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Home My WebLink About20010058.tiff RESOLUTION RE: APPROVE TASK ORDER FOR COLORADO 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 a Task Order for the Colorado Nurse Home Visitor Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment, and the Colorado Department of Public Health and Environment, commencing upon full execution of said task order, and ending June 30, 2001, with further terms and conditions being as stated in said task order, and WHEREAS, after review, the Board deems it advisable to approve said task order, 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 Task Order for the Colorado 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 task order. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 8th day of January, A.D., 2001. BOARD OF COUNTY COMMISSIONERS WELD CO TY, COLORADO ATTEST: � ��_�� i.LLe/ J. Geile, C air Weld County Clerk to the ��: (, '�C), 4/1/17/44° ( el.,/,) �� . 6 �► c lenn Vaad, o- em BY: CeL ,I G rL A, Deputy Clerk to the Bo-.2�`Q� c = LV1 ✓, AJZa�i . m H. Jerke vAPPR ED AS ORM: i d av'd . Long Cou Atyorney k \14141-- Robert D. Masden 2001-0058 HL0027 Department or Agency Name COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Department or Agency Number FAA Contract Routing Number 01-00942 TASK ORDER This TASK ORDER is made this 29TH day of DECEMBER 20O0 by and between: the State of Colorado, for the use and benefit of the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal place of business is 4300 Cherry Creek Drive South, Denver,Colorado 80246 hereinafter referred to as"the State"; and,the BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY(a political subdivision of the state of Colorado) whose address or principal place of business is 915 10th Street, 3rd floor,Greeley,Colorado 80631 for the use and benefit of the Weld County Department of Public Health and Environment whose address or principal place of business is 1555 North 17'"Avenue,Greeley,Colorado 80631,hereinafter referred to as"the Contractor". FACTUAL RECITALS Section 29-1-201, 8 C.R.S. as amended,encourages governments to make the most efficient and effective use of their powers and responsibilities by cooperating and contracting with each other to the fullest extent possible to provide any function,service,or facility lawfully authorized to each of the cooperating or contracting entities. All State contracts with its political subdivisions are exempt from the state of Colorado' State's personnel rules under section 24-50-101 et seq.,and the State procurement code under section 24-101-101, et seq., C.R.S.,as amended. The State has formulated a comprehensive State plan,with associated budgets,relative to the State's programs and services which allocates funds to local health agencies in order to provide certain purchased services to the people of the state of Colorado. This funding is to be allocated through task orders with local health agencies. The State has received funds pursuant to a Master Settlement Agreement between several states, including the state of Colorado,and certain tobacco companies. Section 24-75-1101,et seq.,C.R.S.,as amended,describes how the state of Colorado shall apportion moneys it has received,and will receive,under that Master Settlement Agreement. Section 24-75-1104(a),C.R.S.,as amended,allocates part of these moneys to the "Colorado Nurse Home Visitor Program". Section 25-31-101,et seq.,C.R.S.,as amended;creates the"Colorado Nurse Home Visitor Program" (the Program) Pursuant to section 25-31-106,C.R.S.,as amended,the Contractor has submitted a grant application which has been reviewed the University of Colorado Health Sciences Center in accordance with sections 25-31-105,C.R.S.,as amended,and approved by the State in accordance with section 25-31-107,C.R.S., as amended Finally,as to the State,authority exists in the Law and Funds have been budgeted,appropriated,and otherwise made available,and a sufficient uncommitted balance thereof remains available for subsequent encumbering and payment in Fund Number 13M,Organizational Unit Code 6250,Appropriation Code 593, under Master Contract Page 1 of 6 Routing Number 00-FAA 00008. All required approvals, clearances, and coordination have been accomplished from and with all appropriate agencies. NOW THEREFORE, in consideration of their mutual promises to each other, stated below,the parties hereto agree as follows: A. PERIOD OF PERFORMANCE. In accordance with section 24-30-202(1), C.R.S., as amended, the effective date of this Task Order is the date the State Controller approves this Task Order. The initial term of this Task Order shall commence on the effective date of this Task Order and continue through and including June 30,2001 unless sooner terminated by the parties pursuant to the terms and conditions of this Task Order and the Master Contract. The Contractor may only commence performance under this Task Order as of its effective date. The State shall have no financial obligation to the Contractor for any work or services or, any costs or expenses, incurred by Contractor prior to the effective date of this Task Order. The total term of this Task Order, including any renewals or extensions hereof, may not exceed five (5)years. B. DUTIES AND OBLIGATIONS OF THE CONTRACTOR. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order, shall perform and complete in a timely and satisfactory manner all work in accordance with the following: 1. This Contract is governed by those rules which were adopted by the state Board of Health pursuant to section 25-31-104,C.R.S.,as amended. Those rules, as amended,are incorporated herein by reference, made a part hereof,and attached hereto as "Attachment A". 2. The Contractor shall implement and provide nurse home visitor services through nurses licensed to practice in the state of Colorado to low-income,first-time mothers in those communities served by the Contractor. The Contractor shall coordinate its efforts with the State's Program Manager, the State's Program Nursing Consultant and the National Center for Children, Families and Communities(National Center). The Contractor shall provide these services in accordance with the terms and conditions contained in the Colorado Nurse Home Visitor Act Grant Application Materials,which are incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment B",and the Contractor's grant application,which is incorporated herein by this reference,made a part hereof,and attached hereto as "Attachment C". C. DUTIES AND OBLIGATIONS OF THE STATE. The State, in accordance with the terms and conditions of the Master Contract and this Task Order,shall perform and complete in a timely and satisfactory manner all work in accordance with the following: I. Compensation. In consideration of those services timely and satisfactorily performed by the Contractor under this Task Order,the State shall cause to be paid to the Contractor an amount not to exceed ONE HUNDRED SEVENTY FIVE THOUSAND EIGHT HUNDRED THIRTY ONE DOLLARS,($175,831.00)for the initial term of this Task Order. Of this total financial Page 2 of 6 obligation of the State to the Contractor under this Task Order,$0.00 are identified as attributable to a funding source of the United States and$175.831.00 are identified as attributable to a funding source of the state of Colorado. Payments under this Task Order are subject to verification by the State that the Contractor has fully and satisfactorily complied with the terms and conditions of this Task Order. The Contractor shall maintain original documentation for all costs related to the Contractor's performance under this Task Order for a period of six(6)years following the date of termination of this Task Order. 2. Payment Mechanism. The Contractor may only request reimbursement from the State in accordance with the categories and line items of the budget,which is incorporated herein by this reference,made a part hereof,and attached hereto as "Attachment D". These expense items may include, but are not limited to: the Contractor's salaries, fringe benefits, supplies, travel, operating, and indirect costs which are allowable and allocable expenses related to its performance under this Task Order. To receive compensation under this Task Order, the Contractor shall submit a signed,monthly billing statement, submitted in duplicate. A sample billing statement is incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment E". Billing statements shall: reference this Task Order by its Task Order routing number, and Master Contract routing number, which number is located on page one of this document;state the applicable performance dates, the names of payees;a brief description of the services performed during the relevant performance dates;expenditures incurred; and,the total reimbursement requested. Reimbursement shall be conditioned upon affirmation by the State that all services were rendered by the Contractor in accordance with the terms of this Task Order. Billing statements shall be sent to: Colorado Department of Public Health and Environment Attn: Lee Joseph, Fiscal Officer- PISCY-A4 4300 Cherry Creek Drive South Denver CO 80246-1530 D. ADDITIONAL PROVISIONS. 1. Change Order Letter Process. The State may prospectively increase or decrease the amount payable under this Task Order through a"Task Order Change Order Letter". A sample Task Order Change Order Letter is incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment F". To be effective,the Task Order Change Order Letter must be: signed by the State and the Contractor;and,approved by the State Controller or an authorized designee thereof. Additionally,the Task Order Change Order Letter shall include the following information: A. Identification of the related Master Contract by its contract routing number and this Task Order by its contract number,and the affected Task Order paragraph number(s); B. The type(s)of service(s)or program(s) increased or decreased and the new level of each ; C. The amount of the increase or decrease in the level of funding for each service or program and the new total financial obligation; Page 3 of 6 D. The intended effective date of the funding change; and, E. A provision stating that the Task Order Change Order Letter shall not be valid until approved by the State Controller or such assistant as he may designate. Increases or decreases in the level of contractual funding made through this task order change order letter process during the initial or renewal terms of this Task Order may be made under the following circumstances: F. If necessary to fully utilize appropriations of the state of Colorado and/or non- appropriated federal grant awards; G. Adjustments to reflect current year expenditures; H. Supplemental appropriations, or non-appropriated federal funding changes resulting in an increase or decrease in the amounts originally budgeted and available for the purposes of this Task Order; 1. Closure of programs and/or termination of related contracts or task orders; J. Delay or difficulty in implementing new programs or services;and, K. Other special circumstances as deemed appropriate by the State. Upon proper execution and approval,the Task Order Change Order Letter shall become an amendment to this Task Order. Except for the General and Special Provisions of the Master Contract,the Task Order Change Order Letter shall supersede this Task Order in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the task order change order letter process may be used only for increased or decreased levels of funding, corresponding adjustments to service or program levels, and any related budget line items. Any other changes to this Task Order,other than those authorized by the task order renewal letter process described below,shall be made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of the State of Colorado. If the Contractor agrees to and accepts the proposed change,then the Contractor shall execute and return the Task Order Change Order Letter to the State by the date indicated in the Task Order Change Order Letter. If the Contractor does not agree to and accept the proposed change,or fails to timely return the partially executed Task Order Change Order Letter by the date indicated in the Task Order Change Order Letter,then the State may,upon written notice to the Contractor, terminate this Task Order twenty(20)calendar days after the return date indicated in the Task Order Change Order Letter has passed. The written notice shall specify the effective date of termination of this Task Order. In the event of termination under this clause,the parties shall not be relieved of their respective duties and obligations under this Task Order until the effective date of termination has occurred. 2. The State may renew this Task Order through a"Task Order Renewal Letter",a sample of which is incorporated herein by this reference,made a part hereof, and attached hereto as"Attachment C". To be effective,the Task Order Renewal Letter must be: signed by the State and the Contractor;and, approved by the State Controller or an authorized designee thereof. Additionally, the Task Order Renewal Letter shall include the following information: A. Identification of this Task Order by its contract routing number and affected paragraph Page 4 of 6 number(s); B. The type(s)of service(s)or program(s), if any, increased or decreased and the new level of each service or program for the renewal term; C. The amount of the increase or decrease, if any, in the level of funding for each service or program and the new total financial obligation; D. The intended effective date of the renewal; and, E. A provision stating that the Task Order Renewal Letter shall not be valid until approved by the State Controller or such assistant as he may designate. Upon proper execution and approval,the Task Order Renewal Letter shall become an amendment to this Task Order. Except for the General and Special Provisions of the Master Contract,the Task Order Renewal Letter shall supersede this Task Order in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the task order renewal letter process may be used only to: renew this Task Order; increase or decrease levels of funding related to that renewal; make corresponding adjustments to service or program levels, and,adjust any related budget line items. Any other changes to this Task Order, other than those authorized by the task order change order letter process described above,shall be made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of the state of Colorado. If the Contractor agrees to and accepts the proposed renewal term,then the Contractor shall execute and return the Task Order Renewal Letter to the State by the date indicated in the Task Order Renewal Letter. If the Contractor does not agree to and accept the proposed renewal term, or fails to timely return the partially executed Task Order Renewal Letter by the date indicated in the Task Order Renewal Letter,then the State may,upon written notice to the Contractor, terminate this Task Order twenty(20)calendar days after the return date indicated in the Task Order Renewal Letter has passed. This written notice shall specify the effective date of termination of this Task Order. If the Task Order is terminated under this clause,then the parties shall not be relieved of their respective duties and obligations under this Task Order until the effective date of termination has passed. E. ATTACHMENTS. All attachments to this Task Order are incorporated herein by this reference and made a part hereof as if fully set forth herein. In the event of any conflict or inconsistency between the terms and conditions of this Task Order and those of any attachment hereto,the terms and conditions of this Task Order shall control. Page 5 of 6 IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written. CONTRACTOR: STATE: BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO OF WELD COUNTY Bill Owens,Governor For the use and benefit of the WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT (a political subdivision of the state of Colorado) By: ails By: + t) For a Executive I or Cha r (01/08/2001) Colorado Department of FEIN: 84-6000813 Public Health and Environment If Corporation,Town/City/County,or Equivalent: PROGRAM APPROVAL: T �.�;, ►_edlj/rG,` By: ! issz -;)n— By: 1 Clerk )1x11 Deputy to APPROVALS: COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER Ken Salazar,Attorney Gen ral Arthur L.Barnhart,State Controller / • By: By: w WELD COUNTY riLPArtl Mull OF PUBLIC HEALTH AND t 4di!WNMENII BY: "LA,\Otiak_. Page 6 of 6 Mark E. Waliace, ML). MPH -thrector ATTACHMENT A Rules Concerning the 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 arts a nurse with a master's degree in nursing or health, unless s within the community implementing entity can demonstrate that such a person public unavailable degree or an appropriate) is t either is available. Y qualified nurse without a (14) "Visit Protocols"mean nurse home visit guidelines addressing, at a minimum, prenatal, infancy and toddler development and cover topics such as outcomes, parental life course develop ment and parenting skills. positive birth 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 §I.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§I.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 §I.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 (C) are not toimited to, travel costs and training materials; information purchase em and related techin nical management (D) Operating costs, including limos( t ,office ance; program supplies, but not limited to, and program suppli liability telephones, computer(s) with Y insurance, medical supplies, 2 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 preparation 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; 3 (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§1.2(I)(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 conununity 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 4 (vi) A description of community support for the planned expansion of the program. (2) Timelines for Grant Applications. Grant applications may be solicited up to two times each fiscal year. 1.3 Review of Applications. (I) 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. (I) 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 §I.1; (b) The entity submits a completed application in accordance with the requirements of§I.2; (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 (1) 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 g Grants. (I) 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: 5 (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: 6 (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(3) Program management information nf r a on systems.iends insupporting goal attainment. (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. 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("FTE")nurses; (b) One half FTE nurse supervisor; (c) One-half FTE data entry/clerical asu support (2) The data entry/clericalsu PP person. sthffa e data are submitted person shall provide office support and (4). (3) The assure er any mitted as required by to the nursing one nurse at one time shall not exceed twenty-five low- income,caseload a for mothers. 1.8 Eligibility of Clients. (I) At a minimum, the following is required to be eligible to receive program (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 28th week of pregnancy. 1.9 Number of Clients Served—Waivers. (I) Except as provided in one hundred low-income, first-time mothers inthe co provide services uyinto a program is administeredminimum of (2) (a) and implemented. community which the one hundred population base,se of n o� unity does not have the capacity to enroll this requirement. entity may apply to the board for a waiver from (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 requirements. 1.10 Availability of Funding for Alternative Nurse Home Visitation Programs. (1) An alternative nurse home visitation program may qualify for nurse home visitor program if the alternative nurse home visitation program: (a) funding under the 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; 8 (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§I.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 reconunendations to the board regarding an entity that may receive a grant and 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. (3) Responsibilities of Persons with a Potential Conflict of Interest. A person who believes that 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 9 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 reconunendation 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 §I.6 through §I.8, except as provided in §I.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 subject to reduction or elimination. to ATTACHMENT'11 - COLORADO NURSE HOME VISITOR ACT GRANT APPLICATION MATERIALS Issued October, 2000 APPLICANTS MAY APPLY FOR FUNDS FOR A PROGRAM WHICH PROVIDES SERVICES TO LOW-INCOME, FIRST-TIME MOTHERS THROUGH HOME VISITS BY NURSES AS EITHER: CATEGORY A APPLICANTS: A NURSE HOME "VISITOR" PROGRAM, which means a program that provides home visits by nurses to low-income, first-time mothers which utilizes the program training requirements, program protocols, program management information systems, and program evaluation requirements established by rule of the state board of health. CATEGORY B APPLICANTS: A NURSE HOME "VISITATION" PROGRAM, which means a program that provides home visits by nurses to low-income first-time mothers but does not utilize the program training requirements, program protocols, program management information systems, and program evaluation requirements established by rule of the state board of health and which can show that the program: 1. Has been in operation in the state as of July 1, 1999 for a minimum of five years; and 2. Has achieved a significant reduction in each of the following: A. Infant behavioral impairments due to use of alcohol and other drugs, including nicotine; B. The number of reported incidents of child abuse and neglect among families receiving services; C. The number of subsequent pregnancies by mothers receiving services; D. The receipt of public assistance by mothers receiving services; and E. Criminal activity engaged in by mothers receiving services and their children. ENCLOSURES: I. A description of the Background, Overview and Goals of the Colorado Nurse Home Visitor Act II. Definitions III. A description of Eligible Applicants IV. The Statement of Work for Nurse Home "Visitor" Program Applicants and for the Nurse Home "Visitation" Program Applicants V. Instructions for Grant Application Narrative for Nurse Home "Visitor" Program Applicants and for Nurse Home "Visitation" Program Applicants VI. Grant Narrative ATTACHMENTS: Attachment A Rules Concerning the Nurse Home Visitor Program Attachment B Cover Sheet to Accompany Grant Application Attachment C Assurance Sheet for Nurse Home "Visitor" Program Applicants (Category A Applicants) Attachment D Sample Budget Request Form Attachment E Sample Site Budget for Category A Applicants Attachment F Program Clinical Management Information System Materials Attachment G Provisions of Contracting with the State Attachment H Time Line and Checklist for the Submission and Review of the Grant Applications DEADLINE: Completed applications are due by 3:00 P.M., Wednesday, November 1, 2000. Please submit 5 copies to: Jan Reimer, NHVP Program Coordinator FCHSD - A4 Colorado Depai tuient of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Late applications or those sent by fax or e-mail will not be considered. Completed applications which are received by the Colorado Department of Public Health and Environment after 3:00 P.M. on Wednesday, November 1, 2000 will non be accepted. Completed applications which are sent by facsimile of electronic transmission will not be accepted. Completed applications which are postmarked on or before November 1, 2000, but not received by the Colorado Department of Public Health and Environment until after 3:00 P.M. on November 1, 2000, will not be accepted. GRANT APPLICATION THE NURSE HOME VISITOR PROGRAM Colorado Department of Public Health and Environment (CDPHE) BACKGROUND OVERVIEW AND GOALS A. The Colorado Depaitalent of Public Health and Environment (CDPHE) is administering the Nurse Home Visitor Program (NHVP), as provided for in the Nurse Home Visitor Program Act, section 25-31-101, et.seq., C.R.S., as amended, (the "Act"), which is funded-through the state's Master Tobacco Settlement Agreement. The NHVP, which provides educational, health and other resources for new young mothers during pregnancy and the first years of their infants' lives, has been proven to significantly reduce the amount of drug, including nicotine and alcohol use and abuse by mothers, the occurrence of criminal activity committed by mothers and their children under fifteen years of age, and the number of substantiated incidents of child abuse and neglect. Such a NHVP has also been proven to reduce the number of subsequent births, increase the length of time between subsequent births, and reduce a mother's need for other forms of public assistance. B. The overall goals of the NHVP are: 1. Improve pregnancy outcomes by helping women practice sound health-related behaviors, including decreasing the use of cigarettes, alcohol, and illegal drugs and by improving their nutrition. 2. Improve child health and development by helping parents provide more responsible and competent care for their children; and 3. Improve the economic self-sufficiency of families by helping parents develop a vision for their own future, continue their education, and find jobs. C. The NHVP is limited to low-income, first-time mothers, beginning in pregnancy. Enrollment is restricted to women whose income is at or below 200% of the federal poverty guidelines, and who have not had any previous live births. D. As required in the Act, the National Center for Children, Families "Health Sciences Facility" by the President of the University of Colorado. Under the Act, as the designated Health Sciences Facility, the National Center is responsible for monitoring the administration of the NHVP to ensure that the NHVP is implemented according to the program training requirements, program visit protocols, program clinical information systems, and program evaluation requirements established by the Rules. Consequently, successful applicants will be required to strictly adhere to the visit protocols, procedures and data collection requirements detailed in the Rules unless they apply and are contracted with as an Other Nurse Home "Visitation" Program. Each Nurse Home Visitor Program Applicant will be required to enter into a contract with the organization that will provide the required training, technical assistance and materials to such Applicant. II. DEFINITIONS "Board" means the State Board of Health "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. "Department" means the Department of Public Health and Environment. "Entity" means any nonprofit, not-for-profit, or for-profit corporation, religious or charitable organization, institution or 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. "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. 2 "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. "Low-income" means an annual income that does not exceed two hundred percent of the federal poverty level. "New Entity" means any entity that has not previously received funding for the program pursuant to these rules. "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. "Nurse Home Visitor Program" or "Program" means a program established pursuant to §25-31-101, C.R.S. et seq. and meets the requirements of these rules. "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. "Other 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 as an exception program as defined in §25-31- 104(4), C.R.S. and section 1.10 of these rules. "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. III.ELIGIBLE APPLICANTS Any entity or combinations of entities located in the state of Colorado are eligible to apply. Applicants must strictly adhere to all applicable federal and state laws, rules and regulations that have been or may hereafter be established. 3 • IV.STATEMENT OF WORK for Nurse Home "Visitor" Programs (Category A Applicants) and for Other Nurse Home "Visitation" Programs (Category B Applicants) A. Overview of NHVP. (Applies to both categories.) The NHVP is a voluntary program in which nurses visit the homes of low-income, first-time mothers starting during pregnancy and continuing through the child's second birthday. Visits take place on a weekly or bi- weekly basis and cover topics like: improving pregnancy outcomes through better health care, improving parenting skills, and empowering mothers to take charge of their own lives. Nurses shall use comprehensive visit protocols to assist them in counseling their clients. B. Eligibility of Clients. (Applies to both categories.) The Applicant shall enroll only low-income women who have had no previous live births. Enrollment preference is given to women enrolled prior to the 28th week of pregnancy, but mothers and their babies may be enrolled up to the end of the first month of the baby's life. C. Number of Clients. (Applies to both categories.) Each Applicant shall be expected to provide services to a minimum of one-hundred, low- income, first-time mothers in the community, except when waivers are granted by the State Board, because the population base of the community does not have the capacity to enroll one-hundred eligible women. D. Caseloads. (Applies to both categories.) Each nurse will carry a caseload of no more than 25 families at one time. E. Staffing Requirements. (Applies to both categories.) Every one hundred families will be served by at least 4 FTE Nurses, '/i FTE Nurse Supervisor, and a '/21 FIE data entry clerk/office support person. The Applicant shall use its best efforts to hire nurses with flexible work hours and who are bilingual, where necessary. F. Training. (Applies only to Category A Applicants.) Nurses shall attend the trainings required by the National Center or any other trainings that meet the requirements of Section 1.6(1) of the Rules Concerning a Nurse Home Visitor Program. (Please see Attachment A.) 4 G. Program Guidelines. (Applies only to Category A Applicants.) Nurses shall use home visit guidelines produced by the National Center or any other guidelines that meet or exceed the requirements detailed in Section 1.6(2) of the Rules. H. Program Clinical Management Information System. (Applies only to Category A Applicants.) Applicants shall use a clinical information system that is required by the National Center, or any other clinical information system which complies with the requirements in Section 1.6(3) of the Rules. I. Program Evaluation and Reporting. 1. Data. (Applies only to Category A Applicants.) Applicants shall submit data required by the clinical information system to the National Center on a monthly basis. 2. Program Reports. (Applies to both Category A and B Applicants.) No later than 60 days after the end of each fiscal year for which funding was received from the Nurse Home Visitor Fund, each Applicant shall submit an annual report to both the National Center, the CDPHE and the community in which the Applicant runs the NHVP that reports on the effectiveness of the NHVP within the community. The annual report shall be written in a manner that is understandable for both the National Center and the members of the community. Such report shall include, at a minimum, the following information: (a) The amount of moneys received by the Applicant for the preceding fiscal year; (b) A description of the program, including 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. J. Record Keeping. (Applies to both Categories.) Each Applicant must retain any direct pertinent documents, papers and bookkeeping records involving transactions related to the Contract. These records 5 shall be maintained for a period of three years after the end of each Contract period and shall be made available to the State or its auditors upon request. K. Billing. (Applies to both Categories.) Contracts shall be on a cost- based reimbursement system. Applicants will be required to submit detailed monthly or quarterly billings (at their discretion) with a brief description stating their prior month's or quarter's expenditures. This should include the match according to the categories of the line item budget as approved and attached to the Contract. CDPHE shall provide a standard billing form to all Applicants. L. Budgets for Subsequent Years. (Applies to both Categories.) Budgets for fiscal years two and three shall be submitted to the CDPHE no less than 90 days prior to the end of the current year, and shall be approved upon renewal of Applicant's Contract. V. INSTRUCTIONS FOR GRANT APPLICATION: A. All applicants should begin their application with a Cover Page, following the Sample Cover Page Format found as Attachment B. B. Applicants must specify how the NHVP will be implemented in their communities. The following topics should be included: 1. Assurance of Intention to Meet the Requirements for Nurse Home "Visitor" Programs (Applies to Category A Applicants only.) 2. Qualifying Information for Other Nurse Home "Visitation" Programs (Applies to Category B Applicants only.) 3. Needs of Population Served (Applies to Both Categories.) 4. Capability of Applicant (Applies to Both Category A and Category B Applicants.) a) Organizational structure and commitment b) Broad Based Community Support c) Referral Sources d) Referral Linkages e) Coordination with Existing Visitation Programs 5. Recruitment and Retention of Nurses (Applies to Both.) 6. Clinical Management Information System (Applies to Category A Applicants only.) 7. Collaborative Implementation (Applies to Both Categories.) 6 8. Request for Waiver (Applies to Both Categories, if needed.) 9. Geographical Placement (Applies to Both Categories.) 10. Budget and Budget Narrative (Applies to Both Categories.) VI.GRANT NARRATIVE: A. Please provide information for each of the topics as described in the following instructions, completing the appropriate sections for Category A or Category B Applicants, as indicated. 1. Assurance of Intention to Meet Program Requirements for Nurse Home "Visitor" Programs (Category A Applicants only.) Please complete the Assurance Form which is found as Attachment C, assuring that the Applicant will meet the Program Requirements for Training, Visit Protocols, Program Clinical Management Information System, and Reporting and Evaluation Systems found in Section 1.6 of the Rules Concerning the Nurse Home Visitor Program, which is Attachment A. 2. Qualifying Information for Other Nurse Home "Visitation" Programs (Category B Applicants Only.) (a) Provide information which establishes that the applicant's nurse home visitation program has: (1.) Been in operation in the state for a minimum of five years, prior to July 1, 1999, and (2.) Achieved a significant reduction in each of the following: (aa) Infant behavioral impairments due to use of alcohol and other drugs, including nicotine; (bb) The number of reported incidents of child abuse and neglect among families receiving services; (cc) The number of subsequent pregnancies by mothers receiving services; (dd) The receipt of public assistance by mothers receiving services; and (ee) Criminal activity engaged in by mothers receiving services and their children. 7 • (b) Describe the reporting and evaluation system that the Nurse Home Visitation Program will use to submit an annual report to the Department, no later than sixty days after the end of the contract period, providing the following information: (1.) The amount of tobacco settlement moneys received by the program for the preceding fiscal year; (2.) 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 (3.) An evaluation of the operation of the program, which includes the effectiveness of the program in achieving its stated goals. 3. Needs of Population Served(10 points possible) (Applies to both Categories A and B. Describe in detail the specific needs of the population to be served (including socio-demographic and health characteristics that justify the need for the NHVP, including the number of first-time, low- income mothers eligible for the NHVP). Include an estimate of,the number of families that the Applicant will serve who are Medicaid eligible. (No points will be assigned based on the estimated Medicaid population eligible to be served. Because there is a possibility that this will become a Medicaid reimbursable service, the information is needed for planning purposes only.) 4. Capability of Applicant (Applies to both Categories A and B.) (a) Organizational Structure and commitment. (15 Points Possible) (1) Describe the level of commitment to implement the NHVP through the administrative levels of the Applicant' organization. Describe where in the Applicant's organization the NHVP will be placed and how that will or will not logically support its development and management. Applicant shall include an organizational chart displaying the location of the NHVP in relationship to existing programs. 8 (2) Describe the history and experience of the Applicant in providing maternal and child health and related services. (3) Describe the Applicant's experience with home visiting as a service delivery strategy. (4) Summarize the major strengths of the Applicant and the community that will lead to successful implementation of the NHVP at this site. (b) Broad Based Community Support (10 Points Possible) (Applies to both Categories A and B.) (1) Describe the breadth of community support for the NHVP itself and for the Applicant as the lead organization in its implementation. Include detailed information about the people and organizations that make up the community coalition that is supporting the NHVP's implementation. Breadth of community support shall be judged by the diversity and depth of involvement of those involved in the coalition supporting the NHVP's implementation. (c) Referral Sources (10 points possible) (Applies to both Categories A and B.) (1) Describe the Applicant's relationship with the schools, prenatal clinics, health care providers, social services, or other referral sources for the Low-income, first-time mothers that will be served by the NHVP. Describe the nature of those relationships including how long the relationships have been in place,how formal they are, and prior referral links already established from each relationship. Evidence these referral sources with letters of support specifically describing how the possible referral source will work with the Applicant in recruiting NHVP participants. Explain Applicant's plan for recruiting at least one-hundred participants. (d) Referral Linkages (5 points possible) (Applies to both Categories A and B.) 9 (1) Describe the referral linkages that exist between the lead implementing organization and other service providers such as workforce preparation, job training, legal, housing organizations, health care, mental health, and childcare. Describe the nature of those relationships including how long a relationship has been in place, how formal it is, and the degree to which staff within the (2) Applicant organizations have historically used the services of the linked providers described. Evidence these referral linkages with letters of support of specifically describing how the possible referral linkages will work with the Applicant in providing support services to clients enrolled in the NHVP. (e) Coordination with Existing Visitation Programs (10 points possible) (Applies to both Categories A and B.) (1) Describe the Applicant's coordination with other existing home visitation programs serving young families. Describe how the NHVP will fit in with and complement the community's current efforts to meet the needs of the target population. Include the specific coordination plan agreed to by all Entities implementing home visiting services for young families, including any other Entities already delivering the NHVP. 5. Recruitment and Retention of Nurses (10 points possible) (Applies to both Categories A and B.) Describe the Applicant's plan for hiring and retaining the staff necessary to implement the NHVP. Include: (a) A recruitment plan to hire a half-time Master's prepared clinical nurse supervisor, a team of four Bachelor's prepared Registered Nurses to staff the NHVP, and a half time data entry clerk. Explain whether or not Applicant anticipates having to overcome a nursing shortage in Applicant's community. If a Master's prepared clinical nurse supervisor is not to be hired, demonstrate that such a person is either unavailable within the community or an appropriately it) qualified nurse without a master's degree is available. Describe plans for recruiting bilingual nurses where necessary. (b) Describe where the Nurses will be housed. (c) Describe plans for promoting a stable operating environment for the NHVP and preventing staff turnover. 6. Management Information System (5 Points Possible) (Applies to Category A Applicants only.) Describe the Applicant's capacity to keep records in a computerized clinical information system on participating families and their needs, services provided, progress, and outcomes. Describe what steps would need to be taken by Applicant to make its current computer system compatible with the requirements listed on Attachment D. Describe what quality assurance activities are planned to monitor the implementation of the NHVP. 7. Collaborative Implementation (10 Points Possible) (Applies to both Categories A and B.) Describe Applicant's plan, if any, to work collaboratively with other Entities in either administering the NHVP directly or through an advisory or oversight board. If the collaboration will be in administering the NHVP, please describe the responsibilities of each Entity, and who will have final decision-making authority when issues arise. Please detail whether the other Entities are counties, municipalities, agencies or organizations. Describe how the Applicant will assure effective collaboration/oversight. 8. Request for Waiver (No Points) (Applies to Both.) If Applicant plans to seek a waiver from the State Board from the requirement that it serve at least one hundred, Low-income, first- time mothers, describe the need for such waiver. 9. Geographical Placement of Applicant — (Applies to Both) (Up to two Additional Points) Up to two additional points will be awarded to Applicants that are geographically placed in an area of the State that will advance implementation of the NHVP in communities throughout the State. 10. Budget and Budget Justification (15 Points Possible) (Applies to both categories.) (a) Budget pages: Provide a budget for fiscal year 1 (January 1, 2001 through June 30 2001) for the implementation of the NHVP. The Budget Request Form found as Attachment D may be used or the applicant may use another spreadsheet format that provides all the requested information. The costs of trainings, including the travel to trainings and the materials for the trainings should be listed under the travel section. Category A Applicants should refer to the Sample Budget (Attachment E) for estimated costs of many of the requested line items. (b) Budget Narrative: Provide a detailed narrative description justifying each item listed on the budget pages, so the reader can discern the source of funds, how the funds will be used, and how you arrived at the amounts. Include the descriptive justification for the following: (1) Personnel Costs: Salaries and fringe benefits for the staff. (2) Direct Costs/Operating Expenses: Office and program supplies, postage, telephones, liability insurance, and medical supplies. (3) Direct Costs/ Travel: Travel costs in the course of carrying out the work of the program should be included. Category A 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, as well as the travel costs for each of the Nurses and Nurse Supervisor to attend such trainings. (4) Direct Costs/Equipment: Funding for equipment, including computers with Internet access and the clinical 12 management information system and related technical assistance. (5) Indirect costs are permitted in the budget but shall be capped at 20% of the entire budget or 22% of salary and fringe benefits, depending on which method has been previously approved and utilized by Applicant. (6) Contributions from other funding sources, including in- kind contributions, waivers of indirect costs (in part or in total), contributions from other local agencies or organizations. (7) If Applicant currently operates the NHVP using funding other than from the Nurse Home Visitor Fund, Applicant shall: (a) State whether Applicant expects to continue to receive funding from such alternative-funding source. (b) State whether the funds received pursuant to this RFP will be used to increase the number of clients served or merely to replace that funding. (8) Additional Points: (Up to 5 additional points) Additional points will be awarded to Applicants that provide some community financial contribution, either through partial (or total) waiver of indirect costs, or through other community funding which shall supplement CDPHE funding, because such contributions evidence the community's commitment to implementation of the NHVP. Include a letter of support from each financially contributing organization that details its level of commitment. (9) Narrative should also address: a) the sustainability of any other funding sources; and b) (for Category A Applicants only) unique circumstances that cause any budget items in 13 Applicant's Proposal to deviate from the model site budget attached hereto as Attachment A. 14 Rules Concerning the Nurse Home Visitor Program 1.1 Definitions. "Board" means the State Board of Health (2) "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. (3) "Department" means the Department of Public Health and Environment. (4) "Entity" means any nonprofit, not-for-profit, or for-profit corporation, religious or charitable organization, institution er-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. (5) "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. (6) "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. (7) "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. (8) "Low-income"means an annual income that does not exceed two hundred percent of the federal poverty level. (9) "New Entity"means any entity that has not previously received funding for the program pursuant to these rules. (10) "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. (11) "Nurse Home Visitor Program"or"Program"means a program established pursuant to §25-31-101,C.R.S. et seq. and meets therequirements of these rules. (12) "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. (13) "Other 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 as an exception program as defined in §25-31-104(4),C.R.S. and t section 1.10 of these rules. (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. (I) Grant Application Contents. (a) General. All applications shall be submitted to the department by entities as defined in §1.1(4) 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, 2 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 membership of the community coalition that is supporting the program's implementation. Breadth of community support shall be judged by the diversity of those involved in the coalition 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 referral sources, including, but not limited to, schools, prenatal clinics, providers of social services, mental health services, workforce preparation services,job training services, legal services, health care services and child care services, for the first-time, low-income mothers who will be served by the program with specific information about the duration of these relationships; (v) Except as provided in §1.9, a description of a plan for recruiting at least one hundred first-time, low- income mothers; (vi) 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; (vii) A plan for hiring and retaining qualified staff that represents the community's racial and cultural diversity; (viii) A description of the applicant's capacity to comply with and monitor the implementation of the grant requirements; (ix) Summary of the major strengths of the applicant and the community that will lead to successful implementation of the program; and (x) 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. 3 (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§1.2(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 program. (2) Timelines for Grant Applications. (a) Grant applications may be solicited up to two times each fiscal year. (b) For fiscal year 2000-01, grant applications shall be due on November 1, 2000,unless the department authorizes an extension. 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. 4 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§1.2; (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§§I.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 (1) 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, bipartisan 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. (1) 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 5 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 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; (ii) the environmental health issues such as ensuring a safe environment for the child; (iii) the life course development for the mother, including employment, 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 6 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 provide a quarterly report to the entity evaluating the program's implementation, and on an appropriate(semi-annual)periodic basis shall also provide 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. 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("FTE") 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 is 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 28th week of pregnancy. 1.9 Number of Clients Served—Waivers. (1) Except as provided in§1.9(2), each entity shall provide services to a minimum of 7 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 requirements. 1.10 Availability of Funding for Other Nurse Home Visitation Programs. (I) A nurse home visitation program may qualify for funding under the nurse home visitor program if the 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 other nurse home visitation program qualifying for funding under this section shall be exempt from the requirements of§1.6 through §1.8 if it continues to demonstrate significant reductions in the occurrences specified in §1.10 (1) (b). (3) Any other 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 8 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 and 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. (3) Responsibilities of Persons with a Potential Conflict of Interest. A person who believes that 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 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 subject to reduction or elimination. 1.14 Effective Date. These emergency rules are effective September 30, 2000. 9 GRANT APPLICATION COVER SHEET FOR: COLORADO NURSE HOME VISITOR PROGRAMS (may be typed on this form or information may be computerized) 1. Name of applicant entity: Address: Name of person completing application: Position/Title: Telephone: FAX: E-Mail: 2. Name of authorized signer: Position/Title: Telephone: FAX: E-Mail: Signature: 3. Grant proposal is for: Nurse Home "Visitor" Program (Category A) Other Nurse Home "Visitation" Program (Category B) • 4. Grant amount for Jan. 1, 2001 through June 30, 2001: $ ASSURANCE OF INTENTION TO MEET THE PROGRAM REQUIREMENTS FOR NURSE HOME VISITOR PROGRAM (CATEGORY A) APPLICANTS Please assure that the applicant entity intends to meet the Program Requirements for: Training Requirements Visit Protocols Program Management Information systems Reporting and Evaluating System as described in Section 1.6 of the Rules Concerning the Nurse Home Visitor Program (Attachment A) by signing this assurance page. Name of Authorized Signer: Signature of Authorized Signer: Date: ,PLICANT: aOJECT: Detailed Budget Source of Funds For the Period Annual Number B Total Applicant Requested to Salary Months FTE Amount and from Rate Budget Time Required Other CDPHE DIRECT COST Personal Services: $ $ $ • • • Contractual/Fee-for-service: • Sub-Total $ $ $ Supervising Personnel: Sub-Total $ $ $ Fringe Benefits: (incl. rate or method) S $ $ Total Personal Services (Page _) LSCANT: .1JECT: Source of Funds Total Applicant Requested Amount and from Required Other CDPHE flIRECT COST (Continued) 'perating Expenses: $ $ $ Sub-Total $ $ $ Travel: r . Sub-Total $ $ $ Equipment: • Sub-Total $ $ TOTAL DIRECT COST BUDGET REQUEST (Page 3) "PLICANT: OJECT: Source of Funds Total Applicant Requested Amount and from Required Other CDPHE INDIRECT COST $ $ (Incl. Indir. Rate) Sub-Total $ $ $ TOTAL PROJECT COST $ $ $ r * SOURCE OF FUNDING FOR THE MATCH, i.e. State, Local, in-kind, etc. In-kind: $ Donated: Other (Itemize) : Total $ Hay the non-Federal funds be used to match this grant? Yes _ No ignature of Director or Authorized Representative Assumptions for Sample Site Budget for 100 Families Please keep in mind that the Sample Budget is only a sample. Each site will need to tailor its budget to fit its community's needs. Usted below are examples of some of the line items that may need to be adjusted. This list is by no means exhaustive, however, so please look at each line item to be sure it will meet your community's needs. Keep in mind that the budget is based on a 100 family site served by four full-time nurses, a half-time nurse supervisor and a half-time secretary. 1. Salaries —These line items will need to change to reflect the salaries your agency is currently paying for similar work. 2. The Indirect Cost Line Item will depend on whether your organization receives its indirect costs based on its salaries and benefits or its direct program costs. If your organization uses the latter, this line item will not apply to you and you must include a separate line item based on direct program costs (which should be no more than 20% of those costs). 3. Cellular Phones and Fees — If you will have more than four nurses, you will need to adjust these items. 4. Medical Supplies — If you are going to have nurses stationed in different areas of your community (different agencies or counties), you might want to increase this amount to cover an additional baby scale, for example, if the place the nurses will be housed does not have one. 5. Mileage — If you are in a rural part of the state and the nurses will need to drive long distances to meet their clients, you might want to increase the amount listed. 6. Training and Materials — If you plan to have more than 4 nurses and the nurse supervisor (e.g., if you are a rural site that is going to hire eight half-time nurses instead of four full-time), you should budget in an additional $2,000 for each nurse for training and an additional $315 per nurse for materials. Note: These adjustments will change the amount required by the indirect rate of the University of Colorado Health Sciences Center. 7. Travel —The costs associated with travel for 5 nurses(4 nurses and the nurse supervisor) to go to Denver to attend trainings 1, 2 and 3 (for a total of 10 days of training), are based on the following assumptions. Year One (1/1/01-6/30/01) Assuming nurses will only attend Training 1 in year one because it will be held in March, 2001 a. $100 per night for 5 nights in hotel X 5 nurses = $2,500 (assuming each nurse has her own room) b. $35 per diem for 5 days X 5 nurses = $875 c. 300 miles each way = 600 miles at .31 per mile and 2 cars (for 5 nurses) = $372 d. Total for year one —Training 1 = $3,747 » $3,750 Year Two (7/1/01-6/30/02) Assuming nurses will attend Trainings 2 and 3 in year two a. $100 per night for 5 nights in hotel X 5 nurses = $2,500 (assuming each has her own room) b. $35 per diem for 5 days X 5 nurses = $875 c. 300 miles each way = 600 miles at .31 per mile and 2 cars (for 5 nurses) and 2 round trips (one for each of Trainings 2 and 3) = $744 d. Total for year two —Trainings 2 and 3 = $4,119 » $4,120 8. NCAST/PIPE Training Materials— For NCAST materials, add $170 per nurse for each additional nurse and an additional $180 for every two additional nurses for PIPE materials. Also add $220 for PIPE materials for each additional site where one or more nurses will be housed if it is outside the lead agency. NOTE: Office space is not included on the budget. If your site needs office space you may include it in the budget. However, office space is often a good in-kind contribution that can be made by the implementing agency, the county or others in the community. Another option for this is waiver of part or all of the indirect costs the implementing agency can receive. Because community contributions are important indicators of a community's commitment to a program, 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 or in the narrative that will accompany it. SAMPLE SITE BUDGET BASED ON 100 FAMILIES Personnel Costs (Estimate) Base Fringe Total %Effort Year 1 ' Year 2 Year 3 Salary Benefits 1/1-6/30 7/1-6/30 7/1-6/30 Nurse Supervisor 47,000.00 12,220.00 59,220.00 50% 14,805.00 31,091.00 32,645.00 Nurse 1 36,500.00 9,490.00 45,990.00 100% 22,995.00 48,290.00 50,705.00 Nurse 2 36,500.00 9,490.00 45,990.00 100% 22,995.00 48,290.00 50,705.00 Nurse 3 36,500.00 9,490.00 45,990.00 100% 22,995.00 48,290.00 50,705.00 Nurse 4 36,500.00 9,490.00 45,990.00 100% 22,995.00 48,290.00 50,705.00 Secretary 21,486.00 5,586.00 27,072.00 50% 6,768.00 14,213.00 14,924.00 Sub-Total 113,553.00 238,464.00 250,389.00 (Personne I) Indirect Costs(22%of Salary and 24,981.66 52,462.08 55,085.58 Benefits) Sub-Total 138,534.66 290,926.08 305,474.58 (Personne I and Indirect • Costs) Operational Costs (should be adjusted to reflect local differences) Office Supplies 600.00 1,200.00 1,200.00 $100/mo Program Supplies 6,750.00 7,250.00 500.00 $145/family Copies—forms $1,500 per 750.00 1,500.00 1,500.00 year Postage $50/mo 300.00 600.00 600.00 Telephone 600.00 1,200.00 1,200.00 $100/mo Computer w/modem&MS Office $1850 1,850.00 0.00 0.00 Computer Network Fees $30/mo 180.00 360.00 360.00 4 Cellular Phones 600.00 '0.00 0.00 $150/phon e Cellular Phone Usage Fees $75/mo - 1,800.00 3,600.00 3,600.00 per Nurse Liability Insurance 600.00 1,200.00 1,200.00 $100/mo Medical Supplies $1,500 750.00 875.00 250.00 1st 12 months, $250/yr after Other Staff Development $2,000 1,000.00 1,750.00 1,500.00 1st 12 months, 51,500/yr after Mileage 20 3,100.00 6,200.00 6,200.00 trips/family (2)10 ml RT7© .31/muyr Sub-Total 18,880.00 25,73100 18,110.00 (Operation al) Sub-Total 157,414.66 316,661.08 323,584.58 for Personnel & Operation al Training and Technical Assistance (Provided by National Center for Children Families and Communities) Clinical Training&Tech. 10,000.00 • Assistance $2,000 per person 2-1/2-3 yrs. NCCFC Materials(Cost includes 1,750.00 Perinatal,Infancy,and Toddler Protocol) Clinical Information System Support Purchase of System 1,000.00 Technical Assistance from 2,600.00 5,200.00 5,200.00 NCCFC Sub-Total Tranining& 15,350.00 5,200.00 5,200.00 Technical Assistance Indirect Costs"(26%of Training& 3,991.00 1,547.00 1,547.00 TA Costs) Total Cost of Training& 19,341.00 6,747.00 6,747.00 Technical Assistance Travel Costs Travel From Sites to Trainings 1,2 &3-Mileage/HoteVMeals (Varies with Site-Approximate 3,750.00 4,120.00 Cost$1,000 per trainee) Total Costs of Travel 3,750.00 4,120.00 NCAST Training(Not payable to NCCFC-Site arranges for this training directly with NCAST) Appx. 3,500.00 $2,500- $3,500 per site NCAST and Pipe Training 1,775.00 Materials TOTAL ANNUAL BUDGET • 185,780.66 327,528.08 330,331.58 'Only 6 months because the State fiscal year ends on 6/30+A19 "The University of Colorado's indirect cost rate is 26%of training and technical assistance. If the program funding source requires a lower rate, documentation is required. PECNHV Application-October 2000 National Center for Children, Families and Communities School of Nursing University of Colorado Health Sciences Center Clinical Information System Introduction Sites selected to participate in our dissemination of the Prenatal and Early Childhood Nurse Home Visitation Program are required to have program staff use the CIS which we have designed for the model to keep track of characteristics of families enrolled in the program, their needs, services provided, and families' progress on selected indicators of maternal and child functioning. The current version of the CIS was introduced in January 2000. Computer Requirements The minimum hardware specifications needed for the Clinical Information System are: Pentium II processor 24 mg of RAM I gigabyte hard drive 200 MHz The software and other requirements are: Microsoft Access 97 (version 8.0) Internet Connection File Back up Plan utilizing either: • Tape backup or zip drive for the workstation • Network backup Installation of CIS Software Sites are encouraged to involve their local IS department to assist with establishing an Internet connection and network backup procedures. Please have IS staff contact Gaye Van Buhler(303- 315-5220; vanbuhier.gay@tchden.org) for additional information. The software will be sent to you after you have contacted Gaye Van Buhler and provided the following information: • The path to msaccess.exe. • The path on the network where the tables will reside if the site is using the network backup plan. • Mailing address for the user manual and the installation CD. The software will arrive on a CD and will be a standard software setup. Just click on Setup and follow the steps. Everything is done automatically. There are seven files to be installed: 1. Uphmvst.mde consists of all the forms, queries, macros, and reports. 1. Upgrdtbl.mdb is where all the data and table designs are stored. 3. Nonames.mdb imports all the existing data and strips all personal identifiers of clients, infants and nurses.It then creates the upsend.mdb file that is transferred to Denver via email. 4. Upgrade.mdw which must be loaded in the Access files and contains all the security parameters for the system. PECNHV Application—April, 2000 /9 S. User.mdb creates a copy of the data so the user can manipulate the data, create queries and reports to meet his/her specific needs. 6 Local.mdb which stores the location of the upgrdtbt mdb 7. Stork ico which is the icon on the shortcut icons on the desktop • Transition to Web-based CIS A Web application of the CIS is under development. The current version of the Access application will be distributed to new sites until the completion of the Web database application, approximately August, 2000. After completion of the Web application, all new sites beginning program operations will be trained to use the Web application for data entry(estimate that this will begin with new sites scheduled for Training I in October,2000). The only requirement for new sites, at that point in time, will be an Internet connection with a standard browser(i.e. Netscape, Internet Explorer etc.). Sites using the Web application for data entry, however, will be able to download their own files to a local computer for linkage of data with other informational systems operational at the site or conduct of local analyses. The downloading of data files requires interface with some type of database software, e.g., Access, Excel. Sites may choose the specific software they wish to use for this purpose, but it is our experience that those sites which do not have support staff who are quite facile in use of spreadsheets and conducting data queries will find Access the easiest for personnel to learn to use. The first group of existing sites to be converted to the Web application for data entry will be,those new sites that attended the January 2000 Training I and thereafter who already are using the new version of the recordkeeping forms and CIS software. The plan is to assist these sites to make the transition to the Web application for data entry by the end of the year(e.g.,December,2000). Existing sites which are using the earlier version of the recordkeeping forms and CIS software (available 1997— 1999) will be converted to the Web application for data entry beginning January, 2001. Information about the potential sustainability of the program will be considered when developing a plan to transition to the Web application for data entry older, more established sites. Sites which are not likely to be sustained beyond 2001 will not be asked to transition to the Web application for data entry,but will be maintained on the older version of the CIS until their contracts are completed. D. GENERAL PROVISIONS. 1. If this Contract involves the expenditure of federal or state funds,then this Contract is subject to, and contingent upon,the continued availability of those funds for payment pursuant to the terms of this Contract. If those funds,or any part thereof,become unavailable as determined by the State,then the State may immediately terminate this Contract. 2. The parties warrant that each possesses actual,legal authority to enter into this Contract. The parties further warrant that each has taken all actions required by its applicable law,procedures, rules,or by-laws to exercise that authority,and to lawfully authorize its undersigned signatory to execute this Contract and bind that party to its teens.The person or persons signing this Contract, or any attachments or amendments hereto,also warrant(s)that such person(s)possesses actual, legal authority to execute this Contract,and any attachments or amendments hereto,on behalf of that party. 3. THE CONTRACTOR SHALL PERFORM ITS DUTIES HEREUNDER AS AN INDEPENDENT CONTRACTOR AND NOT AS AN EMPLOYEE OF THE STATE. NEI1 H> R THE CONTRACTOR NOR ANY AGENT OR EMPLOYEE OF THE CONTRACTOR SHALL BE,OR SHALL BE DEEMED TO BE,AN AGENT OR EMPLOYEE OF THE STATE. THE CONTRACTOR SHALL PAY WHEN DUE ALL REQUIRED EMPLOYMENT TAXES AND INCOME TAX AND LOCAL HEAD TAX ON ANY MONIES PAID PURSUANT TO THIS CONTRACT. THE CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND ITS EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS THE CONTRACTOR OR A THIRD PARTY PROVIDES SUCH COVERAGE AND THAT THE STATE DOES NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE. THE CONTRACTOR SHALL HAVE NO AUTHORIZATION,EXPRESS OR IMPLIED,TO BIND THE STATE TO ANY AGREEMENTS,LIABILITY,OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. THE CONTRACTOR SHALL, PROVIDE AND KEEP IN FORCE WORKERS'COMPENSATION(AND SHOW PROOF OF SUCH INSURANCE)AND UNEMPLOYMENT COMPENSATION INSURANCE IN AMOUNTS REQUIRED BY LAW,AND SHALL BE SOLELY RESPONSIBLE FOR THE ACTS OF THE CONTRACTOR,ITS EMPLOYEES AND AGENTS. 4. Except for"public entities",which are described below,during the term of this Contract,and any renewal or extension thereof,the Contractor shall procure,at its own expense,and keep in force and effect,the following insurance coverages: A. As required by State law,standard Workers'Compensation insurance,including occupational disease;and,Employer Liability insurance,which covers all employees,on or off the work site,while acting within the course and scope of employment,in the amounts prescribed by applicable State law. Page 5 of** B. Comprehensive General Liability or Commercial General Liability insurance,to include bodily injury,personal injury,and property damage coverage,in the minimum amount of $600,000 combined single limit for total injuries or damages arising from any one incident(for bodily injuries or damages). The Contractor must purchase additional insurance if claims against the Contractor reduce the available general aggregate amount below$600,000 during the term of the Contract. C. Automobile Liability insurance in the minimum amount of$600,000 combined single limit auto insurance. D. All insurance policies shall be issued by a company authorized to do business in Colorado. The State of Colorado is to be named as additional insured on any issued insurance policy. Each insurance policy shall contain a provision which prevents cancellation of that insurance policy without sixty(60)days'prior written notice,by certified mail,return receipt requested,of such cancellation to the State. On or before the effective date of this Contract,the Contractor shall provide the State with a certificate of insurance as evidence that such insurance coverages are in effect as of the effective date of this Contract If the Contractor is a"public entity"within the meaning of the Colorado Governmental Immunity Act,section 24-10-101,et seq.,7 C.R.S.,as amended("CGIA"),then the Contractor shall at all times during the term of this Contract,and any renewals or extensions hereof,maintain such liability insurance,by commercial policy or self-insurance,as is necessary to meet its liabilities under the CGIA. On or before the effective date of this Contract,the Contractor must provide the State with written proof of such insurance coverage. 5. The Contractor certifies that,as of the effective date of this Contract,it has currently in effect all necessary licenses,certifications,approvals,insurance,permits,etc.,if any,required to properly perform the services and/or deliver the supplies specified in this Contract. The Contractor also warrants that it shall maintain all necessary licenses,certifications,approvals,insurance,permits, etc.,if any,required to properly perform this Contract,without reimbursement by the State or other adjustment in the Contract price. Additionally,all employees or subcontractors of the Contractor performing services under this Contract shall hold,and maintain in effect,all required licenses,certifications,approvals,insurance,permits,etc.,if any,necessary to perform their duties and obligations under this Contract. The Contractor further certifies that,if a foreign corporation or other entity,it currently has obtained and shall maintain any applicable certificate of authority to do business in the State of Colorado and has designated a registered agent in Colorado to accept service of process. Any revocation,withdrawal or nonrenewal of any necessary licenses,certifications,approvals,insurance,permits,etc.,if any,required of the Contractor,or its employees and subcontractors,to properly perform its duties and obligations under this Contract shall be grounds for termination of this Contract by the State for default without further liability to the State. 6. If this Contract involves federal funds,or compliance is otherwise federally mandated,then the Contractor shall comply with the requirements of the following: A. Office of Management and Budget Circulars A-87,A-2I,or A-122,and A-102 or A-110, as applicable; Page 6 of** B. the"Hatch Act"(5 U.S.C. 1501-1508)and Public Law 95-454,Section 4728. These federal statutes declare that federal funds cannot be used for partisan political purposes of any kind by any person or organization involved in the administration of federally-assisted programs; C. the"Davis-Bacon Act"(40 Stat. 1494,Mar.3, 1921,Chap.411,40 U.S.C. 276A-276A-5). This Act requires that all laborers and mechanics employed by contractors or sub-contractors to work on construction projects financed by federal assistance must be paid wages not less than those established for the locality of the project by the Secretary of Labor; D. 42 U.S.C.6101 et seq,42 U.S.C.2000d,29 U.S.C.794. These Acts mandate that no person shall,on the grounds of race,color,national origin,age,or handicap,be excluded from participation in or be subjected to discrimination in any program or activity funded, in whole or in part,by federal funds; E. the"Americans with Disabilities Act"(Public Law 101-336;42 U.S.C. 12101, 12102, 12111 - 12117, 12131- 12134, 12141- 12150, 12161 - 12165, 12181- 12189, 12201 - 12213 and 47 U.S.C.225 and 47 U.S.C.611); F. if the Contractor is acquiring an interest in real property and displacing households or businesses in the performance of this Contract,then the Contractor is in compliance with the"Uniform Relocation Assistance and Real Property Acquisition Policies Act",as amended(Public Law 91-646,as amended and Public Law 100-17, 101 Stat.246-256); and, G. when applicable,the Contractor is in compliance with the provisions of the"Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments"(Common Rule). H. Section 2101 of the Federal Acquisition Streamlining Act of 1994,Public Law 103- 355,which prohibits the use of federal money to lobby the legislative body of a political subdivision of the State. 7. If this Contract involves federal funds,or compliance is otherwise federally mandated,then by signing and submitting this Contract,the Contractor affirmatively avers that: A. the Contractor is in compliance with the requirements of the"Drug-Free Workplace Act" (Public Law 100-690 Title V,Subtitle D,41 U.S.C.701 et seq.);and, B. the Contractor hereby certifies that it is not presently debarred,suspended,proposed for debarment,declared ineligible,or voluntarily excluded from covered transactions by any federal department or agency. The Contractor agrees to comply with all applicable regulations pursuant to Executive Order 12549,including,Debarment and Suspension and Participants'Responsibilities,29 C.F.R.98.510(1990). C. the Contractor agrees to comply with all applicable regulations pursuant to Section 319 of Public Law 101-121,Guidance for New Restrictions on Lobbying,including, Certification and Disclosure,29 C.F.R.93.110(1990). Page 7of** 8. To be considered for payment,billings for payments pursuant to this Contract must be received within a reasonable time after the period for which payment is requested;but in no event no later than ninety(90)calendar days after the relevant performance period has passed. Final billings under this Contract must be received by the State within a reasonable time after the expiration or termination of this Contract;but in no event no later than ninety(90)calendar days from the effective expiration or termination date of this Contract. 9. Unless otherwise provided for in this Contract, "Local Match"shall be included on all billing statements, in the column provided therefor,as required by the funding source. 10. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. I I. In accordance with Office of Management and Budget(OMB)Circular A-133(Audits of States, Local Governments,and Non-Profit Organizations),if the Contractor receives federal funds from any source,including State pass through money, in an aggregate amount in excess of $300,000.00(June 24, 1997),in a State fiscal year(July 1 through June 30),then the Contractor shall have an annual audit performed by an independent certified public accountant which meets the requirements of OMB Circular A-133. If the Contractor is required to submit an annual indirect cost proposal to the State for review and approval,then the Contractor's auditor shall audit the proposal in accordance with the requirements of OMB Circulars A-21 (Cost Principles for Educational Institutions),A-87(Cost Principles for State,Local and Tribal Governments),or A-122(Cost Principles for Non-Profit Organizations),whichever is applicable. The Contractor shall furnish one(1)copy of the audit report(s)to the State's Accounting Office within thirty(30) calendar days of issuance;but in no event later than nine(9)months after the end of the Contractor's fiscal year. If(an)instance(s)of noncompliance with federal laws and regulations occurs,then the Contractor shall take all appropriate corrective action(s)within six(6)months of the issuance of(a)report(s). 12. The Contractor shall grant to the State,or its authorized agents, access to the Contractor's relevant records and financial statements. The Contractor shall retain all such records and financial statements for a period of six(6)years after the date of issuance of a final audit report. This requirement is in addition to any other audit requirements contained in other paragraphs of this Contract. 13. Unless otherwise provided for in this Contract, for all contracts with terms longer than three(3) months,the Contractor shall submit a written progress report,if required by this Contract, specifying the progress made for each activity identified in this Contract. These progress reports shall be in accordance with the procedures developed and prescribed by the State. The preparation of progress reports in a timely manner is the responsibility of the Contractor. If the Contractor fails to comply with this provision,then such failure:may result in a delay of payment of funds;or,termination of this Contract. Progress reports shall be submitted to the State no later than the end of each calendar quarter,or at such other time as may otherwise be specified. Page 8 of** 14. The Contractor shall maintain a complete file of all records,documents,communications,and other materials which pertain to this Contract. Such materials shall be sufficient to properly reflect all direct and indirect costs of labor,materials,equipment,supplies,and services,and other costs of whatever nature for which a contract payment was made. These records shall be maintained according to generally accepted accounting principles and shall be easily separable from other records of the Contractor. Copies of all such records,documents,communications, and other materials shall be the property of the State and shall be maintained by the Contractor,in a central location as custodian for the State,on behalf of the State,for a period of six(6)years from the date of final payment under this Contract,or for such further period as may be necessary to resolve any pending matters,including,but not limited to,audits performed by the federal government. 15. The Contractor authorizes the State,or its authorized agents or designees,to perform audits or make inspections of its records for the purpose of evaluating its performance under this Contract at any reasonable time during the term of this Contract and for a period of three(3)years following the termination of this Contract As such,the Contractor shall permit the State,any appropriate federal agency or agencies,or any other duly authorized governmental agent or agency,to monitor all activities conducted by the Contractor pursuanfto the terms of this Contract. Such monitoring may include,but is not limited to:internal evaluation procedures, examination of program data,special analyses,on-site checks,formal audit examinations,or any other reasonable procedures. All monitoring shall be performed by the State in such a manner that it shall not unduly interfere with the work of the Contractor. 16. If the Contractor obtains access to any records,files,or information of the State in connection with,or during the performance of,this Contract,then the Contractor shall keep all such records, files,or information confidential and shall comply with all laws and regulations concerning the confidentiality of all such records,files,or information to the same extent as such laws and regulations apply to the State. Any breach of confidentiality by the Contractor or third party agents of the Contractor shall constitute good cause for the State to cancel this Contract without liability to the State. Any State waiver of an alleged breach of confidentiality by the Contractor, or third party agents of the Contractor,does not constitute a waiver of any subsequent breach by the Contractor,or third party agents of the Contractor. 17. Unless otherwise agreed to in this Contract,or in a written amendment executed and approved pursuant to Fiscal Rules of the State of Colorado,the parties agree that all material,information, data,computer software,documentation,studies,and evaluations produced in the performance of this Contract for which the State has made a payment under this Contract are the sole property of the State. 18. If any copyrightable material is produced under this Contract,then the State,and any applicable federal funding entity,shall have a paid in full,irrevocable,royalty free,and non-exclusive license to reproduce,publish,or otherwise use,and authorize others to use,the copyrightable material for any purpose authorized by the Copyright Law of the United States as now or hereinafter enacted. Upon the written request of the Contractor shall provide the State with three (3)copies of all such copyrightable material. Page 9 of** 19. If required by the terms and conditions of a federal or state grant,the Contractor shall obtain the prior approval of the State and all necessary third parties prior to publishing any materials produced under this Contract. If required by the terms and conditions of a federal or state grant, the Contractor shall also credit the State and all arr.-scary third parties with assisting in the publication of any materials produced under this Contract. 20. If this Contract is in the nature of personal/purchased services,then the State reserves the right to inspect services provided under this Contract at all reasonable times and places during the term of this Contract. "Services",as used in this clause,includes services performed or written work performed in the performance of services. If any of the services do not conform with the terms of this Contract,then the State may require the Contractor to perform the services again in conformity with the terms of this Contract,with no additional compensation to the Contractor for the reperformed services. When defects in the quality or quantity of the services cannot be corrected by reperformance,then the State may:require the Contractor to take all necessary action(s)to ensure that the future performance conforms to the terms of the Contract and, equitably reduce the payments due to the Contractor under this Contract to reflect the reduced value of the services performed by the Contractor. These remedies in no way limit the other remedies available to the State as set forth in this Contract. 21. If,through any cause attributable to the Contractor's action(s)or inaction(s),the Contractor: fails to fulfill,in a timely and proper manner,its duties and obligations under this Contract;or,violates any of the agreements,covenants,provisions,stipulations,or terms of this Contract,then the State shall thereupon have the right to terminate this Contract for cause by giving written notice thereof to the Contractor. Such written notice shall be given at least ten(10)calendar days before the proposed termination date and shall afford the Contractor the opportunity to cure the default or state why termination is otherwise inappropriate. If this Contract is terminated for default,then all finished or unfinished data,documents,drawings,evaluations,hardware,maps,models,negatives, photographs,reports,software,studies,surveys,or any other material,medium or information, however constituted,which has been or is to be produced or prepared by the Contractor under this Contract shall,at the option of the State,become the property of the State. The Contractor shall be entitled to receive just and equitable compensation for any services or supplies delivered to, and accepted by,the State. If applicable,the Contractor shall return any unearned advance payment it received under this Contract to the State. Notwithstanding the above,the Contractor is not relieved of liability to the State for any damages sustained by the State because of the Contractor's breach of this Contract. The State may withhold any payment due to the Contractor under this Contract to mitigate the State's damages until such time as the exact amount of the State's damages from the Contractor's breach of this Contract is determined. If after terminating this Contract for default,it is determined for any reason that the Contractor was not in default,or that the Contractor's action or inaction was excusable,then such termination shall be treated as a termination for convenience,and the rights and obligations of the parties shall be the same as if this Contract had been terminated for convenience as described in paragraph 22 below. Page 10 of•• NURSE HOME VISITOR PROGRAM GRANT APPLICATION TIME LINEAND CHECKLIST TIME LINE October 1, 2000 Grant Application Packets available October 1 - 10, 2000 Question and Answers Period open October 13, 2000 Written answers to questions mailed to all applicants Nov. 1, 2000 (3:00 PM) Grant Application Submission Deadline Nov. 1 - 3, 2000 Application Qualification Screening by CDPHE Nov. 3 - 9, 2000 Evaluation of Qualified Applications by the National Center at the University of Colorado Health Sciences Center Nov. 10, 2000 Recommendations of National Center Forwarded to Board of Health Nov. 15, 2000 Board of Health Deliberation and Action on Recommendations of National Center Nov. 15 - Dec. 31, 2000 Preparation of Contracts Between CDPH&E and Approved ApplicantsContractors January 1 - June 30, 2001 Implementation of Nurse Home Visitor Programs April, 2001 Grant Application Process for second round of grant awards begins CHECKLIST Cover Sheet (with authorized signature) Grant Narrative Budget Narrative Budget Request Form Assurance Form (Category A) (with authorized signature) Questions and Answers Regarding Applications for the Colorado Nurse Home Visitor Program Question 1: Can new clients be enrolled who are less than 12 weeks pregnant? Answer: Yes, clients should be enrolled as early in pregnancy as possible. Question 2: Can the same individual be served and billed for under both Prenatal Plus and the Nurse Home Visitor Program? Answer: No, not at the same time. The client should be enrolled in whichever program is most appropriate for that client. The statute does allow Nurse Home Visitor Program clients to be enrolled up to the end of the baby's first month of life. Therefore, technically, the same individual could be served under Prenatal Plus through the baby's birth,then closed to that program and enrolled in the Nurse Home Visitor Program before the baby is one month old. However,this practice is strongly discouraged as the likelihood of good outcomes for first-time mothers and their babies under the Nurse Home Visitor Program are improved when there is enrollment early in the pregnancy. Question 3: To whom should the Letters of Support be addressed? Answer: Letters of Support may be addressed to the State Board of Health at the Colorado Department of Public Health and Environment. Question 4: Is there a difference between"advisory" and"oversight" in describing the functions of a board for a collaborative effort? Answer: The intent is that the local initiative has the support of a broad-based conununity group. That group may be primarily advisory or may have more of an oversight role. It is up to the applicant to determine what is appropriate and present information to show there will be a group in place to assure a collaborative effort or to provide oversight,whichever is appropriate. Question 5: What data sources do we need to use to identify"socio-demographic and health characteristics"that justify the need? Answer: Socio-demographic data,which includes birth and infant mortality data as well as racial/ethnicity demographic information is available from the Health Statistics Section of the Center for Health and Environment Information& Statistics Section(CHEIS) of the Colorado Department of Public Health and Environment. This data is also available through local public health agencies for those counties served by that agency. Local public health agencies also have County Maternal and Child Health (MCH) Data Sets that were provided from the state to the counties when regional MCH planning meetings were held around the state in February, 2000. These County MCH Data Sets have some relevant health status indicators, as do Prenatal Risk Assessment Monitoring System (PRAMS) reports. Other socio-demographic data might come from Kids Count. Question 6: If the proposed program is to serve multiple counties,does the application need to describe all the linkages with other agencies in all the counties? Answer: Yes, to an extent. The application should present enough information to show that the applicant has linkages to agencies from which and to which referrals will be made in the implementation of the program in each of the counties or communities in which it will be operating,but it does not need to be a lengthy description of the relationship with every agency. In many cases it will be difficult to generalize across multiple counties about the referral linkages that are in place. Typically, each county will have a few key referral linkages and the applicant should include information on those linkages within each county. The applicant should also provide enough information to establish that it has , experience in providing services which make it an appropriate agency to provide the Nurse Home Visitor Program Services. Question 7: Who has the most accurate data on the number of first-time, low-income mothers in a given county? Answer: An analysis of data from the Prenatal Risk Assessment Monitoring System was done by the Health Statistics Section to provide estimates by county or geographical region. Please see the attached document. Corrections to the Application document: Correction 1: On page 10 of the Grant Application, a part of a sentence is missing at the end of the first paragraph. The additional part of the sentence is: ". . . Applicant organization have historically used the services of the linked providers described." Correction 2: On page 11, under the instructions for Management Information System(No. 6), the reader is referred to the requirements described in Attachment"D",which should be Attachment"F"instead. Estimates of First-Time and Low-Income Mothers The attached pages provide estimates of the number of women who were first-time mothers and low-income who delivered in 1999 by county (or regional grouping of counties) of residence. This information was developed using data from the 1997 and 1998 Prenatal Risk Assessment Monitoring System (PRAMS) telephone surveys of women who had live births in those years. From this data estimates of the percent who were first-time mothers and low-income in the geographical areas were made. Then the estimated percentages were multiplied against the total number of live births in the geographical areas in 1999 to get estimates of the numbers of births to first-time, low-income mothers in each geographical area. This information may be of help in estimating the number of potentially eligible women to be served in any given area. Please note that the term"poor" used in the document means the same as "low-income". You should be aware that: The actual number of first-time low-income mothers is somewhere within the range of the numbers provided. In many cases the range is quite wide. A more precise estimate is not possible at this time. The PRAMS data used to estimate the number of mothers who were low-income is based on those who reported incomes under 185% of the Federal Poverty Level and those who did not know what their income was. The eligibility requirements for women to be served under the Colorado Nurse Home Visitor Program is set at having incomes up to 200 %FPL. So the number who would qualify potentially could be somewhat higher than the numbers reported in this document. There were only two years of PRAMS data to use at this time. Therefore there is a fairly wide range to the estimates of the percent and the number of first-time and low-income mothers in each geographical area. The range of the estimated percents and numbers will become smaller as more years of data become available. PRAMS data for counties with smaller populations is grouped together in regions. Nevertheless, estimates of the number of first-time and low-income mothers for an individual county can be derived,starting with the regional data reported here. To do this take the number of births for that county for 1999 and divide by the total number of 1999 births for that region to get that county's percent of the region's total. Then multiply that percent against the estimated numbers for that region and you will have the estimated numbers for that county. Percent of All Births to First-Time Mothers with Incomes Below 185% of the Federal Poverty Level (Poor): Colorado PRAMS, 1997-1998; Colorado Vital Statistics, 1999 1999 Number 1997-98 Percent 1999 Number State of live births first-time and poor first-time and poor Total 62,142 18.7-22.3 11,637-13,878 1999 Number 1997-98 Percent 1999 Number County of live births first-time and poor first-time and poor Adams 5,719 14.0-27.5 801-1,575 Arapahoe 6,779 11.7-24.8 791-1,678 Boulder 3,620 10.2-27.5 370-994 Denver 10,155 18.5-30.0 1,880-3,047 Douglas 3,093 0.9-11.0 26-342 Eagle 717 12.7-29.9 91-215 El Paso 8,196 18.9-27.1 1,546-2,224 Garfield 695 20.4-37.8 142-263 Jefferson 6,597 10.7-22.7 706-1,497 Larimer 3,131 8.7-20.4 272-637 Pueblo 1,934 13.3-29.6 256-573 Weld 2,868 11.7-24.9 336-715 Region 1999 Number 1997-98 Percent 1999 Number (PMR) of live births first-time and poor first-time and poor 1 1,054 16.6-30.1 175-317 2 5,999 11.9-20.6 713-1,238 3 36,105 16.5-22.0 5,949-7,944 4 8,574 19.0-27.0 1,632-2,314 5 385 not available 6 727 not available 7 1,934 13.3-29.6 256-573 8 667 25.5-43.1 170-288 9 855 11.2-24.4 96-208 10 964 19.7-33.0 - 190-318 11 2,354 21.8-35.6 514-839 12 1,518 15.3-26.5 232-403 13 759 15.3-31.0 116-235 14 246 not available •Planning and Management Regions(PMR) 1:Logan,Morgan,Phillips,Sedgwick,Washington,Yuma:2:Larimer,Weld 3:Adams,Arapahoe,Boulder,Clear Creek,Denver,Douglas,Gilpin,Jefferson;4:El Paso,Park,Teller 5:Cheyenne,Elbert,Kit Carson,Lincoln;6:Baca,Bent,Crowley,Kowa,Otero,Prowers;7:Pueblo • 8:Alamosa,Conejos,Costilla,Mineral,Rio Grande,Saguache;9:Archuleta,Dolores.La Plata,Montezuma,San Juan 10:Delta,Gunnison,Hinsdale,Montrose,Ouray,San Miguel; 11:Garfield,Mesa,Moffat,Rio Blanco 12:Eagle,Grand,Jackson,Pitkin,Routt,Summit;13:Chaffee,Custer,Fremont,Lake;14:Huerfano,Las Animas 5 Sub-State 1999 Number 1997.98 Percent 1999 Number Regions of live births first-time and poor first-time and poor 1 52,092 17.5-21.7 9,123-11,308 2 5,691 21.2-28.5 1,209-1,622 3 2,166 18.2-27.3 394-591 4 667 25.5-43.1 170-288 5 1,525 20.2-31.4 308-480 "Five Region Sub-State Areas 1 (Front Range):Adams,Arapahoe, Boulder,Denver, Douglas,El Paso,Jefferson,Larimer,Pueblo,Weld 2(Western Slope):Archuleta,Delta, Dolores,Eagle,Garfield,Grand,Gunnison, Hinsdale,Jackson, La Plata, Mesa,Moffat, Montezuma, Montrose,Ouray, Pitkin, Rio Blanco, Routt,San Juan.San Miguel,Summit 3(Eastern Plains):Baca,Bent,Cheyenne,Crowley,Elbert, Kiowa,Kit Carson,Lincoln,Logan, Morgan,Otero.Phillips, Prowers,Sedgwick,Washington,Yuma 4(San Luis Valley):Alamosa,Conejos,Costilla,Mineral,Rio Grande,Saguache 5(Eastern Mountains):Chaffee,Clear Creek,Custer,Fremont,Gilpin,Nuerfano,Lake, Las Animas,Park,Teller For more information about Colorado PRAMS or Colorado Vital Statistics, call the Colorado Department of Public Health and Environment Health Statistics Section at(303)692-2160. ATTACHMENT C FAMILY HEALTH SERV C GRANT APPLICATION COVER SHEET FOR: COLORADO NURSE HOME VISITOR PROGRAMS NOV 01 2000 1. Name of applicant entity: Weld County Department of Public Health and Environment Address: 1555 N. 17th Avenue,Greeley,Colorado 80631 Name of person completing application: Mark E. Wallace, MD, MPH Position/Title: Director Telephone: (970)304-6410 FAX: (970) 304-6412 E-mail: mwallace@co.weld.co.us 2. Name of authorized signer: Barbara J. ICirkmeyer Position/Title: Chair,Board of Commissioners, Weld County Telephone: (970) 336-7204,ext. 4200 FAX: (970)352-0242 E-mail: bkir ever@,co.weld.co.us . ,�.t4� Signature: i. L4 t1LJCit. . (11/01/2000) 0 3. Grant proposal is for: XX Nurse Home"Visitor"Program (Category A) Other Nurse Home"Visitation"Program (Category B) 4. Grant amount for Jan. 1,2001 through June 30, 2001: $175,831 /aJo -.17.22 ASSURANCE OF INTENTION TO MEET THE PROGRAM REQUIREMENTS FOR NURSE HOME VISITOR PROGRAM (CATEGORY A) APPLICANTS Please assure that the applicant entity intends to meet the Program Requirements for: Training Requirements Visit Protocols Program Management Information systems Reporting and Evaluating System as described in Section 1.6 of the Rules Concerning the Nurse Home Visitor Prograth(Attachment A) by signing this assurance page. Name of Authorized Signer.Mark E. Wallace, MD, MPH _f, Signature of Authorized Signer: V�/`Ak \- Date: rcf 3, 1n Table of Contents Executive Summary Page 1 Needs of Population Served Page 2 Capability of Applicant Page 3 Organizational Chart Page 5 Evidence of Broad-Based Community Support Page 8 Key Agencies .Page 11 Referral Sources Page 28 Referral Linkages Page 31 Coordination with Existing Visitation Programs Page 32 Plan for Recruitment and Retention of Nurses Page 32 Management Information System Capabilities Page 35 Collaborative Implementation Plan Page 36 Request for Waivers Page 37 Geographical Placement of Applicant Page 37 Budget and Budget Justification Page 37 Community Support of Program page 39 Appendix A: Budget Page 40 Appendix B: Letters of Suppor Page 41 Reference Data Sources Page 42 ii 1 Executive Summary The Weld County Department of Public Health & Environment, in collaboration with other county departments and community agencies, is submitting a proposal to implement a county-wide Nurse Home Visitor Program 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 Colorado Department of Public Health and Environment. The department is seeking funding of$175,831 from January 1, 2001 through June 30, 2001 to support the educational, health and other resources to be provided to new young mothers during pregnancy and the first years of their infants' lives under program guidelines. The department is uniquely qualified in the county to serve as the lead agency to implement and successfully carry out this home visitor program directed at improving outcomes for new mothers and their infants. With over sixty years of experience providing nursing and home visitation services to residents of Weld County, the department has considerable experience in establishing its credibility and likelihood for success in administering the proposed program. The department will integrate program staff consisting of 0.5 FTE of Master's prepared nursing supervisor, 4.0 FTE of Baccalaureate prepared registered nurse visitors, and 0.5 FTE of data entry/support personnel into the Division of Public Health Education and Nursing. The new program staff will join a stable division workforce composed of Baccalaureate prepared public health nurses already experienced in home visitation and other maternal and child health services. The department proposes to collaborate with the Department of Social Services, the Department of Human Services, United Way of Weld County, Sunrise Community Health Center, Salud Family Health Centers, Monfort Children's Clinic,North Colorado Medical Center, North Colorado Family Medicine, First Steps of Weld County, Bright Beginnings, Weld County School District 6 and The Greeley Dream Team, Inc., in implementing this program. Three of the four visiting nurses will be outstationed at Sunrise Community Health Center, Monfort Children's Clinic, and at a county facility in southern Weld County. One visiting nurse, and all other program staff, will operate out the department's main office in Greeley. A Community Advisory Board consisting of eight to ten community representatives will provide advisory oversight to the program and the department's executive director. Accountability will rest with the Department of Public Health& Environment. An existing community agency staffing model will be expanded to incorporate this new program to ensure that services are not duplicated and that clients are referred into the most appropriate program to meet their unique needs. Community in-kind support for the program will include donated office space and supplies, telephone access, staff time to make and receive referrals and coordinate interagency meetings, meeting space, and staff time to participate on the Community Advisory Board. Weld County Department of Public Health and Environment will donate indirect costs of$22,682 during fiscal year one. 1 Needs of Population Served Weld County is a primarily agricultural county covering 4,002 square miles in north central Colorado. There are 31 incorporated towns in Weld County. Greeley is the county seat and principal city in the county with an estimated 1999 population of 84,245' in the greater Greeley area". In 1998, a total county population of 162,253"' was estimated with 36,930' living in unincorporated areas. The ethnic distribution in Weld County is 73.3% White, 24.8% Hispanic, and 1.9%African-American and other groups". The median age in Weld County in 1999 was 33.1 years with 68.3% of the population being less than 45 years of age'. The median household income estimated in 1999 for Weld County was $35,240 and for Greeley was $31,721". These estimates compare to a median family income for Colorado of$35,930"i. Weld County is ranked 5th in the nation and 1st in the state in the value of agricultural products sold and 6% of the workforce is employed in agriculture. Family economic data from the 1990 census indicates that the median income of female- headed households in Weld County was only $13,609"compared to $17,505" statewide. The poverty rate for all ages in Colorado is 10.4% compared to 13.3% in Weld County" Of children under age 18 in Weld County 18.9% are living in poverty. Two-thirds of Hispanic and African-American youths in Colorado come from low-income households. Weld County Medicaid data for fiscal year 1999/00 demonstrates a monthly average of 11,530 eligible clients"" Weld County had a fertility rate of 16.5 per 1,000 among females 10-17 (1994-1998 annual average) while Colorado's rate was 12.2 per 1,000. The fertility rate in 1998 for youth ages 10-14 was 1.4 per 1,000 in Weld County compared to 0.8 per 1,000 in Colorado. Live births in Weld County totaled 2,868 in 1999" '. Of Weld County women giving birth in 1999 only 66.2%received prenatal care beginning in the first trimester"". In comparison, 81.7% of Colorado women giving birth in 1999 initiated prenatal care during the first trimester". In addition to a relatively low rate of initiation of prenatal care in the first trimester, 12.5% of births in Weld County had at least three pregnancy risk factors identified"'. In 1999,42.3%of Colorado births were to women having their first child"'". At North Colorado Medical Center, Weld County's only acute inpatient medical facility providing obstetrical services, 766 births (37.8%) were to first time mothers out of a total of 2,028 births in 1999`""'. Data from one of the county's main providers of prenatal and delivery services (accounting for 31.5%of all births in Weld County)to women indicates that 374 patients out of 903 served in 1999 (41.4%) were covered by Medicaid or Colorado Access'" Another 306 women (33.9%) were uninsured". Applying the North Colorado Medical Center rate for births to primigravidas (37.8%)to this clinic's financial data(0.378 x 680 low-income mothers) yields a conservative minimum estimate (representing the experience of only one clinic)of 257 births to first time, low-income mothers in 1999 in Weld County. Of these 257 first time, low-income pregnancies it would be estimated that 106(0.414 x 257 first-time mothers) might be eligible for Medicaid coverage under existing regulations. 2 Teenage pregnancy is a significant problem in Weld County. It carries substantial social and economic costs (both direct and indirect) to government, business, non-profit agencies and the community. The direct costs given to mother and child by doctors, clinics,North Colorado Medical Center and the community agencies for a one year period in 1996 totaled $3.6 million'''. The indirect costs (those that divert jobs, taxes, wages and salaries, and personal income) over the same period were $16.6 million and 137 jobs""". In 1997, births to teens in Weld County represented 16%of all births (compared to 11.8% statewide)"""'. The Weld County teen birth rate in 1997 was 58.2 per 1,000 compared to 47.4 per 1,000 statewide""'". In January 2000, a county caseload of 496 families was reported for youth involved in the justice system, out of school, or involved in dependency and neglect cases""". The HRSA "Relative Health Importance" table for Weld County suggests that low birth weight (<2,500 grams), no care in the first trimester and white infant mortality deserve additional attention and action if these statistics are to be improved in comparison to a peer group of counties and to the U.S. rate' The need for intensive prenatal and early childhood home visitation interventions in Weld County is great and has been well detailed in the preceding pages. The challenge to our community is also effectively presented in the both the Colorado KidsCount 1999 and 2000 Reports and the Community Health Status Report published by the Health Resources and Services Administration of the U.S. Department of Health and Human Services. The community and its array of agencies, focused on the needs of low-income mothers-to-be and their young families, will easily be able to identify 100 women to voluntarily enroll in the nurse home visitor program proposed in this grant application. Capability of Applicant Organizational Structure and Commitment The commitment to implement and successfully carry forth the intent of the Nurse Home Visitor Program is vested within the collaboration of community agencies already serving the target population in Weld County. The lead agency for this initiative is the Weld County Department of Public Health& Environment under the directorship of Mark E. Wallace, MD, MPH. The organizational commitment to support this community project extends from the Board of Commissioners of Weld County through the staff of the Division of Public Health Education and Nursing and into the many agencies serving residents of Weld County. Coalitions have been hard at work in Weld County serving women and their families long before funding became available to expand home visitor programs in our state. The Department of Public Health& Environment has not only been an active participant with other agencies but has also frequently taken the lead in many efforts to improve the health and welfare of Weld County families. The Board of Commissioners appointed Dr. Wallace to his department director position in March 2000. However,he has been actively working with the department since 1992 3 when he moved to the community from southern California. Dr. Wallace is a board- certified family physician with a Master's in Public Health from UCLA. He serves in many capacities within the greater Greeley community. He provides leadership in graduate and continuing education for Banner Health Colorado, which operates North Colorado Medical Center in Greeley. Dr. Wallace is also an elected official serving as President of the Weld County School District 6 Board of Education. He is a volunteer on the Greeley Dream Team, Inc., Board of Directors, a not-for-profit organization committed to helping at risk youth succeed in school. He organized the Primary Care Access Group to study and recommend changes to meet the needs of low-income people accessing primary health care in the county. He is fully committed to the successful implementation of the Nurse Home Visitor Program under the sponsorship of the Weld County Department of Public Health& Environment. The program as proposed would reside within the Division of Public Health Education& Nursing that is under the direction of Linda Henry, RN, BSN, MA. She leads a division consisting of 17 nurses, three nurse practitioners, one social worker, one dietitian, 6 health educators and 17 support staff. Four supervisors and an office manager assist her in running the daily operations of the division. The Nurse Home Visitor Program staff would be integrated into the division. It is out of this section that home visitation already exists through Prenatal Plus, EPSDT and other program activities. The division would be reorganized to add a fifth section of Community and Family Programs. The Nurse Home Visitor Program would be placed in this new section under the 0.5 FTE supervision of a Master's prepared nurse supervisor to be hired under the grant. The department reorganization would bring another 0.5 FTE support to this new supervisor position to allow a 1.0 FTE to be hired. To best coordinate home visitation programming, Prenatal Plus, EPSDT and Presumptive Eligibility activities would be moved into this new section of Community and Family Programs. The division also has well-developed relationships with prenatal programs and providers of child and family care services in the county. Integrating this new program into the division will facilitate coordination of care and prevent duplication of service while directing clients to the most appropriate program to meet their needs. An organizational chart details the positioning of the program within the agency. 4 • ORGANIZATIONAL CHART Weld County Department of Public Health& Environment Board of County Commissioners Proposed NHVP Advisory Board of Community Advisory Health Board Department of Public Health& Environment Consulting Consulting Mark E. Wallace,MD, MPH Pharmacist Pathologist Executive Director Medical Director Public Health Education& Environmental Health Administrative Nursing Services Services Linda Henry, RN, BSN,MA Trevor Jiricek, MSEH Judy Nero, BS Director Director Business Manager Communicable - Diseases Team Jill Burch,RN,BSN Communicable Community HIV International Supervisor Disease&TB Outreach Testing Travel Children's Health Team Cheryl Weinmeister, RN,BSN Health Care Program for Attachment& Child Health & Supervisor Children with Special Needs Bonding Immunization Women's Health Team Kris Embree,RN,BSN Nurse Practitioner Family STD and Cancer Supervisor Program Planning Screening Outreach Community& - Family Programs - Master's-prepared Nurse Home Prenatal Presumptive Supervisor to be hired Visitor Program Plus Eligibility&EPSDT Health Promotion Gaye Akin,RD,MPH Supervisor 5 The Weld County Department of Health was started in July 1938 under the direction of Dr. R. J. Shale. The Greeley Community Nurse and two county nurses became part of the new department. A health unit and maternity program were planned for the southern part of the county as early as 1939. The department has provided maternal and child health services since its inception. Up to this day the department continues to provide well-child examinations, immunization services, lead screening and health care program for children with special needs. Over 13,000 vaccinations were administered through the department and its community outreach activities in 1999. Maternity services were provided directly through the Public Health Education and Nursing division until 1998 when these services were incorporated under a contract into the obstetrical program operated by North Colorado Family Medicine, a family practice residency program sponsored by North Colorado Medical Center. North Colorado Family Medicine was started in 1974 in Greeley and since its beginning has provided consultation and delivery services to county maternity patients and their infants. The incorporation of the clinical portions of the county's maternity services into those of North Colorado Family Medicine has increased the physician oversight of the care delivered to these high-risk patients by the women's health practitioner. This collaboration has proved hugely successful from a clinical perspective but continues to be threatened by diminishing reimbursement for women not eligible for Medicaid coverage of the costs of prenatal care. This public-private cooperative effort afforded services to over 250 low-income women seeking prenatal care in the county last year. Home visitation essentially began with the start of the organized department of health and the recruitment of the first nurses to the agency. The Weld County Department of,Public Health& Environment has supported home visitation programs in a variety of formats since its inception. Until early in the 1980s acute home health care was part of the health department home visitation program. At that time the Rural Nursing Visitation Association(RVNA) was formed as a separate home health agency. The Early Periodic Screening, Diagnosis and Treatment (EPSDT) Medicaid program left the health department and was operated through RVNA. In 1999 EPSDT moved back into the health department and now operates through the Public Health Education and Nursing division. Prenatal Plus (which had its roots in the Helping Moms programs) was started in the department in 1994 and provides nursing and social work home visitation services. For most of its history of providing home visitation services, the department assigned nurses to designated sections of the county. These nurses provided any type of home visit upon referral from health and social service agencies in the county. The family issues addressed in these home visits varied and included children with special needs, family abuse or neglect situations, high-risk prenatal and postpartum moms and babies, and health promotion in the elderly(e.g., blood pressure assessments.) With the increasing pressure from managed care's influence on acute health care the county began to experience shorter stays following hospitalization and especially after delivery. Early postpartum hospital discharge lead the agency to focus its home visits on postpartum and infant exams within twenty-four to forty-eight hours of discharge. Mothers experiencing difficult deliveries or postpartum complications, at-risk infants(especially the jaundiced 6 and/or breastfeeding baby) and socioeconomically at-risk families needed the expertise of Baccalaureate trained public health nurses. The department's home visitor services provided a continued link between the various clinics and agencies serving low-income women and children in the county. During the last decade, as Weld County's population living in poverty increased, services were strained by financial limitations on programs. In addition, managed care contracts in the Medicaid population directed home visits to agencies other than the health department. Centralized clinics at the health department were increased as a cost- efficient way to provide service to more clients. However, even with decreased funding the department has risen to the challenge of providing home visits to selected high risk families who qualify under various programs upon referral from community agencies. Physical assessment, teaching and linking families with needed services continue to be addressed by baccalaureate prepared public health nurses making home visits. For the last six years, funding of Prenatal Plus services (and its "Helping Moms"predecessor) has allowed our department to expand and compliment the medical component of prenatal care with home visitation. Lead by a full time registered nurse, the Prenatal Plus interdisciplinary team consists of a social worker, a nutritionist, and a part-time nurse and office technician. Qualified pregnant women receive a comprehensive risk assessment, care coordination, home visits, nutrition consultation, and psychosocial counseling from the competent and well- trained team. Prenatal Plus served approximately 120 clients last year. Home visits are started during pregnancy and continue sixty days after delivery. These visits provide clients with specific activities that encourages involvement and interaction with the mother's own individual plan of care. Health education on pregnancy, labor and delivery, nutrition, community resources, and high-risk behaviors such as substance abuse are addressed with the client. The Prenatal Plus interdisciplinary team serves as a respected client advocate in the community. Established resource and referral networks work in unison to provide the necessary services to meet individual needs. The department's social worker has been providing a psychosocial perspective and consultation for the past seven years. Social work duties include counseling, family advocacy, and community referrals. The expertise in working with families and community agencies provides a balance to the two teams on which she works—Prenatal Plus and the Health Care Program for Children with Special Needs. Caseloads from both programs range from 100 to 130 families per year and 12-18 clients a week are visited in their homes. In 1995 the department was awarded a grant from Family Preservation funds to develop a home visitor program that addressed attachment and bonding issues in high-risk families. Initially 5-6 families participated in the home visitor program. The program currently has the capacity to serve 12-14 families. Referrals are received from the Department of Social Services, the court system, or family therapists. Families receive 6-12 months of intervention with emphasis on building positive parent and child relationships. A specially trained bonding nurse addresses nurturing skills, parent-child relationships, and 7 the status of bonding and attachment during the home visit. Home visits are provided to families who have children in foster care, who are adopting, or who are at risk for abusive behaviors. Weekly or bi-weekly home visits are made to families at risk. The nurse works closely with adoptive parents in understanding and responding to the unique bonding needs of adoptive children. The bonding nurse coordinates collaborative efforts between community agencies to achieve the best possible plan of care for each child. The goal of the program continues to be to assure that children at high risk for abuse or neglect due to poor parenting skills will ultimately experience a safe and nurturing environment. This successful home visitation program continues to receive positive recognition in the community as an intervention for at risk families. The Department of Public Health& Environment is well positioned to serve as the lead agency for implementing the Nurse Home Visitation Program proposed in this application. The major strengths of the department are as follows: (1) its long history in providing maternal-child health and home visitor services to the community; (2) a well- trained and stable workforce of Baccalaureate prepared public health nurses into which the new home visitation nurses would be integrated; (3) supervisory staff experienced at running complex programs under federal and state guidelines; (4) an executive director clinically competent in caring for women and children(including high risk obstetrics) and trained in public health who actively participates in a variety of community activities affecting families; and, (5) a well-developed organizational infrastructure supported by a recommended 2001 departmental budget of$4.4 million and long-established relationships with a network of community service agencies. The Greeley community as well as the most populated surrounding areas of Weld County is served by many public and private agencies that have increasingly come together in collaborative relationships to better serve the public. Few other regions with a population comparable to Weld County can claim a children's clinic,two community health centers, a family practice residency training program, and a public health department all focused on meeting the acute and preventive health care needs of the under-served. Additional community assets include critical service agencies operating under funding from United Way of Weld County (e.g., Bright Beginnings)and the North Colorado Medical Center Foundation(e.g., First Steps). Rounding out the community groups cooperating in this program proposal are North Colorado Medical Center, Weld County School District 6, Weld County Department of Social Services, and Weld County Department of Human Services. Staffs from these various agencies have participated together in multiple coalitions such as the Shots for Tots/Weld Immunization Coalition and the Teen Pregnancy Task Force. It is the breadth of agencies working together in Weld County to improve the health and welfare of women and children that is the community's greatest strength. Evidence of Broad-based Community Support While the Department of Public Health& Environment is taking the lead in preparing this application,the proposal has emerged due to recognition by the community that few areas in Colorado have greater need than that in Weld County. Statistics reported by the 8 • Colorado Children's Campaign and the Health Resources and Services Administration present the challenge to our collaboration of agencies. We must work together in new ways to affect change in the indicators of the health and well being of women and children in our county. The number of agencies supporting this new program demonstrates the breadth of commitment to affect change. The table below presents the key agencies and people involved in supporting this application for the Nurse Home Visitor Program. AGENCY KEY PEOPLE IN MISSION OF AGENCY ORGANIZATION Weld County Department of ➢ Mark E. Wallace,M.D., To preserve,protect,and promote Public Health&Environment M.P.H.,Executive Director a healthy life and safe ➢ Division of Public Health ➢ Linda Henry, R.N.,M.A., environment for the residents of Education and Nursing Director,Division of Weld County. Community Health Education and Nursing Weld County Department of ➢ Judy Griego,Executive Social Services Director ➢ Social Services Division ➢ Richard Rowe ➢ Assistance Payments ➢ Frank Aaron Division ➢ General Programs ➢ Child Support Weld County Department of ➢ Walter J. Speckman, Human Services Executive Director ➢ Employment Services of ➢ Leticia Galindo,Family Weld County Community and Parent ➢ Family Educational Network Partnerships Specialist of Weld County ➢ Julie Streeter, Disabilities/Mental Health Specialist ➢ Tere Keller-Amaya,Director of Family Educational Network of Weld County ➢ Beverly Sanchez,Director of Operations United Way of Weld County ➢ Judy Kron, Director of To increase the organized D. Coordinator of Weld County Community Problem Solving capacity of the community to Early Intervention and Programs respond to human care needs and Collaboration to help solve community health ➢ Sponsor of Community and human care problems. Agency Staffings Weld County Early Intervention Collaboration ➢ First Steps of Weld County ➢ Noelle Hause, Ed.D.,L.P.C., To provide a broad-based Executive Director prenatal,postpartum and ➢ Ellen Laurence,R.N. parenting service that is consumer focused and consists of referral, education,advocacy and support. ➢ Bright Beginnings ➢ Sheila Avers To make a Warm Welcome Visit in the homes of newborns in Weld County. ➢ c.a.r.e. 9 AGENCY KEY PEOPLE IN MISSION OF AGENCY ORGANIZATION ➢ Family Connects ➢ North Range Behavioral Health Monfort Children's Clinic ➢ Bob Francella,Executive Director ➢ Gary Schrenk,President, North Colorado Medical Center Foundation ➢ Masroor Kakakhel, M.D., Medical Director Sunrise Community Health ➢ Mike Bloom,Executive To provide access to quality, Center Director comprehensive family health care ➢ Beth Griffin,PA-C,Medical services for the residents of Director Greeley and surrounding areas and to address the special needs of our community's medically underserved and migrant populations. North Colorado Medical Center— ➢ Jon Sewell,Administrator To serve the health needs of Banner Health System ➢ Joanne Fenton,R.N., communities both large and small ➢ Monfort Family Birth Center Assistant Administrator for across the nation in the nonprofit ➢ Emergency Department Patient Care Services tradition by excelling in clinical ➢ Pediatrics ➢ Jeff Abbett, R.N.,Director of care,quality service,financial ➢ Care Coordination Care Coordination stewardship and the creation of ➢ Pat Aimino, RN,Director of work environments where people Maternal&Newborn can realize their full potential. Services Salud Family Health Centers ➢ Stanley J.Brasher,Executive To provide quality, ➢ New Horizons Teen Program Director comprehensive primary health ➢ Mary Ann Martinez Gofigan, services to all the residents of a Director of Client Services defined catchment area,covering parts of Weld,Boulder and Adams Counties,Colorado. North Colorado Family Medicine ➢ Daniel Fahrenholtz,M.D., To educate family physicians to ➢ Weld County Prenatal Clinic Program Director practice successfully in rural at Cottonwood Pointe ➢ Eileen Croissant,Clinic communities. Manager The Greeley Dream Team, Inc. ➢ Charlotte Jimenez,Executive To partner with the community to Director help children succeed in school. ➢ Marisol Gutierrez,Office Assistant ➢ Melanie George-Hernandez, ETS Assistant Director& McKinney Coordinator Weld County School District 6 ➢ Anthony Pariso, To educate all students in a Superintendent nurturing,challenging,and ➢ Mark E.Wallace, President, disciplined environment so their Board of Education performance is a credit to ➢ Ann Heiman, Secretary, themselves and society. Board of Education 10 Key Agencies Weld County Department of Public Health & Environment The applicant lead agency is well described in material preceding this section. The department was formally organized in 1938 and has operated continuously since that time. Three divisions constitute the department: Public Health Education and Nursing; Environmental Health Services; and Administrative Services. The department is lead by Mark E. Wallace, MD, MPH. The Weld County Department of Public Health and Environment has established written agreements in place with the following organizations: ➢ North Colorado Family Medicine (provides prenatal care services for low-income women and primary health care) > North Colorado Medical Center for Med-Aid Contract (provides one-time assistance for prescription medications for acute medical conditions) ➢ University of Northern Colorado (provides educational experiences for nursing, community health, and dietetic students) > United Way of Weld County for the Community Child Health Plan Plus Advocate. (advocate will assist individuals and agencies with the enrollment of eligible children into the Child Health Plan Plus) ➢ Weld County Food Bank (assist families with an emergency food box and/or supplemental food) Informal agreements and referral relationships exist between Weld County Department of Public Health and Environment and the following agencies: ➢ A Woman's Place (shelter for abused women and their children) ➢ Aims Community College (high school graduation program for first-time teenage mothers, child birth classes, boot camp for dads) ➢ Amend(a treatment group for abusive men and their partners) > Board of Cooperative Education Services (BOCES) (provides screening and developmental services for children from birth through school age) > Breast Feeding Task Force (promotion for the initiation and duration of breast feeding) ➢ Bright Beginnings (home visitation program for all new parents in Weld County) > Catholic Charities (emergency funds to assist families with gas, utilities and shelter) ➢ Centennial Developmental Services Inc. (CDSI) (identification and intervention for children and adults with developmental disabilities) > Child Advocacy Resource Education (CARE)(parenting classes and support) ➢ Clothing Resources, Seventh Day Adventist Church, the Light and Life Church, Salvation Army (provide holiday food baskets, gifts, clothing, furniture and carseats) ➢ Colorado Medicaid Presumptive Eligibility (Medicaid coverage during the determination of eligibility) > Colorado Migrant Health Program(health screening and education to the migrant population) ➢ Colorado Rural Legal Services (legal assistance for the indigent) 11 ➢ Connections for Independent Living (provides support and housing for disabled adults) ➢ Department of Human Services, Family Education Network of Weld County/Head Start(education and health services) ➢ Department of Human Services, Employment Services of Weld County Work Force Center(workplace training and instruction,job readiness training, welfare to work program and educational assistance) ➢ Department of Social Services (assist with food stamps, TANF services, child protection and child care services) ➢ First Steps of Weld County (prenatal plus case management for high-risk pregnancies) ➢ Friends of Man(provides funding for the purchase of eyeglasses, medications, wheelchairs,prostheses, etc. for needy children and adults) ➢ Greeley Housing Authority (assistance with application process to provide families the opportunity for low-income housing) ➢ Greeley Police and Weld County Sheriff Department (provide carseat and seatbelt education, intervention for domestic violence and child abuse) ➢ Greeley Transitional House (temporary shelter for families) ➢ Guadalupe Center(homeless shelter) ➢ Island Grove Regional Treatment Center(provides alcohol and drug treatment) ➢ LEAP, Department of Social Services (assists indigent families with their heating bills) ➢ Monfort Children's Clinic (provides health care for indigent children) ➢ North Colorado Medical Center(regional medical center that provides inpatient health care to the community) ➢ North Range Behavioral Health (mental health services provided on a sliding fee scale) ➢ Right To Read(adult literacy program) ➢ Rocky Mountain Planned Parenthood(provides full range of family planning services) ➢ RVNA(home health care agency) ➢ Salud Community Health Center Ft. Lupton(Federally funded community health center in south Weld County that provides primary health care to the indigent) D. School District Six(Trademark alternative high school and Dream Team) ➢ Suicide Education Support Services(community suicide education and support) ➢ Sunrise Community Health Center(Federally funded community health center providing primary health care to the indigent in the Greeley and outlying region) ➢ Weld County Transportation(provides transportation from outlying regions in the county to Greeley or Ft. Lupton for county services) D. Women, Infant and Children (WIC) (nutrition and education for women, infants and children) Monfort Children's Clinic The Monfort Children's Clinic provides complete medical care for children,teens and young adults through age 21. Clinic staff conduct well child exams, school physicals and 12 sports physicals. Clinic staff also treats children with life-long medical problems. The Clinic's bilingual and bicultural staff cares about each child and will do whatever they can to help children get the care they need. Children may qualify for services at Monfort Children's Clinic if family income is under $2,600 per month (or$31,500 per year) for a family of four. The Clinic accepts monolingual Spanish families regardless of income. Clinic staff assists families in enrolling in programs like Medicaid, the Child Health Plan Plus, and the Colorado Indigent Care Program. Monfort Children's Clinic has established written agreements in place with the following organizations: > A Kids' Place (for whom Monfort Children's Clinic conducts sexual abuse examinations) > Colorado State University (social work interns) > North Colorado Family Medicine (places family practice residents at the Clinic in exchange for admitting and following Clinic patients admitted to North Colorado Medical Center) > North Colorado Medical Center Pediatric Rehabilitation (conducts OT, PT, speech and language therapy and other therapies for Clinic patients) > North Range Behavioral Health(places a mental health counselor in the Clinic facility to work with Clinic patients) > Sunrise Community Health Center(offers dental services to 300 children per month on site in the Clinic) > The University of Northern Colorado (owns a hearing sound booth in the Clinic and provides audiology specialists to conduct hearing tests on Clinic patients) > United Way of Weld County (coordinating a partnership of CHP+providers in the community with the intention of increasing enrollment.) Informal agreements and referral relationships exist between Monfort Children's Clinic and the following agencies: > Aims Community College(family and life education, nursing students) > Alternative Homes for Youth(individual, group, family therapy, health assessments and treatment) > American Cancer Society (educational materials and program support) > American Lung Association Asthma Camp (educational and recreational camp for children with asthma) > Autism Support Group(support and education for families with autistic children) > Boy Scouts of America, Longs Peak Council (physicals) > Boys and Girls Club (referrals and camp physicals) > Centennial Development Services, Inc. (identification of developmental problems) > Child Advocacy Resource Education (child abuse identification, parent training and support) > Colorado Migrant Health Program (outreach program and referrals) > Crisis Pregnancy Center of Northern Colorado (testing, counseling, resources and referrals) 13 > The Greeley Dream Team, Inc. (adolescent education and support) ➢ EPSDT(Medicaid referral and enrollment) > Family Connects (identification of developmental delays and other problems of development) > Family Education Network of Weld County—Head Start(education and health services) > First Steps of Weld County (prenatal case management referrals) > Greeley Transitional House (shelter, self-sufficiency case management) ➢ Greeley Youth Net/Youth Initiative (information and referral) > Island Grove Regional Treatment Center(education, evaluations and treatments) ➢ Val Kailassam, MD (volunteer allergist) > Kiwanis Club of Greeley (immunization program support) > Local Law Enforcement agencies (referrals for sexual abuse examinations and car seats) > Med-Aid(provides prescription drugs to medically indigent) > Medicab (medical appointment transportation for disabled) ➢ NCMC Lifetime Wellness (health education and wellness services) > North Colorado Medical Center(lab services, supplies, computer and other support services, referrals and admissions) > Reach Out and Read(program support) > Real Aloud Greeley (reading awareness and support) > Regis University (nursing students) > Sunrise Community Health Center(program support and referrals) > The Children's Hospital (cardiology, neurology, pediatric rehabilitation and genetics clinics) > University of Colorado Health Sciences Center(medical and dental students) > University of Denver(social work interns) > University of Northern Colorado (nursing students, nurse practitioner students, community health education students) ➢ Weld County Department of Public Health(immunization and other specialty clinics and services, referrals for teen pregnancy > Weld County Department of Social Services (Medicaid, Medicare, child protection, managed care support referrals and program collaboration) > Weld County School District 6 (health education) > Weld Opportunity School (adolescent education and support) > WIC (food and nutrition for women, infants and children) Sunrise Community Health Center Sunrise Community Health Center is a federally qualified health center and provides comprehensive primary medical and dental care to predominantly low-income families without a regard for their ability to pay for services. Staff includes board-certified family physicians, physician assistants, nurse practitioners, dentists and a diabetic educator. Sunrise Community Health Center has established written agreements in place with the following organizations: 14 > A Woman's Place: for whom Sunrise Community Health Center conducts sexual abuse examinations > Colorado State University: Social Work and Nutrition Interns > North Colorado Family Medicine: Alternate training track for three family practice residents > North Colorado Medical Center: laboratory, radiology, inpatient and CICP reciprocity > North Range Behavioral Health: Places a Mental Health Counselor in the clinic facility to work with clinic patients > Monfort Children's Clinic: Sunrise manages on-site pediatric dental services > The University of Northern Colorado: On-site hypertension identification and control program > United Way of Weld County: Coordinating a partnership of CHP+providers in the community with the intention of increasing enrollment. > Weld Food Bank: On-site food distribution to Sunrise patients. > Weld County Head Start: Medical and Dental services for Head Start and Migrant Head Start students > Weld County Med-Aid Program: prescription medications for uninsured persons. ➢ EPSDT: Medicaid referral and enrollment Informal agreements and referral relationships exist between Sunrise Community Health Center and the following agencies: > Aims Community College: family and life education, nursing students > American Cancer Society: smoking cessation educational materials and training > Autism Support Group: support and education for families with autistic children > Centennial Development Services, Inc.: Identification of developmental problems > Child Advocacy Resource Education: child abuse identification, parent training and support > Crisis Pregnancy Center of Northern Colorado: testing, counseling, resources and referrals > Family Connects: identification of developmental delays and other problems of development > First Steps of Weld County: prenatal case management referrals > Greeley Transitional House: shelter, self-sufficiency case management > Island Grove Regional Treatment Center: education, evaluations and treatments > Local Law Enforcement agencies: referrals for sexual abuse examinations and car seats ➢ Medicab: medical appointment transportation for disabled ➢ NCMC Lifetime Wellness: health education and wellness services > University of Colorado Health Sciences Center: medical, dental, nurse practitioner and physician assistant students > University of Northern Colorado: nursing students, nurse practitioner students, community health education students > Weld County Department of Public Health: referrals to and from immunization clinics, well-child clinics, family planning clinics, and prenatal clinics 15 > Weld County Department of Social Services: Medicaid, Medicare, child protection, managed care support referrals and program collaboration > King Sooper's Pharmacy: management of pharmacy services and manufacturer's Free Medications Program. North Colorado Family Medicine North Colorado Family Medicine is a family practice residency training program sponsored by North Colorado Medical Center. It has operated in the community since 1974 and offers full-spectrum primary care. Staff includes an interprofessional faculty of board-certified family physicians, family nurse practitioners, licensed professional counselors, a women's health practitioner and a doctor of pharmacy. Family practice residents and family nurse practitioner students also provide medical care to patients under the supervision of faculty. In 1999,the clinic had 53,000 visits for medical care. North Colorado Family Medicine has formal agreements in place with the following organizations: ➢ Monfort Children's Clinic: clinical teaching by staff pediatrician in exchange for accepting hospital admissions from the Clinic. > Sunrise Community Health Center: teaching site for three family practice residents and 0.5 FTE of funded faculty support to coordinate the teaching site. > Weld County Department of Public Health and Environment: medical consultation and colposcopy services. ➢ North Colorado Medical Center: clinical laboratory and diagnostic radiology services. > Insurance companies: health care contracts. ➢ University of Northern Colorado School of Nursing: nurse practitioner students and paid nurse practitioner faculty support. > University of Wyoming School of Pharmacy: doctoral students Informal agreements and referral relationships exist between North Colorado Family Medicine and the following agencies: > Centennial Development Services, Inc.: Identification of developmental problems ➢ Child Advocacy Resource Education: child abuse identification, parent training and support > Greeley Transitional House: shelter, self-sufficiency case management ➢ Island Grove Regional Treatment Center: education, evaluations and treatments ➢ MediCab: medical appointment transportation for disabled ➢ North Colorado Medical Center's Lifetime Wellness Program: health education and wellness services > University of Colorado Health Sciences Center: medical students > Weld County Department of Public Health: referrals to and from inununization clinics, well-child clinics, family planning clinics, and prenatal clinics > Weld County Department of Social Services: Medicaid, Medicare, child protection, managed care support referrals and program collaboration ➢ Weld County Med-Aid Program: prescription medications for uninsured persons 16 United Way of Weld County United Way of Weld County is a key community agency not only for its fundraising activities but also for its assistance and leadership in community problem solving and program planning. The agency coordinates many of the community's service organizations targeting the population of interest to the Nurse Home Visitor Program. Under the grant United Way would coordinate the community agency staffing component of the program that is critical to meaningful collaboration between home visitation and case management agencies. United Way will assist in integrating the visiting nurses from this new program into the existing community staffing meetings. Through this mechanism referrals will be coordinated and avoid potential duplication of services while also finding the agency best suited for that individual client's needs and risks. United Way supports many community activities targeting a wide population. Programs receiving financial support from United Way and directed at young women and families are listed below. Agencies that address the unique needs of the elderly population are excluded from this listing. Programs are categorized into major focus areas. These agencies would serve as important referral sources and targets for the Nurse Home Visitor Program. • HELPING CHILDREN AND STRENGTHENING FAMILIES A KID'S PLACE (AKP) Executive Director: Teresa Huizar-Humes > A Kid's Place is an assessment center that offers a safe, child-friendly location when victims of abuse are interviewed. This reduces trauma to children. > CASA trains community volunteers to advocate for the best interests of abused and neglected children in the court system and for timely case resolution BRIGHT BEGINNINGS Coordinator: Sheila Avers > Bright Beginnings Warm Welcome volunteers visit their neighbors who are parents of new infants and provide a gift, developmental information, community resources and ongoing support. > The program is directly coordinated by United Way of Weld County. CHILD ABUSE PROTOCOL PROJECT CONTACT: Judy Kron > A coalition of professionals, facilitated by United Way to develop and update a written document outlining the rules, procedures, standardized reporting process, and communication between parties handling child abuse in Weld County. > The Protocol Project is a training component to assure professionals are familiar with current requirements. 17 CHILD ADVOCACY RESOURCE AND EDUCATION (c.a.r.e.) Acting Director: Gwen Schooley ➢ Child Advocacy Resource and Education offers community education and intervention regarding parenting issues and child abuse prevention to individuals, groups or families. > Programs are presented in a multi-modal form. CHILD CARE SUBSIDY PROJECT/FAMILY SUPPORT NETWORK ➢ The Child Care Subsidy Program assists low-income working families with child care needs for a temporary time period that helps move them toward dependence and productivity and resource referrals for employees in the area of child and elder care. > The program is directly coordinated by United Way of weld County. ➢ The Family Support Network works with the business community to develop family friendly workplaces, through consultation, support and education. The program contracts with employers to provide child care subsidy to employees The program is directly coordinated by United Way of Weld County. CHILD CARE SUBSIDY PROJECT/FAMILY SUPPORT NETWORK > The Child Care Subsidy Program assists low-income working families with child care needs for a temporary time period that helps move them toward dependence and productivity and resource referrals for employees in the area of child and elder care. The program is directly coordinated by United Way of weld County. HIGHLAND DAY CARE CENTER Executive Director: Marilyn Fuqua > Highland Day Care Center provides child care services to families in north Weld County. Programs include infant and toddler care, preschool, full/half day child care and school-age care. PRO BONO MENTAL HEALTH PROGRAM OF WELD COUNTY Program Director: Roger Pranke > The North Range Behavioral Health Pro Bono Project is a program that provides pro-bono mental health counseling for children and families who have no other resources. CHILD CARE RESOURCE AND REFERRAL Program Director: Rudy Pisano ➢ Child Care Resource and Referral Services offers a single entry, comprehensive referral service which provides child care referrals to parents based on type of care, age of child(ren), location, and schedule. 18 • KEEPING YOUTH ON TRACK BOY SCOUTS, LONGS PEAK COUNCIL Scout Executive: Reed Brannon Weld Executive: Mario Gonzales ➢ Through experiential learning, Scouting helps youth develop essential skills and personal characteristics, such as self reliance, leadership, responsibility, self-esteem and initiative, that will last a lifetime. BOYS AND GIRLS CLUBS OF WELD COUNTY Executive Director: Carey Bryan > Boys and Girls Clubs serve primarily disadvantaged youth 6-18 years old after school, on Saturdays, and throughout summer. These youth are served through activities dedicated to educational, social, health, citizenship,vocational and leadership development. EATON BASEBALL PROGRAM Board President: Dale Souther > The Eaton Baseball Program provides a meaningful experience for youth age 6 to 18 through baseball and softball instruction as well as recreational and competitive games. FORT LUPTON RECREATION PROGRAM Recreation Director: Paul Piper > The Fort Lupton Recreation Program provides a healthy, instructional and enjoyable environment for young athletes. Volunteer coaches are an essential part of the program. The program uses youth within the community for officiating and umpiring to provide local youth employment opportunities. GIRL SCOUTS, MOUNTAIN PRAIRIE COUNCIL Executive Director: Kay Stevens ➢ Girl Scouting is a program of contemporary and traditional activities based on leadership, values and diversity open to all girls ages 5 to 17. HIGHLAND RECREATION PROGRAM Office Manager: Tammy Osborne ➢ Highland Recreation Program provides youth, kindergarten through 8th grade, with recreational programs which foster physical, emotional, and social development. KERSEY RECREATION PROGRAM Recreation Director: Dawn Schrader > Kersey Recreation Program provides the community with recreational programs such as dance, arts and crafts, karate, basketball, baseball, soccer, swimming, and various special interest classes. 19 LASALLE RECREATION PROGRAM Recreation Director: Charlotte Bond > LaSalle Recreation Program is a program serving youth ages 4 to 18, in the community and surrounding rural areas. The program includes activities such as baseball, softball, soccer, flag football,volleyball, and basketball. THOMPSON RIVERS RECREATION PROGRAM Recreation Director: Laura Wilson > Thompson Rivers Recreation Program provides recreational programs such as baseball, soccer, basketball, and other activities for youth in Johnstown and Milliken. WELD COUNTY PARTNERS Executive Director: Michael Muskin > Partners provides programs for at-risk youth, including one-to-one mentoring with adult volunteers, Esperando activity program, and Juvenile Restitution Project. WINDSOR RECREATION PROGRAM Recreation Director: Don Shedd ➢ Windsor Recreation Program provides a wide variety of leisure activities for area residents of all ages. These activities include sports teams and instruction and cultural activities. • ASSISTING PEOPLE THROUGH CRISIS A WOMAN'S PLACE Executive Director: Sharon Mitchell > A Woman's Place is a domestic violence program assisting victims and their children with safe shelter, 24-hour crisis line, individual/group counseling, legal/personal advocacy, support services. Services are available in Greeley and Ft. Lupton. AMERICAN RED CROSS, FRONTIER BRANCH Executive Director: Linda Glendenning > American Red Cross helps the community prevent, prepare for, and cope with emergencies on a 24 hour basis. These services are directed by volunteers. GREELEY TRANSITIONAL HOUSE Executive Director: Linda Akers > Greeley Transitional House provides shelter, food, case management to homeless families. > It offers a supportive environment in which families in crisis can live temporarily while reestablishing their independence. 20 GUADALUPE SHELTER-CATHOLIC CHARITIES NORTHERN Executive Director: Ernest Giron ➢ Guadalupe Center provides emergency shelter, meals and case management services for homeless families and individuals. In this safe, caring environment, homeless people are assisted in breaking the cycle of poverty and moving toward self-sufficiency. SUICIDE EDUCATION & SUPPORT SERVICES OF WELD COUNTY Executive Director: Linda Chase ➢ Suicide Education& Support Services provides free educational presentations, training and support services to the communities of Weld County in the areas of suicide prevention, intervention and postvention. WELD COUNTY LEGAL SERVICES Administrator: Anne Williams > The purpose of Weld County Legal Services is to encourage lawyers living and working in Weld County to provide legal services to the poor and to coordinate and otherwise assist in the provision of these services. WELD FOOD BANK Executive Director: Leona Martens ➢ The Weld Food Bank works to alleviate hunger and reduce food waste by providing an efficient, centralized system for collecting, storing, and distributing food.. CATHOLIC CHARITIES NORTHERN - EMERGENCY ASSISTANCE PROGRAM Executive Director: Ernest Giron ➢ Catholic Charities Northern provides rental assistance, utility assistance, local bus passes and and assistance with other basic needs to help individuals and families. Information, referral and case management services are provided to assist people through difficult times. • SUPPORTING HEALTH, WELLNESS& DISABILITIES CENTENNIAL DEVELOPMENTAL SERVICES, Inc. Executive Director: Mary Lu Walton > Centennial Development Services, Inc. (CDSI)promotes full community inclusion for persons with developmental disabilities residing in Weld County. Services and support available to eligible persons and their families include Early Intervention Services, Family Support Services, Children's Extensive Services, Before and After SchooUSummer Camp Services, Adult Comprehensive Services (specialized habilitation, community access, employment, residential),Adult Supported Living Services, Transportation, and Case Management. > Adult Services 21 > Children and Family Support CONNECTIONS FOR INDEPENDENT LIVING Executive Director: Beth Danielson > Connections for Independent Living assists people with a wide range of disabilities to make their own choices and to live full, independent lives. ISLAND GROVE TREATMENT CENTER Executive Director: B J Dean > Island Grove Regional Treatment Center offers a full range of services: prevention, crisis intervention, detoxification, evaluations, referrals, transitional residential treatment, outpatient, and intensive outpatient services. MED-AID PRESCRIPTION ASSISTANCE PROGRAM Contact: Shannon Quinn > Med-Aid Prescription Assistance Program is a partnership between United Way of Weld County and NCMC Foundation that provides prescriptions for qualifying clients. It focuses on children and elderly who have no other financial means to be able to afford prescriptions. NORTH RANGE BEHAVIORAL HEALTH Executive Director: Dale Peterson > North Range Behavioral Health is a comprehensive community mental health center providing case management, treatment, social rehabilitation, vocational, day care, residential and inpatient services to persons residing in Weld County. RVNA HOME CARE SERVICES Executive Director: Crystal Day > RVNA Home Care Services provides quality professional nursing, therapy, social services, and personal care services in the comfort and safety of the patient's own home. RVNA is a Medicare/Medicaid certified agency which also receives reimbursement from private insurance, private pay and grants such as United Way. The agency is nationally accredited by JCAHO. The Weld County Department of Social Service Social Services programs are administered under the supervision of the State and the County Commissioners. Most regulations governing the programs are made by the federal and state governments who in turn interpret the legislation of Congress and the State Legislature in writing program rules. A staff of approximately 160 caseworkers, technicians, and support personnel provides services and determines eligibility for programs. Financial need is the main factor measured for the Income Maintenance programs. Other needs, such as the need to protect a child from abuse or neglect, determine whether services are provided in other programs. 22 Program costs are shared by Federal, State and County and vary by category. The Department of Social Services is responsible for administering three types of programs for the citizens of Weld County. (1) "Protective or Social Services" programs provide direct or intervention services for families, children and adults. (2)"Assistance Payments" programs provide for basic survival needs - food, shelter, clothing, medical, and job preparation. (3)"Child Support"program provides assistance in obtaining financial and medical support from non-custodial parents. Services to which nurse home visitor clients could possibly need referral are listed below for the Department of Social Services. The applicant agency has existing referral relationships with these programs through current nursing and social work services provided out of the department. SOCIAL SERVICES DIVISION Protective Services to Children Ongoing and Intake Units: Program area for the protection of battered, abused, neglected and dependent children. Primary responsibility of this service is the protection of children who are battered and abused, severely neglected and/or dependent. Age limits within this program area are generally birth to 18 years of age. All cases that meet this definition will be the responsibility of this program area and personnel assigned to it. ➢ Adult Services: Primary objective of this program is to provide protective services to adults, age 18 and over, who are being exploited, abused, neglected, or are incompetent and need supervision. This unit also provides services to the age and disabled in assisting them with Home Care Allowance. ➢ Youth in Conflict: Program area for youth ages 12 to 18. This unit serves children who are experiencing difficulty with the community or parents and require intervention by this Department, usually through court order. Many youth have been adjudicated as status offenders by the court, i.e., dependent or neglected or juvenile delinquents. The goal of this unit is to assist the youth in making the best possible social adjustment with parents and society. ➢ Resource Services: This unit provides resource/support services to other unit previously described. Support services in this area are Family Preservation/Family Support programs, adoption and relinquishment services, and foster care certifications. ➢ Adoption Services: Services for the subject child(ren) of Dependency/Neglect action who has been legally freed for adoption. Services extend to pre and post finalized adoptive parents including application process, home studies, and supportive services. ➢ Foster Care Certification: Services include recruitment, application processing, orientation, certification, support, monitoring, and ongoing training of County foster homes. 23 ASSISTANCE PAYMENTS DIVISION > Assistance Payments assists the elderly, the disabled, children and their caretakers. The Food Stamp program assists those who are also employed but do not earn enough to support their families. ➢ Any request for financial help or income maintenance assistance requires that certain criteria of eligibility, or need, must be met. Once eligibility is established, redetermination of continuing eligibility is made periodically or whenever a client's personal situations change. Generally, an applicant is determined eligible or"needy" if their resources and income fall below established standards. ➢ Assistance may be granted to the elderly under the Old Age Pension program, to the disabled under the Aid to the Needy Disabled program, to the Blind under the Aid to the Blind program, to children under the Temporary Assistance to Needy Families (TANF)program. The Weld County General Assistance Fund may assist persons in emergency situations whose needs are not met by these Assistance Payments Programs. > Aid to the Needy Disabled (AND): The Aid to the Needy Disabled program assists persons with physical or mental impairments that prevent self-support. This program is administered and financed in conjunction with the Social Security Income program (SSI). Determination of eligibility for SSI is made by the Social Security Administration. The Department's AND program supplements SSI payments to the recipient. For those applicants who are at least 18 years of age with short-term disability, final determination of medical disability to qualify for the Department's AND program is made based on medical examination by local doctors. ➢ Aid to the Blind(AB): The Aid to the Blind program provides financial assistance to those persons who are at least 18 years of age and who are legally blind. This program is also administered and financed in conjunction with the Social Security Administration's Supplemental Security Income program(SSI) and eligibility for SSI is determined by the Social Security Administration. The Department also offers medical treatment to clients to prevent total blindness. > Old Age Pension(OAP): The Old Age Pension program provides financial and medical assistance to Colorado residents who are in need and have reached the minimum age of 60.Nursing Home Care is also provided under the Old Age Pension program. ➢ Home Care Allowance: This program provides additional funds to financially eligible clients to allow them to pay a provider to assist them with non-skilled services they are unable to accomplish themselves due to disability. Examples of these types of services would be housekeeping, laundry, meal preparation, and grocery shopping. ➢ Home Community Based Services (HCBS): This program provides full Medicaid for long term care. It is designed for people who are at risk of nursing home placement due to their health and desire to remain at home or in an assisted living facility. > Nursing Home Care: Medicaid is available to provide assistance with the cost of nursing home care. Applicants must qualify both medically and financially for the program. Resource limits vary depending on marital status, number in family receiving public assistance, and the first continuous period of institutionalization. 24 ➢ Estate Recovery: Estate Recovery is a federally mandated program to help pay for medical costs for the increasing number of people in need of care. The Colorado Department of Health Care Policy and Financing recovers medical care costs from the estates of certain former recipients. ➢ Programs for Medicare Beneficiaries: Income guidelines change in mid March every year. Recipients must be eligible for Medicare Part A. Family and Children Categories ➢ Colorado Works in Weld County - Temporary Assistance to Needy Families (TANF): The Colorado Works in Weld County Program provides temporary financial and/or medical assistance to households with children. Income maintenance payments vary according to the size of the family and the income of the parents. The goal of the TANF program is to assist individuals in becoming self-sufficient and/or return to the work force as soon as possible. Collaboration and coordination with the Job Services and other community agencies provide immediate employment, training, and other support opportunities to individuals applying for or receiving TANF benefits. ➢ Child Care/Day Care: The Child Care Program's mission is to provide families with financial assistance for child care to their choosing; to provide families with timely and efficient access to quality child care; and to assist families in meeting their self sufficiency goals by providing referrals to needed support services. ➢ Baby Care/Kids Care: The Baby Care and Kids Care Program provides Medicaid benefits to pregnant women and children born after September 30, 1983. Eligibility is based on income and resources as are other categorical programs but the income guidelines are considerably higher. The objectives of this Medicaid program is to make sure adequate health care is available to children and hopefully set the state for a healthy adult population. ➢ Low Income Energy Assistance Program (LEAP): The Low Income Energy Assistance Program provides for assistance with heating costs for low-income households from November through April. Assistance may also be available through LEAP for emergency utility shut off situations and heating or furnace repairs. General Programs: ➢ Food Stamps: The Food Stamp program is sponsored by the United States Department of Agriculture to provide better nutrition and increased food purchases power for low income families. The amount of stamps issued is determined by the amount of income and expenses during the certification period. There are also resource or asset limitations that are applied to determine eligibility. ➢ Fraud: Experienced investigators employed by the Department evaluate complaints from the public which allege that recipients are fraudulently receiving assistance. If evidence is sufficient, appropriate action is taken to establish the recovery of funds expended and/or referrals are made to the District Attorney for prosecution. 25 CHILD SUPPORT The Department makes an intensive effort to obtain financial and medical support from non-custodial parents no matter where they may be located. It works in close cooperation with the County Attorney's Office in obtaining court ordered child support when necessary. The Child Support Unit is responsible for the following functions: ➢ Establishment: The goal of the Child Support Enforcement office is to have an enforceable order in each case. Some cases will already contain an order from a previous action, e.g., divorce. In most situations, however, there will not be a court order for child support. ➢ Paternity: A paternity case is handled much like an establishment case, except that paternity has not been determined. Some alleged fathers will admit paternity and will voluntarily sign a stipulation. Some will not voluntarily acknowledge paternity and will request that genetic testing be done. ➢ Enforcement: The goal of the enforcement unit is to collect from absent parents who have been ordered to pay child support. The Weld County Department of Human Services Employment Services of Weld County is an integrated system that offers meaningful employment and training programs and services as feasible. The major programs administered are the Workforce Investment Act Program for adults, dislocated workers, and youth; basic labor exchanges under the Wagner-Peyser Act; Welfare to Work; AmeriCorps; Youth Crime Prevention and Intervention programs; the Employment components for the Colorado Works in Weld County; and the Employment First Food Stamp Job Search Program. Each unit supports different programs and functions. These units and the staff would be responsible to help implement the recruitment of clients for the Nurse Home Visitor Program and for effective interagency referrals. Employment Services would support this program through outreach during its recruitment process for its youth programs and its other subsidized programs. Employment Services would also inform clients of the services available under the Nurse Home Visitor Program. The Family Educational Network of Weld County (FENWC) is a department of the Weld County Department of Human Services. FENWC's mission is to provide children and families with a high quality, comprehensive program which promotes self-esteem, fosters social and educational competence, develops independence, and enables children and families to be lifetime learners and responsible, valued members of the community. FENWC is a comprehensive early childhood development program. FENWC has been serving in Weld County and surrounding counties for over 25 years. The population served is low-income children and families with or without special needs. Head Start Program areas include education and early childhood development, health, mental health, 26 disabilities and parent involvement. Head Start services families in Greeley, Gilcrest, Platteville, Frederick, and Hudson during nine months of the year in half day session and two full-day, full-year sessions. The Migrant Head Start Program services families furing four months of the year in Greeley, Fort Morgan, Frederick, Olathe, and Grand Junction. The Department of Human Services has established collaborations in the following areas: Nutrition/Food ➢ Weld County School District 6 (Greeley/Evans) ➢ Weld County School District RE-I (Gilcrest/Platteville) ➢ St. Vrain School District RE-1J (Frederick) > Weld County School District RE-3J(Hudson) ➢ Weld County School District RE-5J(Milliken) > Child Adult Care Food Program/USDA(All sites) Colorado Preschool Project > Weld County School District RE-I (Gilcrest/Platteville) > Weld County School District RE-3J (Hudson) > Weld County School District RE-5J(Milliken) Disabilities Services ➢ Board of Cooperative Educational Services (Milliken/Gilcrest/Platteville, Eaton, Ault, Pierce) > Weld County School District RE-3J (Hudson) ➢ North Colorado Medical Center(Greeley, Frederick, Fort Morgan) Mental Health Services > North Range Behavioral Health(All Head Start and Migrant Head Start sites in Weld County and Fort Morgan) Health Services ➢ Plan de Salud del Valle Community Health Center(Frederick/Hudson) ➢ Colorado Department of Health and Environment Farm Worker Health Program (Entire migrant catchment area) > Sunrise Community Health Center(Greeley/Milliken) The Greeley Dream Team, Inc. The Greeley Dream Team is a not-for-profit agency dedicated to serving low-income and first generation families in School District 6 since 1987. Students and families are served through a number of programs that are funded by a variety of sources. Assistance is also provided through established collaborations with the University of Northern Colorado and Aims Community College. Projects under the umbrella of the The Greeley Dream Team include: ➢ Educational Talent Search Program—serving 750 students in grades 6-12 27 > McKinney Homeless Project—a Weld County District 6 program contracted to the Dream Team ➢ YCPI Leadership—a program serving students in one of the district's alternative schools ➢ Family Visits for the Foster Care—a program at the Weld County Department of Social Services that is funded through the Families, Youth and Children Commission Referral Sources The Weld County Department of Public Health and Environment has well-established relationships with many agencies currently serving low-income mothers-to-be and their families. These relationships extend beyond serving together on community coalitions and task forces. Work integration occurs in several areas with the Department of Social Services, the Department of Human Services,North Colorado Family Medicine, Monfort Children's Clinic, Sunrise Conununity Health Center and the United Way of Weld County CHP+Collaborative. In addition to building upon the existing strong interagency relationships a Community Advisory Board is proposed in this application. The advisory board would provide oversight of the collaborative effort and assist in holding the department, its director, and program staff accountable to the community. The advisory board would be constituted with 8-10 community representatives from the leading collaborative agencies and at least one representative from the target population. This advisory board would meet monthly during the implementation phase of the program and then quarterly thereafter. Examples of service and referral integration and collaboration are detailed in the following pages. Perhaps the closest working relationship between the applicant agency and other community resources has been with providers of prenatal care and pregnancy case management. There are three main providers of prenatal care to low-income women in the county in addition to the Department of Public Health and Environment: Sunrise Community Health Center,North Colorado Family Medicine, and Plan de Salud del Valle. The largest single provider of prenatal services to low-income women in the county is Sunrise Community Health Center. They have actively provided prenatal care to the community since opening in the early 1970s. The applicant agency has had established referral patterns with Sunrise for over 25 years. North Colorado Family Medicine is the next largest provider of comprehensive pregnancy services to low-income women in Weld County. With the transition in 1998 of the clinical components of the county's own maternity program to North Colorado Family Medicine, entry into prenatal care for low-income women was streamlined. North Colorado Family Medicine has provided medical consultation and back up to the applicant agency since 1974. The transition of services to North Colorado Family Medicine was facilitated by the applicant agency continuing to employ the clinical staff for over a year after the services had been moved off site. Even with this assistance and the contract for services, North Colorado Family Medicine sustains a net operating loss for this program of$50,000 - 100,000 annually in addition to donating $15,000 of in-kind services. North Colorado Family Medicine also continues to provide medical 28 consultation to the Department of Public Health through on site consultation clinics and colposcopy services. In addition to contractually providing the county's clinical maternity services,North Colorado Family Medicine provides intrapartum and delivery services to nearly all low- income women delivering at North Colorado Medical Center. These services are provided to Sunrise Community Health Center through a long-standing agreement between the two clinical entities. An excellent working relationship has existed between Sunrise, Family Medicine and Public Health for the last 25 years and has facilitated access to pregnancy services by most of the county's low-income population. In 1999, North Colorado Family Medicine provided services to over 900 women seeking pregnancy-related care. Plan de Salud del Valle operates health centers in seven communities throughout northern Colorado, two of which are in Weld County. As with the other clinics listed above prenatal care is offered in addition to comprehensive primary care services to low-income families. Plan de Salud has worked closely with the applicant agency in southern Weld County with both agencies having offices in Fort Lupton. In addition to established bi- directional referral patterns for maternity care, Plan de Salud has been active in the Weld Immunization Coalition and other collaborative efforts. Sunrise Community Health Center,North Colorado Family Medicine and Plan de Salud—all providers of comprehensive primary care services to low-income families— would play key roles as referral sources and linkages for health care. Both formal and informal agreements are in place between the applicant agency and these health dare centers. From one site alone it is estimated from 1999 data that nearly 300 first-time low- income mothers-to-be would be identified for possible referral into the Nurse Home Visitor Program. Another community asset with which the applicant agency has a close relationship is the North Colorado Medical Center Foundation's Monfort Children's Clinic. Since opening its doors following a huge outpouring of community support through fundraising to build the facility, Monfort Children's Clinic has worked aggressively to meet the medical, dental, social and educational needs of low-income children in and around Greeley. The Children's Clinic and the applicant agency have worked collaboratively on issues of immunization,prenatal care, adolescent health and children with special needs. Well- established mechanisms for bi-directional referrals have been in place for five years between the Children's Clinic and the applicant agency. All of the health care clinics listed above are committed not only to successful implementation of the Nurse Home Visitor Program but also to positively affecting the indicators of well-being for women and children in Weld County. Executive Directors from three of the health centers have served together for five months on the Primary Care Access Group investigating community solutions to better meet the access to health care needs of low-income families. Joining these directors in addressing these community 29 concerns are representatives of North Colorado Medical Center and the Department of Social Services. North Colorado Medical Center will also be a source of referrals to the visitor program. The medical center's care coordination team, directed by Jeff Abbett, RN, has worked closely with staff of the applicant agency for several years to meet the health care needs of low-income families. With many of the more than 2,000 women delivering each year accessing antepartum services at the medical center, the hospital's care coordinators would be additional sources of referrals into the program. The leadership of the medical center is committed to supporting the successful implementation and effective referral to the Nurse Home Visitor Program. United Way of Weld County, and its many supported agencies, would also be key referral sources for the Nurse Home Visitor Program. United Way currently coordinates a twice- monthly community agency staffing where collaboration in making referrals is facilitated between the agencies providing home visitation and case management services. The applicant agency and United Way are joining with a community-wide collaborative to increase enrollment in the Child Health Plan Plus. The Director of Community Problem Solving and Programming for United Way of Weld County has committed to integrate the Nurse Home Visitor Program staff into the community agency staffing. This would facilitate the coordinated referral of clients into the program. Internal referrals to the program will be generated from the EPSDT staff already working in the applicant agency. Program staff is required to contact all Medicaid-eligible clients. With the reorganization of programs within the lead agency to place EPSDT and Presumptive Eligibility services under the same supervision internal referrals between these programs will be facilitated. The director of the applicant agency is also an elected official serving as the President of the Board of Education for the school district with the largest student enrollment in the county. In addition, he also serves as a director from Region 4 on the Board of Directors of the Colorado Association of School Boards. Region 4 represents most of the school districts in Weld County. The applicant agency has worked effectively with many of the school districts in the county on immunization, well-child, children with special needs, tobacco prevention, driver's education and abstinence programming. Schools have been represented on the Teen Pregnancy Task Force since it began meeting to address the high rate of teen pregnancy in Weld County. Weld County School District 6 would be a key agency in making referrals of low-income teens pregnant for the first time. Effective working relationships have existed between the referral sources as listed above for many years. The limiting factor impacting the ability of these agencies to positively affect the indicators of well being of women and children in Weld County results not from a lack of cooperative effort but from inadequate funding to implement programs with sufficiently intense interventions. The Nurse Home Visitor Program would be an opportunity for the community to demonstrate that with additional training, staffing and funding, a real difference could be made in the health and welfare of low-income first- 30 time mothers and their children. These participating agencies each serve a high enough volume of low-income mothers and children that recruiting 100 participants will not be the issue. The challenge, instead, will be to avoid flooding the program with participants as soon as it becomes operational. Referral Linkages Service integration and referral coordination between the applicant agency and the Department of Social Services has become well-established during the last decade and includes: ➢ Placement of an EPSDT worker from the applicant agency on site at Social Services. > Location of a Medicaid outstation worker at the Department of Public Health and Environment. > Family Bonding program referrals and collaborative home visits between the applicant agency and Social Services. ➢ Interagency cooperation with Medicaid and the Health Care Program for Children with Special Needs. ➢ Assistance by the applicant's social worker with food stamps, T.A.N.F. services, housing assistance, child protection and child care services as needed by clients of the lead agency. The Department of Human Services is an important agency in this proposal because of the programming that it currently provides to low-income families. The applicant agency has established referral patterns with both the Family Educational Network of Weld County and the Employment Services of Weld County. These agencies, operated by the Department of Human Services, exchange referrals with the applicant agency in the areas of Health, Dental and Nutrition; Family Partnership; and Parent Involvement programming. The Department of Public Health and Environment has also referred clients to Human Services for remedial education and employability skills training while accepting trainees into the various divisions of the department for Welfare to Work training experiences. Important interagency referral relationships between the departments of Human Services and Public Health include: > Temporary Assistance to Needy Families > Food Stamp Work Program > Welfare to Work Program ➢ HeadStart ➢ Family Support Program > Children with Special Needs The Greeley Dream Team, Inc. also serves as a referral linkage between the applicant agency and services to help at-risk students succeed in school. Dream Team counselors working in several schools would be important collaborators for the Nurse Home Visitor Program. The Director of the applicant agency has the privilege of serving as member of the Board of Directors of the Greeley Dream Team and has secured its support of the 31 Nurse Home Visitor Program as an additional asset to add to the community's armamentarium to support successful outcomes. Coordination with Existing Visitation Programs Coordination of the Nurse Home Visitor Program with existing visitation programs is in the best interest not only of resource utilization by clients but also of program acceptance by community agencies. United Way of Weld County has agreed to expand its monthly community staffing meetings of agencies providing home visitation and case management services to include the Nurse Home Visitor Program staff Client consents would be adapted to integrate the new staff into the releases so that they would be able to participate in the staffing. Referrals made directly to the Nurse Home Visitor Program would be"staffed" at these once or twice monthly meetings. This process would provide the structure for collaborative integration and allow for the appropriate triage of clients to the program best able to meet the individual's needs. Service duplication or confusion would also be avoided by the teams from the various programs coming together for these staffings under the sponsorship and coordination of United Way of Weld County. Plan for Recruitment and Retention of Nurses All staff proposed under this grant application would be employees of Weld County in the Department of Public Health and Environment. The department currently has over 80 people working in the various divisions and programs. Hiring Registered Nurses with a Bachelor of Science Degree in Nursing is a standard requirement of the lead agency for all nursing positions. The department has also successfully attracted nurses who aye Master's prepared and bilingual in Spanish. County government personnel policies provide for standardized employment practices. Weld County is an Equal Opportunity Employer. The department is able to write specific job descriptions for designated positions and would do so for staff sought for this new program. In this way specific skills, experiences and interests could be considered in recruitment efforts. The agency has demonstrated a commitment to recruit bilingual, bicultural staff whenever possible. Positions for Nurse Home Visitor Program staff would first be posted internally. A number of staff has already expressed an interest in moving into the visitor program. Positions not filled by internal candidates would then be posted in the community. Outside agencies, including other home visitation programs, have already begun referring potential candidates to the department. The lead agency is able to place classified ads in local and regional newspapers to solicit applicants.Networking with University Schools of Nursing, hospitals, clinics, local public health agencies, and the state health department have also proven successful in the past for recruiting nursing staff. The applicant agency has been very successful at hiring qualified nurses. Bilingual nurses in the community have already indicated an interest in applying for the Nurse Home Visitor positions. The department currently has four bilingual nurses on staff and this makes it easier to recruit additional Spanish-speaking nurses because candidates know that the agency will share workloads among bilingual staff. In addition, the department 32 has been successful at attracting four Master's prepared nurses who are presently on staff. Cultural sensitivity has been a strong characteristic of the lead agency's recruitment practices. A strong collaborative relationship between the applicant agency and the University of Northern Colorado School of Nursing has helped in recruiting nursing staff. Many of the department's nurses are graduates of the University. The department also hosts many of the University's nursing students on clinical rotation. These clinical rotations have strong home visitation components affording a wonderful opportunity to expose potential candidates to the work of the department. The department has been fortunate in that it has not had difficulty in recruiting Bachelors- prepared nurses. Many of the department's nurses formerly worked at the regional medical center and were quite familiar with the population to be served even prior to coming to work for the agency. These nurses have also found the preventative aspect of Public Health as a very rewarding alternative to acute, inpatient care and the working conditions much more desirable. These factors have aided the agency in its recruitment efforts. The turn over of nursing staff in the applicant agency is very low. Most nurses who resign do so because of family obligations and not because of dissatisfaction with their roles. Health Department employees are also eligible for attractive and competitive benefits offering another incentive for staff recruitment and retention. Weld County government also encourages and supports employees with professional growth training. Of all agencies with the potential to support a new nurse visitor program,the applicant agency is best positioned in the community to attract and retain qualified nursing and support staff in a stable operating environment. The Weld County Department of Public Health and Environment will be the lead agency and administrative entity for the Nurse Home Visitation Program. The clinical nurse supervisor and the data entry clerk would operate out of the department's main office in north Greeley. Office space, desks,phones, and access to office and clinical equipment would be available. Past experience and conversations with collaborating agencies indicates that the best chances of successful integration will occur if visiting nurses are deployed throughout the community at sites where clinical encounters are anticipated. This grant proposes such a deployment of nursing staff even though all would remain employees of the applicant agency, be supervised by the department supervisor and be ultimately accountable to the department director. One of the nurse home visitors would be housed at the department's main office in Greeley with access to supplies and office space. This nurse would establish a relationship with the staff and clients at North Colorado Family Medicine—one of the largest providers of clinical services to pregnant women. The other three nurse home visitors would be stationed in strategic sites around Greeley and Weld County. 33 One site would be the county's southern branch office in Fort Lupton. A new facility is planned in southwestern Weld County and the nurse would move to this site as soon as construction was completed. Office space and access to the county's computer network would be available from this location. The southern Weld County population is expanding and the Plan de Salud Clinic has a growing indigent population to service. Outstationing a nurse at this southern location would facilitate home visits and contact with the clinics and service agencies in that area. It would also serve to strengthen the collaboration and coordination with Plan de Salud in Fort Lupton. Sunrise Community Health Center in Greeley, the largest provider of prenatal services to low-income women, would be a third location for outstationing of a nurse home visitor. This site would facilitate coordination of services with First Steps of Weld County that provides most of the prenatal case management for Sunrise clients. Office space and access to telephone and supplies would be made available by Sunrise. The applicant agency would provide,through Nurse Home Visitor grant funding, a computer and modem access to the county computer network. The fourth site for deployment of a nurse home visitor would be at Monfort Children's Clinic in Greeley. The Children's Clinic is a primary health care provider for many of the indigent children in the greater Greeley area. This site is where many of the first time mothers would be likely to take their children for health care. Location of a nurse visitor at this site would increase coordination of referrals to and from the many medical, dental, educational and social support services provided on-site at the Clinic. Office space and access to supplies would be made available by the clinic. The applicant agency would provide, through grant funding, a computer and modem access to the county computer network. Grant funding is sought to provide each nurse visitor with a cell phone and cellular phone service. Each nurse would also have a department voice mailbox and e-mail address through the lead agency. A single central phone number in the applicant department would be made available to community agencies to make referrals easy. The nursing supervisor would meet regularly with the visitation staff and assist with their integration into the department's regular staff meetings and activities. Placement of nurse visitor program staff within the Weld County system provides for a stable operating environment. The infrastructure to support such a program is already in place. The health department has been in operation for over 60 years and is a credible and accountable agency funded in part by local taxes. A physician director with a Master's in Public Health brings added stability and expertise to the agency. Department leadership is very committed to making this program successful and to providing support to the staff who would be working in this program. A critical factor in predicting success of the visitor program will be the recruitment of a nursing program supervisor who has a passion for such a project. This application proposes increasing the half-time Master's prepared nurse supervisor to a full time position by reorganizing internal resources to support another 0.5 FTE. The applicant 34 agency would direct part of an existing supervisory position to create a full-time position. Creating a full-time position might make the position more attractive and help in the recruitment of an outstanding candidate. Recruiting nurses dedicated to the Home Visitation Model will be essential to the program's success. During the interview and selection process, questions would be asked of the applicants that would identify their commitment to the integrity of the project. Demonstration of a stable past work history, strong work ethic and excellent references will be additional qualities important to the agency's recruitment plan. A key role of the lead agency will be to retain valuable employees. Investing time and money to facilitate training can help with retention. Removing barriers to successful implementation of the program will also be important functions of program and department leadership. It will be vital for staff to feel successful about what they are doing. Empowering staff to meet goals and facilitating broad based community support will help ensure the effectiveness of the program. Building in time for team building activities and to facilitate collegial relationships with other nurse home visitors will also increase the likelihood of successful program implementation and viability. The work of the nurse home visitor is likely to be stressful and difficult at times. Stress management training will help staff develop healthy coping mechanisms. Management Information System Capabilities The applicant lead agency already operates an integrated computer network. Nearly all employees have computers at their workstations. Weld County has a centralized Information System Support staff that has consistently helped the department in meeting the computer needs of all programs in which the agency currently participates. The agency and IS staff are experienced at implementing, working with and debugging programs and databases. The home visitor program data and support staff requested in this grant application will be housed in the lead agency's administrative division. This will improve access to county IS support and other staff experienced with the department's databases. Weld County IS staff will assist with the setup of computers and the required program software. The applicant agency would comply fully with the Clinical Information System requirements as specified by the National Center for Children, Families and Communities. Quality assurance activities will include monthly audits of compliance with program requirements. Assurance and performance improvement activities will be built around the Clinical Information System that is central to the data tracking and documentation tracking. The program supervisor and support staff will coordinate these audits and nurse visitor staff will review the results at regularly scheduled meetings. The results of these audits will lead the team to corrective actions that will change system policies and practices to better support compliance with program requirements. Local agency staff will also coordinate quality assurance activities with the National Center for Children, Families and Communities as they look at the performance of all Nurse Home Visitor Programs in the state. 35 Quarterly reports summarizing Quality Assurance findings would be shared with the Community Advisory Board as another mechanism to hold the collaborative of agencies wholly accountable for successful implementation. Collaborative Implementation Plan Collaborative implementation and community ownership of the proposed Nurse Home Visitor Program is a hallmark of this application. A core group representing agencies concerned about the high rate of teen pregnancies in Weld County has been meeting collaboratively to look at a community approach to better understanding the underlying causes and to suggest possible programming solutions. The Teen Pregnancy Task Force has looked at ways to especially target the teen population in an attempt to avoid unplanned second pregnancies. An extensive peer advocacy program has been discussed but funding to implement such a cooperative effort has been lacking. In addition to the Teen Pregnancy Task Force all of the prenatal and child health providers are engaged with each other in conversations about how to understand and address the high rate of late entry into prenatal care and poor fetal outcome statistics plaguing our community. The Nurse Home Visitor Program proposed in this application would place all program staff within the Department of Public Health and Environment where ultimate accountability and decision-making authority would rest. However, three critical actions would form the foundation of the program's collaborative implementation. First, nurses would be strategically deployed in partnerships with health care providers around the county who are the primary source of care for low-income women and their children. This will increase the likelihood of program acceptance and facilitate referrals between the partners. As noted previously in this application, partnership placements with Monfort Children's Clinic, Sunrise Community Health Center, Plan de Salud/Southern Weld County and North Colorado Family Medicine are planned. The community home visitor agency staffings coordinated by United Way of Weld County would be a second process whereby collaborative implementation and community ownership would occur. Integrating the new Nurse Home Visitor Program staff into existing staffing meetings where referrals are coordinated and client's needs are matched with available programming will avoid confusion and duplication of services. This process would serve to build upon the community assets rather than replace or disrupt them. A third critical action toward collaborative implementation would be creation of a Weld County Nurse Home Visitor Program Community Advisory Board. Eight to ten representatives from community agencies and providers would be joined by at least one representative from the target population. The board would represent the broad interests of the community and would serve two functions. It would be an advisory group to the director of the lead agency who is ultimately accountable for the successful implementation of the program and compliance with protocols. The board would help problem solve issues of collaboration and ensure a group dynamic focused on improving 36 outcomes. The board would also not only hold the lead agency accountable to the community but also demonstrate community investment in the program. Representatives from the following agencies would likely constitute the Community Advisory Board: • Sunrise Community Health Center • The North Colorado Medical Center Foundation's Monfort Children's Clinic • North Colorado Family Medicine • Plan de Salud del Valle • United Way of Weld County • First Steps of Weld County • Weld County Department of Public Health and Environment, Division of Public Health Education and Nursing • North Colorado Medical Center • Weld County Department of Social Services • Weld County Department of Human Services • Community member from target population The board would meet monthly during implementation of the program and then quarterly thereafter. Request for Waivers No waivers are requested in this application. Geographical Placement of Applicant This proposal is designed to strategically place visiting nurses around the county. Southwestern Weld County is an area that is growing rapidly and where residents often cross county lines into Boulder and Adams Counties seeking services. Placement of a nurse visitor in this area could help advance implementation of similar programming in northern Adams and eastern Boulder Counties. Budget and Budget Justification In submitting its request for funding, the Weld County Department of Public Health and Environment is requesting $114,499 in personnel costs for fiscal year one (1/1/01through 6/30/01). This funding would support the hiring of 0.5 FTE of a Master's prepared nursing supervisor, 4.0 FTE Baccalaureate prepared registered nurses, and 0.5 FTE of office support/data entry. The department's personnel costs for fiscal year one are $946 greater than the sample budget due to the Weld County salary schedule for professional personnel. Through internal reorganization, the department would bring funding for an additional 0.5 FTE of nursing supervisor salary. These funds would combine with the requested grant funds to accommodate the hiring of a full-time Master's prepared nursing 37 supervisor overseeing both the nurse home visitation program and other complementary community and family programs. Direct costs for operating expenses in fiscal year one include $600 for office supplies calculated at $100 per month; $6,750 for program supplies calculated at$145 per family; $750 for copies and forms calculated at $1,500 per year; $300 for postage calculated at $50 per month; and $900 for telephones calculated at $150 per month. The department is actually charged $30 per month for each workstation telephone. Support for five additional telephones at$30 per month is requested in fiscal year one. Four cellular telephones are requested in fiscal year one at a total purchase cost of$500. Local pricing allows the purchase of these phones for$100 less than that projected in the sample budget. Cellular phone usage fees are requested in the amount of$1,200 for fiscal year one. These costs are $600 less than the sample budget reflecting local market rates for cellular phone plans. The proposal seeks $4,500 during fiscal year one to support medical supplies. This amount is $3,750 more than that presented in the sample budget. The department's anticipated costs are associated with the supplies necessary to prepare four separate home visitation bags that would include otoscopes, ophthalmoscopes, sphygomanometers, stethoscopes, thermometers, and a convertible adult/infant scale with carrying case. The projected cost for these supplies reflects actual expenses incurred by the department for purchases of similar equipment. Other staff development funding is requested at $1,000 for fiscal year one. Mileage reimbursement of$6,100 is requested. Mileage costs are calculated at 20 trips per family per year, 20 miles roundtrip each visit, and a reimbursement level of $0.305 per mile. Given the size of Weld County, it is anticipated that the calculation used in the sample budget of 10 miles per roundtrip would be inadequate to cover actual costs. The actual Weld County rates for mileage reimbursement is $0.305 per mile. This differs from the $0.31 per mile reimbursed in this sample budget. This results in a subtotal for direct operating costs of$33,825 for fiscal year one. Direct costs for travel are projected at $2,451 for fiscal year one. This is $1,299 less than the estimate provided in the sample budget. Cost savings are anticipated because nurses will share hotel rooms and the distance to be traveled from Greeley to Denver is less than the average distance calculated in the sample budget. Direct costs for training and technical assistance provided by the National Center for Children, Families, and Communities is $15,350 for fiscal year one. This requested amount does not vary from that presented in the sample budget. Direct costs for equipment is $11,225 covering the costs for 5 computers with Microsoft Office installed and 2 modems to support remote access to the County's computer system. Requested funding support for computers is $9,195 higher than that presented in the sample budget due primarily to the County's request for 4 computers above that 38 presented in the sample budget. The sample budget presented support for only one computer. In addition, the County is requesting support for the purchase of 2 modems to facilitate remote access to the County's computer network by the outstationed nurses. Indirect costs for training and technical assistance is calculated at 26% of the training and technical assistance direct costs. This results in a budget request of$3,991. Contributions from other funding sources include donated indirect costs of$22,682 for fiscal year one. While community agencies are donating office space, personnel support, and office supplies, the value of these in-kind donations has not been calculated for the purposes of this budget presentation. Separate liability insurance will not be required given that the staff supported by this funding request would be Weld County employees and would therefore be covered by the County while performing their job responsibilities. The total budget amount requested from the Colorado Department of Public Health and Environment for fiscal year one is $175,831. With the addition of in-kind donated indirect costs calculated at 12.9% of direct program costs, an additional $22,682.20 is presented in the budget proposal for fiscal year one. This results in a total annual budget for fiscal year one of$198,513.20. Community Support of Program Monfort Children's Clinic and Sunrise Community Health Center would be donating office space,office supplies, land-line telephone service and staff time to this project. North Colorado Family Medicine would be donating staff time to make and receive referrals from the program. United Way of Weld County would be donating the staff time to coordinate the community agency staffing meetings and to provide meeting space. The Departments of Social Services and Human Services would both donate all staff time associated with making and receiving referrals related to services provided by these agencies. All representatives to the Community Advisory Board would be donating their time to the project. Weld County Department of Public Health and Environment would donate indirect costs of$22,682 for fiscal year one. These commitments of in- kind donations would be sustainable for the life of the program. 39 Appendix B: Letters of Support r 41 MONFORT 4 ,r- I. 3• o, ' 4, Children's CLINIC c • MG I w o cow MG 4 + November 1, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246-1530 Dear Colorado Board of Health Members: The North Colorado Medical Center Foundation's Monfort Children's Clinic strongly supports the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. Kids Count statistics for the past few years reveal that Weld County has one of the highest teen pregnancy rates in Colorado. Weld County also ranks near the bottom of all Colorado counties for mothers receiving early prenatal care, and in the lower 1/3 of counties for births to single moms. Weld also has a large proportion of infants born to low-income mothers. We know that these factors all lead to problems later in life. Although there are efforts underway to provide a coordinated response to these problems, the Nurse Home Visitation Program will propel our efforts to reverse these negative and troubling trends. Monfort Children's Clinic has a history of collaboration with the Health Department to address the needs of low-income mothers and babies. We have had Health Department employees routinely work at our facility to improve prenatal education and to assist families with birth control planning and methods. We refer clients to the Health Department for many needed services and provide support for their clients through age 21 with healthcare needs. We are committed to supporting the Nurse Home Visitation Program and would provide in-kind office space for a Nurse Home Visitor based in our facility. This would provide many opportunities for the Nurse to meet regularly with our medical team, our social worker, a mental health counselor, and other health professionals working in our facility for referrals and information exchange. I have attended many community meetings leading to this opportunity and there is strong enthusiasm for the program. We believe that Weld County really needs and would dramatically benefit from this program and respectfully request that you seriously consider Weld County's application. Thank you for your consideration of this request. Best Regards, 1-311:fraelt--7 Bob Francella Executive Director x< 100 North 11th Avenue • Greeley,CO 806 31-2 011 • (970) 352-8898 • FAX: (970) 351-7075 • E-MAIL: mcclinic@pawneenet.com sunrise 5 1973 • 25th r199K COMMUNITY HEALTH CENTER , INC . ANNIVERSARY October 31, 2000 Colorado Board of Health Colorado Department of Public Health & Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Members: I am pleased to provide this letter of support for the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. Weld County has one of the highest teenage pregnancy rates in Colorado and a large proportion of infants born to low-income mothers. This program will respond to an important need in our community. Sunrise Community Health Center has a history of effective collaboration with the Weld County Department of Public Health and Environment to address the needs of low-income mothers and babies. We refer clients to the Weld County Department of Public Health and Environment for family planning, immunization and well-child services. Sunrise provides medical and dental services to patients referred from the WCDPHE. And Sunrise has a long-standing collaborative relationship with the Health Department around the provision of environmental sanitation and safety services to Weld County Migrant Farmworkers. Sunrise is committed to providing support for the Nurse Home Visitation Program. Specifically, we will host one of the Nurse Home Visitors---including providing required office space, computer and related administrative services. Additionally, our professional and case management staff will refer families to the NHV Program. And, our medical and dental staff will be a referral source for all NHV Program staff. As a member of the Teen Pregnancy Work Group, Sunrise has worked with the Weld County Department of Public Health and Environment, and other area agencies, to create a dynamic community-based collaborative network that is ready to fully support the Nurse Home Visitation . Program. Thank you for considering funding for this vital program. Sincerely, Michael Bloom, Executive Director /sh P.O. Box 1870 • 1028 5th Ave. • Greeley, CO 80632 • (970) 356-6014 • Fax(970) 353-9906 adel North Colorado Family Medicine North Colorado Medical Center October 27, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Members: North Colorado Family Medicine(NCFM) is pleased to support the Nurse Home Visitation Program proposed in the application made to you by the Weld County Department of Public Health and Environment(WCDPHE). We strongly encourage your approval of the proposal and recommendation for full funding of the program. Our organization has a long history of collaboration with the Weld County Department of Public Health and Environment dating back to the start of our program in 1974. NCFM has formal agreements with WCDPHE to provide medical consultation to clients on site at the department's clinic in Greeley. The consultations include family planning,well child, and sexually transmitted and communicable diseases. Out of our clinic in Greeley, we also operate, under contract, WCDPHE's clinical prenatal program serving low income women. Referrals between the two agencies occur frequently and efficiently. NCFM provided over 40,000 medical visits in 1999 to families in the Greeley area. Forty percent of these visits were uncompensated or reimbursed through Medicaid. NCFM staff include family physicians, family and women's health nurse practitioners, and mental health therapists. Key people in our agency who are supportive of this program include Daniel Fahrenholtz, MD, Program Director; Joanne Fenton, RN,North Colorado Medical Center Assistant Administrator, Patient Care Services; and myself. Our community has a tremendous need for programming and services focused on improving outcomes for first-time mothers and their children. We are committed to collaborating with WCDPHE, Sunrise Community Health Center, Monfort Children's Clinic,North Colorado Medical Center, First Steps and other home visitation programs, social and human service agencies,and the community at large to achieve outcomes in the target population. Sincerely, Eileen Clinic Manager,NCFM EC/cm Residency Training Program • 1600 23rd Ave. • Greeley,CO 80634 • 970-356-2424 • ncmcgreeley.com aro) SALUD Family Health Centers ADMINISTRATIVE OFFICES October 26, 2000 1115 Second Street Fort Lupton,CO 80621 Colorado Board of Public Health and Environment 303-892-6401 4300 Cherry Creek Drive South fax 303-892-1511 Denver, CO 80246-1530 HEALTH CENTERS BRIGHTON To the Colorado Board of Health: 30 S.20th Avenue,Suite A Brighton,CO 80601 Plan de Salud del Valle,Inc. is pleased to provide this letter of support for 303-659-4000 fax 303-659-9306 the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. COMMERCE CITY 6075 Parkway Drive,Suite 16C Commerce City,CO 80022 Salud is a network of community health centers operating in ten service 303-286-8900 sites in five counties in north central and northeastern Colorado, including fax 303-286-8260 southern Weld County. Salud was founded 30 years ago, and today serves ESTES PARK more than 35,000 clients who otherwise would not have access to health 541 Big Thompson x28 Avenue,Suite 8 care. More than 70 percent of Salud's clients are of Hispanic ethnicity. Estes Park,CO 80517 Salud collaborates with organizations serving the same target population in 970-586-9230 each of the counties it serves, including county health de attments;?Women, fax 970-586-0292p Infants and Children; County Social Service Departments; and organizations FORT LUPTON that support low-income expectant mothers. 1115 Second Street Fort Lupton,CO 80621 303-857-2771 303-892-0004 Key staff in our organization which would support the collaborative efforts fax 303-892-1511 of this program are Stanley J. Brasher,executive director and Mary Ann FORT MORGAN Martinez Gofigan, director of client services. Salud has a long history of 909 E.Railroad Avenue collaboration with the Weld County Department of Public Health and Fort Morgan,CO 80701 p 970-867-0300 303-530-2071 Environment. We are committed to continuing that collaboration for the fax 970-867-7607 Nurse Home Visitation Program by referring eligible clients. FREDERICK 630 Main Street Sincerely, Frederick,CO 80530 303-833-2050 303-825-7664 fax 303-825-7664 LONGMONT Stanley J. Bra r 231 East 9th Avenue y Longmont,CO 80501 Executive Director 303-776-3250 303-444-7944 fax 303-682-9269 SALVO Family Health Centers is accredited by • JAW Com a,Iou an koalbEbr M Naha.ppum4'uv RECEIVED COT 3 0 2000 aid." North Colorado Medical Center Banner Health Colorado October 27, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Members: North Colorado Medical Center/Banner Health Colorado is very pleased to support the Weld County Department of Public Health and Environment's application for funding of the Nurse Home Visitation Program. North Colorado Medical is a 324 bed tertiary care center with level II nursery services and over 2200 births annually. As a provider of maternal/child services in Northern Colorado we are very concerned about the high rate of teen pregnancies and the increasing number of infants born to low-income mothers. The Nurse Home Visitation Program will help to insure successful outcomes for infants and families in our communities. North Colorado Medical Center has worked very closely and effectively with the Weld County Department of Public Health and Environment to assure that we continue to meet the needs of infants and mothers who lack the financial resources to obtain necessary care. Members of our Community Care Coordination Team and Monfort Family Birth Center regularly refer patients to Weld County agencies. Staff from these agencies are frequently requested to confer with our healthcare team to identify continuing care needs before mothers and infants are discharged from our facility. As a member of the Teen Pregnancy Work Group, we and other Weld County agencies are striving to create a collaborative network of community services to meet the increasing needs of this under-served population. The Nurse Home Visitation Program is vital to this continued effort. We appreciate your consideration for funding of the critical community resource. Sincerely, J^� Jon Sewell NCMC Administrator 1801 16th St. • Greeley,CO 80631 • 970-352-4121 • Fax 970-350-6644 • ncmcgreeleycom North Colorado Medical Center Banner Health Colorado • October 25, 2000 Colorado Board of Health Colorado Department of Public Health & Environment 4300 Cherry Creek Drive south Denver, CO 80246-1530 Dear Colorado Board of Health Members; I am pleased to provide this letter of support for the Weld County Department of Public Health & Environment's application to receive funding for the Nurse Home Visitation Program, Weld County has one of the highest teenage pregnancy rates in Colorado and a large proportion of infants born to low income mothers. This program will respond to an important need in our community. Monfort Family Birth Center has a history of effective collaboration with the Weld County Department of Public Health and Environment to address the needs of low income mothers and babies. We refer clients for prenatal, postpartum and newborn services. North Colorado Medical Center is committed to providing support for the Home Nurse Visitation Program. If I can be of any further assistance in support of the Weld County Department of Public Health & Environment's application to receive funding for the Nurse Home Visitation Program, please do not hesitate to contact me. Pat Aimino, RN, MS Clinical Director, Maternal & Newborn Services North Colorado Medical Center 1801 16th St. Greeley, CO 80631 970-350-8118 paimino@BHSNET.COM 1801 16th St. • Greeley,CO 80631 • 970-352-4121 • Fax 970-350-6644 • ncntcgreeley.com I United Way of Weld County 814 9th Street P.O.Box 1944 Greeley,CO 80632 970/353-4300 970/353-4738 Fax 800/411-8929 uwwc@ctos.com www.unitedway-weld.org October 30, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Members: On behalf of United Way of Weld County, I am pleased to support the application of the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. Weld County's need for this program is well documented. Our high teen pregnancy rate, our high poverty rate and the continuing low grades on the Colorado Children's Campaign Kid Count Report Card all show our need for additional resources to support mothers and their babies. As the coordinating entity for the Weld County Early Intervention Collaboration, United Way recognizes the need for additional resources in our community to provide home visitation to first time mothers. We feel this program will be an important addition to current services, as no current providers can offer the level of service provided by this nurse home visitation program. This is an important opportunity to strengthen the community collaboration already happening in Weld County. We currently are working with the Weld County Health Department and other children's health providers to enroll children in the Child Health Plan Plus (CHP+). Under the leadership of the Weld County Health Department's director, Dr. Mark Wallace, numerous other community initiatives are under way. Coordination of the nurse home visitation program with other home visitation programs is a critical piece of maximizing limited resources in our community. We will be pleased to host the community agency staffings (currently held monthly) to help guarantee referrals and service delivery of home visitation services are offered in a collaborative manner and support individual family needs. We will provide as our in-kind donation the meeting space, staff support and logistical support(mailings, record keeping, etc.)to the staffing process. Jr;laaaao,: a.a o.2.v r a"+ cye ' C09/1.4/Way e region/a' %a e CQRI: & ACI'L 3O%1C cow/// L /, We are pleased to offer our support to this important program for Weld County. Thank you for giving serious consideration to funding a Weld County Nurse Home Visitation Program. Sincerely, Judy Kron, Director Community Problem Solving and Programs T DEPARTMENT OF HUMAN SERVICES ADMINISTRATION 1551 NORTH 17TH AVENUE CoO 6OX 1805 WI I D O GREELEY,CO 80632 WEBSITE:www.co.weld.co.us (970)353-3800 COLORADO • FAX(970)356 3975 October 24, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246-1530 Dear Colorado Board of Health Members: I am pleased to provide this letter of support for the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. Weld County has one of the highest teenage pregnancy rates in Colorado and a large proportion of infants born to low-income mothers. This program will respond to an important need in our community. The Weld County Division of Human Services has a history of effective collaboration with the Weld County Department of Public Health and Environment to address the needs of low-income mothers and babies. We refer clients to the Weld County Department of Public Health and Environment for a variety of needed services, and provide support for their clients with Head Start, Migrant Head Start,child care,Employment and Training,and job seeking needs. The Weld County Division of Human Services is committed to providing support services for the Nurse Home Visitation Program. As a member of the Teen Pregnancy Work Group,I have worked with the Weld County Department of Public Health and Environment,and other area agencies,to create a dynamic community-based collaborative network that is ready to fully support the Nurse Home Visitation Program. Colorado Board of Health October 24,2000 Page 2 The Weld County Division of Human Services provides financial support for the Nurse Home Visitation Program by contributing in-kind services in the areas of Head Start,Migrant Head Start, child care, Employment and Training,and job seeking,to assure the success of this program. Thank you for considering funding this vital program. Sincerely W J. Speckman E utive Director WJS/sgt 4 " DEPARTMENT OF SOCIAL SERVICES PO BOX A GREELEY,CO 80632 WEBSITE:www.co.weid.co.us 44 11461111kt ‘D Administration and Public Assistance(970)352-1551 C Child Support(970)352-6933 COLORADO October 27, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, COO 80246-1530 Dear Colorado Board of Health Members: The Weld County Department of Social Services is providing a letter of support for the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. The Weld County Department of Social Services has a history of effective collaboration with the Weld County Department of Public Health and Environment to address the needs of low-income mothers and babies. These areas of effective collaboration are as follows: 1. The Weld County Department of Public Health and Environment is an important member of our Child Protection,which reviews cases of abuse and neglect. In addition, my Department contracts with the Weld County Department of Public Health and Environment to provide assessment and services to families with children of attachment disorders. 2. The Weld County Department of Public Health and Environment provides an entrance for families to Medicaid as a Presumptive Eligibility Site and to the Children's Health Plus Program as an Eligibility Site. The Weld County Department of Public Health and Environment has provided in-kind support for our Medicaid Program by allowing us to station our Medicaid staff in their facility. For purposes of maintaining eligibility for my Department's Temporary Assistance for Needy Families and to meet the needs of other low-income families, the Weld County Department of Public Health and Environment provides necessary inunnni7atiion access and services. 3. The Weld County Department of Public Health and Environment provides a focus point for planning and collaboration with health providers and community agencies for meeting the health care needs of the community. Colorado Board of Health Page 2 October 27, 2000 The Weld County Department of Social Services is committed to providing support services for the Nurse Home Visitation Program. As a member of the Teen Pregnancy Work Group, I have worked with the Weld County Department of Public Health and Environment, and other area agencies, to create a dynamic community-based collaborative network that is ready to fully support the Nurse Home Visitation Program. Thank you for considering funding this vital program. Sincerely, y A Uriego ector GO 3w jt SCHooz O/ m9 GREELEY 0=* EVANS 48 alai"' a/atare to lad ettke Tony Pariso,Superintendent October 30, 2000 811 15th Street•Greeley, Colorado 80631 970-352-1543 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Member Weld County School District 6 is pleased to provide a letter of support for the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitor Program. School District 6, serving the communities of Greeley and Evans, is the largest school district in Weld County with an enrollment of over 15,000 students. In addition to traditional elementary (12), middle (5) and high schools (3) the district offers an Arts & Literacy Magnet elementary along with a variety of alternative middle and high school programs. The District also has several charter school options including K-12, K-8 and 8-12 programs. Five elementaries have school-wide Title I programs. As an indicator of the economic status of families with children attending district programs, over 50% of students are eligible for free and reduced lunch. The school district is aware of the high teen pregnancy rate in Weld County and has worked collaboratively with community agencies to support young mothers in completing their education. A representative from the school district has participated in the Teen Pregnancy Task Force coordinated by the Department of Public Health and Environment. The school district and the local health department have worked collaboratively on referrals for immunization, well-child, and children with special needs services for students. The District and Board of Education support efforts to help kids complete school despite adversity. We recognize that a Nurse Home Visitor Program directed at first-time, low- income mothers and their children will offer additional support to young families in our community. We look forward to continued collaboration with the Weld County Department of Public Health and Environment and support its application for funding of a Nurse Home Visitor Progr AACA t, q //'(),, Anthony Pa o Mark E. Wallace Superintendent President, Board of Education ar 811 Fifteenth Street Greeley, Colorado 80631 970-351-6410 Fax 970-353-8042 October 20, 2000 Colorado Board of Health Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, CO 80246-1530 Dear Colorado Board of Health Members: I am pleased to provide this letter of support for the Weld County Department of Public Health and Environment's application to receive funding for the Nurse Home Visitation Program. Weld County has one of the highest teenage pregnancy rates in Colorado and a large proportion of infants born to low-income mothers. This program will respond to an important need in our community. The Greeley Dream Team has a history of effective collaboration with many agencies, including the Weld County Department of Public Health and Environment, who address the needs of low-income mothers and babies. We have a large base of young students who we would refer to the Weld County Department of Public Health and Environment for information on services such as pre-natal care, STD's and child immunizations. We are also available to provide a variety of educational support services to clients who might be referred to us from the Nurse Home Visitation Program. As a member of the Teen Pregnancy Work Group, I have worked with the Weld County Department of Public Health and Environment, and other agencies,to create a dynamic community-based collaborative network that is ready to fully support the Nurse Home Visitation Program. The Greeley Dream Team can provide in-kind staff support to assure the success of this program. Thank you for considering funding this vital program. Sincerely, Charlotte Ji ez Executive Director Reference Data Sources ' Source: Greeley/Weld Economic Development Action Partnership, Inc. " Includes Evans,Garden City,Greeley and LaSalle. "' Source: US Bureau of the Census,Census of the Population;Colorado State Demographers Office;and Claritas, Inc. as reported by the Greeley/Weld Economic Development Action Partnership, Inc. '"Source: Colorado Division of Local Government as reported by the Greeley/Weld Economic Development Action Partnership,Inc. "Source: US Bureau of the Census,Census of the Population;Colorado State Demographers Office; and Claritas, Inc.as reported by the Greeley/Weld Economic Development Action Partnership, Inc. h Source: US Bureau of the Census,Census of the Population;Colorado State Demographers Office;and Claritas,Inc.as reported by the Greeley/Weld Economic Development Action Partnership,Inc. Source:Claritas, Inc.as reported by the Greeley/Weld Economic Development Actin Partnership, Inc. ""Source: Colorado Children's Campaign,Colorado 1999 KidsCount! Report Card. "Source: Colorado Children's Campaign, Weld County 1999 KidsCount! Report Card. `Source:Colorado Children's Campaign,Colorado 1999 KidsCount! Report Card. "'Source: US Bureau of the Census "'Source: Weld County Department of Social Services data provided to the Weld County Primary Care Access Study Group, September 2000. Source: Colorado Department of Public Health& Environment, 1999 Live Births, September 2000 draft. ""Source:Colorado Department of Public Health& Environment, 1999 Live Births, September 2000 draft. `"Source: Colorado Department of Public Health&Environment, 1999 Live Births,September 2000 draft. 'n Source: Colorado Children's Campaign, Weld County 1999 KidsCount! Report Card. Source: Colorado Department of Public Health& Environment, 1999 Live Births, September 2000 draft. Source: North Colorado Medical Center, Maternity and Newborn Services Activity Data,January 1 — December 31, 1999. `"Source:North Colorado Family Medicine financial data provided to the Weld County Primary Care Access Study Group. Source:North Colorado Family Medicine financial data provided to the Weld County Primary Care Access Study Group, September 2000. '"Source: Summarization of Teen Pregnancy Reports,prepared for North Colorado Medical Center, March 29, 1998 by Ken McConnellogue. ""Source: Summarization of Teen Pregnancy Reports,prepared for North Colorado Medical Center, March 29, 1998 by Ken McConnellogue. `x"'Source:Colorado Children's Campaign,Weld County 1999 KidsCount! Report Card. "cly Source:Colorado Children's Campaign, Weld County 1999 KidsCount! Report Card. ""Source: Weld County Department of Social Services. n"Source: National Center for Health Statistics, Vital Statistics Reporting System, 1995-1997 as reported by the U.S. Department of Health and Human Services,Health Resources and Services Administration, Community Health Status Report for Weld County,Colorado July 2000. 42 • ATTACHMENT D APPLICANT: WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PROJECT: NURSE HOME VISITOR PROGRAM i I . i BUDGET , i FOR THE PERIOD: 01/01/01 -06/30/01 , Annual I Number ' i Total Source of Funds'.Salary I Months i Amount *Applicant Requested _ Rate I Budget 1 I Reguired and Other I from CDPHE — PERSONAL T-_-_j_— Nurse 1 37,776', 6' 18,888] 18,888 Nurse 2 --- 37,776! _ 6! I 18,888 - -----18,888 Nurse 3 37,7761 6 18,8881 _ 18,888 Nurse 4 37,7761 6' ' 18,888 18,888 Office Technician III (.5 FTE) i 11,251 — 6 5,626 5,626 I Contractual/Fee for Service: , L — -_ Supervising Personnel: Nurse Supervisor(.5 FTE) j 20,841' 6! 10,421 10,421 i Fringe Benefits: Rate=25% 45,799! 22,9001 22,900 Total Personal 114,499 0i 114,499 OPERATING i (include only costs not part of _ ----� - _ - indirect) F- - ,Supplies F 7 6001 600 Program Supplies _ , 6,750r 6,750 Copies—forms I 750 750 Postage I 300 300 Telephone I 900 900 Cellular Phones Usage Fees I j 1,200 1,200 Medical Supplies 4,5001 4,500 Other Staff Development 1,000` 1,000 NCCFC Training I J 10,000 10,000 NCCFC Materials 1,750 __ 1,750 NCCFC Clinical Info. System Support'] i 1,000 1,000 NCCFC Purchase of System&TA I 1 2,600 2,600 NCCFC Indirect at 26% 3,991 i 3,991 NCAST Training ! 3,500 3.500 NCAST&PIPE Training Materials 1 i i 2,215; I 2215 Sub Total Operating — 41,056 01 41,056 TRAVEL: _ Mileage l 6,100 6,100 Travel to Trainings 2,451 2,451 Sub Total Travel 8,551 0 8,551 - -* - EQUIPMENT: Computers with MS software(5) J --I—" 10,875 Modems(2) ----, ---------- 10875 , Cellular Phones(4) — r.— 50350' 350 T- 5001 500 j Sub Total Equipment 11,7251 i ---- __...--- ------ 0 11,725 Administrative/Indirect @ 12. °/, -- --- 9 22,682! - --- - -- ----- - 22,682." 0 s - , TOTAL PROJECT —____� — 198,513 i --_L._ 22,682 175,831 `Source of Funding for"Applicant — I I i and Other +----'--- I Local/County" 1— 22,6821 Medicaid Funding — _I Patient Fees Other — i Total Applicant and Other 22,682' i "Are these local funds used to match any other grant? Yes No Signature of Director or Authorized Representative -- INVOICE NUMBER CONTRACT REIMBURSEMENT STATEMENT TO: FROM: FAX: ( ) DATE OF EXPENDITURE. TYPE OF FROM: Final PROGRAM: NURSE HOME VISITOR PROGRAM Bill? FEDERAL ID TO: 0 Yes 0 No NUMBER: Description of Expenditure Local Agency Match Reimbursement Total Arnount Requested E- -2 F F GRAND TOTAL This is to certify that the above expenses were incurred per Contract # and we are requesting reimbursement for same. SIGNATURE (CONTRACTOR); DATE: I hereby certify that all contract requirements have been met and the amounts are correct. Payment is authorized. AUTHORIZED DESIGNEE (STATE): DATE: • C.....r N.d1W of,W.1vn...t A...t ta.yr 0 Y. 0 N. Wiw: �,�� STATE OF COLORADO Bill Owens,Governor Jane E.Norton,Executive Director of CO &C ; Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division * Q.,(�:. ; k Denver,Colorado 80246-1530 8100 Lowry Blvd. • • * Phone(303)692-2000 Denver CO 80230-6928 «r876" TDD Line(303)691-7700 (303)692-3090 Located in Glendale,Colorado Colorado Department of Public Health http://www.cdphe.state.cous and Environment Sample Contract Change Order Letter Attachment F State Fiscal Year **-***, Contract Change Order Letter Number** g , Contract Routing Number**-***** *************** Program Pursuant to paragraph"of the contract with contract routing number**-***** and contract encumbrance number *********** (as amended by Contract Renewal Letter , contract routing number , and/or Contract Change Order ** **_k***k Letter", contract routing number**-***** if any),hereinafter referred to as the "Original Contract"(a copy of which is attached hereto and by this reference incorporated herein and made a part hereof)between the State of Colorado, Department of Public Health and Environment and Contractor's Leeal Name, for the term from ******k** *k ***k through ********* ** **** the parties agree that the maximum amount payable by the State for the eligible services referenced in paragraph** of the Original Contract is increased/decreased by dollar amount DOLLARS ($*.**) for a new total financial obligation of the State of dollar amount DOLLARS,($*.**). The revised work plan, which is attached hereto as "Attachment I",and the revised budget, which is attached hereto as "Attachment 2", are incorporated herein by this reference and made a part hereof. The first sentence in paragraph ** of the Original Contract is hereby modified accordingly. All other terms and conditions of the Original Contract are hereby reaffirmed. This amendment to the Original Contract is intended to be effective as of********* **, ****, However, in no event shall this amendment be deemed valid until it shall have been approved by the State Controller or such assistant as he may designate. Please sign,date,and return all ** originals of this Contract Change Order Letter by********* **, **** to the attention of: ************ ************,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South, Denver,Colorado 80246, Mail Code: *****-**. One original of this Contract Change Order Letter will be returned to you when fully approved. Contractor's Legal Name STATE OF COLORADO (legal type of entity) Bill Owens, Governor By: By: Name: For the Executive Director Title:: DEPARTMENT OF PUBLIC HEALTH FEIN: AND ENVIRONMENT APPROVALS: FOR THE STATE CONTROLLER: PROGRAM: Arthur L. Barnhart By: By: NHVP CONTRACT DRAFT 21/12/6/001/LEE JOSEPH Page 18 of 17 STATE OF COLORADO Bill Owens,Governor - Jane E.Norton,Executive Director OQC Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division * �- j Denver,Colorado 8O246-153O 8100 Lowry Blvd. "�'' Phone(303)692-2000 Denver CO 8O23O-6928 te76 TDD Line(303)691-7700 (303)692-3090 Colorado Department Located in Glendale,Colorado eP of Public Health http://www.cdphe.state.co.us and Environment [Date] Sample Contract Renewal Letter Attachment G State Fiscal Year 20** - **, Contract Renewal Letter Number**, Contract Routing Number**-***** *************** Program Pursuant to paragraph **of the contract with contract routing number*******and contract encumbrance number *********** (as amended by Contract Change Order Letter**,contract routing number**-***** and/or Contract Renewal Letter**,contract routing number**-***** if any), hereinafter referred to as the "Original Contract"(a copy of which is attached hereto and by this reference incorporated herein and made a part hereof)between the State of Colorado, Department of Public Health and Environment and Contractor's Legal Name, for the renewal term from ********* ** **** through ********* ** **** the parties agree that the maximum amount payable by the State for the eligible services referenced in paragraph ** of the Original Contract is increased/decreased by dollar amount DOLLARS, ($*.**) for a new total financial obligation of the State of dollar amount DOLLARS,($*.**). The work plan, which is attached hereto as "Attachment I", and the budget,which is attached hereto as "Attachment 2", are incorporated herein by this reference and made a part hereof. The first sentence in paragraph**of the Original Contract is hereby modified accordingly. All other terms and conditions of the Original Contract are hereby reaffirmed. This amendment to the Original Contract is intended to be effective as of ********* ** **** However, in no event shall this amendment be deemed valid until it shall have been approved by the State Controller or such assistant as he may designate. Please sign,date,and return all ** originals of this Contract Renewal Letter by ********* ** **** to the attention of: **********,F* **h********* Colorado Department of Public Health and Environment,4300 Cherry Creek Drive South,Denver, Colorado 80246, Mail Code: *******. One original of this Contract Renewal Letter will be returned to you when fully approved. Contractor's Legal Name STATE OF COLORADO (legal type of entity) Bill Owens, Governor By: By: Name: For the Executive Director Title: DEPARTMENT OF PUBLIC HEALTH FEIN: AND ENVIRONMENT APPROVALS: FOR THE STATE CONTROLLER: PROGRAM: Arthur L.Barnhart By: By: NHVP CONTRACT DRAFT 2J/I2/6/00//LEE JOSEPH Page 19 of 17 Hello