HomeMy WebLinkAbout20102978.tiff RESOLUTION
RE: APPROVE CANCER, CARDIOVASCULAR DISEASE, AND PULMONARY DISEASE
PREVENTION COMPETITIVE GRANT RENEWAL APPLICATION FOR THE WELD
COUNTY CARDIOVASCULAR DISEASE PREVENTION 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 Cancer, Cardiovascular Disease, and
Pulmonary Disease Prevention Competitive Grant Renewal Application for the Weld County
Cardiovascular Disease Prevention 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, Office of Health Disparities, commencing upon full execution, 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 Cancer, Cardiovascular Disease, and Pulmonary Disease Prevention
Competitive Grant Renewal Application for the Weld County Cardiovascular Disease Prevention
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, Office of Health
Disparities, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the restrictions on lobbying by anyone using
funds pursuant to this grant shall apply to any lobbying, as defined in Section 24-6-301 (3.5) (a),
C.R.S., shall apply to all local government bodies, as well as their members.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
erg'l(AA lea Lib Qt 2010-2978
1 Z- iD 1 - 3- 11 HL0037
CANCER, CARDIOVASCULAR DISEASE, AND PULMONARY DISEASE PREVENTION
COMPETITIVE GRANT RENEWAL APPLICATION FOR THE WELD COUNTY
CARDIOVASCULAR DISEASE PREVENTION PROGRAM
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of December, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
ELD COUNTY, COLORADO
ATTEST: .. , . . ..�
la- Radem- her Chair
Weld County Clerk to the Boa
.ara Kirkmeye , Pro-Tern
BY: �ti1 �.C L2i1�yi"'�a 3 ��
Depu' lerk to th- Board
Sean P. Conway
APPROViD A RM: EXCUSED
Wiliam F. Garcia
ounty Attorney � 0C\
David E. Long
Date of signature: 5
2010-2978
HL0037
Memorandum
TO: Sean Conway
Department of Health Services
Commissioner Coordinator
I C FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health
and Environment
COLORADO DATE: January 6, 2010
SUBJECT: Cancer, Cardiovascular Disease, and
Pulmonary Disease (CCPD) Grant
Application
The Health Communication, Education, and Planning (HCEP) Division of the Health
Department would like approval to apply for continuation funding from the state health
department's Cancer, Cardiovascular Disease, and Pulmonary Disease (CCPD) competitive
grants program, for the Heart of Weld project. The focus of the Heart of Weld project is
cardiovascular disease (CVD) screening and lifestyle intervention programming for low-income
woman, age 40-64 years, who are under- or uninsured, with an emphasis on Latina women and
women already enrolled in the Women's Wellness Connection program.
Nationwide, CVD is the number one cause of death for woman. Weld County is no exception.
Between 2004 and 2006, there were 3,775 deaths among all Weld County residents; 1,880 were
female. Nearly 595, or one-third, died from CVD; and approximately half(432/882) of those
who die each year of heart disease are women.
Cardiovascular disease, as with many of the chronic diseases that plague our nation today, is
highly preventable. A recent study analyzing the major modifiable behavioral risk factors
associated with mortality found the two leading actual causes of death to be tobacco (18%) and
poor diet and physical inactivity (leading to obesity) (15%). These three risk factors are also the
three major contributors to the development of CVD.
Our particular target population was chosen because it is this group (low income women, with no
or inadequate insurance) that tends to not participate in preventive health care and is thus over
represented in CVD morbidity and mortality rates.
During the first year and a half of implementation of the Heart of Weld project approximately
367 women have been screened and 74 have participated in the lifestyle intervention portion of
the project, which consists of a series of classes, educational mailings, and follow-up phone
counseling. Although the results are preliminary, many of these women have made great
improvements. As an example, almost two-thirds (63%) of the Heart of Weld participants seen
2010-2978
for their six-month follow-up visit(n=70) lowered their total cholesterol. Of those 70
participants, 42 participated in the more intensive intervention (attending classes, etc.) and the
remaining 28 only participated in screening visits. Interestingly (but not unexpected), more
women in the more intensive program lowered their total cholesterol compared to women in the
minimal intervention group (69% vs. 54%).
This has not been the only benefit of the program. Partnerships have been established with
Sunrise Community Health Center, Salud Family Health Centers, and UrgentCare Quick Care
(Greeley). This has opened the door for other collaborative efforts between the health
department and these entities.
With continued funding the HCEP team hopes to continue providing screening and lifestyle
intervention programming, while working with the health department clinic, Salud Family
Health Centers, and Sunrise Community Health to develop a plan for sustainability of the
program into the regular services of these clinics.
Currently, the Heart of Weld project is funded at$230,705 with 2.35 FTE. For the 2010/11 grant
period we will be allowed to apply for up to $222,379. We will be able to maintain the 2.35 FTE
(in order to reach our goal of 450 screenings) but will cut participant incentives, and media and
marketing (as mandated by the state). If allowed to proceed, a full budget will be presented to
the Board at a later date.
I recommend that the HCEP division be allowed to proceed with an application for the 2010/11
grant year.
Health Disparities Grant Program - FY 11-12 Application
*Please note,Indirect costs In this sheet are calculated at 20%. Change the percentage In the
formulas In cells 816& CI from.20 to your Indirect percentage rate If necessary(maximum 20%).
Enter Project Title in next cell:
Enter Agency/Organization: Weld County Department of Public Health& Environment
Fiscal Year 11-12 Fiscal Year 12-13
Year 1 Year 2
Personnel Expenses
(including salaries or wages and
fringe benefits) $76,982 $80,532 $ 157,514.00
Operating/Itemized Supplies
$1,724 $1,524 $ 3,248.00
In-State Travel Expenses
$1,080 $1,080 $ 2,160.00
Contracts/Subcontracts
$8,550 $7550 $ 16,100.00
!1/4;t5,....Li' g c7,1' , i
1ht r11 C a!itu,:a f 'i'-� Iv ,i ii
Indirect Costs*
(Not to exceed 20%of Direct Costs
listed above: Personnel, Operating,
Travel, Contractual/Subcontracts
bud.etcate•ories $ 7331.89 $ 7,526.94 $ 14,858.83
Total Project Cost
$ 95,667.89 $ 98,212.94 $ 193,880.83
List the detailed cost breakdown In Budget Narrative section of the application for each grant
year separately. Please see the Health Disparities Guidelines" / for detailed budget Information.
Signature of Authorized Official: VV It AA/L' /(, zJ3h t
Print Name of Authorized Official: Mark Wallace, MD, MPH
Title: Executive Director
Date: 12/16/2010
• Remember to submit this signed budget form with your grant application& include file on CDI
Weld County Department of
Public Health & Environment
Request for Funding
December 17, 2010
Colorado Department of
Public Health & Environment
Office of Health Disparities
Health Disparities Grant Program
FY 11-12 Health Disparities Grant Program Applicant Information Form
1. Agency Information
(All correspondence related to this application will he sent to this person)
Organization Name: Weld County Department of Public Health & Environment
Executive Director Dr. Mark Wallace, Executive Director
Name & Official Title: (to ensure timely follow-up, please cc project manager on all correspondence)
Phone: (970) 304-6410, ext. 2104 Fax: (970) 304-6412
Email: mwallace@co.weld.co.us
Address: 1555 N. 17th Ave.
City, State, Zip: Greeley, CO 80634
Federal Tax
Identification Number:
2. Project Title
Please provide a 5-10 word title for the project.
Ama Tu Vida, Cuida to CorazOn (Love Your Life, Take Care of Your Heart), A Healthy Weld 2020 Project
3. Project Manager
Project Manager Gabrielle Vergara
Name:
Title: Health Communication Specialist
Phone: (970) 304-6470, ext. 2375 Fax: (970) 304-6452
Email: gvergara@co.weld.co.us
Address (if different
from above):
City, State, Zip:
4. Fiscal/Contracts Manager
(All fiscal correspondence will be sent to this person)
Fiscal/Contracts Judy Nero
Manager Name:
Title: Business Manager
Phone: (970) 304-6410, ext. 2122 Fax: (970) 304-6412
Email: jnero@co.weld.co.us
Weld County Health Disparities Grant Program Application FY 11-12
2
Address (if different
from above):
City, State, Zip:
5. Type of Agency
Identify the primary applicant's agency type. Mark "X" next to those that apply.
1. Public Health Agency X
2. College or University
3. Community Based Organization
4. Worksite
5. Health Care System
6. Community Health Center
7. Non-governmental or nonprofit organization
8. Public or Private School K-12
9. Other
10. Is this a multi-agency project? (Yes or No)
6. Application Type
Check one.
1. One-year project request
2. Two-year project request X
7. Requested Funding Amount
Enter the total dollar amount requested in each year(maximum $100,000 per year).
Requested funding for Year 1 FY 11 (July 1, 2011 —June 30, 2012) $95,668
Requested funding for Year 2 FY 12 (July 1, 2012 —June 30, 2013) $98,213
8. FY 1 1-12 Funding Priority
Type an "X" next to the funding priority that your project addresses.
(Funding priorities are described in the Office of Health Disparities Grant Program Guidelines)
Check one or more if your program addresses Check one to describe the priority area
one or more of these disease categories your project addresses:
(if applicable):
Weld County Health Disparities Grant Program Application FY 11-12
3
Cancer Patient Navigator Services to increase
access to health care and treatment
services
Develop Policies and Strengthen
Pulmonary Disease Community Partnerships to promote
health care access for underserved
minority populations
Risk Factor Reduction Programs to
Cardiovascular Disease
(Including diabetes and other precursors) address racial and ethnic health X
X disparities for underserved minority
populations
Crosscutting
(Project addresses more than one priority area)
9. CDPHE Funding
Please indicate whether you are currently receiving funding from any of the following CDPHE Grant
programs and enter the amount of funding.
Cancer, Cardiovascular Disease and Pulmonary Disease Amount:
Competitive Grants Program (CCPD)
Health Disparities Grants Program (HDGP) Amount:
State Tobacco Education and Prevention Partnership (STEPP) Amount:
Colorado Physical Activity and Nutrition Program (COPAN) Amount:
Women's Wellness Connection (WWC) Amount:
LiveWell Colorado Amount:
Other: (2) Preventive Health Block Grants Amount: $69,898(total of two)
Do you intend to apply for funding from any of the CDPHE Grant programs listed above during the same
funding cycle that you are currently applying for Health Disparities Grant funding (FY 11-12)?
If so, which programs?
If made available, we will submit applications for CCPD, STEPP, and COPAN funding in 2011.
10. Target Population
Provide the following demographic information about your target population.
Please type"X" next to appropriate categories and indicate the percentage where applicable.
Gender: Male X (40)% Female X (60)% Other ( )%
Age range: School-Age 19-29 X 30-39 X 40-49 X 50—59 X 60-64 X 65+ over X
African American/Black Asian American/Pacific Islander Other,describe below
Race:
Native American/American Indian Other populations served:
Latino/Hispanic X
Weld County Health Disparities Grant Program Application FY 11-12
4
Sub-population(s): Throughout this application we use the term Hispanic/Latino to collective refer to all peoples from Mexico,
Central and South America, and the Caribbean Islands.
Estimated cost per person served through this project:
Estimated Cost Include a short description of how you estimated this cost per person: This estimate was calculated by
Per Person: taking the health educator and promotoras hours(?)and dividing it by the number of individuals we anticipate
reaching (750 unduplicated).
Weld County Health Disparities Grant Program Application FY 11-12
5
1 L Contacts within Community
Have you contacted the local public health departments and/or county nursing services in the counties
your project will serve?
Yes x No Some
Specify: We are the local health department. We did, however, notified other local medical and
service providers (of Weld County's Hispanic/Latino population), including Sunrise Community Health
Center, Salud Family Health Centers,North Colorado Medical Center, Centennial BOCES, and North
Range Behavioral Health, that we were applying for funding, and detailed the strategies we are hoping
to implement.
12. Geographic Reach
Check the geographic area of your project below.
Rural or Frontier Counties X
Regional
Denver Metropolitan Area
Statewide (select one choice below):
Locally available in all counties
Services made available to all counties
Regional Reach = communities in a multi-county area of the state are provided services through the proposed
program. For example, services are provided in the Arkansas Valley or Central Mountain region.
Rural/Frontier Reach = services are available in counties outside of Denver, Boulder, Broomfield, Jefferson,
Arapahoe, Larimer, Adams, Douglas, Weld, Mesa, Pueblo, Elbert, and El Paso counties.
Statewide Reach = services or programs are locally available in the eastern plains, western slope, central
mountains, Front Range, and each corner of the state.
Weld County Health Disparities Grant Program Application FY 11-12
6
13. Counties Served
Indicate whether your project will serve specific counties or if it will be available "statewide".
If you indicate "statewide", list the counties in which your services will originate or will be locally
offered.
A. Check one:
X Specific counties will be served - list the counties in the spaces below
Statewide availability - list the counties in which the services will originate or will be offered
B. List the counties in the spaces below.
Weld
•Weld
Jackso
Broomfield
. Ma I" pit teller
El Paso
ocray
T ... �Qster
Prows
•Dolores
Ccetilla
Weld County Health Disparities Grant Program Application FY 11-12
14. Pro'ect Abstract
Briefly summarize and describe your project proposal.
State the purpose, major interventions, key objectives, target population(s)
(including age group and geographic focus), and expected outcomes.
(Half page maximum).
In order to decrease the prevalence of cardiovascular disease among Latinos aged 25 or older who are either low income,
on Medicaid (or Medicare), or are under-or uninsured and have either high blood pressure, high blood cholesterol, diabetes
or pre-diabetes, or have a family history of cardiovascular disease and/or diabetes, or are overweight (or obese), we will
implement a linguistic and culturally specific, multi-faceted, risk factor reduction program, within the Hispanic/Latino
community. The objectives of the Ama Tu Vida, Cuida to Corazon (Love Your Life, Take Care of Your Head) are:
1. Enroll 200 at risk Hispanic/Latino adults(male or female)aged 25 or older in the six-week iVida Saludable, Corazon Contento!
to reduce CVD related risk factors among the target population, by June 30, 2012.
2. Implement a CVD promotora program that will provide education,support, and advocacy for 330 at risk Hispanic/Latino adults
(male or female)aged 25 or older to increase awareness and motivation to change one or more CVD risk factors, by June 30,
2012.
3. Organize physical activity opportunities(Zumba classes and walking groups)for 100 participants to increase their physical
activity levels and reduce their CVD risk, by June 30, 2012.
4. Enroll 25 participants in an ongoing bi-monthly health-related behavioral support group to increase behavioral well-being for
those dealing with chronic CVD and/or diabetes, by June 30, 2012.
5. Enroll 80 participants with CVD or diabetes in self-management classes taught by a nurse practitioner and/or certified
diabetes educator in order to decrease CVD related morbidity, by June 30, 2012.
The strategies and interventions we will implement, to reduce risk for CVD morbidity and modality and lessen the barriers to
access, for the target population include, (1) Education/Iraining(for the target population) in the form of platicas (small
group discussions) (2) Education/Training(of promotoras) to conduct platicas, provide advocacy and support, and
implement opportunities for increased physical activity, (3) Risk Factor Reduction Programs including lifestyle intervention
classes, opportunities for increased physical activity, and a behavioral health support group, (4) Disease Management in the
form of self-management classes for those with CVD (and/or diabetes), (5) Awareness/Media to health care and other
service providers to inform them of program and solicit for referrals, (6) Collaboration/Partnership to increase accessibility of
behavioral health services, and (7) Infrastructure to establish an advisory group to develop plan for sustainability.
Weld County Health Disparities Grant Program Application FY II-12
8
15. EEO, Diversity, or Non Discrimination Policy Statement
State your organization's EEO, Diversity, or Non-Discrimination Policy statement in the space below.
ARTICLE II
Employment Information
Sec.3-2.10. Equal Employment Opportunity(EEO)
A. The County strives to attain complete compliance with all provisions of equal employment opportunity laws.
Recruiting, selection and advancement of employees will be on the basis of their relative ability, knowledge, skills
and other relevant factors.
B. It is the intent of the County to:
1. Recruit, hire, train and promote persons in all job titles without regard to race, religion, color, sex, age,
national origin, disability, veteran status or any other status or condition protected by applicable state law,
except where a bona fide occupational qualification applies.
2. Administer all personnel actions such as compensation, benefits, transfers, layoffs, return from layoff,
County-sponsored training, education and tuition assistance without regard to race, religion, color, sex, age,
national origin, disability, veteran status or any other status or condition protected by applicable state law,
except where a bona fide occupational qualification applies.
3. An employee should contact the Director of Human Resources if the employee has a suggestion, problem or
complaint with regard to EEO.
4. Any applicant who applies for a job with the County and feels there may have been illegal discrimination on
the basis of race, color, religion, sex, national origin, belief, age or disability during the application/job
selection process may appeal this alleged discrimination in writing to the Director of Finance and
Administration. The Director of Finance and Administration will then investigate the alleged discrimination.
(Weld County Code Ordinance 2003-4; Weld County Code Ordinance 2007-4)
Weld County Health Disparities Grant Program Application FY 11-12
9
16. Pro'ect Staffin' Pattern
Complete the table below to reflect the key personnel in your organization affiliated with this project.
Begin by listing the name of the authorizing "official" or chair of your Board of Directors.
Then, list the name of the project manager and the project manager's supervisor, if applicable.
AA/B-African American/Black, AA/PI —Asian American/Pacific Islander, L/H— Latino/Hispanic, NA/AI — Native
American/American Indian, NHW— Non-Hispanic White, 0—Other(please specify)
Title Name Gender(M/F) Race/Ethnicity Project Role
Authorizing Official(Director, Weld County Mark Wallace, MD M NHW Advisory
Department of Public Health&Environment)
Grant Project Managers Supervisor(Division
Director,Health Communication,Education,and Gaye Morrison, MPH, RD F NHW Oversight
Planning)
Grant Project Manager Gabrielle Vergara, MPH F NHW coordination/outreach
Key Personnel
Health Educator Ofelia Orozco F LJH education/outreach
17. Board of County Commissioners
Complete the table below to reflect your organization's Board Members (if applicable). Begin by listing
the name of the authorizing "official" or chair of your board. AA/B-African American/Black, AA/PI — Asian
American/Pacific Islander, L/H — Latino/Hispanic, NA/Al — Native American/American Indian, n NHW-Non-Hispanic White,
0—Other
Name Gender(M/F) Race/Ethnicity Project Role
William Garcia M IJH advisory
Barbara Kirkmeyer F NHW advises _
Dave Long M NHW advisory
Doug Radamacher M NHW advisory
Sean Conway M NHW advisory
Weld County Health Disparities Grant Program Application FY 11-12
10
18. Letters of Su ort
Submit three (3) letters of support for your application as an appendix to your application.
19. Terms and Conditions for A I lications
Please be sure to review these requirements stated in the Request for Application Guidelines.
• General Terms and Conditions • Reimbursement
• Lobbying Restrictions • Reporting
• Tabor Amendment • Data Collection
• House Bill 06S-1023 Restrictions on Public Benefits
• Certificates of Insurance (Insurance Requirements)
• Financial Assessment Questionnaire (Local public health, universities, Indian Tribes and county nursing services are exempt)
20. Si. natures
By signing and submitting this application, the applicant agrees to operate the program as described
in the grant application in accordance with the grant terms and assurances. In addition, the applicant
also indicates by signature that he or she has reviewed and accepts the general terms and conditions
and has reviewed and agreed to the following statements.
If awarded grant funding,
➢ you agree to participate in state level evaluation or surveillance studies regarding the impact of the
overall grants program at the request of CDPHE.
Y you agree to comply with the State's insurance requirements as described in the terms and conditions.
➢ you agree to comply with House Bill 06S-1023, Restrictions on Public Benefits.
Submission of this application indicates that you have reviewed and agree to
> All general terms and conditions and information listed in item #19 above, as stated in the Health
Disparities Grant Program Request for Applications Guidelines.
The Board of Directors, Chief Executive Officer, Grants Manager, or Authorizing Official acknowledges
and approves the submission of this proposal. /
Signature of Authorized Official: or Ls kSYCLAna 1!"
Title of Authorized Official: Chair, Board of 111111 Weld County Commissioners
Print Name of Authorized Official: Douglas Rademacher
Date: DEC 20 2010
Weld County Health Disparities Grant Program Application FY 11-12
" aola a97ig
Project Narrative
1. Project Title -Ama Tu Vida, Cuida to Corazon (Love Your Life, Take Care of Your Heart), A Healthy
Weld 2020 Project
2. Project Narrative
a) Describe the health disparity issue and/or need to be addressed and current barriers (structural,
social, cultural, etc.),that influence the disparity.
While there have been health improvements for many Weld County residents over the past decade,
significant health disparities persist for certain populations, including the Hispanic/Latino population. Health
disparities are often related to social, economic, and cultural factors that in turn perpetuate reduced health
opportunities. The health disparity regarding cardiovascular disease and diabetes faced by Weld County
Hispanic/Latino residents is complex. Even though being Hispanic/Latino in and of itself may not increase
an individual's risk for developing cardiovascular disease or diabetes, often times that person is more apt to
lack access to timely, useful health information or other resources due to a variety of structural, social, and
cultural barriers.
The major risk factors associated with CVD morbidity and mortality are hypertension, serum cholesterol
levels (high LDL/low HDL), and smoking. Studies have shown that Hispanic/Latinos have blood pressure
and cholesterol levels comparable to White non-Hispanic/Latinos and a smoking rate less than White non-
Hispanic/Latinos, however, the contributing factors to CVD morbidity and mortality (diabetes, physical
inactivity, and obesity) are more prevalent among Hispanic/Latinos (American Heart Association). In the
most recent Weld County Health Survey (2010) 27%of the Hispanic/Latino population surveyed reported
no physical activity or exercise in the past 30 days and 77% reported that they were either overweight or
obese (body mass index greater than 25)compared to 16% and 58%, respectively, of the White non-
Hispanic/Latino population surveyed. As well, diabetes, a leading pre-cursor to CVD (adults with diabetes
have heart disease death rates about 2 to 4 times higher than adults without diabetes) affects about 7% of
all Weld County residents compared to 12%of all Hispanic/Latino residents.
Overall, minority and low-income populations have a disproportionate burden of death and disability from
CVD, which can largely be attributed to a complex interaction among social and economic reasons.
Studies have shown that socioeconomic status, reflected in income and education, underlies a substantial
portion, but not all, of the higher rate of heart disease in minority populations (National Heart, Lung, and
Blood Institute/NHLBI,1995). Weld County has a lower average income than the rest of Colorado; and
over one-fourth (27%) of Weld County households live on incomes that are below 200%of the federal
poverty level. According to the USDA Economic Research Service, in 2008, about one out of eight people
in Weld County were living in poverty. New income data just released by the US Census Bureau shows
than one out of four(25%) Weld County Hispanic/Latino residents reported income in the past 12 months to
be below the federal poverty level compared to 14%of residents overall. Directly tied to income levels are
educational levels. In Colorado, it is estimated that the high school graduation rate for Hispanics/Latinos is
approximately 51% (compared to 80%for non-Hispanic/Latino White students) (Alliance for Excellent
Education). This gap continues to grow into college. The national rate for Hispanics/Latinos earning even
an Associate's Degree is 12%, compared to 66% for Whites (U.S. Department of Education). This gap
increases with degree level.
Weld County Health Disparities Grant Program Application FY 11-12
What does this all mean for health behavior and health status? First of all, we know that lack of income
often means lack of adequate health care coverage and, ultimately, access to care. Individuals who lack
insurance or have less than optimal access to health care are more likely to delay getting health care and
are at risk for experiencing adverse health outcomes. Based on data from the 2007 Weld County
Community Health Survey, approximately one-third (32%) of Hispanic/Latino adults aged 18 to 64 years do
not have any kind of health care coverage compared to 16%of non-Hispanic/Latino White adults. In the
2007 Weld County Community Health Survey, Weld County residents were also asked if someone in their
household had put off seeing a doctor during the past year due to cost of access issues. About one out of
four answered yes to this question. For those without, or with inadequate, health insurance, access to
health care can be out of reach. According to the 2004 Compass Needs Assessment conducted by United
Way, over 50%of respondents, in all areas of Weld County, said that lack of affordable medical care was a
moderate or major problem in Weld County. Additionally, 69%of people with incomes< $14,999 and 60%
of those with incomes between $15,000 and $34,999 reported not having enough money to pay for medical
needs.
When compared to Colorado, as a whole, not only does Weld County have a higher percentage of
minorities, a higher poverty level, and a higher percentage of those without adequate insurance, we also
have fewer physicians per 100,000 people. A 2006 report by the Colorado Health Institute identified
several factors that contribute to the health care disparities in Weld County, including the county's
population to provider ratio of 3,500:1, designating it as a primary care health professional shortage area.
In addition to having a lack of providers, Weld County also lacks affordable and culturally appropriate out-
patient, chronic disease self-management programs for Spanish speaking residents. This is of particular
concern because Hispanics/Latinos generally have lower mortality rates but higher morbidity rates
compared with the overall U.S. population (Kaiser Permanente, 2001). As a result, morbidity and chronic
disease management are areas of great concern for providers working with the Hispanic/Latino population.
We also find that language barriers will often affect access and utilization. At all levels of medical service,
from prevention to management, the lack of Spanish speaking educators and providers limits access and
utilization. There just isn't enough Spanish speaking providers (or programs) to serve Weld County's large
number of Spanish speaking residents. According to the 2010 Census, 20%of Weld County residents
speak a language other than English, compared to 15% for Colorado as a whole. Of those who speak a
non-English language 81% (statewide) are over 18 years of age (Racial and Ethnic Health Disparities in
Colorado, 2009). Although, there may be a sufficient number of translators, many individuals are not
comfortable going this route; and much of the personal interaction (and information) is lost when using a
translator. Written materials, even when written in Spanish, are often difficult to comprehend, particularly if
the translation is directly from English to Spanish without consideration for structural differences between
the languages.
Lastly, cultural differences can also play a role in creating health disparities. Many individuals within the
Hispanic/Latino population hold onto different believes and practices related to health that can affect health
related behavior or influence the adoption or acceptance of a health education message. It is important to
understand what these values, beliefs, and practices are, in order to provide appropriate and
comprehensive care. It is one thing for a health educator or medical provider to be bilingual, but without an
understanding of the culture of the individual you are serving, little progress is going to be made.
Weld County Health Disparities Grant Program Application FY 11-12
2
b) Identify the target population and the estimated number of people who will benefit from or be
served by the project(list Year 1 and Year 2 estimates separately).
Weld County's total Latino population is over 65,000 (American Community Survey 2005-2009 Estimates,
U.S. Census). Nearly 60% (or about 40,000) live in Greeley or Evans. Mexican Americans comprise the
largest percentage (over 80%) of the Weld County Latino population. In both communities, the population
aged 25 years and older is about 50%of the total population. The population this project will target is
Latinos aged 25 or older who are either low income, on Medicaid (or Medicare), or are under-or uninsured
and have either high blood pressure, high blood cholesterol, diabetes or pre-diabetes, or have a family
history of cardiovascular disease and/or diabetes, or are overweight (or obese). Geographically, a large
portion of the target population resides in the neighborhoods surrounding two Greeley District 6 elementary
schools (Bella Romero& East Memorial), Our Lady of Peace Church, and the Rodarte Center. This area is
generally known as East Greeley. We plan to reach approximately 750 adults in year one and 800 adults in
year two. These are unduplicated numbers. Some individuals will participate in more than one component
of the program. Estimating duplicated participation rates we anticipate about 1,500 exposures in year one
and 2,000 exposures in year two. We also anticipate the project will reach additional adults and children
who are family members of participants which will add significantly to our potential program reach.
c) Describe how the project will be accomplished and how key staff members will be involved.
In order to decrease the prevalence of CVD among the target population, we will implement a linguistic and
culturally specific, multi-faceted, risk factor reduction program, within the Hispanic/Latino community. The
strategies and interventions we will implement, to reduce risk for CVD morbidity and mortality and lessen
the barriers to access, for the target population include, (1) Education/Training(for the target population) in
the form of platicas (small group discussions) (2) Education/Training(of promotoras) to conduct platicas,
provide advocacy and support, and implement opportunities for increased physical activity, (3) Risk Factor
Reduction Programs including lifestyle intervention classes, opportunities for increased physical activity,
and a behavioral health support group, (4) Disease Management in the form of self-management classes
for those with CVD (and/or diabetes), (5) Awareness/Media to health care and other service providers to
inform them of program and solicit for referrals, (6) Collaboration/Partnership to increase accessibility of
behavioral health services, and (7) Infrastructure to establish an advisory group to develop plan for
sustainability.
The two Weld County staff implementing this program will be Ofelia Orozco and Gabrielle Vergara.
Ofelia is a first generation, bi-lingual, Latina health educator and medical assistant and has been with the
health department for six years. She was initially contracted as a promotora for breast health education,
and then hired to conduct diabetes education through our diabetes disparities program. She has
conducted many platicas, nutrition classes, cooking demonstrations, and physical activity classes. Ofelia
received 53 hours of promotora training conducted by Ada Torres, through the National Cancer Institute.
Ofelia has also had training in diabetes, nutrition, and HIV education and is a certified medical interpreter.
Ofelia will be the lead health educator for the lifestyle intervention classes. She will also co-lead the
support group and perform outreach and marketing for the program. Ofelia will also oversee the
promotoras and their activities (including the platicas and physical activity opportunities).
Gabrielle has a Master of Public Health and has been employed at the health department for 16 years in a
variety of health education roles. She has extensive experience managing grants and implementing
Weld County Health Disparities Grant Program Application FY 11-12
3
programs, including the Heart of Weld Project, described later in this application. Gabrielle will be
responsible for the day-to-day operations of the program, including staff supervision, arranging and
overseeing contracts (with sub-contractors), progress monitoring and reports, and budget oversight. She
will also be responsible for program outreach and marketing, coordinating referrals with local providers and
service organizations, overseeing promotora training, securing locations for classes, assisting with platicas
and classes, facilitating program advisory group, and assuring implementation of all project elements.
d) Describe the interventions or approaches selected, why they were selected, and the desired
outcomes as they relate to diminishing health disparities.
Ama Tu Vida, will be based on the promotora model (of intervention and outreach). Our promotoras will
originate from and specifically serve their own communities. We will start with the selection of three
individuals from the Hispanic/Latino community to train as promotoras. Those selected will be Spanish
speaking Hispanic/Latino individuals who are well-known and trusted in their communities; they will be
knowledgeable of the Hispanic/Latino culture and beliefs; and they will be models of the lifestyle behaviors
we want replicated. It is our belief that the use of promotoras will increase participation in the program and
increase positive (health) behavior change.
The promotoras will be responsible for conducting platicas and will also provide support and advocacy for
program participants. The platicas will be used to educate small, personal groups about CVD and its risk
factors, as well as an opportunity for outreach for the lifestyle intervention and self-management classes.
In order to encourage attendance and participation, platicas will be conducted in homes, churches,
neighborhood schools, and community centers regularly visited by the target population,where they are
comfortable. Support and advocacy will be in the form of referrals, one-on-one consultations, accessing
resources, and encouragement(to participate in other components of the program or to make positive
lifestyle changes). The promotoras will also assist with implementing and promoting opportunities for
physical activity in their communities. This could be encouraging participation in existing physical activity
opportunities or the creation of other opportunities, such as a neighborhood walking group or Zumba
exercise class. We have found that the target population is not opposed to increasing physical activity, but
access and lack of personal support sometimes hinders action. By offering physical activities within their
own communities and including their family, friends, and neighbors as support, will likely increase
participation.
At the core of the Ama Tu Vida program are the lifestyle intervention classes. These will provide
participants with the knowledge and tools needed to make positive lifestyle changes, to reduce their
individual risk for CVD. The lifestyle intervention classes will be held once a week in two hour sessions for
six weeks and will cover the following topics: healthy eating, physical activity, maintaining weight, and
decreasing stress. The same series of classes will be offered once per quarter, so participants will have
several opportunities to attend. The curriculum used will be the Spanish version of A New Leaf...Choices
for Healthy Living assessment and intervention tool designed by the University of North Carolina, for their
WISEWOMAN program. i Vida Saludable, Corazon Contento!, was adapted from A New Leaf by
California's WISEWOMAN program. Although this curriculum was developed to be used within programs
that specifically target women, the curriculum itself is gender neutral. This is the same curriculum that we
used for our Heart of Weld project(described later in this application), and was very effective and given
high marks by the Heart of Weld project participants.
Weld County Health Disparities Grant Program Application FY 11-12
4
Whereas the lifestyle intervention classes will focuses on increasing the knowledge and skills to promote
healthy behaviors to reduce risk, the self-management class will focus more on the clinical aspects of
managing disease (CVD and diabetes). The self-management workshops will be facilitated by a Spanish
speaking, culturally competent Nurse Practitioner(NP) or Certified Diabetes Educator(CDE) and will be
held four times throughout the year at the conclusion of each series of lifestyle intervention classes. We
believe that the self-management workshops will help to increase compliance with treatment and, in-turn,
decrease morbidity and mortality for the target population.
Building on the idea of need for support, we will also help to implement a support group for individuals
currently diagnosed with CVD and/or diabetes. An additional barrier to effective disease self-management
is the high prevalence of depression, particularly in ethnic and racial minority populations. Patients with a
chronic disease have twice the incidence of depression as the general population, and patients with
depression have worse clinical outcomes, poor adherence to treatment and self-care guidelines, and higher
health care utilizations. As is the case with the self-management workshops, the support groups will help
to alleviate the depression and stress so as to increase likelihood of compliance with treatment and
increase likelihood of engaging in healthy behaviors.
e) Detail the plans for sustainability of this program after the grant period ends.
The Weld County Department of Public Health & Environment (WCDPHE) will coordinate an advisory
group that will include program participants, Hispanic/Latino community leaders, and representation from
Sunrise Community Health Center, Salud Family Health Centers, North Colorado Medical Center, North
Range Behavioral Health, Northern Colorado Health Alliance, the health department, churches, and any
other community members and service organizations with an interest in promoting the health of and
decreasing the barriers for Weld County's Hispanic/Latino population. This group will be tasked with two
jobs. The first will be to advise on the current program, including an evaluation plan, and the second is to
develop a long-range plan for the continued support of and funding for a promotora program.
Capacity Assessment
1. Project Title -Ama Tu Vida, Cuida to Corazon (Love Your Life, Take Care of Your Head), A Healthy
Weld 2020 Project
2. Capacity Assessment
a) Describe the following points for your organization: meaningful involvement with the target population;
inclusion of the target population with the development, planning, implementation, monitoring and
evaluation of the proposed project; and any other programs of your organization serving the same or
similar target population.
The role of any health department is to protect the health of those served, regardless of race, ethnicity, or
income. The majority of those who seek a health department's services tend to do so because they do not
have the financial means to seek those services elsewhere. The Weld County Department of Public Health
& Environment is no exception. The majority of the consumers of our services, particularly our healthcare
and health education services tend to be from lower income groups. Approximately_%of the health
department's clients are Hispanic/Latino.
Weld County Health Disparities Grant Program Application FY 11-l2
5
WCDPHE involves the target population at every level of a program, starting with planning and
development. We regularly conduct community surveys to assess the health status and health needs of
Weld County residents. Surveys are routinely conducted in English and Spanish. Also, during program
planning and development we have held focus groups or have done more in-depth interviews with the
population we are targeting. These methods ensure that our programs are developed with meaningful
input from the target population. At the level of implementation, members of the target population deliver
as many components of the program as is appropriate. Several of our programs have Spanish-speaking or
bilingual lay health outreach workers (promotoras) to provide health education within the communities they
belong. Lastly, at all stages of every program we obtain meaningful feedback from the target population.
This allows us to make changes so that the program is culturally relevant and accessible to the participants.
When members of the target population are involved in a campaign, they can provide invaluable insight on
how to further improve it. Their involvement is critical because they know firsthand the situations that
people encounter on a daily basis. They also help assess whether developed materials and programs are
understood and relevant within the context of their daily lives.
The Health Communication, Education, and Planning (HCEP) Division, which will coordinate this program,
has a long history of successfully competing for and managing grants serving the target population. One
example is the Weld County Diabetes Disparities Project, implemented from 2006 to 2008 with Health
Disparities grant funds. This project provided community-based prevention, intervention, and education
programs related to diabetes, to over 4,000 Weld County residents. The work of the Weld County Diabetes
Disparities Project was described as a "shining star' by the Colorado Diabetes Prevention and Control
program at the Colorado Department of Public Health and Environment, due to its successful outreach to
low income, under-and uninsured residents of Weld County.
Another exemplary program implemented from 2008 to 2010 by the HCEP Division is the Heart of Weld
Project. The Heart of Weld Project offered free CVD risk factor screening for under-or uninsured women,
aged 40 to 64 years, with an emphasis on low income women and women enrolled in the Women's
Wellness Connection program. Those women identified to be at moderate or high risk (for developing
CVD) at screening were encouraged to enroll into our lifestyle intervention program. The lifestyle
intervention program sought to help women improve eating and exercise habits, identify and overcome
barriers, gain basic problem solving skills, set goals, understand behavior, leam stimulus control, and
identify the importance of keeping a supportive and healthy environment. The goal of this project was to
reduce the modifiable risk factors for CVD among the target population, thus reducing CVD related
morbidity and mortality. This was accomplished by improving access and reducing health disparities, by
providing culturally competent screening and education at the community level. During its two years of
implementation, the Heart of Weld Project saw positive results for the participants and favorable feedback
from participants, the community, and health care providers.
LiveWell Weld County is a final example of an exemplary program administered by the HCEP Division.
This program is a grant-funded collaboration with the non-profit, LiveWell Colorado, and addresses the
obesity and physical inactivity epidemics in Colorado. The mission is to make the healthiest choice the
easiest choice in Weld County. LiveWell Weld County focuses on strategies that affect environmental
change in the community, including Active Community Environment (ACE) policy work; community
education; access to better nutrition, and opportunities for physical activity; integration of health and
wellness into childhood education and recreation systems; creation of environments and advancement of
policies that support healthy behaviors in worksites, restaurants, and faith-based organizations. With
Weld County Health Disparates Grant Program Application FY 11-12
6
funding from the Colorado Health Foundation and LiveWell Weld County will continue its work into 2011
under the new name of Healthy Weld 2020. The activities of Healthy Weld 2020 will complement those
proposed in this grant application by focusing on the environmental barriers such as healthy food access
and access to parks and other recreational opportunities, while this program will focus on personal
behavioral change.
b) Describe your organization's commitment to diversity and inclusiveness and representation of the
communities served at all levels in your organization. Describe your organization's efforts to increase
diversity of your staff at all levels of the organization. Include information about any attempts to
increase ethnic, linguistic and other types of diversity among your staff.
The Weld County health department is committed to having a diverse staff and we have increased the
number of staff who is either Hispanic/Latino and/or bilingual. This holds true at all staff levels and within
all divisions. Because the HispaniclLatino population constitutes a large percentage of the clientele served
by the Weld County health department, we strive to create an accessible and acceptable atmosphere for
this population. Going beyond the County's Equal Employment Opportunity (EEO) statement, we make
every attempt to fill those positions that work closely with the public to have someone who is bilingual and
someone who has a first-hand understanding of the HispaniclLatino culture. Within the nursing and HCEP
divisions, the two divisions serving the greatest number of Hispanics/Latinos, approximately 60% and 30%,
respectively, of the staff are at least bilingual, and 50% and 20% are Hispanic/Latino. For staff that are not
bilingual or would like to improve on their cultural competency, cultural competency and Spanish
(language)classes are regularly offered by the county.
c) Describe your organization's understanding of the cultural health beliefs of your target population and
how your program will work with those beliefs to improve the health of this population.
The values that guide Hispanic/Latino culture not only influence the type of interaction that individuals have
with one another, but also with the health care system. Cultural health beliefs in all populations can
determine, to an extent, health behavior and, thus, health status. The strength of these traditional health
beliefs can vary by degree of acculturation, education, and socioeconomic level.
In the Hispanic/Latino culture health is often seen as a temporary condition or a balanced state that avoids
any excess of hot or cold elements, and illness is thought to be caused by extremes of hot, cold, wet, or dry
conditions that upset the body humors. Hispanics/Latinos also tend to depend more on family for services,
emotional support, and advice than they do on health professionals; and, in the majority of Hispanic/Latino
families, the female head of household and especially the extended family matriarch, grand-or great-
grandmother, is responsible for the interpretation of family issues concerning wellness and illness. As well,
what may be seen as lackadaisical attitude towards health among the Hispanic/Latino population, may in
fact be due to the commonly held belief that God or, at the very least, "supernatural"forces are directly
involved in illness. Religious belief systems are crucial aspects of the Hispanic/Latino culture and it is
commonly believed that religious entities like Catholic Saints and Folk-Saints, and the supernatural, are
physically capable of affecting the lives of the living, causing both illness and serving as a pathway to
wellness. It is not uncommon to find some Hispanics/Latinos who do not take, what some would consider,
an active role in their health and well-being, because they believe it is all in the hands of God or other
unseen forces. Also seen as a barrier to health is the misconceptions some Hispanic/Latinos hold as to
what is considered to be healthy or what behaviors are health promoting. Many Hispanic/Latinos see
thinness as a problem or sign of poor health and view plumpness as the ideal. Advice to lose weight may
Weld County Health Disparities Grant Program Application FY 11-12
be ignored because it would create a negative body image. Along this same line of thought, is the belief
that exercise is for the purpose of losing weight and, after that, serves no other purpose. The
Hispanic/Latino people also have an active tradition of"alternative" health care. These practices are
generally lumped together in what is commonly called Curanderismo (or curanderia). A Curandero/a or
folk-healer is often sought out to assist in the treatment of all types of illnesses, including physical,
emotional, and spiritual. Diabetes, hypertension, arthritis, and similar ailments are common in the folk-
healer's patient load.
We are cognizant of the fact that these beliefs have been ingrained into the Hispanic/Latino culture for
hundreds of years and have served the Hispanic/Latino population fairly well. It is not our intention to
educate in order to change these beliefs but rather to supplement and compliment them. Using culturally
competent, Spanish speaking educators (promotoras), who are seen as leaders in the community will help
to build credibility for and trust of our program. Whereas cultural factors must be taken into consideration, it
is important that we don't automatically attribute someone's health behavior or health status as being
determined by their cultural beliefs when, in fact, it is caused or determined, rather, by economic
circumstances.
d) Demonstrate your understanding of the practical (availability, accessibility and quality) barriers
commonly faced by your target population and how your program and your target population will
attempt to address them.
Weld County has one of the lowest provider-to-patient ratios in the state of Colorado (3,500:1). On top of
this, our target population has difficultly accessing what few providers there are available, because either
they do not have the financial means or because of other barriers, such as language, cultural differences,
and unfortunately sometimes racial discrimination. In addition to limiting accessibility to care, these barriers
can also reduce the quality of care that is received. Weld County also lacks affordable and culturally
appropriate out-patient, chronic disease self-management programs for Spanish speaking residents. North
Colorado Medical Center(NCMC) has an exceptional cardiac rehab program for individuals who have
experienced a heart attack or other cardiac episode. Unfortunately, once discharged from the hospital, the
out-patient educational services are only available to those with insurance or other financial means, and
completely unavailable in Spanish. This holds true for NCMC's diabetes education program, as well. The
local Area Agency on Aging also has an excellent chronic disease self-management program (using the the
Stanford model), but they do not have a Spanish speaking educator. Sunrise Community Health Center in
Greeley and Salud Family Health Centers in Fort Lupton and Frederick have culturally competent, Spanish
speaking staff who provide excellent medical, dental, and mental health care, and diabetes self-
management education, but all three facilities have lengthy waiting lists.
Whereas, increasing the number of available and culturally competent providers in Weld County is beyond
the scope of this funding opportunity, we will work with current providers to provide out-patient CVD (and
diabetes) prevention and self-management education for their current patients as well as those on waiting
lists. We will work with local providers to obtain referrals and also to outreach to individuals seeking care.
Our promotoras will also act as a bridge between the Hispanic/Latino community and the formal healthcare
system. This may include referrals to formal healthcare providers, community member education, follow-up
counseling, advocacy, and role modeling of positive health behavior.
Weld County Health Disparities Grant Program Application FY 11-12
8
e) Exhibit your understanding of challenges commonly faced by your target population (health literacy,
generational, linguistic, cultural, acculturation, assimilation, societal challenges) and how your program
will help them overcome those potential barriers.
The health of the Hispanic/Latino population is greatly affected by the many challenges they face on a daily
basis. The most obvious of these is language. For the thousands of Weld County residents whose native
language isn't English, language remains a major barrier in all aspects of life, including access to
healthcare. When language is a barrier between patient and provider, the provider is likely to impart only
the basic information; it is unlikely that they will provide lifestyle counseling regarding diet and exercise.
Having access to an interpreter partially overcomes this barrier, but many mistakes often occur in
translation that can lead to adverse outcomes. It has also been found that many interpreters, even when
available, are insufficiently trained or culturally incompetent. Being able to speak directly to the provider
increases patient satisfaction and the likelihood that health care instructions are going to be followed.
When there is a language barrier, many Hispanics/Latinos are not comfortable with asking questions, which
may lead to the assumption that they understand the information the provider is giving them.
Hispanic/Latinos will also assume that they are in good health if the health provider does not tell them
otherwise. Language problems also arise when there is a difference in the context in which a word is used.
When telling a patient that their test came back positive, many Spanish speaking patients may misinterpret
this as that they are fine. Similar to the language barrier is health literacy. Health literacy can be defined
as"...the degree to which individuals have the capacity to obtain, process, and understand basic health
information and services for appropriate health decisions" (Healthy People 2010). Clear communication in
the health care industry has been a barrier to improved health status, even for the most educated person.
Low literacy is far more than a reading problem -- patients who have a hard time comprehending health
instructions avoid care.
Cultural differences can also be a challenge for Hispanics/Latinos. Culture refers to the learned, shared
and transmitted knowledge of values, beliefs, and ways of life of a particular group that are generally
transmitted inter-generationally and influence thinking, decisions, and actions (Leininger, 2002). Family is
first and foremost in the Hispanic/Latino culture and has been singled out as a primary determinant of what
is"best" in the HispaniclLatino culture. This can directly impact, both positively and negatively, upon a
person's health status. The social network of family and family involvement with the individual is critical to
the well being of the individual; and family interdependence is emphasized over independence. Also
important in the Hispanic/Latino culture is the emphasis on personalismo, or the preference for friendly,
personal relationships with members of the same ethnic group. The Hispanic/Latino patient often expects
their health care provider to take a personal interest, like a friend. The Hispanic/Latino culture is also a
present-oriented one and, as such, they may neglect preventive health care, and may also show up late, or
not at all, for appointments. It isn't always that Hispanics/Latinos don't know what they need to do to
prevent heart disease, but that procrastination about taking care of their health prevents them from
practicing healthy behaviors.
Generational, acculturation, and assimilation also are unique challenges for the Hispanic/Latino population.
Studies have shown that immigrants arriving in the U.S. as children had better access to services,
compared with individuals arriving in the U.S. as adults; and individuals arriving as adults were also
significantly less likely than the, second, third and later generations to have a usual source of care and had
fewer physician visits (Kao, 2009). It has also been found that first generation Hispanic/Latinos tend to
retain more of the traditional health behaviors, beliefs, and lifestyles and stand a markedly lower risk of
eating a poor diet than do second and third generation Hispanics/Latinos,whose nutrient intake resembles
Weld County Health Disparities Grant Program Application FY 11-12
9
that of a White non-Hispanic/Latino (Guendelman &Abrams, 1995). These differences, in large part, are
due to the higher rate of acculturation and assimilation among later generations than first generations
and/or immigrants arriving in the U.S. as adults. Acculturation and assimilation of the HispaniclLatino
population and its culture can, both, positively and negatively impact health. Adaptation to U.S. culture
defined by factors such as language and length of time in the United States, has been positively associated
with increased rates of obesity, substance abuse, and other indicators of poor physical and mental health.
After arriving in the United States, the health status of Hispanic/Latino immigrants tends to decline
(Abraido-Lanza A, et. al., 2006). While acculturation and assimilation can increase one's health risk in
some cases, it can also promote health by creating access to certain forms of health care and by
contributing to the abandonment of risky health-related behaviors and the adoption of behaviors that
promote good health. Acculturation and assimilation has been shown to influence knowledge and attitudes
that shape and influence health behaviors. Because acculturation and socioeconomic status may be
closely related we must be careful to distinguish between acculturation effects from those that can be linked
to income and education. When adjustments are made for socioeconomic status, the relationship between
dimensions of acculturation and health status or health behavior weakens or disappears altogether
(Hazuda, HP, 1990).
Lastly, all over the U. S. there are many societal changes, such as economic downturn, political discontent,
and war that we all are currently being challenged by. In addition to these, many Hispanics/Latinos are
facing additional worries because of the continued and growing concern over illegal immigration. This
issue has become particularly pertinent in Weld County, since the 2006 U.S. Immigration and Customs
(ICE) raid of the Greeley Swift plant. The experience of that event has left many fearful, regardless of
citizenship status. We have found that some are afraid to seek help (i.e., medical care) for free of being
arrested, even if there is no basis for this.
I know it sounds a little over-simplified by saying that we are going to address these barriers my just being
cognizant of them, but that is where it starts. To ensure participation from the target population, we know
that we have to work with those things that define and characterize and, to an extent, determine how the
target population behaves. Because a strong sense of interdependence, family values, and collectivism
prevails in the HispaniclLatino community, this program will focus not on just the individual, but on the
family and the community, as well. The changes we often ask individuals to make (i.e., exercise more, cut
down on fat intake, etc.) will likely affect not just them but their entire family, and this makes it difficult to
make positive health behavior changes. It may start with just one member of the family (attending a Platica
or participating in a walking group) but we will encourage them to bring their spouse, their children, their
grandparents, their friends, and their neighbors, so that they may develop lifestyle changes as a family and
as a community. Including the entire family will also help to overcome the differences that are seen
between the generations-- if we are educating and supporting the entire family, we believe that the
adopted changes will transcend generations and also maximize adherence.
In addition to involving whole families and communities to address these barriers and challenges, we will
also employ and train community members as promotoras to implement many components of this program.
The use of promotoras will increase the cultural competence of our program because of the critical
characteristics or attributes that define their role, including (1) having common ties (with the target
population) including, physical, ethnic, linguistic, cultural, disease process, residence, income, values, and
community ownership; (2) being able to go between and bridge the separate cultures; (3) having credibility
in the community (seen as a knowledgeable and competent leader) and (4) being trusted. Because we
have found, through speaking with members of the target population, that the preference is for the small
Weld County Health Disparities Grant Program Application FY 11-12
10
group discussion format as a way to become better educated about their health, the promotoras will
engage members of the target population through platicas, and then encourage and support them in
participating in other components of the program (i.e., lifestyle intervention and self management classes,
and physical activity opportunities). The use of platicas also creates a bond among the participants, and
provides a support system for people who are making difficult changes in their life for the benefit of their
health.
Weld County Health Disparities Grant Program Application FY 11-12
11
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Evaluation Plan
1. Project Title Ama Tu Vida, Cuida tu CorazOn (Love Your Life, Take Care of Your Heart), A Healthy
Weld 2020 Project
2. Evaluation Plan
a) How will you measure the effects of the program against the goals it set out to accomplish?
The goal of the Ama Tu Vida, Cuida tu CorazOn (Love Your Life, Take Care of Your Heart) project is to
decrease the cardiovascular disease health risk among the Latinos living in Weld County by increasing
access to risk factor reduction and related programming. This population-based goal will be measured
by:
1. Tracking the extent that increased access to risk factor reduction and other programming
was achieved for eligible residents against our overall performance target for reach of
1,500 participants by year 2 of the grant, and
2. Tracking several indicators related to cardiovascular disease risk, including levels of
physical activity, overweight and obesity, and nutrition practices. We will use state data
sources (i.e., BRFSS) as data are available. We have several years of baseline data to
compare furture data against.
Early in year 1, we will engage the advisory board to develop an evaluation plan with specific
evaluation questions that identifies what and how they want to measure the program's effects. They
may, for example, identify qualitative and/or participatory-based evaluation strategies as a means of
evaluating the program's effects in addition to one or more quantiative strategies. If funding is received
in year 2, we will implement the advisory board's plan.
b) How will the proposed activities result in the outcomes you are proposing? You can rely on existing
research evidence.
See logic model in appendix.
c) If you are using other measures beyond those described in the work plan grid, please describe them
here.
We will also measure the project cost per promotora hour. We will do this by tracking the total hours
each promotora spends delivering various facets of the project including time spent delivering Platicas,
engaging in one-on-one outreach, and attending or delivering other community events. This
information will be helpful for our project and perhaps others for program planning, development, and
sustainability purposes.
d) Describe how the results of the evaluation will be used, disseminated, and communicated.
Two primary uses of this project's evaluation are to (a) improve the program and (b) evaluate the
effects of the program. For example, internally, evaluation findings will be disseminated and used by
the project staff during regularly scheduled project meetings in order to identify strengths and
weaknesses and refine project activities. Also, the project advisory board will receive regular updates
on process and outcomes results in order to assess the program's impact in the community. Short-term
and intermediate results will also be disseminated in brief presentations to the Board of County
Commissioners (annually), the Board of Health (annually), and Health Communication, Education, and
Weld County Health Disparities Grant Program Application FY 11-12
19
Planning Division meetings (quarterly) as part of the health departments commitment to accountability
and quality control.
We plan to disseminate project evaluation findings externally to other stakeholders as well. For
example, Ofelia Orozco, the Health Educator and lead promotora, will organize and present the
project's successes at a community meeting at the end of year 1. In addition, project staff plans to
disseminate evaluation findings to the Northern Colorado Health Alliance Board of Directors as well as
some of their individual member organization's management teams such as Sunrise Community Health
Center and Northern Colorado Medical Center.
Budget Narrative
Project Title: Ama Tu Vida, Cuida to CorazOn (Love Your Life, Take Care of Your Heart), A Healthy
Weld 2020 Project
Agency/Organization Name: Weld County Department of Public Health & Environment
Year 1 FY 11-12 (July 1, 2011 —June 30, 2012)
LINE raw NARRATIVE
Personnel Expenses Total for Year 1 = $76,982
Gabrielle Vergara, MPH .50 FTE: Gabrielle will be responsible for managing the day-to-day activities of the
Project Coordinator program,including project implementation,staff supervision,overseeing contracts
(wlsub-contractors),progress monitoring and reports. She will also be responsible for
program outreach and marketing,coordinating referrals with local providers and
service organizations,overseeing promotora training,facilitating the advisory group,
securing locations for classes, and assisting with platicas and classes.
$40,857 Annual salary is$60,287 X.50(FTE)=$30,144
Fringe calculated at 35.54%($30,144)_$10,713
Total salary and fringe requested=$40,857
Ofelia Orozco,MA .50 FTE: Ofelia will be the lead educator for the platicas and lifestyle intervention
Health Educator classes. She will also help lead the support group and oversee the promotoras.
Annual salary is$53,305 X.50(FTE)=$26,653
$36,125 Fringe calculated at 35.54%($26,653)_$9,472
Total salary and fringe requested=$36,125
Operating/Supplies Total for Year 1 = $1,724
Office Supplies An annual budget for office supplies needed to implement the project is estimated at
$500 for the year. Example of supplies needed include printer toner, paper,
$500 pens/pencils,file folders,etc. Actual expenses will be charged to the grant as
incurred.
Printing Miscellaneous copying for the project is budgeted at approximately 300 copies per
month at.09 cents/copy. Items to be copied included class handouts,program
flyers,and other outreach materials.
$324 300(copies)X.09(cents)X 12 months=$324
Platica Host Stipends If a Platica is held in someone's home,we would like to be able to provide a$25
dollar gift card to off-set any expenses they may incur as the host. As the host,most
will want to provide refreshments for their quests. We do not want them to have to
$900 cover this expense out-of-pocket.
3 platicas per month @$25 per Platica X 12 months=$900
In-State Travel Total for Year 1 = $1,080
Mileage reimbursement Actual mileage will be charged to the grant as incurred. Mileage will be used by
Weld County Health Disparities Grant Program Application FY 11-12
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(for project coordinator and health educator) project staff for travel related to the project including travel to and from sites where
platicas and educational classes will be held as well as any meetings in Denver
$1,080 related to the grant. An annual budget for mileage has been set at$1,350(estimated
200 miles per month for all staff at.45 cents/mile X 12 months=$1,080
Contracts/Subcontracts Total for Year 1 = $8,550
promotora Training Either a subcontractor will be hired or a training program will be found to provide
training for three promotoras. It is estimated that the training will cost$500/per
$1,500 promotora for a total of$1,500.
promotoras promotoras will be contracted to provide community presentations(platicas),assist
with community outreach,implement physical activity opportunities in their
communities,and provide backup for the lifestyle intervention classes.
$6,750 3 promotoras X 150 hrs./year X$15/hr.=$6,750
Contract Nurse Practitioner or Certified We will contract with a either a Nurse Practitioner or CDE to teach 3 CVD self-
Diabetes Educator(CDE) management class during the grant year. Each class will be for 1 hr.with 1 hr.of
prep time per class.
$300 2 hrs.X 3 classes X$50/hr. =$300
Indirect Costs (based on 8.3%) Total of Personnel+Operating+Travel+Subcontractors=$88,657
$7,332 $88,336 X.083=$7,332
Total Program Cost(Year 1) $95,668
Project Title: Ama Tu Vida, Cuida to Corathn (Love Your Life, Take Care of Your Head), A Healthy
Weld 2020 Project
Agency/Organization Name: Weld County Department of Public Health & Environment
Year 2 FY 12-13 (July 1, 2012 — June 30, 2013)
LINE ITEM NARRATIVE
Personnel Expenses Total for Year 2 = $80,532
Gabrielle Vergara, MPH .50 FTE: Gabrielle will be responsible for managing the day-to-day activities of the
Project Coordinator program, including project implementation,staff supervision,overseeing contracts
(w/sub-contractors),progress monitoring and reports. She will also be responsible for
program outreach and marketing,coordinating referrals with local providers and
service organizations,overseeing promotora training,facilitating the advisory group,
securing locations for classes,and assisting with platicas and classes.
$42,642 Annual salary is$62,922 X.50(FTE)_$31,461
Fringe calculated at 35.54%($31,461)=$11,181
Total salary and fringe requested=$42,642
Ofelia Orozco,MA .50 FTE: Ofelia will be the lead educator for the platicas and lifestyle intervention
Health Educator classes. She will also help lead the support group and oversee the promotoras.
Annual salary is$55,910 X.50(FTE)_$27,955
$37,890 Fringe calculated at 35.54%($27,955)=$9,935
Total salary and fringe requested=$37,890
Operating/Supplies Total for Year 2 = $1,524
Office Supplies An annual budget for office supplies needed to implement the project is estimated at
$500 for the year. Example of supplies needed include printer toner, paper,
$300 pens/pencils,file folders,etc. Actual expenses will be charged to the grant as
incurred.
Printing Miscellaneous copying for the project is budgeted at approximately 300 copies per
month at.09 cents/copy. Items to be copied included class handouts,program
flyers,and other outreach materials.
Weld County Health Disparities Grant Program Application FY 11-12
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$324 300(copies)X.09(cents)X 12 months=$324
Platica Host Stipends If a Platica is held in someone's home,we would like to be able to provide a$25
dollar gift card to off-set any expenses they may incur as the host. As the host,most
will want to provide refreshments for their quests. We do not want them to have to
$900 cover this expense out-of-pocket.
3 platicas per month @$25 per Platica X 12 months=$900
In-State Travel Total for Year 2 = $1,080
Mileage reimbursement Actual mileage will be charged to the grant as incurred. Mileage will be used by
(for project coordinator and health educator) project staff for travel related to the project including travel to and from sites where
platicas and educational classes will be held as well as any meetings in Denver
$1,080 related to the grant. An annual budget for mileage has been set at$1,350(estimated
200 miles per month for all staff at.45 cents/mile X 12 months=$1,080
Contracts/Subcontracts Total for Year 2 = $7,550
promotora Training In the event that all three promotoras from year one are not retained,we are
budgeting for the training of at least one promotora in year two. Either a
$500 subcontractor will be hired or a training program will be found for the training It is
estimated that the training will cost$500.
promotoras promotoras will be contracted to provide community presentations(platicas),assist
with community outreach, implement physical activity opportunities in their
communities,and provide backup for the lifestyle intervention classes.
$6,750 3 promotoras X 150 hrs./year X$15/hr. =$6,750
Contract Nurse Practitioner or Certified We will contract with a either a Nurse Practitioner or CDE to teach 3 CVD self-
Diabetes Educator(CDE) management class during the grant year. Each class will be for 1 hr.with 1 hr.of
prep time per class.
$300 2 hrs.X 3 classes X$50/hr.=$300
Indirect Costs (based on 8.3%) Total of Personnel+Operating+Travel+Subcontractors=$92,332
$7,527 $90,686 X.083=$7,527
Total Program Cost(Year 2) $98,213
Weld County Health Disparities Grant Program Application FY 11-12
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