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CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
MATERNAL, CHILD AND ADOLESCENT HEALTH (MCAH) DIVISION
FUNDING AGREEMENT PERIOD
FY 2015-2016 (LHJs)/2012-13 to 2015-16 (CBOs)
ANNUAL PERSONNEL UPDATE FORM
At the beginning of each fiscal year Agencies are required to submit this form along with
their AFA/Contract Package, which requires certification signatures (original signatures, no
stamps allowed). This form should also be used when submitting updates that occur during
the fiscal year. Update submissions do not require certification signatures.
The Agency Identification Information section must be completed each time this form is
submitted.
AGENCY IDENTIFICATION INFORMATION
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:
MCAH AFLP BIH FIMR CHVP
Fiscal Year: 2015-16 Update Effective: (only required when submitting updates)
Agreement/Contract
Number:
201510
Federal Employer
ID#:
94-6000512
Complete Official
Agency Name:
County of Fresno
Business Office
Address:
1221 Fulton Mall, Fresno, CA 93721
Agency Phone:
(559) 600-3330
Agency Fax: (559) 600-7729
Agency Website
Address:
www.fcdph.org
1 AGENCY DIRECTOR
Name: David Pomaville
Title: Director
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3200 Ext. FAX: (559) 600-7687
E-Mail Address: dpomaville@co.fresno.ca.us
Page 1 of 7
Revised January 2015
Agency Name: County of Fresno
Agreement/Contract #: 201510 Fiscal Year: 2015-16
2 BOARD INFORMATION
Clerk of the Board Chair Board of Supervisors
Title: Bernice E. Seidel
Mailing Address: 2281 Tulare St, #301, Hall of Records
City: Fresno Zip: 93721-2198
Phone: (559) 600-1601 Ext. FAX:
E-Mail Address:
3 OFFICIAL AUTHORIZED TO COMMIT AGENCY
Name: Deborah Poochigian
Title: Chairman, Board of Supervisors
Mailing Address: 2281 Tulare St, #300, Hall of Records
City: Fresno Zip: 93721-2198
Phone: (559) 600-5000 Ext. FAX: (559) 600-1609
E-Mail Address: district5@co.fresno.ca.us
4 FISCAL OFFICER
Name: Vacant
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
5 MCAH DIRECTOR (Please check box if MCAH and AFLP Director are the same)
Name: Rose Mary Garrone
Title: MCAH Director/Division Manager
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600-7729
E-Mail Address: rgarrone@co.fresno.ca.us
Page 2 of 7
Revised January 2015
Agency Name: County of Fresno
Agreement/Contract #: 201510 Fiscal Year: 2015-16
6 MCAH COORDINATOR (Only complete if different from #5)
Name: Jennifer Day
Title: MCAH Coordinator/Perinatal Services Coordinator
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600-7729
E-Mail Address: jday@co.fresno.ca.us
7 MCAH BUDGET CONTACT
Name: Aphivanh Xayavath
Title: Staff Analyst
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600- 7729
E-Mail Address: axayavath@co.fresno.ca.us
8 MCAH INVOICE CONTACT (Only complete if different from #7)
Name: Michael Chu
Title: Accountant
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-6426 Ext. FAX: (559) 600-7687
E-Mail Address: mchu@co.fresno.ca.us
9 PERINATAL SERVICES COORDINATOR (PSC)
Name: Jennifer Day
Title: MCAH Coordinator/Perinatal Services Coordinator
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600-7729
E-Mail Address: jday@co.fresno.ca.us
Page 3 of 7
Revised January 2015
Agency Name: County of Fresno
Agreement/Contract #: 201510 Fiscal Year: 2015-16
10 AFLP DIRECTOR (Only complete if different from MCAH Director)
Name:
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
11 AFLP COORDINATOR (Only complete if different from #10)
Name:
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
12 AFLP BUDGET CONTACT
Name:
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
13 AFLP INVOICE CONTACT (Only complete if different from #12)
Name:
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
Page 4 of 7
Revised January 2015
Agency Name: County of Fresno
Agreement/Contact #: 201510 Fiscal Year: 2015-16
14 BLACK INFANT HEALTH (BIH) COORDINATOR
Name: Erica Alexander
Title: BIH Coordinator/FIMR Coordinator/SIDS Coordinator
Mailing Address: 142 E. California Ave
City: Fresno Zip: 93706
Phone: (559) 600-1021 Ext. FAX: (559) 600-1132
E-Mail Address: ealexander@co.fresno.ca.us
15 BIH BUDGET CONTACT
Name: Aphivanh Xayavath
Title: Staff Analyst
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600-7729
E-Mail Address: axayavath@co.fresno.ca.us
16 BIH INVOICE CONTACT (Only complete if different from #15)
Name: Michael Chu
Title: Accountant
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-6426 Ext. FAX: (559) 600-7687
E-Mail Address: mchu@co.fresno.ca.us
17 FETAL INFANT MORTALITY REVIEW (FIMR) COORDINATOR
Name: Erica Alexander
Title: BIH Coordinator/FIMR Coordinator/SIDS Coordinator
Mailing Address: 142 E. California Ave
City: Fresno Zip: 93706
Phone: (559) 600-1021 Ext. FAX: (559) 600-1132
E-Mail Address:
Page 5 of 7
Revised January 2015
Agency Name: County of Fresno
Agreement/Contract #: 201510 Fiscal Year: 2015-16
18 SUDDEN INFANT DEATH SYNDROME (SIDS) COORDINATOR / CONTACT
Name: Erica Alexander
Title: BIH Coordinator/FIMR Coordinator/SIDS Coordinator
Mailing Address: 142 E. California Ave
City: Fresno Zip: 93706
Phone: (559) 600-1021 Ext. FAX: (559) 600-1132
E-Mail Address:
19 CALIFORNIA HOME VISITING PROGRAM (CHVP) COORDINATOR/
NURSING SUPERVISOR
Name: Kathleen Kelley
Title: Supervising Public Health Nurse
Mailing Address: P.O. Box 11867
City: Fresno Zip: 93775
Phone: (559) 600-3330 Ext. FAX: (559) 600-7740
E-Mail Address: kkelley@co.fresno.ca.us
20 OTHER
Name:
Title:
Mailing Address:
City: Zip:
Phone: Ext. FAX:
E-Mail Address:
Page 6 of 7
Revised January 2015
Agency Name : County of Fresno
Agreement/Contract#: 201510 Fiscal Year: 2015-16
~~,l. -·'· • • . .--, • -;t-. ·• ~ ~,·,"'."'"of.: ........, ~ ,.•Y~,_-ll':"':"·:~~~"";~':;a'.~:·~."·~ ~~~~.,>1~· ·'/"• .-~-,-~ -., ~ . • ~, • •. .,q_..,_.._ ~., •. , 'I .. _.~;~ ::'\ ::;"~ ...... ~'·"-~f.:::";f~!';~,
-· AGREEMENT:•t7:UNDI~G ;·APPLICATION ~-.. . · _, ;~~~
•' ~ • ) 't. •, I ' ,~, 1' -. • •" ' I • : • • • '~ ~
·"'~-POLICY COMPLIANCE ~AND .CERTIFICATION . -::·:
(.!>I • ' • • • • • -.. _ .. .,.... ~ ---·--""~ ........ -~ .-... _~ -. ,.~ "~·· ,.. -.,_ .. • ---~
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, Divis ion 1 06 of the Health and
Safety code (commencing with section 123225), Chapters 7 and 8 of the Welfare and
Institutions Code (commencing with Sections 14000 and 142), and any applicable rules or
regulations promulgated by CDPH pursuant to this article and these Chapters. I further certify
that this MCAH related program will comply with the MCAH Policies and Procedures Manual ,
including but not limited to, Administration, Federal Financial Participation (FFP) Section. I
further certify that this MCAH related program will comply with all federal laws and regulations
governing and regulating recipients of funds granted to states for medical assistance pursuant
to Title XIX of the Social Security Act (42 U.S. C. section 1396 et seq.) and recipients of funds
allotted to states for the Maternal and Child Health Service Block Grant pursuant to Title V of
the Social Security Act (42 U.S.C. section 701 et seq.). I further agree that this MCAH related
program may be subject to all sanctions or other remedies applicable if this MCAH related
program violates any of the above laws, regulations and policies with which it has certified it
will comply .
Original Signature of Official authorize
commit the Agency to an MCAH Agre
Deborah A. Poochigian
Name (Type or Print)
Rose Marv Garrone
Name (Type or Print)
Revised January 2015
Page 7 of 7
Chairman. Board of Supervisors
Title
Date 1
MCAH Director/Division Manager
Title
Date
ATTEST:
BERNICE E. SEIDEL, Clerk
Board of Supervisors B &~A ·· ~tty
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH) Program
Scope of Work (SOW)
The Local Health Jurisdiction (LHJ), in collaboration with the State MCAH Program, shall strive to develop systems that protect and improve the health of
California’s women of reproductive age, infants, children, adolescents and their families. The goals and objectives in this MCAH SOW incorporate local problems
identified by LHJs 5-Year Needs Assessments and reflect the Title V priorities of the MCAH Division. The local 5-Year Needs Assessment identified problems that
LHJs may address in their 5-Year Action Plans. The LHJ 5-Year Action Plans will then inform the development of the annual MCAH SOW.
All LHJs must perform the activities in the shaded areas in Goals 1-3 and monitor and report on the corresponding evaluation/performance measures. In addition,
each LHJ is required to develop at least one objective in each of Goals 1 and 2 and 2 objectives for Goal 3, a SIDS objective and an objective to improve infant
health. LHJs that receive FIMR funding will perform the activities in the shaded area in Goal 3, Objectives 3.5-3.7 and 3.8. In the second shaded column,
Intervention Activities to Meet Objectives, insert the number and percent of cases you will review for the fiscal year. If resources allow, LHJs should also develop
additional objectives, which they may place under any of the Goals 1-6. All activities in this SOW must take place within the fiscal year. Please see the MCAH
Policies and Procedures Manual for further instructions on completing the SOW.
http://www.cdph.ca.gov/services/funding/mcah/Pages/LocalMCAHProgramDocuments.aspx
The development of this SOW was guided by several public health frameworks listed below. Please consider integrating these approaches when conceptualizing
and organizing local program, policy, and evaluation efforts.
o The Ten Essential Services of Public Health: http://www.cdc.gov/nphpsp/essentialServices.html;
o The Spectrum of Prevention: http://www.preventioninstitute.org/component/taxonomy/term/list/94/127.html
o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm
o The Social-Ecological Model: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
o Social Determinants of Health: http://www.cdc.gov/socialdeterminants/
o Strengthening Families: http://www.cssp.org/reform/strengthening-families
All Title V programs must comply with the MCAH Fiscal Policies and Procedures Manual which is found on the CDPH/MCAH website at:
http://www.cdph.ca.gov/services/funding/mcah/Pages/FiscalDocuments.aspx
FIMR LHJs are required to comply with requirements as stated in the FIMR Policies and Procedures Manual:
http://www.cdph.ca.gov/services/funding/mcah/Pages/FIMRDocuments.aspx
CDPH/MCAH Division expects each LHJ to make progress towards Title V State Performance Measures and Healthy People 2020 goals. These goals involve
complex issues and are difficult to achieve, particularly in the short term. As such, in addition to the required activities to address Title V State Priorities, and Title
V and State requirements, the MCAH SOW provides LHJs with the opportunity to develop locally determined objectives and activities that can be realistically
achieved given the scope and resources of local MCAH programs.
LHJs are required to comply with requirements as stated in the MCAH Program Policies and Procedures Manual, such as attending statewide meetings,
conducting a Needs Assessment every five years, submitting Agreement Funding Applications, and completing Annual Reports.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 1 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 1: Increase access and utilization of health and social services (cross-cutting)
o Increase access to oral health services1
o Increase screening and referral for mental health and substance use services1
o Increase utilization of preventive health services1
o Target outreach services to identify pregnant women, women of reproductive age, infants, children and adolescents and their families who are
eligible for Medi-Cal assistance or other publicly provided health care programs and assist them in applying for these benefits 2.
The shaded area represents required activities. Nothing is entered in the shaded areas.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.1-1.6
All women of reproductive age,
pregnant women, infants,
children, adolescents and
children with special health
care needs (CSHCN) will have
access to:
• Needed and preventive
medical, dental, mental
health, substance use
services, and social services
• Early and comprehensive
perinatal care
• An environment that
maximizes their health
Assessment
1.1
Identify and monitor the health
status of women of reproductive
age, pregnant women, infants,
children, adolescents, and
CSHCN, including the social
determinants of health and
access/barriers to the provision of:
1. Preventive, m edical, dental,
mental health, substance use
services, and social services
2. Early and comprehensive
perinatal care
Monitor trends over time,
geographic areas and population
group disparities.
Annually, share your data with
your key health department
leadership.
Assessment
1.1
Briefly describe the health status
of women of reproductive age,
pregnant women, infants, children,
adolescents, and CSHCN,
including the social determinants
of health, and access/barriers to
health and social services
(includes preventive, medical,
dental, mental health, substance
use services, social services and
perinatal care).
Briefly highlight statistics on:
trends over time, geographic
areas and population group
disparities.
Date data shared with the key
health department leadership.
Briefly describe their response, if
significant.
Assessment
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 2 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.2
Participate in collaboratives,
coalitions, community
organizations, etc., to review data
and develop policies and products
to address social determinants of
health and disparities.
1.2
Report the total number of
collaboratives with MCAH staff
participation.
Submit Collaborative Surveys that
document participation,
objectives, activities and
accomplishments of MCAH –
related collaboratives.
1.2
List policies or products
developed to improve
infrastructure and address MCAH
priorities.
Policy Development
1.3
Review, revise and enact policies
that facilitate access to Medi-Cal,
Medi-Cal Access Program
(MCAP), California Children’s
Services (CCS), Covered CA,
Child Health and Disability
Prevention Program (CHDP),
Women, Infants, and Children
(WIC), Family Planning, Access,
Care, and Treatment (Family
PACT), Text 4 Baby, and other
relevant programs.
Policy Development
1.3
Describe efforts to develop policy
and systems changes that
facilitate access to Medi-Cal,
MCAP, Covered CA, CHDP, WIC,
CCS, Family PACT, Text 4 Baby,
and other relevant programs.
List formal and informal
agreements, including
Memoranda of Understanding with
Medi-Cal Managed Care (MCMC)
plans or other organizations that
address the needs of mothers and
infants.
Policy Development
1.3
Describe the impact of policy and
systems changes that facilitate
access to Medi-Cal, MCAP,
Covered CA, CHDP, WIC, CCS,
Family PACT, and other relevant
programs.
Assurance
1.4
Participate in and/or deliver
trainings in MCAH and public
health competencies and
workforce development as
resources allow.
Assurance
1.4
List trainings attended or
provided and numbers
attending.
Assurance
1.4
Describe outcomes of workforce
development trainings in MCAH
and public health competencies,
including but not limited to,
knowledge or skills gained,
practice changes or partnerships
developed.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 3 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.5
Conduct activities to facilitate
referrals to Medi-Cal, MCAP,
Covered CA, CCS, and other low
cost/no-cost health insurance
programs for health care
coverage2
1.5
Describe activities to facilitate
referrals to health insurance and
programs.
1.5
Report the number of referrals to
Medi-Cal, MCAP, Covered CA,
CCS, or other low/no-cost health
insurance or programs.
1.6
Provide a toll-free or “no-cost to
the calling party” telephone
information service and other
appropriate methods of
communication, e.g. local MCAH
Program web page to the local
community2 to facilitate linkage of
MCAH population to services.
1.6
Describe the methods of
communication, including the,
cultural and linguistic challenges
and solutions to linking the MCAH
population to services.
1.6
Report the following:
1. Number of calls to the toll-free
or “no-cost to the calling
party” telephone information
service
2. The number of web hits to the
appropriate local MCAH
Program webpage
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 4 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.7
Choose one or more of the following
activities to promote family-centered,
community-based, coordinated
systems of care for all CSHCN2.
Activities may be performed at the
individual, provider (medical and non-
medical), and/or community level
1. Promote developmental
monitoring, screening,
identification and referral,
including social-emotional (mental
health), for infants and young
children (0-5yrs)
2. Work with CCS and/or
collaboratives to:
a. Improve care coordination for
CSHCN, especially non-CCS
eligible children or children
enrolled in CCS in need of
services not covered by CCS
b. Link children with positive
screens to needed services
c. Disseminate standard
messaging regarding
developmental screening
3. Other locally developed activities
to serve CSHCN (specify activity
here)
1.7
Describe outreach efforts, barriers and
opportunities for solutions
1. Report the following:
• Number of children screened
and referred
• Number and types of
providers monitoring,
screening and referring
children who screen positive
to services
2. Activities with CCS or
collaboratives to improve:
a) care coordination for CSHCN
b) linking children with positive
screens to needed services
c) disseminating standard
messaging regarding
developmental screening
2. Other specific local activities
completed
Quality Improvement/ Quality
Assurance (QI/QA) activities
completed
1.7 Describe outcomes of activities
conducted to promote:
1. Developmental monitoring,
screening, identification and
referral, including social-emotional
(mental health) for infants and
young children (0-5yrs)
2. Work with CCS and/or
collaboratives to improve care
coordination for CSHCN,
especially non-CCS eligible
children or children enrolled in
CCS in need of services not
covered by CCS, link children with
positive screens to needed
services, and disseminate
standard messaging regarding
developmental screening
3. Other specific local efforts to
serve CSHCN
4. Number of children with positive
screen who were referred to
services
5. Number and types of policies
developed
6. Outcomes of QI/QA
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 5 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.8
• By June 30, 2016, eligible
women and children with
special health care needs
enrolled in MCAH programs
will be assessed for access to
health insurance and a
medical home.
1.8
• Educate MCAH staff on available
health insurance plan options for
women of reproductive age and
CSHCN.
• MCAH staff will collect data
including race and ethnicity,
presence of insurance and a
medical home for women of
reproductive age and children.
• Women and families in MCAH
programs will be given education
and information regarding the
importance of preventative health
care and a medical home.
• Women and families, including
undocumented, will be given
education in personal health
practices, i.e. nutrition and exercise
and how to access free or low cost
preventive services.
• System will be developed to collect
data regarding assessment and
referral of women and children in
MCAH programs to access to care
and to evaluate efficacy of referral
process.
1.8
• Identify and adopt a definition of
medical home.
• The intake process will be reviewed
to ensure assessment for presence
of health insurance.
• Document referral process
developed and implemented to link
women and children to available
health insurance resources.
• Collect race and ethnicity to identify
disparities and challenges related to
maintaining a medical home. (case
reviews needed)
• Briefly describe the evaluation
process developed.
• Describe rationale for interventions,
recommendations and
strategies/policies developed.
1.8
• Number of women linked to
insurance and a medical
home/Number of women enrolled
in MCAH programs.
• Number of children with special
health care needs linked to
insurance and a medical
home/Number of children with
special health care needs enrolled
in MCAH programs.
• Describe the outcome of the
evaluation process including
barriers to access to insurance
and/or a medical home.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 6 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 2: Improve preconception health by decreasing risk factors for adverse life course events among women of reproductive age
o Decrease unintended pregnancies1
o Decrease the burden of chronic disease1
o Decrease intimate partner violence1
o Assure that all pregnant women will have access to early, adequate, and high quality perinatal care with a special emphasis on low-income and
Medi-Cal eligible women 2
The shaded area represents required activities. Nothing is entered in the shaded areas.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
2.1-2.3
All women will have access to
quality maternal and early
perinatal care, including CPSP
services for Medi-Cal eligible
women.
Assurance
2.1
Develop MCAH staff knowledge of
the system of maternal and
perinatal care.
Conduct local activities to facilitate
increased access to early and
quality perinatal care.
Assurance
2.1
Report the following:
1. List of trainings received by
staff on perinatal care
2. List activities implemented to
increase access of women to
early and quality perinatal
care
3. Barriers and opportunities to
improve access to early and
quality perinatal care
Assurance
2.1
Describe outcomes of the
following:
1. Behavior or practice change
following receipt of training
2. Activities implemented to
increase access to and
improve the quality of
perinatal care
3. Activities addressing the
barriers to improve access to
early and quality perinatal
care
2.2
Maintain and manage a network
of perinatal providers, including
certified CPSP providers.
Provide technical assistance or
education to improve perinatal
care access and quality of
2.2
Describe local network of
perinatal providers, including
CPSP providers (e.g.
concentration of Medi-Cal
Managed Care, Fee-for Service,
etc)
List technical assistance activities
provided to perinatal and CPSP
providers (e.g. resources,
2.2
Describe adequacy of current
network of perinatal providers in
meeting the needs of local
maternal population.
Describe improvement/s in
provider knowledge or practice
following technical assistance on
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 7 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
perinatal services.
Conduct activities with local
provider networks and/or health
plans to improve access to and
quality of perinatal services
including coordination and
integration of care.
referrals, tracking system for
follow-up, assessments,
interventions, infant care etc).
** If above is not applicable to
the local site,
Summarize perinatal training or
education sessions conducted
with at-risk, Medi-Cal eligible
women.
Briefly summarize shared
activities performed with current
provider networks and/or local
health plans to improve access to
and quality of perinatal services
including coordination and
integration of care.
perinatal care access and quality
of perinatal services.
Describe outcome of shared
activities performed with the
perinatal provider networks and/or
local health plan in improving
access to and quality of perinatal
services
2.3
Conduct face-to-face quality
assurance/quality improvement
(QA/QI) activities with CPSP
providers to ensure that protocols
are in place and implemented.
2.3
List the types of CPSP provider
QA/QI activities conducted during
site visits.
Report the number of actual site
visits conducted with enrolled
CPSP providers
2.3
Describe the results of QA/QI
activities that were conducted.
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
2.4
• By June 30, 2016, Identify a
training method for Public
Health Nursing (PHN) Division
staff related to preconception
health concepts i.e.
2.4
• Utilize existing resources related
to preconception health, life
course theory, and social
determinants of health with tools
such as the CityMatCH Life
2.4 Briefly describe or report:
• Method of staff training, including
learning objectives, training
module/activities, and evaluation
method.
2.4
• Number of staff trained / Total
number of staff
• Number of trainees stating
confidence to incorporate
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 8 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
reproductive life planning, folic
acid and social determinants
of health.
Course Game; Preconception
Health Council of California
Training materials; and Before,
Between and Beyond Continuing
Education Modules.
• Connect trainees to the
preconception health website to
obtain resource materials
(emphasizing: Folic Acid, Life
Planning and Contraception, and
promoting well women visits and
standardizing well-women visits).
• Develop and implement a
Continuous Quality
Improvement/Quality Assurance
(CQI/QA) process to monitor
implementation of training and
collection of outcome.
• Utilize a Program Evaluator to
provide expertise in quantitative &
qualitative evaluation for MCAH
programs and assistance in
monitoring program progress in
meeting SOW objectives.
• Document type of staff trained
• QA/QI process to monitor
implementation of training
method.
• Assistance with developing
process measures and
quantitative and qualitative
evaluation provided by program
evaluator
preconception health into
services/Number of trainees.
• Outcome of QA/QI process
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 9 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 3: Reduce infant morbidity and mortality
o Reduce pre-term births and infant mortality1
o Increase safe sleep practices1
o Increase exclusive breastfeeding initiation and duration 1
The shaded area represents required activities. Nothing is entered in the shaded areas, except for FIMR LHJs.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.1-3.2
All infants are provided a safe
sleep environment
Assurance
3.1
Establish contact with
parents/caregivers of infants with
presumed SIDS death to provide
grief and bereavement support
services3.
Assurance
3.1
(Insert number) of
parents/caregivers who
experience a presumed SIDS
death and the number who are
contacted for grief and
bereavement support services.
3.2
Attend the SIDS Annual
Conference/ SIDS training(s) and
other conferences/trainings
related to infant health3.
3.2
Provide staff member name and
date of attendance at SIDS
Annual Conference/training(s) and
other conferences/trainings
related to infant health.
3.2
Describe results of staff trainings
related to infant health.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 10 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
3.3
• By June 30, 2016, A
SIDS/Infant Safe Sleep Toolkit
will be developed and
available in English and
Spanish.
• By June 30, 2016, develop a
policy and procedure for the
assessment and distribution of
the SIDS/Infant Safe Sleep
Toolkit in coordination with
existing MCAH program
requirements.
3.3
• Develop a three question
assessment to measure
knowledge changes after
education to follow SIDS risk
reduction and infant safe sleep
guidelines.
• Develop and prepare for
distribution a culturally
appropriate SIDS/Infant Safe
Sleep Tool kit (brochures, book,
handouts, , assessments) and
distribute to all MCAH program
participants
• Utilize SIDS educational materials
from the CDPH and NICHD
3.3
• Number of program participants
receiving education about the
infant safe sleep practices and
SIDS risk reduction
• Briefly describe evaluation tool
developed
• Briefly describe barriers,
challenges, and opportunities to
improve infant safe sleep
• Briefly describe the CQI/QA
process developed to evaluate
and improve education of program
participants
• Brief description of technical
assistance provided
3.3
• Number of MCAH program
participants demonstrating
increased knowledge and
intention to follow infant safe
sleep practices and SIDS risk
reduction / Total number of new
parents educated
• Briefly describe the status of the
completion of the tool kit,
assessment questions and the
policy and procedure developed.
• Describe the status of the
completion of the development of
a policy and procedure for the
assessment and distribution of the
SIDS /Infant Safe Sleep toolkit.
• Describe the outcomes of the
CQI/QA process including
methods of measurements and
results
3.4
• By June 30, 2016, conduct
comprehensive assessment of
prematurity awareness efforts
within the Community Action
Network (CAN).
• By June 30, 2016, a
prematurity prevention training
3.4
• Develop a survey monkey, or
other tool, to assess knowledge of
risk factors, signs and symptoms
of preterm labor; population
served, (ie. women during
pregnancy), access to PTB
information, knowledge of
treatment protocols for women at
3.4
• Evaluate the survey monkey and
create a timeline of training
and/or collaboration.
• Describe successes, challenges
and/or barriers to completing and
implanting these objectives.
3.4
• Number of CAN agencies that
provide prematurity awareness
education / Number of CAN
agencies that serve target
population
• MCAH Staff expressing
confidence in educating about
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 11 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
for MCAH/PHN staff will be
completed to increase staff
knowledge of risk factors and
signs of PTL.
risk for PTL, alignment of services
with the prevention methods for
PTB
• Engage Community Action
Network (CAN) to coordinate and
align activities for prematurity
prevention.
• PHN Division programs and
community agencies that impact
target population will utilize
existing educational materials,
websites, and resource centers,
e.g. March of Dimes prematurity
prevention resource center
(https://www.prematuritypreventio
n.org/portal/server.pt), for
education of members on
prematurity prevention
• Begin to develop policy and
procedure for home visitors’
approach to assessment and
education of preterm birth
• Partner with the March of Dimes
to implement a Healthy Babies
Healthy Futures training
• Home visiting PHNs under MCAH
to be trained on Nurse-Family
Partnership curriculum to include
use of tools to educate at risk
women using client-centered
• Describe evaluation components.
• Evaluate prematurity awareness
efforts and activities within PHN
Division programs
• Work toward developing policy
and procedure for home visitors’
approach to assessment and
education of preterm birth
• Documentation of the date and
number of attendees for the
prematurity prevention training.
prematurity / Total number of PHN
Division Staff trained
• Document number of participants
who report increased knowledge
of signs of PTL/risk factors for
PTB through a post training
test/questionnaire.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 12 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
principles
For FIMR LHJs Only:
3.5-3.7
Preventable fetal, neonatal and
postneonatal deaths will be
reduced.
For FIMR LHJs Only:
Assessment
3.5
Complete the review of at least
_20_ cases, which is
approximately _10_% of all fetal,
neonatal, and postneonatal
deaths.
For FIMR LHJs Only:
Assessment
3.5
Submit number of cases reviewed
as specified in the Annual Report
table.
For FIMR LHJs Only:
Assessment
3.5
Submit periodic local summary
report of findings and
recommendations (periodicity to
be determined by consulting with
MCAH).
Assurance
3.6
Establish, facilitate, and maintain
a Case Review Team (CRT) to
review selected cases, identify
contributing factors to fetal,
neonatal, and postneonatal
deaths, and make
recommendations to address
these factors.
Assurance
3.6-3.7
Submit FIMR Tracking Log and
FIMR Committee Membership
forms for CRT and CAT with the
Annual Report.
3.7
Establish, facilitate, and maintain
a Community Action Team (CAT)
to recommend and implement
community, policy, and/or systems
changes that address review
findings.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 13 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
Insert Short and/or Intermediate Outcome Objective(s), Activities, Evaluation/Performance Measures in the appropriate column below.
For FIMR LHJs Only:
3.8
• By June 30, 2016, 100
community participants who
receive a prematurity
prevention presentation
and/or training will be able to
identify at least one risk factor
for PTB and sign or symptom
for PTL.
For FIMR LHJs Only:
3.8
• Maintain documentation of:
a. Number of community
presentations
b. Number of participants who
attended a prematurity
prevention presentation
• Develop a process to measure
knowledge change and intent to
implement what was learned, e.g.
conducting pre-tests and post-
tests
3.8
• Documentation of the number of
evaluations/post-tests identifying
at least one risk factor for PTB
compared to pre-tests.
• List types of participants
For FIMR LHJs Only:
3.8
• Number of participants who can
identify at least one risk reduction
in a post-evaluation/Total number
of participants who received a
prematurity prevention
presentation and/or training
• Briefly describe knowledge
change and intent to implement
what was learned.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 14 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 4: Increase the proportion of children, adolescents and women of reproductive age who maintain a healthy weight
o Increase exclusive breastfeeding initiation and duration1
o Increase consumption of a healthy diet1
o Increase physical activity1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1
• By June 30, 2016, 2 labor and
delivery hospitals will start
implementing the model
hospital policies or the Baby-
Friendly USA™ Hospital
requirements to comply with
the Infant Feeding Act [Health
And Safety Code Section
123360-123367].
4.1
• All PHN Division staff will receive
training on 10 Steps of Baby-
Friendly and the importance of
breastfeeding education
• Continue working relationships
with birthing hospital
administrators and staff.
• Assist local birthing hospitals to
become Baby Friendly by utilizing
independent consultant, Carol
Melcher, to provide expertise,
training and guidance in pursuing
the Baby Friendly Hospital
Initiative.
• Provide technical assistance and
support to hospitals and perinatal
services providers to meet the
requirements of the Infant
Feeding Act utilizing the following
resources:
1. www.cdph.ca.gov/HealthInfo/h
ealthyliving/childfamily/Pages/
Resourcestomeettherequirem
entsoftheInfantFeedingAct.as
px
2. Birth & Beyond California:
4.1
• Document completion of staff
training
• Track hospital, perinatal
providers and/or staff trained with
Breastfeeding Education Guide
• Independent consultant, Carol
Melcher, will assist with tracking
the impact/outcome of each
hospital's policy development and
implementation progress.
• Number and names of hospitals
contacted and types of technical
assistance provided.
• Briefly describe barriers,
challenges and solutions to
implementing Baby Friendly
Hospital or model hospital
policies.
• Briefly describe the CQI/QA
process developed.
4.1
• Total number of staff educated
• Number of hospitals that initiated
Step 3 of the model hospital
policies or the Baby- Friendly
USA™ Hospital requirements / 2
hospitals
• Number of hospitals that have
implemented the model hospital
policies or the Baby- Friendly
USA™ Hospital requirements / 2
hospitals.
• Describe the outcome of the
CQI/QA process including
methods of measurements and
results.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 15 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
www.cdph.ca.gov/HealthInfo/h
ealthyliving/childfamily/Pages/
BirthandBeyondCaliforniaDes
cription.aspx
• Adapt and disseminate
Breastfeeding Education Guide
developed Breastfeed LA
• Develop and implement a
Continuous Quality
Improvement/Quality Assurance
(CQI/QA) process to monitor
implementation of
policies/processes, a regular
feedback mechanism to
continually improve the process,
and a plan to evaluate its impact
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 16 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 5: Improve the cognitive, physical, and emotional development of all children
o Reduce unintentional injuries1
o Reduce child abuse and neglect1
o Provide developmental screening for all children1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
5.1
• By June 30, 2016, 120 high
risk infants or children with
special health care needs will
receive public health nursing
home visitation to reduce the
number of preventable re-
hospitalizations, minimize
secondary illness and
maximize the potential for
optimal development in all
areas.
5.1
Through Public Health Nurse
home visitation case management
services:
1. Monitor, screen and refer as
needed all children for
physical, emotional and
cognitive delays.
2. Assess, monitor and refer as
needed all home
environments for inadequate,
unsafe and or unhealthy living
conditions.
3. Educate all families served on
optimal emotional, physical
and cognitive environments
for infants and children with a
focus on the positive
characteristics of each family.
Screen all families for
maternal depression and
domestic violence.
4. Continue to support home
visitation staff with self-care
reflective practice sessions
and educational opportunities
for increased knowledge of
medical and emotional needs
of families.
5.1
• Infants and children will be
assessed using the ASQ-3
and the ASQ-SE per program
protocol and prn and referred
as indicated.
• Environments will be
monitored according per
program protocol and prn and
referred as indicated.
• Mothers of high risk infants
and children with special
health care needs will be
screened for PMAD and IPV
according to program policy
and procedure guide and
referred as needed.
• Documentation of home
visitation services will be
maintained in the PHN
electronic charting system.
• Maintain documentation of
referrals to community
resources and outcomes.
5.1
• Number of children receiving
case management
services/120.
• At least 35% of clients
referred will complete referrals
made to community services.
• Preventable re-hospitalization
rate will be less than 10%.
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 17 of 19
6/3/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Maintain documentation of
rates of preventable re-
hospitalizations
5.2
• By June 30, 2016 maintain
collaborative agreement with
First 5, and SMART Model of
Care to support
comprehensive system of
services for children with
special health care needs.
(CSHCN)
5.2
• Continue to participate in Model of
Care Oversight Committee
(MOCPOC) Leadership team.
• Continue collaboration with
partner and community agencies
to support local services for
CSHCN
• Maintain annual local agreements
with First 5, State MCAH and
partner agencies to support
funding for SMART Model of Care
5.2
• Maintain meeting Agendas,
Minutes on file. Document
attendance in annual report.
• Describe collaborative and
capacity building activities.
• Submit local agreements for state
approval of pass through funding.
5.2
• Document on Collaborative Form
• Summarize outcomes and
activities in Annual Report
• Describe state and locally
approved 2015-16 MCAH, First 5
and SMART Model agreement
1 2001-2015 Title V State Priorities 2 Tittle V Requirement 3 State Requirement
Page 18 of 19
6/3/2015
Goal 6: Increase conditions in adolescents that lead to the improved adolescent health
o Decrease teen pregnancies1
o Reduce teen dating violence, bullying and harassment 1
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
6.1
Add specific short and/or
intermediate SMART outcome
objective(s) here.
Consider addressing local
problems related to:
• Adolescent sexual health
• Adolescent pregnancy
• Adolescent injuries
• Adolescent violence
• Adolescent mental health
6.1
List activities to meet the Outcome
Objective(s) here.
Organize intervention activities
and performance measures using
the three core functions of public
health: Assessment, Policy
Development, and Assurance.
http://www.publichealth.lacounty.g
ov/qi/corefcns.htm
6.1
Develop process measures for
applicable intervention activities
here.
6.1
Develop short and/or intermediate
outcome related performance
measures for the objectives and
activities here.
1 2001-2015 Tittle V State Priorities
2 Tittle V Requirement
3 State Requirement
Page 19 of 19
7/3/2014
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
California Department of Public Health (CDPH)
Maternal, Child and Adolescent Health (MCAH)
Black Infant Health (BIH) Scope of Work (SOW)
Black Infant Health Program
The Agency agrees to provide to the Department of Public Health the services in this Scope of Work (SOW). The California Department of Public Health,
Maternal, Child and Adolescent Health (MCAH) Division places a high priority on the poor outcomes that disproportionately impact the African American
community in California. Central to the efforts in reducing these disparities is the Black Infant Health (BIH) Program. The four goals of the BIH Program are to:
1. Improve African-American infant and maternal health.
2. Increase the ability of African American women to manage chronic stress.
3. Decrease Black-White health disparities and social inequities for women and infants.
4. Engage the community to support African American families’ health and well-being with education and outreach efforts.
To achieve these goals, the BIH Program is a client-centered, strength-based group intervention with complementary case management that embraces the
lifecourse perspective and promotes skill building, stress reduction and life goal setting. Each BIH Site shall also assure program fidelity and collect and enter
participant and program data into the electronic Efforts to Outcomes (ETO) data system and engage community partner agencies.
All BIH Sites are required to comply with BIH Policy and Procedures (P&P) and the MCAH Fiscal Policies and Procedures Manual in their entirety. In
addition, all BIH Sites shall work toward meeting the BIH Program Standards and to maximize fidelity in implementing Program services, fulfilling all deliverables
associated with benchmarks, attending required meetings and trainings and completing other MCAH-BIH reports as required. All activities in this SOW shall take
place within the fiscal year.
The Black Infant Health program is a specialized CDPH MCAH program under the local MCAH system and helps to address MCAH SOW Goal 2 – Improve
Maternal and Women’s Health.
Contained within the BIH SOW, under the Measures (Process and Outcome) cells, there are Source Keys that are designed to provide a reference for reporting
purposes. The “E” Source Key refers to information that is based on client-level program data included and maintained in ETO. The “N” “Source Key refers to
narrative information provided in quarterly reports or site surveys.
It is the responsibility of the LHJ to meet the goals and objectives of this SOW. The LHJ shall strive to develop systems that protect and improve the health of
California’s women of reproductive age, infants, children, adolescents, and their families.
The goals in this SOW incorporate local problems identified by LHJs 5-Year Needs Assessments and reflect the Title V priorities of the MCAH Division.
The development of this SOW was guided by several public health frameworks including the Ten Essential Services of Public Health and the three core functions
of assessment, policy development, and assurance; the Spectrum of Prevention; the Life Course Perspective; the Social-Ecological Model, and the Social
Determinants of Health. Please consider integrating these approaches when conceptualizing and organizing local program, policy, and evaluation efforts.
o The Ten Essential Services of Public Health: http://www.cdc.gov/nphpsp/essentialServices.html; http://www.publichealth.lacounty.gov/qi/corefcns.htm
o The Spectrum of Prevention: http://www.preventioninstitute.org/component/taxonomy/term/list/94/127.html
o Life Course Perspective: http://mchb.hrsa.gov/lifecourseresources.htm
Page 1 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
o The Social-Ecological Model: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html
o Social Determinants of Health: http://www.cdc.gov/socialdeterminants/
o Strengthening Families: http://www.cssp.org/reform/strengthening-families
For each fiscal year of the contract period, the Local Health Jurisdiction shall submit the deliverables identified below. All deliverables
shall be submitted to the MCAH Division to your designated Program Consultant in accordance with the BIH Policies and Procedures
Manual and postmarked or emailed no later than the due date.
Deliverables for each FY Due Date for each FY
Annual Progress Report Aug. 15
Coordinator Quarterly Report:
Reporting Period From To Due Date
1) First Report July 1, 2015 September 30, 2015 October 31, 2015
2) Second Report October 1, 2015 December 31, 2015 January 31, 2016
3) Third Report January 1, 2016 March 31, 2016 April 30, 2016
4) Fourth Report (WAIVED)
Information during this reporting period
will be included in the Annual Progress
Report
April 1, 2016 June 30, 2016 July 31, 2016
See the following pages for a detailed description of the services to be performed.
Page 2 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Part II: Black Infant Heath Program
Goal 1: BIH will maintain program fidelity and fiscal management to administer the program as required by the BIH Program Policies and Procedures
and Scope of Work and will assure program implementation, staff competency, and data management.
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
1.1
LHJ Maternal, Child and
Adolescent Health (MCAH)
Director and/or designee (BIH
Coordinator) will provide
oversight, maintain program
fidelity, fiscal management and
demonstrate that it is
conducting BIH activities as
required in the BIH Policies and
Procedures, SOW, Data
Collection Manual, Efforts to
Outcome (ETO) Data Book,
Group Curriculum, and MCAH
Fiscal Policies and Procedures.
1.1
• Annually review and revise
internal policies and
procedures for delivering
services to eligible BIH
participants.
• Submit Agreement Funding
Application timely.
• Submit BIH Annual report by
August 15.
• Submit BIH Quarterly Reports
as directed by MCAH.
1.1
• Describe MCAH Director
and BIH Coordinator
responsibilities as they
relate to BIH.
• Provide organization chart
that designates the
delineation of
responsibilities of MCAH
Director and BIH.
Coordinator from MCAH
to the BIH Program.
1.1
1.2
Each LHJ must have in place
qualified personnel as outlined
in the P&P.
1.2
• At a minimum, the following
key staffing roles are required:
• .0.5 FTE BIH Coordinator
• 2 FTE FHA/Group
Facilitators.
• 1 FTE Community
Outreach Liaison
• 0.5 FTE Data Entry
• 0.5 FTE Mental Health
Professional
• Utilization of a staff hiring
plan.
1.2
• Describe process of hiring
staff at each site that are filled
by personnel meeting
qualifications in the P&P.
• Include duty statements of all
staff with submission of AFA
Packet.
• Submission of all staff
changes per guidelines
outlined in BIH P&P
guidelines.
1.2
Percent of key staffing roles at site
filled by personnel who meet
qualifications in the P&P. (N)
Page 3 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
TRAINING
1.3
All BIH staff will maintain and
increase staff competency.
1.3
• Develop a plan to assess
staff’s ability to effectively
perform their assigned tasks,
including regular observations
of group facilitators.
• Identify staff training needs
and ensure those needs are
met, notifying MCAH of any
training needs.
• Ensure that all key BIH staff
participates in training or
educational opportunities
designed to enhance cultural
sensitivity.
• Require that all key BIH staff
(i.e. MCAH Director, BIH
Coordinator, and ALL direct
service staff) attend mandatory
MCAH Division-sponsored
trainings, meetings and/or
conferences as scheduled by
MCAH Division.
• Ensure that the BIH
Coordinator and all direct
service staff attend mandatory
MCAH Division-sponsored
training(s) prior to
implementing the BIH
Program.
• Ensure that the BIH
Coordinator and/or MCAH
Director perform regular
observations of group
facilitators and assessments of
FHAs’ case management
activities.
1.3
• Describe training activities in
which staff participated. (N)
• Describe improved staff
performance and confidence
in implementing the program
model as a result of
participating in staff
development activities and/or
trainings. (N)
• List gaps in staff development
and training. (N)
• Describe plan to ensure that
staff development needs are
met. (N)
• Describe how cultural
sensitivity training has
enhanced LHJ staff
knowledge and how that
knowledge is being applied.
(N)
• Recommend training topic
suggestions for statewide
meetings. (N)
• Maintain records of staff
participation in staff
development activities and
staff attendance at trainings.
(N)
• Completion of group session
information form.
1.3
• ETO Utilization Reports for all
staff at BIH Sites. (E)
Page 4 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
DATA ENTRY
1.4
All BIH participant information
and outcome data will be
collected timely and accurately
using BIH required forms at
required intervals.
1.4
• Ensure that all direct service
staff participate in data
collection, data entry, data
quality improvement, and use
of data collection software
determined by MCAH.
• Ensure that all subcontractor
agencies providing direct
service enter data in the ETO
as determined by MCAH.
• Ensure accuracy and
completeness of data input
into ETO system.
• Ensure that all staff receives
updates about changes in ETO
and data book forms. Ensure
that a selected staff member
with advanced knowledge of
the BIH Program, data
collection, and ETO is selected
as the BIH Site’s Data Entry
lead and participates in all
Data and Evaluation calls.
1.4
• Review data systems reports
and discuss during calls with
BIH State Team.
• Enter all data into ETO within
7 working days of collection.
1.4
• Number and percent of
enrolled cases with no
information/action entered into
the ETO within two weeks of
enrollment. (E)
PARTICIPANT
RECRUTMENT/OUTREACH
1.5
All BIH LHJs will recruit,
outreach and enroll African
American women 18 years of
age, less than 26 weeks
pregnant.
1.5
• Implement the program
activities as designed.
• Develop a Participant
Recruitment Plan
(standardized intake process)
according to the target
population and eligibility
guidelines in CDPH/MCAH
BIH P&P.
• Recruitment plan is reviewed
annually and updated as
needed.
1.5
• Submit participant triage
algorithm with submission of
AFA packet.
• Participant Recruitment Plan
will be reviewed annually and
updated as needed.
• Describe outreach activities
performed in order to reach
target population.
• Report number and percent of
participants included in
outreach but do not enroll.(E)
• Describe deviations in outreach
activities, noting changes from
local recruitment plan. (N)
• Number and percent of
participants with completed
recruitment forms. (E)Number and
percent of participants included in
outreach but do not enroll.(E)
Page 5 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
ENROLLMENT
1.6
• 100% of participants
enrolled in BIH will be
African American.
• 100% of participants will be
18 years or older when
enrolled in BIH.
• 100% of participants will be
enrolled during pregnancy.
o 100% of participants will
be enrolled at or before
26 weeks of pregnancy.
• 100% of women will
participate in group
intervention.
1.6
• Enroll participants that are
African American.
• Enroll participants during
pregnancy.
• Enroll participants at or before
26 weeks of pregnancy.
• Enroll women that will
participate in group
intervention.
• Provide referrals to other
MCAH programs for women
who cannot participate in
group intervention sessions.
1.6
Not Applicable
1.6
• Number and percent of
participants who are 18 years
of age and older.(E)
• Number and percent of
participants enrolled at or
before 26 weeks of
pregnancy. (E)
PROGRAM PARTICIPATION
1.7.1
• 100% of women will
participate in prenatal
group.
o All women will
participate in group
within 30 days of first
successful contact.
1.7.1
Schedule participants in a
prenatal group within 30 days of
first successful contact.
1.7.1
Describe barriers, challenges and
successes of enrolling participants
in prenatal group within 30 days of
first successful contact. (N)
1.7.1
Number and percent of enrolled
participants who attend a prenatal
group session within 30 days of
first successful
contact. (E)
1.7.2
• All BIH participants will
receive case management
support as defined in the
P&P.
• All participants will
complete all prenatal and
postpartum assessments
within the recommended
time intervals.
1.7.2
• Conduct case management
services that align with Life
Plan activities (goal setting).
• Collect completed self-
administered scaled questions
as described in P&P.
• Collect the required number of
assessments per timeframe
outlined in P&P.
• Develop and implement a Life
1.7.2
• Report number of prenatal and
postpartum participants
served. (E/N)
• Report number and percent of
enrolled participants for whom
the following actions are
completed (E):
o Intake procedures,
including completion of an
1.7.2
• Number and percent of
participants with completed
prenatal and postpartum
assessments, including Birth
Plans at appropriate time
intervals. (E)
• Number and percent of new
participants with completed
initial case conferencing. (E)
• Number and percent of
Page 6 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• All BIH participants will
receive referrals to services
outside of BIH based on her
Life Planning Meetings.
Plan based on goal setting
during Life Planning meetings
for each BIH participant;
complete all prenatal and
postpartum assessments;
provide ongoing identification
of her specific concerns/needs
and referral to services outside
of BIH as needed based on
Life Planning meetings.
• Conduct participant dismissal
activities.
• Conduct participant
satisfaction surveys.
• Submit complete and accurate
reports in the timeframe
specified by MCAH.
initial assessment and
date of initial prenatal
group.
o Initial case conferencing
o Life Planning Meetings
• Prenatal and Postpartum
assessments Participant
dismissal.
participants with documented
disposition of referral
services. (E)
• Number and percent of cases
open more than 2 months
after completion of the last
postpartum group.(E)
• Describe program
improvements resulting from
participant satisfaction survey
findings. (N)
1.7.3
All BIH participants will
participate in Group
Intervention Sessions.
1.7.3
• Schedule group sessions with
guidance from State BIH
Team.
All participants will have the
opportunity to enroll in a group series
within 30 days of the first successful
contact.
• Conduct and adhere to the 20-
group intervention model as
specified in the P&P.
1.7.3
Percentage of enrolled
participants who participated
in group intervention. (E)
• Submit FY 2015-16 Group
Session Calendar to MCAH-
BIH Program by December
31st and upon request.
• Number and percent of
enrolled participants for
whom the following actions
are completed (E):
o 7 of 10 Prenatal Group
Sessions.
o 7 of 10 Postpartum Group
Sessions.
1.7.3
Number and Percent of
participants who complete both
the prenatal and postpartum
group intervention. (E)
1.8
All participant and program
data will be entered in the
1.8
• Accurately and completely
collect required participant
1.8
• Number and percent of
participant records entered into
1.8
• Number and percent of
enrolled participants that have
Page 7 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
MCAH-BIH- ETO timely and
accurately.
information, with timely data
input into the appropriate data
system(s).
• Work with MCAH to ensure
proper and continuous
operation of the MCAH-BIH-
ETO.
• Store Participant level Data
forms on paper per guidelines
in P&P.
• Define a data entry schedule
for staff.
the ETO within 7 working days of
collection on paper forms. (E)
• Generate Standard Reports at
least quarterly as a management
tool to assess data accuracy and
completeness. (E)
• BIH Coordinator and/or FHA/Data
Entry Lead shall conduct periodic
audits of participant records and
report results and number
reviewed (minimum 10%).
information/action entered into
the ETO within two weeks of
collection. (E)
• Number and percent of cases
with completed recruitment
forms. (E)
• Number and percent of
participating women with
cases closed 2 months after
last postpartum group.(E)
Page 8 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 2: Engage the community to support African American families’ health and well-being with education and outreach efforts
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
2.1
BIH Coordinator and/or MCAH
Director will elevate community
awareness of African American
birth outcomes.
2.1
• Inform the community about
poorer birth outcomes among
African American women by
delivering standardized
messages describing how the
BIH Program addresses these
issues.
• Create partnerships with
community and referral
agencies that support the
broad goals of the BIH
Program, through formal and
informal agreements.
• Develop a community
awareness plan that outlines
how community engagement
activities will be conducted.
2.1
• Describe the local plan for
community linkages, including an
effective referral process that will be
reviewed on an annual basis and
updated as needed. (N)
• Briefly describe successes and
barriers to community education
activities or events. (N)
• List and describe formal and informal
partnerships with community and
referral agencies. (N)
• Briefly describe community efforts
such as advisory board involvement
and community collaborations to
address maternal and infant health
disparities, or other similar formal or
informal partnerships. (N)
2.1
• Describe community outreach
activities conducted by BIH
Coordinator and/or MCAH
Director with submission of BIH
Quarterly Reports. (N)
2.2
BIH Community Outreach
Liaison (COL) will increase
information sharing with other
local agencies providing
services to African-American
women and children in the
community and establish a
clear point of contact.
2.2
• Develop collaborative
relationships with local
agencies in the community that
provide services to African-
American women and children,
to establish strong resource
linkages for recruitment of
potential participants and for
referrals of active participants.
• Develop a clear point of
contact (person/s) with
collaborating community
agencies on a regular basis as
it relates to outreach,
enrollment, referrals, care
coordination, etc.
2.2
• List the types of outreach
performed and materials
used to inform community
partners about BIH. (N)
• List and describe barriers,
challenges and/or
successes related to
establishing community
partnerships and points of
contact. (N)
2.2
• Number of agencies where the
COL has a clear point of
contact and with whom
information is regularly
exchanged. (E)
• Describe community outreach
activities conducted by COL
with submission of BIH
Quarterly Reports. (N)
Page 9 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Goal 3: Increase the ability of African American women to manage chronic stress
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
3.1
All BIH participants will report
increased social support and
decreased social isolation after
attending the prenatal and/or
postpartum group intervention
and completing Life Planning
activities.
3.1
• Implement the prenatal and
postpartum group intervention
with fidelity to the P&P.
• Encourage participants to
attend and participate in group
sessions.
• Support clients in fostering
healthy interpersonal and
familial relationships.
• Report results from group
session information form,
including description of
participant engagement in
group activities, for each group
session.
3.1
• Provide FY 2015- 2016 group
intervention schedules upon
request. (N)
• Percent of adherence
indicators with ‘high’ fidelity
ratings. (E)
• Percent of participants who
meet expected prenatal life
planning session attendance
(prenatal dose). (E)
• Percent of participants who
meet expected prenatal group
session attendance (prenatal
dose). (E)
3.1
• Number and percent of
participants who report an
increase in social support as
measured through the Social
Provisions Scale – Short
(SPS-S). (E)
• Number and percent of
completed group session
information forms. (E)
3.2
All BIH participants will report
increased self-esteem, mastery,
coping and resiliency after
attending prenatal and/or
postpartum group intervention
and completing Life Planning
activities.
3.2
All activities are delivered with an
understanding of African
American culture and history.
• Assist participants in
identifying and utilizing their
personal strengths.
• Develop and implement a Life
Plan with each client.
• Teach and provide support to
participants as they develop
goal-setting skills and create
their Life Plans.
• Teach participants about the
importance of stress reduction
and guide them in applying
stress reduction techniques.
• Support participants as they
become empowered to take
3.2
• Number and percent of
participants who complete Life
Planning activities as
evidenced by setting short and
long-term goals. (E)
• Describe challenges/barriers
why participants did not report
an increase in self-esteem,
mastery, coping and resiliency
after attending prenatal and/or
postpartum group intervention
and completing Life Planning
activities. (N)
3.2
• Number and percent of
women who clearly articulate
at least one short and long
term goal as part of their Life
Planning activities as
evidenced by documentation
on the “About Me” and “Short
Term Goal” forms. (E)
• Number and percent of
women who report progress
toward stated short term goals
as evidenced by
documentation on the Short-
Term Goal Update from Life
Plan. (E)
• Number and percent of
participants who maintain or
increase self-esteem based
Page 10 of 14
7/1/2015
Agency: County of Fresno Fiscal Year: 2015-16
Agreement Number: 201510
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
actions toward meeting their
needs.
• Teach participants how to
express their feelings in
constructive ways.
• Help participants to
understand societal influences
and their impact on African
American health and wellness.
on responses to the
Rosenberg Self-Esteem
Scale. (E)
• Number and percent of
participants who maintain or
increase mastery based on
responses to the Pearlin
Mastery Scale. (E)
• Number and percent of
participants who maintain or
increase coping and resiliency
based on responses to the
Brief Resilience Scale. (E)
Page 11 of 14
7/1/2015
Agency: Fiscal Year:
Agreement Number:
Goal 4: Improve the health of pregnant and parenting women, thus also promoting the health of their infants
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.1
All BIH participants will be
linked to services that support
health and wellness while
enrolled in the BIH Program.
4.1
• Assist participants in
understanding behaviors that
contribute to overall good
health, including:
o Stress management
o Sexual health
o Nutrition
o Physical activity
• Ensure that participants are
receiving prenatal care.
• Ensure that healthy nutritious
snacks are available during
group sessions.
• Provide participants with
health information that
supports a healthy pregnancy.
• Ensure that participants have
access to health insurance.
• Identify participants’ health and
social needs and provide
referrals and follow-up as
needed to health and
community services.
• Provide information and health
counseling to participants who
report drug, alcohol and/or
tobacco use.
• Assist participants with
completion of their birth plan.
4.1
• List and describe additional
activities (e.g., Champions for
Change cooking
demonstrations) conducted
that promote health and
wellness of BIH participants.
(N)
• Number and percent of
participants reporting drug,
alcohol and/or tobacco use
who are provided information
and health counseling. (E)
• Number and percent of
prenatal participants who
complete a birth plan. (E)
• Number and percent of
participants receiving prenatal
care by trimester of program
initiation. (E)
• Number and percent of
participants enrolled in WIC.
(E)
• Number and percent of
previously uninsured
participants who obtained
needed health insurance while
enrolled in BIH. (E)
• Number and percent of
prenatal participants who
complete a birth plan. (E)
4.1
• Number and percent of
participants whose health
status improves over the
course of their participation in
BIH. (E)
• Number and percent of
participants and infants who
obtained needed health and
community services while
enrolled in BIH. (E)
• Number and percent of
participants whose healthy
eating behaviors improve over
the course of their participation
in BIH. (E)
• Number and percent of
participants whose physical
activity increased over the
course of their participation in
BIH. (E)
Page 12 of 14
7/3/2014
Agency: Fiscal Year:
Agreement Number:
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
4.2
All BIH participants will report
an increase in knowledge and
understanding of reproductive
life planning and family
planning services.
4.2
• Promote and support family
planning by providing
information and counseling.
• Promote and support
interconception health.
• Help participants understand
and value the concept of
reproductive life planning as
they complete their Life Plans.
• Help participants understand
the characteristics of healthy
relationships and provide
resources that can help
participants deal with abuse,
reproductive coercion or birth
control sabotage.
• Provide referrals and promote
linkages to family planning
providers including FPACT.
4.2
• Describe challenges/barriers
why participants did not have
a 4-6 week postpartum
checkup with a medical
provider. (N)
• Describe challenges/barriers
why participants did not use a
method of birth control after
their child was born. (N)
4.2
• Number and percent of
participants who attend a 4-6
week postpartum checkup with
a medical provider. (E)
• Number and percent of
participants who use any
method of birth control to
prevent pregnancy after their
babies are born. (E)
4.3
All BIH participants will be
screened for Perinatal Mood
and Anxiety Disorders (PMAD)
and those with positive screens
will be given a referral to mental
health services.
4.3
• Help participants understand
how mental health contributes to
overall health and wellness.
• Help participants recognize the
connection between stress and
mental health and practice stress
reduction techniques.
• Help participants understand the
connection between physical
activity and mental health.
• Administer the EPDS to every
client 6-8 weeks after she gives
birth.
• Help participants understand the
symptoms of postpartum
depression.
4.3
• Describe successes and
challenges in addressing
mental health issues, including
mental health referrals. (N)
• Number and percent of
participants who completed the
Edinburgh Postpartum
Depression Screen (EPDS) 6-8
weeks postpartum. (E)
4.3
• Number and percent of
participants with “positive”
EPDS screens who are
successfully referred to a
community mental health
provider. (E)
Page 13 of 14
7/3/2014
Agency: Fiscal Year:
Agreement Number:
Short and/or Intermediate
Objective(s)
Intervention Activities to Meet
Objectives (Describe the steps of
the intervention)
Evaluation/Performance Measures
Process, Short and/or Intermediate Measures
(Report on these measures in the Annual Report)
Process Description and Measures Short and/or Intermediate Outcome
Measure(s)
• Provide referrals and follow-up to
mental health services when
appropriate.
4.4
All BIH participants will report
an increase in parenting skills
and bonding with their infants
and other family members.
4.4
• Assist participants in
understanding and applying
effective parenting techniques.
• Assist participants with
completing home safety checklist.
• Assist participants with increasing
knowledge of infant safe sleep
practices/sudden infant death
syndrome (SIDS), sudden
unexplained infant death (SUID)
risk reduction.
• Assist participants with
completing birth plan.
• Assist participants with identifying
and using bonding strategies,
including breastfeeding, with their
newborns.
4.4
• List and describe additional
activities that enhance
parenting and bonding. (N)
• Number and percent of
participants who complete the
safety checklist. (E)
• List and describe additional
activities on infant safe sleep
practices/SIDS/SUID risk
reduction. (N)
• Number and percent of
postpartum participants who
initiate breastfeeding. (N)
• Number and percent of
prenatal participants who
complete a birth plan. (E)
4.4
• Provide anecdotes/client
success stories about
improved parenting/bonding
with submission of BIH
Quarterly Reports.
• Provide anecdotes/client
success stories about infant
safe sleep practices and
SIDS/SUID risk reduction with
submission of BIH Quarterly
Reports.
• Provide anecdotes/client
success stories about
breastfeeding practices with
submission of BIH Quarterly
Reports.
Page 14 of 14
7/3/2014
fi'~b'11~"Heoflh if;.; S~MM.ARY ~H BIH AFLP Use the hyµerlin~s to quickly access e-'Ch program I BUDGET SUMMARY I FISCAL YEAR BUDGET 2015-16 ORIGINAL llf'f~"fl 1 .... ·1;;>1.1M ~n'>lrn~BlOCk:Bl!Ol'IK Programs MCAH/BIH/AFLP Agency: 201510 County of Fresno SubK: I (t) !21 (31 I TOTAL FUNDINC % TITI.EV MCAH 218,167 ALLOCATIONS BIH 259,379 AFLP EXPENSE CATEGORY Im PERSONNEL 4,947,733 379,520 1111 OPERATING EXPENSES 850,419 21,899 11111 CAPITAL EXPENDITURES llV\ OTHER COSTS 999,975 37.750 IVI INDIRECT COSTS 073.670 39,377 BUDGET TOTALS* 7,670.797 813% 477 546 TOTAL TITLE V TOTALSGF TOTAL AFLP PYO TOTAL TITLE XIX TOTAL AGENCY FUNDS 477.546 I 477,546 J 248,467 3,224,326 3,720,458 (<) % 051% MCAH BLOCK PROGRAM BUDGET I BUDGET STATUS I ACTIVE UNMATCHED FUNDING t6) 141 SCF % 248,467 39,11B 39.118 I 39.118 I (5) AFLP PVO I I I MCAH-TV I (6) I 171 % I Agency Functs• 967.476 190,494 361,693 200,393 2099'lr. 1610046 I 1.610.045 I t=j I BIH-SGF I NON-ENHANCED MATCHING (50/50) (8) I (OJ (10) l ('1) % I Combined Fed/Stale % ICOnlblned Fed/AgencY" 330,365 1,523, 133 638,036 609,532 57,S40 576,360 5.06% 387 895 4363% 3,347,061 [50%1 I 193 ,948 I [50%]1 193,9481 [50%] 1,673,531 150%1 1,673,531 $ 3,950,341 Maximum Amount Payable from State and Federal resources /5 ~~~ AGENCY FISCAL Aws SIGNATURE rs.eAl}E'<lcyc000100tions 201510 MCAH 6111SBudit!t091515 1 of18 I AFLP-TV I I AFLP-PYD I ENHANCED MATCljlNG (75/25) (12) l (13} l14) I t1~) 110> I (17) % I Combined FedlState % I Combined Fed/Agency* I 61,606 1,747,525 ..... 61606 227$% 1 747 525 1""'11 15.402 I [75%11 46,2051 (75%]1 1,310.644 {25%] 436,881 L o{t<t / i ·$' DATE Printed: 10/1/201S9:50 AM
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 2 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
MCAH PCA CODES 53107 53118 53117
(I)PERSONNEL 4,353,326 215,192 867,476 1,523,133 1,747,525
(II) OPERATING EXPENSES 793,654 1,816 190,484 601,354
(III) CAPITAL EXPENSES
(IV) OTHER COSTS 961,225 351,693 609,532
(V) INDIRECT COSTS 772,527 1,159 200,393 570,975
TOTAL 6,880,732 218,167 1,610,046 3,304,994 1,747,525
BIH PCA CODES 53113 53127 53124 53100 53125 53102
(I)PERSONNEL 594,407 163,328 39,118 330,355 61,606
(II) OPERATING EXPENSES 56,765 20,083 36,682
(III) CAPITAL EXPENSES
(IV) OTHER COSTS 37,750 37,750
(V) INDIRECT COSTS 101,143 38,218 57,540 5,385
TOTAL 790,065 259,379 39,118 387,895 42,067 61,606
AFLP PCA CODES 53109 53144 53131 53130
(I)PERSONNEL
(II) OPERATING EXPENSES
(III) CAPITAL EXPENSES
(IV) OTHER COSTS
(V) INDIRECT COSTS
TOTAL
GRAND TOTAL 7,670,797 477,546 39,118 1,610,046 387,895 3,347,061 61,606 1,747,525
STATE USE ONLY
MCAH PCA CODES 53107 53118 53117
(I)PERSONNEL 2,287,403 215,192 761,567 1,310,644
(II) OPERATING EXPENSES 302,493 1,816 300,677
(III) CAPITAL EXPENSES
(IV) OTHER COSTS 304,766 304,766
(V) INDIRECT COSTS 286,647 1,159 285,488
TOTAL 3,181,309 218,167 1,652,498 1,310,644
BIH PCA CODES 53113 53127 53124 53100 53125 53102
(I)PERSONNEL 594,407 163,328 39,118 330,355 61,606
(II) OPERATING EXPENSES 38,424 20,083 18,341
(III) CAPITAL EXPENSES
(IV) OTHER COSTS 37,750 37,750
(V) INDIRECT COSTS 98,451 38,218 57,540 2,693
TOTAL 769,032 259,379 39,118 387,895 21,034 61,606
AFLP PCA CODES 53109 53144 53131 53130
(I)PERSONNEL
(II) OPERATING EXPENSES
(III) CAPITAL EXPENSES
(IV) OTHER COSTS
(V) INDIRECT COSTS
TOTAL
GRAND TOTAL 3,950,341 477,546 39,118 387,895 1,673,532 61,606 1,310,644
SUMMARY BY PROGRAM
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 3 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
% PERSONNEL MATCH
TOTAL OPERATING EXPENSES 793,654 1,816 190,484 601,354
69,298 0.23%159 23.61%16,361 76.16%52,777
17,203 0.23%40 23.61%4,062 76.16%13,102
1 151,537 0.23%349 23.61%35,778 76.16%115,411
2 36,485 0.23%84 23.61%8,614 76.16%27,787
3 12,011 0.23%28 23.61%2,836 76.16%9,148
4 17,438 0.23%40 23.61%4,117 76.16%13,281
5 13,560 0.23%31 23.61%3,202 76.16%10,327
6 16,027 0.23%37 23.61%3,784 76.16%12,206
7 1,447 0.23%3 23.61%342 76.16%1,102
8 13,315 0.23%31 23.61%3,144 76.16%10,141
9 4,061 100.00%4,061
10 90,718 0.23%209 23.61%21,419 76.16%69,091
11 81,550 0.23%188 23.61%19,254 76.16%62,108
12 269,004 0.23%619 23.61%63,512 76.16%204,873
13
14
15
** Unmatched Operating Expenses are not eligible for Federal matching funds (Title XIX). Expenses may only be charged to Unmatched Title V (Col. 3), State General Funds (Col. 5), and/or Agency (Col. 7) funds.
% PERSONNEL MATCH
TOTAL OTHER COSTS 961,225 351,693 609,532
SUBCONTRACTS
1 870,760 30.00%261,228 70.00%609,532
2 16,276 100.00%16,276
3 15,000 100.00%15,000
4 25,000 100.00%25,000
5
OTHER CHARGES
1 2,660 100.00%2,660
2 8,529 100.00%8,529
3 13,000 100.00%13,000
4 10,000 100.00%10,000
5
Medical Supplies 76.16%
76.16%
Match Available
TRAVEL
TRAINING
Facilities
Utilities
Security
Postage
Telephones
Office Supplies
Household Expenses/Maintenance
Printing
(II) MCAH OPERATING EXPENSES DETAIL
Software
Equipment
IT Support
(III) MCAH CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL EXPENDITURES
Client Support Materials 76.16%
(IV) MCAH OTHER COSTS DETAIL 76.16%
Exceptional Parents Unlimited, Inc. (SMART Model of Care)
Nurse-Family Partnership
Match Available
Books & Publications 76.16%
Program Evaluator
Carol Melcher Consulting
Interpreters 76.16%
Media 76.16%
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 4 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
772,527 1,159 200,393 570,975
772,527 0.15%1,159 25.94%200,393 73.91%570,975
TOTAL PERSONNEL COSTS 4,353,326 215,192 867,476 1,523,133 1,747,525
1,886,936 93,274 376,005 660,198 757,459
2,466,390 121,918 491,471 862,936 990,065
INITIALSTITLE OR CLASSIFICATION %
FTE
ANNUAL SALARYTOTAL WAGES
1 RG Division Manager 20.00%112,974 22,595 30.99%7,002 53.57%12,104 15.44%3,489 69.0%69.01%
2 RG MCAH Director 50.00%112,974 56,487 30.99%17,505 53.57%30,260 15.44%8,722 69.0%69.01%
3 V MCAH Director -Physician 70.00%122,879 86,015 35.49%30,527 11.09%9,539 53.42%45,949 69.0%64.51%
4 BA Administrative Assistant 70.00%38,038 26,627 0.00%(0)30.99%8,252 69.01%18,375 69.0%69.01%
5 AX Staff Analyst II 100.00%57,803 57,803 0.00%51.05%29,508 48.95%28,295 69.0%48.95%
6 MC Accountant II 10.00%57,630 5,763 0.00%(0)30.99%1,786 69.01%3,977 69.0%69.01%
7 MR Account Clerk III 100.00%39,059 39,059 0.00%31.32%12,233 68.68%26,826 69.0%68.68%
8 JD PHN II -MCAH Coordinator 100.00%84,318 84,318 35.53%29,958 33.00%27,825 31.47%26,535 69.0%64.47%
9 EA PHN II -FIMR/SIDS Coord 30.00%84,318 25,295 100.00%25,295 69.0%
10 TZ MSW I 30.00%44,018 13,205 0.00%(0)7.00%924 43.00%5,678 50.00%6,603 94.5%93.00%
11 V MSW I 100.00%44,018 44,018 0.00%(0)7.00%3,081 43.00%18,928 50.00%22,009 94.5%93.00%
12 LM MHN II 50.00%43,198 21,599 0.00%(0)5.50%1,188 21.41%4,624 73.09%15,787 94.5%94.50%
13 BV Epidemiologist 25.00%73,066 18,267 100.00%18,267 69.0%
14 EO HEA 25.00%33,364 8,341 0.00%(0)32.00%2,669 68.00%5,672 69.0%68.00%
15 DV HEA 25.00%42,628 10,657 33.95%3,618 66.05%7,039 69.0%66.05%
16 TT HEA 25.00%43,228 10,807 0.00%(0)30.99%3,349 69.01%7,458 69.0%69.01%
17 V HES 50.00%41,290 20,645 0.00%51.55%10,642 48.45%10,003 69.0%48.45%
18 V HES 100.00%40,690 40,690 0.00%51.55%20,976 48.45%19,714 69.0%48.45%
19 AV Health Educator 25.00%60,992 15,248 34.72%5,294 65.28%9,954 69.0%65.28%
20 V SOA 100.00%32,968 32,968 0.00%(0)30.99%10,217 69.01%22,751 69.0%69.01%
21 V OA I 100.00%23,655 23,655 0.00%(0)15.07%3,565 84.93%20,090 94.5%84.93%
22 CM OA III 100.00%36,898 36,898 6.73%2,483 93.27%34,415 94.5%93.27%
23 EP OA III 50.00%36,898 18,449 19.09%3,522 80.91%14,927 94.5%80.91%
24 LW OA III 100.00%29,750 29,750 10.00%2,975 90.00%26,775 94.5%90.00%
25 SR OA III 100.00%36,898 36,898 8.39%3,096 91.61%33,802 94.5%91.61%
26 YL OA III 100.00%37,498 37,498 8.73%3,274 91.27%34,224 94.5%91.27%
27 MM SPHN (1677)11.00%110,725 12,180 23.53%2,865 13.84%1,685 46.54%5,669 16.10%1,961 69.0%62.64%
28 MG PHN II (1677)100.00%86,396 86,396 0.00%(0)77.58%67,026 8.74%7,551 13.68%11,819 69.0%22.42%
29 FT PHN I (1677)45.00%59,171 26,627 0.00%(0)69.22%18,431 9.07%2,415 21.71%5,781 69.0%30.78%
30 MM SPHN (1615)89.00%110,725 98,545 16.00%15,767 17.53%17,275 66.47%65,503 90.5%84.00%
31 BB PHN II (1615)100.00%86,396 86,396 0.00%9.50%8,208 13.08%11,301 77.42%66,888 90.5%90.50%
32 V PHN I (1615)100.00%59,170 59,170 0.00%17.80%10,532 15.98%9,455 66.22%39,182 90.5%82.20%
33 V PHN I (1615)100.00%59,170 59,170 0.00%25.79%15,260 10.46%6,189 63.75%37,721 90.5%74.21%
34 PC PHN II (1615)100.00%86,996 86,996 15.44%13,432 34.09%29,657 50.47%43,907 90.5%84.56%
35 FT PHN I (1615)55.00%59,171 32,544 0.00%(0)19.70%6,411 20.18%6,567 60.12%19,565 90.5%80.30%
36 V OA I (1615)100.00%23,055 23,055 17.78%4,099 82.22%18,956 90.5%82.22%
37 VP PHN II (1670)100.00%74,076 74,076 0.00%(0)24.91%18,452 9.60%7,111 65.49%48,512 94.5%75.09%
38 MV PHN II (1670)100.00%86,996 86,996 0.00%19.20%16,703 7.50%6,525 73.30%63,768 94.5%80.80%
39 LH SPHN 90.00%99,042 89,138 0.00%18.27%16,286 33.83%30,155 47.90%42,697 94.5%81.73%
40 NC PHN I 60.00%59,171 35,503 0.00%(0)5.50%1,953 93.50%33,195 1.00%355 94.5%94.50%
41 LP PHN I 60.00%59,171 35,503 0.00%(0)6.00%2,130 93.00%33,018 1.00%355 94.5%94.00%
42 JC PHN I 60.00%59,171 35,503 0.00%(0)6.00%2,130 93.00%33,018 1.00%355 94.5%94.00%
43 LV PHN II (1688)93.00%68,939 64,113 0.00%(0)5.50%3,526 4.75%3,045 89.75%57,541 94.5%94.50%
44 EL PHN II (1720)100.00%86,396 86,396 0.00%(0)25.56%22,083 29.03%25,081 45.41%39,232 94.5%74.44%
45 AA PHN II (1720)100.00%86,396 86,396 28.46%24,588 29.72%25,677 41.82%36,131 94.5%71.54%
46 V PHN I (1720)100.00%59,171 59,171 28.00%16,568 31.00%18,343 41.00%24,260 94.5%72.00%
47 DK SPHN 65.00%110,727 71,973 20.10%14,467 51.83%37,304 28.07%20,203 94.5%79.90%
48 DK SPHN (1719)25.00%110,727 27,682 0.00%14.23%3,939 53.74%14,876 32.03%8,867 94.5%85.77%
49 SC PHN I (1719)100.00%68,938 68,938 0.00%31.08%21,426 24.13%16,635 44.79%30,877 94.5%68.92%
14.68%of Total Direct Costs
(V) MCAH INDIRECT COSTS DETAIL
TOTAL INDIRECT COSTS
FRINGE BENEFIT RATE
TOTAL WAGES
(I) Justification MCF % Per Staff76.51%
(I) MCAH PERSONNEL DETAIL
Total Match
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 5 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
50 KB PHN II (1719)100.00%86,396 86,396 0.00%(0)14.74%12,735 19.37%16,735 65.89%56,926 94.5%85.26%
51 V PHN I 60.00%59,171 35,503 6.00%2,130 12.00%4,260 82.00%29,112 94.5%94.00%
52 LV PHN I 60.00%74,075 44,445 5.82%2,587 4.74%2,107 89.44%39,752 94.5%94.18%
53 BB PHN I 60.00%68,938 41,363 0.00%(0)7.86%3,251 8.48%3,508 83.66%34,604 94.5%92.14%
54 EB PHN I 60.00%71,102 42,661 0.00%(0)8.23%3,511 9.50%4,053 82.27%35,097 94.5%91.77%
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 6 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 7 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
% PERSONNEL MATCH
TOTAL OPERATING EXPENSES 56,765 20,083 36,682
4,253 35.00%1,489 65.00%2,764
10,000 35.00%3,500 65.00%6,500
1 700 35.00%245 65.00%455
2 2,750 35.00%963 65.00%1,788
3 100 35.00%35 65.00%65
4 23,962 35.90%8,602 64.10%15,360
5 5,000 35.00%1,750 65.00%3,250
6 10,000 35.00%3,500 65.00%6,500
7
8
9
10
11
12
13
14
15
** Unmatched Operating Expenses are not eligible for Federal matching funds (Title XIX). Expenses may only be charged to Unmatched Title V (Col. 3), State General Funds (Col. 5), and/or Agency (Col. 7) funds.
% PERSONNEL MATCH
TOTAL OTHER COSTS 37,750 37,750
SUBCONTRACTS
1 7,750 100.00%7,750
2
3
4
5
OTHER CHARGES
1 15,000 100.00%15,000
2 15,000 100.00%15,000
3
4
5
Reading and Beyond
(III) BIH CAPITAL EXPENDITURE DETAIL
TOTAL CAPITAL EXPENDITURES
(IV) BIH OTHER COSTS DETAIL 66.02%
Printing 1.02%
Equipment 1.02%
TRAINING
1.02%
1.02%
1.02%
1.92%
Building Rents & Leases
Office Supplies
Postage
IT Support
(II) BIH OPERATING EXPENSES DETAIL 66.02%
Match Available
TRAVEL
Media 66.02%
Match Available
Client Support Materials 66.02%
M aternal, Child and Adolescent Health Division
MCAH BLOCK PROGRAM BUDGET
201510 MCAH BIH 5 Budget 091515 8 of 18 Printed: 10/1/2015 9:50 AM
Programs:
Agency:
(1)(2)(3)(4)(5)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)
TOTAL FUNDING %TITLE V %SGF %AFLP PYD %Agency Funds*%Combined
Fed/State %Combined
Fed/Agency*%Combined
Fed/State %Combined
Fed/Agency*
MCAH/BIH/AFLP UNMATCHED FUNDING NON-ENHANCED
MATCHING (50/50)
ENHANCED
MATCHING (75/25)201510 County of Fresno
SubK:
101,134 38,218 57,540 5,385
56.89%57,540 5.32%5,385
101,134 37.79%38,218 56.89%57,540 5.32%5,385
TOTAL PERSONNEL COSTS 594,407 163,328 39,118 330,355 61,606
264,025 72,547 17,376 146,738 27,364
330,382 90,780 21,743 183,617 34,242
INITIALSTITLE OR CLASSIFICATION %
FTE
ANNUAL SALARYTOTAL WAGES
1 EA BIH Coordinator -PHN II 70.00%84,318 59,023 37.53%22,151 23.10%13,634 39.37%23,237 91.2%62.47%
2 V BIH Coordinator -HE 100.00%47,320 47,320 42.15%19,943 57.85%27,377 91.2%57.85%
3 DS FHA Group Facilitator -HES 100.00%52,448 52,448 0.00%(0)27.45%14,397 72.55%38,051 91.2%72.55%
4 SB Community Liaison -HES 100.00%47,814 47,814 12.09%5,779 15.36%7,346 72.55%34,689 91.2%72.55%
5 V FHA Group Facilitator -HES 100.00%40,690 40,690 40.00%16,276 60.00%24,414 91.2%60.00%
6 KM FHA Group Facilitator -HEA 100.00%42,629 42,629 44.84%19,115 55.16%23,514 91.2%55.16%
7 EP Data Entry Manager -OA 50.00%36,898 18,449 30.00%5,535 70.00%12,914 91.2%70.00%
8 TZ Mental Health Professional -MSW 50.00%44,018 22,009 9.00%1,981 41.00%9,024 50.00%11,005 91.2%91.00%
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
TOTAL WAGES
(I) Justification MCF % Per StaffTotal Match79.92%
14.68%of Total Direct Costs
(V) BIH INDIRECT COSTS DETAIL
TOTAL INDIRECT COSTS
(I) BIH PERSONNEL DETAIL
FRINGE BENEFIT RATE
M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 9 of 18 Printed: 10/1/2015 9:50 AM
ORIGINAL
Budget:
Program:
Agency:
Version 1.2A-150 MCAH staffs Block Budget (I) MCAH PERSONNEL DETAIL Use the following link to access the current AFA webpage and the current base MCF% for your agency:
TOTALS 38.48 3,540,628 2,466,390 1,886,936.33
INITIALSTITLE OR CLASS.% FTE ANNUAL
SALARY
TOTAL
WAGES
FRINGE
BENEFIT
RATE %
FRINGE BENEFITS PROGRAM MCF %MCF Type Requirements
(Click link to view)
MCF % Justification
Maximum characters = 1024
1 RG Division Manager 20.00%112,974 22,595 76.51%17,286.53 MCAH 69.0%Base
2 RG MCAH Director 50.00%112,974 56,487 76.51%43,215.94 MCAH 69.0%Base
3 V MCAH Director -Physician 70.00%122,879 86,015 76.51%65,806.64 MCAH 69.0%Base
4 BA Administrative Assistant 70.00%38,038 26,627 76.51%20,371.25 MCAH 69.0%Base
5 AX Staff Analyst II 100.00%57,803 57,803 76.51%44,222.76 MCAH 69.0%Base
6 MC Accountant II 10.00%57,630 5,763 76.51%4,409.04 MCAH 69.0%Base
7 MR Account Clerk III 100.00%39,059 39,059 76.51%29,882.48 MCAH 69.0%Base
8 JD PHN II -MCAH Coordinator 100.00%84,318 84,318 76.51%64,508.33 MCAH 69.0%Base
9 EA PHN II -FIMR/SIDS Coord 30.00%84,318 25,295 76.51%19,352.19 MCAH 69.0%Base
10 TZ MSW I 30.00%44,018 13,205 76.51%10,102.62 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
11 V MSW I 100.00%44,018 44,018 76.51%33,676.41 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
12 LM MHN II 50.00%43,198 21,599 76.51%16,524.53 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
13 BV Epidemiologist 25.00%73,066 18,267 76.51%13,975.35 MCAH 69.0%Base
14 EO HEA 25.00%33,364 8,341 76.51%6,381.37 MCAH 69.0%Base
15 DV HEA 25.00%42,628 10,657 76.51%8,153.24 MCAH 69.0%Base
16 TT HEA 25.00%43,228 10,807 76.51%8,268.00 MCAH 69.0%Base
17 V HES 50.00%41,290 20,645 76.51%15,794.66 MCAH 69.0%Base
18 V HES 100.00%40,690 40,690 76.51%31,130.29 MCAH 69.0%Base
19 AV Health Educator 25.00%60,992 15,248 76.51%11,665.63 MCAH 69.0%Base
20 V SOA 100.00%32,968 32,968 76.51%25,222.50 MCAH 69.0%Base
21 V OA I 100.00%23,655 23,655 76.51%18,097.49 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
22 CM OA III 100.00%36,898 36,898 76.51%28,229.18 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
23 EP OA III 50.00%36,898 18,449 76.51%14,114.59 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
BASE MEDI-CAL FACTOR %69.01%http://www.cdph.ca.gov/services/funding/mcah/Pages/FiscalDocuments.aspx
M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 10 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
24 LW OA III 100.00%29,750 29,750 76.51%22,760.54 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
25 SR OA III 100.00%36,898 36,898 76.51%28,229.18 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
26 YL OA III 100.00%37,498 37,498 76.51%28,688.22 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
and Babies First program services from July 1, 2014 - June 30, 2015 that
had some form of Medi-Cal (Full Scope, Pregnancy Only, Presumptive
Eligibility & Applied).
27 MM SPHN (1677)11.00%110,725 12,180 76.51%9,318.43 MCAH 69.0%Base
28 MG PHN II (1677)100.00%86,396 86,396 76.51%66,098.12 MCAH 69.0%Base
29 FT PHN I (1677)45.00%59,171 26,627 76.51%20,371.25 MCAH 69.0%Base
30 MM SPHN (1615)89.00%110,725 98,545 76.51%75,392.84 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
31 BB PHN II (1615)100.00%86,396 86,396 76.51%66,098.12 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
32 V PHN I (1615)100.00%59,170 59,170 76.51%45,268.60 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
33 V PHN I (1615)100.00%59,170 59,170 76.51%45,268.60 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
34 PC PHN II (1615)100.00%86,996 86,996 76.51%66,557.16 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
35 FT PHN I (1615)55.00%59,171 32,544 76.51%24,898.11 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
36 V OA I (1615)100.00%23,055 23,055 76.51%17,638.46 MCAH 90.5%Variable YES
MCF based on the percentage of clients receiving Nurse Liaison program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
37 VP PHN II (1670)100.00%74,076 74,076 76.51%56,672.58 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving High Risk Infant program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
38 MV PHN II (1670)100.00%86,996 86,996 76.51%66,557.16 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving High Risk Infant program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
39 LH SPHN 90.00%99,042 89,138 76.51%68,195.92 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
40 NC PHN I 60.00%59,171 35,503 76.51%27,161.93 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
41 LP PHN I 60.00%59,171 35,503 76.51%27,161.93 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
42 JC PHN I 60.00%59,171 35,503 76.51%27,161.93 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
43 LV PHN II (1688)93.00%68,939 64,113 76.51%49,050.29 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
44 EL PHN II (1720)100.00%86,396 86,396 76.51%66,098.12 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 11 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
45 AA PHN II (1720)100.00%86,396 86,396 76.51%66,098.12 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
46 V PHN I (1720)100.00%59,171 59,171 76.51%45,269.37 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Babies First program
services from July 1, 2014 - June 30, 2015 that had some form of Medi-Cal
(Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
47 DK SPHN 65.00%110,727 71,973 76.51%55,063.66 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
48 DK SPHN (1719)25.00%110,727 27,682 76.51%21,178.39 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
49 SC PHN I (1719)100.00%68,938 68,938 76.51%52,741.71 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
50 KB PHN II (1719)100.00%86,396 86,396 76.51%66,098.12 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
51 V PHN I 60.00%59,171 35,503 76.51%27,161.93 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
52 LV PHN I 60.00%74,075 44,445 76.51%34,003.09 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
53 BB PHN I 60.00%68,938 41,363 76.51%31,645.18 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
54 EB PHN I 60.00%71,102 42,661 76.51%32,638.22 MCAH 94.5%Variable YES
MCF based on the percentage of clients receiving Nurse-Family Partnership
program services from July 1, 2014 - June 30, 2015 that had some form of
Medi-Cal (Full Scope, Pregnancy Only, Presumptive Eligibility & Applied).
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68
69
70
71
72
73
74
M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 12 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
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M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 13 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
124
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M aternal, Child and Adolescent Health Division
(I) Justification
201510 MCAH BIH 5 Budget 091515 14 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
SubK:
(I) BIH PERSONNEL DETAIL Use the following link to access the current AFA webpage and the current base MCF% for your agency:
TOTALS 6.70 396,135 330,382 264,025.44
INITIALSTITLE OR CLASS.% FTE ANNUAL
SALARY
TOTAL
WAGES
BENEFIT
RATE %FRINGE BENEFITS PROGRAM MCF %MCF Type Requirements
(Click link to view)
MCF % Justification
Maximum characters = 1024
1 EA BIH Coordinator -PHN II 70.00%84,318 59,023 79.92%47,168.35 BIH 91.2%Base
2 V BIH Coordinator -HE 100.00%47,320 47,320 79.92%37,815.87 BIH 91.2%Base
3 DS FHA Group Facilitator -HES 100.00%52,448 52,448 79.92%41,913.92 BIH 91.2%Base
4 SB Community Liaison -HES 100.00%47,814 47,814 79.92%38,210.65 BIH 91.2%Base
5 V FHA Group Facilitator -HES 100.00%40,690 40,690 79.92%32,517.49 BIH 91.2%Base
6 KM FHA Group Facilitator -HEA 100.00%42,629 42,629 79.92%34,067.05 BIH 91.2%Base
7 EP Data Entry Manager -OA 50.00%36,898 18,449 79.92%14,743.56 BIH 91.2%Base
8 TZ Mental Health Professional -MSW 50.00%44,018 22,009 79.92%17,588.54 BIH 91.2%Base
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BASE MEDI-CAL FACTOR %91.20%http://www.cdph.ca.gov/services/funding/mcah/Pages/FiscalDocuments.aspx
(II-V) Justifications
201510 MCAH BIH 5 Budget 091515 Page 15 of 18 Printed: 10/1/2015 9:50 AM
ORIGINAL
Budget:
Program:
Agency:
SubK:
Version 1.2A-150 MCAH staffs Block Budget
(II) MCAH OPERATING EXPENSES JUSTIFICATION
TOTAL OPERATING EXPENSES 793,654
69,298 Reimbursement for staff for private auto mileage at rate of
$0.575/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
for meals & lodging for out of County travel.
17,203 Registration fees to attend required & related conferences,
trainings, workshops & meetings for MCAH staff. Trainings are
located in Fresno County, Sacramento & throughout
California, & on occasion out of state. Fresno will seek State
approval prior to any out of state travel. Includes MCAH Action
& CDPH meetings.
1 151,537 Allocated according to site & program footage. MCAH is
located at 2 sites. MCAH is 6,266 sq ft of Brix total 67,321 sq
ft (9.25%). MCAH is 2,731 sq ft of West Fresno total 37,617
sq ft (7.26%). MCAH's share of West Fresno lease $107,345.
Includes warehouse storage space for archived files.
2 36,485 Allocated according to site & program footage. MCAH is
located at 2 sites. MCAH is 6,266 sq ft of Brix total 67,321 sq
ft (9.25%). MCAH is 2,731 sq ft of West Fresno total 37,617
sq ft (7.26%).
3 12,011 Allocated according to site & program footage. MCAH is
located at 2 sites. MCAH is 6,266 sq ft of Brix total 67,321 sq
ft (9.25%). MCAH is 2,731 sq ft of West Fresno total 37,617
sq ft (7.26%). Includes fire alarm maintenance charges.
4 17,438 Janitorial expenses, furniture moves, thermostat repairs &
copier/FAX machine maintenances.
5 13,560 Costs of long distance & local service, cell phones &
telephone relocation. Rate provided by Fresno County
ITSD/Communications & is based on type of device used.
6 16,027 General office expenses for staff to carry out day to day
MCAH activities. Includes paper, pens, ink, staplers, calendars
& other like items.
7 1,447 Regular mail postage, Federal Express & overnight mail for
correspondences with clients, the public & CDPH.
8 13,315 Charges related to office printing, chart forms, facilitators &
informational handouts. Includes printing related to
breastfeeding education for CPSP coordinator & breastfeeding
coordinator's work with OB providers & hospitals toward Baby-
Friendly initiative.
9 4,061 Assessment tools such as stethoscopes, thermometers, infant
weight scales & latex gloves.
10 90,718 All programs switching to electronic medical health record
system. Staff share of the new electronic medical record
system & costs associated with transition to the new system;
installation, training, project management, maintenance &
support fees.
11 81,550 Equipment needed for electronic medical record system.
Estimated cost for 30 tablets/laptops, 2 color printers & 2
printers. Also includes copy machine leases.
12 269,004 Provides technical & maintenance support of all computer
systems utilized by MCAH. Assists with management
information systems used for evaluation of programs. Includes
charges for PC leases, LAN Admin, information & e-mail
storage & cabling.
13
14
15
ORIGINAL
MCAH/BIH/AFLP
Facilities
TRAVEL
201510 County of Fresno
TRAINING
Household Expenses/Maintenance
Telephones
Utilities
Security
Printing
Medical Supplies
Office Supplies
Postage
IT Support
Software
Equipment
MCAH BIH AFLP
(II-V) Justifications
201510 MCAH BIH 5 Budget 091515 Page 16 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
SubK:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
MCAH BIH AFLP
(IV) MCAH OTHER COSTS JUSTIFICATION
TOTAL OTHER COSTS 961,225
SUBCONTRACTS
1 870,760 An integrated system of health, behavioral health & child
welfare, which will ensure access to appropriate early
intervention services for children birth through 5 years in
Fresno County. Includes salaries/benefits for staff linking
children/families to services, as well as a percentage of
operational costs.
2 16,276 Contract with Nurse-Family Partnership, Inc. in Denver,
Colorado for ongoing technical assistance & program
evaluation.
3 15,000 To be selected through a competitive Request for Proposal
(bidding process) to provide expertise in quantitative &
qualitative evaluation for MCAH programs and assist in
monitoring program progress in meeting SOW objectives.
4 25,000 Independent consultant to assist local birthing hospitals to
become Baby Friendly. Provide expertise, training and
guidance in pursuing the Baby Friendly Hospital Initiative.
Assist with tracking the impact/outcome of each hospital’s
policy development and implementation progress.
5
OTHER CHARGES
1 2,660 Materials in English/Spanish that are provided to clients
regarding perinatal care & caring for babies & children.
2 8,529 Includes items for promotion of MCAH programs during
outreach efforts and for clients in care coordination/case
management programs. It is in compliance with the State's
moratorium on promotional items.
3 13,000 Written & oral translation services for threshold languages
including Spanish, Lao, Cambodian, Hmong, Punjabi &
Vietnamese to assist MCAH staff in communicating with non-
English speaking clients, thus allowing staff to effectively link
these clients to Medi-Cal services.
4 10,000 Costs related to movie theater marketing and digital
advertising messaging to promote pre-conception health, early
prenatal care and overall health as a part of the MCAH scope
of work.
5
(V) MCAH INDIRECT COSTS JUSTIFICATION
TOTAL INDIRECT COSTS 772,527 Per CDPH approved ICR
Exceptional Parents Unlimited, Inc. (SMART Model o
Carol Melcher Consulting
Nurse-Family Partnership
Program Evaluator
Client Support Materials
Interpreters
Books & Publications
Media
(II-V) Justifications
201510 MCAH BIH 5 Budget 091515 Page 17 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
SubK:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
MCAH BIH AFLP
(II) BIH OPERATING EXPENSES JUSTIFICATION
TOTAL OPERATING EXPENSES 56,765
4,253 Reimbursement for staff private auto mileage when they travel
to BIH program related meetings, sites & home visits. Mileage
reimbursement rate is $.575/mile. Fresno County will only bill
up to the State's per diem rate. Also includes expenses for
lodging & meals when traveling out of the County.
10,000 Registration fees to attend required & related conferences,
trainings, workshops & other meetings for BIH staff. Trainings
are located in Fresno County, Sacramento & throughout
California. Includes CDPH BIH meetings.
1 700 Warehouse storage space for archived files & supplies.
2 2,750 General office expenses for staff to carry out day to day BIH
activities. This includes paper, pens, ink, staples, calendars &
other like items.
3 100 Regular mail postage, Federal Express & overnight mail for
correspondences with BIH clients, the public & CDPH.
4 23,962 Provides technical & maintenance support of all computer
systems utilized by MCAH/BIH. Assists with management
information systems used for evaluation of programs. Includes
charges for LAN Administration, HIPAA Compliant Storage,
Equipment Administration, Application Hosting,
Information/Email Storage & Administration, I-Net Line, I-Net
Logon, Enterprise Base, PC Rental, MS Enterprise,
PeopleSoft HR, PeopleSoft Financials Management.
5 5,000 Charges related to printing marketing materials in-house, staff
business cards and group materials, including State BIH
promotional materials.
6 10,000 Equipment needed include, 2 laptops, speakers,
projector/screen, 4 phones, 1 color and 1 printer
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(IV) BIH OTHER COSTS JUSTIFICATION
TOTAL OTHER COSTS 37,750
SUBCONTRACTS
1 7,750 Subcontract for childcare services for clients attending group
interventions for BIH/MCAH program activities.
2
3
4
5
OTHER CHARGES
1 15,000 Items for promotion of the BIH program during outreach efforts
and for clients in care coordination/case management
programs.
2 15,000 Radio public service annoucements with local radio stations to
provide indirect outreach and messaging of BIH program
activities.
3
4
Reading and Beyond
TRAVEL
TRAINING
Building Rents & Leases
Office Supplies
Postage
IT Support
Printing
Equipment
Media
Client Support Materials
(II-V) Justifications
201510 MCAH BIH 5 Budget 091515 Page 18 of 18 Printed: 10/1/2015 9:50 AM
Budget:
Program:
Agency:
SubK:
ORIGINAL
MCAH/BIH/AFLP
201510 County of Fresno
MCAH BIH AFLP
5
(V) BIH INDIRECT COSTS JUSTIFICATION
TOTAL INDIRECT COSTS 101,134 Per CDPH approved ICR
AGREEMENT BETWEEN THE COUNTY OF FRESNO AND THE STATE or CALlFORNIA
No.: CA Department. of Public Health
\t1aterna l , Child and Adolescent Health and
Black Infant HealtJ1 Programs
Agreement if20 l 5 ! 0 -FY 20 ! 5-16
APPROVED AS TO LEGAL FOR_YI:
DANIEL C. CEDERBORG,
COUNTY COUNSEL
APPROVED AS TO ACCOUJ\'TJ)J'G FOR\t1:
VICKI CRO\V, C.P.i\., AUDTTOR-CONTROLLER/
TREASURER -TAX COLLECTOR
By {)£ Z£&e1 f-=
Term: Julv 1.2015-JuneJO. 20l6
::::vo;g:z;D FOR APPROVAL•
David Porn av i Ile
Direclor
Department of Public Health
Fund/Subclass:
Organization #:
Revenue:
ks
0001/10000
56201706, 1700
4382