HomeMy WebLinkAbout20122805.tiff RESOLUTION
RE: APPROVE MEMORANDUM OF AGREEMENT FOR LOCAL INFANT LIFE INITIATIVE
(LILI) PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Weld County Department of Public Health and Environment (WCDPHE)
wishes to cooperate with the Registrar of Vital Statistics in the Health Statistics Section of the
Colorado Department of Public Health and Environment (CDPHE), in the Local Infant Life
Initiative (LILI) program, and
WHEREAS, the LILT program authorizes and limits the ability of the WCDPHE to use
certain vital statistics information, such as death certificates and fetal death certificates, to
conduct analyses of the contributing factors to infant death and fetal death in Weld County, and
WHEREAS, the LILI program is designed to help local health care providers, including
the WCDPHE, to better protect against future infant and fetal deaths, and
WHEREAS, participation in the LILI program by grieving parents is entirely voluntary,
and
WHEREAS, the Board has been presented with a Memorandum of Agreement between
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, and the State of Colorado Department of Public Health and Environment, Health
Statistics Section, commencing upon full execution, with further terms and conditions being as
stated in said Memorandum of Agreement regarding the parties respective responsibilities
regarding the Local Infant Life Initiative.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Memorandum of Agreement be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair is authorized to sign said
Memorandum of Agreement.
'
14.6
1_ 2012-2805
�� _/�- HL0039
MEMORANDUM OF AGREEMENT FOR LOCAL INFANT LIFE INITIATIVE (LILI) PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 3rd day of October, A.D., 2012.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: 61).
Sean P. Con y, Chair - -
Weld County Clerk to the Board — �J
I F. Garc , ro-Tem
BY:
Deputy Cler.ro the Boar:
r Kirkmeyer
4-
JavidAPP AS T R ,,461 . } ;, ~"°l� � r-kkl �• E. Long -�
Co 'money _ rt:),
Douglas/Rademacher
Date of signature:
2012-2805
H L0039
1861 - 2011 DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO 80631
Public Health
.` Web: http://www.co.weld.co.us/departments/healthenvironment/
WE L 1 / O U N T Y Health Administration Public Health&Clinical Environmental Health Communication, Emergency Preparedness
Vital Records Services Services Education&Planning &Response
Tele:970,304.6410 Tele:970.304.6420 Tele:970.304.6415 Tele:970.304.6470 Tele:970.304.6420
Fax. 970.304.6412 Fax: 970.304.6416 Fax: 970.304.6411 Fax: 970.304.6452 Fax: 970.304.6469
Our vision:Together with the communities we serve,we are working to make Weld County the healthiest place to live,learn,work and play.
Memorandum of Agreement between
the Colorado Department of Public Health and Environment, Health Statistics Section
and the Weld County Department of Public Health and Environment
Title of Project: LILI (Local Infant Life Initiative)
Purpose: To decrease Weld County infant and fetal mortality by implementing community based systems
changes utilizing information derived from maternal interviews, medical records, and vital statistics.
Coordinating Agency: Weld County Department of Public Health and Environment
1555 N 17th Avenue
Greeley, CO 80631
Project Coordinator: Melanie Cyphers, RN
Address: Weld County Department of Public
1555 N 17th Avenue
Greeley, CO 80631
Phone: 970-304-6470 X 2423
Fax: 970-304-6452
Email Address: mcyphers@co.weld.co.us
Executive Director: Mark Wallace, MD
Address: Weld County Department of Public
1555 N 174,Avenue
Greeley,CO 80631
Phone: 970-304-6470
Fax: 970-304-6452
Email Address: mwallace@co.weld.co.us
General Terms, Conditions and Understandings
This memorandum of agreement made this 10th day of September 2012, between the Colorado Department of
Public Health and Environment, Health Statistics Section (HSS) and the Weld County Department of Public
Health and Environment (WCDPHE) sets forth the understanding of the parties hereto as to the terms and
conditions. Such terms and conditions are as follows:
1. The agreed upon age of a fetus in this memorandum is 24 weeks gestation to birth.
2. The agreed upon age of an infant is birth to one year of age.
3. The HSS agrees to provide to WCDPHE de-identified electronic files of records in Microsoft Access format
of birth and death Colorado birth and death records for both fetal and infant deaths in which mom was a resident
of Weld County (regardless of county in Colorado death took place) on or within 1 week after the 15th of
January, March, May, July, September, and November. (Each file would contain data from the previous 2
months.)
aoi.- aue5
a. For requested fields for Birth Certificate, see attachment 1
b. For Requested fields for fetal death certificate, see attachment 2.
c. For requested fields for infant death certificate, see attachment 3.
4. If death certificate is unavailable due to death of infant or fetus occurring out of state, HSS is not obligated to
provide record.
5. The HSS agrees to send an initial contact letter in both English and Spanish to the parents of deceased infants
or fetuses requesting consent for contact with WCDPHE. (See attachments 4-7.) Letters will be mailed in
January, March, May, July, September, and November.
6. WCDPHE agrees to track the positive consents received and contact HSS to match responders with
corresponding death certificates.
7. WCDPHE agrees the LILI interviewer will only follow up with families who have given positive consent.
8. WCDPHE agrees to keep vital statistics records in a secure, locked cabinet with access limited to the LILI
Review Team.
9. WCDPHE agrees to only make copies of records as necessary for team review at a closed meeting, collect
and maintain all records after the meeting, and destroy all records after one year except de-identified
information abstracted from vital records that are deemed necessary for case evaluation and reporting purposes.
10. All members of the WCDPHE LILI Review Team will sign a confidentiality agreement stating no member
will keep a copy of the vital statistics and will not discuss or disclose to any other person the existence or
contents of said records.
11. The WCDPHE LILI coordinator will immediately notify MSS of any breach of security involving the vital
records in their possession or data abstracted from them and assist in the investigation of the breach.
12. Reimbursement: WCDPHE will reimburse HSS for the initial set up costs for data preparation and parental
notification, and an annual program maintenance fee based on actual expenses of electronically sending records
and mailing out parent consent letters. Payment will be sent after the receipt of an invoice for services rendered.
IN WITNESS WHEREOF, the parties have executed this Memorandum of Agreement the day and year first
above written.
CDPHE HEALTH STATISTICS SECTION CHAIR, WELD COUNTY BOARD OF COUNTY
REGISTRAR OF VITAL STATISTICS COMMISSIONERS
Date: J - z- iZ Date: OCT 0 3 2012 C
&%2- en05
Attachment 1- Requested Fields from Birth Certificate:
• State File #
• Date and time of birth
• Mother's birth place
• Mother's age
• Sex of infant
• County of birth
• Father's place of birth
• Father's age
Attachment 2 - Data fields requested from fetal death certificate:
• Death certificate #
• Date of delivery
• Gender
• Facility name
• City of Delivery
• County of delivery
• Mother's age
• Mother's residence county and state
• Mother's race
• Mother Hispanic, y/n
• Mother's highest level of education
• Father's age
• Father's race
• Father Hispanic, y/n
• Father's highest level of education
• Method of disposition
• Causes of death
• Other significant conditions
• Estimated gestation
• Autopsy, y/n
• All pregnancy history
• Mother married, y/n
• Month pregnancy prenatal care began
• Prenatal visits total
• Weight of fetus
• Plurality
• Delivery order
• Medical risk factors for this pregnancy
• Other risk factors
• Complications of labor and delivery
• Obstetric procedures
• Method of delivery
• Congenital anomalies of fetus
Attachment 3- Data fields requested from infant death certificate:
• Death certificate #
• Sex
• Date of death
• Age
• Date of birth
• Place of birth(county and state)
• Place of death
• Facility of death
• City and county of death
• Spanish origin
• Race
• Method of disposition
• Coroner notified
• Manner of death
• Injury details if applicable
• Immediate cause of death
• Other significant conditions
• Autopsy performed, y/n
• Autopsy findings used
Attachment 4
Date:
To The Parents Of:
Address
City, State Zip code
Dear Parents:
Please accept our deepest sympathies on the loss of your baby. The loss of a child affects parents deeply, and
we know this is a difficult time for you.
The Weld County Department of Public Health and Environment(WCDPHE) is working to try to prevent
tragedies like this in Weld County. WCDPHE has created a program called LILI (Local Infant Life Initiative)to
gather information, review it, and then take action to prevent similar deaths from occurring. In order to further
understand why these losses are occurring, we need your help. You may participate in this program by:
1. Sharing your personal experiences related to the loss of your baby, including the quality of service
provided and services you may have wanted, with a LILI representative; and
2. Permitting a review of confidential records, including medical and other pertinent records, related to your
pregnancy and the loss of your baby.
Your participation in this process is voluntary and personal information will be kept confidential.
If you would like to participate in the LILI program, please contact Cindy Kronauge at the WCDPHE at 970-
304-6470 x 2221 or return the enclosed postage-paid card. If you choose not to call or return the postcard, be
assured that no one will contact you, and your contact information will not be released.
Sincerely,
Colorado State Registrar.
Attachment 5
Fecha:
A los padres de:
Direccion:
Ciudad, Estado, Casilla Postal
Estimados Padres de Familia:
Por favor acepte nuestras mas profundas condolencias por la perdida de su bebe. La perdida de un nifio afecta a
los padres profundamente, y nosotros sabemos que es un tiempo dificil para usted.
El Departamento de Salud y Medio Ambiente del Condado Weld (Weld County Department of Public Health
and Environment- WCDPHE) esta trabajando para tratar de prevenir tragedias como esta en el Condado Weld.
WCDPHE ha creado un programa llamado LILI (por sus siglas en ingles: Iniciativa Local por la Vida Infantil)
para reunir informacion, revisarla, y entonces tomar accion para prevenir que ocurran muertes similares. Para
comprender mas adelante porque estas perdidas estan ocurriendo, nosotros necesitamos su ayuda. Usted puede
participar en este programa de este modo:
1. Compartiendo sus experiencias personales relacionadas a la perdida de su bebe, incluyendo la calidad de
servicio proveido y servicios que usted puede haber querido, con un representante de LILI; y
2. Permitiendo una revision de records confidenciales, incluyendo records medicos y otros records
pertinentes, relacionados a su embarazo y la perdida de su bebe.
Su participacion en este proceso es voluntaria y su informacion personal sera mantenida confidencialmente.
Si a usted le gustaria participar en el programa LILI, por favor comuniquese con Melanie Cyphers al WCDPHE
al 970.304.6420 x 2423 o retorne la tarjeta incluida con porte de correo pagado. Si usted escoge no llamar o
retomar la tarjeta, este Segura que nadie la contactara, y su informacion de contacto no sera revelada.
Sinceramente,
Colorado State Registrar.
Attachment 6
LILI Response Card
❑ I give permission for someone from the LILI program at Weld County Department of Public Health and
Environment to call me regarding my experience of infant loss or miscarriage.
❑ I give permission for the LILI program with the Weld County Department of Public Health and Environment
to view all pertinent medical records and the birth and death certificates of my child. (This information will
remain confidential and will not be made public.)
If you do not wish to participate in the LILI program and do not want anyone to call you regarding this, it is not
necessary to return this card. Please be assured no one will contact you and your contact information will not be
released.
Name: Best phone number to reach
you:
Address: Best time to call: morning 0 afternoon 0
evening 0
J han& qeu. pvt conoidethzg paxt<cipatcan in tIle LIES 7 pwwcacn.
With yawn help, we can ,,nbwe the ruunteac of infant Beat& in Weld Count*
Attachment 7
Tarjeta de Respuesta del Programa LILI
❑ Yo doy permiso para que alguien del Programa LILI del Condado Weld en el Department of Public Health
and Environment me llame acerca de mi experiencia con la perdida de un infante o aborto.
❑ Yo doy permiso para el Programa LILI en el Weld County Department of Public Health and Environment
yea todos los records medicos y los certificados de fallecimiento de mi hijo. (Esta informacion permanecera
privada y no sera hecha publics.)
Si usted no quiere estar involucrada en el Programa LILI y no quiere que nadie la llame acerca de esto, no
necesita devolver esta tarjeta. Si usted escoge no devolver esta tarjeta, nadie la llamara y su informacion de
contacto no sera revelada.
Nombre: El mejor numero de telefono para
contactarla:
Direccion: El mejor tiempo para llamarla: O maiiana ❑ tarde
❑ noche
Gracias por su tiempo y consideracion con eiPrograma GILL
Con su ayuc[a, nosotros podemos reducir e(numero de muertes infantifes en el
Condado WeCd, CO.
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