HomeMy WebLinkAbout20242828.tiffRESOLUTION
RE: APPROVE APPLICATION FOR EXPANSION OF DIABETES PREVENTION
PROGRAM GRANT FUNDS FOR MEDICAID RECIPIENTS AND AUTHORIZE
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT TO SUBMIT
ELECTRONICALLY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Application for Expansion of Diabetes
Prevention Program Grant Funds for Medicaid Recipients from the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Public Health and Environment, to the Colorado Department of Public Health and
Environment, Office of Health Disparities, with further terms and conditions being as stated in said
application, and
WHEREAS, after review, the Board deems it advisable to approve said application, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Application for Expansion of Diabetes Prevention Program Grant
Funds for Medicaid Recipients from the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Department of Public Health
and Environment, to the Colorado Department of Public Health and Environment, Office of Health
Disparities, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that Kelly Martinez, Department of Public
Health and Environment, be, and hereby is, authorized to electronically submit said application.
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2024-2828
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APPLICATION FOR EXPANSION OF DIABETES PREVENTION PROGRAM GRANT FUNDS
FOR MEDICAID RECIPIENTS
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 23rd day of October, A.D., 2024.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY. COLORADO
ATTEST: ` 47,1 A J ..11`41:4
Weld County Clerk to the Board
BY: / /l •lCtVk)ide
Deputy Clerk to the Board
APVED
County A orney
101ZQ
Date of signature:
Ke� . Ross, Chair
Perry L. B ,- k, Pro-Tem
Mike Freeman
James
Saine
2024-2828
HL0057
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: CDPHE Office of Health Disparities Grant
DEPARTMENT: Public Health and Environment
PERSON REQUESTING: Jason Chessher, Executive Director
DATE: October 21, 2024
Brief description of the problem/issue:
Diabetes is a major public health problem in Weld County. One in nine residents (11.4%) have been diagnosed
with type 2 diabetes by a health care provider, but the Centers for Disease Control (CDC) estimates that one in
three adults in the U.S. are pre -diabetic. Lifestyle change interventions are key components to reducing the risk
of developing type 2 diabetes. The Center for Disease Control Diabetes Prevention Program (DPP) has
demonstrated that people engaged in a structured lifestyle change program reduced their chance of developing
type 2 diabetes by 16 percentage points per year. Funding from the Colorado Department of Public Health and
Environment, Office of Health Disparities, will allow the department to expand on the diabetes prevention program
which will make it easier for Medicaid recipients residing in Weld County with prediabetes to participate in a
relevant, high -quality lifestyle change program. Our programs will include education about diabetes prevention
and lifestyle changes, informal counseling, coaching, and extended support for people with a higher risk for
diabetes.
What options exist for the Board? The Board could approve or disapprove applying.
Consequences:
If successful, this grant award will permit WCDPHE to expand diabetes prevention programming to Medicaid
recipients throughout Weld, thereby potentially preventing or delaying the onset of type 2 diabetes.
Impacts:
Declining the grant opportunity will limit the department's ability to expand the program, thereby continuing to limit
accessibility to the classes because of stretched resources. This could potentially result in increases in type 2
diabetes in Weld County. Diabetes is the most expensive chronic condition in our nation. $1 out of every $4 in
US health care costs is spent on caring for people with diabetes.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years):
There is no County cost associated with this grant. If successful, grant funding will substitute county funding for a
current FTE. Grant funding would be utilized to hire additional part time/temporary employees limited to the term
of the grant.
$68,850.00 for half of fiscal year 2025 (April 1, 2025 — June 30, 2025)
$260,250.00 Fiscal Year 2026 (July 1, 2025 — June 30, 2026)
$260,250.00 Fiscal Year 27 (July 1, 2026 — June 30, 2027)
Recommendation: I recommend approval to place this item on a future BOCC agenda for formal consideration.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck, Pro-Tem
Mike Freeman
Scott K. James
Kevin D. Ross , Chair
Lori Saine
(0/23
2024-2828
At,01051
Section A. Executive Summary
1. Project Title: Corazon de Weld
2. Executive Summary: (500 words)
Diabetes is a major public health problem in Weld County; 1 in 9 residents (11.4%) reported being
diagnosed by a health care provider with diabetes while an additional 11.3% have been told they are
prediabetic. The burden of diabetes is not evenly distributed, however. A higher percentage of Hispanic
Weld County residents reported they have diabetes (15.9%) compared to White, Non -Hispanic residents
(9.7%) in 2022. Additionally, Weld's Hispanic population is overrepresented among residents with
household incomes at or below the Medicaid income limit; 37.1% compared to 18.8% countywide. The
same racial/ethnic discrepancies are not apparent in self -reported rates of prediabetes underscoring the
importance of equitable interventions for the county's prediabetic population aimed at reducing
disparities (2022 Weld Community Health Survey).
Diabetes was the 8th leading cause of death among all Weld County residents and the 5th leading cause
of death among Hispanic/Latino residents between 2020-2022 demonstrating the mortality disparity for
Hispanic/Latino residents. Diabetes was also the 9th leading contributor for years of potential life lost
(YPLL) before age 65 between 2020-2022, demonstrating the impact of diabetes on residents younger
than 65 (Weld County YPLL Analysis, CDPHE Vital Statistics Program, unpublished Data, special data
request). Lifestyle change interventions have proven effective in reducing the risk of developing type 2
diabetes. The Center for Disease Control and Prevention's (CDC) Diabetes Prevention Program (DPP) is a
structured lifestyle change program that reduces an individual's chance of developing type 2 diabetes by
16 percentage points per year. Congress authorized the CDC to establish the National Diabetes
Prevention Program (DPP) in 2010. The program is group -based, facilitated by a trained lifestyle coach,
and uses an evidence -based CDC -approved curriculum. In June 2023, the Weld County Department of
Public Health (WCDPHE) started offering the CDC DPP and in September 2024 received preliminary CDC
Diabetes Prevention Recognition; a process that takes over a year to achieve.
Corazon de Weld interventions will be delivered in English and Spanish by community health workers
(CHWs) to community groups and individuals at increased risk for diabetes. Programs will include
education about diabetes prevention and lifestyle changes, informal counseling, coaching, and extended
support for people with a higher risk for developing diabetes. Content will be delivered through one-on-
one interactions, group sessions, or a combination of the two and may be offered in homes, worksites,
or community -based settings. DPP classes will be offered in -person and through virtual learning
platforms (whichever best fits the needs of community members).
Section B. Required Project Components
3. What key strategies will be implemented, and what data informed the selection:
The National Diabetes Prevention Program (DPP) provides the opportunity for people with prediabetes
or at risk for type 2 diabetes to participate in an evidence -based, affordable, and high -quality lifestyle
change program. DPP programs help adults reduce their risk of type 2 diabetes and improve their overall
health. Research shows that CDC -recognized lifestyle -change program participants who lost 5-7% of their
body weight and added 150 minutes of exercise per week cut their risk of developing type 2 diabetes by
up to 58% (71% for people over 60 years old, 2002 DPP Outcomes Study). A decade later, participants
were one-third less likely to develop type 2 diabetes than individuals who did not join a program.
Participation has been found to lower the risk of having a heart attack or stroke, improve overall health,
help participants feel more energetic, and in many cases, reverse a prediabetes diagnosis. Corazon de
Weld will work to make it easier for low-income and Spanish-speaking community members with
prediabetes to participate in an affordable (free), high -quality lifestyle change program to reduce their
risk of type 2 diabetes and improve their overall health.
Individuals from low socioeconomic backgrounds may have limited access to healthcare services due to
cost, lack of insurance, or transportation challenges, therefore, the Corazon de Weld program will also be
providing free community screenings in addition to the CDC DPP and group exercise opportunities (led
by Hispanic teachers). This strategy is being implemented to identify lower income community members
who may have A1c scores in the prediabetic range due to a lack of consistent primary care. In Weld
County we know that over 1 in 10 individuals (11.3%) have been told they are prediabetic and we want
to ensure there are opportunities for all in the county to learn their risk and register for a free DPP
program that is culturally competent for our Hispanic/Latino community.
CorazOn de Weld's focus on low-income and Hispanic/Latino residents is informed by WCDPHE's 2022
Community Health Survey data, which shows that these demographic groups experience both higher
rates of diabetes and less access to health care. As mentioned in the executive summary, 15.9% of
Hispanic/Latino adults in Weld County have diabetes, compared to 9.7% of White, non-Hispanic/Latino
adults. Twenty-seven percent of those with household incomes between 101 and 138% FPL (Medicaid
threshold) have diabetes, significantly higher than other income groups. While some sources of health
insurance assist with or cover the cost of lifestyle -change programs like DPP, not all Weld residents have
equal access to health insurance; Hispanic/Latino residents of Weld County are uninsured at nearly ten
times the rate of White, non-Hispanic/Latino residents (23.4% and 2.5%, respectively).
We also know that factors like housing instability, food insecurity and employment can make diabetes
management more difficult, therefore WCDPHE will partner with the Weld County Department of
Human Services and the United Way of Weld County to provide resources and connect patients to social
services that can alleviate these external pressures. From Weld CHS data we know that in 2022, 7.1% of
Hispanic/Latino community members needed work-related/employment services, 7.9% needed housing
services, and 26.0% needed food or meal assistance.
Using CHWs to implement the CDC DPP is a key strategy due to the success of CHW programs in
providing culturally competent programming, including programming specifically targeting diabetes.
According to the National Institutes of Health, CHWs share life experience with the people they serve
and have firsthand knowledge of the causes and impacts of health inequity. They provide a critical link
between marginalized communities and health care and public health services. Several studies have
demonstrated that CHWs can improve the management of chronic conditions, increase access to
preventative care, improve patients' experience with care and reduce health care costs. Ingram et al.
found that the inclusion of promotoras was associated with improved HbA1c levels in Mexican American
farmworkers. The farmworkers also reported increased family/friend support and being able to discuss
diabetes more easily with family and friends. By utilizing trained CHWs to deliver the CDC DPP, we can
ensure racial and ethnic congruence with the communities the CorazOn de Weld Program will target.
CHWs have an unparalleled understanding of cultural, linguistic, and social nuances within the
neighborhoods they work which will greatly enhance community engagement among targeted
populations.
Ingram, M.; Torres, E.; Redondo, F.; Bradford, G.; Wang, C. (2007). "The Impact of Promotoras on Social Support and
Glycemic Control...". The Diabetes Educator. 33 (Supplement 6): 172S -178S.
4. How will innovative or evidence -based approaches be used to address the specific health disparities
in the chosen affected community?
Utilizing CHWs to implement the CDC DPP is one evidence -based approach that will be used to reduce
health disparities for the Hispanic/Latino community. CHWs who are from the same cultural background
will help bridge language and cultural barriers. WCDPHE CHWs will provide education, support, and help
to navigate the healthcare system. Family -based interventions can be instrumental in preventing the
development of prediabetes into diabetes (Prakoso et al.). Recognizing the importance of family in
Hispanic/Latino culture, CorazOn de Weld will implement interventions that involve family members. By
recognizing and leveraging the central role of family in Hispanic/Latino cultures, family -centered
approaches will lead to more effective and sustainable diabetes prevention strategies in Weld County.
This approach aligns with cultural values, addresses shared risk factors, and creates a supportive
environment for health behavior changes. This will include using Spanish language materials,
incorporating traditional foods into dietary recommendations, and addressing clinical beliefs about
health and illness. Eighteen percent of households in Weld County prefer a language other than English
in the home, and 90% of those households preferred Spanish.
An innovative approach WCDPHE will implement is to have CHWs assist participants in addressing needs
related to social determinants of health (housing, education, employment, etc.) by sharing information
about available programs and helping participants to navigate complex systems to access resources like
food assistance programs, affordable housing, or job training opportunities. Another crucial, innovative
role CHWs will implement is to facilitate connections between healthcare providers, social services, and
community organizations to create a more integrated support system. Likewise, they will serve as
cultural brokers, helping healthcare and social service providers understand and address cultural factors
affecting health. This approach will allow CHWs to address health disparities for Hispanic/Latino
residents and low-income residents.
The CDC's DPP program itself is an evidence -based diabetes prevention approach which is why WCDPHE
has chosen to implement this particular structured lifestyle change program that has been proven to
reduce an individual's chance of developing type 2 diabetes. (Program participants who lose 5-7% of
their body weight and add 150 minutes of exercise per week cut their risk of developing type 2 diabetes
by up to 58% (71% for people over 60 years old) (2002 DPP Outcomes Study).
Prakoso DA, Mahendradhata Y, Istiono W. Family Involvement to Stop the Conversion of Prediabetes to Diabetes.
Korean J Fam Med. 2023 Nov;44(6):303-310. doi: 10.4082/kjfm.23.0019. Epub 2023 Aug 14. PMID: 37582666; PMCID:
PMC10667073.
5 How do cultural and socioeconomic factors shape the approach and implementation of this project?
Some communities may have a history of mistrust toward healthcare due to past discrimination or
mistreatment. Building trust by employing CHWs from the same cultural background and providing
culturally sensitive programming will help overcome these barriers.
Cultural and socioeconomic considerations in the design and execution of Corazon de Weld will play a
crucial role in the success of our project. Different cultural groups have varying beliefs about health,
illness, and treatment which can influence their understanding of diabetes and its management.
Corazon de Weld will utilize CHWs to conduct outreach, build relationships, and employ culturally
appropriate education and information when engaging with the target population. Likewise, ensuring
culturally appropriate food habits are recognized and respected will be central to ensuring pre -diabetes
and diabetes management within the Hispanic/Latino community. Corazon de Weld's educational
materials and interventions will respect and incorporate culturally specific diets rather than impose
generic dietary recommendations.
Lack of language proficiency can be a major barrier in healthcare access and communication. Corazon de
Weld will ensure that educational materials, resources and programs are available in the participant's
preferred language to engage and improve outcomes.
To help offset the burden that lower income residents may face in accessing preventative services
Corazon de Weld will provide free screenings, diabetes prevention classes and group exercise
opportunities (limited access to healthcare services can be due to cost, lack of insurance, or
transportation challenges). Additionally, factors like housing instability, food insecurity and employment
can make diabetes management more difficult, therefore CHWs will partner with the Weld County
Department of Human Services and the United Way of Weld County to provide resources and connect
patients to social services that can alleviate these external pressures. These strategies are important to
the overall implementation of Corazon de Weld.
Project Impact & Evaluation
6. What impact on community health is expected, and how will success be measured?
The CDC's DPP is designed to reduce the incidence of type 2 diabetes through prevention and its
potential impacts on community health are significant. By promoting lifestyle changes like physical
activity, improved diet, and weight loss, the Weld's DPP can help prevent or delay the onset of type 2
diabetes. This could lead to a reduction in new diabetes cases within the county. Participants in the
CDC's DPP often see improvements in blood pressure, cholesterol levels, and cardiovascular health.
These changes contribute to a lower risk of cardiovascular disease, heart disease, and stroke, common
complications associated with diabetes.
Preventing diabetes through lifestyle changes can lead to significant cost savings for communities,
reducing the burden on healthcare systems by lowering the need for medical treatments and
hospitalizations related to diabetes complications. Through all -payer health insurance claims data
obtained from the Center for Improving Value in Health Care (CIVHC), we know that the total amount
charged for type 2 diabetes claims from 2018-2021 for Weld County residents was roughly $683 million,
with a total of 287,896 health insurance claims related to diabetes made during that period. The average
charge amount per type 2 diabetes claim rose each year. Across the four years included in the analysis,
the average charge was $2,373.80 per claim. By preventing the development of diabetes in residents
significant cost savings could be achieved.
Diabetes disproportionately affects certain populations, including minority and low-income groups. By
offering accessible prevention programs, the DPP can help reduce health disparities in these
communities. The disparity in diabetes rates between Hispanic/Latino and non-Hispanic/Latino
residents, and between income groups will continue to be measured every three years in Weld's
Community Health Survey.
Program success will be measured in the short-term by the number of DPP classes offered by CHWs to
Hispanic/Latino and lower income community members, the number of community members enrolled
and completing each DDP class, and the number of participants who successfully reduced their risk of
developing diabetes by achieving one of three goals outlined by the National DPP: 5% weight loss, 4%
weight loss combined with an average of 150 minutes a week of physical activity, or a 0.2% reduction in
A1C scores.
Program success will be measured in the long-term (10+ years) by a reduction in new diabetes cases
amongst Hispanic/Latino community members (as measured by WCDPHE's Community Health Survey
conducted triennially), a reduction in diabetes prevalence rates across different demographic groups
including but not limited to race/ethnicity, income, region, education, and insurance status (to show a
reduction in the disparity of diabetes rates), a reduction in diabetes -related emergency department
usage, and a reduction in diabetes -related death rates amongst Hispanic/Latino community members in
Weld County.
7. What metrics or indicators will be used to monitor progress and keep the project on track?
Corazon de Weld will follow the CDC's DPP requirements for measuring and monitoring our program.
WCDPHE has shown that we can meet CDC standards and effectively deliver a proven diabetes
prevention lifestyle change program as evidenced by obtaining recent CDC recognition. Corazon de
Weld's lifestyle change program will submit evaluation data every 6 months as required by the CDC. This
data includes elements such as participant demographics, socioeconomic status, weights, and physical
activity minutes. CDC does provide WCDPHE with a report after every data submission that outlines
progress toward program goals. Additional facilitator evaluation forms are given out after six months and
one year to improve program delivery and ensure program learning objectives are being met. Further
enrollment, outreach, and screening objectives will be monitored by DPP interest/sign-up forms,
attendance sheets, intake forms, and health screening documentation. Additionally, program objectives
for any media campaigns associated with the program will be monitored via vendor -supplied reach
analytics, internal website analytics, and prediabetes risk test form submissions.
Monitoring a DPP requires a combination of metrics and indicators that track participant progress, DPP
cohort progress, and overall programming progress.
Participant Progress:
• Percent of participants achieving weight loss goal (5-7% reduction in body weight from baseline,
though a combination of 4% weight loss and 150 minutes average weekly physical activity is also
considered an achievement of risk reduction).
Percent of participants achieving physical activity goal (average of at least 150 minutes of
moderate -intensity exercise per week).
Percent of participants achieving appropriate blood glucose levels (blood glucose levels within
normal ranges (e.g., fasting blood sugar <100 mg/dL, HbA1c <5.7%)).
DPP Cohort Progress:
• Retention rates (CDC requires set retention rates per cohort at various program intervals).
• Percent of participants who say they would recommend the DPP to a friend or family member.
• Percent of participants who agree that all program learning objectives were met.
• Participants' average rating (scale of 1 to 5) of facilitator's knowledge, organization, ability to
engage participants, and ability to effectively present materials.
Program Reach and Demographics
• Number of participants who list their ethnicity as "Hispanic" on demographic questionnaire.
Number of participants enrolled in Spanish -language DPP classes.
Number of participants enrolled in Medicaid (indicating household incomes at or below 138%
FPL).
These metrics will provide a comprehensive framework for evaluating the success and impact of a
diabetes prevention program, allowing for adjustments and improvements as needed.
To monitor programming progress several key metrics and indicators will be used:
Number of screening events and number of individuals screened (track reach by demographic
variables).
Number of individuals referred to DDP program from screenings.
Number of partnerships created with local government, housing authorities, schools, and non-
profit organizations.
Number of participants connected to community resources (housing, food, employment
services, etc.).
Reach data for public awareness campaign.
8. How will the effectiveness of the project be evaluated, and what strategies will be used to manage
risks and ensure success?
To evaluate the effectiveness and manage risks of Corazon de Weld, a comprehensive approach will be
used. We will focus on evaluating the effectiveness of the program in both reducing the development of
diabetes in those participating in our DDP and in ensuring our program delivery is of the highest fidelity.
To ensure the effectiveness of the program in reducing the development of diabetes in participants their
health data will be monitored and assessments at mid -point and program end will occur to identify the
percentage of participants that successfully reduce their risk of developing diabetes by achieving one of
three goals outlined by the National DPP: 5% weight loss, 4% weight loss combined with an average of
150 minutes a week of physical activity, or a 0.2% reduction in A1C scores. If a higher percent of
participants than expected are not achieving individual goals related to their personal progress quality
improvement tools will be utilized to identify root causes and plan program updates (while maintaining
program fidelity).
To ensure the program is delivered to high fidelity evaluations specific to facilitator performance and
participant learning objectives will be completed at mid -point and program end. Project staff and CHWs
will be provided training and support. All staff involved in program implementation will be trained in
cultural sensitivity and health equity principles. Program staff will ensure interventions are culturally
appropriate and linguistically accessible. The health department's newly developed Language Assistance
Plan will be used as a guiding document and resource for ensuring the program is meeting resident's
linguistic needs.
Qualitative feedback will be obtained through surveys and interviews with DPP participants and
stakeholders. Organized focus groups may be used to gather in-depth insights — these may be
particularly relevant to understand and ensure the program is implemented with a high degree of
cultural competence.
To manage risks and ensure success process evaluations will be conducted to assess the implementation
of project activities and to monitor adherence to project timelines and budgets. Additionally, outcome
evaluations will be conducted to compare pre- and post -intervention data and to analyze changes in
health behaviors and knowledge.
Additional, risk management strategies will include stakeholder engagement involving community
leaders and target populations in planning and implementation and to establish partnerships with local
healthcare providers and organizations. Adaptive management practices will be implemented by
regularly reviewing project progress and adjusting strategies as needed by instituting a flexible approach
to accommodate unforeseen challenges. Corazon de Weld will develop clear messaging about the
program's goals and benefits and maintain transparent communication with all stakeholders.
Standards outlined by the National Diabetes Prevention Recognition Program will be used to ensure data
privacy and security compliance.
9. What strategies and partnerships will ensure sustained long-term health improvements?
To ensure sustained long-term health improvements with Corazon de Weld, a combination of strategies
and partnerships will be used. These efforts will address both short-term outcomes and the systemic
factors that contribute to disparities in diabetes prevention.
Program staff will engage community members and leaders in the program design and delivery to ensure
cultural relevance and responsiveness to community needs. There will be involvement from CHWs who
understand the cultural and social dynamics of the target population. Partnerships will be developed and
strengthened with local community organizations, faith -based groups, and neighborhood associations to
build trust and increase participation in the program.
Culturally appropriate education on diabetes prevention, emphasizing healthy lifestyle changes that are
relevant to the daily lives, diets, and traditions of the target population will be provided. Language
differences, literacy levels and cultural beliefs will be considered in the development of all program
materials.
Corazon de Weld will integrate with local healthcare systems by aligning the program with local
healthcare providers and systems to ensure a continuum of care. Local healthcare/health systems that
will approached include UCHealth, Banner Health, North Colorado Health Alliance, Salud Family Health
Centers, and Sunrise Community Health. These integrations will increase the likelihood that participants
who are at risk or diagnosed with diabetes receive timely, coordinated care and follow-up (by being
enrolled in WCDPHE's DPP program). Project staff will work with local clinics, hospitals, primary care
providers, and Federally Qualified Health Centers (FQHCs) to facilitate referrals, screening, and
management of diabetes -related care.
Trainings for healthcare providers, community leaders and program facilitators in the specific needs of
underserved populations, including how to address social determinants of health (e.g., housing, food
access and transportation) that affect diabetes risk will be conducted. In addition, ongoing education and
capacity -building workshops for staff and community health workers will be offered.
Corazon de Weld will have a robust data collection and sharing system to track long-term health
outcomes, program effectiveness, and emerging needs within the community. The project will use data
to continuously improve interventions and adapt to changing health challenges.
Program staff and CHWs will partner with the Weld County Department of Human Services and the
United Way of Weld County along with with local government, housing authorities, schools, and non-
profit organizations to address food insecurity, create safe environments for exercise, and offer
education and economic opportunities to underserved populations.
Lastly, public awareness campaigns to increase knowledge of diabetes prevention and healthy living,
especially within high -risk communities will be conducted. Social media, local radio, geo-fencing, and
billboard campaigns will be used to disseminate culturally appropriate health messages. Corazon de
Weld will have the benefit of submitting outreach materials to the health department's Spanish -
language Community Advisory Committee; a group of community members who receive compensation
for reviewing outreach materials and offer feedback on ways to make them more salient, relevant, and
understandable.
10. How will the Affected Community be engaged, following the "Colorado Community Engagement
Spectrum".
The affected community will be engaged at several levels following the Colorado Community
Engagement Spectrum. Primarily Outreach, Involve, and Collaborate. Our approach of hosting free
health screenings and spreading the word about our DPP program and when and how residents can join
fall into the Outreach level. The outcome of these activities at the Outreach level is to increase
engagement with the community and ensure community members are aware that WCDPHE offers free a
free DPP program. Our strategy includes hosting outreach events and working with other community
organizations to spread the word about WCDPHE's DPP program.
Our approach of working with DPP participants one-on-one to connect them to resources for Social
Determinant of Health needs they may have and working with healthcare/health organizations to create
a referral system fall into the Involve level. The outcome of these activities at the Involve level is to meet
the underlying needs of community members that, if not addressed, may limit their ability to make
healthy choices. Additionally, working with other healthcare/health organizations to create a referral
system linking residents at risk for diabetes with programming increases the sustainability of the
program. Our strategy includes holding regular, one-on-one meetings between CHWs and participants in
order to ensure they receive support and helping them to navigate systems to access support (not just
providing referrals). When working with other healthcare/health organizations we will meet regularly
with them and determine next steps for how best to create an effective referral system — this includes
collaborating on decision -making and reporting on process/needs.
Our approach utilizing CHWs and basing decisions on where, when, and how to conduct DPP classes fall
into the Collaborate level. The outcome of these activities at the Collaborate level is to increase
engagement with the community and empower community members — this will also increase program
participation/engagement and lead to more participants meeting CDC DPP success (reducing their risk of
developing type 2 diabetes). Our strategy includes hiring CHWs from the affected community and
utilizing their lived experience to make decisions (including determining changes to program materials to
increase cultural competence and determining how programming components should be implemented).
We will also ensure participants needs are addressed by ensuring decisions are made with them in
regard to how, when, and where the DPP classes should be scheduled and empowering them to provide
feedback on other support mechanisms we can put in place to improve their success.
11. Legal Name of Applicant Organization
Weld County Department of Public Health and Environment
12. Applicant Street Address
1555 N. 17th Ave.
13. City, State, Zip
Greeley CO 80631
14. Contact Person who will receive information related to this funding opportunity.
Kelly Martinez
15. Contact Person Phone
(970) 400-2325
16. Contact Person Email
kmartinez@weld.gov
17. Number of years your organization has legally been in existence
21-50
18. How many full-time employees does your organization have?
76-100
19. What is the Total Operating Budget of your organization?
> $10,000,000
20. Percentage range of current staff and board that identify with the categories of historically
underrepresented, underserved, or under-resourced populations in Colorado.
Underrepresented
Communities
Board
Staff Leadership
Non -leadership Staff
African
American/Black
0
0
0
Asian / Asian American
0
0
1-25%
Native Hawaiian or
Other Pacific Islander
0
0
1-25%
American Indian or
Alaska Native
0
0
1-25%
Hispanic or
Latin(o)(a)(x)(e)
0
0
1-25%
Older Adults
51-75%
0
1-25%
25pirit, Lesbian, Gay,
Bisexual, Transgender,
Queer, or Questioning
(2SLGBTQIA=)
0
0
1-25%
Gender
nonconforming
0
0
1-25%
People with disabilities
0
0
1-25%
People with low
socioeconomic status
0
0
1-25%
People who live in a
rural and/or
geographically isolated
communities
1-25%
0
1-25%
Total unduplicated
number represented
Prefer not to answer
Prefer not to answer
Prefer not to answer
Total number in
organization
5
6
107
21. Describe the specific cities, neighborhoods, or districts within the selected county(ies) from the
PAR-RFA submission where the project will be implemented.
All Weld County
22. Provide the rationale for selecting these geographic areas, including data that highlights specific
health inequities and other relevant factors that the project aims to address. Use data and evidence to
justify the selection of these areas, focusing on the health disparities and related factors that
necessitate intervention in these locations.
The geographic focus area for this grant is Weld County, an area of Colorado that experiences a greater
burden of diabetes prevalence and diabetes -related negative health outcomes compared to the state at -
large. In 2022, 11.4% of adult Weld County residents reported having been diagnosed with diabetes
compared to 8.1% for all of Colorado. Additionally, Behavioral Risk Factor Surveillance System (BRFSS)
estimates from 2015-2019 accessed through the CDPHE Community Health Equity Map Series, showed
that more than half (52%) of Weld County census tracts have significantly higher age -adjusted rates of
diabetes hospitalizations compared to the statewide average of 1,281.5 per 100,000. Tracts with
particularly high age -adjusted diabetes hospitalization rates are concentrated in the Central and
Southern portions of the county, as high as 6,142.8 per 100,000 in one Greeley census tract, and 4,222.5
in a small Southwest tract near Firestone.
Weld County residents are also disproportionately affected by heart disease mortality, and diabetes is a
common risk factor for developing heart disease. The same BRFSS data from 2015-2019 shows that
central portions of Weld County (particularly in the Greeley/Evans and Windsor/Severance areas) are
significantly higher than the statewide average for age -adjusted heart disease mortality rates. For
example, the census tract that contains the town of Severance has an age -adjusted heart disease
mortality rate of 716.5 per 100,000, more than five times the statewide average of 127.1 per 100,000.
Obesity, a common risk factor for diabetes, is more prevalent in Weld County as 34.1% of Weld residents
in 2022 reported having obesity compared to the contemporaneous statewide obesity rate of 25.0%.
23. Referring to "Honoring All Languages to Advance Equity"; how will you identify and provide
language access, including, but not limited to, translation, interpretation, American Sign Language and
braille, to those in the affected community as needed?
WCDPHE has recently created a Language Assistance Plan (LAP) to ensure all Weld County residents have
equitable access to health and environmental services, to provide clear guidance and training for
WCDPHE staff, and to meet the requirements under Title VI of the 1964 U.S. Civil Rights Act. This Plan
has outlined the Department's policies and procedures to ensure language access. WCDPHE has access
to several options for language translation, other than bi-lingual staff, including Language Link and
PocketTalk devices. We will also contract with other organizations as needed to provide language
services that are beyond the scope of Language Link and PocketTalk (American Sign Language for
instance). In order to identify an individual's language WCDPHE has posted notices in commonly
encountered languages notifying limited English proficiency (LEP) persons of their right to free
interpretation and oral translation of written materials and inviting them to identify themselves as a
person needing language assistance. These signs also explain how to get the language help — they are
posted throughout WCDPHE. For our interactions in the community staff have language identification
cards which will be used to identify an individual's language and language translation services will then
be utilized.
The CHWs that will be hired will be bi-lingual in English and Spanish and will help ensure language access
by teaching all DPP classes in Spanish and ensuring all program materials and outreach documents are
available in Spanish for participants.
Exhibit C Budget
COLORADO
Department of Public
Health Er Environment
Applicant Organization
Weld County Department of Public Health and Environment
Budget Period
April 1, 2025 - June 30, 2025
(3 -Month Planning Period)
Project Name
Corazon de Weld
ADMINISTRATION DIVISION - 3 MONTH BUDGET WITH JUSTIFICATION FORM
HEALTH DISPARITIES AND COMMUNITY GRANT PROGRAM
Program Contact Name, Title, Phone and Email
Kelly Martinez, Public Health Communication Manager, 970.400.2325, kmartinez@weld.gov
Fiscal Contact Name, Title, Phone and Email
Bill Fritz, Public Health Finance Manager, 970.400.1211. bfritz@weld.gov
Goal: To build partnerships to mobilize community power and transform systems to advance health equity and environmental justice.
Objective #1: No later than the expiration date of this contract, the Contractor shall receive support and resources to enhance grant project success.
Mandatory Primary Activity: The Contractor shall participate and complete all mandatory training and technical assistance as required by CDPHE.
Activities Description of Work
IResponsible
Party
Timeframe
(P1, P2, P3)
Intended Outcome
Corresponding Deliverable
Total Amount Requested from CDPHE
1.1
Attend HDCGP Grant Orientation/Post-Award Meeting (2 hours)
1 Project Staff, 1
Fiscal Staff
P3
Grantee will learn about compliance with grant requirements and HDCGP staff will take attendance.
1 meeting
$114.38
1.2
Attend Best Practices for Fiscal Contract Compliance Meeting (2 hours)
1 Project Staff, 1
Fiscal Staff
P3
Grantee will learn about fiscal compliance requirements and HDCGP staff will take attendance.
1 meeting
$114.38
1.3
Beginning of grant cycle grantee conference (1 and a half days)
At least 1 Project Staff
P3
Grantee will network with and grow from meeting with other grantees. Attendance will be tracked.
1 event
$1,199.54
1.4
Attend virtual training sessions (2 sessions, 2 hours each)
At least 1 Project Staff
P3
Grantee will benefit from training that supports their success in fulfilling their project and the HDCGP grant purpose.
Attendance will be tracked.
2 sessions
228.76
1.5
Attend in -person or virtual technical assistance sessions (2 sessions, 1 hour each)
At least 1 Project Staff
P3
Grantee will participate in individual, 1:1 TA sessions as applicable and provide evidence of attendance.
2 sessions
114.38
1.6
Participate in the evaluation conducted by the HDCGP evaluation contractor.
All staff members on
project
P3
Grantee will meet with HDCGP evaluation contractor to design and conduct evaluation and provide evidence of
attendance.
1 evaluation,
228./6
Total Primary Activity 1 Costs
$2,000.20
Please list and justify the expenses included in each Total Amount Requested indicated, ensuring to detail how these costs are both necessary and reasonable for the successful execution of the project. A comprehensive budget breakdown should be provided to accurately represent the deliverable costs, categorized as follows:
1.1
Personnel Services : 1FTE 2 hours x 57-19/hr = ($11438) Required Meeting
1.2
Personnel Services: 1FTE - 2 hours x 57.19/hr = ($114.38) • Required Meeting
1.3
Personnel Services: Travel: 130 miles round trip from WCDPHE to CDPHE x .65/mile = $84.50. Denver Per Diem = Lodging 5200 /night x 1 night. Project Staff Time: 16 hours (2 travel hrs) @ $57.19 / hr. $915.04 - Required Conference
1.4
Personnel Services: 1FTE - 2 sessions x 2 hrs/ea. X $57.19/hr = $228.76 Required Training
1.5
Personnel services including fringe 5118,950 • 2 sessions x 1 hr/ea x $57.19/hr = $114.38
1.5
Personel services: 4 hours x $57.19/hr = 5228.76 Required Meeting
Objective #2: No later then May 30th, WCDPHE will complete project planning and initiate project implementation
Primary Activity #2: By June 30, 2025, the contractor shall complete tasks integral to the development and implementation of the Corazen de Weld program.
Page 1 of V. 1 Jan 2013
Exhibit C Budget
Activities I
Description of Work
Responsible Party
Timeframe
(P1, P2, P3)
Intended Outcome
Corresponding Deliverable
Total Amount Requested from CDPHE
2.1
Hire one Diabetes Prevention Coordinator and (3) part-time bilingual Community Health workers.
Health Communication
Manager
P3
Grantee will hire staff members to implement programming. CHWs increase access to programming for communities experiencing
health disparities and increase the cultural competency of programming.
4 staff hired
$0.00
2.2
Develop detailed project plan
Diabetes Prevention
Coordinator and
community
stakeholders
P3
Grantee will develop structured step-by-step roadmap for executing the project, outlining tasks, timelines, and milestones
1 project plan
$3,568.50
2.3
Create internal evaluation protocols and processes.
Diabetes Prevention
Coordinator and Iii -Kind
WCDPHE Data Specialists
P3
Grantee will determine internal processes and protocols and set-up evaluation tracking documents.
1 evaluation protocols plan
$3,568.50
2-4
Establish partnerships with local healthcare providers and community organizations
Diabetes Prevention
Coordinator
P3
Grantee will meet with local healthcare providers and community organizations to create relationships and referral systems. Referral
systems will increase enhance community engagement, provide more preventative and comprehensive care, and increase long term
program sustainability
list with partner agencies
55,941.50
2.5
Develop and implement a communication and engagement plan to promote participation in DPP programs among
intended high -risk groups including social media, outreach, and presentations at community events. Develop outreach plan
including strategies and linguistically and culturally appropriate outreach materials
Diabetes Prevention
Coordinator and
Community
Stakeholders
P3
Grantee will engage community to achieve program outcomes, ensure equitable decision -making, and deepen relationships and trust
Engagement plan document
$2,973.75
Total Primary Activity 2 Costs
$16,058.25
H
2.1
Personnel Services: Project staff will be mtercviewed and hired by WCDPHE Health Education Communication and Planning Division Management Team (In -Kind) 1FTE Coordinator $118,950.02 Two CHWs x up to 75FTE x S25/hour = up to $78,000 . Justification - Program Coordinator Program leadership and oversight in the development, implementation and evaluation of program strategies aimed at reducing disparities. CHWs: To bridge
language and cultural gaps, to conduct cultural) competent outreach, provide peer support and navigation and provide behavior change support.
2.2
Personnel Services: )FTE Coordinator 59912 50 / mo x 3 mo = $29,737.50 x 12% of time spent on activity = $3568.50 Justification - Establish clear objectives and milestones with community stakeholders and ensure that all activities and deliverables directly contribute to the programs desired outcomes
2.3
x 3 mo = 529,737 50 x 12% of time spent on activity = $3568.50 Justificaton - Track progress toward grant objectives regularly, demonstrate progress and facilitate continuous improvements with data driven decisions
Personnel Services: 1 FTE Coordinator $9912.50 / mo
2.4
Personnel Services: 1 FTE Coordinator $9912.50 / mo x 3 mo = $29, 737.50 x 20% of time spent on activity = $5947.50 Justification - Enhance access to care and resources, streamline access to services, promote culturally competent care and build a network of support for participants.
2.5
Personnel Services' 1 FTE Coordinator $9912.501 mo x 3 mo = 529,737.50 x 10%of time spent on activity = 57973.75 Justification - Targeted messaging, increased engagement through culturally tailored outreach, linguistic accessibility and to ensure comprehensive and inclusive outreach.
Objective #3: No later than June 30, 2025, WCDPHE will hire, train and begin the development of a referral system for project components.
Primary Activity #3: By June 30, 2025, the contractor shall plan and prepare for implementing Diabetes Prevention Program classes.
Activities I
Description of Work
p
Responsible Party
Timeframe
(P1 P2, P3)
Intended Outcome
Corresponding Deliverable
Total Amount Requested from CDPHE
3.1
Set up program infrastructure (identify classroom space, set-up equipment, schedule classes)
Diabetes Prevention
Coordinator
P3
Grantee will have operational efficiency and optimize resources
list of DPP classes
$3,574.00
3.2
Enroll CHWs in DPRP lifestyle Coach training. Provide intense, structured training on lifestyle interventions for chronic
disease prevention, outreach and referral best practices and training on data collection tools
Diabetes Prevention
Coordinator and CHW
P3
Grantee will enhance CHW skills and knowledge, improve delivery of health education, increase community engagement and have a
greater impact on health outcomes
Training completion certificates
$2, 700.00
3.3
Outreach events
Diabetes Prevention
Coordinator and CHW
P3
Grantee will increase program awareness and reach
Outreach event calendars and
interface counts
$20,140.00
3.4
Begin establishing a referral system For program participation
Diabetes Prevention
Coordinator
P3
Grantee will Increase program enrollment, streamline access to services, have timely identification of at -risk individuals, and strengthen
community partnerships
Referral tracking forms
$5,948
3.5
Metro Denver CHW training
CHW
P3
Grantee will ensure CHWs have a consistent level of knowledge, skills, and competencies leading to higher -quality care and services
Graduation Certificates
57,455
Total Primary Activity 3 Costs
$39,817.00
Please list and justify the expenses included in each Total Amount Requested indicated, ensuring to detail how these costs are both necessary and reasonable for the successful execution of the project. A comprehensive budget breakdown should be provided to accurately represent the deliverable costs, categorized as follows:
3.1
Personnel Services including fringe: )FTE Coordinator 59912.50 / mo x 3 mo = $29,737.50 x 10% of time spent on activity = $2973.75 Operating Expenses: Two Apple leads 10th Generation for CHWs 5300 ea ($600 total) to allow for real-time data collection, documentation, patient education, language support, remote communication and support, access to health resources, GPS and Mapping, and Training and Skill Development. Justification . To e
3.2
Personnel Services: 3 CHWs @ $25/hr X 2day /16hr training = $1,200, Other costs: Training - DPRP Required lifestyle Coach Certification for three CHWs @ $500 ea - $1,500
3.3
Personnel Services: 3 CHWs x $25/Hr x 20hrs per week x 13 weeks = ($19,500) Other costs: Printing and photocopying of program educational materials including handouts, pamphletes, and flyers on diabetes prevention, nutrition and lifestyle changes. Costs based on historical usage: black and white 5.0.02/copy x 8,000 = $160; color $0.06 copy x 8,000 = $480 (5160 + $480 = $640); may also include allocated costs for printing Justification - Expand
awareness of diabetes risk and prevention, educate high risk populations, promote and increase recruitment for DPP program.
3.4
Personnel Services including fringe: 117E Coordinator 59912.50 / mo x 3 mo = $29,737.50 z 20 % of time spent on activity = ($5,947.50) Justification To ensure timely identification and enrollment of high -risk individuals into the DPP program, maximize reach of the target population and facilitate continuity of care and holistic support.
3.5
Personnel Services: 3 CHWs x $25/Hr x 10 hrs per week x 8 weeks = (56.000) Other Costs: Training for CHWs to enroll in Metro State University's i oundations of Communty Health Workers 8 wk certfication course to cultivate communication and relationship building skills, gain a deep understanding of social determinants of community health and learn to identify and address disparities in healthcare access and treatment. 3 CHWs x 5485 = ($1,455)
Justification - To ensure that CHWs have received consistent and standardized training across key areas, such as health education, patient navigation and comunity outreach.
Page 2 of V. 1 Jan 2013
Exhibit C Budget
Contractual (Payments to Third Parties or Entities)
Total Amount Requested from CDPHE
Total Contractual
50.00
$57,875.45
SUB -TOTAL BEFORE INDIRECT
Indirect
Total Amount Requested from CDPHE
Total Indirect
$16,973.00
TOTAL AMOUNT REQUESTED
568,848.45
Page 3 of V 1 Jan 2013
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