HomeMy WebLinkAbout20060494.tiff RESOLUTION
RE: APPROVE GRANT APPLICATION FOR PLATICAS PROJECT FOR BREAST
CANCER AND AUTHORIZE CHAIR TO SIGN - THE SUSAN G. KOMEN BREAST
CANCER FOUNDATION, INC.
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 Application for the Platicas Project
for Breast Cancer between 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, and the Susan G. Komen Breast Cancer Foundation, Inc.,commencing April 1,
2006, and ending March 31, 2007, 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 GrantApplication for the Platicas Project for Breast Cancer between 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,and the Susan
G. Komen Breast Cancer Foundation, Inc., be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 15th day of February, A.D., 2006.
♦ BOARD OF COUNTY COMMISSIONERS
/ 4 G ELD CO TY, COLORADO
ATTEST: gel, I �;,� ' 452
J. eile, Chair
Weld County Clerk to the B Fira XCUSD
`�•� +���David E.E Long, Pro-Tem
BY: , Cu 1 ��act 6 6
Duty CIe-k to the Board„
Willi H. Jerke
APP AS TO FO
Robert . Masd
ounty Atto ey f�/ t 1• �
Glenn Vaad
Date of signature: 3i131 l '
2006-0494
H L0033
ag: f{L (r10u,:(.5) O3- /41-0 .,
Memorandum
TO: M. J. Geile, Chair
' Board of County Commissioners From: Mark E. Wallace, MD, MPH, Director
Department of Public Health &
• Environment r 40,f2ecaS
COLORADO
DATE: February 15, 200:\
SUBJECT: Susan G. Koman Breast Cancer
Foundation Grant Application
Attached for Board review and approval is the application for the Susan G.
Komen Breast Cancer Foundation Grant. The grant period would be for 12 months,
April 1, 2006 to March 31, 2007. The grant is for $9,999.61.
Weld County Department of Public Health and Environment will use this funding
to provide one-on-one and small group education and information about breast
cancer prevention and screenings. Presentations will be done at the Swift meat-
packing plant. The funding will also provide screening mammograms or ultrasounds
for 10 women under the age of 40 who have a 1st degree relative with breast cancer or
signs and symptoms of breast cancer.
I recommend your approval.
Enclosure
2006-0494
. r- 6 DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 N. 17`h Avenue
Greeley, 80631
WEBSITE: www.co.weld.co.us
wilD
ADMINISTRATION: (970) 304-6410
FAX: (970) 304-6412
PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420
FAX: (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
COLORADO FAX: (970) 304-6411
Granting Agency: Susan G. Komen Breast Cancer Foundation
Applicant's Name: Weld County Department of Public Health and Environment
Applicant's Address: 1555 N. 17th Avenue
Greeley, CO 80631
Applicant's Phone: (970) 304-6420, ext. 2382
Applicant's Fax: (970) 304-6416
Project Title: Platicas Project for Cancer Prevention
Contact Person: Olivia Martinez
Amount: $9,999.61
Date: February 15, 2006
Weld County Department of Public Weld Count Board of Commissioners
Health and Environment
Mark Wal n acel a ector M. J. G�eile,�C�hair//� �_02/15/2006
Ar
Wel ounty Clerk tp
the Board
I� xk ?�� By: ,(Li UfrXt k tiZZ dt iifte`livi
' it Deput Cle to the Bo rd
•
a1CC -65/9y
2006 COVER PAGE FOR GRANT PROPOSAL
Ni
4NUAt
THE NORTH COLORADO AFFILIATE OF THE
SUSAN G. KOMEN BREAST CANCER FOUNDATION
REQUEST FOR FUNDING
FOR BREAST HEALTH AND/OR BREAST CANCER PROJECT
Olivia Martinez
PROJECT DIRECTOR&TITLE
Weld County Department of Public Health and
INSTITUTE Environment
1555 N. 17th Ave
ADDRESS
Greeley, CO 80631
PHONE ( 970) 304-6420 ext 2382
FAX (970) 304-6452
omartinez@co.weld.co.us
EMAIL
Weld County Plkticas Project for Breast Cancer
TITLE OF PROJECT
$9999.61
TOTAL AMOUNT REQUESTED
April 1,2006 to March 31, 2007
GRANT PERIOD
SIGNATURE&TITLE OF
APPROVING PERSONNEL(OTHER , "_ /// ,
THAN PROGRAM DIRECTOR) ✓^V^^A �'/c5 'h natt.4, DATE 9, I `j ' O LQ
Mark Wallace, MD, MPH
NAME&TITLE OF APPROVING
Director, Weld County Department of Public
INSTITUTIONAL PERSONNEL (TYPED) Health & Environment
PLEASE CHECK TYPE OF APPLICATION: X EDUCATION X SCREENING OTREATMENT
APPLICATIONS MUST BE POSTMARKED BY FEBRUARY 24, 2006
(Photocopies of this form are acceptable)
Project Description
1.This project will continue to provide education about breast self-exam and
mammography screenings to low-income Hispanic women in Weld County through one-
on-one contacts at local agencies, presentations to established groups, and small
gatherings, called platicas, held in homes. The platicas project has been effective and
well received by Hispanic women in Weld County for the past three years. This method
of health education has been expanded to include diabetes prevention and STD/HIV
education platicas, in addition to the original breast health ones. The topics are not
combined in one platica, but sometimes the same group will meet three times for three
separate platicas because it is such a culturally comfortable way to receive health
information.
The platicas generally include women who are 40 years old or younger. The hostess
invites friends and relatives to the informal educational gathering. Mona's Story, a video
about a local breast cancer survivor, and a video about breast self-examination are shown
at the platicas and have been well received. The outreach specialist and the project
director have both completed the training course to perform and teach the instructional
breast self-exam as breast health promotoras. This information can easily be
incorporated into the platicas. The outreach specialist will also accompany clients to
appointments for screening, if needed, to interpret.
During the 2006-2007 grant period, one-on-one contact will continue at the Weld County
Department of Social Services (DSS), the Weld County Department of Public Health and
Environment (WCDPHE), Monfort Children's Clinic, the Sunrise Dental Clinic and
community health fairs. Presentations will continue for Aims Community College ESL
(English as a Second Language) classes, Head Start parent groups, and Strengthening
Latino Family classes. This part of the project can also be expanded to other health
service agencies such as North Colorado Family Medicine, Quick Care, the Weld County
South West Services building, and the Salud Family Health Centers in Fort Lupton and
Frederick.
Initial contact has also been made with workers at the Swift meat-packing plant. One-on-
one contacts have been done with many employees, and there is now interest in classes or
platicas, which would be scheduled right after work. Women will be provided a healthy
snack to enjoy while they participate in health education at the worksite.
Again during the 2006-2007 grant year, part of the funds from the Susan G. Komen Grant
will be used to provide vouchers for a free screening mammogram for 10 women who do
not meet the age requirements for the CWCCI program, but have signs and symptoms of
breast cancer or a first-degree relative with breast cancer. Women who meet the criteria
(50 years of age and older or 40-49 years of age with signs and symptoms of breast
cancer or a first-degree relative with breast cancer) are offered an appointment for a free
mammogram funded by the Colorado Women's Cancer Control Initiative.
2. Data from the Colorado Central Cancer Registry show there were 13 reported new
cases of breast cancer in Hispanic women in Weld County in 2004, compared with 20
cases in 2003. There were three Hispanic women in Weld County who died from breast
cancer in both 2003 and 2004.
According to the Susan G. Komen Breast Cancer Foundation National Hispanic/Latino
Advisory Council, breast cancer is less common among Hispanic/Latino women than
Caucasian women, approximately 70 per 100,000. However, it is the leading cause of
death for Hispanic women. The five-year survival rates remain lower for
Hispanic/Latino women than those in other ethnic groups. The reason may be
attributable to the fact that Latinos are more likely to be diagnosed at a later stage when
tumors are larger and harder to treat. Education about breast cancer screening is a
particular challenge in this population because there are few bilingual education
programs and many women do not have health insurance or screening is not covered by
their insurance.
There are also cultural barriers that prevent Hispanic women from getting screened.
Doing breast self-examinations, physical exams by male physicians, and fear of pain with
mammography are examples of barriers. This project addresses these barriers and takes
breast cancer education to the Hispanic woman in a culturally acceptable format, one-on-
one in their homes with family and friends, and in established group meetings that they
already attend. Thirty percent of Weld County's population is Hispanic and the female
Hispanic population in Weld County was 23,143 in 2000. This population is growing
each year and this project will build on the progress that's been made in breast cancer
education and screening in Weld County.
3. The people to be served with this grant are primarily low-income Hispanic women in
Weld County. A minimum of 35 women will have one-on-one contact with the program
outreach specialist each week, or 1260 women during the grant year. One-on-one
contacts will be done three weeks each month. (3 weeks x 12 months x 35 women=
1260 women). During the 2005-2006 grant year, the project outreach specialist has been
able to meet or exceed this goal by doing one-on-one outreach in more locations.
Group presentations to Head Start parent groups, ESL classes, and Strengthening Latino
Family classes will continue to be done, averaging at least one presentation each month,
with an average of 10 attendees at each presentation. That will reach an additional 120
women.
The platicas discussion groups about breast health will be held monthly with a minimum
of six women attending each one. (12 platicas x 6 women= 72 women)
Through these programs nearly 1400 low-income Hispanic women will be contacted
personally about breast cancer screening during the 2006-2007 grant year. This will help
to increase knowledge of breast cancer screenings and may lead to earlier detection and
higher survival rates among Latino women in Weld County.
4. Objective 1: 35 women a week will be contact one-on-one about breast self exam and
mammograms in the waiting areas of the Social Services buildings, the Health
Department, Monfort Children's Clinic, Sunrise Dental Clinic, and community health
fairs. Of the 35, at least three will sign up for mammograms and PAP test offered by
CWCCI and at least one will sign up to host a platica.
Measure of accomplishment: The outreach specialist will spend four hours per week,
three weeks each month, contacting women at cooperating agencies and events. Records
will be kept on the number of women contacted, referred to CWCCI for screenings, and
scheduled to host platicas.
Objective 2: Twelve discussion groups, or platicas, will be held in homes of Hispanic
women during the grant year. Women who attend the platicas will receive educational
materials, such as the shower card, bookmarks, and brochures related to breast health.
Measure of accomplishment: Records of the groups, attendance sheets and evaluations
will be kept.
Objective 3: Twelve presentations to groups about breast health and breast self-exams
will be done during the grant year. Educational materials will be distributed and
volunteers to host platicas will be solicited.
Measure of accomplishment: A list of presentations and number of attendees will be
kept.
Objective 4: Ten (10) vouchers for free screening mammograms or ultrasounds will be
distributed to women under the age of 40 with a ls` degree relative with breast cancer or
signs and symptoms of breast cancer. These women will be identified in the one-on-one
contacts, the group presentations and the platicas. The women will be referred to
Planned Parenthood for a clinical breast exam and then given a voucher for a
mammogram at the Summit View Medical Commons if the health care provider
determines there is a reason for further study.
Measure of accomplishment: A record will be kept of the women provided with referrals
for clinical breast exams and vouchers for screening mammograms.
Objective 5: Six (6) classes about breast health will be conducted for employees at the
Swift meat packing plant right after work.
Measure of accomplishment: A list of presentations and numbers of attendees will be
kept.
5. This project is an expansion of the Colorado Women's Cancer Control Initiative
(CWCCI) program currently housed at the Weld County Department of Public Health
and Environment, and a continuation and expansion of the platicas project funded by a
Susan G. Komen grant during the past three years. Because the CWCCI position is now
full-time, a bilingual, bicultural outreach specialist has been contracted to continue the
platicas project. She is an experienced educator and has been able to successfully
continue the program.
The platicas programs have been well received in the Greeley-Evans area. This grant
year,platicas have also been done in Ault, Gilcrest, and Galeton. During the upcoming
year, it is planned to expand the platicas to other areas of Weld County that have a
significant Hispanic population, such as Fort Lupton and Wattenberg.
The ability to offer free clinical breast exams and screening mammograms to younger
low-income Hispanic women with a lst degree relative with breast cancer or signs and
symptoms of breast cancer will provide this important screening to more women at risk
of developing breast cancer. The CWCCI Project Director identified the need for
mammograms for this group as a result of hotline calls, screenings, and community
outreach.
6. Because this program has been in place for nearly three years, many important
relationships with other agencies and community groups have been established. The
Susan G. Komen grant will enable the platicas project to continue uninterrupted. The
outreach specialist will continue to divide her time to include three weeks each month of
one-on-one contacts in waiting areas at DSS, WCDPHE, MCC and the Sunrise Dental
Clinic. The addition of the after-work classes at Swift meat-packing plant will be an
opportunity to provide health education to a hard-to-reach population: low-income
working Hispanic women. Community groups will be contacted to schedule
presentations, with an average of one every month. Hostesses for platicas will be
recruited so that a platica is held every month.
7. Many community agencies will continue to be collaborators with the Weld County
Department of Public Health and Environment to ensure the success of the platicas
project. The Department of Social Services (DSS), Monfort Children's Clinic (MCC),
Sunrise Dental Clinic are very willing to have the outreach specialist talk discreetly with
their clients in the waiting areas. Many community groups, such as the Head Start Parent
Groups, elementary school parent groups, Strengthening Latino Families classes, Aims
Community College and faith-based ESL (English as a Second Language) classes have
invited the project director and outreach specialist to do presentations. With a Susan G.
Komen grant to provide clinical breast exams at no cost to the patients referred through
this project, there is a good collaboration between two grant recipients.
8. If, or when, Susan G. Komen grant funds are no longer available for the platicas
project, other funding sources will be identified. The project director is funded with
CWCCI funds and is instrumental in the success of the platicas project because of her
knowledge of the community and the resources.
9. No other group in Weld County is doing platicas related to breast health. As an
extension of this project, a group of Hispanic women were trained to be promotoras for
breast health, and have started to host their own platicas. This expands the outreach of
information and education to a wider circle of women.
There are other programs that provide education about breast cancer to English-speaking
groups, such as the Woman-to-Woman presentations that members of the Weld Women's
Health Consortium do for various groups in the community. The platicas project fills an
educational need for women who use Spanish as their primary language.
10. Success of the program is most easily measured by numbers of women who are
contacted one-on-one, or the number of presentations given to community groups, or
number of platicas held. However, the real success will be an increased number of
women who are doing breast self-exams and getting regular mammograms, leading to
earlier detection and treatment of breast cancer and fewer women in Weld County dying
from breast cancer. Success of the program is also measured by increased outreach to
low-income Hispanic women in Weld County about breast health, leading to increased
awareness and interest in healthier lifestyles. Other programs which complement the
platicas project, such as diabetes prevention and STD/HIV awareness, can then be
introduced to the women and their families who have already made important choices
and changes for better health.
Comments from the women who have attended a platica are very positive:
• "This platica is very important for our family; it is the only way we can be
informed of how to have better health and how we can protect ourselves."
• "I liked the information about how and when to do breast self-exams and where to
go for assistance if we notice a problem."
• "I liked everything about the platica, especially the explanation on the proper way
to do the breast self exam."
11. The results of this project are incorporated into statewide cancer control programs
such as CWCCI. If one-on-one and small group education continues to be successful,
more funds can be directed to those formats. The platicas project outreach coordinator
has been the co-host on a local Spanish language radio station Health talk Show to
discuss the program and provide information and education. The project coordinator has
written articles about platicas and breast health for La Tribuna, the free weekly Spanish
language newspaper in the region. The "ripple effect" of health education also plays a
role in this project. Women who are educated about good health pass that information on
to their family and friends.
2006 ABSTRACT PAGE
Olivia Martinez
PROJECT DIRECTOR
Weld County Department of Public Health and
ORGANIZATION/INSTITUTION Environment
In the space below, please provide a short abstract, not to exceed 200 words, written in
lay terms for release to the general public should this application be chosen for funding.
THE WELD COUNTY PLATICAS PROJECT FOR BREAST HEALTH WILL INCLUDE THREE METHODS
OF EDUCATING LOW-INCOME HISPANIC WOMEN ABOUT BREAST HEALTH, AS WELL AS PROVIDE
FREE SCREENING MAMMOGRAMS OR ULTRASOUNDS TO 10 WOMEN WHO ARE UNDER 40 YEARS
OLD AND HAVE A 1ST DEGREE RELATIVE WITH BREAST CANCER OR SIGNS AND SYMPTMS OR
BREAST CANCER. A BILINGUAL, BICULTURAL OUTREACH SPECIALIST WILL PROVIDE ONE-ON-
ONE EDUCATION AND INFORMATION TO WOMEN IN WAITING AREAS OF HEALTH AND SOCIAL
SERVICE AGENCIES, GIVE PRESENTATIONS TO COMMUNITY GROUPS, AND TEACH BREAST SELF-
EXAM AND LEAD DISCUSSIONS ABOUT BREAST HEALTH WITH SMALL GROUPS OF WOMEN,
THE PLATICAS . THIS SUCCESSFUL PROGRAM WILL BE EXPANDED TO INCLUDE WOMEN WHO
LIVE IN THE SMALLER COMMUNITIES OF WELD COUNTY,AS WELL AS WOMEN WHO WORK
AT THE SWIFT MEAT-PACKING PLANT.
BCCCP PROVIDER? ❑ YES X No
Low Income Latino women
TARGET POPULATION
ABSTRACT
Permission to publish:
Permission is hereby granted to the Susan G. Komen Breast Cancer Foundation, Inc. to publish
the above abstract should this application be selected for funding.
SIGNATURE
February 15, 2006
DATE
Olivia Martinez
NAME (TYPED)
970-304-420 ext 2384
PHONE NUMBER
2006 BIOSKETCH FORM
Martinez, Olivia
PROJECT DIRECTOR(Last Name,First,Middle)
BIOGRAPHICAL INFORMATION
Information should be submitted for the project director and other personnel included in
budget request. Please use a separate form for each person.
NAME OLIVIA MARTINEZ TITLE HEALTH EDUCATION SPECIALIST
EDUCATION
(Begin with baccalaureate or initial professional education, such as nursing, include postdoctoral training)
INSTITUTION DEGREE YEAR FIELD OF
(Indicate Location) CONFERRED STUDY
University of Northern Colorado Bachelor of 2000 Public Health
Greeley, CO Science
PROFESSIONAL EXPERIENCE: Please list, in chronological order, concluding with present
position, previous employment, experience and honors. List, in chronological order, the
titles, authors and complete references to all publications during the past three years
and to representative earlier publications pertinent to this application.
DO NOT EXCEED Two PAGES
See second page.
PROFESSIONAL EXPERIENCE:
Nursing Student Practicum, North Colorado Medical Center, Greeley CO(Sept. 1996-May
1999). Provide patient care in a hospital setting under instructor's supervision. Provide patient care
at Monfort Children's Clinic with supervision.
Community Health Practicum, Nutrition Educator, CSU Cooperative Extension, Greeley, CO
(July-Oct. 1999). Assist with provision of nutrition education for needy eligible community
members.
Health Intern, Weld County Department of Public Health, Health Promotion, Greeley, CO
(Jan.-May 2000). Translate to Spanish Prenatal Plus educational materials. Attend coalition and
staff meetings. Assist with development of work plan for Abstinence Education Program. Write
article for the Greeley Tribune. Develop pamphlets, brochures, flyers, and posters on health
programs.
Clerical Assistant, University of Northern CO, Human Relations/Ombudsmen, Greeley CO
(June 1996-May 1999). Clerical and receptionist duties: answer telephone, file, archive, copy,
collate, and distribute Position Authorization Forms to appropriate personnel, sort mail and type
letters and memos. •
Health Education Specialist, Weld County Dept. of Public Health, Health Promotions,
Greeley CO (May 08, 2000-Sept. 23, 2002). Assist with planning, administration and
implementation of outreach activities to educate teens on abstinence. Implement nutrition classes
at the Jesus Rodarte Cultural Center. Implement General Health Education duties as assigned.
Community Outreach Coordinator, Colorado Women's Cancer Control Initiative,Weld
County Dept. of Public Health, Health Promotions, Greeley CO (March 19, 2001-Present).
Plan and implement outreach activities to recruit eligible women for cancer screenings. Consortium
building to facilitate health care services for women. Evaluate program progress and report to State
Health Department. Administration of program budget. Media collaboration to promote program.
Assist in other health promotion projects as needed.
Weld County Platicas Project Director,Weld County Dept. of Public Health, Health
Promotions, Greeley CO (April 01, 2003-Present). Coordinate the Platicas Project. Contact
possible eligible women for CWCCI, screen women for program eligibility, and refer to health care
provider for breast cancer screenings. Evaluate program progress and report to Susan G. Komen
Foundation. Program budget administration.
BIOGRAPHICAL INFORMATION
Information should be submitted for the project director and other personnel included in
budget request. Please use a separate form for each person.
NAME OFELIA OROZCO TITLE
PLATICAS PROJECT OUTREACH SPECIALIST
EDUCATION
(Begin with baccalaureate or initial professional education, such as nursing, include postdoctoral training)
INSTITUTION DEGREE YEAR FIELD OF
(Indicate Location) CONFERRED STUDY
ATT, Community College 2001 GED
Aims Community College 2004 Early Child
Development
PROFESSIONAL EXPERIENCE: Please list, in chronological order, concluding with present position, previous
employment, experience and honors. List, in chronological order, the titles, authors and complete
references to all publications during the past three years and to representative earlier publications pertinent
to this application.
Do NOT EXCEED Two PAGES
Professional Experience:
Customer Service Representative,Wal-Mart Las Cruces, New Mexico (August 2000 to May 2001). Provide
customer service to customers with questions regarding products. Stock merchandise products on shelves. Perform
inventory on all shelves in assigned area for the day. Translate for Spanish speaking customers. Assist with the
location of items on shelves and in back stock. Take orders for certain items. Assist with clean up when necessary.
Cafeteria Aide, Las Cruces Public School, New Mexico (August 2000 to May 2001). Prepare nutritious meals
following the food pyramid for breakfast and lunch. Follow instructions on receipt cards. Serve children appropriate
portion size of every food group. Supervise the children ages 1 to 5 year. Create and monitor activities throughout the
day.
Family Advisor, Bright Beginnings,Ameri-Corps Member, Greeley CO (November 2,2001 to July 19,2003).
Advise Monolingual, non English speaking parents of current family matters such as car seat and house safety, how
to spend time teaching and reading to their children. Provide information to parents about house safety such as
locks for cabinet doors, keeping medicine&other chemicals out of reach of children and bath equipment safety.
Refer families to Partner agencies that can provide assistance for their specific needs. Provide postpartum
depression information to new mothers. Deliver information on how to stimulate the baby's brain with music and play.
Encourage mothers to become more active in their child's life. Distribute instruction books on learning activities&
learning toys to help the parents teach their children.
Platicas Project Outreach Specialist,Weld County Department of Public Health, Greeley, CO(July 12,2004 to
Present). Provide presentations on breast health to small groups in the community. Contact women one-on-one to
provide information on breast health screenings and community resources. Inform public on breast cancer issues
through radio interviews.
Cerificates
CPR Certified (for adult, infant and older children)
Certificate of Appreciation in recognition of contributions to Colorado Bright Beginnings
Certificate of Completion for Physical Fitness Testing&TEKS Connections
Certificate of Attendance for 7-hours in training for
Colorado Parents As Teachers & Nurturing Ourselves and Others& Program Quality/Assessment
Larimer Center for Mental Health &Centennial BOCES--Satisfactory Completion of the
Strengthening Latino Families Training
Denver Children's Advocacy Center--Certificate for the completion of
The Impact of Adverse Experiences on the Developing Child &Implications for Practice and Policy Training
AIMS Community College Attendance Certificate for Early Childhood Summer Seminar
Juntas Contra el Cancer del Seno Promotora Training Certificate a training course to perform/teach the
Instructional Breast Self Exam as a Breast Health Promotora
2006 BUDGET FORM
GRANT APPLICATION REQUIRED BUDGET FORM
DETAILED BUDGET FOR FROM THROUGH
ENTIRE BUDGET PERIOD 4/1/2006 3/31/2007
PERSONNEL TYPE APPT. % BASE DOLLAR AMOUNT REQUESTED
(MUST BE SPECIFIC TO PROJECT) (MONTHS) EFFORT SALARY
ON
PROJECT
NAME ROLE SALARY FRINGE TOTALS
ON REQUESTED BENEFIT
PROJECT
OFELIA OUTREACH 8 HOURS 100% $15/HR $6,240.00 NONE $6,240.00
OROZCO SPECIALIST PER WEEK
SUBTOTALS $6,240.00 0 $6,240.00
SUPPLIES(ITEMIZE BY CATEGORY)
$40 PER HOSTESS FOR THE PLATICAS IN THE HOMES $ 480.00
12 PLATICAS DURING GRANT PERIOD
SNACKS FOR CLASSES HELP FOR EMPLOYEES AT SWIFT MEAT PACKING PLANT 200.00
EQUIPMENT(NOT TO EXCEED 30% OF DIRECT COST)
N/A
TRAVEL
1174 MILES @ 42.5 CENTS PER MILE $498.95
PATIENT CARE COSTS INPATIENT
OUTPATIENT 10 SCREENING MAMMOGRAMS OR
ULTRASOUNDS @$167.16 EACH $1671.60
OTHER EXPENSES(ITEMIZE BY CATEGORY)
SMALL GIFTS FOR PLATICAS ATTENDEES SUPPPLIED BY CWCCI 00
SUBTOTAL-DIRECT COSTS $9,090.55
INDIRECT COST ALLOCATION(NOT TO EXCEED 10%) $ 909.06
TOTAL FUNDING REQUEST
$9,999.61
PLEASE ATTACH BUDGET JUSTIFICATION
Budget Justification:
Personnel: Ofelia Orozco, the bilingual and bicultural Outreach Specialist, is contracted with
the Weld County Department of Public Health and Environment for $15/hr to implement the
platicas. Because of more community presentations and the outreach to the employees at Swift
meat-packing plant, her hours will be increased to eight per week (from seven).
The CWCCI Project Director, Olivia Martinez, will supervise the grant and provide written
reports for the Susan G. Komen grant on an in-kind funding basis.
Supplies: Each hostess is given a $40 WalMart gift certificate to provide refreshments and as an
incentive to invite friends and family members to the platica in her home. Twelve plkticas are
included in the Susan G. Komen grant funding. Funding has also been included to provide
healthy refreshments for the Swift employees who attend the presentations at the end of their
shifts.
Travel: Mileage reimbursement from the Weld County Government has increased to 42.5 cents
per mile. Since the grant includes more outreach to areas outside "greater Greeley" and the limit
for the 2005 grant was reached before the end of the grant, the mileage amount has been doubled
for this grant application.
Patient Care Costs—Outpatient: Vouchers for mammograms or ultrasounds will be provided
to women under 40 years of age who have a ls` degree relative with breast cancer or signs and
symptoms of breast cancer. These women are not eligible for the mammograms provided by
CWCCI. The women will be identified through the one-on-one contacts and the platicas. The
women will be referred to Planned Parenthood for a clinical breast exam. Planned Parenthood
has received a Susan G. Komen grant to provide clinical breast exams for low-income women,
so this will fit well with their project. The Summitview Medical Commons (Banner Health) has
agreed to provide the mammograms for $167.16 each(2004 CPT approved codes with Medicare
rates CWCCI approved services— 8/04) The number of vouchers has been decreased from the
2005 grant because not all of the vouchers were used during the previous grant period.
Indirect Costs: County policy requires indirect costs to be allocated for each grant to cover
utilities, business office, purchasing support, computer support and housekeeping.
List of other sources of current funding for the proiect:
1. CWCCI pays for the platicas Project Director to maintain the data, schedule appointments for
qualifying women. It also pays for additional educational materials such as brochures on the
CWCCI program.
2. WCDPHE provides the office space, meeting space, a computer and printer and audio-visual
equipment.
3. WCDPHE also provides the support of the health promotion supervisor and an office
technician to meet the project goals.
POLITICAL SUBDIVISION EXEMPTION CERTIFICATE
(For use by States, Territories, or Political
Subdivision thereof, or the District of Columbia)
The undersigned hereby certifies that she is Controller of Weld County Government
and that she is authorized to execute this certificate and that articles/services
purchased from
are for the exclusive use of Weld County Government.
It is understood that the exemption from tax in the case of sales or articles under this
exemption certificate to the State, Territory, or Political Subdivision or District of
Columbia is limited to the sale of the article purchased for their exclusive use, and it is
agreed that if articles purchased tax-free under exemption certificates are used
otherwise or are sold to employees or others, such fact must be reported to the
manufacturer of the articles covered by this certificate. It is also understood that the
fraudulent use of this certificate to secure exemption will subject the undersigned and
all parties making use of this certificate to all applicable criminal penalties under the
Internal Revenue Code.
COLORADO SALES TAX CERTIFICATION OF EXEMPTION NUMBER- 98-03551
FEDERAL TAX EXEMPTION NUMBER- 84-6000813 -
STATE TAX IDENTIFICATION NUMBER - 14-02101
BY "419PC/,r_11aQ 9. ALL' kJ
Responses to comments about Platicas Project for Cancer Prevention grant
Weld County Department of Public Health and Environment
Clarification of project description and abstract—a restatement of paragraph five
in the Project Description
Again during the 2006-2007 grant year, part of the funds from the Susan G. Komen Grant
will be used to provide vouchers for a free screening mammogram or ultrasound for 10
women ages 39 and younger who have signs and symptoms of breast cancer or a first-
degree relative with breast cancer, but do not meet the age requirements for CWCCI
program. Women who meet the criteria(50 years of age and older or 40-49 years of age
with signs and symptoms of breast cancer or a first-degree relative with breast cancer) are
offered an appointment for a free mammogram funded by the Colorado Women's Cancer
Control Initiative (CWCCI).
Clarification of the seamless design of service and who is providing the voucher:
The outreach specialist for the Platicas Project identifies women who meet the criteria
(39 years or younger with signs and symptoms of breast cancer or a first-degree relative
with breast cancer) at platicas, presentations or other educational activities. She has them
complete a registration form. This information is provided to the Project Coordinator
who sets up an appointment for the woman at Planned Parenthood for a clinical breast
exam. (Planned Parenthood has a Susan G. Komen grant to provide clinical breast
exams.) If the health care professional at Planned Parenthood determines that a
mammogram or ultrasound is needed, a voucher is given to the woman, and referral is
made to NCMC Radiology at Summitview. Funds from this grant will be used to pay for
the procedures at Summitview. This procedure was established for CWCCI clients and
works well.
Clarification of the personnel time commitment for the project:
A flexible schedule for the Outreach Specialist includes one-on-one contacts, one platica
a month, one presentation a month, and office time to set up the outreach and make
follow-up contacts. If it were a 40-hour work week, it would be 12 hours of office time,
22 hours of one-on-one outreach, three hours for a platica, three hours for a presentation.
Typically, the outreach specialist works a five week rotation:
Week one: 8 hours one-on-one outreach
Week two: 5 hours one-on-one outreach and 3 hours for a platica
Week three: 4 hours in the office and 4 hours one-on-one outreach
Week four: 5 hours one-on-one outreach and 3 hours for a presentation
Week five: 8 hours in the office.
This is the allocation of time that has been used previously for this position and seems to
work well.
Hello