HomeMy WebLinkAbout32001RON CHAPMAN, MD, MPH
Director & Stat9 Health ~r
State of Cali fornia-Health and Human Services Agency
California Department of Public Health
October 15, 2014
Rose Mary Garrone, RN , BSN , PHN
MCAH Director I Division Manager
Fresno County Department of Public Health
Public Health Nursing I Maternal , Child and Adolescent Health
P. 0. Box 11867
Fresno, CA, 93775
Dear Ms. Garrone:
APPROVAL OF AGREEMENT FUNDING APPLICATION (AFA) FOR
AGREEMENT #201410 -FISCAL YEAR 2014-15
AGREEMENT NO . 15-059
EDMUND G. BROWN JR.
Gove rnor
The California Department of Public Health , Maternal , Child and Adolescent Health
(CDPHIMCAH) Division approves your Agency's AFA, including the enclosed Scope of
Work (SOW) and Budget for administration of MCAH related .programs. ·
To carry out the program outlined in the enclosed SOW, Attachment A Program
Operational Requirements for the Californ ia Home Visiting Program (CHVP) and Budget
during the State Fiscal Year beginning July 1 , 2014 and ending June 30,2015, the
CDPHIMCAH Division will reimburse expenditures up to the following amount:
CALIFORNIA HOME VISITING PROGRAM ............. $ 863,839
The availability of Maternal , Infant and Early Childhood Home Visiting (MIECHV)
TITLE V funds are based upon funds appropriated in the FY 2014-15 Budget Act.
Reimbursement of invoices is subject to compl iance with all federal and state
requirements pertaining to CDPHIMCAH related programs and adherence to all
applicable regulations, policies and procedures . Your Agency agrees to invoice actual
and documented expenditures and to follow all the conditions of compliance stated in
the current CDPHIMCAH Program and Fiscal Policies and Procedures manuals,
including the ability to substantiate all funds claimed . The policies and procedures
manual can be accessed at: http://www.cdph.ca.govlserviceslfundingl
mcah/Pages/FiscaiPoliciesandProceduresManual .aspx
Please ensure that all necessary individuals with in your Agency are notified of this
approval and that the enclosed documents are carefully reviewed . This approval letter
Matemal, Child and Adolescent Health D iv ision/Center for Family Health
MS 8300 • P.O. Box 997420 • Sacra mento , CA 95899·7420
(916} 650-0300 • (916} 650-0305 FAX
lntemet Address: I.'.WW .cd ph .ca .gov
Ms. Garrone
October 15, 2014
Page2
constitutes a binding agreement. If any of the information contained in the enclosed
SOW and Budget is incorrect or different from that negotiated, please contact your
Contract Manager, Stephen Fong, at (916) 650-0340 or by e-mail at
stephen.fong@cdph.ca.gov within 14 calendar days from the date of this letter.
Non-response constitutes acceptance of the enclosed documents.
Enclosure( s)
cc: Bernice E. Seidel
Clerk of the Board
Fresno County
2281 Tulare Street, #301, Hall of Records
Fresno , CA, 93721-2198
Stephen Fong
Contract Manager
Monica Perez
Program Consultant
Central File
FY 2014-2015 AGREEMENT FUNDING APPLICATION (AFA) CHECKLIST
Agency Name: County of Fresno
Agreement #: 20141 0 Program: D MCAH OBIH 0AFLP ~CHVP
~~lfl:@[hoo -.,d[)~,~~lf~
.....
' ~~,~~!.H ;J. n l 0 • -1 Sffiilluli..H.i}JiN.. 'l:fiUfi LT:ltilll [Jill) Li. ;r .,. fit:.: •1 , 1 r-u ill H •I l_•i•J 1 l'.I ;,1 1 t fiim r.JilfffiJ!l2l~
~ 1. AFA Checklist with signature (PDF )
~ 2. Agreement Funding Application U~date Form with signature (PDF )
~ 3. Attestation of Compliance with the Sexual Health Education Accountability Act of 2007 (PDF )
~ 4. Program Narrative for all applicable programs ord )
5. Budget Template (Summary Page, Detail Pages, and Justifications) listing all staff (by position)
~ and costs (including projected salaries and benefits). Personnel must be consistent with the Duty
Statements and Organizational Charts (Excel)
~ 6. Duty Statements (OS) for all staff (numbered according to the Personnel Detail Page and
Organization Chart) listed on the budget (Word )
7. Org Chart(s) of the applicable programs, identifying all staff positions on the budget (w/line item#)
~ and its relationship to other services for women and children, the local health officer and overall
agency (Word, Excel, PDF )
~ 8. A~~roval Letters including waivers for the following positions (PDF ): OMCAH Director;
OBIH Coordinator; OAFLP Director; [8JCHVP Coord.//Nurse Sup.; OOther
~ 9. Scope of Work (SOW) documents for all applicable programs (PDF/Word )
~ 10. Annuallnvento!Y-Form CDPH 1204 (Word )
~ 11. CHVP Attachment A -Program Operational Requirements, CHVP Attachment C -Transmittal
Form [CHVP only] (PDF )
D 12. Local Health Officer Approval Letter to conduct FIMR [MCAH only] (PDF )
~ 13. Subcontractor (SubK) Agreement Packages (required for all SubKs $5,000 or more) (PDF )
D 14. Certification Statement for the Use of Certified Public Funds (CPE)
[AFLP CBOs and/or SubKs with FFP] (PDF )
Revision Date: 08/01/14 Page 1 of2
File Naming Convention Example
Please save all electronic documents using the required naming convention below:
(Agreement# [space] Program Abbreviation (space] Checklist# (space] Document Name [space]
Version Date]
Below is an example of the submitted documents for Alameda County:
2D1301 BlH 1 AF Checlkli,st 042913.doc
~ 201301 B1H 2 Update Form 0 2913.doo:
2.01301 BJH 3 :Hestation 042913.doc
2.01301 BIH 4 Program Narrative 042913.doc
201301 BIH 5 Budget 042913.xlsx
f@ l0130i BIH 6 DS line l 04!2913.doo:
~ 201301 BIH 6 DS line 2 042913.docx
~ 201.301 BlH 6 DS line 3 042913.doa
w 2D1301 BIH 1 Org Chart -Overall Agency 0429r:l.3 docx
WI 2.0130 ,1 BlH 1 Org Chart -Program On'}t 0429~3.docx
111 201301 BIH 8 aiv er letter -MCAH Director 042913.doa
201301 BIH 9 SO . 042913 .doc
2D1.30i B1H 10 ]nv entory 0429!1.3 .doc
~ 201301 BIH 13 SubK 042913.pdf
~ 201301 BJH 14 CPE 042913.pdlf
Please contact your contract manager (CM) if you have any questions.
Revision D ate: 08/0 1114 Page 2 of2
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIVISION
FUNDING AGREEMENT PERIOD
FY 2014 -15 (LHJs)/2012-13 to 2014-15 (CBOs)
AGREEMENT FUNDING APPLICATION (AFA)/UPDATE FORM*
~ ------------------------------------------------------------------------
At the beginning of each fiscal year Agencies are required to submit this AFA Form along
with their AFA Package, which requires certification signatures (original signatures, no
stamps allowed}. This form should also be used when submitting updates that occur during
the fiscal year. Update submissions do not require certification signatures.
The Agency Identification Information section must be completed each time this form is
submitted.
Any program related information being sent from the CDPH MCAH Division
will be directed to the MCAH and/or AFLP Director.
Please check the applicable "Program " boxes below : changes being submitted :
1:8:] MCAH
Fiscal Year: 2014-15
OAFLP
u
Agreement Number: 201410
Federal Employer 94 -6000512
ID#:
Complete Official County of Fresno
Name:
1:8:] BIH t8l FIMR t8l CHVP
Effective : uired when submittin
1221 Fulton Mall , Fresno , CA 93721 (Physical Address)
P .O . Box 11867 Fresno CA 93775 Ma i
600 -3330 600 -7729
Name : David Pomaville
Title : Director
P .O . Box 11867
E-Mail Address : us
Page 1 of 7
Revised June 2014
Agency Name : County of Fresno
Agreement#: 201410
Title : Bernice E. Seidel
2281 Tulare #301 Hall of Records
E-Mail Address :
3 OFFICIAL AUTHORIZED TO COMMIT AGENCY
Name: Deborah A. Poochigian
Title : Chairman, Board of Supervisors
Mailing Address : 1 2281 Tulare St, #301 , Hall of Records
City: Fresno
Phone : (559) 600 -5000 I Ext. I
E-Mail Address: I dpoochigian@co.fresno.ca.us
4 FISCAL OFFICER
Name : Chris Markus
Title : Principal Staff Analyst
Mailing Address : I P.O. Box 11867
City: Fresno
Phone : (559} 600 -7090 I Ext. I
E-Mail Address : cmarkus@co.fresno .ca . us
Fiscal Year: 2014-15
93721-2198
l Zip : 1 93721-2198
I FAX : I (559) 455-4704
I Zip : 1 93775
I FAX : I (559) 6oo -7687
5 MCAH DIRECTOR (Please check box if MCAH and AFLP Director are the same)
Name: Rose Mary Garrone
T itl e: MCAH Director/Division Manager
Mailing Address : I P.O. Box 11867
City: Fresno I Zip : 1 93775
Phone: (559) 600 -3330 I Ex t. J I FAX : I (559) 6oo -7729
E-Mail Address : rgarrone@co.fresno .ca.us
Page 2 of?
Revised June 2014
•
Agency Name : County of Fresno
Agreement#: 201410 Fiscal Year: 2014-15
6 MCAH COORDINATOR (Only complete if different from #5)
Name : Jennifer Day
Title: MCAH Coordinator/Perinatal Services Coordinator
Mailing Address: I P.O. Box 11867
City: Fresno I Zip : 1 93775
Phone : (559) 600-3330 I Ext. I I FAX : I (559) 6oo -7729
E-Mail Address : I jday@co .fresno.ca .us
E-Mail Address:
8 MCAH INVOICE CONTACT (Only complete if different from #7)
Name: Michael Chu
Title : Accountant
Mailing Address: J P .O. Box 11867
City: Fresno I Zip: 1 93775
Phone : (559) 600 -6426 I Ext. I I FAX : I (559) 6oo -7687
E-Mail Address: I mchu@co.fresno .ca.us
9 PERINATAL SERVICES COORDINATOR (PSC)
Name : Jennifer Day
Title: MCAH Coordinator/Perinatal Services Coordinator
Mailing Address : I P .O . Box 11867
City: Fresno I Zip : 1 93775
Phone : (559) 600 -3330 I Ext. I I FAX: I (559) 6oo -7729
E-Mail Address : I jday@co .fresno.ca .us
Page 3 of 7
Revised June 2014
I
I
I
Agency Name : County of Fresno
Agreement#: 201410 Fiscal Year: 2014-15
10 AFLP DIRECTOR (Only complete if different from MCAH Director)
Name :
Title :
MailingAddress : J
City: I Zip: I
Phone: I Ext. I I FAX: I
E-Mail Address: I
11 AFLP COORDINATOR (Only complete if different from #10)
Name :
Title :
Mailing Address: I
City: I Zip : I
Phone : I Ext. I I FAX: I
E-Mail Address: I
12 AFLP BUDGET CONTACT
Name:
Title :
Mailing Address : I
City: I Zip : I
Phone : I Ext. I I FAX : I
E-Mail Address : I
13 AFLP INVOICE CONTACT (Only complete if different from #12)
Name :
Title:
Mailing Address: I
City: I Zip: I
Phone : I Ext. I I FAX : I
E-Mail Address: I
Page 4 of 7
Revised June 2014
Agency Name : County of Fresno
Agreement#: 201410
14 BLACK INFANT HEALTH (BIH) COORDINATOR
Name : Erica Alexander
Title: BIH Coordinator/Public Health Nurse
Mailing Address: 1 142 E. California Ave
City: Fresno
Phone: (559) 600-1021 I Ext. I
E-Mail Address : I ealexander@co .fresno .ca.us
E-Mail Address:
Fiscal Year: 2014-15
I Zip: 1 93706
I FAX : I (559) 6oo-1132
16 BIH INVOICE CONTACT (Only complete if different from #15)
Name : Michael Chu
Title : Accountant
Mailing Address : I P.O. Box 11867
City : Fresno I Zip : I 93775
Phone: (559) 600 -6426 I Ext. I I FAX : I (559) 600 -7687
E-Mail Address: I mchu @co .fresno.ca .us
17 FETAL INFANT MORTALITY REVIEW (FIMR) COORDINATOR
Name: Erica Alexander
Title : BIH Coordinator/Public Health Nurse
Mailing Address : 11 42 E . California Ave
City: Fresno I Zip: 1 93706
Phone : (559) 600 -1021 I Ext. I I FAX: I (559) 6oo -1132
E-Mail Address : I ealexander@co .fresno .ca.us
Page 5 of 7
Revised June 2014
I I I
' I
Agency Name: County of Fresno
Agreement #: 20141 0 Fiscal Year: 2014-15
18 SUDDEN INFANT DEATH SYNDROME (SIDS) COORDINATOR I CONTACT
Name: Erica Alexander
Title: BIH Coordinator/Public Health Nurse
MailinQ Address: 11 42 E. California Ave
Citv: Fresno I Zip : 1 93706
Phone : (559) 600 -1021 I Ext. I I FAX: I (559) soo-1132
E-Mail Address : ealexander@co .fresno. ca. us
19 CALIFORNIA HOME VISITING PROGRAM (CHVP) COORDINATOR/
NURSING SUPERVISOR
Name: Kathleen Kelley
Title : Supervising Public Health Nurse
Mailing Address : I P .O. Box 11867
City: Fresno 1 ZiQ_: _1 93775
Phone: (559) 600-3330 I Ext. I I FAX: I (559) 6oo -1140
E-Mail Address : kkelley @co .fresno .ca .us
20 OTHER
Name:
Title :
Mailing Address: I
Citv: lziQ_: J
Phone : I Ext. I I FAX : I
E-Mail Address:
Page 6 of 7
Revised June 2014
I
I
~
Cll
Agency Name : County of Fresno
Agreement #: 20141 0 Fiscal Year: 2014-15
AGREEMENT FUNDING APPLICATION I
1
POLICY COMPLIANCE AND CERTIFICATION
The undersigned hereby affirms that the statements contained in the Agreement Funding
Application (AFA) are true and complete to the best of the applicant's knowledge.
I certify that this Maternal, Child and Adolescent Health (MCAH) related program will comply
with all applicable provisions of Article 1, Chapter 1, Part 2 , Division 1 06 of the Health and
Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and
Institutions Code (commencing w ith Sections 14000 and 142), and any applicable rules or
regulations promulgated by CDPH pursuant to this article and these Chapters . I further certify
that this MCAH related program w i ll comply with the MCAH Policies and Procedures Manual ,
including but not limited to, Administration , Federal Financial Participation (FFP) Section. I
further certify that this MCAH related program will comply with all federal laws and regulations
governing and regulating recipients of funds granted to states for medical assistance pursuant
to Title XIX of the Social Security Act (42 U.S.C. section 1396 et seq .) and recipients of funds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of
the Social Security Act (42 U .S.C . section 701 et seq .). I further agree that this MCAH related
program may be subject to all sanctions or other remedies applicable if this MCAH related
program violates any of the above laws , regulations and policies with which it has certified it
will comply .
Original Signature of Official auth
commit the Agency to an MCAH
Chairman, Board of Supervisors
Title
0_ '_?i
_J (/) ~ UJ ~ ~-~ j en<ll . a.
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•. UJ en
1-() 0 en z-o -UJ 0:: ~ ~ UJ ~ >-
<( co co co
Deborah A. Poochigian
Name (Type or Print)
Rose Mary Garrone
Name (Type or Print)
Re vi sed June 20 14
Page 7 of 7
Date
MCAH Director/Division Manager
Title
Date
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
Agency Name: County of Fresno
Agreement/Grant Number: 201410
Compliance Attestation for Fiscal Year: 2014-15
The Sexual Health Education Accountability Act of 2007 (Health and Safety Code , Sections
151000-151 003) requires sexual health education programs (programs) that are funded or
administered , directly or indirectly , by the State , to be comprehensive and not abstinence-only .
Specifically , these statutes require programs to provide information that is medically accurate ,
current , and objective, in a manner that is age , culturally , and linguistically appropriate for targeted
audiences . Programs cannot promote or teach religious doctrine , nor promote or reflect bias (as
defined in Section 422 .56 of the Penal Code), and may be required to explain the effectiveness of
one or more drugs and/or devices approved by the federal Food 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 pregnancy 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 condition of funding . The Attestation of Compliance must be
submitted to CDPH/MCAH annually as a required component of the Agreement Funding
Application (AFA) Package . By signing this letter the MCAH Director or Adolescent Family Life
Program (AFLP) Director (CBOs only) is attesting or "is a witness to the fact that the programs
comply with the requirements of the statute ". The signatory is responsible for ensuring compliance
with the statute . Please note that based on program policies that define them , the Sexual Health
Education Act inherently applies to the Black Infant Health Program, AFLP, and the California
Home Visiting Program , and may apply to Local MCAH based on local activities .
The undersigned hereby attests that all local MCAH agencies and AFLP CBOs will comply with all
applicable provisions of Health and Safety Code, Sections 151000-151003 (HS 151000-
151 003). The undersigned further acknowledges that this Agency is subject to monitoring 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 funding , including those enumerated in HS
151000-151003.
Signed
Signature o MCA Director
Signature of AFLP Director (CBOs only)
Rose Mary Garrone
Printed Name of MCAH Director
Printed Name of AFLP Director (CBOs only)
October 2011 Page 1 of 3
201410
Agreement/Grant Number
Exhibit K
Attestation of Compliance with the
Sexual Health Education Accountability Act of 2007
CALIFORNIA CODES
HEALTH 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 program that provides instruction or
information to prevent adolescent pregnancy , 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 accurate and objective by professional 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 Adolescent
Medicine , the American Academy of Pediatrics , and the American College of Obstetricians
and Gynecologists .
151002 . (a) Every sexual health education 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, nationality, race or ethnicity , religion , or sexual 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 2011 Page 2 of 3
Exhibit 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 all 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 activities 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
required to, include information otherwise required pursuant to paragraph (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 transmitted diseases other than
HIV/AIDS .
(d) An applicant for funds to administer a sexual health education program shall attest in writing
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, Chapter 5.6 (commencing with Section 51930) of the Education Code.
Notwithstanding Section 4 7610 of the Education Code, "publicly funded school" includes a
charter 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 not apply to one-on-one interactions between a health practitioner and his
or her patient in a clinical setting.
151003. This division shall apply only to grants that are funded pursuant to contracts entered into
or amended on or after January 1, 2008 .
October 2011 Page 3 of 3
CHVP LOCAL HEALTH JURISDICTION PROFILE NARRATIVE
County of Fresno Nurse Family Partnership Program 201410
1. Description of the geographic, socioeconomic , demographic and cultural composition
of the "high-risk community " that the LHJ site will target for home visiting services :
a . Southeastern Fresno County . The operation of Fresno County's Nurse
Family Partnership program provides primary prevention services for first time
mothers focusing on the underserved southeastern area of the county . Services
are provided to families in Del Rey , Fowler, Kingsburg , Laton, Malaga, Orange
Cove , Parlier , Reedley , Sanger and Selma. The northern border is Kings
Canyon Road. The southern border is the Northern Tulare County line . The
eastern border is the Friant/Kern canal. The western border is Highway 41.
b . The community is located in a rural area with an agriculturally based
economy. There are many high-risk socioeconomic issues facing our community
including poverty , poor wages , crime , drug trafficking , air pollution , low school
achievement rates , domestic violence, disproportionate number of single parent
families , domestic violence , substandard housing , drought conditions , tobacco
use and alcohol and substance abuse . The cultural composition of the
community is over 90% Hispanic with 20% of families being non-English
speakers . Many families have family members that are not legal residents of the
United States .
c . 88% of clients served are less than 25 years of age , with 59% of them being
teens. Of the clients referred , 85% are Hispanic , 3 .5% are American Indian and
3.5 % are African American . Primary Spanish speakers make up 20% of those
served.
2 . The intake criteria for Fresno County 's Nurse Family Partnership is low-income, first
time mothers pregnant before 28 weeks gestation and residing within the county of
Fresno .
3 . The County of Fresno has a Triage Nurse who triages all clients referred to the
Department of Public Health . Anyone can refer to the department for services. There is
a standardized form to submit, but anyone can call and refer by phone as well. The
nurse then determines the most appropriate MCAH early infant childhood programs
(AFLP , BIH , etc.) and submits the referral to the program supervisor . The program
supervisor the assigns the case to a nurse based on client need.
4. Barriers to health service delivery in/among the "high-risk community."
Due to the rural location, there is a lack of lack of transportation for clients to access
medical care, including prenatal care . Teens are typically in school and many are
struggling to complete their high school education . Once the child is born then childcare
becomes a barrier.
Access to:
a. Primary care providers include several Rural Health Centers and Federally
Qualified Health Clinics in the service area.
b . Providers in the service area accept Medi-Cal.
c. Obstetric care specialists are extremely limited within the service area . The
closest Perinatologist is in the city of Fresno .
d . Labor and delivery hospitals in the service area are scarce . The Selma
Adventist Health Care Center recently closed for deliveries and only the Sierra
Kings Birthing Center in Reedley remains .
e . Sierra Kings Birthing Center provides normal neonatal care. The closest
Neonatal Intensive Care Unit is in the city of Fresno. Children 's Hospital of
Central California which provides an array of specialized care is located in
Madera, 25 miles outside the service area.
f . There are several community agencies that support maternal, infant and family
health needs in the service area . The County of Fresno has contracted with
Turning Point for Mental Health Services at three of the largest cities in the
service area ; Selma , Sanger and Reedley. The Marjoree Mason Center provides
domestic violence services including shelter, counseling and legal assistance .
Legal Aid services are available at the Selma Regional Center one day a week.
Drug treatment services are available such as counseling and support group .
However, no residential treatment facilities exist in the rural area . There are
Housing Projects in the service area but no homeless shelters . There are a
variety of food banks and faith-based assistance centers providing food , clothing
and credit counseling .
,_,..~ oo-.•~ .1. Puot•c Health :r\Di•Jj Mllemal Ollld and AdotHcent Haalth Division ,--BUDGETSUMMARY I •cn!U<l'"'~__,., -·-• Pro~ram: California Home VIsiting Program Agency: SubK: 201410 Fresno (Comcetitive) EXPENSE CATEGORY ll PERSONNEL Ill OPERATlNG EXPENSES ((I) CAPITAL EXPENDITURES IV) OTHERCDSTS VI INDIRECTCOSTS TOTAL CHVP TOTAL-TOTAL-BUDGET TOTALS* TOTAL TITLE XIX TOTAL AGENCY FUNDS I )1) 12l (3) I TOTAL FUNDING •4 CHVP ALLOCA TION(S) --+ ~63~ 666.344 668.344 66,443 66,443 18,500 18,500 110,552 110,552 863,839 100.00% 863 839 BALANCE(S) -§ -I 863.8391 ORIGINAL BUDGET BUDGET STATUS ACTIVE UNMATCHED FUNDING AGENCY FUNDS (4) (51 (4) (5) (8) 1 C1i % % oy, !Agency Funds· L._ I I I I $ Maximum Amount Payable from State and Federal resources CP STATE USE ONLY-TOTAL STATE AND FEDERAl REIMBURSEMENT AF~~D~~ PCACOdes 53143 IN/A IN! A (II PERSONNEL 666,344 (II) OPERATING EXPENSES 66,443 (Ill) CAPITAL EXPENSES (IV) OTHER COSTS 18.500 (V) INDIRECT COSTS 110,552 l-Totals ror PCA Codes 863,839 863,839 201410 CHVP 51!udget091214 1 of 3 I BALANCE I NON~ ANCED MATCHING (50150) ,., I ,., % j 1"''"1~ 150%1t=j IN/A ""' I (11) ',(, I Combined -,..,.,.,c::::::::=J ,,.,.,c::::::::=J ENHANCED MATCHING (75125) ,,2, 1 (13) (14) I (15) % I 'lo !Combined -J2SO<o)~ [75%1t=j f75"Jc::::::::=J [25"1c=:=J l(J -lrJ '-f-j DATE IN/A Printed: t017nG14 4:C5 PM
GGI'<t·~~o.,..,....., ... .-~ ..!1.:_ PvoliC Health ~~1.'111 M•t••nai.Ci'ikl•ndAdol-scer-.HnlthDMsM)I"' ORIGINAL BUDGET Program: Califomla Home Visiting Program NON-eNHANCED ENHANCED A!jl8ncy: 201410 Fresno (Competitive) UNMATCHED FUNDING MATCHING (SO/SO) MATCHING (7S/1S) SubK: I I I AGENCY FUNDS I I I (1) (2) I 13) I (<) I (5) I (4) I (S) 1 (0) 1 (1) l•l .I 10) I 110) J ,,, 1121 1 (13) I I"' I (15) I TOTAL FUNDING % I CHVP I "' I I % I I % I Agency Funds• "1. I I % ~~=!~:~"* "' I I "' 1~::~~'::::!~ (II) OPERATING EXPENSES DETAIL TOTAL OPERATING EXPENSES 66,443 66,443 I I I TRAVEL 27,500 100.00\1 27,500 ~ 1----1---1---~ -----H TRAINING 16,443 100.00% 16 .•• 3 1 Telephono 900 100.00% 900 2 Household, Building, Equipment Maintenance 200 r----1---1---200 100.00% 1---c---1---~ 3 lw1ed1ca.l & Dental Suppfles 1,500 100.00% 1,500 ~ Office Supplies 4,000 100.00% 4.000 1------1---5 Postage 100 100.00% 100 r-----1---El Printing 1,700 100.00% 1,700 f----!---~ 7 Rents & leases 100.00% 7,500 r--r--1----1---7,500 1-~ r---1---8 SmaU Tools & Instruments 6,000 100.00% 6,000 9 Facil~$/l)tjlities 600 100.00% 600 r---1----~ 10 1-c---'----1---11 1----c----1-----1----r--12 -!--'----1---1J -1---1----1---14 -r---r--,_ 1---15 Jnmatched ()()eraUnQ EXDenus au1 note Ill ble for Fedara matchmp nd$ (T"'ctta X.IX). Expenses mav ontv be charaed to unmatched Trtle V CCol, 3), Slate Genent unds (Col. ~J. and/or Aaencv ((.;ot 1 runds. (Ill) CAPITAL EXPENDITURE DETAIL TOTAL CAPITAL EXPENDITURES (IV) OTHER COSTS DETAIL TOTAL OTHER COSTS SUBCONTRACTS 1 Nurse-Fami~ Partnership 2 3 ~ 5 6 7 8 OTHER CHARGES 1 Bocks & Publications 2 Promotional Items/Client Support Materials 3 lnterp~ters 4 5 6 7 8 20I410CHVP 5 Budget 091214 2 of 3 l'rinnld. G71201~ 4:05 I'M
c~•-~"·•-"" ..... ~ ..:)..::_.. Public Health •h DJ.,I Maternai,ChildandAdolescm:He;tlthOivision ORIGINAL BUDGET Program: California Home Visiting Program NON-CNHANCED ENHANCED Ageney: 201410 Fresno (Competitive) UNMATCHED FUNDING MATCHING 150150) MATCHING (75125) SubK: AGENCY FUNDS I II) (2) I 13) 14) I iS) (4) 1 ,., (6) r (71 (I) I (9) (10) 1 (11) c•21 1 (13) "•' I (15) I TOTAL FUNDING % I CHVP ,., I % I % I Agency Funds' % I % 1;~mbi0Cld % I % ~~~mbined I .. ~ (V) INDIRECT COSTS DETAIL I TOTAL INOIRECT COSTSI 110,552 I 110,552J I I I I I r I I l I I l 15,.,1,.• of TotaJ Oireet Costs -- --_ _L __ 1_10,552 100.00%1 110,5521 I I I I I T l T T I (I) PERSONNEL DETAIL TOTAL PERSONNEL COSTS SU,34.4 668,344 I I I FRINGE BENEFIT RATE 71.95% 279,668 I 279.688.H H H __ bj 1-=--J. 1=--l H TOTAL WAGES 388,676 I 388,676 "' -'> -' 'J, <a: < TITLE OR CLASSIFICATION ~:l TOTAL WAGES I ;: FTE ~ Z< "'"' 1 RG MCAH Direclor 15.00% 106,327 15,949 100.00% 15,949 1--1---r---r---r----2 KK SPHN 100.00% 96,375 96,375 100.00% 96,375 l ow PHN I 100.00% 67,084 67,084 100.00% 67,084 1--,.-----r---I--I---4 LW PHN I 100.00% 83,653 1--1---r---r---r----83,653 83,853 100.00% 1--1---r---I--r----5 ST PHN I 100.00% 5e,924 66,924 100.00% 66,924 6 cw PHN I 100.00% 58,691 58,691 100.00% 58,691 r---1--I--I--I---7 r---r----r---r---r----I 8 I--r----r---r---r----9 -I---I--I--I---i ---r---r---r----10 ---r---r---r----11 I 12 ;------I--I---i 13 ;------r---r----I .. 1-----r---r----15 1--I--,----I--I---16 1--;-----r---r----17 1--1--;----I--I---18 1--1--'------I--I---19 1--1--r----r---I---I 20 1--~ ;----I--I--;----21 1--1--r----r--r----! 22 1--1--r----I--I---23 r-----1--r---1--1---i 24 -1--I--,.----I--I----1----1--1---I 25 -1---1--I--I---26 27 -1--1--1--1----1---1--r---I---28 -1----1--I--1---29 I -)-----1-----30 -I---1-----I 31 32 -)-----1-----' -I--1--1-----33 34 -I---r------I --1--1-----35 1---r---1-----' 36 37 1---1--r------1-,.----1--1-----38 1---r---1-----39 40 1---1--1--~ --'----'-----'-----201410CHVP 5 Budge! 0912H 3or3 Printed: 101712014 4:05PM
Callwnlo o.ponnwt\1 ~ Public Health -*-;}t'DPII Mate mat, Child and Adolescent Health Division (I) Justification Budget: ORIGINAL Program: California Home Visiting Program Agency: 201410 Fresno (Competitive) SubK: v, ver:ston <t . .>l'\-<tU uuanen (I) PERSONNEL DETAIL BASE MEDI-CAL FACTOR % Use the following link to access the current AFA webpage and the current base MCF% for your agency: htto://www.cdoh.ca.e:ov/services/fundin_gf_rncah/Pages/FiscaiDocuments.asox TOTALS 5.15 479,054 388,676 279,667.93 rn FRINGE ..J ANNUAL TOTAL MCF %Justification <{ TITLE OR CLASS. %FTE BENEFIT FRINGE BENEFITS PROGRAM MCF% MCF Type Requirements i= SALARY WAGES (Click link to view) ~ RATE% Maximum characters= 1024 1 RG MCAH Director 15.00% 106,327 15,949 71.95% 11,475.94 2 KK SPHN 100.00% 96,375 96,375 71.95% 69,345.67 3 DW PHNI 100.00% 67,084 67,084 71.95% 48,269.62 4 LW PHNI 100.00% 83,653 83,653 71.95% 60,191.68 5 ST PHNI 100.00% 66,924 66,924 71.95% 48,154.49 6 CW PHN I 100.00% 58,691 58,691 71.95% 42,230.52 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 I 28 I 29 30 31 32 33 34 35 36 37 38 39 40 ·--· 201410 CHVP 5 Budget 091214 1 of 1 Printed: 1112412014 2:10PM
Budget: ORIGINAL
Program : California Home Visiting Program
Agency: 201410 Fresno (Competitive)
SubK :
(II) OPERATING EXPENSES JUSTIFICATION
(11-V) Justifications
TOTAL OPERATING EXPENSES 66 ,443
TRAVEL 27 ,500
TRAINING 16,443
1 Telephone 900
2 Household , Building , Equipment Maintenance 200
ers1on 4 . -4 V 3A OQ uarterl
Reimbursement for staff for private auto mileage at rate of
$0 .56 /mile when they travel to sites , home visits & program
related meetings. County will bill only up to the State's per
diem rate . Includes County vehicle & vehicle rental costs
when private vehicles are not used . Also includes expenses
R. . '' '(',
Registration fees to attend required & related conferences ,
trainings , workshops & meetings for home visiting staff.
Trainings are located in Fresno County, Sacramento &
throughout California, & on occasion out of state . Fresno will
"'"I C:bte> """''"'"' ndnt In ""' no ot nf obi<>''"""'
Long distance & local service , cell phones & telephone
relocation . Rate provided by Fresno County
ITSD/Cornmunications & is based on the type of device used .
Janitorial expenses , furniture moves, thermostat repairs , &
lcooier/FAX machine
3 Medical & Dental Supplies 1,500 Assessment tools such as thermometers & protective
equipment. PHNs utilize proper clean bag technique and
barriers are required for every home visit. Additionally, hand
sanitizer and sanitizing wipes are utilized after each use of
equipment. In each home visit for example the blood pressure
cuff, stethoscope , and the scale , both adult and infant ,
measuring mat, measuring tapes are all wiped down after
every use . This occurs in the home before being returned to
the nurse 's bag . These items are also cleaned intermittently
with spray disinfectants. If a client is known to have MRSA,
disposable equipment is used whenever possible .
4 Office Supplies 4 ,000 General office expenses for staff to carry out day to day
activities . Client chart binders , shredders. paper, pens . ink ,
d;mle>r~ ~>lr. R. fnrm~ ~n~>r.ifir. In lhA nrnnr"m
5 Postage 100 Regular mail postage , Federal Express & overnight mail for
'with clients . the oublic & CDPH .
6 Printing 1,700 Office printing, chart forms & NFP Facilitator Guides, used by
home visitors every visit. PHNs have different visit-to-visit
· tnnl~ R. n11r~A indr11f'linn"l n11irlA~ AvArv vi~il
7 Rents & Leases 7,500 Space rental for Selma Regional Center facility & community
events/meetings. Program 's share of Selma lease is 785 sq ft
at $0 .66 per sq ft , per month . Includes 3.34% of total annual
'"r"';t"
8 Small Tools & Instruments 6,000 Office landscaping, cabinets & chairs . Equipment for new
electronic medical record system (tablet or handheld device),
P~lim,.IPrl at $1?00 Par.h
9 Facilities/Utilities 600 Allocated according to site & program square footage .
Program located in approximately 785 sq ft at Selma Reg ional
Center. Includes costs for garbage collection , utilities &
r.n11nlv h"~ir. br;l;t;e>o rnoto
10
11
12
13
14
15
lUll) CAPITAL EXPENDITURE JUSTIFICATION
TOTAL CAPITAL EXPENDITURES II
I (IV) OTHER COSTS JUSTIFICATION
TOTAL OTHER COSTS 1a,soo II
SUBCONTRACTS
1 Nurse-Family Partnership 15 ,500 Contract with Nurse-Fam ily Partnership , Inc . in Denver,
Colorado for ongoing technical assistance & program
evaluation
2
3
4
201 410 CHVP 5 Budget 09 1214 Page 1 of 2 Printed : 111241201 4 2:10PM
Budget: ORIGINAL
Program : California Home Visiting Program
Agency : 201410 Fresno (Competitive)
SubK :
11
OTHER CHARGES
1 Books & Publicatio ns
2 Promotional Items/Client Support Materials
3 Interpreters
4
5
6
7
8
INDIRECT COSTS JUSTIFICATION
(11-V) Justifications
I
1,000
1,000
1,000
I I
Supplemental materials to NFP to support CHVP SOW, in
English/Spanish that are provided to clients regarding
perinatal care & caring for babies & children . Cognitive
stimulation support items to support early reading . Safety
education items to ensure safe home environment & reduce
unnecessary Emergency Room visits . These materials
usually have more contents in detail to facilitate client
education . Examples : Breastfeeding methods , Stages of
Labor, Methods of Birth Control , NCAST Network Survey
forms , etc. Fresno uses INjoy educational materials since
they have a lot of graphic materials that allow visual learning
and facilitation of education especially for migrant famil ies ,
and non-Spanish speaking bilingual clients . Also includes
outreach materials/marketing materials for partner
agencies/community resources such as hospitals, provider
Items for promotion of the program during outreach efforts &
for clients in care coord ination/case management programs
as caseloads are increasing to full capacity . It is in compliance
with the State 's moratorium on promotional items.
Written & oral translation services for threshold languages
inc luding Spanish , Lao , Cambodian , Hmong , Punjabi, &
Vietnamese to assist CHVP staff in communicating w ith non -
English sp e a ki ng cl ients , thus allowing staff to effectively link
' .. . ,..,
TOTAL INDIRECT COSTS 110,552 Per CDPH approved ICR
201410 CHVP 5 Budg et 09121 4 Page 2 of 2 Printed : 11124/2014 2:10PM
COUNTY OF FRESNO
CALIFORNIA HOME VISITING PROGRAM
NURSE-FAMILY PARTNERSHIP (NFP)
MCAH DIRECTOR
SPMP
Duty Statement
(CHVP #1)
DEFINITION
• Responsible for overall programmatic and fiscal administration of Maternal, Child and
Adolescent Health , Black Infant Health (BIH), and California Home Visiting Programs
(CHVP). Also provides programmatic and fiscal oversight of Public Health Nursing
programs which include In Home Supportive Services , High Risk Infant , and Child Care
Health Linkages program . Functions as the Public Health Nursing Director for the Fresno
County Department of Public Health .
• Plans , directs , implements and evaluates the effectiveness of nursing and MCAH
programs and services .
• Liaison with the State MCAH Branch and CHVP .
• Acts in a culturally-sensitive manner when working with clients , their families and the
community .
DUTIES
1. Oversee the development and implementation of the medical and public health nursing
services provided within the MCAH program , CHVP , and other nursing programs.
2. Review and evaluate best practice models for delivery of health care services to at risk
populations .
3. Review staff recommendations on strategies to increase the medical provider system
capacity and to close service gaps in service .
4 . Advocate for maternal , child and adolescent healthcare services within traditional and non-
traditional delivery systems .
5. Provide SPMP expertise when participating in collaborative planning meetings to improve
the healthcare delivery system capacity and access to care.
6. Represent the Department of Public Health on boards and commissions to inform the
public about MCAH , CHVP , and other public health nursing programs . Advocate for the
needs of women and children , and other at risk populations .
2014 -15
Revised September 2014
7. Review and evaluate interagency agreements and Memorandums of Understanding as
necessary to insure coordination of services for MCAH, CHVP , BIH and Public Health
Nursing programs .
8. Participate in CHVP system of care improvement activities , including but not limited to ,
CHVP oversight , fostering partnerships and collaboration within the LHJ , and directing the
local CHVP Community Advisory Board (CAB).
9. Develop and implement standardized nursing procedures and protocols .
10 . Oversee training which improves the ability of MCAH , CHVP , BIH , Nursing and Health
Education staff to assess and serve the health needs of clients .
11 . Attend educational programs/trainings/meetings/conferences relevant to the scope of
medical services administered by the MCAH , CHVP , and BIH programs as well as those
related to the PHN programs .
12 . Participate in training sessions relating to scope of MCAH , CHVP , and BIH program
benefits and changes in program management.
13 . Review nursing protocols written by MCAH , CHVP , BIH , and Public Health nursing staff for
quality assurance purposes .
14. Review health care data compiled by staff on program activities and operations to evaluate
impact and effectiveness for quality assurance.
15 . Review administrative and fiscal procedures and activities to evaluate MCAH , BIH and
CHVP program compliance/effectiveness and progress towards reaching MCAH, BIH , and
CHVP program goals and objectives for quality assurance .
16 . Develop budgets and monitors use of program funds .
17 . Oversee the recruitment , interviewing , hiring and training of new employees for MCAH ,
CHVP , BIH and PHN programs .
18 . Prepare reports , correspondence and statistical reports . Review and edit/modify
documents written by other MCAH , CHVP , BIH and Nursing staff.
19 . Supports CHVP success through collaboration with Fresno County CHVP-SNL and the
NFP designated Nurse Consultant (DNC).
20 . Develops community partnerships and collaboration within Selma and the adjacent
communities to promote a strong network of community services which address client
needs.
21 . Provides SPMP oversight and supervision of data collection , entry , and submission to
ensure contract compliance and adherence .
22 . Directs Fresno County NFP Advisory Board for the CHV project.
23 . Supports the role of the CHVP-SNL as specified in the local NFP agreement.
24 . Ensures local staff compliance with NFP and CHVP required education and training .
2014-15
Revised September 2014
25 . Promotes and supports attainment of appropriate continuing education in collaboration
with NFP DNC.
26 . Supports mentoring of CHVP Supervisor and nursing staff by NFP DNC to support his/her
clinical and administrative role .
27 . Fosters supportive communication , successful practice , and mutual problem solving
among nurse home visitors .
28 . Informs CHVP-SNL and the NFP DNC of implementation issues which arise in the CHV
program and collaborates to resolve issues in a timely manner.
29 . Supports the role of the NFP DNC in mentoring nurse supervisor in her clinical and
administrative role .
30 . Supports the role of the CHVP-SNL in her clinical and administrative role within local
project.
31 . Supports and advocates for CHVP system of care improvements to promote positive
outcomes for children and their families .
32 . Seeks opportunities to leverage funds as appropriate to enhance the local systems of
care .
33 . Develops and implements local program policies and procedures as necessary to ensure
program compliance and success .
34 . Attends State sponsored meetings and trainings for the CHV program .
35 . Supports the State MCAH Branch in its efforts to build a high quality and comprehensive
statewide early childhood system of care through attendance and participation in
workgroups and other activities .
36 . Participate in updating program policies through the development, implementation and
evaluation of assessment tools in operation of the electronic documentation system .
EDUCATION & EXPERIENCE
• This position must be a Skilled Professional Medical Personnel.
• Graduated from an accredited college or university with a bachelor's degree that is
acceptable within the United States ' accredited college or university system.
• Possesses three years of full-time , paid supervisory or managerial experience which
involved the supervision of professional staff. Graduation from an accredited college or
university with a master's degree that is acceptable within the United States ' accredited
college or university system may substitute for one year of the required experience .
• Possesses valid certificate as a Public Health Nurse and valid license as a Registered
Nurse issued by the State of California , Department of Consumer Affairs , Board of
Registered Nursing .
2014 -15
Revised September 2014
• Possesses a valid California Class "C" Driver 's License .
2014 -15
Revised September 2014
COUNTY OF FRESNO
CALIFORNIA HOME VISITING PROGRAM
NURSE-FAMILY PARTNERSHIP (NFP)
SUPERVISING PUBLIC HEALTH NURSE
SPMP
Duty Statement
(CHVP #2)
DEFINITION
• Under the supervision and direction of the MCAH Director/PHN Division Manager,
provides direction for all aspects of the Nurse-Family Partnership program in accordance
with regulations , standards , and guidelines established by the National Center for Children
and Families at the University of Colorado as well as the CHVP .
• The management and coordination of the program is based on the expertise of a skilled
medical professional that possesses in-depth knowledge and understanding of the overall
program and specialized program components comprising of comprehensive perinatal
care .
• Administers , plans , develops , and evaluates the overall program which includes the
budget , policies and procedures , and personnel supervision of Public Health Nurse home
visitors.
• Acts in a culturally-sensitive manner when working with clients , their families and the
community .
DUTIES
1. Coordinate with outreach on appropriateness and quantity of referrals for serv ice .
2. Supervise staff as they identify first time mothers and make appropriate referrals and
medical linkages to services and medical providers .
3. Assign and delegate referrals to nursing staff according to program needs .
4. Assist staff in providing comprehensive case management services to pregnant ,
postpartum , and parenting first time mothers and their infants.
5. Assist staff with providing comprehensive case management services that focus on the
concepts of prevention, treatment , education , and rehabilitation .
6. Attend and collaborate with intra/interagency departments which provide services for
pregnant and parenting women and their families.
2014-15
Revised September 2014
7 . Provide nursing staff with regularly scheduled consultation , support on an ongoing bas is ,
and one on one clinical supervision , including weekly one on one meeting with PHN HV for
1 hour duration .
8. Assist in scheduling in-services per program and staff needs , i.e ., NCAST
lactation/breastfeeding , obstetrical , domestic violence , community services , resources ,
mental health and substance abuse .
9. Oversee the orientation of new staff to the Department of Public Health .
10 . Assists in the orientation of new staff to the Nurse-Family Partnership Program.
11 . Provide direct supervision to public health nurse(s) who are in the role of preceptors to
new staff, California State Univers ity , Fresno nursing students , and senior focus students .
12 . Evaluate staff through chart review and supervising home visits for quality assurance .
13 . Facil itate cons istent and thorough completion of data forms for monthly transmission.
14 . Provide required data reports , supervisor reports , and any additional reports required by
CHVP , as identified in the SOW for CHVP and attend all required meetings .·
15 . Provide consultation and assistance to improving charting and data sheet complet ion of
new staff. Provide periodic chart audits/reviews to NFP PHN Staff for quality assurance
and appropriate intervent ions/linkages .
16 . Communicate with the CHVP and National Center for Children and Families on program
issues and help facilitate data reports .
17 . Conduct staff meetings twice a month to discuss program implementation issues .
18 . Case conferences with the team to review cases for professional growth and problem
solving to be held twice monthly .
19 . Provide field supervision with the PHN HV between 4 to 8 hours per nurse every 4 months
or as needed .
20 . Provide oversight and superv is ion to the PHN HV when complex physical and/or mental
health issues are identified on clients that are being case managed .
21 . Ensure that the PHN HV is assigned a caseload of no more than 25 clients.
22 . During the vacation or leave of absence of a PHN HV two weeks or longer, SPHN will
evaluate and reassign cases as indicated by case triage to ensure provis ion of services .
23 . Upon the employment separat ion of a PHN HV , SPHN will reassign the cases to the
remaining nurses .
24 . Provide supervision for FTE PHN HVs on a ratio of one FTE supervisor to 4 FTE PHN
HVs , unless exception is granted by CHVP Branch Quality Assurance team .
25 . Supervisor will dedicate a full time effort to CHVP .
2014-15
Revised September 2014
26 . Support CHVP in the activities that will lead to success in achieving the benchmarks ,
constructs and operational component of the SOW.
27 . Participate in a minimum of 6 one-on-one meetings with the CHVP SNL to evaluate the
progress of CHVP and identify quality improvement activities as needed .
28 . Serve as the LHJ liaison with the CHVP SNL ; attend meetings required by the NFP/CHVP
SNL .
29 . Write protocols for quality assurance activities for the PHN HV.
30. Complete all supervisor trainings as outlined by NFP NSO .
31 . Attend all mandatory trainings and recommended trainings identified by CHVP .
32 . Attend meetings/trainings or perform activities required for employees of Fresno County
Department of Public Health .
33 . Perform program administrative activities such as reading and responding to email ,
completing mileage forms , reviewing technical literature and research articles , drafting ,
analyzing , and/or reviewing reports , monitoring program expenditures , assisting with the
interview, selection and hiring of a new public health nurse and other support activities as
needed .
34 . Facilitate communication between the supervisor, CHVP staff and the University of
Colorado .
35. Attend administrative meetings with the MCAH Director/PHN Division Manager, division
meetings and other meetings , trainings and/or conferences that focus on MCAH-related
issues .
36 . Perform other duties as assigned .
37 . Participate in updating program policies through the development, implementation and
evaluation of assessment tools in operation of the electronic documentation system .
EDUCATION & EXPERIENCE
• Possesses a master's degree in nursing or public health nursing from an acceptable
college or university . A minimum of a bachelor degree in Registered Nursing plus an
additional year of experience can be substituted .
• This position must be a Skilled Professional Medical Personnel.
• Possesses a minimum of three years full time paid work experience equivalent to that
gained as a Public Health Nurse in Fresno County .
2014-15
Revised September 2014
• Possesses the following licenses and certificates : valid California Registered Nurse
License , California Public Health Nurse Certificate , and California Class "C" Driver's
license .
2014 -15
Revised September 2014
COUNTY OF FRESNO
CALIFORNIA HOME VISITATION PROGRAM (CHVP)
NURSE-FAMILY PARTNERSHIP (NFP)
PUBLIC HEALTH NURSE 1111
SPMP
Duty Statement
(CHVP #3-6)
DEFINITION
• Under direct supervision of a Supervising Public Health Nurse or designated
Charge Public Health Nurse, provides comprehensive case management services
to pregnant, postpartum , and parenting women and their infants in the Nurse-
Family Partnership Program.
• Conducts home visiting integrating use of required assessment tools and refer
clients to necessary resources as appropriate .
• Promotes early access to health/dental care and early intervention services to
women and their children.
• Acts in a culturally-sensitive manner when working with clients, their families and
the community.
DUTIES
1. Provide comprehensive case management nurse home visiting through skilled
assessment and instruction to pregnant and postpartum women and their infants .
2 . Complete Nurse-Family Partnership forms, nursing documentation of home visits and
telephone calls.
3. Complete Management Information System (MIS) forms and other program and funding
forms as required .
4 . Assist in health planning and resource development with other agencies which will
improve access to care , quality and cost-effectiveness of the health care delivery system
and the availability of Medi-Cal medical and dental referral sources .
5. Assist clients in obtaining food , clothing, and needed services identified through ongoing
assessment during home visits .
6 . Screen , assess , and provide education/information on the dangers of tobacco , alcohol and
other drugs and refer to community-based treatment programs as needed .
7 . Identify potentially at-risk women and assist in their enrollment in perinatal services
(MCAH and/or other agencies) as appropriate .
2014-15
Revised September 2014
8. Assist client in completing Medi-Cal , AIM , Healthy Families and other forms as appropriate
to the client 's needs .
9. Complete NFP core competency trainings (Unit 1, 2 , and 3) following the scheduled
guidelines by NFP NSO .
10 . Attend medical trainings and other trainings to build skills in areas such as substance
abuse, tobacco , mental health , NCAST and parenting . Attend medical training as
appropriate for skilled nursing assessment of pregnant , post-partum , parenting women ,
and newborn , infant , and toddler assessments . Attend all trainings required by NFP and
CHVP .
11 . Attend administrative meetings with supervisor, program staff meetings , MCAH division
meetings and meetings/trainings required for employees of Fresno County Department of
Public Health .
12 . Complete data reports for the Medi-Cal program population as requested .
13 . Review technical literature and research articles pertinent to health issues affecting clients
in caseload .
14 . Maintain a caseload of 25 first time pregnant women prior to 28 weeks gestation .
15 . Assist pregnant clients to obta in prenatal care through a CPSP provider.
16. Coord inate w ith the client 's physician on client 's progress in meeting treatment goals .
17 . Assists client and their children in accessing Medi-Cal services and other medical related
appointments including obtain ing a referral to a specialist.
18 . Provide a summary of case physical assessment , developmental and case documentation
during a reflective case conference with the supervisor.
19 . Participate in case conferences or multidisc iplinary teams to review client needs and
treatment plans .
20 . Provide consultation to professional staff in other agencies about specific medical
conditions within their client population .
21 . Perform se lf-chart aud its for appropriateness of case management intervention , Med i-Cal
provider referrals , and linkages to Medi -Cal services and resources .
22 . Read and respond to program specific emails .
23 . Complete time sheets and program mileage forms , dailies and other forms and documents
as required.
24 . Perform other duties as assigned .
25 . Participate in updating program pol icies through the development , implementation and
evaluation of assessment tools in operation of the electronic documentation system .
2014-1 5
Revised September 2014
EDUCATION & EXPERIENCE
• Possesses a baccalaureate degree with approved coursework in nursing or a related field ,
as required by Title 16 . California Code of Regulations , Division 14 . Board of Registered
Nursing , Article 9 . Public Health Nurse .
• This position must be a Skilled Profess ional Medical Personnel.
• Possesses valid California Public Health Nurse Certificate , issued by the Board of
Registered Nurses as authorized by Title 16 . California Code of Regulations, Article 9.
Public Health Nurse ; Registered Nurse License issued by the California State Board of
Registered Nurses ; and California Class "C" Driver 's License .
• Experience in public health and cultural competency , as required by Policy & Procedure
NFP CHVP 300 item B.(d .).
20 14-15
Revised September 2014
I I I Health Officer of Public Health CHVP CHVP PHN I PHN I #3 #4 = directly reports to supervisor = completes work requests for duties as assigned by CHVP Supervising Public Health Nurse County of Fresno Department of Public Health Public Health Nursing Division Organizational Chart FY 2014-15 Director of Public Health l I I I Assistant Director of Public Health MCAH Director/Division Manager #1 I Healthy Start Project Officer HE I CHVP -------------SPHN -----------, MCAH SOA II #2 I I I I CHVP CHVP PHN I PHN I CHVP #5 #6 OAIII
Attachment C
California Home Visiting Program Transmittal Form
1. Directions : Use this CHVP Transmittal form to submit supporting documentation or when
requesting prior approval from CHVP. Send form and attachments to :
CA-MCAH-HomeVisiting@cdph.ca .gov
TO : California Home Visiting Program
CHVP LHJ site : County of Fresno
CONTRACT #: 20121 0
0 BUDGET REVISION
D EQUIPMENT REPORT
0 Purchase
0 STAFFING REPORT
0 New Hire and Supporting Documents
0 Separation
[gl Nurse/Program (SPECIFY):
Exemption
D ·Data (SPECIFY): ·
D Contract (SPECIFY):
D Training (SPECIFY):
Date : 8/2/2012
0 SCOPE OF WORK REVISION
0 PROGRESS REPORT:
0 02/02/12 -06/30/12
0 07/01/12-12/31/12
0 01/01/13-06/30/13
DUE DATE:
07/31/12
01/31/13
07/31/13
Comments: Supervising Public Health Nurse Kathleen Kelley has a BSN . No suitable applicants were
found that had their MSN . Please see attached resume for Kathleen Kelley SPHN .
7/2012
Agency: County of Fresno Agreement Number: 201410 AUTHORITY CALIFORNIA HOME VISITING PROGRAM Scope of Work -FY15 Fiscal Year: 2014-2015 The Patient Protection and Affordable Care Act of 2010 established the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program to provide an opportunity for collaboration and partnership at the federal, state, and community levels to improve outcomes for families who reside in at-risk communities through evidence-based home visiting programs. The Local Health Jurisdiction (LHJ) agrees to provide the services presented in this Scope of Work (SOW) from the California Department of Public Health, Maternal, Child and Adolescent Health (CDPH/MCAH) Division in collaboration with the California Home Visiting Program Branch for implementation of the California Home Visiting Program (CHVP). The funded LHJ/Agency is referred to as "LHJ site" in this SOW. CHVP shall strive to develop collaborative community systems that protect and improve the health and developmental outcomes for California's pregnant women, parents, and families. The purpose of the SOW is to provide parameters for implementing or expanding an existing Nurse-Family Partnership (NFP) or Healthy Families America (HFA) home visiting program in accordance with Federal MIECHV and State requirements to achieve positive outcomes for each of the following five goals: 1. Provide leadership and coordinate maternal and early childhood systems and supports to advance federal, state, and local efforts to improve the health and well-being of families in California 2. Cultivate strong communities · 3. Promote maternal health and well-being 4. Improve infant and child health development 5. Strengthen family functioning Each LHJ site shall assure program integrity and fidelity to their selected evidenced-based model. The site .shall comply with the terms of this SOW and its attachments, including CHVP Operational Requirements, in their entirety. These requirements include, but are not limited to, fulfilling all deliverables associated with benchmark constructs, attending required meetings and trainings, using a version of the Efforts to Outcomes data system (referred herein as the "CHVP ETO data system") to measure outcomes, perform continuous quality improvement, enter and submit timely data, and complete other reports as required. LHJ site agrees to abide by the Maintenance of Effort (MOE) as defined in the Affordable Care Act Section 295: "Funds provided to an eligible entity receiving a grant shall supplement, and not supplant, funds from other sources for early childhood visitation programs or initiatives. The grantee must agree to maintain non-Federal funding (State General Funds) for grant · activities at a level which is not less than expenditures for such activities as of the date of enactment of this legislation, March 23, 2010."
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno FY: 2014-15 Agreement No: 201410 All activities in this SOW shall take place from receipt of funding beginning July 1, 2014 to June 30, 2015, contingent on availability of funds and spending authority. The table below summarizes a list of reports due to CHVP. Specifics related to the contents of reports are described further in this SOW and located under Evaluation/Performance Measure of each objective. Reporting From To Due Date First Progress Report Second Progress Report Third Progress Report July 1, 2014 November 1, 2014 March 1, 2015 October 31, 2014 February 28, 2015 June 30, 2015 See the following pages for a detailed description of the services to be performed November 30, 2014 March 31, 2015 July 31, 2015 21Page
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno FY: 2014-15 Agreement No: 201410 Goal 1: Provide leadership and coordinate maternal and early childhood systems and supports to advance federal, state, and local efforts to improve the health and well-being of families in California. Evaluation/Performance Measures # Short and/or Intermediate Intervention Activities to Meet Obj~ctives Process, Short and/or Intermediate Measures Objective(s) (Describe the steps of the intervention) Process Description and Short and/or Intermediate Measures Outcome Measure(s) MCAH DIRECTOR'S RESPONSIBILITIES The LHJ Maternal, Child and (.1) The MCAH Director must be designated as Submit organizational chart Adolescent Health (MCAH) Director 0.15 Full Time Equivalent (FTE) on the CHVP and budget with appropriate and/or designee will provide budqet.1 FTE in AF A Packet. oversight to the LHJ and/or its (.2) Provide informative advice, guidance, and subcontractors with matters related assistance to LHJ site managers, supervisors, to CHVP. staff, and various non-profit and private entities on all matters related to the development, implementation, operation, administration, evaluation, and funding for CHVP. (.3) Participate in activities to improve the local Complete all required CHVP 1.1 early childhood systems of services with specific surveys regarding change in emphases on enhancing cross-agency systems of care. coordination, collaboration and communication; preventing duplication of services; addressing gaps in local services and supports; and inteqratinq home visitinq. (.4) LHJ site shall hire and maintain sufficient staff Report staffing changes to Submit staffing changes in to serve 100 clients and adhere to the specific CHVP. Progress Reports. evidence-based model guidelines. (.5) Conduct an annual review of policies and . Provide a brief description Present to CHVP when procedures and update policies, procedures, or of policies that have been requested at Site Visit processes as needed revised or added.2 CULTURAL SENSITIVITY 1 2 J LHJ Site will implement home · visiting programs using culturally j (.1) LHJ staff will participate in trainings or educational opportunities designed to enhance l Maintain a training log which I Present to CHVP when includes topic, trainer, and l~t reque~ed a! Site Visit. 3IPage
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) sensitive home visiting practices. 1.2 NFP AND HFA CORE TRAINING LHJ site will ensure staff completes 1.3 required NFP or HFA core trainings. CASELOAD REQUIREMENTS NFP and HFA Sites: 100 families will be enrolled within 15 months of 1.4 program implementation and maintained throughout the duration of the program. Intervention Activities to Meet Objectives (Describe the steps of the intervention) cultural sensitivity by utilizing cultural sensitivity trainings via webinars and/or attending trainings. (.2) Staffing should reflect the diverse cultures and languages of the LHJ population being served. When possible hire staff that reflect the culture and speak the language of clients. (.3) Use culturally sensitive materials and translation services when necessary. (.1) LHJ site shall ensure that home visiting staff is trained in appropriate curricula, assessment tools and other items as needed.3 (.1) LHJ site shall receive referrals from appropriate agencies and triage as appropriate to meet the required enrollment number of families.4 PROGRAM FIDELITY AND QUALITY ASSURANCE LHJ site will ensure CHVP and (.1) LHJ site supervisor will manage staff activities 1.5 NFP/HFA program fidelity. using reflective supervision based on NFP and HFA model requirements. PARTICIPATION IN EXTERNAL EVALUATION MIECHV Competitive Grant (.1) Ensure all MIECHV staff cooperate and recipients (Merced County, Fresno participate in external evaluation activities County, Sacramento County, Los including: interviews, facilitating evaluator site Angeles County, Nevada County, visits, assisting in client participation, and all other 1.6 Stanislaus County, San Mateo meetings and/or calls/webinars/contacts County, and Solano County) will associated with the external evaluation. work with the CHVP external evaluator and ensure that all data are provided as requested. 1.7 Sites selectedto participate in (.1) Ensure all MIHOPE staff cooperate and FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and · Short and/or Intermediate Measures Outcome Measure(s) of attendees. Observe at Site Visit. Present to CHVP when requested at Site Visit. Maintain a training log which Present to CHVP when includes topic, trainer, and list requested at Site Visit. of attendees. Maintain an outreach log Present to CHVP when which includes program requested at Site Visit. contacted, method, materials used and date of contract. Observe at Site Visit. Program staff partiCipated in all external evaluation activities as needed. Program staff participated in· 41Page
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno -# Short and/or Intermediate Objective(s) MIHOPE (Mother and Infant Home Visiting Program Evaluation), the national evaluation for MIECHV, will work with the MIHOPE external evaluators and ensure all operational procedures, data, and interviews are satisfied as requested. DATA COLLECTION REQUIREMENTS Collect participant information and outcome data using the model and CHVP-required forms through self-report and observation at each of the defined time intervals. 1.8 Collect all information that will contribute to the 35 constructs that comprise the six federally-mandated benchmark domains and additional evaluation measures specified by CHVP. 1.9 --Intervention Activities to Meet Objectives (Describe the steps of the intervention) participate in external evaluation activities including: interviews, randomization, client enrollment in the evaluation, facilitating evaluator site visits, assisting in client participation, and all other meetings and/or calls/webinars/contacts associated with the external evaluation. (.1) LHJ sites will use model required data forms and processes as defined in the model specific data collection requirements for NFP or HFA. (.2) Appropriate LHJ staff shall collect and enter the data defined in the NFP or HFA ETO User Manual into the secure ETO data system within seven working days of the client visit and as required by NFP or HFA. (.3) Staff shall verify the accuracy and completeness of data input into the CHVP and NFP ETO systems. (.1) LHJ sites will use CHVP required data forms and processes as defined in the <:JHVP Data Collection Manual (.2) Appropriate LHJ staff will collect and enter the data defined in the CHVP ETO User Manual into the secure ETO data system on an ongoing basis and as required by CHVP. (.3) Staff will verify the accuracy and completeness of data input into the CHVP and NFP ETO data systems. Supervisor and/or peer will audit 10% of all current charts quarterly. (.4) Supervisors will use CHVP-created reports as they become available in the ETO Data System for the purposes of data cleaning, Continuous Quality Improvement, and for program management. FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and . Short and/or Intermediate Measures Outcome Measure(s) all external evaluation activities as needed. Review data system reports and discuss during regularly scheduled Continuous Quality Improvement (CQI) conference calls. Retain audit documentation Present to CHVP when for review at site visits. requested at Site Visit siPage
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) Assure COl process is in place at 1.10 LHJ and coordinate efforts with CHVP. Intervention Activities to Meet Objectives (Describe the steps of the intervention) Sites may periodically be required to run reports as directed by the QA Team. (.1) Perform model-specific and CHVP-directed COl activities. Update LHJ site-specific COl plan based on guidelines in the CHVP Policies and Procedure Manual. (.2) Identify priority program or evaluation areas for focus in COl teleconferences; also identify strengths and best practices and create action steps for COl. Participate in COl teleconferences with CHVP OA team. Discuss ongoing internal COl process (.3) Coordinate communication of quality assurance/improvement activities between the LHJ program and Community Advisory Board (CAB) or other community collaborative designated to address quality improvement. FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and Short and/or Intermediate Measures Outcome Measure(s) Submit in second Progress Report. Identify and report action steps to address priority areas and ongoing internal COl process. . On COl calls, discuss highlights of CAB or other community group discussions related to COl including recommendations and outcomes. 6IPage
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno Goal 2: Cultivate strong communities. The federally required benchmarks and constructs corresponding to Goal 2 include: FY: 2014-15 Agreement No: 201410 Improvement in the coordination and referrals for other community resources and supports: number of families identified for necessary services; number and percentage of families that required services and received a referral to available community resources; number of completed referrals; number of Memoranda of Understanding or other formal agreements with other social service agencies in the community; number of agencies with which the home visiting provider has a clear point of contact in the collaborating community agency [that) includes regular sharing of information between agencies Evaluation/Performance Measures # Short and/or Intermediate Intervention Activities to Meet Objectives Process, Short and/or Intermediate Measures Objective(s) (Describe the steps of the intervention) Process Description and Short and/or Intermediate Measures Outcome Measure(s) COMMUNITY ADVISORY BOARD -·· -··--·····-·---LHJ site will maintain a Community (.1) Maintain CAB activities including: Maintain a list of current CAB Submit first Progress Report Advisory Board (CAB) • Recruitment of members and active members in July. participation • Quarterly meetings • Meeting minutes • NFP-refer to Model Element 17 • HFA-refer to Self-Assessment Tool, 2.1 Governance and Administration (GA) -1 • CAB will assist in informing program operation, quality assurance/improvement, child and family.advocacy, and public awareness of home visiting. • CAB will assist with efforts to improve systems integration, interagency coordination, information sharing, and referral systems. INCREASE FORMAL AGREEMENTS LHJ site will increase or enhance the (.1) Develop community partnerships and facilitate Maintain an outreach log Present to CHVP when 2.2 number of formal agreements, coordination and integration of services among which includes program requested at Site Visit. informal written agreements, and/or MCAH and other community programs/services contacted, method, materials Memorandums of Understanding used and date of contract. ?I Page
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) ·----"'-(MOUs) with other local social service agencies in the community. LHJ site will increase the number of collaborating community agencies with whom they have a clear point of contact. 2.3 2.4 Clients will access services and resources in their community for each identified need through a referral process. Intervention Activities to Meet Objectives (Describe the steps of the intervention) (.2) Develop and/or maintain formal agreements, informal written agreements (e.g. letters of support) and/or MOUs with community agencies and other service providers. (.1) Develop collaborative relationships with local service agencies and hospitals in the community to create and maintain ties. (.2) LHJ site will develop a clear point of contact (person/s) with collaborating community agencies for purposes of making warm referrals by phone or in person on a participant's behalf. (.3) Educate the community about CHVP services. (.1) Home Visitor will make appropriate referrals and LHJ will develop a process to ensure follow-up to pending referrals are completed. Train staff to follow-up on referrals made to clients. (.2) Maintain access to, or develop an updated directory of, community referral resources and services. FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and Short and/or Intermediate Measures Outcome Measure(s) Respond to CHVP Service Provider survey regarding MOUs and other agreements. Respond to CHVP Service Provider Survey regarding agencies with which you have warm referral relationships. Maintain an outreach log Present to CHVP when which includes program requested at Site Visit. contacted, method, materials used and date of contract. Maintain training log Observe at Site Visit. Maintain a current referral Present to CHVP when resources and services requested at Site Visit. directory. BIPage
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno Goal 3: Promote Maternal Health And Well-being. The federally required benchmarks and constructs corresponding to Goal 3 include: FY: 2014-15 . Agreement No: 201410 Improved Maternal and Newborn Health -Prenatal care; Parental use of alcohol, tobacco, or illicit drugs; Preconception care; Inter-birth intervals; Screening for maternal depressive symptoms; Breastfeeding; Well-child visits; Maternal and child health insurance status Evaluation/Performance Measures # Short and/or Intermediate Intervention Activities to Meet Objectives Process, Short and/or Intermediate Measures Objective(s) (Describe the steps of the intervention) Process Description and Short and/or Intermediate Measures Outcome Measure(s) INCREASE NUMBER OF WOMEN RECEIVING PRENATAL CARE Increase the number of women who (. 1) Educate and reinforce the importance of early Clients are provided Observed at Site Visit. receive prenatal care as a result of and adequate prenatal care. education and referral. 3.1 participating in CHVP. (.2) Identify and address barriers to keeping Identify and explore solutions Update in Progress Report. prenatal appointments. to emerging barriers. INCREASE MATERNAL ACCESS TO HEALTH INSURANCE Increase the number of women with (. 1) Provide information and referrals to clients on Maintain a current referral Present to CHVP when health insurance during pregnancy how to access health insurance and the benefits of resources and services requested at Site Visit. 3.2 and postpartum. health care coverage. directory. (.2) Collaborate with local programs to decrease Identify and explore solutions Update in Progress Report. barriers to accessinq healthcare insurance. to emerging barriers. DECREASE NUMBER OF MATERNAL EMERGENCY DEPARTMENT (ED) VISITS 3.3 Decrease non-emergency use of (. 1) Educate families on appropriate use of EDs Clients are provided Observed at Site Visit. Hospital Emergency Departments and patient centered· medical homes for their own education and referral. (ED). routine care. DECREASE MATERNAL USE OF ALCOHOL, TOBACCO AND ILLICIT DRUGS Decrease or stop maternal use of (.1) Assess mother for alcohol, tobacco, and illicit Maintain a current referral Present to CHVP when 3.4 alcohol, tobacco, and illicit drugs drug use during pregnancy and postpartum; resources and services . requested at Site Visit. during pregnancy and postpartum. provide information and referrals to counseling as directory. appropriate. DECREASE THE NUMBER OF WOMEN WITH SUBSEQUENT PREGNANCY WITHIN 18 MONTHS Decrease the number of women with (. 1) Assist clients in reproductive life planning. Clients are provided Observed at Site Visit. 3.5 a subsequent pregnancy within 18 education and referral. months postpartum and increase the 9IPqge
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) number of women using contraception up to 12 or more months postpartum. Intervention Activities to Meet Objectives (Describe the steps of the intervention) INCREASE THE NUMBER OF WOMEN SCREENED FOR MATERIAL DEPRESSION AND PARENTAL STRESS Increase the number of women (.1) Educate women on the signs and symptoms of 3.6 screened for maternal depression maternal depression and stress. and parental stress; increase the number referred for services. INCREASE BREASTFEEDING INITIATION, EXCLUSIVITY, AND DURATION Increase the number of prenatally (.1) Encourage and support breastfeeding: enrolled women initiating • Educate women on the importance of breastfeeding; increase exclusive initiating breastfeeding and continuing breastfeeding up to 6 months of age; through one year postpartum. and increase the duration of the Educate and support women on the 3.7 breastfeeding period in the first year • importance of exclusive breastfeeding for at of life. least 6 months. • Refer to breastfeeding and lactation support when appropriate (WIC Peer Counseling Program or other local resource). INCREASE NUMBER OF WOMEN RECEIVING POSTPARTUM APPOINTMENTS WITHIN 6 WEEKS Increase number of women who (.1) Educate women regarding the importance of a have a postpartum visit within 6 postpartum visit. 3.8 weeks. (.2) Make an appropriate referral to women in need of postpartum care. FY: 2014-15 . Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and Short and/or Intermediate Measures ·Outcome Measure(s) Clients are provided Observed at Site Visit. education and referral. Processes in place to ensure Observed at Site Visit. client is provided education and support. Clients are provided Observed at Site Visit. education. Maintain a current referral Present to CHVP when resources and services requested at Site Visit directory. --~--10 I Page '
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno FY: 2014-15 Agreement No:'201410 Goal 4: Improve Infant and Child Health and Development The federally required benchmarks and constructs corresponding to Goal 4 include: # Improved Maternal and Newborn Health Prenatal care; Parental use of alcohol, tobacco, or illicit drugs; Preconception care; Inter-birth intervals; Screening for maternal depressive symptoms; Breastfeeding; Well-child visits; Maternal and child health insurance status Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of Emergency Department Visits Visits for children to the emergency department from all causes; Visits of mothers to the emergency department from all causes; Information provided or training of participants on prevention of child injuries; Incidence of child injuries requiring medical treatment; reported suspected maltreatment for children in the program; Reported substantiated maltreatment for children in the program; First-time victims of maltreatment for children in the program. Improvements in School Readiness and Achievement Parent support for children's learning and development; Parent knowledge of child development and of their child's developmental progress, Parenting behaviors and parent-child relationship; Parent emotional well-being or parenting stress; Child's communication, language and emergent literacy; Child's general cognitive skills Intervention Activities to Meet Evaluation/Performance Measures Short and/or Intermediate Objective(s) Objectives (Describe the steps of the Process, Short and/or Intermediate Measures intervention) Process Description and Short and/or Intermediate Measures Outcome Measure(s) INCREASE THE NUMBER OF CHILDREN WITH HEALTH INSURANCE Increase number of children who have health (.1) As needed, assist parents in the Maintain a current referral Present to CHVP when 4.1 insurance continuously through two years of referral and application process for low resources and services requested at Site Visit. age. cosUno cost health insurance programs directory. for their children. 4 DECREASE THE NUMBER OF EMERGENCY DEPARTMENT (ED) VISITS FOR CHILDREN Increase parental awareness on appropriate (.1) Educate parents on appropriate use Clients are provided Update in Progress Report. 4.2 use of Emergency Department (ED) visits for of ED and help establish a medical home education. children. for their child's routine care. INCREASE THE NUMBER OF CHILDREN RECEIVING ALL AAP RECOMMENDED WELL-CHILD VISITS Increase the number of children who receive (.1) Assist families in understanding the Clients are provided Observed at Site Visit. 4.3 all recommended well-child visits from 0-2 importance of well-child visits and education. years. immunizations. Support parents to adhere to scheduled well-child visits. PROMOTE CHILD SAFETY AND INJURY PREVENTION 4.41 Decrease the incidence of child injuries J (.1) Educate and support families in child j Clients are provided education. j Observed at Site Visit. 11 I P a g e I
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) requiring medical treatment. CHILD ABUSE AND NEGLECT PREVENTION Prevent child abuse and neglect. 4.5 Intervention Activities to Meet Objectives (Describe the steps of the intervention) injury prevention."' (.1) Provide resources to parents to prevent child abuse. (.2) Provide support for appropriate parenting skills and refer to parenting classes, counseling, or other support resources. (.3) Provide emotional support to the family. (.4) Look for signs of child abuse and/or neglect through observation at each home visit and report suspected abuse. FY: 2014-15 Agreement No:.201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures Process Description and Short and/or Intermediate Measures Outcome Measure(s) Maintain a current referral Present to CHVP when resources and services requested at Site Visit. directory. Maintain a current referral Present to CHVP when resources and services requested at Site Visit. directory. Observed at Site Visit. Observed at Site Visit. 121 P a g e
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno FY: 2014-15 Agreement No: 201410 Goal 5: Strengthen family functioning The federally required benchmarks and constructs corresponding to Goal 5 include: Child Injuries, Child Abuse, Neglect, or Maltreatment and Reduction of Emergency Department Visits Visits for children to the ED from all causes; Visits of mothers to the ED from all causes; Information provided or training of participants on prevention of child injuries; Incidence of child injuries requiring medical treatment; Reported suspected maltreatment for child in the program; Reported substantiated maltreatment for children in the program; First-time victims of maltreatment for child in the program. Improvements in School Readiness and Achievement Parent support for children's learning and development; Parent knowledge of child development and of their children's developmental progress; Parenting behaviors and parent-child relationship; Parent emotional well-being or parenting stress; Child's communication, language and emergent literacy; Child's general cognitive skills. Domestic Violence Screening for domestic violence; Of families identified for the presence of domestic violence, number of referrals made to relevant domestic violence services; Of families identified for the presence of domestic violence, number of families for which a safety plan was completed. Family Economic Self-Sufficiency Household income and benefits; Employment or Education of adult members of the household; Health insurance status. Evaluation/Performance Measures Intervention Activities to Meet Process, Short and/or Intermediate Measures # Short and/or Intermediate Objective(s) Objectives (Describe the steps of (Reporting Method In Red)) the intervention) Process Description and Short and/or Intermediate Measures Outcome Measure(s) INTEGRATE THE FIVE PROTECTIVE FACTORS OF STRENGTHENING FAMILIES Increase family strengths, enhance child (.1) LHJ site will integrate the Progress Report development and reduce child abuse and Strengthening Families framework 5.1 neglect by integrating the Five Protective into the home visiting program and Factors of Strengthening Families. also incorporate the framework into their local Policies and Procedures.6 INCREASE SCHOOL READINESS Parents will increase support of their (.1) Assist families in improving the Observed at Site Visit. 5.2 child's learning and development and have quality of the child's home an improved relationship with their child. environment. IDENTIFY AND SUPPORT CHILDREN WITH SOCIAL, EMOTIONAL, COGNITIVE AND PHYSICAL DEVELOPMENT NEEDS Parents will identify and support their (.1) Administer CHVP-required tools Progress Report 5.3 children's social, emotional, cognitive and related to school readiness I physical development needs strengtheninQ families (see 13 I P a g e I
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) INCREASE DOMESTIC VIOLENCE (DV) AWARENESS Increase support for women to have healthy and safe relationships. 5.4 Intervention Activities to Meet Objectives (Describe the steps of the intervention) Attachment D for data collection times): 1. HOME Inventory 2. ASQ-3 3. ASQ-SE (.2) Make appropriate referrals for developmental evaluation or services based on HOME Inventory, ASQ 3, or ASQ-SE. Develop policies, procedures or a process for referring and follow-up (.1) Participate in trainings on DV awareness. Develop policies and procedures for screening, referral and follow-up? (.2) Home Visitor will discuss healthy relationships, safety, and reproductive coercion. (.3) The home visitor will screen for relationship related issues and DV using the Women's Experience with Battering (WEB) tool (see Attachment D for data collection times). (.4) If women screen positive on the WEB or they self-disclose DV, home visitor will assist women with the creation of a safety plan. Revisit/update the plan as needed. (.5) The home visitor will refer women to DV services and follow-FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures (Reporting Method In Red)) Process Description and Short and/or Intermediate Measures Outcome Measure(s) Policies, procedures or a Present to CHVP when process for referring and requested at Site Visit follow-up on referrals were developed. Maintain a training log which Present to CHVP when includes topic, trainer, and list requested at Site Visit of attendees Policies and procedures developed? Observed at Site Visit. Observed at Site Visit. Observed at Site Visit. Maintain a current referral Present to CHVP when resources and services requested at Site Visit. ... 141 P a g e
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno # Short and/or Intermediate Objective(s) ---------Intervention Activities to Meet Objectives (Describe the steps of the intervention) up as needed. IMPROVING INCOME, EMPLOYMENT, AND EDUCATIONAL STATUS OF CLIENTS Increase the number of women improving (.1) Assist women in identifying their 5.5 employment status or educational educational and employment goals; attainment. provide SUJlQ.Ort in achieving goals. Increase the number of women whose (.1) Assist women in developing an 5.6 income increases. economic self-sufficiency plan. Refer to community resources, job training, and employment events. --------· --------FY: 2014-15 Agreement No: 201410 Evaluation/Performance Measures Process, Short and/or Intermediate Measures (Reporting Method In Red)) Process Description and Short and/or Intermediate Measures Outcome Measure{s} directory. Maintain a current referral Present to CHVP when resources and services requested at Site Visit. directory. 15IPage
CALIFORNIA HOME VISITING PROGRAM Program: County of Fresno NOTES FY: 2014-15 Agreement No: 201410 1. The MCAH Director may designate the MCAH Coordinator as the central point of contact for CHVP program-related administration. In this case, the MCAH Director must maintain a minimum of .05 FTE. The total FTE for both the Director and Coordinator must total .15 FTE. 2. LHJ policies and procedures will be made available to CHVP upon request. 3. NFP Model • Partners in Parenting Education (PIPE) • Dyadic Assessment of Naturalistic Caregiver-Child Experiences (DANCE) • Nursing Child Assessment Satellite Training (NCAST) o Keys to Caregiving o How to Promote Good Sleep Habits Parent Booklets o Beginning Rhythms Manual o Personal Environmental Assessments • Difficult Life Circumstance • Network Survey • Community Life Skills Scale • Ages and Stages Questionnaire (ASQ) • Home Observation and Measurement of the Environment (HOME) Inventory • Women's Experience of Battering (WEB) • Any other CHVP required trainings to be announced via program letters. HFA Model • Partners for a Healthy Baby • Ages and Stages Questionnaire (ASQ) • Kempe Family Stress Checklist • Home Observation and Measurement of the Environment (HOME) Inventory • Women's Experience of Battering (WEB) Any other CHVP required trainings to be announced via program letters. 4. Link to State Injury Prevention Website: Safe and Active Communities (SAC) Branch: http://www.cdph.ca.gov/programs/SACB/Pages/default.aspx 5. www.strengtheningfamilies.net LHJ site will utilize the resources and training provided by Strategies for TA regarding Strengthening Families. 16! Page
State of California-Health and Human Serv1ces Agency California Department of Public Health Exhibit I of2 ------INVENTORY/DISPOSITION OF CDPH-FUNDED EQUIPMENT Current Contract Number: 20 I 410 ~--~--------------------------------------Previous Contract Number (if applicable): _2...:..0_1 ::_:3_1 ::_:0 __________________________ _ Contractor's Name: County of Fresno, Department of Public Health Contractor's Complete Address: P.O. Box 11867; Fresno, CA 93 775. Contractor's Contact Person: _K_il_n...:Z=-e.:...~p::_:e...:d...:._a ______________________________ _ Contact's Telephone Number: -'-'(5...:5...:._9-L)-'-6-'-0-'-0--=3...:..3...:..3...:..0 _____________ _ Date Current Contract Expires: -"6-'/3'---0...:._/_1_5 _____________________________ _ CDPH Program Name: California Home Visiting Program CDPH Program Contract Manager: _S_te__..p_h_e_n_F_o_n_.g.,_ _____________ _ CDPH Program Address: 1615 Capital Ave, Suite 73560, MS 8305 CDPH Program Contract Manager's Telephone Number: (916) 650-0340 Date of this Report: 09-1 0-14 ----------------------(THIS IS NOT A BUDGET FORM) ITEM DESCRIPTION STATE/ CDPH 1. Include manufacturer's name, model number, type, size, and/or capacity. CDPH ASSET MGMT. PROPERTY TAG 2. If motor vehicle, list year, make, model number, type of vehicle (van, sedan, UNIT COST USE ONLY ORIGINAL MAJOR/MINOR EQUIPMENT OPTIONAL-(If motor vehicle, list pick-up, etc.) PER ITEM CDPH Document PURCHASE SERIAL NUMBER PROGRAM USE license number.) QUANTITY 3. If van, include passenger capacity. (Before Tax) (DISPOSAL) Number DATE (If motor vehicle, list VIN number.) ONLY I Copier-Kyocera T A 45001 $3700 6/29/2012 N432304028 Attachment DP-771 $950 6/29/2012 NES2314106 Dual 1500 Sheet Paper PF-740 $600 6/29/2012 N3P2311660 I 000 Sheet Multi Position OF -770 $650 6/29/2012 NZN2400982 2/3 Punch Unit PH-7 A $ 325 6/29/2012 N362207573 6 24 In Widescreen Flat Panel Monitor, Dell P24I2H $237.60 6/II/20I2 2 Lap Top-Latitude, Dell E6520 $ I765 6/14/2012 I FAX- Brother Laser FAX-2820 $ I79.99 5/10/20 I2 I Digital Camera-Lumix DMC-S2 $94 6/1 I/20I2 I Battery Charger-Panasonic DE-A91 BA $23 6/II/20I2 I Camera Pouch -Lowepro Dublin I 0 $ I4 6/Il/20I2 5 Scale Mechanical Baby $ 160.88 6/18/20I2 I Durashock Blood Pressure Cuff Adult Lg $41.48 5/29/2012 5 Gauge w/Durable I pc Adult Cuff $45.05 5/29/2012 5 Thennofocus thermometer $ 106.95 5/17/2012 5 _ Hop~ins Measure Mat li $49.95 5/17/2012 CDPH 1204 (8/07)
INSTRUCTIONS FOR CDPH 1204 (Please read carefully.) The information on this form will be used by the California Department of Public Health (CDPH) Asset Management (AM) to; (a) conduct an inventory of CDPH equipment and/or property (see definitions A, and B) in the possession of the Contractor and/or Subcontractors, and (b) dispose of these same items. Report all items, regardless of the items' ages, per number 1 below, purchased with CDPH funds and used to conduct state business under this contract. (See Health Administrative Manual (HAM}, Section 2-1060 and Section 9-2310.) The CDPH Program Contract Manager is responsible for obtaining information from the Contractor for this form. The CDPH Program Contract Manager is responsible for the accuracy and completeness of the information and for submitting it to AM. Inventory: List all CDPH tagged equipment and/or property on this form and submit it within 30 days prior to the three-year anniversary of the contract's effective date, if applicable. The inventory should be based on previously submitted CDPH 1203s, "Contractor Equipment Purchased with CDPH Funds." AM will contact the CDPH Program Contract Manager if there are any discrepancies. (See HAM, Section 2-1 040.1.) Disposal: (Definition: Trade in, sell, junk, salvage, donate, or transfer; also, items lost, stolen, or destroyed (as by fire).) The CDPH 1204 should be completed, along with a "Property Survey Report" (STD. 152) or a "Property Transfer Report" (STD. 158), whenever items need to be disposed of; (a) during the term of this contract and (b) 30 calendar days before the termination of this contract. After receipt of this form, the AM will contact the CDPH Program Contract Manager to arrange for the appropriate disposal/transfer of the items. (See HAM, Section 2-1 050.4.) 1. List the state/ CDPH property tag, quantity, description, purchase date, base unit cost, and serial number (if applicable) for each item of; A. Major Equipment: (These items were issued green numbered state/ CDPH property tags.) • Tangible item having a base unit cost of $5,000 or more and a life expectancy of one (1) year or more. • Intangible item having a base unit cost of $5,000 or more and a life expectancy of one (1) year or more (e.g., software, video.) B. Minor Equipment/Property: Specific tangible items with a life expectancy of one (1) year or more that have a base unit cost less than $5,000. The minor equipment and/or property items were issued green unnumbered "BLANK" state/ CDPH property tags with the exception of the following, which are issued numbered tags: Personal Digital Assistant (PDA), PDNcell phone combination (Blackberries), laptops, desktop personal computers, LAN servers, routers and switches. 2. If a vehicle is being reported, provide the Vehicle Identification Number (VIN) and the vehicle license number to CDPH Vehicle Services. (See HAM, Section 2-10050.) 3. If all items being reported do not fit on one page, make copies and write the number of pages being sent in the upper right-hand corner (e.g. "Page 1 of 3.") 4. The CDPH Program Contract Manager should retain one copy and send the original to: California Department of Public Health, Asset Management, MS1801, P.O. Box 997377, 1501 Capitol Avenue, Sacramento, CA 95899-7377. 5. Use the version on the CDPH Intranet forms site. The CDPH 1204 consists of one page for completion and one page with information and instructions. For more information on completing this form, call AM at (916) 650-0124. CDPH 1204 (8107)
State of California-Health and Human Serv1ces Agency California Department of Public Health Exhibit 2 of2 -=--.::..._ ___ _ INVENTORY/DISPOSITION OF CDPH-FUNDED EQUIPMENT Current Contract Number: 201410 -------------------------------------------Date Current Contract Expires: 6/3 0115 -------------------------Previous Contract Number (if applicable): _2-=-0-=-13::._::__1 0"------------------------------CDPH Program Name: California Home Visiting Program Contractor's Name: County of Fresno, Department of Public Health CDPH Program Contract Manager: --'-S_te__...p:..._h_e_n_F_o:..._n_.g2__ ___________ _ CDPH Program Address: 1615 Capital Ave, Suite 73560, MS 8305 Contractor's Complete Address: P.O. Box 11867; Fresno, CA 93775. CDPH Program Contract Manager's Telephone Number: (916) 650-0340 Contractor's Contact Person: .:...K:.:.i:.:.m~Z=-e.::..Jp[_e~d:.:.a:__ ______________ _ Date of this Report: _0_:_9-_1_:_0_-_14 __________________ _ Contact's Telephone Number: ~( 5~5....::.9.L):.:.6....::.0-=-0-=-3:...::3...::.3...::.0 _____________ _ (THIS IS NOT A BUDGET FORM) ITEM DESCRIPTION STATE/CDPH 1. Include manufacturer's name, model number, type, size, and/or capacity. CDPH ASSET MGMT. PROPERTY TAG 2. If motor vehicle, list year, make, model number, type of vehicle (van, sedan, UNIT COST USE ONLY ORIGINAL MAJOR/MINOR EQUIPMENT OPTIONAL-(If motor vehicle, list pick-up, etc.) PER ITEM CDPH Document PURCHASE SERIAL NUMBER PROGRAM USE license number.) QUANTITY 3. If van, include passenger capacity. (Before Tax) (DISPOSAL) Number DATE (If motor vehicle, list VIN number.) ONLY 5 Stethoscope, Littmann Cardiology $ 174.95 5/17/2012 I Scale, Mechanical w/tote $39.95 5/17/2012 5 Scale, Digital $59.95 5/17/2012 5 Carrying Case for Baby Scale $ 64.95 5/17/2012 I 4 7" Bookcase Metal $ 136 8/12/2012 4 Storage Cabinets -2-door $263 8/12/2012 5 Littman Infant & Pediatric Stethescope $ 97.95 3/8/2013 5 D-Liteful Pediatric Baby Scale $363.95 3/8/2013 I Diagnostic Set Standard Otoscope $ 144.95 3/8/2013 $ $ $ $ $ $ $ CDPH 1204 (8107)
INSTRUCTIONS FOR CDPH 1204 (Please read carefully.) The information on this form will be used by the California Department of Public Health (CDPH) Asset Management (AM) to; (a) conduct an inventory of CDPH equipment and/or property (see definitions A, and B) in the possession of the Contractor and/or Subcontractors, and (b) dispose of these same items. Report all items, regardless of the items' ages, per number 1 below, purchased with CDPH funds and used to conduct state business under this contract. (See Health Administrative Manual (HAM), Section 2-1060 and Section 9-2310.) The CDPH Program Contract Manager is responsible for obtaining information from the Contractor for this form. The CDPH Program Contract Manager is responsible for the accuracy and completeness of the information and for submitting it to AM. Inventory: List all CDPH tagged equipment and/or property on this form and submit it within 30 days prior to the three-year anniversary of the contract's effective date, if applicable. The inventory should be based on previously submitted CDPH 1203s, "Contractor Equipment Purchased with CDPH Funds." AM will contact the CDPH Program Contract Manager if there are any discrepancies. (See HAM, Section 2-1 040.1.) Disposal: (Definition: Trade in, sell, junk, salvage, donate, or transfer; also, items lost, stolen, or destroyed (as by fire).) The CDPH 1204 should be completed, along with a "Property Survey Report" (STD. 152) or a "Property Transfer Report" (STD. 158), whenever items need to be disposed of; (a) during the term of this contract and (b) 30 calendar days before the termination of this contract. After receipt of this form, the AM will contact the CDPH Program Contract Manager to arrange for the appropriate disposal/transfer of the items. (See HAM, Section 2-1 050.4.) 1. List the state/ CDPH property tag, quantity, description, purchase date, base unit cost, and serial number (if applicable) for each item of; A. Major Equipment: (These items were issued green numbered state/ CDPH property tags.) • Tangible item having a base unit cost of $5,000 or more and a life expectancy of one (1) year or more. • Intangible item having a base unit cost of $5,000 or more and a life expectancy of one (1) year or more (e.g., software, video.) B. Minor Equipment/Property: Specific tangible items with a life expectancy of one (1) year or more that have a base unit cost less than $5,000. The minor equipment and/or property items were issued green unnumbered "BLANK" state/ CDPH property tags with the exception of the following, which are issued numbered tags: Personal Digital Assistant (PDA), PDA/cell phone combination (Blackberries), laptops, desktop personal computers, LAN servers, routers and switches. 2. If a vehicle is being reported, provide the Vehicle Identification Number (VIN) and the vehicle license number to CDPH Vehicle Services. (See HAM, Section 2-10050.) 3. If all items being reported do not fit on one page, make copies and write the number of pages being sent in the upper right-hand corner (e.g. "Page 1 of 3.") 4. The CDPH Program Contract Manager should retain one copy and send the original to: California Department of Public Health, Asset Management, MS1801, P.O. Box 997377, 1501 Capitol Avenue, Sacramento, CA 95899-7377. 5. Use the version on the CDPH Intranet forms site. The CDPH 1204 consists of one page for completion and one page with information and instructions. For more information on completing this form, call AM at (916) 650-0124. CDPH 1204 (8/07)
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
Purpose
The California Home Visiting Program (CHVP) Local Health Jurisdiction (LHJ) sites
must meet all objectives and complete each of the required intervention activities stated
in the Scope of Work (SOW) in order to remain in compliance with the contract
agreement. The Program Operational Requirements outlines additional information and
specifics to assist each LHJ site in completing activities , meeting objectives defined in
the SOW, and implementing program activities with quality and fidelity to the home
visiting model. The Program Operational Requirements are considered supplemental
information to the SOW which contains federally mandated requirements . LHJ's ability
to meet and maintain CHVP goals and objectives will affect future LHJ funding .
Background Information
The delivery of home visiting services addresses the diverse needs of children and
families in communities at risk and provides an unprecedented opportunity for
collaboration and partnership at the federal, state , and community levels to improve
health and developmental outcomes for at-risk children through evidence-based home
visiting programs.
The California Department of Public Health/Maternal , Child and Adolescent Health
(CDPH/MCAH) Division selected two evidence-based home visiting models for
implementation in California : Nurse-Family Partnership (NFP) and Healthy Families
America (HFA). Selection of these models was based on findings from the Home
Visiting Evidence of Effectiveness Review (HomVEE) Study that gave NFP and HFA the
most favorable ratings for primary and secondary outcomes in the benchmark areas .
LHJ sites are responsible for administering the CHVP in accordance with model fidelity ,
the requirements stated in the SOW, Operational Requirements , and the current CHVP
Policies and Procedures . LHJ site staff is responsible for being knowledgeable of all
CHVP program components , CHVP Data Collection and ETO User manuals , and the
CHVP Policies and Procedures for LHJ sites , NFP model or HFA model , as well as the
CHVP measures for the federal benchmark constructs , found on the CHVP
website : http ://cdph .ca.gov/programs/mcah/Pages/HVP-HomePage.aspx .
CHVP PROGRAM REQUIREMENTS RELATED TO THE SCOPE OF WORK
The Quality Assurance (QA) Teams
The CHVP established QA teams to lead and support each LHJ to ensure : model
fidelity , creation of continuous quality improvement (CQI) measures , training and
technical assistance and timely and accurate reporting . The NFP QA team consists of
a Nurse Consultant, Health Program Specialist, Research Scientist, and Contract
Manager. The HFA QA Team consists of a Health Program Specialist, Research
Scientist , and Contract Manager.
Site Visits and Technical Assistance
The CHVP will perform formal and/or informal site visits at their discretion . LHJ sites
are required to participate in CHVP site visits and allow CHVP QA Teams access to
program-related records , partic ipant records , and observe home visiting activities .
Jul y 2 0 14 Page 1
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
Progress Reports
• LHJ site will prepare three Progress Reports in accordance with the information
and format provided by CHVP .
• LHJ site must submit one copy of the Progress Report , via email , in CHVP format,
to CA-MCAH-HomeVisiting@cdph .ca .qov by the due date stated below no later
than 30 days after the report ending date . LHJ site's failure to submit the Progress
Report in a timely manner may jeopardize future funding for LHJ site . CHVP
reserves the right to require additional components in the Progress Report. The
schedule below must be followed for the Progress Reports :
Reporting From To Due Date
1st Progress Report
2nd Progress Report
3rd Progress Report
Additional Reports
July 1, 2014
November 1, 2014
March 1, 2015
October 31 , 2014
February 28 , 2015
June 30 , 2015 ·
November 30 , 2014
March 31 ,2015
July 30 , 2015
• LHJ site will be required to respond as necessary to any ad hoc and/or final reports
as designated by CHVP.
• LHJ site shall submit "Staffing Report," with each Progress Report reflecting any
change in personnel or percentage of effort, and staff leave of absence of 2 weeks
or more . Prior approval from CHVP is required for changes in staffing patterns that
deviate from the original contract agreement and standard model staffing
requirements .
Program Letters
Any clarification related to the SOW including this Program Operational Requirement
will be communicated to the LHJ site via a CHV Program Policy Alert Letter.
Maintenance of Effort (MOE) Agreement
LHJ sites agree to abide by the MOE as defined in the Affordable Care Act
Section 295:
"Funds provided to an eligible entity receiving a grant shall supplement, and
not supplant, funds from other sources for early childhood visitation programs
or initiatives. The grantee must agree to maintain non-Federal funding (State
General Funds) for grant activities at a level which is not less than expenditures
for such activities as of the date of enactment of this legislation, March 23,
2010."
Specific questions or proposals should be directed to the local county counsel.
Home Visiting defined by the Health Resources and Services Administration
(HRSA):
"Home visiting is defined as an evidence-based program, implemented in response to
findings from a needs assessment, that includes home visiting as a primary service
delivery strategy (excluding programs with infrequent or supplemental home visiting},
and is offered on a voluntary basis to pregnant women or children birth to age 5
targeting the participant outcomes in the legislation which include improved maternal
Jul y 2014 Page 2
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
and child health , prevention of child injuries, child abuse, or maltreatment, and
reduction of emergency department visits, improvement in school readiness and
achievement, reduction in crime or domestic violence, improvements in family
economic self-sufficiency, and improvements in the coordination and referrals for other
community resources and supports ." (HRSA-1 0-275)
Performance and Accountability
LHJ site must comply with deliverables as outlined in the SOW and may receive
technical assistance from CHVP , if needed . In addition , CHVP reserves the right to
require a Corrective Action Plan from the LHJ site . LHJ sites must contact their CHVP
QA team to request assistance from . CHVP as soon as concerns regarding meeting
deliverables are identified .
CHVP PROGRAM REQUIREMENTS ON IMPLEMENTATION
The following actions must be implemented :
Contract Agreements at the Local, State, and National Level
LHJ site must have a current contract agreement or affiliation with either national model
(NFP or HFA) to fully implement a CHVP. Before an LHJ approaches the national
models for contract agreement , the site is required to collaborate and receive approval
from CHVP . A copy of the most recent contract agreement, approved affiliation or
accreditation agreement from the NFP National Service Office (NSO) or the Prevent
Child Abuse America (PCAA) National Office (NO) must be kept on file and made
available upon request by CHVP . LHJ site must regularly inform the assigned CHVP
NFP Nurse Consultant or HFA Statewide Consultant regarding the contract status or
any changes from NFP NSO or accreditation status from PCAA NO .
LHJ site must comply with NFP or HFA requirements for program implementation of the
national program model (NFP or HFA). LHJ site organizational structure must be
prepared to assume the capacity to house the service and manage the hiring ,
supervision , and payment of all personnel and ensure general fiscal stability . LHJ sites
must comply with the following requirements :
For NFP Sites Only: MCAH Director will support the collaboration of the CHVP
Statewide Nurse Liaison (CHVP-SNL) with the NFP Designated Nurse Consultant
(DNC). The MCAH Director will include the CHVP-SNL 's role in the LHJ/NFP
Implementation Agreement (contract) which includes :
• Ongoing collaboration between CHVP-SNL and NFP 's DNC .
• Provide support to the MCAH Director and/or their designee as specified in the
contract between the LHJ and NFP .
• Provide ongoing coaching and consultation ; conduct education sessions as
appropriate to help nurse supervisors and nurse home visitors improve their
knowledge , skills and ab ilities to implement the program with high quality and
fidelity to the model in collaboration with NFP 's DNC .
• Provide education and support to MCAH Directors , nurse supervisors , and nurse
home visitors on specific topics as reasonably requested by NFP in collaboration
with NFP DNC.
July 2014 Page 3
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
• Monitor ongoing quality improvement.
• Assist in delivering appropriate continuing education in collaboration with NFP
DNC .
• Continually assist MCAH Director to help nurse supervisors meet NFP professional
development requirements as specified in the NFP Policies and Procedures
(P&Ps) in collaboration with NFP DNC.
• Assist NFP DNC in mentoring nurse supervisors in their administrative and clinical
roles . ·
• Foster communication of successful practices and mutual problem solving among
nurse home visitors at LHJs .
• Keep NFP informed of implementation issues that arise with any LHJ. Work with
the NFP DNC to facilitate visits , not less than quarterly , between NFP 's DNC and
nurse supervisors . The NFP DNGs shall meet with nurse supervisors at least
quarterly.
The above stated terms must be established in the contractual agreement between
each NFP LHJ and the NFP NSO .
In order to implement the program with fidelity to the models , LHJ site shall share
experiences learned and program improvement with other LHJ entities that are
implementing the NFP or HFA models through CHVP coordinated meetings and
teleconferences . If issues or difficulties arise regarding home visiting program
implementation , the LHJ site must contact the assigned CHVP NFP Nurse Consultant
or HFA Statewide Consultant. Other responsibilities include :
• LHJ shall implement the Home Visiting Program in accordance with model fidelity .
• LHJ staff shall demonstrate a level of competence in the skills related to Home
Visiting including assessments , interventions , referrals and follow-up .
• LHJ staff for each site shall ensure that the assigned CHVP NFP Nurse Consultant
or HFA Statewide Consultants involved in the process of program implementation
and accreditation .
• CHVP Home V isitors shall collect required data on family visits , and the Home
Visiting Supervisor will ensure that this data is entered into the CHVP ETO data
system within seven working days of the client visit , (see SOW, Objective 1.9)
taking all appropriate steps to maintain client confidentiality .
• LHJ staff will obtain agreement from CHVP Branch before reporting CHVP data to
anyone other than CHVP. LHJ will send copies to CHVP of all reports submitted to
NFP NSO or PCAA NO .
• CHVP reserves the right to access all collected data and establishes CHVP
ownership of CHVP uniquely -defined data content and functionality .
CHVP MEETINGS AND TRAINING REQUIREMENTS
LHJ site is required to participate in CHVP meetings , workgroups , and trainings directed
by CHVP . LHJ site is responsible for staff members ' receiving core training on NFP or
July 2 0 14 Page 4
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
HFA models and other CHVP required training .· For additional information on training
requirements :
• For a description of requ ired training , current schedules and dates for NFP and
HFA staff, refer to the CHVP website :
http://www.cdph.ca .gov/programs/mcah/Pages/HVP-HomePage.aspx.
• For further information about NFP training requirements , refer to the NFP
webs ite : http://www.nursefamilypartnership .org/assets/PDF/Policy/HV-Funding-
Guidance/NFP Core Education
• For further information about HFA training requirements , refer to the HFA Self-
Assessment Tool : http ://www.cdph .ca .gov/programs/mcah/Documents/MO-
CHVP-20 14-20 16-H FABestPracticeStandards. pdf
Ongoing training
LHJ site is required to provide ongoing training to staff in topics which take into
account the worker's knowledge , skill base , and needs. CHVP will collaborate with
each LHJ site to determine needs and coordinate training .
Note : For new and expansion sites , LHJ shall keep on file proof of completion of all
required core and follow-up trainings , and CHVP-required trainings of employed staff
along with their curricula . Current staff training for the required reporting period must
be documented in the Annual Progress Report.
WORK SPACE AND EQUIPMENT
LHJ site shall provide necessary equipment and establish an optimal work space for
program staff, including :
• appropriate telecommunication and computer equipment capabilities for staff use ;
• access to LHJ site Policies and Procedures for easy reference ; and
• easy access to community resources or agencies either electronically or on paper.
SPECIFIC REQUIREMENTS FOR THE MOTHER AND INFANT HOME VISITING
PROGRAM EVALUATION (MIHOPE)
The Affordable Care Act of 2010 required the U.S . Department of Health and Human
Services (USDHHS) to evaluate the federal Maternal , Infant, and Early Childhood Home
Visiting (MIECHV) Program . USDHHS contracted with MDRC , James Bell &
Associates , Johns Hopkins University , and Mathematica Policy Research to implement
the Mother and Infant Home Visiting Program Evaluation (MIHOPE) to assess
effectiveness of the home visiting models supported by MIECHV across the country .
The national evaluation sample encompasses 85 sites in 12 states . California has been
selected as a participating state and 6 sites (1 HFA and 5 NFP) have been identified .
Within each site , 60 families will be randomly assigned to intervention and control
groups .
july 2 01 4 Page 5
ATTACHMENT A
PROGRAM OPERATIONAL REQUIREMENTS FOR THE CALIFORNIA HOME VISITING PROGRAM
Local Staff are required to:
• participate in interviews and surveys ;
• provide program records ;
• complete participation logs ; and
• facilitate videotaping of home visits (performed by MIHOPE research staff on 9
families, 2 visits each).
MIHOPE Evaluation Staff will :
• enroll participant (including obtaining consent); and
• collect data (phone and in-person surveys and discussions).
In addition to surveys , home visitors and supervisors will complete logs regarding home
visit content , supervision and training . Logs for home visits and supervision will be
completed at the end of each week and training logs will be completed monthly. The
logs will take approximately 5 minutes to complete .
Participants will receive a $25 gift card for completing the baseline survey. Sites will
receive $22 ,000 to support staff participation in research activities which is available for
use over the entire study duration (Mid 2013-Mid 2015).
Jul y 2 01 4 Page 6
TO :
Attachment C
California Home Visiting Program Transmittal Form
Directions : Use this CHVP Transmittal form to submit supporting documentation or when requesting prior approval
from CHVP . Refer to Use of Transmittal Form Guideline regarding the use of this form . Send form and attachments
to : CA -MCAH -Home Visiting@cd ph . ca .gov .
California Home Visiting Program Date : 09122014
CHVP LHJ site : County of Fresno
CONTRACT#:
0 SCOPE OF WORK REVISION
0 SUPERVISOR QUARTERLY REPORT
0 Reporting Period :
0 STAFFING REPORT
D New Hire and Supporting Documents
D Separation
0 PROGRESS REPORT: DUE DATE:
D 02102 /13-06/30/13
D 07 /01 /13-06/30 /14
D 071 0 1/14-06/30 /15
07 /31/13
07/31 /14
07 /31 /15
0 Leave of Absence , 2 wee ks or more (for Superv isors , HFA Assessment Workers and Home Vis itors )
0 NURSE/PROGRAM (SPECIFY).'
0 DATA (SPECIFY):
X CONTRACT (SPECIFY).'
FY 2014-2015 Agreement Funding Application
0 TRAINING (SPECIFY).·
Comments :
FOR CHVP USE ONLY Date (s) CHVP Team Distribut ion
Received on : Contract Manager: --
Distributed to staff: Nurse Consultant: --
Distributor's Name : Program Specialist: --
Response to LHJ : Training Coordinator: --
Evaluation Consultant: --
CHVP Chief : --
Comments :
6/2013
Complete and submit this Subcontract Agreement Transmittal Form to obtain California Department of Public
Health (CDPH), Maternal, Child and Adolescent Health (MCAH) Division Subcontract approval.
REQUIREMENT: If the total subcontract amount over the term of the subcontract is $5,000 or more, a
Subcontract Agreement Package must be submitted for approval to CDPH MCAH Division prior to the
Subcontract/Agency Agreement being signed by either party, unless this prior approval requirement is
waived in writing by CDPH MCAH Division.
The following items are needed as additional components to complete the Subcontract Agreement Package:
1. A brief (one page or less) explanation of the award process including all information necessary
to evaluate the reasonableness of the price or cost and the necessity or desirability of incurring such cost, if
contract Exhibit Provision Terms and
2. Subcontract Agreement Package consisting of:
• Subcontract Agreement Transmittal Form
• Subcontractor/Agency Agreement or copy of waiver letter
• Proposed Scope of Work (CDPH MCAH Division format is recommended)
• Budget (CDPH MCAH Division format is mandatory unless optional format is approved by CM)
• Detailed Budget Justification
Address : 1900 Grant Street, Suite 400, Denver, Colorado 80203
Subcontractor Contact: Elizabeth Subcontractor Phone Number: 327-4271
Total Subcontract Amount: $15,500
Is Subcontract: Single Year Agreement [gl or Multiple Year Agreement D
If multiple year term , what is the entire term of Subcontract (i.e., 2005-2012):
Current Fiscal Year Subcontract Amount: $15 , Current FY Subcontract Period : FY2014-15
Federal I. D. Number or Social Security Number: 20-0234163
bcontractor's Program Director
(N/A for consultants): Tom Jenkins Phone Number: (303) 327-4274
For-profit organization Non-profit Organization
University D Governmental Agency
the above named subcontractor, all applicable terms and condit s are
thl-nWltr,..,.t MCAH ~
Printed Name: Rose Mary Garrone
Revised June 2014
Page 1 of 1
Title
Date:9/10/2014
P~.:::..,.He0fih ~., 1 Matamal, Chid and Adolescem Heath DMs,bn ORIGINAL BUDGET I BUDGET SUMMARY I SUBCONTRACT t=j Ym11U14 • .11\~U~ Program: California Home Vlsltlna Proaram UNMATCHED FUNDING NON-ENHI\N! .l 0 lNtt~NCliJ Agency: 201410 Fresno MA! C:~N(I ;')!I 50} UA I CHIN(, ti.C:.. ]";~ SubK: Nurse Family Partnership, Inc. AGENCY FLNlS I (I) ~ 13) I" I (5) I• I (5) Ill I (7) (8) l (9) 1••> 1 (II) 1121 1 (13) I••> I (15) I TOTAL FUNDING % CHVP % % % _lAgency Funds" % I % ~~ombineo % I % 1;~mblneO ALLOCATION(S) ---> 15,500 EXPENSE CATEGORY lm PERSONNEL :111 OPERA11NG EXPENSES 15,500 15,500 [IW CAPITAL EXPENDfTURES icM OTHER COSTS IM INDIRECT COSTS BUDGET TOTALS* 15,500 100 00% 15500 BALANCE(S) --+ TOTALCHVP § • I 15.5001 [ I TOTAL--§ ~·a TOTAL--1 I TOTAL TITLE XIX ------------_,. 150%1 )50%8 (75% 175%)8 TOTAL AGENCY FUNDS -~I I 150%1 125%1 $ 15,500 J Maximum Amount Payable from State and Federal resources WE CERTF't' THAT THIS BUDGET HAS BEEN CONSTRUCTED 5N COMPUANCE Willi All MCAH ADMINISTRAT1VE AND PROGRAM POLICES. MCAHIPROJECT Dl:tECTOR'S SIGNATURE DATE AGENCY FISCAL AGENT'S SIGNATURE DATE These arin.wrts-conta.i110ca1 revenue submittad for i'tbtmation and matr:hing ptKpOses. MCAH doas nOt rainbursaAgeney corrtnbi.mons STATE USE ONLY· TOTAL STATE AND FEDERAL REIMBURSEMENT I AF~';.ND~ PCA Codes ~'A #OIA #'>A #'>A #'\.A (I) PERSONNEL I {II) OPERATING EXPENSES 15.500 ~-(Ill) CAPITAL EXPENSES (lVI OTHER COSTS (V) INDIRECT COSTS i '---Totals tor PCA Codes 15500 15,5,:•~ CHVP SubK budge! 1 o13 Prin1ed: 9/t0/2014 10:20 AM
~'Vbilc:""'Heaffh ~,I Mal8tnal, Chid and A-.-Haollh I>Mobn ORIGINAL BUDGET Progrom: California Home VIsiting Program UNMATCHE'D FUNDING NON·rHHAHCED lNhANC~_Ll Agency: 201410 Fresno UA l CHING (50 50) M.A.! CHINC•: 75 25; SubK: Nurae Family_ Partnership, Inc. I AGENCY FUNOS I I I Ill (21 I (3) I (A) I (5) <•I I (5) (8) I (7) (II) l {t) I t1ot I (11) <'"' I (13) I <,., I (15) I I TOTAL FUNDING % I CHVP I % I % I % I Agency Funds" % I J _'1{, ~~;:"onea __ _ fed/Aaencv• % I I % ~~=n'::~ (U) OPERATING EXPENSES DETAIL TOTAL OPERATlNG EXPEIISES 15,500 15,500 I I I TRAVEL -1---1----I TRAINING -I l J -1 Amual Program Support MO Consultation 15,500 100.00% 15,500 --1---1----2 3 --1---1----4 --1---1----5 --1---1----6 --r---1----7 --i---r---1---' 8 ---1---1---9 ---i---r---10 ---c----1---11 ---~ 1---12 -1-----r---13 -r-----1---14 -1-----1---15 -1-----r---• Jm'latcflecf Uperaung EJCpenSes are not eligible fa ederal m&!CJW1Q s ( 111e AlAI. c:xpenses mayoriy be charged to Lkmatched n~ V (Cot ), titate General t-urds (Ga. 5), anct'cr Agency {Cot ) turds. (Ill) CAPITAL EXPENDITURE DETAIL TOTAL CAPITAL EXPENDITURES (IV) OTHER COSTS DETAIL TOTAL OTHER COSTS 1 I I I I I I I I I T l I I SUBCONTRACTS 1 f---1---1---~ ~ r---~ 2 1---~ 1---~ 1---1---~ 3 1---1---t---~ ~ f---1---4 f---1---1---~ ~ 1----1---5 1---t---1---~ 1---f-----~ 6 1---1---t---~ ~ f-----1---7 1---1---~ ~ 1----~ t---8 '---'-----'-----'---'----L-_ OTHER CHARGES c----.--.------.----..----1 1---1----~ 1---~ 2 f---f-----1---~ ~ 3 1---f-----1---~ 1---4 f-----t-----t---~ ~ 5 f-----f-----1---~ I---6 1----~ 1---I---1---7 f-----t-----t---I---I---8 ------~-----CHVP SubK budge! 2ot 3 Printed: 9/10/2014 10:20 AM
,.iilii'..7tieaftn ~M I Matomal Chid and A-.cant Hoalh DM<t>n ORIGINAL BUDGET Program: California Home VIsiting Program UNMATCHED FUNOING NON-ENHANCED EIIHAHCED Agency: 201410 Fresno UJ~;: HINC, 1';fl '5Cj Mil' :;H.N~; · ,w Q.) SubK: Nurse Family Partnership, Inc. I AGENCY FUNDS I I I (I) (2) I (3) I 141 I (5) <•I J (5) (8) I (7) (8) _L (9) I c••1 1 (11) <•21 1 (13) I c,.1 I P•l i I TOTAL FUNDING % I CHVP I % I % I % I Agency Funds• "" I l % ~~~r::::.v. "" I I % ~~==~:r:.c:..,. ---L ____ (V) INDIRECT COSTS DETAIL TOTAL INDIRECT COSTS! I I I I I I I I I I I I I ISolec!ICR option ..• I I I I I I I I I I I I I (I) PERSONNEL DETAIL TOTAL PERSONNEL COSTS I I I I I I I I I I FRtNGE BENEffi RATE H H H H H 1---=j H TOTAL WAGES .... "" .. TITLE OR CLASSIFICATION :::> TOTAL WAGES FTE z ~ 1 2 f--f----f--r-----'----3 r-----f----r-----f---4 f--r-------f--'----5 f--f----f----6 r-----f----r-------7 r-----f----:-----8 f--r------ ---t--9 f--t------t--10 r-----f---r-----f--11 :---f---~ -f--r-----12 t--t--r-----t---f--:---13 f--t--t--t---r-----'----14 r-----t--f--f---t--'----15 :---f--r-----r------f---16 t--:---t--t---r------17 f--t--t--f---r------18 r-----f--f--f--r-----,....___ -19 t--r-----r-----r-----t----20 f--t--t--r--f----r------f---f--f--r------f--21 r--1------r-----r-----r---t--22 23 f--f---r--f--f---r--24 r-----f---f--r-----r------r-----r--r-----r------r---r--25 26 r-----f---f---r-----r--f--27 r--1------r------'----f--r-----28 f--f---r----r------29 r-----f---f----r---30 f--1------r-------r------31 r-----f---f----r------32 r-----f---i----'----r--1------- ---t--33 34 f--'-------t--35 r---- -t---f--36 f--- - -r---t--37 f--- -f--f---f--36 -- -f--t--f--1---39 1-----t--r--f---40 ---f--f--t------'------'----CHVP SubK budge! 3 o13 Printed: 911012014 10:20 AM
CHV P SubK budget
(11-V) Jus:ifications
Budget: ORIGINAL
Program: California Home Visiting Program
Agency: 201410 Fresno
SubK: Nurse Family Partnership, Inc.
II) OPERATING EXPENSES JUSTIFICATION
TOTAL OPERATING EXPENSES
TRAVEL
TRA INING
1 Annual Program Support and Consultation
2
3
4
5
6
7
8
9
10
11
12
13
14
15
.Ulll CAPITAL EXPENDITURE JUSTIFICATION
TOTAL CAPITAL EXPENDITURES
ICM OTHER COSTS JUSTIFICATION
TOTAL OTHER COSTS
SUBCONTRACTS
1
2
3
4
5
6
7
8
OTHER CHARGES
1
2
3
4
5
6
7
8
INDIRECT COSTS JUSTIFICATION
TOTAL INDIRECT COSTS
Page 1 of 1
15,500
15,500
Version 4.3A-40 Qua rt er!
Data system (ETO) operation and use; Conference calls , NFP
~ommunity resources, updating of NFP Education & Visit-to-
Visit Guidelines ; Marketing and communications consu~ation
and support; NFP Nurse Consultant support for Program
I
I
Per CDPH approve d ICR
Pri nted: 91 10/20 14 10:20 m
AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE OF CALIFORNIA
No.: CA Dept. of Public Health Term: July 1, 2014-June 30 ,2015
Maternal , Child and Adolescent Health Division
California Home Visiting Program (CHVP)
Nurse Family Partnership
Agreement No . 201410
APPROVED AS TO LEGAL FORM :
DANIEL C. CEDERBORG,
COUNTY COUNSEL
By_L ~-~-
APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
By {ffi,{L~(=
REVIEWED AND RECOMMENDED FOR APPROVAL :
By 4t/?Jt{
David Pomaville
Director
Department of Public Health
Fund/Subclass:
Organization#:
Revenue:
ks
0001/10000
56201718
4382
AGT. # 1 2 -5 4 2
NURSE-FAMILY PARTNERSHIP IMPLEMENTATION AGREEMENT
This Agreement ("Agreement"), for the period July 1, 2012, through June 30 , 2015 , is by
and between County of Fresno , a Political Subdivision of the State of California
("Agency") and Nurse-Family Partnership , a Colorado nonprofit corporation ("NFP")
(together, the "Parties").
RECITALS:
A. The Parties understand and agree that the Nurse-Family Partnership® Program (the
"Program") is an evidence-based program developed on the basis of randomized
controlled trial research to yield certain benefits for low-income , first-time mothers
and the i r children ("Program Benefits ").
B . The Parties understand and agree that Program Benefits can be described generally
as .helping low-income , first-time mothers develop behaviors that enable them to
have healthier pregnanc ies , be better parents , have emotional ly and physically
healthier children , and attain greater economic self-sufficiency .
C. The Parties understand and agree that Program implementation by Agency must be
based upon key parameters ("Model Elements") identified through research and
refined based upon the Program 's experience since 1997 and attached to this
Agreement as Exhibit A , Nurse-Family Partnership Model Elements.
D . Agency desires and intends to implement the Program to serve low-income , first-time
mothers in the geographic area it serves and to be known to the public as Nurse-
Family Partnership .
E . NFP desires and intends to guide and support the Program implementation process
in order to help Agency obtain Program Benefits for the mothers and children that
Agency serves .
F . Accordingly , the Parties wish to enter into this Agreement in order to memorialize the
mechanisms and means by which Agency shall implement the Program and NFP
shall support such implementation . The Parties intend to remain in a contractual
relationship for the period described in Section V herein and thereafter, so long as
funding is available to both of the Partie~ for th is purpose .
AGREEMENT:
In consideration of the foregoing recitals , which are incorporated herein , and for other
good and valuable cons ideration , the receipt a nd adequacy of which are hereby
acknowledged , the Parties agree as follows :
I. DEFINITIONS .
A Agreement-Specific Definitions . In addition to terms defined above and
elsewhere in this Agreement, the following terms shall have the meanings set
forth below:
1. "ETO™" means the Efforts to Outcomes™ software system that NFP makes
available to Agency , into which designated , NFP-approved Agency personnel
enter data collected about Clients and the Program , and from which the
Parties can obtain reports to help manage and evaluate program
imp lementation and results .
2 . "ETO Website " means the Internet URL through which designated , NFP-
approved Agency personnel can access the ETO to enter data and obtain
certain reports and other services . ETO software is secured against
unauthorized use by VeriSign® 128-b it Security Encryption , the industry
standard in Internet site protection . Authorized access to the ETO Website
can only be prov ided by NFP
3 . "Administrator" means a person with fiscal and quality oversight, operational
coordination respons ibil ities, and/or evaluation responsibility for the
Program's management.
4 . "Cl ient" means a low-income , first-time mother who is enrolled in the Program
implemented by Agency .
5 . "Effective Date " means the date first noted above and upon which this
Agreement becomes effective .
6 . "Fide lity to the Model " means implementing the Program in a manner
consistent w ith the Model Elemen t s and therefore maximizing the likelihood
of achiev ing results comparable to those measured in resea rch .
7 . "Visit-to-Visit Guidelines®" means a written guide or guides for how a Nurse
Home Visitor schedules and conducts visits with Clients during their
participat ion in the Program .
8 . "Location " means the work address of a Program Supervisor.
9 . "Program Superv isor" means a person who ·supervises up to eight Nurse
Home Visitors who imp lement the Program on behalf of Agency .
10 . "Research " means any activity , including program evaluation and/or quality
improvement activ ities , (i) that would , according to Federal regulat i ons ,
require rev iew by a n Institutional Rev iew Board ("IRS "), or (ii ) that cou ld be
expected to yield generalizable knowledge that could be shared publicly with
the professional , academic , and/or lay communit ies .
11 . "Team" means a half-to full-time Program Supervisor and up to eight (8)
Nurse Home Visitors who report to the Program Supervisor.
B. "Proprietary Property" means all of (i) the Program , including facilitators and
handouts , (ii) the Model Elements, (iii) the name "Nurse-Family Partnership" and
the acronym "NFP" when used in connection with the NFP Logo and the goodwill
associated therew ith , (i v) all NFP Community Website and ETO website conten t,
and (v) the copyrighted mate rials and other materials used in the Program as of
the date hereof tha t would be designated as protectable intellectual property
under applicable law , including , but not limited to , all modifications , additions ,
updates, and derivative works thereof and all of the rights of NFP and its
licenso rs associat ed w ith th is prop e rt y . Pro p rietary Property shall also include ,
individually and collecti vely , all ideas , concepts , designs , methods , inventions ,
mod ifications , improvements , new uses , and discoveries which are conceived
and/or made in the performance of the responsibilit ies stated under this
Agreement by one or more of Agency , NFP , or its licensors , whether or not they
are incorporated into the Program o r the Proprietary Property . NFP and its
li censors reserve th e r ight to modify the Proprietary Property from time to t ime in
accordance with the data , research and c urrent modalities of del ivery of the
Program and for any other reason NFP or its licensors , in their sole and absolute
discretion , deem appropriate . NFP w ill provide Agency with reasonable notice of
those modifications . NFP and its licensors shall reta in ownership and all rights to
all Proprietary Property , whether modified or not by Agency .
Proprietary Property sha ll not include Agency 's confidential , non-public data
entered separate ly for Californ ia Home Vis iting Program (CHVP ) or materials
developed exclus ively by Agency which would be designated as protectable
i ntellectual property under applicable law .
C. General Appl icat ion. Un less a clear contrary intention appears , words used w ith
init ial-cap italized letters shall have the meanings set forth in this Agreement, and
(i) the singular includes the plura l and vice versa , (ii ) reference to any document
means such document as amended from time to t ime , (iii) "include " or "includ ing "
means including w ithout li m iting the genera li ty of any description preceding such
term , and (i v) the te rm "or " is not exclus ive .
II. NFP OBLIGATIONS .
A. NFP g rants to Agency a non-exclus ive li mited right and license to use the
Proprietary Property for t he purpose of ca r rying out Agency 's obl igations under
this Agreement in the geographic area within which Agency Nurse Home Vis itors
serve Clients . NFP reserves the right to modify the Proprietary Property from
ti me to t ime in accordance wi th t he data , research and current modalities of
delivery of the Program . NFP wil l provide reasonable notice of those
modifications as set fo rth in the Implementation Agreement. NFP shall retain
ownership and all of the ri ghts to any Proprietary Property , whether modified or
not by any Agency . In an y event , all software and ETO Website content,
ex clud ing Agency's and other agencies ' data, shall remain the sole property of
NFP .
B. NFP w ill prov ide support to help Agency implement the Program as described in
Exhibit 8 , Nurse-Fam i ly Partnership Support for an Agency.
C . NFP shall subm it invoices to Agency for serv ices provided to Agency , listing a
date of provision , a descript ion of each such service , and amounts based upon
the fee schedule prov ided in Exh ibit C , Fees for Nurse -Fam il y Partnersh ip
Services .
D. NFP may , from time to t ime , requ est that Agency collect additional data and/o r
participate i n Research in it iated by NFP and intended to improve the NFP model
or implementat ion of th e model. NFP may provide the publ ic w ith info r mation
about Agency 's NFP-re lated Research , publica t ions and presentations .
E. NFP , independently o r j ointly w ith Agenc y, may publish or present NFP-related
information or Program results in research reports , books , book chapters , peer-
reviewed journal art icles , and at academic or professional conferences , a lways
g iving due cred it to the Part ies involved and recogn izing the rights of the
individuals doing th e wo rk.
F . NFP understands that pursuant to th is Agreement , NFP and its employees may
have access to patients ' Protected Health Information ("PHI") and Agency's
business information . NFP acknowledges that this information has a high level of
confidentiality , and NFP and its employees agree to keep all information made
available to its employees confidential and not to disclose this information. NFP
wi ll instruct its employees/staff/affiliates to follow Agency's policies regarding
patient and business confidentiality . Further, NFP acknowledges that Agency is
bound by law to have written agreements with its business partners who may
have access to patient information requ iring compliance with the Health
Insurance Portability and Accountability Act of 1996 (HIPAA) and the rules and
regulations promulgated thereunder . Accordingly , NFP warrants and represents
that NFP is in compliance with HIPAA and all relevant federal statutes, rules,
regulations , and applicable interpretive rulings promulgated under HIPAA, or will
become compliant to regulations and requirements effective at future dates
accord ing to the applicable t i metables . Exhibit D , HIPAA Business Associate
Addendum , is hereby incorporated in this Agreement . Failure by NFP to comply
with this provision and the provisions of Exh i b it D, HIPAA Business Associate
Addendum , shall result in immed iate and automatic termination of this
Agreement without penalty or cost to Agency . NFP will cooperate with any
Agency program(s) instituted in the future to bring Agency into compliance with
HIPAA .
G . California Department of Public Health (CDPH). NFP shall collaborate with the
Cal ifornia Home Visit ing Program 's State Nurse Liaison (SNL) to provide support
for nurses and supervisors funded by the Maternal , Infant and Early Childhood
Home Visit ing (MIECHV) Program and shall support California 's Maternal , Child,
and Adolescent Health Director in accordance with terms outlined in Exhibit B ,
Nurse-Family Partnership Support for Agency
Ill . AGENCY OBLIGATIONS .
A. Agency will make best efforts to implement the Program with Fidelity to the
Model and will undertake the steps described in Exh ibit E, Agency
Responsibilities, in order to do so .
B . Agency will take all appropriate steps to maintain client confidentiality and obtain
any necessary written c lient consents for data analysis or disclosure of protected
hea lth information , in accordance with appl icable federal and state laws ,
including , but not lim ited to , authorizatio ns, data use agreements, business
associate agreements , as necessary .
C. Agency assumes responsibility for knowledge of and compliance with the State
Nurse Practice Act of its state , state laws , regulations , and licensing
requirements pertaining to nursing practice and state laws and regulations
pertaining to mandatory reporting .
D. Agency will ensure that nurses whom it employs to implement that Program are
able to provide care to clients in a manner consistent w ith the NFP Visit-to-Visit
Guide lines.
E . When requested by NFP , Agency will make reasonable efforts to collect
additional data and/or participate in Research intended to improve the NFP
model or implementation of the model .
F. In order to avoid becoming involved in Research that conflicts with implementing
the Program with Fidelity to the Model , Agency will request NFP 's permission
prior to participating in any Research that is ( 1) initiated by a party other than
NFP and (2) that involves Program staff or explicitly targets the families that are
enrolled in the Program . NFP will review and approve or disapprove Agency's
request for participation in such Research on a timely basis and will not
unreasonably withhold such approval . Agency is not required to request NFP 's
permission to participate in additional evaluations in connection with the
California Home Visiting Program's competitive expansion grant or the national
evaluation of MIECHV-funded programs .
G . Agency will inform NFP of Agency proposals to publish or present NFP-related
information in research reports, books, book chapters, peer-reviewed journal
articles, and at academic or professional conferences . Results of the Program
herein outlined may be published by Agency, or jointly by Agency and NFP,
always giving due credit to the Parties involved and recognizing the rights of the
individuals doing the work.
H . Agency will supply NFP with all applicable Catalog of Federal Domestic
Assistance (CFDA) codes if Federal funds are used to pay NFP for services it
provides to Agency under the terms of this Agreement.
I. Agency is authorized to reproduce certain published materials specified below
and used in the implementation of the Program so long as (1) this Agreement is
in effect, (2) Agency uses the reproductions solely for Program implementation,
and (3) Agency does not sell or otherwise distribute the reproductions to any third
party not involved in Agency 's implementation of the Program .
1. The published materials covered by this authorization are delivered to Nurse
Home Visitors as part of the Nurse-Family Partnership Home Visitor
education materials in sets referred to as follows :
a) Pregnancy Facilitators and Handouts
b) Infancy Facilitators and Handouts
c) Toddler Facilitators and Handouts
2. The handouts bear notices indicating copyright by any of the following:
a) University of Colorado
b) Un iversity of Colorado Health Sciences Center
c) University of Co lorado at Denver and Health Sciences Center
d) Nurse-Family Partnership
3. NFP has the right to grant perm ission to reproduce materials specified above
and that bear the University copyright notice under the terms of a
Memorandum of Understanding ("MOU") dated March 31 , 2003, between the
University of Colorado Health Sciences Center, now known as University of
Colorado at Denver and Health Sciences Center, and NFP . The MOU gives
5
NFP an exclusive , perpetual, royalty-free right and license to use copyrighted
materials and other materials used in the Program for the purpose of
implementing the Program to serve low-income, first-time mothers and their
families .
4. The corresponding Spanish-language versions of these materials are also
covered by this authorization .
5 . Agency may not authorize any other entity to reproduce the materials without
prior written permission from NFP .
J. Agency understands and agrees that all Proprietary Property is owned
exclusively by NFP and its licensors, including all intellectual property rights
therein . Agency shall use the Proprietary Property solely for the purpose of
carrying out Agency's obligations under this Agreement and shall not modify any
Proprietary Property without the prior express written permission of NFP .
Agency shall protect all Proprietary Property that belongs to NFP or its licensors .
Agency shall not duplicate and shall prohibit distribution of or access to Visit-to-
Visit Guidelines and the ETO to any individual or organization not party to the
implementation, administration , and operation of the Program, except as
authorized by this Agreement. Agency shall not change or alter the ETO
software , and shall allow only trained , NFP-authorized users to access the ETO
Website . If a person leaves Agency 's employ, Agency shall retrieve all
Proprietary Property that the person may have in his or her possession .
K . California Department of Public Health. In accordance with the California
Department of Public Health and its requirements related to funding
implementation of the Program , Agency shall :
1. Collaborate with the California Home Visiting Program 's State Nurse Liaison
(SNL);
2. Support California 's Maternal, Child and Adolescent Health (MCAH) Director
in accordance with terms outlined in Exhibit E , Agency Responsibilities;
3. Provide ongoing coaching and consultation and conduct education sess i ons
as appropriate to help nurse supervisors and nurse home visitors improve
their knowledge , skills and abilities to implement the Program with high
quality and Fidelity to the Model , in collaboration with NFP ;
4 . Provide education and support to MCAH Directors , nurse supervisors and
nurse home visitors on specific top ics as reasonably requested by NFP from
time to time in collaboration with NFP ;
5 . Monitor ongoing quality improvement to ensure Agency enters timely and
accurate data into ETO ;
6 . Assist in delivering appropriate continuing education in collaboration with
NFP ;
7. Continually assist MCAH Director to help supervisors meet NFP's
professional development requirements as specified by NFP;
8. Assist NFP in mentoring nurse supervisors in their administrative and clinical
roles ;
9. Foster communication of successful practices and mutual problem solving
among nurse home visitors ; and
10. Keep NFP informed of implementation issues that arise and work with NFP to
facilitate visits, not less often than quarterly , between NFP's designated nurse
consultant and Agency 's nurse supervisors . NFP's designated nurse
consultant shall meet with nurse supervisors at least quarterly.
IV . FEES AND PAYMENT.
A . Fees associated with NFP services in support of an implementing agency are as
follows :
1. Initial Educat ion Services . NFP provides in itial Nurse-Family Partnership
educat ion for nurse home v isitors , Program Supervisors , and Agency
Administrators . Th is fee appl ies once for each individual nurse home visitor,
nurse superviso r, and administrator at an agency . Fees are due upon
completion of the face-to-face session .
a) Nurse Home Vis itor In itial Education Tuition . Educati on for nurse home
visitors (NHV) consists of one face-to-face education un it supported by
distance education components . All Program Superv isors who have
never taken NHV Education or who completed it more than two years
prior to being promoted to Supervisor are required to attend NHV
Education as wel l as Supervisor Education .
b) Superv isor In it ial Educat ion Tuition . For Program Supervisors , educat i on
cons ists of Nurse Home Visitor Initial Education plus two face-to -face
education un its supported by distance education components and nurse
consultation .
c) Annual Supervisor Educat ion . Program Supervisors are required to
attend a three day face-to -face session held annually in Denver. There is
no tuition or registration fee .
d) Agency Adm i nistrator O rientation Tuition . A two day face-to -face session
in Denver, requ ired for new adm i nistrators and recommended for
experienced administrators .
e) Nurse-Fam il y Partnership Education Materials Fee . Contributes toward
the cost of the follow ing materials :
(1) Nurse-Family Partnersh ip Orientat ion Materials
(2) Set of P renatal , Infan cy and Toddler Guidelines
(3) A seri es of additional nursing pract ice and program management
resources ti ed to implementation of Nurse-Family Partnership .
2. Implementation Support Services . Fees are due on the Effective Date and
each anniversary thereof and are based on the number of Program
Supervisor Posit ions (the greater of (1 ) the numbe r of individuals w ith
supervi sory responsibil ity at the agency or (2) the number of supervisor FTEs
that are required to be implement ing the model with fidelity (at least one per
eight nurse home vis itors or fo r the CHVP NFP expansion program , one per
four nurse home visitors , until otherw ise notified by CDPH ). Fees are as
follows :
7
a) Program Support . Fees are per Program Supervisor Position per year
and contribute to covering costs associated with the following :
(1) Data system (ETO) operation and use, Program Quality System, and
Reporting .
(2 ) Ongoing Nurse-Family Partnership nurse home visitor , supervisor,
and administrator education; resource library; conference calls; web
forums ; Nurse-Family Partnership Community resources ; and
updating of Nurse-Family Partnership Education and Visit-to-Visit
Guidelines and supporting materials .
(3) Marketing and Communications consultation and support , including
marketing and community outreach materials (brochures , posters ,
Client Referral Kits (with wallet cards , counter display , posters and
other program informat ion); health fair bags, and nurse recruitment
packets . The agency , however,· is responsible for printing , stamping or
affixing labels with their local contact information to the majority of
these materia ls . Client Referral Kits are customized/printed at no
additiona l charge to the agency. Also provided are the NFP marketing
and communications resources and guidance and a copy of the NFP
Public Awareness Video , as well as updates and regular month ly
communications from the NFP National Service Office .
(4) Policy and Government Affairs, including advocacy and educational
work at federal and state levels .
b) Nurse Consultation . The fee is per Program Supervisor Position per year .
The full fee is charged for the first Program Supervisor Position at a
geographic location and a reduced fee is charged for each additional
Program Supervisor Position at that same location . The fees contribute
to covering costs associated with a Nurse-Family Partnership Nurse
Consultant provid ing the following support to Program Supervisors :
(1) Helping each Program Supervisor develop an annual plan for
implementation .
(2) Monitoring reports based on each Program Supervisor and her/his
team's activity and performance .
(3) Ongoing ema il support for each Program Supervisor and periodic
regular calls with each Program Supervisor.
(4) Period i c visits to each Program Supervisor with potential travel with
each Program Supervisor and/or selected nurse home visitors .
(5) Clinical and supervisory coach ing and consultation with each Program
Supervisor.
c) Program Supervisor Expansion or Replacement Fee . A one-time fixed
fee is charged for extra support when a new Program Supervisor Posit ion
is added or a vacant position is filled .
B. Prices are subject to change in accordance with Section IV D below.
C. All fees are based upon NFP's standard terms of invoicing and payment, as
follows :
1. Start-Up Services Fees are invoiced on the effective date of the contract and
are due in 30 days .
2. Program Support and Nurse Consultation Fees are invoiced on the Effective
Date and each anniversary thereof to cover each ensuing year and are due in
30 days. No special reporting or documentation is provided with the
invoice(s).
3 . Education Fees are invo iced when individuals attend in-person education
sessions . No special reporting or documentat ion is provided with the
invoice(s).
4. Program Supervisor Expansion or Replacement Fees are invoiced when the
new supervisor is hired . No special reporting or documentation is provided
with the invoice(s).
D . NFP shall invoice , without limitation, not to exceed Thirty-Six Thousand One
Hundred Seventy-One Dollars ($36, 171) annual ly, for services provided to
Agency based upon the fee schedule set forth in Exhibit C , Fees for Nurse-
Family Partnersh ip Services . NFP reserves the right to change the fees set forth
in Exhibit C during the te rm of this Agreement but not more often than annually .
NFP will notify Agency at least one year prior to any such change becoming
effective .
E . Invoices w i ll be sent to :
County of Fresno
Department of Public Hea lth
PO Box 11867
Fresno, CA 93775
Attention: Accounts Payable
Telephone : (559) 600-3330
Facsimile: (559) 600-7729
Email: dph@co.fresno.ca .us
F. Agency will send payments , identifying the NFP invoi ce, within 30 days of invoice
to :
Nurse-Family Partnership
Attention : Accounts Receivable
1900 Grant Street, Su ite 400
Denver, CO 80203
V . TERM AND DEFAULT.
A. Term of Agreement. This Agreement shall rema in in full force and effect through
June 30 , 2015 , unless it is term inated by mutual agreement of the Parties or as
otherwise provided below .
B . Early Termination . The Parties agree that they intend to and will engage in
mutual efforts to keep th is Agreement in force . Recognizing , however, that
circumstances beyond the control of the Parties may compel one Party to des ire
termination before completion of the term or an extension thereof, either Agency
or NFP may term inate t hi s Agreement at any time by giv ing the other party
written not ice of not less than s ixty (60 ) days.
C . Default. A party shall be in default under this Agreement if a party (i) breaches a
material provision of this Agreement, which breach is not cured to the non-
breaching party 's reasonable satisfaction within thirty (30) days of written notice
given to the breaching party by the non-breaching party or (ii) the bankruptcy of a
party.
D. Remedies upon Default. The Parties shall use commercially reasonable efforts
to take steps necessary to cause the breaching party to cure the applicable
default. If such default is not cured to the reasonable satisfaction of the other
party , and both of the Parties do not agree to terminate this Agreement , the
Parties shall proceed in accordance with the dispute resolution process set forth
in Section VI . '
E. Effect of Termination .
1. If this Agreement is terminated by notice of one party to the other, Agency will
pay NFP for all work performed up to the date of termination and all non-
cancelable obligations incurred in accordance with this Agreement. Payment
shall be due within thirty (30) days of termination .
2 . If this Agreement is terminated through the dispute resolution process, the
rights and obligat ions of each of the Parties upon termination shall be spelled
out in the dispute resolution process .
3 . Upon termination of this Agreement , regardless of the timing, cause , or
mechanism of such terminat ion :
a) Agency will no longer have access to ETO or the ETO Website ;
b) All software and ETO Website content , excluding data which has been
collected by Agency in the course of implementing the Program , shall
remain the sole property of NFP ;
c) NFP may retain a record of all data which has been collected by Agency
in the course of implementing the Program and may use that data and
reports derived from it to evaluate the overall progress in national
replication of the Program;
d) Agency and NFP will continue to comply with all relevant state, federal
laws and all other provisions of this Agreement with respect to
maintaining Client confidentiality;
e) All materials in Agency 's possession that utilize the Nurse-Family
Partnership logo, tag line , or other protected marks must be returned to
NFP or destroyed ;
f) All copies of Propr ietary Property that have been provided to Agency by
NFP or that have come into Agency 's possession from other sources
must be returned to NFP or destroyed; and
g) Agency wi ll cease to implement the Program and will cease to represent
that it is implementing the Program .
VI . DISPUTE RESOLUTION . If a dispute arises relating to this Agreement, the Parties
shall attempt to resolve that dispute at the lowest poss i ble level. If the dispute cannot
be resolved at that level, the dispute shall be elevated to the Director, Program
Development, of NFP and the Program Supervisor . If these persons cannot resolve
the dispute, it shall be elevated to the next organizational level of NFP and Agency . If
the dispute is not resolved through the foregoing process within a reasonable period
of time , not to exceed any period of time that could reasonably be deemed to have a
ID
detrimental impact on the implementation of the Program by Agency , either party
may initiate dispute resolu t ion through any avenue perm itted in law or in equity .
VII . HOLD-HARMLESS .
A. NFP agrees to indemnify , save , hold harmless, and at Agency's request , defend
A gency, its officers , agen ts , and employees from any and all costs and
expenses , includ ing attorney fees and court costs , damages, liabilit ies , claims ,
and losses occurring o r resulting to Agency in connecti on with the performance ,
or failure to perfo rm , by NFP , its officers , agents , o r employees under this
Agreement, and from any and all costs and expenses , including attorney fees
and court costs , damages , liab ilit ies , claims , and losses occurring or result ing to
any person , f irm , or corpo ration who may be injured or damaged by the
performance , or failure to perform , of NFP , its officers , agents , or employees
under this Agreement.
VIII. INSURANCE .
A. NFP, at its sole expense , shall maintain in full force and effect the following
insurance polic ies ·through out the term of this Agreement:
1. Commercial Gene ral Liabil ity . Commercial General Liab ility Insurance w ith
limits of not less than One Million Dollars ($1 ,000,000 .00) per occurrence and
an annual aggregate of Two M ill ion Dollars ($2,000 ,000). This pol i cy shall be
issued on a pe r occurrence basis . Agency may require specific coverages
incl uding completed operat i ons , product s liabil ity , contractual liabil ity ,
Explosion-Collapse-Underground (ECU), f ire legal liability or any other liabil ity
insurance deemed necessary because of the nature of this Agreement.
2 . Automobile Liab ility . Comprehens ive Automobile Liability Insurance w ith
limits for bod ily i njury of not less than Two Hundred Fifty Thousand Dollars
($250,000) per person , Five Hundred Thousand Dollars ($500 ,000) per
accident and for property damages of not less than Fifty Thousand Dollars
($50,000), or such coverage with a combined single l imit of Five Hundred
Thousand Dollars ($500 ,000). Coverage should include owned and non-
owned veh icles used in connect ion with this Agreement.
3 . Professional L iabil ity . If NFP employs licensed professional staff (e .g . Ph.D .,
R.N ., L .C .S .W ., M .F .C.C.) i n provid i ng services , Professional Liability
Insurance with lim its of not le ss than One Million Dollars ($1 ,000 ,000) per
occurrence , Three M ill ion Dollars ($3 ,000 ,000 ) annual aggregate. NFP
agrees that it s hall m ainta in , at its sole expense , in fu ll force and effect for a
pe riod of three (3 ) years fol lowing the termination of this Agreement , one or
more pol icies of professional l iabi li t y insurance with limits of coverage as
specified herein .
4 . Worker's Compensati on. A pol icy of worker's compensation insurance as
may be requ ired by California Labor Law .
B . NFP shall obtain endorsements to the Comme rcial General Liability insurance
naming the County of Fresno , its office rs , ag ents , and employees , individually
and collective ly , as add itional insured , but only insofar as the operations under
this Agreement a re concern ed . Such coverage for add itiona l insured shal l appl y
as primary insurance and any other insurance, or self-insurance maintained by
II
Agency , its officers, agents and employees shall be excess only and not
contributing with insurance provided under NFP's policies herein. This insurance
shall not be cancelled or changed without a minimum of thirty (30) days advance
written notice given to Agency .
C. Within thirty (30) days from the date NFP executes this Agreement, NFP shall
provide certificates of insurance and endorsement as stated above for the
foregoing policy , as required herein, to the County of Fresno, Department of .
Public Health , P .O . Box 11867, Fresno , California , 93775, Attention : Contracts
Section-61h Floor, stating that such insurance coverages have been obtained
and are in full force ; that the County of Fresno , its officers , agents and
employees will not be responsible for any premiums on the policies ; and that
such Commercial General L iability insurance names the County of Fresno , is
officers , agents and employees County of Fresno , its officers , agents and
employees, individually and collectively, as additional insured , but only insofar as
the operations under this Agreement are concerned ; that such coverage for
additional insured shall apply as primary insurance and any other insurance, or
self-insurance, maintained by Agency , its officers, agents and employees, shall
be excess only and not contributing with insurance provided under NFP's policies
herein ; and that such insurance shall not be cancelled or changed without a
minimum of thirty (30) days advance , written notice given to Agency .
D. In the event NFP fails to keep in effect at all times insurance coverage as herein
provided , the Agency may , in add ition to other remedies it may have, suspend or
terminate this Agreement upon the occurrence of such event.
E. The policy shall be w ith admitted insurers licensed to do business in the State of
California . Insurance purchased shall be purchased from companies possess ing
a current A.M . Best , inc. rating of A FSC IX or better .
IX . CONFIDENTIALITY . All services performed by NFP under this Agreement shall be
in strict conformance with all applicable laws and regulations relating to
confidentiality .
X NONDISCRIMINATION . During the performance of this Agreement , NFP shall not
unlawful ly discriminate against any employee or applicant for employment, or
recipient of services , because of race, religion , color, national origin , ancestry ,
physical handicap , medical condit ion , marital status , age or sex , pursuant to all
app licable State and Federal statutes and regulations .
Xi. ASSIGNMENT; SUBCONTRACTING . Except as prov ided herein , this Agreement,
and the rights and obligations hereunder, is not assignable or transferable by either
party without the prior written consent of the other party . Without limiting the
previous sentence , Agency shall not have the right to engage or utilize the services
of any subcontractor to perform any of Agency 's services hereunder without the prior
written consent of NFP .
XII . MISCELLANEOUS PROVISIONS .
A Consents . Whenever a Party 's consent or approval is required under this
Agreement , such consent or approval shall not be unreasonably withheld . If
consent or approval is requ i red by an employee of a Party , the Party who
employs such employee shall cause the employee to give or withhold such
consent or approval in accordance with this Paragraph. If no response is
received by the request ing Party within ten bus i ness days after delivery of the
applicable request , consent shall be deemed given .
B. Audits and Inspect ions. NFP shall at any time during business hours, and as
often as Site may deem necessary , make available to Site at NFP's offices for
examination all of its records and data with respect to the matters covered by this
Agreement. NFP shall , upo n request by Site, permit Site at NFP's offices to audit
and inspect all such records and data necessary to ensure NFP's compliance
with the terms of this Agreement. If this Agreement exceeds Ten Thousand and
No/100 Dollars ($10 ,000 .00 ), NFP shall be subject to the examination and aud it
of the State Auditor Genera l at NFP 's offices for a period of three (3) years after
f inal payment under contract (California Government Code section 8546 .7).
C . Notices. All notices and other communications that are requ i red or permitted to
be given to the Part ies under this Agreement shall be suffic ient in all respects if
given in writing and delivered by overnight courier or certified mail , postage
prepaid, return receipt requested . to the receiving party at the following address :
For NFP :
Original to :
Nurse-Family Partn e rs hi p
1900 Grant Street, Su ite400
Denver, CO 80203
Attention : Chief Execut ive Officer
Telephone : 303-327-4274
Facsimile: 303-327-4260
Email :
Tom .Jenkins@NurseFamilyPartnership .org
For Agency :
Orig inal to :
Edward L. Moreno , D irector
County of Fresno Departme nt of Public
Health
P . 0 . Box 11867
Fresno , CA 93775
Telephone : (559 ) 600 -3200
Facsim i le : (559 ) 600-768 7
With a copy to :
Nurse-Family Partnership
1900 Grant Street , Suite400
Denver, CO 80203
Attention : Legal Affairs Manager
Telephone: 303-327-4271
Facsimile : 303-327-4260
Email:
Elizabeth .Jasper@NurseFamilyPartnership.org
W ith a copy to :
Rose Mary Garrone
Pub lic Health Nursing Div isi on
Manager
County of Fresno Department of Public
Health
P .O . Box 11867
Fresno , CA 93775
Telephone : (559) 600-3330
Facsimi l e: (559 ) 600-77 29
Email : edmoreno@co .fr esno .ca .us Ema i l: rgarrone@co .fresno .ca .us
or to such other add ress as such party may have given to the other by notice
pursuant to th is Paragraph . Notice shall be deemed given on the delivery or
refusal date , as specifi e d on the return rece ipt i n the case of cert ified mai l or on
the tracking report in the cas e of overn ight courie r.
D. Binding Upon Successors and Assigns. This Agreement, and all covenants,
terms, provisions, and agreements contained herein, shall be binding upon and
shall inure to the benefit of the Parties' respective successors and permitted
assigns.
E. Waivers . No covenant, term, or condition , or the breach thereof, shall be
deemed waived, except by written consent of the party against whom the waiver
is claimed; and any waiver of the breach of any covenant, term, or condition shall
not be deemed to be a waiver of any preceding or succeeding breach of the
same or any other covenant, term, or condition.
F . Responsibility for Debts and Obligations. Neither party shall be responsible
either directly or indirectly for any of the debts or obligations of the other party
except as provided under this Agreement.
G. No Third Party Beneficiary . This Agreement does not create any third party
beneficiary rights in any person or entity .
H . Authority to Contract. The undersigned individuals represent that they are fully
authorized to execute this Agreement on behalf of the respective Parties and
make all representations, warranties and covenants set forth herein. The Parties
represent and warrant that the execution, delivery, and performance of this
Agreement have been duly authorized by all necessary corporate actions of the
Parties and do not violate any laws or any provisions of any agreement to which
the Parties are bound .
I. No Joint Venture . Nothing contained in this Agreement shall be deemed or
construed as creating a joint venture or partnership among the Parties. No party
shall have the power to control the activities or operations of another party and
their status is, and at all times shall continue to be, that of independent
contractors with respect to each other. No party shall hold itself out as having
authority or relationship in contravention of this Paragraph.
J . Attorneys' Fees . If a party shall commence any action or proceeding against
another party in order to enforce the provisions of this Agreement, or to recover
damages as a result of the alleged breach of any of the provisions of this
Agreement, the prevailing party shall be entitled to recover all reasonable costs
in connection therewith, including reasonable attorneys' fees .
K. Further Assurances . The Parties shall cooperate fully with each other and
execute such further instruments, documents , and agreements, and shall give
such further written assurances , as may be reasonably requested by another
party to better evidence and reflect the transactions described herein and
contemplated hereby, and to carry into effect the intent and purposes of this
Agreement.
L . Entire Agreement. This Agreement (together with Exhibits hereto, which are
hereby incorporated by this reference) constitutes the entire agreement between
the Parties relating to the subject matter hereof and supersedes all prior or
contemporaneous agreements , whether written or oral , among themselves or
the ir agents and representatives relating to the subject hereof. This Agreement
may be altered , amended , or revoked only by an inst r ument in writing signed by
all the Parties hereto .
M. Severability . If any term or provis ion of this Agreement shall , to any extent , be
determined to be inval id or unenforceable by a court or body of competent
jurisdiction , the rema inde r of this Agreement shall not be affected thereby , and
each term and provis ion of th is Agreement shall be valid and enforceable to the
fullest extent permitted by law .
N. Applicable Law. This Agreement shall be governed by and construed according
to the internal laws of the State of California . By execution of this Agreement,
each Party submits and irrevocably waives any objection to in personam
jurisdiction in the State of California and the forum and convenience of the state
and federal courts thereof. It is further mutually agreed that venue for any
dispute arising out of th is Agreement shall be in Fresno County , California.
0 . Survival. The terms and condit ions of this Agreement shall survive the expiration
or termination of th is Agreement to the full extent necessary for their enforcement
and for the protection of the party in whose favor they operate .
P. Counterparts and Facsimile Signatures . This Agreement may be executed in two
or more counterparts . each of which shall be deemed an original and all of which .
taken together, shall constitute one agreement. A facsimile signature to this
Agreement shall be deemed an original and binding upon the party against whom
enforcement is sought.
IN WITNESS WHEREOF , the Parties hereto have caused this Agreement to be
executed as of the date set forth herein by their duly authorized representatives.
For NFP :
Nurse-Family Partnership
Date : ___ q.;__ . .....:::~:::..._·---'--{ --''-::;__ __ _
Federal EIN : 20-0234163
For Agency:
County of Fresno, a Political Subdivis i on of
the State of California
. ' By :~~~:.....:..:._:~~~,~~~
Deborah A. Poochigian
Chairman, Board of Supe
Oate : __ \"'"--'0=---__,cl:...;z::...;:!>;._-_\ ~..::..._;_ __ _
~~~nic~~~~ M
Board of Supervisors
Date : \0-d=~ ... lJ
PLEASE SEE ADDITIONAL SIGNATURE PAGE ATTACHED
ll.'
APPROVED AS TO LEGAL FORM :
KEVIN B. BRIGGS , COUNTY COUNSEL
PPROVEDASTOAC OU
FORM :
VICKI CROW , C .P .A., AUDITOR-
CONTROLLER/
TREASURER-TAX COLLECTOR
REVIEWED AND RECOMMENDED FOR
APPROVAL :
EDWARD L. MORENO, MD, MPH ,
DIRECTOR
DEPARTMENT OF PUBLIC HEALTH
Fund/Subclass : 0001/1 0000
Organizat ion : 56201719/56201718
Account/Program : 7295/0
11
EXHIBIT A. NURSE-FAMILY PARTNERSHIP MODEL ELEMENTS
When the Program is implemented in accordance with these Model Elements , the
Parties can reasonably have a high level of confidence that results will be comparable to
those measured in research . Conversely , if implementation does not incorporate these
Model Elements , results may be different from research results .
Element 1 Client participat es vo luntarily in the Nurse-Family Partnership program .
Element 2 Client is a fi rst -time mother.
Element 3 Client meets low-income c riteria at intake .
Element 4 Client is enrolled in the program early in her pregnancy and receives her
first home visit by no later than the end of the 28 1h week of pregnancy .
Element 5 Client is visited one to one , one Nurse Home Visitor to one first-time
mother/ family .
Element 6 Client is vis ited in her home .
Element 7 Client is visited throughout her pregnancy and the first two years of her
chi ld 's life in accordance with the current Nurse -Family Partnership Guidelines .
Element 8 Nurse Home Visito rs and Nursing Superv isors are registered professional
nurses with a minimum of a Bacc alaureate degree in nursing .
Element 9 Nurse Home Visitors and Nurs ing Supervisors complete educational
sessions required by NFP NSO and deliver the intervention with fidelity to the NFP
Model.
Element 10 Nurse Home Visitors , us ing professional knowledge , judgment and skill ,
apply the Nurse-Family Partnersh ip Visit-to -Visit Guidelines individualizing them to the
strengths and challenges of each family and apportioning time across defined program
domains .
Element 11 Nurse Home Visito rs apply the theoretical frameworks that underpin the
program , emphasizing Self-Efficacy , Human Ecology and Attachment theories , through
current cl inical methods
Element 12 A full time Nurse Home Visitor carries a case load of no more than 25
active clients .
Element 13 A full-time Nursing Superv isor provides supervision to no more than 8
individual Nurse Home Vis itors (No more than 4 individual Nurse Home Visitors for the
CHVP NFP expansion program , unt il otherwise notified by CDPH).
Element 14 Nurs ing Superv iso rs provide Nurse Home Visitors clinical superv ision
with reflection , demonstrate integration of the theories, and facilitate professional
development essential to the Nurse Home Visitor role through specific supervisory
activities including 1:1 clinical supervision , case conferences , team meetings and field
supervision .
Element 15 Nurse Home Vis itor and Supervisors collect data as specified by the NFP
NSO and use NFP Reports to guide their practice , assess and guide program
implementation, inform clinical supervision, enhance program quality, and demonstrate
program fidelity .
Element 16 Nurse-Family Partnership Imp lementing Agency i s located in and
operated by an organ ization known in the community for being a successfu l provider of
prevention services to low-income famil ies.
Element 17 Nurse-Family Partnership Implementing Agency convenes a long-term
Community Advisory Board that meets at least quarterly to promote a community
support system to the program and to promote program quality and sustainabil ity .
Element 18 Adequate support and structure shall be in place to support Nurse Home
Visitors and Nursing Supervisors to implement the program and to assure that data is
accurately entered into the data base in a timely manner.
EXHIBIT B. NURSE-FAMiLY PARTNERSHIP SUPPORT FOR AN AGENCY
To help Agency implement the Program with Fidelity to the Model , NFP provides the
following support to Agency :
I. NFP provides support to help Agency prepare to implement the Program including :
A Materials to help Agency :
1. Maintain Agency 's work space;
2 . Maintain telecommunications and computer capabilities ;
3. Recruit , hire , and retain Program Supervisors , Nurse Home Visitors, and
administrative support staff;
4 . Maintain and improve a network of sources who may refer low-income , first-
time mothers to Agency ;
5. Facilitate enrollment of Clients ;
6 . Maintain and improve a network of social services that can prov ide support
to Agency 's Cl ients ;
7. Work with media ;
8. Inform the community and build support for Agency , the Program, and
Program Benefits ;
9. Establish and maintain strong , stable, and sustainable funding for Agency
operations.
B . An ETO users ' manual, which provides instructions describing what data must be
collected for ETO by Agency staff, how that data must be entered into ETO, and
how reports can be obtained . NFP may modify the ETO users ' manual from time
to time and will provide Agency with updated versions on a timely basis .
C Access to an Internet-based discussion forum with other entities that are
implementing the Program .
D . A visit to Agency by a member of NFP staff to offer direct consultation on
Program implementation .
II. NFP provides ongoing support to Agency via telephone and email during Program
implementation and operation, including :
A Consultation with respect to topics such as human resources, developing
community support , keeping interested constituencies informed about progress
and results , planning and implementing expansion, and sustaining and
increasing funding ;
B. Clinical consultation for Program Supervisors and Nurse Home Visitors ;
C . Consultation regarding data collection , entry, management , and interpretation .
D. On-site consultation as is mutually deemed necessary and appropriate .
Ill . NFP provides a description of education programs , both required and optional , and a
schedule of upcoming education events and locations . NFP may modify the specific
names , descriptions , and content of education programs , as well as their schedule
and locations from time to time and will inform Agency of such modifications on a
timely basis .
IV. NFP provides education to Program Supervisors and Nurse Home Visitors at dates
and locations to be determined by NFP . Education will cover the following topics :
A The Program , Program Benefits. and Model Elements ;
B . Use of ETO , including data collection , entry , management, and interpretation ;
,_o
C . Implementation of the Program us ing the NFP Visit-to-Vi sit Guidelines and
associated tools and materials ;
D . Knowledge and skills needed by the NFP Program Supervisor; and
E . Other aspects of the Program that NFP believes are warranted for successful
Program implementation by the staff at Agency .
V . NFP provides Visit-to-Visit Guidelines and other materials to help Program
Supervisors and Nurse Home V isitors implement the Program with Fidelity to the
Model Elements . NFP may mod ify the Visit-to -Vis it Guidelines from time to time and
will provide Agency with updated versions on a timely basis .
VI. NFP provides support for Agency 's use of ETO , including :
A . Monitoring the Agency 's data collect ion and entry activity and quality and
providing feedback to Agency as appropriate :
B . Mainta ining and supporting ETO software ;
C. Upgrading ETO software when deemed necessary by NFP ; and
D . Technical assistance via telephone or e-mail to support Agency 's use of ETO .
VII. NFP provides implementation reports and evaluation reports at such times as NFP
deems commercially reasonable and necessary to meet the needs of Agency and
entities to which Agency may be obligated to provide such information. Subject to
applicable federal and state laws, if any, such reports cover :
A. Agency activity. Reports designed primarily for Program Supervisors and Nurse
Home Visitors to help them manage Nurse Home Visitor activity .
B. Qual ity improvement. Reports aimed to help Agency improve Fidelity to the
Model including reports designed (i) to assist Program Supervisors and Nurse
Home Visitors identify and prioritize actions for improving Program outcomes ,
and (ii) to help NFP staff assess how Agencies are performing with respect to
Fidelity to the Model .
C . Program outcomes . Reports designed to help Program Supervisors and funding
decision makers assess the effectiveness of the Program as applied to Agency's
particular circumstances .
D. These reports are available on a pre-defined schedule or from the ETO Website
on demand. NFP may mod ify the Program Reports from time to time .
VIII. NFP will provide art work and color and usage guidelines to help Agency develop
and produce communications materials that properly use the NFP trademark , logo ,
tag lines, and other copyrighted or otherwise protected language, images , and
materials controlled by NFP .
IX. From time to time , NFP may engage either internal or external auditors to evaluate
the performance of the Agency . Agency will cooperate fully with any quality audit
that is undertaken by or on behalf of NFP .
t.'
EXHIBIT C. FEES FOR NURSE-FAMILY PARTNERSHIP SERVICES
NFP fees for services provided under this Agreement will be as follows , subject to change in
accordance with Section IV 0 :
Initial NFP Education Fee (Invoiced upon completion of the face-to-face session)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $4.069 .00 One time per NHV or Supervisor
7/1/2013 6/30/2014 $4 ,069 .00
7/1/2014 6/30/2015 $4 ,069 .00
Initial NFP Program Supervisor Education Fee (Invoiced upon completion of the first face -to-face session)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $734 .00 One time per Supervisor
7/1/2013 6/30/2014 $734 .00
7/1/2014 6/30/2015 $734 .00
NFP Agency Administrator Education Fee (Invoiced upon completion of the first face-to-face session )
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $480 .00 One time per Administrator
7/1/2013 6/30/2014 $480.00
7/1/2014 6/30/2015 $480 .00
Initial NFP Educational Materials Fee (Invoiced upon completion of the face-to-face NHV Education session)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $517 .00 One t ime per NHV Trainee
7/1/2013 6/30/2014 $517 .00
7/1/2014 6/30/2015 $517 .00
Annual Program Support Fee (Invoiced annually on the Price Effective Date)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $7 ,046.00 Per Program Supervisor Position
7/1/2013 6/30/2014 $7 .046 .00 per Year
7/1/2014 6/30/2015 $7 .046 .00
Annual Nurse Consultation Fee for Each First Program Supervisor at a Location
(I nvoiced annually on the Price Effective Date)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $8,447 .00 Per Program Supervisor Position
7/1/2013 6/30/2014 $8,447.00 per Year
7/1/2014 6130/2015 $8,447 .00
Annual Nurse Consultation Fee for Each Additional Program Supervisor at a Location
(Invoiced annually on the Price Effective Date)
Pr ice Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $5,068 .00 Per Program Supervisor Position
7/1/2013 6/30/2014 $5 .068 .00 per Year
7/1/2014 6/30/2015 $5 ,068 .00
Program Supervisor Expansion or Replacement Fee (Invoiced at the time of hire)
Price Effective Date End Date Unit Price Unit of Measure
7/1/2012 6/30/2013 $2 .764 .00 One time per Expansion or Replacement Program
7/1/2013 6/30/2014 $2 .764 .00 Supervisor
per Year
7/1/2014 6/30/2015 $2 .764 .00
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EXHIBIT D. HIPAA BUSINESS ASSOCIATE ADDENDUM
I. The U .S Department of Health and Human Services has issued final regulations ,
pursuant to the Health Insurance Portability and Accountability Act of 1996
("HI PAA"), governing the privacy of individually identifiable health information . See
45 CFR Parts 160 and 164 (the "HIPAA Privacy Rule "). The Agency, as a "Covered
Entity" as defined by HIPAA, is a provider of heath care , a health plan , or otherwise
has possession, custody or control of health care information or records .
II . "Protected health information " ("PHI ") means individually identifiable health
information including all information , data , documentation and records , including but
not limited to demographic , medical , and financial information that relates to the past ,
present, or future physical or mental health or condition on an individual ; the
provision of health care to an individual or payment for health care provided to an
individual ; and that identifies the individual or which Agency believes could be used
to identify the individual.
A. "Electronic protected health information " means PHI that is transmitted by
electronic media or maintained in electronic media .
B. "Security incidenf' means the attempted or successful unauthorized access , use,
disclosure, modificati on , or destruction of information or interference with system
operat ions in an information system.
Ill. NFP is considered a Business Associate of Agency , as NFP either: (A) performs
certain functions on behalf of or for Agency that may involve the use or disclosure of
protected individually identifiable health information by Agency to NFP, or the
creation or receipt of PHI by NFP on behalf of Agency ; or (B) provides legal,
actuarial, accounting, consulting , data aggregation , management, administrative,
accreditation , financial or social services for Agency involving the disclosure of PHI.
IV. NFP agrees that all PHI obtained as a result of this Agreement shall be kept
confidential by NFP , its agents , employees , successors and assigns as required by
HIPAA law and regulations and by this Agreement and addendum .
V . NFP agrees to use or disclose PHI solely (A) for meet ing its obligations under this
Agreement, or (B) as required by law , rule or regulation or as otherwise permitted
under this Agreement of the HIPAA Privacy Rule .
VI . The parties acknowledge that data that may be (but is not with certainty) PHI is
collected during the term of this Agreement for NFP's reporting and evaluation of (a)
Agency 's implementation of the Program, (b) comparison of Agency's
implementation of the Program with implementation by other entities, and (c) regional
and national patterns and trends in Program implementation . Returning this data is
not feasible . Therefore, NFP shall extend the protections of this Agreement to such
data and/or PHI and limit further uses and disclosures of such data and/or PHI to
those set out in this agreement for so long as NFP maintains such data and/or PHI.
If it becomes necessary for NFP to use the data and/or PHI in any manner other than
what is contemplated in this Agreement . NFP agrees to consult with and obtain the
permission of the Agency .
VII. In the course of providing the services to Agency under the terms of this agreement,
NFP will be enabling the Prevention Research Center for Family and Child Health
("PRC "), an organization wh ich is part of the University of Colorado at Denver and
Health Sciences Center, to access data that may be PHI for the purposes of
research, analys i s, and reporting . NFP will ensure that PRC and its employees and
NFP 's agents, employees , subcontractors or others to whom it provides PHI received
by or created by NFP on behalf of Agency agree to the same restrictions and
cond it ions tha t apply to NFP w ith respect to such information . NFP also agrees to
take all reasonable steps to ensure that its employees ', agents ' or subcontractors '
actions or om issions do not cause NFP to breach the terms of this Addendum . NFP
will use al l app ropri ate safeguards to prevent the use or d isc losure of PH I other than
pursuant to the terms and condit ions of this Agreement and Addendum .
VII I. NFP shall , with in th ree (3 ) days of becoming aware of any use or disclosure of
PHI , other than as perm itted by th is contract and Addendum , report such disclosure
in w riting to Agency .
IX . NFP shall make available su ch info r mation in its possess ion which is requ ired for
Agency to provide an accounting of disclosures in accordance with 45 CFR 164 .528 .
In the event that a request fo r account ing is made d irectly to NFP , NFP shal l forward
such request to Agency within two (2 ) days of such receipt. NFP shall implement an
appropriate record keeping process to enable it to comply with the requirements of
this prov ision. NFP shal l mainta in data on all disclosures of PHI for which account ing
is requ ired by 45 CFR 164 .528 for at least six (6 ) years after the date of the last such
disclosure .
X . NFP shall make PHI available to Agency upon request in accordance with 45 CFR
164 .524 .
X I. NFP sha ll make PHI available to Agency upon request for amendment and shall
incorporate any amendments to PHI in accordance with 45 CFR 164 .526 .
XII . NFP shal l make its interna l pract ices , books , and records relating to the use and
d isclosure of PHI received from or created or rece ived by NFP on behalf of Agency
available to the Secretary of the U.S. DHHS for purposes of determin ing Agency 's
compliance with the HIPAA P rivacy Rule .
XII I. Compliance with Security Regulations : In addition to the other prov isions of this
Addendum, if NFP creates , receives , maintains , or transmits electronic PHI on
Agency 's behalf, NFP shall :
A. Implement adm inistrat ive , physical, and technical safeguards that reasonably
and appropriately protect t he confidential ity , integrity , and availability of the
electronic protected health information that it creates , receives , maintains , or
transmits on behalf of Agency ;
B. Ensure that any agent, inc luding a subcontractor, to whom it provides such
information agrees to implemen t reasonab le and appropriate safeguards to
protect it ; and .
C. Report to Agency any security incident of which it becomes aware .
XIV . NFP agrees to indemn ify and hold Agency harm less from and ·against al l liability
and costs , includ ing attorneys ' fees , c reated by a breach of this Addendum by NFP ,
its agents , employees or subcontractors , without regard to any limitation or exclus ion
of damages prov ision otherwise set forth in the Agreement.
XV. Notwithstanding any other prov ision of the Agreement , Agency shall have the right to
terminate the Agreement immed iately if Agency determines that NFP has viola t ed
any material term of th is Exh ibit D ..
v·\
EXHIBIT E. AGENCY RESPONSIBILITIES
To ensure that the Nurse-Family Partnership Program is implemented with Fidelity to
the Model . Agency will undertake the following actions during initial implementation
and ongoing operation :
I. Agency will:
A. Maintain an appropriate work space for staff who are to implement the
Program ;
B. Maintain appropriate telecommunications and computer capabilities for
staff;
C. Recruit. hire , and retain Program Supervisors , Nurse Home Visitors. and
administrative support staff;
D . Maintain and improve a network of referral sources who may refer low-
income, first-time mothers to Agency ;
E. Enroll clients that meet the criteria specified in the Model Elements .
F. Maintain and improve a network of social services that can provide
support to Agency 's Clients ;
G . Work with media to ensure timely and accurate communication to the
public about the Program and its implementation by Agency ;
H. Inform the community and build support for Agency , the Program, and
Program Benefits;
I. Establish and maintain strong , stable, and sustainable funding for Agency
operations .
J . · Utilize NFP 's Internet-based discussion forum to share learning with other
entities that are implementing the Program .
II. Agency will keep NFP informed of implementation issues that arise .
Ill. Agency wil l ensure that all Program Supervisors , nurses , and administrative staff
attend , participate in , and/or complete education programs required by NFP , do so
on a timely basis , and , upon completion , demonstrate a level of competence deemed
satisfactory by NFP .
IV. Agency will ensure that no Nurse Home Visitor is assigned a case load or makes
a Client visit (except in the company of an NFP -educated Nurse Home Visitor) until
after she/he has completed education on the Program, Program Benefits , Model
Elements , use of the ETO , and implementation of the Program for mothers who are
pregnant.
V . Agency will implement the Program in accordance w ith Visit-to-Visit Gu idelines
including :
A. Ensure enrollment of 23 to 25 first-t ime mothers per full-time Nurse Home
Visitor within nine months of beginning implementation and make best efforts to
maintain that leveJ of enrol lment on an ongo ing basis ;
B . Ensure that each full-time Nurse Home Visitor carries a caseload of not
more than 25 active families ;
C . Maintain the estab lished v isit schedule ; and
D . Ensure that the essential Program content as described in the Visit-to-
Visit ·Gu idelines is covered w it h Clients by Nurse Home Visitors .
VI. Agency w i ll ensure the availabi lity of appropriate , fully functioning computer
systems and software at Agency for use of ETO and for commun ication w ith NFP by
email.
VII. Agency will ensure that Program Supervisors and Nurse Home Visitors (a) collect
requ ired data on client vis its a·nd enter it in ETO complete ly and accurately within
one week of each client visit and (b) enter any other data for ETO completely and
accurately on or before the last day of each calendar month , taking all appropriate
steps to maintain client confidentiality and obtain any necessary written permissions
or' agreements for data ana lysis or disclosure of protected health information , in
accordance with HIPM (Health Insurance Portability and Accountability Act of 1996)
regulations , includ i ng , but not l im ited to , authorizations , data use agreements ,
business associate agreements , as necessary. Fa ilure of Agency to comp ly with any
applicable provision of HI PM will const itute a breach of this Agreement.
VIII . Agency wil l ensure that Program Supervisors :
A. Aim to develop a supportive relationship with the Nurse Home Visitors
she/he supervises ;
B . Meet one-on -one with each Nurse Home Visitor at least weekly to provide
cl inical supervision using reflection , preferably in person but by telephone where
travel constraints lim it nurse or Program Supervisor mobility ;
C . Run activity reports and quality improvement reports from the ETO
Website on a timely basis (typ ically month ly); use such reports to assess areas
where systems , organizational , or operational changes are needed in order to
enhance the overal l qual ity of program operations ; and develop and implement action
plans based on such assessments .
IX. Agency will deve lop a Community Advisory Board with diverse representation
(for example , hea lth , mental health , education , cr iminal j ustice, youth , business ,
social services , faith-based leaders , other prom inent community organization
leaders ) to ensure broad -based commun ity support for Agency's implementation of
the Program .
X. NFP will periodically assess the extent to which Agency is implementing the
Program with F idel ity to the Model. When such assessment indicates opportun ities
for Agency to improve its resu lts by strengthening Fidelity to the Model , NFP staff will
meet with Agency supervis ion and mu t ually develop a plan to do so .