HomeMy WebLinkAbout29606CALIFORNIA DEPARTMENT OF PUBLIC HEAL TH
MATERNAL, CHILD AND ADOLESCENT HEAL TH (MCAH) DIVISION
FUNDING AGREEMENT PERIOD
FY 2017-2018
AGENCY INFORMATION FORM
Agencies are required to submit an electronic and signed copy (original singatures only) of this form
along with their Annual AFA Package.
Agencies are required to submit updated information when updates occur during the fiscal year.
Updated submissions do not require certification signatures.
-
,,._ -· ---
-. ----
AGENCY 1 1DENT IFICA1710N INFORMA_T.ION
---- --
---" --
-.... ----�
Any program related information being sent from the CDPH MCAH Division will be
, directed to all Program Directors.
.... ,.-�1,,:.1-· I::...-:; I• 1; .. 1:.11 •• ::..1 :•·--· 11flf:Iet•1 ,.,111iir.l"iar,u ::.r:•-iil---•"l•••T�oi1•1•111 , ..... .,,u.•1•1.-._. ..
20-1710 MCAH 201710 BIH # AFLP 115-10157 CHVP I
-
Update Effective Date: (only required when submitting updates)
Federal! Employer
ID#: 94.16000512
Complete Official
Age11q� Name: Gounty of Fresno
Business Office
Address: 1221 Fulton Mall, lfresno. CA 93721
Agency Phone: (559)600-3330
·Agency Fax:(559)455-4 705
Agency Website: W\vw.fcdoh.ore.
Page 1 of 2
. .
'
I I
'
Agreement No. 18-016
Please enter the agreement or contract number for ea_ch of t he app li cab le programs
201710 MCAH 201710 13 1H 201710 FIMR/SIDS '# AFLP 15-10157 CHVP
The unde rsigned hereby aff irms that the statements contained i n the Agreement Funding Appl icati on
(AFA} are tru e and complete to the best of the appl icant's knowledge.
I certify that these Maternal , Child and Adolescent Health (MCAH) programs will comply with all
appli cable pr ovisions of Artic le 1, Chapte r 1, Part 2, Divis ion 106 of t he Health and Safety code
(commencing with section 123225) Chapters 7 and 8 of the Welfa re and Institutions Code
(commencing w it h Sections 14000 and 142), a nd a ny a p pl icab le rules or regu'lation s promulgated by
CDPH p ursuant t o this artic le and these Chapte r s. I further certify that all MCA H re lated programs will
comply with the most cu rrent MCAH Po.licies and Procedures Manual , -includi ng but not limited t o ,
Admi ni strati on , Federal Fi na ncia l Partic ipation (FFP) Section . I further certify that t he MCAH related
programs wi ll comply with all f ederal laws and regu;lations governing and regulati ng recipients of funds
g ranted to states for medi cal assistance pursuant to Title XIX of the Socia! Security Act (42 U.S.C.
section 1396 et seq .) and recipients of funds all otted t o states for the Maternal a nd Ch ild Health Service
B lock G ra nt pursuant to Tit le V of the Social Security Act (42 U .S .C. secti.on 701 et seq.). I f u rth er
agree that the MCA H related programs may be subject to al l sanctions , or other remedies applicab le, if
the MCAH re lated prog rams viol ate any of the abov-e laws, regulations and pol icies w ith which it has
certified it will comply .
co
of offi cial authorized to
y to an MCAH Agreement
Sa l Q uintero
-Na rne (Pri nt)
R os e Mar Rahn
Nam e (Print)
..._ ________ ATTEST :
BERNICE E. SEIDEL
Clerk to the Board of Supervi sors
County of Fresno , State of California
By ~ ~ Deputy
Page 2 of 2
Chairman, Board of Su ervisors
Tit le
MCAH Director
Title
FO R f "RESNO COU NTY A C COlJNT J Ci U SF. ()NI .Y :
Fund/Su class: OIJO l/100 0
Org. No. _6201706
ACCOu.1\1 No .: JS-2
ORIGINAL
Cc' fc-,,.. o ,.p~m•~.1 cl ~.:..,,..
Public Health •)\ ~1'11 Malemal, Child and Adolescent Heallh DiviS1on
~-----~
BUDGET SUMMARY FISCA L YEAR BUDGET
2017-18 ORIGINAL
Versi on 4.6-150 Quanertv
Program: Maternal , Child and Adolescent Hea lth UN MATCHED FUN DING Agency : 20171 O Fresno
SubK: MCAH-TV SIDS
I (1) (2) (3) (4) (5)
I TOTAL F UNDING % TITLE V % SIDS -ALLOCATION(S) 2 10,795 7 ,372
EXPENSE C ATEGOR Y
(I) PERSONNEL 4,186,924 210,795 7.372
1(1 1) OPE RAT I N G EXPENSES 423,659
llllll CAPITAL EXPEN DITURES
I (I V\ OTH ER COST S 1,183,943
ltVl IND IR ECT COSTS 1,046,731
BUDGET TOTALS* 6,841 ,257 3.08% 210,795 0 .11% 7 ,372
BALANC E(S) -
TOT AL TITLE V
TOTAL SIDS
210,795 -2 10,7951
TOT AL TITLE XIX
TOTAL AGENCY FUNDS
7,372
2,665,009
3 ,958,083
7,3721
BUD GET STA TUS
ACTIVE
NO N-ENHANC ED
MATC HING (50150)
AGENCY FUNDS MCAH Cnly-N
(6) I (7) (10) I (11)
% I Agency % I Com bi ned
~un-< ..
,_ ,..
1.112.558 1.432.314
14 1,669 281,990
418,139 765,804
332,651 714,080
29.31% 2 005,0 17 46.69% 3 194 188
[50%) 1,597,094
2,005,0 17 1 [50%) 1,597,094
MCAH & SI DS
B ALANCE
EN HA NC ED
MAT CHING (75125 )
MCAH Cnly-E
(14) I (15) (16)
% I Combi ned
I l:aAIAn.ci.nr.i'"
1,423 ,886
20.81% 1 ,423,886
[75%] 1,067,9 15
125%) 355,972
$ 2,883, 176 Maximum Amount Payable from State and Federal resources
RUCTED IN COMPLIANCE WITH ALL MCAH ADMINISTRATIVE AN D PROGRAM POLICIES.
II -2 -J.OI (
MC AH/PROJECT DIRECTOR'S SIGNATUR E DATE AGENCY FISC L AGEN T'S SIGNATUR E DATE
T hese amoun ts contai n local revenue submitted for informati on and matching purpose s. MCAH does not re i mburse Agency contribut ions
STATE US E ON LY -TOTAL ST ATE AND FEDERAL REI MBU RSEM ENT MC A H-TV SIDS M\>t:''°'" T MCAH Cnty-N MCAH Cnty-E ~• .. 1n<::
PCA Codes 53107 53112 53118 53117
(I) PERSON NEL 210,795 7,372 716,157 1,067,915
(II ) OPERATING EXPENSES 140,995
(Il l) CA PITA L EXPENSE S
(I V) OTHER COSTS 382,902
(V) INDIRE CT COSTS 357,040
Tot a l s f o r PC A Codes 2,883, 176 210,795 7,372 1,597,094 1,067,915 -
20 1710 MCAH 5 Budget 2017-18 08-24-17.xlsm 1of4 Printed: 11/1/2017 12:02 PM
I
I
Maternal, Child and Adolescent Health DivisionORIGINALProgram: Agency: (1)(2) (3) (4) (5) (6) (7) (10) (11) (14) (15) (16) (17)TOTAL FUNDING %TITLE V%SIDS%Agency Funds*%CombinedFed/Agency*%Combined Fed/Agency*MCAH Cnty-N MCAH Cnty-ENON-ENHANCED MATCHING (50/50)ENHANCED MATCHING (75/25)Maternal, Child and Adolescent HealthSubK:201710 FresnoMCAH-TVUNMATCHED FUNDING SIDS AGENCY FUNDS% PERSONNEL MATCHTOTAL OPERATING EXPENSES423,659 141,669 281,99058,280 32.74% 19,081 67.26% 39,19917,203 32.74% 5,632 67.26% 11,5711149,603 32.74% 48,980 67.26% 100,623238,439 32.74% 12,585 67.26% 25,854313,240 32.74% 4,335 67.26% 8,905418,938 32.74% 6,200 67.26% 12,738518,862 32.74% 6,175 67.26% 12,687612,027 32.74% 3,938 67.26% 8,08971,147 32.74% 376 67.26% 77185,515 32.74% 1,806 67.26% 3,70994,405 100.00% 4,4051059,000 32.74% 19,317 67.26% 39,6831127,000 32.74% 8,840 67.26% 18,16012131415 ** Unmatched Operating Expenses are not eligible for Federal matching funds (Title XIX). Expenses may only be charged to Unmatched Title V (Col. 3), State General Funds (Col. 5), and/or Agency (Col. 7) funds.% PERSONNEL MATCHTOTAL OTHER COSTS 1,183,943418,139 765,804SUBCONTRACTS 11,094,006 30.00% 328,202 70.00% 765,804217,256 100.00% 17,256315,000 100.00% 15,000425,000 100.00% 25,0005OTHER CHARGES 12,660 100.00% 2,660219,492 100.00% 19,492310,529 100.00% 10,5294567.26%TOTAL CAPITAL EXPENDITURESCarol Melcher ConsultingResource Development AssociatesNurse-Family Partnership(III) CAPITAL EXPENDITURE DETAIL67.26%Exceptional Parents Unlimited(IV) OTHER COSTS DETAILBooks & PublicationsInterpretersClient Support Materials67.26%Match AvailableUtilitiesSecurityHousehold Expenses/MaintenanceTelephonesOffice Supplies67.26%PostagePrintingIT SupportTRAININGMedical SuppliesSoftwareMatch Available67.26%FacilitiesTRAVEL67.26%(II) OPERATING EXPENSES DETAIL% TRAVEL NON-ENH MATCH % TRAVEL ENH MATCH#DIV/0! #DIV/0!201710 MCAH 5 Budget 2017-18 08-24-172 of 4Printed: 10/26/2017 5:01 PM
Maternal, Child and Adolescent Health DivisionORIGINALProgram: Agency: (1)(2) (3) (4) (5) (6) (7) (10) (11) (14) (15) (16) (17)TOTAL FUNDING %TITLE V%SIDS%Agency Funds*%CombinedFed/Agency*%Combined Fed/Agency*MCAH Cnty-N MCAH Cnty-ENON-ENHANCED MATCHING (50/50)ENHANCED MATCHING (75/25)Maternal, Child and Adolescent HealthSubK:201710 FresnoMCAH-TVUNMATCHED FUNDING SIDS AGENCY FUNDS1,046,731 (0) 332,651 714,0801,046,731 0.00% (0) 31.78% 332,651 68.22% 714,080TOTAL PERSONNEL COSTS4,186,924210,795 7,372 1,112,558 1,432,314 1,423,8861,803,331 90,790 3,175 479,185 616,905 613,2752,383,593 120,004 4,197 633,373 815,408 810,610INITIALSTITLE OR CLASSIFICATION% FTEANNUAL SALARYTOTAL WAGES1 RG Division Manager 20.00% 112,543 22,509 0.00% 31.50% 7,090 48.00% 10,804 20.50% 4,614 69.7%2 RG MCAH Director 50.00% 112,543 56,272 31.50% 17,726 48.00% 27,011 20.50% 11,536 69.7%3 BA Administrative Assistant 70.00% 37,324 26,127 0.00% 95.00% 24,821 5.00% 1,306 69.7%4 AX Staff Analyst II 100.00% 60,153 60,153 0.00% 94.00% 56,544 6.00% 3,609 69.7%5 MC Senior Accountant 10.00% 66,360 6,636 0.00% 95.00% 6,304 5.00% 332 69.7%6 DM Account Clerk I 100.00% 28,089 28,089 0.00% 95.00% 26,685 5.00% 1,404 69.7%7 JD PHN II -MCAH Coordinator 100.00% 89,753 89,753 36.50% 32,760 36.00% 32,311 27.50% 24,682 69.7%8 LP PHN II -FIMR/SIDS Coord 100.00% 70,330 70,330 24.53% 17,254 5.97% 4,197 55.50% 39,033 14.00% 9,846 69.7%9 V MSW I 85.00% 44,888 38,155 0.00% 6.50% 2,480 36.00% 13,736 57.50% 21,939 94.5%10 EJ MSW I 50.00% 47,580 23,790 0.00% (0) 6.00% 1,427 78.00% 18,556 16.00% 3,806 94.5%11 BV Epidemiologist 25.00% 73,446 18,362 0.00% 94.00% 17,260 6.00% 1,102 69.7%12 AC HEA 60.00% 34,606 20,764 38.00% 7,890 62.00% 12,874 69.7%13 TT HEA 60.00% 44,300 26,580 42.50% 11,297 57.50% 15,284 69.7%14 CV HES 60.00% 42,588 25,553 0.00% (0) 45.50% 11,627 54.50% 13,926 69.7%15 PG HES 100.00% 41,492 41,492 0.00% (0) 55.00% 22,821 45.00% 18,671 69.7%16 AV Health Educator 60.00% 61,662 36,997 38.50% 14,244 60.00% 22,198 1.50% 555 69.7%17 VW SOA 100.00% 49,777 49,777 0.00% 95.00% 47,288 5.00% 2,489 69.7%18 GT OA I 100.00% 23,192 23,192 10.00% 2,319 90.00% 20,873 94.5%19 CM OA III 100.00% 37,325 37,325 10.00% 3,733 90.00% 33,593 94.5%20 VC OA III 100.00% 37,325 37,325 10.00% 3,733 90.00% 33,593 94.5%21 DC OA III 100.00% 35,135 35,135 10.00% 3,514 90.00% 31,622 94.5%22 LW OA III 100.00% 32,157 32,157 10.00% 3,216 90.00% 28,941 94.5%23 SR OA III 100.00% 37,925 37,925 10.00% 3,793 90.00% 34,133 94.5%24 YL OA III 100.00% 37,925 37,925 10.00% 3,793 90.00% 34,133 94.5%25 MG PHN II (1677) 100.00% 87,803 87,803 0.00% 86.00% 75,511 3.50% 3,073 10.50% 9,219 69.7%26 FT PHN I (1677) 100.00% 64,482 64,482 0.00% 82.00% 52,875 12.50% 8,060 5.50% 3,547 69.7%27 MM SPHN (1615) 77.00% 111,974 86,220 10.00% 8,622 14.00% 12,071 76.00% 65,527 93.4%28 BB PHN II (1615) 100.00% 87,803 87,803 0.00% 11.00% 9,658 7.00% 6,146 82.00% 71,998 93.4%29 RN PHN I (1615) 100.00% 59,826 59,826 0.00% (0) 31.00% 18,546 15.00% 8,974 54.00% 32,306 93.4%30 SP PHN I (1615) 100.00% 74,324 74,324 0.00% 30.50% 22,669 15.50% 11,520 54.00% 40,135 93.4%TOTAL WAGESStaff Traveling (X)(I) PERSONNEL DETAILFRINGE BENEFIT RATE(V) INDIRECT COSTS DETAIL75.66%TOTAL INDIRECT COSTSJ-Pers MCF Per Staff25.00% of Total Wages + Fringe Benefits201710 MCAH 5 Budget 2017-18 08-24-173 of 4Printed: 10/26/2017 5:01 PM
Maternal, Child and Adolescent Health DivisionORIGINALProgram: Agency: (1)(2) (3) (4) (5) (6) (7) (10) (11) (14) (15) (16) (17)TOTAL FUNDING %TITLE V%SIDS%Agency Funds*%CombinedFed/Agency*%Combined Fed/Agency*MCAH Cnty-N MCAH Cnty-ENON-ENHANCED MATCHING (50/50)ENHANCED MATCHING (75/25)Maternal, Child and Adolescent HealthSubK:201710 FresnoMCAH-TVUNMATCHED FUNDING SIDS AGENCY FUNDS31 PC PHN II (1615) 100.00% 88,403 88,403 0.00% (0) 32.00% 28,289 12.00% 10,608 56.00% 49,506 93.4%32 MM SPHN (1670) 23.00% 111,974 25,754 24.00% 6,181 50.50% 13,006 25.50% 6,567 94.5%33 VP PHN II (1670) 100.00% 77,718 77,718 20.00% 15,544 14.50% 11,269 65.50% 50,905 94.5%34 MV PHN II (1670) 100.00% 88,403 88,403 34.55% 30,540 5.50% 4,862 59.95% 53,001 94.5%35 EA SPHN 90.00% 87,204 78,484 0.00% 11.00% 8,633 48.00% 37,672 41.00% 32,178 94.5%36 DO PHN I 60.00% 61,648 36,989 0.00% (0) 6.00% 2,219 60.00% 22,193 34.00% 12,576 94.5%37 NC PHN II 60.00% 62,000 37,200 17.00% 6,324 54.00% 20,088 29.00% 10,788 94.5%38 JC PHN II 10.00% 60,722 6,072 15.00% 911 58.00% 3,522 27.00% 1,639 94.5%39 EL PHN II (1720) 100.00% 87,803 87,803 0.00% (0) 17.50% 15,366 33.00% 28,975 49.50% 43,462 94.5%40 AA PHN II (1720) 100.00% 87,803 87,803 22.50% 19,756 39.50% 34,682 38.00% 33,365 94.5%41 V PHN I (1720) 50.00% 60,121 30,061 25.50% 7,666 28.50% 8,567 46.00% 13,828 94.5%42 LH SPHN 65.00% 103,323 67,160 22.00% 14,775 53.50% 35,931 24.50% 16,454 90.1%43 LH SPHN (1719) 10.00% 103,323 10,332 0.00% 12.00% 1,240 70.50% 7,284 17.50% 1,808 90.1%44 SC PHN II (1719) 100.00% 75,724 75,724 0.00% 33.50% 25,368 24.00% 18,174 42.50% 32,183 90.1%45 KB PHN II (1719) 100.00% 87,803 87,803 0.00% 20.00% 17,561 33.00% 28,975 47.00% 41,267 90.1%46 V PHN I 30.00% 60,121 18,036 0.00% 10.00% 1,804 20.00% 3,607 70.00% 12,625 90.1%47 LV PHN II 60.00% 77,718 46,631 10.00% 4,663 14.00% 6,528 76.00% 35,440 90.1%48 BB PHN II 60.00% 75,363 45,218 0.00% 10.00% 4,522 20.00% 9,044 70.00% 31,653 90.1%49 EB PHN II 60.00% 75,363 45,218 0.00% 10.00% 4,522 20.00% 9,044 70.00% 31,653 90.1%5051525354555657585960616263646566676869707172737475201710 MCAH 5 Budget 2017-18 08-24-174 of 4Printed: 10/26/2017 5:01 PM
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 1 of 17 3/15/2017 California Department of Public Health (CDPH) Maternal, Child and Adolescent Health (MCAH) Program Scope of Work (SOW) ☒ IMPORTANT: By clicking this box, I agree to allow the state MCAH Program to post my Scope of Work on the CDPH/MCAH website. The Local Health Jurisdiction (LHJ), in collaboration with the State MCAH Program, shall strive to develop systems that protect and improve the health of California’s women of reproductive age, infants, children, adolescents and their families. The goals and objectives in this MCAH SOW incorporate local problems identified by LHJs 5-Year Needs Assessments and reflect the Title V priorities of the MCAH Division. The local 5-Year Needs Assessment identified problems that LHJs may address in their 5-Year Action Plans. The LHJ 5-Year Action Plans will then inform the development of the annual MCAH SOW. All LHJs must perform the activities in the shaded areas in Goals 1-3 and monitor and report on the corresponding evaluation/performance measures. In addition, each LHJ is required to develop at least one objective in each of Goals 1 and 2 and 2 objectives for Goal 3, a SIDS objective and an objective to improve infant health. LHJs that receive FIMR funding will perform the activities in the shaded area in Goal 3, Objectives 3.5-3.7 and 3.8. In the second shaded column, Intervention Activities to Meet Objectives, insert the number and percent of cases you will review for the fiscal year. If resources allow, LHJs should also develop additional objectives, which they may place under any of the Goals 1-6. All activities in this SOW must take place within the fiscal year. Please see the MCAH Policies and Procedures Manual for further instructions on completing the SOW. http://www.cdph.ca.gov/services/funding/mcah/Pages/LocalMCAHProgramDocuments.aspx The development of this SOW was guided by several public health frameworks listed below. Please consider integrating these approaches when conceptualizing and organizing local program, policy, and evaluation efforts. o The Ten Essential Services of Public Health: http://www.cdc.gov/nphpsp/essentialServices.html; o The Spectrum of Prevention: http://www.preventioninstitute.org/component/taxonomy/term/list/94/127.html o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm 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: http://www.cssp.org/reform/strengthening-families All Title V programs must comply with the MCAH Fiscal Policies and Procedures Manual which is found on the CDPH/MCAH website at: http://www.cdph.ca.gov/services/funding/mcah/Pages/FiscalDocuments.aspx CDPH/MCAH Division expects each LHJ to make progress towards Title V State Performance Measures and Healthy People 2020 goals. These goals involve complex issues and are difficult to achieve, particularly in the short term. As such, in addition to the required activities to address Title V State Priorities, and Title V and State requirements, the MCAH SOW provides LHJs with the opportunity to develop locally determined objectives and activities that can be realistically achieved given the scope and resources of local MCAH programs. LHJs are required to comply with requirements as stated in the MCAH Program Policies and Procedures Manual, such as attending statewide meetings, conducting a Needs Assessment every five years, submitting Agreement Funding Applications, and completing Annual Reports.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 2 of 17 3/15/2017 Goal 1: Increase access and utilization of health and social services (cross-cutting) o Increase access to oral health services1 o Increase screening and referral for mental health and substance use services1 o Increase utilization of preventive health services1 o Target outreach services to identify pregnant women, women of reproductive age, infants, children and adolescents and their families who are eligible for Medi-Cal assistance or other publicly provided health care programs and assist them in applying for these benefits2 o Provide developmental screening for children in MCAH programs1 The shaded area represents required activities. Nothing is entered in the shaded areas, except for 1.7 as needed. 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) 1.1-1.6 All women of reproductive age, pregnant women, infants, children, adolescents and children and youth with special health care needs (CYSHCN) will have access to: Needed and preventive medical, dental, mental health, substance use services, and social services Early and comprehensive perinatal care An environment that maximizes their health Assessment 1.1 Identify and monitor the health status of women of reproductive age, pregnant women, infants, children, adolescents, and CYSHCN, including the social determinants of health and access/barriers to the provision of: 1. Preventive, medical, dental, mental health, substance use services, and social services 2. Early and comprehensive perinatal care Monitor trends over time, geographic areas and population group disparities. Annually, share your data with your key health department leadership. 1.1 This deliverable will be fulfilled by completing and submitting your Community Profile with your Agreement Funding Application each year Report date data shared with the key health department leadership. Briefly describe their response, if significant. Nothing is entered here.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 3 of 17 3/15/2017 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) 1.2 Participate in collaboratives, coalitions, community organizations, etc., to review data and develop policies and products to address social determinants of health and disparities. 1.2 Report the total number of collaboratives with MCAH staff participation. Submit online Collaborative Surveys that document participation, objectives, activities and accomplishments of MCAH –related collaboratives. 1.2 List policies or products developed to improve infrastructure and address MCAH priorities. Policy Development 1.3 Review, revise and enact policies that facilitate access to Medi-Cal, Medi-Cal Access Program (MCAP), California Children’s Services (CCS), Covered CA, Child Health and Disability Prevention Program (CHDP), Women, Infants, and Children (WIC), Family Planning, Access, Care, and Treatment (Family PACT), Text 4 Baby, or other relevant programs. 1.3 Describe efforts to develop policy and systems changes that facilitate access to Medi-Cal, MCAP, Covered CA, CHDP, WIC, CCS, Family PACT, Text 4 Baby, or other relevant programs. List formal and informal agreements, including Memoranda of Understanding with Medi-Cal Managed Care (MCMC) plans or other organizations that address the needs of mothers and infants. 1.3 Describe the impact of policy and systems changes that facilitate access to Medi-Cal, MCAP, Covered CA, CHDP, WIC, CCS, Family PACT, or other relevant programs. Assurance 1.4 Participate in and/or deliver trainings in MCAH and public health competencies and workforce development as resources allow. 1.4 List trainings attended or provided and numbers attending. 1.4 Describe outcomes of workforce development trainings in MCAH and public health competencies, including but not limited to, knowledge or skills gained, practice changes or partnerships developed.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 4 of 17 3/15/2017 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) 1.5 Conduct activities to facilitate referrals to Medi-Cal, MCAP, Covered CA, CCS, and other low cost/no-cost health insurance programs for health care coverage2 1.5 Describe activities to facilitate referrals to health insurance and programs. 1.5 Report the number of referrals to Medi-Cal, MCAP, Covered CA, CCS, or other low/no-cost health insurance or programs. 1.6 Provide a toll-free or “no-cost to the calling party” telephone information service and other appropriate methods of communication, e.g. local MCAH Program web page to the local community2 to facilitate linkage of MCAH population to services 1.6 Describe the methods of communication, including the, cultural and linguistic challenges and solutions to linking the MCAH population to services. 1.6 Report the following: 1. Number of calls to the toll-free or “no-cost to the calling party” telephone information service 2. The number of web hits to the appropriate local MCAH Program webpage
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 5 of 17 3/15/2017 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) 1.7 All LHJs are required to perform activities for CYSHCN. As resources allow, all LHJs are required to adopt protocols/policies for developmental screening and access/linkage to health insurance and services for children in MCAH Home Visiting (HV) or Case Management (CM) programs (bolded activities and measures #1,2,3) You may also choose to implement activities #4,5,6 in the second column or develop locally specific activities by inserting the activity and the performance measures. You are required to report on the activities you chose to implement. You may also add additional CYSHCN activities to the MCAH SOW Goal 5, Child Health 1.7 Increase the rate of: Developmental screening for children ages 0-5 years according to AAP guidelines – 9 months, 16 months and 30 months All children, including CYSHCN, receive a yearly preventive medical visit 1.7 Promote the American Academy of Pediatrics (AAP) developmental screening guidelines. Required: 1. Promote the yearly medical visit for children, including CYSHCN 2. Adopt protocols/policies to screen, refer, and link all children in MCAH HV or CM Programs 3. Develop quality assurance (QA) activities to ensure children in MCAH programs are screened, referred and linked As resources allow, choose one or more (Bold or highlight in yellow): 4. Promote the use of Birth to 5; Watch Me Thrive or other screening materials consistent with AAP guidelines 5. Participate in Help Me Grow (HMG) or programs that promote the core components of HMG 6. Work with health plans (HPs), including MCMC, to identify and address barriers to screening, referral, linkage and increase the number of HPs requiring screening per AAP guidelines 7. Other activities to promote developmental screening, referral and linkages and improve services for CYSHCN (specify activity here) 1.7 Describe or report the following: Required 1. Activities to promote the yearly preventive medical visit 2. Describe protocols/policies to screen, refer and link all children in MCAH programs 3. List QA process developed to ensure screening, referral and linkage Report the following based on the activities you chose to implement in the second column (Bold or highlight in yellow): 4. Number of providers receiving information about Birth to 5 or other screening materials 5. Describe participation in HMG or HMG like programs 6. Describe barriers and strategies to increase screening, referral and linkage Number of HPs requiring screenings per AAP guidelines 7. List process or performance measures for other activities here 1.7 Describe or report the following: Required 1. Number of children, including CYSHCN, receiving a yearly preventive medical visit 2. Number of children in local MCAH programs receiving developmental screening Number of children with positive screens that complete a follow-up visit with their primary care provider Number of children with positive screens linked to services Number of calls received for referrals and linkages to services 3. Outcomes of protocols/policies and QA activities to ensure screening, referral and linkage Describe the following based on the activities you chose to implement in the second column (Bold or highlight in yellow): 4. See Column 3 5. Outcomes of participation in HMG or HMG like programs. Describe results of work to implement HMG core components 6. Outcomes of activities with HPs 7. List outcomes of other activities here
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 6 of 17 3/15/2017 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) Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. 1.8 By June 30, 2018 90% of community partners identified as providing services to women 18-44 will develop referral pathways to health insurance and medical, dental, and/or mental health care as needed. 1.8 Community Partners/MCAH staff will implement updated Pathways to assess and refer women 18-44 to needed insurance, medical, dental and/or mental health services. Develop a list of desired outcomes of collaboration with partners identified. Assist community partners to develop a QA/QI to ensure that referral pathways implemented are effective and revised as needed 1.8 Briefly describe relationships developed with WIC and other public health programs that serve eligible women. Briefly describe barriers, challenges and solutions to linkages. Briefly describe methods used by partners to assess access to care. Develop and share list of community resources for medical, dental and/or mental health care Describe QA/QI technical assistance provided to community partners 1.8 Describe referral pathways developed Describe outcomes of regular meetings/communications Total number of community partners using referral pathway/# of community partners engaged (goal is 90%)
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 7 of 17 3/15/2017 Goal 2: Improve preconception health by decreasing risk factors for adverse life course events among women of reproductive age o Decrease unintended pregnancies1 o Decrease the burden of chronic disease1 o Decrease intimate partner violence1 o Assure that all pregnant women will have access to early, adequate, and high quality perinatal care with a special emphasis on low-income and Medi-Cal eligible women 2 The shaded area represents required activities. Nothing is entered in the shaded areas. 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) 2.1-2.3 All women will have access to quality maternal and early perinatal care, including CPSP services for Medi-Cal eligible women. Assurance 2.1 Develop MCAH staff knowledge of the system of maternal and perinatal care. Conduct local activities to facilitate increased access to early and quality perinatal care. 2.1 Report the following: 1. List of trainings received by staff on perinatal care 2. List activities implemented to increase access of women to early and quality perinatal care 3. Barriers and opportunities to improve access to early and quality perinatal care 2.1 Describe outcomes of the following: 1. Behavior or practice change following receipt of training 2. Activities implemented to increase access to and improve the quality of perinatal care 3. Activities addressing the barriers to improve access to early and quality perinatal care 2.2 Maintain and manage a network of perinatal providers, including certified CPSP providers. Provide technical assistance or education to improve perinatal care access and quality of perinatal services. 2.2 Describe local network of perinatal providers, including CPSP providers (e.g. concentration of Medi-Cal Managed Care, Fee-for Service, etc.) List technical assistance activities provided to perinatal and CPSP providers (e.g. resources, referrals, tracking system for 2.2 Describe adequacy of current network of perinatal providers in meeting the needs of local maternal population. Describe improvement/s in provider knowledge or practice following technical assistance on perinatal care access and quality of perinatal services.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 8 of 17 3/15/2017 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) Conduct activities with local provider networks and/or health plans to improve access to and quality of perinatal services including coordination and integration of care. follow-up, assessments, interventions, infant care etc.). ** If above is not applicable to the local site, Briefly summarize shared activities performed with current provider networks and/or local health plans to improve access to and quality of perinatal services including coordination and integration of care. Describe outcomes of shared activities performed with the perinatal provider networks and/or local health plan in improving access to and quality of perinatal services 2.3 Conduct face-to-face quality assurance/quality improvement (QA/QI) activities with CPSP providers or Medi-Cal Managed Care (MCMC) liaison to ensure that protocols are in place and implemented. 2.3 List the types of CPSP provider QA/QI activities conducted during site visits. Identify your MCMC liaison contact Report the number of actual site visits conducted with enrolled CPSP providers and/or MCMC liaison 2.3 Describe the results of QA/QI activities that were conducted. Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 9 of 17 3/15/2017 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) 2.4 By June 30, 2018, 90 percent of Medical Providers that interact with MCAH populations will indicate that they provide education and/or distribute information regarding preconception health to their clients. 2.4 Perform the following activities: Survey OB, Family Practice, FQHCs to determine if they are integrating preconception and interconception health into service provision. Continue evaluation to include Health Plans – Cal Viva and Anthem Blue Cross that interact with MCAH populations. Provide preconception health information, education and materials to provider staff. Develop a QA/QI process to monitor implementation of preconception health messages to providers. Review policies to assess inclusion of preconception and interconception health; revise as needed. Develop staff training or communications to ensure appropriate policy implementation Consult with RPPC to determine capacity for collaboration 2.4 Briefly describe or report: Rationale for the preconception content targeted as a result of collaboration Draft language for policies Road blocks to policy development or implementation Number of providers’ surveyed, number receiving information and materials and number agreeing to integrate preconception messages in their offices. Briefly describe method of survey 2.4 Measures include: Number of providers who indicate they educate and distribute information regarding preconception health/ # of providers who completed the survey. Briefly describe outcomes of survey and next steps Describe QA/QI process developed and outcomes. Describe any protocols or policies developed.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 10 of 17 3/15/2017 Goal 3: Reduce infant morbidity and mortality o Reduce pre-term births and infant mortality1 o Increase infant safe sleep practices1 o Increase breastfeeding initiation and duration 1 The shaded area represents required activities. Nothing is entered in the shaded areas, except for FIMR LHJs. 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) 3.1-3.2 All infants are provided a safe sleep environment Assurance 3.1 Establish contact with parents/caregivers of infants with presumed SIDS death to provide grief and bereavement support services3. 3.1 (Insert number) of parents/caregivers who experience a presumed SIDS death and the number who are contacted for grief and bereavement support services. 3.2 Attend the SIDS Annual Conference/ SIDS training(s) and other conferences/trainings related to infant health3. 3.2 Provide staff member name and date of attendance at SIDS Annual Conference/SIDS training(s) and other conferences/trainings related to infant health. 3.2 Describe results of staff trainings related to infant health.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 11 of 17 3/15/2017 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) Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. 3.3 By June 30, 2018, 75% of Medi-Cal managed-care health plans will adopt and implement SIDS/Infant safe sleep materials and education to all pregnant and postpartum clients. 3.3 SIDS coordinator to provide infant safe sleep education and SIDS risk reduction materials to Medi-Cal managed care plans. SIDS coordinator/public health professional to assess the number of culturally and linguistically appropriate infant safe sleep and SIDS risk reduction materials distributed by the health plan and provide technical assistance to local Medi-Cal managed care health plans as needed. SIDS Coordinator works to promote activities, education and information on infant safe sleep education and SIDS risk reduction. Develop a process to measure knowledge change and intent to change behavior and assist plans or providers to measure outcomes. Encourage Medi-Cal managed care providers to share the educational materials with parents to promote the infant safe sleep education and SIDS risk reduction. 3.3 Briefly describe collaboration with Medi-Cal managed care plans. Briefly describe assessment process and tools developed to assess culturally and linguistically appropriate infant safe sleep and SIDS risk reduction materials distributed. Briefly describe key infant safe sleep education and SIDS risk reduction accomplishments and barriers. . 3.3 Number of presentation/training given to managed health care insurers Number of Medi-Cal managed care providers (health education units who adopt infant safe sleep practices and SIDS risk reduction materials/Total number of Medi-Cal managed care providers educated. Number of health insurers who adopt, promote and distribute infant safe sleep and SIDS risk reduction materials/total number of managed care insurers educated. Number of parents/families/provider partners receiving infant safe sleep and SIDS risk reduction materials. 3.4 By June 30, 2018 collaborate with the Preterm Birth Initiative to institute a 3.4 3.4 Briefly describe collaboration and model development. 3.4 Submit brief report on group prenatal care model developed.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 12 of 17 3/15/2017 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) group prenatal care model in the County. MCAH Director, CPSP and BIH Coordinator to participate in group pregnancy care model workgroup. Discuss how CPSP will be provided with fidelity to model to clients participating in group prenatal care. Policies and procedures Group Prenatal Care sessions established Providers will complete needed applications to bill Medi-Cal at Lighthouse for Children. All practitioners acting as facilitators for “Glow” will be certified by “Expect With Me” to be able to provide the program with fidelity to the model. All providers that are currently CPSP Certified will apply to be CPSP Certified for the Lighthouse for Children in order to be able to bill for prenatal care and group education. Develop policies and procedures, curriculum and evaluation methods for group prenatal care model. Provide TA as needed. Develop a QA/QI process to ensure that program is implemented as intended and the results evaluated. Group Prenatal Care sessions established-develop a process to Describe process of providing CPSP in group setting Workgroup accomplishments Women enrolled in Group prenatal care. Briefly describe outcomes of provider certification process Describe process to measure effectiveness of program. Describe TA provided. Number of meetings attended Number of providers certified for group model Number of policies established and description. Number of women enrolled Number of (high risk? Or?) Briefly describe the QA/QI process developed and any outcomes. Briefly describe client satisfaction of prenatal group program
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 13 of 17 3/15/2017 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) measure effectiveness of program and client satisfaction. For FIMR LHJs Only: 3.5-3.7 Preventable fetal, neonatal and post neonatal deaths will be reduced. For FIMR LHJs Only: Assessment 3.5 Complete the review of every African American case and 1 in 5 of all other fetal, neonatal, and post neonatal deaths. For FIMR LHJs Only: Assessment 3.5 Submit number of cases reviewed as specified in the Annual Report table. For FIMR LHJs Only: Assessment 3.5 Submit periodic local summary report of findings and recommendations (periodicity to be determined by consulting with MCAH). Assurance 3.6 Establish, facilitate, and maintain a Case Review Team (CRT) to review selected cases, identify contributing factors to fetal, neonatal, and post neonatal deaths, and make recommendations to address these factors. Assurance 3.6-3.7 Submit FIMR Tracking Log and FIMR Committee Membership forms for CRT and CAT with the Annual Report. 3.7 Establish, facilitate, and maintain a Community Action Team (CAT) to recommend and implement community, policy, and/or systems changes that address review findings.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 14 of 17 3/15/2017 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) Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. For FIMR LHJs Only: 3.8 By June 30, 2018, at least 50% of Medi-Cal Managed Care and WIC agencies who received prematurity awareness materials and training will demonstrate intent to educate and distribute prematurity awareness materials to pregnant and/or parenting program participants For FIMR LHJs Only: 3.8 FIMR Coordinator/Public Health Professional will link Medi-Cal managed care plans and WIC agencies to available prematurity awareness materials and provide technical assistance as needed. FIMR Coordinator/Public Health Professional works to promote activities on preterm birth risk factors, ways to reduce risk of preterm birth and prematurity efforts. Encourage Medi-Cal managed care providers and WIC agencies to share the educational materials with pregnant and parenting women and their families to understand risk factors for preterm birth. . For FIMR LHJs Only: 3.8 Briefly describe collaboration with Medi-Cal managed care and local WIC agencies. Briefly describe key prematurity education, accomplishments and barriers including timelines. List technical assistance provided For FIMR LHJs Only: 3.8 Number of Healthy Babies/Healthy Future presentation/trainings given to managed health care insurers and local WIC agencies. Number of Medi-Cal managed care providers/WIC agencies who adopt prematurity awareness practices and prematurity awareness/prevention education materials / Total number of Medi-Cal managed care and WIC providers educated. Number of health insurers and WIC agencies who adopt, promote and distribute prematurity awareness/prevention materials/total number of managed care insurers and WIC agencies educated. Number of parents/families/provider partners receiving prematurity awareness/prevention materials.
Agency: County of Fresno Fiscal Year: 2017-18 Agreement Number: 201710 1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 15 of 17 3/15/2017 Goal 4: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight o Increase consumption of a healthy diet1 o Increase physical activity1 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 By June 30, 2018, 3 labor and delivery hospitals will have implemented the model hospital policies or the Baby-Friendly USA Hospital requirements to comply with the Infant Feeding Act [Health and Safety Code Section 123360-123367] and 1 labor and delivery hospital will have achieved the Baby Friendly Hospital Designation 4.1 Continue working relationships with current birthing hospital administrators and staff and develop relationships when leadership changes occur. Provide technical assistance and support to hospitals to meet the requirements of the Infant Feeding Act and Baby Friendly Hospital. Participate and support hospitals to attend Cross County Collaborative (San Joaquin, Merced, & Fresno) to develop “Best Practices” for achieving “Baby Friendly” status. Develop and implement a Continuous Quality Improvement/Quality Assurance (CQI/QA) process to monitor implementation of policies/process, and a plan to evaluate its impact. 4.1 Dates, number and names of hospitals contacted and types of technical assistance provided. Briefly describe barriers, challenges and solutions to implementing the Infant Feeding Act and Baby Friendly Hospital. Hospital share and learn from other hospitals how to achieve Baby Friendly. Description of the CQI/QA process developed. 4.1 Number of hospitals that have implemented the model hospital policies or the Baby-Friendly USA Hospital requirements/ 3 hospitals. Scores for the Implementation of 10 Steps to Successful breastfeeding. Attendance and minutes of the collaborative. Describe the outcome of the CQI/QA process including methods of measurements and results.
1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 16 of 17 3/15/2017 Goal 5: Improve the cognitive, physical, and emotional development of all children, including children and youth with special health care needs o Reduce unintentional injuries1 o Reduce child abuse and neglect1 o Provide developmental screening for all children1 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 By June 30, 2017, 120 children identified through referrals from Community Partners at high risk for unintentional injuries, child abuse and neglect, will receive Public Health Nursing home visitation, including developmental screening. By June 30, 2017, 150 children receiving services from Nurse-Family Partnership (NFP) and Babies First will receive developmental screening. 5.1 Through Public Health Nurse home visitation case management services: Monitor, screen and refer as needed all children for physical, emotional and cognitive delays. Assess, monitor and refer as needed all home environments for inadequate, unsafe and or unhealthy living conditions. Educate all families served on the optimal emotional, physical and cognitive environments for children with a focus on the positive characteristics of each family. Screen all families for maternal depression and domestic violence. Continue to support home visitation staff with self-care reflective practice sessions and educational opportunities for increased knowledge of medical and emotional needs of families. 5.1 Develop process measures for applicable intervention activities here. Number of families assessed/screened for maternal depression /DV / Total number of families screened Number of home environments assessed for inadequate living conditions and referred to community resources / Total number of home environments assessed. Documentation of home visitation will be maintained in the Electronic Charting System. Maintain documentation of referrals to community resources and outcomes. NFP and Babies First data will be collected in the Management Information System (MIS) 5.1 Develop short and/or intermediate outcome related performance measures for the objectives and activities Number of completed referrals made to community services/At least 35% (goal) of clients referred will complete referrals made to community services. Report % of preventable re-hospitalizations/Preventable re-hospitalization rate will be less than 10%= goal Number of children at high risk for unintentional injuries, child abuse and neglect received public health nursing home visitation, including developmental screening / 120 Number of children from NFP and Babies First received developmental screening / 150 re.
1 2016-2020 Title V State Priorities 2 Tittle V Requirement 3 State Requirement Page 17 of 17 3/15/2017 Goal 6: Promote and enhance adolescent strengths, skills, and supports to improve adolescent health. o Decrease teen pregnancies1 o Reduce teen dating violence, bullying and harassment 1 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 Add specific short and/or intermediate SMART outcome objective(s) here. Consider addressing local problems related to: Adolescent sexual health Adolescent pregnancy Adolescent injuries Adolescent violence Adolescent mental health 6.1 List activities to meet the Outcome Objective(s) here. Organize intervention activities and performance measures using the three core functions of public health: Assessment, Policy Development, and Assurance. http://www.publichealth.lacounty.gov/qi/corefcns.htm 6.1 Develop process measures for applicable intervention activities here. 6.1 Develop short and/or intermediate outcome related performance measures for the objectives and activities here.
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
Agency Name: County of Fresno
Agreement/Grant Number: 201710
Compliance Attestation for Fiscal Year: 2017-18
The Sexual Health Education Accountability Act of 2007 (Health and Safety Code , Sections
151000 -151003) requires sexual health education programs (programs) that are funded or
administered , directly or indirectly, by the State , to be comprehensive and not abstinence-only.
Specifically , these statutes require programs to provide information that is medically accurate,
current , and objective, in a manner that is age , culturally , and linguistically appropriate for targeted
audiences . Programs cannot promote or teach religious doctrine , nor promote or reflect bias (as
defined in Section 422 .56 of the Penal Code), and may be required to explain the effectiveness of
one or more drugs and/or devices approved by the federal Food and Drug Administration for
prevent ing pregnancy and sexually transmitted diseases. Programs directed at minors are
additionally required to specify that abstinence is the only certain way to prevent pregnancy and
sexually transmitted diseases .
In order to comply with the mandate of Health & Safety Code , Section 151002 (d), the California
Department of Public Health (CDPH) Maternal, Child and Adolescent Health (MCAH) Program
requires each applicable Agency or Community Based Organization (CBO) contracting with MCAH
to submit a signed attestation as a condition of funding . The Attestation of Compliance must be
submitted to CDPH/MCAH annually as a required component of the Agreement Funding
Application (AFA) Package . By signing this letter the MCAH Director or Adolescent Family Life
Program (AFLP) Director (CBOs only) is attesting or "i s a witness to the fact that the programs
comply with the requirements of the statute". The signatory is responsible for ensuring compliance
with the statute . Please note that based on program policies that define them , the Sexual Health
Education Act inherently applies to the Black Infant Health Program , AFLP , and the California
Home Visiting Program , and may apply to Local MCAH based on local activities .
The undersigned hereby attests that all local MCAH agencies and AFLP CBOs w ill comply with all
applicable provisions of Health and Safety Code , Sections 151000 -151003 (HS 151000-
151003). The undersigned further acknowledges that this Agency is subject to monitoring of
compliance with the provisions of HS 151000-151003 and may be subject to contract termination
or other appropriate action if it violates any condition of funding, including those enumerated in HS
151000-151003.
Signed
County of Fresno
Ar/yNam
Signature of
Signature of AFLP
Rose Mary Rahn
Printed Name of MCAH Director
Printed Name of AFLP Director (CBOs only)
October 2011 Page 1 of 3
201710
Agreement/Grant Number
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
CALIFORNIA CODES
HEAL TH AND SAFETY CODE
SECTION 151000-151003
151000. This division shall be known , and may be cited, as the Sexual Health Education
Accountability Act.
151001 . For purposes of this division, the following definitions shall apply :
(a) "Age appropriate" means topics, messages, and teaching methods suitable to particular
ages or age groups of children and adolescents , based on developing cognitive, emotional ,
and behavioral capacity typical for the age or age group .
(b) A "sexual health education program" means a program that provides instruction or
information to prevent adolescent pregnancy , unintended pregnancy , or sexually
transmitted diseases , including HIV, that is conducted , operated, or administered by any
state agency, is funded directly or indirectly by the state , or receives any financial
assistance from state funds or funds administered by a state agency , but does not include
any program offered by a school district, a county superintendent of schools , or a
community college district.
(c) "Medically accurate" means verified or supported by research conducted in compliance with
scientific methods and published i n peer review journals , where appropriate , and
recognized as accurate and objective by professional organizations and agencies with
expertise in the relevant field, including , but not limited to , the federal Centers for Disease
Control and Prevention, the American Public Health Association , the Society for Adolescent
Medicine , the American Academy of Pediatrics, and the American College of Obstetricians
and Gynecologists.
151002. (a) Every sexual health education program shall satisfy all of the following requirements :
(1) All information shall be medically accurate , current , and objective .
(2) Individuals providing instruction or information shall know and use the most current scientific
data on human sexuality , human development , pregnancy , and sexually transmitted
diseases.
(3) The program content shall be age appropriate for its targeted population .
(4) The program shall be culturally and linguistically appropriate for its targeted populations .
(5) The program shall not teach or promote religious doctrine.
(6) The program shall not reflect or promote bias against any person on the basis of disability,
gender, nationality , race or ethnicity , religion , or sexual orientation , as defined in Section
422 .56 of the Penal Code.
(7) The program shall provide information about the effectiveness and safety of at least one or
more drugs and/or devices approved by the federal Food and Drug Administration for
preventing pregnancy and for reducing the risk of contracting sexually transmitted diseases .
October 2011 Page 2 of 3
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
(b) A sexual health education program that is directed at minors shall comply with all of the
criteria in subdivision (a) and shall also comply with both the follow ing requirements :
(1) It shall include information that the only certain way to prevent pregnancy is to abstain from
sexual intercourse, and that the only certain way to prevent sexually transmitted diseases is
to abstain from activities that have been proven to transmit sexually transmitted diseases.
(2) If the program is directed toward minors under the age of 12 years , it may, but is not
requ i red to , include information otherwise required pursuant to paragraph (7) of subdivision
(a).
(c) A sexual health education program conducted by an outside agency at a publicly funded
school shall comply with the requirements of Section 51934 of the Education Code if the
program addresses HIV/AIDS and shall comply with Section 51933 of the Education Code if
the program addresses pregnancy prevention and sexually transmitted diseases other than
HIV/AIDS.
(d) An applicant for funds to administer a sexual health education program shall attest in writing
that its program complies with all conditions of funding , including those enumerated in this
section . A publicly funded school receiving only general funds to provide comprehensive
sexual health instruction or HIV/AIDS prevention instruction shall not be deemed an
applicant for the purposes of this subdivision.
(e) If the program is conducted by an outside agency at a publicly funded school , the applicant
shall indicate in writing how the program fits in with the school's plan to comply fully with the
requirements of the California Comprehensive Sexual Health and HIV/AIDS Prevention
Education Act, Chapter 5 .6 (commencing with Section 51930) of the Education Code.
Notwithstanding Section 47610 of the Educat ion Code, "publicly funded school" includes a
charter school for the purposes of this subdivision .
(f) Monitoring of compliance with this division shall be integrated into the grant monitoring and
compliance procedures. If the agency knows that a grantee is not in comp l iance with this
section , the agency shall terminate the contract or take other appropriate action .
(g) This section shall not be construed to limit the requirements of the Californ ia
Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (Chapter 5 .6
(commencing with Section 51930) of Part 28 of the Education Code).
(h) This section shall not apply to one-on-one interactions between a health practitioner and his
or her patient in a clinical setting .
151003. This division shall apply only to grants that are funded pursuant to contracts entered into
or amended on or after January 1, 2008.
October 2011 Page 3 of 3
CERTIFICATION OF INDIRECT COST RATE METHODOLOGY
Version: 2/2017 Page 1 of 2
Please list the Indirect Cost Rate (ICR) Percentage and supporting methodology for the contract or
allocation with the California Department of Public Health, Maternal Child and Adolescent Health
Division (CDPH/MCAH Division).
Date: 4/20/2017
Agency Name: County of Fresno
Contract/Agreement Number: 201710 Contract Term/Allocation Fiscal Year: 2017-18
1. NON-PROFIT AGENCIES/ COMMUNITY BASED ORGANIZATIONS (CBO)
Non-profit agencies or CBOs that have an approved ICR from their Federal cognizant agency are
allowed to charge their approved ICR or may elect to charge less than the agency’s approved ICR
percentage rate.
Private non-profits local agencies that do not have an approved ICR from their Federal cognizant
agency are allowed a maximum ICR percentage of 15.0 percent of the Total Personnel Costs.
The ICR percentage rate listed below must match the percentage listed on the Contract/Allocation
Budget.
0.00% Fixed Percent of:
Total Personnel Costs:
2. LOCAL HEALTH JURISDICTIONS (LHJ)
LHJs are allowed up to the maximum ICR percentage rate that was approved by the CDPH
Financial Management Branch ICR or may elect to charge less than the agency’s approved ICR
percentage rate. The ICR rate may not exceed 25.0 percent of Total Personnel Costs or 15.0
percent of Total Direct Costs. The ICR application (i.e. Total Personnel Costs or Total Allowable
Direct Costs) may not differ from the approved ICR percentage rate.
The ICR percentage rate listed below must match the percentage listed on the
Allocation/Contracted Budget.
25% Fixed Percent of:
Total Personnel Costs:
Total Allowable Direct Costs:
3. OTHER GOVERNMENTAL AGENCIES AND PUBLIC UNIVERSITIES
University Agencies are allowed up to the maximum ICR percentage approved by the agency’s
Federal cognizant agency ICR or may elect to charge less than the agency’s approved ICR
percentage rate. Total Personnel Costs or Total Direct Costs cannot change.
0.00% Fixed Percent of:
Total Personnel Costs (Includes Fringe Benefits)
Total Personnel Costs (Excludes Fringe Benefits)
Total Allowable Direct Costs
CERTIFICATION OF INDIRECT COST RATE METHODOLOGY
Please provide you agency's detailed methodology that in cludes all indirect costs, fees and
percentages in the box below.
County of Fresno , Department of Public Health's Indirect Cost Rate (ICR) of 26.19% was
calculated by dividing the Total Allowable Indirect Costs by the Total Allowable Di rect Cost s for
Salaries. The I CR was prepared and calculated using the 2014-2015 actual costs and b udget
information for the Department of Public Health . The allocation of a llowable indirect costs were
accomplished by classifying the total cost, based on actual cost incurred , as direct or indirect
cost, which included salaries , benefits , computer services, audit serv ices , janitorial services ,
rental expenses , mileage/travel , office supplies , telephone, liabi lity insurance, etc. The ICR is
based on the most recent audited financials for the County which received an unqualified c lean
opinion from the County's independent e xte rnal auditors .
This rate was reviewed and approved by the County of Fresno, Auditor-ControllerrTreasurer-
Ta x Collector. County will claim CDPH's approved ICR of 25% of Total Perso nnel Costs.
Please submit this form via email to your assigned Contract Manager.
The unde rsign ed certifies that th e costs us ed to calculate the ICR are based on the most recent,
avai lable and independently audited actua l financi a ls and are the same costs approved by the CDPH
to determine th epa ment appr ICR.
Signature :
Printed First & La st Name: Rose Mary Rahn
Title/Position : MCAH Director
Date: 8 /22/2017
Version; 2/2017 Page 2 of 2
STATE-OF CALIFORNIA
CALIFC>RNIA·CIVIL RIGHTS LAWS ATTACHMENT
OGS OLS 04 :(~8Y. 0111 i)
PEF'A~TMENT PF GENERAL SERVICES
OFFiCE Of LEGAl SERVICES
. ' .
Pursuant to Public Contract Code section 2010, a person thatsubinits a bid or proposal to, or
· otheri.vise proposes to enter into or renew a contract with, a state agency with respect 1o any
~nfract in the amount ()f $100,Q00 or above shall certify, Under penaltyperjury, atthe time the
bid or proposal is submitted or the contract fs renewed, all of the following:
.1. CAUFORNIA CIVIL RiGHTS, LAWS: For contracts executed _or renewed after January 1;
2017, the contractor certifies oompliance with the Unruh CivH Rights Act (Section· 51 of the Civil
Code}and the Fair Employment and Housing Act {Section 12960 of the Government Code);
and
. 2. EMPLOYER DISCRIMINATORY POLICIES: For contracts executed or renewed after .
January 1, 2017, if a Contractor has an internalpqlicy ag~inst a sovereign nation or peoples
· recognized by the United States govenimant, the Contractor certifies that such. policies are not .
used in violation of the Unruh Civil Rights Act (Section 51 ofthe Civil Code) or the Fair
. Employment and Housing Act (Section12960 of the Government Code).
CERTIFICATION
· 1.rt'fie~oificTai"namedbeiow:-certiffuncierperia1ty-of pe~ury-un-iet ·FecleraT7i5~Nurhber
1 the laws of the State of California that the foregoing is true a.nd
correct. · · · ·
Proposer/Bidder Firm Name (Printed)
County of Fresno
946000512
I
I
· By. (Authorized Signature) · ----------------· I·
I f~nffeof~ s_1_g_m;_n_g_· ----~---------,----------i
! Sal Quintero, Chairman. Board .of Supervisors · I
[
Date Executed .----. -· Executed in th(! County and State of . -_.·-__ -.]' .
. --. · · .· q .Qo\~ ·. Fresno California .
. S:,J~jJ_Ch ,--;-~---
ATTEST:
BERNICE E. SEIDEL
Clerk to the Board of Supervisors
Cou~t of Fresno, State of California . -t
By Le 'tf: Deputy