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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) Page 1 oft 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 Page2of2 Hello