HomeMy WebLinkAboutAgreement A-19-572 with CDPH.pdfAgreement No. 19-572
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1 AGREEMENT-FUNDING APPLICATION
:.. . POLICY. COMP.LIANCE AND :CERTIF.iCATION _ •
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Please enter the agreement or contract number for each of the applicable programs
MCAH #: 201910
B IH #: 201910
AFLP#:
Update Effective Date : (only required when submitting updates
The undersigned hereby affirms that the statements contained in the Agreement Funding Application
(AFA) are true and complete to the best of the applicant's knowledge.
I certify that these Maternal, Child and Adolescent Health (MCAH) programs will comply with all applicable
provisions of Article 1, Chapter 1, Part 2, Division 106 of the Health and Safety code (commencing with
section 123225), Chapters 7 and 8 of the Welfare and Institutions Code (commencing with Sections
14000 and 142), and any applicable rules or regulations promulgated by CDPH pursuant to this article
and these Chapters. I further certify that all MCAH related programs will comply with the most current
MCAH Policies and Procedures Manual, including but not limited to , Administration , Federal Financial
Participation (FFP) Section. I further certify that the MCAH related programs will comply with all federal
laws and regulations governing and regulating recipients of funds granted to states for medical assistance
pursuant to Title XIX of the Social Security Act (42 U.S .C . section 1396 et seq .) and recipients of funds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of the Social
Security Act (42 U.S.C . section 701 et seq .). I further agree that the MCAH related programs may be
subject to all sanctions, or other remedies applicable , if the MCAH related programs violate any of the
above laws, regulations and policies with which it has certified it will comply.
Original signature of official authorized to commit the Agency to a MCAH Agreement
Name (Print) Nathan Magsig
Title_Chairman of the Board of Supervisors of the County of Fresno_ Date ~ 6" p-0"1
H / AFLP Director ATTEST:
BERNICE E. SEIDEL
Name (Print)_Rose Mary Rahn ________ _
Title ~~~
Page 2 of 2
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 1 of 26 04/11/2019
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 in the 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 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 two local objectives in Goal 1, one to address the health of reproductive age women and one to address the
needs of pregnant women and two local objectives for Goal 3, a SIDS/SUID objective and an objective to improve infant health. LHJs that receive FIMR funding
will perform the activities in the shaded area in Goal 3.5, including one local objective addressing fetal, neonatal, post-neonatal and infant deaths. In the second
shaded column of 3.5a, Intervention Activities to Meet Objectives, insert the number and percent of cases that will be reviewed for the fiscal year. Lastly, if
resources allow, LHJs should develop additional objectives, which can be placed under any of the Goals 1-5. All activities in this SOW must take place within the
fiscal year. Please see the MCAH Policies and Procedures for further instructions on completing the SOW.
The development of this SOW was guided by several public health frameworks including the ones 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
o The Spectrum of Prevention
o Life Course Perspective
o The Social-Ecological Modelhttp://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
o Social Determinants of Health
o Strengthening Families
All Title V programs must comply with the MCAH Fiscal Policies and Procedures Manual, which is found on the CDPH/MCAH website
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
requirements, the MCAH SOW provides LHJs 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 Progress Reports.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 2 of 26 04/11/2019
Goal 1: Women/Maternal Domain: Improve access to and utilization of comprehensive, quality health and social services
The shaded and/or highlighted areas represent required activities.
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)
Objective 1.1
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,
and social services by:
• Targeting 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
• Decreasing Medi-Cal eligible
women, children, post-partum
women without insurance1
Assessment
1.1a
i. 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:
• Preventive, medical,
dental, and social
services
1.1a
i. This deliverable will be fulfilled
by completing and submitting
your Community Profile with
your Agreement Funding
Application each year
1.1a
Nothing is entered here.
ii. Review data books and
monitor trends over time,
geographic areas and
population group disparities
ii. Briefly describe process for
monitoring and interpreting
data
iii. Annually, share your data with
key local health department
leadership
iii. Report the date data shared
with the key health
department leadership. Briefly
describe their response, if
significant.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 3 of 26 04/11/2019
Goal 1: Women/Maternal Domain: Improve access to and utilization of comprehensive, quality health and social services
The shaded and/or highlighted areas represent required activities.
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)
1.1b
Participate in collaboratives,
coalitions, community
organizations, etc., to review data
and develop policies and products
to address social determinants of
health and disparities.
1.1b
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.
1.1b
List policies or products
developed to improve
infrastructure that address MCAH
priorities.
Policy Development
1.1c
i. Review, revise and enact
protocols or policies that
facilitate access to Medi-Cal,
California Children’s Services
(CCS), Covered CA, and
Women, Infants, and Children
(WIC)
1.1c
i. List types of protocols or
policies developed or revised
to facilitate access to health
care services.
1.1c
i. List formal and informal
agreements in place including
Memoranda of Understanding
with Medi-Cal Managed Care
Plans (MCP) or other
organizations that address the
needs of mothers and infants
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 4 of 26 04/11/2019
Goal 1: Women/Maternal Domain: Improve access to and utilization of comprehensive, quality health and social services
The shaded and/or highlighted areas represent required activities.
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)
ii. Develop and implement
protocols to ensure all clients
in MCAH programs are
enrolled in a health insurance
plan, linked to a provider, and
complete an annual visit.
Protocols include the following
key components:
• Assist clients to enroll in
health insurance
• Link clients to a health
care provider for a
preventive and/or medical
visit
• Develop a tracking
mechanism to verify that
the client enrolled in
health insurance,
completed a preventive or
well medical visit
ii. Briefly describe the key
components of the protocols
developed to ensure all clients
in MCAH programs are
enrolled in insurance or a
health plan, linked to a
provider and complete an
annual preventative and/or
medical visit.
ii. Describe and summarize the
impact of protocols or policy
and systems changes that
facilitate access to Medi-Cal,
CCS, Covered CA, and WIC.
Assurance
1.1d
Develop staff knowledge and
public health competencies for
MCAH related issues
1.1d
Summarize staff knowledge and
competencies gained
1.1d
Nothing is entered here
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 5 of 26 04/11/2019
Goal 1: Women/Maternal Domain: Improve access to and utilization of comprehensive, quality health and social services
The shaded and/or highlighted areas represent required activities.
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)
1.1e
Conduct activities to facilitate
referrals to Medi-Cal, Covered
CA, CCS, and other low cost/no-
cost health insurance programs
for health care coverage2
1.1e
Describe activities to ensure
referrals to health insurance,
programs and preventive visits
1.1e
Report the number of referrals to
Medi-Cal, Covered CA, CCS, or
other low/no-cost health insurance
or programs.
1.1f
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
1.1f
Describe the methods of
communication, including the,
cultural and linguistic challenges
and solutions to linking the MCAH
population to services
1.1f
Report the following:
• Number of calls to the toll-free
or “no-cost to the calling party”
telephone information service
• The number of web hits to the
appropriate local MCAH
Program webpage
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 6 of 26 04/11/2019
Goal 1.2: WOMEN/MATERNAL DOMAIN: Improve access to and utilization of comprehensive, quality health and social services for reproductive age
women.
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 LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures
in the appropriate column below. Each LHJ is required to develop at least one specific short and/or intermediate SMART outcome objective(s) to
address access to needed preventive services. Number each locally developed objective as follows: 1.2, 1.2a, 1.2b, 1.2c, 1.2d, etc.
Objective 1.2
By June 30, 2020, increase the
number of MCAH women of
reproductive age who access
and utilize preventative health
services by 5%.
• Well-women visit
• Mental health
• Substance use
• Chronic disease
• Preconception/
Interconception care
• Birth Intervals-Spacing
• Unintended/mistimed
pregnancy
• Family planning
• Intimate partner/domestic
violence
1.2
1-key question (Reproductive Life
Plan questions in Electronic
Medical Record (EMR)) to all
MCAH women (pregnant and non-
pregnant)
Collect number of women who
access and utilize preventative
health services
Identify defined list of preventative
services/activities to support
mom’s reproductive goals
(American College of
Obstetricians and Gynecologists
(ACOG))
Develop a quality improvement
process related to the process of
collecting data on identified list of
preventative services/activities
1.2
Develop data reports in Avatar to
measure outcomes
Define/develop description of
preventative health services for
reproductive women to be
collected in EMR/Management
Information System (MIS)
Participate in Preterm Birth
Initiative (PTBi) Coordination of
Care W orkgroup to coordinate a
Connectors’ Conference to
improve the coordination and
integration of physical and
behavioral healthcare, social
services and other support for
women, before, during and after
pregnancy by sharing resources
1.2
Percentage of MCAH women of
reproductive age who access and
utilize preventative health service
such as well-woman visit,
interconception care and or/family
planning/Baseline of 57%
Number of women utilizing
preventative services/Total
number of women served
100 attendees will attend
Connector’s Conference for Care
Navigators, Case Managers to
have an opportunity to share the
services they offer to the
community
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 7 of 26 04/11/2019
Goal 1.3: WOMEN/MATERNAL DOMAIN: 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.
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)
Objective 1.3
All women will have access to
quality maternal and early
perinatal care, including CPSP
services for Medi-Cal eligible
women by:
• Increasing first trimester
prenatal care initiation1
• Increasing postpartum visit1
• Increasing access to providers
that can provide the
appropriate services and level
of care for reproductive age
women1
Assurance
1.3a
i. Develop MCAH staff
knowledge of the system of
maternal and perinatal care
1.3a
Report the following:
i. List of trainings received by
staff on perinatal care, such
as roundtables, regional
meetings, collaborative work
1.3a
Provide the number and describe
the outcomes of:
• Roundtable meetings
• Regional meetings
• Other maternal and perinatal
meetings
ii. Develop a comprehensive
resource and referral guide of
available health and social
services
ii. Submit resource and referral
guide
iii. Attend the yearly CPSP
statewide meeting
iii. Date and attendance at the
CPSP yearly meeting
iv. Conduct local activities to
facilitate increased access to
early and quality perinatal
care
iv. List activities implemented to
increase access of women to
early and quality perinatal
care. Identify barriers and
opportunities to improve
access to early and quality
perinatal care
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 8 of 26 04/11/2019
Goal 1.3: WOMEN/MATERNAL DOMAIN: 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.
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)
1.3b
Outreach to perinatal providers,
including Medi-Cal Managed Care
i. Enroll in CPSP (Fee-for-
Service and FQHC/RHC/IHC
providers)
1.3b
i. Enroll FFS and
FQHC/RHC/IHC providers
Identify the MCP liaison(s).
1.3b
Nothing is entered here
ii. Identify and work with MCP
liaisons to provide CPSP
comparable services
ii. Work with MCP(s) to provide
CPSP comparable services
iii. Assist MCP providers to
provide CPSP comparable
services
iii. Work with MCP providers to
provide CPSP comparable
services
1.3c
Coordinate perinatal activities
between MCAH and the Regional
Perinatal Programs of California
(RPPC) to improve maternal and
perinatal systems of care,
including coordinated post-partum
referral systems for high-risk
mothers and infants upon hospital
discharge
1.3c
List number of meetings attended
to facilitate coordination of
activities between RPPC and
MCAH and briefly describe
outcomes
1.3c
Nothing is entered here.
1.3d
Conduct technical assistance and
face-to-face quality
assurance/quality improvement
(QA/QI) activities with CPSP
providers or managed care
providers in collaboration with
1.3d
Report the number of CPSP
provider technical assistance
activities conducted by phone or
email
1.3d
Describe the results of technical
assistance provided by phone or
email
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 9 of 26 04/11/2019
Goal 1.3: WOMEN/MATERNAL DOMAIN: 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.
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)
MCP(s) liaison to ensure that
CPSP services are implemented
and protocols are in place
Report the number of QA/QI face-
to-face site visits conducted with:
• Enrolled CPSP providers
• MCPs providers (with MCP
liaison(s))
• Number of chart reviews
List common problems or barriers
and successful interventions
Describe the results of QA/QI
activities that were conducted
with:
• Enrolled CPSP providers
• MCPs providers (with MCP
liaison(s))
• Summary of findings from the
chart reviews
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 10 of 26 04/11/2019
Goal 1.4: WOMEN/MATERNAL DOMAIN: Improve access to and utilization of comprehensive, quality health and social services for pregnant women.
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 LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures
in the appropriate column below. Each LHJ is required to develop at least one specific short and/or intermediate SMART outcome objective(s) to
address access to needed preventive services. Number each locally developed objective as follows: 1.4, 1.4a, 1.4b, 1.4c, 1.4d, etc.
Objective 1.4
Establish a collaborative
exchange with Communicable
Disease(CD)/STD program to
provide a warm handoff of
women/infants identified during
investigation and treatment for
syphilis to PHN home visitation
and case management
1.4
Work with the CD/STD program to
establish collaboration and warm
handoff of women/infants identified
during treatment for syphilis for
case management/home visitation
services
Verbal agreement with the CD/STD
program that all infants born to
syphilis infected mothers will be
referred to children’s home
visitation programs for case
management
1.4
Develop data reports in Avatar to
measure outcomes of syphilis
infected pregnant women and
their infants
1.4
Number of syphilis infected
pregnant and/or parenting women
referred from CD/STD program to
PHN services /Total number of
pregnant and/or parenting women
identified by CD/STD as syphilis
infected
Number of infants referred from
CD/STD program to PHN services
/Total number of infants identified
by CD/STD born to syphilis
infected mothers
Objective 1.4a
Throughout the pregnancy, all
CPSP providers will receive
education on the importance of
informing clients of the health
benefits of fourth trimester care
1.4a
PSC will supply all CPSP providers
with the ACOG Postpartum Toolkit
and provide round table on use
and implementation
1.4a
Track the number of CPSP
providers that received the Toolkit
and that attended the round table
1.4a
Number of CPSP providers that
received Toolkit /Total number of
CPSP providers
Number of CPSP providers that
attended round table/Total
number of CPSP providers
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 11 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
Objective 2.1
Provide developmental
screening for all children1 in
MCAH programs
• All children, including
CYSHCN, receive a yearly
preventive medical visit
• Increase the rate of
developmental screening for
children ages 0-5 years
according to AAP guidelines –
9 months, 18 months and 30
months
Child Objective
2.1a
Promote the American Academy
of Pediatrics (AAP) developmental
screening guidelines.
2.1a
2.1a
The following bolded activities,
i, ii, are required:
i. Promote regular preventive
medical visits for all
children, including
CYSHCN, in MCAH Home
Visiting and Case
Management programs, per
Bright Futures/AAP,
Required
Describe or report the following
for MCAH programs:
i. Activities to promote the
yearly preventive medical
visit
Required
Describe or report the following
for children in MCAH programs
i. Number of children,
including CYSHCN,
receiving a yearly
preventive medical visit
ii. Adopt protocols/policies,
including a QA/QI process,
to screen, refer, and link all
children in MCAH Home
Visiting or Case
Management Programs
ii. Describe protocols/policies
including QA/QI process to
screen, refer and link all
children in MCAH programs
ii. Number of children in
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 12 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
• Number of calls
received for referrals
and linkages to services
CYSHCN Objective(s)
At least one activity is required.
Choose from activities 2.1.b-2.1.
(highlight your choices in yellow):
Report the following based on the
activities you chose to implement
in the second column (highlight
your choices in yellow):
Describe the following based on the
activities you chose to implement
in the second column
(highlight your choices in yellow):
2.1b
Promote the use of Birth to 5;
Watch Me Thrive, Learn the
Signs, Act Early or other
screening materials consistent
with AAP guidelines
2.1b
Number of providers or provider
systems receiving information
about Birth to 5, Learn the Signs,
Act Early or other screening
materials
2.1b
Nothing is entered here
2.1c
Participate in Help Me Grow
(HMG) or programs that promote
the core components of HMG
2.1c
Describe participation in HMG or
HMG like programs
2.1c
Outcomes of participation in HMG
or HMG like programs. Describe
results of work to implement HMG
core components
2.1d
Increase understanding of the
specific barriers to referral and
evaluation by early intervention or
pediatric specialists (including
mental/behavioral health)
2.1d
Describe barriers to referral and
evaluation by early intervention or
pediatric specialists
2.1d
Nothing is entered here
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 13 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
2.1e
Plan and implement a family
engagement project to improve
local efforts to serve children and
youth with special health care
needs (e.g., convene a family
advisory group to assess how
CYSHCN are served in local
home visiting or case
management programs)
2.1e
Describe project activities, goals,
and outcomes such as number of
family members engaged, number
of community meetings, and other
process measures specific to the
planned project
2.1e
Nothing is entered here
2.1f
Work with health plans (HPs),
including MCPs, to identify and
address barriers to screening,
referral, linkage and to assist the
HPs in increasing developmental
screenings for their members,
per AAP guidelines, through
education, provider feedback,
incentives, quality improvement,
or other methods
2.1f
Describe barriers and strategies to
increase screening, referral and
linkage
• Number of HPs requiring
screenings per AAP
guidelines
2.1f
Nothing is entered here
2.1g
Identify methods to measure and
monitor rates of developmental
and other types of childhood
screening, referrals, and
successful linkages to care in
your jurisdiction
2.1g
If applicable, provide data on
developmental and other
screening rates, referrals, and
successful linkages to care for the
target population
2.1g
Nothing is entered here
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 14 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
2.1h
Based on local needs, develop
strategies to promote awareness
of and address childhood
adversity and trauma, including
Adverse Childhood Experiences
(ACEs), and build family and
community resilience
2.1h
Provide a description, and data if
applicable, on process measures
and outcomes relevant to the
planned activities
2.1h
Nothing is entered here
2.1i
Outreach and education to
providers to promote
developmental screening, referral
and linkages
2.1i
Describe type of
outreach/education performed and
results of outreach to providers
2.1i
Nothing is entered here
2.1j
Provide care coordination for
CYSHCN, especially non-CCS
eligible children or children
enrolled in CCS in need of
services not covered by CCS
2.1j
Describe activities for care
coordination provided
2.1j
List the number of children
receiving care coordination
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 15 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures
in the appropriate column below. Number each locally developed objective as follows: 2.2, 2.2a, 2.2b, 2.2c, etc.
Objective 2.2
By June 30, 2020 120 children
identified through referrals from
Community Partners at high
risk for unintentional injuries,
child abuse and neglect, will
receive PHN home visitation,
including developmental
screening
2.2
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.
Screen all families for maternal
depression and intimate partner
violence.
2.2
Collect data on the number of
children that receive assessment
over the total number of children
served
Collect data on the number of
completed referrals for a physical,
emotional, or cognitive delay over
the total number of children
referred
Collect data on the number of
preventable re-hospitalizations
over the number of children
served
2.2
The number of children in PHN
division’s children’s programs who
received developmental
screening/120
At least 35% of clients referred will
complete referrals made to
community services
Preventable re-hospitalization rate
will be less than 10%
Objective 2.2a
By June 30, 2020, 125 children
receiving services from Nurse-
Family Partnership Program
(NFP) and Babies First at risk
for cognitive, emotional or
physical delays will receive
2.2a
All families served will be
educated on the optimal
emotional, physical and cognitive
environments for children with a
2.2a
Collect data on the number of
children that receive assessment
over the number of children
served
2.2a
The number of children in Nurse
Family Partnership and Babies
First Programs who received
developmental screening/125
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 16 of 26 04/11/2019
Goal 2: CHILD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
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)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures
in the appropriate column below. Number each locally developed objective as follows: 2.2, 2.2a, 2.2b, 2.2c, etc.
PHN home visitation including
developmental screening
Examples of focus areas can
include but are not limited to:
• Reducing unintentional
injuries1
• Reducing child abuse and
neglect1
focus on the positive
characteristics of each family
All children identified with a
cognitive, physical, or emotional
delay will be referred to the
appropriate resource to address
the problem identified
The number of completed
referrals for developmental delays
will be tracked in Avatar and MIS
system
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 17 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUID deaths
The shaded area represents required activities.
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)
Objective 3.1
All parents/caregivers
experiencing a sudden and
unexpected death will be
offered grief and bereavement
support services
Assurance
3.1a
Establish contact with
parents/caregivers of infants with
presumed SIDS death to provide
grief and bereavement support
services3
Provide grief and support
materials to parents
3.1a
(Insert number) of
parents/caregivers who
experience a presumed SIDS
death and the number who are
contacted for grief and
bereavement support services.
3.1a
Nothing is entered here
3.1b
Contact local coroner office to
ensure timely reporting and
referral of parents of all babies
who die suddenly and
unexpectedly regardless of
circumstances of death
3.1b
Report the coroner’s notifications
received
Briefly describe barriers and
opportunities for success
3.1b
Nothing is entered here
Objective 3.2.
All professionals, para-
professionals, staff, and
community members will
receive information and
education on SIDS risk
reduction practices and infant
safe sleep
3.2a
Disseminate AAP guidelines on
infant safe sleep and SIDS risk
reduction to providers,
pediatricians, CPSP providers,
parents, community members and
other caregivers of infants
3.2a
Numbers receiving AAP
guidelines on infant safe sleep:
• Providers
• Pediatricians
• CPSP providers
• Child care providers
• Other – list
3.2a
Nothing is entered here
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 18 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUID deaths
The shaded area represents required activities.
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)
3.2b
Attend the SIDS Annual
Conference/SIDS training(s),
SIDS Coordinators’ meeting and
other conferences/trainings
related to infant health3.
3.2b
Provide staff member name and
date of attendance at SIDS Annual
Conference/SIDS training(s) and
other conference/trainings related
to infant health.
3.2b
Describe results of staff trainings
related to infant health.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 19 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUID deaths
The shaded area represents required activities.
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 LOCAL OBJECTIVE: Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the
appropriate column below. Each LHJ must provide at least one specific short and/or intermediate SMART outcome objective(s) to address
SIDS/SUID. Number each locally developed objective as follows: 3.3, 3.3a, 3.3b, 3.3c., etc.
Objective 3.3
By June 30, 2020, provide at
least 1 training per month for
the Department of Social
Services prospective resource
families to obtain required Safe
Sleep education for completion
of resource family application
requirements
3.3
Collaborate with Department of
Social Services to provide
required SIDS/SUIDS/Safe Sleep
education monthly to prospective
resource families
3.3
Track number of Resource Family
trainings provided
3.3
Number of Resource Family
trainings provided/12
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 20 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality
The shaded area represents required activities.
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 LOCAL OBJECTIVE: Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the
appropriate column below. Each LHJ must provide at least one specific short and/or intermediate SMART outcome objective(s) to address
perinatal/infant health. Number each locally developed objective as follows: 3.4, 3.4a, 3.4b, 3.4c., etc.
Objective 3.4
By June 30, 2020, increase
breastfeeding duration among
participants enrolled in home
visitation services at 2 months
and 6 months by 10%
3.4
Partner with local WIC agencies to
educate staff on available WIC
resources to support
breastfeeding moms
Identify and link families to
supportive services to
sustain/increase breastfeeding
duration
Update Electronic Medical Record
system to a) capture client
breastfeeding history and goals;
b) WIC site utilized by participant;
c) track breastfeeding initiation,
breastfeeding at 2 months and 6
months; d) breastfeeding duration
by race/ethnicity
3.4
Collaborate with WIC agencies
and maintain sign-in sheets for
presentation(s) to staff
Update the Breastfeeding
Resources Directory
Monitor and summarize
breastfeeding duration and efforts
quarterly for breastfeeding
duration at 2 months and 6
months
Utilize QI process to address and
summarize breastfeeding duration
challenges
3.4
Total number of staff trained on
WIC services
Number of pregnant clients who
plan to breastfeed/Total number of
pregnant clients who delivered
Number of clients breastfeeding at
2 months/Total number of clients
who delivered
Number of clients breastfeeding at
6 months/Total number of clients
with baby at least 6 months
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 21 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality
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)
For FIMR LHJs only complete
Objective 3.5
Reduce preventable fetal,
neonatal and post-neonatal and
infant deaths.
For FIMR LHJs only complete
Assessment
3.5a
Complete the review of at least __
cases, which is approximately
__% of all fetal, neonatal, and
post-neonatal deaths.
For FIMR LHJs only complete
Assessment
3.5a
Develop a process for sample.
Submit number of cases reviewed
as specified in the Annual Report
table.
For FIMR LHJs only complete
Assessment
3.5a
Submit annual local summary
report of findings and
recommendations (periodicity to
be determined by consulting with
MCAH).
Assurance
3.5b
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.
3.5b
Submit FIMR Tracking Log and
FIMR Committee Membership
forms for CRT and CAT with the
Annual Report.
3.5b and c
Nothing is entered here
3.5c
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: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 22 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality
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 LOCAL OBJECTIVE for FIMR LHJs Only: Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance
Measures in the appropriate column below. Each LHJ must provide at least one specific short and/or intermediate SMART outcome objective(s) to
address perinatal/infant health. Number each locally developed objective as follows: 3.6, 3.6a, 3.6b, 3.6c, etc.
Objective 3.6
By June 30, 2020, MCAH home
visiting staff will receive
training on interventions to
reduce the occurrence of
preterm birth
3.6
Conduct a staff training and
educate on evidence based
interventions to reduce the
occurrence of a preterm delivery
and how to present this
information to a client, once
identified
3.6
Revise and update Policy &
Procedures Guide for Case
Review for Poor Birth Outcomes
3.6
Number of staff trained on
evidence based intervention to
reduce the occurrence of a
preterm delivery/Total number of
home visitation staff
Objective 3.6a
By June 30, 2020, 100% of
women enrolled in PHN case
management services with a
history of preterm delivery will
be identified and provided
educational materials to
increase their knowledge of
preterm delivery risks
3.6a
Provide culturally appropriate
educational materials to all clients
identified with a history of preterm
delivery
3.6a
Collaborate with our IT
department to:
• pull data and identify in the
EMR the number of enrolled
women with a history of a
preterm delivery
• collect data on interventions
to prevent preterm birth
3.6a
Number of enrolled women with a
history of preterm delivery who
received education materials/Total
number of enrolled women with a
history of preterm delivery
Objective 3.6b
By June 30, 2020, Fresno
County MCAH in partnership
with March of Dimes, Fresno
Economic Opportunity
Commission, First 5 Fresno
County and West Fresno Family
3.6b
Develop community engagement
strategy and network to identify
interventions and resources to
develop community lead
intervention aimed at improving
birth outcomes
3.6b
Year one objectives:
• Hire Project Coordinator
• Develop community
engagement strategy
3.6b
Verification of hiring of Project
Coordinator
Identification of community
engagement strategy developed
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 23 of 26 04/11/2019
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality
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)
Resource Center will establish a
Best Babies Zone – Fresno
GROWS (Growing Real
Opportunities for West Fresno)
in the 93706 zip code with the
goal of reducing poor birth
outcomes among African
Americans residing in the
greatest impacted census
tracts.
• Host 3 community wisdom
gatherings in the targeted
census tract areas
• Launch pilot of first
community-generated
intervention
Number of community wisdom
gatherings held
Identification of intervention
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 24 of 26 04/11/2019
Goal 4: CROSSCUTTING DOMAIN: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight.
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)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance
Measures in the appropriate column below. Number each locally developed objective as follows: 4.1, 4.1a, 4.1b, 4.1c, etc.
Objective 4.1
By June 30, 2020, 1 labor and
delivery hospital 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)
4.1
Support the continuation of the
Cross County Collaborative (San
Joaquin, Merced & Fresno) to
develop and share “Best Practices”
Technical assistance and support
for hospitals to meet the
requirements of Model Hospital
policies and/or Baby-Friendly USA
Hospital requirements will be
provided by RPPC
4.1
Dates, number and names of
hospitals contacted and types of
technical assistance provided
Describe how continuation of the
Cross County Collaborative will be
continued
Briefly describe barriers,
challenges and solutions to
implementing 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).
4.1
Number of hospitals that have
implemented the model hospital
policies or the Baby-Friendly USA
Hospital requirements/Total
number of hospitals
Scores for the implementation of
the 10 Steps to Successful
Breastfeeding
Attendance and minutes of the
collaborative.
Objective 4.1a
By June 30, 2020, in collaboration
with RPPC, will develop and adopt
a process to monitor & recognize
labor & deliver hospitals who are
striving to achieve Model Hospital
Policies and/or Baby-Friendly USA
Hospital requirements as well as a
process to provide Quality
Assurance for hospitals that have
attained this designation to be
4.1a
Utilize PDSA cycles to develop a
Continuous Quality
Improvement/Quality Assurance
(CQI/QA) process, to monitor and
recognize hospital achievements
and maintain quality of care for
recertification with RPPC
4.1a
Description of the CQI/QA process
developed
4.1a
Describe the outcome of the CQI/QA
process including methods of
measurements and results.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 25 of 26 04/11/2019
Goal 4: CROSSCUTTING DOMAIN: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight.
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)
ready for recertification every 2
years
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
1 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements Page 26 of 26 04/11/2019
Goal 5: ADOLESCENT DOMAIN: Promote and enhance adolescent strengths, skills, and supports to improve adolescent health.
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)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance
Measures in the appropriate column below. Number each locally developed objective as follows: 5.1, 5.1a, 5.1b, 5.1c, etc.
Objective 5.1
Insert a local objective that
promotes and enhances
adolescents strengths, skills and
supports improve health by:
• Decreasing teen pregnancies1
• Reducing teen dating
violence, bullying and
harassment 1
Examples of focus areas can
include but not limited to:
• Adolescent sexual health,
including contraception,
preconception health, STIs
• Racial ethnic disparities in
adolescent birth rates
• Adolescent injuries
• Adolescent violence
• Adolescent mental health
• Development of a Positive
Youth Development
framework
• Reducing suicides
5.1
List evidence-based or informed
activities to meet the objective(s)
here
Organize intervention activities
and performance measures using
the three core functions of public
health: Assessment, Policy
Development, and Assurance
5.1
Develop process measures for
applicable intervention activities
here
5.1
Develop short and/or intermediate
outcome related performance
measures for the objectives and
activities here
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 1 of 27 7/1/2019
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 2 – Improve Maternal and
Women’s Health. 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 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, Solano, Kern
San Diego,
Alameda, Riverside
Sacramento, San
Bernardino
Los Angeles
BIH Coordinator 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE
FHA/Group Facilitator 2.0 FTE 3.0 FTE 4.0 FTE 6.0 FTE 8.0 FTE
Mental Health
Professional
0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 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 (Optional) 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 2 of 27 7/1/2019
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:
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, Solano, Kern
San Diego,
Alameda, Riverside
Sacramento, San
Bernardino
Los Angeles
64 96 128 192 240
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.
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 the Agreement or amend it to reflect reduced funding. Continued participation in the BIH
program beyond the current fiscal year is also subject to successful performance of agreed upon activities.
The development of this SOW 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.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 3 of 27 7/1/2019
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, 2019 September 30, 2019 October 31, 2019
Second Report October 1, 2019 December 31, 2019 January 31, 2020
Third Report January 1, 2020 March 31, 2020 April 30, 2020
Fourth Report (WAIVED)
Information during this reporting period will
be included in the Annual Progress Report
April 1, 2020 June 30, 2020 July 31, 2020
See the following pages for a detailed description of the services to be performed.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 4 of 27 7/1/2019
Part II: Black Infant Health (BIH) Program
Goal 1: BIH 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:
o 0.5 FTE BIH Coordinator
o Family Health Advocates
(FHA)/Group Facilitators (GF)
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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 5 of 27 7/1/2019
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)
based on MCAH-BIH
designated tier level.
o 1 FTE Community Outreach
Liaison (COL)
o 0.5 FTE Data Entry
o 0.5 FTE Mental Health
Professional (MHP)
o 0.5 FTE PHN (Optional)
• 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
1.3
• List staff training activities in
quarterly report. (N)
• Describe improved staff
performance and confidence in
implementing the program model
as a result of 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 being 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.
1.3
• Maintain records of staff
attendance at trainings. (N)
• Number of trainings and
conferences (both state and local)
attended by staff during FY 2018-
19.
• Completion of at least 2 group
observation feedback forms by
the BIH Coordinator for every
group facilitator during FY 2018-
19. (E)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 6 of 27 7/1/2019
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)
rates and to develop SIDS risk
reduction strategies.
• Require that all key BIH staff (i.e.
BIH Coordinator, and ALL direct
service staff) attend mandatory
MCAH Division-sponsored
trainings, conference calls,
meetings and/or conferences as
scheduled by MCAH Division.
• Quarter 1:
o Annual 2-day Basic Training
o Annual COL Meeting
• Quarter 2:
o Annual 2-day Advanced
FHA/GF Meeting
• Quarter 3:
o Annual MHP/Public Health
Nurse (PHN) Meeting
• Quarter 4:
o Annual Coordinator Meeting
o 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’ case
management activities.
• Recommend training topic
suggestions for statewide
meetings. (N)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 7 of 27 7/1/2019
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
and 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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 8 of 27 7/1/2019
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
conducting outreach
activities, including the use of
social media.
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 2018-19. (E)
• Number of new Memorandum of
Understanding (MOUs)
established in FY 2018-19. (E)
• Total number (overall and by
type) of outreach activities
completed by all staff during FY
2018-19. (E)
PARTICIPANT RECRUITMENT
1.6
All BIH LHJs will recruit
African- American women 18
years of age, less than 30
weeks pregnant.
1.6
• 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.
• Review Recruitment plan annually
and update as needed.
1.6
• 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.
1.6
• 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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 9 of 27 7/1/2019
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)
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 2018-19. (E)
PARTICIPANT ENROLLMENT
1.8
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.
• All participants will be enrolled
during pregnancy.
o All participants will be
enrolled at or before
30 weeks of pregnancy.
• All women will participate in
group intervention.
1.8
• Enroll women that are African-
American.
• Enroll women at or before 30
weeks of pregnancy.
• Enroll women that will participate
in the group intervention.
1.8
• Visual inspection of all
recruitment eligibility fields on
incoming referral forms for
completeness.
• Inclusion of eligibility criteria with
materials used for referral and
recruitment.
1.8
• Number and percent of enrolled
women who meet eligibility
criteria defined by age and timing
of pregnancy. (E) – Fidelity
Indicator A1b
PROGRAM PARTICIPATION
1.9.1
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
1.9.1
• Assign participants to a prenatal
group as part of enrollment
process.
1.9.1
• Describe barriers, challenges and
successes of enrolling women in
a prenatal group within 30-45
days of first successful contact
1.9.1
• Number and percent of enrolled
women who attended a prenatal
group session within 45 days of
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 10 of 27 7/1/2019
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 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)
• 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.
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)
enrollment. (E) – Fidelity Indicator
A3a
• Percent of group sessions that
were conducted in the prescribed
sequence and at the prescribed
time intervals. (E) – Fidelity
Indicator A3c
• Percent of group sessions in a
series that were attended by at
least 5 participants. (E) - Fidelity
Indicator A3b.
1.9.2
BIH Coordinator, under the
guidance and leadership of the
MCAH Director will ensure the
following:
• All BIH participants will receive
case management support as
defined in the P&P.
• All BIH participants will complete
all prenatal and postpartum
assessments within the
recommended time intervals.
• All BIH participants will receive
referrals to services outside of
BIH based on Life Planning
meetings.
1.9.2
• 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
needed based on Life Planning
meetings.
• Ensure participant referrals are
generated and completed for all
services identified.
1.9.2
• 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)
1.9.2
• 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
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 11 of 27 7/1/2019
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 participant dismissal
activities.
• Conduct participant satisfaction
surveys.
• Submit complete and accurate
reports in the timeframe specified
by MCAH.
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)
1.9.3
BIH Coordinator, under the
guidance and leadership of
the MCAH Director will
ensure that all BIH
participants will participate in
Group Intervention Sessions.
1.9.3
• 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.
1.9.3
• Collect and record Group
Intervention Session attendance
records for all enrolled women
into ETO.
• Submit FY 2019-20 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)
1.9.3
• Number of Group Intervention
Sessions entered into ETO that
began during FY 2018-19. (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.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 12 of 27 7/1/2019
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)
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).
• 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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 13 of 27 7/1/2019
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:
o Improve access to health care
services
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.
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 2018-19. (E/N)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 14 of 27 7/1/2019
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 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.
• Document collaborative efforts
with local MCAH programs and
Regional Perinatal Programs
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-
American women and children, to
establish strong resource linkages
for recruitment of potential
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.
• Describe materials used to inform
community partners about BIH.
(N)
2.2
• Number of agencies where the
COL has a documented point(s)
of contact and with whom
information is regularly
exchanged. (N)
• Total number of agencies with
outreach records during FY 2018-
19. (E)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 15 of 27 7/1/2019
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 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.
• List and describe barriers,
challenges and/or successes
related to establishing community
partnerships and point(s) of
contact at least quarterly. (N)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 16 of 27 7/1/2019
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 2018-19 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-
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 17 of 27 7/1/2019
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)
setting skills and create their Life
Plans.
• 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.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 18 of 27 7/1/2019
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:
o Stress management
o Sexual health
o Healthy relationships
o Nutrition
o 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 psycho-social 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.
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 19 of 27 7/1/2019
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.
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,
reproductive coercion or birth
control sabotage.
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)
4.3
BIH Coordinator under the
guidance and leadership of
the MCAH Director will
4.3
• Local staff will work with or
support participants to:
4.3
• Summarize successes and
challenges in addressing mental
health issues, including mental
4.3
• Number and percent of enrolled
participants who completed the
EPDS 6-8 weeks postpartum. (E)
– Fidelity Indicators A5a
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 20 of 27 7/1/2019
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)
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.
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.
health referrals at least once per
quarter. (N)
• 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.
• Assist participants with
completion of the birth plan that
outlines specific labor/delivery
and birthing requests to be
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.
• List and describe additional
activities on infant safe sleep
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 21 of 27 7/1/2019
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)
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.
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.
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 22 of 27 7/1/2019
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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 23 of 27 7/1/2019
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
• 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
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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 24 of 27 7/1/2019
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)
• Provide participants with health
education materials related to
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)
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 25 of 27 7/1/2019
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 26 of 27 7/1/2019
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
Agency: County of Fresno Fiscal Year: 2019-20
Agreement Number: 201910
Page 27 of 27 7/1/2019
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.
California Department of Public Health
Name/No.: MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) Agreement
Funding Application (AFA). Agreement No. 201910 MCAH and Agreement No. 201910
Black Infant Health (BIH)
Fund/Subclass: 0001/10000
Organization #: 56201700; 56201706
Revenue Account #: 4382