HomeMy WebLinkAboutAgreement A-17-009 with CADPH.pdfCALIFORNIA DEPARTMENT OF PUBLIC HEALTH
MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIVISION
FUNDING AGREEMENT PERIOD
FY 2016-2017 (LHJs)/2012-13 to 2016-17 (CBOs)
ANNUALPERSONNELUPDATEFORM
At the beginning of each f i scal year Agencies are required to submit this form along with
their AFA/Contract 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. Updated submissions do not require certification signatures.
The Agency Identification Information section must be completed each time this form is
submitted.
AGENCY IDENTIFICATION INFORMATION
Any (:!rogram 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:
~ MCAH DAFLP [8J BIH [8J F IMR OCHVP
·-
Fiscal Year: 2016-17 Update Effective: 09/27/16 (only re quired when submitting updates)
Agreement/Contract 201610
Numbe r;
Federal Employer 94-6000512
10#:
Complete Official County of Fresno
Agency Name:
Business O ffice 122 1 f ul ton Ma ll, Fresno, CA 93721
Address:
Agency Phone: (559) 600 ~3330 Agency Fax: (559) 455-4705
Agency Website
Address: www.fcdph.org
-
~~ ·.!J \U,l~ J ::t~[lfl•f.IIJI~< ::::{lfl (e]~~ ·; i ,;._• .:.~· 1.-','•';;"t;;.,:.}_i •, I ~(..:.f.~,)i'f~•, '_> .. ' ~~ '~ .Jf)' !~i~.:-:':;:;W: l,
Name : David Pomaville
Title; Di rector
M ai ling Address: I P.O. Box 11 867
City: Fresno I Zip : 1 93775
Phone; (559) 600 -3200 I Ext. I I FAX: I (559)600-7687
E-Mail Address : I dpomaville@co.fresno .ca.us
Page 1 of 7
Revised February 20 16
Agency Name: County of Fresno
Agreement/Contract#: 201610
Title: Bernice E. Seidel
2281 Tulare St, #30 I Hall of Records
E-Mail Address:
Name: Brian Pachecco
Title:
E-Mail Address: .fresno.ca.us
Name: Eve Re im er
T itle: Public Health Busin ess Mana
P.O. Box 11867
E-Mail Address :
T itle : MCAH Director/Divis ion
P.O. Box 11867
E-Mail Address: fresno.ca.us
Page 2 of 7
Revised February 2016
Fiscal Year: 2016-17
93721
93721
93 775
Agency Name : County of Fresno
Agreement/Contract#: 201610 Fiscal Year: 2016-17
r 6 __ j i_· M_«;:AI-! G_OO~QINATOR (Only· comple.te-·~f -d~ffEir:~nf frqi!l.:_#!§f --:--:;__-~,_-,. ·= _-~ -~ ~ -~--~ J
Name: Jeru1ifer Day
Title: MCAII Coordinator/Perinatal Services Coordinator
Mailing Address : I P.O. Box 11867
City ; Fresno I Zip: I 93775
Phone : (559) 600-3330 I Ext. I I FAX: I (559) 455-4705
E-Mail Address : I jday@co.fresno.ca.us
Title; Staf f Analyst
Cit : Fresno 93775
Phone ; (559) 600-3330
E-Mail Address : axayavath~~co.fresno .ca.us
~~ -~[.MC_~H !NVQICE _CO~TACT (Only .c9~pljitejf,.diff~~nt)~~~L :_.~~= ~----~-~=--~=-~-]
Name : Michae l Ch u
Title : Accountant
Mail ing Address: I P.O. Box 118 67
City: Fre sno I Zip : I 93775
Phone: (559) 600 -6426 I Ext. I I FAX : I (559) 600-7687
E-Mail Address : mchu@co.frcsno.ca.us
Name : Jennifer Da
Title : MCAH Coordinator/Perinatal Services Coordinator
Mail in P.O. Box I 1867
Cit : Fresno 93775
Phone: 559) 600 -3330
E-Mail Address: co .lhJsno.ca . us
Page 3 of 7
Revi sed Februa ry 2016
Agency Name : County of Fresno
Agreement/Contract#: 201610
rnJ'I t.!.,"" lll:.!oi1JI::-4:tii~•J::«L•IDl•JLI{•
Name:
Title:
MailinQ Address : I
City :
Phone:
E-Mail Address :
Name:
Title:
Cit :
Phone:
E-Mail Address:
Fiscal Year: 2016-17
'
• ~nlfm mrnrn tuiirril'fi'itif.!., :n•1rr:rtt. {•T~J; ~ -: ' ·, '~~ :;::;.-
'
I Zip: I
I Ext. I I FAX: I
ttr~~AF.bP ~_UD_G_E]"~C~ONJACT _.:__ _-_· -~~·~_: _ _:. ~~~~·;._~-~~·~-=-~·~J
Name:
Title :
Mailing Address : I
City: I Zip : l
Phone: I Ext. I I FAX: I
E-Mail Address : I
Name:
Title:
C it :
Phone :
E-Mail Address :
Page 4 of 7
Revised February 2016
Agency Name: County of Fresno
Agreement/Contact #: 20161 0
Name ; Fanta Nelson
Title: BIH Coordinator
Mail in P .O. Box 11867
E-Mail Address;
E-Mail Address: fresno.ca. us
Name: Michael Chu
Title :
Mail in P.O . Box ll867
Cit ; Fresno
Phone: (559) 600-6426
E-Mail Address: co.fresno.ca.us
Name: Lisa Poole
Title : F lMR Coordinator/S ID S Coordinator
Mailin P.O. Box 11867
Cit : Fresno
Phone: _ _{552l@Q-333 0
E-Mail Address: ,co.fresno.ca.us
Page 5 of 7
Revised Fe bruary 2016
Fiscal Year: 2016 -17
93775
93 775
93775
Agency Name : County of Fresno
Agreement/Contract#: 201610
Name: Lisa Poole
Title: F'IMR Coordinator/SIDS Coordinator
Mail i n P.O. Box I J 867
Cit : Fresno
Phone: 559) 600 -3330
E-Mail Address:
Name: Kathl een Kellc
Title:
Cit : Fresno
Phone: (559) 600-3330
E·Mail Address: kkelle ,co.fresno.ca.us
Name:
T itl e :
Mailin
Cit :
Phone :
E-Mail Address :
Page 6 of 7
Revised February 20 16
Fiscal Year: 2016-17
93775
93775
Agency Name: County of Fresno
Agreement/Contract#: 201610 Fiscal Year: 2016-17
·. · · · Aa·~&~~·irrr. i;uN·~~~c AP~~.c~:rlaNq·
_ . . POI!,Ig)leQNJ'~~~~~f! .~NQ~CERJrfEJC,lll.<rJ,N . ,
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 106 of the Health and
Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and
Institutions Code (commencing with Sections 14000 and 142), and any applicable rules or
regulations promulgated by CDPH pursuant to this article and these Chapters. I further
certify that 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.
Original Signature of Official authorized to
commit the Agency to an MCAH Agreement
Brian Pacheco
I •
Name (Type or Print)
Original Signature of MCAH/AFLP Director
Rose Mary Rahn
Name (Type or Print)
Page 7 of 7
Revised february 2016
Chairman. Board of Supervisors
Title
MCAH Director/Division Manager
Title
Date ATTEST:
BERNICE E. SEIDEL, Clerk
Boa d Supervi~ors
c .. ,_, O.POII.,.,..., o1 ,._1. -
Public Health ;}t1S"I'H Materl\81 , Chid and Adolescent Health Dlvi$ion
Program :
Agency:
SubK:
BUDGET SUMMARY
Version 4.5--150 Quarterly
Maternal, Child and Adolescent Health
201610 Fresno
EXPENSE CATEGORY
I (I} PERSONNEL
I ill} OPERATING EXPENSES
I (III} CAPITAL EXPENDITURES
I (IV) OTHER COSTS
IIVJ INDIRECT COSTS
TOTAL TITLE V
TOTALSIDS
BUDGET TOTALS*
TOTAL TITLE XIX
TOTAL AGENCY FUNDS
FISCAL YEAR
2016-17
BUDGET
ORIGINAL
ORIGINAL
UNMATCHED FUNDING
MCAH-TV
I (1) (2) (3) (4)
I TOTAL FUNDING % TITLE V %
ALLOCATION(S) ~ 343,422
4,671 ,879 343,422
482,610
1,117,954
792,006
7 064,449 4.86% 343 422 0 .10%
BALANCE(S) -4
343.422 ----+ 3 43.422 1
7,372 ---=====-...... 1------1
2,964 ,264
3 ,749,391
SIDS
(5)
SICS
7,372
7,372
7 372
7 ,372 1
BUDGET STATUS BALANCE
ACTIVE
NON-ENHANCED ENHANCED
MATCHING (50150) MATCHING (75125)
AGENCY FUNDS MCAH Cnty-N MCAH Cnty-E
(6 ) I (7) (10) I (11) (14) I (15) (16) I (17)
% I Agency % I Combined % ~~omblned I Funds' l c,,~,.
850,284 1,851.451 1,619,349
123,794 358,816
405,773 712,181
214,951 577,056
2 2 .58% 1,594 802 49.54% 3 ,499,504 22.92% 1 6 19 349
1,594,802 1
$ Maximum Amount Payable from State and Federal resources
WE CERn
FISCAL AGENrS SIGNATURE DATE
STATE USE ONLY· TOTAL STATE AND FEDERAL REIMBURSEMENT MCAH-TV SIDS "F~~~~ MCAH Cnty-N MCAH Cnty-E
PCA Codes h310,-5311 53 118 531 1
(I) PERSONNEL 343.422 7,372 925,726 1,214,512
(II) OPERATING EXPENSES 179,408
(Ill) CAPITAL EXPENSES
(IV) OTHER COSTS 356,091
(V) INDIRECT COSTS 288,528
Totals for PCA Codes 3,315,059 343,422 7,372 1,749,753 1,214,512 -
20161 0 MCAH 5 Budget 20 160817 FINAL 1 of6 Pri nled: 811 812016 8:40 AM
CftWtwot'C! O.OOI'I'f\erlt of .,d.:,_..
Pu b he Health •)< I!' I~ I Ma<emo<, Chid and Adolescent Health Divioion
ORIGINAL
Program: Maternal, Child and Adolescent Health UNMATCHED FUNDING NON-ENHANCED ENHANCED
Agency: 201610 Fresno MATCHING (50/SO) MATCHING (75/25 )
SubK: MCAH-1V SIDS AGENCY FUNDS MCAHCn<y-N MCAHCnty-E
I (1) (2) I (l) (<) I (5) (6) I (7) (10) I (11) (1<) I (15) (16) I (17)
I TOTAL FUNDING % I TITLE V % I SIDS % I Agency % ~~ombined % ~~omb ined I Funds' l c. ,,.. l c. ItA . .
(II) OPERATING EXPENSES DETAIL OJ. PERSONNEL MATCH
74.98',1,
TOTAL OPERATING EXPENSES 482,610 123,794 358,816 I '-'aleh Avdlblt
TRAVEL 69,298 25.02% 17,338 ~ 51,960 H TRAINING 17,203 1----25.02% 4 ,304 74 .98% 12,899
1 Facil ities 148,76 5 25.02% 37,221 ;::::: 111,54 4
Utilities 36.485 1---~~~~: 27,356 2 9,129
3 Security 12,011
(-------
3,005 74.98% 9,006
4 Household Expenses/Mainten ance 2 1,938
(-------25.02% 5,489 74 .98% 16 ,44 9
5 Telephones 13,560 -25.02% 3,393 74.98% 10,167
6 Office Supplies 16,027
-25.02% 4 ,010 74.98% 12,017
7 Postage 1,447
-~ 362 74.98% 1,085
8 Printing 5,815 -~ 1,455 74.98% 4,360
9 Medical Supplies 4,061
-~ 4,061 74.98%
Software 59,000 -14 ,762 ~---=-:--=-:-:-44,238 10 ~ 74.98%
11 Equipment 50,000
-~ 12,510 74 .98% 37,490
12 IT Support 27,000 25.02% 6 ,755 74.98% 20,245
13 --
14 --15
... Unmatched Operat inQ Expenses are not el1~ible ror Federal malchinq funds (Title XIX). Expenses may only be char~ed to Unmatched Title V (Col. 3), State General Funds (Col. 5), and/or A,.qencv (Col. 7) unds.
(III) CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL EXPENDITURES
(IV) OTHER COSTS DETAIL %PERSONNEL MAlCH
74.9 8%
TOTAL OTHER COSTS 1 ,117,954 405,773 712,181
SUBCONTRACTS
1 Exceptional Parents Unlimited 1,017,401 30.00o/o 305,220 70.00% 712,181
2 Nurs.,.Family Partnership 16,752
(-------
: 100.00% 16,752
-
3 Resource Development Associates 15,000
(-------
15,000
--
Carol Melcher Consulting 25,000
(-------I 100.oo%
25,000
--4 (-------
100.00% --5 '-----'---~ -
OTHER CHARGES MllchAYIIIable
Books & Publica tions § r==:-:-'~§ 74.9 8% 1 2,660 I 1oo.oo%
2 Client Support Materials 10,529 I 100.00% 10,529 74.98%
3 Interpreters 30,612 100.00% 30,612 7 4 .9 8-!o
4 1---
5 1---
~
201610 MCAH 5 Bu dget 20160817 FINAL 2of6 Printed: 8/18/2016 8 :40 AM
C~O<,lo 0.POrt-r.t91 ~.:,._ Public Health •)( ~PI I MatemOJI, Chikj and Adolescent Health Division
ORIGIN AL
Pro gram: Maternal, Child and Adolescent Health UNMATCHED FUNDING NO N-ENHANCED ENHANCED
Agency: 201610 Fresno MATCHING (50150) M ATCHING (75125)
SubK: MCAH-TV SIDS AGENCY FUNDS MCAHC«y-N MCAH Cnty-E
I 111 (2) I (3) (41 l (5) (6) I (7) (10) I (11) (14) I (15) (161 I (17)
I TOTAL FUNDING 'lo l TITLE V % I SIDS % I Agency % I Combined % ~~ombined I Funds• I F•d i Aa•n cv"
(V) INDIRECT COSTS DETAIL
TOTAL INDIRECT COSTS I 792,006 I I I I I 214,951 1 I 577,0561
15.D0%1 ofTotal Direct Costs I 792.006 I I I 27.14%1 214.951 t 72.86%1 577,056 1
(I) PERSONNEL DETAIL
TOTAL PERSONNEL COSTS 4,671 ,879 343,422 7,372 8 50,284 1,851,451 1,619,349
FRINGE BENEFIT RATE I 74.97% 2,001,700 147,142 3,158 364,310 793,267 693,822
1----TOTAl WAGES 2,670,179 196,281 4,213 485 ,974 1,058,184 925,528 ...
-'> u :e
"' =<l!
..J % ..:a: •"' .. TITLE OR CLASSIF ICATION ~:) TOTAL WAGES
.. . ~ ;:: FTE ~0.. ~ Zq ql/l
1 RG Division Manager 20.00% 112,543 22 ,509 32 .00% 7,203 57.00% 12,830 11 .00% 2,476 69.1% 68.00%
112,543 56,272 32.00% 18,007 1--
57.00% 32,075 11 .00% 6,190 69.1% 68.00% 2 RG MCAH Director 50.00%
70.00% 122,408 85,686 0.00% 1-35.00% 29,990 15.00% 12,853 50.00o/o 42.843 69.1% 65.00% 3 v MCAH Director -Physician
70.00% 37,324 26,127 1-31.00% 8,099 69.00% 18,028 -69.1% 69.00% 4 BA Administrative Assistant
58,978 58,978 1-39.00% 23,001 61.00% 35,977 -69.1% 61.00% 5 AX Staff Analyst II 100.00%
6 1,178 6,118 0.00% (0) 1-77.00% 4,711 23.00% 1,407
-
69.1% 23.00% 6 MC Accountant II 10.00%
28,089 1-35.00% 9,831 65.00% 18,258
-69.1% 65.00% 7 OM Account Clerk I 100.00% 28,089 --100.00% 87,803 87,803 37.50% 32,926 30.50% 26,780 32.00% 28,097 69.1 % 62.50% 8 J D PHN II -MCAH Coordinator
81 ,927 40,984 85.72% 35,112 10.29% 4 ,213 1-0.70% 2 8 7 3.30% 1,352 69.1% 4.00% 9 EA PHN 11-FIMRISIDS Coord 50.00% -
10 TZ MSW I 85.00% 47,580 40,443 0.00% 8.50% 3,438 42.50% 17,188 49.00% 19,817 94.0% 9 1.50% -
11 EJ MSW I 50.00% 44,888 22,444 0.00% 9.00% 2,020 43.00% 9,651 48.00% 10,773 94.0% 9 1.00%. -43,901 0.00% (0) 7.00% 3,073 22.00% 9,658 71.00% 31,170 94.0% 9J.OO% 12 LM MHNII 100.00% 43,901
25.00% 72,846 18,212 -31.0 0% 5,646 69.00% 12,566 1-69.1% 69.00% 13 BV Epidemiologist
33,732 20,239 0.00% (0)
-
34.00% 6,881 66.00% 13,358 r----69.1 % 66.00% 14 v HEA 60.00%
25,860 0 .00% (0) -34.00% 8,792 86.00% 17,068 1-69.1% 66.00% 15 DV HEA 60.00% 43,100
25,860 0.00% (0) -34.00% 8,792 86.00% 17,068 1-69.1% 66.00% 16 TT HEA 60.00% 43,100
24,895 -50.00% 12,448 50.00% 12,448 1-69.1% 50.00% 17 v HES 60.00% 4 1,492
4 1,492
r--50.00% 20,746 50,00% 20,746 1-69.1% 50.00% 18 v HES 100.00% 41,492
36,997 1-36.50% 13,504 61.50% 22,753 2 .00% 74 0 69.1% 63.50% 19 AV Health Educator 60.00% 61,662
49,777
,---
50 .00% 2 4,889 50.00% 24,889 1-69.1% 50.00% 20 vw SOA 100.00% 49,777
37,925
1-10.00% 3,793 90.00% 34,133 1-94.0% 90.00% 2 1 RZ OA III 100.00% 37,925
37,325 1-9.00% 3,359 9 1.00% 33,966 94.0% 91 .00% 22 CM OAIII 100.00% 37,325
23 EP OAIII 100.00% 37.325 37,325 0.00% (0):== 7.00% 2,613 93.00% 34,712 94.0% 93.00%
35,135 14.00% 4 ,919 86.00% 30,216 1-94.0% 86.00% 24 DC DAIII 100.00% 35,135 1-7.50% 2,412 92.50% 29,745 94 .0% 92.50% 25 LW DAIII 100.00% 32,157 32,157
1-
11.00% 4,172 ~ 33,753 1-94.0% 89.00% 26 SR OAII I 100.00% 37,925 37,925 1-6.50% 1-
27 YL DAIII 100.00% 37,925 37.925 2,465 93.50% 35_460 94 .0% 93.50%
1-r--:-:---4.5o% 14.00% 69.1% 28 MG PHN II (1677) 100.00% 87,803 87,803 0.00% 81.50% 71,559 3.951 12,292 18 .50%
1-4.50% 4 .00% 29 FT PH N 1(1677) 100.00% 64,482 84,482 0.00% (0) 91.50% 59,001 2,902 2,579 69.1% 8.50%
11.00% 1-1-21.00% 18,106 68.00% 58.630 91.0% 89.00% 30 MM SPHN (1615) 77.00% 11 1,974 86,220 9 ,484 --9.00% 7,902 8.00% 7,024 83.00% 72,876 91.0% 91.00% 31 BB PHN II (1615) 100.00% 87,803 87.803 --
10.00% 6,0 12 87.00% 52,305 3.00% 1,804 91.0% 90.00'.4 32 CP PHN I (1615) 100.00% 60.121 60,121 --74,324 10.00% 7,432 87,00% 64,662 3.00% 2,230 91.0% 90.00% 33 SP PHN I (1615) 100.00% 74,324 --87,803 23.00% 20,195 14 .00% 12,292 63.00% 55,3 16 91.0% 77.00".4 34 PC PHN II (1615) 100.00% 87,803 -20.00% 25.00% 6,764 ~ 14,880 94.0% 35 v P HN I (1501) 45.00% 60,121 27,054 5,411 ~ 80.00°/o --
17.00% 4,378 12,877 92 .5% 36 MM SPHN (1670) 23.00% 11 1,974 25.754 33.00% 8,499 50.00% 67.00'-' --37 VP PHN II (1670) 100.00% 77,718 77,718 19.00% 14,786 16.00% 12,435 65.00% 50,517 92.5% 81 .00% -
38 MV PHN II (1670) 100.00% 87,803 87,803 20.00% 17,561 10.00% 8,780 70.00% 61 ,462 92.5% 80.00"/e --
59.50% 55,330 39 LH SPHN 90.00% 103.323 92,991 6 .00% 5,579 34.50% 32,082 94.0% 94 .00%
'---
23.50% --::-::-:-:c-2,774 25,522 94.0% 40 DO PHN I 60.00% 61,648 36,989 0.00% 8,692 7.50% 69.00% 76.50% -1-::-::-::=-26,758 41 LP PHN I 60.00% 84,633 38,780 0 .00% 23.50% 9,113 7.50% 2,90 9 69.00% 94.0% 76 .50% -
201610 MCAH 5 Budget 20160817 FINAL 3 of6 Printed: 8118/2016 8:4 0AM
CoWetn.lo De~""•"' Ill ~.:_., Public Health ;Jt. ~PI I Maternal, Child and Adolescent Heahh Division
ORIGI NAL
Program: Maternal, Child and Adolescent Health UNMATCHED FUNDING NON-ENHANCED ENHANCED
Agency: 201610 Fresno MATCHING (SO/SO) MATCHING (75/25)
SubK: MCAH-lV SIOS AGENCY FUNDS MCAH Cnty-N MCAH Cnty-E
(1) (2) (3) (4 ) (5) (6) (7) (10) (11) (1 4) (15) (16) (17)
TOTAL FUNDING % T ITLE V % SIDS % Agency % Combined % Combined
Funds~ Fed/Aaencll"
42 JC PHNI 60.00% 60,121 36,073 12.50% ~1~ ~·~ 22,185 26.00% 9,379 94 .0% 87.50%
43 E L PHN II (1720) 100.00% 87,803 87,803 21 .00% 20,634 ~ 48 ,731 94.0"h 79.00%
44 AA PHN II (1720) 100.00% 87,803 87,803 20.00% 21,512 55.50% 48.731 94 .0% 80.00%
45 NC PHN II (1720) 100.00% 67,028 67,028 0 .00% 19.00% 26,811 41 .00% 27 ,481 94 .0% 81.00%
46 DK SPHN 65.00% 111 ,974 72,783 13.17% 9,585 7.83% 5.700 I 56 .00% 40,758 : 23.00% 16 ,740 94 .0% 79.00%
SPHN (1719) 25.00% 27.994
-
: 73 .50% 47 DK 111 ,974 11 .50% 3,219 20,576 15.00% 4,199 94 .0% 88.50%
48 sc PHN II (1719) 100.00% 75,724 75,724 0 .00% (0);--31.00% 23.474 I 20.00% 15.145 : 49.00% 37 ,105 94 .0% 69 .00%
49 KB PHN II (1719) 100.00% 87,803 87,803 0 .00% 21:00% 18,439 30.00% 26,341 49.00% 43,023 94 .0% 79 .00%
50 v PHNI 60.00% 60,121 36,073 0.00%
f----;o:Q(j% 3,607 I 30.00% 10,822 I 60.00% 21 ,644 94 .0% 90.00% -
201610 MCAH 5 Budget 20160817 FINAL 4 of6 Printed: 8/18/2016 8:40 AM
ColiiOf"'~ O•PCHf"'•~"~~ of ~.,:_,. Public Health :)I I:! Ill Ma tcm.al, Chitdard Adolescent Heahh DiW>ion
ORIGINAL
Program : Maternal, Child and Adolescent Healt h UNMATCHED FUNDING NON-ENHANCED ENHAN CED
A gency: 201610 Fresno MATCHING (50/50) MAT CHING (75/25)
SubK: MCAH·TV SIDS AGENCY FUNDS MCAHCr<y·N MCAH Cnty·E
(1) (2) (3) (4) (5) (6) (7) (10) (11) (14) (15) (16) (17)
TOTAL FUN DING % TITLE V % SI CS 'lo A gency
F~nds; % Combined % Combine d
I Fed/Aoencv"
51 LV PHN II 60.00% 77,718 46,631 6 .00% 2,798 12.00% 5,596 82.00o/o 38,237 94 .0% 94.00%
52 BB PHN II 60.00% 75,363 45,218 -9 .00% 4,070 : 27.00% 12,209 64.00% 28,940 94.0% 91.00%
53 EB PHNJ 60.00% 75,363 45,218 0.00%
,------
9.00% 4 ,070 29.00% 13,113 62.00% 28,035 94.0o/o 91.00% '---
54
55
,-------1--
56 r----1--
57 r----1--
58 r----1-·-
59 r----1--
60 r---r---1--
61 r---r---1--
62 r---r---1--
r----1---63 r----64 -
65 r---,------r----
66 r---r---r----
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201610 MCAH 5 Budget 20160817 FINAL 5 016 Printed: 8/1812016 8:40AM
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201610 MCAH 5 Budget20160817 FINAL 6of6 Printed: 811812016 8:40AM
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 1 of 19
3/2/2016
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH) Program
Scope of Work (SOW)
The Local Health Jurisdiction (LHJ), in collaboration with the State MCAH Program, shall strive to develop systems that protect and improve the health of
California’s women of reproductive age, infants, children, adolescents and their families. The goals and objectives in this MCAH SOW incorporate local problems
identified by LHJs 5-Year Needs Assessments and reflect the Title V priorities of the MCAH Division. The local 5-Year Needs Assessment identified problems that
LHJs may address in their 5-Year Action Plans. The LHJ 5-Year Action Plans will then inform the development of the annual MCAH SOW.
All LHJs must perform the activities in the shaded areas in Goals 1-3 and monitor and report on the corresponding evaluation/performance measures. In addition,
each LHJ is required to develop at least one objective in each of Goals 1 and 2 and 2 objectives for Goal 3, a SIDS objective and an objective to improve infant
health. LHJs that receive FIMR funding will perform the activities in the shaded area in Goal 3, Objectives 3.5-3.7 and 3.8. In the second shaded column,
Intervention Activities to Meet Objectives, insert the number and percent of cases you will review for the fiscal year. If resources allow, LHJs should also develop
additional objectives, which they may place under any of the Goals 1-6. All activities in this SOW must take place within the fiscal year. Please see the MCAH
Policies and Procedures Manual for further instructions on completing the SOW.
http://www.cdph.ca.gov/services/funding/mcah/Pages/LocalMCAHProgramDocuments.aspx
The development of this SOW was guided by several public health frameworks listed below. Please consider integrating these approaches when conceptualizing
and organizing local program, policy, and evaluation efforts.
o The Ten Essential Services of Public Health: http://www.cdc.gov/nphpsp/essentialServices.html;
o The Spectrum of Prevention: http://www.preventioninstitute.org/component/taxonomy/term/list/94/127.html
o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm
o The Social-Ecological Model: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
o Social Determinants of Health: http://www.cdc.gov/socialdeterminants/
o Strengthening Families: http://www.cssp.org/reform/strengthening-families
All Title V programs must comply with the MCAH Fiscal Policies and Procedures Manual which is found on the CDPH/MCAH website at:
http://www.cdph.ca.gov/services/funding/mcah/Pages/FiscalDocuments.aspx
CDPH/MCAH Division expects each LHJ to make progress towards Title V State Performance Measures and Healthy People 2020 goals. These goals involve
complex issues and are difficult to achieve, particularly in the short term. As such, in addition to the required activities to address Title V State Priorities, and Title
V and State requirements, the MCAH SOW provides LHJs with the opportunity to develop locally determined objectives and activities that can be realistically
achieved given the scope and resources of local MCAH programs.
LHJs are required to comply with requirements as stated in the MCAH Program Policies and Procedures Manual, such as attending statewide meetings,
conducting a Needs Assessment every five years, submitting Agreement Funding Applications, and completing Annual Reports.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 2 of 19
3/2/2016
Goal 1: Increase access and utilization of health and social services (cross-cutting)
o Increase access to oral health services1
o Increase screening and referral for mental health and substance use services1
o Increase utilization of preventive health services1
o Target outreach services to identify pregnant women, women of reproductive age, infants, children and adolescents and their families who are
eligible for Medi-Cal assistance or other publicly provided health care programs and assist them in applying for these benefits2
o Provide developmental screening for all children1
The shaded area represents required activities. Nothing is entered in the shaded areas, except for 1.7 as needed.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.1-1.6
All women of reproductive age,
pregnant women, infants,
children, adolescents and
children and youth with special
health care needs (CYSHCN)
will have access to:
• Needed and preventive
medical, dental, mental
health, substance use
services, and social services
• Early and comprehensive
perinatal care
• An environment that
maximizes their health
Assessment
1.1
Identify and monitor the health
status of women of reproductive
age, pregnant women, infants,
children, adolescents, and
CYSHCN, including the social
determinants of health and
access/barriers to the provision of:
1. Preventive, medical, dental,
mental health, substance use
services, and social services
2. Early and comprehensive
perinatal care
Monitor trends over time,
geographic areas and population
group disparities.
Annually, share your data with
your key health department
leadership.
Assessment
1.1 This deliverable will be fulfilled by
completing and submitting your
Community Profile with your
Agreement Funding Application
each year
Report date data shared with the
key health department leadership.
Briefly describe their response, if
significant.
Assessment
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 3 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.2
Participate in collaboratives,
coalitions, community
organizations, etc., to review data
and develop policies and products
to address social determinants of
health and disparities.
1.2
Report the total number of
collaboratives with MCAH staff
participation.
Submit Collaborative Surveys that
document participation,
objectives, activities and
accomplishments of MCAH –
related collaboratives.
1.2
List policies or products
developed to improve
infrastructure and address MCAH
priorities.
Policy Development
1.3
Review, revise and enact policies
that facilitate access to Medi-Cal,
Medi-Cal Access Program
(MCAP), California Children’s
Services (CCS), Covered CA,
Child Health and Disability
Prevention Program (CHDP),
Women, Infants, and Children
(WIC), Family Planning, Access,
Care, and Treatment (Family
PACT), Text 4 Baby, and other
relevant programs.
Policy Development
1.3
Describe efforts to develop policy
and systems changes that
facilitate access to Medi-Cal,
MCAP, Covered CA, CHDP, WIC,
CCS, Family PACT, Text 4 Baby,
and other relevant programs.
List formal and informal
agreements, including
Memoranda of Understanding with
Medi-Cal Managed Care (MCMC)
plans or other organizations that
address the needs of mothers and
infants.
Policy Development
1.3
Describe the impact of policy and
systems changes that facilitate
access to Medi-Cal, MCAP,
Covered CA, CHDP, WIC, CCS,
Family PACT, and other relevant
programs.
Assurance
1.4
Participate in and/or deliver
trainings in MCAH and public
health competencies and
workforce development as
resources allow.
Assurance
1.4
List trainings attended or
provided and numbers
attending.
Assurance
1.4
Describe outcomes of workforce
development trainings in MCAH
and public health competencies,
including but not limited to,
knowledge or skills gained,
practice changes or partnerships
developed.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 4 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.5
Conduct activities to facilitate
referrals to Medi-Cal, MCAP,
Covered CA, CCS, and other low
cost/no-cost health insurance
programs for health care
coverage2
1.5
Describe activities to facilitate
referrals to health insurance and
programs.
1.5
Report the number of referrals to
Medi-Cal, MCAP, Covered CA,
CCS, or other low/no-cost health
insurance or programs.
1.6
Provide a toll-free or “no-cost to
the calling party” telephone
information service and other
appropriate methods of
communication, e.g. local MCAH
Program web page to the local
community2 to facilitate linkage of
MCAH population to services
1.6
Describe the methods of
communication, including the,
cultural and linguistic challenges
and solutions to linking the MCAH
population to services.
1.6
Report the following:
1. Number of calls to the toll-free
or “no-cost to the calling
party” telephone information
service
2. The number of web hits to the
appropriate local MCAH
Program webpage
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 5 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.7 Increase the rate of:
• Developmental screening for
children ages 0-5 years
according to AAP guidelines –
9 months, 16 months and 30
months
• All children, including
CYSHCN, receive a yearly
preventive medical visit
1.7 Perform activities at the individual,
provider, and/or community level.
Promote the American Academy
of Pediatrics (AAP) developmental
screening guidelines.
Choose one or more:
1. Promote the use of Birth to 5;
Watch Me Thrive or other
screening materials consistent
with AAP guidelines
2. Participate in Help Me Grow
(HMG) or programs that promote
the core components of HMG
3. Work with health plans (HPs),
including MCMC, to identify and
address barriers to screening,
referral, linkage and increase the:
• Number of HPs requiring
screening per AAP guidelines
• Knowledge of appropriate
Medi-Cal billing code for
developmental screening
4. Promote the yearly medical visit
for children, including CYSHCN
5. Adopt policies to screen, refer,
and link all children in MCAH
programs
6. Develop quality assurance (QA)
activities to ensure children are
screened, referred and linked
7. Other activities to promote
developmental screening,
referral and linkages and
improve services for CYSHCN
(specify activity here)
a) Promotes the use of
1.7 Describe outreach efforts, barriers
and opportunities for solutions
Report the following based on the
activities you chose to implement
in the second column:
1. Number of providers receiving
information about Birth to 5 or
other screening materials
2. Describe participation in HMG or
HMG like programs
3. Describe barriers and strategies to
increase screening, referral and
linkage
• Number of HPs requiring
screenings per AAP
guidelines
• Number of providers stating
knowledge of the appropriate
billing code
4. Activities to promote the yearly
preventive medical visit
5. Number of local programs that
adopted policies to screen, refer
and link all children in MCAH
programs
6. List QA process developed to
ensure screening, referral and
linkage
7. List process or performance
measures for other activities
here
a) ASQ-3 and ASQ-SE will be
utilizes
b) One-Call Line for Kids
c) MOCPOC meetings and work
groups.
1.7 Describe the following based on
the activities you chose to
implement in the second column:
1. Number and types of targeted
providers using Birth to 5 or other
AAP recommended screening
materials.
• List other materials used
2. Outcomes of participation in HMG
or HMG like programs. Describe
results of work to implement HMG
core components
3. Outcomes of activities with HPs
4. Number of children, including
CYSHCN, receiving a yearly
preventive medical visit
5. Number of children in local MCAH
programs receiving developmental
screening/all children in MCAH
programs
• Number of children with
positive screens linked to
services/all children in MCAH
programs with positive
screens
6. Outcomes of policies/protocols
and QA activities to ensure
screening, referral and linkage
7. List outcomes of other
activities here
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 6 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
standardized developmental
screening in pediatric settings per
AAP guidelines. b) creates and
participates in family and
community networking
opportunities that promote early
detection and referral, c) provides
a centralized access point that
offers child development
information and links families to
needed services, and d)
facilitates greater access to
community services through
collaboration and use of data.
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
1.8
By June 30, 2017, 90% of community
partners identified as providing
services to women of reproductive age
will participate in a survey to assess
the collection of insurance related
data elements and referral process to
identify gaps and opportunities to link
women to available health services.
1.8
Develop a list of desired outcomes of
collaboration with partners.
Develop a list of community partners
available to participate in an
assessment of access to insurance
and a medical home and to evaluate
barriers and challenges to access
Develop a survey to utilize with
community partners to assess
collection of related data elements
and referral to services to evaluate
barriers and challenges to access
Establish a QI/QA system to improve
the process and plan to evaluate the
impact.
1.8
Select and describe a logic model for
developing list of desired outcomes.
Briefly describe process to identify
and survey community partners for
project.
Briefly describe data collected to
identify barriers to access.
Briefly describe barriers and
challenges identified.
Briefly describe QI/QA process
utilized.
1.8.
Total number of organizations
surveyed./Total number of community
partners identified as providing
services to women of reproductive
age.
A summary of survey findings.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 7 of 19
3/2/2016
Goal 2: Improve preconception health by decreasing risk factors for adverse life course events among women of reproductive age
o Decrease unintended pregnancies1
o Decrease the burden of chronic disease1
o Decrease intimate partner violence1
o Assure that all pregnant women will have access to early, adequate, and high quality perinatal care with a special emphasis on low-income and
Medi-Cal eligible women 2
The shaded area represents required activities. Nothing is entered in the shaded areas.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
2.1-2.3
All women will have access to
quality maternal and early
perinatal care, including CPSP
services for Medi-Cal eligible
women.
Assurance
2.1
Develop MCAH staff knowledge of
the system of maternal and
perinatal care.
Conduct local activities to facilitate
increased access to early and
quality perinatal care.
Assurance
2.1
Report the following:
1. List of trainings received by
staff on perinatal care
2. List activities implemented to
increase access of women to
early and quality perinatal
care
3. Barriers and opportunities to
improve access to early and
quality perinatal care
Assurance
2.1
Describe outcomes of the
following:
1. Behavior or practice change
following receipt of training
2. Activities implemented to
increase access to and
improve the quality of
perinatal care
3. Activities addressing the
barriers to improve access to
early and quality perinatal
care
2.2
Maintain and manage a network
of perinatal providers, including
certified CPSP providers.
Provide technical assistance or
education to improve perinatal
care access and quality of
2.2
Describe local network of
perinatal providers, including
CPSP providers (e.g.
concentration of Medi-Cal
Managed Care, Fee-for Service,
etc)
List technical assistance activities
provided to perinatal and CPSP
providers (e.g. resources,
2.2
Describe adequacy of current
network of perinatal providers in
meeting the needs of local
maternal population.
Describe improvement/s in
provider knowledge or practice
following technical assistance on
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 8 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
perinatal services.
Conduct activities with local
provider networks and/or health
plans to improve access to and
quality of perinatal services
including coordination and
integration of care.
referrals, tracking system for
follow-up, assessments,
interventions, infant care etc).
** If above is not applicable to
the local site,
Summarize perinatal training or
education sessions conducted
with at-risk, Medi-Cal eligible
women.
Briefly summarize shared
activities performed with current
provider networks and/or local
health plans to improve access to
and quality of perinatal services
including coordination and
integration of care.
perinatal care access and quality
of perinatal services.
Describe outcome of shared
activities performed with the
perinatal provider networks and/or
local health plan in improving
access to and quality of perinatal
services
2.3
Conduct face-to-face quality
assurance/quality improvement
(QA/QI) activities with CPSP
providers or MCMC liaison to
ensure that protocols are in place
and implemented.
2.3
List the types of CPSP provider
QA/QI activities conducted during
site visits.
Identify your MCMC liaison
contact
Report the number of actual site
visits conducted with enrolled
CPSP providers and/or MCMC
liaison
2.3
Describe the results of QA/QI
activities that were conducted.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 9 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
2.4
By June 30, 2017, 90% of identified
CBO’s and health plans will participate
in a survey to assess knowledge of
preconception health as an
intervention to promote optimal
reproductive health.
2.4
Assess CBOs/agencies
knowledge of current
preconception health activities.
Link CBOs/agencies to materials
and trainings related to
preconception health, life course
theory, and social determinants of
health.
CBOs/agencies will identify
priorities and goals for integrating
preconception care services into
public health programs.
2.4
Briefly describe evaluation method
used, available resources and
materials provided.
Top 3 priorities identified by CBOs
for integrating preconception care
services into public health
programs.
2.4
Number of organizations that have
implemented policies to promote
preconception health/ Number of
organizations evaluated.
Number of CBOs that
demonstrate adequate knowledge
of preconception health as an
intervention.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 10 of 19
3/2/2016
Goal 3: Reduce infant morbidity and mortality
o Reduce pre-term births and infant mortality1
o Increase infant safe sleep practices1
o Increase breastfeeding initiation and duration 1
The shaded area represents required activities. Nothing is entered in the shaded areas, except for FIMR LHJs.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.1-3.2
All infants are provided a safe
sleep environment
Assurance
3.1
Establish contact with
parents/caregivers of infants with
presumed SIDS death to provide
grief and bereavement support
services3.
Assurance
3.1
(Insert number) of
parents/caregivers who
experience a presumed SIDS
death and the number who are
contacted for grief and
bereavement support services.
3.2
Attend the SIDS Annual
Conference/ SIDS training(s) and
other conferences/trainings
related to infant health3.
3.2
Provide staff member name and
date of attendance at SIDS
Annual Conference/SIDS
training(s) and other
conferences/trainings related to
infant health.
3.2
Describe results of staff trainings
related to infant health.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 11 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
3.3
By June 30, 2017, collaborate with
Medi-Cal managed-care health plans
to adopt and distribute SIDS/Infant
safe sleep materials to 90% of
program participants.
3.3
SIDS coordinator provides infant safe
sleep education and SIDS risk
reduction materials to Medi-Cal
managed care plans.
SIDS coordinator/public health
professional to assess the number of
culturally and linguistically appropriate
infant safe sleep and SIDS risk
reduction materials distributed by the
health plan and provide technical
assistance to local Medi-Cal managed
care health plans as needed.
SIDS Coordinator works to promote
activities on infant safe sleep
education and SIDS risk reduction.
Encourage Medi-Cal managed care
providers to share the educational
materials with parents to promote the
infant safe sleep education and SIDS
risk reduction.
Develop and implement a Continuous
Quality Improvement/Quality
Assurance (CQI/QA) process to
monitor implementation of
policies/process, and a plan to
evaluate its impact.
3.3
Briefly describe collaboration with
Medi-Cal managed care.
Briefly describe assessment
process and tools developed to
assess culturally and linguistically
appropriate infant safe sleep and
SIDS risk reduction materials
distributed.
Briefly describe key infant safe
sleep education and SIDS risk
reduction accomplishments and
barriers.
List technical assistance provided.
Briefly describe the CQI/QA
process developed.
3.3
Number of presentation/training
given to managed health care
insurers
Number of Medi-Cal managed
care providers (health education
units who adopt infant safe sleep
practices and SIDS risk reduction
materials/Total number of Medi-
Cal managed care providers
educated.
Number of health insurers who
adopt, promote and distribute
infant safe sleep and SIDS risk
reduction materials/total number
of managed care insurers
educated.
Number of
parents/families/provider partners
receiving infant safe sleep and
SIDS risk reduction materials.
Describe the outcomes of the
CQI/QA process including
methods of measurements and
results.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 12 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.4
By June 30, 2017, collaborate with a
local WIC agency to implement at
least 3 strategic activities targeted to
pregnant African American women
and their families to increase
breastfeeding initiation and duration
rates.
3.4
BIH Coordinator/Public Health
professional and an identified WIC
leader and their respective staff
will implement African American
baby showers/breastfeeding
workshops to engage and inform
women and families about the
importance of breastfeeding.
3.4
Briefly describe:
• Collaboration process with
local WIC agency
• Evaluation method/survey
used
• Objectives, key activities and
timelines
Briefly describe barriers,
challenges and successes
implementing targeted activities
and evaluation of impact.
Briefly describe collaboration with
Medi-Cal managed care
3.4
• Number of strategic activities
implemented.
• Number of
participants/families served
• Results of pre/post workshop
evaluation
• Describe the outcomes of the
CQI/QA process including
methods of measurement and
results
For FIMR LHJs Only:
3.5-3.7
Preventable fetal, neonatal and
postneonatal deaths will be
reduced.
For FIMR LHJs Only:
Assessment
3.5
Complete the review of at least 20
cases, which is approximately
10% of all fetal, neonatal, and
postneonatal deaths.
For FIMR LHJs Only:
Assessment
3.5
Submit number of cases reviewed
as specified in the Annual Report
table.
For FIMR LHJs Only:
Assessment
3.5
Submit periodic local summary
report of findings and
recommendations (periodicity to
be determined by consulting with
MCAH).
Assurance
3.6
Establish, facilitate, and maintain
a Case Review Team (CRT) to
review selected cases, identify
contributing factors to fetal,
neonatal, and postneonatal
deaths, and make
Assurance
3.6-3.7
Submit FIMR Tracking Log and
FIMR Committee Membership
forms for CRT and CAT with the
Annual Report.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 13 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
recommendations to address
these factors.
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.
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, 2017, at least 75% of
Medi-Cal Managed Care and WIC
agencies who received prematurity
awareness materials and training will
demonstrate intent to educate and
distribute prematurity awareness
materials to pregnant and/or parenting
program participants
For FIMR LHJs Only:
3.8
FIMR Coordinator/Public Health
Professional will link Medi-Cal
managed care plans and WIC
agencies to available prematurity
awareness materials and provide
technical assistance as needed.
FIMR Coordinator/Public Health
Professional works to promote
activities on preterm birth risk
factors, ways to reduce risk of
preterm birth and prematurity
efforts.
Encourage Medi-Cal managed
care providers and WIC agencies
For FIMR LHJs Only:
3.8
Briefly describe collaboration with
Medi-Cal managed care and local
WIC agencies.
Briefly describe key prematurity
education, accomplishments and
barriers including timelines.
List technical assistance provided.
Briefly describe the CQI/QA
process developed.
For FIMR LHJs Only:
3.8
Number of Healthy
Babies/Healthy Future
presentation/trainings given to
managed health care insurers and
local WIC agencies.
Number of Medi-Cal managed
care providers/WIC agencies who
adopt prematurity awareness
practices and prematurity
awareness/prevention education
materials / Total number of Medi-
Cal managed care and WIC
providers educated.
Number of health insurers and
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 14 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
to share the educational materials
with pregnant and parenting
women and their families to
understand risk factors for preterm
birth.
Develop and implement a
Continuous Quality
Improvement/Quality Assurance
(CQI/QA) process to monitor
implementation of
policies/process, and a plan to
evaluate its impact.
. WIC agencies who adopt,
promote and distribute prematurity
awareness/prevention
materials/total number of
managed care insurers and WIC
agencies educated.
Number of
parents/families/provider partners
receiving prematurity
awareness/prevention materials.
Describe the outcomes of the
CQI/QA process including
methods of measurements and
results.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 15 of 19
3/2/2016
Goal 4: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight
o Increase consumption of a healthy diet1
o Increase physical activity1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1
By June 30, 2017, 3 labor and delivery
hospitals will have implemented the
model hospital policies or the Baby-
Friendly USA Hospital requirements to
comply with the Infant Feeding Act
[Health and Safety Code Section
123360-123367].
4.1
Continue relationships with
birthing hospital administrators
and staff.
Provide technical assistance and
support to hospitals to meet the
requirements of the Infant Feeding
Act.
Participate in a collaborative of
counties (San Joaquin, Merced,
Fresno) to develop “Best
Practices” for achieving “Baby
Friendly” status.
Develop and implement a
Continuous Quality
Improvement/Quality Assurance
(CQI/QA) process to monitor
implementation of
policies/process, and a plan to
evaluate its impact.
4.1
Number and names of hospitals
contacted and types of technical
assistance provided.
Briefly describe barriers,
challenges and solutions to
implementing the Infant Feeding
Act.
Briefly describe the CQI/QA
process developed.
4.1
Number of hospitals that have
implemented the model hospital
policies or the Baby-Friendly USA
Hospital requirements/ 3
hospitals.
Describe the outcome of the
CQI/QA process including
methods of measurements and
results.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 16 of 19
3/2/2016
Goal 5: Improve the cognitive, physical, and emotional development of all children, including children and youth with special health care needs
o Reduce unintentional injuries1
o Reduce child abuse and neglect1
o Provide developmental screening for all children1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
5.1
By June 30, 2017, 120 children
identified through referrals from
Comm unity Partners at high risk for
unintentional injuries, child abuse and
neglect, will receive Public Health
Nursing home visitation, including
developmental screening.
By June 30, 2017, 150 children
receiving services from Nurse-Family
Partnership (NFP) and Babies First
will receive developmental screening.
5.1
Through Public Health Nurse
home visitation case management
services:
• Monitor, screen and refer as
needed all children for
physical, emotional and
cognitive delays.
• Assess, monitor and refer as
needed all home
environments for inadequate,
unsafe and or unhealthy living
conditions.
• Educate all families served on
the optimal emotional,
physical and cognitive
environments for children with
a focus on the positive
characteristics of each family.
Screen all families for
maternal depression and
domestic violence.
Continue to support home
visitation staff with self-care
reflective practice sessions and
educational opportunities for
increased knowledge of medical
and emotional needs of families.
5.1
Number of families
assessed/screened for maternal
depression /DV / Total number of
families screened
Number of home environments
assessed for inadequate living
conditions and referred to
community resources / Total
number of home environments
assessed.
Documentation of home visitation
will be maintained in the
Electronic Charting System.
Maintain documentation of
referrals to community resources
and outcomes.
NFP and Babies First data will be
collected in the Management
Information System (MIS)
5.1
At least 35% of clients referred will
complete referrals made to
community services.
Preventable re-hospitalization rate
will be less than 10%
Number of children at high risk for
unintentional injuries, child abuse
and neglect received public health
nursing home visitation, including
developmental screening / 120
Number of children from NFP and
Babies First received
developmental screening / 150
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 17 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Children will be assessed using
the ASQ-3 and the ASQ-SE per
program protocol and PRN.
The Infant Motor Screen (IMS) will
also be used per program protocol
to screen for neuro-motor delays.
(Utilized by HRIP and Liaison
Programs only)
Environments will be monitored
per program protocol for health
and safety, including education
on: housing integrity, accident
prevention, car seat safety, lead
poisoning,
All mothers or primary care givers
will be screened for PMAD and
IPV according to program protocol
and referred as needed.
All charts are reviewed after initial
home visit, every three months
and closure of services for quality
of services, interventions
appropriate to family needs,
outgoing referrals and
documentation (HRIP and Liaison
Program only)
5.2
By June 30, 2017 maintain
collaborative agreement with First
5, and SMART Model of Care to
support comprehensive system of
5.2
Continue to participate in Model of
Care Oversight Committee
(MOCPOC) Leadership team.
5.2
Maintain meeting agendas,
minutes on file. Document
attendance in annual report.
5.2
Document on Collaborative Form.
Summarize outcomes and
activities in Annual Report.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 18 of 19
3/2/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
services for children with special
health care needs. (CSHCN)
Continue collaboration with partner
and community agencies to support
local services for CSHCN.
Maintain annual local agreements with
First 5, State MCAH and partner
agencies to support funding for
SMART Model of Care.
Describe collaborative and
capacity building activities.
Submit local agreements for state
approval of pass through funding.
Describe state and locally
approved 2016-17 MCAH, First 5
and SMART Model agreement.
1 2001-2015 Tittle V State Priorities
2 Tittle V Requirement
3 State Requirement
Page 19 of 19
7/3/2014
Goal 6: Increase conditions in adolescents that lead to improved adolescent health
o Decrease teen pregnancies1
o Reduce teen dating violence, bullying and harassment 1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
6.1
Add specific short and/or
intermediate SMART outcome
objective(s) here.
Consider addressing local
problems related to:
• Adolescent sexual health
• Adolescent pregnancy
• Adolescent injuries
• Adolescent violence
• Adolescent mental health
6.1
List activities to meet the Outcome
Objective(s) here.
Organize intervention activities
and performance measures using
the three core functions of public
health: Assessment, Policy
Development, and Assurance.
http://www.publichealth.lacounty.g
ov/qi/corefcns.htm
6.1
Develop process measures for
applicable intervention activities
here.
6.1
Develop short and/or intermediate
outcome related performance
measures for the objectives and
activities here.
Prognrn;
Agency:
r ubK:
BUDGET SUMMARY
\.'-:~.CS·•OOulit".ctt
FISCAL YEAR
201<6-17
BUDGET
ORIGINAL
ORIGINAL BUDGET
BUDGET STATUS
ACTIVE
Black Infant Health UNMATCHED FUNDING 201610 Fresno.
TffiE'I
I (11 (2) (l)
I TOTAL FVJICING % TIRE 'I
ALLOCAilON(S)---+ 296,649
EXPfNSE. CATEGORY
l tn PERSONNEL 576,105 1'79,Ei99
Inn o!'ERAllNG exPe~'ISES 52,())) 15,0<~
lUll\ CAP1TAL EXPENDITURES
1nv1 OTHER COSTS 57,3g5 57,395
:(VI tJ•IDIRECT COST S tG2,9~S ~1 .515
BUDGET TOTALS* 7~01 5 l7_etJ¥. 296:€49
TOTAL TITLE V
TOTALSGF
BALANCE(S) -
296.649 -29&,FA9 1
EIH:•SGJ= AGEN:YFI.tcOS
(A) (!) "'l I n,
% SGF % I A~oney Func!s•
246,467
21.671
2.1ft 21 621
1
~00-l:IIIHMI'CEO
WATCIHING 150150) I
E:IH-N T BiHt:ft1'J •;f
rol I I !I] I I I·<) 111 )
% I '-crncmed
f ed/Stale % ~~mbg·u~G
F dJ e .. ,;
I :>01.2$1
33,.51
61,4C2
_ss,.... 436,634 -
TOTAL TITLE XIX
TOTAL AGENCYFUNDS
~--~2~48~.~~~~ ---~====~~
2:~3.!>!13 :~~----l
$ 789,018 Maximum Amount Payable from State and Federal resources
WE
A3E~V FISC AL 4GE.I'r'S SIGt.IA TU~E
ST l>.iE liSE OIILY-TOUL STATE AIIO FEDtRAL Ra!lSURSEIAEr.IT Tln.EV BIH-SGJ' ~u~:~~ BIH-N 3 1H Cnty -~
PCACcdes $3.,3 SJ12l 53'24 S311lll
11 ?'U!SON.IIEL 17 9.61!~ 21 ,521 34.,281
Ill) CPERAnNG EJ;PENSES ·e.e.~~ 33.95 1
1111) CAPITAL EXPEII!SE;S
INl OT~COSTS 57.395
M I>IOtRECT COSTS 41~1& I 6 l ,411Q
L--Tot1b fOt i'CA Codes 71!5',0 !8 ~&49 I 21.62 l 4JE,634
201610 BIH AS 2t>l 6CGI!
E1'1HMICEO
MATCHIIIG {~125]
:Jfo· -E
{12) 1 :11)
% ,-C'ombln<a
Fltd.ISI3te
S.C ,114
-4 .3-2"' J.4 1 14
125'0!~
17 1'0 1 ~
SIH-E
53125
~.11-4
3•.11•
B.H J>l·r • 5
jlA) I [1-5)
% -~Co-mbined
IF'odlllo-c••
r-•c==J
r:z•~:c:=J
S IH Cn<y -E
53102
i 16, I (171
I
OR•G NAL SUOOET
Plo!l""'c Black Infant Health UNMATCHED FUNDING '10.'\I.Eio'HAKCED ENHANCED
I Agenc.,. 201610 Fresno ltATCMIIIG 15CI50] MATCHI!IG 17"25)
Suti!K.. nn.Ev IIOH·$31' J.GEP¥.:YrU<DS I!IH-~ E>HC.C,·N 'iii~-( I E>Ho.r, · e
I Ill (".>) I (l) (4) I !'l (!) : £7) (!) I til 1 I'Dl J I~ 1t 1'71 J Ill) , ... , I 1'~1 l "t 1 c•11 ~
I TOTAL FUti CiNG "lo mL.Ev % SGF % 1 Asener Funct~o• % l.OIT'bs:\e<l I
Fed1St.J111 y, ~~~btntd 'II I ...,,.,omea
FO<IISUII y, ~~binad
'"'"• ,...,.. I l
1(11) OPERATING EXPENSES DETAIL "C.Pe~E\._WA1Qo
66..:>0 •
TOT At. Ol'fRA T1NG EXPE'ISES 52,000 18,049 l3,9st 1 I I I I --lPV-VEl. L 15,1111~ 3>..43% 5,015 66~ 9.9~H I I I
~JNI~ I 2D.CCC) 33.•310 6.686 -r----65.Sl''% 13,3"0 I I I
1 3•,i;lr.g Renl• l Lea-I 1CO 33.43% 2)4 65.57% ~£6 '~--' ,...---~ 2 Of" A:t Sup~iN I 3.teo l3.43% • ,C)C3 I 55.57% 1.!197 ...,__! ;----3 """"'90 ~ 33.43% •&1 r---~ 333 _
• ~'11n9 7000 33.43., 2,3AO 56.57110 4a;Q r-----I
5 ~1elrOa<shJ;>• HXJO 10000¥; 1000 r---1--~ I
6 rTSuFPC>1 •.&Xl 334l'il 1E05 r---~ ~ 3195 r---I
7 r----r-; -I 1-1---8 r---r---r------j -I 9
10 r---r---f-------1 -
11 r---r---r-----
'2 ~ r------
13 1--r-----
r----r------
14
15-r----r----
· Urrrattbtd ~reUtiQ E.cDtf'..$ .... 1 ~ oletb..-rol FHiill'll.-.at.el'ln' 1..ne11 fT45eXOClo. ~er:5es.ma:. ~·be<harue-:tllDUmna~hed • ._ ICO J~ &.lito ann11 h't"dii'Gd. )1, wY:tfor Aaencv cc;ol. it u,;:s.
(Ill} CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL E)(PE)IOITURES
(IV) OTHER COSTS DETAIL
'-P't.A1CJt\IO.WIL"CJot
··~'"'
TOTALOTHERCOS'"SI 57.395 1 I 57,3151 I I I I I I I I I I I
SUBCONTRACTS
. I Re»rog ..:I 8<-t""" I 7,75~ 110;Y.Il!. 7,75' r---r----r--r---
2 I --r---r-----r----3 I 1--r--r-----r--• I 1---r------
$ I r------! § ~ 6 -, - -I ;---1-T 1--r---'--' ,___ -5 i '------..__ l._l '----OTHER CHARGES .... ~ . ........_..
1 Cf~T. 5u>FOI1 ~1ot on.ol• 19.645 10000'>1 19 64 5 r-----c=J d. ~ 66.57'1',
l M~a• :l'l/Y.ll 1:1000'>1 :;oooor--~ I_ 66.Sl'f. ·-
J r---• --• ---5 r---
& I !-------r---;---
1---1-!------
1 I 1----t---r----e1
201610 !!-'iA8201&:J$15 ~oil
'-••-•r~o·--........ ..;/.:_
PubUc Heol th •l• ~"' ""'""~ Chll "'"..,"""""'""""OMs=
~~gr.~n: Bla c k Infant Health UNM ATCHED FUNDIN G ~lOiN~MiAKCED WHA.'IICED I
·Auunc-~: 201610 Fresno ~Tet11tfGISCI'SQ1 MATCliiNG j75/Z$) I S ub11: rrr..ev I!IH· SG" MlEN:Y F l..t40S eJH~N &~ -:rry-~ 'il"'. E I IJ>iC..If· E
I I' I (2) I (l) (C) I (~) (e) I (7) cal I llrl f"jj I , •. tJ 1'>1 I Ill\ I''J I tiSI I ~£i > I (11; I I TOTAL RJNOII'IG % I TITLEV % I SGF " Agency Funds" % I -.om.,.,oc I % ~~:;btntd "
I .,.,.,.,. ... 0 % l;:;"blr<!<l I J Fed.'Sr...te ~ADo nov• Fo<IISuto ltA~<u"
(V) INDIRECT COSTS DETAIL
TOTALlll ~ECTCOSTSI 102,515 I '1.5151 I I I I I &1,402 1 I I I tS.C~Io! T .... l Ci"c' Cosu I 102.815 .<()~~~ <1.5151 I I I I 59~1 SI,<JZ I I I
{I) PERSONNEL DETAIL
TOTAL PERSONNEL COSTS 578,705 111,,., 1 21,521 1 34 1,281 I I J•,n•
F,_..GE IKkUIT ... Tt:' 71ntlo 2S"J.cn I 71.15<!
1
H a.•ssH H ·•9.•s~H H I4,87CH
TOT Al..\'f~ 323,6l8 I ICC,U8 12,133 "!r.,S15 11,143 .. ->-.J % <a: s Tffi.E DR CL.ASSIFI<::A llOio ~j TDTALWA~S i FTE Z< < ..
I EA Putfle Heal11t Nu-r.n U scccm t1.927 40..96-1 ~5.0011. 14,337 4S.CC% 16,1!43 ~ 7,78:1 g l.210 65.0010
2 FN. ~ Coo«<nalor -HE 1coccm 48.W7 46.,302 9.9 111. 4,8.3& 20CS% UC2 -I 55.CC% :21;,eAt~ 7,320 .....------
Sl 210 7a.DDII. !-"--'---'--'-,....---I 7J.CO"-
C)% r--3 ss Comrnu,l:y Uoi>on -HES I CO.ccm so~ ro,.sc5 :ncoo. ll.eJO 3&.&-9 1----9 l.2% 73.COIO
• OS fHA G""'J' F~ilalll r .>;f5 10000% 53,015 ~.015 40.Wh 21,2lle f--,....---
: &O,CCII. 31&19 r---r--91.2% 50.011%
5 1.18 fHA G""-"' FooltolM ..HE~ 1coccm 4 1.492 41.492 44.00'>1 1e-.2~ f--r--SS .OU% Zl-2:!6 f--r---------1 r--!rl.2% 55 CIW,I
f--1------,----r-----r-----r-----
5 KM fHA Gro-•o F'~--HEA 1co.ccm .,;_too .,;,100 47.CC% 20.2~7
I-I ~ 22.64~ r--r--,_______ !tl.2% 53 DC%
7 .,~, Oot. EniJyM..._~ 10000% 23,»5 23WS 1 1occm 2 .~31 SC.OO'll 20975 4040~ 9 1.211. 9C.CC'IIt
e EJ ~·enl>l H .. ll~ Prtias"'""' -MSW 5).00% '-",888 22 ...... 3700% ~~ r-----r--4S00'1. 10.100 -I ucm; !11.2% 53J:t-llo
g r--r--1--r--f--
I C r--r--r----r--r---
., i -r---· --:------I
•2 I r-r-----r--
r-------r--\3 f-------.. I f-------
1S -r---r---
16 I I I -1--1-r----17( I I -f--r---r---1-----18 I I I I
-I -r--;------j 1--I
19 I I I
3 1-f-------I >--------= r-.--------1 I 20 I I f-------r--r--21 I r-----~I I r--r---r--, zz I r--~ -~ .....___ I
23 I r--~ ~ t--r--~ I
I r---I 2• r--1 I P, 75 I r--.-----r-----: ~ r--r---f-------
:21; ~ -r--i---r--f-------27 r--f---------t---28 f--r--f----I 29
33 r--r-----r----r---r--31 -----32 :---
---:-----,..-------.
33 ---I r--!---
lC - -
r--:----35 --------! 1----r--r--35 ----r-r------: r-----:.7
;;e -r---!--1-!--I
:;; -!---1----r---~----. I -1----r-r-----1-t=:i r .co '------'-------'---
2016105.H .. 820180615 3<13
Budg.,t: ORIGINAL
Program: B lack Infant Health
Agency: 201610 Fresno
Su!>K:
Base .. ,ed!.Cal FKtcr% c.annol t .e chanQed.. ~ value is ·~a iD f or ='"( 1&171or :he s~llu;
V~n"" 4 5 -~D Quarwty
'I) PERSONNEL DET All BASE MEDI-CAL FACTOR% 91 .18% l.ke lha foll>wi->;J [nk ID aoc.>s>lho currenl AFA "'"bpa!j<! ard """' C<Jr••.r~ t:>He 1/CF% for·.,..r.o;cr.c;c
Tto:f/www .cdnll .c•.•O\•I>e";.,•<lf ~rdin•l m<ah i,.,.;..,;Fbta !Ot:<~ments..o sor
TOTALS 7.00 387,035 323,.628 253,077.10
11)
FRINGE Personn~lfWCF % J..,tffic~tion ...J ANNUAL T OTAl ct TITLE OR CLASS. %FTC BENEFIT FRINGE BENEFITS PROGRAM MCF'k IIICFType R~lliil'emrn1s
F SALARY WAGES j ctitlc link t.o Yiew ) !; RATE % Maximum r.nar~cters = 1024
I EA P\Jblk: Heallh Nurse 11 50.00% 81,927 'i0.964 78.20% 32,003.85 9 1.18% Base
' FN BIH C<lortfuaiPr -HE. 1CO.OO'!\ '18,802 43,S02 78.20% 38,l 63.16 9U 8% Base
3 SB ComrntJnlty liaisoo-HES 100.00% 50,505 51.),505 16.20"16 39,49'i.91 1 91.18% Base
4 OS FHA GroL41 :faci~oor -l-IES 100.00% 53.015 53.015 1 8.20% '!1 ,457.73 91 .18% Base
5 MB FHA Grou;~ F acili1a1or -l-IES 100.CO% -41.~92 4 1,'i92 18.20% 32,446.74 91.18% Base
5 KM FHA Group Facii~310t -HEA 100.00% -43,10!) 43,\00 18.20% 33,704.20 91.H.% Base
7 MM Oata Enlr'y Mar-age< ..()A 101>.00% 2J.'J06 23,3()6 71!.20% t &.2Z5.29 91.111% Base
& EJ -~.(ental Heanh Pro'.e:ssicmal ·MSW so.cor. 4-4..8a8 22,4-44 78.20% 17 ,:55 1.21 91.16'% Base
9
10
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15
16
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16
19
20
21
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610 BIH AS 201 6C~HS 1 ctl
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 1 of 16
7/1/2016
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH)
Black Infant Health (BIH) Scope of Work (SOW)
Black Infant Health Program
The 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 Efforts to Outcomes (ETO) data system and engage community partner agencies.
All BIH Sites are required to comply with BIH Policy and Procedures (P&P) 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 “E” Source Key refers to information that is based on participant-level program data included and maintained in ETO. The “N” “Source Key refers to
narrative information provided in quarterly reports or site surveys.
It is the responsibility of the Local Health Jurisdiction (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/essentialServices.html; http://www.publichealth.lacounty.gov/qi/corefcns.htm
o The Spectrum of Prevention: http://www.preventioninstitute.org/component/taxonomy/term/list/94/127.html
o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 2 of 16
7/1/2016
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
For each fiscal year of the contract period, the Local Health Jurisdiction shall submit the deliverables identified below. All deliverables
shall be submitted to the MCAH Division to your designated Program Consultant in accordance with the BIH Policies and Procedures
Manual and postmarked or emailed no later than the due date.
Deliverables for each FY Due Date for each FY
Annual Progress Report Aug. 15
Coordinator Quarterly Report:
Reporting Period From To Due Date
1) First Report July 1, 2016 September 30, 2016 October 31, 2016
2) Second Report October 1, 2016 December 31, 2016 January 31, 2017
3) Third Report January 1, 2017 March 31, 2017 April 30, 2017
4) Fourth Report (WAIVED)
Information during this reporting period
will be included in the Annual Progress
Report
April 1, 2017 June 30, 2017 July 31, 2017
See the following pages for a detailed description of the services to be performed.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 3 of 16
7/1/2016
Part II: Black Infant Heath Program
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.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.1
LHJ Maternal, Child and
Adolescent Health (MCAH)
Director and/or designee (BIH
Coordinator) will provide
oversight, maintain program
fidelity, fiscal management and
demonstrate that BIH activities
are conducted as required in
the BIH Policies and
Procedures, SOW, Data
Collection Manual, Efforts to
Outcome (ETO) Data Book,
Group Curriculum, and MCAH
Fiscal Policies and Procedures.
1.1
• Implement the program
activities as designed.
• Annually review and revise
internal policies and
procedures for delivering
services to eligible BIH
participants.
• Submit Agreement Funding
Application (AFA) timely.
• Ensure that BIH Coordinator is
involved in the BIH budget
process prior to submission of
AFA to MCAH.
• Submit BIH Annual report by
August 15.
• Submit BIH Quarterly Reports
as directed by MCAH.
1.1
• Describe MCAH Director and
BIH Coordinator
responsibilities as they relate
to BIH. (N)
• Provide organization chart that
designates the delineation of
responsibilities of MCAH
Director and BIH Coordinator
from MCAH to the BIH
Program.
• Describe collaborative process
between MCAH Director and
BIH Coordinator related to BIH
budget prior to AFA
submission. (N)
1.1
1.2
Each LHJ must have in place
qualified personnel and
required Full Time Equivalent
(FTE) to conduct a BIH Program
that is relevant to African-
American women, culturally
competent and honors the
unique history/traditions of
people of African-American
descent as outlined in the P&P.
1.2
• Maintain culturally competent
staff to perform program
services.
• At a minimum, the following
key staffing roles are required: o .0.5 FTE BIH Coordinator o Family Health Advocates
(FHA)/Group Facilitators
(GF) based on MCAH-BIH
designated tier level. o 1 FTE Community
Outreach Liaison (COL) o 0.5 FTE Data Entry o 0.5 FTE Mental Health
1.2
• Describe process of hiring
staff at each site that are filled
by personnel meeting
qualifications in the P&P.
• Include duty statements of all
staff with submission of AFA
Packet.
• Submission of all staff
changes per guidelines
outlined in BIH P&P.
1.2
• Percent of key staffing roles at
site filled by personnel who
meet qualifications in the P&P.
(N)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 4 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Professional (MHP) o Utilization of a staff hiring
plan.
TRAINING
1.3
All BIH staff will maintain and
increase staff competency.
1.3
• Develop a plan to assess the
ability of staff to effectively
perform their assigned tasks,
including regular observations
of group facilitators.
• Identify staff training needs
and ensure those needs are
met, notifying MCAH of any
training needs.
• Ensure that all key BIH staff
participates in training or
educational opportunities
designed to enhance cultural
sensitivity.
• Require that all key BIH staff
(i.e. MCAH Director, BIH
Coordinator, and ALL direct
service staff) attend mandatory
MCAH Division-sponsored
trainings, meetings and/or
conferences as scheduled by
MCAH Division.
• Ensure that the BIH
Coordinator and all direct
service staff attend mandatory
MCAH Division-sponsored
training(s) prior to
implementing the BIH
Program.
• Ensure that the BIH
Coordinator and/or MCAH
Director perform regular
observations of Group
1.3
• List staff training activities. (N)
• Describe improved staff
performance and confidence in
implementing the program
model as a result of
participating in staff
development activities and/or
trainings. (N)
• List gaps in staff development
and training. (N)
• Describe plan to ensure that
staff development needs are
met. (N)
• Describe how cultural
sensitivity training has
enhanced LHJ staff knowledge
and how that knowledge is
being applied. (N)
• Recommend training topic
suggestions for statewide
meetings. (N)
1.3
• Maintain records of staff
attendance at trainings. (N)
• Completion of group session
information form. (E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 5 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Facilitators and assessments
of FHAs’ case management
activities.
DATA COLLECTION AND
ENTRY
1.4
All BIH participant program
information and outcome data
will be collected and entered
timely and accurately using BIH
required forms at required
intervals.
1.4
• Ensure that all direct service
staff participate in data
collection, data entry, data
quality improvement, and use
of data collection software
determined by MCAH.
• Ensure that all subcontractor
agencies providing direct
service enter data in the ETO
as determined by MCAH.
• Ensure accuracy and
completeness of data input
into ETO system.
• Ensure that all staff receives
updates about changes in ETO
and data book forms.
• Ensure that a selected staff
member with advanced
knowledge of the BIH
Program, data collection, and
ETO is selected as the BIH
Site’s Data Entry lead and
participates in all Data and
Evaluation calls.
• Accurately and completely
collect required participant
information, with timely data
input into the appropriate data
system(s).
• Work with MCAH to ensure
proper and continuous
operation of the MCAH-BIH-
1.4
• Review ETO and fidelity
snapshot reports and discuss
during calls with BIH State
Team.
• Review ETO Utilization
Reports for all staff at BIH
Sites.
• Enter all data into ETO within
7 working days of collection.
• Review of the BIH Data
Collection Manual by all staff.
• Completion of ETO training by
all staff.
• Participation in periodic
MCAH-Data calls.
• Participation in role-specific
trainings by the Data Entry
Lead.
• Review of ETO data quality
reports by the BIH Coordinator
and Data Entry staff on at
least a monthly basis.
• Conduct and report on audits
of recruitment, enrollment, and
service delivery paper forms
against ETO reports; audit
sample must include at least
10% of recruitment records
and 10% of enrollment
records.
1.4
• Number and percent of
enrolled women for whom no
information/action was
entered into the ETO within
two weeks of enrollment. (E)
• Number and percent of forms
that were entered within 7
days of collection. (E)
• Number and percent of forms
collected within the required
timeframe per the BIH Data
Collection Manual. (E)
• Number and percent of
enrolled participants that have
information/action entered into
the ETO within two weeks of
collection. (E)
• Number and percent of cases
with completed recruitment
forms. (E)
• Number and percent of
referred or recruited women
with no enrollment decision
after 30 days. (E)
• Number and percent of
participating women with
cases closed 2 months after
last postpartum group. (E)
• Number and percent of key
staff that completed FY 16-17
BIH ETO Training. (E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 6 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
ETO.
• Store Participant level Data
forms on paper per guidelines
in P&P.
• Define a data entry schedule
for staff.
OUTREACH
1.5
All BIH LHJs will elevate
community awareness of BIH
by conducting outreach
activities.
1.5
• All BIH LHJs will conduct
outreach activities and build
collaborative relationships with
local social service providers,
health care providers and
individuals to ensure that
eligible women are referred to
BIH.
1.5
• Describe the types of
community partner agencies
contacted by LHJ staff. (N)
• Describe outreach activities
performed in order to reach
target population. (N)
• Describe deviations in
outreach activities, noting
changes from local recruitment
plan. (N)
1.5
• Number of existing MOUs prior
to FY 16-17. (E)
• Number of new MOUs
established in FY 16-17. (E)
• Total number and type of
outreach activities completed
by all staff. (E)
PARTICIPANT RECRUITMENT
1.6
All BIH LHJs will recruit
African- American women 18
years of age, less than 26
weeks pregnant.
1.6
• Develop a Participant
Recruitment Plan
(standardized intake process)
according to the target
population and eligibility
guidelines in MCAH-BIH P&P.
• Review Recruitment plan
annually and update as
needed.
1.6
• Submit participant triage
algorithm with submission of
AFA packet.
• Participant Recruitment Plan
will be reviewed annually and
updated as needed.
1.6
• Number and percent of
referred and recruited women
who enrolled into the BIH
Program. (E)
• Number and percent of
recruited and referred women
that were eligible (at least 18
years old and <26 weeks
gestation). (E)
PARTICIPANT REFERRAL
1.7
All BIH LHJs will establish a
network of referral partners.
1.7
• Collaborate with community
agencies to develop a network
1.7
• Describe process for ensuring
that referral partner agencies
1.7
• Number of women that were
recruited by referral source
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 7 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
of referral partners who will
refer eligible women to BIH.
• Provide referrals to other
MCAH programs for women
who cannot participate in
group intervention sessions.
are referring eligible women to
BIH. (N)
type (Provider versus Non-
provider). (E)
• Number and percent of
referred women with
completed referral form. (E)
ENROLLMENT
1.8
• All participants enrolled
in BIH will be African-
American.
• All participants will be 18
years or older when
enrolled in BIH.
• All participants will be
enrolled during pregnancy.
o All participants will be
enrolled at or before 26
weeks of pregnancy.
• All women will participate in
group intervention.
1.8
• Enroll women that are African-
American.
• Enroll women during
pregnancy.
• Enroll women at or before 26
weeks of pregnancy.
• Enroll women that will
participate in group
intervention.
1.8
• Visual inspection of all
recruitment eligibility fields on
incoming referral forms for
completeness.
• Inclusion of eligibility criteria
with materials used for referral
and recruitment.
1.8
• Number and percent of
enrolled women who are 18
years of age and older at
enrollment. (E)
• Number and percent of
enrolled women who were
pregnant 26 weeks or less at
enrollment. (E)
PROGRAM PARTICIPATION
1.9.1
• All women will participate in
prenatal group.
• All women will participate in
group within 30 days of
enrollment.
1.9.1
• Assign participants to a
prenatal group as part of
enrollment process.
• Schedule prenatal groups to
allow participants to attend
within 30 days of enrollment.
• Enroll participants in a prenatal
group within 30 days of first
successful contact.
1.9.1
• Describe barriers, challenges
and successes of enrolling
women in prenatal group
within 30 days of first
successful contact. (N)
1.9.1
• Number and percent of
enrolled women who attended
a prenatal group session within
30 days of enrollment. (E)
• Number and percent of
enrolled women assigned to a
prenatal group. (E)
• Percent of group sessions that
were conducted in the
prescribed sequence and at
the prescribed time intervals.
(E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 8 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.9.2
• All BIH participants will
receive case management
support as defined in the
P&P.
• All participants will
complete all prenatal and
postpartum assessments
within the recommended
time intervals.
• All BIH participants will
receive referrals to services
outside of BIH based on Life
Planning Meetings.
1.9.2
• Assign participants to a FHA
as part of enrollment process.
• Conduct case management
services that align with Life
Plan activities (goal setting).
• Collect completed self-
administered scaled questions
as described in P&P.
• Collect the required number of
assessments per timeframe
outlined in P&P.
• Develop and implement a Life
Plan based on goal setting
during Life Planning meetings
for each BIH participant;
complete all prenatal and
postpartum assessments;
provide ongoing identification
of her specific concerns/needs
and referral to services outside
of BIH as needed based on
Life Planning meetings.
• Ensure participant referrals are
generated and completed for
all services identified.
• Conduct participant dismissal
activities.
• Conduct participant
satisfaction surveys.
• Submit complete and accurate
reports in the timeframe
specified by MCAH.
1.9.2
• Collect and record service
delivery activities for enrolled
women into ETO. (E)
• Report number and percent of
enrolled women for whom the
following actions are
completed (E):
o Assigned to an FHA
o Intake procedures,
including completion of an
initial assessment and
assigned date of initial
prenatal group.
o Initial case conferencing.
o Life Planning Meetings.
o Prenatal and Postpartum
assessments.
o Birth Plan
o Referrals
o Participant dismissal
• Describe successes and/or
challenges in assisting
participants with setting short
and long-term goals during Life
Planning meetings. (N)
• Describe program
improvements resulting from
participant satisfaction survey
findings. (N)
1.9.2
• Number and percent of
enrolled women assigned to
an FHA. (E)
• Number and percent of
enrolled women who complete
prenatal and postpartum
assessments at the P&P-
designated time intervals. (E)
• Number and percent of
enrolled women who are
assigned to a prenatal group
upon enrollment.
• Number and percent of
enrolled women who received
at least one case conference
attended by a FHA or GF,
MHP or Public Health Nurse
(PHN). (E)
• Percent of enrolled women
who have (a) a long term goal
and (b) one or more short-term
goals documented in each of
the three focus areas (health,
relationship, and finances)
(among women enrolled 30
days or longer) during Life
Planning meetings. (E)
• Number and percent of
enrolled women with a Birth
Plan collected within the P&P-
designated time frame. (E)
• Number and percent of
enrolled women who have a
known referral status for every
documented referral at time of
exit from the program (among
women dismissed from BIH.(E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 9 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Number and percent of
enrolled women who have not
been dismissed from BIH 2 or
more months after completion
of their last postpartum
group.(E)
• Number and percent of
enrolled women who have
been dismissed from
enrollment with a completed
participant satisfaction survey.
(E)
1.9.3
All BIH participants will
participate in Group
Intervention Sessions.
1.9.3
• Schedule group sessions with
guidance from State BIH
Team.
• All participants will have the
opportunity to enroll in a group
series within 30 days of the
first successful contact.
• Conduct and adhere to the 20-
group intervention model as
specified in the P&P.
1.9.3
• Collect and record group
session attendance records for
all enrolled women into ETO.
(E)
• Submit FY 2016-17 Group
Session Calendar to MCAH-
BIH Program with submission
of AFA and upon request.
• Describe participant successes
or challenges with completing
7 of 10 prenatal and/or
postpartum group sessions.
1.9.3
• Number of group series
entered into ETO. (E)
• Number and percent of
enrolled women who attend at
least one prenatal group
session. (E)
• Number and percent of
enrolled women who attended:
o 7 of 10 Prenatal Group
Sessions.
o 7 of 10 Postpartum Group
Sessions.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 10 of 16
7/1/2016
Goal 2: Engage the community to support African-American families’ health and well-being with education and outreach efforts
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
2.1
BIH Coordinator and/or MCAH
Director will elevate community
awareness of African-American
birth outcomes.
2.1
• Inform the community about
poorer birth outcomes among
African-American women by
delivering standardized
messages describing how the
BIH Program addresses these
issues.
• Create partnerships with
community and referral
agencies that support the
broad goals of the BIH
Program, through formal and
informal agreements.
• Develop a community
awareness plan that outlines
how community engagement
activities will be conducted.
2.1
• Submit quarterly reports that
describe outreach activities
electronically using ETO in a
timely manner. (E)
• Document the local plan for
community linkages, including an
effective referral process that will
be reviewed on an annual basis
and updated as needed. (N)
• Document successes and
barriers to community education
activities or events at least once
per quarter in the ETO through
quarterly reporting. (E/N)
• List and maintain current
documentation on the nature of
formal and informal partnerships
with community and referral
agencies at least once a quarter;
record MOUs and referral
relationships in the ETO service
provider details form . (E/N)
• Document community efforts
such as advisory board
involvement and community
collaborations to address
maternal and infant health
disparities, or other similar formal
or informal partnerships at least
once per quarter. (N)
• Enter all outreach activities in the
Community Contacts Log in
ETO.
2.1
• Number, format, and outcomes
associated with community
outreach activities conducted by
BIH Coordinator and/or MCAH
Director. (E/N)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 11 of 16
7/1/2016
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Maintain current lists of
community providers and Service
Provider details in ETO.
2.2
BIH Community Outreach
Liaison (COL) will increase
information sharing with other
local agencies providing
services to African-American
women and children in the
community and establish a
clear point of contact.
2.2
• Develop collaborative
relationships with local
agencies in the community that
provide services to African-
American women and children,
to establish strong resource
linkages for recruitment of
potential participants and for
referrals of active participants.
• Develop a clear point of
contact (person/s) with
collaborating community
agencies on a regular basis as
it relates to outreach,
enrollment, referrals, care
coordination, etc.
2.2
• Enter all outreach activities in the
Community Contacts Log in
ETO.
• Maintain current lists of
community providers and Service
Provider details in ETO.
• Describe materials used to
inform community partners about
BIH. (N)
• List and describe barriers,
challenges and/or successes
related to establishing community
partnerships and points of
contact. (N)
2.2
• Number of agencies where the
COL has a documented point of
contact and with whom
information is regularly
exchanged. (E)
• Number of agencies with
outreach records documented in
ETO. (E)
• Completeness and timeliness of
reporting on community outreach
activities conducted by COL.
(N/E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 12 of 16
7/3/2014
Goal 3: Increase the ability of African-American women to manage chronic stress
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.1
All BIH participants will report
increased social support and
decreased social isolation after
attending the prenatal and/or
postpartum group intervention
and completing Life Planning
activities.
3.1
• Implement the prenatal and
postpartum group intervention
with fidelity to the P&P.
• Encourage participants to
attend and participate in group
sessions.
• Support clients in fostering
healthy interpersonal and
familial relationships.
• Report results from group
session information form,
including description of
participant engagement in
group activities for each group
session.
3.1
• Provide FY 2016- 2017 group
intervention schedules upon
request. (N)
• Percent of adherence
indicators with ‘high’ fidelity
ratings. (E)
• Percent of participants who
meet expected prenatal life
planning session attendance
(prenatal dose). (E)
• Percent of participants who
meet expected prenatal group
session attendance (prenatal
dose). (E)
3.1
• Number and percent of
participants who report an
increase in social support as
measured through the Social
Provisions Scale – Short
(SPS-S). (E)
• Number and percent of
completed group session
information forms. (E)
3.2
All BIH participants will report
increased self-esteem, mastery,
coping and resiliency after
attending prenatal and/or
postpartum group intervention
and completing Life Planning
activities.
3.2
• All activities are delivered with
an understanding of African-
American culture and history.
• Assist participants in
identifying and utilizing their
personal strengths.
• Develop and implement a Life
Plan with each client.
• Teach and provide support to
participants as they develop
goal-setting skills and create
their Life Plans.
• Teach participants about the
importance of stress reduction
and guide them in applying
stress reduction techniques.
3.2
• Describe challenges/barriers
why participants did not report
an increase in self-esteem,
mastery, coping and resiliency
after attending prenatal and/or
postpartum group intervention
and completing Life Planning
activities. (N)
3.2
• Number and percent of
participants who maintain or
increase self-esteem based on
responses to the Rosenberg
Self-Esteem Scale. (E)
• Number and percent of
participants who maintain or
increase mastery based on
responses to the Pearlin
Mastery Scale. (E)
• Number and percent of
participants who maintain or
increase coping and resiliency
based on responses to the
Brief Resilience Scale. (E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 13 of 16
7/3/2014
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Support participants as they
become empowered to take
actions toward meeting their
needs.
• Teach participants how to
express their feelings in
constructive ways.
• Help participants to
understand societal influences
and their impact on African-
American health and wellness.
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 14 of 16
7/3/2014
Goal 4: Improve the health of pregnant and parenting women, thus also promoting the health of their infants
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1
All BIH participants will be
linked to services that support
health and wellness while
enrolled in the BIH Program.
4.1
• Assist participants in
understanding behaviors that
contribute to overall good
health, including:
o Stress management
o Sexual health
o Nutrition
o Physical activity
• Ensure that participants are
receiving prenatal care.
• Ensure that healthy nutritious
snacks are available during
group sessions.
• Provide participants with
health information that
supports a healthy pregnancy.
• Ensure that participants have
access to health insurance.
• Identify participants’ health and
social needs and provide
referrals and follow-up as
needed to health and
community services.
• Provide information and health
education to participants who
report drug, alcohol and/or
tobacco use.
• Assist participants with
completion of their birth plan.
4.1
• List and document additional
activities (e.g., Champions for
Change cooking
demonstrations) conducted
that promote health and
wellness of BIH enrollees and
their infants at least once per
quarter. (N/E)
4.1
• Number and percent of
participants and infants who
obtained health and
community services while
enrolled in BIH. (E)
• Number and percent of
participants whose healthy
eating behaviors improve over
the course of their participation
in BIH. (E)
• Number and percent of
participants whose physical
activity increased over the
course of their participation in
BIH. (E)
• Number and percent of
recruited and enrolled
participants reporting drug,
alcohol and/or tobacco use
who are provided information
and health education. (E)
• Number and percent of
participants receiving prenatal
care by trimester of program
initiation. (E)
• Number and percent of
participants uninsured at
enrollment who received
referral and follow-up for
health insurance before
delivery. (E)
• Number and percent of
participants who complete a
birth plan. (E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 15 of 16
7/3/2014
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.2
All BIH participants will report
an increase in knowledge and
understanding of reproductive
life planning and family
planning services.
4.2
• Promote and support family
planning by providing
information and education.
• Promote and support
interconception health.
• Help participants understand
and value the concept of
reproductive life planning as
they complete their Life Plans.
• 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 Family
Planning, Access, Care, and
Treatment (Family PACT).
4.2
• Summarize challenges/barriers
of birth control usage among
enrolled women who have
delivered. (N)
4.2
• Number and percent of
participants who attend a 4-6
week postpartum checkup with
a medical provider. (E)
• Number and percent of
participants who use any
method of birth control to
prevent pregnancy after their
babies are born. (E)
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.
4.3
• Help participants understand
how mental health contributes
to overall health and wellness.
• Help participants recognize the
connection between stress and
mental health and practice
stress reduction techniques.
Help participants understand
the connection between
physical activity and mental
health.
4.3
• Summarize successes and
challenges in addressing
mental health issues, including
mental health referrals at least
once per quarter. (N)
4.3
• Number and percent of
enrolled participants who
completed the EPDS 6-8
weeks postpartum. (E)
• Number and percent of
participants with “positive”
EPDS screens with a recorded
referral to a community mental
health provider within 2 weeks
after the EPDS collection date.
(E)
Agency: County of Fresno Fiscal Year: 2016-17
Agreement Number: 201610
Page 16 of 16
7/3/2014
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Administer the Edinburgh
Postpartum Depression
Screen (EPDS) to every
participant 6-8 weeks after she
gives birth.
• Help participants understand
the symptoms of postpartum
depression.
• Provide referrals and follow-up
to mental health services when
appropriate.
4.4
All BIH participants will report
an increase in parenting skills
and bonding with their infants
and other family members.
4.4
• Assist participants in
understanding and applying
effective parenting techniques.
• Assist participants with
completing home safety
checklist.
• Assist participants with
increasing knowledge of infant
safe sleep practices, Sudden
Infant Death Syndrome
(SIDS), Sudden Unexplained
Infant Death (SUID) risk
reduction.
• Assist participants with
completing birth plan.
• Assist participants with
identifying and using bonding
strategies, including
breastfeeding, with their
newborns.
4.4
• List and describe additional
activities that enhance
parenting and bonding. (N)
• Provide anecdotes/participant
success stories about
improved parenting/bonding
with submission of BIH
Quarterly Reports.
• List and describe additional
activities on infant safe sleep
practices/SIDS/SUID risk
reduction. (N)
• Provide anecdotes/participant
success stories about infant
safe sleep practices and
SIDS/SUID risk reduction with
submission of BIH Quarterly
Reports.
• Provide anecdotes/participant
success stories about
breastfeeding practices with
submission of BIH Quarterly
Reports.
4.4
• Number and percent of
participants who complete the
safety checklist prior to
delivery. (E)
• Number and percent of
postpartum participants who
initiate breastfeeding. (N)
• Number and percent of
prenatal participants who
complete a birth plan prior to
delivery. (E)
AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA
No.: CA Department of Public Health
Maternal, Chi ld and Adolescent Health and
Black Infant Health Programs
Agreement# 20 1610 FY 2016-17
APPROVED AS TO LEGAL FORM:
DANIEL C. CEDERBORG,
COUNTY COUNSEL
APPROVED AS T AC UNTING FORM:
Term: July 1, 20 16 -June 30.2017
OSCAR J. GARCIA, C.P.A., AUDITOR-CONTROLLER/
TREASURER -TAX COLLECTOR
RAPPROVAL:
By ~~~~~~~~~L-~--
David Pomavllle
Director
Department of Public Health
Fund/Subclass:
Organization #:
Revenue:
ks
0001 /10000
56201706,56201700
4382