Vernon City Council
July 16, 2024

SAMHSA GRANT PROGRAM AGREEMENT BETWEEN THE CITY OF VERNON

AND ALTAMED HEALTH SERVICES FOR ON-THE-STREETS PORTABLE

CLINICAL CARE WITH INTEGRATED BEHAVIORAL HEALTH AND HIV CARE

COVER PAGE
Provider: AltaMed Health Services
Responsible Principal of Provider: Paula Jamison, Sr. VP Notice Information – Provider: AltaMed Health Services
2040 Camfield Avenue
Los Angeles, CA 90040
Attention: Paula Jamison, Sr. VP
Telephone: (323) 303-2476
Notice Information - City: City of Vernon
4305 Santa Fe Avenue
Vernon, CA 90058
Attention: Freddie Agyin,
Director of Health &
Environmental Control
Telephone: (323) 583-8811 ext. 840
Commencement Date: July 16, 2024
Termination Date: September 29, 2026
Consideration: Total not to exceed $1,499,175(includes
all applicable sales tax); and more
particularly described in Exhibit B

SAMHSA GRANT PROGRAM AGREEMENT BETWEEN THE CITY OF VERNON AND

ALTAMED HEALTH SERVICES FOR ON-THE-STREETS PORTABLE CLINICAL CARE

WITH INTEGRATED BEHAVIORAL HEALTH AND HIV CARE
THIS GRANT PROGRAM AGREEMENT ("Agreement") is entered into on July 16, 2024, by and between the City of Vernon, a California charter City and California municipal corporation ("City") and AltaMed Health Services, a California corporation (“Provider”). City and Provider are sometimes hereinafter individually referred to as “Party” and hereinafter collectively referred to as the “Parties.”

R E C I T A L S
A. The City has been awarded a grant for On-the-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care (“Project”) by the Substance Abuse and Mental Health Services Administration (“SAMHSA”).

B. The City as part of accepting the grant has agreed to SAMHSA’s Terms and Conditions and Special Terms and Conditions in the Notice of Award from SAMHSA to City (“Notice of Award”).

C. Provider is able and willing to abide by all the terms of the SAMHSA Terms and Conditions and Special Terms and Conditions in the Notice of Award.

D. City desires to enter into this Agreement for Provider to provide the services required by the SAMHSA Project.

E. Provider desires to enter into this Agreement with City to provide the services for the City and SAMHSA as required by the Project.

A G R E E M E N T
NOW, THEREFORE, in consideration of the mutual promises and covenants made by the Parties and contained herein and other consideration, City and Provider hereby agree as follows:

1. TERM. This Agreement begins on the July 16, 2024 and expires on September 29, 2026 (“Term”), unless terminated earlier in accordance with the terms herein.

2. SERVICES.

2.1 Scope of Work. Provider shall perform all work necessary to complete the services set forth in the City’s Request for Proposals issued on or about May 20, 2024, and titled RFP for On-The-Streets Portable Clinical Care with Integrated Behavioral Health and HIV Care, and the Scope of Work attached hereto as Exhibit “A”.

2.2 Invoices. Provider must complete the Scope of Work for the Project and submit properly itemized invoices to the satisfaction of the City and in the format attached hereto as Exhibit “B”, with all relevant information necessary for the City to complete the reporting requirements in SAMHSA’s Notice of Award attached hereto and incorporated by reference herein as Exhibit “C”. Provider invoices must include the position of any person performing billable work, the hours and location worked, and what billable work was completed. In addition to the invoice template requirements, Provider agrees to comply with the terms and conditions set forth in the SAMHSA Notice of Award, including but not limited to funding conditions, detailed narrative/justification for all costs, and required reports.

2.3 The SAMHSA award number must be included on all invoices.

2.4 Payment. Subject to the conditions and requirements set forth herein, City agrees to pay Provider a sum not to exceed $1,499,175 for work performed under this Agreement. Provider acknowledges that it is familiar with the section of the SAMHSA Notice of Award titled “Funding Limitations” and agrees to comply with its provisions.

2.5 Use of Grant Monies. Provider use of any Project funds must comply with the Contractor Agreement between the City and SAMHSA. Provider must comply with all applicable federal laws and regulations, including Code of Federal Regulations (C.F.R) Part 200 (Uniform Administrative Requirements, Costs Principles, and Audit Requirements for Federal Awards), and 45 C.F.R. Part 75 (Uniform Administrative Requirements, Cost Principles, HHS Grants Policy Statement, and Audit Requirements for HHS Awards). It is Provider’s responsibility to understand and comply with all requirements set forth therein.

2.6 Services Limited to Term. No services shall be rendered by Provider under the Project after September 29, 2026 and no payments will be made by City for services rendered under the Project after September 30, 2026.

3. COMPLIANCE WITH CONTRACTOR AGREEMENT BETWEEN CITY
AND SAMHSA AND INDEMNIFICATION OF CITY.

3.1 Provider agrees to comply with all the provisions of the Contractor Agreement between the City and SAMHSA. Provider must indemnify, defend (with counsel reasonably acceptable to City), protect and hold City, and its officers, employees, agents and representatives, harmless from, any and all claims of any kind or nature arising out of the Project or this Agreement or the implementation hereof, including, but not limited to, any damages to property, injuries to persons or accidental death (including reasonable attorneys’ fees and costs), which may be caused by work performed under this Agreement or any activities associated with the Project, whether such activities or work is performed by Provider or by anyone directly or indirectly employed or contracted by the Provider (“Claims”). Provider’s indemnity obligations under this section will survive termination of this Agreement. Provider’s indemnity obligations under this section do not extend to claims, demands, damages, defense costs or liability for property damage, bodily injury or death occasioned by the willful misconduct of the City, or its officers, employees, agents or representatives.

3.2 Provider hereby waives, releases and discharges forever the City, and its employees, officers, volunteers, agents and representatives, from any and all present and future Claims arising out of or in any way connected with this Agreement, the performance of the Project, or Provider’ obligation to comply with all laws with respect to the Agreement.

4. LEGAL REQUIREMENTS.

4.1 Compliance with Applicable Laws. Provider must comply with all laws applicable to the performance of the Project.

4.2 Nondiscrimination and Equal Opportunity. Provider must not discriminate, on the basis of a person’s race, sex, gender, religion (including religious dress and grooming practices), national origin, ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), marital status, age, sexual orientation, color, creed, pregnancy, genetic information, gender identity or expression, political affiliation or belief, military/veteran status, or any other classification protected by applicable local, state, or federal laws (each a “Protected Characteristic”), against any employee, applicant for employment, subcontractor, bidder for a subcontract, or participant in, recipient of, or applicant for any services or programs provided by Provider under this Agreement.

5. GENERAL PROVISIONS.

5.1 Compliance with Laws. Provider must carry out the Project in conformity with all applicable federal, state and local laws, including Labor Code requirements; all provisions of the City’s Municipal Code; and all applicable disabled and handicapped access requirements, including the Americans with Disabilities Act, 42 U.S. Code Section 12101, et seq., Government Code Section 4450, et seq., Government Code Section 11135, et seq., and the Unruh Civil Rights Act, Civil Code Section 51, et seq., and Executive Order (E.O.) 11246, “Equal Employment Opportunity,” as amended by E.O. 11375, “Amending Executive Order 11246 Relating to Equal Employment Opportunity,” and as supplemented by regulations at 41 C.F.R. Part 60, “Office of Federal Contract Compliance Programs, Equal Employment Opportunity, Department of Labor.”

5.2 Ownership of Materials. Provider hereby transfers and assigns to City all right, title and interest (including copyright rights) in and to all materials created or developed by Provider pursuant to this Agreement, including, without limitation, reports, summaries, articles, pictures and art (collectively, the “Materials”) (subject to any licensed third-party rights retained therein). Provider must inform City in writing of any third-party rights retained within the Materials and the terms of all license agreements to use any materials owned by others. Provider understands and agrees that Provider retains no rights to the Materials and must assist City, upon reasonable request, with respect to the protection and/or registrability of the Materials. Provider represents and warrants that, unless otherwise stated to City in writing, the Materials are original works and do not infringe or violate the rights of any third party or violate any law. The obligations of this paragraph are subject to any applicable requirements of a Federal funding agency.

5.3 Assignment. Without the prior written consent of the City, Provider may not assign this Agreement nor delegate any duties herein.

5.4 Notices, Demands and Communications between the Parties. Any approval, disapproval, demand, document or other notice (“Notice”) which either party may desire to give to the other party under this Agreement must be in writing and may be given by email to the party to whom the Notice is directed at the address of the party as set forth below, or at any other address as that party may later designate by Notice.

If to the City:

City of Vernon
Attention: Freddie Agyin
Director of Health & Environmental Control
4305 Santa Fe Ave
Vernon, CA 90058
Email: [email protected]
If to the Provider:

Provider: AltaMed Health Services
Attention: Paula Jamison
Sr. VP, Population Health Management
Address: 2040 Camfield Avenue
Los Angeles, CA 90040
Email: [email protected]
Notices sent by a party's attorney on behalf of such party are deemed delivered by such party.

5.5 Relationship between City and Provider. It is hereby acknowledged that the relationship between City and Provider is not that of a partnership or joint venture and that City and Provider are not deemed or construed for any purpose to be the agent of the other. Provider agrees to indemnify, hold harmless and defend City from any claim made against City arising from a claimed relationship of partnership or joint venture between City and Provider with respect to the Project or Agreement.

5.6 Entire Agreement. This Agreement, including any exhibits attached hereto, constitutes the entire agreement and understanding between the parties regarding its subject matter and supersedes all prior or contemporaneous negotiations, representations, understandings, correspondence, documentation, and agreements (written or oral).

5.7 Order of Precedence. In case of conflict between the terms of this Agreement and the terms contained in any document attached as an Exhibit or otherwise incorporated by reference, the terms of this Agreement shall strictly prevail.

The terms of the City’s Request for Proposals shall control over the Provider’s Proposal.

5.8 Written Amendment. This Agreement may only be changed by written amendment executed by Provider and the City Administrator or other authorized representative of the City, subject to any requisite authorization by the City Council. Any oral representations or modifications concerning this Agreement shall be of no force or effect.

5.9 Conflicts of Interest. No member, official or employee of City can have any personal interest, direct or indirect, in this Agreement, nor must any such member, official or employee participate in any decision relating to the Agreement which affects his or her personal interests or the interests of any corporation, partnership or association in which he or she is directly or indirectly interested.

5.10 Severability. If any provision of this Agreement is held by any court of competent jurisdiction to be invalid, illegal, void, or unenforceable, such portion shall be deemed severed from this Agreement, and the remaining provisions shall nevertheless continue in full force and effect as fully as though such invalid, illegal, or unenforceable portion had never been part of this Agreement.

5.11 Applicable Law; Venue. The laws of the State of California, without regard to conflict of laws principles, must govern the interpretation and enforcement of this Agreement. In the event of litigation between the Parties, venue in state trial courts lies exclusively in the County of Los Angeles, California Superior Court. In the event of litigation, venue lies exclusively in the United States District Court, Central District of California, in Los Angeles.

5.12 No Third Party Rights. This Agreement is made and entered into solely for the benefit of the City and Provider and no other third party has any right of action under this Agreement.

5.13 Disclosure of Documents. Provider acknowledges that the City is subject to the provisions of the California Public Records Act and that any information submitted to the City may be disclosed to the extent required by law.

5.14 Liability. Provider is wholly liable for any Claims arising out of this Agreement.

5.15 Termination. In addition to City’s right to terminate under Section 1.1, City or Provider may terminate this Agreement for any reason with or without cause upon at least 15 days written Notice to the other in the event that the other party fails to comply with its obligations under this Agreement.

The Parties have executed this Agreement as of the Effective Date. The persons whose signatures appear below certify that they are authorized to sign on behalf of the respective Party.

CITY OF VERNON, California charter AltaMed Health Services, a California City and California municipal corporation corporation
By: By:

Daniel Calleros,
Interim City Administrator Name:

Title:

ATTEST:

By:

Yonnie Parker, Deputy City Clerk
Name:

APPROVED AS TO FORM:

Title:

Zaynah N. Moussa, City Attorney
Exhibit A
Scope of Work

1. During the project period ending September 29, 2026
a. Provide basic primary health care services and supplies to 600 unhoused individuals
b. Conduct 600 screenings and assessments of substance use disorders and cooccurring mental and substance use disorders utilizing a low threshold approach that offers SUD services, including medication assisted Opioid Use disorder and alcohol use disorder with unhoused individuals.
c. Provide 600 unhoused clients with case management including comprehensive assessment of the client’s needs and development of an individualized service plan (including infectious disease prevention/treatment services, funding for treatment, etc) and referral/linkage to treatment as appropriate. d. Screen 600 unhoused individuals and their drug-using and/or sexual partners for HIV, viral hepatitis (B and C), STI’s, Mpox, and tuberculosis and provide HIV testing, using a portable clinical care approach. Note: Hepatitis A testing will also be performed if an outbreak takes place in the area. e. Provide treatment for 210 unhoused individuals and their drug-using and/or sexual partners for HIV, viral hepatitis, STIs, Mpox, and tuberculosis, and provide HIV testing using a portable clinical care approach. f. Navigate 30 unhoused individuals to Mpox testing, treatment and prevention resources, and mental health support.
g. Provide testing to 600 unhoused individuals for STIs (gonorrhea, chlamydia, and syphilis) and provide treatment on-site as needed.
h. Screen 300 unhoused individuals for symptomatic tuberculosis. i. Test 300 unhoused individuals for latent or active tuberculosis j. Provide tuberculosis treatment to 20 unhoused individuals.

2.Prior to grant activities beginning implement infectious disease testing quality assurance measures following established guidelines.

3.Prior to grant activities beginning, develop a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options and develop Memoranda of Agreement (MOAs) with the following, as appropriate:
• Primary HIV treatment and care providers, including Ryan White providers, to strengthen integration of care through case management. • Treatment providers for referrals and linkages to follow-up care and treatment for individuals with viral hepatitis (B or C). • Care providers for referrals and linkages to Pre-Exposure Prophylaxis (PrEP). • Care providers for referrals and linkage to Post-Exposure Prophylaxis (PEP).

4. During the project period ending September 29, 2026, provide evidence-based harm reduction education and supplies including FDA-approved overdose reversal medication as well as drug supply testing and overdose prevention education and services on-site, as allowable under this award and adhering to federal, state, and local laws, regulations, and other requirements related to such programs or services for a total 600 unhoused individuals.

5. During the project period ending September 29, 2026, provide Mental healthcare, treatment, and referral for a total of 300 unhoused individuals including:
a. Screening and assessment of mental health conditions and cooccurring mental and substance use disorders. b. Trauma-informed, culturally responsive, client-centered, evidencebased, recovery- oriented, and integrated mental health and substance use services on-site
c. Deliver or coordinate any services determined to be necessary to address identified mental health conditions

6. During the project period ending September 29, 2026, provide outreach services to 1200 unhoused individuals living in the streets, encampments or other places not meant for human habitation by implementing strategies that effectively reach the people who are experiencing unsheltered homelessness.

7. During the project period ending September 29, 2026, provide 200 unsheltered homeless individuals case management services to address social determinants of health, including housing for a total of unhoused individuals including the following:
• Implementing strategies that effectively reach the people who are experiencing unsheltered homelessness
• Implementing a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options, including collaborating with HUDs Continuum of Care to enroll individuals in the local Coordinated Entry System, as well as the Housing Opportunities for Persons with AIDS program and other public housing options.
• Providing case management services to coordinate all aspects of care, including behavioral health, primary care, infectious disease prevention and treatment, other supportive services (e.g., housing, benefits, employment), and assist with transitions for returning to the community after any hospitalization or emergency room visit as appropriate, including enrolling eligible individuals in health insurance, Medicaid, Medicare, and other benefit programs (e.g., Social Security Disability Insurance and Supplemental Security Income, Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program, prescription assistance programs, etc.), and other human and community-based services as appropriate.

8. During the project period ending September 29, 2026, provide transportation directly to and from referral providers for a total 150 unhoused individuals.

9.Prior to the beginning of service provision, provide training for 100% of staff and service providers on harm reduction strategies, evidence-based practices, motivational interviewing, intensive case management, community reinforcement approach and/or peer supports.

10. During the project period ending September 29, 2026, distribute hygiene kits, safer sex kits and, or equipment and supplies to 1200 unhoused individuals to enhance harm reduction efforts

11. During the project period ending September 29, 2026, utilize telehealth and/or telemedicine services with a total of 25 unhoused individuals

12. At the conclusion of 4 quarters of service delivery, develop policies to support needed service system improvements regarding establishment of standards of care for IBHPC + HIV Street Medicine.

13. Annually throughout the performance period, participate in a virtual learning collaborative to share best practices and lessons learned, as well as brainstorm solutions to challenges faced by members of the learning collaborative.

14. Annually throughout the performance period, document best practices and lessons learned while implementing integrated care using a portable clinical care approach and Disseminate findings from pilot program.

15. Upon completion of the performance period, document best practices and lessons learned for the public through either the development of white papers, participation in conference presentations, a guide to be shared with the public about launching their own portable clinical care program, etc.

Exhibit B
Invoice Requirements
Invoices must be submitted on a monthly basis and include the following information:

1. Project/Activity Name

2. Date (Performance Period)

3. Cost breakdown for proposed reimbursable expenses

4. A detailed description of work by each individual billing services including but not limited to hours worked, key personnel assigned, summary of meetings, staff hired with date of hire, number of clients served, type of services provided, and point of care.,

5. Itemized travel and boarding expense information

6. Adequate support as applicable including:
a. Itemized receipts (including but not limited to copies of reports/supporting documents referenced in Exhibits A, C-D)
b. Staff resumes/credentials
c. Staff training dates and applicable certifications

7. In addition to the invoice requirements noted above, the SAMHSA Grant Application, Notice of Award, and Disparity Impact Statement attached hereto as Exhibits C-E are incorporated herein by reference and Provider agrees to comply with all terms and conditions therein, including but not limited to funding conditions, detailed narrative/justification for all costs, and reporting requirements.

Exhibit C
Grant Application
OMB Number: 4040-0004
Expiration Date: 11 /30/2025
Application for Federal Assistance SF-424
* 1. Type of Submission:

Q Preapplication
Q Application
• Changed/Corrected Application
* 2. Type of Application: * If Revision, select appropriate letter(s):
•New
Q Continuation *Other (Specify)
Q Revision
* 3. Date Received: 4. Applicant Identifier:
7/26/2023
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
-23-024 93.899
State Lase Only:

6. Date Received by State: 7. State Application Identifier:

8. APPLICANT INFORMATION:
* a. Legal Name: he City of Vernon
* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. UEI:
95-6000808 ZMK4GCEKJ7G3
d. Address:
* Street1: 305 Santa Fe Avenue
Street2:
* City: ernon
County/Parish:
* State: CA: California
Province:
* Country: USA: UNITED STATES
* Zip /Postal Code: 90058-1714
c. Organi-rational unit:

Department Name: Division Name:
f. \`ame and contact information of person to he contacted on matters involving this application:

Prefix: *First Name: -
Middle Name:
* Last Name:

Suffix:

Title:

Organizational Affiliation:
* Telephone Number: Fax Number:
* Email:

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024. Received Date: 2023-07-26714:03:34.000-04:00 OMB Number: 4040-0004
Expiration Date: 12/31 /2022
Application for Federal Assistance SF-424
* 9. "Cype of Applicant l: Select Applicant 'Type:

C: City or Township Government
Type of Applicant 2: Select Applicant Type:

Type of Applicant 3: Select Applicant Type:
* Other (specify):
x 10. Name of Federal Agency:

Substance Abuse and Mental Health Services Adminis

11. Catalog of Federal Domestic Assistance Number:

CFDA Title:
x 12. Funding Opportunity Number:
-23-024
* Title:

Minority HIV/AIDS Fund: Integrated Behavioral Health and HIV Care for Unsheltered Populations Pilot Project

13. Competition Identification Number:
-23-024
Title:

Portable Clinical Care Pilot Project

14. Areas Affected by Project (Cities, Counties, States, etc.):

File Name: 1247-Attachment 9.pdf
IS. Descriptive Title of Applicant's Project:

On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care Attach supporting documents as specified in agency instructions.

File Name:

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024. Received Date: 2023-07-26714:03:34.000-04:00 OMB Number. 4040-004
Expf ration Date: 12/31 /2Q22
Application for Federal Assistance SF-424

16. Congressional Districts Of:
* a. Applicant q-042 * b. Program/Project: q-a42
Attach an addtt(onal list of Program/Project Congressional D(st~icts if needed.

17. Proposed Project:
* a. Start Date: 0/01 /2023 * b. End Date: 9/3 /2026

18. Estimated Fending (S):
* a. Federal 1,498,900.0
* b. Applicant 0.0
* c. State
* d. Local 0.0
* e. Other 0.0
* f. Program Income p,
* g. TOTAL 1,998,900.0
* 19. Is Application Subject to Review By State Under Ezecn6f e Order 12372 Process? p a. This application was made available to the State under the Executive Order 12372 Process for review on ~ b. Program is subject to E.0.12372 but has not been selected by the State for review.

Q c. Program is not covered by E.0.12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide ezplanation in attachment.) p Yes ~ No
Z1. *By signing this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements herein are tree, complete and accurate to the best of my knowledge. I also pro~zde the required assurances** and agree to comply with ant resulting terms if I accept an award.

I am aware that any false, ficfitious, or fraudulent statements or claims may subject me to criminal, civil, or administrati~~e penalties. (U.S. Code, Title 218, Section 1001)
~1 ** I AGREE
**The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency specific instructions.

Authorized Representati~•e:

Prefix: *First Name: -
Middle Name:
* Last Name:

Suffix: -
* T(tle: edical Director
* Telephone Number. Fax Number.
* Email:
* S(gnature of Authorized Representative: *Date Signed:

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024. Received Date: 2023-07-26T14:03:34.000-04:00 Los Angeles Economic Development Corporation's Most Business-Friendly City July 5, 2023
Statement of Certification of Geographic Catchment Area This letter serves to certify the City of Vernon's On-The-Streets Portable Clinical Care Program will target unsheltered homeless individuals in Los Angeles County, California, which is one of the ALL INside Initiative jurisdictions.

In Community
. .~
Fredrick Agyin,
Director of Health
City of Vernon
4305 Santa Fe Avenue Vernon, CA 90058-1714
1247-Attachment 9 Page 5

BUDGET INFORMATION -
Non-Construction Programs
OMB Approval No. 4040-0006
Expiration Date 02/28/2025

SECTION A -BUDGET SUMMARY
Grant Program
Function or Activit a
y ~ ~
Catalog of Federal
Domestic Assistance
Number (b)
Estimated Unobligated Funds New or Revised Budget
Federal (c) Non-Federal (d) Federal (e) Non-Federal (fl Total (g) 1 . Personnel 0 $0.00 $0.00 $53,000.00 $0.00 $53,000.00

2. Contractual 0 $0.00 $0.00 $569,500.00 $0.00 $569,500.00 3 . Other 0 $0.00 $0.00 $35,000.00 $0.00 $35,000.00
4 . Indirect 0 $0.00 $0.00 $8,800.00 $0.00 $8,800.00

5. Totals $0.00 $0.00 $666,300.00 $0.00 $666,300.00

SECTION B -BUDGET CATEGORIES

6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY Total (1) Personnel (2) Contractual (3) Other (4) Indirect (5) a. Personnel X53,000.00 $532,000.00 $0.00 $0.00 $585,000.00 b. Fringe Benefits $0.00 $0.00 $0.00 $0.00 $0.00
c. Travel $0.00 $0.00 $0.00 $0.00 $0.00
d. Equipment $0.00 $0.00 $0.00 $0.00 $0.00
e. Supplies $0.00 $10,000.00 $0.00 $0.00 $10,000.00
f. Contractual $0.00 $0.00 $0.00 $0.00 $0.00
g. Construction $0.00 $0.00 $0.00 $0.00 $0.00
h. Other $0.00 $25,000.00 $35,000.00 $0.00 $60,000.00
i. Total Direct Charges (sum of 6a-6h) $53,000.00 $567,000.00 $35,000.00 $0.00 $655,000.00 j. Indirect Charges $0.00 $2,500.00 $0.00 $8,800.00 $11,300.00 k. TOTALS (sum of 6i and 6j) $53,000.00 $569,500.00 $35,000.00 $8,800.00 $666,300.00

7. Program Income $0.00 $0.00 $0.00 $0.00 $0.00
Standard From 424A (Rev. 7-97)
Prescribed by OMB Circular A-102

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date: 2023-07-26714:03:34.000-04:00

SECTION C -NON-FEDERAL RESOURCES
(a) Grant Program (b) Applicant (c) State (d) Other Sources (e) TOTALS

8. Personnel $0.00 $0.00 $0.00 $0.00

9. Contractual $0.00 $0.00 $0.00 $0.00
10 . Other $0.00 $0.00 $0.00 $0.00
11 . Indirect $0.00 $0.00 $0.00 $0.00

12. TOTAL (sum of lines 8-11) $0.00 $0.00 $0.00 $0.00

SECTION D -FORECASTED CASH NEEDS

13. Federal
Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $666,300.00 $166,575.00 $166,575.00 $166,575.00 $166,575.00

14. Non-Federal $0.00 $0.00 $0.00 $0.00 $0.00

15. TOTAL (sum of lines 73
and 74 ) $666,300.00 $166,575.00 $166,575.00 $166,575.00 $166,575.00

SECTION E -BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (Years)
(b) First (c) Second (d) Third (e) Fourth

16. Personnel $53,000.00 $53,000.00 $0.00 $0.00

17. Contractual $569,500.00 $569,500.00 $0.00 $0.00
18 . Other $35,000.00 $35,000.00 $0.00 $0.00
19 . Indirect $8,800.00 $8,800.00 $0.00 $0.00

20. TOTAL (sum of lines 76-79) $666,300.00 $666,300.00 $0.00 $0.00

SECTION F -OTHER BUDGET INFORMATION

21. Direct Charges: 0 22. Indirect Charges: Indirect Charges: de minimis rate 10% on $88,000

23. Remarks:

Standard Form 424A (rev. 7-97) Paget
Authorized for Locai Reproduction

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date: 2023-07-26714:03:34.000-04:00

ASSURANCES -NON-CONSTRUCTION PROGRAMS
OMB Approval No. 4040-0007
Expiration Date 02/28/2025
Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0040), Washington, DC 20503.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY.

NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.

As the duly authorized representative of the applicant, I certify that the applicant:

1. Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal
share of project cost) to ensure proper planning,
management and completion of the project described
in this application.

2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State,
through any authorized representative, access to and
the right to examine all records, books, papers, or
documents related to the award; and will establish a
proper accounting system in accordance with generally
accepted accounting standards or agency directives.

3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational
conflict of interest, or personal gain.

4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding
agency.

5. Will comply with the Intergovernmental Personnel Act 7 of 1970 (42 U.S.C. §§4728-4763) relating to prescribed
standards for merit systems for programs funded
under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of
Personnel Administration (5 C.F.R. 900, Subpart F).

6. Will comply with all Federal statutes relating to
nondiscrimination. These include but are not limited
to: (a) Title VI of the Civil Rights Act of 1964 (P.L.
88-352) which prohibits discrimination on the basis
of race, color or national origin; (b) Title IX of the
Education Amendments of 1972, as amended (20
U.S.C. §§1681- 1683, and 1685-1686), which prohibits
discrimination on the basis of sex; (c) Section 504 of
the Rehabilitation
Previous Edition Usable Authorized for Local Reporoduction Act of 1973, as amended (29 U.S.C. §794), which
prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42
U.S.C. §§6101-6107), which prohibits discrimination
on the basis of age; (e) the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended,
relating to nondiscrimination on the basis of drug
abuse; (fl the Comprehensive Alcohol Abuse and
Alcoholism Prevention, Treatment and Rehabilitation
Act of 1970 (P.L. 91-616), as amended, relating to
nondiscrimination on the basis of alcohol abuse or
alcoholism; (g) §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290
ee- 3), as amended, relating to confidentiality of .
alcohol and drug abuse patient records; (h) Title VIII
of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et
seq.), as amended, relating to nondiscrimination in
the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statutes)
under which application for Federal assistance is
being made; and, (j) the requirements of any other
nondiscrimination statutes) which may apply to the
application.

Will comply, or has already complied, with the
requirements of Titles II and III of the Uniform
Relocation Assistance and Real Property Acquisition
Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose
property is acquired as a result of Federal or federallyassisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases.

8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit
the political activities of employees whose principal
employment activities are funded in whole or in part
with Federal funds.

Standard Form 4248 (Rev. 7-97)
Prescribed by OMB Circular A-102

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date:
2023-07-26714:03:34.000-04:00

9. Will comply, as applicable, with the provisions of the Davis- Bacon Act (40 U.S.C. §§276a to 276a-7), the
Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874),
and the Contract Work Hours and Safety Standards
Act (40 U.S.C. §§327- 333), regarding labor standards
for federally-assisted construction subagreements.

10. Will comply, if applicable, with flood insurance
purchase requirements of Section 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234) which
requires recipients in a special flood hazard area
to participate in the program and to purchase flood
insurance if the total cost of insurable construction and acquisition is $10,000 or more.

11. Will comply with environmental standards which
may be prescribed pursuant to the following: (a)
institution of environmental quality control measures
under the National Environmental Policy Act of 1969
(P.L. 91-190) and Executive Order (EO) 11514;
(b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO
11990; (d) evaluation of flood hazards in floodplains
in accordance with EO 11988; (e) assurance
of project consistency with the approved State
management program developed under the Coastal
Zone Management Act of 1972 (16 U.S.C. §§1451 et
seq.); (fl conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of
the Clean Air Act of 1955, as amended (42 U.S.C.
§§7401 et seq.); (g) protection of underground sources
of drinking water under the Safe Drinking Water Act of
1974, as amended (P.L. 93-523); and, (h) protection of
endangered species under the Endangered Species
Act of 1973, as amended (P.L. 93- 205).

12. Will comply with the Wild and Scenic Rivers Act of
1968 (16 U.S.C. §§1271 et seq.) related to protecting
components or potential components of the national
wild and scenic rivers system.

13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation
Act of 1966, as amended (16 U.S.C. §470), EO 11593
(identification and protection of historic properties), and the Archaeological and Historic Preservation Act of
1974 (16 U.S.C. §§469a-1 et seq.).

14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development,
and related activities supported by this award of
assistance.

15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et
seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or
other activities supported by this award of assistance.

16. Will comply with the Lead-Based Paint Poisoning
Prevention Act (42 U.S.C. §§4801 et seq.) which
prohibits the use of lead-based paint in construction or rehabilitation of residence structures.

17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit
Act Amendments of 1996 and OMB Circular No. A-133,
"Audits of States, Local Governments, and Non-Profit
Organizations."

18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and
policies governing this program.

19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000,
as amended (22 U.S.C. 7104) which prohibits grant
award recipients or asub-recipient from (1) Engaging
in severe forms of trafficking in persons during the
period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that
the award is in effect or (3) Using forced labor in the performance of the award or subawards under the
award.
* SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL *TITLE
Medical Director
* APPLICANT ORGANIZATION *DATE SUBMITTED
The City of Vernon 07-26-2023
Standard Form 4246 (Rev. 7-97) Back

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date:
2023-07-26T 14:03:34.000-04:00
OMB Number: 4040-0019
Expiration Date: 02/2812022
Project Abstract Summary
Funding Opportunity TI-23-024
Number:

CFDA(s):

Applicant Name: The City of Vernon
Descriptive Title of Applicant's Project:

On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care Project Abstract:

In order to address the growing need in our community to provide healthcare to the unhoused, The City of Vernon is partnering with and MLK Hospital Street Medicine and Wellness Equity Alliance to implement our On-The-Streets Portable Clinical Care IBHPC+HIV Care Program. This program combines the best practices of Integrated Behavioral Health and Primary Care and HIV/AIDS prevention and treatment interventions with the promising practice of Street Medicine to provide comprehensive services to unsheltered people experiencing homelessness. On-The-Streets provides direct patient care through multi-disciplinary teams who conduct walking rounds and pop up clinics for the unsheltered homeless population in the Greater Vernon Area. Our implementation strategy for this program is built on a foundation trust-building, flexibility, and respect for the unsheltered individuals' unique experiences and wishes. We recognize that unsheltered individuals have many of the same medical issues as the general population, we also recognize that traditional doctor-patient relationship in brick and mortar practices does not meet the needs of this population. We firmly believe that quality healthcare is a fundamental right that should be accessible to every person, irrespective of their housing situation and we are experienced in addressing the unique needs and challenges faced by unhoused individuals, particularly those who have been living on the streets or encampments for extended lengths of time and those with complex co-morbidity issues. On the Streets will improve health outcomes of those who do not readily utilize shelters or the adjunctive services co-located within shelters by providing direct patient care to unsheltered individuals experiencing homelessness. The Street Medicine Team is a roaming multi-disciplinary team will be a with "relationship-based" model including frequent/re-occurring contact with patients. The team will be comprised a Psychiatric Nurse Practitioner, a Medical Assistant, Community Health Worker SUD Counselor, Community Health Worker/HIV Counselor/Tester and a Consulting Psychiatrist.

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date:
2023-07-26T 14:03: 34.000-04:00
OMB Number: 4040-0010
Expiration Date: 11/30/2025
Project/Performance Site Locations)
Project/Performance Site Primary Location
Organization Name: City of Vernon
O I am submitting an application as an individual, and not on behalf of a company, state, local or tribal government, academia, or other type of organization.

UEI: ZMK4GCEKJ7G3
Street1*: 4305 Santa Fe Avenue
Street2:

City*: Vernon
County:

State*: CA: California
Province:

Country*: USA: UNITED STATES
Zip /Postal Code*: 90058-1714
Project/Performance Site Congressional District*: CA-037 Additional Locations) File Name:

Tracking Number: GRANT13946260 Opportunity Number: TI-23-024 . Received Date:
2023-07-26T 14:03:34.000-04:00
A-1 The population of focus is unhoused individuals, youth and families living on the streets or locations not meant for habitation such as cars, vans, tents, and makeshifts in the City of Vernon and the surrounding area within the county of Los Angeles. This catchment area is west of the Los Angeles River, south of I-10 east of I-110, and north of I-105. The Zip Codes included are 9001 1, 90003, 90001, 90002, 90058, 90255, 90280, 90270.90744 and 90745. The greater Vernon area is part of Los Angeles Continuum of Care (CoC) and is located within Service Planning Area 6 South. It is located in one of the identified U.S. Interagency Council on Homelessness' ALLIn Initiative jurisdictions. (Certification in attachments) In this CoC, there are more than 45,000 unsheltered homeless adults and nearly 800 unsheltered homeless children. Approximately half are Hispanic/Latino. (US Department of~Housing and Urban Development Point-In-Time Courtl 2022) Demographically this population is 31 %Female, 67% Male, and 2% identifying as Non-binary, Questioning or Transgender; 42% are Hispanic/Latino, 31%Black or African American, 19% White and 5% multiple races or other. In addition: 5%are transition-age youth (age 18-24); 42% are chronically homeless; 30% have substance abuse disorders, 25%suffer from serious mental illness and an estimated 3-4% are positive with HIV. Socioeconomically they have low or no income and few resources. They have lost connection with family and friends and are socially isolated within encampments or in cars. They suffer from trauma and are reluctant to seek out care. Source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless Count Report, June 2023)
A-2 Vernon is located in Los Angeles County which has the largest homeless population in the U.S. The unsheltered population is experiencing profound healthcare access issues here. Improved health-cat•e access among people experiencing homelessness is identified as a critical need for Vernon and the surrounding area. As such, the City Health Department is targeting this population for services and care. (City of Vernon Community Health Needs Assessment, 2023) The upstream causes of poor health in the homeless population in the greater Vernon Area include extreme poverty, harsh living envit•onments, trauma and structural bari•iei•s to care. The downstream causes include infectious diseases, HIV, heart disease, substance use disorders (SUDs) and mental illnesses and SUDS which are all quite prevalent among this population.

Exacerbating this problem is the fact that aside from the City Department of Health and a few urgent care practices, there are minimal options for health care in Vernon with no primary care providers, women's health providers, mental health providers or substance use disorder resources. (Source: City of Vernon Commzmity Health Needs Assessment, 2023) The majority of unhoused individuals in Vernon have been living on the streets or in places not meant for habitation for many years and typically show signs of physical decline and mental health decompensation. There is currently no system in place to addt•ess the myriad of barriers these individuals face. As such the City Police Department is navigating complex systems of care in Los Angeles County to find health care and mental health services for these individuals. This is inefficient and unsustainable for the City. (Source: City of Vernon Community Health Needs Assessment, 2023)
A 2022 study by the RAND Institute found that 54% of unhoused people living in Los Angeles reported having a ►rental health condition. And, when a broad view of mental health is taken into consideration —including depression, stress and anxiety —some experts argue that it impacts all homeless people.
1248-City of Vernon Street Medicine Narrative Page 12
In our area, just as in the rest of the United States, homeless services systems continued to expand the availability of both temporary and permanent beds in 2022, but these resources still fall short of reaching everyone in need. (Source: National Alliance to End Homelessness State of Homelessness: 2023 Edition.) And so, while we understand that housing can serve as an excellent platform for providing a system of care, the fact remains that housing remains elusive to the unhoused individuals in the Greater Vernon Area and street homeless men and women have life spans nearly 30 years shorter than their housed counterparts as access to primary care services remains difficult due to structural and economic barriers. (Source: Street Medicine Program, Keck School of Medicine, University of Southern California, Los Angeles, California and Street Medicine Institute, Ingomar, Pennsylvania) We simply cannot wait for all of these individuals to be housed before addressing these critical physical and mental health issues if we are to improve the overall health and wellness of the Greater Vernon Area.

Number of unduplicated Individuals to be Served with Award Funds Year 1 Year 2 Year 3 Total
300 400 500 1200
The overarching goal of this program is to improve access to healthcare for the unsheltered population is in the Greater Vec•non Area as ide~ltified in the 2023 Community Health Needs Assessment. While housing for homeless individuals is preferred, the City will address this inequity by implementing efficient and effective strategies to provide health care on the streets and in encampments with the following objectives:
l .During the project period ending Sept 30, 2026 we will:
a. Provide basic primary health care services and supplies to 600 unhoused individuals b. Conduct 600 screenings and assessments of substance use disorders and co-occurring mental and substance use disorders utilizing a low threshold approach that offers SUD services, including medication assisted Opioid Use disorder and alcohol use disorder with unhoused individuals.
c. Provide 600 unhoused clients with case management including comprehensive assessment of the client's needs and development of an individualized service plan (including infectious disease prevention/treatment services, funding for treatment, etc) and referral/linkage to treatment as appropriate.
d. Screen 600 unhoused individuals and their drug-using and/or sexual partners for HIV, viral hepatitis (B and C), STI's, Mpox, and tuberculosis and provide HIV testing, using a portable clinical care approach. Note: Hepatitis A testing will also be performed if an outbreak takes place in the area.
e. Provide treatment for 210unhoused individuals and their drug-using and/or sexual partners for• HIV, viral hepatitis, STI's, Mpox, and tuberculosis and provide HIV testing, using a portable clinical care approach.
f. Navigate 30 unhoused individuals to Mpox testing, treatment and prevention resources and mental health support.
g. Provide testing to 600 unhoused individuals for STIs (gonorrhea, chlamydia, and syphilis) and provide treatment on-site as needed.
h. G Screen 300unhoused individuals for symptomatic tuberculosis. i. Test 300 unhoused individuals for latent or active tuberculosis j. Provide tuberculosis treatment to 20 unhoused individuals. 1248-City of Vernon Street Medicine Narrative Page 13

2. Prior to grant activities beginning implement infectious disease testing quality assurance measures following established guidelines.

3. Prior to grant activities beginning, develop a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options and develop Memoranda of Agreement (MOAs) with the following, as appropriate:
• Primary HIV treatment and care providers, including Ryan White providers, to strengthen integration of care through case management.
• Treatment providers for referrals and linkages to follow-up care and treatment for individuals with viral hepatitis (B or C).
• Care providers for referrals and linkages to Pre-Exposure Prophylaxis (PrEP). • Care providers for referrals and linkage to Post-Exposure Prophylaxis (PEP).

4. During the project period ending Sept 30, 2026, provide evidence-based harm reduction education and supplies including FDA-approved overdose reversal medication as well as drug supply testing and overdose prevention education and services on-site, as allowable under this award and adhering to federal, state, and local laws, regulations, and other requirements related to such programs or services for a total 600 unhoused individuals.

5. During the project period ending Sept 30, 2026, provide Mental healthcare, treatment, and referral for• a total of 300 unhoused individuals including:
a. Screening and assessment of mental health conditions and co-occurring mental and substance use disorders.
b. Trauma-informed, culturally responsive, client-centered, evidence-based, cecoveryoriented, and integrated mental health and substance use services on-site c. Deliver or coordinate any services determined to be necessary to address identified mental health conditions

6. During the project period ending Sept 30, 2026, provide outreach services to 1200 unhoused individuals living in the streets, encampments or other places not meant for• human habitation by implementing strategies that effectively reach the people who are experiencing unsheltered homelessness.

7. During the project period ending Sept 30, 2026, provide 200 unsheltered homeless individuals case management services to address social determinants of health, including housing for a total of unhoused individuals including the following:
• Implementing strategies that effectively reach the people who are experiencing unsheltered homelessness
• Implementing a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options, including collaborating with HUDs Continuum of Care to enroll individuals in the local Coordinated Entry System, as well as the Housing Opportunities for Persons with AIDS program and other public housing options. • Providing case management services to coordinate all aspects of care, including behavioral health, prima►•y care, infectious disease prevention and treatment, other supportive services (e.g., housing, benefits, employment), and assist with transitions for returning to the community after any hospitalization or emergency room visit as appropriate, including enrolling eligible individuals in health insurance, Medicaid, Medicare, and other benefit programs (e.g., Social Security Disability Insurance and Supplemental Security Income, Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program, prescription assistance programs, etc.), and other human and community-based services as appropriate.
1248-City of Vernon Street Medicine Narrative Page 14

8. During the project period ending Sept 30, 2026, provide transportation directly to and from referral providers for a total 150 unhoused individuals.

9. Prior to the beginning of service provision, provide training for 100% of staff and service providers on harm reduction strategies, evidence-based practices, motivational interviewing, intensive case management, community reinforcement approach and/or peer supports. 10 During the project period ending Sept 30, 2026, distribute hygiene kits, safer sex kits and, or equipment and supplies to 1200 unhoused individuals to enhance harm reduction efforts

11. During the project period ending Sept 30, 2026, utilize telehealth and/or telemedicine services with a total of 25 unhoused individuals

12. At the conclusion of 4 quarters of service delivery, develop policies to support needed service syste►n improvements regarding establishment of standards of care for IBHPC +HIV Street Medicine.

13. Annually throughout the performance period, participate in a virtual learning collaborative to share best practices and lessons learned, as well as brainstorm solutions to challenges faced by members of the learning collaborative.

14. Annually throughout the performance period, document best practices and lessons learned while implementing integrated care using a portable clinical cac•e approach and Disseminate findings from pilot program.

15. Upon completion of the performance period, document best practices and lessons learned for the public through either the development of white papers, participation in conference presentations, a guide to be shared with the public about launching their own portable clinical care p►•ogram, etc
B-2 The City of Vel•non Health Depat-tment is currently providing Integt•ated Behavioral Health and Primary Care (IBHPC) including HIV interventions from 3 mobile trailers and 2 ►nobile units (Mercedes Sprinter vans). In order to address the growing need in our community to reach the unhoused, we are pa~~tnering with MLK Hospital Street Medicine and Wellness Equity Alliance to implement our On-The-Streets Portable Clinical Care IBHPC+HIV Care Program. This program combines the best practices of IBH/Primary Care and I-IIV/AIDS prevention and treatment interventions with the promising practice of Street Medicine to provide comprehensive services to unsheltered people experiencing homelessness.

On-The-Streets provides direct patient care through multi-disciplinary teams who conduct walking rounds and pop up clinics for the unsheltered homeless population in the Greater Vernon Area.

Our implementation strategy for this program is built on a foundation trust-building, flexibility, and respect for the unsheltered individuals' unique experiences and wishes. We recognize that unsheltered individuals have many of the same medical issues as the genet•al population, we also recognize that traditional doctor patient relationship in bc•ick and mortar practice does not meet the needs of this population.

We firmly believe that quality healthcare is a fundamental right that should be accessible to every person, irrespective of their housing situation and we are experienced in addressing the unique needs and challenges faced by unhoused individuals, particularly those who have been living on the streets or encampments for extended lengths of time and those with complex co-morbidity issues. On the Streets will improve health outcomes of those who do not readily utilize shelters or 1248-City of Vernon Street Medicine Narrative Page 15
the adjunctive services co-located within shelters by providing dire direct patient care to unsheltered individuals experiencing homelessness.

The Street Medicine Team is a roaming multi-disciplinary team will be a with "relationshipbased" model including frequent/re-occurring contact with patients. The team will be comprised a Psychiatric Nurse Practitioner, a Medical Assistant, Community Health Worker (CHW) SUD Counselor, CCHW/HIV Counselor/Tester, and a Consulting Psychiatrist.

Planning
Prior to deploying this team, we will
• convene a planning session with all partners, staff and stakeholders including individuals with lived experience.
• develop Electronic Medical Record workflow that allows for efficient reporting on outcomes for this project and a
• develop and review a Behavioral Health Disparity Impact Statement (DIS). • provide training to staff and other• stakeholders on the National CLAS standards, mental health and substance use disorders, harm reduction strategies; Street Medicine; Project specific policies and p►•oceduces; Integrated Care; U=U messaging, telehealth services, and other relevant topics
GIS Street Mapping
WEA will provide a series of comprehensive community health needs assessments (CHNAs) to identify the most impactful locations from a social detet•minants of health (SDoH) standpoint. WEA is able to pet•form 360° community health assessments using adata-science technique that consolidates a group of SDoH data-sets (>90) focusing on social vulnerability and the cascading impacts of SUD and HIV risk, coupled with GIS-guided anonymized cell phone data. Our group will evaluate this data overlaid on GIS to determine the "hotspots" where altel•native medical services (e.g. HIV prevention mobile units) sf~ould be deployed in order to achieve maximal impact.

These data-driven decisions will not supplant, but rather• enhance our coordination with CBOs and other community stakeholders involved in identifying sites. In addition, when we superimpose anonymized cellphone movement data (GIS), we can better understand where people are spending their time. Data like this can be analyzed more granula►•ly to identify specific places, days of the week, and time of day where these residents may be reached. It can also be used to identify movement patterns and behaviors to help inform strategy, such as how often residents visit health centers, child care facilities, as well as other community engagement (e.g. fast food, liquor establishments, churches, grocery stores, etc). Having adata-informed strategy to target equitable distribution of resources, close gaps in access, and ►neet patients and ►•esidents "where they are at" with targeted interventions designed based on information rather than an Deployment Strategy
In terms of data analytics, our approach isthree-pronged. First, we will work with our data analytics approach to provide demographic, SDo~-I, and mobility data to pinpoint specific locations in vulnerable neighborhoods from each region to deploy mobile clinics and/or provide community health education on HIV prevention. The analysis support will focus on identifying key communities that are particularly vulnerable due to lack of access to care (many socially-determined) and lack of actionable data for programs to target limited resources like mobile clinics-to reach the highest 1248-City of Vernon Street Medicine Narrative Page 16
number of people. The city of Vernon (in collaboration with our partners) will provide the following deliverables:
• Conduct iterative analyses in order to identify specific locations within the regions that are frequently visited by community residents that are highly impacted by SDoH and community vulnerabilities, which may include data factors such as: socioeconomic and language barriers, access to care and transportation, housing stability, chronic condition prevalence, etc.
o We will mostly focus on areas of known high population density of IDUs, including shooting galleries and encampments.
• Utilizing these data indicators, we will outline the highest-risk geographies/neighborhoods to focus on (5 sq mi area each).
• Conduct analysis of mobility patterns using human mobility data within the region identified to isolate the highest-density areas- this shows high-level foot traffic and travel patterns across the areas) of analysis.
• From the highest-density areas identified, WEA will isolate specific sites/buildings to generate descriptive statistics on peak days and times- these will be the specific site recommendations for• mobile health or community outreach efforts. • Provide a written report outlining the methodology, findings, and recommendations. • Determine the data fields and frequency required to track outcomes of interest, which may be of interest to SAMHSA.
• Analyze tracked program data on an ad hoc basis to identify any key insights that can be used to guide the strategy of the program, outreach, or workflow ope►•ations.

Implementation
The Street Medicine team will utilize a combination of roaming rounds and pop-up clinics to • Provide basic primary health care services and supplies • Provide Low bar►•ier substance use disorder treatment • Syndemically address infectious diseases, including HIV/AIDS, sexually transmitted infections (STI), vi►•al hepatitis, Mpox, and tuberculosis, as appropl•iate • Provide harm reduction services
• Provide Mental healthcare, treatment, and referral
• Conduct outreach and provide case management services to address social determinants of health, including housing.

After our initial implementation we will conduct an Initial Project Evaluation and Continuous Quality Improvement (CQI) Analysis. We will revise procedures as appropriate based on results from CQI analysis and redeploy. We will follow up with a Rapid CQI Changes Assessment and revise protocols again if needed. We will report all findings including best practices lessons learned and challenges as well as throughputs and outcomes.

Integrated Behavioral Health Care —Chronic diseases that drive morbidity and health ca►•e costs are often influenced by behavioral health conditions such as depression, anxiety and substance use disorders. When effectively managed, these behavioral health symptoms are mitigated, improved patient outcomes can be seen for chronic and infectious diseases. We will utilize this approach with primary care and behavioral health providers working together, in teams. Traditionally, this Evidence Based Practice is site-based with practitioners co-located in the same building. We will adapt this model to work within a street medicine concept by taking the practitioners out of the building. We will keep them in integrated teams that will operate in the streets in roaming rounds and pop-up clinics in areas where unhoused individuals congregate. 1248-City of Vernon Street Medicine Narrative Page 17
Medication for Opioid Use Disorder and Medication for Alcohol Use Disorder —These EBPs use medications that target the brain in combination with counseling and behavioral therapies to provide a whole patient approach to treahnent. These practices are effective with this population of focus and are critical components of recovery for individuals experiencing homelessness. They decrease deaths by overdose and are supported by research. We will refer patients to certified providers.

Motivational interviewing (Mn is aclient-centered counseling approach that helps individuals overcome ambivalent feelings and insecurities and generate motivation to change undesired behaviors and reduce or stop unhealthy lifestyle choices. It helps individuals with a variety of presenting problems, including mental health disorders andlor SUDS typically experienced by tuisheltered homeless individuals. MI can move individuals towards recovery and engage theta iu treatment before and while working toward a stable housing placement.

Street Medicine —Street Medicine is a practice that has emerged in the past decade in which healthcare providers deliver medical care to homeless populations outside of traditional healthcare facilities in various settings where unsheltered people live. There are cturently no definitive standardized protocols for delivering street mnedicine. However, there are best practices w~iich can be followed. Street medicine works well with unsheltered people experiencing homelessness as it reduces health inequities and stigma ainon~ excluded populations. It also allows early interventions and easier access to healthcare services. These types of programs also represent a cost-effective delivery model that unproves health outcomes in uuderserved populations. It is preventive nature, which reduces serious and costly complications that can increase healthcareassociated costs for a coininunity.

C-2 Fidelity monitoring is a key eleulent in successful unpleineutation, sustainmeut, and expansion of otu~ program. As such the City of Vernon will incorporate Fidelity reviews as part of the evaluation and unprovetnent process to evaluate adherence, exposiue, quality of delivery, participant responsiveness, and program differentiation. The data collection protocol inay include data sources and methods of observation such as "site" visits while the team is working iu the streets or encampment, at teaiu ineetiugs, interviews with staff and patients, and a review of docuineutation.

D1 -The City of Vernon, which is one of only fotu cities in the state of Califonua with its own health departYneut, is focused on ensuring the health and safety of its residents, workers, visitors and neiahborina communities. The City of Vernon will lead. direct and oversee t}us nroiect. . He will be the Project
uector or s program. e as years o experience ea g popu atiou and public health systems across the nation and beyond. He serves as one of 12 members of the boards for the HIV Medicine Association (F.~TMA), representing >12,000 HIV providers in the US. Here has served as one of the leaders to promote the effectiveness of street medicine for people living with or at risk of HIV. Iu fact, he co-authored a white paper on this topic, which was published by F.[IVMA.

He is widely laiowu as a national subject matter expert on HIV prevention and treahnent for eo le ex eriencing homelessness.
is well positioned to be the Project Director having served as the first Chief Medical O icer or NYC dluing the first COVID-19 stage in 2020, overseeing COVID-19 clinical operations for the Office of Emergency Mauageuient and numerous CMO posts overseeing community health centers focusing on homelessness, indigenous health, migrant health, substance 1248-City of Vemon Street Medicine Narrative Page 18
abuse and mental health across the US. He has been MAT medical director for a number of organizations. He was also previously the national director of infectious diseases for the AIDS Healthcare Foundation, the largest community-based HIV organization in the US.

MLK Community Healthcare is an integrated healthcare delivery system that serves the medicallyunderserved community of South Los Angeles in the Greater Vernon Area. Their Street Medicine Department is addressing the needs of the unsheltered patients that seek care in their facilities. The Street Medicine Department sends an interdisciplinary team of clinical care experts, social services personnel and outreach experts onto the streets to do regular checks on formerly hospitalized MLK Community Hospital patients who are unhoused. The team performs a range of health and supportive functions, from refilling prescription medicines to performing simple wound care or staple or suture removal. MLK Community Health Care Street Medicine has committed to proving appropriate referral of eligible unhoused patients in the MLK Community Healthcare service area and to collaborating on care for patients.

Wellness Equity Alliance (WEA), the organization that prepared the 2023 Community Health Needs Assessment for the City of Vernon will be providing the street medicine team staff and supplies, program coordination, project evaluation, quality assurance and improvement process as well as the Electronic Medical Record & Telehealth service/technical interface, GIS technology.

WEA is a national public health organization and multidisciplinary team of physicians, health professionals, and organizational experts with expertise in infectious disease, public health, emergency medicine, primary care, cardiology, pediatrics, psychiatry, community health work (CHW), nursing and advanced pI•actice pharmacy. WEA partners with governme~lt, non-profit or sovereign entities to provide comprehensive community &public health extension services tailored to minimize access barriers for historically marginalized communities. WEA's core mission is to addt•ess healthcare disparities largely driven by the social determinants of health (SDoH). Their team has experience and proven ability to rapidly deploy professional medical personnel and resources as needed to accommodate outbreaks and other unexpected issues in demanding environments.

WEA's team members built their• national reputation by partnering with more than 60 government agencies to respond to the COVID-19 mass vaccination program. Their work delivered more than 2 million COVID-19 vaccinations across more than 10 states in the US with a focus on underserved and historically marginalized communities. Standing up amulti-state, mass vaccination program in the midst of a pandemic required a relentless focus on quality care and rapidly implemented performance improvement cycles as CDC guidelines changed. Given the worsening of chronic disparities exacerbated by impact of the pandemic, they quickly expanded their operational models across the U.S. to encompass a wide scope of communicable diseases including HIV/AID, Tuberculosis, Hepatitis, STI's, Mpox as well as behavioral health, substance abuse diabetes and other clinical needs of historically marginalized populations.

Brett J. Feldman, MSPAS, PA-C, will be serving as an advisor through WEA on this project. Mr.

Feldman serves as the Vice Chair of the Street Medicine Institute, an international organization that provides technical assistance to street medicine prograrr►s around the world. His work has been featured on the BBC, Channel News Asia, Washington Post, LA Times, CNN, the Associated Press and Telemundo. A PBS documentary featuring Brett and the street medicine program that he founded, Close to Home: Street Medicine, won an Emmy award in 2018.

Mr. Feldman is also the Director and co-Founder of Street Medicine at the Keck School of Medicine (KSOM) of USC and an Assistant Professor of Family Medicine. He has practiced homeless medicine since 2007 and founded programs at Lehigh Valley Health Network (LVHN) 1248-City of Vernon Street Medicine Narrative Page 19
Street Medicine in Allentown, PA, and co-founded the KSOM of USC Street Medicine in Los Angeles, CA.

Title Role Qualifications Level of Effort
A master's degree in
public health, healthcare
Oversee and manage the day-to-day
ad►ninistration, social
operations of the integrated behavioral health
work, or a related field is
Project
and primary care street medicine program,
required. A clinical o.25 FTE (25 /o
Director ensuring smooth functioning and efficient degree (e.g., MD, DO, LOE) delivery of services. NP, PA) is preferred.

Extensive experience
serving marginalized
populations required.

A bachelor's degree in a relevant
field is required. Extensive
Lead the development and implementation of experience serving unsheltered Program an HIV integrated behavioral health and individuals such as ublic health, p 1 FTE Coordinator primary care street medicine program, healthcare administration social ~ 100%) ensuring alignment with the organization's work, or a related discipline is mission, goals, and strategic objectives. required.

Develop and implement an evaluation plan for A master's degree or higher in Project the integrated behavioral health and primary public health, social sciences, Evaluator care street medicine program, including the evaluation, or a related field is identification of evaluation methods, data required. .25FTE (25% collection tools, and perfor►nance indicators. LOE)
Master's degree in Nursing, with
a specialty in Psychiatric
ursing
Valid CA licensure as a
Physical health assessments, Mental health Psychiatric Nurse Practitioner assessments, Designing treatment plans, 10+years of experience in a Psychiatric Prescribing psycho-pharmaceuticals and clinical setting preferred Nurse medication, Experience working in
o
1 FTE (100 /o
Practitioner Working with patients and families to explain ambulatory settings Experience working with
LOE)
treatment plans, adjust medication and underserved communities, treatment for patients including those experiencing homelessness
5+years' experience prescribing
medication assisted treatment
(MAT)
Completion of a medical
Medical Assists with all clinical needs and supports assistant training program from 1 FTE (100% Assistant administrative overflow work. an accredited institution is LOE) required.

Community Associate's or Bachelor's degree
Health Worker Assists with patient outreach, resourcing, in public health, social work, ~ FTE (100% SUD patient retention, com►nunity surveillance, and nursing, psychology, or a related LOE) Counselor operational support; provide SUD counseling. field; Credentialed to provide SUD counseling. 3-5 years'
1248-City of Vernon Street Medicine Narrative Page 20
experience SUD patients and
unsheltered homeless population
preferred.

Community Associate's or Bachelor's degree
Health Worker Assists with patient outreach, resourcing, in public health, social work, HIV patient retention, community surveillance, and nursing, psychology, or a related 1 FTE (100% Counselor/Tes operational support; provides HIV testing and field; 3-5 years' experience with LOE) ter
counseling. HIV patients and unsheltered
homeless population preferred.

Medical Doctor licensed to
practice in California; General
Psychiatry Board Certification
Diagnostic evaluations, treatment from The American Board of Consulting recommendations based on their assessments; Psychiatry and Neurology; Child Psychiatrist medication management; consultation, and Adolescent Psychiatry .25~FTE recommendations, and guidance to the street Board Certification from The (25 /o LOE) medicine team regarding patients with mental American Board of Psychiatry Health diagnoses. and Neurology; Certification in
Community Psychiatry from
American Association of
Community Psychiatrists
E1 The City of Vernon is committed to i►nplementing a robust monitoring and evaluation system to track the program's progress and outcomes. We will regularly collect data, analyze results, and use the findings to make informed decisions. WEA ground and support staff will continue to engage in highly tc•ained data collection efforts throughout the operational pe►•iod, which will funnel into our population health analytic tools analyzing the following measures:
• Using our local digital platforms (engaging local HIE platforms), we will perform M&E of the following:
o Changes in Knowledge, Attitudes and Beliefs (KAB) iterative surveys (starting with baseline) of those who have completed the workshops andqualitative data about feelings of "engagement" and "connection" to PCMHs, community centers, schools, etc. o Increase in PHQ-9 score implementation among patients o Increase in # of MAT patients (e.g. buprenorphine rx)# patients served o Demographics, including: Neighborhood makeup Primary languages spoken Race/ethnicity Sexual orientation/gender identity (SOGI) o # comorbidities
o # refer►•als to Social services, HIV care, primary care medical home o #adverse events
o Changes in HIV or behavioral health-related cases related to ED visits, pioid overdose, Hospitalizations, ICU admissions, or deaths
This (along with a number of WEA-determined QI measures), will help determine the level of success and direction of ongoing and sustainable clinical needs and assist in focusing on CQI efforts using the Triple Aim approach. \1Ve will work with the Vernon epidemiology team to continue to work on data comparisons to help us continue to laser-focus our ongoing operational blueprints and help us make improvements to our operational models as we continue to improve quality.
1248-City of Vernon Street Medicine Narrative Page 21
Exhibit D
Notice of Award

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM

Department of Health and Human Services
Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment
Notice of Award
FAIN# H79TI087013
Federal Award Date
07/05/2024
Recipient Information

1. Recipient Name

CITY OF VERNON
4305 S SANTA FE AVE
VERNON, CA 90058

2. Congressional District of Recipient
42 3. Payment System Identifier (ID)
1956000808A1

4. Employer Identification Number (EIN)
956000808

5. Data Universal Numbering System (DUNS)
060883022

6. Recipient’s Unique Entity Identifier
ZMK4GCEKJ7G3

7. Project Director or Principal Investigator
Veronica Petrosyan
[email protected]
323-583-8811

8. Authorized Official
Fredrick Agyin
[email protected]
323-583-8811
Federal Agency Information

9. Awarding Agency Contact Information
Robert Corless
Grants Specialist
[email protected]
(240) 276-1146

10. Program Official Contact Information
Kirk E James
Program Official
[email protected]
240-276-1617
Federal Award Information

11. Award Number
5H79TI087013-02

12. Unique Federal Award Identification Number (FAIN)
H79TI087013

13. Statutory Authority
Div. H, Title II of the CAA, 2023 (Public Law No. 117-103)

14. Federal Award Project Title
On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care

15. Assistance Listing Number

93.899

16. Assistance Listing Program Title
Minority HIV/AIDS Fund (MHAF)

17. Award Action Type
Non-Competing Continuation

18. Is the Award R&D?
No
Summary Federal Award Financial Information

19. Budget Period Start Date 09/30/2024 – End Date 09/29/2025

20. Total Amount of Federal Funds Obligated by this Action $666,300 20a. Direct Cost Amount $666,300
20b. Indirect Cost Amount $0

21. Authorized Carryover

22. Offset

23. Total Amount of Federal Funds Obligated this budget period $666,300

24. Total Approved Cost Sharing or Matching, where applicable $0

25. Total Federal and Non-Federal Approved this Budget Period $666,300 ---------------------------------------------------------------------------------------------------------

26. Project Period Start Date 09/30/2023 – End Date 09/29/2026

27. Total Amount of the Federal Award including Approved Cost Sharing or Matching this Project Period
$1,332,600

28. Authorized Treatment of Program Income
Additional Costs

29. Grants Management Officer - Signature
LeSchell D Browne

30. Remarks
Acceptance of this award, including the "Terms and Conditions," is acknowledged by the recipient when funds are drawn down or otherwise requested from the grant payment system.

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM Notice of Award
Portable Clinical Care Pilot Project Issue Date: 07/05/2024 Department of Health and Human Services
Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment
Award Number: 5H79TI087013-02
FAIN: H79TI087013
Program Director: Veronica Petrosyan
Project Title: On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care Organization Name: CITY OF VERNON
Authorized Official: Fredrick Agyin
Authorized Official e-mail address: [email protected] Budget Period: 09/30/2024 – 09/29/2025
Project Period: 09/30/2023 – 09/29/2026
Dear Grantee:

The Substance Abuse and Mental Health Services Administration hereby awards a grant in the amount of $666,300 (see “Award Calculation” in Section I and “Terms and Conditions” in Section III) to CITY OF VERNON in support of the above referenced project. This award is pursuant to the authority of Div. H, Title II of the CAA, 2023 (Public Law No. 117-103) and is subject to the requirements of this statute and regulation and of other referenced, incorporated or attached terms and conditions.

Award recipients may access the SAMHSA website at www.samhsa.gov (click on “Grants” then SAMHSA Grants Management), which provides information relating to the Division of Payment Management System, HHS Division of Cost Allocation and Postaward Administration Requirements. Please use your grant number for reference.

Acceptance of this award including the “Terms and Conditions” is acknowledged by the grantee when funds are drawn down or otherwise obtained from the grant payment system.

If you have any questions about this award, please contact your Grants Management Specialist and your Government Project Officer listed in your terms and conditions.

Sincerely yours,
LeSchell D Browne
Grants Management Officer
Division of Grants Management
See additional information below

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM SECTION I – AWARD DATA – 5H79TI087013-02
Award Calculation (U.S. Dollars)
Personnel(non-research) $53,000
Contractual $613,300
Direct Cost $666,300
Approved Budget $666,300
Federal Share $666,300
Cumulative Prior Awards for this Budget Period $0
AMOUNT OF THIS ACTION (FEDERAL SHARE) $666,300

SUMMARY TOTALS FOR ALL YEARS

YR AMOUNT
2 $666,300
3 $666,300
Note: Recommended future year total cost support, subject to the availability of funds and satisfactory progress of the project.

Fiscal Information:

CFDA Number: 93.899
EIN: 1956000808A1
Document Number: 23TI87013A
Fiscal Year: 2024
IC CAN Amount
TI C96N825 $666,300
IC CAN 2024 2025
TI C96N825 $666,300 $666,300
TI Administrative Data:

PCC: PCCPMHAF / OC: 4145
SECTION II – PAYMENT/HOTLINE INFORMATION – 5H79TI087013-02 Payments under this award will be made available through the HHS Payment Management System (PMS).

PMS is a centralized grants payment and cash management system, operated by the HHS Program Support Center (PSC), Division of Payment Management (DPM). Inquiries regarding payment should be directed to:

The Division of Payment Management System, PO Box 6021, Rockville, MD 20852, Help Desk Support – Telephone Number: 1-877-614-5533.

The HHS Inspector General maintains a toll-free hotline for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. The telephone number is: 1-800-HHS-TIPS (1-800-447- 8477). The mailing address is: Office of Inspector General, Department of Health and Human Services, Attn:

HOTLINE, 330 Independence Ave., SW, Washington, DC 20201.

SECTION III – TERMS AND CONDITIONS – 5H79TI087013-02
This award is based on the application submitted to, and as approved by, SAMHSA on the above-title project and is subject to the terms and conditions incorporated either directly or by reference in the following:
a. The grant program legislation and program regulation cited in this Notice of Award. b. The restrictions on the expenditure of federal funds in appropriations acts to the extent those restrictions are pertinent to the award.
c. 45 CFR Part 75 as applicable.

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM d. The HHS Grants Policy Statement.
e. This award notice, INCLUDING THE TERMS AND CONDITIONS CITED BELOW.

Treatment of Program Income:

Use of program income – Additive: Recipients will add program income to funds committed to the project to further eligible project objectives. Sub-recipients that are for-profit commercial organizations under the same award must use the deductive alternative and reduce their subaward by the amount of program income earned.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts with cumulative total value greater than $10,000,000 must report and maintain information in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently the Federal Awardee Performance and Integrity Information System (FAPIIS)). Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75.

SECTION IV – TI SPECIAL TERMS AND CONDITIONS – 5H79TI087013-02

REMARKS

Continuation Award

1. This Notice of Award (NoA) is issued to inform your organization that the application submitted for the Minority HIV/AIDS Fund: Integrated Behavioral Health and HIV Care for Unsheltered Populations Pilot Project (PCCPMHAF) program is being continued.
o This award reflects approval of the revised budget submitted 4/4/2024 in response to a Request for Additional Materials (RAM).
o This award also reflects acceptance of supporting documentation submitted 4/4/2024, 4/11/2024 and 5/2/2024 in response to a Request for Additional Materials (RAM).

2. Key Personnel
Key Personnel are listed below:

Veronica Petrosyan, Project Director @ 25% level of effort Jovanka Ciares, Project Coordinator @ 100% level of effort James Brown, Project Evaluator @ 25% level of effort
Organizations receiving Federal Funds may not exceed 100% level of effort for any program staff member (Key Personnel or otherwise) across all federally funded sources.

Any changes to Key Personnel including level of effort involving separation from the project for any continuous period of three months or longer, or a reduction in time dedicated to the project of 25% or more requires a prior approval and must be submitted as a postaward amendment in eRA Commons.

Note: If an organization is awarded a grant and chooses to move forward with hiring an individual for a Key Personnel position before receiving SAMHSA’s formal approval, this will be done at the organization’s own risk.

For additional information on how to submit a post-award amendment, please visit the SAMHSA website: https://www.samhsa.gov/grants/grants-management/post-

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM award-amendments.

3. All responses to award terms and conditions and post award amendment requests must be submitted as .pdf documents in eRA Commons. For more information on how to respond to tracked terms and conditions or how to submit a post award amendment request please refer to
https://www.samhsa.gov/grants/grants-training-materials under heading Grant Management Reference Materials for Grantees.

4. Recipients are expected to plan their work and ensure that funds are expended within the 12-month budget period reflected on this Notice of Award. If activities proposed in the approved budget cannot be completed within the current budget period, SAMHSA cannot guarantee the approval of any request for carryover of remaining unobligated funding.

STANDARD TERMS AND CONDITIONS

Annual Programmatic Progress Report
Per the NOFO, your entity is required to submit a semi-annual and an annual progress report on the project performance for each budget period/incremental period as follows;
By 04/30/2025 submit via eRA Commons
By 12/28/2025, submit via eRA Commons.

The Programmatic Report is required on a semi-annual basis and must be submitted as a .pdf to the View Terms Tracking Details page in the eRA Commons System
Each Programmatic Report must, at a minimum, include the following information:
o Data and progress for performance measures as reflected in your application regarding goals and evaluation activities.
o A summary of key program accomplishments to-date.
o Description of the changes, if any, that were made to the project that differ from the application for this budget period.
o Description of any difficulties and/or problems encountered in achieving planned goals and objectives including barriers to accomplishing program objectives, and actions to overcome barriers or difficulties. o Progress achieved in the project which should include qualitative and quantitative data (GPRA) to demonstrate programmatic progress to include updates on required activities, successes, challenges, and changes or adjustments that have been made to the project.
o Progress toward reaching all required goals and objectives of the pilot project. o Programmatic data such as staffing footprint, expenditures, and other reporting requirements as appropriate to reach pilot goals. o Progress on the inclusion of underserved populations related to the Disparity Impact Statement (DIS).
o Barriers encountered, including challenges serving populations of focus; Efforts to overcome these barriers.
o Evaluation activities for tracking DIS efforts.

Note: Recipients must also comply with the GPRA requirements that include the collection and periodic reporting of performance data as specified in the FOA or by the Grant Program Official (GPO). This information is needed in order to comply with

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM PL 102-62, which requires that Substance Abuse and Mental Health Services Administration (SAMHSA) report evaluation data to ensure the effectiveness and efficiency of its programs.

The response to this term must be submitted as .pdf documents in eRA Commons.

Please contact your Government Program Official (GPO) for program specific submission information.

For more information on how to respond to tracked terms and conditions please refer to https://www.samhsa.gov/grants/grants-training-materials under heading How to Respond to Terms and Conditions.

Additional information on reporting requirements is available at https://www.samhsa.gov/grants/grants-management/reporting-requirements.

Annual Federal Financial Report (FFR or SF-425)
All financial reporting for recipients of Health and Human Services (HHS) grants and cooperative agreements has been consolidated through a single point of entry, which has been identified as the Payment Management System (PMS). The Federal Financial Report (FFR or SF-425) initiative ensures all financial data is reported consistently through one source; shares reconciled financial data to the HHS grants management systems; assists with the timely financial monitoring and grant closeout; and reduces expired award payments.

The FFR is required on an annual basis no later than 90 days after the end of each Budget Period. The FFR should reflect cumulative amounts. Additional guidance to complete the FFR can be found at http://www.samhsa.gov/grants/grantsmanagement/reporting-requirements.

SAMHSA reserves the right to request more frequent submissions of FFRs. If so, the additional submission dates will be shown below.

Your organization is required to submit an FFR for this grant funding as follows:
o By 12/28/2025, submit the Federal Financial Report (FFR)/(SF-425). o The grant recipient staff member(s) responsible for FFR preparation, certification and submission of the FFR must either submit a request for New User Access or Update User Access to the FFR Module as applicable. Refer to the PMS User Access website https://pms.psc.gov/grant-recipients/useraccess.html for information on how to submit a New User Access, Update User Access or Deactivate User Access. You can also view PMS’ Video on how to request new user access @ https://youtu.be/kdoqaXfiuI0 and PDF resource with instructions on Requesting Access @ https://pms.psc.gov/forms/New-UserRequest_Grantee.pdf o Instructions on how to submit a FFR via PMS are available at https://pmsapp.psc.gov/pms/app/help/ffr/ffr-grantee-instructions.html (The user must be logged in to PMS to access the link). Updates to the FFR instructions effective 4/1/2022 are also available @ https://pms.psc.gov/grantrecipients/ffr-updates.html o While recipients must submit the FFR in PMS, the FFR can also be accessed by connecting seamlessly from the eRA Commons to PMS by clicking the “Manage FFR” link on the “Search for Federal Financial Report (FFR)” page in eRA Commons, which will redirect to PMS. SAMHSA will not accept FFRs submitted by email or uploaded as an attachment into eRA. To access the “Manage FFR” link in eRA Commons, the individual must be registered in eRA Commons and

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM assigned the Financial Status Reporter (FSR) role for their organization. The individual assigned the FSR role is responsible for reporting the statement of grant expenditures for their organization. Refer to the page Managing eRA User Accounts on SAMHSA's website for instructions on how to assign a the FSR role.

If you have questions about how to set up a PMS account for your organization, please contact the PMS Help Desk at [email protected] or 1-877-614-5533.

Note: Recipients will use PMS to report all financial expenditures, as well as to drawdown funds; SAMHSA recipients will continue to use the eRA Commons for all other grant-related matters including submitting progress reports, requesting postaward amendments, and accessing grant documents such as the Notice of Award.

Standard Terms for Awards
Your organization must comply with the Standard Terms and Conditions for the Fiscal Year in which your grant was awarded. The Fiscal Year for your award is identified on your Notice of Award. SAMHSA's Terms and Conditions webpage is located at: https://www.samhsa.gov/grants/grants-management/notice-awardnoa/standard-terms-conditions.

Standards for Financial Management
Recipients and subrecipients are required to meet the standards and requirements for financial management systems set forth in 45 CFR part 75 Subpart D. The financial systems must enable the recipient and subrecipient to maintain records that adequately identify the sources of funds for federally assisted activities and the purposes for which the award was used, including authorizations, obligations, unobligated balances, assets, liabilities, outlays or expenditures, and any program income. The system must also enable the recipient and subrecipient to compare actual expenditures or outlays with the approved budget for the award. SAMHSA funds must retain their specific identity − they may not be commingled with nonfederal funds or other federal funds. “Commingling funds” typically means depositing or recording funds in a general account without the ability to identify each specific source of funds with related expenditures.

Reasonable Costs for consideration
Recipients must exercise proper stewardship over Federal funds and ensure that costs charged to awards are allowable, allocable, reasonable, necessary, and consistently applied regardless of the source of funds according to “Reasonable Costs” consideration per 2 CFR § 200.404 and the “Factors affecting allowability of costs” per 2 CFR § 200.403. A cost is reasonable if, in its nature and amount, it does not exceed that which would be incurred by a prudent person under the circumstances prevailing at the time the decision was made to incur the cost.

Consistent Treatment of Costs
Recipients must treat costs consistently across all federal and non-federal grants, projects and cost centers. Recipients may not direct-charge federal grants for costs typically considered indirect in nature, unless done consistently. If part of the indirect cost rate, then it may not also be charged as a direct cost. Examples of indirect costs include (administrative salaries, rent, accounting fees, utilities, office supplies, etc.). If typical indirect cost categories are included in the budget as direct costs, it is SAMHSA’s understanding that your organization has developed a cost accounting system adequate to justify the direct charges and to avoid an unfair

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/5/2024 12:12 AM allocation of these costs to the federal government. Also, note that all awards are subject to later review in accordance with the requirements of 45 CFR 75.364, 45 CFR 75.371, 45 CFR 75.386 and 45 CFR Part 75, Subpart F, Audit Requirements.

Compliance with Award Terms and Conditions

FAILURE TO COMPLY WITH THE ABOVE STATED TERMS AND CONDITIONS MAY RESULT IN ACTIONS IN ACCORDANCE WITH 45 CFR 75.371, REMEDIES FOR NONCOMPLIANCE AND 45 CFR 75.372 TERMINATION. THIS MAY INCLUDE WITHHOLDING

PAYMENT, DISALLOWANCE OF COSTS, SUSPENSION AND DEBARMENT, TERMINATION OF THIS AWARD, OR DENIAL OF FUTURE FUNDING.

All previous terms and conditions remain in effect until specifically approved and removed by the Grants Management Officer.

Staff Contacts:

Kirk E James, Program Official
Phone: 240-276-1617 Email: [email protected]
Robert Corless, Grants Specialist
Phone: (240) 276-1146 Email: [email protected]

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/2/2024 12:08 AM

Department of Health and Human Services
Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment
Notice of Award
FAIN# H79TI087013
Federal Award Date
07/02/2024
Recipient Information

1. Recipient Name

CITY OF VERNON
4305 S SANTA FE AVE
VERNON, CA 90058

2. Congressional District of Recipient
42 3. Payment System Identifier (ID)
1956000808A1

4. Employer Identification Number (EIN)
956000808

5. Data Universal Numbering System (DUNS)
060883022

6. Recipient’s Unique Entity Identifier
ZMK4GCEKJ7G3

7. Project Director or Principal Investigator
Veronica Petrosyan
[email protected]
323-583-8811

8. Authorized Official
Fredrick Agyin
[email protected]
323-826-1448
Federal Agency Information

9. Awarding Agency Contact Information
Robert Corless
Grants Specialist
[email protected]
(240) 276-1146

10. Program Official Contact Information
Kirk E James
Program Official
[email protected]
240-276-1617
Federal Award Information

11. Award Number
6H79TI087013-01M003 (Administrative Change)

12. Unique Federal Award Identification Number (FAIN)
H79TI087013

13. Statutory Authority
Div. H, Title II of the CAA, 2023 (Public Law No. 117-103)

14. Federal Award Project Title
On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care

15. Assistance Listing Number

93.899

16. Assistance Listing Program Title
Minority HIV/AIDS Fund (MHAF)

17. Award Action Type
Amendment

18. Is the Award R&D?
No
Summary Federal Award Financial Information

19. Budget Period Start Date 09/30/2023 – End Date 09/29/2024

20. Total Amount of Federal Funds Obligated by this Action $0 20a. Direct Cost Amount $0
20b. Indirect Cost Amount $0

21. Authorized Carryover $0

22. Offset $0

23. Total Amount of Federal Funds Obligated this budget period $666,300

24. Total Approved Cost Sharing or Matching, where applicable $0

25. Total Federal and Non-Federal Approved this Budget Period $666,300 ---------------------------------------------------------------------------------------------------------

26. Project Period Start Date 09/30/2023 – End Date 09/29/2026

27. Total Amount of the Federal Award including Approved Cost Sharing or Matching this Project Period
$666,300

28. Authorized Treatment of Program Income
Additional Costs

29. Grants Management Officer - Signature
Robert Corless

30. Remarks
Acceptance of this award, including the "Terms and Conditions," is acknowledged by the recipient when funds are drawn down or otherwise requested from the grant payment system.

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/2/2024 12:08 AM Notice of Award
Portable Clinical Care Pilot Project Issue Date: 07/02/2024 Department of Health and Human Services
Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment
Award Number: 6H79TI087013-01M003
FAIN: H79TI087013
Program Director: Veronica Petrosyan
Project Title: On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care Organization Name: CITY OF VERNON
Authorized Official: Fredrick Agyin
Authorized Official e-mail address: [email protected] Budget Period: 09/30/2023 – 09/29/2024
Project Period: 09/30/2023 – 09/29/2026
Dear Grantee:

The Substance Abuse and Mental Health Services Administration hereby awards a grant in the amount of $0 (see “Award Calculation” in Section I and “Terms and Conditions” in Section III) to CITY OF VERNON in support of the above referenced project. This award is pursuant to the authority of Div. H, Title II of the CAA, 2023 (Public Law No. 117-103) and is subject to the requirements of this statute and regulation and of other referenced, incorporated or attached terms and conditions.

Award recipients may access the SAMHSA website at www.samhsa.gov (click on “Grants” then SAMHSA Grants Management), which provides information relating to the Division of Payment Management System, HHS Division of Cost Allocation and Postaward Administration Requirements. Please use your grant number for reference.

Acceptance of this award including the “Terms and Conditions” is acknowledged by the grantee when funds are drawn down or otherwise obtained from the grant payment system.

If you have any questions about this award, please contact your Grants Management Specialist and your Government Project Officer listed in your terms and conditions.

Sincerely yours,
Robert Corless
Grants Management Officer
Division of Grants Management
See additional information below

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/2/2024 12:08 AM SECTION I – AWARD DATA – 6H79TI087013-01M003
Award Calculation (U.S. Dollars)
Personnel(non-research) $585,000
Supplies $10,000
Other $60,000
Direct Cost $655,000
Indirect Cost $11,300
Approved Budget $666,300
Federal Share $666,300
Cumulative Prior Awards for this Budget Period $666,300 AMOUNT OF THIS ACTION (FEDERAL SHARE) $0

SUMMARY TOTALS FOR ALL YEARS

YR AMOUNT
1 $666,300
Note: Recommended future year total cost support, subject to the availability of funds and satisfactory progress of the project.

Fiscal Information:

CFDA Number: 93.899
EIN: 1956000808A1
Document Number: 23TI87013A
Fiscal Year: 2023
IC CAN Amount
TI C96N825 $0
IC CAN 2023
TI C96N825 $0
TI Administrative Data:

PCC: PCCPMHAF / OC: 4145
SECTION II – PAYMENT/HOTLINE INFORMATION – 6H79TI087013-01M003 Payments under this award will be made available through the HHS Payment Management System (PMS).

PMS is a centralized grants payment and cash management system, operated by the HHS Program Support Center (PSC), Division of Payment Management (DPM). Inquiries regarding payment should be directed to:

The Division of Payment Management System, PO Box 6021, Rockville, MD 20852, Help Desk Support – Telephone Number: 1-877-614-5533.

The HHS Inspector General maintains a toll-free hotline for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. The telephone number is: 1-800-HHS-TIPS (1-800-447- 8477). The mailing address is: Office of Inspector General, Department of Health and Human Services, Attn:

HOTLINE, 330 Independence Ave., SW, Washington, DC 20201.

SECTION III – TERMS AND CONDITIONS – 6H79TI087013-01M003 This award is based on the application submitted to, and as approved by, SAMHSA on the above-title project and is subject to the terms and conditions incorporated either directly or by reference in the following:
a. The grant program legislation and program regulation cited in this Notice of Award. b. The restrictions on the expenditure of federal funds in appropriations acts to the extent those restrictions are pertinent to the award.

Version: 201 - 12/14/2023 2:33 PM | Generated on: 7/2/2024 12:08 AM c. 45 CFR Part 75 as applicable.
d. The HHS Grants Policy Statement.
e. This award notice, INCLUDING THE TERMS AND CONDITIONS CITED BELOW.

Treatment of Program Income:

Use of program income – Additive: Recipients will add program income to funds committed to the project to further eligible project objectives. Sub-recipients that are for-profit commercial organizations under the same award must use the deductive alternative and reduce their subaward by the amount of program income earned.

In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts with cumulative total value greater than $10,000,000 must report and maintain information in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently the Federal Awardee Performance and Integrity Information System (FAPIIS)). Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75.

SECTION IV – TI SPECIAL TERMS AND CONDITIONS – 6H79TI087013-01M003

REMARKS

Post Award Amendment - Administrative Change
This award is an administrative change to correct the Authorized Representative's name and contact information from Frederick Aygin ([email protected]) to Fredrick Agyin ([email protected]).

STANDARD TERMS OF AWARD
All previous terms and conditions remain in effect until specifically approved and removed by the Grants Management Officer.

Staff Contacts:

Kirk E James, Program Official
Phone: 240-276-1617 Email: [email protected]
Robert Corless, Grants Specialist
Phone: (240) 276-1146 Email: [email protected] Exhibit E
Disparity Impact Statement
SAMHSA Disparity Impact Statement
Grantee Organization Name: City of Vernon
Grant ID: 13946260
Grant Program: On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care
Project Director: Tyler Evans, MD, MS, MPH, AAHIVS, DTM&H, FIDSA Grant Project Officer: Jovanka Ciares
SECTION I. Identifying Behavioral Health Disparities
IDENTIFY and DESCRIBE THE SCOPE of the PROBLEM
The main, overarching problem we are seeking to address is the lack of access to healthcare for the unsheltered population in the Greater Vernon Area as identified in the 2023 Community Health Needs Assessment. While housing for homeless individuals is preferred, the City will address this inequity by implementing efficient and effective strategies to provide health care on the streets and in encampments. This includes but are not limited to:
● Provide mental health, support, care, treatment, and referrals ● Provide outreach services to 1200 unhoused individuals living on the streets, in encampments or other places not meant for human habitation by implementing strategies that effectively reach the people who are experiencing unsheltered homelessness.
● Implementing a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options, including collaborating with HUDs Continuum of Care to enroll individuals in the local Coordinated Entry System, as well as the Housing Opportunities for Persons with AIDS program and other public housing options.

In addition, we seek to address the lack of screening for substance use disorders and co-occurring mental and substance use disorders and provide Substance Use Disorders (SUD) services, including medication-assisted Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) treatment with unhoused individuals, including:
● Provide evidence-based harm reduction education and supplies, including FDA-approved overdose reversal medication as well as drug supply testing and overdose prevention education and services on-site, as allowable under this award and adhering to federal, state, and local laws, regulations, and other requirements ● Provide training for 100% of staff and service providers on harm reduction strategies, evidence-based practices, motivational interviewing, intensive case management, community reinforcement approach and/or peer support.

Our team also seeks to address the lack of infectious disease prevention and treatment services, funding for treatment, and referral/linkage to treatment for unhoused individuals and their drug-using and/or sexual partners for HIV, viral hepatitis (B and C), STI’s, Mpox, and tuberculosis, including but not limited to:
● Distribute hygiene kits, safer sex kits and, or equipment and supplies to 1200 unhoused individuals to enhance harm reduction efforts.
● Utilize telehealth and/or telemedicine services with a total of 25 unhoused individuals Source: City of Vernon CHNA Report

DISPARATE POPULATION(S) OF FOCUS
The population of focus is unhoused individuals, youth and families living on the streets or locations not meant for habitation such as cars, vans, tents, and makeshifts in the City of Vernon and the surrounding area within the county of Los Angeles. This catchment area is west of the Los Angeles River, south of I-10 east of I-110, and north of I-105.

The Zip Codes included are 90011, 90003, 90001, 90002, 90058, 90255, 90280, 90270.90744 and 90745. The greater Vernon area is part of Los Angeles Continuum of Care (CoC) and is located within Service Planning Area 6 South. In this CoC, there are more than 45,000 unsheltered homeless adults and nearly 800 unsheltered homeless children. Approximately half are Hispanic/Latino.*
Demographically this population is 31% Female, 67% Male, and 2% identifying as Non-binary, Questioning or Transgender; 42% are Hispanic/Latino, 31% Black or African American, 19% White and 5% multiple races or other. In addition: 5% are transition-age youth (age 18-24); 42% are chronically homeless; 30% have substance abuse disorders, 25% suffer from serious mental illness and an estimated 3-4% are positive with HIV. Socioeconomically they have low or no income and few resources. They have lost connection with family and friends and are socially isolated within encampments or in cars. They suffer from trauma and are reluctant to seek out care.**
*Source: (US Department of Housing and Urban Development Point-In-Time Count 2022) **Source: Los Angeles Homeless Services Authority, Greater Los Angeles Homeless Count Report, June 2023)

DEMOGRAPHIC TABLE
Measure
Greater
Vernon
Area
Champagne
Area
I-15 &
CA-60
Area
Lenwood
Area
Auto Club
Speedway
Area
Population estimate 248 4,106 9,055 4,153 6,372
Percentage of persons below 150% poverty 17.7% 21% 18.3% 33% 20.6% Unemployment Rate 9.6% 9.1% 6.8% 10.8% 11.1%
Percentage of housing cost-burdened occupied
housing units with annual income less than
$75,000 (30%+ of income spent on housing)

28.2% 29.7% 20.5% 32.8% 30.4%
Percentage of persons with no high school
diploma (age 25+) 13.2% 11.5% 23.4% 23.8% 26.9%
Percentage uninsured in the total civilian
noninstitutionalized population 8.5% 4.1% 13.7% 10.2% 12.8% Percentage of persons aged 65 and older 12.5% 4.3% 8.3% 12% 4.5% Percentage of persons aged 17 and younger 39.5% 28.9% 26.4% 33.5% 29.8% Percentage of civilian noninstitutionalized
population with a disability 8.1% 5.7% 14.6% 15% 4.4%
Percentage of single-parent households with
children under 18 42.3% 14.4% 3.8% 12.6% 10.1%
Percentage of persons (age 5+) who speak
English “less than well” 11.5% 4.4% 8.8% 4% 12.5%
Percentage minority persons 91.9% 76.8% 74.3% 55.3% 89.8% Percentage of Hispanic or Latino persons 83.9% 61.9% 59.3% 44% 75.2% Percentage of Black/African American, not
Hispanic or Latino persons

6.9% 5.3% 4.2% 8% 9.1%
Percentage of Asian, not Hispanic or Latino
persons

1.2% 7.4% 9.3% 1.5% 4.5%
Percentage of American Indian or Alaska Native,
not Hispanic or Latino persons
0% 0% 0% 0% 0%
Percentage of Native Hawaiian or Other Pacific
Islander, not Hispanic or Latino persons
0% 0% 0.4% 0% 0%
Percentage of two or more races, not Hispanic
or Latino persons
0% 2.2% 1.1% 1.9% 0.4%
Percentage of some other race, not Hispanic or
Latino persons
0% 0% 0% 0% 0.6%
Percentage of housing in structures with 10 or
more units 38.4% 4.8% 4.7% 12.6% 9.5%
Percentage of mobile homes 0% 1% 23.1% 2.8% 17.9%
Measure
Greater
Vernon
Area
Champagne
Area
I-15 &
CA-60
Area
Lenwood
Area
Auto Club
Speedway
Area
Population estimate 248 4,106 9,055 4,153 6,372
Percentage of persons below 150% poverty 17.7% 21% 18.3% 33% 20.6% Unemployment Rate 9.6% 9.1% 6.8% 10.8% 11.1%
Percentage of housing cost-burdened occupied
housing units with annual income less than
$75,000 (30%+ of income spent on housing)

28.2% 29.7% 20.5% 32.8% 30.4%
Percentage of persons with no high school
diploma (age 25+) 13.2% 11.5% 23.4% 23.8% 26.9%
Percentage uninsured in the total civilian
noninstitutionalized population 8.5% 4.1% 13.7% 10.2% 12.8% Percentage of persons aged 65 and older 12.5% 4.3% 8.3% 12% 4.5% Percentage of persons aged 17 and younger 39.5% 28.9% 26.4% 33.5% 29.8% Percentage of civilian noninstitutionalized
population with a disability 8.1% 5.7% 14.6% 15% 4.4%
Percentage of single-parent households with
children under 18 42.3% 14.4% 3.8% 12.6% 10.1%
Percentage of persons (age 5+) who speak
English “less than well” 11.5% 4.4% 8.8% 4% 12.5%
Percentage minority persons 91.9% 76.8% 74.3% 55.3% 89.8% Percentage of Hispanic or Latino persons 83.9% 61.9% 59.3% 44% 75.2% Percentage of Black/African American, not
Hispanic or Latino persons

6.9% 5.3% 4.2% 8% 9.1%
Percentage of Asian, not Hispanic or Latino
persons

1.2% 7.4% 9.3% 1.5% 4.5%
Percentage of American Indian or Alaska Native,
not Hispanic or Latino persons
0% 0% 0% 0% 0%
Percentage of Native Hawaiian or Other Pacific
Islander, not Hispanic or Latino persons
0% 0% 0.4% 0% 0%
Percentage of two or more races, not Hispanic
or Latino persons
0% 2.2% 1.1% 1.9% 0.4%
Percentage of some other race, not Hispanic or
Latino persons
0% 0% 0% 0% 0.6%
Percentage of housing in structures with 10 or
more units 38.4% 4.8% 4.7% 12.6% 9.5%
Percentage of persons in group quarters 0% 0% 0% 0% 0.9% Percentage of occupied housing units with more
people than rooms

9.9% 10.1% 13.1% 8.9% 21.7%
Measure
Greater
Vernon
Area
Champagne
Area
I-15 &
CA-60
Area
Lenwood
Area
Auto Club
Speedway
Area
Population estimate 248 4,106 9,055 4,153 6,372
Percentage of persons below 150% poverty 17.7% 21% 18.3% 33% 20.6% Unemployment Rate 9.6% 9.1% 6.8% 10.8% 11.1%
Percentage of housing cost-burdened occupied
housing units with annual income less than
$75,000 (30%+ of income spent on housing)

28.2% 29.7% 20.5% 32.8% 30.4%
Percentage of persons with no high school
diploma (age 25+) 13.2% 11.5% 23.4% 23.8% 26.9%
Percentage uninsured in the total civilian
noninstitutionalized population 8.5% 4.1% 13.7% 10.2% 12.8% Percentage of persons aged 65 and older 12.5% 4.3% 8.3% 12% 4.5% Percentage of persons aged 17 and younger 39.5% 28.9% 26.4% 33.5% 29.8% Percentage of civilian noninstitutionalized
population with a disability 8.1% 5.7% 14.6% 15% 4.4%
Percentage of single-parent households with
children under 18 42.3% 14.4% 3.8% 12.6% 10.1%
Percentage of persons (age 5+) who speak
English “less than well” 11.5% 4.4% 8.8% 4% 12.5%
Percentage minority persons 91.9% 76.8% 74.3% 55.3% 89.8% Percentage of Hispanic or Latino persons 83.9% 61.9% 59.3% 44% 75.2% Percentage of Black/African American, not
Hispanic or Latino persons

6.9% 5.3% 4.2% 8% 9.1%
Percentage of Asian, not Hispanic or Latino
persons

1.2% 7.4% 9.3% 1.5% 4.5%
Percentage of American Indian or Alaska Native,
not Hispanic or Latino persons
0% 0% 0% 0% 0%
Percentage of Native Hawaiian or Other Pacific
Islander, not Hispanic or Latino persons
0% 0% 0.4% 0% 0%
Percentage of two or more races, not Hispanic
or Latino persons
0% 2.2% 1.1% 1.9% 0.4%
Percentage of some other race, not Hispanic or
Latino persons
0% 0% 0% 0% 0.6%
Percentage of housing in structures with 10 or
more units 38.4% 4.8% 4.7% 12.6% 9.5%
Percentage of households with no vehicle
available 4.2% 1.3% 2% 5.1% 2.3%
Percentage of households without a computer
with a broadband Internet subscription 15.3% 5.2% 1.3% 19.4% 9.4% SECTION II. Addressing Disparities Using the Funding Opportunity

SOCIAL DETERMINANTS OF HEALTH
From the five Social Determinant of Health Domains, our organization will focus on two, namely:

1. Education and Quality:
a. Providing evidence-based harm reduction education and supplies including FDA-approved overdose reversal medication as well as drug supply testing and overdose prevention education and services on-site, as allowable under this award and adhering to federal, state, and local laws, regulations, and other requirements related to such programs or services for a unhoused individuals. b. Implementing strategies that effectively reach the people who are experiencing unsheltered homelessness.
c. Implementing a detailed plan of action with purposeful and documented engagement for sustainable permanent housing options, including collaborating with HUDs Continuum of Care to enroll individuals in the local Coordinated Entry System, as well as the Housing Opportunities for Persons with AIDS program and other public housing options.
d. Providing case management services to coordinate all aspects of care, including behavioral health, primary care, infectious disease prevention and treatment, other supportive services (e.g., housing, benefits, employment), and assist with transitions for returning to the community after any hospitalization or emergency room visit as appropriate, including enrolling eligible individuals in health insurance, Medicaid, Medicare, and other benefit programs (e.g., Social Security Disability Insurance and Supplemental Security Income, Temporary Assistance for Needy Families, Supplemental Nutrition Assistance Program, prescription assistance programs, etc.), and other human and community-based services as appropriate.

2. Health Care Access and Quality, including but not limited to:
a. Providing basic primary health care services and supplies to unhoused individuals
b. Conducting screenings and assessments of substance use disorders and co-occurring mental and substance use disorders utilizing a low threshold approach that offers SUD services, including medication assisted Opioid Use disorder and alcohol use disorder with unhoused individuals. c. Screening and assessment of mental health conditions and co-occurring mental and substance use disorders.
d. Offering trauma-informed, culturally responsive, client-centered, evidence-based, recovery oriented, and integrated mental health and substance use services on-site
e. Delivering or coordinating any services determined to be necessary to address identified mental health conditions

BEHAVIORAL HEALTH IMPLEMENTATION GUIDE FOR THE NATIONAL STANDARDS FOR

CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES IN HEALTH AND

HEALTHCARE
These are the CLAS activities, policies, and procedures we will undertake to advance health equity, improve quality, and help eliminate health care disparities:

1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
a. We are a highly culturally diverse, highly trained staff that are both committed and trained to provide care in various languages, cultures and take into account the idiosyncrasies of the population we serve. Our robust policies & procedures will continue to meet the maximum standards of care at a national level.

2. Offer language assistance to individuals who have limited English proficiency (LEP) and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services.
a. We prioritize the hiring of staff that is bi-lingual or multi-lingual and our outreach and educational materials are always available in at least two languages, often in up to five languages.
b. We provide language assistance through professional translators to individuals with LEP
c. We inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. This is currently standard practice for our work in the Vernon community; offering services 100% of the time in Spanish and English, while also incorporating other languages (Korean, Simplified Chinese, others.
d. We ensure the competence of individuals providing language assistance, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. We use professional translators when a staff member who speaks the patient's primary language is not on site.
e. We are committed to providing easy-to-understand print and multimedia materials and signage in the languages commonly used by the populations in the service area. With an extremely diverse community this is standard practice and staff are trained to understand that this is a priority. 100% of our materials are produced in Spanish and English, while also incorporating other languages (Korean, Simplified Chinese, others) based on the target audience.

3. We will advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices, and allocated resources. a. We recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population in the service area.
b. We educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis.

4. Our leadership and staff are committed to establishing culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization's planning and operations.
a. We conduct ongoing assessments of the organization's CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities.
b. We collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery.
c. We conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. d. Partnering with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness is a priority
e. Our conflict and grievance resolution processes are designed to be culturally and linguistically appropriate to identify, prevent, and resolve conflicts or complaints. f. Our progress in implementing and sustaining CLAS is communicated to appropriate stakeholders, constituents, and the general public.

SECTION III. Developing a Disparity Reduction Quality Improvement Plan

IMPLEMENTATION OF ACTIVITY
The implementation plan includes the following goals:

1. Provide unhoused clients with case management including comprehensive assessment of the client’s needs and development of an individualized service plan (including infectious disease prevention/treatment services, funding for treatment, etc) and referral/linkage to treatment as appropriate, screen individuals and their drug-using and/or sexual partners for STI’s and other diseases, navigate unhoused individuals to treatment and prevention resources and mental health support.

2. Develop a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options.

3. Provide unsheltered homeless individuals case management services to address social determinants of health, including collaborating with HUDs Continuum of Care to enroll individuals in the local Coordinated Entry System, as well as the Housing Opportunities for Persons with AIDS program and other public housing options.

4. Provide case management services to coordinate all aspects of care, including behavioral health, primary care, infectious disease prevention and education.

5. Conduct screenings and assessments of substance use disorders and co-occurring mental and substance use disorders utilizing a low threshold approach that offers SUD services, including medication assisted Opioid Use disorder and alcohol use disorder with unhoused individuals.

INTENDED OUTCOMES AND IMPACT
Through the implementation of the activities mentioned above, our intended goals and impact are to:

1. Increase access to and use of mental health and substance use services and better overall behavioral health outcomes in the greater Vernon area.

2. Increase access to education and supplies including FDA-approved overdose reversal medication for harm reduction as well as drug supply testing and overdose prevention education and services.

3. To increase testing and treatment for unhoused individuals and their drug-using and/or sexual partners for STI and other infectious diseases.

4. To implement a detailed plan of action with purposeful and documented engagement with sustainable permanent housing options.

CLIENT/PEER/PARTNER INVOLVEMENT
Per the City of Vernon Community Health Needs Assessment Report, we will engage Vernon businesses, residents and other area stakeholders for outreach, to provide enhanced training.

We are actively engaging with the Vernon business community and are contracting with the Street Medicine Institute at USC to provide enhanced specialty training to our staff.In addition, SUD, other mental health specialists and community health workers will also be part of the community engagement and outreach teams.

Finally, we will ensure that our peers and partners for training and support are from diverse populations (African American, Native Americans, Hispanic/Latinx, Asian American, Native Hawaiian, and Other Pacific Islander communities, individuals who identify as two or more races, and LGBTQIA+).

ACTION PLAN
Activities regarding Health Disparities have begun and will continue throughout the grant project period.

MEASUREMENT/ EVALUATION
We will implement a robust monitoring and evaluation system to track the program's progress and outcomes. We will regularly collect data, analyze results, and use the findings to make informed decisions.

Our in-the-ground and support staff will continue to engage in highly trained data collection efforts throughout the operational period, which will funnel into our population health analytic tools analyzing the following measures:
● Using our local digital platforms (engaging local HIE platforms), we will perform Monitoring and Evaluation (M&E) of the following:
○ Changes in Knowledge, Attitudes and Beliefs (KAB) iterative surveys (starting with baseline) of those who have completed the workshops and qualitative data about feelings of “engagement” and “connection” to PCMHs, community centers, schools, etc.
○ Increase in PHQ-9 score implementation among patients ○ Increase in # of MAT patients (e.g. buprenorphine rx)# patients served ○ Demographics, including: Neighborhood makeup Primary languages spoken Race/ethnicity Sexual orientation/gender identity (SOGI) ○ # comorbidities
○ # referrals to Social services, HIV care, primary care medical home ○ # adverse events
○ Changes in HIV or behavioral health-related cases related to ED visits, opioid overdose, Hospitalizations, ICU admissions, or deaths
This (along with a number of other QI measures) will help determine the level of success and direction of ongoing and sustainable clinical needs and assist in focusing on CQI efforts using the Triple Aim approach of improving the experience of care, improving the health of populations, and reducing per capita costs of health care.We will work with the Vernon epidemiology team to continue to work on data comparisons to help us continue to laser-focus our ongoing operational blueprints and help us make improvements to our operational models as we continue to improve quality.

SUSTAINABILITY
From a sustainability standpoint, our team will develop policies to support needed service system improvements regarding establishment of standards of care for On-The-Streets Portable Clinical Care Program with Integrated Behavioral Health and HIV Care.

In addition, the team will:
● Participate in a virtual learning collaborative to share best practices and lessons learned ● Brainstorm solutions to challenges faced by members of the learning collaborative. ● Document best practices and lessons learned while implementing integrated care using a portable clinical care approach and disseminate the findings from the pilot program. ● Document best practices and lessons learned through the development of white papers, participation in conference presentations, and others.