HomeMy WebLinkAbout20060495.tiff RESOLUTION
RE: APPROVE GRANT APPLICATION FOR WELD WOMEN'S HEALTH CONSORTIUM
BREAST CANCER AWARENESS CONFERENCE AND AUTHORIZE CHAIR TO
SIGN - THE SUSAN G. KOMEN BREAST CANCER FOUNDATION, INC.
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with a GrantApplication forthe Weld Women's
Health Consortium Breast Cancer Awareness Conference between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Weld County Department of Public Health and Environment, and the Susan G. Komen Breast
Cancer Foundation, Inc.,commencing April 1,2006,and ending March 31,2007,with further terms
and conditions being as stated in said application, and
WHEREAS,after review,the Board deems it advisable to approve said application,a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE,BE IT RESOLVED by the Board of County Commissioners of Weld
County,Colorado,that the GrantApplication for the the Weld Women's Health Consortium Breast
CancerAwareness Conference 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 the Susan G. Komen Breast Cancer Foundation, Inc., be,
and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 15th day of February, A.D., 2006.
BOARD OF COUNTY COMMISSIONERS
E4a\ELD CO �r , COLORADO
ATTEST: leN' I� �` -
�' _.,_ill . .. Geile, Chair
Weld County Clerk to the B.
Ii -'' Y CUSED
mob, . David E. Lon Pro-Tem
D uty CI�tk to the Board, ''L1 /r/
Wi ' m H. Jercl
AP R AS TO FKii,--Q,- ( i'` ----
Robert D. Mas en
unty Attorney
Glenn Vaad
Date of signature:
31 1I
2006-0495
HL0033
(1'P : //1--C) E73 4-O�
Memorandum
(it
TO: M. J. Geile, Chair
IBoard of County Commissioners
From: Mark E. Wallace, MD, MPH, Director
Department of Public Health &
COLORADO Environment /A gca
DATE: February 15, 2006 --�A^ 1 �
SUBJECT: Susan G. Koman Breast
`Cancer
Foundation Grant Application
Attached for Board review and approval is the application for the Susan G.
Komen Breast Cancer Foundation Grant. The grant period would be for 12 months,
April 1, 2006 to March 31, 2007. The grant is for $2,475.00.
Weld County Department of Public Health and Environment will use this funding
to help organize a Women's Breast Cancer Awareness Conference during October,
Breast Cancer Awareness Month. Other agencies which are part of the Weld
Women's Health Consortium, such as the American Cancer Society, Rocky Mountain
Planned Parenthood, and the Breast Cancer Center at North Colorado Medical
Center, will collaborate on this effort.
I recommend your approval.
Enclosure
2006-0495
Kisse ta14.41 , DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 N. 17th Avenue
Greeley, CO80631
WEBSITE: www.co.weld.co.us
I ADMINISTRATION: (970) 304-6410
FAX: (970) 304-6412
C PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420
O FAX: (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
COLORADO FAX: (970) 304-6411
Granting Agency: The North Colorado Affiliate of the
Susan G. Komen Breast Cancer Foundation
Applicant's Name: Weld County Department of Public Health and Environment
Applicant's Address: 1555 N. 17th Avenue
Greeley, CO 80631
Applicant's Phone: (970) 304-6420, ext 2382
Applicant's Fax: (970) 304-6452
Project Title: Weld Women's Health Consortium
Breast Cancer Awareness Conference
Contact Person: Olivia Martinez, Health Education Specialist
Amount of Request: $2,475.00
Time Period of Request: April 1, 2006 to March 31, 2007
Weld County Department of Weld County Board of Commissioners
Public Health and Environment
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Mark E. Wallace, MD, M erector M. J. eile, Chair Date
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2006 COVER PAGE FOR GRANT PROPOSAL
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THE NORTH COLORADO AFFILIATE OF THE
SUSAN G. KOMEN BREAST CANCER FOUNDATION
REQUEST FOR FUNDING
FOR BREAST HEALTH AND/OR BREAST CANCER PROJECT
Olivia Martinez
PROJECT DIRECTOR&TITLE
Weld Women's Health Consortium, based at the
INSTITUTE Weld County Department of Public Health and
Environment
1555 N. 17th Ave
ADDRESS
Greeley, CO 80631
PHONE ( 970) 304-6420 ext 2382
FAX (970) 304-6452
omartinez@co.weld.co.us
EMAIL
Weld Women's Health Consortium Breast Cancer
TITLE OF PROJECT Awareness Conference
$2475.00
TOTAL AMOUNT REQUESTED
April 1,2006 to March 31, 2007
GRANT PERIOD
SIGNATURE&TITLE OF
APPROVING PERSONNEL (OTHER //� �,, /�{'�,,Ly Q\
THAN PROGRAM DIRECTOR) 1AAf JA ' j1 jYll,1 DATE ,,.;Q J13 '(�` 9
Mark Wallace, MD,
NAME&TITLE OF APPROVING Director, Weld County Department of Public
INSTITUTIONAL PERSONNEL(TYPED) Health & Environment
PLEASE CHECK TYPE OF APPLICATION: X EDUCATION ❑SCREENING ❑TREATMENT
APPLICATIONS MUST BE POSTMARKED BY FEBRUARY 24, 2006
(Photocopies of this form are acceptable)
2006 ABSTRACT PAGE
Olivia Martinez
PROJECT DIRECTOR
Weld Women's Health Consortium/Weld County
ORGANIZATION/INSTITUTION
Department of Public Health and Environment
BCCCP PROVIDER? YES X No
Rarely and never screened women
TARGET POPULATION
ABSTRACT
In the space below, please provide a short abstract, not to exceed 200 words, written in
lay terms for release to the general public should this application be chosen for funding.
A FREE EDUCATIONAL WORKSHOP ABOUT BREAST HEALTH WILL BE HELD DURING OCTOBER,
2006, BREAST CANCER AWARENESS MONTH, WITH SPECIAL EMPHASIS ON INVITING THE
MEDICALLY UNDERSERVED WOMEN WHO HAVE NEVER BEEN SCREENED OR HAVE NOT HAD A
MAMMOGRAM IN THE LAST FIVE (5) YEARS. THE PROGRAM WILL OFFER THREE SPEAKERS: ONE
TO ADDRESS THE MEDICAL ASPECTS OF BREAST SCREENING AND BREAST HEALTH; ONE TO TALK
ABOUT THE PSYCHOLOGICAL ASPECTS OF HEALTH; AND ONE TO DISCUSS RESOURCES
AVAILABLE IN THE COMMUNITY. THE PROGRAM WILL BE OFFERED IN ENGLISH, BUT HEADSETS
WILL BE PROVIDED TO MONO-LINGUAL SPANISH SPEAKERS AND SIMULTANEOUS TRANSLATION
WILL BE DONE. REFERRALS FOR CLINICAL BREAST EXAMS, MAMMOGRAMS OR ULTRASOUNDS
WILL BE GIVEN TO THOSE FOR THOSE WHO QUALIFY. THIS WILL BE A JOINT PROJECT BY THE
MEMBERS OF THE WELD WOMEN'S HEALTH CONSORTIUM WHICH WORKS COOPERATIVELY TO
PROVIDE BREAST HEALTH INFORMATION AND OUTREACH.
Permission to publish:
Permission is hereby granted to the Susan G. Komen Breast Cancer Foundation, Inc. to publish
the above abstract should this application be selected for funding.
SIGNATURE t9�i,,;- ` r`
February 15, 2006
DATE
Olivia Martinez
NAME(TYPED)
970-304-6420 ext 2382
PHONE NUMBER
Project Description:
1. The Weld Women's Health Consortium will organize and sponsor a half-day
educational event for women, with special emphasis on those who are medically
underserved and those who have rarely or never had a cancer screening done. It will
require unique and focused promotion to reach this population.
Successful, bilingual breast cancer awareness conferences have been held previously in
Weld County, sponsored by the Colorado Women's Cancer Control Initiative, Susan G.
Komen Foundation, and the American Cancer Society. Now that a solid coalition has
been established, the whole group will be working together on this event. The plan is to
host the workshop during October, Breast Cancer Awareness Month
2. Statement of Need/problem to be addressed: Educational workshops serve many
purposes. They help provide information and motivate individuals to take action towards
improving their health. They provide support for those who have "traveled the road" of
cancer diagnosis, treatment, and survival. Many women, for a variety of reasons, do not
follow the guidelines for routine cancer prevention screenings, such as clinical breast
exams and/or mammograms. This workshop will help empower those who are in need of
breast cancer screening to make appointments, by providing the vouchers and contacts,
and by sharing the stories of survivors and health care professionals.
3. Description of constituency to be served and how they will be benefited: A wide
variety of women will be invited to the workshop, with special emphasis on those who
are medically underserved and those who have never had a clinical breast exam or who
have not had one recently. They will benefit from both the educational aspect of the
workshop, as well as the opportunity to actually receive a voucher for breast cancer
screening. It is hoped that this combination will encourage them to become more
"diligent" about their personal health.
Other women who will be encouraged to attend will be the women who participate in and
host platicas (the small group educational activities), women who are contacted at the
Swift meat-packing plant, and women who visit the educational booths at the Greeley
Fiesta and the WalMart Women's Health events. Breast cancer survivors and others with
a special interest in early detection and treatment of breast cancer will be encouraged to
attend, as well.
4. Description of program goals and measurable objectives:
Goal: Coordinate a successful workshop for women about personal health, breast cancer
early detection and treatment.
Objective 1: Members of the Weld Women's Health Consortium (WWHC) will work
together to put on this workshop.
How this will be measured: Minutes from the WWHC meetings will indicate that each
member/agency had responsibility for a piece of the planning and organization of the
workshop and completed it.
Objective 2. At least 100 women will attend the workshop.
How this will be measured. Registrations
Objective 3: At least 10 women who have never been screened or who have not been
screened for breast cancer within the last five years will attend the half-day workshop.
How this will be measured: Registration and referrals
Objective 4: Provide referrals and/or vouchers for clinical breast exams, mammograms,
or ultrasounds women who attend who have never or rarely had a mammogram.
How this will be measured: Follow-up phone calls
5. Description of activities planned to accomplish these goals. Is this a new or
ongoing activity of your organization? A bilingual breast cancer awareness conference
has been held before, primarily coordinated by the project director for the Colorado
Women's Cancer Control Initiative (CWCCI). This year the other agencies that are
members of the WWHC have agreed to help with the organization and planning of the
event. Having additional resources will help make the event even more successful.
6. Timetable for accomplishing goals:
March: Identify date, location, contact speakers, reserve simultaneous translation
equipment
April, May, June, July: Develop flyers and invitations. Sign contracts with speakers.
Select caterer. Develop evaluation tools
August, September: Issue invitations. Confirm with speakers. Publicize on local radio
stations. Promote the event at local events, such as the Greeley Fiesta and Potato Days.
October: Participate in Women's Health Fairs at WalMarts to identify women to invite to
conference; register participants; have the conference; recover!
7. Description of other organizations or entities participating in the program. If
applicable, letters of collaboration should be included from each organization.
North Colorado Medical Center Breast Cancer Center will help identify and invite the
speakers, as well as identify and invite women to attend the conference.
American Cancer Society will help publicize the event, invite women who are breast
cancer survivors to attend, and will provide an information booth at the event.
Colorado Women's Cancer Control Initiative (CWCCI): Will take the lead in
coordinating the event; schedule meetings of WWHC, develop posters and invitations,
take the registrations, arrange for simultaneous translation equipment and staffing.
Rocky Mountain Planned Parenthood: Will provide clinical breast exams and
mammograms to women with funding from CWCCI and Susan G. Komen Breast Cancer
Foundation Grant.
8. Long term strategies for funding of the program after initial funding. If this
program is a successful way to reach the never and rarely screened woman, the NCMC
Foundation might be interested in funding this activity in the future. Or one of the
cooperating agencies might take the lead in securing funding another year.
9. A review of comparable programs offered in this service area and an explanation
of how this program is unique. There are programs that reach out to women who are
already actively involved in their health care. This program will work to identify women
who need help in following the recommendations for regular cancer screenings,
particularly related to breast cancer. Providing information in a supportive, educational
environment will help the women take additional steps towards self-care and disease
prevention.
10. Definition of success for the program and how it will be measured: The first
measure of success will be the attendance at the workshop. Another measure will be the
increased collaboration of the WWHC. Will all the agencies do their part? The long-
term goal will be an increased number of women who have annual clinical breast exams
and mammograms, as well as earlier detection of breast cancers, resulting in earlier
treatment and less fatalities.
11. Use of the program's results and how they are to be disseminated. The event
will be publicized before it happens, to boost attendance. If this proves to be a successful
method of getting women into routine health care, then it can be duplicated in other
counties and for other health issues. The media will be invited to attend the event, to
provide the information to readers and listeners.
2006 BUDGET FORM
GRANT APPLICATION REQUIRED BUDGET FORM
DETAILED BUDGET FOR FROM THROUGH
ENTIRE BUDGET PERIOD 4/ 1 /2006 3 / 31 /2007
PERSONNEL TYPE APPT. % EFFORT BASE DOLLAR AMOUNT REQUESTED
(MUST BE SPECIFIC TO PROJECT) (MONTHS) ON SALARY
PROJECT
NAME ROLE SALARY FRINGE TOTALS
ON REQUESTED BENEFIT
PROJECT
WWHC
MEMBERS WILL
COORDINATE
SUBTOTALS
SUPPLIES(ITEMIZE BY CATEGORY)
LUNCH FOR 100 ATTENDEES AT EVENT $1000
DECORATIONS 100
EQUIPMENT(NOT TO EXCEED 30% OF DIRECT COST)
RENTAL OF SIMULTANEOUS TRANSLATION EQUIPMENT AND HEADSETS $ 500
TRAVEL
PATIENT CARE COSTS INPATIENT
OUTPATIENT
OTHER EXPENSES(ITEMIZE BY CATEGORY)
PRINTING-COLOR COPIES OF INVITATIONS&PROGRAMS $ 250
HONORARIUMS FOR SPEAKERS 200
SIMULTANEOUS TRANSLATOR 200
SUBTOTAL-DIRECT COSTS $2250
INDIRECT COST ALLOCATION (NOT TO EXCEED 15%) (10%) $ 225
TOTAL FUNDING REQUEST $2475.00
PLEASE ATTACH BUDGET JUSTIFICATION
Budget Justification
Personnel: None of the grant funds will be used for personnel to coordinate the Weld
Women's Health Consortium Workshop. Members of the group from the Weld County
Department of Public Health and Environment, North Colorado Medical Center,
American Cancer Society, Rocky Mountain Planned Parenthood and other agencies will
work together to arrange speakers, invite attendees, and make the event successful.
Supplies: This includes the meal/refreshments for the attendees at the workshop and a
few decorations to make the room more attractive.
Equipment: This will cover the cost of renting the simultaneous translation equipment
and headsets.
Other Expenses: Honorariums will be offered to the speakers who are not active
participants in the WWHC. Also included is color printing for attractive posters and
invitations and the fee for someone to do the simultaneous translation.
Other sources of current funding for the project
The grant request to the Susan G. Komen Breast Cancer Foundation is to pay for
the event. The work to coordinate, publicize, invite, and produce the event is all provided
by the members of the Weld Women's Health Consortium. The actual cost of the event
planning will be provided as in-kind funding by the Colorado Women's Cancer Control
Initiative, the American Cancer Society, the Breast Cancer Center for North Colorado
Medical Center, and Rocky Mountain Planned Parenthood. Planning an event takes
many hours: creating the brochures, contacting the speakers, planning the meal with the
caterer, etc. The in-kind donations of the agencies and individuals will easily match the
grant request if in-kind is calculated at $25 an hour.
2006 BIOSKETCH FORM
Martinez, Olivia
PROJECT DIRECTOR(Last Name,First,Middle)
BIOGRAPHICAL INFORMATION
Information should be submitted for the project director and other personnel included in
budget request. Please use a separate form for each person.
NAME OLIVIA MARTINEZ TITLE HEALTH EDUCATION SPECIALIST
EDUCATION
(Begin with baccalaureate or initial professional education, such as nursing, include postdoctoral training)
INSTITUTION DEGREE YEAR FIELD OF
(Indicate Location) CONFERRED STUDY
University of Northern Colorado Bachelor of 2000 Public Health
Greeley, CO Science
PROFESSIONAL EXPERIENCE: Please list, in chronological order, concluding with present
position, previous employment, experience and honors. List, in chronological order, the
titles, authors and complete references to all publications during the past three years
and to representative earlier publications pertinent to this application.
Do NOT EXCEED Two PAGES
See second page.
PROFESSIONAL EXPERIENCE:
Nursing Student Practicum, North Colorado Medical Center, Greeley CO (Sept. 1996-May
1999). Provide patient care in a hospital setting under instructor's supervision. Provide patient care
at Monfort Children's Clinic with supervision.
Community Health Practicum, Nutrition Educator, CSU Cooperative Extension, Greeley, CO
(July-Oct. 1999). Assist with provision of nutrition education for needy eligible community
members.
Health Intern,Weld County Department of Public Health, Health Promotion, Greeley, CO
(Jan.-May 2000). Translate to Spanish Prenatal Plus educational materials. Attend coalition and
staff meetings. Assist with development of work plan for Abstinence Education Program. Write
article for the Greeley Tribune. Develop pamphlets, brochures, flyers, and posters on health
programs.
Clerical Assistant, University of Northern CO, Human Relations/Ombudsmen, Greeley CO
(June 1996-May 1999). Clerical and receptionist duties: answer telephone, file, archive, copy,
collate, and distribute Position Authorization Forms to appropriate personnel, sort mail and type
letters and memos.
Health Education Specialist, Weld County Dept. of Public Health, Health Promotions,
Greeley CO (May 08, 2000-Sept. 23, 2002). Assist with planning, administration and
implementation of outreach activities to educate teens on abstinence. Implement nutrition classes
at the Jesus Rodarte Cultural Center. Implement General Health Education duties as assigned.
Community Outreach Coordinator, Colorado Women's Cancer Control Initiative, Weld
County Dept. of Public Health, Health Promotions, Greeley CO (March 19, 2001-Present).
Plan and implement outreach activities to recruit eligible women for cancer screenings. Consortium
building to facilitate health care services for women. Evaluate program progress and report to State
Health Department. Administration of program budget. Media collaboration to promote program.
Assist in other health promotion projects as needed.
Weld County Platicas Project Director, Weld County Dept. of Public Health, Health
Promotions, Greeley CO (April 01, 2003-Present). Coordinate the Platicas Project. Contact
possible eligible women for CWCCI, screen women for program eligibility, and refer to health care
provider for breast cancer screenings. Evaluate program progress and report to Susan G. Komen
Foundation. Program budget administration.
BIOGRAPHICAL INFORMATION
Information should be submitted for the project director and other personnel included in
budget request. Please use a separate form for each person.
NAME OFELIA OROZCO TITLE
PLATICAS PROJECT OUTREACH SPECIALIST
EDUCATION
(Begin with baccalaureate or initial professional education, such as nursing, include postdoctoral training)
INSTITUTION DEGREE YEAR FIELD OF
(Indicate Location) CONFERRED STUDY
ATT, Community College 2001 GED
Aims Community College 2004 Early Child
Development
PROFESSIONAL EXPERIENCE: Please list, in chronological order, concluding with present position, previous
employment, experience and honors. List, in chronological order, the titles, authors and complete
references to all publications during the past three years and to representative earlier publications pertinent
to this application.
DO NOT EXCEED Two PAGES
Professional Experience:
Customer Service Representative,Wal-Mart Las Cruces, New Mexico(August 2000 to May 2001). Provide
customer service to customers with questions regarding products. Stock merchandise products on shelves. Perform
inventory on all shelves in assigned area for the day. Translate for Spanish speaking customers. Assist with the
location of items on shelves and in back stock. Take orders for certain items. Assist with clean up when necessary.
Cafeteria Aide, Las Cruces Public School, New Mexico(August 2000 to May 2001). Prepare nutritious meals
following the food pyramid for breakfast and lunch. Follow instructions on receipt cards. Serve children appropriate
portion size of every food group. Supervise the children ages 1 to 5 year. Create and monitor activities throughout the
day.
Family Advisor, Bright Beginnings,Ameri-Corps Member, Greeley CO(November 2, 2001 to July 19,2003).
Advise Monolingual, non English speaking parents of current family matters such as car seat and house safety, how
to spend time teaching and reading to their children. Provide information to parents about house safety such as
locks for cabinet doors, keeping medicine&other chemicals out of reach of children and bath equipment safety.
Refer families to Partner agencies that can provide assistance for their specific needs. Provide postpartum
depression information to new mothers. Deliver information on how to stimulate the baby's brain with music and play.
Encourage mothers to become more active in their child's life. Distribute instruction books on learning activities&
learning toys to help the parents teach their children.
Platicas Project Outreach Specialist,Weld County Department of Public Health,Greeley,CO (July 12,2004 to
Present). Provide presentations on breast health to small groups in the community. Contact women one-on-one to
provide information on breast health screenings and community resources. Inform public on breast cancer issues
through radio interviews.
Cerificates
CPR Certified (for adult, infant and older children)
Certificate of Appreciation in recognition of contributions to Colorado Bright Beginnings
Certificate of Completion for Physical Fitness Testing&TEKS Connections
Certificate of Attendance for 7-hours in training for
Colorado Parents As Teachers&Nurturing Ourselves and Others& Program Quality/Assessment
Larimer Center for Mental Health &Centennial BOCES--Satisfactory Completion of the
Strengthening Latino Families Training
Denver Children's Advocacy Center--Certificate for the completion of
The Impact of Adverse Experiences on the Developing Child& Implications for Practice and Policy Training
AIMS Community College Attendance Certificate for Early Childhood Summer Seminar
Juntas Contra el Cancer del Seno Promotora Training Certificate a training course to perform/teach the
Instructional Breast Self Exam as a Breast Health Promotora
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