 10,943 39,057 22%

TOTAL 213,357,559 61,334,851 189,832,359 25,609,984 89%

NOTES - EXPENDITURES BY FY 2013-14 PROGRAM BUDGET:

* The FY 2013-14 Program Budget was approved by the Board of Commissioners on June 13, 2013.

(1) The Dental Home Project (OHN) was given a cash advance in October 2012 and reported as an asset in the Statement of Net Assets of First 5 LA. An amount was not included in the budget for FY 2013-14; funds expended during the fiscal year are drawn down from the advance.

LOS ANGELES COUNTY CHILDREN AND FAMILY FIRST - PROPOSITION 10 COMMISSION (AKA FIRST 5 LA)EXPENDITURES BY FY 2013-14 PROGRAM BUDGET

JUNE 30, 2014, AUDITED

Budget and Finance Committee Meeting

December 11, 2014

First 5 LA Oral Health Investments

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• Since 2012, $47 million to improve oral health access through two projects:

1. 21st Century Dental Home Project -UCLA

2. Children’s Dental Care Program(CDCP) -Western University, USC and UCLA

• Together the Dental Home Project and CDCP will serve 108,000 children over the course of 5 years

• Served 24,392 children countywide in FY 13-14

Dental Home and Children’s Dental Care Program Overview

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Program goal • Increase access to oral health services for 13,000 children

prenatal to age 5 by establishing dental homes in 12 Federally Qualified Health Centers (FQHC's) countywide

Program overview • 3.5 year, $9.2 million program began July 1, 2012 • UCLA is the project lead, working with Safety Net Solutions and

the Childcare Alliance of Los Angeles County

Dental Home Project (DHP)

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• Clinic Subcontracts executed January 1, 2014 to begin implementing enhancement plans, including direct services

• Dental services provided to 5,056 children from January through

June 2014 • Over 100 clinical providers and 800 early care and education

providers trained

DHP Implementation Status

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• Approximately 60% of the $ 3.4 million FY 13-14 budget was spent

• Primary contributors to lower than anticipated rate of spending include:

• 6-month delay in execution of subcontracts with 12 clinics

• Delay in hiring clinic personnel

• Clinic expenditures less than ½ of projected

DHP FY13-14 Budgeted vs. Actual Expenditure

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• CDCP was approved by the Commission in June 2012

• Expanded existing First 5 LA dental care investments with UCLA, Western University and USC

• Total investment: $38 million over 5 years (March 2013 to March 2018)

• Through the course of the project, CDCP will serve 95,000 children through preventative and therapeutic treatments

Children’s Dental Care Program (CDCP)

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• Provided capital funding to San Fernando Community Health Center for dental clinic expansion

• Completed in July 2014 • Released Request for Applications (RFA) to select 10 clinics to

participate in the project

• 6 clinics identified to date

UCLA CDCP Implementation Status

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• Established partnerships with community sites and school districts for service delivery

• Served over 2,300 children through preventative and therapeutic services

• 285 dental providers received training on preventative screenings, assessment and pediatric dental services

• Provided pediatric dental training to 279 dental students

Western CDCP Implementation Status

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• Established community outreach sites

• Hired case management teams consisting of social work intern, oral health promotora, and a benefits enrollment specialist

• Served over 6,100 children through treatment and linkages to a dental home

• Provided 10,355 parents education regarding early childhood oral health needs and milestones

• Trained 244 providers on preventative screenings, assessment and pediatric dental services

USC CDCP Implementation Status

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CDCP FY13-14 Budgeted vs. Actual Expenditure

• Total budget for Year 1 of the CDCP project was $9,789,879 • During Year 1, contractors expended 57% of the total budget

($5,578,738)

• Primary contributors to lower than anticipated rate of spending include:

• Overall delays in full project implementation • Clinic selection delay • Issues with capital project invoicing • Staff turnover and unfilled personnel positions

Questions