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Home My WebLink AboutAgreement A-24-625 - FY 2024-25 CHVP Agt. Funding Application with CDPH.pdf Agreement No. 24-625 State of California—Health and Human Services Agency - California Department of Public Health TOMAS J.ARAGON,M.D.,Dr.P.H GAVIN NEWSOM Director and State Public Health Officer Governor May 29, 2024 TO: MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIRECTORS/CALIFORNIA HOME VISITING PROGRAM (CHVP) DIRECTORS, COORDINATORS, OR DESIGNEES SUBJECT: CHVP AGREEMENT FUNDING APPLICATION (AFA) ANNOUNCEMENT FOR STATE FISCAL YEAR (SFY) 2024-2025 This letter announces the SFY 2024-2025 AFA process that provides allocation and contract funding updates for the California Department of Public Health, Maternal, Child and Adolescent Health (CDPH/MCAH) Division's California Home Visiting Programs. SFY 2024-2025 funding for CHVP programs are as follows: A. Maternal, Infant, and Early Childhood Home Visiting (MIECHV) B. State General Fund Evidence Based Home Visiting (SGF EBHV) C. State General Fund Innovation Project (SGF INNV 1.0) D. State General Fund Innovation Project (SGF INNV 2.0) All CHVP allocation amounts will remain the same as SFY 2023-24. E. Title XIX (TXIX) Funding (if applicable)— Local Health Jurisdictions (LHJs) can request any amount with the understanding that the agency must have the State General Funds and/or additional agency funds to match TXIX and that their spending plan reflects the agency's ability to spend all their TXIX request. Due to new FI$Cal requirements, budget revisions that are requesting an increase in TXIX funding must be received after your Q2 invoice has been submitted but no later than March 31, 2025. Please note: At this time, only AFA documents for FY24-25 are required. The FY24-25 budget template(s) will be sent to each LHJ individually in a separate email to follow. CHVP funding allocations cannot be combined, but may be braided. Please note that a new Scope of Work (SOW) and budget template will be provided for each initiative (i.e., MIECHV, SGF EBHV, and Innovation 1.0 and 2.0) on an annual basis. Please reach out to your Contract Liaison (CL) if you have questions. CDPH Maternal, Child and Adolescent Health Division/Center for Family Health MS 8305, P.O. Box 997420,Sacramento, CA 95899-7420 (916)650-0300 • (916) 650-0305 FAX �¢ Internet Address:www.cdph.ca.gov �"•,,,,M y�,.+� MCAH Directors, CHVP Project Coordinators, or Designee AFA Timeline/ Important Dates: Wednesday, May 29, Release of CHVP FY 24-25 AFA Notification. 2024 AFA forms will be sent via email attachment. Friday, June 7, 2024 Last Day to Register for your AFA Development Support and Budget Training Meeting — Optional budget meetings can be provided for technical assistance necessary to complete local agency budgets. Please reach out to your CL and PC via email to request a Budget Training Meeting. If a meeting is requested, Local CHVP Program and Fiscal representatives with decision making authority are required to attend. CHVP AFA budget meetings will be offered via TEAMS. Meetings will be scheduled on a first-come, first-served basis between June 101" —June 2111, 2024. Friday, June 28, 2024 AFA Packages Due back to CDPH/CHVP. Once received, your CL and Program Consultant (PC) will begin the review of your AFA package. LHJs can expect to receive a response regarding their submitted AFA package within approximately 2 weeks of submission, notifying them of any revisions needed prior to approval. AFA Submission: Packages are due via email to MCAHFINACT(aD_cdph.ca.gov by Friday, June 28, 2024. If you have any questions about the AFA process please contact your CL as soon as possible. Agencies that opt-in to claiming TXIX must submit a signed justification letter, which provides the rationale for the intended Medi-Cal Factor(MCF) percentages if utilizing a MCF other than base. This letter must be on county letterhead and include your justification in claiming each of the various MCFs that are being requested on your budget. Please note, the letter will not replace the MCF justification area for personnel on the budget template. We have provided an example letter for your reference titled "Bean County" letter. Agencies will be authorized via email to invoice for services after their AFA packages are approved and an approval letter is in place. There may have been changes since the last AFA submission. We recommend that all LHJs review the MCAH Fiscal Policy & Procedures Manual prior to building and submitting their FY 24-25 AFAs. LHJs will be notified via email when their AFA package is approved. At that time, they will be permitted to invoice for services retroactively to July 1, 2024. MCAH Directors, CHVP Project Coordinators, or Designee Invoice Submission: All invoices and supporting documentation must be submitted via email to the MCAH invoice box: MCAHlnvoices(@cdph.ca.gov. To ensure appropriate processing, please use the following invoice naming convention for the signed invoice PDF and Excel files as well as the subject line of the email: Agreement Number (space) LHJ Name (space) Fiscal Year (space) Invoice Quarter Number Example: CHVP SGF EBHV 24-01 Alameda FY24-25 Q1 Invoice submission must include: • Signed cover letter noting invoice amount, invoice period, remit to address, and any personnel changes • Signed invoice • Excel version of the invoice • Signed and completed TXIX Cover Sheet (if applicable) • Signed and completed Attestation form (if applicable) • TV and/or TXIX time studies (if applicable) Invoice Submission Timeline: Pay Period Duration Due Date Quarter 1 Jul — September November 15tn Quarter 2 October— December February 15tn Quarter 3 January— March May 15t" Quarter 4 April — June August 15t" Thank you for your assistance and timely submission of your AFA package. If you have any questions or concerns, please contact your Contract Liaison or Program Consultant. Sincerely, 4t6"Z—'� C. Azm-etr Artnecia Ramirez Assistant Division Chief Maternal, Child and Adolescent Health Division Center for Family Health California Department of Public Health State of California—Health and Human Services Agency ,a. California Department of Public Health I)COPH 0 a� TOMAS J.ARAGON,M.D.,Dr.P.H GAVIN NEWSOM Director and State Public Health officer Governor March 12, 2024 TO: The 21 local health jurisdictions (LHJs) funded by the California Home Visiting Program (CHVP) Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grant, including the Local Health Officers; Deputy Health Officers; Health Executives; and Maternal, Child and Adolescent Health (MCAH) and CHVP Directors CC: California Department of Public Health (CDPH) and state MCAH leadership, and representatives from the County Health Executives Association of California (CHEAC) and the California Conference of Local Health Officers (CCLHO) FROM: California Department of Public Health (CDPH), Maternal Child and Adolescent Health Division (MCAH), California Home Visiting Program (CHVP) SUBJECT: CDPH/CHVP MEMO#24-04: NOTICE OF INTENT TO AWARD FOR CHVP MIECHV FUNDING FOR STATE FISCAL YEAR (SFY) 2024-25 Please ensure that all necessary individuals within your agency are notified of this Notice of Intent to Award. If you have any questions,please email the MIECHV lead, Susan Zimny at susan.zimny@cdph.ca.gov and cc your assigned CHVP program consultant(PC) or the CHVP mailbox at ca-mcah-homevisiting@cdph.ca.gov. For State Fiscal Year (SGF) 2024-25, the California Department of Public Health (CDPH)/California Home Visiting Program (CHVP) intents to award the 21 current MIECHV- funded LHJs an allocation amount that is equal to the amount allocated in SFY 2023-24. This includes a 25% increase above the SFY 2022-23 allocations. The funding allocation dollar amounts for SFY 2024-25 are presented in Table 1 below. Please note that the allocations in Table 1 are for SFY 2024-25 only. CDPH/CHVP may receive additional MIECHV funding in future years as a result of the Federal MIECHV reauthorization in December 2022; however, the details are unknown at this time. CDPH/CHVP will assess and engage with LHJs about the use of additional funding when more information is available. CDPH/CHVP will use input and feedback from the MIECHV reauthorization partner engagement sessions held in 2023, the Funding Interest and Feedback survey from early 2024, as well as other input/feedback to determine how to use MIECHV funding in the future. Following issuance of this Notice of Award, CDPH/CHVP will release a CHVP Agreement Funding Application (AFA) package for SFY 2024-25 to each LHJ. The AFA package will include the scopes of work and budgets for CHVP MIECHV, CHVP State General Fund (SGF) Evidence-Based Home Visiting (EBHV), and CHVP SGF Innovation (INNV). LHJs will complete the applicable components based on their CHVP allocation(s) across each of these funding sources and projects. SGF EBHV and SGF INNV allocations are released in a separate notice of award. Reimbursement of invoices is subject to compliance with all state and federal requirements pertaining to CDPH/CHVP and adherence to all applicable regulations, policies, and procedures, and the CDPH/ MCAH Fiscal Administration Policy and Procedure manual. All awards are contingent upon approval and appropriation of federal funding and state spending authority. Table 1. CHVP MIECHV Allocations for SFY 2024-25 The table below indicates CHVP MIECHV funding allocations by LHJ for SFY 2024-25. Local Health . Allocationir above(maintenance of SFY 2023-24 allocation levels which included a 25% Alameda $1,087,793 Butte $711,333 Contra Costa $1,170,758 Fresno $805,195 Humboldt $1,032,710 Kern $899,248 Los Angeles $1,910,893 Madera $718,202 Merced $532,270 Nevada $882,135 Riverside $1,056,160 Sacramento $1,125,130 San Diego $949,268 San Francisco $1,410,536 San Mateo $1,248,653 Shasta $841,537 Solano $1,034,682 Sonoma $440,920 Stanislaus $783,467 Tehama $501,858 Yolo $465,195 TOTAL FUNDS ALLOCATED $19,607,943 eP t%tatit 04$. CDPH Center for Family Health Maternal, Child and Adolescent Health Division MS 8300 • P.O. Box 997420 • Sacramento, CA 95899-7420 q a (916) 650-0300 • (916) 650-0305 FAX Internet Address: www.cdph.ca.gov 'kit W,.4CM0a'e \• ( State of California—Health and Human Services Agency s�p� Oq Tye California Department of Public Healthy ym I)COPH Cq'�FORN�P TOMAS J.ARAGON,M.D.,DrRH GAVIN NEWSOM Director and State Public Health officer Governor DATE: March 11, 2024 TO: The 59 local health jurisdictions (LHJs) funded by the California Home Visiting Program (CHVP) State General Funds (SGF), including the Local Health Officers; Deputy Health Officers; Health Executives; and Maternal, Child and Adolescent Health (MCAH) and CHVP Directors CC: California Department of Public Health (CDPH) and state MCAH leadership, and representatives from the County Health Executives Association of California (CHEAC) and the California Conference of Local Health Officers (CCLHO) FROM: California Department of Public Health (CDPH), Maternal Child and Adolescent Health Division (MCAH), California Home Visiting Program (CHVP) SUBJECT: CDPH/CHVP MEMO #24-03: NOTICE OF INTENT TO AWARD FOR CHVP SGF EVIDENCE- BASED HOME VISITING (EBHV)AND INNOVATION (INNV) FUNDING FOR STATE FISCALYEAR(SFY) 2024-2025 Please ensure that all necessary individuals within your agency are notified of this Notice of Intent to Award. If you have any questions, please email your assigned CHVP program consultant(PC) or the CHVP mailbox at ca-mcah-homevisiting@cdph.ca.gov. The purpose of this Notice of Award (NOA) is to provide information about SFY 2024-25 local allocations for the California Department of Public Health (CDPH)/California Home Visiting Program (CHVP) State General Fund (SGF) evidence-based home visiting (EBHV) and the Innovation Project (INNV). CDPH/CHVP receives and will allocate $54.7 million annually in SGF local assistance funding for early childhood home visiting across the state. Evidence-Based Home Visiting (EBHV). Effective July 1, 2024, CDPH/CHVP will distribute a total of$47,760,624 to the 57 local health juridictions (LHJs) that opted in for SGF EBHV funding. Each LHJ will receive an annual allocation with a base amount of$400,000 plus an additional amount based on each LHJ's proportion of Medi-Cal births statewide. Final annual allocations for SFY 2024-25 for the 57 LHJs are indicated in column two of Table 1 below. The goal of this funding is to increase the number of families participating in the five EBHV models supported by CDPH/CHVP; the three continuing EBHV models: Healthy Families America (HFA), Nurse Family Partnership (NFP), Parents as Teachers (PAT), and two new EBHV models options: Family Connects (FCI), and Home Instruction for Parents of Preschool Youngsters (HIPPY). CDPH/CHVP will provide more information and engagement opportunities related to these two additional model in the near future. Innovation Funding (INNV). Effective July 1, 2024, a combined total of $6.9 million will be distributed in CHVP SGF Innovation (INNV) funding. $3,736,067 will be distributed to the seven remaining SGF INNV 1.0 Project recipients and $3,203,309 to the six SGF INNV 2.0 project recipients. The annual awards by LHJ are indicated in columns three and four of Table 1 below. The goal of this funding is to support implementation of home visiting as a primary intervention strategy for families from pregnancy through kindergarten entry with focus on an innovative practice to meet local needs. Following issuance of this Notice of Award, CDPH/CHVP will release a single agreement funding application (AFA) package for SFY 2024-25 to each LHJ. The AFA package will include separate scopes of work and budgets for MIECHV, SGF EBHV, and SGF INNV 1.0 and 2.0 and LHJs will complete the applicable components based on their CHVP allocation(s). The MIECHV allocations are released in a separate notice of award. Reimbursement of invoices is subject to compliance with all state requirements pertaining to CDPH/CHVP and adherence to all applicable regulations, policies, procedures, and the CDPH/MCAH Fiscal Administration Policy and Procedure manual. All awards are contingent upon approval and appropriation of State General Funds for CHVP in the Budget Act and state spending authority. Table 1: CHVP SGF Evidence-Based Home Visiting and Innovation Project Annual Allocations for SFY 2024-25 The table below indicates CHVP SGF EBHV funding allocations by LHJ for the period of July 1, 2024-June 30, 2025. It also includes, the CHVP SGF INNV funding allocations by LHJ for the Innovation 1.0 and 2.0 Projects for the period of July 1, 2024-June 30, 2025. ColumnColumn 1 i Column 3 , Local Health Jurisdiction SFY 024 7024 EBHV Allocation INNV 0 Award INNV 2.0 Award Alameda (excludes Berkeley) $918,434 FApine $701,850 Amador $418,206 Butte $562,486 Calaveras $426,765 City of Berkeley $413,713 City of Long Beach $749,658 $757,563 City of Pasadena $457,362 $565,328 Colusa $423,455 Contra Costa $708,043 Del Norte $421,043 El Dorado $469,799 Fresno $1,726,516 Column • • • Local • • EBHV Allocation AwardAward Glenn $430,738 Humboldt $474,717 Inyo $412,058 Kern $1,492,197 Kings $573,694 Lake I $470,413 Lassen $418,395 Los Angeles (excludes Long $6,388,878 Beach and Pasadena) $1,000,000 Madera $605,047 Marin I $483,986 Mariposa I $410,356 Mendocino I $474,575 $135,000 Merced $761,669 $486,893 $400,000 Modoc $402,175 Mono $408,086 Monterey $806,310 $50,286 $319,145 Napa $464,124 See San Francisco Nevada I $441,094 Orange I $1,712,424 Placer I $600,563 Plumas $410,687 Riverside $2,263,062 Sacramento $1,601,530 San Benito $442,702 San Bernardino $2,279,944 San Diego $2,185,366 San Francisco $654,275 $1,000,000 San Joaquin $1,113,030 San Luis Obispo I $528,107 I See Santa Cruz [San Mateo $647,418 Column • • • Local • • Allocation AwardAward Santa Barbara $837,191 Santa Clara $1,022,802 Santa Cruz $549,718 $421,188 Shasta $545,320 Sierra I $401,229 Siskiyou I $429,697 Solano I $653,471 $498,560 Sonoma I $627,178 See San Francisco Stanislaus I $932,762 Sutter $500,490 Tehama $461,429 Tulare $1,015,235 Tuolumne $426,954 Ventura I $909,874 Yolo $513,163 Yuba $481,574 TOTAL FUNDS ALLOCATED $47,760,624 $3,736,067 $3,203,309 rN OFp'9'' CDPH Center for Family Health /ID JAW Maternal, Child and Adolescent Health Division Q MS 8300 • P.O. Box 997420 • Sacramento, CA 95899-7420 ' (916) 650-0300 • (916) 650-0305 FAX Internet Address: www.cdph.ca.gov y� tiAccxco "� CALIFORNIA DEPARTMENT OF PUBLIC HEALTH MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIVISION FUNDING AGREEMENT PERIOD FY 2023-2028 AGENCY INFORMATION FORM Agencies are required to submit an electronic and signed copy (original signatures only) of this form along with their Annual AFA Package. Agencies are required to submit information when updates occur during the fiscal year. Updated submissions do not require certification signatures. Any program related information being sent from the CDPH MCAH Division will be directed to all Program Directors. Please enter the aareement or contract number for each applicable program CHVP 24-10 / CHVP SGF EBHV 24-10 Update Effective Date: (only required when submitting updates) Federal Employer ID#: FISCAL ID#: Complete Official Agency Name: lCounty of Fresno Business Address: 11221 Fulton Street, Fresno, CA 93721 Agency Phone: (559) 600-3330 Agency Fax: (559) 455-4705 Agency Website: www.fcdph.org Page 1 of 1 Please enter the agreement or contract number for each of the applicable programs CHVP 24-10/CHVP SGF EBHV 24-10 Update Effective Date: (only required when submitting updates) The undersigned hereby affirms that the statements contained in the Agreement Funding Application (AFA) are true and complete to the best of the applicant's knowledge. I certify that this Maternal, Child and Adolescent Health (MCAH) program will comply with all applicable provisions of Article 1, Chapter 1, Part 2, Division 106 of the Health and Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and Institutions Code (commencing with Sections 14000 and 142), and any applicable rules or regulations promulgated by CDPH pursuant to this article and these Chapters. I further certify that all MCAH related programs will comply with the most current MCAH Policies and Procedures Manual, including but not limited to, Administration. I further agree that the MCAH related programs may be subject to all sanctions, or other remedies applicable, if the MCAH related program violates any of the above laws, regulations and policies with which it has certified it will comply. Original signature of official authorized to commit the Agency to a CHVP Agreement Signature line: Name (Print): Nathan Magsig Title: Chairman of the Board of Supervisors of the County of F Date: 114 3 0,0s+ Original Signature of MCAH Director Signature line: Name (Print): Ge Vue Title: MCAH Director Date: 6/28/2024 ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors County of Fresno,State of Californiarn By� li —-eputy Page 1 of 1 \ § § ! § ! § § § § § \ 4L [ � \ - 3® \ \ / \ f ! ! ! ! ! ! !o ( \ \ \ ) j \ jw \ \ \ � k \ / \ \ \ _ `o { � ; \ $ } 0 \10 L - 2 ) /{ ) § } r ` \ , :o ! [ \ ) ) ) ) \ \ ( § } \ } \ \ \ \ k /\\ \ \ \ \} \ / \ \ , \ ! ! ! ! I ! o \ \ } \ 7 } oIo o } { ! . ) ; f |! 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O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 O O o O O O O O O O O O O O O O O O O O O o O O O O O O O O O O O O O O W O O O O O O O O O O O O O O O O OH O0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 °) m O) °' °) O) J-PersMCF 000000 00000 0 0 0 0 0 00 0 0 0 o Per Staff e a e v o o v o o a s o Staff Traveling (X) Contract#/LHJ Name: 24-10/County of Fresno \� California Home Visiting Program—MIECHV CDPH I mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 The purpose of this Scope of Work (SOW) is to provide guidance and outline requirements for implementing early childhood home visiting services in the California Department of Public Health/California Home Visiting Program (CDPH/CHVP)funded by the federal Maternal, Infant, and Early Childhood Home Visiting(MIECHV) grant. CDPH/CHVP MIECHV-funded local health jurisdictions (LHJs) are approved to implement Healthy Families America (HFA) and/or Nurse Family Partnership (NFP) evidence-based home visiting programs in accordance with federal MIECHV and State requirements to achieve positive outcomes.The SOW includes the following goals: 1. Provide leadership and structure to implement California Home Visiting Program (CHVP) in funded LHJs. 2. Integrate the home visiting program into the local early childhood system. 3. Monitor federal benchmark measures to demonstrate improvement in maternal and early childhood health. Goals, Objectives,Activities and Deliverables for July 1, 2024—June 30, 2025 Goal 1: Provide leadership and structure to implement CHVP in the LHJ. # Objective Activities Deliverables 1.1 MCAH Director or designee will provide (a) Provide leadership and oversight on all matters Submission of: effective leadership and oversight of related to the development, implementation, . Status Reports CHVP. operation, administration, evaluation, and reporting of all CHVP-funded home visiting • CAB Meeting Materials NOTE:The MCAH Director is required to programs following CDPH/CHVP Policies and • Staffing Reports devote a minimum of 0.05 FTE and a Procedures (P&P). Participation in: maximum of 0.15 FTE to CHVP oversight, • Quarterly CHVP Director calls fostering partnerships and collaboration (b) Attend quarterly CHVP Director calls. . Virtual and/or in-person site within the LHJ, and directing the local visits every two years CHVP Community Advisory Board (CAB). Contract#/LHJ Name:24-10/County of Fresno \� California Home Visiting Program—MIECHV 1 1 ICah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 The FTE percentage allocated to the CHVP (c) Participate in ongoing community advisory board NOTE: If an LHJ establishes a Director shall not be included in the (CAB) meetings, other local community groups, site subcontractor (subK) to deliver MCAH budget.This approach ensures visits, meetings, and conferences as directed. home visiting services, an LHJ compliance with the MCAH Director FTE representative (the CHVP limits specified in the local MCAH Director when possible and program policies and procedures. If an appropriate) must be present MCAH Director cannot meet the during all technical assistance requirements of the CHVP SOWs, they (TA) calls, virtual or in-person can identify a designee, as outlined in the visits, and be involved in all Local MCAH Program P&P. In this programmatic, data, contract, situation, the designee, who may be and fiscal communications with identified as an MCAH Coordinator or CDPH/CHVP.This requirement other position, can act as the responsible ensures that the LHJ maintains party for CHVP, and should be designated oversight and direct involvement as such on the CHVP budget justification. in all aspects of the contracted services, guaranteeing alignment with CDPH/CHVP standards and expectations. Additionally, no more than 10% of the allocation can be spent on administrative oversight of a SubK. 1.2 LHJ leadership and home visitors will (a) Review the MCAH Title V Needs Assessment to Submission of: implement home visiting services utilizing determine the community's equity needs. . Status Reports culturally responsive practices to ensure that all interactions, interventions, and 0 Staff Training Logs Contract#/LHJ Name: 24-10/County of Fresno A� California Home Visiting Program—MIECHV )COPH I mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 service deliveries effectively meet the (b) Participate in opportunities designed to enhance • Staffing Reports diverse needs of the communities served, cultural sensitivity through webinars,trainings, employing a cultural humility approach. and/or conferences. (c) Provide culturally responsive services that address the identified cultural needs of families (e.g. literacy levels, disabilities, military families, grandparents,tradition, etc.). (d) Provide documents in the family's preferred language, when feasible. Documents should be written in no more than an eighth-grade reading level and use plain language. (e) Recruit and hire staff that reflect the community served and/or speak the language of program participants, when possible. (f) As needed, develop and document adaptations that are developmentally, culturally, and linguistically responsive to families, upon approval from model developer and CDPH/CHVP. Contract#/LHJ Name:24-10/County of Fresno California Home Visiting Program—MIECHV !)CZ1) l I Ca California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 1.3 LHJ Leadership will hire,train, and retain (a) Participate in model required trainings related to Submission of: staff to comply with selected home screening tools, health assessments, reflective • Status Reports visiting model requirements and supervision, data collection tools, and software. . Training Logs CDPH/CHVP Policies & Procedures • Training Plans (P&Ps). (b) Participate in CHVP site visits every two years. . Staffing Reports • Confirmation of signed (c) Maintain full staffing capacity to serve families in Confidentiality Agreement for the home visiting program and adhere to model each staff member requirements. (d) All staff will sign a Confidentiality Agreement at the time of hire and annually thereafter. 1.4 LHJ leadership will ensure the program (a) Develop and sustain relationships with appropriate Submission of: reaches and maintains contracted agencies to obtain home visiting participant • Status Report Caseload Capacity(CC). referrals. • Outreach activity logs • Referral triage plans outlining (b) Develop a referral triage process for incoming referral process (flow chart, home visiting participants to ensure families are logic model, narrative, etc.). connected with the program that best meets their . Confirmation of signed needs. Participant Consent Form for each enrolled participant. • Complete and timely caseload data. Contract#/LHJ Name:24-10/County of Fresno ��, 0 California Home Visiting Program—MIECHV )C;DPH mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 (c) Ensure newly enrolled participants receive informed consent and sign a CHVP Participant Consent Form. NOTE:Any LHJ that falls below 85%of the CC for three (3) consecutive months may be required to participate in an Extra Support Plan. 1.5 MCAH Director or Designee will provide (a) Implement model requirements in accordance Submission of: oversight and leadership to ensure with the selected model(s)fidelity standards. • Selected home visiting selected home visiting model fidelity and model(s) certificate of quality assurance. fidelity, accreditation or fidelity report, or similar document demonstrating good standing and model fidelity. 1.6 LHJ Leadership will develop and (a) Conduct an annual review of LHJs P&Ps related to Submission of: implement home visiting Policies and home visiting and update as needed. • Status Report Procedures (P&P). • Confirmation of review of (b) Conduct an annual review of CDPH/CHVP P&Ps. local and CDPH/CHVP P&Ps (c) Conduct an annual review of, and ensure compliance with, the MCAH Fiscal Administration P&P Manual. Contract#/LHJ Name:24-10/County of Fresno �0'`- California Home Visiting Program—MIECHV )C:DI'H I mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 (d) Conduct an annual review of, and ensure compliance with, the Local MCAH Programs P&Ps. 1.7 LHJ leadership will conduct CQI projects (a) Participate in quality improvement activities as Submission of: and activities to support program directed by CDPH/CHVP. • Status Report implementation and improvement goals. • CAB Meeting materials (b) Utilize the CAB to inform and address quality . CQI plans, data, and other improvement projects and decisions. requested information (c) Utilize data to inform and improve program Participation in: activities. • Technical Assistance (TA) meetings • CQI meetings • Learning Collaborative Presentations Contract#/LHJ Name: 24-10/County of Fresno 'A 's California Home Visiting Program—MIECHV )C OPH mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 . . . . . # Objective Activities Deliverables MCAH Director or designee will (a) Maintain a CAB that includes local early childhood Submission of: collaborate with local early childhood system partners and meets at least quarterly to . Status Report system partners to ensure a continuum of establish appropriate linkages to referral and service • CAB Meeting materials 2.1 services for families. systems. . MOUs and/or informal agreements (b) Meet and work with other local early childhood system and community partners to coordinate services to families. MCAH Director or designee will pursue, (a) Develop Memoranda of Understanding (MOUs) Submission of: develop, and maintain relationships with and/or informal written agreements (e.g., letters of . Status Report 2.2 local service agencies and referral support) with community agencies and service resources to facilitate participant providers. MOUs and/or informal written agreements recruitment. Outreach logs Contract#/LHJ Name: 24-10/County of Fresno oil 0 California Home Visiting Program—MIECHV )CDI'H mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 improvementGoal 3: Monitor federal benchmark measures to show . . . # Objective Activities Deliverables 3.1 LHJ leadership, home visitors, and data (a) Complete all model-issued forms and assessment Submission of data for the support staff will collect and submit all tools as defined by CDPH/CHVP and model-issued following federal reports: information required for HRSA/MIECHV data collection manual(s). • Demographic, serviced reporting. Utilization, and Select Clinical (b) Collect and enter federally required priority Indicators (Form 1) population data for all participants into the • Performance Indicators and designated data system. Systems Outcomes (Form 2) • Quarterly Performance Report (Form 4) For NFP: Submission of Priority Population Survey on Status Reports. 3.2 LHJ leadership, home visitors, and data (a) Accurately collect and submit participant data using • Demonstrated compliance support staff will maintain clean and selected home visiting model and CHVP-required with data related policies and compliant data. documents. program quality measures. • Evidence of data cleaning on a (b) Ensure accuracy and completeness of data input into monthly or quarterly basis designated data systems using data quality reports using the CDPH/CHVP data and monitoring. cleaning schedule. Contract#/LHJ Name: 24-10/County of Fresno California Home Visiting Program—MIECHV j)CDI'H I mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 (c) NFP LHJs will coordinate data system requirements • Evidence of signed Participant with the NFP National Service Office. Consent form for each family, as requested. (d) HFA LHJs will coordinate with the CHVP Data Team to establish buildout/modification in Efforts to Outcomes (ETO) data system and will comply with all CHVP HFA Data Collection Manual requirements. (e) Collect and enter participant data into designated data systems within seven working days, or as required by the selected home visiting model. (f) Provide and/or coordinate with data collection system owners to provide monthly enrollment and other requested reports to CDPH/CHVP as needed. Contract#/LHJ Name: 24-10/County of Fresno California Home Visiting Program—MIECHV )CDI'I 1 I n1Cdh California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 All reports and documentation must be submitted via SharePoint, unless otherwise directed by CHVP. All Staffing Report January 15, April 15,July 15, October 15 Status Report • CAB Roster, Minutes, and Agendas • MOUs or informal agreements with community agencies and service providers • Outreach logs • Training plans and logs All • Policies and Procedures April 15 and/or October 15 • Referral Triage Plan • Confirmation of signed Participant Consent Forms • Confirmation of signed confidentiality agreements for all direct staff • Model Developer agreement, accreditation, and affiliation documentation Nurse-Family Partnership Priority Population Survey April 15 and October 15 All CQI plans, data, and information Upon Request All Technical Assistance calls/meetings Quarterly (TBD) All Site Visit Biennially (TBD) Contract#/LHJ Name: 24-10/County of Fresno \� California Home Visiting Program—MIECHV !)CD1'H I mcah California Home Visiting Program Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Scope of Work July 1, 2024- June 30, 2025 NOTE: If compliance standards are not met in a timely manner, CDPH/CHVP may temporarily withhold cash payment pending correction of the deficiency; disallowing all or part of the cost of the activity or action out of compliance; wholly or partly suspending or terminating the award; or withholding further awards. Ge Vue MCAH Director Name MCAH Director Signature Date 5 §§ \ \ \ \ \ \ \ \ \ \ \ - 2 : www 00 y § § ) k ~ rrr k � ± C) \ / \ \ m q ( k ), � _- \ \ � 10 // j \ - 2 q § k § gym & \ § - �)?I / k a !(» m / E ) � c � 7 _ - c ] a o w CD ) cn 4 , ! r _ . ; x \ m q o c ( ) q M B ( Q m f ; ] - > - G R-aL--. --- k �{ \ 0 ) 2 ■ _ co / n m < C 27_ \ ƒ En § � -n _ : |z m a C k CD k) o So q ) a@gGk :L�z � SS ekkkkk ( / ) § ` : N / } _ co �o \_ : ! � � jE; \ \ i § ; ; § : \ § / ; !- \ ; ► C N v � ? n A A o 2 V z m m z m o c 2 O O m n O y ur X cn m ID U) 0 Z v 'moo o p o m o m —_ U) � ° s T r= m = cn 3 m Z RL T 3 s m Q a m - 2 EO n < w m _ 3 - C) x 3 y � Q X = y R o 3 D Z r r 3 y A Z m x m m z - m x m z N N A y N y y y C O 3 1 D r T C Z G O Z O � n y e _ G1 x U x Z � D a o 0 0 0 0 0 ° ii n O 0 0 0 = m c� C z a � TT7 n � � � c - T O O C O O N O O R � g e V�M, 0 T n D c = 3z 9 p p 9 9 p p p p 9 9 p p p p p p 9 p p p p p 9 p p p 9 C. 9 9 9 51 a 0 0 Q Z o O =m Z Z Q x n —z m � o 0 Tn n° A D Q Z p p p p p p p 0 O G 71 O O O O R n O� < T I T O 41 aa3 ' 0 0 0 m 0 o n z 0 o xx za im m e No �3 � n 0 0 < 0 0 10 0 0 � R R 3 ; E |[ m m u` 00 e! | . o = , � � �m � {� $ R � 0 ! ° 0 � § / - - - - - = = ƒ )f\ 2 §§ ! o — - % %%% g 2 — i ! ! i ! ) ) � \2 ) f ! / / ( ( ƒ J = _ _ _ _ _ : }( ] ! 22 \ / ; _ ) e � 2 | | | ! ! | | 5 | | 6 | | ] 10, - ; =4»AA2R $$ ®> § § § ■t ¥ ¥ q § q4 ! $ �( ! n ) A* � k § ! ; ; | . . . . . . | & | § ; ; . . . . .3. ^| § 2 | ! | | | | | | | 7 ! § ; ; ■ _ : @eQaaaG2GaaaGGaeeaaG , � � „ , � ; o LL 1 § k k IL ( 10 ) 71 ! z !§ £ ; ; § 22 ; ; § § ; ; q § & § ; § § ; § ; ; K ; / R § § § ; ; ; /k * � )§ _ |k z xx E; = \ / ~ e , , , , , , e , ; & @a ' ; ; ; ; ; ; ; ; _�_ Contract#/LHJ Name: 24-10/County of Fresno !)COM I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 The purpose of this scope of work (SOW) is to provide guidance and outline requirements for implementing early childhood home visiting services in the California Department of Public Health/California Home Visiting Program (CDPH/CHVP) funded by California State General Funds (SGF). CHVP SGF-funded local health jurisdictions (LHJs) may implement and/or expand Healthy Families America (HFA), Nurse-Family Partnership (NFP), Parents as Teachers (PAT), Family Connects, and/or Home Instruction for Parents of Preschool Youngsters (HIPPY) home visiting programs in accordance with State requirements to achieve positive outcomes.The SOW includes the following goals: 1. Provide leadership and structure to implement the California Home Visiting Program (CHVP) in LHJs. 2. Integrate the home visiting program into the local early childhood system. 3. Collect, enter, and report on all required participant data. 4. Provide relief and support with rebuilding and stabilizing for staff and families served by Local MCAH home visiting programs including CHVP Innovation Projects through enhanced training, technology, additional staff costs, and family support materials (Special Support Activities). Note: LHJs may continue to spend up to 25%of the SFY 2024-25 SGF EBHV allocation on Special Support Activities, as outlined in Goal 4, below. Contract#/LHJ Name: 24-10/County of Fresno !)CDPH mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 Goals, Objectives,Activities, and Deliverables for July 1, 2024—June 30, 2025 # Objective Activities Deliverables MCAH Director or designee will provide (a) Provide leadership and oversight on all matters Submission of: effective leadership and oversight of related to the development, implementation, . Status Reports CHVP. operation, administration, evaluation, and • CAB meeting materials reporting for local implementation of home . Staffing Reports NOTE:The MCAH Director is required to visiting programs following CDPH/CHVP Policies devote a minimum of 0.05 FTE and a and Procedures (P&P). Participation in: maximum of 0.15 FTE to CHVP oversight, • Virtual and/or in-person site fostering partnerships and collaboration (b) Attend quarterly CHVP Director calls. visits within the LHJ, and directing the local CHVP community advisory board (CAB). (c) Participate in ongoing community advisory board NOTE: If an LHJ establishes a 1.1 The percentage FTE dedicated to CHVP ) g y groups, subcontractor (subK)to deliver home p g (CAB) Meetings, other local community budgets should be deducted from the site visits meetings and conferences as directed. visiting services, an LHJ local MCAH budget to ensure the LHJ representative (the CHVP Director does not exceed the MCAH Director FTE when possible and appropriate) must Requirements as outlined in the Local be present during all technical MCAH Program P&P Manual. If an assistance (TA) calls,virtual or in- MCAH Director cannot meet the person visits, and be involved in all requirements of the CHVP SOWS, they programmatic, data, contract, and can identify a designee, as outlined in fiscal communications with the Local MCAH Program P&P. In this CDPH/CHVP.This requirement Contract#/LHJ Name: 24-10/County of Fresno mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 # Objective Activities Deliverables situation,the designee, who may be ensures that the LHJ maintains identified as an MCAH Coordinator or oversight and direct involvement in other position, can act as the all aspects of the contracted services, responsible party for CHVP, and should guaranteeing alignment with be designated as such on the CHVP CDPH/CHVP standards and budget justification. expectations.Additionally, no more than 10% of the allocation can be spent on administrative oversight of a subK. LHJ leadership and home visitors will (a) Review LHJs MCAH Title V Needs Assessment to Submission of: implement home visiting services determine the community's equity needs. • Status Reports utilizing culturally responsive practices • Staffing Reports to ensure that all interactions, (b) Participate in opportunities designed to enhance . Staff Training Logs interventions, and service deliveries cultural sensitivity through webinars,trainings, effectively meet the diverse needs of and/or conferences. 1.2 the communities served, employing a cultural humility approach. (c) Provide culturally responsive services that address the identified cultural needs of families (e.g., literacy levels, disabilities, military families, grandparents,tradition, etc.). (d) Provide documents in the family's preferred language, when feasible. Documents should be 4.`,- Contract#/LHJ Name: 24-10/County of Fresno )CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 PrQyWgjqjadership and structure to implement CHVP in the LHJ. # 1 Objective I Activities Deliverables written in no more than an eighth-grade reading level and use plain language. (e) Recruit and hire staff that reflect the community served and/or speak the language of program participants, when possible. (f) As needed, develop and document adaptations that are developmentally, culturally, and linguistically responsive to families, upon approval from model developer and CDPH/CHVP. LHJ leadership will hire, train, and retain (a) Participate in model required trainings related to Submission of: staff to comply with selected home screening tools, health assessments, reflective • Status Report visiting model requirements and supervision, data collection tools, and software. . Staff training logs and plans CDPH/CHVP Policies and Procedures. • Staffing Reports (b) Participate in CHVP site visits as directed by . Confirmation of signed CDPH/CHVP. 1.3 confidentiality agreement for each staff member (c) Maintain full staffing capacity to serve families and adhere to specific model requirements. (d) All staff will sign a confidentiality agreement at the time of hire and annually thereafter. Contract#/LHJ Name: 24-10/County of Fresno )CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 MOTM # Objective Activities Deliverables LHJ Leadership will ensure the program (a) Develop and sustain relationships with Submission of: reaches and maintains contracted appropriate agencies to obtain home visiting • Status Reports Caseload Capacity (CC). participant referrals. • Outreach activity Log • Referral triage process outlining (b) Develop a referral triage process for incoming referral process (flow chart, logic home visiting participants to ensure families are model, narrative, etc.). connected with the program that best meets . Confirmation of signed CHVP their needs. 1.4 Participant Consent Form for each enrolled participant (c) Ensure each newly enrolled participant receives . Submission of complete and informed consent and signs a CHVP Participant timely participant enrollment Consent Form. data. NOTE:Any LHJ that falls below 85% of the CC for three (3) consecutive months may be required to participate in an Extra Support Plan. MCAH Director or designee will provide (a) Implement model requirements in accordance Submission of: oversight and leadership to ensure with the selected model(s) fidelity standards. • Selected model Certificate of 1.5 selected home visiting model fidelity Fidelity, Fidelity or Accreditation and quality assurance. (b) LHJs interested in implementing a model- Report, or similar document approved adaptation must obtain written demonstrating good standing and model fidelity. Contract#/LHJ Name: 24-10/County of Fresno I)COPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June-30, 2025 # Objective Activities Deliverables approval from CDPH/CHVP prior to implementation. LHJ leadership will develop and (a) Develop and conduct an annual review of local Submission of: implement home visiting policies and P&Ps related to home visiting. • Status Reports procedures (P&P) and follow all • Annual confirmation of review of applicable MCAH and CHVP P&Ps. (b) Conduct an annual review of, and ensure local and CDPH/CHVP P&Ps compliance with, CDPH/CHVP P&Ps. 1.6 (c) Conduct an annual review of, and ensure compliance with,the MCAH Fiscal Administration P&P Manual. (d) Conduct an annual review of, and ensure compliance with,the Local MCAH Programs P&Ps. Contract#/LHJ Name: 24-10/County of Fresno !)CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 301 2025 # Objective Activities Deliverables LHJ leadership will participate in (a) Participate in TA meetings and quality Submission of: technical assistance (TA) and Continuous improvement activities as directed by • Status Reports Quality Improvement (CQI) projects and CDPH/CHVP. • CAB meeting materials activities to support program • CQI Plans, data, and information 1.7 implementation and improvement goals. (b) Utilize the CAB to inform and address quality improvement projects and decisions. Participation in: �(c) Utilize data to inform and improve program Quarterly TA meetings activities. Contract#/LHJ Name: 24-10/County of Fresno )COPH mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 (01:, � �S e 4— cl; Y r. =.1�' f E. I_i •1' o �.;,Y'':7i ;�,:1�.v c�f7ilalc� f 1�1 1+ ,y��i€dS __..,.. _.. _ - '. - # Objective Activities Deliverables MCAH Director or designee will (a) Maintain a CAB that includes local early childhood Submission of: collaborate with local early childhood system partners and meets at least quarterly to • Status Reports system partners to ensure a continuum establish appropriate linkages to referral and . CAB meeting materials 2.1 of services for families. service systems. . MOUs and/or information written agreements (b) Meet and work with other local early childhood system and community partners to coordinate services to families. MCAH Director or designee will pursue, (a) Develop Memoranda of Understanding(MOU) Submission of: develop, and maintain relationships with and/or informal written agreements (e.g., letters • Status Reports 2.2 local service agencies and referral of support) with community agencies and service . MOUs and/or informal written resources to facilitate participant providers. agreements recruitment. • Outreach logs Contract#/LHJ Name: 24-10/County of Fresno )CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 # Objective Activities Deliverables LHJ leadership, home visitors, and data (a) Accurately collect and submit participant data Submission of timely and support staff will maintain clean and using selected home visiting model and CHVP- accurate data on participant compliant data. required documents. demographics, service utilization, and performance (b) Ensure accuracy and completeness of data input measures, according to, and into designated data systems using data quality with fidelity to, the selected reports and monitoring. home visiting model guidelines and CHVP requirements. (c) NFP LHJs will coordinate data system requirements . Participate in regular technical with the NFP National Service Office. assistance calls and site visits 3.1 with CDPH/CHVP staff. (d) HFA LHJs will coordinate with the CHVP Data Team to establish buildout/modification in Efforts to Outcomes (ETO) data system and will comply with all CHVP HFA Data Collection Manual requirements. (e) PAT LHJs will coordinate data system requirements with the PAT National Office for use of the Penelope or Visit Tracker Web data system(s) Contract#/LHJ Name: 24-10/County of Fresno !)CDPH I mcah California Home Visiting Program—SGF El3HV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 F, �k o' # Objective Activities Deliverables (f) Collect and enter participant data into designated data systems within seven working days, or as required by the selected home visiting model. (g) Provide and/or coordinate with data collection system owners to provide monthly enrollment and other requested reports to CDPH/CHVP as needed. Contract#/LHJ Name: 24-10/County of Fresno !)CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 ' . . . !7LuH ctive Activity Deliverable eadership will monitor the use of (a) Additional Staff Costs: Fund staff costs associated Submission of: s for Special Support Activities. with providing home visits or administration for • Special Support Activity Report programs, including incentive bonuses or overtime Additional Staff Costs: NOTE: LHJs can spend up to 25% of the pay that supports individual employees. o Number of staff(not FTE) FY 2024-25 SGF EBHV allocation on receiving incentive or Special Support Activities. (b) Training: Fund additional training opportunities other pay that address the needs of families, including but o Total amount spent on not limited to health equity, reproductive justice, Additional Staff Costs social determinants of health, etc. o Explanation of fund use Training: 4.1 (c) Technology: Fund and distribute the necessary o Name and date of training. technological means for participant families and o Purpose and description of staff. training o Name and number of staff (d) Family Support Materials: Fund the purchase of participating in training necessary support materials, including diapers, o Costs associated with diapering supplies, gift cards, and prepaid grocery training, including travel cards to participating families for the purpose of Technology: providing extra support. o Hardware or software purchased o Number of families receiving technology 4*'4tL- Contract#/LHJ Name: 24-10/County of Fresno )CDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 o Number of staff receiving technology Family Support Materials: o Type and number of gift cards purchased and distributed o Type and number of prepaid grocery cards purchased and distributed. o Number of families receiving diapers and diapering supplies o Information about "other" Family Support Materials purchased LHJ leadership will maintain clean and (a) Collect, maintain, and report use of Special Submission of: compliant special support activity data, Support funds as outlined in CHVP Special Support • Special Support Activity Report 4.2 per CHVP guidelines. Activity guidance. • Additional documentation upon request Contract#/LH1 Name: 24-10/County of Fresno !)COPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 Home Visiting Model Monitoring Chann Due Date All reports and documentation must be submitted via SharePoint, unless otherwise directed by CHVP. All Staffing Report January 15,April 15, July 15, October 15 All Status Report April 15 and/or October 15 as • CAB Roster, Minutes, and Agendas determined by CDPH/CHVP • MOUs or informal agreements with community agencies and service providers • Outreach logs • Training plans and logs • Policies and Procedures • Referral Triage Plan • Confirmation of signed Participant Consent Forms • Confirmation of signed confidentiality agreements for all direct staff • Model Developer Agreement, Accreditation, and/or Affiliation documentation. • Special Support Activity Report Nurse-Family Priority Population Survey April 15 and October 15 Partnership All CQI plans, data, and information Upon Request Contract#/LHJ Name: 24-10/County of Fresno )CDDPH I mcah California Home Visiting Program—SGF EBHV California Home Visiting Program State General Fund (SGF) Evidence-Based Home Visiting (EBHV) Scope of Work July 1, 2024- June 30, 2025 Home Visiting Model __ __ - ;Monitoring Channel D. Due te All Technical assistance calls/meetings Quarterly (TBD) All Site Visit TBD All (if applicable) Special Support Activity Report April 15 and October 15 NOTE: If compliance standards are not met in a timely manner, CDPH/CHVP may temporarily withhold cash payment pending correction of the deficiency; disallowing all or part of the cost of the activity or action out of compliance; wholly or partly suspending or terminating the award; or withholding further awards. Ge Vue y� MCAH Director Name MCAH Director Signature Date Funding Allocation from California Department of Public Health Allocation Name: California Home Visiting Program - Maternal, Infant, and Early Childhood Home Visiting (MIECHV) and California Home Visiting Program — State General Fund — Evidence Based Home Visiting (EBHV) Allocation Fund/Subclass: 0001/10000 Organization: 56201718, 56201750 Revenue Account #: 4380, 3530