HomeMy WebLinkAbout20061646.tiff RESOLUTION
RE: APPROVE TASK ORDER OPTION TO RENEW LETTER#1 FOR NURSE HOME VISITOR
PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Task Order Option to Renew Letter#1 for
the Nurse Home Visitor Program 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 Colorado Department of Public Health and Environment,
commencing July 1, 2006, and ending June 30, 2007, with further terms and conditions being as
stated in said renewal letter, and
WHEREAS, after review, the Board deems it advisable to approve said renewal letter, 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 Task Order Option to Renew Letter#2 for the Nurse Home Visitor Program
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 Colorado Department of Public Health and Environment be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said renewal letter.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 19th day of June, A.D., 2006.
��..` BOARD OF COUNTY COMMISSIONERS
/ ♦ WELD COUNTY, COLORADO
ATTEST: CUSED� J.,ile, Chair
Weld County Clerk to the r• 4Pia
- 0
�� ' 'David E. Long, Pro-Tem
BY: _
Dep y Clerk to the Board ' kA„
Will H Jerk �n
APP AST , , Vr
Robert D. Masd n
un A rney
GI nn Vaa
Date of signature: `0`7
1(149
2006-1646
HL0033
eO ; / (3eiJ) ob.
Memorandum
TO: M.J. Geile, Chair
Board of County Commissioners
I C FROM: Mark E. Wallace, MD, MPH Director,Environment
Pub is
and Environment _ IM
COLORADO DATE: June 15, 2006
SUBJECT: Task Order Option to Renew Letter#1
for the Nurse Home Visitor Program
Enclosed for Board review and approval is task order option to renew letter#1 between the Weld
County Board of Commissioners on behalf of the Department of Public Health and Environment
(WCDPHE) and the State of Colorado through the Colorado Department of Public Health and
Environment for the Nurse Home Visitor Program.
Under the provisions of this renewal letter, WCDPHE will provide countywide nurse home
visitor services to low-income, first-time mothers. The funding from this task order will be used
to support health, education, and other resources for new young mothers during pregnancy and
the first years of their infants' lives.
For providing the services described above during the time period of Julyl, 2006 through
June 30, 200, the State will pay Weld County an amount not to exceed $457,399, and it is
anticipated Medicaid will pay approximately $168,756.
I recommend your approval of this task order.
Enclosure
2006-1646
TASK ORDER OPTION TO RENEW LETTER
June 12,2006
Task Order Option to Renew Letter Number 01, Contract Routing Number 07 FLA 00241
State Fiscal Year 2006-2007 PSD—CASH-NHVP
This Task Order Option to Renew Letter is issued pursuant to paragraph F. of the Master Contract identified by
contract routing number 05 FAA 00054 and paragraph C. 5. of the Task Order identified by contract routing
number 06 FLA 00093 and contract encumbrance number PO FLA NHV0600093. This Task Order Option to
Renew Letter is between the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
and BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY (a political subdivision of the state of
Colorado), for the use and benefit of the Weld County Department of Public Health and Environment,The
Task Order,as amended, if applicable, is referred to as the"Original Task Order". This Task Order Option to
Renew Letter is for the renewal term of July 1,2006,through June 30,2007. The maximum amount payable by
the State for the work to be performed by the Contractor during this renewal term is Four Hundred Fifty Seven
Thousand Three Hundred Ninety-Nine Dollars, ($457,399.00)for an amended total financial obligation of the
State of NINE HUNDRED TWENTY-FIVE THOUSAND FOUR HUNDRED TWENTY-TWO DOLLARS
($925,422.00). This is an increase of Four Hundred Fifty Seven Thousand Three Hundred Ninety-Nine
Dollars,($457,399.00)of the amount payable from the previous term. The revised specifications to the original
Scope of Work,revised Budget,and revised Medicaid Reimbursement Guidelines, if any, for this renewal term
are incorporated herein by this reference and identified as EXHIBIT G, EXHIBIT H and EXHIBIT I. The first
sentence in paragraph C. of the Original Task Order is modified accordingly. All other terms and conditions of
the Original Task Order are reaffirmed. This change to the Task Order shall be effective upon approval by the State
controller, or designee,or on July 1,2006,whichever is later.
Please sign, date,and return all four(4)originals of this Task Order Change Order Letter by June 21,2006, to the
attention o1 Peggy Becker,Colorado Department of Public Health and Environment,4300 Cherry Creek
Drive South, Mail Code PSD-MCH-A4, Denver, Colorado 80246. One original of this Task Order Change Order
Letter will be returned to you when fully approved.
BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO
OF WELD COUNTY Bill Owens,Governor
(a political subdivision of the state of Colorado)
for the use and enefit of the
Weld County apartment of Pubic Health and Environment (Lt.,
By: By:
Name: David E. Lon For the Executive Director
Title: Chair P DEPARTMENT OF PUBLIC HEALTH
FEIN: 84-6000813 AND ENVIRONMENT
/2006
PROGRAM PPROVAL:
By:1161 4S2
�''��� � lam'
, t
De 7t31 C' erk to the Board
- ' ! ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until
the State Controller,or such assistant as he may delegate, has signed it. The contractor is not authorized to
begin performance until the contract is signed and dated below. If performance begins prior to the date
below,the State of Colorado may not be obligated to pay for the goods and/or services provided.
TE CONTROLLER:
Leslie M. S net
WELD COUNTY DEPARTMENT OF
PU IC HEALTH AP�NY Da bC
((, Date: 3 C1 6BY:
Mark E. Wallace, MD, MPH-Director
Revised: 11/5/04
EXHIBIT G
COLORADO NURSE HOME VISITOR PROGRAM
PROGRESS REPORT
Page 1 of 20
Colorado Nurse Home Visitor Program(NHVP)
2006-07 PROGRESS REPORT COVER SHEET
1. Name of Agency: Weld County Department of Public Health and Environment
2.. Address/City/Zip 1555 N 17th Avenue, Greeley, CO 80631
2. Name of person completing Progress Report: Susan Morse,RN,
Position/Title: Program Supervisor
Telephone: 970 304 6420 ext 2186 FAX: 970 304 6416
E-Mail: smorse@co.weld.co.us
3. Name of Authorized Signer: Dr. Mark Wallace
(Must be an individual with authority to sign a grant application.)
Position/Title: Director
Telephone: 970 304 6420 ext 2104 FAX: 970 304 6416
E-Mail: mwallace@co.weld.co.us
Afj I " k Signature:X (1"9—Cat 'o� �
Chairman, Board
try
of County 18��o6
ATTEST:
4. Total request for July 1,2006 through June 30,2007:$ 640,045
WE COUNTY CLERK TO THE BOARD
5. List county(ies)to be served: Weld County V 2 16 1
BY:
DE TY CCLEF2K TO THE BB RD
6. Total number of families to be served: 150
llMr
H s
7. Total FTE to be funded with NHVP dollars:_8.75 FTE �/!
gSt
8. Total number of nurse home visitors to be funded with NHVP dollars: 7 FTE
w
Page 2 of 20
FY 2005-06 NHVP/NFP PROGRESS REPORT
PROGRAM EVALUATION: Section#1:
Date this data was retrieved from CIS: 17 January 2006
Site CO NFP Complete this table by(1)inserting your
(as of 12/31/05) Objective site's most recent figure for each data point,
Weld County Department of and (2)where your site's performance falls
Public Health &Environment, below the Colorado average,please describe
Greeley,Colorado the reasons why and what steps are being
taken to improve. NOTE: In the area of
"Content of Visits,"please focus primarily
on Maternal Role.
GESTATIONAL AGE at INTAKE:
by 16 weeks 45% 60% Exceeds Colorado benchmark - a
48% reflection on the quality case-
finding among our community school
nurses and truancy liaisons.
by 28 weeks 88% 88% 100% Meets Colorado benchmark
VISITS
Mean number of completed visits
9.9 8.5 Exceeds Colorado benchmark - a
reflection on the responsiveness
of those clients who truly become
Pregnancy
engaged with their nurse / program
content and are committed to
experience better things for
themselves and their future child.
14.8 12.4 27 possible Exceeds Colorado benchmark - a
reflection on the continued
quality engagement / relationship
between the nurse and client. We
also see high intervention needs
and respond to the mother / baby
Infancy diad according to prematurity,
multiple birth, unstable home
environments, and multiple
community service interventions
that are called on as partners in
supporting a mother with one of
life's great transition times.
9.1 6.4 22 possible Exceeds Colorado benchmark - we
applaud our mother / baby diads
Toddlerhood who continue to give us time to be
a part of their lives at this
developmental milestone stage.
Page 3 of 20
Percent of expected visits completed
Pregnancy 85% 79% 80% Exceeds Colorado benchmark
Infancy 51% 44% 65% Exceeds Colorado benchmark
Toddlerhood 43% 32% 60% Exceeds Colorado benchmark
Average length of visits
Pregnancy 72 73 f,Ornirmths Meets Colorado benchmark
Infancy 74 72 ≥60minutes Exceeds Colorado benchmark
Toddlerhood 75 72 ≥60 minutes Exceeds Colorado benchmark
CONTENT of VISITS
Pregnancy
Personal Health 39.5% 37.2% 35-40%. Exceeds Colorado benchmark
7.4% 8.4% 5-7% Needs Improvement - In an effort
to best meets the needs of a
pregnant population that
notoriously is late in starting
prenatal care, is at extreme risk
of delivering low birth weight
infants, and is challenged by the
Environmental Health current Medicaid access issues if
the woman is undocumented, this
topic area has received less
priority. To remind ourselves of
its importance, the back of our
every-visit documentation sheet is
being amended to highlight the
content covered here and the
target expectations.
Life Course Development 12.9% 127% 10-15% Meets Colorado benchmark
25.5% 27.3% 23-25% Needs Improvement - The Maternal
Role topic is one we are
increasingly finding to be covered
for the school-attending client.
Many school and community programs
have adopted the "Parents as
Teachers" curriculum and are
providing this guidance in "life-
skills" classes. As our typical 17
year old also has been responsible
for caring for younger siblings,
we are finding it a challenge to
Maternal Role engage the pregnant girl in this
topic. The clients who are
concurrently serving Probation
time while in our program are
obligated to attend community
centered parenting classes. These
programs also offer the "Parents
as Teachers" content. Our team
meetings have been set up for 2006
to include a focused half hour to
a selected Maternal Mental Health
activity. This will refresh the
experienced staff and strengthen
skill and knowledge among the more
Page 4 of 20
novice staff. To remind ourselves
of its importance, the back of our
every-visit documentation sheet is
being amended to highlight the
content covered here and the
target expectations.
Page 5 of 20
Family and Friends 14.8% 14.3% 10-15% Exceeds Colorado benchmark
Infancy
23.4% 20.2% 14-20% Exceeds Colorado benchmark - it is
here that the challenges of birth
control compliance comes to the
top of the concerns list for our
mothers - for health reasons, some
options are not appropriate; the
changes in drug safety issues and
prescribing standards over the
past year have presented
unforeseen issues and required
Personal Health changes in method choice. This
calls for different education
needs and medical follow-up. As we
have a high 2°d pregnancy rate, we
may be over-compensating on this
focus topic. To remind ourselves
of its importance, the back of our
every-visit documentation sheet is
being amended to highlight the
content covered here and the
target expectations.
8.8% 9.2% 7-10% Needs improvement - To remind
ourselves of its importance, the
back of our every-visit
Environmental Health documentation sheet is being
amended to highlight the content
covered here and the target
expectations.
10.6% 13.5% 1045% Needs Improvement - As a
collective staff, we are not sure
why this topic is so far below the
benchmark. We are taking steps to
Life Course Development remind ourselves collectively of
its value and importance. The back
of our every-visit documentation
sheet is being amended to
highlight the content covered here
and the target expectations.
41.4% 43.5% 45-50% Needs Improvement - The Maternal
Role topic is one we are
increasingly finding to be covered
for the school-attending client.
Many school and community programs
have adopted the "Parents as
Teachers" curriculum and are
providing this guidance in "life-
skills" classes. As our typical 17
year old also has been responsible
Maternal Role for caring for younger siblings,
we are finding it a challenge to
engage the pregnant girl in this
topic. The clients who are
concurrently serving Probation
time while in our programs are
obligated to attend community
centered parenting classes. These
programs also offer the "Parents
as Teachers" content. We do feel
_ success in the high participation
Page 6 of 20
/ engagement levels our mothers
give to the PIPE curriculum. While
we have the high participation of
our teen mothers in all areas of
program content, if her mother is
also in the household, we nurses
are at times balancing good
information and role modeling
against family parenting styles.
To remind ourselves of the
maternal role importance, the back
of our every-visit documentation
sheet is being amended to
highlight the content covered here
and the target expectations.
Page 7 of 20
155% 13.6% 10-15% Exceeds Colorado benchmark - here
we are tackling the issues of gang
FamilyandFriends family / friends; im
proved
selection of life partner
qualities and characteristics.
Toddlerhood
20.4% 16% 10-15% Exceeds Colorado benchmark - the
lack of continued Medicaid
insurance presents overwhelming
challenges for the nurse / client
at this time. Birth control
access / follow-up abnormal pap
smears, the events of acute
Personal Health illnesses without insurance can
and do move to the top of the
client priority list - sacrificing
Maternal Role in an effort to meet
•
the basic self-care need. At this
time, our population also has a
high ratio of 2"° pregnancies,
causing the mother to shift the
nurse focus back to this topic.
Environmental Health 10.0% 10.2% 7-10% Meets Colorado benchmark
14.5% 16.5% 18-20% Needs Improvement - At this time
in the life of our clients, they
have generally exceeded our
abilities to facilitate focusing
on school or education. Our high
percent of undocumented women (who
have dropped out at age 15 -
before our interventions) are an
especially challenging population
Life Course Development when it comes to this content
area. We are continually seeking
ways to support child-care and
transportation issues for a
significant percent of our
families. To remind ourselves of
its importance, the back of our
every-visit documentation sheet is
being amended to highlight the
content covered here and the
target expectations.
39.1% 42.8% 40-45% Needs Improvement - As noted in
Personal Health in this phase, the
mothers are presenting with their
own agendas - and we struggle to
meet the expectations of this
focus with their perceived needs.
We do feel success in the high
participation / engagement levels
Maternal Role our mothers give to the PIPE
curriculum. We struggle to guage
one of our measures - language
development - as the assessment
tool does not fit our high numbers
of Spanish Speaking families. To
remind ourselves of the maternal
role importance, the back of our
every-visit documentation sheet is
being amended to highlight the
Page 8 of 20
content covered here and the
target expectations .
16.0% 155% 10-15% Exceeds Colorado benchmark - here
we are tackling the issues of
dissolved / rebuilding personal
relationships; school / work
setting relationships and
expectations; family / friends;
Family and Friends improved selection of life partner
qualities and characteristics,
etc. As a stable relationship has
a significant bearing on the
emotional availability of the
mother caregiver, we are
responding to their expressed
topic concerns.
ATTRITION: (Amenable to Intervention: declined further participation,unable to locate,excessive missed appointments)
Pregnancy 4.1% 6.6% 10%all reasons Exceeds Colorado benchmark
18.1% 17% 20%aureasons Needs improvement - this one is
tough. It is the considered wisdom
of the 3 senior nurses on our team
that those mothers who respond to
their life course development
activities and stay in school or
obtain gainful employment are the
most likely to leave the program
early. The demands of competing
interests do not lend time or
energy to having a nurse visitor
meeting for up to 1 ' hours every
ancy other week. In November, 2005, we
Infidentified infant / toddler
retention as one of our 2 primary
quality improvement endeavors for
2006. The team has challenged
themselves to define the
environment / context of visits,
the materials that are in
duplication / unique and our
strategies for prolonged
retention. We are proud to note
that we exceed the number of
visits / length of visit time for
these populations.
Toddlerhood 10.8% 8.7% 10%all reasons Needs improvement - see the above
remarks.
SMOKING REDUCTION:
•
Page 9 of 20
-19% -21% -20% Has been improving. A review of
our per/quarter evaluations shows
a continuous impact of our quit-
smoking education component. We
ranged at -10% in the 1st 2
quarters of our program, and moved
to -19% with our last evaluation
Percentage change between intake report. We recognize and value
and36weeks the importance of this campaign.
One of our focus efforts is to
match this reduction rate into
post-partum behaviors. There are
3 new staff who will be attending
the Train-the-Trainer sessions on
Smoking Cessation support in the
1s` half of 2006.
REFERRALS:
Number of referrals received. 156
Percentage enrolled(NFP Objective-75%). 57%
1. Clients decline to participate in a program that
expects intense home visitation over 2 plus years.
This time commitment conflicts with school / work /
family and other activities. If the prospective client
lives with her own family of origin, often her mother
speaks for her and declines the home visitation
program. These clients are referred to other, less
intense pre-natal intervention programs such as
Prenatal Plus.
2. Staff do not get responses from attempts to contact
clients - phone calls / messages, letters of
invitation, unscheduled drop-in visits to the client
home. We see this most often when the referring agency
routes potential NFP candidates through an intermediary
List top three reasons why the referral was not referral source and there is a significant delay in
enrolled. contact time before we actually receive the referral.
In October, 2005, Sunrise Community Health Center began
directing all prenatal referrals to a community pre-
natal plus model program. It is now up to the staff of
this agency to determine which qualifying first time
mothers-to-be might be interested in the NFP program
and direct those referrals to us. This is a process
which is actively changing. A mulit-agency meeting is
now taking place on Monday mornings for the purpose of
referral coordination and reporting on responses.
3. We have access to knowing when clients have OB
visits scheduled and make efforts to meet the client at
an OB appointment. The client either fails to keep the
appointment or declines program participation at that
time.
ENROLLMENT:
Number of active clients enrolled as of 115
Page l0 of 20
February 1,2006.
Number of active clients enrolled one year 84
ago(February 1,2005).
We have identified 6 clients that fit this comment.
Three are in the pru'.c.n of mo--i rig out of our area -
the home visit staff are waiting to hear from the
client about their new location so we can initiate a
transfer / case closure.
Number of clients shown as active on 2 family units are college students who left the area
February 1,2006,but not seen inpast6 for extended holiday breaks to match the school
weeks. Please explain why clients have not calendar. We anticipate re-establishing home
been seen and your plan for clients to receive visitations this week (Feb. 6) .
visits according to the recommended visit
schedule. The 6`h client (mother of a 6 month old infant) took a
job in late December working after school 4 PM - 10 PM
Monday - Friday. She asked for a break from the
program so she could evaluate her energy levels for a
Saturday visit schedule. Contact has been maintained
on a weekly basis by phone about availability.
NURSE ATTRITION:
Nancy Weber - accepted a nursing position within a
school system. This was her background field prior to
her NFP position. She accepted this position for
Please list any nurse(s)who left your program better working conditions.
between March I, 2005 and February 28,
2006 and the reasons for the departure. Caroline Valdez - moved to another state and returned
to work in a hospital based labor / delivery setting.
In transitioning Caroline's caseload, only 2 of her
clients declined continued participation.
Page 11 of 20
Section#2: Nurse Home Visitor Support,Retention and Recruitment
a. Give examples of how reflective supervision is integrated into supervision of nurses.
Reflective supervision is practiced with an open and relaxed approach
for both celebrations and nurse growth. In the most informal application,
the reflective cycle is as simple as 2 nurses conversing among themselves
about a challenging event or as an acknowledgement of an achievement . This
spontaneity and collegiality is fostered physically as the work space
cubicles are set up to house 2 staff per cubicle. This approach provides for
daily practices of the process and enhances the nurse' s skill level and
ability to use it comfortably and confidently in the home visit setting.
Formal use of reflective supervision is integrated into our daily
routine as well . As staff are in the office preparing for their day, a few
minutes are spent with the supervisory / peer staff reflecting on the events
/ feelings / outcomes of the visits from the day before; the nurse' s
emotional refueling activities after work or before work; and action plans
for the daily challenges experienced or anticipated.
New staff members and the supervisor meet at least once a day for the
first 3 months of home visitation. While the time is not defined, the
parameters of the Reflective Cycle are followed. This frequent check-in
activity provides modeling of the cycle components, and builds a recognition
among the new nurses for when the reflective cycle is being applied. This
may be blended with the above paragraph described activity.
b. Describe your schedule for 1-on-1 meetings with nurses, for team meetings including case
conferences, and for home visit observations with the home visitors. Attach one team meeting
agenda that included a case conference.
The Agency supervisor for the Weld County NFP program currently is
carrying a caseload of 10 active clients (infancy / toddler) . In order to
adapt this visit schedule with 6 very active nurses (2 very novice, and a new
Administrative Assistant) , 1-on-1 meetings with nurses occur spontaneously
except as noted above for new staff. There is a formal 1-on-1 process that
takes place in response to our agency practice of doing performance
evaluations on an every 6-month basis. Having 3 very experienced NFP nurses
(4 1/2 years with the program) , team relationships are fostered as the
progressing experts are paired with the novice staff on a rotating weekly
basis for guidance and mentoring.
Team meetings are held weekly for a 2 hour block of time. Activities
incorporated here are: a) weekly visit schedule updates, b) shared
celebrations / successes, c) graduation announcements, d) rotation of case
conference / chart audit, e) rotation of PIPE activity / Maternal Mental
Health activity. A sample team meeting schedule / agenda are attached.
Home visitation is an area that is very much in a developing state for
the Weld County NFP team. The clinical supervisor has been in this position
for 6 months and been challenged to reduce her caseload and assume the full
role of supervisor. So far only three joint nurse / supervisor visits have
been completed (sample document is attached) . There are 3 nurses whose annual
or 6 month reviews are to be done in the month of February, 2006. Each nurse
will have 2 joint home visits done as part of the evaluation process .
As the Weld County team has added 2 new nurses in the past 6 months,
joint visits between the novice / experienced nurse has been an integral part
of the orientation process. This cross-teaching / demonstration method,
while not rated on the home visit scale, provided the supervisor with
indirect assessments and feedback on the skills of the mentor nurse and new
staff.
The NFP staff currently are sponsoring a University of Northern
Colorado student nurse during her Public Health rotation this winter
Page 12 of 20
semester. Here, role-modeling is a reinforcement of the home visit behavior
/ outcome expectations.
c. Which forms are used to record supervision with home visitors and your home visit
observations? Attach a completed supervision form (remove client identifiers) used with home
visitors.
The NFP provided Visit Implementation Scale is used to record
supervision when a home visit is done. A modified Reflective Supervision
Form is used to document the Reflective Cycle. In addition, a Feedback Log is
maintained as a summation of recognitions / commendations and coaching for
improvement events. A completed supervision form is attached.
d. In addition to the required supervision and case conferencing, what activities have taken place to
ensure the nurses feel supported and receive the professional development they need to thrive in
their positions?
Activities that foster professional development and emotional
refueling: off-site training in areas applicable to the caseload / family
work done by the staff: Fetal Alcohol Syndrome, Car Seat Installation,
Prematurity Risks and Care, Assets for Colorado Youth Annual Conference,
March of Dimes conferences, International Breast Feeding Conference, joint
team meetings with Larimer County w/ Invest In Kids consultants (focus on
Maternal Mental Health / Well Being) , etc. Focused, short session inservice
topics have included: Discipline and the 1-2 year old, home visit safety
(Gangs, Meth houses) , WIC updates, and many more.
The seasoned staff (4 1/2 years with the NFP program) , responded with:
flexibility w/ schedules - as this enhances attachment with clients and- -
rewards for the nurse as goals are achieved; educational activities bring
heightened energies to chronic / challenging settings of care; active support
from cooperative community agencies that work in collaboration with the
families the NFP program serves; team activities designed for emotional
refueling.
All staff nurses are partners with United Way to bring the Bright
Beginnings (Warm Welcome and Moving On) materials into our client homes. The
recognition as a community partner and participation in the United Way events
brings added humor and honor to our work.
Section #3: Integration of CIS
a. Describe your team process and schedule for reviewing data from 1) CIS, 2) Quarterly Summary
Reports and, 3)annual Evaluation Reports from the Nurse-Family Partnership National Office.
When any CIS report is received, printed copies are made and
distributed to staff for their review. These reports become the center focus
of the next team meeting. Celebrations are honored for areas of outstanding
outcomes as well as focused quality improvement activities in the less then
stellar areas.
As we work and measure our outcomes for our quality improvement
focuses, these measures are referred to often.
b. Describe how your team utilizes the National Performance Objectives as a tool for performance
improvement.
For 2006, we intently reviewed our data and have selected 2 primary
focus areas for quality improvement: Retention of the infant / toddler diad
(for attrition areas amenable to intervention) and decreasing our early, 2nd
pregnancy rates. The benchmark for retention: increase retention by 1% in
Page 13 of20
each age. The decreased pregnancy rate benchmark is one half a percent at
each bench mark.
These reports also come to our quarterly Perinatal Advisory Board.
Here we also highlight the quality outcomes and seek strategies for areas of
improvement.
These files are also placed onto a common computer drive for access by
any Health Department staff who may have an interest in them (such as needing
data for other reports / grants) .
Printed reports are compiled chronologically in a notebook for staff
access. Graphs are generated around key benchmarks (such as caseload count,
client visit counts, enrollment / retention / graduation rates) and brought
into staff meetings for discussions.
c. Describe how available data and reports are used to address performance concerns with
individual nurses (i.e., failure to make visits according to the schedule, failure to address all
domains, failure to meet required caseload).
On a weekly basis, the mileage report is printed as a way for nurses to
validate with their calendars that the Every Visit Data sheet has been
submitted for data entry. On a monthly basis the Monthly Activity Profile
and Due Dates for Evaluation Forms are printed and brought to the team
meeting for each nurse. As they plan visits, the information from these
reports is incorporated.
At each staff meeting as of November, 2005, a roster of each nurse case
load is provided as -a planning / communication tool for the coming week's
planned visits . This roster has information about the last visit made to
each client. It is by this weekly scan, we have early detection about no
visit contact in the past 2 weeks (or more) . It is part of the conversation
to have an active engagement plan formulated or acknowledge planned lapses
(honoring a long school break / vacation, etc) . Having implemented this
protocol, we are seeking to retain those infant / toddler diads per our
Quality Improvement measure. There was not an effective strategy for
caseload activity assessments prior to November.
This same roster includes a listing of the referral clients who are
candidates for program enrollment. Contact attempts are charted / and
updated. We adopted a unified position in November that each nurse will
over-enroll her caseload by 2 or 3 in an effort to facilitate complete
enrollment and visit productivity. This strategy has had early and promising
success:
Nurse 2 (1 FTE) Caseload: 27 capacity: 25
Nurse 4 (1 FTE) Caseload: 24 capacity: 25
Nurse 6 (1 FTE) Caseload: 26 capacity: 25
Nurse 7 (1 FTE) Caseload: 24 capacity: 25
Nurse 9 (.25 FTE) Caseload: 10 capacity: 7
Nurse 10 ( .75 FTE)Caseload: 17 capacity: 18 (hire 8/1/05)
Nurse 11 (1 FTE) Caseload: 6 capacity: 25 (hire 12/1/05)
The Content and Length of Client Visit report is printed for each
nurse. A simultaneous review with the quarterly and year-end reports is done
in a team meeting setting. This simultaneous review provides the basis for
any needed work performance conversations. In this process, we know that the
novice nurses are the most challenged and thus receive the most focused
coaching.
d. Based on all data and reports, describe the specific action your team has taken over the past year
to address areas that need improvement.
As each quarterly report has become available to us, focus time has
been taken during team meetings to celebrate the quality outcomes achieved
Page 14 of20
and have discussions on areas for improvement. These discussions have been
lively and productive. Over time, we have seen increased enrollment of
referrals, an increased toddler retention rate, and significant smoking rate
changes from admission to 36 weeks.
In November, 2005, a summary of all quarterly reports was brought to
the team. The summation added other columns for the staff discussion: Are
we hitting target? Can we influence our own outcomes? Do we want to
influence our own outcomes? From this discussion came a strategic focus
quality improvement plan for 2006. We are working on strategies for improved
infant / toddler diad retention and decreased subsequent pregnancy by 6, 12,
18 and 25 months postpartum.
Section#4: Advisory Coalition/Supporting Council
a. How are the coalition/council participants actively engaged in the program? What have been the
strategies for keeping them involved? If they are not engaged, what is your strategy to increase
participation and support?
The Weld County Perinatal Advisory Committee serves as the NFP Advisory
Board. This Board meets on a quarterly basis, over a catered lunch at the
Health Department.
As board members are our community partners, there is usually staff /
client / Advisory Board member contact on a weekly or daily basis. This
contact may be for delivering direct services (medical appointment or WIC
counseling) or support services (United Way Bright Beginnings program,
Interventions donations) to the client. This personal contact is the best
way to bring the demonstrated benefits of the home visitation services into
the provider's own home. This in turn, promotes provider engagement and
enhanced client outcomes overall .
At each Board meeting, the most recent quarterly report is reviewed
with dynamic discussions about achievements and areas for improvement. As
the entire NFP staff attend, direct and real time discussions benefit all .
This is also a time for updates from our partner providers about changes in
their programs. With this dialogue, the NFP staff are better able to engage
clients with other referrals when needed.
Standing agenda items for the Advisory Board also includes an NFP
update from a staff member of Invest In Kids. This topic generally covers
the broad picture of legislative and budget issues.
After each board meeting, a thank-you letter for participating is
included with the mailing of the minutes.
b. Give an example of what your board/council has done to support the Nurse Home Visitor
Program.
External support for the NFP program comes in the form of referrals
from working peers - school nurses / school psychologists via the Truancy
Case Manager who is a Board member. This same Board member affected the
Program Supervisor being a part of a community panel that presented to
community Youth Organizations - representing the father perspective in Teen
Pregnancy.
Our next scheduled meeting is March 13, 2006. A tentative agenda is
attached. You will find a "Project Planner" is one of the discussion items.
Board members will be asked to partner with NFP staff and other community
providers / grant funders in hopes of expanding our enrichment activities for
our families.
c. Attach two samples of coalition meeting minutes from the last year.
Two meeting minutes from the past year are attached.
Page 15 of 20
d. If no NFP specific coalition/council exists,what alternatives are used to help the program meet its
objectives?
No response needed.
Section 85: Broad-Based Community Support
a. Provide specific examples of community support for the program (ie. donations of client
incentive, equipment).
The Weld County NFP program has a strong presence and valued offering
among the pregnant populations that we service. This valued relationship
carries over to the partner agencies whose target populations include our lsc
time mother / family units. Staff participation on a number of service
agency / community coalition boards is highly sought after and valued. Board
/ panel participation ranges from United Way, Libraries, Catholic Charities
Northern, Community Based Collaborative Panels, etc.
Our clients benefit from such activities by the receipt of regular
donations of new-born layettes from several church organizations, donations
from Community Baby Showers hosted by United Way partner agencies, and books
from Church sponsored book drives. This past year we were one of the
beneficiaries of the Darian Book Aid Plan. This is an organization that
collects new / gently used children's books for redistribution. We received
over 200 books !
We also are beneficiaries of newly purchased items through our local
court system. Here, restitution options include the purchase of baby care
items (car seats, cribs, high chairs, diapers, swings, etc) . These items are
made available for distribution to grant funded programs such as the NFP. We
distributed over $5, 000 of items in the calendar year 2005 .
We are in the beginning stages of discussions with a national retailer
about becoming a recipient agency for some of their discontinued body care
product lines. These body creams, lotions, aroma products would then be used
as added incentives and special day honorings.
b. What actions have been taken to develop new community support and maintain existing
community support for the program?
Through the activities of one of our visiting nurses, the Weld County
NFP program partnered with the Union Colony Children's Music Academy. This
linkage generated a grant that was funded in December, 2005, for $500.00 by
the Women's Fund of Weld County. In January, we began offering weekly music
and movement classes for free to our mother / baby diads. This is a series
of 18 sessions. Attendance varies from 7 to 10 families each week. A
renewal grant has been written for a summer session and we are awaiting the
award announcement.
Another of the visiting nurses has recently found herself to be
incorporated into the Catholic Charities Northern community support panel.
This coalition provides a dynamic range of services in support of our
undocumented population and we are honored to have representation here. Her
participation will be evidenced early this spring as this panel is working to
put together a one-day offering that "cares for the care-giver" . We are
anticipating massages, soft yoga, aroma therapy, and lots of comfort food.
The nurse supervisor for the Weld County NFP team sits on 2 United Way
Committees - Home Visitation and Family Support. These activities allow
access to grant funded activities and partnerships with the day care provider
community. Visiting staff are also committed UW volunteers . We participate
in the delivery of the Warm Welcome (newborn) visits. The materials provided
focus on brain development and infant safety. Between the ages of 1 and 2,
Page 16 of 20
we provide the Moving On developmental materials. Early literacy and toddler
safety are the focus of these materials.
Our local Retired Senior Volunteer Program spends 15-20 hours monthly
making baby blankets and layettes for us to distribute to our families. This
busy group of women (over the age of 65) are a tremendously valued asset.
c List the types of community exposure the program has received from print media, television,
radio, and other coverage, including specific dates. (Fictional example. Denver Daily TV news
show entitled "How NFP helps young moms and their babies" aired on November 2006. The
program highlighted the local work of our NFP program. The nurse supervisor was interviewed
along with two moms.)
In March, 2005, at the encouragement of one of the visiting staff, a
participating 17 year old mother entered a competitive poster contest. The
theme was "Teenage Pregnancy - Why It Matters" . She won 1st prize for her
efforts ($100.00 cash award) . Her recognition was followed up by a detailed
article on her challenges with recognition of the Nurse Family Partnership as
a front page write-up in a local newspaper.
Section 6: General Program Implementation
a. Because of their integral part in the program, describe how administrative staff, such as data
entry staff, are recognized, supported and actively engaged in the implementation and success of
the program.
Administrative support staff are active participants in team meetings,
community awareness events and educational offerings. Administrative staff
participate actively in the combined regional forums sponsored by Invest In
Kids . We actively engage in having our admin staff go and visit our
partnering agencies at least once a year. Recognitions come at the team,
general staff, and agency wide level and is equal to recognitions awarded to
any WCDPH&E employee.
b. How do you assure that non-English speaking clients are successfully participating in the NFP
program? If interpreters are used, describe your supervision of these staff to assure they are
comfortable with and competent in their role.
The Weld County NFP team is extremely fortunate to have 2 nurses who
are fluently bi-lingual in English / Spanish (oral and written) . These
nurses have been with the program since 2001 and carry caseloads that are 50-
751 mono-lingual Spanish speaking clients. Our Administrative support staff
person is also fluently bi-lingual in English / Spanish. She is able to
facilitate telephone / written messages as needed for the English only staff.
She is also called on to translate education materials as needed. The nurse
supervisor is fluent enough in Spanish to meet the communication needs of the
most common conversational topics of clients / families. At this time, we
are not using interpreters.
c. Share specific successes and challenges your site has had in the reporting period.
Successes: Hiring and orienting two very skilled and engaging nurses
(August 05; December 05)
Transition of staff nurse into supervisory / staff nurse
position with the vacancy created by Nancy Weber's leaving
Hiring and orientating new administrative assistant (as of
Feb. 6, 2005)
Successful mother / baby participation at our annual Fall
Event / Halloween party
Page 17 of 20
•
Completing over 90 Warm Welcome visits on behalf of United
Way's Bright Beginnings program
Continuing to improve our smoking cessation rates - so very
close to Colorado / NFP rates for the 36 week mark.
Medicaid billing is smooth and in line with budget
projections
Acquired additional storage space for visit related
materials and donated materials related to client care
New staff nurse (6 months) who has set a stellar retention
rate of 93% for new / transferred clients while building case-load
Grant award for music / movement classes
New participant at the High Risk OB meetings at our
Community Health Center provider office
Long term retention of bilingual nursing staff
Community value of the NFP program with a consistent
referral pattern
Challenges: Loss of a highly respected and well liked supervisor, July,
2005
Longer then expected vacancy for a nurse position July -
November, 2005
Prolonged absence / termination of administrative assistant
September - December, 2005
Challenging transition of a full-time visiting nurse into
3/4 supervisory slot - carrying active caseload above capacity / learning
organizational behaviors of Health Department structure
work flow design for Medicaid billing w/ health alliance
computer system
Change in OB management / referral patterns by one of our
larger health care partners
Staff car vandalized w/ the theft of 5 client charts (in a
locked case) while presenting in a panel at the local library - mid-afternoon
A recent trend for referrals out of our hospital system the
day after delivery - instead of from the provider office during the pregnancy
stage
Page 18 of20
B. FUNDING LEVEL and FISCAL MANAGEMENT:
1. What is the total cost of the program for FY05-06(July 1,2005 through June 30,2006)?
$647, 575
2. How much FY05-06 NHVP funding did the program receive? How much revenue is expected
from Medicaid claims? (The combination of these two sources is expected to cover the total cost
of the program.)
FY-05-06 NHVP funding; $478, 819
Medicaid revenue: $168, 756
$647, 575
3. Describe your current spending of NHVP funds, including whether or not you expect any NHVP
funds to remain unexpended at the end of the contract period (June 30,2006)and, if so, why.
We are not expecting unexpended dollars at the end of our contract
period (June 30, 2006) .
Our caseload roster is 115 active clients (Jan. 31, 2006) . We have
identified 2 additional referral sources and fully expect to be at caseload
capacity of 150 clients by March 31, 2006.
4. Describe your current rate of generating Medicaid revenue, including whether or not you are on
target to make the contract estimated revenue and, if not, why. Who in the organization is
responsible for tracking NHVP Medicaid revenue?
Weld County Dept of Public Health
Medicaid Client NHV totals 7/1/2005 - 6/30/2006
revised -2/17/2006
# Billed pending
Medicaid $ Amount Clients Medicaid Billed ineligible & or pd
Total
in
Month paid updated seen # seen # paid # undocumented process Children
Jul-05 13,113.45 1/6/06 95 85 69 8 1 38
Aug-05 14,317.10 2/15/06 111 96 76 9 9 47
Sep-05 13,493.55 2/15/06 106 72 71 34 3 51
Oct-05 11,022.90 2/15/06 113 79 58 34 3 42
Nov-05 15,013.95 2/15/06 145 93 79 29 11 61
Dec-05 13,683.60 2/15/06 115 91 72 24 15 59
Total
2005 80,644.55
Medicaid Budgeted Recovery: (July - December 05) $ 84,378
Medicaid Actual Recovery: (July - December 05) $ 80, 644
Medicaid Recovery Deficit: (July - December 05) $ 3, 734
We are waiting for medicaid numbers on 2 mothers and 13 infants
so we can bill services from September - December 2005. Our Medicaid
eligible mothers / babies comprise 85-90% of our active caseload at any given
time. We anticipate meeting our financial objective in recovery of Medicaid
dollars for targeted case management.
Wendy Paris is responsible for tracking NHVP Medicaid revenue.
Page 19 of 20
Prevention of Attrition—Amenable situations—Jan. 3, 2006
CIS r ported Attrition events:
4 quarter 2005 Pregnancy Infancy Toddlerhood
CUMMULATIVE
Missed appointments 0.4% (1) 3.3% (6) 0.8% 1
Unable to locate 1.1% (3) 4.4% (8) 5.4% (7)
NoHVfor180days - - -
Review of CIS reasons for discharges for 4`h quarter 2005:
4a'quarter 2005 Pregnancy Infancy Toddlerhood
Actual Oct/Nov/
Dec
Missed appointments - 1 -
Unable to locate 1 1 No HV for 180 days - - -
Actions of staff
Define "unable to locate" vs "move"—if they were there for regular, routine visits —then
"disappear"—how categorized? Consistency in terminology—
regular, routine visitation at same location(s) over the previous 4-6 visits—MOVE
irregular pattern of locations, multiple changes/disconnections in phone numbers - UNABLE
TO LOCATE
Clients are either seen or have telephone contact on the visit schedule frequency for stage in
pregnancy/infancy/Toddlerhood. Staff do "every visit form" for each and every not-at-home
event. Document attempted phone contacts.
Scheduled visit 9:30—no response—not at home
Phone call/reschedule for 3:00—home visit
Characteristics of similarity between any client falling off the radar? Think about...
No family? Too much family? Age? School? No School? Work? No Work?
Language? Mental Health? Health issues? $$ issues? ...
Page 20 of 20
COLORADO NURSE HOME VISITOR PROGRAM ATTACHMENT D
2006-07 APPLICATION BUDGET FORM
APPLICANT:Weld County Department of Public Health and Envrionment FOR THE PERIOD: July 1,2006 June 20,2007
PROJECT: Nurse Family Partnership Continuation
SOURCE OF FUNDS
Annual No.of Total
Requested I
Salary months Amount Received
Rate Budget FTE Required Other Sources* from CDPHE
NHV ARD CHN II 51,608 12 1 51,608 13,714 37,894
NHV ER CHN II 51,608 12 1 51,608 13,714 37,894
NHV GH CHN II _ 51,176 12 1 51,176 13,599 37,577
NHV VU CHN II _ --._ -_ 47,511 12 1 _ 47,511 -_-_ 12,625 34,886
NHV PC CHN II 35,589 12 0.75 35,589 9,457 26,132
NHV KS CHN II 46,942 12 1 46,942 12,474 34,468
Administrative Assistant GT 28,470 12 1 28,470 7,565 20,905
Contradual/Fee for Service
Supervising Personnel ---- ----- -- -
Program Supervisor SM _ 52,345 12 1 -_ _ 52,345 -. - 13,909 _ 38,436
Fringe Benefits: Rate=33.32% 121,701 12 121,701 32,339 89,362
TOTAL PERSONAL SERVICES 486,950 7.75 $ 486,950 129,396 357,554
Operating Expenses(which are not part of indirect):
Office Supplies __ - ___1,320 351 969
Client Support Materials 7,260 _ 1,929 _ _5,331
Copies forms/facilitators/outreach materials 1,650 438 1,212
Postage 660 175 485
Land line telephones 1,320 351 969
Computer Network Fee 396 105 291
Cellular Phones Usage Fees 3,360 893 2,467
Medical Supplies 431 115 316
Professional Development 3,500 2,144 1,356
TOTAL OPERATING $ 19,897 $ 6,501 $ 13,396
Equipment Expenses _ -
-
ComputerswithMSsoftware 1,682 447 1,235
Digital Cameras/photo printer 2,000 531 1,469
TOTAL EQUIPMENT $ 3,682 $ 978 $ 2,704
Travel Expenses -
Mileagevts) _. _ 28,898 9,101 — -� 19,797
Mileage/hotel/food(traininqs) 1,000 1,000
TOTAL TRAVEL $ 29.898 $ 9,101 $ 20,797
NCCFC/UCHSC Training&Technical Assistance -NCCFC Training_ 1125 1,125
CCFC Materials -
0
NCCFC TA - 6500_ __ _ 6,500
NCCFC indrect - 1296 1,296
TOTAL TRAINING 8 TECH ASSISTANCE $ 8.921.00 $ - 8,921
NCAST Traing&Materials ---
NCAST Traing 2,100 558 1,542
NCAST Materials 360 96 265
PIPE Materials
TOTAL NCAST COSTS $ 2,460 $ 654 $ 1,807
TOTAL DIRECT COSTS(Personal Servmo+operating+Travel+Contractual) $ 551,808 $ 146,630 $ 405,179
Indirect Costs Contracted rate 15.09%of direct costs _83,268 22,126 61,141
TOTAL INDIRECT COSTS $ 83,268 $ 22,126 $ 61,141
TOTAL PROJECT COST 5 635,076 S 168,756 $ 466,320
LESS COSTS TO BE PAID TO UCDHSC(NFP) -S 8,921
REQUESTED FROM CDPHE(CONTRACT AWARD) S 457,399
OTHER SOURCES of FUNDING(Match or In-kind):
MEDICAID 168,756
$
$
TOTAL OTHER SOURCES $168,756
Signature of Authorized Representative Date
RevA/15/20W BUDGETAPPLFORMALS Bataan
EXHIBIT I
Colorado Department of Public Health and Environment
State Fiscal Year 2006-2007
Colorado Nurse Home Visitor Program
MEDICAID REIMBURSEMENT GUIDELINES
Agencies receiving funding through the Colorado Nurse Home Visitor Program (NHVP) are required to bill the Colorado
Department of Health Care Policy and Financing (HCPF) for Targeted Case Management (TCM) services provided to
Medicaid eligible mothers and children receiving services through the NHVP. Below is the information pertaining to the
NHVP Medicaid reimbursement process.
Contractor Name: Weld County Department of Public Health and Environment
Reimbursement Period: July 1,2006 To June 30, 2007
Definition of Reimbursable Services: Colorado Nurse Home Visitors will provide Targeted Case Management (TCM)
services to first-time (defined as no previous live births), pregnant women or whose first child is less than one month old and
who are at or below 200% of the Federal Poverty Level. Program enrollment occurs during pregnancy, or within one month
postpartum, and services are designed to continue through the child's second birthday. TCM services include: Assessment of
the needs for health, mental health, social services, education, housing, child care, and related services for the women and
children; Development of care plans to obtain the needed services; Referral to resources to obtain the needed services,
including to medical providers who provide care to Medicaid-eligible pregnant women and children; Routine monitoring and
follow-up visits with the women in which the progress in obtaining the needed services is monitored, problem-solving
assistance is provided, and the care plans are revised to reflect the women and children's current needs.
Medicaid Billing Information:
NHVP providers will submit bills through the Medicaid Management
Billing Cycle Information System (MMIS)at the end of the month for each mother/child
receiving a visit.
Medicaid Reimbursement Rate $190.04
Claim Form CO-1500
Claim Type E(practitioner/physician)
40(clinic)
Category of Service Includes provider types 16(clinic), 32(Family Qualified Health Center), and 45
(Rural Health Center).
G9006, HD(For services rendered to the mother)
Procedure Code Modifiers
T1017,HD(For services rendered to the child)
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For the Mother-Services to the mother shall be limited to 3 units per month
with a lifetime maximum of 30 units, or 3 units per month for 10 months. One
(1)unit equals 15 minutes of service. Each unit will equal $63.35($190.04
divided by 3). Full Medicaid reimbursement will be earned with a minimum of
45 minutes of service per month.
Service Limits
For the Child- Services to the child shall be limited to 3 units per month with
a lifetime maximum of 75 units, or 3 units per month for 25 months. One(1)
unit equals 15 minutes of service. Each unit will equal$63.35 ($190.04 divided
by 3). Full Medicaid reimbursement will be earned with a minimum of 45
minutes of service per month.
Affiliated Computer Services(ACS),the Medicaid fiscal agent,has a 120-day
Billing Requirements "timely filing"policy (invoices must be submitted to ACS within 120 days
from the date of service). Claims are usually paid/denied/adjusted within two
weeks of receipt—the maximum ACS response time is set at 30 days.
For information related to Medicaid billing and training,please contact
Affiliated Computer Services(ACS)at http://coloradomedicaid.acs-inc.com or
Provider Services Unit at 1-800-237-0757 or(303)534-0146 Monday through
Medicaid Contractor Friday, 8:00 a.m. to 5:00 p.m.
You may also contact Dolores Archuleta, Colorado Department of Health Care
Policy and Financing,at 303-866-2693 or dolores.archuleta@state.co.us state.co.us if you
have questions on the Medicaid enrollment or billing process.
FY 2006-2007 Funding Structure:
Medicaid Reimbursement Rate $190.04
Estimated Medicaid Clients by Site 74
Estimated Monthly Medicaid Revenue $14,063
Estimated Annual Medicaid Revenue $168,756
CDPHE Tobacco Funding $466,320
TOTAL FY06-07 NHVP FUNDING $635,076
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