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Home My WebLink About20060591.tiff RESOLUTION RE: APPROVE COLORADO NURSE HOME VISITOR PROGRAM (NHVP) 2006-2007 PROGRESS REPORT AND AUTHORIZE CHAIR TO SIGN WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Colorado Nurse Home Visitor Program (NHVP)2006-2007 Progress Report 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 report, and WHEREAS,after review, the Board deems it advisable to approve said report, 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 Colorado Nurse Home Visitor Program (NHVP)2006-2007 Progress Report 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 report. The above and foregoing Resolution was,on motion duly made and seconded,adopted by the following vote on the 1st day of March, A.D., 2006. BOARD OF C UNTY COMMISSIONERS fi Elia,, ELD CO TY, COLORADO _QA ATTEST: ��' f � ,l` �j ,Or/.z.- ,,��. . Geile, Chair Weld County Clerk to the B�r w! /Iii CUSED l° / David E. Long, Pro-Tem By: � 1 �LZG� De u CI to the Bo Vdffliam H. Jerk APP V AS TO FO en unty� EXCUSED Glenn Vaad - Date of signature: -31/3 i bG' 2006-0591 HL0033 ec /-}i I o-ck5� (73- i4-c'' Memorandum TO: M.J. Geile, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH, Director C Department of Public Health and Environment / ( I L(.� COLORADO• DATE: February 27, 2006 SUBJECT: Nurse Home Visitor Program Renewal Application Enclosed for Board review and approval is a program funding proposal to the Colorado Department of Public Health and Environment (CDPHE) for the Weld County Nurse Home Visitor Program. If the renewal proposal is funded, WCDPHE will continue to provide county-wide nurse home visitor services to low-income, first-time mothers as provided for in the Nurse Home Visitor Program Act, section 25-31-101, et. Seq., C.R.S. as amended, and administered by the CDPHE. For these services, Weld County is requesting funding in the amount of$640,045 for the time period July 1, 2006 through June 30, 2007. I recommend your approval of this funding proposal. Enclosure 2006-0591 Attachment A Colorado Nurse Home Visitor Program (NHVP) 2006-07 PROGRESS REPORT COVER SHEET 1. Name of Agency: Weld County Department of Public Health and Environment 2. Address/City/Zip 1555 N 17`s Avenue,Greeley, CO 80631 2. Name of person completing Progress Report: Susan Morse,RN Position/Title: Program Supervisor Telephone: 970 304 6420 ext 2186 FAX: 970 304 6416 E-Mail: smorse@co.weld.co.us 3. Name of Authorized Signer: Dr. Mark Wallace (Must be an individual with authority to sign a grant application.) Position/Title: Director Telephone: 970 304 6420 ext 2104 FAX: 970 304 6416 E-Mail: mwallace@co.weld.co.us / \Signature:X (I) 6:1- Chairman, Board C 4xtr ° ��06 ATTEST: g4# t( ! 1 4. Total request for July 1,2006 through June 30,2007:$ 640,045 WE COUNTY CLERK p THE BOARD 5. List county(ies)to be served: Weld County BY: ti�TO fra�Q ( � DE TY CL K THE BO RD 6. Total number of families to be served: 150 ,E,�`` 7. Total FTE to be funded with NHVP dollars:_8.75 FTE !IV .'S. Total number of nurse home visitors to be funded with NHVP dollars: 7 FTE 'f?& ..11A :tavgi Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 1 C 3 n1 -nc ' . F � i _ _�ta5� � c ✓rlG C J/ Attachment B Colorado Nurse Home Visitor Program(NHVP) PROGRESS REPORT CHECKLIST EV Attachment A: Progress Report Cover Sheet EVAttachment B: Progress Report Checklist ID/Progress Report. The Progress Report and all required attachments covering the time period of March 1,2005 through February 28,2006 Er' Attachment C: Grantee Response to Year-End Letter dated August 2005 In an effort to both recognize the work of each NFP grantee and to provide ongoing performance feedback and support, each NFP site was sent a year-end letter. The letter, created by the Colorado NFP Coordination Team, summarized your FY 2004-05 achievements as well as highlighted areas that required strengthening in FY 2005-06. The general topics covered in this letter included: Data, Community, Staffing, and Fiscal. Applicants must provide an update for each topic covered in your year- end letter. Responses are limited to no more than two (2), single-spaced pages using Courier font, 10 pt, with 1" margins per page. Please contact Esperanza Ybarra at 303.692.2943 if you need another copy of this letter. Attachment D(A separate Excel spreadsheet for each year) ❑' FY06-07-July 1,2006 through June 30,2007 a FY07-08-July 1,2007 through June 30,2008 IY FY08-09-July 1,2008 through June 30, 2009 a- A detailed Budget Narrative to justify projected expenses for each of the corresponding budgets submitted. la- Attachment F: Assurance of Intention to Meet Program Requirements Elk Attachment G: Assurance of Intention to be an Active Medicaid Provider EY One team meeting agenda that included a case conference. EY A completed supervision form(remove client identifiers). G7' Latest Transition Plan to prevent client attrition. /Attach two samples of coalition/council meeting minutes. II One (1) original and Four (4) copies of the completed. Progress Report and Budgets for a total of Five (5) Progress Reports. The copies must be stapled or binder clipped only. No rubberbands or paperclips allowed. Copies may be made double-sided to save paper. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 2 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/°5) 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 the reasons why and what steps are being Greeley,Colorado 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 reflection on the quality case- 48% 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. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 3 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 ≥60minutes Meets Colorado benchmark Infancy 74 72 ≥60 minutes Exceeds Colorado benchmark Toddlerhood 75 72 260 minutes Exceeds Colorado benchmark CONTENT of VISITS Pregnancy Personal Health 39.5% 37.2% 3540% 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% 12.7% 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 "lif e- 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 4 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. Nurse Family Partnership Program-Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 5 Family and Friends 14.8% 143% 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"a 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% 10-15% 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 Nurse Family Partnership Program-Weld County Depauutd of Public Health and Environment Sue Morse,RN.Supervisor 6 / 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. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 7 15.5% 13.6% 10-15% Exceeds Colorado benchmark - here we are tackling the issues of gang FamilandFriends Y family / friends; improved 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 2nd 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 8 content covered here and the target expectations. 16.0% 15.5% 1045% 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%attreasos Exceeds Colorado benchmark 18.1% 17% 20%anreaso. 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 Infancy other week. In November, 2005, we identified 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%au,easons Needs improvement - see the above remarks. SMOKING REDUCTION: Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse.RN,Supervisor 9 49% -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 ls` 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 in a participate 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 Listtopthreereasonswhythereferralwasnot 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 ,_ .... or... Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,R RN,Supervisor 10 February 1,2006. Number of active clients enrolled one year 84 ago(February 1,2005). We have identified 6 clients that fit this comment. L.__- the L of iiaL cc are in tia�c piG�.caa LL moving- 'JUL GL our aI"ca - 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 February 1,2006,but not seen in past 6 2 family units are college students who left the area weeks. Please explain why clients have not for extended holiday breaks to match the school been seen and your plan for clients to receive calendar. We anticipate re-establishing home visits according to the recommended visit visitations this week (Feb. 6) . . schedule. The 6th 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 1,2005 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. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 11 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 12 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 13 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 14 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. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 15 d. If no NFP specific coalition/council exists,what alternatives are used to help the program meet its objectives? No response needed. Section#5: 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 1s` 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, Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 16 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- 75% 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 17 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 Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 18 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. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor I9 Attachment C Progress Report - Year End Letter - August 8, 2005 The Weld County NFP site was asked to address : A) Medicaid billing issues with HCPF - this was a discrepancy of what we reported as captured Medicaid revenue and what HCPF was reporting as captured Medicaid revenue - Summer / Fall 2005 Many conversations were held with Lee Joseph about this a few times on the phone over the last few months. Lee Joseph was sent two or three emails last fall regarding the "medicaid billing issues" and that we have all of our remittance statements showing the payments Medicaid made to us if they ever want to see them. We have not heard any comments or had further conversations and believe the issue has been resolved. • B) A thorough plan for nurse recruitment and retention. This plan was submitted to Esperanza Ybarra on October 7, 2005. A copy is attached. As of December 1, 2005, we attained the full RN staffing complement budgeted for our site. The vacant position was temporarily covered by a 0.75 FTE nurse stepping up to a 1.0 FTE work position between October 2005 - February, 2006, and the Nurse Supervisor continuing to carry a caseload in excess of her 0.25 budgeted visiting FTE. Our task now is to rapidly build caseload to our budgeted 150. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 24 Nurse-Farriily Partnership Helping Fint-TimeParents Succeed Weld County Department of Public Health and Environment (970)304-6420 1555 N. 17th Avenue Greeley,Colorado 80631 October 7, 2005 Esperanza Ybarra,Program Director Colorado Nurse Home Visitor Program 4300 Cherry Creek Dr South PSD-A4 Denver, CO 80246 Response: Progress Report Reviewer Remarks Letter of August 8, 2005 Dear Esperanza, This letter is to address the Funding Conditions issue—Plan for nurse recruitment and retention. Background: In July, 2005, the nursing supervisor for the Nurse Family Partnership program, after 4 %2 years of employment with the Weld County program, accepted a nursing position outside of the Health Department. In addition, a relatively new NFP program nurse(one year of employment) also left the agency for an out-of- state nursing opportunity. On July 15, 2005, a full time visiting staff nurse moved into the vacated supervisory position. Sue Morse will continue to carry a caseload of 7 clients (0.25 visiting staff FTE). These changes created a staffing vacancy of 1.75 FTE among the visiting staff. We have successfully filled the 0.75 FTE position with an internal transfer nurse. She became available to the NFP program as of August 16. As of today, Peggy's case load is 10 clients. Her caseload capacity is 18. Based on our current referral patterns, Peggy will be at 18 clients by December, 2006. The vacant full time position was offered,but declined in August. The candidate cited a salary cut($200 from current income) and an increased cost in benefits ($200/month out of pocket over current costs) as reasons. We are currently conducting a second round of advertising/interviewing. The pool of applicants is stronger then I have seen in the recent past,with 5 applicants responding so far. Current Recruitment Efforts: The Nurse Family Partnership Program, as a component section of the Weld County Department of Public Health and Environment,has access to the organization Nurse Recruitment/Retention policy and activities. These include but are not limited to: ➢ County employees are given 11 paid holidays off per year. ➢ Employees accumulate 8 hours of sick leave and vacation leave per month. ➢ Bereavement leave, Personal leave ➢ Life insurance,Disability insurance or Sick leave bank ➢ Health insurance available for employee and family options. ➢ PERA(Public Employees Retirement Association)retirement plan. ➢ Tuition reimbursement Retention • Nursing Education Loan Repayment • Extensive Training and Professional Growth opportunities: including Spanish language classes. • Leadership and Management opportunities with increased pay for new classifications. • Agency, County Government, and Community support and linkages • Multi-disciplinary programs and opportunities Current Retention Efforts within the NET program: Flexibility of work hours/self-scheduling to meet the client work/school commitments continues to provide a high degree of job satisfaction for the visiting staff. As staff flex their visit times to allow for availability to clients, a reciprocal flexibility allows for time to meet a variety of individual staff needs as well. This promotion of emotional availability benefits everyone and enhances retention of a skilled work-force. Generous and applicable staff education opportunities as provided by the NET program and Invest In Kids, as well as registration fees for other conferences,builds a stronger community of nurse visitors and acknowledges the wide scope of needs found among the clients/families we serve. In the past eight weeks alone, each of the visiting staff has had the opportunity to attend at least one off-site learning session. As a team,we continue to meet weekly for collaborative team meetings. These staff times are for the primary purpose of case-load support,peer support, interactions with invited community resource experts/providers and for personal celebrations. These weekly meetings will also be expanded in January, 2006 to include quarterly off-site retreats (generally 1/2 day in length). The activities are planned to include expanded individual and team celebrations, self-care activities, and opportunities to improve working knowledge/resource utilization on one focused mother/baby care topic of staff choosing. The high attrition rate of staff throughout the nursing division over the past nine months has directly and indirectly prompted formal/informal new peer support and communication points. As a team,we are continuing to process on our own team-member changes and relationships. As these are worked through, I believe we are achieving an expanded sense of integration into the Nursing Division overall. Efforts are underway to minimize staff time doing visit billing documentation into the Health Department's Electronic Medical Record system. This is an area where nurses are feeling the pull away from the NFP caseload activities and attending to a perceived time-consuming computer data-entry task. While no one questions the benefits to the program/clients to have the ability to recover additional Medicaid dollars, the visiting staff are appreciative when the activities are minimal as it relates to their time/participation in the process. Regular updates for the staff on the Medicaid dollars recovered from their efforts will become a component of the weekly team meetings. If you have further questions or comments,please let me know. Sincerely, Susan Morse, RN 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 Annual No.of Total SOURCE OF FUNDS • Requested/ Salary months Amount Received Rate Budget FTE _ Required Other Sources* from CDPHE NHV ARD CHN II 51,608 12 1 51,608 51,608 NHV ER CHN II • N51,608 12 1 51,608 51,608 NHV OH CHN II 51,176 12 1 51,176 51,176 NHV VU CHN II 47,511 12 1 47,511 47,511 NHV PC CHN II 35,589 12 0.75 35,589 35,589 NHV KS CHN II 46,942 12 1 46,942 46.942 Administrative Assistant GT 28,470 12 1 28,470 28,470 ConeactualFee for Service Supervising Personnel Program Supervisor SM 52,345 12 1 52,345 52,345 • Fringe Benefits: Rate=33.32% 121,701 12 121,701 121.701 TOTAL PERSONAL SERVICES 486.950 7,75 $ 486,950 $ $ 486.950 Operating Expenses(which are not pad of indirect): Office Supplies 1,320 1,320 Client Support Materials 7,260 7,260 Copies forms/facilitators/outreach materials 1,650 1,650 Postage 660 660 Land line telephones 1,320 1,320 Computer Network Fee 396 396 Cellular Phones Usage Fees 3,360 3,360 Medical Supplies 500 500 Contingency fund 1,000 1,000 Professional Development 7,000 7000 TOTAL OPERATING $ 24,466 $ - $ 24,466 Equipment Expenses Computers with MS software 6,000 6,000 Digital Cameras/photo printer 2,000 2,000 TOTAL EQUIPMENT $ 8,000 $ - $ 8,000 Travel Expenses Mileage(visits) 29,750 29,750 Mileage/hotel/food(trainings) 4,500 4,500 TOTAL TRAVEL $ 34,250 $ - $ 34,250 NCCFC/UCHSC Training&Technical Assistance - NCCFC Training - 0 0 CCFC Materials - 0 0 NCCFC TA - 0 0 NCCFC indrect - 0 0 TOTAL TRAINING 8 TECH ASSISTANCE $ $ $ - NCAST Traing&Materials NCAST Traing 2,100 2,100 NCAST Materials 360 360 PIPE Materials TOTAL NCAST COSTS $ 2.460 S - $ 2,460 TOTAL DIRECT COSTS personal sercantos.operaecg+Trevei.Convactual) $ 556,126 S - $ 556,126 Indirect Costs Contracted rate 15.09%of direct costs • 83,919 83,919 TOTAL INDIRECT COSTS $ 83.919 $ - $ 83.919 TOTAL PROJECT COST $ 640,045 $ $ 640,045 OTHER SOURCES of FUNDING(Match or In-kind) $ $ $ $ $ $ TOTAL OTHER SOURCES $ Signature of Authorized Representative Date • R 22412006 eUDGETAPPLFORmns 06miN 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 1,2007 June 20,2008 PROJECT: Nurse Family Partnership Continuation Annual No.of Total SOURCE OF FUNDS Requested/ Salary months Amount Received Rate Budget FTE Required Other Sources' from CDPHE NHV ARD CHN II 54,020_ 12 1 54,020 _ 54,020 NHV ER CHN II 54,020 12 1 54,020 54,020 NHV GH CHN II 53,414 12 1 53,414 _ _ 53,414 NHV VU CHN II 50,579 12 1 50 579 50 579 NHV PC CHN II 37,889 _ 12 0.75 37,889 _ 37,889 NHV KS CNN II 49,919 12 1 49,919 _ 49,919 Administrative Assistant GT 29,939 12 1 29,939 29939 Contractual/Fee for Service Supervising Personnel Program Supervisor SM 54,659 12 1 54,659 54,659 Fringe Benefits: Rate=33.32% 128,095 12 128,095 128,095 TOTAL PERSONAL SERVICES 512,534 7.75 $ 512,534 $ $ 512,534 Operating Expenses(which are not part of indirect): Office Supplies 1,353 1,353 Client Support Materials 7,442 7,442 Co ies forms/facilitators/outreach materials 1,691 1,691 Posta a 677 _ 677 Land line telephones 1,353 1,353 Computer Network Fee 406 406 Cellular Phones Usage Fees 3,444 3,444 Medical Supplies 513 513 Contingency fund 1,025 1,025 Professional Development 7,175 7.175 TOTAL OPERATING $ 25,079 $ - $ 25,079 Equipment Expenses Computer with MS software 1,500 1,500 TOTAL EQUIPMENT $ 1,500 $ - $ 1,500 • Travel Expenses Milage(visits) 30 494 30,494 Milaqe(trainings) 4,613 4,613 TOTAL TRAVEL $ 35,107 $ - $ 35.107 NCCFC/UCHSC Training&Technical Assistance - NCCFC Training - 0 - CCFC Materials - 0 NCCFC TA - 0 - — NCCFC indrect - 0 - TOTAL TRAINING&TECH ASSISTANCE $ - $ - $ - NCAST Traing&Materials - NCAST Traing _-- 2,205 2,205 NCAST Materials 378 378 PIPE Materials TOTAL NCAST COSTS $ 2,583 $ - $ 2,583 TOTAL DIRECT COSTS(Personal servicestoperatine4Traveetcontrenual) $ 576,803 $ - $ 576,803 Indirect Costs Contracted rate 15.09%of direct costs 87,040 _ 87,040 TOTAL INDIRECT COSTS $ 87,040 $ - $ 87,040 TOTAL PROJECT COST $ 663,843 $ - $ 663,843 OTHER SOURCES of FUNDING(Match or In-kind) $ $ $ $ $ $ TOTAL OTHER SOURCES $ Signature of Authorized Representative Date COLORADO NURSE HOME VISITOR PROGRAM ATTACHMENTD 2006-07 APPLICATION BUDGET FORM APPLICANT:Weld County Department of Public Health and Envrionment FOR THE PERIOD: July 1,2008 June 20,2009 PROJECT: Nurse Family Partnership Continuation Annual No.of Total SOURCE OF FUNDS Requested/ Salary months Amount Received Rate Budget FTE Required Other Sources' from CDPHE NHV ARD CHN II 58 930 12 1 56,930 56,930 NHV ER CHN II 56,930 12 1 56,930 NHV GH CHN II 56,459 12 1 56,459 NHV VU CHN II 52,414 12 1 52,414 52414 NHV PC CHN II 39,262 12 0.75 39,262 39 262 NHV KS CHN II 51.790 12 1 51.790 51,790 Administrative Assistant GT 31,417 12 1 31,417 31,417 Contractual/Fee for Service Supervising Personnel Program Supervisor SM 57,756 12 1 57,756 _ 57,756 Fringe Benefits: Rate=33.32% 134,266 12 134,266 134,266 TOTAL PERSONAL SERVICES 537,224 7.75 $ 537,224 $ - $ 537,224 Operating Expenses(which are not part of indirect): Office Supplies 1,421 1,421 Client Support Materials 7,814 7,814 Copies forms/facilitators/outreach materials 1,776 1 776 Postage 711 711 Land line telephones 1,421 1,421 Computer Network Fee 3,616 3,616 Cellular Phones Usage Fees 539 539 Medical Supplies 539 539 Contingency fund 1,076 1.076 Professional Development 7,534 7,534 TOTAL OPERATING $ 26,447 $ - $ 26,447 Equipment Expenses - Computer with MS software 1,575 1,575 TOTAL EQUIPMENT $ 1,575 $ - $ 1,575 Travel Expenses Milage(visits) _ 32 018 32,018 Milage(trainings) 4,843 4843 TOTAL TRAVEL $ 36,861 $ - $ 36,861 NCCFC/UCHSC Training&Technical Assistance - - NCCFC Training - 0 CCFC Materials - 0 NCCFC TA - 0 NCCFC indrect - 0 TOTAL TRAINING&TECH ASSISTANCE $ - $ - $ - NCAST Traing&Materials NCAST Train 350 350 NCAST Materials 60 60 PIPE Materials TOTAL NCAST COSTS $ 410 $ - $ 410 TOTAL DIRECT COSTS(Personal servlceropera i, .Travtl4cenirous$ $ 602,517 $ - $ 602,517 Indirect Costs Contracted rate 15.09%of direct costs 90,920 90,920 TOTAL INDIRECT COSTS 90,920 - 90,920 TOTAL PROJECT COST 693,437 - 693,437 OTHER SOURCES of FUNDING(Match or In-kind) $ $ $ $ $ $ TOTAL OTHER SOURCES $ Signature of Authorized Representative Date Budget Attachment D - Budget Narrative: 150 families 2006-2007-2008 a. Personnel Costs: Salaries and fringe benefits for the staff. It is anticipated that the current staff will remain with the NFP program in their current work hour configuration for the funding year 2006 - 2007 . Supervisor 0.75 FTE Salary: $ 52, 345 Visiting Staff(0.25 from supervisor)6.00 FTE Salaries: $284,435 Administrative Assistant 1. 00 FTE Salary: $ 28,470 Fringe: 33 .07% $121,700 $486,950 Having the Administrative Assistant as full time balances the home visit time required by the supervisor's caseload. Salaries listed allow for planned increases within the guidelines of Weld County Government. b. Operating Costs: Office supplies, client support materials, copies of forms/facilitators and outreach materials, postage, telephone, computer network fees, cellular phone usage, medical and program supplies,professional development. Office supplies are used by the 8 staff members housed with the Weld County Department of Public Health and Environment. 3-ring notebook binders are given to each client to store NFP program materials. Office supplies are used to complete learning activities, client projects, maintain program organization, and generate, file and store visit activity documentation. Our 2006 / 2007 expenses are estimated at $1, 320. Client Support Materials: The total amount allocated for this cost over a client's three year period in the program is $150 - $70 in the first year and $40 in the both the second and third years. Estimate the number of clients graduating in the FY06-07 and then budget$70 per client to fill those spots. Budget an additional $40 for each on-going client. Do not budget for clients that may be lost due to attrition. Explain how you arrived at your estimates. The Weld County NFP program projects the following graduation rates / client replacement needs: 2006 - 2007 42 graduations 108 ongoing 42 X $70 = $2, 940 clients based on current 108 X $40 = $4,320 caseload activity based on caseload $7, 260 of 150 active clients 2007 - 2008 70 graduations 80 ongoing 70 X $70 = $4, 900 clients based on current 80 X $40 = $3, 200 caseload activity based on caseload of 150 active $8, 100 clients Copy costs for the 2006-2007 year are anticipated to be $1, 650. We utilize the county print shop. The established prices are $. 06 per page, and $ . 09 for double sided printing. We anticipate 30, 000 copies / printed materials in client facilitators, forms, and outreach materials. This averages $11/family/year. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 20 Postage costs are budgeted to be $660. This covers the cost of appointment reminder cards, letters of invitation to prospective clients, celebratory cards for birthdays, graduations, etc. Each visiting staff carry cell phones for safety. As a county governmental entity, we utilize discounts for our phone plans negotiated by the county purchasing department. Our current costs are $40 per phone (7 phones = $3, 360) : Each of the 8 NFP work stations contain a computer used for data entry / patient care charting, etc. 2 of our computers are lap-tops . These are taken into the homes and used to play DVD based learning materials related to pregnancy / parenting. Office telephone equipment and services are in provided for all program staff at a cost projection of $1,320. A variety of professional staff development activities take place each year. Some are very low-cost - a guest speaker from a partnering agency at no charge. Some education topics are subsidized - Hepatitis C by a pharmaceutical company. Some require registration fees, travel, food reimbursement - an annual March of Dimes conference, an annual Breast Feeding symposium - as examples. We budget registrations at $1, 000 per nurse for annual continuing education sessions. $1, 000 x 7 nurses = $7, 000. A contingency fund for client emergencies of $1, 000. This is to help families who face acute events - need for a space heater or fan, purchase of an extra can of formula for a growth spurt, obtain a crib mattress to go into a donated crib, pay a registration fee for a parenting class, buy bottled water when the pipes freeze, birth-certificate fees, smoke detector units and batteries, etc. Replacement of medical supplies - blood pressure cuffs, thermometers, baby scales are estimated to be $500. c. Equipment Costs: Funding for equipment, including computers and software. The visiting staff have identified a need for digital cameras (7) and a color printer for the purposes of taking the photos that mark milestone events among our client families. A survey of our households shows that less than 7% own or have access to cameras, nor do they obtain commercial photo studio portraits of their children. We would like to use these photos for maternal role reinforcement and in a variety of PIPE activities. Our projected costs for cameras / printer / ink cartridges / paper is $2 , 000. We would like to replace 4 desk-top computers with lap-top units . Current cost estimates are $1, 500 per lap-top unit. The reliability of utilizing our own equipment for playing patient education materials is better then watching clients fish DVDs out of their home equipment with knives or forks. The budgeted amount is $6, 000. This also allows us to keep up with the changing video format found in the client home. 85% of our mothers no longer have video tape players available for our education materials . We are converting video materials into DVD format. d. NCCFC/UCHSC Training, Technical Assistance and Materials Costs: NCCFC/UCHSC clinical training and support, NCCFC/UCHSC materials, purchase of clinical information system (CIS), NCCFC/UCHSC technical assistance, indirect rate costs paid to NCCFC/UCHSC and purchase of PIPE materials. Applicants should include funding to cover the costs of each of the trainings (including training materials) required by Section 1.6(1) of the Rules for each of the Nurses and Nurse Supervisor to attend such trainings. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 21 At the time of this progress report, there are no anticipated staff training needs for this category. e. Travel Costs: Travel costs in the course of carrying out the work of the program through visits to clients and outreach in the community, travel to attend the NCCFC/UCHSC trainings and travel to attend NCAST training. Home visit travel—70,000 miles X$0.425=$29,750 Training travel—7 NHV staff X 120 mi (RT to Denver) X 4 events X$0.425=$1,428 Hotel/meals associated w/trainings=$3,072 f. NCAST Training and Materials Costs: Costs of NCAST training and materials. We will need to recertify 3 of our nursing staff with NCAST Feeding and Teaching scales in 2006 - 2007. Their last trainings were done 2001 / 2002 . Feeding class fee: $350 X 3 nurses: $1, 050 Feeding resource materials: $60 X 3 $ 180 Teaching class fee: $350 X 3 nurses: $1, 050 Teaching resource materials: $60 X 3 $ 180 $2,460 g. Indirect Costs: Implementing agency indirect costs are permitted in the budget but shall be capped at 25% of total direct costs, 27% of total direct salary and fringe benefits, or 30% of total direct salary and fringe where no other direct costs are charged, depending on which method has been previously approved and utilized by Applicant in contracting with CDPHE. If the applicant's organization does not have an approved indirect rate, the applicant's proposed budget may include a flat indirect rate of 10% of salary cost, excluding fringe benefits, requested from the CDPHE. If the applicant's organization does not have an approved indirect rate but wants reimbursement for overhead costs in excess of 10% of funds requested, they may go through the approval process with the State. Please note that this process takes several weeks and may not be the best option for agencies that do not have multiple State contracts. Once a contract is received, a contractor can submit an indirect cost proposal to the CDPHE for review and approval. Such indirect rates are valid for one year and must be approved prior to payment for indirect costs. Indirect cost allowances have been pre-set by contracts between the Weld County Department of Public Health and environment and the Colorado State Department of Health. This pre-set rate is 15.09%. h. In-Kind Contributions: In order to have all true costs of the program reported, as recommended in the 2002 Performance Audit, all in-kind contributions need to be presented. These in-kind contributions need to be limited to those that support the basic program budget as presented in the Sample Budget. They may include the contribution of program administrators' time, i.e. an Executive Director, Nursing Director or Program Manager's time, not to exceed a total of.1 FTE. In-kind contributions also may include all or part of the agency's indirect costs. If the agency's negotiated indirect rate is higher than the amount allowed under the CDPHE indirect rate cap, the difference should be reported as an in-kind contribution. The Weld County NFP program does not have any in-kind contributions to report. i. Other funds: If Applicant currently operates the NHVP using funding other than from the Nurse Home Visitor Fund,Applicant shall: Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 22 1. State whether Applicant expects to continue to receive funding from such alternative-funding source. The Weld County NFP program does not receive alternative funding. 2. State whether the funds received pursuant to a Contract will be used to increase the number of clients served or merely to replace that funding. Not applicable. j. In-Kind Contributions and Other Community Contributions: Community contributions are important indicators of a community's commitment to the program and we encourage you to solicit in-kind or monetary contributions from your community. Be sure to list any in-kind contributions or financial donations in your budget and/or in the narrative that will accompany it. Those contributions that are for the basic program costs presented in the sample site budget should be reported as In-Kind Contributions on the budget form. If your site needs office space, you may include it in the budget request. However, office space and/or furniture is often a good in-kind contribution that can be made by the Implementing Agency, the county or others in the community. If you do offer office space as an in-kind donation, indicate if this includes any furniture the staff may need (examples: desks,chairs, file cabinets). Not applicable. k. Narrative should also address: 1. The sustainability of any other funding sources; and 2. Unique circumstances that cause any budget items in Applicant's Proposal to deviate by more that five(5) percent from the model site budget. Not applicable. Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse.RN,Supervisor 23 A ...re--,qt F Colorado Nurse Home Visitor Program (NHVP) ASSURANCE of INTENTION to MEET PROGRAM REQUIREMENTS Current Nurse Home Visitor Program grantees seeking continuation funding must assure that they intend to meet the Program Requirements, as described in Section 1.6 and Section 1.7 of the Rules Concerning the Nurse Home Visitor Program (Attachment A), by initialing each of the outlined areas below and by signing this assurance page. Training Requirements Visit Protocols Program Management Information Systems Reporting and Evaluating System Staffing Requirements Name of Applicant Entity: Weld County Department of Public Health and Environment Name of Authorized Signer: Mark E. Wallace, MD, MPH Signature of Authorized Signer: X 1.& k " �( `C "`-"'( 1 • Date: .4,11-- ��' Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 25 •i'C Attachment G .416* Colorado Nurse Home Visitor Program (NHVP) ASSURANCE of INTENTION to be an ACTIVE MEDICAID PROVIDER The Center for Medicaid and Medicare Services(CMS)has approved Medicaid reimbursement for Targeted Case Management(TCM)services provided by Colorado Nurse Home Visitor Program sites. Targeted Case Management is a large part of the activities provided by nurse home visitors. These case management services are defined by CMS as"services which will assist individuals eligible under the Colorado State Plan in gaining access to needed medical,social,educational,and other services."Specifically,the approved Colorado Medicaid State Plan further elaborates:"Nurse home visitors provide targeted case management...through 1)assessment of the needs for health,mental health,social service, educational,housing,child care and related services to women and children;2)development of care plans to obtain the needed services;3) referral to resources to obtain the needed services;and,4)routine monitoring and follow-up visits with the women in which the progress of obtaining the needed services is monitored." The Colorado Department of Public Health and Environment and the Colorado Department of Health Care Policy and Financing have created a Medicaid Management Information System(MMIS)that allows for electronic billing of TCM services. All Nurse Home Visitor Program sites will be required to become an active Medicaid provider,if not already,and must bill Medicaid for TCM services as applicable. Current Nurse Home Visitor Program grantees seeking continuation funding must assure that they intend to meet the Medicaid requirements by initialing each of the outlined areas below and by signing this assurance page. The applicant entity: Will be an active Medicaid Provider on or before July 1, 2006. Will enroll all NHVP nurses in Medicaid as providers. Will have a Medicaid consulting physician. Will submit TCM claims as determined by Medicaid billing rules and requirements, including timely filing of claims. • Name of Applicant Entity: Weld County Department of Public Health and Environment Name of Authorized Signer: Mark W. Wallace, MD, MPH • / Signature of Authorized Signer:X \\1)1C--111C7 (-adiesZ-L- Clc.57 Date: Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 26 Standing Agenda 2006 Standing Agenda 2005 Weekly visit schedule updates Weekly visit schedule updates Successes Successes Graduations Graduations Celebrations Celebrations Ouallity Improvement Benchmarks Quallity Improvement Benchmarks Delay 2nd Pregnancy Delay 2nd Pregnancy Toddler Retention Toddler Retention 1st Tuesday Care Conf Pipe Topic 1st Tuesday Care Cont Pipe Topic 7-Feb Ariane Eva 5-Jul Ariane Eva 7-Mar Eva Gerri 2-Aug Eva Gerri 4-Apr Gerri Vesta 6-Sep Gerd Vesta 2-May Vesta Sue 4-Oct Vesta Sue 30-May Sue Peggy 1-Oct Sue Peggy 27-Jun Peggy Karen 6-Dec Peggy Mane 25-Jul Karen Ariane 3-Jan Ariane Eva 22-Aug Ariane Eva 19-Sep Eva Gerd 2nd Tuesday Chart Audit MMH Topic 17-Oct Gerd Vesta 12-Jul Gem Vesta 14-Nov Vesta Sue 9-Aug Vesta Sue 12-Dec Sue ' Peggy 13-Sep Sue Peggy 11-Oct Peggy Ariane 8-Nov Ariane Eva 2nd Tuesday Chart Audit MMH Topic 13-Dec Eva Gerri 14-Feb Gerri Vesta 10-Jan Gerri Vesta 14-Mar Vesta Sue 11-Apr Sue Peggy 3rd Tuedsay Care Conf Pipe Topic 9-May Peggy Karen 19-Jul Sue Peggy 6-Jun Karen Ariane 16-Aug Peggy Arlene 4-Jul Ariane Eva 20-Sep Ariane Eva 1-Aug Eva Gerd 18-Oct Eva Gerri ' 29-Aug Gerri Vesta 15-Nov Gerd Vesta 26-Sep Vesta Sue 20-Dec Vesta Sue 24-Oct Sue Peggy 17-Jan Sue Peggy 21-Nov Peggy Karen 19-Dec Karen Ariane 4th Tuesday Care Conf MMH 26-Jul Peggy Ariane 23-Aug Ariane Eva 3rd Tuedsay Care Conf Pipe Topic 27-Sep Eva Gem 21-Feb Sue Peggy 25-Oct Gerri Vesta 21-Mar Peggy Karen 22-Nov Vesta Sue 18-Apr Karen Ariane 27-Dec Sue Peggy 16-May Ariane Eva 24-Jan Peggy Arlene 13-Jun Eva Gerri 11-Jul Gerd Vesta 5th Tuesday retreat topic 8-Aug Vesta Sue 30-Aug Eva/Vesta 5-Sep Sue Peggy 29-Nov Gerry/Peggy 3-Oct Peggy Karen 31-Oct Karen Ariane 28-Nov Ariane Eva 26-Dec Eva Gerd 4th Tuesday Care Cont MMH 28-Feb Karen Ariane 28-Mar Mane Eva 25-Apr Eva Gerd 23-May Gerri Vesta 20-Jun Vesta Sue 18-Jul Sue Peggy 15-Aug Peggy Karen 12-Sep Karen Arlene 10-Oct Ariane Eva 7-Nov Eva Gerri 5-Dec Gerri Vesta 2-Jan Vesta Sue 5th Tuesday retreat topic 31-Jan Sue 30-May \riane/Karen 29-Aug Eva/Vesta 31-Oct 3erry/Peggy Mi NURSING\NFP\NFP 2005\Team Meeting Notes 2006\Staff Meeting Schedule o Nurse-Family r\ Partnership t V Helping First-Time Parents Succeed Nvrse VIsLtor case cow-revel/Lae Date: /2--07.2-a.5- Ci ewt Name a CLiewt IP AOB tearriertNicivue Ivt.favtt In ' Strewgths Coweerws I wtervewttows wivnt al S u,1-,/ Pregwawcuu c L P Prewatal care �, fr yo3 "„ -dam,,, Persowat I-Fealth - ',orr-t-' in 4,1-417„,,,,e- ./- Referred: WIC, r.sFp CO,41(74:11u,/^^A //'9 AcCta - Cr t th9 4— srtAR.E WCF& Evwi.rowvaewtal htealth i TAN FA- /" tn 7410cd/- yaaly---..�, --- �f _ L% y Courss/e DeveLcjneeitt /o.-¢o-� 7-.- "`� i e e f fectLve dates !` (/ e..) Applied for mecii,cad Reg R Iaterual Role l O� .c-- ,�-1,6 Lv r svigviky,via, “Aost jaa,0,71-4-1,4-, tFamilu av,,c1 brie :, ,� �� w �E -tom r L. �,_ - . fd �J Cowitre e��tt//ewd" % robacoo status: AdY Never Curvet/It • orvuer /7 e"-(A ua, ie t -O. Ate-6,0,e Nurse-Family r-Q Partnership Helping Flat-Time Parents Succeed Nurse Family Partnership Reflective Supervision Home Visitor: a Mentor: _allDate: Event/Topi /Follow-up of previous activity: Descriptiriled hai happened. p _c,4 ,e Feelings: /c,t Q i /I<L-74�ingafrceit,,,,,,; - CM ) Evaluation 'tat hat t�asgood clink tilt: C�� "' / jk ICJ Ge 7CI r‘ • 1 ZI Analysis i. ssn,(s) lean'G le ' Ss / COnClUSIOn(s Ih fie wilt tidciueoni action: /� /9/ 61 Action Plan tvCu time: HV agrees to: 4$ j / Avt,e by when: Mentor agrees to: n • by when: Next meeting plans: when: VISIT IMPLEMENTATION SCALE (VIS) (0403.1) Visitor ID Home Visitor farts Client ID f' Client Name Date /, -9-4-supervisor ID 9 Supervisor #16,,t.--c—_ RATINGS: 1 = Poor; 2 = Below Average; 3 — Average; 4 = Good; 5 = Very Good; NA = Not Applicable PLANNING/SCHEDULING 1. Home Visitor(HV) has plan or written notes Yes No NA r ❑ ❑ 2. HV has necessary materials for visit Yes No NA IV ❑ ❑ 3. Visit has been pre-arranged Yes No NA ®' ❑ ❑ 4. HV calls ahead to confirm visit Yes No NA ;1°- ❑ ❑ GREETING 1. HV friendly in greeting client/family 1 2 3 4 5 W ❑ ❑ ❑ 2. HV solicits client concerns 12 „ ,,,,.A'e" 1 2 3 4 5 ��'11L11^^�VVV��" ❑ ❑ ❑ IY ❑ 3. Acute/Immediate problems are adequately addressed 1 2 3 4 5 ❑ ❑ ❑ ay ❑ REVIEW AND REPORT 1. HV asks about progress on previous activities 1 2 3 4 5 ❑ ❑ ❑ ❑ El 2. HV reviews any records the client agrees to keep 1 2 3 4 5 ❑ ❑ ❑ ❑ 3V 3. HV and Client revise any previous plans in need of change 1 2 3 4 5 ❑ ❑ ❑ ❑ 2' 4. HV acknowledges client's success and/or effort 1 2 3 4 5 ❑ ❑ ❑ ❑ l" ASSESSMENT OF CURRENT STATUS > /iP j7„--/1- 1. HV adequately assesses personal health 1 2 3 4 5 ❑ LIDDY 2. HV adequately assesses environmental health 1 2 3 4 5 ❑ ❑ ❑ ❑ ca' 3. HV adequately assesses life course development 1 2 3 4 5 ❑ ❑ ❑ ❑ 3/ 4. HV adequately assesses maternal role 1 2 3 4 5 O 000lit 5. HV adequately assesses relationships with family and friends 1 2 3 4 5 O 000 O 6. HV adequately assesses service utilization Sjli m,e- _y 2 4 1 3 5 -Fi��,-,�,e�-,,.,q:,ac% - ,fir 1 • .A ©National Center for children, Families, and Communities 1 of 3 PLANNED GUIDANCE(ADULT) 0/41 1. HV follows content agreed upon at previous visit 1 2 3 4 5 ❑ ❑ ❑ rte❑ 2. Content is appropriate for client's understanding 1 2 3 4 5 ❑ ❑ ❑ ❑ Q' 3. HV leaves appropriate written or printed adult-focused items 1 2 3 4 5 ❑ ❑ ❑ ❑ PLANNED GUIDANCE(CHILD) 1. HV presents and describes at least one or more child activities l 1 2 3 4 5 _I 2. HV encourages parent and child to try out the activity OR...models activity if child 1 2 3 4 5 not present ❑ ❑ ❑ ❑ Q' 3. HV leaves written or printed child-focused guidance items 1 2 3 4 5 ❑ ❑ ❑ ❑ o' SUMMARY 1. HV appropriately recaps main points of planned guidance 1 2 3 4 5 ❑ ❑ ❑ ❑ GOAL SETTING AND NEGOTIATION FOR NEXT VISIT 1. HV and client decide specific goals for coming week(s) 1 2 3 4 5 ❑ ❑ ❑ ❑ C3' 2. Goals are realistic and obtainable 1 2 3 4 5 ❑ ❑ ❑ ❑ a' 3. HV and client jointly decide content of next visit 1 2 3 4 5 ❑ ❑ ❑ m' ❑ 4. Time/Place of next visit is decided and reviewed 1 2 3 4 5 • 000 ;1/ GENERAL OVERVIEW 1. HV appropriately handles current crisis/concerns 1 2 3 4 5 ,y DOODO An 2. HV listens/attends to client ❑ ❑ ❑ ❑ d 3. HV uses appropriate opportunities to encourage and praise client on competence, .1 2 3 4 5 positive behaviors,and efforts towards positive change ❑ ❑ ❑ ❑ LW 4. HV expresses sincerity and demonstrates appropriate expression of encouragement 1 2 3 4 5 and praise ❑ ❑ ❑ ❑ I ' 5. HV is appropriately challenging and gives constructive feedback to client 1 2 3 4 5 ❑ ❑ Li a/ ❑ 6. HV appropriately deals with environmental distractions 1 2 3 4 5 ❑ ❑ ❑ ❑ d 7. HV demonstrates cultural competence in client/family interactions 1 2 3 4 5 ❑ ❑ ❑ ❑ Er 8. HV uses solution focused techniques to promote client/family self-efficacy 1 2 3 4 5 • ❑ ❑ ❑ ❑ d 9. HV engages client with open-ended questions and opportunities to talk 1 2 3 4 / 5 ❑ ❑ ❑ off❑ 10. HV and client use problem-solving techniques 1 2 3 4 5 DODO 11. HV uses praise to enhance client's competence in learning 1 2 3 4 5 / ❑ 000 °National Center for children, Families, and Communities 2 of 3 12. HV gives positive/constructive feedback to activity 1 2 3 4 5 FAMILY/CLIENT FACTORS 1. Client is engaged in the visit 1 2 3 4 5 Li aeD 2. Working environment is filled with distractions 1 2 3 4 5 ❑ ❑ CEr ❑ ❑ 3. Client showed hostility toward HV 1 2 3 4 5❑ ❑ ❑ ❑ ❑/I/ n 4. Client has done work from previous session 1 2 3 4 5 COMMENTS 1. Use this space to remark on any notable features of this visit. 1 2 3 4 5 '66.7 t t lti /- ©National Center for children, Families, and Communities 3 of 3 Measured Characteristic Value in 3rd qtr 05 rpt Hitting target? Can we influence? Do we want to influence? Yes No Yes No Yes No Number of active clients (150 active clients) 105 x x Age at enrollment 17 x x #of clients <19 yrs 66 x x Yrs of education 10 x x %married 15 x x Household income 7500 x x % receiving Food Stamps 4% x x on medicaid insurance 78% % participating in TANF 1% % participating w/WIC 68% Gestational age at intake(60% by 16 wks) 17 wks (6-38) x x x Attrition during pregnancy(10% or less) 9.10% x x x declined participation 2.70% x x excessive missed appointments unable to locate 1.80% ? ? moved out of area 4.10% X X miscarriage/fetal death 0.50% x maternal death paternal rights severed unable to serve no HV for 180 days Attrition during infancy(20%or less) 27.50% x x x declined participation 10.50% x x excessive missed appointments 2% x unable to locate 3.90% ? ? moved out of area 10.50% x x miscarriage/fetal death maternal death paternal rights severed unable to serve 0.70% ? ? no HV for 180 days Attrition during toddlerhood ° (10%or less) 25/° x x x declined participation 5.20% x x excessive missed appointments 0.90% x x unable to locate 6% ? moved out of area 12.90% X x miscarriage/fetal death maternal death paternal rights severed unable to serve no HV for 180 days Frequency/duration ot pregnancy visits (80%or 85% x x x greater) Frequency/duration of infancy ° visits (65%or greater) 52/° x x x Frequency/duration of toddler visits (60%or greater) 42% x x x Content/client engagement during pregnancy Personal Health (35-40%) 39% x x x Environmental Health (5-7%) 7% x x x Measured Characteristic Value in 3rd qtr 05 rpt Hitting target? Can we influence? Do we want to influence? Yes No Yes No Yes No Life Course Development(10- 15%) 13% x x x Maternal Role (23-25%) 25% x x x Friends& Family(10-15%) 15% x x x Content/client engagement during infancy Personal Health (14-20%) 24% x x x Environmental Health (7-10%) 9% x x x Life Course Development(10- 15%) 11% x x x Maternal Role (45-50%) 42% x x x Friends& Family(10-15%) 16% x x x Content/client engagement during toddlerhood Personal Health (10-15%) 21% x x x Environmental Health (7-10%) 10% x x x Life Course Development(18- 20%) 15% x x x Maternal Role(45-50%) 39% x x x Friends& Family (10-15%) 16% x x x Change in Maternal Smoking in ° pregnancy(20%decrease) -14/° x x x #smokers @ intake(over the 14 life of the program) #smokers @ 36 weeks(over the life of the program) 12 Change in Maternal Smoking in infancy #smokers @ intake (over the 5 life of the program) #smokers @ infant 1 yr old reporting (over the life of the 7 program) Premature Birth (7.6%) 8.00% x ? x N-H White(8.5%) 12.50% x ? x Hispanic (7.8%) 7.90% x ? x A-A Black (11.0%) Native American (8.3%) Asian (8.0%) Multiracial/other(8.0%r Low Birth Weight(5%) 8.00% x x x N-H White (8.5%) 12.10% x x x Hispanic(7.8%) 7.90% x x x A-A Black (11.0%) Native American (8.3%) Asian (8.0%) ' Multiracial/other(8.0%) Inadequate Maternal-Wt-Gain N-H White (8.5%) Hispanic(7.8%) A-A Black (11.0%) Native American (8.3%) Asian (8.0%) Multiracial/other(8.0%) Occurrence of Breastfeeding Initiated (75%) 78.10% x x x Infancy 6 months (50%) ) 32.90% I I x I x I I x Measured Characteristic Value In 3rd qtr 05 rpt Hitting target? Can we influence? Do we want to influence? Yes No Yes No Yes No Infancy 12 months (25%) 19.40% x x x Immunizations (90%@ 24 months) DTaP Infancy 6 months 98% x x x Infancy 12 months 99% x x x Toddler 18 months 100% x x x Toddler 24 months 79% x x x HIB Infancy 6 months 93% x x x Infancy 12 months 83% x x x Toddler 18 months 38% x x x Toddler 24 months 51% x x x Polio Infancy 6 months 90% x x x Infancy 12 months 99% x x x Toddler 18 months 100% x x x Toddler 24 months 98% x x x Hepatitis B Infancy 6 months 96% x x x Infancy 12 months 100% x x x Toddler 18 months 100% x x x Toddler 24 months 100% x x x MMR Toddler 24 months 100% x x x Language Development(2b%or less<10%) 15.2 x x x Subsequent pregnancy(25%or 46.20% less by 24 months child age) x x x Education Status -No Diploma/ GED at intake Intake-#clients 40 x x 6 months PP-#clients 38 x x 12 months PP -#clients 39 x x 18 months PP-#clients 38 x x 24 months PP -#clients 33 x x Education Status -Diploma/ GED @ intake Intake-#clients 9 6 months PP-#clients 9 12 months PP -#clients 9 18 months PP -#clients 9 24 months PP -#clients 7 Workforce Participation <17 yr olds Intake-#clients 26 6 months PP -#clients 27 12 months PP-#clients 27 18 months PP -#clients 25 24 months PP -#clients 22 Workforce Participation >18 yr olds Intake -#clients 22 x 6 months PP-#clients 22 x 12 months PP -#clients 22 x 18 months PP-#clients 22 x 124 months PP-#clients I 17 I I I x I I I I Prevention of Attrition—Amenable situations—Jan. 3, 2006 CIS r?orted 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) No HV for 180 days - - - Review of CIS reasons for discharges for 4th quarter 2005: 4th 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? ... Nurse Family Partnership Program—Weld County Department of Public Health and Environment Sue Morse,RN,Supervisor 27 Weld County Perinatal Advisory Board Meeting Agenda Monday, March 21 , 2005 1 . Welcome 2. 2004-2005 Budget Review 3. NFP 2005-2006 Program Proposal 4. Invest In Kids Update e Perinatal Advisory Board Monday, March 21, 2005 In attendance: Nancy Weber, Andrea Snyder, Nelly Macias, Gerri Holton, Sue Morse, Vesta Unruh, Caroline Valdez, Ariane Rowe-Denning, Eva Rodriguez, Melynda Childers, Lisa Merlino, Jan Rogestad, Din Tuttle, Kris Howard, Faye Hummel, Norma Fritchell, Azucena Martinez, and Linda Henry Nancy gave an update on the funds for this year, including the current Medicaid reimbursement amount and also discussed the 2005-06 budget proposal. Most of the proposal remained the same as before, except the addition of.5 FTE for another nurse visitor for 7 total nurses. Nancy reviewed the state and local summaries and asked for suggestions for the improvement of the local summary. Suggestions included adding breastfeeding statistics and emergency room visit statistics. Lisa gave an update on the state of the funding for the NFP program. All looks positive, but you never know. The Board of Health will meet on April 20, 2005 to review the recommendations for the program. Securitization of funding will go up for a vote in November. Invest in Kids not only lobbied for NFP this year, but also for the reinstatement of PE, and an amendment was passed to exclude undocumented folks from receiving PE benefits. This brings up many implementation issues, such as how to verify citizenship. Din expressed concern for the pregnant residents that are addicted to methamphetamines in Weld County. She wanted to make sure that probation officers and Dept. of Social Services are aware of our program. Nancy will follow up to make sure these folks are aware of the program. Kris Howard reminded us that the NCMC birthing classes are still rolling. Booklets are available for distribution to clients and are located in the storage area next to the mail room. Weld County Perinatal Advisory Board Meeting Agenda Monday, September 19, 2005 12:00 - 1 :00 1 . Welcome/Introductions 2. Supervisory change 3. Staffing 5. Evaluation Report 4 / Summary Table Reporting 4. Client Referrals and Census 5. Invest In Kids Update Weld County NFP Program September 19, 2005 Synopsis of Information—Evaluation Report 4 Initiation (May 2001) through May 31, 2005 Participant characteristics - 263 women enrolled with a median age of 17 with 10 years of education - 85% unmarried; 86% unemployed; 78% on Medicaid Weld County NFP participants received more visits during all program phases, on average, than participants in the national NFP. - pregnancy 9.9 (8.2 national NFP) - infancy 15.3 (11.1 national NFP) - toddlerhood 8.4 (5.1 national NFP) Weld County NFP participants received higher percent of scheduled visits as compared to national NFP participants. - pregnancy 84% (74% national NFP) - infancy 53% (39%national NFP) - toddlerhood 40% (25%national NFP Gestational Age at intake— 17 weeks (span 6 — 38 weeks) 50% enrolled by 16 weeks 89% enrolled by 28 weeks GOAL: 60% enrolled by 16 weeks Attrition: Pregnancy—9.1% Infancy—27.5% Toddlerhood—25% NPF objective <10% <20% <10% Smoking: At intake 8.48% At 36 wks preg. 7.27% At 12 months post-partum 8.97% (smaller population base) Premature Births: 8% of our mothers delivered prematurely(objective: 7.6%) Low Birth Weight (51bs or less at birth): 8% of our babies had low birth weights (objective: 5%) Breastfeeding: 78% of our mothers initiated breastfeeding (objective: 75%) 33% of our mothers continued breastfeeding at 6 months 19% of our mothers continued breastfeeding at 12 months Education Status over time for clients without HS Diploma/GED at intake 40 clients had no diploma/ GED at intake At 6 months postpartum: 13 clients in school At 12 months postpartum: 14 clients in school At 18 months postpartum: 10 clients in school At 24 months postpartum: 12 clients in school (at 12, 18, 24 months—these may be the same women? New students?) Supervisory change— Sue Morse—0.75 / 0.25 caseload Staffing—Welcome: Peggy Corliss —transfer from the HCP/ Children w/Special Needs team— 0.75 position Yet to be hired— 1 FTE position Ad running this weekend—hope to start interviews week of 09 26 Referral /Intake Report July 15, 2005 — September 15, 2005 Referrals: 33 Sunrise Community HC 17 Schools 3 Probation department 2 Client referrals 2 Health Department OB clinic 2 Transfer from other county 2 Other sources 5 Admissions 15 Attempting to contact 9 Declined participation 9 Current caseload: 122 active mother/mother/baby diads Staffing: 125 Vacant position: 25 Currently — Capacity for Spanish speaking clients is maximized—looking to address use of interpreter for home visits once we are staffed. Home Visit Encounter Form(Jan 06) Client ID Client Name DOB Baby Name DOB Baby Name DOB Medicaid Billing ❑routine infant/child health check ❑normal pregnancy ❑high-risk pregnancy ❑ 1"postpartum visit Date Time from AM/PM to AM/PM Miles Visitor ID Name Visit: ❑ Completed ❑ Attempted ❑Translator Location of visit: ❑(1)Client's Home ❑ (2)Doctor/Cllinic ❑ (3)Employment ❑(4)Family/Friend ❑(5)School ❑ (6)Other Participants engaged in visit:rate 1(low)to 5(high) %of time spent on each program area Time Spent Mother G-mo H/BF Other Personal Health Involvement • IEnvironmental Health Conflict w/material Life Course Understanding of material Maternal Role Friends&Family Total 100% %time spent following program plan Referrals ❑ (1)YES ❑(2)NO Services/Agencies Referrals Comments: specify Services/Agencies Referrals Comments:specify Made service,agency,etc. Made service,agency,etc. 1. Financial Assistance 6.Health Care Services a.TANF/Welfare a.Mother b. Medicaid b. Child c. Food Stamps 7. Developmental Referral d. Social Security 8.Child Care 2. WIC 9.Job Training 3. Crisis Intervention 10.Housing a.Domestic Violence 11.Transportation b.Child Abuse 12. Injury Prevention 4. Mental Health 13 Childbirth education classes 5. Substance Abuse 14. Lactation Specialist a. Smoking Cessation 15. Other:Specify b.Alcohol a. c.Illicit drugs b. c. Address change?❑ Yes(complete Client Activity Status) CIS Data Entry EMR Billing Entry Visit Itinerary Entry NFP 01 06 Staff form Personal Health—pre- &postnatal: nutrition & exercise, fatigue & loss of sleep, physical / emotional symptoms, birth control, pre-term labor,postpartum depression, health maintenance practices, substance use, mental health,etc Preg - 35-40% Infancy- 14-20% Toddler- 10-15% Environmental Health—factors within the home, school, neighborhood or community: domestic violence, inadequate heating, gun safety, gangs, etc. Preg -5-7% Infancy- 7-10% Toddler- 7-10% Life Course Development—mother's plan for the future; education,job training, employment, decisions about further children, etc Preg - 10-15% Infancy- 10-15% Toddler- 18-20% Maternal Role— adjustment to responsibilities: facilitation of infant attachment, child care, immunizations, well child care, discipline, promotion of child development, mothering role, physical care, behavioral & emotional care, Jr toddler—promoting exploration w/ supervision/ safe environment, Sr toddler—caregiver patience etc. Preg - 23-25% Infancy- 45-50% Toddler—40-45% Friends & Family—development of social networks / support systems; changes in relationships w/spouse/boyfriend/significant others/ families, etc. Preg - 10-15% Infancy - 10-15% Toddler— 10-15% Hello