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Home My WebLink AboutAgreement A-15-109 with CA Dept. of Public Health.pdfAGT. # 15-109 CALIFORNIA DEPARTMENT OF PUBLIC HEALTH MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIVISION FUNDING AGREEMENT PERIOD FY 2014-15 (LHJs)/2012-13 to 2014-15 (CBOs) AGREEMENT FUNDING APPLICATION (AFA)/UPDATE FORM* ----------- At the beginning of each fiscal year Agencies are required to submit this AFA Form along with their AFA Package, which requires certification signatures (original signatures, no stamps allowed). This form should also be used when submitting updates that occur during the fiscal year. Update submissions do not require certification signatures. The Agency Identification Information section must be completed each time this form is submitted. reement refers to Allocations for LHJs or Grants for CBOs. Any program related information being sent from the CDPH MCAH Division will be directed to the MCAH and/or AFLP Director. Please check the applicable "Program" boxes below: changes being submitted: ~ MCAH OAFLP ~BIH ~FIMR ~CHVP Fiscal Year: 2014-15 U ate Effective: uired when submitti Agreement Number: 201410 Federal Employer 94-6000512 10#: Complete Official County of Fresno 1221 Fulton Mall, Fresno, CA 93721 (Physical Address) P.O. Box 11867 Fresno CA 93775 600-3330 600-7729 Name: David Pomaville Title: P.O. Box 11867 E-Mail Address: .fresno.ca.us Page 1 of 7 Revised June 2014 Agency Name: County of Fresno Agreement#: 201410 #301 Hall of E-Mail Address: 3 OFFICIAL AUTHORIZED TO COMMIT AGENCY Name: Deborah A. Poochigian Title: Chairman, Board of Supervisors Mailing Address: 12281 Tulare St, #300, Hall of Records City: Fresno Phone: (559) 600-5000 I Ext. I E-Mail Address: I district5@co.fresno.ca.us E-Mail Address: .fresno.ca.us Fiscal Year: 2014-15 93721-2198 I Zip: 193721-2198 I FAX: I (559) 600-1609 5 MCAH DIRECTOR (Please check box if MCAH and AFLP Director are the same) Name: Rose Mary Garrone Title: MCAH Director/Division Manager Mailing Address: I P.O. Box 11867 City: Fresno I Zip: J 93775 Phone: (559) 600-3330 I Ext. I I FAX: I (559) 6oo-7729 E-Mail Address: l rgarrone@co.fresno.ca.us Page 2 of? Revised June 2014 • Agency Name: County of Fresno Agreement#: 201410 Fiscal Year: 2014-15 6 MCAH COORDINATOR (Only complete if different from #5) Name: Jennifer Day Title: MCAH Coordinator/Perinatal Services Coordinator Mailing Address: I P.O. Box I 1867 Citv: Fresno I Zip: I 93775 Phone: (559) 600-3330 I Ext. I lFAX: J_(_559) 600 -7729 E-Mail Address: I jday(Zijco.fresno.ca.us E-Mail Address: 8 MCAH INVOICE CONTACT (Only complete if different from #7) Name: Michael Chu Title: Accountant Mailing Address: I P.O. Box 11867 Citv: Fresno l Zij:>_: 193775 Phone: (559) 600-6426 I Ext. J lFAX: I (559) 6oo-7687 E-Mail Address: I mchu(Zijco.fresno.ca.us 9 PERINATAL SERVICES COORDINATOR (PSC) Name: Jennifer Day Title: MCAH Coordinator/Perinatal Services Coordinator Mailino Address: I P.O. Box 11867 Citv: Fresno 1 ZlJ?: 193775 Phone: (559) 600-3330 I Ext. I I FAX: I (559) 6oo-7729 E-Mail Address: I jday@co.fresno.ca.us Page 3 of 7 Revised June 2014 Agency Name: County of Fresno Agreement#: 201410 Fiscal Year: 2014-15 10 AFLP DIRECTOR (Only complete if different from MCAH Director) Name: Title: Mailing Address: I City: lz~ l Phone: J Ext. I I FAX: I E-Mail Address: I 11 AFLP COORDINATOR (Only complete if different from #10) Name: Title: Mailing Address: I Citv: I Zip: I Phone: I Ext. I I FAX: I E-Mail Address: I 12 AFLP BUDGET CONTACT Name: Title: Mailing Address: I City: I Zip: I Phone: I Ext. I I FAX: l E-Mail Address: I 13 AFLP INVOICE CONTACT (Only complete if different from #12) Name: Title: MailinQ Address: I City: I Zip: I Phone: I Ext. l .I FAX: 1 E-Mail Address: I Page 4 of 7 Revised June 2014 Agency Name: County of Fresno Agreement#: 201410 14 BLACK INFANT HEALTH (BIH) COORDINATOR Name: Erica Alexander Title: BIH Coordinator/Public Health Nurse Mailing Address: 1142 E. California Ave City: Fresno Phone: (559) 600-1021 I Ext. I E-Mail Address: I ealexander@)co.fresno.ca.us E-Mail Address: Fiscal Year: 2014-15 I Zip: 193706 I FAX: I (559) 600-I 132 16 BIH INVOICE CONTACT (Only complete if different from #15) Name: Michael Chu Title: Accountant Mailing Address: I P.O. Box 11867 City: Fresno J Zip: l93775 Phone: (559) 600-6426 I Ext. I lFAX: I (559) 600-7687 E-Mail Address: I mchu@co.fresno.ca.us 17 FETAL INFANT MORTALITY REVIEW (FIMR) COORDINATOR Name: Erica Alexander Title: BIH Coordinator/Public Health Nurse Mailing Address: 1142 E. California Ave City: Fresno I Zip: l93706 Phone: (559) 600-1021 I Ext. I I FAX: I (559) 6oo-1132 E-Mail Address: I ealexander@)co.fresno.ca.us Page 5 of 7 Revised June 2014 Agency Name: County of Fresno Agreement#: 201410 Fiscal Year: 2014-15 18 SUDDEN INFANT DEATH SYNDROME (SIDS) COORDINATOR I CONTACT Name: Erica Alexander Title: BIH Coordinator/Public Health Nurse Mailin!l Address: 1142 E. California Ave Citv: Fresno I Zip: 193706 Phone: (559) 600-I 021 I Ext. I T FAX: T (559) 600-1132 E-Mail Address: l ealexander(a)co.fresno.ca.us 19 CALIFORNIA HOME VISITING PROGRAM (CHVP) COORDINATOR/ NURSING SUPERVISOR Name: Kathleen Kelley Title: Supervising Public Health Nurse Mailing Address: I P.O. Box 11867 City: Fresno I Zip: 193775 Phone: (559) 600-3330 I Ext. I I FAX: I (559) 600-7740 E-Mail Address: kkelley(a)co.fresno.ca.us 20 OTHER Name: Title: Mailing Address: I City: I Zip: I Phone: I Ext. I I FAX: I E-Mail Address: l Page 6 of 7 Revised June 2014 Agency Name: County of Fresno Agreement#: 201410 Fiscal Year: 2014-15 AGREEMENT FUNDING APPLICATION POLICY COMPLIANCE AND CERTIFICATION 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 this Maternal, Child and Adolescent Health (MCAH) related program will comply with all applicable provisions of Article 1, Chapter 1, Part 2, Division 1 06 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 this MCAH related program will comply with the MCAH Policies and Procedures Manual, including but not limited to, Administration, Federal Financial Participation (FFP) Section. I further certify that this MCAH related program 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 this MCAH related program may be subject to all sanctions or other remedies applicable if this MCAH related program violates any of the above laws, regulations and policies with which it has certified it will comply. MmJJa. Original Signature of Official authoriz commit the Agency to an MCAH Agre Deborah A Poochigian Name (Type or Print} Rose Marv Garrone Name (Type or Print) Revised June 2014 • Page 7 of7 Chairman. Board of Supervisors Title MCAH Director/Division Manager Title Date FY 2014-2015 AGREEMENT FUNDING APPLICATION (AFA) CHECKLIST Agency Name: County of Fresno Agreement#: 201410 Program: k8J MCAH k8JBIH 0AFLP only) DcHvP one Please check the box next to all submitted dbcuments. ~ 1. AFA Checklist with signature (PDF) ~ 2. Agreement Funding Application Uedate Form with signature (PDF) ~ 3. Attestation of Compliance with the Sexual Health Education Accountability Act of 2007 {PDF) (g] 4. Program Narrative for all applicable programs (Word) 5. Budget Template (Summary Page, Detail Pages, and Justifications) listing all staff (by position) (g] and costs (including projected salaries and benefits). Personnel must be consistent with the Duty Statements and Organizational Charts (Excel) (g] 6. Duty Statements (OS) for all staff (numbered according to the Personnel Detail Page and Organization Chart) listed on the budget (Word) 7. Org Chart(s) of the applicable programs, identifying all staff positions on the budget (w/line item #) (g] and its relationship to other services for women and children, the local health officer and overall agency (Word, Excel, PDF) ~ 8. Approval Letters including waivers for the following positions (PDF): ~MCAH Director; OBIH Coordinator; OAFLP Director; OCHVP Coord.//Nurse Sup.; OOther (g] 9. Scope of Work (SOW) documents for all applicable programs (PDF/Word) (g] 10. Annuallnventort-Form CDPH 1204 (Word) D 11. CHVP Attachment A -Program Operational Requirements, CHVP Attachment C -Transmittal Form [CHVP only] (PDF) ~ 12. Local Health Officer Approval Letter to conduct FIMR [MCAH only] (PDF) ~ 13. Subcontractor (SubK) Agreement Packages {required for all SubKs $5,000 or more) (PDF) ~ 14. Certification Statement for the Use of Certified Public Funds (CPE) [AFLP CBOs and/or SubKs with FFP] (PDF) Revision Date: 08/01114 Page I of2 File Naming Convention Example Please save all electronic documents using the required naming convention below: [Agreement# [space] Program Abbreviation [space) Checklist# [space] Document Name [space] Version Date] Below is an example of the submitted documents for Alameda County: ~ 201.301 BlH 1 AFA Checklist 042913.doc ~ 201.301 BIH 2 Update Form 042913.docx ~ 201.301 BIH 3 Attestation 042913.doc ~ 201.301 BlH 4 Program Narrative 042913.doc ~ 201301 BIH 5 Budget 042913.xlsx ri)201301 BIH 6 OS line 1 042913.docx ~ 201.301 BIH 6 OS line 2 042913.docx ~ 201.301 BlH 6 OS line 3 042913.docx ~ 201.301 BlH 7 Org Chart -Overall Agency 042913.docx i}201.301 BIH 7 Org Chart -Program Only 042913.docx i}201.301 BlH 8 Waiver Letter -MCAH Director 042913.docx l'!) 201.301 BIH 9 SOW 042913.doc l!J201301 BlH 10 Inventoty 042913.doc '=t 201.301 BlH 13 SubK 042913.pdf '=1201.301 BIH 14 CPE 042913.pdf Please contact your contract manager (CM) if you have any questions. Revision Date: 08/0l/14 Page 2 of2 Agency: County of Fresno Agreement Number: 201410 BACKGROUND: California Department of Public Health (CDPH) · Maternal, Child and Adolescent Health (MCAH) Program Scope of Work (SOW) Fiscal Year: 2014-15 In an effort to increase efficiency, simplify and allow for local flexibility, MCAH has consolidated four Title V programs into one scope of work (SOW). All Local Health Jurisdictions (LHJs) will be accountable for Part I, the Local MCAH SOW. Only those LHJs with the Fetal Infant Mortality Review (FIMR) Program funding are accountable for Objectives 3.5-3.7 and 3.8 within Part I of the Local MCAH SOW. LHJs that receive funding for the Adolescent Family Life Program (AFLP) and/or the Black Infant Health (BIH) Program must adhere to their respective SOWs. The BIH SOW has two parts: Part I. Local MCAH, which includes Title V and State required activities, the Comprehensive Perinatal Services Program (CPSP), the Sudden Infant Death Syndrome (SIDS) Program, and FIMR for those LHJs with FIMR funding. Part II. BIH 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. The goals in this SOW incorporate local problems identified by LHJs 5-Year Needs Assessments and reflect the Title V priorities of the MCAH Division. The development of this SOW was guided by several public health frameworks including the Ten Essential Services of Public Health and the three 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 consider integrating these approaches when conceptualizing and organizing local program, policy, and evaluation efforts. o The Ten Essential Services of Public Health: http://www.cdc.gov/nphpsp/essentiaiServices.html; http://www.publichealth.lacounty.gov/gi/corefcns.htm o The Spectrum of Prevention: http://www.preventioninstitute.org/componenUtaxonomy/term/lisU94/127 .html o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm o The Social-Ecological Model: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html o Social Determinants of Health: http://www.cdc.gov/socialdeterminants/ o Strengthening Families: http://www.cssp.org/reform/strengthening-families 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Page 1 of 29 7/3/2014 Agency: County of Fresno Agreement Number: 201410 BUDGET: All Title V programs must comply with the MCAH Fiscal Policies and Procedures Manual which is found on the CDPH/MCAH website at: http:l/www.cdph.ca.gov/services/funding/mcah/Pages/FiscaiDocuments.aspx ACTION REQUIRED: Part I. Local MCAH Fiscal Year: 2014-15 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 objectives to address one problem in each of Goals 1 and 2. LHJs are required to develop 2 objectives for Goal 3, a SIDS objective to promote infant safe sleep and risk reduction community health education and an objective to improve infant health outcomes. If resources allow, LHJs should also develop additional objectives, which they may place under any of the Goals 1-6. All activities in this SOW must take place within the fiscal year. Please see the MCAH Policies and Procedures Manual for further instructions on completing the SOW. http://www.cdph.ca.gov/services/funding/mcah/Pages/LocaiMCAHProgramDocuments.aspx For LHJs that receive FIMR funding, perform the activities in the shaded area in Goal 3, Objectives 3.5-3.7 and 3.8. In the second shaded column, Intervention Activities to Meet Objectives, insert the number and percent of cases you will review for the fiscal year. CDPH/MCAH Division expects each LHJ to make progress towards Title V State Performance Measures and Healthy People 2020 goals. These goals involve complex issues and are difficult to achieve, particularly in the short term. As such, in addition to the required activities to address Title V State Priorities, and Title V and State requirements, the MCAH SOW provides LHJs with the opportunity to develop locally determined objectives and activities that can be realistically achieved given the scope and resources of local MCAH programs. Please review your data with key health department leadership at least annually. LHJs are required to comply with requirements as stated in the MCAH Program Policies and Procedures Manual, such as attending statewide meetings, conducting a Needs Assessment every five years, submitting Agreement Funding Applications, and completing Annual Reports. · FIMR LHJs are required to comply with requirements as stated in the FIMR Policies and Procedures Manual: http://www.cdph.ca.gov/services/funding/mcah/Pages/FIMRDocuments.aspx 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Page 2 of 29 7/3/2014 Agency: County of Fresno Agreement Number: 201410 Part I. Local MCAH Goal 1: Improve Outreach and Access to Quality Health and Human Services Fiscal Year: 2014-15 o Link the MCAH population to needed medical, mental, social, dental, and community services to promote equity in access to quality services, especially for those who are eligible for Medi-Cal or other publicly provided health care programs 1 o Outreach services will be targeted 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 benefits 2 The shaded area represents required activities. !'Jothing is entered in the shaded areas. Short and/or Intermediate Objective(s) 1.1-1.6 All women, infants and children will have access to: • Medical, mental, dental care and available social support services • Early and comprehensive perinatal care and maternal medical, dental, and mental health care • An environment that maximizes their health 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement lntervention.Activities to Meet Objectives (Describe. the steps of . 1 '"""f:I""IL .v11 .,,.,.,.., ..... a., .... ..,., ...... .., ,.,, ... , ... a, .~ .. ,..,vu1 1 the intervention) · ' Short and/or Intermediate Outcome Measure(s 1.1 1,2 Assessment Identify and monitor trends, geographic areas and/or population groups, including disparities, social determinants and barriers to the provision of: 1. Health and human services to the MCAH population 2. Early and comprehensive perinatal care 3. Maternal medical, dental and mental. health care 4. Fetal and infant health care Annually, share your data with your key health department leadership Participate in collaboratives, coalitions, community organizations, etc., to review data and develop policies and products to address social determinants of health and disparities. Process Description and Measures . 1.1 1.2 Assessment List and briefly describe. trends, geographic areas and/or population groups, including disparities; social determinants and barriers to the provision of: 1. Health and human services to the MCAH population 2. Early and comprehensive perinatal care 3. Maternal medical, dental and mental health care 4. Fetal and infant health care. Date data shared with the key health department leadership. Briefly describe their response, if sian ificant. Report the total number of collaboratives with MCAH staff participation. Submit up to three Collaborative Su!Vevs that document Page 3 of 29 1.1 ··Assessment Submit Long Term Outcome Objectives Data Table. 7/'>,/')()1A Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement InterVention Activities to Meet Objectives (Describe the steps of the intervention) · 1.4 Review, revise and enact policies that facilitate access to Medi-Cal, Covered CA, Child Health and Disability Prevention Program {CHOP), Women, Infants, and Children (WIC), Family Planning, Access, Care, and Treatment (Family PACT), and other relevant programs. Assurance Participate in and/or deliver trainings in MCAH and public health competencies and workforce development as . resources allow. 1.5 Conduct activities to facilitate referrals to Covered CA, Medi-Fiscal Year: 2014-15 Evaluation/Performance Measures Process, Short' ar~dfor.lntermediate Measures Reoort on these measures in the Annual Report.).· Process Description and Measures 1 .Short and/or Intermediate Outcome · ·. Measure(s) participation, objectives, activities ·and accomplishments of MCAH...;, related collaboratives. List formal and informal agreements, including Memoranda of Understanding with Medi-Cal Managed Care (MCMC) plans or other organizations that address the needs of niothers and. infants. Assurance. 1.4 1.5 List trainings attended or provided and numbers attending. Describe activities to facilitate referrals to health insurance and 1.4 Describe the impact of policy and systems changes thatfacilitate access toMedi-Cal, Covered CA; . CHOP, WIC, Family PACT, and other relevant programs. . Assurance " Describe outcomes of workforce development trainings in MCAH and public health competencies, including but not limited to, · knowledge or skills gained, . practice changes or partnerships develooed. 1.5. Report the number of referrals to Medi-Cal, CHOP, WIC, Page 4 of 29 7n/?014 Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) Intervention Activities to Meet Objectives (Describe the steps of 1.6 · the.intervention) · Cal, and other low cost/no-cost health insurance programs for health care coverage and local MCAH programs, CHOP, WIC, and other relevant programs2, such as Text4baby: 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 communitl to facilitate linkage of MCAHpopulation to services. Fiscal Year': 2014-15 Evaluation/Performance Measures Process, Short and/or.lntermediate Measures: (Report on these measures in the Annual Report) . Process Description and: Measure~ I Short and/or Intermediate Outcome Measure(s) programs. I FamilyPACT, Text4Baby, or other low/no-cost health insurance or · programs. .,1.6 .·.Report the following: 1. Number ()f calls to the toll-free or "no-cost to the calling party" telephone information serVice 2. The number of web hits to the appropriate local MCAH • .. Program webpage Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. 1.7 By June 30, 2015, 150 women who are contacted through outreach services will be referred to Medi-Cal, CPSP, Covered California programs, or other low cost programs. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement 1.7 Outreach staff will promote and refer women to access available programs. Target outreach to high birth and/or high infant mortality zip codes to promote early prenatal care and Reduce transportation barrier by providing bus tokens for women to access care, including prenatal and infant care. 1.7 Utilize logs to track linkages made during outreach or over the phone. Outreach efforts tracked in database including if in a high birth and/or high infant mortality zip code. Bus token distribution information collected on an electronic log. Briefly describe barriers, challenges and opportunities for success Page 5 of 29 1.7 Number of women referred to Medi-Cal, CPSP, Covered California I 150 Total events in high birth and/or high infant mortality zip code I 150 Number of women who received bus tokens enabling her to access care I 100 7nt?014 Agency: County of Fresno Agreement Number: 201410 Goal 2: Improve Maternal and Women's Health Fiscal Year: 2014-15 o Improve maternal health by optimizing the health and well-being of girls and women across the lifecourse 1 o Reduce maternal morbidity and mortality and the increasing disparity in maternal health outcomes 1 o Assure that all pregnant women will have access to early, adequate and high quality perinatal c·are with a special emphasis on low-income and Medi-Cal eligible women 2 · The shaded area reoresents reauired activities. Nothina is entered in the shaded areas. Short and/or Intermediate Objective(s) 2.1-2.3 All women will have access to quality maternal and early perinatal care, including CPSP services for Medi-Cal eligible women. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Intervention· Activities to· Meet Objectives (Describe the steps of the intervention) 2.1 2.2 2;3 Assurance Develop MCAH • staff knowledge of the system of maternal and perinatal care and CPSP. Recruit and assist Medi-Cal providers to become CPSP providers and implement CPSP according to MCAH Policies and Procedures. Provide technical assistance to CPSP providers and MCMCPians related to the provision of CPSP · services. At a minimufl'l, conduct annual quality improvement quality assurance .(QI/QA) activities, reviewing CPSP prenatal and .postpartum services, for CPSP providers. Conduct QI/QA in collaboration with MCMC plan staff, if applicable. Evaluation/Performance Measures Process, Short and/or Intermediate Measures (Report on these measures in the Annual Reoort Process Description and Measures. 1 Short and/or Intermediate Outcome ·. · Measure(s) Report the following: 1. Number of current and newly enrolled CPSP providers . 2. Number ofMedi~Cal Obstetric (OB) providers 3. Barriers and opportunities for successful recruitment and· retention of CPSP providers 4. Barriers and opportunities to . improve access to quality maternaland oerinatal care 2.2 '' 2.3. . List technical assistari~e provided · to CPSP providers arid MCMC ·. plans; List CPSP provider QI/QA . ·.activities that were conducted. Report the number of .site visits and face t()'face contacts with current andpotential CPSP . providers and MCMC ·providers·· and plans.· · Describe the impact on access to and quality of maternal and perinatal care and CPSP services. '2.2 Describe outcomes of technical assistance.provided toCPSP. ·. providers and MCMC plans. 2.3 ' Describe the results of QI/QA activities thatwere conducted. Page 6 of 29 7/"J./?n1A Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) Intervention Activities to Meet Objectiyes (Describe the steps of the intervention) Fiscal Year: 2014-15 Evaluation/Performance·.Measures Process, Short and/or Intermediate Measures· (Report on thesemeastires in the Annual Report) Process Description and Measures .j. Short.and/or Intermediate Outcome · .. · • . Measure(s) . providers receiving a QI/QA site ·· I · visit. · Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. 2.4 By June 30, 2015, 35 CPSP staff will be trained to administer the Edinburgh or the PHQ-9 and will understand how to interpret and refer for PMAD and co-occurring substance use accordingly. 2.5 By June 30th, 2015, 40 perinatal women at risk due to substance abuse will be provided case management services with the goal of assisting clients in accessing a drug treatment program. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement 2.4 Training will be provided for CPSP staff related to PMAD, how to use Edinburgh or PHQ-9 and how to address and refer for PMAD and/or co-occurring substance use. Assist provider to establish protocols to screen all women for PMAD, refer positive screens and link women to care Provide updated resources/referral list as needed 2.5 On home visits, Public Health Nurses will provide physical, emotional, developmental, feeding and home assessments with a variety of evidenced based tools (i.e. NCAST feeding, ASQ, and ASQ-SE) as age appropriate. Participate in Pathways to Recovery Drug Rehabilitation Program staff meetings at least once a month to establish communication and referral network. 2.4 Pre and post tests will be administered to access level of knowledge before and after training. 2.5 Documentation of case management services will be kept in nursing records. Describe participation in Pathways to Recovery Drug Rehabilitation Program staff meetings at least once a month to.establish communication and referral network. Attendance at meetings recorded on attendance log. Briefly describe number of meetings attended/number of meetings held and outcomes or next steps identified Briefly describe barriers, challenges and opportunities for success Page 7 of 29 2.4 Number of CPSP staff trained to administer the Edinburgh or the PHQ-9 and understood how to interpret and refer for PMAD and co-occurring substance use accordingly I 35. Briefly describe protocols developed and implemented 2.5 Number of women provided case management/40 7/::l/?n14 Agency: County of Fresno Agreement Number: 201410 Goal 3: Improve Infant Health Fiscal Year: 2014-15 o Reduce infant mortality and address disparities by promoting preconception health and health care and by preventing causes such as birth defects, low birth weighUprematurity, SIDS, and maternal complications in pregnancy 1 · The shaded area represents required _a~Lv!tie~. _Nothing js_entered in the shad~d_ a_rE!_as, except for FIMR LHJs. Short and/or Intermediate Objective(s) 3.1-3.2 All infants are provided a safe sleep environment. .Intervention Activities to Meet Objectives (Describe the steps of · the intervention) Assurance 3.1. 3.2 Establish contact with parents/caregivers of infants with presumed SIDS death to provide grief and bereavement support services3: . Attend the SIDS Annual Conference/ SIDS training(s) and other conferences/trainings related to infant health3. · Evaluation/Performance Measures Process, Short and/or Intermediate Measures (R~J>Ort on these measures in the Ai"muaiReport) Process Description and Measures· 1· S~ort and/or Intermediate Outcome . · · Measure(s) Assurance I 3.1 .. . .. (Insert numb~r) of .... parents/caregivers who experience a presumed SIDS death and the number who are contacted for grief and bereavement support services. 3.2 Provide staff member name and date of attendance atSIDS Annual Confererice/fraihing(s) and other conferences/trainings · related to infant health. 3.2 · Describe results of staff trainings .. related to infant health. -Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. 3.3 By June 30,2015, 100 presentation participants, who receive a SIDS/Infant Safe Sleep presentation and/or training will be able to identify at least one SIDS risk reduction strategy. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement 3.3 Maintain documentation of: • Number of community presentations • Number of participants who attend a SIDS risk reduction/infant safe sleep presentation • Develop a process to measure knowledge change and intent to implement what was learned 3.3 Documentation of the number of evaluations/post-tests identifying at least one risk reduction strategy. List types of participants Page 8 of 29 3.3 Number of participants who can identify at least one SIDS risk reduction strategy in a post-evaluation /100 Briefly describe knowledge change and intent to implement what was learned 7/':l./?n1A Agency: County of Fresno . ·~ ...... -.............. ·-··· ber: 201410 Short and/or Intermediate Objective(s) 3.3a By June 30, 2015, all local delivering and/or children's hospitals will receive 1 a SIOS/Infant Safe Sleep 1 presentation, and/or new Sl OS 1 materials to distribute to patients of infants before hospital discharge. 3.3b By June 30, 2015, 300 outreach participants will receive SIDS/infant safe sleep materials. 3.3c By June 30, 2015, organize and implement a central valley SIDS training to increase the number of providers who can provide SIDS education and increase community awareness of SIDS/Safe sleep practices. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Fiscal Year: 2014-15 Evaluation/Performance Measures Intervention Activities to Meet . · Process; Short and/or Intermediate Measures Objectives (Describe the steps of (Report on these measures in the Annual Report) ·. the intervention) Process Description and Measures Short and/or Intermediate Outcome I .·· ·Measure(s) 3.3a 3.3a 3.3a Maintain documentation of: Documentation of the number of Number of local hospitals who hospitals that received a presentation, received a presentation and/or • Number of SIDS/infant safe and/ or educational materials on materjals and expressed sleep presentations SIDS/Infant safe sleep. understanding of how to access SIDS • Number of participants who educational materials I 5 attend a SIDS risk Briefly describe types of staff who reduction/infant safe sleep received information Briefly describe knowledge gained presentation and intent to implement what was • Develop relationship with local Briefly describe process to measure learned delivery and/or children's knowledge change and intent to hospitals implement what was learned Briefly describe policies implemented, • Develop a process to if any measure staff knowledge Describe T A provided change of SIDS risk reduction and infant safe sleep and intent to implement what they I learned • Provide technical assistance as needed I 3.3b 3.3b 3.3b I Documentation of education materials Documentation of education materials Number of participants who received I distributed at local health and distributed during HV's, at local SIDS/Infant Safe Sleep materials I resource fairs, during street outreach community events, during street 300 and home visits for MCAH program outreach and community clients presentations. 3.3c 3.3c 3.3c The SIDS Coordinator will coordinate Documentation of the date and Document number of participants who with the State SIDS program to secure number of attendees for the SIDS received increased knowledge of a date and location for a northern training. SIDS/safe sleep through a post California/Central Valley SIDS training training questionnaire. Page 9 of 29 7/3//014 Agency: County of Fresno Aareement Number: 201410 3.4 Short and/or Intermediate Objective(s) · At least one specific short and/or intermediate SMART outcome objective(s) to address infant health is required here. Objectives that improve infant health may address local problems related to: • Prematurity/Low birth weight • Perinatal substance use For FIMR LHJs Only: 3.5-3.7 Preventable fetal, neonatal and postneonatal deaths will be reduced. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Intervention Activitlesto Meet Objectives (Describe the steps of the intervention) 3.3 3.5 List activities to improve infant health here. Organize intervention activities and performance measures using the three core functions of public health: Assessment, Policy Development and Assurance. http://www.publichealth.lacounty.g ov/gi/corefcns.htm For FIMRLHJs Only: Assessment Complete the review of at least 20 cases, which is approximately 10% of all fetal, neonatal, and postneonatal deaths. Assurance 3.6 .Establish, facilitate; and. maintain ,aCase ReviewTeam (CRT) to ·reView selected. cases, identify contributing factors to fetal, neonatal, and postneonatal deaths, and make recommendations to address these factors. Fiscal Year: 2014-15 Evaluation/Performance Measures . Proce~s, Shqrt' and/or Intermediate. Measures Reoort on these rneasuresin the Annual Report Process Description and· Measures ·I Short and/()r Intermediate .Outcome · Measure(s 3.4 Develop process measures for applicable intervention activities here. · For FIMR LHJs. Only: Assessment 3.5 .·. Submit number of cases reviewed as specified in the Annual Report table, Assurance 3.6-3.7 . ~ . :• SubmitFIMR Tracking Log anti ·. FIMR Committee Membership forms for CRTand.CATwith the Annual Report. · 3.4 Develop short and/or intermediate outcome related performance measures for the objectives and activities here. . For FIMR LHJs Only: . Assessment . 3.5 Submit periodic local summary report of findings and . recommendations (periodicity to be determined by consulting with MCAHY. ' Page 10 of 29 7f?.l?n111 Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) Intervention Activities to Meet ObjeCtive's (Describe the steps. of the intervention)· · 3.7 Establish, facilitate, and maintain a Community Action Team (CAT) to recommend and implement ·· community, policy, and/or systems changes that address review findings. Fiscal Year: 2014-15 . Evaluation/Performance Measures . Process;·Shor:tand/or Intermediate Measures .. (Report on.the~e measures inthe•Armual Report} Process Description ancf M~~sure~ r $hort and{or Intermediate Outcome · Measure(~} 'I. Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. For FIMR LHJs Only: 3.8 By June 30, 2015, 120 high risk infants will receive public health nursing home visitation to reduce the number of preventable re-hospitalizations and secondary illnesses in addition to early referral to services. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement For FIMR LHJs Only: 3.8 On home visits, Public Health Nurses (PHN) will provide physical, emotional, developmental, feeding and home assessments with a variety of evidenced based tools (i.e. NCAST feeding, ASQ, and ASQ-SE) as age appropriate. Referrals and linkages to community resources shall be made as indicated. For FIMR LHJs Only: 3.8 Maintain documentation of referrals to community resources and outcomes. Maintain documentation of rates of preventable re-hospitalization. Documentation of home visitation services will be maintained in the PHN electronic charting system. Page 11 of 29 For FIMR LHJs Only: 3.8 Number of children receiving case management services/120. Report compliance on referrals made to community resources (goal is 35%) Report on preventable re-· hospitalization rate (goal is less than 10%) 7/?.J?() 1/1. Agency: County of Fresno Agreement Number: 201410 Goal 4: Improve Nutrition and Physical Activity Fiscal Year: 2014-15 o Promote healthy nutrition and physical activity among MCAH populations throughout the lifespan beginning with exclusive breastfeeding of infants to six months of age1 Short and/or Intermediate Objective(s) 4.1 By June 30, 2015 3 Fresno county delivery hospitals are actively participating in the Baby friendly Hospital Initiative process or implementing the Model Hospital policies. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 . State Requirement Evaluation/Performance Measures Intervention Activities to Meet.· Process, Shqrt and/or Intermediate Measures Objectives (Describe the steps of . (Report on these measures in the Annual Report) . the intervention) . . . ·. Short and/or Intermediate Outcome Process·oescription and Measures Measure(s) 4.1 4.1 4.1 Convene regular meetings of the Document Consortium meeting Number of hospitals working on the Fresno County Baby-Friendly Hospital attendance, handouts, agendas and Baby Friendly Hospital Initiative Consortium with hospital staff notes. process /3. assigned to pursue the Baby-Friendly Hospital Initiative and provide Identify members of each Baby-Briefly list types of policies/protocols technical expertise, training resources, Friendly Hospital Multi-Disciplinary developed and ongoing support and guidance. Team. The Consortium will meet at least quarterly Agendas and minutes of hospital team meetings. Identify Baby-Friendly Hospital Multi-Disciplinary Teams at each of the 3 Document meetings to identify and identified hospitals address training/education gaps for staff and patients. Each hospital/s multi-disciplinary team is convening and implementing the Document meeting to set up and hospitals1 0 Steps infant feeding policy review data. Work with 3 delivery hospitals to Develop documentation and meetings identify training/education gaps for with hospitals to measure impact and staff and patients and address the outcome measures. gaps Work with 3 delivery hospitals to gather skin to skin and ex breastfeeding data In coordination with hospitals, the Baby-Friendly Hospital consultant and project coordinator, will use 1 0 Steps to Baby Friendly Hospital assessment Page 12 of 29 7/3/?014 Agency: County of Fresno --Number: 201410 Short and/or Intermediate Objective(s) 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Fiscal Year: 2014-15 Evaluation/Performance-Measures Intervention Activities-to Meet Process, Short arid/or Intermediate Measures Objectives (Describe the steps of---{Report on these 'measures in the Annual Report). the intervention) Pr9cess ·oescriptionand-Measures-__ Short and/or Intermediate Outcome ' -Measure(s)-and provider survey to track the impact/outcome of each hospital's policy development, implementation progress, barriers and change strategies, and staff trainings implemented. --L----------------- - -Page 13 of 29 7!1t?n14 Agency: County of Fresno Agreement Number: 201410 Goal 5: Improve Child Health Fiscal Year: 2014-15 o Support the physical, socio-emotional, and cognitive development of children, including the prevention of injuries, through the implementation of prevention, early identification and intervention strategies 1 5.1 Short and/or Intermediate Objective(s) By June 30, 2015, 7 Fresno County Child Care providers will complete the health and safety components of the 10 standards required for meeting national accreditation benchmarks, set forth by the National Association for Family Child Care and the National Association for Education of Young Children. 5.2 By June 30, 2015, 30 identified developmentally and/or behaviorally delayed children from child care settings will be screened, referred and linked to appropriate services. 5.3 By June 30,2015, local MCAH will maintain collaborative agreement with First 5 and SMART Model of Care to support services for children with 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement lnterven,tion Activities to Meet .. Objectives (Describe the steps of the intervention) 5.1 MCAH staff will assist child care providers to complete the health and safety components of accreditation benchmarks. Activities include classes and technical assistance by phone, email and site visits. Also, close collaboration with the Fresno Accreditation Institute for individual provider support given in the process of accreditation in the health and safety components. Referrals made to other services for children with special needs. 5.2 Screening and identification of children with symptoms of developmental and/or behavioral delay at risk for poor school performance and referral to appropriate services. 5.3 Continue to participate in Model of Care Partnership Oversight Committee (MOCPOC) meetings. · Evaluation/Performance Measures ·.Process, Short and/or Intermediate Measures . {Report on these measu·res inthe AnilUal Report)· Process Description and Measures 1 Short and/or Intermediate Outcome · Measure(s) 5.1 Briefly describe technical assistance provided Briefly describe barriers, challenges and opportunities for success 5.2 ASQ-3/ ASQ-SE as well as visitation to child care site and the child's home for direct observation make up the screening process. Records are kept in the nursing documentation of all referrals and services received. Briefly describe barriers, challenges and opportunities for success 5.3 Maintain meeting minutes on file. Document attendance in annual report. 5.1 Number of providers completing the health and safety component of accreditation I 7. Describe standards met 5.2 Number of children screened and referred I 30. Number of children linked to care/number referred 5.3 Document on Collaborative Form. Page 14 of 29 7 !') 1'1("1-1 _....,. I Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) special needs. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Fiscal Year: 2014-15 :Evaluation/Performance Measures .Intervention Activities to Meet Process; Short and/or Intermediate Measures Objective~ (~escribethe steps of .·.· · · (Report on these. measures in the Annual Report). · ··. the rntervention) . . ·-:.··.. · .. ·· · .. · Short and/or Intermediate Outcome . •. ·Process Description and Measures Measure(s) Continue collaboration to build and/or Describe collaboration and capacity Summarize activities and outcomes in maintain capacity to support local building activities. Annual Report. services for children with special needs. I I Continue to maintain annual local Submit local agreements for State I Describe state and locally approved I agreements with First 5 and State approval of pass through funding. 2014 ~ 15 MCAH, First 5, and SMART 1 MCAH to support funding for SMART Model of Care agreements. I ' Model of Care. Page 15 of 29 7/</')1'11 A Agency: County of Fresno Agreement Number: 201410 Goal 6: Improve Adolescent Health Fiscal Year: 2014-15 o Promote positive youth development strategies to support the physical, mental, sexual and reproductive health of adolescents1 Short and/or Intermediate Objective(s) 6.1 By June 30, 2015, 60 pregnant or parenting teens will be provided a comprehensive nursing assessment for high risk prenatal /parenting risk factors through the Adolescent Family Living Program or provided home case management services through the Callearn program. 1 2001-2015 Tittle V State Priorities 2 Tittle V Requirement 3 State Requirement Evaluation/Performance Measures i Intervention Activities to Meet Process, Short. and/or Intermediate Measures ' Objectives (Describe the steps of . (Report on these measures in the Annual Report) the intervention) Snort and/or Intermediate Outcome , Process Description and .Measures . Measure(s}. 6.1 6.1 6.1 On home visits, Public Health Nurses Documentation of services will be Number of teens serviced I 60. will provide physical, emotional, maintained in the charting system developmental, feeding and home particular to AFLP or in the PHN assessments with a variety of electronic charting system for evidenced based tools (i.e. NCAST Cal learn. feeding, ASQ, and ASQ-SE) as age appropriate. Briefly describe barriers, challenges and opportunities for success Page 16 of 29 7/':l./'Jn1 A Agency: County of Fresno Agreement Number: 201410 Part 11. Black Infant Health Program Fiscal Year: 2014-15 The Agency agrees to provide to the Department of Public Health the services in this Scope of Work (SOW). The California Department of Public ·Health, Maternal, Child and Adolescent Health (MCAH) Division places a high priority on the poor outcomes that disproportionately impact the African American community in California. Central to the efforts in reducing these disparities is the Black Infant Health (BIH) Program. The four goals of the BIH Program are to: 1. Improve African American 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 and collect and enter participant and program data into the electronic MCAH-BIH-MIS and engage community partner agencies. All BIH Sites are required to comply with the BIH Policy and Procedure (P&P) Manual and the MCAH Fiscal Policies and Procedures Manual in their entirety. In addition, all BIH Sites shall work toward meeting the BIH Program Standards and to maximize fidelity in implementing Program services, fulfilling all deliverables associated with benchmarks, attending required meetings and trainings and completing other MCAH-BIH reports as required. All activities in this SOW shall take place within the fiscal year. The Black Infant Health 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. 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 "M" Source Key refers to information that is based on client-level program data maintained in the MCAH BIH Management Information System (MIS) included in the MCAH-BIH-MIS. The "N" "Source Key refers to narrative information provided in quarterly reports or site surveys. Page 17 of 29 7r<t?n1A Agency: County of Fresno Agreement Number: 201410 Part II: Black Infant Heath Program Fiscal Year: 2014-15 Goal 1: BIH will maintain program fidelity and fiscal management to administer the program as required by the BIH Program Policies and Procedures and Scope of Work and will assure program implementation, staff competency, and data management Evaluation/Performance Measures ·. Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures ·. •·· Objectives (Describe the steps of (Report on these measures in the Annual Report) Objective(s) the intervention) Short and/or Intermediate Outcome Process Description and Measures · Measure(s) 1.1 1.1 1.1 1.1 LHJ Maternal, Child and • Annually review and revise • Briefly describe MCAH Adolescent Health (MCAH) internal policies and Director and/or BIH Director and/or designee (BIH procedures for delivering Coordinator Coordinator) will provide services to eligible BIH responsibilities as they oversight, maintain program participants. relate to BIH. fidelity, fiscal management and • Submit Agreement Funding • Provide organizational demonstrate that it is Application timely. chart that outlines conducting BIH activities as • Submit BIH Annual report by delineation of required in the BIH Policies and August 15, 2015. responsibilities from Procedures, SOW, Client Data • Submit BIH Quarterly Reports MCAH to the BIH Book, Group Curriculum, and as directed by MCAH. Program. MCAH Fiscal Policies and Procedures. 1.2 1.2 1.2 1.2 Each LHJ must have in place • At a minimum, the following • Describe process of hiring Percent of key staffing roles at site qualified personnel as outlined key staffing roles are required: staff at each site that are filled filled by personnel who meet in the P&P. • 1 FTE BIH Coordinator by personnel who meet recommended qualifications in the • 3 FTE FHNGroup recommended qualifications in P&P. (N) Facilitators the P&P. • Include duty statements of all • . 50 FTE PHN staff with submission of AFA • 1 FTE Community Packet. Outreach Liaison • Submission of all staff • 1 FTE Data Entry Staff changes per guidelines. • 1 FTE Mental Health outlined in BIH P&P Clinician guidelines. • Utilization of a staff hiring plan. Page 18 of 29 71~1?n111 Agency: County of Fresno Agreement Number: 201410 Short and/orlntermediate Objective(s) TRAINING 1.3 All BIH staff will maintain and increase staff competency. -Fiscal Year: 2014-15 .. Evaluation/Performance Measures Intervention Activities to Meet ·. Process, Short and/or Intermediate Measures Objectives (Describe the steps of ... ' (Report on these measures in the Annual Report) the interilention) . Short and/or Intermediate Outcome . Process Description and ,Measures Measure(s) 1.3 1.3 1.3 • Develop a plan to assess • Describe training activities in • MCAH-81 H-MIS Utilization staff's ability to effectively which staff participated. (N) Reports for all staff at BIH perform their assigned tasks, • Maintain records of staff Sites. (M) including regular observations participation in development of group facilitators. activities and staff attendance • Identify staff training needs at trainings. (N) and ensure those needs are • Describe how staff has met, and notifying MCAH of improved their performance any training needs. and confidence in • Ensure that all key BIH staff implementing the program participates in training or model. (N) educational opportunities • List gaps in staff development designed to enhance cultural and training. (N) sensitivity. • Describe plan to ensure that • Require that all key BIH staff staff development needs are (i.e. MCAH Director, BIH met. (N) Coordinator. and ALL direct • Describe how cultural service staff) attend mandatory sensitivity training has MCAH Division-sponsored enhanced LHJ staff trainings, meetings and/or knowledge and how that conferences as scheduled by knowledge is being applied .. MCAH Division. (N) • Ensure that the BIH • Recommend training topics Coordinator and all direct that could be addressed at service staff attend mandatory statewide meetings. (N) MCAH Division-sponsored • Completion of group training(s) prior to observation form. implementing the BIH Program. • Ensure that the BIH Coordinator and/or MCAH Director perform regular observations of group facilitators and assessments of FHAs' case management activities. ----------------Page 19 of 29 7nt?n111 Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) DATA ENTRY 1.4 All BIH participant information and outcome data will be collected timely and accurately using BIH required forms at required intervals. PARTICIPANT RECRUTMENTIOUTREACH 1.5 All BIH LHJs will recruit, outreach and enroll African American women 18 years of age early in pregnancy. Fiscal Year: 2014-15 Evaluation/Performance Measures. I I Intervention Activities to Meet Process, .Short and/or Intermediate Measures . Objectives (Describe the steps of (Report on these measures.in the Annual. Report) . the intervention) .< ., .. Short and/or Intermediate Outcome Process Description and Measures Measure(s) . 1.4 1.4 1.4 • Ensure that all direct service • Review data systems reports • Number and percent of staff participate in data and discuss during calls with enrolled cases that have not collection, data entry, data BIH State Team. had any information/action quality improvement, and use • Enter All data into the MCAH-entered into the MIS within of data collection software BIH-MIS within 7 working days two weeks of enrollment. (M) determined by MCAH. of collection • Number and percent of • Ensure that all subcontractor participants with completed agencies providing direct client recruitment forms. (M) service enter data in the • Number and percent of open MCAH-BIH-MIS as determined cases more than 12 months by MCAH. after delivery date. (M) • Ensure accuracy and completeness of data input into MCAH-BIH-MIS system. • Ensure that all staff receives updates about changes in the MCAH-BIH-MIS and data book forms. Ensure that a selected staff member with advanced knowledge of the BIH Program, data collection, and the MCAH-BIH-MIS is selected as the BIH Site MIS lead and participates in all Data and Evaluation Committee calls. 1.5 1.5 1.5 • Implement the program • Submit participant triage • Describe deviations in activities as designed. algorithm with submission of outreach activities, noting • Develop a Participant AFA packet. changes from local Recruitment Plan • Participant Recruitment .Plan recruitment plan. (N) (standardized intake process) will be reviewed annually and • Describe any program according to the target updated as needed. improvements resulting from population and eligibility • Describe outreach activities client satisfaction survey guidelines in CDPH/MCAH performed in order to reach findings. (N) BIH P&P. target population. Page 20 of 29 ...,,,...,,...I"\ ....... I I I I I I Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) ENROLLMENT 1.6 • 100% of participants enrolled in BIH will be African American. • 95% of participants will be 18 years or older when enrolled in BIH. • 100% of participants will be enrolled during pregnancy. o 80% of participants will be enrolled at or before 26 weeks of pregnancy. • 100% of women will participate in group intervention. PROGRAM PARTICIPATION 1.7.1 • 100% of women will participate in prenatal group. 0 80% of women will participate in group within 30 days of signing consent. 1.7.2 • All BIH participants will receive complementary case management support as defined in the P&P. • At least 65% of all participants will complete all prenatal and postpartum Fiscal Year: 2014-15 .... Evaluation/Performance. M.easures . . lntervEmtiori Activities to Meet . I Process, Short and/or Intermediate Measures I Objectives (Describe the steps of (Report onthesemeasures in.the AnnualReport)· I I,·' .. I the. intervention) I Process Descriptio~ andMeas.ures Short and/or Intermediate Outcome 1 Measure(s) I • Recruitment plan is reviewed annually and updated as needed. 1.6 1.6 1.6 • Enroll participants that are Not Applicable • Number and percent of African American . pafiicipants who are 18 years • Enro!l participants during of age and older.(M) pregnancy. • Number and percent of I • Enroll participants at or before participants enrolled at or 26 weeks of pregnancy. before 26 weeks of I I • Enroll women that will pregnancy. (M) i participate in group I I intervention. I • Provide referrals to other MCAH programs for women who cannot participate in group intervention sessions . 1.7.1 1.7.1 1.7.1 .. I Schedule participants in a Describe barriers, challenges and Number and percent of enrolled prenatal group within 30 days of successes of enrolling participants participants who attend a prenatal 1 signing consent form. in prenatal group within 30 days of group session within 30 days of ' I signing consent form. (N) signing consent form. (M) I I I i 1.7.2 1.7.2 1.7.2 • Conduct complementary case • Report number of prenatal and • Number and percent of management services that postpartum participants· participants with completed align with the Individualized served. (M/N) prenatal and postpartum Client Plan. • Report number and percent of assessments, including Birth • Collect completed self-participants included in Plans at appropriate time I administered scaled questions outreach but do not enroii.(M} intervals. (M} as described in P&P. Page 21 of 29 I Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective{s) assessments within the recommended time intervals. • 100% of BIH participants will receive referrals to services outside of BIH based on her JCP. 1.7.3 All BIH participants will participate in Group Intervention Sessions. 1.8 All participant and program Fiscal Year: 2014-15 Evaluation/P.erformance Measures Intervention Activities to Meet Process,.Shortand/orlntermediate·Measures Objectives (Describe the steps ·of (Report on these measures in the Annual Report) . ' 0. the intervention) Short and/or Intermediate Outcome Process·Description and.Measures . Measure(s) .. • Collect the required number of • Report number and percent of • Number and percent of new I assessments per timeframe enrolled participants for whom participants with completed outlined in P&P. the following actions are initial case conferencing. (M) I • Develop and implement an completed (M): • Number and percent of ICP for each BIH participant; participants with documented complete all prenatal and 0 Intake procedures, disposition of referral I postpartum assessments; including completion of an services. (M) provide ongoing identification initial assessment and I of her specific concerns/needs, date of initial prenatal and referral to services outside I group. of BIH as needed based on 0 Initial case conferencing I her ICP 0 ICP/Life Plan • Conduct case closure 0 4 of 6 assessments activities. (prenatal clients) • Regularly conducting client • Case closure, including Life satisfaction surveys. Plan, ICP, and Assessments. • Submit complete and accurate reports in the time specified by ' MCAH. 1.7.3 1.7.3 1.7.3 • Schedule group sessions with Percentage of enrolled Number and Percent of guidance from State BIH participants who participated participants who complete both Team. in group intervention. (M) the prenatal and postpartum • Conduct and adhere to the 20-• Submit FY 2014-15 Group group intervention. (M) group intervention model as Session Calendar to MCAH-specified in the P&P. BIH Program upon request. • Number and percent of enrolled clients for whom the following actions are I completed (M): 0 7 of 1 0 Prenatal Group Sessions. I 0 7 of 10 Postpartum Group Sessions. 1.8 1.8 0 1.8 I • Accurately and completely • Number and percent of • Number_a_ng percef}tpf ----~ ---------Page 22 of 29 7/') /'"lf'\-1 A Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective( s) data will be entered in the MCAH-BIH-MIS timely and accurately. -Fiscal Year: 2014-15 Evaluation/Performance Measures · Intervention Activities to Meet Process, Short and/orJntermediate Measures_·. Objectives (Describe thesteps of (Report on these· measures inthe Annual Report) · the intervention) · .. . . . ; .. . :· .. Shoit and/or Intermediate Outcome Process Description and Measures . . · · Meast.Jre(s) 1 collect required participant participant records entered into enrolled participants that have . information, with timely data the MCAH-BIH-MlS within 7 information/action entered into . input into the appropriate data working days of collection on the MIS within two weeks of system(s). paper forms. (M) collection. (M) • Wori< with MCAH to ensure • Generate Standard Reports at • Number and percent of cases proper and continuous least quarterly as a management with completed recruitment operation of the MCAH-BIH-tool to assess data accuracy and forms. (M) MiS. completeness. (M) • Number and percent of • Store Client Data Book forms • BIH Coordinator and/or FHA/Data participating women with on paper per guidelines in Entry Staff shall conduct periodic cases closed 12 months after P&P. audits of participant records and delivery date. (M) • Define a data entry schedule report results and number for staff. reviewed (minimum 1 0%). I ---- - -----------------~-------------------· ------------------------ ----- - - --I Page 23 of 29 7/~/'J(\1 A Agency: County of Fresno Agreement Number: 201410 Fiscal Year: 2014-15 Goal 2: Engage the community to support African American families' health and well-being with education and outreach efforts Evaluation/Performance Measures · Intervention Activities to Meet .· Prbcess, Short and/or Intermediate Measures Short and/or Intermediate Objectives (Describe the steps of ·. (Report on these measures in the Annual Report):. Objective(s) the intervention) Short and/or Intermediate Outcome Pr:ocess Description andMea~ures · Measure(s). 2.1 2.1 2.1 2.1 BIH Coordinator and/or MCAH • Educate the community about • Describe the local plan for • Describe community outreach Director will elevate community the BIH Program by delivering community linkages, including an activities conducted by BIH awareness of African American standardized messages about effective referral process that will Coordinator and/or MCAH birth outcomes and the impact poorer birth outcomes among be reviewed on an annual basis Director with submission of on society. African American women and and updated as needed. (N) BIH Quarterly Reports. (N) about how the BIH Program • Briefly describe successes and addresses these issues. barriers to community education • Create partnerships with activities or events. (N) community and referral • List and describe formal and agencies that support the informal partnerships with broad goal of the BIH community and referral agencies. I Program, through formal and (N) informal agreements. • Briefly describe community efforts I • Develop community such as advisory board I awareness plan that outlines involvement, community I I how community engagement collaboration to address maternal i will be conducted. and infant health disparities, or I other similar formal or informal partnerships. (N) 2.2 2.2 2.2 2.2 BIH Outreach Liaison will • Develop collaborative • List the types of outreach • Number of agencies where I increase information sharing relationships with local service performed along with the Outreach Liaison has a i with other local social services agencies in the community to materials used to educate clear point of contact and with agencies in the community and establish strong resource community partners about whom information is regularly I establish a clear point of linkages for recruitment of BIH. (N) exchanged. (M) I contact. potential participants and for • List and describe barriers, • Describe community outreach I referrals of active participants. challenges and/or activities conducted by : • Develop a clear point of successes related to Outreach Liaison with contact (person/s) with establishing community submission of BIH Quarterly collaborating community partnerships and points of Reports. (N) agencies on a regular basis as contact. (N) it relates to outreach, enrollment, referrals, care I coordination, etc. Page 24 of 29 7/3/2014 I I Agency: County of Fresno Agreement Number: 201410 Fiscal Year: 2014-15 Goal 3: Increase the ability of African American women to manage chronic stress . Evaluation/Performance Measures Intervention Activities to Meet •· Short and/or Intermediate .. Process, Short and/or Intermediate Measures Objectives (Describe the steps of (Report on these measures in the Anriual Report):.··. Objective(s) the intervention) Process Description and Measures Short and/or Intermediate Outcome . :.c . '. .. . . . . . .• · .Measure(s) 3.1 3.1 3.1 3.1 All BIH participants will report • Implement the prenatal and • Provide FY 2014-2015 group • Number and percent of increased social support and postpartum group intervention intervention schedules upon participants who report an decreased social isolation after with fidelity to the P&P. request.(N) increase in social support as attending prenatal and/or • Encourage participants to • Number and percent of measured through the Social postpartum group intervention attend and participate in group enrolled participants who Provisions Scale -Short and completing ICP/Life Plan. sessions. participate in group (SPS-SHM) • Support clients in fostering intervention. (M) • Number and percent of healthy interpersonal and completed group facilitator familial relationships. forms. (M) • Report results from group facilitator feedback form, including description of participant engagement in group activities, for each group session. 3.2 3.2 3.2 3.2 All BIH participants will report All activities are delivered with an • Number and percent of • Number and percent of increased self-esteem, mastery, understanding of African participants who complete a women who dearly articulate coping and resiliency after American culture and history. Life Plan.(M) at least one short and long attending prenatal and/or • Assist participants in • Number and percent of term goal as part of their ICP. postpartum group intervention identifying and utilizing their participants who complete an (M) and completing ICP/Life Plan. personal strengths. ICP. (M) • Number and percent of • Develop and implement an • Describe challenges/barriers women who report progress Individual Client Plan why participants did not report toward stated short term goals (ICP)/Life Plan with each an increase in self-esteem, identified in their ICP. (M) client. mastery, coping and resiliency • Number and percent of • Teach and provide support to after attending prenatal and/or participants who maintain or participants as they develop postpartum group intervention increase self-esteem based goal-setting skills and create and completing ICP/Life Plan. on responses to the their Life Plans. (N) Rosenberg Self-Esteem • Teach participants about the Scale. (M) importance of stress reduction • Number and percent of and guide them in applying participants who maintain or stress reduction techniques. increase mastert based on Page 25 of 29 7/?,/')111 A : Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate Objective(s) Fiscal Year: 2014-15 · Evaluation/Performance Measures Intervention Activities to Meet · Process, Short and/or Intermediate Measures Objectives (Describe the steps of .: .. (Report on these measures in the Annual Report) · the intervention) · · .. ·. . . .. ; . ' . Short and/or Intermediate Outcome , Process Description and Measures · · Measure(s) _j • Support participants as they responses to the Pearlin I become empowered to take Mastery Scale. (M) actions toward meeting their • Number and percent of needs. participants who maintain or • Teach participants how to increase coping and resiliency express their feelings in based on responses to the constructive ways. Brief Resilience Scale. (M) • Help participants to understand societal influences and their impact on African American health and wellness. Page 26 of 29 7 /'7!,/?()1 A Agency: County of Fresno Agreement Number: 201410 Fiscal Year: 2014-15 Goal 4: Improve the health of pregnant and parenting women, thus also promoting the health of their infants Intervention Activities to Meet · .. ·... EvaluatiortPerformance Measures Short and/or Intermediate · Process, Short. and/or Intermediate Measures Objective(s) Objectives (Describe the steps of (Report on thesemeasures·in the Annuai·Report) the intervention) Process Description and.Measure.s: Short and/or Intermediate Outcome · · Measure(s) ' ' 4.1 4.1 4.1 '4.1 ' All BIH participants will be • Assist participants in • List and describe additional • Number and percent. of I linked to services that support understanding behaviors that activities (e.g., Champions for participants whose health health and wellness while contribute to overall good Change cooking status improves over the enrolled in the BIH Program. health, including: demonstrations} conducted course of their participation in 0 Stress management that promote health and BIH. (M) 0 Sexual health wellness of BIH participants. . • Number and percent of 0 Nutrition (N) participants and infants who 0 Physical activity • Number and percent of obtained needed health and • Ensure that participants are participants reporting drug, community services while receiving prenatal care. alcohol and/or tobacco use . enrolled in BIH. (M) • Ensure that healthy nutritious who are provided information • Number and percent of snacks are available during and health counseling. (M) participants whose healthy group sessions. • Number and percent of eating behaviors improve over • Provide participants with prenatal participants who the course of their participation health information that complete a birth plan. (M) in BIH. (M) supports a healthy pregnancy. • Number and percent of • Number and percent of • Ensure that participants have participants receiving prenatal participants whose physical access to health insurance. care by trimester of program activity increased over the • Identify participants' health and initiation. (M) course of their participation in social needs and provide • Number and percent of BIH. (M) referrals and follow-up as participants enrolled in WIC. needed to health and (M) community services. • Number and percent of 0 Provide information and health previously uninsured counseling to participants who participants who obtained report drug, alcohol and/or needed health insurance while tobacco use. enrolled in BIH. (M) 0 Assist participants with • Number and percent of completion of their birth plan. prenatal participants who complete a birth plan. (M) -------· ----------·-----~---·--Page 27 of 29 i I I Agency: County of Fresno Agreement Number: 201410 Short and/or.lntermediate Objective(s) 4.2 All BIH participants will report an increase in knowledge and understanding of reproductive life planning and family planning services. 4.3 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. Fiscal Year: 2014-15 Evaluation/Performance Measures Intervention .Activities to Meet Process, S.hort and/or Intermediate. Measures Objectives·(oescribe the steps.of . (Reporton these.measures.in theAnnual Report) the intervention) . .. Short and/or Intermediate Outcome Process Description and Measures Measure(s) : . : . ' . ,:. 4.2 4.2 4.2 • Promote and support family Number and percent of. • Number and percent of planning by providing participants who complete a Life . participants who attend a 4-6 information and counseling. Plan. (M) week postpartum checkup with • Promote and support a medical provider. (M) interconception health. .. Number and percent of • Help participants understand participants who use any and value the concept of method of birth control to reproductive life planning as prevent pregnancy after their they complete their Life Plans. babies are born. (M) • Help participants understand the characteristics of healthy relationships and provide ; resources that can help participants deal with abuse, reproductive coercion or birth control sabotage. • Provide referrals and promote ' linkages to family planning providers including FPACT. 4.3 4.3 4.3 • Help participants understand • Describe successes and • Number and percent of how mental health contributes to challenges in addressing participants with "positive" overall health and wellness. mental health issues, inc!uding EPDS screens who are • Help participants recognize the mental health referrals. (N) successfully referred to a connection between stress and • Number and percent of community mental health mental health and practice stress participants who completed the provider. (M) reduction techniques. Edinburgh Postpartum • Help participants understand the Depression Screen (EPDS) 6-8 connection between physical weeks postpartum. (M) activity and mental health. • Administer the EPDS to every client 6-8 weeks after she gives birth. • Help participants understand the symptoms of postpartum depression. Page 28 of 29 Agency: County of Fresno Agreement Number: 201410 Short and/or Intermediate 0 bjective{s) 4.4 All BIH participants will report an increase in parenting skills and bonding with their infants and other family members. Fiscal Year: 2014-15 Evaluation/Performance Measures Intervention Activities to Meet . Process, Short' and/or Intermediate Measures Objectives (Describe t.he steps of (Report on these measures in the Annual Report} the intervention) · Process Description and Me~sures Short and/or Intermediate Outcome Measure(s} • Provide referrals and follow-up to mental health services when appropriate. 4.4 4.4 4.4 • Assist participants in • List and describe additional • Provide anecdotes/c.lient understanding and applying activities that enhance success stories about effective parenting techniques. parenting and bonding. (N) improved parenting/bonding • Assist participants with • Number and percent of with submission of BIH completing home safety checklist. participants who complete the Quarterly Reports. • Assist participants with increasing safety checklist. (M) • Provide anecdotes/client knowledge of infant safe sleep • List and describe additional success stories about infant practices/sudden infant death activities on infant safe sleep safe sleep practices and syndrome (SIDS), sudden practices/SIDS/SUID risk SIDS/SUID risk reduction with unexplained infant death (SUI D) reduction. (N) . submission of BIH Quarterly risk reduction. • Number and percent of Reports. • Assist participants with postpartum participants who .. Provide anecdotes/client completing birth plan. initiate breastfeeding. (N) success stories about • Assist participants with identifying • Number and percent of breastfeeding practices with and using bonding strategies, prenatal participants who submission of BIH Quarterly including breastfeeding, with their complete a birth plan. (M) Reports. newborns. Page 29 of 29 •••'-'•"' • _._ __ ,..._ 1 .-...v.._.•V""~oi•l WUL.IUL..t _..UbiiC r1e0Uh •)'.'LWII M~letn~I.Ctllld~n4AdaJeK.rniHU/t1101\tb.lan ~ SU~MARY : ; ~ ~ ~~~,;~~~i!i~~:&~f;§;tiSiM~~~;r;~rJ~l Version 1.1A-150_0uattertY • MCAH 81ock B Programs MCAH/BIH Agency: 201410 Fresno County SubK: ALLOCATIONS % MCAH BIH AFLP 156,238' 141,559, SGF 135,604, [1:.,,c::: <:exF!~E~E't::~~:;~::;·;;,<·'·r~;::;~l·· '"·{. ·s .:·rn> ~"c·~~~~ c 1 '''" >~·, '"'···.•? 4.996.3051 1 258.061 1 ~ j .... J. .••• __ ,·_~_!l ••. ,_. '(!·i."~~~i.&~lllet&( .' ""'2 J'F ".{~~~~iik~~~Wf~~~s'i~\::.-~~·:~0:; 812,031 258,061 55,864 ;·· :~~,:!: · · .. : . ~~~--. ~)~-;-~-{~ -·r::~,z~s~~~-:;r,~-~ ; :;.:.~:I~:· ... ~-): .. ~~;:: m . C~eJMb.E*REI':IE>~TURES .. ,_ .. ·•"" . . ~'-tfrif[~i~~srs :f:\4-eji:.;· .. ~;{;~JA~&'; 966,518 >~~·.:·.=.-::;~.~ .)'; ... ·, :-~·~·.:::_.;,·:-.:~};,"··~::~-~:-' . . .. t~:-·-'(V):'c IN[l)IRE!OliTi:.C.Q:SJT.S . ·'·'> 871,308 11.272 2,711 25,753 % PYD ·x;~:' '-. r· ; :· .... :;:;;~;, . ·:~· 1,015,930 263,482 354.275 225.489 Combined Fed/State '''-' ,,~:.; .-:.,;-.. ~:.r.~:· ... ~-... -·-~~-... ,: 146,978 1,602,679 S37.2n 609,532 620,066 *I .. c;.:c:;c .• :::~~.~T,~.-·c'f' ·•.·; :• ... :c.,c:.:,F:::..0·"Cr.:;.·:•--.><<F··· ·'I :.: .... BUDGET TOTALS ''.:,,,,, .... ,,7;;6ii6;l62:.:~·.J,;;,;..·. :'· 297,7.97·· ·:·o.?3" · 551864·., ,.2,32'<.1· ·1:859.17a•F ....... m 14s:~ialf.'~.:.:.o7~t'· · :i:~~,ss;.J' · $ wee TOTAL TITLE V TOTAL SGF TOTAL PYD TOTAL TITLE XIX TOTAL AGENCY FUNDS 201410 MCAH BIH S Budaet 122214 2g7,797 _., I 297,7971 135,604 . I 55,8641 I I -3,195,861 4,016,901 . I 1,859,1761 (50%![~4891 ~-c--;;:4;9J Maximum Amount Payable from State and Federal resources AQ.ncycon«~ 1of14 ~ CJ ~ CJ ::,,;::~~.:I~~lzmt~e~~&if;~:~~n:i~i ;···'-'-tis(:'?(f' ~~·J;i"'li'il:::' Combined FediAgency-.. _,~ .,.-·· ::· >_·.;~~-.~~;:--• .. --:~:. ~;~!'?f·.:~ 25,003 1,891,790 2<C.7<C% 2Mo3 o:33% . . -~':'-i',89l.790; (25%11 - -~.2~1-1 f75"'' . -1-;, 7~2-, f75"11 . . -, (25%( 472,948 1-'8-:15 DATE Printed: 1/S/2015 4:18PM •••-""'• • &...J&..vvr' r r'V\,;J"'"'IVI ouuuc:: I t'Ubhc Health •)<. "'DI'II M•••rn~l. ChUd ~nd AdoJ.s~"~ H••llh DMJion Programs MCAH/BIH Agency: 201410 Fresno County SubK: IIWI~I:"r.l:::'l (I) PERSONNEL (II) OPERATING EXPENSES (Ill) CAPITAL EXPENSES (IV) OTHER COSTS M INDIRECT COSTS fB'i~iB (I) PERSONNEL (II) OPERATING EXPENSES (Ill) CAPITAL EXPENSES (IV) OTHER COSTS M INDIRECT COSTS ~F,If"R"'" 1:\l;i&.;,;r.·:• (I) PERSONNEL (II) OPERATING EXPENSES (Ill) CAPITAL EXPENSES (IV) OTHER COSTS M INDIRECT COSTS STATE USE ONLY PCACODES .-....................... 4,666,637 788,211 963,807 817,878 -------· ----·-TOTAL 7,236,533 PCACODES 329,668 23,820 2,711 53,430 TOTAL 409,629 PCACODES .-........................ TOTAL GRAND TOTAL 7,646,162 ~t:.i·f:::::'f~;]~lih~iir~~iJ~3~r'· .•.'d~L.".'J'· ·. _,;t5j_·,,;<· 53107 .. ,.,, .. , 156,238 156,238 53113 101,823 55,864 11,272 2,711 --~~L---~----141,559 55,864 53109 '>~""'"'~ 53144 ............ 297,797 55,864 MCAH .. ··. ---. -_,-, ·. ,-•. ,,·: : .. ·;•·' ... :· ·,, .. :::'~:,f>d..:c'tio~s~::~:-:c:;.:;:-. s31o1 ':·' .-• ..... :,-~ · •-' · ~:·. ~.-c:-,. '· · · ... -1,015,930 263,482 354,275 225,489 1,859,176 --- - - -----L____ 1,859,176 ~-: :.! . · ~·$:;; ·.'~:: .. ~:/.;·';•;:·= ~~-~· _·~n ·. · J•·· ·•· __ ; 1.1::i.· _·,··1·· .. _-JJ:·· ..... 1· er~::;: -~· .• -z ~}Y.o})s ::.,:7.:d~~~~;~·:.::,:--~5~=;~~~-~-~::C:'~-· .... : . .,:.:; m •• 4ERSdNNEL ·· .. •·. -.• -.·co---"'T .. ··:· _::• (II) .. :oPERATIIiiG.eXPENSES ·:.· -: • '::., .. _: :.·!'.,.,:-_:_ \iAAIT~.EXPEJiiSt:S· :·''/ . ,., · .. ~::; .· .. :_. ~~>:::· .. _._ ..... ·--·-_,,._ .. , ......... ,, •·.· .. ,·,.,:.-: ·' ;:;:i9.~~ ~~LP':;'; .. :~:~:r.~!~:;_~g:~~ri;r~-.· 201410 MCAH BIH 5 Bud&d 122214 · . ." ~ ';.I .';": .!·.:. ··;·:· ~ • ; .... :·:·· • ~.· ,. . •• • •• '1· .• ~-:. :} -~~-~:-.. ~{.~ .~~ . ::•· ~ _···:-.::r· .. , ' .. ::.···. : • :l;'.o:¥,1\i:~--"-'."'' ·;c,·'.;·'-.-'-'-~~ .···"-:· :~.· .. 2ofl4 53118 ......... 53117 ....... 1,602,679 1,891,790 524,729 609,532 592,389 3,329,329 1,891,790 53100 53102 146,978 25,003 12,548 L__ ---27,677 -------146,978 40,225 25,003 313 ~ ........ W~I~U 146,978 3,369,554 '-----~·_D_03 1,891,790 --..... >.::.·:·· .. ~ .. ':t"'' ·.·;: __ ' ··!" .. ·· .• ; ··7. !-~ -· .. ~:: 1:<" ~ ' "·. Printed: t/5/2015 -11:11 PM PUbliC Heaiih ;)<. ':""DPI i M~tern~l. Child •nd Adolncent He~fth Oftri\lon Pn>grams MCAH/BIH Agency: 201410 Fresno County SubK: li~!:~~~~~~~ <1:~r~~::.:; ~ :.~t~;J :: >~-:·:~~~.=·:·· SUBCONTRACTS SMART Model of Care Nurse-Family Partnership 3 Evaluator 4 Ca1o! Melcher ----OTHER CHARGES Books & PubOeations P1omotiona111ems1Ciient Support Materiafs 31~ 201410 MCAH BIH 5 8ud1et 122214 870,760 15,500 ~ 15,125 3,360 8,957 35,105 i., ..... ,r,. • _._V.._.I\. ,-j ... vua·v-'\lll'i L.,j.V~U~ I 3of14 3,153 4,227 4,306 3,804 300 3,563 4,873 90,718 19,7681 56,592 261,228 15,500 15,000 15,125 3,360 8,957 35,105 35,014 9,856 13,211 13,457 11,888 937 11,135 61,782 176,874 ~ 609,532 r--§ ~ ~ MIICI'IA,..._. 'l.f.7~%·' ;:: ·. :; ~s;~.~~~ :c; ·,: ·: ... ·:,, ·l.$;76%· .. ~· ."•·:. ·.-··~-. :::.~; ;~-};~~-.. ~:-·--·_,._-.... --····.-·.·; [:;'0_{". ';. ··?··._: Printed: 1/S/2015 4:18PM twfWI"\i t w.._v....,.r' r-f,U\.:H"V-\IIfl LH.JLI\.;11.:;. I •}l"t\1'11 M•l•flloi~ChildandAdold«ntHeafthOivlskln 8: ., .. .... ;;l ~ -6,869 6,348 120.36% I 10,824 28,261 13.20% 12,034 9,317 20,738 19,409 36,045 1,673 3,724 (0) 12,064 24,718 28,610 23,67( 25,096 2,786 17,730 (0) 2,326 6,448 16,798 (0) 6,428 12,477 (0) 8,216 15,949 (0) 8,216 15,949 (0) 6,203 13,181 (0) 9,835 20,900 (0) 9,221 19,596 14,423 32,104 1,919 32,968 (0) [2:§] 2,442 32,«5 10,466 24,421 361 4,872 7,850 18,316 10,466 24,421 3,244 31,643 1,989 32,898 (0) 707 341 (0) 63,995 5,856 (0) 64,079 8,282 8,923 14,154 (0) 15.90% 13,301 25,933 18,738 16,145 20,830 11,879 15,476 10,457 4,181 25,473 (0) I7.0o%l 611 8,111 18,822 11,962 17,233 13,468 (0) 5,155 33,874 (0) 2,010 335 (0) 2,010 335 (0) 812 665 (0) 3,012 502 26,518 17,902 26,518 17,902 (0) 4,392 31,011 2,867 13,130 (O) 18,460 15,975 201410 MCAH BIH 5 Budaet 122214 4of14 Printed: 1/S/2015 4:18PM PUb'iiCH'e·Qith ;fc1;i•lt M•'•'"'~ Child '"dAdolesc:ent H••llh Division JVII...AM OLUI...I'\ t'KUI.;JKAIVI t:SUL)I.;it: I Programs MCAH/BIH Agency: 201410 Fresno County SubK: ~ ~ ~ ~ 54 u M ~ 60 ~ ~ ~ ~ ~ 68 u 68 ~ ~ n n n H ~ ~ 77 n ~ 60t ~ ~ ~ M ~ 68 ~ 68 ~ ~ ~ ~ ~ ~ ~ 96 ~ 96 ~ wo 1m ·~ ·~ ·~ ·~ ·~ ·~ ·~ ·~ 11D 111 201410 MCAH &IH 5 Budaet 12221<1 100.00% 83,654 60.00% 83,654 60.00% 65,280 60.00% 68,526 6D.OO% 68,362 1DD.DD% 55,822 1DO.OO% 34,887 i·:·~· ' _-.· ... '-_:. :::f. ).~;·~;;U.~M~'f~~;~~;~tJN~iN~. ~-~; \ .. :i · ~i.~ .• ~ j~·:; ·--~, ••• · .•. __ : ,, ... _.._:; .1 :·.: •• · ;; · .. ·:: 'i'• ,:~'cT~r:'@_-J'' ", -er::;~:c:"L-~J~E t5) _ ,.;.LJ·~~ . I -:~ . (5) '·'· ... ~J .. :' :·"® ~ L •;_.;. m~~·LJ!!:,_L" ... toi;: ·:.:::;1 : il'Pf·· L ·-:; ;:, c;;• ~:.: L':li2t'J . -: c•!i· '!:~} -~ C\!~d ·. c•sii. ;v .. · c,_.,-;;r,;nn TOTAL FUNDING % mLEV SOF I % I I --J --~c-;,mb~ --~-jco;bl;;;,d--~--lcomblned I !Combined PYD % Agency Funds' I % Fed/State % Fed/Agency' % Fed/Stale % J Fed/Agency' 83,654 19,D73 28.00% 23,423 49.2D% 41,158 94.5% ~I o.oo% (D) ' 2,761 5,521 41,911 94,5% 39,168 4,778 16,059 18,331 94.5% 41,116 0.00% (D) 2,261 2,D56 36,799 94.5% 41,017 0.00% 3,6D9 7,793 29,614 94.5% ~ 0.00% 17,696 11,946 26,181 94.5% 34,887 2,D93 ~~ 94~ 5of14 Print~d: 1/5/20154:18 PM P'UbliC~ .. H·e·aith 'j(js;.,' M.-c.,. .. ~ child .Jfldo\dolft«M "••llh o~v~s1o" ···"'"''"''I UL..V\Jf\. fi"'\.VYI"'\.1'\1'11 0\.JL.J\,:JI::. I ... -~ ·~ .. H.~~f€~~,~~~~:!~~ ... :\;,.·_:;f\~~~:-~ \~ ·'. , /y~~~~~~~~i~i;;,.:;j':~~;.i~ . .. ,!.~:J~1~;~c@i~~;'::·-~):j~~~~~~ Programs MCAH/BIH Agency: 201410 Fresno County r====-----------v'?i':'.'"i;;-;:'"?'~~~~~+~7-f.~~tc~~?lH~~tci~~e?illEiill;Ssiifb~:::lcs~~jJ~ti8s;;wtt;d~~~~J£~lqi:!~1f~0!~q :'(1er.·r' {17):; SubK! I -l ~-l-----r ~ ~ r --·-~--,C~blned I !Combined T --f:comblned I !Combined 112 1U 114 115 116 117 118 119 1~ 1~ 1~ DJ 1~ 1~ D6 D7 1U 1~ 1~ 1~ 1U UJ 1~ 1~ 1~ 1D 1~ U9 1~ m M2 MJ 1« 1G 1~ 1U 1~ M9 1~ 201410 MCAH 81H S Bud1et 122214 TOTAL FUNDING % J TITLE V I % SGF % PYD % 1 Agoncy Funds' % J:od!State % Fed/Agency' % Fod/State % Fed/Agency' 6of14 Printed: 1/S/2015 4:18PM ···-···· ----· ...... --.~··· ____ ...... Public Health J'<.1.'1•11 Mal.,,. ... cllllcfandAdo~•" .. hi'IOMJion 201410 MCAH BIH 5 Budld: 122214 7ofl4 Printed: 1/5/2015 4:11PM PubliC Health .)<.i~l'll Malerna~ChildandAdo'-:n!Hea!lh 01\th.lon Programs MCAH/BIH Agency: 201410 Fresno County SubK: •••-•~•• _..._ __ ,, 1 ,, __ 1"'"'111 UV...,UL-i -,,i~~.~--,j_c:} .. 'ii~~~{¢.~~-~-;v~~~~~r:::,;f'JHi;. _: -. . ·;·~--'. ..· ';;?~~;6~~f~~~~t:~;t:E'·S~\ _;·_~:::~ _:!\~'f.~" 1.:"' -.~>.'11l. ':TC·· J:<:(2)· 'H.:-. -ii3i: , ... J.. :(4)'\;;,c~--:-.:':·· .!Si'-··::.-'i:L 0:.(4) 1·•.·-•:. (5)\ ·. ·•,I/: .@_: ·-!':·<: ro .,. :. r •s!r ·-I .. ·':~i9i:'•; · .. c}<.;d!9UJ ... ' 11iif•::: I': ii21. ·•I ·' (•.1131. ·,; ,._.,,., .•. 1 ,., .... n!SV' .;., f.·•--tis;· T r.:n::: ~fg~~~~~~~ .. e~~:~~~e~~~~-,_ · -;; .. : _:. 1.o1;1i#l•' '"·· · '·•/::s&,86if ·,., .I\':. .. _:::·•,,•t:;.-: ,. •--:·,: -·. _,. · .. •;, .. -... ~ '~~~;;t~J~· ' '"'.·[/?. · .. ;;-~51".'•· :~:;_ I ::·:. '2s,oo~{';:'.·:::· '1 .. :.,);' · -:.·,: .:::: FRINGE BENEFIT RATE 83.26% 149,7n I 46,259H_ 25.380_H 1=-1 H 66,n4H H 11,35~H TOTAL WAGES 179,896 I 55,563 30,484 80,204 13,644 g ~ _,,_ .... ~~ % <o: .. ;; < nTLE OR CLASSIFICAnON ~:s TOTAL WAGES ~i .. > i FTE e Z< ,_ .. ., 1 EA PHN II • BIH COORD INA TOR 70.00% 83,654 58,558 28.39% 16,624 ~ 14,822 ~ 13,468 23.30% 13,644 -89.6% ;---27,255 ,---89.6% 2 OS HES 100.00% 49,554 49,554 31.50% 15,610 ~ 6,690 r---~ ---3 KM HEA 100.00% 40,275 40,275 32.50% 13,089 ~ 5,034 55.00% 22,151 ---89.6% v HEA 100.00% 31,509 31,509 3,939 r---55.00% 17,330 89.6% 4 32.50% 10,240 12.50% L----r---;----5 6 ;---r----!---!----7 r---!----r---r----8 1----r----!---r---9 !---1---:---r---1----r---!----r--1----10 1---1----r-r--11 12 1---r--'---r---r--13 ~ r--1---1----1---r---;---r--1----14 1---1---;---1---r---15 16 1---t--r---1---!---17 1---t--!---1----1----r----1----18 19 1----r----1---:---20 1----r---1----21 1----r--t--'---22 1----1---:---1---'---23 --r--:---1---;___ 24 --1---;-----1---25 -'---1---'---r-26 :---'----1----1---27 -;----r---r--28 -------r----1---29 -r----1----f--30 -r----r---r--31 -r---f-------f--32 -r----r--;---r--33 -1---r---r----r--34 -r--'----1---;____ f--35 -1---!---!--1---36 -r--!---!--r--37 -1---r---;---r--38 '---r---!---1---r--39 '---1---!---r--r--40 r--1---r--;---!---41 !--1---r--;---f---42 -· 1----r--r---f---1----1-!--1----43 1-----!-----44 45 1-----!---- -46 1-----!-----47 t----!---'------'----201410 MCAH BIH 5 Budaet 122214 80f14 Printed: 1/S/2015 4:18 PM PUbiiC~"'H'e:·Qfth ·.:tt:Di111 M''~"'~ Child '"d #odolncen1 .......... otvtslon Prognoms MCAH/BIH Agency: 201410 Fresno County SubK: ••ttr.....l""\1 I I..,.I~V-f' ,-· t '\.VVI~IIfl UU""""'VL-I ' ',i • i ·.~ , ·:::·c~,-:-.;,,~r;:m_-::-r:.;::;"cm····_ 1 <•i·· + ·:.~w-'J··.-<•l .".1·:·.· (S) ··l.' -@--r:'-;m~9-(8)=?'1:-:;:~-~<.''<tlii.~'' (11i'-. '::::.(12)::-t, ,~~::wi __ ,-:,·.n:<,-•11·'":7115)': :-:·1.! (16) :-..1(~7)-··· ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ro n n n N H ~ n n n ~ ~ ~ ~ ~ ~ ~ u " ~ 00 ~ ~ ~ ~ ~ ~ ~ ~ ~ 100 ~ 1~ 1ro 1~ . as 100 1~ 1~ 1~ TOTAL FUNDING % mLEV 201410 MCAH BIH S 8ud1et 122214 % r % SGF PYD Agency FtM'Ids• Combined Fed/Agency-9of14 Printed: 1/5/2015 4:18PM PUbi1C'H1e~Q ifh :)c~'H M~t~,~~~•. child ~n{·Adolnc.nt H~~lth olvi$1on Programs MCAH/BIH Agency: 201410 Fresno County SubK: IYI'-An DLU\..n I"'KUI.:>KAIVI I:IUUI.:>I= I {·'-· • · ,_~;:-~ti··::~~~krci;~iii~~:&i~~/t::·~:,.::·:·:::{;;_Q~~;i~·;?:ii:._: _·;::'~-~ ~:~:-/:!:.:_;},~.:M~~~~~~~#.isi ~~· · '-,c,,_:-'!>Y: ._cc,-,:: ;G,:t2i_:_"]-~;-o.-:"2;'!3!'~l:E _<4i_;<::~ft:i''-::m-_·;y::t:· c<1 ·~r:·:·':":isl~ -"'-+ ~16[-·:J. ·-.-.: m::-::!]C:::'iaCI-.:: ,:· ~IOLJS:~.:--liTi:~?;]/:!!,21. T'£,~-.: (1_3,-;.':.;:1. __ c1•f~ •·c•$!'.,:., l·:·ct.,-.1:-c•rL' I % I Combined % Combined % Combined % Combined TOTAL FUNOING % TITLEV % SGF pyO % Agency Funds• % Fed/State Fed/Agency" Fed/State Fed/Agen~ 110 1---1---I--f----1---1---111 1---1---I--1---I--1-112 1---r---I--1---I--1-113 ,-------~ I--1--114 '----'---'---1--r---115 '-----'---'-----I--1--116 1---c.,__ '---1--r---117 1--c.,__ I--r---1---1--118 r---!---r---!---!--r---119 1--1--1---r---1---r---120 1---r---1--1---r---1---121 1-1-1---r---I--r---122 1---f---!--1---I--f---123 1-1---I--r---I--r---124 1-f---1---1-I--f---125 1---1-1-1-1-1---126 1-1-1--1-1--1---127 !---1-1---1-1---!---128 r---r---1---,.......-1----129 1---r---1---r---1----130 1---1--1---r---1---131 !---1---r---r---1---132 r---r---1-1---I--,_.___ 133 r---r---1--r---1--'-----134 1-1-1--1---r---~ 135 r---r---1--1---I--136 1-1---1---1---1--137 1--1--!---1-1---138 r--!---1-1-1-139 r--1---1-1---1---i----! 140 1---1--I--1-1:---i----! 141 1-1-I--1-1---:-1---142 1---1-1---I--1-1---143 1---r---1--1-1---1---144 --I--r---I--r-----1 145 --1---r---1--t-----1 146 --1---r---r---t-----1 147 -;---1---r---I--~ 148 r---;---1---r---1--~ 149 r---r----1---r---r---t-----1 150 201410MCAH BIH S Budaet 122214 10of14 Printed: 1/5/201S 4:18PM PUbliC ··H·e'Qfth ;){1SPH ,...,..,,. • ._chDd•lldAdolftu"l H••'-h Dtvisioll P••g .. ms MCAH/BIH Agency: 201410 Fresno County SubK: .v&-_1-\j i U'-U'-"1'-r ;'-UUl......,.....iVi UUL.J\.:JL i ,;_ ·, !-·. .~ ~7 ~· 'C ~~~~~ira~~:/25~1';::; ,. ··_,:.;; ········· .... ': ·,··· . ;-.:.: . ~;. :·· :;~·· ~:_,.,··;,'''•~· or :m .. J' -:-~-·,·--1.--~·:<•i·.;;lf:~~,.,:o.l -<•l·''.:.r. (S) .; . r· (6) :f:: .. ·en·:: ... I · t8l·:· .I · (gj.'.:.:·'•-1· ·c;;;, ·r· 'ci•l .: TJi2!SLJJm: ... 'J:i.~•r 'ri:-"'li!i···.·-:..V::ci~t'l'"cl., · TOTAL FUNDING % TITLE V % SGF % PYO ·~fJ:A~Ji;~~~R-:~~'l)'m~[i:~~~~f~~:~~T~!:t:'.~!t~~\::.:~Jf~t;·~,T: % Agency Funds• % 'Combined Fed/Stale % Combined Fed/Agency" % I Combined I % I Combined Fed/Stale Fed/Agency-·:.}•;.:."):•f:_:;':·:;::'::;;i,;;:.:'!}Y'·:,:r.qt~c6P~MTiNGi~icPi:N~esj .. -~<;:,:·:•,:i.;"~:.·:;;c'l'''·~r;.:,l.':;:~:·;.o(~.~~·q_o,;;;;(:'.:j:~:;,,,,;, .. ;c:''l;,_::. .. .. ·. · ·.:::r;o,:.·;:::,.-... r:::::c:.::<•-'2'1<'c.,~.:·:o+··,u:•.>:'.;''~T'P-"7."".J'··> •.. ,, ,,. TRAINING TRAVEL f---1 I H lll I I I 15 "..--Uilmafched Operatin-RExpeniM are not e!IQibiO fofFedefartnatChilij, fundS O''lileXOO.EX"""Pens-cs iMVDrliY 60 charAed to unmatched Tille V (Col3lState Gel\erifFunds (CoCS). and/or AAencv CCoi.-7Tfunds. ,;~~-0~:~~~~~-~~~~T:s:;~~T~~t:~~~~~~·;,, ·J;:~-~:s.· .. ,-,~,; ';:,;:[ --.. ;-:..-'.''.•!--'·''-'·' :hj;,., £;.!~4: ·./'ie{.'.'' l -~~;;J. ::' ... (••.•.·J~z;:;:-.T;:' ~-.;?J~~;r: ~'d.; ~ ~ ~-' .. ':'iFC_cc_~j, · · · ,"'··r .... , .. ~:r l, ·: ~~·:~ SUBCONTRACTS ~ ~ ~ ~ OTHER CHARGES ~ ~ ~ -·-r~~r l.latch~blt 201410 MCAH BIH 5 Budget 122214 11 of14 Printed: 1/S/2015 4:18PM ,.~ubr1C"I~i'evCiifh ';feii111 Mltern~l. Child andAdolncen1 Hell1h Division P•ograms MCAH/BIH Agency: 201410 Fresno County SubK: ;i;f~AE~ofr•.··,-o-"1'0_-_-E-~wt.>f.\_·s· ,fljgi:l;)iilifJJr~>w..' ohi·.'··· _;.;;;.;--_• ;_· -"" ~,?!_-,-.,. .. _l!ii.:"' '-·''' ..... ---...., •• ~ -~V~J~'. -~·."'J~t~J ~ ~.IJ"., ~~~~~'ec.~J~L.t...:~~ ~~~~~~~3~··. ··.: IVI\..ol-\11 CL..U\...1"\. r-t\UUKAIVI OULJ\..:Jt: I _,;::;~c;:J,;:;;:.:_;SfJX~:£t~i~~~,kk~~:~~J~N-~:~i:f\'~c;:-I'? ; -;;;,,~::;~·:::~i~?-~~;,~<~:-?:·-o: ··_.';:Nt§rf~)lloi~Eiql'·p9sl'S :.'iY:<:;~::. ,· :--:7,:IQ.·:;:::: :;1 .';':1~ -·_-.--. ->:fc·, ''"··FJ!<'.:,•<·:;::/;-.::_!•' : -::•.-j·•{:\c?:~--:;c_;:: ->:·-''!•'•:_: ' •-(:'' ·c;o:·:·~·--t-<, '\: .-q;·:: '"1''·-:::·-r::· .. : %ofTotaiDil'eetCosts I I I I I r I I I I --I -I l~§~WP.~ii~f>Nrt~~i>,§:f~!~;~~g;,cc;;;}.~·~;.~:.f~t!~:':;::;:-:·-~ , :).r~t•Si·:c>;:;•r; 'ct_sh cy,: ~7) __ . Combined Fed/Agency" ~(i •··•,_'::\::.::··:-; •·-·-''(:;:; .. r\ir~kfiiRsoilliet;'q~sTs -;:,•,:>::'';''" •Oji;,; 1~;'~{\J·:'\ ··. ·~:::•;[.".:\Y:]f:X·~:Yi.;;,:·<:\1 '.,_~c;·~:n c;:.-_Jc.: l~C'' ~7'BIL:]•~ -~~~;ro_·.-·:'kc'"~:~.:.:il:'-;.?,~:"''4 '~·::lfo::;\i:;' .. <··'l.-· .. :-:1f': -~ FRINGEBENEFITRATE H H H H H H H. TOTAL WAGES g ~~ !~~ = TITLE OR Cl.ASSIFICAnON ~E ~ :) TOTAL WAGES ~ t; ~ ; ~~ ;~: 1r-r------------t---t~-1--------r---,----------------y--~-----.---,------r---------~--.-----,---------.---.----~~-+~ 2 f-.-1--1-3 !----1---1--4 1--1---1--5 1--1--~ 6 1--1--1--1--7 1--1-1--1----8 r-r--r-1-9 1--1--1--1-10 1--1--1--1----11 f---f---f---1--12 1--1--1---1-13 1---1--1--1----14 1--1-1--1----15 r--1--r--1--16 r--1--1--1-17 1--1--1---l-IB f----1--1--1--19 f---1--1--1-20 1--1--1--1--21 1--1--1--1--22 1--1-r-1--23 1--1--1--1--24 1--1-1--1--25 1--1--r-1--26 1--1--1--1-27 1--1-1-1--28 1--1--1--1--29 1--1-I--1-30 1-1--r-1--31 1--1-I--1-32 1--1-1-1-33 r--1-I--1-34 I--1-1--1-35 1--1--1--1--36 1--I-1--1----37 1-1--1-1-38 1-1--f---1--39 1--1--1--1-40 1--1--1--1-41 1--1-r--1-42 1--1-r--1-43 I--1-r--1-44 1--1-1--f---45 1--1-I--f---46 t--t--· 1--1-1--1--47 1-1-1--1----'---'--'-----l.____ 201410MCAH BIH 5 Buds:~t 122214 12ofl4 Printtd: 1/5/2015 4:18PM P'~bii~~J:fE."Qifh ·~i'i111 M~r•rn~•. Child ~ndAdalnc•nt H•mh Oi¥111on Programs MCAH/BIH Agency: 201410 Fresno County SubK: ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ m n n n " g ~ n n n ~ ~ ~ ~ « ~ ~ g u ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 100 m W2 1ro 1~ ws 1~ 1~ 1~ 1~ 201410 MCAH BIH 5 &udaet 122214 ;:·:::-:.;_;,:(,_ TOTAL FUNDING IVII,An UL.U\,1>. rN.U\.>IV\IVI OUU\.>1:: I 'Y!':' ~~;_}/~l~t:l~~-~~~;~~~;~~-~; i;;:: ,_x? ; ..... · % I PYD % Agency Funds'" % % 13of14 Printed: 1/5/2015 4:18 PM Pubhc Health .)('DJlH Mattrna.J.ChlldalldAdoleK•ntH•althOMslon Prog,.ms MCAH/BIH Agency: 201410 Fresno County SubK: i'UVM.• t WL-V\..or\ rf'\U\,;Jl'V-\.JVI UUU\.:IC I ··',. -~Frlr''cc._;~., :•,'_J<).:.c'··:';'''<!f :-'\ '':®:, \::. ::0-~:,'·o2)·-.;; .~;'(I3JJ:~;-, -~iJ'i. 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 ' 201410 MCAH BIH 5 Bud&et 122214 TOTAL FUNDING SGF % PYD % Agency Fa.nds• % % 14otl4 Printed: 1/5/2015 4:11PM AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA No.: CA Department of Public Health Maternal, Child and Adolescent Health and Black Infant Health Programs Agreement #201410-FY 2014-15 APPROVED AS TO LEGAL FORM: DANIEL C. CEDERBORG, COUNTY COUNSEL By t:LIM/) APPROVED AS TO ACCOUNTING FORM: VICKI CROW, C.P.A., AUDITOR-CONTROLLER/ TREASURER-TAX COLLECTOR By ~i&~J= Term: July 1, 2014-June 30, 2015 REVIEWED AND RECOMMENDED FOR APPROVAL: By J)tl{( David Pomaville Director Department of Public Health Fund/Subclass: Organization #: Revenue: ks 0001/10000 56201706, 1700 3530,4382