HomeMy WebLinkAbout20042973 RESOLUTION
RE: APPROVE APPLICATION FOR 2004 IMMUNIZATION GRANT FOR OUTREACH
SERVICES 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 an Application for 2004 Immunization Grant
for Outreach Services 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 October 11,2004, and ending June 30, 2005,with further terms and conditions being
as stated in said application, and
WHEREAS,after review,the Board deems it advisable to approve said application,a copy
of which is attached hereto and incorporated herein by reference.
NOW,THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County,Colorado,that the Application for 2004 Immunization Grant for Outreach Services 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 application.
The above and foregoing Resolution was,on motion duly made and seconded, adopted by
the following vote on the 6th day of October, A.D., 2004.
BOARD OF COUNTY COMMISSIONERS
LD COUNTY COLORADO
LORADO
T: , '�y/J_ �h\\V�\ w�V_ (1?I __
l
� ( Robert D. Masden, Chair
Clerk to the Board
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I86 777 / William H. rke, Pro-Tem
%e 4.;,De `�..$W rk to the Board 77/ '
C%r n1—'11Wii M. J. eile
DASTOFe :
EXCUSED
David E. Long
ounty Atto ey 1)014
Glenn Vaad
Date of signature: __,IFA*09
2004-2973
H L0031
CO ; /1/2_ /o - rZ6 --OV
Memorandum
TO: Robert D. Masden, Chair
Board of County Commissioners
I C FROM: Mark E. Wallace, MD, MPH, Director Department of Public Health and � ��
Environment fl'w- & I/�Q�!��
COLORADO DATE: October 4, 2004 -43 /ire,
SUBJECT: 2004 Immunization Grant Application
for Outreach Services
Enclosed for Board review and approval is a grant application to the Colorado Department of
Public Health and Environment for immunization services. If approved, the application will
provide funding for monthly immunization outreach clinics to improve the immunization up-to-
date rates for children in Weld County. By increasing immunization rates, the rate of vaccine
preventable disease should decrease, thus improving the health of children in Weld County. The
proposal is to use the Mobile Medical Van at the same location once a month, staffed by Sunrise
Community Health Center nurses and/or midlevel practitioners who will provide the
immunization services.
The submitted request for$15,990 is the projected amount needed to provide an effective
outreach program for the time period of October 11, 2004 through June 30, 2005. Given the
recent attention at the state level to Colorado's poor immunization rates, it is reasonable to
expect funding may be available next year as well.
I recommend your approval of this grant application.
Enclosure
2004-2973
Granting Agency: Colorado Department of Public Health and Environment
Applicant's Name: Weld County Department of Public Health and Environment
Applicant's Address: 1555 N. 17th Avenue
Greeley, CO 80631
Applicant's Phone: (970) 304-6420, Ext. 2302
Applicant's Fax: (970)304-6416
Project Title: 2004 Immunization Grant for Outreach Services
Contact Person: Trish McClain, RN, Child Health Supervisor
Amount of Request: $15,990
Time Period of Request: October 11, 2004—June 30, 2005
Weld County Department of Public Weld County Board of
Health and Environment Commissioners
Mark E. Wallace, MD, MPH, Director 41 %i\ Robert D. Masden, Chair
llia MAaLh
S61 ate, i4j Vo Weld County Clerk to the Board
Kr, 4 j
Y
I EPU"Y CLERK ICJ T`it Ht
_a-b"00 173
E. Application Content and Format
Please provide the following scope of work information in the format described below:
1. Scope of Work
Name of Grantee: Weld County Department of Public Health& Environment
Mailing address: 1555 N 17th Avenue, Greeley, CO 80631
Phone: 970/304-6420 Fax: 970/304-6416
Name of Individual Responsible for ensuring the scope of work is completed:
Trish McClain
Phone: 970/304-6420, x2302 Email address: pmcclain(&,co.weld.co.us
Name of Individual who completed this application (if different from above)
Phone: Email address:
Name of Individual who will be in charge of this outreach project:
Trish McClain
Phone: 970/304-6420, x2302 Email address: pmcclain@co.weld.co.us
Please list the names and job duties of staff persons who will be present at each outreach
clinic: RN or midlevel provider from Sunrise Community Health Center
MA from Sunrise Community Health Center
Weld County paramedic crew—for delivery & pick-up of medical van only
1. Easily accessible location for all outreach clinics: The proposed location is the Walmart
parking lot located at 3103 23`° Avenue in Greeley
2. Describe why this location is ideal for accessing under-immunized children in the target
age group: This location is located in the area indicated on the map provided as having
428 children age 5 and younger living at or below poverty per Census Tract, 2000. The
location is on the city bus route and is within walking distance of several housing and
apartment developments.
3. Hours of the outreach clinics: 10 am to 4 pm
Describe how you will reach clients who are not up to date: Monthly newspaper
advertisements, PSA on local radio stations, PSA on Walmart's overhead system, flyers
sent home with school age children to target younger siblings
4. How will you screen for VFC eligibility?
The form we use currently to screen for vaccine contraindications and allergies has a
section to screen for VFC eligibility.
5. What screening tool will be used to determine VFC eligibility? Please see additional
attachment titled: WCDPHE Vaccination Questionnaire
6. Describe how immunization histories of each child will be entered into the Colorado
Infant Immunization System (CIIS): At this point neither the Weld County Health Dept
nor Sunrise Community Health Center are using the registry because the North Colorado
Health Alliance (of which both agencies are a part) is in the process of implementing a
patient scheduling/billing system as well as an electronic medical records system. Given
the amount of time and training that the systems are requiring, we were unable to
participate in the CIIS this year but hope to be able to do so in the near future. The
electronic medical record system that we are working on will be a shared record for the
Weld County Health Dept, Sunrise Community Health Center at both the Greeley and
Loveland locations, Sunrise Dental at both Greeley and Loveland locations, and Monfort
Children's Clinic in Greeley.
7. Describe how you will augment the outreach project workforce —non-traditional staff,
volunteers, other public employees): We hope to be able to utilize volunteers from the
Weld County Children's Immunization Coalition to help distribute information/publicize
the clinics. We also hope to use UNC Nursing students to be immunization providers
with appropriate supervision.
8. Describe plans for marketing the outreach clinics in the community utilizing
collaboration/partnerships with community organizations: The Walmart corporation has
been consistently supportive of public health activities such as immunizations and West
Nile education. By using their location we increase our visibility since it is a popular
shopping destination for many families. Also, in the past, Walmart has announced public
health activities over the store loud speaker system on the days when those activities are
taking place. We also plan to partner with the Latino Alliance for Health & Education to
promote the clinics in Spanish newspapers and on Spanish radio. In addition, we hope to
have flyers promoting the clinics available to community partners such as United Way,
District 6, and the Weld County Day Care Association.
10. What promotional items will be used with this outreach project? We will use age
appropriate toys and/or stickers for children receiving their immunizations at the outreach
clinic. To provide incentive for families to get their children up to date with the 4`h DTaP,
a digital thermometer will be given to the parent/guardian of a child who gets their 4`h
DTaP at the outreach clinic.
11. Describe how this proposal demonstrates unique and creative approaches to
conducting outreach clinics: People shop at Walmart anyway, if they are able to get their
children immunized at the same time, we've just saved them a trip to a provider's office or
the health department. The Mobile Medical Van is highly visible and by utilizing it to
give the immunizations, it will be easy for the public to connect that when they see the
Van at Walmart, shots are available for their children.
12. State why this proposal should be funded over other proposals: The Weld County
Health Department and Sunrise Community Health Center have had a very successful
summer using the Mobile Medical Van to provide immunizations in rural schools as well
as the Walmart discussed in this application. We've also collaborated to bring health care
to the Migrant population in our county, with Sunrise providers using the Van several
days each week at various locations. The Weld County Paramedic Team has been
instrumental in providing delivery and pick-up of the Van when Health Department staff
is unable to do so. The relationships for this current project are already in place for this
proposal to be a successful and beneficial outreach to the children in our communities.
2. Budget Justification
Please ensure that the budget requested reflects the scope of work described. Individual projects
may not need support in all the budget categories. If no funds are requested in a budget category,
please indicate that by placing a zero in the budget column on the summary table. The table
below provides a format for submitting your budget. Please edit the items as necessary to fit the
funding categories needed.
ITEM AMOUNT
Personnel 4864.00
RN or Midlevel Provider @ $28/hour x 6 hours clinic time, 4 hours
prep time, 4 hours post time x 8 clinics = $3136
MA or Outreach worker @ $12/hour x 6 hours clinic time, 6 hours
prep time, 6 hours post time x 8 clinics = $1728
Fringe 31.97% 1555.02
Operating Cost:
• Medical supplies 680.00
Syringes, needles, gloves, band-aids, sharps containers, cotton
balls, alcohol wipes, dry ice= $85/clinic x 8 clinics
• Office supplies 400.00
Screening forms, VIS forms, parental consent forms, HIPAA
information/consent forms= $50/clinic x 8 clinics
• Promotional Cost 6105.50
Newspaper advertisements 1/month $250 x 8 clinics=$2000
Flyers 3000 %2 sheet double sided at 0.625/copy=$187.50
Radio PSA $100/month x 8 clinics=$800
Med Van Lease fee $150 x 8 clinics=$1200
Assorted toys/stickers for clients=$400
Thermometers for children receiving 4`h DTaP 200 @ 7.59
each=$1518
Equipment 0.00
Travel 44.80
If staff must travel to location separately, reimbursement for mileage
is 0.35/mile, approximately 16 miles round trip x 8 clinics
Subtotal 13649.32
Indirect 17.15% 2340.86
Total 15990.18
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
VACCINATION QUESTIONNAIRE
Name of person receiving shots Birth Date Age(years, months) Today's Date
Is the person receiving shots today an American Indian or an Alaskan Native? Yes No
Does the person receiving shots today have: Medicaid? Yes No
Colorado Child Health Plan insurance? Yes No
other health insurance? Yes No
If the person receiving shots does have insurance, does it cover immunizations? Yes No
This form helps us decide which shots should be given. If any of the questions are not clear,
please ask a nurse to explain them.
1. If the person receiving shots is under 18 years, is his or her parent
or guardian present,or has a consent been signed by a parent or guardian? Yes No Don't know
2. Is the person receiving shots sick today? Yes No Don't know
3. Does the person receiving shots have any allergies to foods
or medicines? Yes No Don't know
4. Does the person receiving shots have problems that affect his or her
brain or nervous system, such as seizures, convulsions, or "spells"? Yes No Don't know
5. Does the person receiving shots or anyone in his or her home have cancer,
leukemia, severe asthma,AIDS, or other immune system problems? Yes No Don't know
6. Is the person receiving shots or anyone taking cortisone,
prednisone, other steroids, or x-ray treatments? Yes No Don't know
7. Has the person receiving shots ever had a serious reaction after getting
shots in the past? Yes No Don't know
8. Has the person receiving shots had a blood transfusion or
immune globulin in the past year? Yes No Don't know
9. Is the person receiving shots pregnant or planning to become
pregnant within the next 3 months? Yes No Don't know
10. Has the person receiving shots ever fainted during or after getting shots Yes No Don't know
in the past?
I hereby affirm that the above information is correct to the best of my knowledge.
Signature of client OR Signature of parent/guardian if client is under 18
Name of person signing above(Please print clearly.)
O:\GRANTS\WCDPHE VACCINATION QUESTIONNAIRE.DOC Revised 1/04 TMC 19-
4140-9022
.VEC'y 2I73
DEPARTAMENTO DE SALUD DEL CONDADO DE WELD
CUESTIONARIO DE SALUD SOBRE VACUNAS
Nombre del paciente Fecha de nacimiento Edad (arios, meses) Fecha de hoy
tEs la persona que va a recibir vacunas indio/indigena norteamericana o de Alaska? Si No
tTiene la persona que va a recibir vacunas:
Medicaid? Si No
el plan de seguro medico para los nifos ("Colorado Child Health Plan")? Si No
otro tipo de seguro medico? Si No
Si Ia person que va a recibir vacunas tiene seguro medico, zpaga los gastos de las vacunas? Si No
Las siguientes preguntas nos ayudan a determinar cuales vacunas el paciente debe recibir. Si usted no entiende
alguna de las preguntas, por favor, pidale a la enfermera que se la explique.
1. i,Si la persona que recibe las vacunas es menor de 18 afios, estan presentes los
padres u otra persona responsable por el o ella, o trae un consentimiento firmado? Si No No se
2. i,Esta enferma la persona que va a recibir las vacunas hoy? Si No No se
3. i,Es alergica a alguna comida o medicina la persona que va a recibir las vacunas? Si No No se
4. Jiene la persona que va a recibir las vacunas algal] desorden que afecta su cerebro
o sistema neurol0gico, como por ejemplo alguna condicien que le causa ataques? Si No No se
5. i,Tiene la persona que va a recibir las vacunas, u otra persona que vive en la misma casa
cancer, leucemia (cancer de la sangre), el SIDA, u otra condiciOn de baja inmunidad? Si No No se
6. i,Toma la persona que va a recibir las vacunas esteroides como"cortisone",
"prednisone", o recibe tratamientos de radiografia? Si No No se
7. i,Ha tenido la persona que va a recibir las vacunas alguna reaccien con sus ultimas
vacunas? Si No No se
8. i,Ha tenido la persona que va a recibir las vacunas una transfusion de sangre o ha
recibido una injecciOn de inmunoglobulina en el ultimo ano? Si No No se
9. i,Esta embarazada la persona que va a recibir las vacunas o piensa quedarse
embarazada en los prOximos tres meses? Si No No se
10. i,La persona que va a recibir vacunas ahora,sea desmallado durante o Si No No se
despues de recibir sus vacunas anteriormente?
Afirmo que la informaciOn arriba es correcta a mf entender.
Firma del paciente O Firma del padre/de la madre ode la persona responsable
Nombre de la persona que firma arriba. (Por favor, escriba en letra de molde.)
O:\GRANTS\WCDPHE VACCINATION QUESTIONNAIRE.DOC Revised 1/04 TMC 19-4140-
9022
cO COI/ .)973
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