HomeMy WebLinkAboutAgreement A-20-443-1 with CDPH.pdfAgreement No. 20-443-1
Agency: County of Fresno Fiscal Year: 2020-21
Agreement Number: 202010
Page 1 of 30 Effective 07/01/2020
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH)
Black Infant Health (BIH) Scope of Work (SOW)
Black Infant Health Program
The BIH Program is a specialized CDPH MCAH program under the local MCAH system and helps to address MCAH SOW Goal 1 - Women/Maternal Domain:
Improve access to and utilization of comprehensive, quality health and social services and Goal 3 - Perinatal/Infant Domain: Reduce infant morbidity and
mortality. The goals in this SOW incorporate local problems identified by the Local Health Jurisdiction’s (LHJs’) 5-Year Needs Assessments and reflect the Title V
priorities of the MCAH Division.
All BIH sites are required to comply with BIH Policy and Procedures (P&P) and the Fiscal Policies and Procedures
https://www.cdph.ca.gov/Programs/CFH/DMCAH/Pages/Fiscal-Documents.aspx in their entirety. In addition, all BIH Sites shall work towards maximizing fidelity in
the following four domains (adherence, dose, participant engagement and quality of service delivery) by implementing Program services, fulfilling all deliverables
associated with benchmarks, attending required meetings and trainings and completing other MCAH-BIH reports as required. A list of the fidelity indicators for
each domain is located in table 1: BIH Fidelity Indicator Listing (rev. 7/1/2017),
The CDPH Maternal, Child and Adolescent Health (MCAH) Division places a high priority on the poor outcomes that disproportionately impact the African-
American community in California. The BIH site agrees to implement all activities in this Scope of Work (SOW). Central to the efforts in reducing these disparities,
listed below are the four (4) goals that are the hallmark of the program:
1.Improve African-American (AA) infant and maternal health.
2.Increase the ability of African-American women to manage chronic stress.
3.Decrease Black-White health disparities and social inequities for women and infants.
4.Engage the community to support African-American families’ health and well-being with education and outreach efforts.
To achieve these goals, the BIH Program is a client-centered, strength-based group intervention with complementary case management that embraces the
lifecourse perspective and promotes skill building, stress reduction and life goal setting. Each BIH Site shall also assure program fidelity, collect and enter
participant and program data into the electronic Efforts to Outcomes (ETO) data system and engage community partner agencies.
All BIH Sites are required to comply with the following tiered staffing matrix per the BIH 2015 Request For Supplemental Information (RSI) BIH RSI Instructions
and Fiscal Year (FY) 2019-20 State General Fund expansion funding requirements to ensure fidelity and standardization across all sites:
Staffing Requirements Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Local Health Jurisdiction San Francisco, Santa Clara, Contra Costa, Long
Beach, Fresno, San
Joaquin, Kern
San Diego,
Alameda, Riverside
Sacramento, San
Bernardino
Los Angeles
BIH Coordinator 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE
FHA/Group Facilitator 2.0 FTE 3.0 FTE 4.0 FTE 6.0 FTE 8.0 FTE
Mental Health
Professional
1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE
Outreach Liaison 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE 1.0 FTE
Data Entry 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE
PHN 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 2 of 30 Effective 07/01/2020
All BIH Sites are required to and will be held accountable for complying with the following tiered enrollment target per the BIH 2015 Request For Supplemental
Information (RSI) BIH RSI Instructions to ensure fidelity and standardization across all sites:
:
RSI Enrollment Target Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Local Health Jurisdiction San Francisco, Santa Clara Contra Costa, Long
Beach, Fresno, San
Joaquin, Kern
San Diego,
Alameda, Riverside
Sacramento, San
Bernardino
Los Angeles
64 96 128 192 240
All BIH Sites are required to and will be held accountable for complying with the following additional tiered BIH Model or Case M anagement (CM)
enrollment targets per the FY 2019-20 BIH State General Fund expansion-funding requirements:
Additional Enrollment
Target for Expansion
Funding to be served
through BIH Model or
Case Management
Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Local Health Jurisdiction San Francisco, Santa
Clara,
Contra Costa, Long
Beach, Fresno, San
Joaquin, Kern
San Diego,
Alameda,
Riverside
Sacramento, San
Bernardino
Los Angeles
Enrollment Target 40 50 66 90 208
Local Health Jurisdiction Solano
Enrollment Target 8
Updated BIH Group Model objectives and intervention activities are documented in bold below as applicable.
Updated BIH CM objectives and intervention activities are documented in bold italics below in goal 1 as applicable. Per the BIH P&P, the following criteria applies
to participants enrolled in the Case Management-Only intervention:
•African-American
•16 years of age or older
•Pregnant through 6 months postpartum
•Women 18 years of age and older are offered BIH Group model services before consenting to the BIH CM Intervention
•Has a signed consent, completed Assessment 1, received 1 referral for services
•May receive Case Management services until infant is 1 year of age
•Not required to attend BIH Group sessions
Contained within the BIH SOW, under the Measures (Process and Outcome) cells, there are Source Keys that are designed to provide a reference for reporting
purposes. The “E” Source Key refers to information that is based on participant-level program data included and maintained in ETO. The “N” “Source Key refers to
narrative information provided in quarterly reports or site surveys.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 3 of 30 Effective 07/01/2020
It is the responsibility of the LHJ to meet the goals and objectives of this SOW. The LHJ shall strive to develop systems that protect and improve the health of
California’s women of reproductive age, infants, children, adolescents, and their families. It is the responsibility of an LHJ to solicit technical assistance and
guidance from MCAH if performance issues arise. If a program does not meet the goals and objectives outlined in this SOW, the LHJ may be placed on a
corrective action plan (CAP) status. After implementation of the CAP, if the LHJ does not demonstrate substantial growth or fails to successfully meet the
goals and objectives of this SOW, MCAH will either cancel or amend the agreement/contract to reflect reduced funding. Continued participation in the
BIH program beyond the current fiscal year is also subject to successful performance in meeting caseload requirements and implementing the agreed
upon activities.
The development of this SOW is a collaborative process with BIH Program Coordinators and was guided by several public health frameworks including the Ten
Essential Services of Public Health and the three (3) core functions of assessment, policy development, and assurance; the Spectrum of Prevention; the Life
Course Perspective; the Social-Ecological Model, and the Social Determinants of Health. Please integrate these approaches when conceptualizing and organizing
local program, policy, and evaluation efforts.
o The Ten Essential Services of Public Health: https://www.cdc.gov/stltpublichealth/publichealthservices/essentialhealthservices.html
o The Spectrum of Prevention: The Spectrum of Prevention | Prevention Institute
o Life Course Perspective: Life Course Approach in MCH
o The Social-Ecological Model: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
o Social Determinants of Health: http://www.cdc.gov/socialdeterminants/
o Strengthening Families: Center for the Study of Social Policy / Young Children & Their Families / Strengthening Families
All activities in this SOW shall take place within the fiscal year.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 4 of 30 Effective 07/01/2020
For each fiscal year of the contract period, the LHJ shall submit the deliverables identified below. All deliverables shall be submitted to the MCAH Division to your
designated Program Consultant in accordance with the BIH P&P Manual and postmarked or emailed no later than the due date.
Deliverables for each FY Due Date for each FY
Annual Progress Report August 15
Coordinator Quarterly Report:
Reporting Period From To Due Date
First Report July 1, 2020 September 30, 2020 October 15, 2020
Second Report October 1, 2020 December 31, 2020 January 15, 2021
Third Report January 1, 2021 March 31, 2021 April 15, 2021
Fourth Report (WAIVED)
Information during this reporting period will
be included in the Annual Progress Report
April 1, 2021 June 30, 2021 July 31, 2021
See the following pages for a detailed description of the services to be performed.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 5 of 30 Effective 07/01/2020
Part II: Black Infant Health (BIH) Program
Goal 1: BIH local staff will assure program implementation, staff competency, data management, and maintain program fidelity and fiscal management to
administer the program as required by the Program’s Policy and Procedures (P&P’s) and Scope of Work (SOW) guidelines.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
IMPLEMENTATION
1.1
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will provide
oversight, maintain program
fidelity, fiscal management and
demonstrate that BIH activities
are conducted as required in the
BIH P&Ps, SOW, Data Collection
Manual, ETO Data Book, Group
Curriculum, and MCAH Fiscal
P&Ps.
1.1
•Implement the program activities
as defined in the SOW.
•Annually review and revise
internal local policies and
procedures for delivering
services to eligible BIH
participants.
•BIH Coordinator will coordinate
and collaborate with MCAH
Director to complete, review, and
approve the BIH budget prior to
submission.
•Submit Agreement Funding
Application (AFA) timely.
•Submit BIH Annual report by
August 15.
•Submit BIH Quarterly Reports as
directed by MCAH.
1.1
•Define and describe MCAH
Director and BIH Coordinator
responsibilities as they relate to
BIH. (N)
•Provide organization chart that
designates the delineation of
responsibilities of MCAH Director
and BIH Coordinator from MCAH
to the BIH Program in AFA
packet.
•Describe collaborative process
between MCAH Director and BIH
Coordinator related to BIH
budget prior to AFA submission.
(N)
1.1
•Submit BIH Annual report by
August 15.
•Submit BIH Quarterly Reports as
directed by MCAH. (See page 3)
1.2
Hire and maintain culturally
competent/relevant personnel
and required Full Time
Equivalent (FTE) to implement a
BIH Program that is relevant to
the cultural heritage of African-
American women, and the
community.
1.2
•Maintain culturally competent
staff to perform program services
that honors the unique
history/traditions of people of
African-American descent as
outlined in the P& P.
•At a minimum, the following key
staffing roles are required:
•1.0 FTE BIH Coordinator
•Family Health Advocates
(FHA)/Group Facilitators (GF)
based on MCAH-BIH designated
tier level.
1.2
•Describe process of recruiting
and hiring staff at each site that
are filled by personnel meeting
qualifications in the P&P.
•Include duty statements of all
staff with submission of AFA
packet.
•Submission of all staff changes
per guidelines outlined in BIH
P&P.
1.2
•Percent of key staffing roles at
site filled by personnel who meet
qualifications in the P&P. (N)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 6 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•1 FTE Community Outreach
Liaison (COL)
•0.5 FTE Data Entry
•1.0 FTE Mental Health
Professional (MHP)
•0.5 FTE Public Health Nurse
(PHN)
•Utilization of a staff-hiring plan.
TRAINING
1.3
All BIH staff will maintain and
increase staff competency.
1.3
•Develop a plan to assess the
ability of staff to effectively
perform their assigned tasks,
including regular observations of
group facilitators.
•Identify staff training needs and
ensure those needs are met,
notifying MCAH of any training
needs.
•Ensure that all key BIH staff
participates in on-going training
or educational opportunities
designed to enhance cultural
sensitivity.
•Ensure that all new and key BIH
staff attend the Annual MCAH
Sudden Infant Death Syndrome
(SIDS) Conference to receive the
latest AAP guidelines on infant
safe sleep practices and SIDS
risk reduction strategies.
•Establish local SIDS
collaborative workgroups with
community partners in order to
enhance awareness of AA SIDS
rates and to develop SIDS risk
reduction strategies.
•Require that all key BIH staff (i.e.
BIH Coordinator, and ALL direct
1.3
•List staff training activities in
quarterly report. (N)
•Describe improved staff
performance and confidence in
implementing the program model
due to participating in staff
development activities and/or
trainings. (N)
•List gaps in staff development
and training in quarterly report.
(N)
•Describe plan to ensure that staff
development needs are met in
quarterly report. (N)
•Describe how cultural sensitivity
training has enhanced LHJ staff
knowledge and how that
knowledge is applied. (N)
•Describe how staff utilized
information from the MCAH SIDS
conference with participants.
•Document strategies and action
plans related to SIDS risk
reduction strategies developed
from SIDS collaborative
workgroup meetings.
•Recommend training topic
suggestions for statewide
meetings. (N)
1.3
•Maintain records of staff
attendance at trainings. (N)
•Number of trainings and
conferences (both state and
local) attended by staff during FY
2020-21.
•Completion of at least 2 group
observation feedback forms by
the BIH Coordinator for every
group facilitator during FY 2020-
21. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 7 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
service staff) attend mandatory
MCAH Division-sponsored
trainings, conference calls,
meetings and/or conferences as
scheduled by MCAH Division.
•Quarter 1:
Annual 2-day Basic Training
Annual COL Meeting
•Quarter 2:
Annual 2-day Advanced
FHA/GF Meeting
•Quarter 3:
Annual MHP/Public Health
Nurse (PHN) Meeting
•Quarter 4:
Annual Coordinator Meeting
Annual 2-day Statewide
Meeting
•Ensure that the BIH Coordinator
and all direct service staff attend
mandatory MCAH Division-
sponsored training(s) prior to
implementing the BIH Program.
•2-day Abbreviated Training –
scheduled by MCAH based on
LHJ needs.
•2-day Basic Training Quarter 1
•Ensure that the BIH
Coordinator and/or MCAH
Director perform regular
observations of GFs and
assessments of FHAs, MHPs
and/or PHNs case
management activities.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 8 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
DATA COLLECTION AND
ENTRY
1.4
All BIH participant program
information and outcome data
will be collected and entered
timely and accurately using BIH
required forms at required
intervals.
1.4
•Ensure that all direct service staff
participate in data collection,
data entry, data quality
improvement, and use of data
collection software determined
by MCAH.
•Ensure that all subcontractor
agencies providing direct service
enter data in the ETO as
determined by MCAH.
•Ensure accuracy and
completeness of data input into
ETO system.
•Ensure that all staff receives
updates about changes in ETO
and data book forms.
•Ensure that a selected staff
member with advanced
knowledge of the BIH Program,
data collection, and ETO is
selected as the BIH Site’s Data
Entry lead and participates in all
Data and Evaluation calls.
•Accurately and completely collect
required participant information,
with timely data input into the
appropriate data system(s).
•Work with MCAH to ensure
proper and continuous operation
of the MCAH-BIH- ETO.
•Store Participant level Data
forms on paper per guidelines in
P&P.
•Define a data entry schedule for
staff and monitor for adherence.
1.4
•Review ETO and fidelity reports,
discuss during calls with BIH
State Team.
•Review ETO Utilization Reports
for all staff at BIH Sites.
•Enter all data into ETO within
seven (7) working days of
collection.
•Review of the BIH Data
Collection Manual by all staff.
•Completion of ETO training by all
staff.
•Participation in periodic MCAH-
Data calls.
•Participation in role-specific
trainings by the Data Entry Lead.
•Review of ETO data quality
reports by the BIH Coordinator
and Data Entry staff on at least a
monthly basis.
•Conduct and report on audits of
recruitment, enrollment, and
service delivery paper forms
against ETO reports; audit
sample must include at least
10% of recruitment records and
10% of enrollment records.
1.4
•Number and percent of forms
that were entered within seven
(7) days of collection. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 9 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
OUTREACH
1.5
All BIH LHJs will increase and
expand community awareness of
BIH by collaborating with other
BIH counties and individually
as a county on communication
outreach activities, including the
use of social m edia.
1.5
•All BIH LHJs will conduct
outreach activities and build
collaborative relationships with
local Women, Infants, and
Children (WIC) providers,
Comprehensive Perinatal
Services Program (CPSP)
Perinatal Service Coordinators,
social service providers, health
care providers, the Faith-based
community, and other
community-based partners and
individuals to increase and
maximize awareness
opportunities to ensure that
eligible women are referred to
BIH.
•All BIH LHJs will establish
referral mechanisms that will
facilitate reciprocity with partner
agencies as appropriate.
•At a minimum, all BIH LHJs will
utilize social media campaigns
developed by MCAH to increase
community awareness while
conducting outreach activities.
1.5
•Describe the types of community
partner agencies contacted by
LHJ staff. (N)
•Describe outreach activities
performed in order to reach
target population. (N)
•Describe deviations in outreach
activities, noting changes from
local recruitment plan. (N)
•Document type, frequency and
number of social media activities
conducted on the BIH Primary
Contact Table and submit with
Quarterly and Annual Report. (N)
1.5
•Number of existing MOUs prior
to FY 2020-21. (E)
•Number of new Memorandum of
Understanding (MOUs)
established in FY 2020-21. (E)
•Total number (overall and by
type) of outreach activities
completed by all staff during FY
2020-21. (E)
PARTICIPANT RECRUITMENT
1.6a
For BIH Group Sessions, all BIH
LHJs will recruit African-
American women 18 years of age
and older, and less than 30 weeks
pregnant.
1.6a
•Develop and implement a
Participant Recruitment Plan
(standardized intake process)
according to the target
population and eligibility
guidelines in MCAH-BIH P&P
and submit upon request.
1.6a
•Submit participant triage
algorithm with submission of AFA
packet.
•Track and document progress in
meeting goals of the Participant
Recruitment Plan, review
annually and update as needed.
1.6a
Number and percent of recruited
and referred women that were
eligible (at least 18 years old and
less than 30 weeks pregnant)
based on their recruitment date.
(E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 10 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•Review Recruitment plan
annually and update as needed.
1.6b
For Case Management Only, all
BIH LHJs will recruit African-
American teens at least 16 years
of age and adult women,
pregnant or up to 6 months
postpartum.
1.6b
•Develop and implement a
Participant Recruitment Plan
(standardized intake process)
according to the target
population and eligibility
guidelines in MCAH-BIH P&P
and submit upon request.
1.6b
•Track and document
progress in meeting goals
of the Participant
Recruitment Plan, review
annually and update as
needed.
1.6b
Total number of women served
via Case management services
only.
PARTICIPANT REFERRAL
1.7
All BIH LHJs will establish a
network of referral partners.
1.7
•Collaborate with network of
established partners (community-
based organizations, traditional
and non-traditional partners, etc.)
to develop a network of referral
partners who will refer eligible
women to BIH.
•Provide referrals to other MCAH
programs for women who cannot
participate in group intervention
sessions.
1.7
•Describe process for ensuring
that referral partner agencies are
referring eligible women to BIH in
quarterly reports and during
technical assistance calls. (N)
1.7
•Total number of service
providers that made referrals to
the BIH Program in FY 2020-21.
(E)
PARTICIPANT
ENROLLMENT
1.8a
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
•All participants enrolled in
BIH will be African-
American
•All participants will be 18
years or older when
enrolled in BIH.
1.8a
•Enroll women that are African-
American.
•Enroll women at or before 30
weeks of pregnancy.
•Enroll women that will participate
in the group intervention.
1.8a
•Visual inspection of all
recruitment eligibility fields on
incoming referral forms for
completeness.
•Inclusion of eligibility criteria with
materials used for referral and
recruitment.
1.8a
•Number and percent of enrolled
women who meet eligibility
criteria defined by age and timing
of pregnancy. (E) – Fidelity
Indicator A1b
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 11 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•All participants will be
enrolled during
pregnancy.
•All participants will be
enrolled at or before 30
weeks of pregnancy.
•All women will participate
in group intervention.
1.8b
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
•All participants enrolled in
•Case Management-Only
intervention will be African-
American.
•All participants will be 16
years or older when
enrolled in Case
Management-Only
intervention
•All participants 18 years of
age and older will be given
the opportunity to enroll in
the BIH Group Model first
and if not able to enroll will
then be offered the Case
Management-Only
intervention.
•Participants will be enrolled
in Case Management-Only
during pregnancy through
6 months postpartum.
•Participants enrolled in
Case Management-Only
intervention are not
1.8b
•Enroll women that are
African-American.
•Enroll women during
pregnancy through 6
months postpartum.
•Enroll women to participate
in the Case Management-
Only intervention.
1.8a
•Visual inspection of all
recruitment eligibility fields on
incoming referral forms for
completeness.
•Inclusion of eligibility criteria
with materials used for referral
and recruitment.
1.8b
Number and percent of enrolled
women who meet eligibility
criteria for Case Management-
Only.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 12 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
required to attend BIH
Group sessions.
PROGRAM PARTICIPATION
1.9.1
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
•All women will participate in a
prenatal group.
•All women will participate in a
group within 45 days of
enrollment.
•All groups will be implemented
according to the 20-group
intervention model as specified in
the P&P. (see 1.9.3)
1.9.1
•Assign participants to a prenatal
group as part of enrollment
process.
•Schedule prenatal groups to
allow participants to attend within
30 days of enrollment.
•Enroll participants in a prenatal
group within 45 days of first
successful contact.
•Begin groups with the minimum
required number of participants
per the BIH P&P.
1.9.1
•Describe barriers, challenges
and successes of enrolling
women in a prenatal group within
30-45 days of first successful
contact during technical
assistance calls. (N)
•Describe barriers, challenges
and successes of beginning
groups with the minimum
required number of participants
during technical assistance calls.
(N)
1.9.1
•Number and percent of enrolled
women who attended a prenatal
group session within 45 days of
enrollment. (E) – Fidelity
Indicator A3a
•Percent of group sessions that
were conducted in the prescribed
sequence and at the prescribed
time intervals. (E) – Fidelit y
Indicator A3c
•Percent of group sessions in a
series that were attended by at
least 5 participants. (E) -
Fidelity Indicator A3b.
1.9.2a
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
•All BIH participants (enrolled in
BIH Group) will complete all
prenatal and postpartum
assessments within the
recommended time intervals.
•All BIH participants (enrolled in
BIH Group) will receive referrals
to services outside of BIH based
on Life Planning meetings.
•All BIH participants (enrolled
in BIH Group) will receive
transportation assistance as
needed to attend group
sessions and Life Planning
meetings.
1.9.2a
•Assign participants to a FHA as
part of enrollment process.
•Conduct case management
services that align with Life Plan
activities (goal setting).
•Collect completed self-
assessment administered scaled
questions as described in P&P.
•Collect the required number of
assessments per timeframe
outlined in P&P.
•Develop and implement a Life
Plan based on goal setting
during Life Planning meetings for
each BIH participant; complete
all prenatal and postpartum
assessments; provide ongoing
identification of her specific
concerns/needs and referral to
services outside of BIH as
1.9.2a
•Collect and record service
delivery activities for enrolled
women into ETO. (E)
•Describe successes and/or
challenges in assisting
participants with setting short
and long-term goals during Life
Planning meetings. (N)
•Describe program improvements
resulting from participant
satisfaction survey findings at
least quarterly. (N)
1.9.2a
•Number and percent of enrolled
women who complete prenatal
and postpartum assessments at
the P&P-designated time
intervals. (E)
•Number and percent of enrolled
women who received at least
one (1) case conference
attended by a FHA or GF, and
either the MHP or PHN. (E) –
Fidelity Indicator A2a
•Percent of enrolled women who
have (a) a long-term goal and (b)
one (1) or more short-term goals
documented in one (1) of the
three (3) focus areas (health,
relationship, and finances)
(among women enrolled 30 days
or longer) during Life Planning
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 13 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•All BIH locations will include a
space dedicated for Child
Watch during group sessions.
needed based on Life Planning
meetings.
•Ensure participant referrals are
generated and completed for all
services identified.
•Ensure participants have
access to transportation
assistance via Uber/Lyft or
other door-to-door services in
order to attend group sessions
and Life Planning meetings.
•Ensure location of group
services have dedicated child
watch staff and space when
group sessions are conducted.
•Conduct participant dismissal
activities.
•Conduct participant satisfaction
surveys.
•Submit complete and accurate
reports in the timeframe specified
by MCAH.
meetings. (E) – Fidelity Indicator
P1a
•Number and percent of enrolled
women with a Birth Plan
collected before the expected
date of delivery (among women
past due). (E) – Fidelity Indicator
(supplemental) A4ai.
•Number and percent of enrolled
women who have a known
referral status for every
documented referral at time of
exit from the program (among
women dismissed from BIH).(E)
–Fidelity Indicator Q4a
•Number and percent of enrolled
women who have been
dismissed from BIH with a
completed participant satisfaction
survey. (E)
1.9.2b
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
•Case Management participants
will receive BIH Case
Management support as
defined in the P&P.
1.9.2b
•Assign participants to a FHA,
MHP and/or PHN as part of
enrollment process.
•Conduct case management
services that align with
identified needs of each
participant.
•Collect required assessments
per timeframe outlined in P&P.
•Develop and implement a Care
Plan based on participant
needs during case
management meetings for
each BIH participant; complete
all prenatal and postpartum
assessments; provide ongoing
1.9.2b
•Collect and record service
delivery activities for enrolled
women into ETO. (E)
•Describe program
improvements resulting from
participant satisfaction survey
findings at least quarterly. (N)
1.9.2b
•Number and percent of enrolled
women who complete
assessments at the P&P-
designated time intervals.
•Number and percent of enrolled
women who received at least
one (1) case conference
attended by a FHA or GF, and
either the MHP or PHN.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 14 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
identification of her specific
concerns/needs and referral to
services outside of BIH as
needed based on case
management meetings.
•Ensure participant referrals
are generated and completed
for all services identified.
•Conduct participant dismissal
activities.
•Conduct participant
satisfaction surveys.
•Submit complete and accurate
reports in the timeframe
specified by MCAH.
•BIH Case Management support
will be provided until the child
turns one year of age.
1.9.3a
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure that
all BIH participants will
participate in Group Intervention
Sessions.
1.9.3a
•Schedule Group Intervention
Sessions with guidance from
State BIH Team.
•All participants will have the
opportunity to enroll in Group
Intervention Sessions within 30-
45 days of the first successful
contact.
•Conduct and adhere to the 20-
group intervention model as
specified in the P&P.
1.9.3a
•Collect and record Group
Intervention Session attendance
records for all enrolled women
into ETO.
•Submit FY 2020-21 Group
Intervention Sessions Calendar
to MCAH-BIH Program with
submission of AFA and upon
request.
•Describe participant successes
or challenges with completing
seven (7) of ten (10) prenatal
and/or postpartum Group
Intervention Sessions. (N)
1.9.3a
•Number of Group Intervention
Sessions entered into ETO that
began during FY 2020-21. (E)
•Number and percent of enrolled
women who attend at least one
(1) prenatal Group Intervention
Session. (E)
•Number and percent of enrolled
women who attended the
expected number of Group
Intervention Sessions based
upon the number of days in
program (E) – Fidelity Indicators
D1a and D1b.
1.9.3b
BIH Participants enrolled in
the Case Management only
intervention are not required
to attend BIH group sessions.
1.9.3b
•Schedule case
management meetings per
guidance in the BIH P&P.
1.9.3b
•Describe participant successes
or challenges with completing
case management services.
1.9.3b
•Number and percent of
enrolled women who
complete case
management meetings at
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 15 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•Participants enrolled in the
BIH Case Management only
intervention may enroll in
the BIH Group model on a
case-by-case basis.
the P&P- designated time
intervals.
PARTICIPANT RETENTION
1.9.4
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure that
participant retention strategies
are in place.
1.9.4
•Discuss and develop participant
retention strategies during team
meetings.
•Plan participant retention
strategies as they relate to
program implementation
components
(outreach/recruitment,
enrollment, Life Planning, group
sessions, program completion).
•Ensure participants have
access to transportation
assistance via Uber/Lyft or
other door-to-door services in
order to attend group sessions
and Life Planning meetings.
•Ensure location of group
services have dedicated child
watch staff and space when
group sessions are conducted.
•Designated staff will conduct
participant satisfaction surveys
after group sessions and at
program completion to obtain
feedback related to improvement
of retention strategies.
1.9.4
•Discuss participant retention
strategies during technical
assistance calls. (N)
•Review participant retention
strategies quarterly and update
as needed. (N)
•Document participant retention
strategies in ETO and in
Quarterly Reports. (E/N)
•Submit participant retention
strategy successes and
challenges with Annual Report.
(N)
1.9.4
•Submit Participant Retention
Strategies with Quarterly and
Annual Report. (N)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 16 of 30 Effective 07/01/2020
Goal 2: Engage the African American community to support African-American families’ health and well-being with education and outreach efforts
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
2.1
BIH Coordinator under the
guidance and leadership of the
MCAH Director will increase and
expand community awareness of
African-American birth outcomes
and the role of the Black Infant
Health Program.
2.1
•Implementation of a Community
Advisory Board (CAB) in order
to:
•Inform the community about
disparate birth outcomes among
African-American women by
delivering standardized
messages describing how the
BIH Program addresses these
issues.
•Create partnerships with
community and referral agencies
that support the broad goals of
the BIH Program, through formal
and informal agreements.
•Develop and implement a
community awareness plan that
outlines how community
engagement activities will be
conducted.
•Develop and implement activities
related to multi-level community
engagement and awareness with
referral partners to identify
service gaps in the LHJ target
area.
•Develop performance strategies
with local organizations that
provide services to AA women
and infants to improve referrals
and linkage to BIH services.
•Collaborate with local MCAH
programs and other partners
such as Medi-Cal to identify
strategies, activities and provide
technical assistance to:
2.1
•Document efforts of Community
Advisory Board, collaborations or
other similar formal or informal
partnerships to address maternal
and infant health disparities,
social determinants of health,
well-woman visits and postpartum
visits at least once per quarter.
(N)
•Submit quarterly reports that
describe outreach activities
electronically using ETO in a
timely manner. (N)
•Document the local plan for
community linkages, including an
effective referral process that will
be reviewed on an annual basis
and updated as needed. (N)
•Document successes and barriers
to community education activities
or events at least once per
quarter in the ETO through
quarterly reporting. (E/N)
•List and maintain current
documentation on the nature of
formal and informal partnerships
with community and referral
agencies at least once a quarter;
record MOUs and referral
relationships in the ETO service
provider details form. (E/N)
•Enter all outreach activities in the
Community Contacts Log in ETO.
•Document collaborative efforts
with local MCAH programs and
Regional Perinatal Programs
2.1
•Submit CAB meeting materials
(roster, agenda, minutes) with
BIH quarterly report. (N)
•Number, format, and outcomes
associated with community
outreach activities conducted by
BIH Coordinator and/or MCAH
Director during FY 2020-21.
(E/N)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 17 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
o Improve access to health care
services
o Increase utilization of well-
woman and postpartum visits
o Identify Preterm Birth (PTB)
reduction strategies
o Increase the utilization of
preconception health
services.
•Collaborate with local MCAH
programs and Regional Perinatal
Programs to improve maternal
and perinatal systems of care.
•Participate in collaboratives with
community partners to review
data and develop strategies and
policies to address social
determinants of health and
disparities.
•Collaborate with agencies
providing services to AA moms
to develop and disseminate
tangible Reproductive Life
Planning training materials (e.g.
power point presentation,
webinars, toolkits, etc.) to focus
on Before, During, and Beyond
Pregnancy for dissemination and
integration in their service
delivery protocols.
describing strategies to improve
maternal and perinatal systems of
care at least quarterly. (N)
•Maintain current lists of
community providers and Service
Provider details in ETO.
2.2
BIH COL will increase information
sharing with other local agencies
providing services to African-
American women and children in
the community and establish a
clear point of contact.
2.2
•Develop collaborative
relationships with local Medi-Cal
Managed Care, Commercial
Health Plans, WIC and local
agencies in the community that
provide services to African-
2.2
•Enter all outreach activities in the
Community Contacts Log in
ETO.
•Maintain current lists of
community providers and Service
Provider details in ETO.
2.2
•Number of agencies where the
COL has a documented point(s)
of contact and with whom
information is regularly
exchanged. (N)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 18 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
American women and children,
to establish strong resource
linkages for recruitment of
potential participants and for
referrals of active participants.
•Develop a clear point(s) of
contact with collaborating
community agencies on a regular
basis as it relates to outreach,
enrollment, referrals, care
coordination, etc.
•Assess referrals from partner
agencies to determine enrollment
points of entry quarterly.
•Describe materials used to
inform community partners about
BIH. (N)
•List and describe barriers,
challenges and/or successes
related to establishing
community partnerships and
point(s) of contact at least
quarterly. (N)
•Total number of agencies with
outreach records during FY
2020-21. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 19 of 30 Effective 07/01/2020
Goal 3: Increase the ability of African-American women to manage chronic stress
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.1
BIH Coordinator under the
guidance and leadership of the
MCAH Director will ensure that all
BIH participants will have their
social support measured at
baseline and after attending the
prenatal and/or postpartum group
intervention and completing Life
Planning activities using the
Social Provisions Scale – Short
(SPS-S).
3.1
•Implement the prenatal and
postpartum group intervention
with fidelity to the P&P.
•Encourage participants to attend
and participate in group
sessions.
•Support clients in fostering
healthy interpersonal and familial
relationships.
•Report results from group
session information form,
including description of
participant engagement in group
activities for each group session.
3.1
•Provide FY 2020-21 group
intervention schedules upon
request. (N)
•Percent of participants who meet
expected prenatal life planning
session attendance (prenatal
dose). (E) – Fidelity Indicator
D2a
•Percent of participants who meet
expected prenatal group session
attendance (prenatal dose). (E)
–Fidelity Indicator D1a and D1b.
3.1
•Number and percent of enrolled
participants who have both a
baseline and follow-up
measurement. (E) – Fidelity
Indicator P3aii
3.2
BIH Coordinator under the
guidance and leadership of the
MCAH Director will ensure that all
BIH participants will have their
self-esteem, mastery, coping and
resiliency measured at baseline
and after attending prenatal
and/or postpartum group
intervention and completing Life
Planning activities using the
Rosenberg Self-Esteem, Pearlin
Mastery and the Brief Resilience
Scales.
3.2
•LHJ staff will facilitate the
administration of the self-esteem,
mastery, coping, and resiliency
tools and their frequency as
outlined in the P&P focused on
the participant’s ability to be
resilient and manage chronic
stressors presenting during
pregnancy.
•All activities are delivered with an
understanding of African-
American culture and history.
•Assist participants in identifying
and utilizing their personal
strengths.
•Develop and implement a Life
Plan with each participant.
•Teach and provide support to
participants as they develop
goal-setting skills and create
their Life Plans.
3.2
•Describe challenges/barriers why
participants did not have their
self-esteem, mastery, coping and
resiliency measured after
attending prenatal and/or
postpartum group intervention
and completing Life Planning
activities. (N)
3.2
•Number and percent of enrolled
participants who have both a
baseline and follow-up
measurement. (E) – Fidelity
Indicator P3aii
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 20 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•Teach participants about the
importance of stress reduction
and guide them in applying
stress reduction techniques.
•Support participants as they
become empowered to take
actions toward meeting their
needs.
•Teach participants how to
express their feelings in
constructive ways.
•Help participants to understand
societal influences and their
impact on African-American
health and wellness.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 21 of 30 Effective 07/01/2020
Goal 4: Improve the health of pregnant and parenting African American women and their infants
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1
BIH Coordinator under the
guidance and leadership of the
MCAH Director will ensure that all
BIH participants will be linked to
services that support health and
wellness while enrolled in the BIH
Program.
4.1
•Assist participants in
understanding behaviors that
contribute to overall good health,
including:
Stress management
Sexual health
Healthy relationships
Nutrition
Physical activity
•Ensure that participants are
enrolled in health insurance and
are receiving risk-appropriate
perinatal care.
•Ensure that healthy nutritious
food is available during group
sessions.
•Provide participants with health
information that supports a
healthy pregnancy.
•Provide participants with health
education materials that address
preterm birth reduction
strategies, such as the MCAH-
BIH prematurity awareness and
Provider sheet tip sheet.
•Identify participants’ health,
dental and psychosocial needs
and provide referrals and follow-
up as needed to health and
community services.
•Provide information and health
education to participants who
report drug, alcohol and/or
tobacco use.
•Assist participants with
completion of the birth plan that
4.1
•List and document additional
activities (e.g., Champions for
Change cooking demonstrations)
conducted that promote health
and wellness of BIH participants
and their infants at least once per
quarter. (N/E)
•Describe collaborative efforts
with March of Dimes,
MotherToBaby and other
agencies that provide health
education, preterm birth
reduction materials and
resources.
4.1
•Number and percent of
participants uninsured at
enrollment who received referral
and follow-up for health
insurance before delivery. (E)
•Number and percent of
participants who complete a birth
plan. (E) – Fidelity Indicator A4ai
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 22 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
outlines specific labor/delivery
and birthing requests to be
conveyed to their prenatal care
provider.
•Provide information on the
benefits and importance of
delivering a full term baby.
•Provide information related to
the risks associated with
delivering via cesarean section
in order to make an informed
decision related to their
delivery.
4.2
BIH LHJ staff will coordinate with
State MCAH and BIH staff to assist
BIH Participants with increased
knowledge and understanding of a
Reproductive Life Plan and Family
Planning services by providing
culturally and linguistically
appropriate tools for integration
into existing program materials.
4.2
•Promote and support family
planning by providing information
and education on birth spacing
and interconception health during
group sessions and Life Planning
Meetings.
•Help participants understand and
value the concept of reproductive
life planning as Life Plans are
completed and discussed with
Family Health Advocates during
Life Planning Meetings and
Group Facilitators during group
sessions.
•Provide referrals and promote
linkages to family planning
providers including Family
Planning, Access, Care, and
Treatment (Family PACT).
•Help participants understand the
characteristics of healthy
relationships and provide
resources that can help
participants deal with abuse,
4.2
•Summarize challenges/barriers
of birth control usage among
enrolled women who have
delivered. (N)
•Document collaborative activities
with local MCAH programs and
other partners such as Medi-Cal
Managed Care and CPSP
Provider networks to identify
strategies, activities and provide
technical assistance to improve
access to health care services
and increase utilization of the
postpartum visit. (N)
•Describe collaborative efforts
with Violence Prevention
Organizations such as Futures
without Violence to determine
service capacity to adequately
meet needs identified by
participants and LHJ staff
providing case management
services. (N)
4.2
•Number and percent of
participants who use any method
of birth control to prevent
pregnancy after their babies are
born. (E)
•Number and percent of
participants who attend a 4-6
week postpartum checkup with a
medical provider. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 23 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
reproductive coercion or birth
control sabotage.
4.3
BIH Coordinator under the
guidance and leadership of the
MCAH Director will ensure that all
BIH participants will be screened
for Perinatal Mood and Anxiety
Disorders (PMAD) and those with
positive screens will be given a
referral to mental health services.
4.3
•Local staff will work with or
support participants to:
o Understand how mental
health contributes to overall
health and wellness,
o Recognize the connection
between stress and mental
health and practice stress
reduction techniques,
o Help participants understand
the connection between
physical activity and mental
health,
o Understand the symptoms of
postpartum depression.
•Local staff will administer the
Edinburgh Postpartum
Depression Screen (EPDS) to
every participant 6-8 weeks after
she gives birth; and
•Provide referrals and follow-up to
mental health services when
appropriate.
4.3
•Summarize successes and
challenges in addressing mental
health issues, including mental
health referrals at least once per
quarter. (N)
4.3
•Number and percent of enrolled
participants who completed the
EPDS 6-8 weeks postpartum. (E)
–Fidelity Indicators A5a
•Number and percent of
participants with “positive” EPDS
screens with a recorded referral
to a community mental health
provider within two (2) weeks
after the EPDS collection date.
(E)
4.4
All BIH participants will report an
increase in parenting skills and
bonding with their infants and other
family members.
4.4
•Assist participants in
understanding and applying
effective parenting techniques.
•Assist participants with
completing home safety
checklist.
•Assist participants with
increasing knowledge of infant
safe sleep practices, SIDS,
Sudden Unexplained Infant
Death (SUID) risk reduction.
4.4
•List and describe additional
activities that enhance parenting
and bonding. (N)
•Provide anecdotes/participant
success stories about improved
parenting/bonding with
submission of BIH Quarterly
Reports.
•Provide participants with health
education materials related to
safe sleep practices and SIDS
reduction.
4.4
•Number and percent of
participants who complete the
safety checklist. (E) – Fidelity
Indicators A4aii
•Number and percent of
postpartum participants who
initiate breastfeeding. (E)
•Number and percent of prenatal
participants who complete a birth
plan prior to delivery. (E) –
Fidelity Indicator A4ai
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 24 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
•Assist participants with
completion of the birth plan that
outlines specific labor/delivery
and birthing requests to be
conveyed to their prenatal care
provider.
•Provide participants with health
education materials addressing
the benefits of breastfeeding.
•Assist participants with
identifying and using bonding
strategies, including
breastfeeding, with their
newborns.
•List and describe additional
activities on infant safe sleep
practices/SIDS/SUID risk
reduction. (N)
•Provide anecdotes/participant
success stories about infant safe
sleep practices and SIDS/SUID
risk reduction with submission of
BIH Quarterly Reports. (N)
•Document collaborative activities
with State MCAH Programs used
to identify strategies, provide
technical assistance and
disseminate resource materials
that address the benefits of
breastfeeding. (N)
•Provide anecdotes/participant
success stories about
breastfeeding practices with
submission of BIH Quarterly
Reports.
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 25 of 30 Effective 07/01/2020
Goal 5: Improve interconception health by decreasing risk factors for adverse life course events among African American women of reproductive age.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
5.1
BIH Coordinator under the
guidance and leadership of the
MCAH Director will ensure that all
BIH participants are linked to
services that support timely
prenatal care, postpartum visits
and well-woman check-ups while
enrolled in the BIH Program.
5.1
•Ensure that participants are
enrolled in prenatal care and are
receiving risk-appropriate
perinatal care.
•Provide participants with health
education materials and
messages including but not
limited to: the importance of
attending prenatal care visits;
recognizing the signs and
symptoms of preterm labor; safe
sleeping practices.
•Provide participants with health
information that supports a
healthy pregnancy.
•Ensure that participants are
attending postpartum visits and
well-woman check-ups as
scheduled.
•Increase knowledge of and
facilitate collaboration with local
MCAH programs to improve
perinatal and post‐partum
referral systems for high-risk
participants.
5.1
•Describe collaborative activities
with Text 4 Baby to deliver health
education messages to pregnant
women about the importance of
postpartum visits. (N/E)
•Document collaborative activities
with March of Dimes (MOD),
MotherToBaby and other
agencies that provide preterm
birth reduction and health
education resources and
messaging. (N)
•Describe collaborative efforts
with local MCAH programs and
other partners such as Medi-Cal
Managed Care and CPSP to
identify strategies, activities and
provide technical assistance to
improve access to health care
services and increase utilization
of the postpartum visit. (N)
5.1
•Number and percent of
participants who attend a 4-6
week postpartum checkup with a
medical provider. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 26 of 30 Effective 07/01/2020
Goal 6: Assist in reducing Infant Morbidity and Mortality by decreasing the percentage of preterm births.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
6.1
BIH Participants will have an
increased knowledge of strategies
and interventions they can utilize to
reduce the occurrence of preterm
births.
6.1
•Provide participants with health
education materials that address
preterm birth reduction strategies
from MCAH-BIH and MOD.
•LHJ staff will distribute any
customized preterm birth
resources to local medical
providers and monitor/track how
providers utilize and/or
incorporate resources to engage
clients in service delivery.
•LHJ staff will support, promote,
and attend preterm birth
educational webinars for medical
providers.
•Assist participants with
increasing knowledge of infant
safe sleep practices, SIDS, SUID
risk reduction by participating in
local SIDS collaborative
meetings and trainings.
•Provide participants with health
education materials addressing
the benefits of breastfeeding.
6.1
•Participate in MOD webinars and
trainings that provide LHJ staff
with opportunities to increase
their knowledge of preterm birth
reduction strategies and other
approaches for having a healthy
pregnancy. (N)
•Distribute and encourage MCAH
programs to integrate the
following preterm birth resources
to educate women and providers
on preventing preterm births: (N)
o Reducing Preterm Birth: What
Black Women Need to Know
Tip Sheet
o Reducing Premature Birth:
What Providers Need to Know
Tip Sheet
o Reducing Premature Birth
Discussion Points – guidance
to encourage conversation
with women about preterm
birth reduction strategies
•Facilitate one – two educational
webinars for medical providers
on topics such as: (N)
o Roles and Responsibilities:
Steps to Prevent Preterm
Birth
o The use of 17P to prevent
preterm birth
o Reducing Preterm Birth:
Evidence-Based Strategies to
Improve Outcomes
•Provide participants with health
education materials related to
6.1
•Maintain records of staff
attendance at trainings. (N)
•Maintain attendee records of
trainings/Webinars hosted by
LHJ. (N)
•Number and percent of
participants who complete the
safety checklist prior to delivery.
(E) – Fidelity Indicator A4aii
•Number and percent of
postpartum participants who
initiate breastfeeding. (E)
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 27 of 30 Effective 07/01/2020
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of the
intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
safe sleep practices and SIDS
reduction. (N)
•Document collaborative activities
with State MCAH Programs used
to identify strategies, provide
technical assistance and
disseminate resource materials
that address the benefits of
breastfeeding. (N)
Fiscal Year: 2020-21
Page 28 of 30 Effective 07/01/2020
Agency: County of Fresno
Agreement Number: 202010
Table 1 - Black Infant Health Selected Fidelity Dimensions, Measures and Indicators1 (Revised 7/1/2017)
DIMENSION MEASURE INDICATOR
ADHERENCE
A1. Adherence to
orientation and
enrollment
standards
A.1.a. Percent of recruited women that either a) enroll within 2
working days or b) receive a documented contact within two
working days of the recruitment date
A.1.b. Percent of enrolled women who meet eligibility criteria
defined by age and timing of pregnancy
A.1.c. Percent of recruited women who enroll within 14 days of
their first in‐person or phone contact
A.1.d. Percent of enrolled women whose Rights,
Responsibilities and Consent form was administered by either
the Mental Health Professional, the BIH Coordinator, or the
Public Health Nurse
A2. Coordination of
service provision
A.2.a. Percent of enrolled women who receive at least one case
conference attended by the Family Health Advocate or Group
Facilitator and either the Mental Health Professional or Public
Health Nurse
A3. Adherence of
group program
delivery to standards
A.3.a. Percent of enrolled women who attend a group session
within 45 days of enrollment.
A.3.b. Percent of group sessions attended by at least 5
participants
A.3.c. Percent of group sessions that were conducted in the
prescribed sequence and at the prescribed time intervals
A.3.d. Percent of group sessions that were led by two trained
facilitators
A.3.e. Percent of participants attending a prenatal group series
who attend session 1, 2, or 3
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 29 of 30 Effective 07/01/2020
DIMENSION MEASURE INDICATOR
DOSE
D1. Completeness
of group sessions
attended
D.1.a.
[PRELIMINARY]2 – Percent of women enrolled at least 45
days that have attended the expected number of prenatal
group sessions in the prescribed P&P timeframes.
To date, number of days
since women enrolled…
Minimum Expected
Number of Group
Sessions Attended
0 to 44 days Not measured
45 to 60 days 1
61 to 67 days 2
68 to 74 days 3
75 to 81 days 4
82 to 88 days 5
89 to 95 days 6
96 days or more 7
[FINAL]2 – Percent of enrolled women who have attended 7 or
more prenatal group sessions
Fiscal Year: 2020-21 Agency: County of Fresno
Agreement Number: 202010
Page 30 of 30 Effective 07/01/2020
DIMENSION MEASURE INDICATOR
D2. Completeness
of life planning
meetings attended
D.2.a.
[PRELIMINARY]2 – Percent of women enrolled for at least 30
days who have attended the expected number of life planning
meetings
To date, number of days
since women enrolled…
Minimum Expected
Number of Life Planning
Meetings Attended
0 to 29 days Not measured
30 to 44 days 1
45 to 59 days 2
60 to 85 days 3
86 days or more 4
[FINAL]2 – Percent of enrolled women who have attended 4 or
more prenatal life planning meetings.
1.Source: BIH Fidelity Methods Presentation (January 2016)
2.Preliminary dose indicators are used when there is less than 6 months between recruitment cohort end date and data extraction date. Final dose scores
are only when a minimum of 6 months lag exists between the end date and the data extraction date.
Amendment I to County Agreement No. 20-443 with California Department of Public Health
Name/No.: CDPH Maternal , Child and Adolescent Health -Black Infant Health Agreement No . 202010
COUNTY OF FR~
Steve Brd hairman of the Board of
Supervisors of the County of Fresno
ATTEST:
Bernice E. Seidel
Clerk of the Board of Supervisors
County of Fresno, State of Californ ia
By ci~I-~ r~
Deputy
FOR ACCOUNTING USE ONLY :
Fund/Subclass : 0001/10000
Org . No .: 56201700
Revenue Acct. No.: 4382