HomeMy WebLinkAbout20110439.tiff RESOLUTION
RE: APPROVE GRANT CONTINUATION APPLICATION FOR FISCAL YEARS 2011 AND
2012, INCLUDING 2010 PROGRESS REPORT, FOR NURSE HOME VISITOR 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 Board has been presented with a Grant Continuation Application for Fiscal
Years 2011 and 2012, for the Nurse Home Visitor Program, commencing July 1, 2011, and ending
June 30, 2012, including the 2010 Progress Report, for the period commencing July 1, 2010,
through January 31, 2011,from the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Weld County Department of Public Health
and Environment,to the Colorado Department of Public Health and Environment,with further terms
and conditions being as stated in said application, and
WHEREAS, after review,the Board deems it advisable to approve said application, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado,that the Grant Continuation Application for Fiscal Years 2011 and 2012, including
the 2010 Progress Report, for the Nurse Home Visitor Program from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Weld County Department of Public Health and Environment,to the Colorado Department of Public
Health and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application
cJS,„j \ Q tc0 o'c.:a"t-- 2011-0439
ty_tt 3" i���� HL0038
GRANT CONTINUATION APPLICATION FOR FISCAL YEARS 2011 AND 2012, INCLUDING 2010
PROGRESS REPORT, FOR NURSE HOME VISITOR PROGRAM
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 14th day of February, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD OUNTY, RADO
ATTEST: ",�
Ba ara Kirkmeye , Chair
Weld County Cle
S
' �_ ,� Sean P. i y, Pro-Te
BY: / ��.vfi�w' ��.�� t(
Deputy Clerk to t
Willi F. arcia
APPROVED AS TO FORM: eve.
David E. Long
ty Atto ey
j f Dougla Radema her
Date of signature: Si
2011-0439
HL0038
86 zo Memorandum
1TO: Barbara o, Chair
of County Commissioners Board County C
WELD COUNTY FROM: Mark E. Wallace, MD, MPH, Director
I ( Department of Public Health and
uEnvironment
DATE: February 2, 2011
SUBJECT: Nurse Home Visitor Grant Proposal
Enclosed for Board review and approval is the Grant Proposal between the Colorado Department
of Public Health and Environment and Weld County Board of Commissioners for the
Department of Public Health and Environment's Nurse Home Visitor program.
Funding for this program will be provided by Colorado State Tobacco Settlement Funds and
Medicaid payments for targeted case management services. Weld County Department of Public
Health and Environment is applying for funding in the amount of$717,749 with $641,659
coming from the State Nurse Home Visitor Program and approximately $76,090 from Medicaid
reimbursements. These funds are for activities performed during the time period of July 1, 2011
through June 30, 2012.
The grant will fund 8 FTE including 1 FTE OT, 6 FTE Public Health Nurse II andl FTE Public
Health Nurse III, supervisor. This will fund existing staff while making the supervisory position
a full time position.
At no cost to the client, specially trained registered nurses provide bi-monthly home visits to
low-income, first time mothers residing in Weld County. These home visits begin in pregnancy
and continue until the client's child reaches the age of two years. Clients are educated and
encouraged to develop positive maternal/child health practices, and understanding of
infant/toddler developmental needs, effective parenting, and maternal economic self-sufficiency.
I recommend your approval of this request for funding.
Enclosure
2011-0439
0 • Attachment A
FY2011-12 Colorado Nurse Home Visitor Program
CONTINUATION APPLICATION(2010 Progress Report) CHECKLIST: Materials must be submitted in the order listed bolo'
Name of Agency: _Weld County Department of Public Health & Environment
Attachment A: Application Checklist
tgl Continuation Application(2010 Progress Report)Cover Sheet. This page must be typed and signed.
r. Continuation Application (2010 Progress Report), not including the budget page (Attachment Cl), Expenditures-
to-date Report (AttachmentC2) and other attachments, is limited to no more than seven (7) single-spaced, 81 x 11
numbered pages.Use Courier font, 10 pt.
p Attachment Cl: FY2011-12 Proposed Continuation Budget for the period of July 1, 2011 through June 30,2012.
p Attachment C2: FY2010-11 Expenditures-to-Date Report for the period of July 1,2010 through January 31, 2011.
CI Electronic Excel copy of Attachments Cl and C2 emailed to Julie Becker by 4:00 pm on February 11,2011 at:
julie.becker@state.co.us.
SI Attachment D: Assurance of Intention to Meet Program Requirements
94 Attachment E: Assurance of Intention to be an Active Medicaid Provider
illl Attachment F: Assurance of Intention to Follow Caseload Guidelines
Assembly and Submission:
• Binding: All materials must be binder clipped ONLY. Rubberbands,staples and paperclips are not allowed.
• Signatures: Cover Sheet must be signed by both the agency authorized signer and the NFP Supervisor.
• Copies: One(1) original and four(4) copies. Five complete sets of all required materials,including attachments.
• Complete: All items listed in the Application Checklist (Attachment A) are included in each copy. Excel copies of
attachments C1 and C2 are emailed to Julie Becker.
• Due Date: Received by CDPHE on or before Tuesday, February 11,2011 by 4:00 p.m.
• Mailed or delivered to:
Mary Martin,Home Visitation Programs Director
CDPHE
4300 Cherry Creek Drive South,PSD-A4
Denver,CO 80246-1530
17
eYC//—C T-3 l
FY2011-12 Colorado Nurse it me Visitor Program • O ,
CONTINUATION APPLICATION(2010 Progress Report) COVER SHEET 1/467'
1. Name of Agency:Weld County Department of Public Health and Environment
Address/City/Zip 1555 North 17th Avenue Greeley, CO 80631
2. For the period of July 1,2011 through June 30,2012,please indicate:
Total funding request: $ 721, 630
County(ies) to be served:Weld
Total number of families to be served/caseload: 150
Total FTE to be funded: 8.0 FTE
Total number of nurse home visitors to be funded: 6 .0 FTE
3. Name of person completing Progress Report: Barbara Francisco
Position/Title: Nurse-Family Partnership Supervisor
Telephone: 970-304-6420 ext.2186 FAX: 970-304-6416
E-Mail: bfrancisco@co.weld.co.us
4. Name of Authorized Signer: Barbara Kirkmever
Position/Title: Chair, Weld County Board of Commissioners
Telephone: (970)356-4000 X4200 FAX: (970)352-0242
E-mail: bkirkmever@co.weld.co.us
Signature(Authorized Signer):0/v( -`� i �d it.i FEB 1 4 2011
Signature:(NFP Supervisor):X - Z,i`. � r.� ,
Signature indicates review and approval of application as submitted."
5. Name of Agency Contract Administrator:FY2011-12 contract:
Name: Wendy Paris
EmailAddress:wparis@co.weld.co.us Phone: 970-304-6410 ext 2116 ,>?C//- C'439
9
FY2011-12 Colorado Nurse Home Visitor Program
Part A. 2010 Progress Report.
1.Provide the 2010-11 CDPHE funded 150
caseload for your agency
2.Note your agency's NFP caseload on
Feb.1 2011 and include your source of 138
information(itmaybefromyourown This information comes from the NHV Home Visit Itinerary
records) forms that are updated weekly by our office technician.
3.Indicate the number of clients served June 30,2010: 133
for the last 3 quarters(those that had a September 30,2010: 146
least one home visit) December 31,2010: 136
Please data from the Quarterly
Summary Tables reports for the
quarters ending in June and September.
You may use data from your own
records for quarter ending in December
4.If your caseload size did not meet One FTE was converted to a job share position of two 0.5
CDPHE contract requirements during FTEs with a current nurse home visitor going from 1.0 FTE
any of the reporting periods above to 0.5 FTE, effective 6/28/2010. She carried a caseload
(Quarters ending June 30,2010, of 15 clients until 2 graduations brought her down to 13 .
September 30,2010 and December 31, A Weld County sunset review was conducted to assess the
need to hire another nurse home visitor for the 0.5 FTE
2010)explainwhyanddescribehow
and once approval was given the position was advertised.
and when your team will achieve
A 0.5 FTE nurse home visitor was hired and reported to
funded caseload size. work on November 16, 2010. She received Unit Two
training the week of 01/10/2011 and has begun to build
her caseload. I anticipate that this NHV will be at
caseload (12 clients) by 05/01/2011.
Referrals slowed down over the summer and stayed sluggish
until December, 2010. Several NHVs and the supervisor did
community outreach from 9/10 - 12/10 to increase
referrals. We currently have 24 referrals on our waiting
list and 13 referrals in the process of being contacted &
evaluated for enrollment.
Program Outcome Indicator Chosen by site on which to focus Intensive Quality Improvement
5.Program Outcome Indicator Outcome Date began Participants
to focus on
Reduce Infancy Phase July 2010 Supervisor and Team
Attrition
6.Program Outcome Indicator Rationale: Retention of clients is essential to achieving long term
program outcomes.
7.Program Outcome Indicator Current Status: 33% Attrition in Infancy Phase
10
8.Progra Outcome Indicator Outcome m achieve: Decreased attrition in e infancy phase
9.Program Outcome Indicator Strategy Responsible persons How measured
1.Upon enrollment in NFP Nurse Home Visitors NHVs will scale (1 -10) new
the NHV will clearly clients' enthusiasm for the
explains the duration & program.
client & RN
responsibilities of the
program.
2 .Clients will receive a Nurse Home Visitors Feedback from clients
welcome letter signed by Office Technician
the NFP team. Supervisor
3.Using the new curriculum
NHVs will tailor the
program to the desires,
goals, & needs of each
client. Clients are given
permission to ask for Nurse Home Visitors & Feedback from clients
change in visit schedule or Office Technician
visit structure.
4.Clients will receive a
certificate of
accomplishment at Nurse Home Visitors Increased client retention
completion of each program
phase & completion of the
program.
5.NHVs will begin
discussion of the benefits Supervisor Decreased Client Attrition
of NFP when caring for a
newborn, infant & toddler
during the pregnancy phase.
6 .Referral sources will be Decreased number in
reminded about the Supervisor referrals who decline to
importance of a referral NHVs enroll.
showing interest in the Office Technician
program & clearly
explaining program length.
Also the importance of
early enrollment Discuss client scenarios &
7.NHVs will increase role play in team meetings
proficiency in & supervision.
Motivational Interviewing NHVs
techniques.
8. NHVs will offer to video
clients and their children
& will provide the client
with a compilation DVD as a Decreased infancy attrition
graduation present.
10.Program Outcome Indicator Ongoing Evaluation:
Cumulative data from QST "Attrition During Infancy" indicates we remain at 33.3%
attrition, the same as 2009. Implementation reports show that 70.12% of our clients
are between 15 & 19 years of age and live with parents, family members or FOC family.
Data from the QST report of 9/30/10 indicates that 25% returned to or started
employment & 21.9% returned to school. The Weld County school districts require new
moms to return to school 2 weeks after delivery. 15 .6% of clients who left the program
did so after being pressured by family & 18.8% felt they had received what they wanted
from the program during pregnancy.
We continue to be challenged by the cultural influences in the Hispanic families we
serve (70.4% of clients) that support clients' female relatives as the experts in
child development and child care. Our teen clients are susceptible to this influence
11
and also are easily overwheiZlfed with expectations from schoo , and with some clients,
the need for employment to provide for themselves, their children and many times to
assist with supporting other family members. Referrals are arriving when potential
clients are early in pregnancy now. NHVs are becoming more comfortable with MI
techniques. Some do some visits at school or place of employment during lunch hour.
Team cannot visit after 5 or weekends due to Weld County HD policy. Nurses have made
program expectations clear and realistic to clients. Nurses have offered spaced out
visit schedules or breaks for clients in hopes of retaining them in the long term.
Client Intervention/Process Chosen by site on which to focus Intensive Quality Improvement
11.Client Intervention/Process to focus Date began Participants
on
Motivational Interviewing Aug 2010 Supervisor and team
12.Clientlntervention/ProcessRationale: MI is a valuable tool to use with our vulnerable
population, as it works to promote self-efficacy
13.Client Intervention/Process Current Status: Team continues to work on their skills.
14.Client Intervention/Process Outcomes to achieve:Team continues to improve skills, client retention
increases
15.Client Intervention/Process Strategy Responsible persons How measured
1.Use MI workbook examples Supervisor & team NHVs will self report
in team meetings and increased success with MI
supervision meetings. techniques.
Observation of MI skills
during supervisory client
visits. Attrition in
infancy phase will
2 .Ask each team member to Supervisor & team decrease.
lead one team meeting
discussion about MI Same as above
techniques.
16.Client Intervention/Process Ongoing Evaluation:
NHVs report improvement in gaining information and developing stronger therapeutic
relationships with clients. There is still some reticence about pursuing information
from a client who is uncomfortable sharing or is distrustful of the NHV's intentions
in asking. The greatest challenge for the NHVs seems to be encouraging a nonverbal
client to give any information. We continue to discuss and role play how to persist
using MI open ended questions, reflection and observation to avoid one word answers.
Program Implementation/Structural Indicator Chosen by site on which to focus Intensive Quality Improvement
17.Program Implementation/Structural Date began Participants
Indicator to focus on
Supervisor, team, IIK
Increase program's exposure July 2010 advisory board,
in the community. administrator/
18.Program Implementation/Structural Indicator Rationale: Community support is essential for the
transfer of commitment to the program and for long-term sustainability.
19.Program Implementation/Structural Indicator Current Status:
12
Well attended advisory bond, •
Wsupportive administrator, nedirector of Division of
Public Health (Health Department) , new Public Health Manager to whom I report.
20.Program Implementation/Structural Indicator Outcomes to achieve:
Increased community awareness of program and increased number of referrals.
21.Program Implementation/Structural Responsible persons How measured
Indicator Strategy
Educate new director and Supervisor and IIK Director & manager will
manager about NFP operating Consultant understand the unique
structure and supervisor structure of the NFP
duties. program and will make
informed decisions that
support the program.
Maintain Executive Supervisor Exec. Director will
Director's support continue to demonstrate
support for the Weld County
NFP program through words
and actions.
Supervisor, team & IIK Consistent attendance by
Consider Advisory Board
consultant active board members.
membership & determine if
recruitment of new members
Purge inactive board
is warranted.
members from the roster
after discussing their
inactive status with them.
Invite new individuals to
become members of the
Advisory Board.
22.Program Implementation/Structural Indicator Ongoing Evaluation:
The new Division of Public Health Director attended the 3`a quarter meeting and the
new Public Health Manager attended the 4th quarter meeting. The invitation to join our
Advisory Board was extended to 2 new community members: the Weld County Division of
Public Health nurse liaison to the Youth and Family Connects program and the director
of the Best Start for Babies program, a new parenting program in Weld County. A Weld
County Magistrate also became a new member this year. Supervisor and IIK Consultant
met with Director and Manager to explain NFP structure, NHV, Supervisor, Consultant
responsibilities.
Part B. Grantee Response to FY10-11 NHVP Award Summary
1. Develop strategies to reduce client attrition, especially in infancy and toddler phases.
Strategies used are the same as noted in numbers 5-8 for clients in the infancy
toddler phase.
2. Continue to work on increasing completed visits.
Per QST Reports the percentage of completed visits during pregnancy remained at
83% for 2010. Infancy rates dropped 49% to 48% and Toddlerhood rates dropped from 49%
to 37%. Please refer to 2010 Progress Report page 10. We continue to be held to
visiting clients M-F, 8AM to 5PM which limits NHVs availability to their clients who
are employed or in school.
3 . Use more collaborative problem-solving with the team.
The supervisor and team have collaborated to develop strategies to improve the
identified areas for enhancement, to bring experts to case conferences, to review an(
tailor the new program facilitators and visit outlines to our site and clients.
Collaboration is also used in supervision meetings to explore & identify challenges
with clients, with caseload and completed visits, and to develop strategies to
improve performance and job satisfaction.
4. Increase the number of experts included in case conferencing.
Experts at case conferences in 2010: Penny Gonzales-Soto, Esq. , Catholic Charities,
13
Kathy Anderson, Direct , Envisions (Early Intervention ystem) , Alena Clark, Asst.
Prof, UNC Dietetic Program, Janis Pottorff, Family Connects & Parents as Teachers,
Janneth Atteby & Martha Tatro, FFN-Paso program, education for unlicensed daycare
providers. We also have great expertise within our team. One NHV became a certified
Lactation Counselor and presented at 2 case conferences. NHVs who attended outside
trainings presented what they learned to the rest of the team. The Health Department
monthly staff meetings often have an outside speaker. Some who have presented: Staci
Fuller, Parents As Teachers, Shaken Baby Syndrome, Lindsey Sides & Laurie Dunn, SKIRT
& Family Planning Program, Connie Wacker & Fran Garza, Burmese Culture and
Assimilation to Life in Greeley, Partners Mentoring Youth coordinator, and Bree
& Leigh, SBIRT(CO Screening Brief Intervention & Referral to Treatment. We sper
20hours in the past year reviewing and deciding how to present the new curriculum, ar
7-8 hours reviewing ETO documents and process.
5. Develop Strategies to increase the program's exposure in the community. Three NHVs did
presentations at 3 high schools in Weld County. One NHV is on the board of the Union
Colony Music Academy which provides scholarships for our NFP clients. The supervisor
attended 2 community health fairs, a resource fair during 2010 She sits on 2 advisory
boards: Healthy Baby Campaign & Smart Baby Program which meet quarterly. The
supervisor also attends the High Risk OB Review Meeting weekly at the Sunrise Monfort
Family Clinic, the Weld Co. Early Childhood Council meetings, and she chairs the
United Way Home Visitation Program. Beginning in June the supervisor will attend
Quarterly meetings of the Young Child Wellness Council, a collaborative county
committee who will assess the needs of low income Weld County children and develop a
structure to streamline the process of providing medical, dental and behavioral healti
services for this population.
6. Continue to address and clarify the number of dispositions listed as "Unknown". Track
referral dispositions to better understand and improve the referral and enrollment
processes.
The NHV who began working 09/09 was on maternity leave from 01/22/10 to 03/23/10. She
had 2 clients prior to maternity leave and began to build her caseload upon her returr
to work. A 1FTE NHV went to .5 FTE 06/28/10 and the .5 FTE was not filled until
11/16/10. She did Unit 2 training 01/10-14/11 and will begin building her caseload
01/31/11. What was seen as Unknown dispositions were referrals waiting to be called
when we had a program opening. While we were short staffed the team collectively
agreed to enroll referrals who were beyond 26 weeks if they had indicated interest in
the program and had been on the referral list since early pregnancy. We have worked
hard to get referral sources to submit referrals early in pregnancy so we can keep
them open for a longer period of time. 3 years ago a written protocol was developed
to streamline the process of contacting referrals and ascertaining their interest in
the program. This process works well, especially when the team is fully staffed.
Part C. Fiscal Management.
1. Related to FY2009-10(July 1,2009 through June 30,2010):
Total grant award(NHVP and Medicaid estimate): $ 630, 921
Total ending project costs: $ 671, 082
Total amount of ending costs paid with the NHVP grant: $ 671, 082
Amount of estimated Medicaid revenue for FY09-10: $ 17 0, 056
Total amount of actual Medicaid revenue for FY09-10: $ 39, 055
Total amount of ending costs paid with Medicaid revenue: $ 3 9, 0 55
2. Related to FY2010-11(July 1,2010 through January 31,2011):
Total grant award(NHVP and Medicaid estimate): $ 708, 717
Amount of estimated Medicaid revenue for the fiscal year: $ 77,797
Amount of Medicaid revenue generated-to-date(July 1,2010 though January 31,2011): $ 22,793
14
NHVP Attachment Cl
FY2011-12 Proposed Budget for the period of July 1,2011 through June 30,2012
COUNTY
"441 Marna.
TOTAL GREBE 1,575L AGENCY
FY 11112 BUDGET July1 FY11512
2011 to June 30,2012 CONTRACT FY11113 NNVP
BUDGET 16.41 BUDGET IALBLCl
Annual No of
6alary months A. .. "y
5......Elf, (A•B•q
Ria Budget FIE Feeder tt
PERSONAL SERVICES Mall Eagnenl BUDGET
nn Fain senimlTMaal4M Namel _ 10 10
SO w_
Garvey Dane,PXN II NNJ 518,61 12 1 $5679 348.077 564,541 151.851
▪e NASA
INN 9/ 59,516 17 1 16327 552,691 565956 551318_
Peon..Loma PNNIINXV 54.565 12 1 33.52 $30691
.454
5688.0alnew are PEN
59.045 12 1 16611 530110 SL I61 35(031
RawmanBarNb-PHI PHI IL ENNJ :6.`515 12 _ 1 _ 5284816 551 252 3120$1 $56%5
Silverman is PR .NHV 56,369 12 05 5687 55?.YD_ 1m81S 5]4815
Unruh Vests •VIII II N 56 36925064 12 1 52026 52.366 350 _ 5.72,064
Wrofxvrd,JWI�PHN IL NHJ 25,W 12 05 E2fi7 5537 MOSS 525,064
10 w
So
SO So
Conitacival/Fea for Sena. 10 w
50 w
10 SO
Supervising Personnel
Fnrcaos 10 w
2 6.Barbara•PUN III Spanned 59.615 1] 1 _....5•v.72 352933_ $7.615 556.816
Fringe&norms Rata 35.55% 151 350 Yp*W 516.291 5135,09 3151350 5155,35SO 90
1.TOTAL PERSONAL SERVICES IS 561156 $12156 $010.117 $560.156
OPERATING(CN-I Eapeons) I BUDGET
010.Operating E.n.e(I e.supplies.pens.Mc) ' 40 _ 1431 5359 w OL 540130
Cheri Supper Materials ---- ---C27 5613 55354_ 14003 36000
P rn,p6Pudlulro. ' ' 14'56 $452 53958`_ 40?5 1432
Postal 6emone gong
��„,�_ 1YV 5110 511Y` 11 300 54.3K
nelbry titlpl*R ae uler end nelwah.rcuq 1* 5128 51675 __ 51.200 31.=cog raarau
I08t• .trcces msrgple. ^ 1 .. 5(33 51091 51X0 61.760
V w 50
w GET 5521529 $3q)w fm 256
EQUIPMENT 15 ftware neat' BUDGET
CS en wlsoR.rera 0 _ W 00
Ceildar phones W ...110 Sid80 $10 58)
90
T TOTAL EOIMPEENT w T NO 556
Mart
ONTj0.Weal,. u1 BU
DGET each OW
NC FMJCHSC.9e_. _ ___ _ 91.W0 52525 521119_ 124 485 f 3185
NLLFLNCH6L Training Trawl _ 1(S _ 121 $t&av_ 317 317
NCESTTel 0 00 10
P IPE.Travel 115 425 wo 42
prop...ravel ( wPemew.WMr) _.�._—�.� ...... 653 3520. 14so $l.03
50
4Other TOTAL
I 16 w
NFP TRAVEL w GET 561.9/ Iw.31/ 321,6529
NFPTRAINING 6TKX ASSISTANCE(MYI Exposes) 'J BUDGET
06.90.61 0065 Ew 1ry0 1168 1362 51.616 51110_
06.9669 5101181 on .mom_ 1 1G 173. 31526 51.560
Initial NurseEd1EIO 0 _ w $0
Education50
Supervisor Education __. 0 _.-.. SC_ 10
9 SC SO
6▪TOeALT Development 100V 51.017 5615_ 4 -... 56.562
NCAST TOTAL TRAINING(PAS
TECH AASSISTANCE MI T 511321 H5.M3 311.W
X2089 ROBTSt6XeF X25189 TfabWp6MYeN s1 BUDGET
LP T Reg0 50 IC
110657 Maria% 0 30 IC
TM Wing%PE nrre}.Lna. __. a w 5c
I w SC
3 TOTAL ROAST COSTS 0 w w w w w
OTHER COSTS10mM 000m Program C.bl I BUDGET
fD Sc
_._._,.____.__..... 15 SC
w S
T.TAUIRECT OTHER
PROGSTSRAM
w 10 w w w
TOTAL DIRECTCOSMMCOStt14l10dd0X categories 111 w BUDGET
3W.fM ww/Y WO.W
AWIWTRA 11VECOSTS(Da19AO aCCIT2OveCo DR)
BUDGET
Admllo.arlw Per wn6I6em5.p.eamlr ......HRl _ 10 5D
Administrative 1m1e$a ma J_ __. SO fso
Supoeaq pae.he485...ee.lnealm E9 so
Supporting Gps imn.9e remunmenn _ _ w W
Board of Heap —4—.----- ___ 10 30
Other LAOMINye Coats $1046 8931 723212 5655553 561010
TOTAL ADMINISTRATIVE COSTS w µT]1 912.312 wfAW 111.041
TOTAL PROJECT COSTS Mired Program a Administrative 256117 90 tlMw 5941.7 0721630 1721130
TOTAL PROGRAM COSTS
TOTAL APPROVED BUDGET
DFFERENCBADJUSTMENT
Spiel./'OTHER SOURCES'(Mash.NtlM51mm the column A above.
S
S
a
$
TOW Other Sources 300100
SEG,re el 4ulhonaed Agency Representative. �lG., k C0t 6 }��— -L j . ]/IJi91
{Spina,.al CDPN E Program D red Of 0 Dl'. Rte
l'Agildture or,Opt'El- (Min, 06' Salo
,C//—0X39
Amount of Medicaid revenue generafed-to-date(July 1,2010 though January 31,201 $ 22,793
Part D. FY2011-12 Proposed Continuation and Narrative.
Personnel Costs:
During the current fiscal year as noted above 1 NHV went from a 1 FTE to a 0.5 FTE and a
new HNV was hired to fill the vacant 0.5 FTE. This is a job share position providing .5
benefits of health insurance and holidays to both NHVs. 4 team members will receive step
increases during the next fiscal year. Fringe benefits will remain at the current
percentage during the next fiscal cycle. As the supervisor I am requesting to increase my
position from 0.75 FTE to 1 FTE. This would increase my salary from $43,999 to $58, 665
with a 25% increase in the cost of my benefits. I am now supervising 7 NHVs (7 hours of
weekly meetings) and 1 Office Technician (1 hour monthly meeting. One NHV works in
southern Weld County most of her time so I meet with her weekly at our southwest county
facility. It is a 45 minute drive between the SW and N offices. I attend WCDPHE
supervisors' meetings (3 hours monthly) , WCDPHE staff meetings (1.5 hours monthly) , and
am on the WCDPHE Quality Assurance Committee (8-10 hours annually) . As part of my
community outreach I chair the United Way, Bright Beginnings Home Visitation Committee
(lhour plus prep time) & represent that committee on the Weld County Early Childhood
Council (1.5 hours) . Both meet quarterly. The Home Visitation Committee plans and hosts
quarterly trainings for community program personnel (prep time varies) . I also attend
the Monfort Sunrise Clinic OB High Risk Review meetings (1.5 hours weekly) as this is the
major source of our referrals. As an NFP supervisor I attend quarterly NFP supervisors'
meetings (6 hours each) , meet in person or by phone monthly with my IIK consultant (1
hour) , attend the NFP State Meeting (3 days) , and will begin attending annual NFP
Supervisor's Training this year (3 .5 days) . I chair the site Advisory Board meetings (1
hour quarterly plus prep time) and sit on 2 additional advisory boards, Healthy Babies
Campaign (1.5 hours quarterly) and the Weld-Larimer Best Start for Babies (1.5 hours
quarterly) . I am a member of the new Young Child Wellness Council this year (1.5 hours
quarterly) . In addition to these obligations I attend local health & resource fairs,
present the NFP program to various community programs, contact each referral source with
the disposition of referrals, and communicate updates regarding NFP (local, state and
national happenings) via email & phone to referral sources and Advisory Board members.
Our team does working/refueling retreats 3-4 times annually (7 hours each) . Each week out
of 30 hours I average 12 hours in meetings. This leaves 18 hours to do the administrative
tasks of my job. Currently I am challenged to do chart audits, client surveys, data
input into the ETO systems and have to plan very carefully to do 3 supervisory visits per
NHV a year.
Operating Costs:
Office operating costs continue to increase so I have requested a $300 increase in this
line item from FY10-11. We purchase large 3 ring binders for clients and for NHVs to use
as office charts and small pocket file folders for field charts, etc. This site exceeded
the budgeted amount for operating expenses ($3000) by $841. 51 in FY09-10 & FY10-11
($3900) . We are charged a percentage rate by WCDPHE for copying, printing paper, printer
ink, pencils, pens, & other office supplies (currently $250 monthly) . The county has a
print shop that charges $.03-$.09 per one sided copies and $.06-$.09 per 2 sided copies.
The FY09-10 budgeted amount ($3900) for printing & publications was exceeded by 146.72 .
In FY 09-10 we budgeted $3702 for communication services & spent $320. In FY10-11 we
budgeted $4200. For FY11/12 we are requesting $4050, a decrease, to add text messaging to
our cell phone plans. We have an increasing number of clients who prefer to communicate
with the NHVs via text messaging regarding visit scheduling as it saves the clients'
phone minutes. We have amended our consent form to allow a client to request text
messaging for the above purpose and I would like to add this service to our cell phone
package. The consent form has been approved by Weld Health Department. The additional
cost would be $840/year, $10/month/phone/ for 7 HNVs for 250 text messages monthly per
NHV. NHVs can reach clients more quickly by texting and we believe it will decrease the
# of no show appointments & increase the # of cancellation notifications.
2 categories have been combined on this application. Program Expendables & Client Support
Materials are now Client Support Materials. Between the 2 categories our FY10-11 amount
was $9750. For FY11-12 I have lowered that amount to $6000. We received a one-time grant
15
IPfrom the United Way Bright ginnings program for $517 .00 toorchase children's books
that are given to our clients when demonstrating & discussing the importance of reading
to children. This has purchased a 2 year supply of books.
I have decreased the amount for Medical Supplies for FY11-12 from $2500 in FY10-11 to
$1200.
Equipment
I am requesting $90 for replacement of a 2 cell phone chargers and a belt clip. Our cell
phones are free of charge. Currently the HNVs and the supervisor carry county provided
cells.
Travel
The FY09-101 amount that was budgeted for Visit Outreach Miles was $22323. We spent 50%
of this amount. I estimate that for FY11-12 this team will travel 46, 000 miles at a cost
of $22,540. Weld County is currently reimbursing at the rate of $.49/mile. It is likely
that the cost of gas will continue to increase which could increase the reimbursement
rate so I am requesting $24, 000, a decrease from the FY10-11 amount of $33, 000. I have
also decreased the amount requested for the other mileage categories by $1320.
NFP Training&Tech Assistance
The Tech Assist fee is set. Our new NHV has completed the costliest part of her NFP
training. I have requested $1526 for ongoing RN Education. 3 NHVs have been on this team
for 9 or 10 yrs and would like refresher courses. $4200 is requested for Professional
Development. This is $600 per NHV.
Administrative Costs
These costs are calculated by the county and increased by $661 from FY10-11.
16
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• • Attachment D
•
FY2011-12 Colorado Nurse Home Visitor Program (NHVP)
ASSURANCE of INTENTION to MEET PROGRAM REQUIREMENTS
NHVP applicants seeking funding must assure that they intend to meet the Program Requirements, as described in
Sections 1.6, 1.7 and 1.8 of the Rules Concerning the Nurse Home Visitor Program (Attachment H), by initialing each
of the outlined areas below and by signing this assurance page.
Annual Plan
Training Requirements
Visit Protocols
Program Management Information Systems
Reporting and Evaluation System
Staffing Requirements including to hire nurses as stated in Definitions (11) and (13)of the Rules
Concerning the Colorado Nurse Home Visitor Program and to obtain and retain documentation
demonstrating all nurses have a current license.
Eligibility of Clients including securing and maintaining proof of income for each mother
participating in the program.
Name of Agency: Weld County Department of Public Health&Environment
Name of Authorized Signer: Mark Wallace, Executive gDiirector,WCDPHE
“titif Signature of Authorized Signer:X �� 1 l \' ` �
Date: "C 1 i 4 )
c,?c//- 01/59
19
• • Attachment E
•
• • FY2011-12 Colorado Nurse Home Visitor Program (NHVP)
ASSURANCE of INTENTION to be an ACTIVE MEDICAID PROVIDER
The Center for Medicaid and Medicare Services (CMS) has approved Medicaid reimbursement for Targeted Case
Management (TCM) services provided by NHVP sites. Targeted Case Management services are defined by CMS as
"services which will assist individuals eligible under the Colorado State Plan in gaining access to needed medical, social,
educational, and other services." Nurse home visitors provide targeted case management through 1) assessment of the
needs for health, mental health, social service, educational, housing, child care and related services to women and
children;2) development of care plans to obtain the needed services;3) referral to resources to obtain the needed services,
including medical providers who provide care to a first-time pregnant woman and her first child; and, 4) routine
monitoring and follow-up visits with the women where progress in obtaining the needed services is monitored, problem-
solving assistance is provided and the care plans are revised to reflect the woman's and child's current needs."
The Colorado Department of Public Health and Environment and the Colorado Department of Health Care Policy and
Financing have created a Medicaid Management Information System that allows for electronic billing of TCM services
under the NHVP. All NHVP sites are required to be active Medicaid providers,if not already, and must bill Medicaid for
TCM services as allowed.A portion of the annual funding for each NHVP site is derived from Medicaid reimbursements.
NHVP applicants seeking funding must assure that they intend to meet the Medicaid requirements by initialing each of
the outlined areas below and by signing this assurance page. The entity will:
Be an active Medicaid Provider on or before July 1,2011 through June 30,2012.
Enroll all NHVP nurses in Medicaid as providers.
Have a Medicaid consulting physician.
Submit TCM claims as established by Medicaid billing rules and requirements,
including timely filing of claims.
Ensure that all Medicaid-eligible participants are identified and receive assistance with
enrollment and referrals to other programs,including the Early and Periodic Screening,
Diagnosis and Treatment(EPSDT).
Name of Agency: Weld County Department of Public Health&Environment
Name of Authorized Signer: Mark Wallace, Executive Director, WCDPHE
ttiA z ) f ( to
Signature of Authorized Signer: X
( 11) III
Date: , e// -0931
20
T.< • Attachment F
FY2011-12 Colorado Nurse Home Visitor Program (NHVP)
6,0
ASSURANCE of INTENTION to Follow CASELOAD GUIDELINES
The 2006 NHVP audit conducted by the Office of the State Auditor included a recommendation to the CDPHE to work with the State
Board of Health and the NHVP management partners to address program costs through caseload standards and attrition rates. More
specifically,the Department should:
(a) Determine why local sites are not achieving and maintaining caseload standards and develop strategies to help increase
participation.
(b) Establish guidelines for reducing caseloads and funding when sites do not meet caseload standards.
(c) Provide attrition analyses to the local sites and develop specific strategies to reduce the level of addressable attrition at each local
site.
It is understood that sites will not always reach 100%of their funded caseload due to factors such as(1)nurse turnover, (2)new nurses
learning the NFP model, (3) caseload build-up over 7-9 months, and (4) sites developing adequate referral networks. Instead, a
statewide baseline of an 85%active caseload of the total number of participants funded to be served within a given fiscal year has been
set. Active clients are defined in the NFP Efforts to Outcomes (ETOTM) software as those that have not been discharged from the NFP
program and have had a completed nurse visit within 90 days. The CDPHE and the NHVP management partners will review site-
specific active caseload trends covering a three-year period (current year and two years prior) to assess for legitimate caseload size
variances and to arrive at site-specific funding recommendations based on a reasonable expected active caseload size. Please
acknowledge review of this material by signing below.
Sites are expected to track their active caseload numbers using ETO reports and will be expected to report any caseload variations.
Sites will be alerted to any issues they need to address to insure they are meeting active caseload expectations.
The NHVP mid-year budget adjustment process will be enhanced to consider year-to-date expenditures based on active caseload size.
If a site has cost savings as a result of a lower active caseload,those dollars may be redistributed to another grantee site.
For sites indicating an active caseload deficiency (consistently below baseline over the three-year trend period), a Performance
Improvement Plan will be required,including specific strategies and timelines for meeting active caseload expectations.
If a site does not meet the Performance Improvement Plan active caseload size expectation, a recommendation may be made to the
State Board of Health to reduce the active caseload number and funding in the site's contract to be commensurate with the site's
consistent performance.
The CDPHE contract will include active caseload size expectations as well as this plan as a means to formalize these requirements and
to hold all parties accountable for maximum caseload and funding efficiency.
The CDPHE and NHVP management team will develop a detailed caseload maintenance process and timeline to guide and assist the
sites in effectively managing caseload size,including implementation of proven strategies to retain clients or to recruit new participants
to the program.
Name of Agency: Weld County Department of Public Health& Environment
Name of Authorized Signer: Mark Wallace,( Executive Director, WCDPHE
Signature of Authorized Signer: X ` °�' " C
Date:
a PI.
l ) 1
Attachment G
21
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