HomeMy WebLinkAboutAgreement A-19-218 with CDPH.pdfAgreement No. 19-218
CALIFORNIA DEPARTMENT OF PUBLIC HEAL TH
MATERNAL, CHILD AND ADOLESCENT HEAL TH (MCAH) DIVISION
FUNDING AGREEMENT PERIOD
FY 2018-2019
AGENCY INFORMATION FORM
Agencies are required to submit an electronic and slgned copy (original signatures only) of this form along
with their Annual AFA Package.
Agencies are required to submit updated information when updates occur during the fiscal year. Updated
submissions do not require certification signatures.
,~ ,.... ( • 1"' •• , "t•->-,., ~ ~~ .,,-, ';; "'.;1.._..,.,,., o:;." ~ .. --, >"T'"'"' ,./f:l' ,..c ':n ....-,"1'.._, . ao-~ .., .,'i~" {,#fYS1~'~ P',("' ~ r~;;
~t\.,,, r~~..,, •fc •t ,,; ' ·,• /··· · .· ·"AGENc/10ENTIEIC.ATION ·INFORMATION .. ,.':· .: '·' ,:. ·s·· .. · : ? il
~1;L ! -~,i ~~:~ .,~ ~,._• ~ , , "~~ "-'.,.,~:¼4~~ ..... :;:~ ',_ .. ·.,_":~i:~~,.;,.i{J;> --.:'<~--~-·~ ,.__.,J;.,;~~~:'; ~1c~~:, ~ --,~< <>+, ",< • --~:.-·-> j. t ,,4.j4
Any program related Information being sent from the CDPH MCAH Division will be directed
to all Program Directors.
•... . . . . • :;•••••·r:-11 1 ••-• tl . 11111u·••• ~_ .. _ a ·=· .. •-11111::.:111,11 :11••"!--··••111~11
201810 MCAH 201810 fil.tl I # AFLP
Update Effective Date: (only required when submitting updates)
Federal Emplover ID#: 94-6000512
Complete Official
Agency Name: County of Fresno
Business Office
Address; 1221 Fulton Street, Fresno, CA 93721
Aaencv Phone: (559) 600-3330
Aaencv Fax : (5591 455-4705
Agency Website: www.co .fresno .c a .u s
Page 1 of 2
Please enter the agreement or contract number for each of the applicable programs
201810 MCAH 201810 BIH # AFLP
The undersigned hereby affirms that the statements contained in the Agreement Funding Appl ication
(AFA) are true a nd complete to the best of the applicant's knowledge.
I certify that these Maternal, Child a nd Adolescent Health (MCAH) programs will comply with all applicable
provisions of Article 1, Chapter 1, Part 2, D ivision 106 of the Health and Safety code (commencing with
section 123225), Chapters 7 and 8 of t he 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 f u rther certify that all MCAH related programs will comply with the most current MCAH
Policies and Procedures Manual, including but not limited to, Administration, Federal Financial
Participation (FFP) Section. I further certify that the MCAH related programs will comply with all federal
laws and regulations governing and regulating recipients of funds granted to states for medical assistance
pursuant to Title XIX of the Social Security Act (42 U.S.C. section 1396 et seq.) and recipients of funds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of the Social
Security Act (42 U.S.C . section 701 et seq.). I further agree that the MCAH related programs may be
subject to all sanctions, or other remedies applicable, if the MCAH related programs violate any of the
above laws, regulations and policies with which it has certified it will comply.
Original signature of official authorized to
commit the Agency to an MCAH Agreement
Nathan Magslg
Name (Print)
Rose Ma Rahn
Name (Print)
ATTEST:
BERNICE E. SEIDEL
Clerk of the Board of Supervisors
County of Fresno, State of California
By &~~Sh
Deputy 0:-p
Page 2 of 2
Chairman of the Board of Supervisors of
the County of Fresno
Title
MCAH Director
Title
Date
-------------
P�bu�-Health it��-;�! Mater�. Ct.klaodAdolesceril Hodh C>i-mion
BUDGET SUMMARY FISCAL YEAR BUDGET
2018-19 ORIGINAL
vo .... ior, ;n.1,;nauarterl Program: I Maternal Child and Adolescent Health (NCAH) Agency: 1201810 Fresno SubK: I MCAH-TV
I ,,, (2) (3) l TOTAL FUNDING o/, TITLE V
ALLOCATION(S) -210,795.00
EXPENSE CATEGORY
(l) PERSONNEL
(II) OPERATING EXPENSES
(Ill) CAPITAL EXPENDITURES
(IV) OTHER COSTS
(V) INDIRECT COSTS
TOTAL TITLE V
TOTAL SIDS
BUDGET TOTALS•
4,721,781.71 210,795.00
115,826.00 0.00
0.00 0.00
516,285.00 0.00
1,180,445.43 0.00
6,534,338.14 3.23'!1, 210,795.00
BALANCE(S) -0.00
210.795.oo -1 210.1s5.oo 1
7,372.00
2,723,356.14
ORIGINAL
UNMATCHED FUNDING
MCAH-SIOS TOO AGENCY FUNDS •
(4) (5) (� 15) (5) I (7) (6) I
'lo SIDS o/, TBO 'lo I Agency Funds• ¾ I
7,372.00 0.00
7,372.00 0.00 1,118,007.78
0.00 0.00 34,319.24
0.00 0.00 0.00
0.00 0,00 154,885.50
0.00 0,00 334,066.06
0.11% 7,372.00 0.00% 0.00 25.12% 1,641,278.58 O.OO'lli
0.00 0.00
7,372.00 1
TOT AL TITLE XIX
TOTAL AGENCY FUNDS 359 2815.00 ------------------------11,841,278.581 ��===�
$I\ ,----.. 2,941,523.151 Maximum Amount Payable from State and Federal resources
we! i z;;'j[ r BEEN CONSTRUCTEC �:;:LL MCAHADMINISTRATMAN;;;; �a / /
ID i , A......-1 ,A� 6CAHJPROJECT0!RE!°TOR'��TU� -/ \
--, -I .. 'DAT& A�t:.Nl.'T FISCAL AGENT'S SIGNATURE
Tlwse amounts contttln loeal revGflue submitted "{lnforalioo 900 matching purposos. MCAH does nol rolmbor'M A9ffncy c<ll'ttlbt.1ions.
STATE USE ONLY -TOTAL STATE AND FEDERAL REIMBURSEMENT MCAH-TV MCAH..SIOS TBO AGENCY FUNDS PCA Codes 53107 53112 0
(I) PERSONNEL 210,795.00 7,372.00 0.00
(II) OPERATING EXPENSES 0.00 0.00 0.00
(Ill) CAPITAL EXPENSES 0.00 0.00 0.00
(IV) OTHER COSTS 0.00 0.00 0.00 M INO1RECT COSTS 0.00 0.00 0.00
Totals for PCA Codes 2,941,523.15 210,795.00 7,372.00 0.00
201810 Fresno MCAH Budget 3.22.19,xlsx I al5
BUDGET STATUS
ACTIVE
NON-ENHANCED MATCHING (SO/SO)
I
(9) II
0.00
0.00
0.00
0.00
0.00
0.00
0
0
0.00
0.00
0.00
0.00
0.00
0.00
MCAH-CntyNE
(10)
'lo
47.92%
I {11)
190mblned ,,. v'
1,841,967.49
e1,soo.1e
0.00
361,399.50
646,379.37
3,131,253.12
l�'l(,J 1,565,626.56
{50%] 1,565,626.56
MCAH-Cnty NE
53118
920,983.75
40,753.36
0.00
160,699.75
423,189.69
1,565,626.57
(12) I
¾ I
0.00%
•
BUDGET BALANCE
0.00
ENHANCED MATCHING (75/25)
(13)
0
0
I I I
0.00
0.00
0.00
0.00
0.00
0.00
MCAH-cntyE
(14) I (15)
% l;omblned I
#VALUE!
1,543,639.44
0.00
0.00
0.00
0.00
23,62% 1,543,839.44
[75%] 1,157,72S.58
[25'!6] 385,909.86
'/(?iy
DATE
MCAH-Cnty E
53117
0.00 1,157,729.56
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 1,157,729.58
Primed: 3'29/2019 10:57 MA
ORIGINAL
Program: I Matemal Child and Adolescent Health IMCAHI UNMATCHED FUNDING Agency: I 201810 Fresno SubK: I MCAH•TV I MCAH-SIDS I TBO ,,, <') (3) (4) <'l ,.,
TOTAL FUNDING % TITLEV % SIDS %
(II) OPERATING EXPENSES DETAIL
TOTAL OPERATING EXPENSES 115,826.00 0.00 o.oo
TRAVEL 49,988.00 0.00% 0,00 0.00
TRAINING 22,535.00 0.00% 0.00 0.00 � ' Telephones 24,803.00 0.00% 0.00 0.00
2 Office Supplies 11,000.00 0.00% 0.00 0.00 -
3 Postage --1,000.00 0.00% 0.00 -0.00 f----4 Oup!ic:atiog 1,500.00 0.00% 0.00 0.00
5 Minor Office Equf)ment 5,000.00 0.00% 0.00 -0.00 --6 0.00 0.00
7 0.00 -0.00 � --' 0.00 0.00 -9 0.00 0.00 -f----10 0.00 0.00 -� " 0.00 0.00 --12 0.00 0.00
13 0,00 0.00 � " o.oo 0.00 f------15 0.00 0.00 " Unrna.ched Ooeratm Expenses are not el101ble for Federal matchffll funds (Tille XIX). Exoenses mav onlv be ch1raed to Unmatched Tille V (Col. 31. State General Funds CCol. 51. and/or Aaencv (Col. 71 funds.
(Ill) CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL EXPENDITURES
(IV) OTHER COSTS DETAIL
TOTAL OTHER COSTS
SUBCONTRACTS
1 Exceptional Parents Un!in1ited
2
3 4
5
OTHER CHARGES
1
2
3
4
5
6
7
8
(V) INDIRECT COSTS DETAIL
TOTAL INDIRECT COSTS
25,00% of Total Wages+ Fringe Bane-fits
201810 Fresno MCAH Budget3.22.19 )(is:(
516,235.00
516,285.00 0.00%
1,180,4-45.43
1,180,445.43 0.00%
0.00
o.oo
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
a.co
0.00
0.00
0.00
1--0.00 1--0.00 � 0.00 -0,00 -0.00 -
0.00 -� 0.00 --0.00
0.00 --0.00 -1--0.00 --0.00 -0.00
0.00
0.00
2 of5
(5)
TOO
I AGEOCY FUNDS
(6)
%
0.00
0,00 � 0.00 29.63% 0,00 29.63%
0.00 29.63% f----0.00 29.63%
0.00 29.03%
0.00 � 0.00
0.00 �
f----0.00 f----0.00 f----0.00 � 0.00 -0.00
0.00 --0.00 f----0,00
0.00
0.00
0.00 � 0.00
0.00 -0.00
0.00 -
0.00 -0,00
0.00 -0.00 -0.00 � 0.00 -0.00 -0.00
o.oo
0.00 28.30ll/i
(7)
Agency Funds"
34,319.24
14,811.44
6,677.12
7,349.13
3,259.30
296.30
444.45
1,481.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0,00
0.00
0.00
154,885.50
154,865.50
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
334,066,06
334,066.06
0
{6)
o/,
>------
-
f----
----
f-----
---
>----
�
>----
f----
f----�
r--r--
NON-ENHANCED
MATCHING (50/50}
MCAH-CntyNE
(8) (10) (11) (12) I
% i���"..�� ... t, I % TRAVS.NCff.Et+t lr1ATCH 46.32o/,
0.00 81,506.76 I 0.00 70.37% 35,176.56 H0.00 7Q37% 15,657,88
0.00 70.37% 17,453.87
0.00 f--7,740.70 70,37%
0.00 � 703,70
0.00 � 1,055.55
0.00 � 3,518.50
0.00 0.00 -0.00 0.00 f--0.00 f--0.00
0.00 0.00 -0.00 0.00 -0.00 0.00
0.00 0.00 -0.00 0.00 -0.00 f--0.00
0.00 0.00
0.00 0.00
o.oo I I 381,399.so I
0.00 � 0.00
0.00 -0.00
0.00
0.00 -0.00 -0.00 -0.00
0.00 -0.00 -0.00
0.00
0.00
0.00 71.70%
361,399.50 -0.00 -0.00
0.00 -
f----0.00
0.00
0.00
000
0.00
0.00
0.00
0.00
0.00
846,379.37
846,379.37
ENHANCED MATCHING (75/25)
0 UCAH•CntyE
(13) (14) I (15}
¾ l��mblned �"-··-·"'TAAVEL E/#4 WITCH "PERSONNEL MATCH
25,111"/9 70,37%
0.00 I 0.00 MatchAvtl!,at,j1
0.00 � 0.00 1.O5o/t
0.00 0.00 O,0o,',
0.00%
0.00%
0.00%
0.00%
0.00%
% PERSONNEl.M>,TC H 70,373/o o.oo I I o.oo
0.00 0.00 -0.00 a.co
0.00 0.00
0.00 0.00
0.00 0.00
"1otcnAwU11bi.
Primed: 3/291:2019 10:57 AM
ORIGINAL
Program: I Maternal Child and Adolescent Health IMCAHl UNMATCHED FUNDING NON-ENHANCED ENHANCED
Agenc:y; 1201810 Fresno MATCHING (50/60) MATCHING (75/25)
SubK: I MCAH·T\I I MCAH-SIOS I TBO I AOENCY FUNDS 0 I MCAH.CntyJIIE 0 I MCAH-Cnty E I {I) {2) I {3) I ,. I ,,, I {◄) I (5) I {6) I {7) ,., I {6) I {10) I (11) (12) I (13) I (14) I (15) I TOTAL FUNDING % I TITLEV I % I SIDS I % I TBD I % I Ag&ney Funds� % I I % l�om-.........% I I % J;,omblned
e /6c---· ..
(I) PERSONNEL DETAIL
TOTAL PERSONNEL COSTS 4,721,781.71 210, , ... oo ! 7,372,00 o.oo I 1,118,007.78 0.00 1,841,987.49 0.00 1,643,639.44
FR!NQE BENEFIT RATE 73.62% 2,002,252.71 I 89,386.7BH 3,126.07H O.OOH 474,086 .74 H o.ooH ra,.01e.97 H o.ooH 654,574.15
TOT.Al WAGES 2,719,529.00 121,408.22 4,245.S3 0.00 643,921.04 o.oo 1,060,688.52 0.00 889,065.29 ..
FULL NAME TITlE OR CLASSIFICATION ANNUAL a h {First Name Last Name) (No Acronyms ) %FTE SALARY TOTAL WAGES l i
1 Rose Mary Rahn Division Manager 20.00% 121,100 24,220.00 0.00% (0.00) 0.00 0.00 32.00% 7,750.40 0.00 51.00% 12,352.20 0.00 17.00% 4,117.40 68.6% X
Rose Mary Ralvl MCAH Director 50.00% 32.00% >----0.00 I-----0.00 -0.00 I----0.00 I---2 121,100 eo,sso.oo 19,376.01 I---0.00 I---51,00",b 30,880.49 -17,00% 10,293.50 68.6% X --3 Bertha Conchas Administrative Assistant II 70.00% 41,316 '28,921.00 0.00% (0.00) 0.00 0.00 62.25% 18,003.32 0.00 37.75% 10,917.68 0.00 0.00 88.6% X
4 Aphivanh Xayevath Staff Analyst Ill 100.0 0% 66,842 66,842.00 0.00% (0.00) -0.00 -0.00 � 41,609.1� -0.00 Jill% 25,232.86 -0.00 -0 .00 es.a� X -----5 Dalgit Martinez Account Clerk I 100.00% 32,312 32,312,00 0.00% (0.00)
1----
o.oo 0.00 62.25% 20,114.22 0.00 Jill% 12,197.78 0.00 0,00 8 8.6% X
6 litdaGtiffrth 100.00% 35.00% 0.00 -0.00 --35.00% --Pt.b� Health Nurse !I ·PSC Coord 82,677 82,677.00 28,938.95 0.00 0.00 28,936.95 0.00 30.00% 24,803.10 68.6% X
7 Lisa Poole Pl.bk Heettti Nixse 11-FfMR/SIOS Coor 100.00% 0.00 I----0.00 >-----I----I---80,165 80,165.00 0.00 % � 4,245.93 -30.70% 24,613.47 -0.00 50.00°4 40,082.50 0.00 � 11,223.10 88.0% X � -8 Jenrtifer Pinc Medical Social Worker I 85.00% 55,280 46,988.00 0.00'.-ii 0.00 -0 .00 -0.00 � 7,98 7.98 -0.00 39,00 0.04 -0.00 -0,00 !R4% X
9 Vacarrt Medical Social Worker I 50.00% 45,962 22,981.00 0,00% 0.00 -0.00 -0.00 30.00% 8,894.30 0.00 moo% 16,08 6.70 0.00
1----
0,00 94.4% X
10 Ana Carbajal Heatth Education Assistant 60.00% 36,723 22,034.00 0.00% 0.00 0,00 � 9,033.94 -0.00 59.00% 13,00 0.06 -0.00 0.00 66.6% X
Tong Thao Health Education Assistant 60.00% 44,161 0.00% 0.00 -0.00 -0.00 � -0.00 I----0.00 I---X 11 26,497.00 9,273.95 65.00'¼ 17,223.05 0.00 68.6% ----I----� 12 Vacant Health Education Assistant 6 0.00% 34,398 20,639.00 0.00% (0.00) 0.00 0.00 32.00% 6,804.48 0.00 68.00% 14,034.52 0.00 0.00 68 .6% X
13 Chr�tine Vang Health Education Specialist 60.0□% 45,179 27,107.00 0.00% 0.00 -0.00 -0.00 40.00% 10,842.80 -
0.00 � 16,264.20 -0.00 -0.00 68 .6% X -----14 Vacam Health Education Specialist 100.0 0% 42,328 42,328.00 0.00% 0.00 � 0,00 -0.00 � 31,746.00 0.00 25.00% 10,58 2.00 0.00 0.00 68.6% X
15 AhVang Hea!th Educator 6 0.00% 63,188 37,913.00 0.00 % 0 ,00 0.00 41.00 % 15,544.33 -0.00 � 22,368.67 -0.00 -0.00 68.6% X
16 Faota Nelson Health Educator 25.00% 0.00% I---0.00 -0.00 --0.00 I----0.00 I---51,262 12,8 18.00 0.00 --31.50% 4,0 37.04 -68.50",.(, 6,778 .98 -,__0.00 68.6½ X
17 VBlerie Wefts Supervisi,g Office A&Sistant 100.00",fi 50 ,999 50,999.00 0.00% -0 .00 -0.00 57.56% 29,356.15 -0.00 42.44% 21,642.85 -0.00 -0.00 68.6% '
18 Gabriel Torres Office Assist.ant I 100.aw. 25,215 25,215.00 0.0 0% 0.00 0.00 0.00 � 4,034.40 0.00 84.00% 21,180.60 0.00 0.00 94.4% X ---85.00% --18 Christina Wyrick Office Assistant tu 100.00"/4 38,26 3 38,26'.lOO 0.00% 0.00 0.00 0.00 15.00% 5,739.45 0.00 32,523.55 0.00 0.00 S4.4% X
Diana ColITT Office Assistant Ill 100.00% 38,263 38,26 3.00 0.00% 0.00 -0.00 -0.00 15.00% -0.00 --0.00 -X 20 5,739.45 85.00% 32,523.55 0.00 94.4',i, ----I----I---21 Linda Willame Office Assistant lll 100.00% 33,828 33,826.00 0.00% 0,00 0.00 0.00 15.00% 5,073.90 0.00 85.00'¼ 26,752.10 0.00 0.00 94.4% X -22 Sophia Rodriguez Office Ass!stant Ill 100.00% 38,865 38,8 65.00 0.00% 0.00 0.00 -0.00 15.00% 5,829.75 -0,00 � 33,035.25 -0.00 � 0 .00 94.4% X
23 Martha Garcia Office Assistant Ill 100.00% 38,685 38,865.00 0.00% 0.00 -0.00 -0.00 15.00% -
0,00 � 33,035.25 -0.00 � 0 .00 94.4% X
1-----5,829.75 --24 Met.lda Meza Office Assist.int n 50.00% 28,702 13,351.00 4.00% 534.04 0 .00 0.00 11.00% 1,468.81 0,00 85.00% 11,348.35 0.00 I---0 .00 94.4% X
Vacant 100.00% 0.00% -
0 .00 -0.00 --
0 ,00 ,__ -0.00 I---25 Pubftc Heatth Nurse l (16 77) 65,563 65,583.00 --8 4.00% 55,072.92 -5.00% 3,278.15 -11.00% 7,211.93 88.6% X >---26 Fred Toshlmltsu Pub1C Health Nurse 11 (1677) 100.00% 80,153 80,15-3.00 0.00 % (0 00) 0 .00 0.00 � 64,923.93 0.00 12.00% 9,618.36 0.00 7.00% 5,810.71 8 8.6% X
27 Megan GLinn SUpervlsr'lg Public Health Nurse (1615) 70.00% 96,020 68,614.00 0.00% 0.00 -0 .00 -0 .00 � 8,233.88 -0.00 � 25,387.18 -0 .00 51.00% 34,993.14 93.0'4 X ----26 Barbara Besmer Public Health Nurse II (1615) 100.00% 96,413 96,413.00 10 .00% 9,641.30 0.00 0.00 0.00 0.00 � 8,677.17 0.00 81.00% 78,094.53 93.0% ' ----29 Eileen Murry Public Health Nurse I (1615) 100.00% 65,563 65,56 3.00 0.00% 0.00 0.00 13.00'¼ 8,523.19 0.00 30.00% 19,668 .90 0.00 57.00% 37,370.91 83.0% '
Shelby Peterson 100.00% 20.00% I---0.00 -0.00 --I----I---' 30 Public Health Nursa I (1615) 83,865 83,865.00 1a,m.oo ,__ -2.00% 1,677.70 -0.00 15.00 % 12,58 2.75 0 ,00 63.00% 52,847.55 93.0%
31 Pon Chin Public Health Nwse It (1615} 100.00"Ai 96,413 96,413.00 0.00% 0.00 0.00 24.00% 23,139.12 0,00 � 14,461.95 -0.00 61.00% 58,811.93 93.0% '
32 Megai,Gunn Supervising PublK: Health Nurse (1670) 30.00% 96,020 29,406.00 8.74% 1,982.41 -0 .00 -0.00 � 4,410.90 -0,00 � 13,820.82 -0.00 � 9,191.87 93.7% ' ----� 33 Vicki Phangrath PublC Health Nurse II (1670) 100.00% 90,645 90,645.00 20.00% 18 ,129.00 0.00 0.00 -0.00 0,00 16.00% 14,503.20 0.00 58,012.80 93.7% '
27.00% --0.00 -I----I---34 Mai Vang Public Health Nurse 11 (1670 ) 100.00% 96,413 96,413.00 26,0 31.51 -0 .00 --0.00 -0.00 9.00% 8,677.17 -0.00 64.00% 8 1,704.32 93.7% '
Erice Alexander 0.0 0% 0.00 I---I---35 Supervising Public Health Nurse -MCAH SO.OD% 92,525 83,273.00 -0 .00 � 14,156.41 0.00 49.00% 40,603.77 0.00 34.00% 28,312.82 94.4% ' --57.00¾ -37.00% 36 Deborah Omolayo Public Health Nurse I 60.00% 69,739 41,843.00 0.0 0% 0.00 -0.00 -0.00 � 2,510.58 0.00 23,650.51 -0.00 15,461.91 94.4% '
37 Nadia Chavez Public Health Nurse U 60.00% 64,122 38 ,473.00 0.00% 0.00 0,00 23.00% 8,648 .79 -0.00 36.00% 13,850.28 0.00 � 15,773.93 94.4% '
Janel Claybon Public Heatth Nurse U 20.00% 0.000,t, -0.00 -0,00 9.00% )---0.00 17.00 % -74.00% 36 80,153 16,031.00 1,442.79 2,725.27 0,00 11,002.94 94.4% '
Miriam Ellison Public Health Nurse I 93.00% 0.00% 0.00 -0.00 -0.00 ->----0.00 I----0,00 I---38 69,739 64,657.00 --12.00% 7,782.84 >---51.00% 33,077.07 -37.00% 23,897.09 94.4°,i, '
40 Evelyn Lotter Public Health Nurse II (1720) 100.00% 96,413 96,413.00 0.00 % 0.00 0.00 18.00% 17,354.34 0.00 � 28,9 23.90 0 .00 � 50,134.76 94.4% '
41 Attracla Ayoub Public Health Nurse II (1720) 100.00% 96,413 96,413.00 0.00% -0.00 -0.00 � 21,210.86 -
0.00 � 33,744.55 -0.00 43.00% 41,457.59 94.4% '----42 Natalie Adolph Public Health NUJ?.e U ( 1720) 100.00% 80,171 60,171.00 0.00% 0.00 0.00 21.()0% 16,835.91 0.00 � 29,663.27 0.00 � 33,871.82 94.4% '
43 Lorraine Hardy Supervising Public Health Nurse 75.00% 107,924 80,943.00 0.000,t, a.co -0.00 >----0.00 15.00% 12,141.45 -
0.00 55.00 % 44,518.65 -0.00 30.00¾ 24,28 2.90 68.8 % '
Lorrak'le Hardy 15.00% 0.00% 0.00 -0.00 -0.00 I----I----I---44 Suµervising Pubfic Health Nurse (1719) 107,924 16,189.00 -14.00% 2,266.46 0.00 71.00 % 11,494.19 0.00 � 2,426.35 63.8% ' --� -45 Stena Honim<1n Public Health Nurse H (1719) 100.00% 87,905 87,905.00 0.00% (0.00) -0 .00 -0 .00 � 29,008.65 -0.00 21,976,25 --0.00 � 36,920.10 88.8% '
46 Kendla Buckowski Public Health Nurse 11(1719) 100.00% 96,413 96,413.00 0.0 0% -0,00 -0 .00 � 18,318.47 -0,00 � 32,780.42 -0.00 47.00% 45,314.11 es.81'Ai '
47 Melanie Deto Pubfic Health Nurse I 60.00% 69,739 41,843.00 0.0 0% 0.00 0.00 0 .00 21.00% 8,787.03 0.00 75.ooeA, 31,382.25 0.00 � 1,673.n 88.8 % '
liaVar,gyi Public Health Nurse 1-1 60.00% 0.0 0% -0.00 -0.00 >---I---0.00 --0.00 -88 .8% ' 46 90,645 54,387.00 I----18.59% 9,022.80 >---28.75% 15,636.28 � 54.66% 29,727.93 I---I---I---Balbara Besmer 60.00% 0.00 0.00 49 Publlc Health Nurse II 87,905 52,743.00 0.00% I---� 8,750.06 >----0.00 28.75% 15,163.61 0.00 � 28,829.32 BS.8% '
50 REtehel Nevarez Public Health Nul'&e l 60.00% 69,739 41,843.00 0.00% 0.00 0.00
-0.00 18.60% 6,945.94 0.00 � 12,029.86 -0.00 54.65% 22,867.20 ea.a•A. '
Hilary Davis Pubk Health Nul'&e II ( 1501) 55.00% 44,08 4.00 0.00% -0.00 -0.00 � 15,429.40 -0.00 15.00% 6.612.60 -0.00 � 93.01/o '51 80,153 --22,042.00 -I-----52 0.00 0.00 -0.00 I---0.00 -0.00 -0.00 I---0.00 -0.00 I---0.00 O.O'lb
53 0.00 0.00 -0.00 1--0.00 I---0 .00 >---0.00 I---0.00 -0.00 0.00 0,01ft � 54 0.00 0 .00 0.00 0 .00 0.00 0.00 0 .00 0 .00 0.00 O.O'lb ----� -� 55 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 .00 0.00 o.mb ------� 56 0.00 0.00 0 .00 0 .00 0.00 0.00 0 .00 0.00 0.00 O.O'lb I----1----I---I----I---57 0.00 0.00 I---0.00 -0.00 I---0.00 >---0.00 I---0 .00 -o.oo I---0.00 0.0% " 0.00 0.00 0.00 0 .00 0.00 0.00 0.00 0.00 0.00 0.0%. --,__-�--58 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.01<, � ------60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0¼
1----1----0.00 0,00 )------0.00 0.00 -0.00 I---0.00 -I---61 -I---I---0.00 >----I----0.00 I---0.00 0.0'h
62 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.0'h �-1--1--� --1--
201810 Fresno MCAH Budget 3.22. 19.xls x 3of5 Printed: 3/2912019 10:57 AM
ORIGINAL
I Maternal, Child and Adolescent Health fMCAHl UNMATCHED FUNDING NON•ENHANCEO ENHANCED 120181 O Fresno MA"fCHING (50/50) MATCHING (75/25)
SubK: MCAH•TV MCAH.SIDS TBD AGEHCY FUNDS D 0 MCAH-Cnl)'E
(2) (3) (4) (B) [1) (8) (9) (10) (11) (12) (13) (1,!)
TOTAL FUNDING TITLE V % SIDS % TSO % % ¼ Combined
63 0.00 0.00 f--0.00 0.00 t---0.00 t---0.00 0,00 00-0 t---0.00 0.0%
64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 D.00 0.0%
67 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 t---0.00 0.0%
0.00 0.00 0.00 0,00 t---0.00 0.00 0.00 0.00 0.00 f--0.0%
69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 t---0.00
73 0.00 0.00 0.00 0.00 t---0.00 0,00 0.00 0.00 0.00 1---t---0.0%
74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
75 0.00 0.00 0.00 0.00 (J.00 0.00 0,00 0.00 0.0%
78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
77 0.00 0.00 0.00 D.00 0.00 0.00 0.00 0.00 t---0.00 0.0%
78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 t---t---0.0%
79 0.00 0.00 0.00 0.00 0.00 '--0.00 0.00 0.00 0.00 0,01,(,
80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,0'jf,
62 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
83 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0%
0.00 0.00 0.00 0.00 0.00 1---0.00 0.00 0.00 t---0.00 0.0%
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 t---0.00 0.0%
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%.
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 t---0.00
0.00 0.00 0.00 0.00 0.00 1---0,00 0.00 0.00 t---0.00 t---I---0.0%
0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
91 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% ,----92 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0¼
93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0-0 I---a.co t---t---0.0½
95 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
96 0.00 0,00 0.00 0,00 0.00 0.00 0 00 0.00 0.00 O.O'k
97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
98 0.00 0.00 0.00 0.00 0.00 0.00 t---0,00 0.00 0.00 0.0%
0.00 0.00 0.00 0.00 t---
t---0,00 0.00 0.00 0.00 I---000 0.0%
100 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
101 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 O.O'fo
102 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ,-0.0%
103 0.00 D.00 0.00 0.00 0.00 0,00 0,00 0.00 0.00 0.0%
104 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.0%
105 0.00 000 0.00 0.00 0.00 0.00 0.00 0,00 0.00 O.OOk
106 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
107 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
108 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.0%
109 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
110 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
111 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.0%
112 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 OJ)��
114 0,00 0.00 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.0%
115 0.00 0.00 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.0%,
116 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.0%
117 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
118 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
119 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
120 0.00 o.oo 000 0.00 0.00 0.00 0.00 0.00 0.00 0.0"..<i
121 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
122 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00
123 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
124 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.0%
125 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.�/4
126 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 t---127 0.00 0.00 0.00 0.00 0.00 0.00 0.00 -----'--0.00 OJ)<>A,
128 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 ODO 0.0%
129 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
130 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.DO 0.0%
131 0.00 0.00 0.00 0.00 t---0.00 I---0.00 0.00 0.00 0,00 0.00'/4
132 0.00 0.00 0.00 0.00 0,00 0.00 000 0.00 0.00 0.0%
133 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
201810 Fr&Sno MCAH Budget 3.22.19.xlsx Printed: 3/29/2019 10:57 AM
ORIGINAL
Program: NON-ENHANCED ENHANCED
Agency: MATCHING (50/50) MATCHING (75126)
SubK: MCAH-TV TBO AGENCY FUNDS 0 MCAH-CntyNE 0 MC.A.H-CntyE
(11 (4) C,) (4) (0) (0) (') (10) (11} (12) (1� (1◄) {15)
TOTAL FUNDING % TITLE V % SICS % T1!0 % Agency Funds• % % Combined % % Combined
134 0.00 0.00 0.00 0.00 0.00 0.00 0.00
135 0,00 0.00 0.00 0.00 0,0%
136 0.00 0.00 0.00 0.00 0.0%
137 0.00 0.00 0,00 0.00 0.0%
138 0.00 0.00 0.00 0.00 0,00 0.00 0,00/.,
13" 0.00 0,00 0.00 0,1)0,(,
140 0.00 0.00 0.1)0 0.0%
0.00 0.00 0.00 0.00
142 0.00 0.00 0.00 0.00 0.0%
143 0.00 0.00 0.00 0.00
144 0.00 0.00 0.00 0.00/4
145 0.00 0.00 0.00 0.0%
146 0.00 0.0%
147 0.00 0.00 0.00 0.00 0,00 0.0%
148 0.00 0,00 0.00 0,00 0.00,(,
149 0.00 0.00 0,00 0.0C'A, I-I-0.00 0.0% 150
201810 Fresno MCAH Budget 3.22.19.x!S)I 5 of 5 Printed: 3/29/201910:57 AM
ORIGINAL
BUDGET SUMMARY FISCAL YEAR BUDGET BUDGET STATUS
2018-19 ORIGINAL ACTIVE
,n.150-Program: I Black Infant Health {BIH) UNMATCHED FUNDING NON-ENHANCED
Agency: 1201810 Fresno MATCHING (�50)
SubK: I BIH-TV S!H-SGF TBD AGENCY FUNDS BIH-SGF-NE I {1) i2) (� i◄) i5) (') (5) (6) I m (8) I @) I TOTAL FUNDING 'I, TITLE V % SGF o/, TBD % I Agency Funds* o/, j combined
Fed/State
ALLOCATION(S) -259,379,00 248,467,00 0.00
EXPENSE CATEGORY
{I) PERSONNEL
(II) OPERATING EXPENSES
(III) CAPITAL EXPENDITURES
(IV) OTHER COSTS
(V) INDIRECT COSTS
TOTAL TITLE V
TOTAL SGF
TOTAL TITLE XIX
TOTAL AGENCY FUNDS
BUDGET TOTALS*
560,626.26 197,389.94 16,076.12 0.00 0.00 338,187.28
26,424.36 17,007.46 0.00 0.00 0.00 9,416.90
0.00 0.00 0.00 0.00 0.00 0.00
19,774.38 0.00 19,774.38 0.00 0.00 0.00
118,123.95 44,981.60 0.00 0.00 0.00 73,142.35
724,948.95 35.71!1% 259,379.00 4.95% 35,850.50 0.00.S 0.00 '·""' 0.00 58.0◄� 420,746.53
BALANCE(S) 0.00 0.01 0.00
2se,3re.oo __,. 1 2se.3re.oo 1
248,466.99 35,aso.so 1 ,,.,., 210,373.21
217,102.95 ------------------------------(5°"1 210,373,27 >------< 0.00 o.oo 1
$/'I -124,948.94 1 Maximum Amount Payable from State and Federal resources
M (J;�
:
IS ;:t;··<i::ST1�:WITHALLMCAHAOMINISTRATIV, ·;1:;7�• ,
MCAH/PR.,,.CTOIRECTOR'S-ATURE 7 \ ' I e
These amounts contain local revenue submltt&dt lntor,,.,,tion and matching purpo$et. MCAH doe, riot-reimburse Agency contributions.
STATE USE ONLY. TOTAL STATE ANO FEOE�MBURSEMENT
PCA Codes
(I)PERSONNEL
(11) OPERATING EXPENSES (Ill) CAPITAL EXPENSES
(IV) OTHER COSTS
(V) INDIRECT COSTS
Totals, for PCA Codes 724,948.94
201810 Fresno BIH Template 3.25.19 032719.xlsx
BIH-TV
53113
197,369.94
17,007.46
0.00
0.00
44,981.60
259,379.00
, -�; -
AGENCY FISCAL AOENrs SIGNATURE
BlH-SGF TBO AGENCY BIH-SGF-NE FUNDS
53127 0 53124
16,078.12 0.00 336,187.28
0.00 0.00 9,416.90
0.00 0.00 0.00
19,774.38 0,00 0.00
0.00 0.00 73,142.35
35,850.50 0.00 420,7-46.53
1of5
I I I
BIH-CntyNE
(10) I {11)
% 1;o��Jned
0.00
0.00
0.00
0.00
0.00 '·""" 0.00
150'1EiJ�
\50%J �
-.
BlH•CntyNE
53100 0.00
0.00
0.00
0.00
0,00
0.00
BUDGET BALANCE
0.01
ENHANCED
MATCHING {75/2&)
BlH-SGF-E
{12) I {13)
% I Combined FedJState
8,972.91
0.00
0.00
0.00
0.00
l.2◄% 8,972.91
12srw.1 2,243.23
I I I
r------< [75'Ai) 6,729.66
811-!-CntyE
(1<1) I j1!5)
'I, J�omblned
#VALUE!
0.00
0.00
0.00
0.00
0.00 '·""" 0.00
�"'l�
(25•J�
v-ftlir
DATE
BJH-SGF-E BIH-CntyE
53125 53102
8,972.91 0.00
0.00 0.00
0.00 0.00
0.00 0.00
0,00 0.00
8,972.91 0.00
Printed: 414/2019 4:12 PM
ORIGINAL
Program: I Black Infant Health (BIHi UNMATCHED FUNDING Agency: 1201810 Fresno
SubK: I BIH-TV BJH-SGF TBD ,,, �) (3) (<) (!) (<) (5)
TOTAL FUNDING % TITLE V % SGF % Tl!D
(II) OPERATING EXPENSES DETAIL
TOTAL OPERATING EXPENSES 26,424,36 17,007.46 0.00 0.00
TRAVEL 3,ns.oo 38.87% 1,467.34 0.00 0.00
TRAINING 38.�4% f.----0.00 0.00 6,500.00 2,355.60
1 Office Supplies 3,000.00 36.24% 1,087.20 0.00 0.00 --2 P0stage 150.00 36.24% 54.36 0.00 0.00 --3 Dupticatlon 1,500.00 36.24¾ 543,60 0.00 0.00
4 Media 11,499.36 100.00% 11,499.36 -0.00 -0,00
f.----5 0.00 0.00 0.00 --6 0.00 0,00 O.DO --7 0.00 0,00 O,DO -0.00 -0.00 8 0.00 --0.00 f.---0.00 0.00
10 0,00 0.00 0.00 --11 0.00 0.00 0.00 --12 D.00 0.00 0.00
13 0.00 -0.00 -O.DO
f.----14 0.00 0.00 0.00 --15 0.00 0.00 0.00 .. Unmatched Ooerall!'KI Expenses ate not eliaible for Federel malch1na funds (Tille X!Xl. Expen$1$ mav onlv be charoed to Unmatched Title V (Col. 3). State General Funds (Col. 5), andlor Aoencv (Col. 7l funds .
(Ill) CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL EXPENDITURES 0.00 0.00 0.DO
(IV) OTHER COSTS DETAIL
TOTAL OTHER COSTS 19,77'.38 o.oo 19,n.4.38 O.DO
SUBCONTRACTS
1 Reading and Beyond 7,750.00 0.00'/4 0.00 100.00% 7,750.00 ODO --2 0.00 D.00 0.00 f.----3 0.00 D.00 0.00 -4 0.00 0.00 0.00
5 O.DO -0.00 -0.00
OTHER CHARGES
1 Cient Support Materials 12,024.38 0.00% 0.DO � 12,024.38 O.DO -2 0.00 0.00 0.00 -0.00 0.00 3 0.00 --4 0.00 0.00 0.00 f.---5 0.00 0.00 0.00 --8 0.00 0.00 0.00 --7 0.00 0.00 0.00 --8 0.00 0,00 0.00
(V) INDIRECT COSTS DETAIL
TOT AL INDIRECT COSTS 118,123.95 44,981.60 o.oo 0.00
21.07% of Total Wages+ Fringe Beneflts 118,123.95 38.06% 44,981.60 0.00 O.DO
201810 Fresno BIH Template 3.25.19032719.xtsx 2 of5
NON-ENHANCED
MATCHING (S0/60)
AGENCY FUNDS 8JH-SGF-NE BIH-CntyNE
(� (7) (8) '• Agency Funds" ..
0.00
0.00 61.13% --0.00 63.76%
0.00 � -0.00 � -0.00 63.76% --0,00 -0.00 --0.00 --0.00 -0.00 --0,00
f.----0,00 --0.00 --0,00 -0,00 --
f.---0.00 -0.00
0,00
0.00
0.00 ---0.00
0.00 --0.00 --0.00
0.00 --O.DO ---0.00 --0.00 -0.00 --0.00 -0.00 --0.00
0.00
0.00 61.82%
(9) (10) (11)
\,;omomea % Combined
Fed/State F ""·····• !lo TRAVEL NON.fNH MATCH
9,416.90
2,301.ee 0,00% -4,144.40 D.00%
1,912.80 0.00%
95.64 �
956.40 �
O,DO 'coo%
0,00 -0,00 -0.00 -0.00
0.00
0,00 -0.00
0.00 -0.00 -0,00 -0.00
0.00
0.00
0.00 0.00% r-0.00 -0,00 -O.DO -O.DO
0.00 � 0.00 -0.00 r-O.DO -0.00 -0.00 -0.00
0.00 -
73,142.35
73,142.35 0.00%
8'1.1;,,-r.
0.00
0,00
0.00
0.DO
O.DO
0.00
0.00
0.00
0,00
0,00
O.DO
O.DO
0.00
0.00
0.00
0.00
0.00
ODO
0.00
0.00
0.00
0.00
O.DO
0.00
0.00
0,00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 . 0.00
ENHANCED
MATCHING {75125)
BIH-SGF-E B!tt-cntyE
(1� I (13) (14) I (15)
% I 1..omb1nea % I�����-.. FedfState 'ii, TAAVELENHMATCH % PERSOt,tH:1 MATCH
0,00% 63.rtl')'o I 0.00 I 0,00 Mi,,lchA111l�ble
� 0.00 � 0.00 0.00%
0.00 0.00 0.00%
0.00¾
0.00%
0.00%
63.76%
•� PERSONNEL MATCH
63.75,.o
I 0.00 0.00
0.00 0,00 --D.OD 0.00 f.---f.---0.00 0.00 --0.00 0.00 --0.00 0.00
Ma.11:h,t,,fd'■!;,k
63.76%
Pmted: 4/4/2019 4:12 PM
C'>··•�i-,/1 t,,,�<•'·,.,-,,ft;: ..... ;.;:. Public Heatth .-)1 i.'l/·11 Maternar,ChlldandAdolesc11n1H1111!1!thDi-.1sion
Program: I Black Infant Health (BIHi Agency: 1201810 Fresno SubK: I
(I) PERSONNEL DETAIL TOTAL PERSONNEL COSTS
FULL NAME (Flrat Niime Last Name)
1 Janel Claybon 2 Fanta Nelson Sabrina Beavers Denise Simon
5 Megan Black 6 Kim Murphy
7 Melinda Meza S Vacant
FRlNOE BeNEFIT RATE 66.58%
IDLE OR CLASSIFICATION (No Acronyms)
Public Health Nurse ll BlH Coordinator -Health Educator
%FT£
40.00% 75.00% Comm. Outreach Liaison -Health Educat f 00.00% FHA Group Facilitator -Health Education 100,00% FHA Comm. Outreach Liaison -Health E 100.00% FHA Group Facilitator -Health Education 100,00% Deta Entry Mana(;ler -Office Assistant 50.00% Mental Heafth Professional -Medical Soc 50.00'.-ii
TOTAt.WAOES
ANNUAL SALARY
80,153 51,262 50,505 54,351 44,611 44,166 28,702 45,962
I (1) (2) I TOTAL FUNDING %
260,151.26 300,475.00
TOTAL WAGES
32,061.00 75.00% 38,447.00 17.50% 50,505.00 19.00% 54,351.00 40.00% 44,611.00 47.14% 44,168.00 46.00% 13,351.00 17.50% 22,981 ,00 0.00% 0.00
I I
10 1---------+----------+---+----+----c.o·c.oo+---j 11 0.00 >---------+-----------+---+----+------+-----< 12 0.00 f---------+-----------+---+----+------+----1 13 0.00 ,.1---------+----------+---+----+----c-o."'oo+---j
15 0.00 >---------+-----------+---+----+------+-----< IB ->---------+-----------+---+----+------+----! IT -18 1---------+----------+---+----+----c-o."'oo+---j
18 0.00 >---------+-----------+---+----+------+-----< w -f---------+-----------+---+----+------+----1 � -22 1---------+----------+---+----+----c-o."'oo+---j D ->---------+-----------+---+----+------+-----< M ->---------+-----------+---+----+------+-----< . -2s 1---------+----------+--+----+----c-o."'oo+---j
27 1---------+----------+---+----+-----"D.c.00+---j . -f---------+-----------+---+----+------+----1 . -f---------+-----------+---+----+------+----1 w -31 �=================:===================�=====:======:========:;:o.:;:oo��===� m = >---------+-----------+---+----+------+-----< n = f---------+-----------+---+----+------+----1 M -
35 �=================:===================�=====:======!========:;:o.:;:oo�====�
$ ->---------+-----------+---+----+------+-----< n = f---------+-----------+---+----+------+----1 !: 1---------+----------+---+----+----c-�:cc:+---j
m = >---------+-----------+---+----+------+-----< � -f---------+-----------+---+----+-------+----1 G -" f----------+----------+--+----+----c-o."'oo+---j
« ->---------+-----------+---+----+------+----1 0 -f---------+-----------+---+----+-------+----1 . -47 f----------+----------+--+----+----c-o."'oo+---j
0 ->---------+-----------+---+----+------+-----< 0 ->---------+--�--------+---+----+------+-----< 60 -51 f----------+----------+--+----+----c-o.o"'o+---j . ->---------+-----------+---+----+------+-----< � ->---------+-----------+---+----+------+-----< 54 0,00 f---------+-----------+---+----+-------+----1 55 0.00 56 1---------+----------+---+----+-----D.0�0+---j 57 0.00 >---------+-----------+---+----+------+-----< 58 0.00 >---------+-----------+---+----+-------+-----< 58 0.00 60 f----------+----------+---+----+----c-0.0-ccO+---j � -f---------+-----------+---+----+------+----1 . -�--------+----------�--+----+------�
201810 Fresno BIH Template 3.25.19 032719.xtsx
ORIGINAL
UNMATCHED FUNDING
BIPHV I BIH-SGF I TBD
(J) I (<) I TITLEV I % I
197,389.94 91.596.21H 105,793.73
24,045.75 f------6,728.23 i---9,595.95 21,740.40 21,029.70� 20,317.28 "----2,338.43 0.00� 0.00 0.00 0.00 0.00 0.00 0.00
--
--o.oo_ 0.00
0.00 0.00 0.00 0.QO0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
---
------
---
-
--
-
-------
-
-
(5) I 14) I
SGF I r, I
16,076.12 7,459.91H 8,616.21
0.00 f---0.00 0.00 0.00
1,721.91 == 0.00 0.00 8,894.30 0.00 0.00 0.00 0.00 0.00 0.00
0.00
D.00
0.00
f----
f---0.00 0.00 0.00 0.00 0.00 D.00 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 D.00 0.00
0.00
D.00
0.00 0.00 0,00 D.00 0.00 0,00 D.00 0.00 0.00 0.00 D.00
-
-
-
f---
--
--
-
3of5
(5)
TBD
NON-ENHANCED ENHANCED MATCHING (5ll/50) MATCHING (75125)
I AGENCY FUNDS BJH-SGF-NE I BIH-Cnl)INE BIH-SGF-E I BIH.CntyE I ,,, I m ,� I (9) I (10) I (l1) {12) I (13) I (14) I (1!S) I % ! Ageni;y Funds" % !l,;OfflDlhCO Fed/State I % J;�mblned /•-·--·· % I �::::: I % l�omblned ·"·-·--··
0.00 O.OOH 0.00
0.00 f---0.00 f---0.00 0.00 0.00 f---0.00 f---0.00 0.00 f---0.00 f---0.00 f---0.00 0.00 0.00 f---0.00 f---0.00 0.00 0.00 f---0.00 f---0.00 f---0.00 0.00 f---0,00 f---0.00 f---0.00 0.00 f---0.00 f---0,00 f---0.00 0.00 f---0.00 f---0.00 f---0.00 0.00 0.00 f---0.00 f ---0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
f---
f---
f---
f---0.00 f---0.00 f---0.00
0.00 f---0.00 f---0.00 f---0.00 0.00 -0.00 -0.00 -0.00 0.00 -0.00 -0.00 0.00 0.00
0.00 D.OOH 0.00
0.00 10.00% -0.00 82.50% 0.00� 0.00 BD.OQ% 0.00 � -0.00 � 0,00 82.50% 0,00� 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0,00
--
--
--
---
-
f---0.00 1 ---0.00 0.00 0.00 f---0.00 1---0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.DD
--
-
1---0.00 f---0,00 0.00 0.00 f---0.00 f---0.00 0.00 0,00 f---
338,187.28 156,9:31.37H 181,255.91
3,206.10 1--31,718.78 40,909.05 32,010.00_ 21,859.39� 23,850.72 ,---11,014.58
16,086.70 0.00 '---
a.co_ 0.00 0.00 -0.00 f---0.00 f---0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0,00 0.00
--
-
-o.oo_ 0.00 0.00 0.00 0.00 0.00 0.00
0.00 0.00
-
--o.oo_ 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0,00 0,00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00
-----
-
-
--
---
0,00 O.OOH 0.00
0.00 15.00% 0.00 0.00 0.00 1---0.00 f---0.00 0.00 0.00 1---0.00 f---0.00 0.00 0.00 0.00 0.00 0.00 0,00
-
0.00 I---0.00 0,00 0,00 f---0.00 f---0,00 f---0.00 0.00 0,00 f---0,00 f---0.00 0.00 0.00 f---0.00 f---0.00 0.00 0.00 0.00 f---0,00 0.00 1---0.00 f---0,00 f---0.00 D.00 0.00 0,00 f---0.00 D.00 D.00 0.00 f---0.00 f--D.00 0.00 0.00 f---0.00 f---0.00 0.00 0.00 f---0.00 f---0.00 0,00 0,00 f---0.00 f---0.00 0.00 D.00 �
8,972.91 4,163.76H 4,609.15
4,809.15_ 0.00 0.00 0.D0 r--0.00 f------0.00 0.00 0.DO r--0,00 f------0.00 0.DO 0.00 1---0.00 1---D.00
D.00 0.00 0.00 f---0.00 1-0.00 0.00 r-o.oo r---0.00 1---0.00 0.00 0.00 f---0.00 1---0.00 0.00 0.00 f---0.00 1--D,00
0.00 D.00 1--o.oo t--D.00 0.00 0,00 f---0.00 1---0.00 � 0.00 0,00 o.oo r--,---0.00 1---0.00 0.00 f---0.00 f---0.00 f-----0.00 0.00 0.00 f--o.oo t---0.00 0.00 0.00 f--o.co f--0.00 1--0.00 0.00 f---0.00 i-----0.00 f--0.00 0.00 �
D.00 0.00 1--�--. 0.00
0.00 83.0% 0.00 83.0% 0.00 83.0% 0.00 83,0% 0.00 83.0% 0.00 83.0% 0,00 83.0% 0.00 83.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.00,-i, 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.00AI 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0% 0.00 0.0%
Printed; 4(4/2019 4:12 PM
ORIGINAL
Program: I Black Infant Health IBIHl UNMATCHED FUNDING NON-ENHANCED ENHANCED
Agency: 1201810 Fresno MATCHING (50,'SO) MATCHING (75/25)
SubK: BIH-TV BIH-SGF TBO AGENCY FUNDS BlH-SGF -NE BIH--C�NE BIH.SGF-E Bli-1-C�E
(3) (4) (4) (6) (7) (9) (11) (14)
TOTAL FUNDING TITLEV % SGF % TBO Agency Fundii� 1;ombmea Combined , ... umu,nei:i Combined
....•.• _., Fed/State FediState
63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
64 0.00 0.00 0.00 0.00 0.00 >-------0.00 0.00 0.00 0.0%
65 0.00 0.00 0.00 0.00 I---0.00 0.00 0.00 0.00 0.0% I----66 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.1)%
0.00 0.00 0,00 0.00 0.00 0.00 0.00 0,00 0.00 0.0%
68 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0,00 0.00 0.0%
0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.0% I---70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% I----71 0.00 0.00 0.00 0,00 0.00 0,00 0.00 0:00 0.00 0.0%
72 0.00 0,00 0.00 0.00 0.00 0,00 0,00 0.00 0.00 0.0%
73 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
0.00 0.00 0.00 0,00 0.00 0.00 I---0.00 0.00 I---0.00 0.0%
75 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0,00 0.0% >----76 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0:00 0.00 0,0%
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.0%
78 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0,00 0.0%
79 0.00 0.00 0.00 0,00 0.00 0.00 I---0.00 I---I---0,00 0.00 0.0'¾
80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.0% I---61 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.0¾
82 0.00 0.00 0.00 0,00 0,00 0.00 0.00 0.00 0,00 0.0%
83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.0'¾
64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
85 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.0% I---0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
87 0.00 0.00 0,00 0.00 0.00 0.00 0,00 0.00 0.00 0.0%
88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.0%
89 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% 0.00
90 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.0% I---81 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.0%
92 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
93 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
95 0.00 0.00 0.00 0.00 0.00 0,00 I---0.00 0.00 0.00 0.0%
96 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.0%
97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
98 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.0'>
98 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00
100 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 I---I---101 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0�
102 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
103 0.00 0,00 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.0%
104 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0%
105 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0%
106 0.00 0.00 0,00 0.00 0.00 0.00 0,00 0.00 0.00 0.0% I----107 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.0%
108 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
109 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
110 0.00 0,00 0.00 0.00 0.00 0.00 0.0% 0,00 0.00 0.00
111 0.00 0.00 0,00 0.00 0.00 0.00 0.00 >----0.00 0.00 0.0%
112 0.00 0.00 0,00 0.00 0.00 0.00 0.00 >----0.00 0.00 0,0';(,
113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0 ....
114 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%
115 0.00 0,00 0.00 0.00 0.00 0.00 0.00 0.00 0.0%. 0.00
116 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0:00 0.00 f---117 0.00 0.00 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.0%
118 QOO 0.00 0.00 0.00 0.00 0.00 0.00 0:00 O.CIO
118 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0':6
120 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
121 0.00 0.00 0.00 0.00 f---0.0t.ti 0.00 0.00 0,00 0.00 0.00 >---->----122 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0:00 0.00
123 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0%
124 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
125 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
126 0.00 0.00 0.00 0.00 0.00 I---0.00 0.0% 0.00 0.00 0.00 I---127 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
128 0.00 0.00 0.00 0.00 0,00 0.00 0.00 0.00 0.00 0.0%
129 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0'/4
130 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 D.00 0.0%
131 0.00 0.00 0.00 0.00 0.00 I---0.00 0.00 0.00 0.00 I---f---132 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0¼ f----� 133 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0'1/4
201810 Fresno B!H Template 3.25, 19 032719.:idsx 4of5 Printed: 4/4/2019 4:12 PM
ORIGINAL
Program: I Black Infant Health IBIHI UNMATCHED FUNDING NON�ENHANCED ENHANCED
Agency: 120181 o Fresno MATCHING (50/50) MATCHING (75/25)
SubK: I BIH•TV BIH-SCF TBD AGENCY FUNDS BIH-SGF•NE BIH,CntyNE BIH•SGF-E Blft-CntyE
(l) �) Ill (') (S) (<) (') (� (7) (., (9) (10) (11) (1� (13) (14) {1&)
TOTAL FUNDING % illLE V % SGF % TBO % Agency Funds• % _,,_, __ r, Combined % 1,,0motnea '4 Combined Fed/State c-"''A,,....,,....lr Fed/State !c�JAnenc:v"
134 0,CO 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% --- ----135 0.00 0.00 0.00 0.00 -0.00 -0.00 -0.00 -0.00 -0.00 0.0%
0.00 -0.00 -0.00 0.00 0.00 0.00 0.00 0.00 0.0% 136 0.00 --->--->---137 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% e---->--,__ -,__ -0.00 0.00 0.00 0,00 0.00 0,00 0.00 0.00 0.0% "'" 0.00 ,___ --�----13'> 0.00 0.00 0.00 0.00 0.00 0.00 0.00 o.oo 0.00 0.0% ------0.00 0.00 -0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% 140 -------0.00 0.00 0.00 0.00 0.00 0.00 0.0% 141 0.00 0.00 -0,00 -->--->---142 0.00 0.00 0.00 0.00 a.co 0.00 0,00 0.00 0.00 0.0% ,___0.00 -0.00 ,__ 0.00 >--0.00 -0.00 ,__ 0.00 -0.00 0.0% 143 0.00 0.00 -------144 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% -------145 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.0% ----146 0.00 0.00 >--0.00 -0.00 >--0.00 0.00 0.00 0.00 0.00 0.0%
147 0.00 0.00 f---0.00 -0.00 >--0.00 >--0.0D -0.00 >--0.00 -0.00 0.0% ,___ -,__ ,__ -,__ -146 0.00 0.00 0.00 0.00 D.OD ,___ 0.00 -0.00 ,___ 0.00 -0.00 0.0% ---0.00 0.00 0.00 0.00 0.00 0.0D 0.0% 149 0.00 0.00 � O.D0 ---'-----150 0.00 0.00 0.00 0.0D 0.00 0.00 0.00 0.00 0.00 0.0% "------
201810 Fremo B!H Template 3.25.19 032719.xlsx 5of5 Printed: 4/412019 4:12 PM
Agency: County of Fresno Department of Pu lie Health Agreement Number: 201810 Fiscal Year: 2018-19
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH) Program
Scope of Work (SOW)
� IMPORTANT: By clicking this box, I a ree to allow the state MCAH Program to post my Scope of Work on the CDPH/MCAH website.
The Local Health Jurisdiction (LHJ), in collab,ration with the State MCAH Program, shall strive to de\lelop 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 Assessmenr and ceflect the Tme V priorities of the MCAH Division. The local 5-Year Needs Assessment ident ified problems that LHJs may address in their 5-Year Action Pia s. The LHJ 5-Year Action Plans will then inform the development of the annua l MCAH SOW. All LHJs must perform the activities in the sh ded areas in Goals 1-3 and monitor and report on the corresponding evaluation/performance measures. In addition, each LHJ is required to deve.lop at least two bjectives in Goal 1, one to address the health of reproductive age women and one to address the needs of pregnant women and two objectives for Goal 3, a SID /SUID objective and an objective to improve infant health. LHJs that receive FIMR funding will pe rform the activities in the shaded area in Goal 3.5, including one objective addressing fetal, neonatal, post-neonatal and infant deaths. In the second shaded column of 3.5a, lntel"\lention Activities to Meet Objectives , ins rt the number and per cent of cases that will be reviewed for the fiscal year. Lastly, if resources allow, LHJs should develiop additional objectives, which can be paced under any of the Goals 1-5. All activities in this SOW must take place within the fisc al year. Please see the MCAH Policies and Procedures Manual for f rther instructions on completing the SOW. The development of this SOW was gui ded by several public health frameworks including the ones listed below. Please consider integrating these approaches when conceptualizing and organizing local pr gram, policy, and evaluation efforts. o The Ten Essential Services of Public Health: http://ww1,v.cdc.gov/nphpsp/essentialServ ices.html;o The Spectrum of Prevention: htt ://www. reventioninstitute.or com onent/taxonom /term/list/94/127.htmloLife Course Perspect ive: http://mchb,hrsa .gov/lifecourseresources .htmoThe Soci al-Ecological Model: htt ://vvww.cdc. av/violence reventionloverview/social-ecolo icalmodel.htm loSocial Determinants of Health: htt :/ www.cdc.Qov/soci aldeterminants/o Strengtheni ng Families: http://www.c. s.p.oro/refo rm/strengtheninq-familTesAll Title V programs must comply with the MdAH Fiscal Policies and Procedures Manual which is found on the CDPH/MCAH website CDPH/MCAH Division expects each LHJ to I ake progress towards Title V State Performance Measures and Healthy People 2020 goals. These goals involvecomplex 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 p�ovides LHJs the opportunity to develop locally determined objectives and activities that can be realistically achieved given the scope and resources of local MCAH programs. LHJs are required to comply with requiremen s as stated in the MCAH Program Policies and Procedures Manual, such as attending statewide meetings, conducting a Needs Assessment every five y1 ars, submitting Agreement Funding Applications, and completing. Annual Reports.
1 2016-2020 Tille V State Priorrties 2 MCH Title V Block Grant Requirements
� State Requirements Page 1 of 25 03/08/2018
Agency: County of Fresno Department of Pu ;,lie Health Fiscal Year: 2018-19
Agreement Number: 201810
Goal 1: Improve access to and utilization of comprehensive, quality health and social services
The shaded areas represent required acti'II ities.
Evaluation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objective( s} 01 jectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
Objective 1.1 Ass essment
All women of reproductive age, 1.1. 1.1a 1.1a
pregnant women, infants, i Identify and monitor the health i.This deliverable will be fulfilled Nothing Is entered here.
children, adolescents and status of women of by completing and submittin g
children and youth with special reproductive age, pregnant your Community Profile with
health care needs (CYSHCN) women, infants. children. your Agreement Funding
will have access to needed and adolescents, and CYSHCN, Applrcat1on each year
preventive, medical, dental, including the social
and social services by: determinants of he alth and •Targeting outr each services to ac cess/barriers to the
identify pregnant women,provision of:
women of reprod uctive age,•Preven tive. medical.
infants. children and dental, and social
adolescents and their families services
who are eligibl'e for Medi-Cal
assistance or ottler publicly ii Review data books and II Bnefly describe process for
pr ovided health care monrtor trends over time, mo nitoring and interpretin g
programs and assist them in geographic areas and data
applying for these benefits2 populat10n group disparities •Decreasing Me di-Cal eligible
women. child ren, post-partum iii Annually, share your data wrth Ill Report the date data shared
women without insurance 1 key local health department with the key health
leadership department leadership Briefly
describe their response, if
significant
1 2016-2020 Title V Stale Priorities
z MCH ntle V Block Grant Requiremen!s
' State Req uifements Page 2 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 201'8-19
Goal 1: Improve access to and utilization of comprehensive, quality health and social services
The shaded areas represent required activities. I
Sho rt and/or Intermediate
Objective(s)
1 2016-2020 Title V State Priorities
h1tervention Activities to Meet
Objectives (Describe the steps of
the intervention)
1.1b
Participate m coll aboratives.
coalitions, communrty
organizations, etc., to review data
and develop policies and products
to address social determinants of
health and disparities
Policy Development
1.1c
i.Review, revise and enact
protocols or policies that
facilitate access to Medi-Cal,
Callforma Children's Services
(CCS), Covered CA, and
Women, Infants. and Children(WIG)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures
1.1b
Report the total number of
collaboratives with MCAH staff
participation
Submit onhne Collaborative
Surveys that document
participation, objectives. activities
and accomplishments of MCAH -
related collaboratives.
1.1c
i.List types of protocols or
policies developed or revised
to facilitate access to health
care services.
Short and/or rntennediate Outcome
Measure(sl
1.1b
1.1c
List policies or products
developed to improve
infrastructure that address MCAH
pnorities.
1.List formal and informal
agreements in place including
Memoranda of Understanding
with Medi-Cal Managed Care
Plans {MCP} or other
organizations that address tlle
needs of mothers and infants
2 MCH Title V Block Grant Requirements
3 State Requirements Page 3 of25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fisca l Year: 2018-19
Goal 1: Improve access to and utUization of comprehensive,, quality health and social services
The shaded areas represent required acUvities.
Short and/or Intermediate o bjective(s)
1 2016-2020 rrtle V State Priorities2 MCH Title V Block Grarit Requirements
3 State Requirements
Evaluation/Performance Measure.s
Intervention Activities to Meet Process, Short and/or rntermediate Measures
Objectives (Describe the steps of {Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
ii.Develop and implement ii Briefly describe the key ii.Describe and summarize the
protocols to ensure a'll clients components of the protocols impact of protocols or policy
in MCAH programs are devefoped to ensure all clients and systems changes that
enrolled in a healt h insurance in MCAH programs are facilitat e access to Medi-Cal,
plan, linked to a provider, and enrolled [n insurance or a CCS, Covered CA, and WIC
complete an annual visit.health plan. linked to a
Protoco[s include the following provider and complete an
key components:annual preventatLve and/or •Assist clients lo en roll m medical visit.
health insurance•Link clients to a health
care prov[der for a
preventive and/or medical
vistl•Develop a tracking.
mechanism lo verify that
the chent enrolled in
health insurance,
completed a preventive or
well medical visit
Assurance
1.1d 1.1d 1.1d
Develop staff knowledge and Summarize staff knowledge and Nothing is entered here
public health competencies for com petenc.ies gained
MCAH related issues
Page 4 of.25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goaf 1: Improve access to and utilization of comprehensive, quality health and social services
The shaded areas represent required activities.
EvaluationfPerformance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objective(s) Objectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure{s)
1.1e 1.1e 1.1e
Conduct activities to facilitate Describe activities to ensure Report the number of referrals to
referrals to Medi-Cal, Covered referrals to health insurance. Medr-Ca1. Covered CA. CCS, or
CA, CCS, and other low cost/no-programs and preventive visits other low/no-cost health insurance
cost health insurance programs or programs.
for health care coverage2
1.1f 1.1f 1.1f
Provide a toll-free or "no-cost to Descrrbe the methods of Report the following·
th.e calling party" telephon e communication, including the, •Number of calls to the toll-free
information service and ot her cultural and linguistfc challenges or "no-cost to the calling party�
appropriate methods of and solutions to llnkmg the MCAH telephone information service
communication. e.g. local, MCAH population to services •The number of web hits to the
Program web page to the local appropriate local MCAH
community2 to facilitate linkage of Program webpage
MCAH population to services
1 2016-2020 Trtle V State Prioiilies 2 MCH Title V Brock Grant Requirements
'State Requirements Page 5 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 1.2: WOMEN/MATERNAL DOMAIN: Improve access to and utilization of comprehensive, quality health and social services for reproductive age
women.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short andlor Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure{s)
REQUIRED LOCAL OBJECTIVE: Insert locally developed Short andfor Intermediate Outcome Objective(s), Activities, EvaluatfonJPerformance Measures
in the appropriate column below. Each LHJ is required to develop at least one specific short and/or intermediate SMART outcome objectivets) to
address access to needed preventive services. Number each locally developed objective as follows: 1.2, 1.2a, 1.2b, 1.2c, 1.2d, etc.
Objective 1.2
By June 30, 2019, increase the
number of MCAH women of
repr oductive age who access
and utilize preventative health
services by 5%
Examples of focus areas can
include but are not limited to:
•We ll-women visit•Mental health•Substance use•Chronic disease•Preconception/
lnterconcept1on care•Birth Intervals-Spacing•Unintend ed/m1stimed
pregnancy., Family ptannmg•Intimate partner/domestic
violence
' 2016-2020 Title V State Priorities
2 MCH Title V Block Grant Requirements
3 State Requirements
1.2a
Assessment
1-key question (RLP questions in
EMR) to all MCAH women
(pregnant and non-pregnant)
Collect number of women who
access and utillze preventative
health services
Po licy Development.
Identify defined hst of preventative
services/activities to support
mom's reproductive goals
(ACQG?)
Assurance
Develop a quality improvement
process rerated to the process of
collecting data on rdentified list of
pr eventaUve servrceslactivities
1.2a
Participate in PTBi Coordination of
Care to improve the coordination
and integration of physical and
behavioral healthcare, social
services and other support for
women. before. during and after
pregnancy
Define/develop description of
preventative hea Ith services for
reproductive women to be
collected in EMR/MIS
Develop data reports rn Avatar to
measure outcomes
Page 6 of 25
1.2a
Work in collaboration with
community partners and women
with lived experience to devetop
focus of PTBi Coordination of
Care Worl<group in cortaboration
with the Shared Measures
Work.group
# of women utilizing preventative
services/Total# of women served
Percentage of MCAH women of
reproductive age who access and
utiltze preventative health service
such as well-woman visit.
1nterconception care and' or/family
plannmg/baseline of 57%
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 1.3: WOMEN/MATERNAL DOMAIN: All pregnant women will have access to earl.y, adequate, and high quality perinatal care with a special
emphasis on low-income and Medi-Cal eligible women.
Short and/or Intermediate
Objective(s)
Objective 1.3
All women will have access to
quality maternal and earfy
perinatal care, including CPSP
services for Medi-Cal eligible
women by: •lncreasmg first tnmester
prenatal care in1t1ation1
•lncreasmg postpartum vis1t1
•Increasing access to providers
that can provide the
appropriate services and level
of care for reproductive age
women1
1 2016-2020 Title V Slate Priorities 2 MCH Title V Block. Grant Requirements
•State Requirements
Evaluation/Performance Measures
Intervention Acti:vities to M.eet Process, Short and/or Intermediate Measures
Objectives (Describe the steps (Report on these measur es in the Annual Report)
of the intervention) Short and/or Intermediate Outcome Process Description and Measures. Measure(s)
Assurance
1.3a 1.3a 1.3a
i Develop MCAH staff Report the following. Provide the number and describe
kn owledge of the system of I. LJst of trainings received by the outcomes of'
maternal and perinatal care staff on perinatal care, such •Roundtable meetings
as roundtables, regional •Regronal meetingsmeetings, collaborative work •Other maternal and pennatal
meetings
ii Deve·lop a comprehensive Fi Submit resource and referral
resource and referral guide of guide
available health and social
services
iii Attend the yearly CPSP iii Date and attendance at the
statewide meeting CPSP yearly meetmg
IV Conduct local activities to iv.Ltst activities implemented to
facilitate increased access to increase access of women to
early and quality perinatal early and qualfty pennatal
care care. Identify barners and
opportunities to rmprove
access to early and quality
perinatal care
Page 7 of25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 1.3: WOMENJMATERNAL DOMAIN: All pregnan.t women will have access to early, adequate, and high quality perinatal care with a special
emphasis on low-income and Medi-Cal eligible women.
Short and/or lntennediate
Objective{s)
1 2016-2020 Title V State Priorities
2 MCH TIiie V Block Grant Requirements
; State Requirements
EvaluationJPerformance Measures
Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objectives (Describe the steps (Report on these measures in the Annual Report)
of the intervention} Short and/or Intermediate Outcome Process Description and Measures Measure(s)
1.3b 1.3b 1.3b
Outreach to perinatal providers, Nothing is entered here
including Medi-Cal Managed Care
i.Enroll m CPSP {Fee-for-i.Enroll FFS and
Service and FQHC/RHC/IHC FQHC/RHC/IHC providers
providers)Identify the MCP liaison(s)
ii.Identify and work with MCP ii Work with MCP(s) to provide
liaisons to provide CPSP CPSP comparable services
comparable services
in Assist MCP providers to ni. Work with MCP providers to
provide CPSP comparable provide CPSP comparable
services services
1.3c 1.3c 1.3c
Coordinate perinatal activities List number of meetings attended Nothing Is entered here.
between MCAH and the Reg1011al to facilitate coordination of
Perinatal Programs of California acbv1tIes between RPPC and
( RPPC) to improve maternal and MCAH and briefly describe
perinatal systems of care, outcomes
including coordinated post-partum
referral systems for high-nsk
mothers and infants upon hospital
discharge
Page 8 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 1.3: WOMEN/MATERNAL DOMAIN: All pregnant women will have access to ea.rly, adequate, and high quality perinatal care with a special
emphasi.s on low-income and Medi-Cal eligible women.
Short and/or lntennediate
Objective(s)
1 20l6-2020 Tille V State Priorities 2 MCH Tille V Block Grant Requirements
' State Req u irernents
EvaluationlPerfonnance Measures
Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objectives (Describe the steps (Report on these measures in the Annual Report)
of the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
1..3d 1.3d 1.3d
Conduct technical assistance and Report tile number of CPSP Describe the results of technical
face-to-face quality provider technical assistance assistance provided by phone or
assurance/quality improvement activities conducted by phone or email
(QNQI) activities with CPSP email
providers or managed care Describe the resutts of QNQI
providers in collab oration with Re port the number of QNQI face-acttvrt1es that were conducted
MCP(s) liaison to ensure that to-face stte visits conducted with. with
CPSP services are implemented •Enrolled CPSP providers •Enrolled CPSP providers
and protocols are in place •MCPs providers (with MCP •MCPs providers (with MCP
lia1son(s}}liaison(s))•Number of chart reviews •Summary of findings from the
chart reviews
Ust common problems or barriers
and successful interventions
Page 9 of 25 03/08/2018
I
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 1.4: WOMEN/MATERNAL DOMAIN: Improve access to and utilization of comprehensive, quality health and social services for pregnant women.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
EvaluationfPerformance Measures
Process, Short andlor Intermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Description and Measures Measure-ls}
REQUIRED LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures
in the appropriate column below. Each LHJ is required to develop at least one specific short and/or intermediate SMART outcome objective(s) to
address access to needed preventive services. Number each locally developed objective as foflows: 1.4, 1.4a, 1.4b, 1.4c, 1.4d, etc.
Objective 1.4 1.4 1.4 1.4
All CPSP certified providers
and other providers of Obstetric
services will receive a visit to
inform them of the importance
of the Tdap vaccine between
27-36 weeks of pregnancy for
the well-being of the infant
Establish a collaborative
exchange with CD/STD Program
to provide a warm handoff of
women/infants identified during
investigation and treatment for
syphilis to PHN home visitation
and case management.
•
1 2016-2020 Trtle V State Prionties
2 MCH Titie V Block Grant Requirements
3 State Requiremenis
AU providers identified as serving
pregnant women will receive a
packet developed by CDPH and
the Fresno County Communicable
Disease, Immunizations, and
Comprehensive Perinatal
Services Programs and will be
educated on the importance of
Tdap at 27-36 weeks pregnancy
as well as the state requirements
for documentation and fo llow-up
All pregnant women receiving
PHN home visitation will be
educated about Tdap vacc ination
between 27 and 36 weeks
Work with the CO/STD Na vigator,
to complete the objechves created
dunng the STD QI event to
estabhsh co llaboration and warm
handoff of women/infants
identified during treatment for
syphilis for case
management/home visitation
services.
Bnefly describe the packet
developed and instruction
provided
Collect the number of pr oviders
who provide services to pregnant
women that received a packet
and/or Instrucl:lon on the
importance of the Tdap vaccine.
Collect the number of pregnant
women rece,vmg home visitation
from MCAH programs who
receive a Tdap vaccme between
27-36 weeks
Describe u,e barriers to pregnant
women receIv1ng the Tdap
vaccine at the appropriate time
Briefly descnbe the policies
developed for collaboration and
warm handoff of women/infants
identified durmg treatment for
case management/home
Vfsitation
Page 10 of 25
# of providers that received a
packet and/or visct/# of identified
providers
# of pregnant women who
received a Tdap vaccination
between 27 to 36 weeks
pregnancy/total# of pregnant
women receiving home visitation
# of women/1 nfants who rece ived
warm handoff to case
management/home visitation
services/# of women identified
during irwestIgation and treatment
for syphilis.
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 2: CHILDICYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all chil dren, including children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
Short and/or Intermediate
Objective(s)
Objective 2.1
Provide developmental
screening for all children1 in
MCAH programs
•All children, indudrng
CYSHCN, receiv e a yearly
preventive medical visit•Increase the rate of
developmental screening for
children ages 0-5 years
according to AAP guidelines -
9 months, 18 months and 30
months
1 201&-2020 Title V State Priorities
Intervention Activities to Meet
Objectives {Describe the steps of
the intervention)
2.1a
Promote the American Academy
of Ped1atncs (AAP) developmental
screemng guidelines
The following bolded ac tivities,
i, ii, are required:
i.Promote regular preventive
medical visits for all
ctlildren, including
CYSHCN, in MCAH Home
Visiting and Case
Management programs, per
Bright Futures/AAP,
ii.Adopt protocols/policies,
including a QA/Q1 process,
to screen, refer, and link all
children in MCAH Home
Visiting or Case
Management Programs
EvaluationJPerformance Measures
Process, Short and/or intermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Description and Measures Measure(s)
2.1a 2.1a
Required Required
Describe or report the following Describe or report the following
for MCAH programs: for children in MCAH programs
i.Activi ties to promote the i.Number of children,
yea1rly preventive medical including CYSHCN,
visit receiving a yearly
preventive medical visit
ii.Describe protocols/poli cies ii.Number of children in
including QA/QI process to MCAH programs receiving
screen, refer and link all developmental screening
children in MCAH programs •Number of children with
positive screens that
complete a follow-up
visit with their primary
care provider•Number of children with
positive screens linked
to services•Number of ca Its
received for referrals
and linkages to services
2 MCH Trtle V Block Grant Requirements
3 State Requirements Page 11 of25 03/08/2018
I I I
Agency: County of Fresno Department of Pu lie HealthAgreement Number. 201810 Fiscal Year: 2018-19
Goal 2: CHILD/CYSHCN DOMAIN: lmpro e the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent r,quired activities.
Jntervention Activities to Meet Short and/or Intermediate Objective(s) Objectives (Describe the steps ofthe. intervention}
As esources allow, choose one or
mote activities 2.1.b-2.1.h (highlight
vour choices in yel/owl:
2.1 > Promote the use of Birth to 5; ·Watch Me Thrive, Learn the Signs, Act Early or other screening materials consistentwith AAP guidelines
2.14• Participate in Help Me Grow (HMG) or programs that promotethe core components of HMG
1 2016-2020 Title V State Priorities 2 MCH Title V Block Grant Requirements
Evaluation/Perfonnance Measures Process, Short andlor Intermediate Measures (Report on these measures in the Annual Report) Process Description and Measures
Reeort the following based on the
activities l!:OU chose to imeJement
in the second column (highlight
your choices in veflow):
2.1b Number of providers or providersystems receiving information about Birth to 5. Learn the Signs,Act Early or other screening materials
2.1c Describe participation in HMG orHMG like programs
•MCAH Director is a memberof the Fresno County HMG Leadership Team •MCAH Contracts with First 5 and Exceptional Parents Unlimited to provide HMG Core Components •During FY 2018-19 FCHMG Leadership team will identifyan Organizing Entity and establish contracts with agencies to promote Help MeGrow Core Components.
Short and/or Intermediate Outcome
Measure(s)
Describe the following based on the
activities you chose to imelement
in the second column
(highlight your choices in yellow}:
2.1b Nothing is entered here
2.1c Outcomes of participation in HMG or HMG like programs. Describe results of work to implement HMGcore components
• Develop FCHMG LeadershipTeam Charter • Identify HMG Organizing Entity Initiation of FCHMG StrategicPlan
' State Requirements Page 12 of25 03/08/2018
Agency: County of Fresno Department of Puolic Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 2: CHILD/CYSHCN DOMAIN: lm prm e the co gnitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and bolded areas represent rE quired activities.
Short and/or lntennediate
Objective(s)
1 2016-2020 Title V State Priorities
ntervention Activities to Meet
0 �jectives (Describe the steps of
the intervention)
2.1 d
Increase understanding of the
specific barriers to referral and
evaluation by early intervention or
pediatric specialists (including
mental/behavioral health)
2.1 �
2.11
Work with health plans (HPs},
including MCPs, to identify and
address barriers to screening,
referral, linkage and to assist the
H Ps in increasing developmental
screenings for their members,
per AAP guidelines, through
education, provider feedback,
incentives, quality improvement,
or other methods
Identify methods to measure and
monitor ra tes of de velopmental
screening and referrals in your
jurisdiction
2.1 J
Outreach and education to
providers to promote
developmenta l screening, referral
and linkages
Evaluation/Perfonnance Measures
Process, Short and/or Intermediate Measures (Repo,rt on these measures in the Annual Report)
Process Description and Measures
2.1d
Describe !barriers to referral and
evaluation by early intervention or
pediatric specialists
2.1e
Describe barriers and strategies to
increase screening, referral and
linkage
2.1f
•Number of HPs requiring
screenings per AAP
guidelines
If applicable, provide data on
developmental screening rates for
the target population (e.g. health
care provider, health plan)
2.1g
Describe type of
outreach/education perfonmed and
results of outreach to providers
Short and/or Intermediate Outcome
Measure(s)
2.1d
Nothing is entered here
2.1e
Nothing is entered here
2.1f
Nothing is entered here
2.1g
Nothing is entered here
2 MCH Title V Block Grant Requirements
•State Req lli rements Page 13 of 25 03/08/2018
Agency: County of Fresno Department of Pu lie Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 2: CHILOICYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including children and youth with
special health care needs.
The shaded and balded areas represent required activities.
Evaluation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objective{s) Objectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention) Short and/or Interme diate Outcome Process Description and Measures Measure(sj
2.1h 2.1h 2.1h
Provide care coordination for Describe activities for care List the number of children
CYSHCN, especially non-CCS coordination provided receiving care coordination
eligible children or children
enrolled in CCS in need of
services not covered by CCS
2
3 Page 14 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 2: CHILDICYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of aH children, including children and youth with special health care needs ..
The shaded and bolded areas represent required activities.
Short and/or Intermediate Objective-(s)
Intervention Activities to Meet Objectives {Describe the steps of the intervention)
Evaluation/Performance Measures Process, Short and/or lntennediate Measures (Report on these measures in the Annua'I Report)
Process Description and Measures Short and/or lntennediate Outcome Measure(s)
OPTIONAL LOCAL OBJECTIVE:. Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below. Number each locally developed objective as follows: 2.2, 2·.2a, 2.2b, 2.2c, etc.
Objective 2.2
By June 30 3018, 120 children
identified through referrals from
Community Partners at high risk
for unintentional inJuries, child
abuse and neglec t. will receive
Public Health Nursing home
visitation, including deveJopmental
screening.
By June 30 2019. 150 children
receiving services from Nurse
Family Partnership (NFP} and
Babies First at risk for cognitive,
emotional or physical delays will
receive PHN home visitation
including developmental
screening.
Examples of focus areas can
include but are not limited to:
•Reducing unintentional
injuries 1
•Reducing child abuse and
neglect1
1 2016-2020 Title V State Priorities 2 MCH Title V Block Grant Requirements
J State Requirements
2.2
Assessment: Monitor, screen and
refer as needed all children for
physical, emo tional and cognitive
delays.
Assess. monitor and refer as
needed all home environments for
inadequate, unsafe and or
unhealthy riving conditions_
Screen all families for maternal
depression and domestic
violence.
Policy: All families served will be
educated on the optimal
emotional, physical and cognitive
environments for children with a
focus on the positive
characteristics of each family.
All children identified with a
cognitive, physical, or emotional
delay will be referred to the
appropriate resource to address
the problem identified.
Assurance: The number of
completed referrals for
12.2
1.Collect data on the number of
children that receive assessment
over the number of children
served.
2.Collect data on the number of
completed re ferrals for a physical,
emotional, or cognitive delay over
the number of children referred.
3.Collect data on the number of
preventable re-hospitalizations
over the number of children
served.
Page 15 of 25
2.2.
The number of children in Public
Health Nursing, children's
programs who received
developmental screening/120
At least 35% of cl ients referred will
complete referrals made to
community services
Preventable re-hospitalization rate will be less than 10%
The number of children in Nurse
Family Partnership and Babies
First Programs who received
developmental screening1150
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 2: CHJLD/CYSHCN DOMAIN: Improve the cognitive, physical, and emotional development of all children, including. children and youth with
special health care needs.
The shaded and bolded areas represent required activities.
Evaluation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objectives (Describe the steps of (Report on these measures in the Annual Report) Objective{s) the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Evaluat ionfPerformance Measures
in the appropriate column below. Number each locally developed objectjve as follows: 2.2, 2.2b, 2.2c, etc.
developmental delays will be
tracked in Avatar (electronic
medical record) and the MIS
system.
Page 16 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Numb er. 201810
Fiscal Yeac 2018-19
Goal 3: PERINATAUINFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SJDS/SUID deaths
The shaded area represents required activities.
Evaluation/Performance Measures
Intervention Activities to Meet Process, Short and/or Intermediate Measures Short and/or Intermediate Objectives (Describe the steps (Report on these measures in the Annual Report) Objective(s) of the intervention) Short and/or lntennediate Outcome Process Description and Measures Measure(s)
Objective 3.1 Assurance 3.1a 3.1a
3.1a (Insert number) of Nothing. 1s entered here
AJI parents./caregivers ·Establish contact with parents/caregivers who
experiencing a sudden and parents/caregivers of infants with experience a presumed SIDS
unexpected death will be presumed SIDS death to provide death and the number who are
offered grief and bereavement grief and bereavement support contacted for gnef and
support services services3 bereavement support services.
Provide grief and support
matenals to parents
3.1b 3.11b 3.1b
Contact local coroner office to Report the coroner's notifications Nothing 1s entered here
ensure timely reporting and received
referrar of parents of all babies
who die suddenly and Briefly describe barriers and
unexpectedly regardless of opportunities for success
circumstances of death
Objective 3.2. 3.2a 3 .. 2.a 3.2a
All professionals, para-Disseminate AAP gu1delmes on Numbers receiving AAP Nottung Is entered here
pl"ofessionals,. staff, and infant safe sleep and SIDS rrsk gwdel1nes on infant sate sleep ·
community members will reduction to providers, •Pro vider s
receive infonnati.on and ped1atnc1ans, CPSP providers, •Pediatricians
education on S10S risk parents. community members and •CPSP providersreduction practices and infant other caregivers of infants •Child care providerssafe sleep •Other-list
1 2016-2020 Title V State Pric rities 2 MCH Title V Blocl< Grant Requirements 3 State Requ irements Page 17 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 3: PERINATAUINFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUID deaths
The shaded area represents required activities.
Evaluation/Performance Measures
Intervention Activities to Meet Process, Short and/or Intermediate Measures
Short and/or Intermediate Objectives (Describe the steps of (Report on these measures in the Annual Report)
Objective(s) the .intervention) Short an dfor Intermediate Outcome Process Description and Measure.s Measure(s)
3.2b 3.2b 3.2b
Attend the SIDS Annual Provide staff member name and Describe results of staff trainings
Conference/SIDS trarning(s) and date of attendance at SIDS Annual related to infant health
other conferences/trainings Conference/SIDS trammg(s} and
related to infant health other conference/trainmgs related
to infant health
Page 18 of25 03/08/2018
Agency· County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 3: PERINATAUINFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUIO deaths
The shaded area represents required activities.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives {Describe the steps of
the intervention)
,I Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Re.port}
Short and/or Intermediate Outcome Process Description and Measures Measure(s)
REQUIRED LOCAL OBJECTIVE: Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the
appropriate column bel .ow. Each LHJ must provide at least one specific short and/or intennediate SMART outcome objective(s) to address
SIDS/SUID. Number each locally developed objective as follows: 3.3, 3.3a, 3.3b, 3.3c., etc.
Objective 3.3
3.3a
By June 30. 2019, provid e one
SIDS/SU IDS/Safe Sleep training
to Medi-Cal managed health
plans, local birth and children's
hospitals, local WIC organizations
and local providers of higher
education for their staff to learn of
current information regarding safe
sleep practices and SIDS risk
reduction, factors
3 3b
By June 30, 2019 provide at least
1 training per month for the
Department of Social Services
prospective resource families to
obtain required Safe Sleep
education for completion of
resource family apphcat1on
requirements
· 2016-2020 Title V State Priorities
�-MCH Title V Block Grant Requirements
' State Requirements
3.3
3 3a. Collaborate with CDPH,
California State SIDS contractor.
medical experts, PHNS, Grief and
Bereavement organizations and
community partners to implement a
Central Valley Safe Sleep Conference
to corncide with SIDS/SU JDS
Awareness month in October 2018.
3.3b. Collaborate with Department of
Social Services to provide required
SIDS/SU IDS/Safe Sleep educatio n
monthly to prospective resource
families
3.3a and b. Develop a pre and post
test to assess individual knowledge of
topic and increased mastery of
content.
3.3
3.3a
1.One Central Valley
SHJS/SUIDS/Safe Sleep
Conference and
2 2 Nursing Students classroom
presentations where pre and post
test tools are administered
3.3b
12 Resource Family trainings
where pre and post test tools are
administered
Page 19 of 25
3.3a. Total number of
participants to the Central
Valley conference, number of
participants with increased
knowledge.
Number of Medi-Cal managed
care provider participants,
num ber of participants with
increased knowledge.
Number of Hospital staff
participants, number of
participants with increased
knowledge.
Number of local WIC
organization staff participants,
number of participants with
increased knowfedge.
Number of Nursing Student
participants, number of
participants with increased
knowledge.
3.3b Number of Resource
Family participants, number of
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality by reducing the rate of SIDS/SUID deaths
The shaded area represents requir ed activities.
Short and/or Intermediate
Objective(s)
' 2016-2020 Trtle V State Priotilies 2 MCH Title V Block Grant Requirements
' State Requirements
Evaluation/Performance Measures
ln ,tervention Activiti es to Meet Process, Short and/or Intermediate Measures
Objectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention) Process Description and Measures Short andlor Intermediate Outcome
Measure(s)
participants with increased
knowledge.
Page 20 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Goal 3: PERINATAL/INFANT DOMAIN: Reduce infant morbidity and mortality
The shaded area represents required activities.
Short and/or Intermediate
O bjective(s)
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(RePOrt on these measures in the Annual Report)
I nte rventi.on Activities to Meet
Objectives (Describe the steps of
the intervention) Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
REQUIRED LOCAL OBJECT(VE: Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the
appropriate column below. Each LHJ must provide at least one specific short and/or intermediate SMART outcome objective(s) to address
perinatal/infant health. Number each locally developed objective as follows: 3.4, 3.4a, 3.4bs 3.4c., etc.
By June 30, 2019. increase
breastfeeding duration among
participants enrolled m home
visitation services at 2 months and
6 months by 10%
1 2016-2020 Title V State Prionties
2 MCH Title V Block Grant Requirements 1 State Requirements
3.4
11
Staff trained as CLEs will provide
technical assistance to other staff
Partner with local WIC agencies to
educate staff on available WIC
resources to support
breastfeeding moms
Identify and link families to
supportive services to
sustain/increase breastfeeding
duration
Update Electronic Medical Record
system to a) capture client
breastfeeding history and goals,
b)WtC site utilized by partJctpant;
c)track BF initiation. BF at 2
month and 6 months; d) BF
duration by race/ethnicity
3.4
Staff to develop TA plan and
tracking l.og to document TA
provided
Collaborate with WIG agencies
and maintain s1gn-1n sheets for
presentation(s) to staff
Conve11e a team to deve lop and
incorporate BF data mto the EMR
Update the Breastfeeding
Resources Directory
Monftor and summanze BF
duration and efforts quarterly for
BF duration at 2 months and
6mo11ths
Utilize QI process to address and
summanze BF duration
challenges
Page 21 of 25
3.4
Total# of CLEs trained
Total Number staff Trained on
WIC services
Number of pregnant clients who
plans to BF/Total number of
pregnant clients who delrvered
Number of clients breastfeeding at
2 monthsffotal number of clients
who delivered
Number of clients breastfeeding at
6 monthsffotal number of clients
with baby at least 6 months
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 2018-19
Goal 3: PERIN.ATAUINFANT DOMAIN: Reduce infant morbidity and mortality
Short and/or Intermediate
Objective{s)
For FIMR iLHJs only complete
Objective 3.5
Reduce preventable fetal,
neonatal and post-neonatal and
infant deaths.
1 201.6-2020 Title V State Priorities2 MCH Title V Block Grant Requirements
; State Requ:irements
EvaluationlPerformance Measures
Intervention Activities to Meet Process, Short and/or lntennediate Measures
Objectives (Describe the steps of {Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure{s)
For FIMR LHJs onl.y complete For FIMR LHJs only complete For FIMR LHJs only complete
Assessment Assessment Assessment
3.5a 3.Sa 3.5a
Complete the review of at least_ Develop a process for sample. Submit annual local summary
cases. which is approximately Submit number of cases reviewed report of findings and
_% of all fetal, neonatal, and as specified in the Annual Report recommendations (periodicity to
post-neonatal deaths table. be determined by consulting with
MCAH)
Assurance Assurance
3.5b 3.5b 3.5b and c
Establish, facilitate . .and maintain Nothing is entered here
a Case Review Team (CRT) to Submit FlMR Tracking Log and
review selected cases, identify FIMR Committee Membership
contributing factors. to fetal, fonns for CRT and CAT with the
neonatal, and post-neonatal Annual Report.
deaths, and make
recomme(ldations to address
these factors.
3.5c,
Establish, facilltate, and maintain
a Community Action Team {CAT)
to recommend and implement
community, policy, and/m systems
changes that address review
findings.
Page 22 of 25 03/08/2018
'
,I
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Goal 3: PERINATAUINFANT DOMAIN:. Reduce infant morbidity and mortality
Short and/or Intermediate Intervention Activities to Meet
Objecttve(s.) Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or rntennediate Measures
(Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
REQUIRED LOCAL OBJECTIVE for FIMR LHJs Only: Insert Short and/or Intermediate Outcome Objective(s}, Activities, Evaluation/Performance
Measures in the appropriate column be.low. Each LHJ must provide at least one specific short and/or intermediate SMART outcome objective(s) to
address perinatal/infant health. Number each locally developed objective as follows: 3.6, 3.6a, 3.6b, 3. 6c, etc.
Objective 3.6
By June 30 th , 2019, MCAH home
visiting staff will receive training
on intervention to reduce the
occurrence of preterm birth
By June 30, 2019, 75% of women
enrolled in PHN case
management services with a
history of pr eterm delivery before
37 weeks gestation will be
screened to assess their
knowledge of the nsk of
subsequent pretenn delivery and
provided educational materials to
increase their knowledge.
' 201 6-2020 Title V State Priorities 2 MCH Trtle V Block Grant Requirements
3 State Requirements
3.6
1.
2
3
4
3.6
Conduct a staff training and 1.Collaborate with our IT
educate on evidence based department to pull data and
interventions to reduce the identify the number of enrolled
occurrence of a pretemi women in EHR with a history
delrvery and how to present of a preterm delivery.
this 1nformahon to a client. 2, Review data screening tool s
once identified . and documents to develop a
Develop a questionnaire to short questionnaire to assess
admIn1ster during the history of preterm birth.
comprehensive assessment to 3.Collaborate with March of
1dent1fy clients with a history of Dimes. MCAH Director and
preterm delivery. local Maternal Fetal Medicine
Develop a culturally physician to provide a training
app ropriate information al on evidence based
packet related to risks and interven ti ons in the prevention
interventions appropriate for of pretenn birth.
clients with a history of 4.Develop a preterm birth PPG
preterm de livery to provide guidance to PHN 's
Develop and provide an to screen, assess and tink
education al packet to all identifi ed women
identified Clients. 5.Briefly describe the education
packet developed
Page 23 of 25
3.6
1.# of staff trained on evidence
based intervention to reduce
the occurrence of a preterm
delivery/total# of home
visitation staff
2.# of questionnaires
adm inistered to clients with a
history of pretemi
de lJVery/total # of clients
identmed
3.# of clients who received
educational packet
developed/total# of clients
1dentifed
4._# clients received culturally
appropriate educ ational
information, which entailed
risks and interventions 1f
clients identified with a history
of preterm delivery
03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year: 20 1:8-19
Goal 4: CROSSCUTTING DOMAIN: Increase the proportion of chi:ldren, adolescents and women of reproductive age who maintain a healthy weight.
Evaluation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or lntennediate Measures
Objective(s) Objectives {Describe the steps of (,Report on these measures in the Annual Report}
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
OPTIONAL LOCAL OBJECTIVE: [nsert locally developed Short and/or Intermediate Outcome Objective{s), Activities, Evaluation/Performance
Measures in the appropriate column below. Number each locally developed objective as follows: 4.1, 4.1a, 4.1b, 4.1c, etc.
Objective 4.1
1.By June 30, 20191 labor and
deii,very hospital will have
implemented the model
hospital policies or the Baby-
Friendly USA Hospital
requirements to comply with
the Infant Feeding Act (Health
and Safety Code Section
123360-123367}.
2.By June 30, 2019, in
collaboration with RPPC, will
develop and adopt a process
to monitor & recognize labor &
deliver hospitals who are
striving to ac hieve Model
Hospital Policies and/or Baby-
Friendly USA Hospital
requirements as well as a
process to provide Quality
Assurance for hospitals that
have attained this designation
to be ready for recertification
every 2 years.
1 2016-2.020 Title V State Priorities 2 MCH Tille V Block Grant Requirements
•State Requiremenls
4.1
1.
2.
3.
4.1 4.1
Number of hospitals that have
Support the continuation of Dates, number and names ot implemented the model hospjtal
the Cross County hospitals contacted and types of policies or the Baby-Friendly USA
Coltaborative (San Joaquin. technical assistance provided Hospital requirements/total# of
Merced & Fresno} to develop hospitals
and share �Best Practices" Describe how continuation of the
Technical assistance and Cross County Collaborative will be Scores for the impl'ementation of
support for hospitals to meet continued the 10 Steps to Successful
the requirements of Model Breastfeeding
Hospital policies and/or Baby-Briefly describe barriers,
Friendly USA Hospital challenges and solutions to Attendance and minutes of the
requirements will be provided implementing the model hospital collaborative.
by RPPC policies or the Baby-Friendly USA
Utilize PDSA cycles to Hospital requirements to comply Describe the outcome of the
develop a Continuous Quality with the Infant Feeding Act CQI/QA process including
J mprovement/Quality (Health and Sa fety Code Section methods of measurements and
Assurance (CQI/QA) process, 123360-123367}. results.
to monitor and recognize
hospital achievements and Description of the CQI/QA
maintain quality of care for process developed
recertification with RPPC.
Page 24 of 25 03/08/2018
Agency: County of Fresno Department of Public Health
Agreement Number: 201810
Fiscal Year. 2018-19
Goal 5: AD OLESCENT DOMAIN: Promote and enhance adolescent strengths, skills, and supports to improve adolescent health.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives {Describe the steps of
the intervention)
Evalu ation/Performance Measures
Process,. Short and/or Interm ediate Measures
{Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
OPTIONAL LOCAL OBJECTIVE: Insert locally developed Short and/or Intermediate Outcome Objective(s), Activities, Eval.uation/Performance
Measures in the appropriate column below. Number each locally developed objective as follows: 5.1, 5.1 a, 5.1 b, 5.1c, etc.
Objective 5 .. 1
Insert a local objective that
promotes and enhances
adolescents strengths, skills and
supports improve health by:
•Decreasing teen pregnancies 1
•Reducing teen dating
violence, bullying and
harassment
Examples of focus areas can
include but not limited to:
•Adolescent sexual health,
including con traception,
preconception health. STl s
•Racial ethnic disparities in
adolescent birth rates
•Adolescent injuries
•Adolescent violence
•Adolescent mental health
•Development of a Positive
Youth Devetopment
framework
•Reducing suicides
1 2016-2020 Title V State Prio,ities 2 MCH Title V Block Grant Requirements
"State Re quir,ements
5.1 List evidence based or
infonned activities to meet the
objective(s) here. Organize
intervention activities and
performance measures using the
three core funtions of public
health: Assessment, Policy
Development and Assurance
5.1
Develop process measures for
applicable interventjon activities
here
Page 25 of 25
5.1
Develop short and/or in tennediate
outcome related performance
measures for the objectives and
activities here
03/08/2018
Agency: County of Fresno, Department of Public Health
Agreement Number: 201810
Black Infant Health Program
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH)
Black Infant Health (BIH} Scope of Work (SOW)
Fiscal Year: 2018-19
The BIH Program is a specialized CDPH MCAH program under the local MCAH system and helps to address MCAH SOW Goal 2-Improve Maternal and
Women's Health. The goals in this SOW incorporate local problems identified by the Local Health Jurisdiction's (LHJs') 5--Year Needs Assessments and reflect the
Title V priorities of the MCAH Division.
All BIH sites are required to comply with B.IH Policy and Procedures (P&P) and the Fiscal Policies and Procedures
https :llwww_cdph .ca.gov/Programs/CFH/DMCAH JPages/Fiscal-Do cuments.aspx in their entirety. in addition, all BIH Sites shall work towards maximizing fidelity in
the foll ow ing four domains (adherence, dose, participant engagement and quality of service delivery} by implementing Program services, fulfilling all deliverables
associated with benchmarks, attending required meetings and trainings and compfeting other MCAH-BIH reports as required. A list of the fidelity indicators for
each domain is located in table 1: BIH Fidelity Indicator Listing (rev. 7/1/2017),
The CDPH Maternal, Child and Adolescent Health {MCAH) Division places a high priority on the poor out comes that disproportionately impact the African
American community in California. The BIH site agrees to implement all activities in this Scope of Work (SOW). Central to the efforts in reducing th ese disparities,
listed below are the four (4} goals that are the haUrnar1< of the program:
1.Improve African-American (AA) infant and materna l health.
2.Increase the ability of African-American women to manage chronic stress.
3.Decrease Black-White health disparities and social inequities for women and infants.
4.Engage the community to support African-American families' health and well-being with education and outreach efforts.
To achieve these goals, the BIH Program is a client-centered, strength-based group intervention with complementary case management that embraces the
lifecourse perspective and promotes skill building. stress reduction and life goal setting. Each BIH Site shall also assure program fidelity. collect and enter
participant and program data into the electronic Efforts to Outcomes {ETO) data system and engage community partner agencies.
An BIH Sites are required to comp[y with the following tiered staffing matrix per the BIH 2015 Request For Supplemental Information (RSI) BIH RSI Instruc tions to
ensure fidelity and standardization across all sites:
Staffing Requirem!._nts Tier 1 Tier2 Tier 3 Tier4 Tiers
Local Health Jurisdiction San Francisco, Santa Clara Contra Costa, Long San Diego Sacramento, San Los Angeles
Beach. Fresno San Alameda , R1vers1de Bernardino
Joaquin. Solano, Kern
BIH Coordinator 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE
FHA/Group Facilitator 2.0 FTE 3.0 FTE 4.0 FTE 6.0 FTE 8.0 FTE
Mental Health 05 FTE 0.5 FTE .0.5 FTE 0.5 FTE 0.5 FTE
Professional
Outreach Liaison 1 0 FTE 1 0 FTE 1.0 FTE 10 FTE 1 0 FTE
Data Ent 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE 0.5 FTE ----
Page 1 of 28 7/1/2018
Agency: County of Fresno. Department of Public Health
Agreement Number: 20181C
Fiscal Year: 2018-19
All BIH Sites are required to and wi11 be held accountable for compfying with the following tiered enrollment target per the BIH 2015 Request For Supplemental
l,nformation (RSI) BIH RSI Instructions:
---Tier3 Tiers Enrol!_ment Target Tier 1 Tier 2 Tier4
Local Health Jurisdiction San Francisco Santa Clara. Contra Costa. Long San Diego. Sacramento San Los Angeles
Beach Fresno. San Alameda Riverside Bernardino
Joaquin. Solano. K€m
64 96 128 192 240
Contained within the BIH SOW, under the Measures (Process and Outcome) cells. there are Source Keys that are designed to provide a reference for reporting
purposes. The "E" Source Key refers to information that is based on participant-level program data included and maintained in ETO. The "N" "Source Key refers to
narrative information provided in quarterly reports or site surveys.
It is the responsibility of the lHJ to meet the goals and objectives of this SOW. The LHJ shall strive to develop systems that protect and improve the health of
California's women of reproductive age, infants, children, adolescents, and their families. It is the responsibility of an lHJ to solicit technical assistance and
guidance from MCAH if performance issues arise. If a program does not meet the goals and objectives outlined in this SOW, the LHJ may be placed on a
corrective action plan (GAP) status. After implementation of the CAP, if the LHJ does not demonstrate substantial growth or fails to successfully meet
the. goals and objectives of this SOW, MCAH will either cancel the Agreement or amend it to reflect reduced funding. Continued participation in the BIH
program beyond the current fiscal year is also subject to successful performance of agreed upon activities.
The development of this SOW was guided by several public health frameworks including the Ten Essential Services of Public Health and the three (3) core
functions of assessment. policy development, and assurance; the Spectrum of Prevention; the Life Course Perspective: the Soda I-Ecological Model, and the
Social Determinants of Health. Please integrate these approaches when concep tualizing and organizing local program, policy, and evaluation efforts.
o The Ten Essential Services of Public Health: https://www.cdc.gov/stltpublichealth/publichealthse rvices/essential healthservi ces.html
o The Spectrum of Prevention: The Spectrum of Prevention I Prevention Institute
o life Course Perspective: life Course Approach in MCH
o The Social-Ecological Model: http:/twww.cdc.go v/violenceprevention/overview/social-ecologicalmod el .html
o Social Determinants of Health: htto://www.cdc.gov/socialdeterminants/
o Strengthening Families: Genter for the Study of Social Policy / Young Children & Their Families/ Strengthening Families
AU activities in this SOW shall take place within the fiscal year.
Page 2 of 28 7/1/2018
Agency: 1 :.0•_1 ·1t·:·' of Fr-2:::i-o [-E-�•a·u�-,ent :/ r::·L,!1c '-l�·altr
Agreement Number: .J ;,3:'
Fiscal Yeac 2018-19
For each fiscal year of the contract period, the LHJ shall submit the deliverables identified below. All deliverables shall be submitted to the MCAH Division
to your designated Program Consultant in accordance with the Bl H P&P Manual and postmarked or emailed no later than the due date.
Deliverables for each. FY
Annual Progress Report
Coordinator Quarterly Report:
Reporting Period
1 ) First Report
2)Second Report
3)Third Report
4)Fourth Report (WAIVED}
Information during this reg,orting Q.eriod
will be included in the Annual Progress
Report
From
July 1, 2018
October 1. 20t 8
January 1. 2019
April 1, 2019
Due Date for each FY
August 15
To
September 30, 2018
December 31 , 2018
March 31. 2019
June 30, 2019
See the following pages for a detailed description of the services to be performed.
Page 3 of 28
Oue Date
October 31, 2018
January 31, 2019
April 30, 2019
July 31, 2019
7/1/2018
Agency: County of Fresno, Department of Public Health
Agreement Number: 20181 �
Part II: Black .Infant Hea:lth (BIH) Program
Fiscal Year. 2018-19
Goal 1: BIH will assure program implementation, staff competency, data ma,nagement, and maintain program fidelity and fiscal management to
administer the program as required by the Program's Po ,licy and Procedures (P&P's) and Scope of Work (SOW) guidelines.
EvaluationJPerforma nee Measures
Short and/or lntermed iate Intervention Activities to Meet Process,. Short and/or Intermediate Measures
Obje ctive(s, Objectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measurefs) ---
IMPLEMENTATION
1.1 1.1 1.1 1.1
BIH Coordinator, under the •Implement the program •Define and describe MCAH •Submit BIH Annual report by
gu idance and leadership of the activities as defined in the Director and BIH Coordinator August 15.
MCAH Director will provide SOW.responsibilities as they relate •Submit BIH Quarterly Reportsoversight, maintain program •Annually review and revise to BIH. (N)as directed by MCAH. (Seefidelity, fiscal management and internal local policies and •Provide organization chart that page 3}demonstrate that BIH activities procedures for delivering designates the delineation ofare conducted as required in services to eligible BIH responsi.bilities of MCAHthe BIH P&Ps, SOW, Data participants.Director and BIH CoordinatorCollection Manual, ETO Data •B:IH Coordinator will coordinate from MCAH to the BlHBook, Group Curriculum, and and collaborate with MCAH Program in AFA packelMCAH Fiscal P&Ps. Director to complete, review,•Describe colraborative process
and approve the BIH budget between MCAH Director and
prior to submission_BIH Coordinator re1ated to BIH•Submit Agreement Funding budget prior to AFA
Application {AFA) timely.submission. (N}•Submit BIH Annllal report by
August 15.•Submit BIH Quarterly Reports
as directed bv MCAH.
1.2 1.2 1.2 1.2
Hire and maintain culturally •Maintain culturally competent •Describe process of hiring •Percent of key staffing roles at
c.ompetent/re[evant personnel staff to perfom, program staff at each site that ar e filled site filled by personnel who
and required, Full Time services th at t, onors the by personnel meeting meet qualifications in the P&P.
!Equivalent (FTE) to implement a unique history/traditions of qualifications in the P&P.(N)'BIH Program that is relevant to people of African-American •Include duty statements of all
the cultural heritage of African-descent as outlined in the staff with submission of AFA
American women, and the P& P.packet.community.• At a minimum, the following •Submtssion of all staff
key staffing roles are required:changes per gui.delines
0 0.5 FTE BIH Coordinator outlined in BIH P&P.
0 Famil y Health Advocates
WHA)/Group Facilitators
Page 4 of 28 7/1/2018
Agency: Coumy of Fresno. Department of Public Hea!tl7
Agreement Number: 201W0
Short and/or rntermediate Intervention Activiti.es to Meet
0 bjective( s) Objectives (Describe the steps of
the intervention)
(GF) based on MCAH-BlH
designated tier level.
0 1 FliE Community
Outreach Liaison (COL)
0 0 .. 5 FTE Data Entry
0 0.5 FTE Mental Healt:h
Professional (MHP)
0 Utilizatron of a staff hiring
olan.
TRAINING
1.3 1.3
AU BIH staff will maintain and •Develop a plan to assess the
increase staff competency. 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
par ticipates in training or
educational opportunities
designed to enhanc-e cultural
sensitivity.•Ensure that all key BIH staff
atten d the Annual MCAH
Sudden Infant Death
Syndrome (SIDS) Conference
to receive the latest AAP
guidelines on infant safe sleep
practices and SIDS risk
re duction strategies.•Estab lish rocal SIDS
collaborative workgroups with
communi:ty partners in order
to enhance awareness of AA
SIDS rates and to develop
SIDS risk reduction strategies.
Fiscal Year: 2018-19
EvaluaUon/Performance Measures
Process, Short and/or Intermediate Measures
{Report on these measures in the Annual Report}
Short and/or Intermediate Outcome Process Description and Measures Measure(s)
1.3 1.3 •List staff training activities in •Maintain records of staff
quarterly report. ( N)attendance -at trainings. {N}•Describe improved staff •Number of trainings and
performance and confidence in conferences (both state and
implementing the program local} attended by staff during
model as a result of FY 2017-18. {E)
participating in staff •Completion of at least 2 g:roup
development activities and/or ob servation feedback forms by
trainings. (N)tine BIH Coordinator for every•List gaps in staff development group facilitator during FY
and training in quarterly report.2017-18. (E}
(N)•Number and percent of key•Describe plan to ensure that staff that completed BIH ETO
staff development needs are Training. (E)
met in quarterly report. (N)•Describe how cultural
sensitivity training has
enhanced LHJ staff knowle dge
and how that knowledge is
being applied. (N}•Describe how staff utilized
information from the MCAH
SIDS conference with
participants.•Document strategies and
action plans related to SIDS
risk re duction strategies
developed from SIDS
Page 5 of 28 7/1/201'8
Agency: County of Fresno. Departmem of Pub 1 ic Health
Agreement Number: 201810
Short and/or In termediate Intervention Activities to Meet
Objective(s� Objectives (Describe the steps of
the intervention)
•Require that all key BIH staff
(i.e. BIH Coordinato r, and ALL
direct service staff) attend
mandatory MCAH Division-
sponsored trainings ,
conference cans. meetings
and/or conferences as
scheduled by MCAH Division.-• Quarter 1:
0 Annual 3-day Basic
Training
0 Annual COL Training •Quarter 2:
0 Annual 3-day
Advanced FHAlGF
Training •Quarter 3:
0 Annual MHP/Public
Health Nurse {PHN)
Training •Quarter 4:
0 Annual Coordinator
Meeting
0 Annual 2-day
Statewide Meeting •Ensure that the BIH
Coordinator and all direct
service staff attend mandatory
MCAH Division-sponsored
training{s) prior to
implementing the BIi-i
Program.•2-day Abb reviated
Training -scheduled by
MCAH based on LHJ
needs.•3-day Basic Training
Quarter 1•Ensure that the BIH
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or tntermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Description and Measures Measure{s)
collaborative workgroup
meetings. •Recommend training topic
suggestions for statewide
meetings. (N)
Page 6 of 28 7/1/2018
Agency: County of Fresno, Department of Public Health
Agreement Number: 201e�o
Short andfor Intermediate Intervention Activities to Meet
0 bjective( s) Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or lntennediate Measures
(Report on these measures in the Annual Report}
the intervention) Short and/or lntennediate Outcome Process Description and Measures Measure(s)
Coordinator and/or MCAH
Director perform regular
observations of GFs and
assessments of FHAs' case
mana�ement activities_
DATA COLLECTION AND
ENTRY
1.4 1.4 1.4 1.4
All BIH participant program •Ensure that all direct service •Review ETO and fidelity •Number and percent of forms
information and outcome data staff participate in data snapshot reports and discuss that were entered within
will be collected and entered collection, data entry, data during calls with BIH State seven (7} days of collection.
timely and accurately using BIH quality improvement, and use Team_(E)required forms at required of data collection software •Review ETO Utiliz.ation •Number and percent of forms
intervals. determined by MCAH_Reports for all staff at BIH collected within the required•Ensure that all subcontractor Sites.timeframe per the BIH Data
agencies providing direct •Enter all data into ETO within Collection Manual. {E)
service enter data in the ETO seven (7} working days of •Number and percent of
as determined by MCAH.collection.referred or recruited women•Ensure accuracy and •Review of the BIH Data with no enrollment decision
completeness of data input Collection Manual by all staff_after 14 days. (E)
into ETO system_•Completion of ETO training by •Number and percent of•Ensure that all staff receives an staff .participating women with
updates about changes in ETO •Participation in periodic cases closed two (2) months
and data book forms.MCAH-Data calls.after last postpartum group.•Ensure that a selected staff •Participation in role-specific (E)
member with advanced trainings by the Data Entryknowledge of the Bl H lead.Program, data collection, and •Review of ETO data qualityETO is selected as the BIH reports by the BIH CoordinatorSite's Data Entry lead and and Data Entry staff on atparticipates in all Data and least a monthly basis.Evaluation calls_•Conduct and report on audits•Accurately and completely of recruitment, enrollment, and
collect required participant service delivery paper fom,s
information, with timely data against ETO reports; audit
input into the appropriate data sample must include at least
system(s).10% of recruitment records
and 10% of enrollment•Work with MCAH to ensure records_
Page 7 of 28 7/1/2018
Agency: County of Fresno, Department of Publtc Heaith
Agreement Number 20181C
Sho.rt and/or Intermediate Intervention Activities to Meet
0 bjective(s) Objectives (Descri.be the steps of
the intervention)
proper and continuous
operation of the MCAH-BIH-
ETO. •Store Participant l:evel Data
forms on paper per guidelines
in P&P.•Define a data entry schedule
for staff and monitor for
adherence.
OUTREACH
1.5 1.5
All BIH LHJs will increase and •Afl BIH LHJs will conduct
expand community awareness outreach activities and buildof BIH by conducting outreach collaborati,ve relationships wittiactivities, including the use of local Women, Infants, andsocial media. Children (WIC} providers,
Comprehensive Perinatal
Services Program (CPSP}
Perinatal Service
Coordinators, soda! service
providers, health care
provide rs, the Faith-based
community, and other
community-based partners and
individuals to increase and
maximize awareness
opportunities to ensure that
eligrble women are referred to
B(H.•All BIH LHJs will establish
referral mechanisms that will
facilitate reciprocity with
partner agencies as
appropriate.•At a minimum, all BIH LHJs
will utiliz e social media
campaigns developed by
MCAH to increase community
awareness while conductino
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or lnte .rmediate Measures
(Report on these measures in the Annuall Report)
Short and/or Intermediate Outcome Process Description and Measures Measure{s)
1.5 1.5 •Describe the types of •Number of existing MOUs prior
communrty partner agencies to FY 2017-18. (E}
contacted by LHJ staff. (N)•Number of new Memorandum•Describe outreach activities of Understanding {MOUs)
performed in order to reach established i;n FY 2017 -18. ( E}
target population. {N)•Total number (overall and by•Descr ibe deviations in type) of outreach activities
outreacti activities, noting com pleted by all staff during
changes from local recruitment FY 2017-18. {E)
plan. (N)•Document type, frequency and
number of social media
activities conducted and
submit with Quarterly and
Annual Repor t (N)
Page 8 of 28 7/1/2018
Agency: County of Fresno, Department of Public Hea:th
Agreement Number: 201812
Short and/or Intermediate Intervention Activities to Meet
Objective{s) Objectives (Describe the steps. of
the intervention)
outreach activities.
PARTICIPANT RECRUITMENT
1.6 1.6
All BIH LHJs will recruit •Develop and implement a
African-American women 18 Participant Recruitment Plan
years of age, less than 30 (standardiz.ed intake process}
weeks pregnant. according to the target
population and eligibility
guidelines in MCAH-BIH P&P
and submit with Annual
Report.•Review Recruitment plan
annually and update as
needed.
PARTICIPANT REFERRAL
1.7 1.7
All BIIH LHJs will establish a •Collaborate with network of
network of referral partners. established partners
(community-based
organizat ions , traditional and
non-traditional partners, etc.)
to develop a network of
referral partners who will refer
eligible women to Bl H.•Provide referrals to other
MCAH programs for women
wh.o cannot participate in
qroup intervention sessions.
PARTICIPANT ENROLLMENT
1.8 1.8
BIH Coordinator, under the •Enroll women that are African-
guidance and leadership of the American.
MCAH Director will ensure the •Enroll women at or before 30following: weeks of pregnancy.•All participants enrolled •Enroll women that willin BIH will be African-participate in groupAmerican.intervention.
Fiscal Year: 2018-19
Evaruatio n/Perfonnance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Description and Measures Measure(s}
1.6 1.6 •Submit participant triage •Number and percent of
algorithm with submission of recruited and referred women
AFA packet.that were eligible {at least 18•Submit Participant Recruitment years old and less than 30
Plan with Annual Report.weeks pregnant) based on•Track and document progress their recruitment date. (E}
in meeting goals of the •Submit Recruitment Plan
Participant Recruitment P[an,August 15.
review annually and update as
needed.
1.7 1.7 •Describe process for ensuring •Total number of service
that referral partner agencies providers that made referralsare referring eligible women to to the Bl H Program in FYBIH in quarterly reports and 2017-18. {E)during technical assistance
calls. (N)
1.8 1.8 •Visual inspection of all •Number and percent of
recruitment eligibility fields on enrolled women who meet
incoming referral forms for eligibility criteria defined by
complete ness.age and timing of pregnancy.•Inclusion of eligibility criteria (E)-fldeJity Indicator A 1 b
with materials used for referral
and recruitmenl
Page 9 of 28 7/1/2018
Agency: Count}' of Fresno, Department of Pub1tc Health
Agreement Number: 2�18 IC
Short andlor Intermediate Intervention Activities to Meet
Objective(s) Objectives (Describe the steps of
the interventiont
•All participants will be 18
years or older when
enrolled in B.IH.•All participants will be
enrolled during pregnancy ..
0 All participants will be
enrolled at or befor e 30
weeks of pregnancy. •AH women will participate in
arouo intervention.
PROGRAM PARTICIPATION
1.9.1 1.9.1
BIH Coordinator, under the •Assign participants to aguidance and leadership of the prenatal group as part of
MCAH Director will en sure the enrollment process.following: •Schedule prenatal groups to•All women will participate in allow participants to atten d
a prenatal group.within 30 days of enrollment.•All women will particjpate in •Enroll participants in a prenatal
a group within 30 days of group within 30 days of first
enrollment.successful contact•All groups will be •·Begin groups with the
implemented according to minimum required number ofthe 20-group intervention participants per the BIH P&P.
mode I as sp ecified in the
P&P. (see 1.9.3)
1.9.2 1.9.2
BIH Coordinator, under the •Assign participants to a FHA
guidance and leadership of the as part of enro.llment process.
MCAH Director wm ,ensure the •Conduct case managementfollowing: services that align wrth Life•AH BIH participants will Plan activities (goal setting) .
recerve case management •Collect completed self-support as defined in the assessment administeredP&P.scaled questions as described•All BIH participants will in P&P.
Fiscal Year: 2018-19
Evaluation/Performance Measure.s
Process, Short and/or lntennediate Measures
(Report on these mea sures in the Annual Report)
Short andlor Intermediate Outcome Process Description and Measures Measure(s}
1.9.1 1.9.1 •Describe barriers, chall enges •Number and percer.t of
and successes of enrolling enrolled women who attended
women in a prenatal group a prenatal group session within
within 30 days of first 45 days of enrollment (E)-
successful contact during Fidelity Indicator A3a
technical as sistance calls. (N')•Number and percent of•Describe baniers. challenges enrolled women assigned to a
and successes of beginning pre.natal group. (E)
groups with the minimum •Percent of group sessions that
required number of were conducted in the
participants during technical prescribed sequence and at
assistance calls. (N)the prescribed time intervals.
(E)-Fidelity Indicator A3c•Percent of group sessions in a
series that were attended by at
least 5 participants. (E) -
Fidelity Indicator A3b.
1.9.2 1.9.2 •Collect and record service •Number and percent of
delivery activities for enrolled enrolled women assigned to
women into ETO. {E)an FHA. (E}•Report number and percent of •Number and percent of
enrolled women for whom the enrolled women who complete
following actions are prenatal and pos tpartum
completed (E}:assessments at the P&P-
0 Assigned to an FHA designated time in tervals. (E)
0 Intake procedures, •Number and percent of
Page 10 of 28 7/1/2018
Agency: County of Fresno, Department of Publtc Heaith
Agreement Number: 201810
Short and/or l.ntennediate Intervention Activities to Meet
Objective(s) Objectives (Describe the steps of
Fiscal Yeac 2018-19
Eva I uation/ Performance Measures
Prncess, Short and/.or Intermediate Measures
(RePOrt on these measures in the Annual Report)
the intervention) Short and/or In termediate· Outcome Process Des cription and Measures Measure(s)
complete aH prenatal and •Collect the requir ed number of including completion of an enrolled women who are postpartum assessments assessments per timeframe initial assessment and assigned to a prenatal group within the recommended outlined in P&P.assigned date of initial upon enrollment. time intervals. •Develop and implement a Life prenatal group. •Number and percent of•All BIH participants will Plan based on goal setting 0 Initial case conferencing. enrolled women who received receive referrals to services during Life Planning meetings 0 Life Planning meetings. at least one ( 1 ) case outside of BIH based on Uf-e for eae,h BIH participant;0 Prenatal: and Postpartum con ference at tended by a FHA Planning meetings.compl'ete all prenatal and assessments. or GF, and either the MHP or
postpartum asses sments;0 Birth Plan PHN. (E) -Fidelity Indicator
provide ongoing identification 0 Referrals A2a
of her specific concerns/needs 0 Participant dismissal •Percent of enrolled women
and referral to services outside •Describe succe sses and/or who have (a) a long-term goal
of BIH as needed based on challenges in assisting and (b) one, (1) or more short-Life Planning meetings.participants with setting short term goals documented in one•Ensure participant referrals are and long-term goals during life {1) of the three (3) focus areas
generated and completed for Planning meetings. (N) (health, r,elationship, and
all services identified.•Describe program finances} (among women.,Conduct participant dismissal improvements resulting from enrolled 30 days or longer)
activities.participant satisfaction survey during Life Planning meetings.•Conduct participant findings at least quarterly. (N)(E)-Fidelity Indicator P1a
satisfaction surveys.•Number and percent of•Submit complete and accurate enrolled women with a Birth
reports in the hmeframe Plan collected before the
specified by MCAH.expected date of delivery
(among women past due)-. (E)
-Fidelity Indicator
(supplemental) A4ai.•Number and percent of
enrolfed women who have a
known referral status for every
documented referral at time of
exit from the program (among
women dismissed from
BIH).(E}-Fidelity Indicator
Q4a•Number and percent of
enrolled women who have not
l:leen dismissed from BIH two
(2l or more months after
Page 11 of 28 7/1/2018
Agency: Count )1 of Fresno. Department of Public Heatth
Agreement Number: 201810
Short andlor Intermediate Intervention Activities to Meet
Objective(s) Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or lntennediate Measures
(Report on these measures in the Annual Report)
the intervention) Short and/or Intermediate Outcome Process Description and Measures Measure(s)
completion of tlleir :1ast
postpartum group. (E} •Number and percent of
enrolled women who have
been dismissed from BIH with
a completed participant
satisfaction survev. (E)
1.9.3 1.9.3 1.9.3 1.9.3
BIH Coordinator, under the •Schedule Group Interve ntion •Colle ct and re cord Group •Number of Group Intervention
guidance and leadership of the Sessions with guidance from Intervention Session Sessions entered into ETO
MCAH Director will ensure that State BIH Team.attendance records for all that began during FY 2017-18.
all BIH participants will •AU participants will have the en rolled women into ETO. (E)(E}
participate in Group opportunity to enroll in Group •Submit FY 2018-19 Group •Number and percent ofLntervention Sessions. Intervention Sessions within 30 I nte rvention Sessions enrolled women who attend at
days of the first successful Ca lendar to MCAH-BlH least one (1) prenatal! Group
contact.Program with submission of Inte rvention Session. (E)•Conduct and adhere to the 20-AFA and upon request •Number and percent of
group intervention model as •Describe particip ant successes enrolled women who attended
spe cified in the P&P.or challenges with completing the expe cted number of Group
seven (7) of ten (10) pr enatal Intervention Sessions based
and/or postpartum Group upon the number of days in
Intervention Sessions.program (E) -Fidelity
Indicators 01a and D1b.
PARTICIPANT RETENTION
1.9.4 1.9.4 1.9.4 1.9.4
BIH Coordinator, under the •Discuss and develop participant •Discuss participant rete ntion •Submit Participant Retention
guidance and leadership of the retention strateg ies during team strate gies during technical Strategies witll Quarterly and
MCAH Director will ensure that meetings.assistance calls. (N)Annual Report. {N)
participant retention strategies •Plan part icipant retention •Review participant retention
are in pface. strategies as they relate to st rat egies quarterly and
program implementation update as nee ded. (N)
components •Do cument parti.cipant
(outrea ch/ recru ilm e nt, en ro 11 ment,retention stra tegies in ETO
Life Planning, group sessions,and in Quarterly Reports.
program completion}.(E/N)•Designated staff will conduct •Submit participant retention
participant satisfaction surveys strategy successes and
after group sessions and at challenges with Annual
pr ogram completion to obtain Report. (N)
Page 12 of 28 7/1/2018
Agency: C:t..nty of Fresno Department of Fublic Health
Agreement Number. .2.0'i8·10
Short and/or lntennediate Intervention Activities to Meet
Objectrve{s) Objectives (Describe the steps of
the intervention)
feedback related to improvement
of retention slrateqies.
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Desciiption and Measures Measure{s)
Page 13 of 28 7/1/2018
Agency: County of Fresno. Department of Public Health
Agreement Number: 20181 �
Fiscal Year: 20118-19
Goal 2: Engage the African American community to support African-American familie .s' health and well-being with education and out,reach efforts.
EvaluationJPerformance Measures
Short and/or l.ntermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objective(s) Objectives . (Describe the steps of {Report on these measures in the Annual Reoortt
the· intervention) Short and/or Intermediate Outcome Process Description and Measures Measure{s)
2.1 2.1 2.1 2.1
BIH Coordinator under the •inform the community about •Submit quarterly reports that •Number, format, and outcomesguidance and leadership of the disparate birth outcomes describe outreach activities associated with, communityMCAH Director will increase among African-American electronically using ETO in a outreach activities conducted byand expand community women by delivering timely manner. (N}BIH Coordinator and/or MCAHawareness of African-American standardized messages •Document the local plan for Director during FY 2017-18.birth outcomes and the role of describing how the BIH community linkages, including an {E/N)the Black Infant Health Program addresses these effective referral process that wi,11Program. issues.be reviewed on an annual basis•Create partnerships with and updated as ne eded. (N)
community and referral •Document successes and
agencies that support the barriers to communi'ty education
broad goals of the BlH ac tivities or events at l,east once
Program, through formal and per quarter in the ETO through
informal agreements.quarterly reporting. (E/N}•Develop and implement a •List and maintain ourrent
community awareness pfan documentation on the nature of
that outlines how community formal and informal par tnerships
engagement achvities will be with community and referral
conducted.agencies at least once a quarter;•Develop and implement record MOUs and referral
activ ities related to multi-levet relationships in the ETO service
community engagement and provider details form. (E/N)
awareness wi:th refer,al •Document community efforts
partners to identify service such as advisory board
gaps in th e LHJ target area.involvement community•Develop pe rformance collaborations or other similar
strategies with local formal or informal partnerships lo
organizations that provide address maternal and infant
services to AA women and health disparities, social
infants to improve re ferrals de terrninants of health, well-
and linkage to BIH services.woman visits and postpartum•·Colilaborate with local MCAH visits at least once per quarter.
programs and other partners (N}
such as Me di-Cal to identify •Enter all outreach activities in the
strategies, activities and Community Contacts Log i11
orovide technical assistance ETO.
Page 14 of 28 7.11/2018
Agency: County of Fresno, Department of Public Health
Agreement Number: 201810
Short and/or lntermed.iate Intervention Activities to Meet
Objective(s} Objectives (Describe the steps. of
the intervention)
to:
C Improve access to health
care services
C Increase utilization of
well-woman and
postpartum vis its
0 Identify Preterm Birth
(PTB) reduction strategies
0 Increase the ut ilization of
preconception health
services. •Collaborate with local MCAH
programs and Regional
Perinatal Programs to improve
maternal and perinatal
systems of care.•Participate in collaboratives
with community partners to
review data and develop
strategies and policies to
address social determinants
of health and disparities.•Collaborate with agencies
providing services to AA
moms to develop and
disseminate tangible
Reproductive Life Planning
training materials (e.g. power
point presentation, webinars,
toolkits. etc.) to focus on
Before, During, and Beyond
Pregnancy for dissemination
and integration in their service
delivery protocols.
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process De .scription and Measures Measure{s) •Document collaborative efforts
with local MCAH programs and
Regional Perinatal Programs
describing strategies to improve
maternal and perinatal systems
of care at least quarterly. {N)•Maintain current lists of
community providers and Servic e
Provider details in ETO. (E)
Page 15 of 28 7/1/2018
Agency: County of Fresno, Department of Public Health
Agreement Number: :201810
Short and/or intermediate Intervention Activities to Meet
Objective(s> Objectives (De scribe the steps of
the intervention)
2.2 2.2
BIH COL wiH increase •Develop collaborative
information sharing with other relationships with local Medi-local agencies prov iding Cal Managed Care,
services to African-American Commercial Health Plans, WICwomen and children in the and local agencies in thecommunity and establish a community that provideclear point of contact_ services to African-Am erican
women and children. to
establish stro11g resource
linkages for recruitment of
potential participants and for
ref errals of active participants.•Develop a clear point(s) of
contact with collaborating
community agencies on a
regular basis as it relates to
outreach, enrollment, referrals,
care coordination, etc_•Assess referrals from partner
agencies to determine
emollment points of entry
quarterlv.
Fiscal Year: 2018-19
Evaluation/Performa nee Mea sures
Process, Short and/or lntennediate Measures
(Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process DescripUon and Measures Measure(s)
2.2 2.2 •Enter all outreach activities in the •Number of agencies where the
Community Contacts Log in COL has a documented point(s}
ETO. (E}of co11tact and with whom•Maintain current lists of information is regularly
community providers and Service exchanged. ( E)
Provider details in ETO. (E}•Total number of agencies with•Describe materials used to outreach records during FY
inform community part11ers about 2017-18. (E)
BIH. {N)•·List and describe barri ers,
chall.enges and/or success es
related to establishing community
partnerships and point(s} of
contact at least quarterly. {N)
Page 16 of 28 7/1/2018
Agency: Ccunty of Fresno, Departfllent of Public .,ealth
Agreement Number: 2:::1s1c
Goal 3: Increase the ability of African-American women to manage chronic stress
Short andJor Intermediate Intervention Activities to Meet
Objective{s) Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
{Report on these measures in the Annual Reoortl
the intervention) Short and/or Intermediate Outcome Process Description and Measure.s Measure(s}
3.1 3_1 3.1 3.1
BIH Coordinator under the •Implement the prenatal and •Provide FY 2017-18 group •Number and percent of
guidance and leadership of the postpartum group int ervention intervention schedul es upon enrolled participants who naveMCAH Director will ensure that with fidelity to the P&P.request. (N)both a baseline and follow-up
all BIH participants will have •Encourage participants to •Percent of participants who me asurement in social support
their social support measured attend and participate in group meet expected prenatal life as mea sured through the SPS-
at baseline and after attending sessions.planning session attendance S, (E)
the prenatal and/or postpartum •Support clients in fostering (prenatal dose). (E) -Fidelitygroup intervention and healthy interpersonal and lnd;cator D2acompleting life Planning familial re lationships.•Percent of participants whoactivities using the Social •Report results from group meet expected prenatal groupProvisions Scale -Short (SPS-session information form,session attendance (prenatalS)-including description of dose). (E) -Fidelity Indicator
participant engagement in 01a and D1b.
group ac tivities for each group
sessi on.
3.2 3.2 3.2 3.2
BIH Coordinator under the •LHJ staff will facilitate the •Describe cil a II e ng es/barriers •Number and percent of
guidance and leadership of the administration of the self-why participants did not have enrolled participants who have
MCAH Director will ensure that esteem, mastery, coping, and their self-esteem, mastery,both a baseline and follow-up
all BIH participants will have resiliency tools and their coping and resiliency measurement in self-esteem
their self-esteem, mastery, frequency as outlined in the measured after attending as measured through the
coping and resifiency measured P&P focused on the prenatal and/or postpartum Rosenberg Self-Esteem Scale.
at baseline and after attending participant's ability to be group intervention and (E)prenatal and/or postpartum resilient and manage chronic completing Life Planning •Number and percent of
group intervention and stressors presenting during activities. (N}enrolled participants who havecompleting Life Planning pregnancy.both a baseline and follow-upactivities using the Rosenberg •All activities are delivered with measurement in mastery as
Self-Esteem,. Pearlin Mastery an understanding of African-measured through the Pearlin
and the Brief Resilience Scales. American culture and history.Mastery Scale. (E)•Assist participants in •Number and percent of
identifyin g and utilizing their enrolled participants who have
personal strengths.both a baseline and follow-up•Develo p and implement a Life measurement in coping and
Plan with each client resiliency as measured•Teach and provide support to through the Brief Resilience
oarticioants as thev devel op Scale. (E)
Page 17 of 28 7/1/2018
Agency: County of Fresno. Department of Public Health
Agreement Number: 20181G
Short andlor Intermediate Intervention Activities to Me.et
Objective(s) Objectives {Describe the steps of
the intervention)
goal-setting skills and create
their Life Plans. •Teach participants about the
importance of stress reduction
and guide them in applying
stress reduction techniques.•Support participants as they
become empowered to take
actions toward meeting their
needs.•Teach participants how to
express their feelings in
constructive ways.•Help participants to
understand societal influences
and their impact on African-
American health and
wellness.
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short andlor Intermediate Measures
{Report on these measures in the Annual Report)
Short and/or Intermediate Outcome Process Description and Measures Measure(s)
Page 18 of 28 711/2018
Agency: County of Fresno, Department of Pubiic Health
Agreement Number: 20".810
Fiscal Year:. 2018-19
Goal 4: Improve the h.ealth of pregnant and parenting African American women and their infants
Evaluation/Perfonnance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measur es
Objective( s) Objectives (Describe the steps of {Report on these measures in the Annual Report)
the intervention) Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1 4.1 4.1 4.1
BIIH Coordinator under the •Assist participants in •list and document addittonal •Number and percent of
guidance and leadership of the un derstanding behaviors that activities (e.g., Champions for participants and infants who
MCAH Director will ensure that co ntribute to overal'I good Change co oking obtained health and
atl BIH par ticipants will be health, including:demonstrations} conducted community services while
linked to services that support 0 Stress management that promote health and enrolled in BIH. (E)
health and wellness while 0 Sexual health wellness of BIH participants •Number and percent ofenrolled in the BIH Pirogram. 0 Healthy relationships and their infants at least once participants whose healthy
0 Nutrition per quarter.. (N/E}eating behaviors improve over
0 Physical activity •Describe collaborative efforts the course of their participation•Ensure that participants are with March of Dimes,in BIH (E)
enrolled in health insurance MotherToBaby and other •Number and percent of
and are receiving risk-agencies that provide health participants whose physical
appropriate pe rinatal, care.education, preterm birth activity increased over the•Ensure that healthy nutritious reduction materials and course of their participation in
food is avaHable during group resources.BIH. (E}
sessions.•Number and percent of•Provide participants with recruited and enrolled
health information that participants reporting drug.
supports a heafthy pregnancy.alcohol and/or tobacco use•Provide participants with who are provided information
health education materials that and health education. (E)
address preterrn birth •Number and percent of
reduction strategies, such as participants receiving prenatal
the MCAH-8 I H prematurity care by· trimester of program
awareness and Provider sheet initiation. (E}
tip sheet.•Number and percent of•Identify participants' health,participants uninsured at
dental and psycho-social enrollment who reoeived
needs and provide referrals referral and foflow-up for
and follow-up as needed to health insurance before
health and community delivery. ( E)
services.•Number and percent of•Provide i nformation and health participants who complete a
education to participants who birth plan. (E)
report drug, alcohol and/or
tobacco use.
Page 19 of 28 7/1/2018
Agency: Count•,, of Fresno. Department of Public Health
Agreement Number: 201810
Short and/or Intermediate Intervention Activities to Meet Objectives (Describe the steps of Objective(s) ttle intervention)
•Assist participants with
comple tion of the birth plan
that outlines specific
labor/delivery and birthing
requests to be conveyed to
their .prenatal care provider.4.2 4.2 BIH LHJ staff will coordinate •Promote and support familywith State MCAH and BIH staff planning by providingto assist BIH Participants with information and education onincreased knowledge and birth spacing andunderstanding of a interconception health duringReproductive Life Plan and group sessions and LifeFamily Planning services by Planning Meetings.providing cu lturally and •Help participants understandlinguistically appropriate tools and value the concept offor integration into existing reproductive life planning asprogram materials. Life Plans are comple ted and
discussed with Family Health
Advocates during Life Planning
Meetings and Group
Facilitators during group
sessions.•Provide referrals and promote
linkages to family planning
providers including Family
Planning, Acce ss, Care. and
Tre atment (Family PACT).•Help part icipants understand
the characteris tics of healthy
relationships and provide
resources that can help
participants deal with abuse,
reproductive coercion or birth
control sabotaqe_
Fiscal Year: 2018-19
Evaluation/Performance Measures Process, Short and/or Intermediate Measures I Report on these measures in the Annual Report)
Process Oescription and MeasUf'es I Short aod/or���::r:�fte Outcome
4.2 4.2 •Summarize •Number and percent of
challenges/barriers of birth participants who use any
control usage among enrolled method of birth control to
women who have delivered.prevent pregnancy after their
(N)babies are born. (E)•Do cument collaborative •Number and percent of
activities with local MCAH participants who attend a 4--6
programs and other partners week postpartum checkup
such as Medi-Cal Managed with a medical provider. (E}
Care and CPSP Provider
networks to identify strategies,
activities and provide
technical assis tance to
improve access to health care
services and increase
utilization of the postpartum
visit. (N)•Describe co llaborative efforts
with Violence Prevention
Organizations such as
Futures without Vio lence to
de termine service capacity to
adequately meet needs
identified by participants and
LHJ staff pro viding case
management service s. (N)
Page 20 of 28 7/1/2018
Agency: County of Fresno, Department of Public Heaith
Agreement Number: 201810
Short and/or Intermediate Intervention Activities to Meet
Objective(s} Objectives (Describe the steps of
the intervention)
4.3 4.3
BIH Coordinator under the •local staff will work with or
guidance and leadership of the support participants to:
MCAH Director will ensure that 0 Understand how mental
all BIH participants will be health contributes to
screened for Perinatal Mood overall health and
and Anxiety Disorders (PMAD) wellness.
and those with positive screens 0 Recognize the connection
will be given a referral to mental between stress and
health services. mental health and
practice stress reduction
techniques,
0 Help part.icipants
understand the
connection between
physical activity and
mental health,
0 Understand the symptoms
of postpartum depression. •Local staff will adminjster the
Edinburgh Postpartum
Depression Screen (EPDS) to
every participant 6-8 weeks
after she gives birth; and•Provide referrals and follow-
up to mental health services
when appropriate.
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the An nual Report}
Short and/or Intermediate Outcome Process Description and Measures Measure(s)
4.3 4.3 •Summarize successes and •Number and percent cf
challenges in addressing enrolled participants who
mental health issues,completed the EPDS 6-8
including mental health weeks postpartum. (E)
referrals at least once per •Number and percent of
qu arter. (N)partici pants with "positive»
EPDS screens with a
recorded referral to a
community mental healtln
provider within two (2} weeks
after the EPDS collection
date. {E)
.
Page 21 of 28 7/1/2018
Agency: Coumy of Fresno. Department of Public Hearth
Agreement Number: 201 B '0
Short and/or Intermediate Intervention Activiti.es to Meet
Obj ective(s }-Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual ReoorO
the intervention) Short and/or lnterm.ed iate Outcome Process Description and Measures Measure{s) 4.4 4.4 4.4 4.4 All BIH participants will report •Assist participants in •List and describe additional •Number and percent ofan increase in parenUng skills understanding and applying activrties that enhance participants. who complete theand bonding with their infants effective parenting parenting and bonding. (N)safety checklist and receiveand other family members .. techniques.•Provide anecd ates/participant health education materials•Assist participants with success stories about related to safe sleep practices
completing home safety improved parenting/bonding and SIDS reduction prior to
checklist.with submission of BIH delivery. (El•Asscst participants with Quarterly Reports.•Number and percent of
increasing knowledge of infant •Provide participants with po stpartum participants who
safe sleep practices, SIDS,health education materials initiate breastfeeding. (E)
Sudden Unexplai11ed Infant related to safe sleep practices •Number and percent of
Death (SUI □) risk reduction.and SIDS reduction.prenatal participants who•Assist participants with •List and describe additional complete a birth plan prior to
completion of the birth plan activities on infant safe slee p delivery. (El
that outlines specific practices/SIDS/SU ID risk
labor/delivery and birthing reduction. {N)
requests to be conveyed to •Provide an ecd ates/pa rticipant
their prenatal care provider.success stories about infant•Provide participants w,th safe sleep practices and
health education materials SIDS/SU ID risk reducbon with
addressing the benefits of submission of BIIH Quarterly
breastfeeding.Reports. {N}•Assist participants witll •Document collaboraUve-
identifying and using bonding activities with State MCAH
strategies, including Programs used to identify
breastfeeding, with their strategies, provide technical
newborns.assi,stance and disseminate
resource materials that
address the benefits of
breastfeeding. (N)•Provide anecdotes/participant
success stories a bout
br,eastfeeding practices with
submission of BIH Quarterly
Reports.
Page 22 of 28 7/1/2018
Agency: Coun:y of Fresno Department of Public Health
Agreement Number: 201 B10
Fiscal Year: 2018-19
Goal 5: Improve preconception health by decreasing risk factors for adverse life course events among African American women of reproductive age.
Evaluation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or lntermed;ate Measures
Objective(s) Objectives (Describe the steps of (Report on these measures in the Annual Report)
the intervention} Short and/or Intermediate Outcome Process Desciiption and Measures Measure(sl
5.1 5.1 5.1 5.1
BIH Coordinator under the •Ensure that participants are . Describe collaborative •Number and percent of
guidance and leadership of the enrolled in prenatal care and activities with Text 4 Ba by to participants receiving prenatal
MCAH Director will ensure that are receiving risk-appropriate deliver health education care by trimester of program
all BIH participants are linked to perinatal care.messages to pregnant women initiation. (E)
services that support timely •Provide participants with about the importance of •Number and percent of
prenatal care and postpartum health education materials postpartum visits. (N/E) participants who attend a 4-6
visits while enrolled in the BIH and messages including but . Document coUaborative week postpartum checkup
Program. not limited to: the importance activities with March of Dimes with a medical provider. {E)
of attending prenatal care (MOD), MotherToBaby and
visits; recognizing the signs other agencies tl7at provide
and symptoms of preterm preterm birth reduction and
labor; safe steeping practices.health education resources •Provide participants with and messaging (N)
health information that . Describe cotlaborative efforts
supports a healthy pregnancy.with local MCAH programs •Ensure that participants are and other partners such as
attending postpartum visits as Medi-Cal Managed Care and
scheduled.CPSP to identify strategies,
•Increase knowledge of and activities and provide
facilitate collaboratio n with technical assistance to
local MCAH programs to improve access to he alth care
improve perinatal and services and increase
post-partum referral systems utilization of the postpartum
for hiqh-risk participants.visit (N)
Page 23 of 28 7/1/2018
Agency: Ccun:y of Fresno Department of Public Health
Agreement Number: 20'1810
Fiscal Year: 2018-19
Goal 6: Reduce Infant Morbidity and Mortality by decreasing the percentage of preterm births.
Eva I uation/Performance Measures
Short and/or Intermediate Intervention Activities to Meet Process, Short and/or Intermediate Measures
Objectives (Describe the steps. of (Report on these measures, in the Annual Report) Objective(s) the intervention) Short. and/or Intermediate Outcome Process Description and Measures Measure(s)
6.1i 6.1 6.1 6.1
BIH Participants wm have an •Prov ide participants with •Participate in MOD webir1ars •Maintain records of staff
increased knowledge of health education materials and trainings that provide LHJ attendance at trainings. (N!}
strategies and interventions that address preterm birth staff with opportunities lo •Maintain attendee ,ecords ofthey can utiliz.e to reduce the reduction strategies; from increase their knowledge of trainings/Webinars hosted byoccurrence of p,reterm births. MCAH-BIH and MOD.preterm birth reduction LHJ. {N)•LHJ staff will d.istribute any strategies and other •Number and percent ofcustomized preterm birth approaches for having a participants who complete theresources to local medicall healthy pregnancy. (N}safety checkli,st and receiveproviders and monitor/track •Distribute and encourage health education materialshow providers utilize and/or MCAH programs to integrate related to preterm birthincorporate resources to the following preterm birth reduction prfor to delivery. (E)engage clients in service resources to educate women •Number and percent ofdelivery.and providers on preventing participants who complete the•LHJ staff will support,preterm births: (N)safety checklist and receivepromote, and attend preterm C Reducing Preterm Birth: health education materialsbirth educational webinars for What Black Warne n Need related to safe sleep practicesm edical1 providers.to Know Tip Sheet and SIDS reduction prior to .-•Assist participants with 0 Reducing Premature delivery. (E)increasing knowledge of infant Birth: What Providers •Number and percent ofsafe sleep practices, SIDS,Need to Know Tip Sheet postpartum participants whoSU I D risk reduction by 0 Reducing Premature Birth initiate breastfeeding. (E)participating in local SIDS Discussion Points -
coll aborative meetings and guidance to encourage
trainings.conversation with women •Provide participants with about
health education materials •Facilitate one -two
addressing the benefits of educational webinars for
breastfeeding.med ical providers on topics
such as: (N)
0 Holes and
Res ponsibilitie.s: Steps to
Prevent Preterm Birth
0 The use of i 7P to prevent
preterm birth
0 Reducing Preterm Birth:
Evidence-Based
Page 24 of 28 7/1/2018
Agency: County of Fresno, Department of Pubhc Health
Agreement Number: 2C • 810
Short and/or Intermediate Intervention Activities to Meet
Objective(s) Objectives (Describe the steps of
Fiscal Year: 2018-19
Evaluation/Perfonnance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
the intervention} Short and/or Intermediate Outcome Process Descri'Ption and Measures Measure(s)
Strategies to Improve
Outcomes •Provide participants with
health education materials
related to safe sleep practices
and S10S reduction. (N)•Document collaborative
activities with State MCAH
Programs used to identify
strategies, provide technical
assistance and disseminate
resource materials that
address the benefits of
breastfeedinQ. (N}
Page 25 of 28 7/1/2018
Agency: County of Fres110, Department of Public Health
Agreement Number: 2�7810
Table 1 -Black Infant Health Selected Fidelity Dimensions, Measures and Indicators ] (Revised 7/1/2017)
DIMENSION MEASURE INDICATOR
A.Lil. Percent of recruited women that either a) enroll within 2 working days
orb) receive a documented contact within two working days of the
recruitment date
A.l. b. Percent of en ro lied wome 11 who meet eligibility criteria deli ned by ageAl. Adherence to and timjng of pregnancy
orientation and
enrollment standards A.1.c. Percent of recruited women who enroll within 14 days of their first
i n-pe rs.on or phone contact
Al.d. Percent of enrolltxl women whose Rights, Responsibil.ities aml
Consent form was administered by either the Mental Health Professional,
the BIH Coordinator, or the Public H ea Ith Nurse
ADHERENCE A2 Coordination of A. 2 .a. Percent of enrolled women who re<"e1ve at least one case conference
seN1ce provision attended by the Family Health Advocate or Group facilitator and either
the M enta I Hea Ith P rofess1ona I or Puolic 1-leaJtti Nurse
A.3.a. Percent at enrolled women who attend a g.roup sess,ori within 4S days
or enrollment.
t\..3.b. Percent ot group ses�kmsattende-d by at lea�t S part1<,1pants
A3. Adherence of grnup A.3.c. Percent of g,roup sess,ons that were conduned ,n the r,resci ibedprogfam delivery to
standards sequence and a, the prescribed ti1nE' lmervals
A.3.o. Percent of group sessions that WE're led by two !f<1med facilitat.o�
A.3.e. Percent of part1i:,pants attending a prenc1tal .group s.ene� who attend
session 1, 1, or 3
Page 26 of 28
Fiscal Year: 2018-19
7/1/2018
Agency: Courty of Fresno. Departme11t of Public Health
Agreement Number: 201810
01.Completeness of
group sessions attended
DOSE
02.Completeness of life
planning meetings
attended
Fiscal Year: 2018-19
O.1.a.
[PHELIMINARY]2-Percent of women enrolled at least 45 days that have
attended the expected number of prenatal group sessions in the prescribed
P&P tiimeframes.
To date, number of days since women Minimum Expected Number of
enrolled ... Group Sessions Attended
Oto 44 days Not measured
45to60 days 1
61 to67 days
68 to74 days 3
75 to81 days 4
82to 88days 5
89 to9Sdays 6
96 days or more 7
[FINAL)2-Percent of enrolled women who have attended 7 or more prenatal
group se>Sions
D.2.a.
[PRELIMINARY]2-Percent of women enrolled for at least 30 days who have
attended the expected number oflrfe planntng meetings
To date, .number of days since wamen Minimum Expected Number of
enrolled�. Life Planning Meetings Attended
Oto 29days Not measured
30to 44days l
45 to 59days 2
60 to BS days 3
Page 27 of 28 7/1/2018
Agency: County of Fresno, Department of Public Hea Ith
Agreement Number: 20181 C
11
1. S011rce: 81!-f Fide lity Methods Presentation f Janu.ar�• 2'016)
Fiscal Year:. 2018-19
I 86 d!ays or more I 4 I
[FINALP -Percent of en ro I led women who have attended 4 or more pre nara I
,hfe p:lanning meeUngs.
2.Preliminary close indicators are u.sei:l when there is less thon 6 mon rhs between-recrvitment cohort end 1:late and data extraction date. Fina I dose scores are only when a minim um of 6 months lag exists bet\vee.n
the end elate and the dat.i exu-acti-0 n d•ate.
Page 28 of 28 7/1/2018
CERTIFICATION OF INDIRECT COST RATE METH_O_D_O-LO_G_Y __ 7
Please list the Indirect Cost Rate (ICR) Percentage and supporting metMdology for the contract or
allocation with the California Department of Public Health, Maternal Child and Adolescent Health
Division (CDPl-1/MCAH Division).
Agency Name: County of Fresno
Contract/Agreement Number: 201810 Contract Term/Allocation Fiscal Year: 201?�
_L NON-PROFIT AGENCIES/ COMMUNITY BASED ORGANIZATIONS (CBO)
Non-profit agencies or CBOs that have an approved ICR from their Federal cognizant agency are
allowed to charge their approved ICR or may elect to charge less than the agency's approved ICR
percentage ra te.
Private non-profits local agencies that do not have an approved ICR from their Federal cognizant
agency are allowed a maximum ICR percentage of 15.0 percent of the Total Personnel Costs.
The ICR percentage rate listed below must match the percentage listed on the ContracUAllocation
Budget.
0.00% Fixed Percent of:
D Total Personnel Costs:
2.LOCAL HEA_LTH JURISDICTIONS (LHJ)
LHJs are allowed up to the maximum ICR percentage rate that was approved by the CDPH
Financial Management Branch ICR or may elect to charge less than tt1e agency·s approved ICR
percentage rate. The ICR rate may no t exceed 25.0 perce n t of To tal Personnel Costs or 15.0
percent of Total Direct Costs. The ICR application (1.e. Total Personnel Costs or Total Allowable
Direct Co sts) may not differ from the approved ICR percentage rate.
The ICR percentage rate listed below must match the percentage listed on the
Allocation/Contracted Budget.
25% Fixed Percent of.BJ Total Personnel Costs:
[] Total Allowable Direct Costs:
3.OTHER GOVERNMENTAL AGENCIES AND PUBLIC UNIVERSITIES
University Age ncies are allowed up to the maximum ICR percentage approved by th e agency's
Federal cognizant agency ICR or rnay elect to charge less than the agency's approved ICR
percentage rate. Total Personnel Costs or Total Direct Costs cannot change.
0.00% Fixed Percent of:
0 Total Personnel Costs {Includes Fringe Benefits)
0 Total Personnel Costs (Excludes Fringe Benefits)
D Total Allowable Direct Costs
Version: 2/2017 Page 1 of 2
CERTIFICATION OF INDIRECT COST RATE METHODOLOGY
Please provide you agency's deta iled methodology that includes all indirect costs. fees and
percentages in thre box below.
I County of Fresno. Department of Public Health's Indirect Cost Rate (ICR) of 26.5% was
calculated by dividing the T otal Allowable Indir ect Costs by the Total Allowable Direct Costs for Salaries. The ICR was prepared and calculated using the 2015-2016 actual costs and budget information for the Department of Public Health. The allocation of allowable indirect costs were accomplished by classifying the total cost, based on actual cost incurred, as direct or indirect cost. which included salaries. benefits. computer services, audit services, janitor ial services, rental expenses, mileage/travel, office supplies, telephone, liability insuran ce, etc The ICR is based on the most recent audited financials for the County which received an unqualified clean opinion from the County's independent external auditors.
This rate was reviewed and approved by the County of Fresno, Auditor-Controller/TreasurerTax Collector. County will claim CDPH's approved ICR of 25% of Total Personnel Costs for the Black Infant Health program.
Please submit this form via email to your assigned Contract Manager.
The undersigne d certifies that the costs used to calculate the ICR are based on the most recent. available and independe ntly audited actual financials and are the same costs approved by the CDPH lo delecmme th
�
Signatu,e: �
Printed First & Last Name: �ose Mary Rahn
Title/Position: MCA!-! Director, Division Manager
Date: � l'? ... I
Version: 2/2017 Page2of2
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
Agency Name: County of Fresno
AgreementJGrant Number: __ Z01810
Compliance Attestation for Fiscal Year: 2018-19
n,e Sexual Health Education Ac countability Act of 2007 (Health and Safety Code, Se ctions
151000 -151003) requires sexual health education progra ms (programs) that are funded or
administered, directly or indirectly, by the State. to be comprehensive and not abstinence-only.
Specifically, these statutes require p rograms to provide information that 1s medically accurate,
current, and objective. 1n a manner that is age, culturally , and linguistically appropriate for targeted
audiences. Programs c annot promote or teach religious doctrine. nor promot e or reflect bias (a s
define d 1n Section 422.56 of the Penal Code), and may be required to explain the effectiveness of
one or more drugs and/or devices appro ved by the federal Foo d and Drug Administration for
preventing pregnancy and sexually transmitted diseases Programs directed at minors are
additionally required to specify that abstinence is the only certain way to prevent pregn ancy and
sexually transmitted diseases.
In order to comply with the mandate of Health & Safety Code, Section 151002 (d), the California
Department of Public Health (CDPH) Maternal, Child and Adolescent Health (MCAH) Program
requires each applicable Agency or Community Based Organization {CBO) contracting with MCAH
to submit a signed attestation as a co ndition of fun ding. The Attestation of Compliance must be
submitted to CDPH/MCAH annually as a required comp onent of the Agreement Funding
Application (AFA) Pa ckage. By signing this letter the MCAH Director or Adolescent Family Life
Program (AFLP) Director (C!:30s only) is attesting or "1s a witness to the fact that the programs
comply with the requirements of the statute··. The signatory is responsible for ensurin g compliance with the statute. Please n ote that base d on program policies that define them, the Sexual Health
Education Act inherently applies lo the Black Infant Health Program, AFLP, and the California
I tome Visitin g Program, and may apply to Local MCAH based on local activities.
The undersigned hereby attests that all local MCAH agencies and AFlY CBOs will comply with all
applicable provisions of Health and Safety Code, Sections 151000 151003 (HS 151000-
151003). The undersigne d furth er acknowledges that this Agency is subject to monitorin g of
compliance with the provisions of HS 151000-151003 and may be subject to contract termination
or other appropriate action if it violates any condition of fundin g, including those enumerated in HS
151000-151003,
Signed
Signature of MCAJ.-1 Director
Signature of AFLP Director (CB Os only)
Ros�M_ary Rahn
Printed Name of MCAN Director
Pnnted Name of AFLP Director (CBOs only)
Page 1 of 3
Agroomcnt/Grnnt Nurnbcr
Date
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
CALIFORNIA CODES
HEAL TH AND SAFETY CODE
SECTION 151000-151003
151000. This division shall be known, and may be cited, as the Sexual Health Education
Accountability Act.
151001. For purposes of this division, the following definitions shall apply:
(a} "Age appropriate" means topics, messages, and teaching methods suitable to particular
ages or age groups of children and adolescents, based on developing cognitive, emotional,
and behavioral capacity typical for the age or age group.
(b)A "sexual health education program" means a pr ogram that provides instruction orinformation to prevent adolescent pre gnancy, unintended pregnancy, or sexually
transmitted diseases, including HIV, that is conducted, operated, or administered by any
state agency, is funded directly or indirectly by the state, or receives any financial
assistance from state funds or funds administered by a state agency, but does not include
any program offered by a school district, a county superintendent of schools, or a
community college district.
(c)"Medically accurate'' means verified or supported by research conducted in compliance with
scientific methods and published in peer review journals, where appropriate, and
recognized as accura te and objective by pr ofessional organizations and agencies with
expertise in the relevant field, including, but not limited to, the federal Centers for Disease
Control and Prevention, the American Public Health Association, the Society for AdolescentMedicine, the American Academy of Pediatrics, and the American College of Obstetricia ns
and Gynecologists.
151002. (a) Every sexual health educa tion program shall satisfy all of the following requirements:
(1)All information shall be medically accurate, current, and objective.
{2) Individuals providing instruction or information shall know and use the most current scientific
data on human sexuality, human development, pregnancy, and sexually transmitted
diseases.
(3)The program content shall be age appropriate for its targeted population.
(4)The program shall be culturally and linguistically appropriate for its targeted populations.
{5) The program shall not teach or promote religious doctrine.
{6) The program shall not reflect or promote bias against any person on the basis of disability,
gender, nati onality, race or ethnicity, religion, or se xual orientation, as defined in Section 422.56 of the Penal Code.
(7)The program shall provide information about the effectiveness and safety of at least one or
more drugs and/or devices approved by the federal Food and Drug Administration for
preventing pregnancy and for reducing the risk of contracting sexually transmitted diseases.
October �o 11 Page 2 of 3
E.xhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
(b) A sexual health education program that is directed at minors shall comply with alt of the
criteria in subdivision (a) and shall also comply with both the following requirements:
(1)It shall include information that the only certain way to prevent pregnancy is to abstain from
sexual intercourse. and that the only certain way to prevent sexually transmitted diseases is
to abstain from ac tivities that have been proven to transmit sexually transmitted diseases.
(2)If the program is directed toward minors under the age of 12 years, it may, but is not
re quired to, include information otherwise required pursuant to para graph (7) of subdivision
(a).
(c) A sexual health education program conducted by an outside agency at a publicly funded
school shall comply with the requirements of Section 51934 of the Education Code if the
program addresses HIV/AIDS and shall comply with Section 51933 of the Education Code if
the program addresses pregnancy prevention and sexually transmit ted diseases other than
HIV/AIDS.
(d)An applicant for funds to administer a sexual health education program shall attest in writin g
that its program complies with all conditions of funding, including those enumerated in this
section. A publicly funded school receiving only general funds to provide comprehensive
sexual health instruction or HIV/AIDS prevention instruction shall not be deemed an
applicant for the purposes of this subdivision.
(e)If the program is conducted by an outside agency at a publicly funded school, the applicant
shall indicate in writing how the program fits in with the school's plan to comply fully with the
requirements of the California Comprehensive Sexual Health and HIV/AIDS Prevention
Education Act, Chap ter 5.6 (commencing with Section 51930) of the Education Code.
Notwithstanding Section 47610 of the Education Code, ''publicly funded school" includes a
ch arter school for the purposes of this subdivision.
(f)Monitoring of compliance with this division shall be integrated into the grant monitoring and
compliance procedures. If the agency knows that a grantee is not in compliance with this
section, the agency shall terminate the contract or take other appropriate action.
(g)This section shall not be construed to limit the requirements of the California
Comprehensive Sexual Health and HIV/AIDS Prevention Education Act (Chapter 5.6
(commencing with Section 51930) of Part 28 of the Education Code}.
(h)This section shall no t apply to one-on-one interactions between a health practitioner and his
or her patient in a clinical setting.
151003. This div ision shall apply onl y to grants that are funded pursuant to contracts entered into
or amended on or after January 1, 2008.
October 2011 Page 3 of 3
State 6f Caiifornla-tiealth and Human Services Agency
Submit •
California Department of Public Health 1616 Capitol Ave, Suite 74,262
P.O. Box 997377, MS 1800 SaCfamento. CA 95899-7377 www cdph ca gov
GOVERNMENTAGENCYTAXPAYERIDFORM
The principal purpose of the information provided is to establish the unique identification of th& government entity. Instructions: You may submit one form for the principal governmenl agency and all subsidiaries sharing U'll!I sam& TIN. Subsidiaries with a different lJN must s1Jbmit a separate form. Fields bordered in red are required. Please print the form to sign prior to submlitai. You may email the form to: GovSuppliers@cdph.ca.gov or fax it to {916) 650-0100, or mail it lo the address ebove.
Principal Government Agency Name
Remit-To Address (Street or PO Box)
City;
Government Type:
County of Fresno
PO Box 11867
Fresno
0 City D Special District D Other (Specify)
[ii County D Federal
State: CA Zip Code+4: 93775
Federal I 94-5ooos12 Employer Identification Number (FEIN)
List other subsidiary Departments, Divisions or Units under your principal agency's jurisdiction who share the same FEIN and receives payment from the State of California.
FISCsl ID# Depl/Division/Unl1 I Complete
11111110¥fflJ Name Address
FISCatlD# Dept/Division/Unit I Complete
f1l1mtnw1) Address Nam8
I I
FISCal ID# DepVDivision/Unii I Complete J(ti�) Address Nsme
Dept/Division/Unit I Fl$Ca! ID#
111 lrmwnl Name
Contact Person ... I E_v_e .... ly_n_R_e_im_e_r _______ �
Complete Address
Title I Business Msm1ger
Phone number 1 css9) 600-6438 E•mail address I ereimer@co.fresno.ca.us
Signature
CDPH 9083 (1 /18)
I
California Department of Public Health
Name/No.: MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) Agreement
Funding Application (AFA). Agreement No. 201810 MCAH and Agreement No. 201810
Black Infant Health (BIH)
Fund/Subclass: 0001/10000
Organization #: 56201700; 56201706
Revenue Account #: 4382