HomeMy WebLinkAbout32042RON CHAPMAN, MD, MPH
D/mctor & State Health Officer
State of California-Health and Human Services Agency
California Department of Public Health
January 20, 2015
Laura Lopez
AFLP Director
County of Fresno, Department of Social Services
4455 E. Kings Canyon Road
Fresno, CA 93702
Dear Ms. Lopez:
APPROVAL OF AGREEMENT FUNDING APPLICATION (AFA) FOR
AGREEMENT #201410-2-FISCAL YEAR 2014-15
EDMUND G. BROWN JR.
Governor
The California Department of Public Health, Maternal, Child and Adolescent Health
(CDPH/MCAH) 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 and Budget, during the period
of July 1, 2014 through June 30, 2015, the CDPH/MCAH Division will reimburse
expenditures up to the following amount:
Adolescent Family Life Program ........................ $ 422,611
The availability of Title V funds and State General funds (BIH only) are based upon
funds appropriated in the FY 2014-15 Budget Act. Reimbursement of invoices is
subject to compliance with all federal and state requirements pertaining to the
CDPH/MCAH 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 CDPH/MCAH
Program and Fiscal Policies and Procedures manuals, including the ability to
substantiate all funds claimed. The policies and procedures manuals can be accessed
at: http:l/www.cdph.ca.gov/services/funding/mcah/Pages/FiscaiPoliciesandProcedures
Manual.aspx
For agencies claiming Title XIX funds, you also agree to maintain secondary
documentation that clearly substantiates time study activities as being non-program
Maternal, Child and Adolescent Health Division/Center for Family Health
MS 8300 • P.O. Box 997420 • Sacramento, CA 95899-7420
(916) 650-0300 • (916) 650-0305 FAX
Internet Address: www.cdph.ca.gov
Ms. Lopez
January 20, 2015
Page 2
related, unmatched, non-enhanced or enhanced. You also agree to use either:
1. the web-posted CDPH/MCAH, BIH, and/or AFLP Base Medi-Cal Factor (MCF),
2. a Variable Base MCF for specific staff who serve a unique client population, and
who verify and document 100% of their Medi-Cal enrolled and non-Medi-Cal
enrolled clients during each time study period (MCAH Program only), and/or
3. the Lodestar generated MCF (AFLP Program only).
Please ensure that all necessary individuals within your Agency are notified of this
approval and that the enclosed documents are carefully reviewed. This approval letter
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.
Since:el~
)J_llJ,. '-"'A~6ie Aguirre 1
Acting Division Chief
Enclosure(s)
cc: Chair Board of Supervisors
County of Fresno Board of Supervisors
2281 Tulare Street, Room 301, Hall of Records
Fresno, CA 93721-2198
Stephen Fong
Contract Manager
Susan Fleischer
Program Consultant
Central File
AGT. # 15-126
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:
D MCAH IZI AFLP DBIH DFIMR DCHVP
Fiscal Year: 2014-15 U ate Effective: ired when submitti
Agreement Number: 201410-2
Federal Employer 94-6000512
ID#:
Complete Official County of Fresno, Department of Social Services
Name:
Business Office PO Box 1912, Fresno, CA 93718-1912
Address:
Agency Phone:
Agency Website
Address:
559-600-2346
www .co. fresno.ca. us/DSS
1 AGENCY DIRECTOR
Name: Delfino E. Neira
Title: Director
Mailing Address: I PO Box 1912
City: Fresno
Phone: 559-600-2300 I Ext. I
E-Mail Address: I dneira@co.fresno.ca.us
Page 1 of 7
Revised June 2014
Agency Fax: 559-600-2357
I Zip: 193718-1912
I FAX: 1559-600-2310
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
2281 Tulare Room 301 Hall of Records
93721-2198
Phone: 559-6003529
E-Mail Address: .ca. us
3 OFFICIAL AUTHORIZED TO COMMIT AGENCY
Name: Deborah Poochigian
Title: Chairman, Board of Supervisors
Mailing Address: 12281 Tulare, Room #300
City: Fresno I Zip: 193721-2198
Phone: 559-600-5000 I Ext. I I FAX: 1559-600-1609
E-Mail Address: I district5@co.fresno.ca.us
4 FISCAL OFFICER
Name: Joel Bugay
Title: The County of Fresno, Department of Social Services Finance Division Chief
Mailing Address: I PO Box 1912
City: Fresno l Zip: 193718-1912
Phone: 559-600-2823 I Ext. I I FAX: 1559-600-2882
E-Mail Address: jbugay@co .fresno.ca. us
5 MCAH DIRECTOR (Please check box if MCAH and AFLP Director are the same) • Name: Rose Mary Garrone, RN, BSN
Title: The County of Frenso, DeQ_artment of Public Health, Division Manag_er
Mailing Address: I PO Box 118867
City: Fresno I Zip: 193775
Phone: 559-600-3353 I Ext. I I FAX: I 559-600-7729
E-Mail Address: rgarrone@co.fresno.ca.us
Page 2 of 7
Revised June 2014
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
6 MCAH COORDINATOR (Only complete if different from #5)
Name: Jennifer Day, RN, BSN
Title: The County of Fresno, Department of Public Health, MCAH Coordinator
Mailing Address: I PO Box 11867
City: Fresno I Zip: 193775
Phone: 559-600-6339 I Ext. I I FAX: I 559-600-7729
E-Mail Address: I jday@co.fresno.ca.us
7 MCAH BUDGET CONTACT
Name:
Title:
Mailinq Address: I
City: I ZiQ: I
Phone: I Ext. I I FAX: I
E-Mail Address: I
8 MCAH INVOICE CONTACT (Only complete if different from #7)
Name:
Title:
Mailino Address: I
Citv: I Zip: I
Phone: I Ext. I I FAX: I
E-Mail Address: I
9 PERINATAL SERVICES COORDINATOR (PSC)
Name:
Title:
Mailing Address: I
Citv: I Zip: I
Phone: I Ext. I l FAX: I
E-Mail Address:
Page 3 of 7
Revised June 2014
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
10 AFLP DIRECTOR (Only complete if different from MCAH Director)
Name: Laura Lopez
Title: County of Fresno, Department of Social Services, Program Manager
Mailing Address: 14455 E. Kings Canyon Road
City: Fresno l ZiQ_: 193702
Phone: 559-600-3251 I Ext. I I FAX: I 559-600-3256
E-Mail Address: lauralopez(Ci}co.fresno.ca.us
11 AFLP COORDINATOR (Only complete if different from #10)
Name: Bonnie J. Burns
Title: County of Fresno, Department of Social Services, Deputy Director
Mailing Address: 14455 E. Kings Canyon Road
City: Fresno I Zip: I 93 702
Phone: 559-600-3253 I Ext. I I FAX: 1559-600-3256
E-Mail Address: I bbums@}co.fresno.ca.us
12 AFLP BUDGET CONTACT
Name: Howard Hamme
Title: Count1 of Fresno, Department of Social Services, Staff Analyst
Mailing Address: PO Box 1912
City: Fresno J Z!Q: 193718-1912
Phone: 559-600-2346 I Ext. I I FAX: 1559-600-2357
E-Mail Address: I hhamme(Ci}co.fresno.ca.us
13 AFLP INVOICE CONTACT (Only complete if different from #12)
Name:
Title:
Mailina Address: I
City: 1zip: 1
Phone: I Ext. I I FAX: I
E-Mail Address: I
Page 4 of 7
Revised June 2014
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
14 BLACK INFANT HEALTH (BIH) COORDINATOR
Name:
Title:
Mailing Address: I
City: r Zip: ·1
Phone: I Ext. I I FAX: l
E-Mail Address:
15 BIH BUDGET CONTACT
Name:
Title:
Mailil}g Address: I
City: I Zip: I
Phone: I Ext. I I FAX: I
E-Mail Address: I
16 BIH INVOICE CONTACT (Only complete if different from #15)
Name:
Title:
Mailing Address: I
City: T Zip: T
Phone: I Ext. I -~FAX: 1
E-Mail Address: I
17 FETAL INFANT MORTALITY REVIEW (FIMR) COORDINATOR
Name:
Title:
Mailing Address: I
City: I Zio: I
Phone: I Ext. I I FAX: I
E-Mail Address: I
Page 5 of 7
Revised June 2014
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
18 SUDDEN INFANT DEATH SYNDROME (SIDS) COORDINATOR I CONTACT
Name:
Title:
Mailinq Address: I
City: I Zip: I
Phone: I Ext. I I FAX: I
E-Mail Address:
19 CALIFORNIA HOME VISITING PROGRAM (CHVP) COORDINATOR/
NURSING SUPERVISOR
Name:
Title:
Mailinq Address: I
City: I Zip: I
Phone: TExt. T I FAX: I
E-Mail Address:
20 OTHER
Name:
Title:
Mailing Address: I
City: I Zip: I
Phone: I Ext. I I FAX: I
E-Mail Address:
Page 6 of 7
Revised June 2014
Agency Name: County of Fresno, Department of Social Services
Agreement#: 201410-2 Fiscal Year: 2014-15
AGREEMENT FUNDING APPLICATION
POLICY COMPLIANCE AND CERTIFICATION
The undersigned hereby affirms that the statements contained in the Agreement Funding
Application (AFA) are true and complete to the best of the applicant's knowledge.
I certify that this Maternal, Child and Adolescent Health (MCAH) related program will comply
with all applicable provisions of Article 1, Chapter 1, Part 2, Division 106 of the Health and
Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and
Institutions Code (commencing with Sections 14000 and 142), and any applicable rules or
regulations promulgated by CDPH pursuant to this article and these Chapters. I further certify
that this MCAH related program will comply with the MCAH Policies and Procedures Manual,
including but not limited to, Administration, Federal Financial Participation (FFP) Section. I
further certify that this MCAH related program will comply with all federal laws and regulations
governing and regulating recipients of funds granted to states for medical assistance pursuant
to Title XIX of the Social Security Act (42 U.S.C. section 1396 et seq.) and recipients of funds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of
the Social Security Act (42 U.S.C. section 701 et seq.). I further agree that this MCAH related
program may be subject to all sanctions or other remedies applicable if this MCAH related
program violates any of the above laws, regulations and policies with which it has certified it
will comply.
~a.
Original Signature of Official author"
commit the Agency to an MCAH
Deborah Poochigian
Name (Type or Print)
Laura Lopez
Name (Type or Print)
Revised June 2014
Page 7 of 7
Chairman. Board of Supervisors
Title
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Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 1. Service Overview Scope of Work (SOW) Adolescent Family Life Program (AFLP) The Contractor agrees to provide to the California Department of Public Health (CDPH) the services in this SOW. As defined in the implementing statute in Health and Safety Code Sections 124175, 124180, and 124185, the purpose of the AFLP is to address the social, medical, educational, and economic consequences of adolescent pregnancy by (1) establishing local networks to provide necessary services to pregnant and parenting teens and their children, and (2) providing case management services focused on achieving the following goals: • Improve the health of the pregnant and parenting teen, thus supporting the health of the baby • Improve high school graduation rates for pregnant and parenting teens • Reduce repeat pregnancies for pregnant and parenting teens, and • Improve linkages and create networks for pregnant and parenting teens and their child(ren) The statute also requires the AFLP to assess client needs and refer clients to services including comprehensive prenatal care, medical care, psychological and nutritional counseling, maternity counseling, adoption counseling, academic and vocational programs, day care, and substance abuse prevention, intervention, and counseling. Each AFLP shall also assure program integrity and maintain a data base to measure outcomes. To positively impact the goals of the AFLP program, AFLP emphasizes strengths-based case management based on positive youth development principles with integrated life planning. The AFLP program is part of the CDPH Center for Family Health Division's (CFHD) strategy to achieve the following Division priorities identified by the federally required Title V, 5-year Needs Assessment for the adolescent pregnant and parenting population the AFLP serves: • Improve maternal health by optimizing the health and well-being of girls and women across the life course. • Promote healthy nutrition and physical activity among Maternal, Child, and Adolescent Health (MCAH) populations throughout the lifespan beginning with exclusive breastfeeding of infants to six months of age. • Reduce maternal morbidity and mortality and the increasing disparity in maternal health outcomes. • Reduce infant mortality and address disparities by promoting preconception health and health care and by preventing causes such as birth defects, low birth weighUprematurity, Sudden Infant Death Syndrome (SIDS), and maternal complications in pregnancy. • Support the physical, socio-emotional, and cognitive development of children, including the prevention of injuries, through the implementation of prevention, early identification and intervention strategies. • Promote positive youth development strategies to support the physical, mental, sexual and reproductive health of adolescents. • Link the MCAH population to needed medical, mental, social, dental, and community services to promote equity in access to quality services. The development of this SOW was also guided by the three core public health functions of assessment, policy development, and assurance, the Ten Essential Services of Public Health, the Spectrum of Prevention, the Life Course Perspective, the Socioecological Model, and the Social Determinants of Health. Page 1 of 21 Final 4/30/14 with Goal 6
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) AFLPs are also required to comply with requirements stated in the AFLP Program Policies and Procedures Manual and the MCAH Fiscal Policies and Procedures Manual such as attending statewide meetings, submitting Agreement Funding Applications, submitting timely invoices and Lodestar data, and completing Annual and Quarterly Reports. Copies of manuals will be provided or posted on the CDPH website. All activities in this SOW must take place within the fiscal year. The measures marked with *will be calculated by Branagh Information Group from Lodestar data in a Scope of Work report from data in Lodestar data forms, which include Intake, Status Change, Follow Up Form, Service Matrix, Additional Outcomes, Pregnancy Outcome, Freecode Forms. It is essential that local agency staff complete these forms accurately and completely. 2. Service Location(s) The services shall be performed at various Agencies throughout California. 3. Service Hours The services shall be provided during normal Agency working hours, excluding holidays. 4. Project Representatives The AFLP representatives and contacts during the term of this agreement will be: California Department of Public Health Maternal, Child and Adolescent Health Division Program Allocations, Integrity and Support Branch Contract Manager: Stephen Fong 1615 Capitol Avenue, MS 8305 PO Box 997 420 Sacramento, CA 95899-7420 Telephone: (916) 650-0340 Fax: (916) 650-0309 Agency Name: County of Fresno, Department of Social Services Agency Contact: Laura Lopez Agency Address: 4455 E. Kings Canyon Road City, State, Zip: Fresno, CA, 93702 Telephone: (559) 600-3251 Fax: (559) 600-3256 Email: lauralopez@co.fresno.ca.us Either party may make changes to the information above by giving written notice to the other party. Said changes shall not require an amendment to this agreement. Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final 4/30/14 with Goal 6 Page 2 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 5. SOW Changes Scope of Work (SOW) Adolescent Family Life Program (AFLP) A. Pursuant to Health and Safety code Section 38077(b) (2), changes and revisions to the SOW contained in the agreement, utilizing the "Allowable cost payment system" may be proposed by the Contractor in writing. Failure to notify the State of proposed revisions to the SOW may result in an audit finding. B. The State will respond, in writing, as to the approval or disapproval of all such requests for changes or revisions to the SOW within 30 calendar days of the date the request is first received in the Department. Should the State fail to respond to the Contractor's request within 30 calendar days of receipt, the Contractor's request may be deemed approved. C. The State may also request changes and revisions to the SOW. The State will make a good-faith effort to provide the Contractor 30 calendar days advance written notice of said changes or revisions. D. No changes to the SOW agreed to pursuant to this paragraph shall take effect until the cooperative agreement is amended and the amendment is approved as required by law and this agreement. 6. Performance Requirements A. In accordance with AFLP Standards, AFLP Local Agency will provide, at a minimum, the following case management Months of Service (MOS) to eligible adolescents and their children for fiscal year(s): 1644 AFLP MOS (137 clients) for the budget period of 07/01/12 through 06/30/13 1644 AFLP MOS (137 clients) for the budget period of 07/01/13 through 06/30/14 1908 AFLP MOS (159 clients) for the budget period of 07/01/14 through 06/30/15 Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 3 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Fiscal Years: FY 2012-2015 B. For each fiscal year of the contract period, the Local Agency shall submit the deliverables identified below. With the exception of the Management Information System (MIS) Data, the LodeStar program, all deliverables shall be submitted to the MCAH Division in accordance with the AFLP Policies and Procedures Manual and postmarked no later than the due date. The LodeStar Data must be submitted to the current MIS contractor or MCAH Program Consultant by the date specified below. Deliverables for each FY Annual Progress Report Quarterly Report: Cover Sheet MOS Quarterly Report Caseload Analysis Personnel List Due Date for each FY Aug. 15 Oct. 31, Jan. 31, Apr. 30, July 31 Oct. 31, Jan. 31, Apr. 30, July 31 Oct. 31, Jan. 31, Apr. 30, July 31 Oct. 31, Jan. 31, Apr. 30, July 31 MIS Data (content of previous month) ?'h and/or 1?'h of each month for electronic submission 7. See the following pages for a detailed description of the services to be performed. Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with GoalS Page 4 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 1: Improve linkages and create networks for pregnant and parenting teens and their children Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Short, Intermediate, and Long Term Measures to be Reported in the Annual Outcome Objective(s) Objectives Report or more frequently where indicated Process Measures Outcome Measures 1.1 AFLP will assess local needs, 1.1.1 Identify and monitor local 1.1.1 List and briefly describe local and develop and maintain a trends in teen pregnancy and trends in teen pregnancy and comprehensive, culturally parenting outcomes, including parenting outcomes, including Not Applicable appropriate local network of disparities, and social disparities and social teen friendly supportive determinants. determinants. services 1.1.2 Identify and monitor local 1.1.2 List and briefly describe: geographic areas or population groups that have • Geographic areas or insufficient access to health population groups that have and human services for insufficient access to health pregnant and parenting teens. and human services for Not Applicable Identify high risk groups and pregnant and parenting areas. teens. • Any activities that have specifically addressed these gaps and the associated outcomes. 1.1.3 Identify community agencies 1.1.3 a. Complete the table in the 1.1.3 Summarize: and other service providers for Annual Report to describe a. service gaps and changes pregnant and parenting teens services available to clients in the provider network and work toward developing and type of agreement for during the reporting period. documented agreements referral. b. the impact on the AFLP (e.g., MOUs, letters of support b. Describe the relationship with population or agreement) for referral with the local MCAH program c. key challenges and at least the following: c. Describe venues where case strategies to address the management services are gaps and challenges. • Local MCAH Program (for delivered to clients, address of CBOs) offices, and • Family PACT providers d. model of service delivery • CPSP providers (group, individual, face to face, • WIC telephone, combination) • Cal Learn (500 word limit) • Cal SAFE Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 5 of 21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 1: Improve linkages and create networks for pregnant and parenting teens and their children Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Short, Intermediate, and Long Term Measures to be Reported in the Annual Outcome Objective(s) Objectives Report or more frequently where indicated Process Measures Outcome Measures • Primary care providers • Child care and development services • Local schools or education services, including migrant education where appropriate Other resources could include: • Psychological counseling • Social services • Vocational programs • Emergency support • Housing • Legal Assistance • Substance Abuse Prevention • Adoption Counseling • Parenting Classes • Home Visiting Programs Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 6 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 1: Improve linkages and create networks for pregnant and parenting teens and their children Fiscal Years: FY 2012-2015 Evaluation/Performance Measures Intervention Activities to Meet Short, Intermediate, and Long Term Measures to be Reported in the Annual Outcome Objective(s) Objectives Report or more frequently where indicated Process Measures Outcome Measures 1.2 Improve local systems of care 1.2 Participate in at least one 1.2 Submit Collaborative Form to 1.2 Collaborative Form submitted through collaboration collaborative, coalition, network, document participation in at least in Process will designed to establish, sustain etc., that develops products or one and not more than 3 AFLP and enhance comprehensive strategies that address unmet collaboratives or coalitions that a. Document objectives and systems of care for pregnant needs and promote increased address unmet needs and improve accomplishments and and parenting teens and their local access to health and access to health and human b. Include a description of the children. human services for pregnant services: Maintain records of collaborative's impact on and parenting teens and their collaboration in AFLP Agency (i.e. the local system of care for children. network coordination pregnant and parenting documentation, summaries, and/or teens. minutes of meetings attended). c. List products developed and outcomes of dissemination on collaborative form. 1.3 Improve community 1.3 AFLP will conduct outreach 1.3 Describe: 1.3 State the number and percent knowledge of AFLP services activities to high risk groups, a. top three outreach activities of clients completing intake by and identify potential clients areas, and community agencies b. State number of clients on source of referral in MIS Scope by conducting outreach and other service providers to current waiting list of Work Report. activities. ensure that appropriate and c. describe the process of referrals eligible clients are identified, for clients that are not referred to the program and appropriate for AFLP enrolled or placed on a waiting d. three challenges list, or referred to other community services. Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 7 of21
I Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 1: Improve linkages and create networks for pregnant and parenting teens and their children Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s) Objectives Short, Intermediate, and Long Term Measures to be Reported in the Annual Report or more frequently where indicated 1.4 Clients will obtain health insurance. 1.5 Client will access needed services for herself and her child. 1.6 Client will develop a supportive relationship with a stable, caring adult outside of AFLP. *MIS Scope of Work Report **Service Referral Analysis Report Process Measures 1.4 Make referrals and assist clients 1.4 Provide the number of clients and to enroll in Medi-Cal, Access for their children receiving referrals to Infants and Mothers (AIM) and Medi-Cal.** other low cosUno cost health insurance programs for health care coverage. 1.5 Case Managers (CMs) will work Not Applicable with clients to assure that clients and children receive linkages to services. CMs will educate client to understand the importance of well child visits and immunizations. 1.6 CMs will encourage clients to 1.6 a. Describe the process to identify a stable, caring adult incorporate this objective into outside of AFLP. This could case management activities and include improving relationships b. List three challenges and with parents, involvement with successes in achieving this community groups or faith objective. communities, or educational institutions. -L...-·----------·------Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Outcome Measures 1.4 Report: a. Number and percent of adolescent clients with health insurance at intake* b. Number and percent of adolescent clients with health insurance at last follow up* c. Number and percent of index children with Medi-Cal* 1.5 Report the following: a. Percent of clients and index children who needed and received services** b. Attach the Service Referral Analysis Report 1.6 Report the number and percent of clients who self-report that they have a supportive relationship with a caring adult outside of AFLP. (In development for future reporting) Page 8 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Fiscal Years: FY 2012-2015 Goal 2: Improve the health of the pregnant or parenting teen, thus also supporting the health of the index child Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s} Objectives Short, Intermediate, and Long Term Measures Report items below in the Annual Reoort or more freQuently where indicated Process Measures Outcome Measures (Forms) 2.1 Clients will have healthy 2.1 Refer to WIC and follow up to 2.1 List three key activities used to 2.1 Report number. and percent of clients nutrition and healthy promote healthy nutrition and receiving WIC. weight. encourage linkage. Refer to CPSP healthy weight provider if pregnant and reinforce healthy diet/weight gain. Assist client to develop a goal to achieve or maintain a healthy weight. Program policies and activities, including case management activities, will promote and model healthy diet and reinforce healthy nutrition. 2.2 Clients will engage in daily 2.2 Encourage physical activity daily, 2.2 List three key activities used to 2.2 Report the number and percent of: physical activity. at least one hour four times a promote physical activity. a. clients with any physical activity week, or as allowed by MD if b. for those clients that report any pregnant. physical activity, report the average Program policies and activities, days of physical activity per week including case management activities, will promote and model regular and frequent physical activity. 2.3 Pregnant clients will 2.3 Refer to prenatal provider, use 2.3 Describe three success/challenges 2.3 Report the number and percent of receive timely prenatal CPSP provider when available. in linking to CPSP and other clients pregnant at enrollment who: care in order to maximize Identify and address barriers to prenatal providers. Received prenatal care* their health and deliver a a. healthy baby. keeping appointments. b. Had a LBW baby (<2500g}* c. Had a pre-term baby (<37 wks)* d. Had an LGA baby (>4000g or 8#---13oz.)* MIS Scope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final 4/30/14 with Goal6 Page 9 of 21 i I
I Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Fiscal Years: FY 2012-2015 Goal 2: Improve the health of the pregnant or parenting teen, thus also supporting the health of the index child Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective( s) Objectives Short, Intermediate, and Long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures Outcome Measures (Forms) 2.4 Clients will initiate and 2.4 Encourage breastfeeding. 2.4 List three activities used to promote 2.4 a. Report number and perqent of clients continue breastfeeding. breastfeeding. who did any breastfeeding . b. Report number and percent of clients planning to breastfeed if pregnant at intake*. 2.5 Clients will not use 2.5 Assess each client for tobacco 2.5 Briefly describe three activities to 2.5 a. Report number and percent of tobacco. use using self-report and/or screen and refer clients to tobacco clients who were smoking at intake.* validated screening tool. cessation. b. Report the number and percent of clients who were smoking at last Advise to quit or decrease follow up.* tobacco use. Refer to tobacco quit line, other treatment as appropriate. 2.6 Clients will not use alcohol 2.6 Assess each client for alcohol or 2.6 Describe three key challenges 2.6 Report number and percent of clients or other drugs. other drug use using self-report related to alcohol or other drug use who: and/or validated screening tool. among clients. a. Admit use of alcohol in the 6 months before intake* Advise to quit or decrease alcohol b. Admit use of alcohol in the 6 or other drug use. months before last follow up* c. Admit use of drugs in the 6 months Refer to treatment for alcohol or before intake* other drug use. d. Admit use of drugs in the 6 months before last follow up* -··---------MIS Scope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 10 of 21 I I
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Fiscal Years: FY 2012-2015 Goal 2: Improve the health of the pregnant or parenting teen, thus also supporting the health of the index child Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s) Objectives Short, Intermediate, and Long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures Outcome Measures (Forms) 2.7 Non pregnant clients will 2.7 Discuss with each client the 2.7 Briefly describe three successes 2.7 Report the number and percent of receive primary preventive importance of receiving primary and challenges in clients obtaining clients who received primary preventive health care. preventive health care to prevent primary preventive care. health care. illness and identify and address health conditions early (for example, STis, chronic conditions, pregnancy related conditions). Educate clients about importance of chlamydia screening (per CDC recto annually screen all youth_:: 25) and encourage to request testing by provider. Identify and address barriers to clients receiving primary preventive health care. 2.8 Clients will demonstrate 2.8 Observe client/child interactions. 2.8 State how AFLP agency 2.8 Attach the Service Referral Analysis knowledge of normal child Provide child development and implements objective. Identify Report. development and parenting education. This could assessments or other curricula appropriate parenting include use of validated early used and usual types of referrals. skills. childhood developmental screening Discuss referrals made to improve tools (e.g. ASQ, ASQ SE) and knowledge of child development •• must include identification of a and appropriate parenting skills. source of preventive and primary care for the client and her child. Provide anticipatory guidance and education regarding importance of developmental screening and well child visits. Model appropriate parenting skills MIS Scope of Work Report -Service Referral Analysis Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final 4/30/14 with Goal 6 Page 11 of21 I
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal2: Improve the health of the pregnant or parenting teen, thus also supporting the health of the index child Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s) Objectives Short, Intermediate, and Long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures and refer to parenting classes or other resources. -Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final 4/30/14 with Goal 6 Outcome Measures (Forms) -Page 12 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 3: Improve high school graduation rates for pregnant and parenting teens. Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Objectives Short, Intermediate, and Long Term Measures Outcome Objective(s) (Describe the steps of the Report items below in the Annual Report or more frequently where indicated intervention) Process Measures Outcome Measures (Forms) 3.1 All clients will set and 3.1 Case managers will work with all 3.1 List and briefly describe the top 3.1 Report the number, percent and total achieve a goal to clients to develop and execute a three barriers to clients completing clients who: complete high school plan for the client to complete high school and strategies to or equivalent. high school or the equivalent. address barriers. a. Are attending school or have CM will communicate with school graduated or the equivalent" staff responsible for tracking the b. Have an educational goal * client's academic progress (e.g. high school counselor, special education teacher, or migrant education program) routinely, at least biannually and note in Individual Service Plan (ISP). Identify and address barriers to attending and completing high school. 3.2 Parenting Clients will 3.2 CM will help client identify and 3.2 List and briefly describe the top 3.2 Report number and percent of clients have a reliable source address barriers to obtaining three barriers to clients obtaining not in school because of child care of quality child care to reliable, high quality child care. child care and strategies to barrier* enable them to attend address. school. 3.3 Clients will have 3.3 CM will help client to identify and 3.3 List and describe the top three 3.3 Report number and percent of clients reliable transportation address barriers to obtaining barriers to clients having not attending school because of to school. reliable transportation to school. transportation to school and transportation barrier.* strategies to address these barriers. 3.4 Clients who have 3.4 CM will assist clients to develop 3.4 List and describe the top three 3.4 Report the number and percent of graduated from high and execute a plan for barriers to clients enrolling in clients who have graduated high school school will enroll in postsecondary education or postsecondary education or that are enrolled in postsecondary postsecondary training or employment (see next training and strategies to address education or vocational training. education or vocational objective) after high school these barriers. Identify 'MiSS cope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Fina14/30/14 with Goal6 Page 13 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 3: Improve high school graduation rates for pregnant and parenting teens. Fiscal Years: FY 2012 -2015 Intervention Activities to Meet Evaluation/Performance Measures Objectives Short, Intermediate, and Long Term Measures Outcome Objective(s) (Describe the steps of the R~rt items below in the Annual Report or more frequently where indicated intervention) Process Measures Outcome Measures (Forms) training or will be completion. opportunities for policy employed. development, program planning and collaboration. 3.5 Clients who have 3.5 CM will assist clients who do not 3.5 List and describe the top three 3.5 Report the number and percent of graduated from high wish to pursue postsecondary barriers to clients obtaining clients who have graduated high school school and are not education or training to develop employment and strategies to and are employed. enrolled in and execute a plan to obtain address these barriers. Identify postsecondary employment after high school opportunities for policy education training will completion. development, program planning be employed. and collaboration. -MISS cope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 14 of21 I
I Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 4: Reduce repeat pregnancies in pregnant and parenting teens. Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s) Objectives Short, Intermediate, and Long Term Measures (Describe the steps of the Report items below in the Annual Report or more frequently where indicated intervention) Process Measures Outcome Measures (Forms) 4.1 Clients who are not pregnant 4.1 Refer to Family PACT/ primary 4.1 Describe the top three barriers to 4.1 Report Number and Percent of sexually and are sexually active will: care provider. clients using contraception and active non-pregnant clients who: strategies to address these . • Always use Identify and address barriers to barriers . a. are always using contraception contraception, correct and consistent use of b. are using long acting contraceptives • Use long acting contraception. (6-IUD,?-implant)* contraceptives • Not have a repeat Encourage clients to use long Report number and percent of sexually pregnancy while in the acting contraceptives active clients who: program. • Use condoms to prevent Document client pregnancies c . had a repeat birth while in the STis Encourage clients to use program (all female clients)* condoms to prevent STis. d. are using condoms* e. are using condoms with another Educate on family planning as contraceptive method * possible within the scope of training and licensure of the CM. 4.2 Clients will verbalize 4.2 AFLP will integrate information 4.2 a. Report number and percent of 4.2 a. Report number and percent of characteristics of healthy about RC/BCS into the SID and clients who received information clients who state they feel safe in relationships and how to train CMs to provide information on reproductive coercion and their relationship with their recognize and respond to to clients. birth control sabotage. * partner/other parent at intake.* reproductive coercion and Screen clients for RC/BCS. Describe process to integrate b. Report number and percent of birth control sabotage clients who state they feel safe in (RC/BCS). Provide resources (Safety cards, information on reproductive their relationship with their Web sites) on recognizing and coercion and birth control sabotage partner/other parent at last follow addressing this. into case management. up.* Refer clients to providers to b. Report number and percent of clients referred for "coercion obtain coercion resistant birth resistant" birth control methods control methods and counseling. and counseling.* Provide emotional support Maintain and train on local policy Provide compelling anecdotal ~--~ --MiSScope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 15 of 21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 4: Reduce repeat pregnancies in pregnant and parenting teens. Fiscal Years: FY 2012-2015 Intervention Activities to Meet Evaluation/Performance Measures Outcome Objective(s) Objectives Short, Intermediate, and Long Term Measures (Describe the steps of the Report items below in the Annual Report or more frequently where indicated intervention) Process Measures Outcome Measures (Forms) and procedure for mandatory stories when available. reporters. -· ----·· -· -----------~------------~-Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 16 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 5: AFLP will maintain program and fiscal management capability to administer the program as required by the AFLP Program Policies, Procedures and Scope of Work and will assure staff competency, program integrity, and data completeness. Intervention Activities to Meet Objectives Evaluation/Performance Measures Outcome Objective( s) (Describe the steps of the intervention) Short, Intermediate, and long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures 5.1 AFLP will maintain program 5.1 5.1 a. Submit Entry Criteria and fiscal management • Annually review, revise and b. discuss risk rating factors used capability and will enhance internal policies and c. discuss successes and demonstrate that it is procedures for delivering services to challenges in meeting or conducting AFLP activities clients to prioritize the highest risk exceeding MOS as required in the AFLP clients (Entry Criteria). d. complete the staffing profile in Policies and Procedures, • Meet the MOS . Annual Report SOW and Program and • AFLP will maintain a client to case e. complete the client profile in the Fiscal Policies and manager ratio of no more than 50 Annual Report Procedures. clients per case manager. f. state criteria for program • Submit AFA and Annual Report completion/exit timely. g. state top three reasons for • Collect and input monthly Follow client exit Up, Service Matrix and Additional h. state common linkages to other Outcomes forms that are due. programs or services for clients exiting the program 5.2 AFLP will maintain and 5.2 a. Identify staff training needs 5.2 a. List gaps in core competencies increase staff competency b. Provide or support staff training identified and trainings and c. AFLP Director will attend statewide professional development for meetings. AFLP staff to address these d. If they have not done so already, gaps and other training needs. AFLP Director will conduct self-b. Describe the plan for assessment of Core Competencies conducting ASHWG core for Providers of Adolescent Sexual competency assessment for and Reproductive Health using the case managers ASHWG (CA Adolescent Sexual Health Workgroup) tools and require MIS Scope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Fina14/30/14 with Goal6 Outcome Measures (Forms) 5.1 a. Report number of clients and MOS for the year along with percent of allocation delivered (MOS and . Caseload Analysis Report). b. Submit the MOS and Caseload Analysis Report and AFLP Personnel List quarterly. * c. Report the percent of clients who have completed Follow Up Forms by the time the index child is six months old* d. Report the percent of clients who have Service Matrix and Additional Outcome forms with the most recent Follow Up Form. * 5.2 a. Describe the outcome of the training evaluation. Page 17 of21 I I I
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 5: AFLP will maintain program and fiscal management capability to administer the program as required by the AFLP Program Policies, Procedures and Scope of Work and will assure staff competency, program integrity, and data completeness. Intervention Activities to Meet Objectives Evaluation/Performance Measures Outcome Objective(s) (Describe the steps of the intervention) Short, Intermediate, and Long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures Outcome Measures (Forms) supervisory staff and case managers to do so. e. Staff who have completed the self-assessment will develop and implement a plan to improve their skills and document progress annually f. Develop training for CM 5.3 AFLP director will assure 5.3 AFLP will conduct monitoring and 5.3 State number and percent of clients 5.3 Describe the outcome of the that CMs conduct intake, evaluation of client documentation for: that: Ql plan comprehensive baseline assessment, develop an . Comprehensive Baseline a . received a Comprehensive Individual Service plan, Assessment within 60 days of Baseline Assessment (CBA). provide appropriate consent-includes HV. within 60 days of enrollment referrals, and conduct other . Individual Service Plan within 60 b . received a Home Visit within elements of case days of consent 60 days of enrollment* management defined in the • monthly face to face client contact c . received monthly face to face Standards, Policies and . Quarterly Home Visit contact* Procedures. . quarterly contact with collaterals (i.e. d . had an Individual Service Plan parents, teachers, counselors) and (ISP) within sixty days of service providers; enrollment • identification of barriers to services e . case manager made quarterly and emerging or changing client contact with collaterals or needs, service providers.* . evaluation of client use of services f. received a reassessment using feedback from client, collateral, subsequent to the initial and service providers. assessment.* . Quarterly client reassessment and g . received a case review to update and revision, if needed, of assure compliance with AFLP Standards, Policies and MIS Scope of Work Report Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 Page 18 of21 I
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 5: AFLP will maintain program and fiscal management capability to administer the program as required by the AFLP Program Policies, Procedures and Scope of Work and will assure staff competency, program integrity, and data completeness. Intervention Activities to Meet Objectives Evaluation/Performance Measures Outcome Objective(s) (Describe the steps of the intervention) Short, Intermediate, and Long Term Measures Report items below in the Annual Report or more frequently where indicated Process Measures Outcome Measures (Forms) service plans Procedures (narrative). Monitor above measures in a quarterly i. State what opportunities are currently available for staff to random sample of 25 charts or 10%, meet and share successes, whichever is lower, and routinely identify challenges and implement Ql activities to address strategize around solutions. measures not meeting the standard. j. state how frequently Consider addressing one deficient opportunities identified in i. are measure per quarter. available Refer to the MIS SOW Report or the MIS Client Contact Summary Report Briefly describe Ql activities and which standard(s) have been addressed. Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final 4/30/14 with Goal 6 Page 19 of21
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal 6: To support pregnant and parenting teens at high schools and community service centers to implement the AFLP Positive Youth Development intervention. (Only for AFLP-PYD agencies) Evaluation/Performance Measures Outcome Objectives Intervention Activities to Meet Objectives Short, Intermediate, and Long Term Measures to be Reported in the Annual Report or semi-annually where indicated Process Measures Outcome Measures 6.1 Address internal agency 6.1.1 Continue to update strategic plan 6.1.1 Strategic plan updated by 6.1.1 Submit a progress report conditions and external based on guidelines provided by State agencies. factors that affect youth-MCAH. The strategic plan will address serving partnerships with the youth serving programs and schools and community. systems that provide client linkages to community support. 6.2 Assure baseline 6.2.1 AFLP managers, supervisors, and CMs 6.2.1 Training attendance list. knowledge and skills will participate in trainings that support necessary to work with the key concepts and content areas of pregnant and parenting the AFLP PYD intervention. teens and support the implementation of the standardized case management intervention with integrated life planning. 6.3 Inform the development 6.3.1 Participate in state sponsored site 6.3.1 Submit information to State and effective visits. MCAH as appropriate and assist implementation of the State MCAH staff to summarize standardized case and integrate findings. management intervention Maintain documentation onsite. with integrated life planning. 6.3.2 Participate in conference calls, focus 6.3.2 Submit information to State groups, regional meetings, surveys MCAH as appropriate and assist and work groups to inform the State MCAH staff to summarize development, implementation, and and integrate findings. Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 related to activities and goals identified in the strategic plan. 6.2.1 Following each training, 80% of the AFLP managers, supervisors and CMs will demonstrate increased knowledge related to training topics based on a retrospective pre/post evaluation. 6.3.1 Pilot and implement the revised, standardized intervention. 6.3.2 Pilot and implement the revised, standardized intervention. Page 20 of21 I
Agency: County of Fresno, Department of Social Services Agreement Number: 201410-2 Fiscal Years: FY 2012-2015 Scope of Work (SOW) Adolescent Family Life Program (AFLP) Goal6: To support pregnant and parenting teens at high schools and community service centers to implement the AFLP Positive Youth Development intervention. (Only for AFLP-PYD agencies) Evaluation/Performance Measures Outcome Objectives Intervention Activities to Meet Objectives Short, Intermediate, and Long Term Measures to be Reported in the Annual Report or semi-annually where indicated Process Measures Outcome Measures resolution of challenges of the AFLP intervention. Participate in development of AFLP program standards. 6.4 Ensure a quality 6.4.1 Work with State MCAH to develop a 6.4.1 CQI plan will be developed and 6.4.1 Agencies will report on the intervention with program CQI plan to evaluate and monitor the implemented. fidelity and Continuous implementation of the standardized Quality Improvement (CQI) case management intervention with as the standards for the integrated life planning. These intervention are developed. activities may include participating in focus groups, site visits, and use of CQI tools developed by State MCAH. 6.5 To comply with required 6.5.1 Complete annual report using format 6.5.1 Develop plan to maintain records --reporting requirements. provided by state MCAH. for reporting on SOW. --Outcome Measures require Lodestar Reports by Branagh Information Group using data from Lodestar forms Final4/30/14 with Goal6 outcomes of CQI activities and indicate how gaps will be addressed. 6.5.1 Complete annual report. (to MCAH Program Consultant and postmarked by due date): August 15 --Page 21 of21
p~~ifh ~11; W~; Ou~...a~MNI!I'.Qt-m.:;,n i BUDGET SUMMARY -i jF~LYEAR I ----r----, I 2014-15 : BUDGET STATUS ACTIVE BALANCE' ;-------; iPn>gram: rA;;;""~F:ml!y Ufe. Allocation ------------UNMATCHED FUNDING N0MS1HANCED ---~o ~ \Ag..,.y: ~2 Fresno 0SS -----------------____ _ ___ _ __ ,------------r -------~c MATCMI'IG(-1 _____ ~TCHING(751l51 :SUbK: r AFt.P-Tv .f\FlP-PYDiNEVIJ AGENCYfvNos 1 Afu~Ct'!t,.-N ----r-~~ I I --f-------r-. . 1------,------r--· -. . ;--T --~ , I I tH (:ZJ I l)~ (4) J <5J ~ .. ~ (S: (6) < .?l (5~-~ J-!'91 r t1C>J 1 .n') r1::;l {1:'1:.._~ -r {1$) I TOTALRJNDING 'Jr. I TITLEV % l % I NfWPn> % \AeoncvF-· % I % ~~ " I ! % I~ ... · '---~---ALLOCAT10N(S) -I 270,340 EXPENSE CATEGORY fi;;-;ERSONNEl. -J!!l OPERAllNG EXPENSES_ 1111 CAPITAl EXPENDITURES 35,000 -·-----; L ___ __, i ·-----< . ' -·--~----~---~-~ ~-f---~ 47.!lJ8 1.011 1840 151966 f---;ill1_9THER COS__!!________------+ ~~ECT~C~OS~TS~-------~-BUDGET TOT ALS• . -----t··---,.__ __ .:__ __ _, 270.340 I I 1295"'[ 35000 I ( '' ""' 159_872f __ , ________ _;__o3_ 49.7?8_ TOTAL TITLE V TOTAL-TOTAL NEW PYD TOTAL mLE XIX TOTAL AGENCY FUNDS 1 z1o.:wo 1 _ _, [-vo:;w 1 ~--1 I 35.ooo1 ---·-·--·-------117,270 92.381 • I ---J "·'''§ . ' ........... , ... -..;.~ ,., .... -~ ,;, ........ ~ .. ~t==j ~C·-~ '''·)~ / '-~----------------~~ $~·~-aximum Amount Payable from State and Federal resources . '~ ~ ~"""AU.IIICAtiADM-TRATI\IEANDPAOGRAioii'OIJC4ES. ~'7-__ s..--~----T HAS 8E£" C !OUC:nO"' CO --<._~ fE CERTl -AGENCY A<)£l<T"S$llli.ATUfl£ ...... \f.l:~-1 t:!Ot4 ~-<-'! ·.,.~Du'M. }.;eht'.' ~~~· ----------------------/ .;2 / .:;.v I kJ' • y ~ 1; r 00.1£ ---------------STATE use cir.Lv-TOTAL siAl£ AM) FEDfRAL REIMBURSE~ ! AFLPc.rty.fol .. ~· AFUQIYt) -----.! "~: . I i ><·'"; ... a I , 531•• ---I , -I 9,483J ' 561 Codes (11 PERSON!EL (h) OPfAATING EXPElllSES ------------------(Ul) CAPITAL EXPENSES (IV) OTHER COSTS------------__ ----rl) INDIRECT COSTS TotalatorPCACodoe FY14_1~ DS$_01-CI.alln :.du -~----t-~ 1ol3 L---f '--~ 1,380 ~---37.334 Pnnled l2/30120f4 2.10 PM
c...._~_..~ Public Health ..)• 1>11 ............. "-"' .. ~' ... "'"'·_, .---· -----~~ ~ ~ENHANCED Pr<>9fiom:-iAdoleKent Family Ufe • ARocatlon UNMATCHED FUNDING IIAlCHING (-) MATCHING f7'12SI Agon<y: i201"1G-2FresnoDSS I I ... ..,._..,.,, ... w, r AG£/<CYF~-1----~----~--T--A>U'c,.,y~N -------.---..,LPCo<v.C .AA...P-T\1 --1 --~ ~~ fl _________________ rt--~--+~~i~~~-i~~~-~~.~-1~(;.,-r-~.-~,~~;,-, m ~ ~ I ·~J ~·I ~ .~~ I.~ I ~ +-HI ~21 ! jJI (4} ! l -_1_ -I -,...-----+.~ === ! TOTAL-"" i ~ TITLEV I "" I "" l N£WP'I'1> l .. jA9oncYFunds" % 1 "" ~ ~ ! "" ~ ·~----~-----------~----~ ~--------(II) OPERATING EXPENSES DETAIL :.-'----------;TO;;:iAi.oP£R.\Twci EXPENSES! "·' -~ ----------~------I --r !TRAVEL ------! TiwNING ----~ ~ ___j '" . ~-~ ~ ~ :~i~-~ -i --~ -R o ~~ -----~==-__:_~-~~ =--~ ~ t~ •• tJ~_..:t~oJ ~IOilbnl Es~ Mt nu! ~for F~a! matd".inq b.lnd$ IT Ilk'~ f.~po~fn*'l rna. Cl'fi,~ ~ ~ tC> lJnnoi.tdlO<: Tina V tCot ~· Stato Gem~ l"'undr. fCoi £l •1\Civ. ~ rCt-.J tf~undi 11648%! !162 r-==~--~-r--. -. ___ _. :----j I J ·-~ --l I ' f---..-! I I >-----1 ' I r---, [-----~----! ~__; -----,-~ -~---1.1140 ' 1 3000% ' a•~ I JOOQ'll; I '.022 jlii)CAi>iTALEx~~~~~--=--=---=-----~ -=-=c-·: -=r=~ ~ n--~ c---~ ---~~ J ov1 ~~o-TH_E_R_c_o_sTS--oE_T_A_IL------~---~---~~::---.~-Jr~-----.-----~-~~-.. ;;;;r------.-~----r-.~-~---~---~ ~---~ ~~~-,-~-1_-_-__ -~--~--~ ~~~ -.5-•. ~ r_-_-_· ~~~~-~~-' ~-~ ~---·~ ==-1 --------~----10TAi.oTHi:RCoils, ~ 1 Z1"~1-~----~~~~ -· -· -~~&CONTRACTS ~~---~~ -.. --::_:=:----~•.m "'~ • '"·'~ •-1 ,._ t --:. t[~ ~: 2 ~ . ! ~~------~~----Hr = . ~ ' . --· t==J 8 OOOCHAAGES ~ --------~----p ~---'-----.-l I ~ I I ! '----t I ___, >-~-'----i f--f-I f-~ I ------i 1----I ' FY14_t5 OSS_QtCioorrudox 2013 J8!13% ' , ___ 1 ; i I--· ~ r-----i f.--_; ' I '---· ~ : __ I. ,-· __ _j r---_j ~ I --..J ' c:=J 15~ 966 t-------1 f...---. ---·~ :==] Pnmod: 12/3011014 2:10PM
P~~rth ~~·l! foWOfnai.C'klO~Adol~~n?t~ """"""'' [Adolescent Family Life ·Allocation ~ 1201£10.2 Fresno DSS ~ '" TOTAL~ ------------~----~ 1-F'J'-TV -;-;-~ 'II. I nn.EY UNMATCHED FUNDING AF\.P-PYO (~E\V) ------~---,---~~ ,., !~, ~ ... ,,, 'II. % I N£WPVD N<JN.DIHANCED MATCHING,_, ~~'C'I'FlJN~ ·--~··-·~(..-.ry.N '!1. IAgtncyF..,.... ·--------~~--;~~-: (10! b~ -·-"' I , % 'Frt'~~~m ----a.tlANCED MATCHING (751:15) ------i -~;y~ f , . ., %=c-· -~ J (V) IIORECTCOSlSDETAIL I TOTAI.-CTCO$TSI I ~ m-~;_%ofTo .. IDi~Costs u-~ ~~-_. ______ _ __ t~--__ I ±=~-~ Ef_-_ T----E I ,----~ : ----c : ] ~-"---------~ ------·-------~--~· --------(I) PERSONNEL DETAIL TOTAL PERSONNEL COST$! 11&..884 I -. FR1H<it..,.HEfll"""' ruOO% • ~ -3=3~ I I 48129 I ~-~-------I •••• '' . TOfALWAGES' • 21.646 i ---~ .-~ -----_, ' ---~ ' 68755 I ' I --I ~--·,---~--.,. . • •.m ' . '-~ ... . . .. ....,---,-•~~~-• -~·1 I --. '~.R ~ .. · -: -~ ' -,---~ ~ • •' I . . ,__, >.m ~ I --., ~ E ;;!: 1 H j . ... ' I TOTAL WAGES 1 ~fPubiic Health N~ 2 ' Ll Program M•nagar 3~~~ ~ RK $entor Aceoum.n1 5 OT Social Wofic. &lpervisor E LM otftee As~nt 55.00%f 62.61o I 45.436 19 30'4 ,----s769 ~ -10011*1 73130 I 7,313 95~. I 6!147 800%J 66036! 5,283 9500'!1. ' 5019 1691 9500% J 1606 1 11.()0%! 71,006 i 7,811 9500'10 i 742\J -~-34·~---1221 95~, 1160§ ___ '~ g.-·, ------· _____ ---i --+---t---------~ I 10 · ---~---· I 11 ·-···---~--------""---t--! ~ 12 ~ ·---------------i -----"--------¥ ---------l ~ ~3 ;______ ----~ ,_ ___ , __ ·-------+-"---------1 \4: ! 15 : 16 ---------------~---r------i--17 16 I 19! 20 I 21 22' 23: 14! 25-----------26 F'Y14_ 15 OSS_ Q tcsarn"t.:.:Su ~ ·--------, -I I 1-I '-"! --.J 9~71% ~ -----j ~ -i I I ~ ~ 3of3 .... ,, 36!5 2&C 65 -----rB9i%-~--·;·o;sl==I ~--~-----1 L !------~ ~ , ___ , f-. ___ , I·~ :_____, i-~ r-------1 j---~-,---' r--· L __ I r--1 r--I J L_, i r~--~-·-J ~ ----: >------r-~ -i I :J ~--j ·--1 :-----i r----: ~--j '-------' J 1 ~ r--, !--~~ 1----~ -·---: ' i I : ',___j _i __ _ ;-. ---~ e----; ---~ -12/3012014 2 10""' 2!3 199
1 APPLICATION FUNDING AGREEMENT BETWEEN THE COUNTY OF FRESNO AND
2 THE STATE OF CALIFORNIA
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4 No. 201410-2 Term: Fiscal Year 2014-15
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APPROVED AS TO LEGAL FORM:
APPROVED AS TO ACCOUNTING FORM:
By (ffi £~-a it
Vicki Crow, C.P.A., Audit r-Controller/
Treasurer-Tax-Collector
REVIEWED AND RECOMMENDED FOR
APPROVAL:
2 3 Fund/Subclass: 0001/10000
Organization: 56107033/56107034
2 4 Account/Program: 4382
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- 1 -Fresno, CA