HomeMy WebLinkAbout20040584.tiff RESOLUTION
RE: APPROVE 2004-2005 GRANT APPLICATION FOR RENEWAL OF NURSE HOME
VISITOR PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS,the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS,the Board has been presented with the 2004-2005 Grant Application for renewal
of the Nurse Home Visitor Program from 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, to the Colorado Department of Public Health and Environment,
commencing July 1, 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 2004-2005 Grant Application for renewal of the Nurse Home Visitor
Program between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment be,and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be,and hereby is,authorized to
sign said application.
The above and foregoing Resolution was,on motion duly made and seconded,adopted by
the following vote on the 25th day of February, A.D., 2004.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: £ / ,/I E tt' `' " V _
��111 Robert D. Masden, Chair
Weld County Clerk to 43
William H. rke, Pro-Tem
BY: iit tiG !�-i ;L_ L a
Deputy Clerk to the e'
M. eile
A O DASTO •
David E. Long
- SI a. *. JS
ou t rne� -2- -�
3/� Glenn Vaad
Date of signature:
2004-0584
HL0031
Attachment B
,~ Colorado Nurse Home Visitor Program
2004-05 GRANT APPLICATION COVER SHEET
1. Name of Applicant Entity Weld County � artment cif P� �,[ Hgalsh nn� Fn�rirnmm�nt-
Address/City/Zip 1555 N. 17th Avenue, Greeley, CO 80631
•
2. Name of person completing application: Nancy Weber. BSN.MRH
Position/Title: Nurse-Family Partnership - Supervisor
Telephone: (970) 304-6420 est. 2341 FAX: (970) 304-6416
E-Mail: nweber@co.weld.co.us
3. Name of Authorized Signer: Linda Henry,RN,MA
Position/Title: Director of Nursing and Health Education
• Telephone: (970) 304-6420 FAX: (970) 304-6416
E-Mail: Lhenrv@co.weld.co.us
Signature: XWe41.1, AtA
- Grant proposal is for(check one):
X Category A: Nurse Home Visitor Program
Category B: Alternative Nurse Home Visitation Program
Category C: Nurse Home Visitor Program Expansion
5. Grant request for July 1,2004 through June 30,2005: $ 400,716
FEB 2 5 2004
Robert D. Masden, Chairman, Board of County
ATTEST:
WELD COUNTY CLERK r
H wvnocsvn+vr ,.��,w,eaaios,�c�,se,.aa BY: '• • •
DEPUTY CLERK TOft
. -
PROGRESS REPORT CONTENTS
/7F-Y03-04 Progress Report questions for the time period of March 1,2003 through February 28, 2004.
,Attachment A: Response to Site Review Letter dated November 19, 2003.
//// Attachment B: Budget Page to be used for—
FY04-05-July 1,2004 through June 30,2005
FY05-06-July 1, 2005 through June 30, 2006
FY06-07-July 1, 2006 through June 30,2007
Attachment C.1 and Attachment C.2: Sample Budget and Detailed Narrative
ttachment D: Rules Concerning the Colorado Nurse Home Visitor Program
a'Attachment E: Assurance of Intention to Meet Program Requirements
Attachment F: Medicaid Assurance
•
Weld County Nurse Family Partnership
Progress Report—March 1, 2003 —February 28, 2004
FUNDING LEVEL:
The Weld County Nurse Family Partnership (NFP)program, at the Weld County
Department of Public Health and Environment, was awarded$366,231 from the Nurse
Home Visitor Program funds, for the fiscal year July 1, 2003 through June 30, 2004.
CLIENT INFORMATION:
As of February 20, 2004, 87 clients are currently enrolled in the Weld County
NFP program. In the month of December,we limited the recruiting efforts of new
referrals, due to vacation, holiday,and other leave of the NFP staff. In February, we are
increasing the rate of referrals received through the intake staff at the Sunrise Community
Health Center, and the Weld County Presumptive Eligibility process. In the week of 2-2-
04,3 referrals were received from the community, and all 3 clients were enrolled.
Through the time period of 7-1-03 to 2-20-04, 927client visits were completed, and an
additional 159 visits were recorded as attempted by the Nurse Home Visitors.
PROGRAM EVALUATION:
1. Referral and Resources—In the period of 7-1-03 to 2-4-04, 51 referrals were
received by the Weld County Nurse Family Partnership program from the Weld County
community. The breakdown of the referral sources is as follows:
Medicaid Presumptive Eligibility 12
Salud Family Health Center 1
North Colorado Family Medicine 4
Sunrise Community Health Center 19
Colorado Access 2
School District#6 5
North Colorado Medical Center 1
Loveland Health Center 1
Larimer County NFP (Transfer) 1
TriCounty NFP(Transfer) 1
Self Referred 4
b. Most of the referring sources were identified as partners with the Weld County NFP
program. Initial program start up involved input from staff of the school district,
community health centers, area family clinics, local hospital, and other support agencies.
New referral sources include,neighboring county transfers, the Colorado Access case
coordinator, and clients themselves that know of the program from friends or other
contacts.
c. Because of our close connection to the Presumptive Eligibility process at the Health
Department, we often have access to eligible client referrals at early gestational dates,
even at the identification of pregnancy in our own clinic. The nursing staff that interview
the pregnant women are well connected to the NFP nursing staff, and have a great
understanding of the NFP program and referral guidelines.
d. Referrals are received in the Weld County NFP program by fax or phone contact.
Supervisor Nancy Weber assigns appropriate referrals to a visiting nurse with in 2 days of
receiving the referral information. The NFP staff are committed to responding to the
referring agency within one month, about the status of the client.
e. The greatest needs of the typical NFP clients are: lack of housing, low education and
no connection to school,poor partner relationships, mental health concerns, and overall
poverty. All pregnancy clients that enter the Health Department system or the NFP
program are referred to the WIC program for nutrition support. All clients described
above, are also encouraged to complete a Medicaid application for health service
coverage. The staff of the NFP work community agencies and boards to link the needs of
the NFP clients to appropriate available services, i.e. Weld County Promises For
Children; mental health and parenting services, Bright Beginnings; infancy and brain
development, Family Connects; child development support.
2. Enrolling and Retaining Clients
a. One hundred and twenty clients have been served in the Weld County NFP program
year of 7-1-03 to present. Current enrollment of active clients is 87, with consistent
ongoing referrals from the SCHC and Medicaid PE process. In the months of December
and January 3 clients were dismissed after finishing the program.
b. It is important to enroll clients with a desire to be successful in the program. Strategies
to keep clients active and interested in the program curriculum have included that each
client receives an individualized notebook for all their program materials, and at need
intervals, or success celebrations, clients are presented items for their babies that are
provided by a community program in a partnership with the Health Department. These
items are presented at the discretion of the nurse, and can vary depending on the client
needs. Two other factors to client retention are that nurses carry cell phones, and are
available to clients by phone during all business days, and the exceptional relationships
that the nurses develop with the clients and families based on trust and positive outcomes.
c. Client attrition is monitored by monthly nurse caseload reports. Also at regular
supervision meetings with nursing staff,the caseload and client status numbers are
reviewed.
d. Moving from the area served, is the most common reason for clients to discontinue the
NFP program (30 Clients). A second reason is related to noncompliance, or declining
participation(20 clients). Screening clients prior to enrollment, and holding discussions
about the extent and expectations of the program, are strategies to prevent attrition.
Another observation of the nurses, is that very young clients, age 13— 14 years, are often
not able to appreciate the program interventions and the influence on the future.
3. Nurse Retention and Recruitment
a. Our NFP nursing staff share a close office environment that facilitates teamwork and
team support, and is in close proximity to the supervisor office. Sharing materials, and
having an opportunity to discuss program issues each morning is very valuable. The
supervisor and data assistant each are available to help the RN's with projects,
community contacts, supply acquisition, and resources. As group activities,the NFP
team has attended workshops on parenting,breastfeeding, child development,
professional re-energizing, and women's leadership.
b. A great challenge for the RN's is to implement the NFP curriculum when the clients
are in situations with very few resources, needing housing, food, and frequently need
mental health assistance. In Weld County,we have access to several agencies to assist
with basic needs, and work closely to make proper referrals to those agencies. Often,
clients that are under age 18 are not able to apply for housing assistance, lack
transportation, do not qualify for TANF services, have negative adult role models, and
are at risk of making negative choices to meet basic needs.
c. The Weld County NFP program has not had changes in the RN staff since October
2001.
d. In other programs at the Weld County Health Department, it has been very difficult to
fill RN positions. Wages are much below other area RN opportunities. We have had a
limited number of applicants for open positions.
e. In the case of RN vacancy—We anticipate that clients would be contacted in the
following manner:
i. Biweekly phone contact with each client from program staff
ii. Monthly visits by the supervisor and rotating RN as assigned
4. Advisory Board/Supporting Council
a. The Weld County Perinatal Advisory Committee serves as the advisory board for the
NFP program. The committee meets at quarterly luncheon meetings, and has participated
in developing a policy for prioritizing referrals, and coordinating with other community
programs. Representatives on the board are able to influence how the NFP program can
interface with their community agency, and how referrals can be encouraged and
managed.
New community support was initiated when a grant proposal was written by the NFP
staff in partnership with the Union Colony Children's Music Academy, to promote that
NFP clients and children participate in the developmental music program. The proposal
was written to the Starbucks Foundation, and included that the local Starbucks staff work
with the NFP program in a role of support, reading to children,hosting client activities,
and participate on the advisory board.
b. Agency representatives from our board provided letters of support for the 2003-04
NFP renewal proposal, and an expansion proposal in March of 2003. A board member
that represents United Way of Weld County,plans a media/newspaper story that
highlights a teen pregnancy and birth. She asked to use a real life story of a NFP client
from the NFP program. A school nurse representative from the board compiled an
outline of the curriculum, and presented to school administration to advocate for student
credit for participation.
c. The membership of the advisory board has remained quite constant. The County
Judicial system has changed their representative that attends,but continue to be involved.
We have added an additional school district representative, due to her high interest and
support of the program.
d. Minutes from 2 Advisory Board meetings are attached.
5. Broad-Based Community Support
a. Weld County NFP is involved in the community group Promises For Children. The
focus of this group is to improve the lives of children through early prenatal care, early
infant intervention services, and connecting families to community resources. The NFP
staff can refer clients for services such as child development screening, family
management, and mental health assessments through this network. We have developed a
process to reciprocate appropriate client referrals with the First Steps Prenatal Plus
program.
b.The Weld County NFP program staff have visited with community health care
providers, including area Community Health Centers, a new midwife center for women,
and child health centers, to increase communication with providers, and assist with client
serviced and accessing health care. We continue to accept referrals from a variety of
sources, and offer the program to clients in Spanish and English.
c. The Weld County Department of Public Health and Environment continues to be
supportive of the NFP staff and activities. We have reorganized storage of NFP materials
in cooperation with other programs. Four members of the NFP staff are active members
of agency committees, creating a cooperative work environment, and opportunities for
relationships with agency staff. The WCDPHE has provided that the NFP staff receive
Emergency Preparation training, regular inservice opportunities, and recognition of
service. In December 2003, the NFP Team was presented the STAR Performer Award
from the Nursing Division Director.
d. Support for the Weld County NFP program has steadily increased in the community.
Many agencies are fully aware of the program goals and activities. We can site
supporters for each area, such as:
Presumptive Eligibility, School District#6—Referrals,
Sunrise Community Health Center, North Colorado Family Medicine—Prenatal Health Care,
North Colorado Family Medicine, Monfort Childrens Clinic, Family Connects, United Way-
Childrens health and development needs.
6. Existing Visitation Programs
a. The WCDPHE hosts both the NFP program and a Prenatal Plus program. This is a
benefit, as we both have access to clients early in pregnancy. A Prenatal Plus RN screens
all clients for eligibility in both programs. Referrals are received immediately, and
clients have been given an overview of the program. The First Steps Prenatal Plus
program in Greeley serves clients of all income ranges, all parity, and clients from many
provider clinics. At times they have eligible referrals that their staff feel would benefit
more from the NFP program, and they contact to find the client a placement if possible.
In 2003 3 active clients were referred to NFP from the First Steps program.
In cooperation with the Bright Beginnings Program of United Way, the Weld County
NFP RNs are trained in the Warm Welcome program, and make visits to their own clients
to share the newborn information and resources of Bright Beginnings. This allows other
community volunteers to focus on families that do not have a visiting nurse,to facilitate
that resources are stretched as far as possible in the Bright Beginnings program.
7. Integration of CIS
a. We review the CIS information for the Weld County NFP program on a monthly basis.
For supervision, it is useful to have up to date data on client caseloads, mileage expenses,
and number of client visits completed.
i.Fidelity to the NFP model is reflected in the% of time spent in particular topics and
domains, as reported by the nurse. It is also useful to track the number of visits done by 6
weeks after birth.
ii In RN conferences, nurses are asked to describe their visit schedule with clients. In
quarterly reports, the ratio of completed to expected visits are followed to give feed back
to the staff about the status of actual visits and target visits. In the Pregnancy Phase our
ration has consistently been at .80 or higher.
iii. The data that describes the visit time spent in particular domains is reviewed with RN
staff at monthly meetings. The RN staff are very motivated to meet the expectations of
the NCCFC, and have had lengthy discussions defining which topics belong in which
domain. The staff did an exercise with a mock visit, and practiced how to designate the
visit into each domain.
iv. The Weld County NFP data demonstrates that the average visit is over 1 hour. This is
a statistic that the nurses balance carefully to not have visits too long and jeopardize their
schedule, but long enough to cover all the necessary content. Another area that has been
focused on is the number of early post partum visits for each client. We choose to audit
that client charts should have four baby weights documented in the infants first 2 months
of life. We found about 80% of charts to contain four infant weights recorded in the
client chart in the expected time frame.
8. General Program Implementation
a. At the current stage of the Weld County NFP program, the greatest challenge is for the
Home Visit RNs to schedule the preparation for necessary visits, travel,meetings,
documentation, and client support,with in their work schedule. The nurses are creative
and flexible to meet the needs, yet the demands are sometimes overwhelming. The
clients served often have serious mental health issues and needs, and the nurses are faced
with assisting clients with strategies and information beyond the NFP curriculum. It is
difficult for the team and the supervisor to always provide the support, guidance, and
answers for the challenges and demands of each visitors caseload.
b. The Weld County NFP program is pleased that the Visiting Nurse staff has remained
consistent since October 2001. This fact attributes greatly to our success and teamwork.
A positive addition to the Weld County NFP program is the July 2003 hiring of our
current Data Assistant. She is a highly skilled, motivated worker, with commitment to the
program and assisting the RNs to implement the program as efficiently as possible. She
has helped staff complete other projects, such as taking digital photos of the clients for
graduation, generating certificates for program participation, shopping and material
preparation, and coordinating Advisory Board communication and activities. These
actions all serve to minimize the extra duties for the RN staff. We have experienced a
reorganization of client materials, designed a refill system to avoid running out of forms,
and have increased the speed that data is entered into the CIS.
In working with one school district in Weld County,we have finalized arrangements to
offer High School credit for successful participation in Nurse Family Partnership. A
second alternative school board has been presented the curriculum and program outline,
and responded positively that they hope to soon award credit for program participation to
their students.
A final success statement is that the Weld County NFP program has responded to
referrals through out the 4000 sq miles of Weld County, serving clients in English and
Spanish, across 11 zip codes.
Attachment A: Weld County Department of Public Health and Environment
NURSE HOME VISITOR PROGRAM(NHVP)
(Nurse-Family Partnership)
2003-04 Grantee Response to Site Review Letter Date November 19, 2003
In two (2) single-spaced pages or less,please response to each of the stated issues emphasizing your
progress-to-date if applicable. These issues can be found in your site review letter dated November 19,
2003 from the National Center for Children,Families and Communities and Colorado Department of
Public Health and Environment.
The following is the feedback for the Weld County Site:
• As far as specific feedback goes for Weld County,we can sum everything up by saying that we
all view this NFP site as a model for NFP programs everywhere. Given the struggles that many
sites are experiencing,it is refreshing to have a shining star like Weld. Congratulations!
• Your clinical data from the CIS looks great,your coalition is strong and supportive and you have
very strong supervision and critically important upper level management support for the
program. The challenge, of course, is to maintain this kind of excellence but we are confident that
you will be able to do so. We hope that you will always share your successes with the community
at large through your coalition meetings and beyond—like in the press!
H.\W PDD6\NHVP\Application\0I0SPrograssReportv\(Attaa.A)Wdd.doc
2003-04 Grantee Response to Site Review Letter Date November 19, 2003
1. The Weld County Nurse Family Partnership program has been successful at
implementing the Nurse Home Visitor Program, throughout the 2003-04 contract. We
remain at full staff, and maintain an active client caseload near the target number of 100.
The Administration of the Weld County Department of Public Health and Environment
continue to be supportive of the program, the staff, and the community connections
necessary for success.
2. At a recent Weld County Perinatal Community Advisory Board meeting,
members of the board discussed the desire to design a newspaper article that would
highlight the struggles of area teen parents, and the success of parents that participate in
program such as NFP. It was anticipated that the article would feature a NFP client from
the Weld County program. Members that were promoting this activity were
representatives from United Way of Weld County, School District#6 in Greeley, and
Sunrise Community Health Center. We will continue to discuss this project at future
meetings. The next Perinatal Advisory Board meeting is scheduled on March 23, 2004.
APPLICANT: WELD COUNTY DEPARTMENT OF PUBLIC HEATH AND ENVIRONMENT ,
PROJECT: NURSE HOME VISITOR PROGRAM _
RENEWAL PROJECT I -- . - I —_ i .. I -- - .. -_ 1
:—.
BUDGET I i I
FOR THE PERIOD: 07/01/0406/30/05 - i ' i
I Annual) mber - ; Total Source of Funds 2004.2005 j 2005-2006 2006-2007
_ I Salary _Months `' Amount I *Applicant j Requested i Requested i Requested
Rate i Budget I I Required I and Other I from CDPHE from CDPHE I from CDPHE
PERSONAL --- --- -
Visiting RN-CHN II _ ! 46,642 12I � 466421 _ .I 46,642 48,5921 50,975
Visiting RN-CHN II 46,642 12. ! 46,642 _ 46,642 48,5921 50,975
Visiting RN-CHN II 1 46,6.42' 12' 46,642' 46,6421 48,592' 50,975
1 -- 46,248 k 48,041 50,547
Visiting RN-CHN II 46,248' 12+ 46,2481
Office Technician III 12,5061 12 I 12,506 - 12,506 12,8971 13,663
Contractualifee for Service: ! -- -- -A— —4_
.
i__ ,
Supervising Personnel:_ I. I
Nancy Weber(.5 FTE) 27,003: 12i 27,0031 1 -- 27,0031 28,620' 29,514
• Fringe Benefits: Rate=31.97% i i 72,1511 72,151, 72,151 75,2361 78,854
1 ,
I ! I
L_
Total Personal I 297,834' 297,834. 297,834 ' 310,5701 325,503
._ _ . _. -
OPERATING - --. -
L _;
Enclude only costs not part off
indirect I
— i
Office Supplies I_ ._ _ -- 1,200; _ 1,200 _ 1,200
Client Materials 1 5,800! 4,350; 4,350
Copies—forts _ 2,000- 1,250! 1,250
Eme enc fund I - ! T..
_. Y . . . f 500 500 500
Postage — 6001 600; 600
Telephone ---. _- „ --.. . .1 .. ..- 1,200. _ - 1,200] _ 1,200
Computer Network Fee
- _ _ , ._ _ . --- -- — ' 360 360' 360
---_ _
—.— I '
Cellular Phones Usage Fees 2,5001 2,500 2,500
Medical S pplies ! , I I __ 600 3001 300
I Other Staff Development _ 2,000 1,5001 1,500
I
Sub Total Operating 1 _ 16,7601 13,760; 13,760
•NCCFC Training 1
NCCFC Training _. . .. I 0• 0� 0
NCCFC Materials tI of 0' 0
NCCFC Clinical Info.System Suppory' ) _ 1 _ 1,000' _ 0
NCCFC Purchase of System&TA 1 I 6,000 6,000. 6,000
NCCFC Indirect at 26% i 1,8201 1,560 1,560
PIPE Material I ! I - SOOI 200 200
Sub Total Training _. _ _ I _- 9,320. 7,760, _ 7,760,
NCASTTraining 1 I _ - -
NCAST Materials i ! 1 100 1001 100
Total NCAST -- - - - - - - __. 100 100 100
I
TRAVEL:
Mileage(Visit) - _ _ _ _I- _ _ -__17,040'! 17,210' 17,382
Travel to Trainings-NCCFC _ _ 1,000 1,000 1,000
•
--r- I I
Sub Total Travel �- I • _ I 18,040! 18,2101 18,382
I i
Imo—
EQUIPMENT: 1 -- - _
Computers with MS software(5) L
_ _ 1 0 _ 0 _ _ 0
Modems(2) - - 1 - -i--_ 0'I _ 0_ 0
4 Cellular Phones -
( ) I _ — 0 L 500: 0
Sub Total Equipment { I I. 1 0 5001 0
— j ;
Total Direct Costs I !. I 342,054! 350,900 365,505
I i I ..
Administrativellndirect @ 17.15% ' 1 i 58,662. 60,1791 62,684
I
I
I
TOTAL PROJECT "---n- : I _ - 400,716 411,080: 428,189
i l
*Source of Funding for"Applicant ! ii i
and Other" i L__.. I—r—LocaVCounty.. -- -I I f _ � -1 -
Medicaid Funding i
Patient Fees _.
Other ' _• _
Total Applicant and Otherr
_.�
Are these local funds used to i IX__! f ---r - -
match any other grant? I Yes No X � ! -j I I X - I l'Ik1404-b-' _ ... .
Signature of Director or Authorized Representative j
i
1
Weld County NFP Budget Narrative for 2004-2005
Personal
• The amounts in this section reflect the salaries and benefits of four staff members in
the position of Community Health Nurse II, a .5 FTE Office Technician III staff
person, and a .5 RN supervisor. The RN personnel involved in these positions each
have three years of experience in the Nurse Family Partnership program. The fringe
benefit formula is assigned by the Weld County Government Personnel Division. All
projected salaries, include service step increases and anticipated cost of living
increases.
Operating Expense
• General office supplies are used by the 6 staff members housed at the Weld County
Department of Public Health and Environment. Large 3 ring notebooks are provided
for each client to store their program materials. Craft paper, scissors,markers, and
glue are often utilized by staff to complete client projects and learning activities.
Other materials assist with general program organization and storage.
• Client support materials are provided to clients at age appropriate intervals to foster
child development and promote parenting skills. It is anticipated that in year 2004-05,
40% ($5800) of the$145 will be utilized on families,based on the stages of our client
caseload. 30% is designated in year 2005-06, and 30% in year 2006-07. ($4350).
• Copy costs for the 2004-05 are anticipated to be at $2000 for the year. Our entire
agency is expected to use the county print shop for all printing needs. The established
prices are$.06 per page, and $.09 for double sided printing. A caseload of 100 clients
requires nearly 20,000 printed forms in their visit materials.
• A small designated fund is necessary for urgent client needs. The clients of the Weld
County NFP are poorer, and less educated than clients in other programs. Clients are
often isolated with a lack of transportation and lack of resources. The visiting nurses
occasionally need to provide emergency supplies of food,baby items, or health care
items.
• Postage is for client and program contacts.
• Office phone equipment and service is provided for all program staff.
• Computer network fees provide access to the internet system.
• Five cell phone service package contracts each cost$40 per month times 12 months.
• Health and program supplies will include scale batteries, tape, gloves,models,
sanitizer and paper towels.
• Staff development is available to provide team or individual training in program
related fields.
NFP Clinical Training and Support
• There is no anticipated need for NCCFC training or materials in the year 2004-05.
All current staff have completed the series of three trainings for the NFP program.
In the event of needing to hire and train a replacement RN or supervisor, it would
be required to add the customary costs of the entire NCCFC training, lodging,
materials and support.
• CIS program availability is expected to cost$1000 for the year 2004-05.
• The Weld County NFP program is expected to pay the NCCFC $6000 for
technical assistance of the CIS .
• The Weld County NFP program is expected to pay indirect cost to the NCCFC of
$1820. (26%or total expenses.
• Additional sets of PIPE materials will be utilized by the program staff.
NCAST Training and Materials
• There is no anticipated need for NCAST training in the year 2004-05. All current
staff have completed the series of NCAST trainings and certifications. In the
event of needing to hire and train a replacement RN or supervisor, it would be
required to add the customary costs of the entire NCAST training, lodging,
materials, and support.
• A small amount of NCAST materials will be necessary to complete client
assessments. It is required to purchase the screening materials from the NCAST
program directly.
Travel
• Program visits are calculated for 25 clients with an average of 2 visits per month.
Two nurses have a 10 mile round trip average, and 2 nurses have a 30 mile around
trip average.
• 50 visits x 10 miles x 12 months x $.355 reimbursement= $2130 x 2 nurses=4260
50 visits x 30 miles x 12 months x $.355 reimbursement=6390 x 2 nurses = 12780
• The reimbursement rate of$.355 /mile is determined by the Weld County
government. Total visit mileage expense is expected to be$17, 040. A 1% increase is
projected in the reimbursement rate for the years 2005-06 and 2006-07.
Equipment
• The only anticipated equipment expense is the cost of five replacement cell phones in
the year
2005-06.
Attachment D
vo
Rules Concerning the Colorado Nurse Home Visitor Program
1.1 Definitions.
(1) "Alternative Nurse Home Visitation Program"means a program that provides home visits by nurses but is not
the program described in §25-31-104(1), C.R.S., but does qualify for funding from the Nurse Home Visitor
Fund because it meets the requirements of§25.31-104(4),C.R.S.and§1.10 of these rules.
(2) "Board"means the State Board of Health.
(3) "Conflict of interest" means a personal or financial interest that could reasonably be perceived as an interest
that may influence an individual in his or her official duties.
(4) "Department"means the Department of Public Health and Environment.
(5) "Entity" means any nonprofit, not-for-profit, or for-profit corporation, religious or charitable organization,
institution of higher education, visiting nurse association, existing visiting nurse program, local health
department, county department of social services, political subdivision of the state, or other governmental
agency or any combination thereof.
(6) "Expansion Site"means a program that is already serving at least one-hundred low-income,first-time mothers,
through a grant received under these rules,in the previous fiscal year,and the implementing entity is applying
for additional funding to enable it to serve additional low-income,first-time mothers.
(7) "Financial Interest"means a substantial interest held by an individual which is an ownership or vested interest
in an entity,or employment or a prospective employment for which negotiations have begun,or a directorship
or officership in an entity.
(8) "Health Sciences Facility"means a facility located at the University of Colorado Health Sciences Center that is
selected by the President of the University of Colorado.
(9) "Low-income"means an annual income that does not exceed two hundred percent of the federal poverty level.
(10) "New Entity" means any entity that has not previously received funding for the program pursuant to these
rules.
(11) "Nurse" means a person licensed as a professional nurse pursuant to§12-38-102, C.R.S., et seq., or accredited
by another state or voluntary agency that the state board of nursing has identified by rule pursuant to§12-38-
108(1)(a),C.R.S.,as one whose accreditation may be accepted in lieu of board approval.
(12) "Nurse Home Visitor Program" or"Program" means a program that is described in§25-31-104(1), C.R.S., and
meets the requirements of these rules.
(13) "Nurse Supervisor"means a nurse with a master's degree in nursing or public health,unless the implementing
entity can demonstrate that such a person is either unavailable within the community or an appropriately
qualified nurse without a master's degree is available.
(14) "Visit Protocols" mean nurse home visit guidelines addressing, at a minimum, prenatal, infancy and toddler
development and cover topics such as positive birth outcomes,parental life course development and parenting
skills.
1.2 Procedures for Grant Application.
(1) Grant Application Contents.
(a) General. All applications shall be submitted to the department by entities as defined in §1.1(5) in
accordance with these rules and shall contain,at a minimum,the following information:
(i) A description of the specific training to be received by each nurse employed by the applicant
to provide home visiting nursing services through the program, which training shall include,
at a minimum,the training required in§1.6(1);
(ii) A description of the protocols to be followed by the applicant in administering the program,
which protocols shall, at a minimum,comply with the requirements of§1.6(2);
(iii) A description of the management information system to be used by the applicant in
administering the program,which system shall,at a minimum,comply with the requirements
in§1.6(3);
(iv) A description of the reporting and evaluation system to be used by the applicant in measuring
the effectiveness of the program in assisting low-income, first-time mothers, which shall, at a
minimum,comply with the requirements in§1.6(4);
(v) A budget which includes,at a minimum,each of the following:
(A) Salaries and benefits for the staff required in§1.7;
(B) Costs of the training provided by the Health Sciences Facility, and costs to cover any
other training required by the Health Sciences Facility. Allowable costs include but
are not limited to, travel costs and training materials;
(C) Costs to purchase and maintain the management information system and related
technical assistance;
(D) Operating costs, including but not limited to, office and program supplies, postage,
telephones, computer(s) with internet access, liability insurance, medical supplies,
mileage reimbursement and other staff development for the required staff;
(E) A description of how the applicant will fund any additional costs not funded by the
grant;
(F) Any in-kind contributions the applicant or other stakeholders in the community may
donate.
(b) Applications for New Entities. In addition to the requirements of§1.2 (a)of these rules, applications
for new entities shall contain, at a minimum, the following information:
(i) A description of the experience the applicant has working with the target population and
existing home visitation programs;
(ii) A description of the community support for the program and for the applicant as the lead
organization in its implementation, including detailed information about the broad based
support for the program's implementation. Breadth of community support shall be judged by
the diversity of those involved in supporting the program's implementation, and can be
evidenced through letters of support and more formal referral relationships among various
community organizations and the applicant;
(iii) A description of the specific needs of the population to be served, including but not limited to,
the socio-demographic and health characteristics that justify the need for the program and the
number of first-time,low-income mothers eligible for the program;
(iv) A description of the relationship of the applicant with the schools, prenatal clinics and other
referral sources for the first-time, low-income mothers who will be served by the program,
with specific information about the duration of these relationships;
(v) A description of the nature and duration of the referral linkages that exist between the
applicant and other service providers throughout the community, including but not limited
to, providers of social services, mental health services, workforce preparatian services, job
training services, legal services, health care services and child care services;
(vi) Except as provided in §1.9, a description of a plan for recruiting at least one hundred first-
time, low-income mothers;
(vii) A description of the collaboration between the applicant and other entities providing similar
services to the same population, including plans for coordination and a description of how the
program will fit in with and complement the community's efforts to meet the needs of the
target population, if applicable;
(viii) A plan for hiring and retaining qualified staff that represents the community's racial and
cultural diversity;
(ix) A description of the applicant's capacity to comply with and monitor the implementation of
the grant requirements;
(x) Summary of the major strengths of the applicant and the community that will lead to
successful implementation of the program;and
(xi) A statement as to whether the applicant plans to work collaboratively with other entities in
either administering the program or through an oversight board, and whether the other
entities are other counties,municipalities,agencies or organizations.
(xi) If an applicant currently provides services in compliance with §§ 1.6 through 1.9(1) using
funding other than from the Nurse Home Visitor Program Fund, the applicant shall:
(A) State whether the applicant expects to continue to receive funding from such
alternative funding source;and
(B) State whether the funds received pursuant to these rules will be used to increase the
number of clients served.
(c) Applications for Multiple Community Collaboration. If multiple communities with lower birth rates
need to collaborate to meet the one hundred-family requirement, the applicant shall provide specific
plans that address the mechanisms and history of the collaboration in addition to complying with the
requirements of§1.2 (a) and (b). The plan shall include, but not be limited to, examples of previous
collaborations.
(d) Applications for Expansion Sites. In addition to complying with the requirements of§l.2(1)(a), each
expansion site shall submit the following in its application:
(i) Confirmation that the entity has implemented the program in compliance with these rules;
(ii) A description of additional community demand for the program that is not being met through
the current funding;
(iii) A specific plan for building additional infrastructure to support the expansion of the program,
including, but not limited to, physical space, staff supervision and computer data entry
personnel;
(iv) A description of how the implementing entity has addressed previous specific challenges
relating to the program;
(v) A plan describing the implementing entity's strategy to recruit and train sufficient qualified
nurses to implement and expand the program;and
(vi) A description of community support for the planned expansion of the progran.
(2) Timelines for Grant Applications.
Grant applications may be solicited up to two times each fiscal year.
1.3 Review of Applications.
(1) The department shall conduct an initial review of submitted applications.
(2) After the department's initial review of the applications, the health sciences facility shall review the
applications and shall submit to the board a list of entities that the health sciences facility recommends to
administer the program in communities throughout the state.
1.4 Criteria for Selection of Entities.
(1) At a minimum, the following criteria shall be used for selecting potential grantees:
(a) The applicant meets the definition of an"entity"as defined in§1.1;
(b) The entity submits a completed application in accordance with the requirements of§1.i;
(c) The entity demonstrates the capacity and ability to adequately administer and implement the
program;
(d) The entity demonstrates that it will comply with the requirements of§§1.6 through 1.8;
(e) The entity's geographic service area and/or the population it serves advances the implementation of
the program in communities throughout the state;and
(f) The entity is selected on a competitive basis.
(2) More than one entity may receive funding in a particular community if it can demonstrate in its application:
(a) Broad community support for the implementing entity;
(b) Existence of a sufficient number of eligible women to support multiple implementing entities;
(c) Existence of close coordination and mutual support between the entities;and
(d) A specific plan for the coordination by the applying entity and other nurse home visitation programs
in the community.
1.5 Awarding of Program Grants.
(l) The board shall award grants to the selected entities specifying the amount of the grant.
(2) The grant awards may,at a minimum, include monies to fund:
(a) Reasonable and necessary salaries and benefits for nurses, nurse supervisors and data entry
employees;
(b) Reasonable and necessary operating costs, including but not limited to, medical, program and office
supplies, telephones,computer equipment, mileage reimbursement, any required insurance, and staff
development;
(c) Reasonable and necessary training, training materials and travel costs associated with obtaining
training required by§1.6(1);
(d) Reasonable and necessary cost for purchasing the management information system, and any related
technical assistance;and
(e) Reasonable and necessary costs for developing any infrastructure necessary for program
administration and implementation.
1,6 Program Requirements.
(1) Training Requirements. Each nurse employed by an entity to provide home visiting nursing services through
the program shall be required,at a minimum,to attend and complete the following training:
(a) Up to five days preparatory training for prenatal visits which shall include training on the following
topics:
(i) program goals and theoretical underpinnings;
(ii) assessment of family strengths and risk factors;
(iii) relationships skills and principles for developing self-efficacy;
(iv) strategies for facilitating change in maternal health behaviors;
(v) orientation to the prenatal visit protocols;and
(vi) orientation to the management information system and clinical recordkeeping.
(b) Up to four days preparatory training for infant visits which shall
include training on the following topics:
(i) nurturing parent-infant attachment;
(ii) care of the baby;and
(iii) use of infant visit protocols.
(c) Up to four days preparatory training for toddler visits which shall include training on the following
topics:
(i) information on parenting issues;
(ii) achieving goals related to family economic self-sufficiency;and
(iii) orientation to the toddler visit protocols.
(2) Visit protocols.
(a) The visit protocols followed by the entity in administering the program shall cover information
specific to prenatal,infant and toddler phases. The visit protocols shall,at a minimum,address:
(i) the physical and emotional health of the mother and the baby, including for the mother
information on the importance of nutrition and avoiding alcohol and drugs, including
nicotine;
(ii) the environmental health issues such as ensuring a safe environment for the child;
(iii) the life course development for the mother, including employment, educational achievement,
budgeting and financial planning,transportation and housing;
(iv) the parental role and responsibilities;and
(v) the role of family and friends in supporting goal attainment.
(3) Program management information systems.
(a) The management information system used by the entity in administering and implementing the
program shall,at a minimum,include the following:
(i) documentation of the services received by clients enrolled in the program;
(ii) information to assist the program staff in tracking the progress of families in attaining
program goals;
(iii) information to assist nurse supervisors in providing feedback to individual nurse home
visitors on strengths and areas for improvement in implementing the program.and
(iv) information to assist program staff in planning quality improvements to enhance program
implementation and outcomes.
•
(4) Reporting and evaluation system.
(a) At least once every month, each implementing entity shall submit the data generated by the
management information system required by§1.6(3) to the health sciences facility;and
(b) The data will be analyzed and the health sciences facility shall make available, on no less than a
quarterly basis, a report to the entity evaluating the program's implementation, and on a semi-annual
basis shall also make available reports on benchmarks of program outcomes.
(c) The implementing entity shall submit an annual report that complies with the requirements in§1.11 to
both the health sciences facility and the community in which the entity implements the program that
reports on the effectiveness of the program within the community.
(d) The annual report shall be submitted on or before March 1,or not later than sixty days after the end of
the fiscal year for which funding was provided if the program has not submitted a request for
continuation of funding. The annual report shall be written in a manner that is understandable for
both the health sciences facility and members of the community that the program serves.
1.7 Staffing Requirements.
(1) For every one hundred low-income, first- time mothers enrolled in the program the program shall, at a
minimum,have the following staff:
(a) Four full time equivalent("FIE")nurses;
(b) One half FTE nurse supervisor;and
(c) One-half FTE data entry/clerical support person.
(2) The data entry/clerical support person shall provide office support to the nursing staff and assure data are
submitted as required by§1.6(3)and(4).
(3) The caseload for any one nurse at one time shall not exceed twenty-five low-income, first-time mothers.
1.8 Eligibility of Clients.
(1) At a minimum, the following is required to be eligible to receive program services:
(a) A woman with an annual income that does not exceed two hundred percent of the federal poverty
level;
(b) No previous live births;and
(c) Enrolled in the program during pregnancy or prior to the end of the first month of the baby's life.
(2) Preference will be given to women who enroll in the program prior to the 281h week of pregnancy.
1.9 Number of Clients Served—Waivers.
(I) Except as provided in §1.9(2), each entity shall provide services to a minimum of one hundred low-income,
first-time mothers in the community in which the program is administered and implemented.
(2) (a) If the population base of a community does not have the capacity to enroll one hundred eligible
families,an entity may apply to the board for a waiver from this requirement.
(b) Prior to granting any waivers, the board shall consult with the health sciences facility to ensure that the
entity can implement the program within a smaller community and comply with program-equirements.
1.10 Availability of Funding for Alternative Nurse Home Visitation Programs.
(1) An alternative nurse home visitation program may qualify for funding under the nurse home visitor program
if the alternative nurse home visitation program:
(a) Has been in operation in the state as of July 1, 1999 for a minimum of five years;
(b) Has achieved a significant reduction in each of the following:
(i) Infant behavioral impairments due to use of alcohol and other drugs,including nicotine;
(ii) The number of reported incidents of child abuse and neglect among families receiving
services;
(iii) The number of subsequent pregnancies by mothers receiving services;
(iv) The receipt of public assistance by mothers receiving services;and
(v) Criminal activity engaged in by mothers receiving services and their children.
(2) Any alternative nurse home visitation program qualifying for funding under this section shall be exempt from
the requirements of §1.6 if it continues to demonstrate significant reductions in the occurrences specified in
§1.10 (1)(b).
(3) Any alternative nurse home visitation program qualifying for funding under this section shall comply with the
requirements of§1.11 of these rules.
1.11 Reporting Requirements for Tobacco Settlement Programs.
(1) All programs shall annually submit to the department a report which, at a minimum, includes the following
information:
(a) The amount of tobacco settlement moneys received by the program for the preceding fiscal year;
(b) A description of the program, including the program goals, population served by the program, the
actual number of people served,and the services provided;and
(c) An evaluation of the operation of the program, which includes the effectiveness of the program in
achieving its stated goals.
(2) Reports shall be submitted to the department no later than sixty days after the end of the fiscal year for which
funding was provided.
1.12 Conflicts of Interest.
(1) Applicability. Except as provided for in §§25-31-105, C.R.S. through 25-31-108, C.R.S. regarding the health
sciences facility,this section applies to any person involved in:
(a) The review of completed applications;
(b) Making recommendations to the board regarding an entity that may receive a grant ar.d the amount of
said grant;or
(c) Members of the board.
(2) Prohibited Behavior. No person who is involved in the activities specified in§1.12 (1) shall have a conflict of
interest. Such conflict of interest includes, but is not limited to, any conflict of interest involving the person
and the grantee or the person and the tobacco industry.
(4) Responsibilities of Persons with a Potential Conflict of Interest. A person who believes thzt he or she may
have a conflict of interest shall disclose such conflict of interest as soon as he or she becomes aware of the
conflict of interest. If the person is a member of the board and acting in the capacity of a board member, the
person shall publicly disclose the conflict of interest to the board; other persons shall disclose the conflict of
interest in writing to the department. If the board or the department,whichever is appropriate, determines the
existence of a conflict of interest, the person shall recuse himself or herself from any of the activities specified in
§1.12(1)relating thereto.
1.13 Criteria for Reduction or Cessation of Funding.
(1) Upon recommendation from the health sciences facility, the board may reduce or eliminate the funding of a
program if the entity is not operating the program in accordance with the program requirements established in
§1.6 through§1.8, except as provided in§1.10 of these rules,or is operating the program in such a manner that
it does not demonstrate positive results.
(2) An entity shall receive written notification from the board if the entity's funding is subect to reduction
or elimination.
tL\WPDOC5\NH VP\AppI'c timr\0405ProgrersRepotlh\(Al1uhD)0405Rulesdoc
r Attachment E
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.
x Training Requirements
x Visit Protocols
x Program Management Information Systems
Reporting and Evaluating System
x Staffing Requirements
Name of Applicant Entity:we 1 d County Department of Public Health and Environment
Name of Authorized Signer: Linda Henry RN MA
Signature of Authorized Signer:X i C1 , E/V LKg
Date: •.„6. /2, r,20() q
H.\W Pp0.'5\NHVP`,Application\0405PmgreteReparte\(AttachE)6105.1uurance doc
Attachment F
ASSURANCE of INTENTION to be an active MEDICAID PROVIDER:
Applies to all NURSE HOME VISITOR PROGRAMS
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 commencing July 1, 2004. All Nurse Home Visitor Program sites
will be required to become an active Medicaid provider, if not already, and must be willing to bill
Medicaid for TCM services.
Please assure that the applicant entity is either an active Medicaid provider or will become on by July 1,
2004.
x Presently an active Medicaid Provider.
Will become an active Medicaid Provider by July 1, 2004.
Name of Applicant Entity: Weld County Department of Public Health and Environment
Name of Authorized Signer: Linda Henry.RN.MA
Signature of Authorized Signer: X cc W (vl LAl 4
Date: -4-41.4( /l ion
Ha WPDOCS\NHVP\Application\0405ProgrereReporle\(AlbchF)0405Mediaaid doc
1:( p DEPARTMENT OF PUBLIC HEALTH & ENVIRONMENT
1555 N. 17`h Avenue
Greeley, CO 80631
WEBSITE: www.co.weld.co.us
ADMINISTRATION: (970) 304-6410
FAX: (970) 304-6412
C PUBLIC HEALTH EDUCATION & NURSING: (970) 304-6420
O FAX: (970) 304-6416
ENVIRONMENTAL HEALTH SERVICES: (970) 304-6415
COLORADO FAX: (970) 304-6411
Esperanza Y. Zachman
Nurse Home Visitor Program Manager
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South—A4
Denver, CO 80246-1530
February 11, 2004
Dear Esperanza,
Please accept our proposal and application to continue participation in the Nurse Home
Visitation Program by implementing the Nurse Family Partnership (NFP) program for Weld
County, Colorado. Attached is the Progress Report, proposed budget of$400.716, and budget
narrative.
We have had great success in our community as clients and families experience growth,
nurturing, and the ability to make positive choices for themselves. The NFP staff in Weld
County continues to work effectively with clients and community members to provide this model
Nurse Home Visitor Program to as many eligible clients as possible.
We ask for your consideration in the application process.
Nancy Webebe BSN, MPH
Nursing Supervisor
Memorandum
I TO: Rob Masden, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH, Director
• Department of Public Health and En iro
COLORADO DATE: February 19, 2004UVak
I lj ti
SUBJECT: Nurse Home Visitor Program Renewal and
Expansion Proposals
Enclosed for Board review and approval are two program funding proposals 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 $400,716 for the term of July 1, 2004, through
June 30, 2005.
The proposal to expand the nurse home visitor program would increase our capacity to service
eligible clients in Weld County. Additional program personnel, training, and operating costs
would be covered by the requested amount of$430,485.
This funding will be used to support health education and other resources for new young mothers
during pregnancy and the first years of their infants' lives under program guidelines. WCDPHE
will collaborate with multiple agencies in implementing this program.
I recommend your approval of these grant proposals.
Enclosure
2004-0584
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