99-873CawcilFde# Q 1 � 0 � �
ORIGINAL
:�
RESOLUTION
OF SAINT PAUL, MINNESOTA
Pcesented By
Refermd To
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Green Sheet # 103701
Committee: Date
WHEREAS, the City of Saint Paul seeks to improve the health of high risk, low-income
mothers and infants, and adolescents; and
WHEREAS, the Minnesota Department of Health accepts application grants from
Community Health Boards for programs which provide health services to high risk
pregnant women and children in Saint Paul; and
WHEREAS, the City of Saint Paul is a designated Community Health Board identified
by State Statute 145.882 Subd.3 to receive Maternal and Child Health funding; and
WHEREAS, the City of Saint Paul wilf submit a grant to the Minnesota Department of
Health to fund programs to improve pregnancy outcomes and to improve adolescent
health; and
WHEREAS, the operating agency for this grant will be the Saint Paul - Ramsey County
Department of Public Health;
THEREFORE, BE IT RESOLVED, that the Saint Paul Board of Health supports the grant
application and subsequent contract with the Minnesota Department of Health for the
Saint Paul Maternal and Child Health Block Grant, and authorizes proper City Officials
to contract on its behalf with the Minnesota Department of Health.
by Department of:
Adoption �rtified by Council
BY� I
Approved by
By: _
r�lf�[`/rN�� 1 ,/e .
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Date f`7"' �yT / Appr Mayot for Submi ion to CouncIl
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AdoptedbyCouncIl: Date��,_g,� ����
qa-t�3
Public Health
Diane
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GREEN SHEET
ov.Rr�r ow�art
No 103701
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(CLJP ALL LOCATIONS FOR SIGNATURE)
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8/20(99
TOTAL # OF SIGNATURE PAGES 1
signatures on a Resolution for Board of Health support of the 2000-2001 Saint Paul
nal and Child Health grant application to the Minnesota Department of Health.
PLANNING COMM1SSlON
d6 COMMITTEE
CNIL SERVICE fAMMISSION
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ta �his tlepartment'7
�wt no�mallypoaaeasetl bY aM' curteM oitlt empbv�7
INITIATWGPROBLEMISSUE.OPPORIUNITY(WIq,WIH[,Wl�en.W11He,WFIy) '1�12 C1t�T Ot J31Tlt Yaui, thT011gh Yllb11C iieatin W11.L
submit a grant proposal to the Minnesota Department of Health for funding of services to
improve pregnancy outcomes and improve adolescent health. By State Statute,Maternal and Child
Health Special Project Grant funding is designated to Che Saint Pau1 Board of Health. Through
the Public Health Joint Powers Agreement, the City of Saint Paul retains a Board of Health.
The operating agency for the_administration of this grant and these programs is the Saint Paul
The City will xeceive funding to help assure that pxenatal and other sexvices are provided
to high risk, low-income populations.
The health status of Saint Paul residents may improve.
Saint Paul residents will have greater access eo health care for these services.
NONE
Funding will not be received to support the above mentioned activities.
amouw70vsanwsncr�w+5 7 ,fi2�.1 53
sounceState of Minnesota
(O6�WN)
COS7/ttEVFNUE St70GETED (CIRCLE ON�
ncrrvm NuMS�
YES NO
Caura:�1 R�sea�ch Center
aR-�3
From: Nancy Anderson
l'o: jerryb, baribeau, gerrym, colemanc, barbb, leschj,...
Date: 8/18/9911:50am
Subject: SOARD OF PUBLIC NEAITH MEETlNG.
Councilmembers - FYI:
The City Council wili meet as the Board of Public Healtb on Wednesday, September 8, 1999, immediately foflowing
the regular City Council Meeting.
The agenda item will be: A resolution supporting the 2000-2001 Saint Paul Matemal and Child Health grant
application to the Minnesota Department of Health.
Please add this meeting date and time to your calendar.
Nancy Anderson
CC: CAO.Atlorney.byrne, TMSD.TMS.devine, TMSD.TMS.hans...
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99-�73
�
MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
�
IMPROVED PREGNANCY OUTCOMES
AND
AD�LESCENT HEALTH
Z000 - 2001
Submitted by:
SAINT PAUL COMMITNITY HEALTH BOARD
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR STREET
ST. PAUL, MN 55141
,
The Saint Paul Board of Health
�a � The Saint Paul - Ramsey County Depardnent of Pubiic Health
The public health joint powers agreement between the City of Saint Paul and Ramsey
County became effective July 1, 1997. The Joint Powers Agreement forms the Saint Paul -
Ramsey County Deparnnent of Public Health and idenufies one Community Health Services
Agency for the Saint Paul - Ramsey County community. However, both Saint Paul and
Ramsey Counry witl maintain a Board of Heaith. The Saint Paul Community Health Boazd
wili consider issues affecting those services maintained by the Ciry of Saint Paul, which will
include the Maternal and Child Health Special Projects Grant. The Sairn Paul - Ramsey
Couaty Department of Public Health becomes the operating agency for the MCH grant.
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� SAINT PAUL MATERNAL AND CffiLD HEA��',�; ;
SPECIAL PROJECTS GRANT 2000-2001
Table of Contents
Page(s)
MINNESOTA DEPARTMENT OF HEALTH FORMS
FaceSheet .............................................................. 1-2
ProjectInformation ....................................................... 3-4
Evidence of Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Assurances and Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8
Certification Conceming Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1�
Certification Regarding Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Efforts to Reduce Racial Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Subgrants/Subcontracts ................................................. 13-14
Services Provided By L,egislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 5-20
Budgets 2000 and 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-22
� BudgetJustification ....................................................... 23
Budget Detail of Local Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Budget By Legislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-26
APPLICATION NAItRATIVE
COMMUNITY ASSESSMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-39
IMPROVED PREGNANCY OUTCOMES
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Q-49
Program Response to Minnesota MCH Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49-50
Inventory of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Project ..............................................................52
ProjectObjectives ....................................................... 52-53
Project Tazget Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
SUBGRANTEE INF012MATION
Subgrantee Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54-56
Health Start,Inc . .................................................... 57-64
Face to Face Health & Counseling Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65-73
� West Side Community Health Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74-7&
Table of Contents
(Continued}
ADOLESCENT HEALTH PROGT2AM
Community Assessment/Problem Statement/Response to MCH Priorities . . . . . . . . . . . . . 79-85
�
Health Start, Inc.
Goalofthe Project .......................................................86
TargetPopularion ..................................................... 86-87
Objectives ........................................................... 87-88
MeYhods............................................................ 88-89
Evaluation..............................................................89
Training/Experience ................................................... 89-90
Linkages............................................................ 90-91
Reimbursementand Fees ............................................... 91-92
Subgrants/Subcontracts ...................................................92
BudgetJustification ..........................................•••.........92
Budgets-2000 and 2001 ................................................ 93-96
Room111 ............................................................. 97-99 •
ATTACHMENTS
Attachment A - Inventory of Community Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100-103
Attachment B - Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104-119
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MINNESOTA DEPARTMENT OF HEALTH �
FORMS
�
C�
�See
of
�Grent Applieation for. �
Maternal and Child Health Special Projects
1. Appliwnt Ageney With Which Gnnt ConLact is to be Exeeuted
LegaiName: StreetAddress:310 City Hall, 15 W. Kellogg Bl
Saint Paul, rIN 55102
Saint Paul Co�unity E-MailAddress:
Health Board
2 Director of Appiicant Agency
555 Cedar Street
Name and TiUe: Sveet Adtlress: Saint Paul, NIN 55101
Rob Fulton E-MailAddress: rob.fulton@co.ramsey.mn.us
Director of Public Health
3. Fiscal Management O�cer of Applieant Ageney
NameandTitle: 5lreetAddress:555 Cedar Street
Diane Holmgren Saint Paul, MN 55101
IHealth Administration E-MailAddress:diane.holmgren@ci.stpaul.mn.us
4. Operating Age�cy (it diHe2nt fiom number 1 above)
NameandTitle: I StreetAddress:555 Cedar Street
>aint Paul - Ramsey Countyl ,�aint Paul, MI� 55101
1e�artment of Public E-MailAddress.
5. Contact Person for Operating Agency (if diHe2nf from number 2 a4ove)
Name and Title: � Street Address:
�iane Holmgren I E-Mail Address:
see 9l3 above)
6. Contact Person for Further Infortnation on Appiieation (if diHerent fmm 5 a6ove)
Name and 7itte: Streel Atldress:
Siane Holmgren E-MailAddress:
;see 1l3 above)
99� 8?3
ad Teiepeone ( 5 )266-856
�� 65� 266-8574
7etephone ( 5 )266-242
F,qX6 5 j 222-2770 '
Telephone6 j292-��1
F �b s j222-2770
Te�ephone�� )292-771
FqX6 5 j2 22-2770
Telephone ( )
FAX ( )
Telephone ( )
FAX ( )
— __
7 ��p�i�ti�9,4�iency F:'isc31'Coiifac! _
�fdifleranffromnumbarSabove3 StreetAddcesa:� - _ . � . _ � . .. -.� .7elephone( ) .
nfame aoC Te�e: : . : .
E-Maif Address " - �. " . . . FAX { � )
$��lte+�..P.aytnBttSs',� - .
e
(dd�flerenttmmnumberlabovej� - SVeetAUdress: 3�3 �edar�St�eet?,• Te7ephone{.�
t�ameandTiUe: Saint Paul i`SN SS10i ��651222-277fl
4ichael Hagen E-Mail Address: � j
9. Copies of This Appiication Have Been Sent to the Followin9 Community Fiealth Boards for Review
(NOt Applicable for Communiry Health Board(s) if tbe 8oard is fhe Applicant)
Aaenw iJame Date Sent
tU. Certifieation
t ceRify that the information contained herein is Vue and accu2te to the best of my knowledge and that I submit this appiiption on behalf of
the appli nt age .� _�� r/
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Signature ot Direclot oi AppiiWnt Agenty T� ���
A
1
Instrucfions for Completiag Face Sheet
Please Type or print all items on tLe Grant Application Form Face Sheet
Applicants please note: The application fo:m has been designed to be used on all Special Project granu administered by the
Minnesota Deparcment of Heahh. If you have questions, or need assistance in completing the
application form, please contact the program Manager or Consultan2 idrntified u responsibte for the
grant
Applicant Agency
I,egal name of the agency autt�orized w enter into a grani contract with the Minnesota Departrnent of Health, e.g., North
Woods Community Health Board.
2. DireMOr of the Applicant Agency
Person responsible for directing the applicant agency.
3. Fiscal Management O�eer of Applicant Agenc�
i
The chief fiscal officer for the recipient of funds who has primary responsibiJity for grant and subsid,v funds expendimre and
reporting. If rhe applicant agency is a Communirv Health Board, the Fiscal Management �cer must be the same person
who is identified as the Fiscal Manaeement Officer in the Boazd's Community Health Service Plan.
4. Operatine Agency
Complete only if other than the applicant agency tisted in namber ] above.
5. Contact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this project
6. Coatact Person for Fnrtber Iniormaaon
�
Person who may be contacted for detailed informarion concerning the appiicaaon or the project if different from number 5
above.
Person in openting agency who may be contacted regarding fescal matters if different ftom 5.
8. �ere�a '� es#S
�� �:.
Address where MDH sbould mail paymenu if different than 1.
9. Copies of this Apptication $ave Been Sent to the Following Communiq� Hea1tL Boards for Review
Provide copies of this application and any subsequent revisions to the appropriate community health boards as required by
the individual insavctions_
] 0. Sigaatum of Director of Applicant Agency
Provide original signamre and date. �
Z
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�SaRwerseSideforLuwaions MinnesotaDepartmentofHealth{MD�
Project Information Sheet for Special Projects
NameofMAHProgzam: Matemal and Child Aealth Special Projects Grant
1. ProjectInformation Saint Paul Community Health Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Public Health
Beginning Dau: End Date: Minaaota Tar I.D. No.: Federal I.D. Number. Social Security Number.
O1/O1/2000 12/31(2001 802-7226 41-6005875
Project Funds Requested: Local Match Provided:
Yeaz I Year 2 Ye�l eaz
$ 810,07� $ 810,077 $ 467,993 $ 4b7,993
Service Area (city, county, or counties):
City of Saint Pau1
2. *?ou-� � aii �iarus - SO1.C3 Copy Attached
❑ Yes � Not Appiicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence o,fComptia,fce Fo,m)
❑ No ❑ Yes � Not Applicable
4. �rmative Action
Tbe agency fias a certiicate from tbe Commissiouer of Auman Rights, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Applicable Because:
❑ 7'otal Convact is $] 00,00 or Less
❑ Agenc;� Hu 40 or Fewer Full-Time Employees
in MinneSOEa
� Uniu of Local Govemment
❑ Indian Reservation
� HE-01274.05(3/99j-PARTB
1CA 1bb42S
Instructions for Completing Project Tnformation Sheet for Speciat Projects �
Please type or print all items on t6e Yroject Informa6on Sheet for Special Yrojects.
Applications please note: The application fozm has been designed to be used on all Speciai Project grants
adminiscered by the Mmnesota Department of Health. If you have questions, or need
assistance in complering tl�e application form, please contaet the Progcam Manger oz
Consultant identified as responsible for the gzant
Projeet Information
ptovide name of applieant agency, beginning and ead date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicabie), or Social Securiry Number, aad geographic service azea. List the totai
amount requested for each year for Project Funds Requested and Local Match Provided. Please refer to
individual instrucrions for each special project grant to deteraane if local match requ'uements aze needed.
2. Non-Profit Status - SQ1.C3 Copy Attxchment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit instituvon, corpontion or organization.
Worker's Compensation
Minaesota Statutes, ChapteT 176, forbids the Commissioner of Health from enteriag into any contract until �
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requiremenu from the contractor. Complete the form entided "Evidence of Compliance" and
retum it with your grant application.
4. �rmative Actioa
Minnesota Statutes, Section 363.073, says "For all contraets for goods and services in excess of S I00,000,
no depamnent or agency of the state shall accept any bid oz proposal for a contract or agreement from any
business having more than 40 futl-rime employees within this state oa a single working day during the
previous 12 months, unless tUe firm or business has an affnmative action plan for the employmenY of
minoriry persons, women, and qualified disabled individuais, submitted to the commissioner of human
rights for approval. No depamnent or agency ofrhe state shal] eacecute any such contract or a�eement until
theaffirmativeactionplanhasbeenapprovedbythecommissionerofhumanrighu. Receiptofacerrificate
ofcompIiance issued by the commissioner sball signify that a firm orbusiness has an affim3ative action plan
that has been approved by t6e commissioner." If the grant or contract you propose meets the "in excess of
$100,000" criterion and youz agency meexs the "more than 40 fu11-time employees" criterion, a CertiScate
of Compliance must accompany your proposal, unless your agency is exempt If you have questions about
the Certificate of Compliance, please contact the:
Minnesota Department of Human Righu
Contract Compliance
Army Corps of Engineers Centre
190 East Fifth Street, Suite 700
St Paul, IviN 55101
(651) 296-5663
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� P Pleacc 7ype or Print
Minnesota Aepartment of Health
Evidence of Compliance
State ]aw forbids the Commissioner of Health from entering into any grant conttaet until the Commissioner
receives acceptable evidence of compliaace with workers' compensation insurance coverage requiremenu from
the gantee. The e�cception to this requirement is a self-employed grantee who has no employees. An employee,
as defined by M.S. 176.01 I, subd. 9, is any person who performs services for another for hire, including minors
and family members.
Ifyou do not fali within the exception and you wish to enter into a grant contract with the Commissioner of Health,
you must fumish acceptabie evidence of compliance with worker's compensation coverage in any one of the
following four ways:
1.
F�
Attach a certificate of insurance (supplied by your workers' compensation carrier) to this Evidence of
Compiiance form; or
If you are self-insured, attach to this E��idence of Compliance form, a written order from ihe Minnesota
Commissioner of Commerce ailowing you to self-insure; or
3. Ifyou aze seif-insuted and you aze a state agency or a municipal subdivision of the state, pursuant to M.S.
176.181, subd. 2, and aze not required to obtain a written order from the Commissioner of Commerce,
circle this entire statement and sign and date the form below in the space provided; or
� 4. Fill in the
�--
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Name and Addrcss of Grantee'S Insurzncc Camer.
and si2n and date
Gronuc's insurana Policy Number.
HE-0327a-05 (3l99) • PAR7 C
1C M )a0.428
I afftrm that all ofthe employ¢es oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are covered by ihe workers' compensation ensu�ance policy fisted above.
ASSURANCES AND AGREEMENTS
�
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES ?.I�'D ASSURES THAT:
1. Services will be provided in accordance with appiicable state and federal laws, rules and proce@ures.
2. The agency will comply with state and federa] requiremenu relating to privacy of client information.
The agency will comply with the Minnesota Clean Indoor Air Act w3vch prohibits smoking in MCH Special
Projeet facilibes and clinics.
4. The agency (if it has I S or more empioyees} and any subcontractors with 15 or more employees will have
on file and available for submission to Minnesota Department of Heatth {IvIDI� upon re.quest a written non
discrimination policy containing at least the following:
"All pmgrams, services, and benefits which are administered, authorized, and provided shaIl be
operated in accordance with the tton discriminatory requirements pursuant to Titte VI of the Civil
Rights Act of 1964, Section 504 of the Rehabilitarion Act of 1973, as aznended, the Age
Discrimination Act of 1975, and the non discriminatory requiremenrs of the MCH Block GzanL
No person or persons shalI on ihe ground ofrace, color, national origin, handicap, age, sex, or religion,
be excluded from participation in, be denied the benefits of, orbe otherwise subjected to discrimination �
under any program service or benefit advocated, autl�orized, or provided by this Department."
5. The agency (if it has I S or more employees) and any subconu�actors with 15 or more employees will
disseminate information to bene8ciarics and the generat public that services are provided in a non
diseriminatory mannez in compliance with civil rights statutes and regutations. Tlus may be accomplished
by:
A. Including a handout containing civi] rights policies in any brochures, pamphleu, or other
communications designed ta acquaintpotential beneSciaries andthepublicwith pmgrams; and/or
B. Notifying refemi sources in routine letters by inctuding prepared handouts which state that
services and benefiu must be provided in a non discriminatory manner.
Copies of each document disseminated and a description of how these documents have been
disseminated will be provided to the MI�H upon request.
6. In futfilling the duties and responsibiliaes of this grant, the grantee shall comply with the Americans with
Disabilives Act of 1990, 42 U.S.C. § 12101, et seq., and the regutatians promulgated pursuant to it.
No residency requirements for services other xhan state residence, wili be imposed.
S. Services shatl not be denied based on inabiliry to pay. -
� =%- �73
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9. Atiangemenu shal] be made for communications to take place in a language understood by the matemal and
child health service recipient
10. All written materials developed to determine client eligibility and to describe services provided undez this
gant will be understandable to a person w3�o reads at a seventh grade ]evel using the Flesch Analysis
Readability Scale as required in Minnesota Statute 144.054 (see Appendix 10, Plain Language in Written
Mazerials, Minnesota Statute, Secuon 144.054).
11_ T'heagencywillprovideservicesinkeepingwithprogramguidelinesoftheMinnesotaDepamnentofHealth
and gwdelines of accepted professionai goups such as the American Academy of Pediatrics, American
College of Obstetricians and Gynecologiscs, and American Public Health Association.
12. Upon request, one copy of any subcontract executed as part of the project wiil be provided to the Minnesota
Department of Health.
13. TheagencywillreportaccomplistunenuoftheprojecttotheMinnesotaDepartmentofHealth. Suchreports
will be submitted no later than 90 days after the compietion of the calendaz yeaz. Upon request, the agency
will provide additional information needed b}° the Department for evaluation ofthe projecYs objectives and
methods and compliance with any special conditions (see Appendix 18, Program Reporting Requiremenu
for Matemal and Clri]d Health Special Projecu).
14.
� 15.
I6.
.
Grant funds shall not be used for inpatient services except for high-risk pregnant women and infanu.
Cash paymenu shail not be made to intended recipients of health services.
Grant funds shal] not be used for purchase or improvement of ]and or facilities.
17. Grant funds shall not be used for purchaze of equipment costing more than $5,000.00 per nnit and v.9th a
usefui life exceeding one year. '
18. Grant funds shall not be used for reimbursement for travel and subsistence expenses incurred outside the
state unless it has received prior written appzoval from the Minnesota Department of Health for such out-of-
state travel.
19. VJhen appiicable, the agency shal] provide nonpartisan voter registration services and assistance using fonns
pmvided by the state to employees of the a2ency and the public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Registration).
20. VJhen issuing statemenu, press releases, requests for proposa3s, bid solicitations, and other documenu
describing projeets and programs funded in whole or in part with federal money, al] grantees receiving
federal funds shall clearly state (a) the percentage of the total cost of the prograzn or projeet which v.�ill be
financed with federal money, and (b) the dollaz amount of federal funds for the project or program.
21. The agency will not use grant funds to pay for any item or service (other than an emergency item or service)
fiunis3�ed by an individual ot entity convicted of a critninal o$ense under the Medicare or any staze health
care program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant programs).
22. Materials developed by Matemal and Child Health Specia] Project grant and matching fimds will be part
of the public domain and will be ac�essible to the pubiic as financially reasonable. Materials developed by
the Matema] and Child Health Specia] Project grant and matchittg funds may be reproduced and distributed
by the Project to otl�er agencies and providers for a profit so long as [he revenues from such sale aze credited �
to the Specia] Project budget for expenditure by the Special Project
23. The agency will comP1Y W'ith all standa''�S reiating to frscai accountability that apply to the Minnesota
Deparcment of Health, specifically:
A. Budget revisions with justificarion will be submitted to MI7H for prior approval whenever:
(1) changes are made in the objectives to be met in the MatemaI and Chiid Health Special
Project, or
(2) the cumulative amouat of funds uansfeaed into or out of an operating agency's budget line
iiem exceeds or is expected to exceed 10% of that approved for the grant year or 52,500.00,
whichever is greater.
B. Final expenditure reports aze due 90 days after the end of the calendar yeaz.
C. Graat funds are used as payment for services only aftez third-party payments, snch as from the
Medical Assistance/Medicaid (I'itle }�X SSA), Children's . Health Plan/MinnesotaCare
reimbursement programs of the Minnesota Department of Human Services and private insurance
are utilized:
D. Project financial management systems will provide for:
(i) Accvrate, current, and complete disclosure ofthe financiai status ofthe project. �
(2) Records which identify adequately the source and application offunds for Materaal and Chiid
Heaith Special Project acti��ives. These records aze to contain information pertaining to
project awards and authorizations, obligations, unobIigated batances, tiabilities
(encumbrances), oudays, and income.
(3) Effective control over the accountability for all funds, property and other asseu. Projecu aze
to adequately safeguard such assets and assure that they aze used solely for authorized
purposes.
(4) Comparison of actual obtigations with bu@get amounts for each activity.
(5} Accounting records which are supported by source documentation.
(6) Audiu which wiil be made by or ai the direction of the Minnesota Department of Health (see
Append' 6, State udits).
Signature of Chair or Vice�chair Of t6� unity Healtb Board or An Agent Appointed by Reso►ution
of th ommunity H Iih Board:
, e � �
� �� � .
�
CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT GRANT
FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
CHECK ONLY ONE BOX:
Q
No
sterili7aflon
provided
�
Xes
sterilization
provided
MCH Special Project grant funds will not be used during CY 199&-99 to
provide and/or azrange sterilizarions. If a client is merely referred to another
health care provider, this provision of information is not consideTed to
„ azT�S�S" a sterilization.
MCH Specia] Project grant funds will be used to provide and(or arrange
sterilizations during CY 1948-99. Agencies wkrich use MCH Special Project
grant funds to pay for a ptocedure or related purpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requuemenu described eisewhere in this document.
� T certify that to the besi ofmy knowledge the above information is correct, and that if this stanu changes, formal
notification in this regard will be sent to the Section Manager, Matemal and Child Health Section, Minnesota
Department of Health, Minneapolis.
Signatum of Director
of Appiicant Agency:
Tit3e:
Date:
L�J
Director of Public Health
9
Iastructions for Completing Certification
Coacerning Use of MCH Special Prnjeet Grant Funds
to Promote and/or Arrange Steritizations
All federal Public Health Service supported progams including the Matemai and Child Health Services Block
Crrant progrun, which use federal funds to provide and/or arrange for sterilization are required to follow federa]
procedures and to provide written documentation in this regard on a quarterly basis.
MCH Special Projects (MCHSP) xnay obiain an exemption from this reporting requirement by signing a
certificaLion that their agency is not using MCFiSP funds to provide and/or amange sterilizations. (If a client is
merely provided infoxmation and refetred, this is aot reported.) Reporting is requzred if MCHSP funds aze used
in some fotm of participation (paying for the procedure, providing transportation, matong an appointment with
another health provider, or detailed counseling beyond simple provision of information).
All Community Health Boazds aze required to complete the Certification. For agencies wlvch do not provide
sterilizations, no fiuther action will be needed dsuing CY 1998-99. The agencies which indicate they do provide
sterilizations must adhere to specific federal service and reporting requirements described elsewhere in this
document
��
l J
r .__
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10
�'�-�573
• CERTIFICATIOT REGARDAVG LOBBYIlVG
The undersigned certifies, to the best of his or her knowiedge and belief that:
(1) No federel appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempring to influence an ofFicez or an employee of any agency, a
member of congess, an officer or an empioyee of any agency, a member of congress, an officer or
employee of congress, or an empIoyee of a member of congress in connec�ion with the awazding of
any fedeml con�act, the making of ang federal grant, the making of any federal loan, the entering into
of any cooperative agreement, and the eatension, continuation, renewal, amendment, of modification
of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or eraployee of any agency, a member of congress,
an officer or employee of congress, or an employee of a member of congress in connection with this
federal contract, gzant, loan, or cooperative a}eement, the undersigned shali complete and submit
Standard Forcn-111, "Discloswe Form to Report Lobbying," in accordance with its inshvctions.
(3) The undersi�ed shall require that the language of this certification be included in the awazd
documents fos al] subawazds at ail tiers {including subcontraeu), subgranu, and contracts under 2rants,
loans and cooperative agreemenu) and that all subrecipienu shal] certify and disclose accordingly.
T1ris certificaGon is a material representation of fact upon which reliance was placed when this transaction was
� made or entered into. Submission of this certification is a prerequisite for making or entering into tlus transacvon
imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shail be
subject to a civi] penalty of not less than $10,000 and not more than � 1 Q0,000 for each such failure.
Rob Fulton, Director of Public Aealth
Name of Authorized Individual
S^int p^ l- Ramsek Cnvntv_�,�artment nf Publir Health
Name & Address of Organi7ation 555 Cedar Street
Saint Paul, MI3 55101
.
11
Efforts to Reduce Racial Disparities
I. Describe how the CHS needs assessment used available data to analyze the extent to �
which the CHS area has disparities in risk facfors and health status between MCH
populations of color and the majority popularioa.
Whenever available, data is analyzed by numerous factors, including race. It is particularly
important that this data be available for Saint Paul specifically as this is where the majority
of the populations of color in Ramsey County reside. Through the Community Assessment
for the Saint Paul - Ramsey County 2000-2003 CHS Plan, data was nsed by the data analysis
team to identify that disparities of health status exist in our community. Tkris has been
identified as a high priority problem: "Despite overall health improvement in Miimesota,
popnlations of color continue to experience poorer health and disproportionately higher rates
of illness and death".
II. Within the populations to be provided services by the MCHSP during CY 2000-Oi,
what raciaUeYhnic disparities were identified.
As is shown in the data and graphics in the community assessment portion of this grant,
populations of color aze identified as having disparities related to late enhy into prenatal
care and infant mortality.
•
III. What strategies and objectives have been established to reduce sign�cant dispariHes?
Of particular interest are community and systems strategies/objectives wlrich recognize
the potential roie all types of community-based organizations can ptay in the decrease
of disparities.
One primary strategy u6lized by the Saint Paul MCHSP Grant to reduce dispariries is to
contract with community providers for services to improve pregiancy outcomes and address
adolescent health issues. These providers, who have years of experience, aze accessible to a
variety of the population by location as welt as the presence of bilingual, culturally specific
and/or culturally sensitive staff. The linkages that these agencies have with other
community agencies help to support their efforts to decrease the disparities of heahh status.
Additional information on each of the subcontractors specific objectives/methods and
strategies is detailed within the Application Narrative.
�
12
�'�� �73
� Subgrants/Subcontracts - Solicitation Process and Monitoring
Guidelines for Subganting Process are contained in Appendix 16. Onlv other Qovemment and nonvrofit
aeencies f501 C31 are elieible to nartici�ate in this Qrocess
NOTE: T'he process for conducting tLe subgranUsubcontracts solicitation is specifically stated in the
state MCH Law. The process must be carefully conducted as specified and documented as described
below.
Solicitation Process
a Please summarize the procedures used to plan and implement the required subgranting process
including the process for selection of prioriry program acrivities to be solicited of other providers and
deternvnauon of funds availab]e for this purpose.
See Attachment B
� b. Please provide documentation that notification of the availability of funding was provided to al]
qualified progrntns in 1he Community Health board azea including those of nonprofit and other public
agencies and Indian reservations. This docwnentarion must include evidence of d'uect mailings to
providers and evidence of pubiication of pertinent information in newspapers of general circulation in
the community health services azea.
See Attachment B
c. Please list all public and nonprofit agencies which requested subgrants of the Community Health
Board indicating which requests were inciuded in the grant application.
See Attachment'B
d. Please explain how priorities were established for selecting the requests included in the grant
application.
� See Attact�ment B
13
�
e. Please list the criteria tl�e Community Health Boazd used to seleet the requests included in the grant
application.
See Attachment B
2. Monitoring and Evaluation of Subgrantees/Subconhactors
All subgantees aze accountable for provision of services as specified by the Community
Health Baard and further are accountable for compliance with applicable federa] and state
requirements. Please describe the monitoring procedures ihe Commurdty Health Boazd pZans to utilize
in assuring fiscal and progam accountability of each of its subgrants. Indicate the extent to which on-
site monitoring procedures will be utilized.
See Application Narrative - Subgrantee In£ormation
3. Please list all subgrantee/subcontractors selected and the award amounts for the two year period CY
2000-01.
SubgranteelSubcontractor CY 2000-2009 Award Amount
�.�
�7_
�
I4
�'' �73
. , '�flL��'Z�V� � Saint Paul Community �
- Health Board
__ ,
1VICHSP SUMMARY. OF TYP�S:4� ,:.. coMMUN»r Hea�.r�
„, .
., ,
`` AC�'IVlTIES-AND,.S�RVIGES, ` Boa�t�tct�s� -
PR41tIDE� B�( OP�RATlNG ` s aint Paul - Ramsey Co ��
-- -- - '` Department of Public H alth
A�LiENCIES �Y LE�7ISLAT�VE � pPE12A�lNG AGENCY -
, °PRIQR1T1l . _ t�fa�reren�f.�m�H$� '
'exampies of operating agency incfude county, school district, Indian reservation, nonprofit health agency, etc.
fmproved Pregnancy Outcome Program
Geographic area served: -
Citv of Saint Paul and Ramsey County- -__
�
Types ef ActivitieslServices
Please cheek those serviees provided:
� core public heatth activities not direct service 7�%pregnancy testing and referral
l� individualized educalionlcounseling ]�,pre-term biRh prevention
� health education/wunseling in groups }�prenatai case management
� prenatal medical care }� enabling and non-health support
Other - ptease specify:
Describe the target popuiation(s) refative to age, income, and risk factors consistent with program et+gibility
guidelines found in Appendix 12. The target population(s) should be the specific group(s), including estimated
numbers, that the MCH Special Project proposes to serve using the MCHSP grant and other resources.
See subgrantee information within Narrative Application
Describe the manner in which the progtam responds to the needs and priorities for services idertt�ed by the
Matemal and Child Health Advisory Task Force (see Appendix 77). Differences must be described in detaif.
See Narrative Application
r
�_
15
- 200�
1111CHSP SUMM�
, = ACT11/)TlE� �
PR01/li?ED �
; " A�ENCiES 8
. ���
(fl,� Saint Paul Co�unity �
-- - Health Board
OF TYPES �F : ,�aMnnuN�n:yFa.� : _
1 SERVICE� : . � soa� tc�s�.
)QERATlNG s aint Paul - Ramsey Co t
Department of Public H I
E�7�SLAT�VE' °:: -
-
ITY . ,--->. .:.1BilifferentlromCHS)- ---
11, Famity Planning Progrem
Geographic area served:
Types of Actiritiesl5ervices
Please cF�eck those services provided:
❑ wre pubiic health activities not direct service O method services
p individuai"¢ed educatioNcounseling ❑ task force
� education in schools ' ❑ enabling and rton-health supporf
O other public education �f��`�?�'
Other - p�ease specify:
Describe the target population(s} relative to age, income, and risk factors consisieni with program eligibil'dy
guidelines iound in Appendix 92. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Special Project praposes to serve using the MCHSP grant and other resources.
Describe the manner in which the program responds to the needs and priorities for services identified by ihe
Matema! and Child Healih Advisory Task Force (see Appendix 17). Differences must be described in de;ail.
�
�
�
16
����; �73
�
� _: -2�Q��204� Saint Paul Community
.
Health Board
MCHSP; SUNIMARY. OF ° connnnuNmr �EC,�.zH -
_
A��'!1/{T1ES AND'.S.E.RVIG�S ° ' BoA�e �ct�s? . :
PROVIDED BY OPERATING: �. Sa�nt Paul - Ramsey �ou ty
,:.
Department of Public He lt�i
A�ENCfES;BY LEGiSLATlV�
.. . ! .. � 7t1 � .. I � V aQ�rlarir�� ���r�cv
: �iilV�1:1 7 __ _ ,' ;` -(HdiHerentfromCHBj'
ill_ HandicaocedlCAronically 111 Children's Program
�
Describe the manner in which the program responds to the needs and priorities for services ident�ed by tfie
Matemal and Child Heaith Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
17
Describe the target population{s) relative to age, income, and risk factors consistent with program eiigibii'ity
guidetines found in Appendix 12. The target population(s) shouid be the specific group(s), including estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
>;:
. . 1111CHSP S
` A�TI1/1
PROVI
�l�7�N�
Z���� • _ Saint Pau1 Community
- - Health Board
_ -
MiVIARY �F TYPES'OF , _ '
,,. • : , , . _ . ..:. ; �OMMUNI7Y HEALTti .
IES 1�ND'S�RVICES=° - soArin {ct�s�
ED BY OPERATiNG;' = s aint Pau2 - Ramsey Cou ty
Department of Public He Yh
S BY LEGISLATIVE;
t , flPEitATING AG�b[CY' _
,; .
P���Rl� . ? ' , (ifdifterentiromCH� __
�
IV. Childhood lnjury ConUol Program
Describe the manner in which the program responds to the needs and priorities for services ident�ed by the
Matemai and Child Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
�
�
Describe ihe target population(s) relative to age, income, and risk factors consistent with program eligibility
guidelines found in Appendix 12. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
°� �W :�73 ��
� �� _ 20D0-
MCHSP SllMIV1AF
j ' PR01l1DED BY OP
AGENCIE�:BY lEt
. P.RiflR1�'
x
� Saint Paul Community �
ealth Board
� TYPES OF -
COMMI3NIT1'.HEf1LTH _ :
:V�GES_-� `BOA�2DjCH$).
�'�'���" Saint Pau1 - Ramsey Co nty .
- Department of Public H a1Lh
l.ATlVE -
, .. __ .
: OPERA7ING AGENCY'_ ` - ° .. -
' , °° ' �if diHerant#rom CHB) -° " .
V. Other Programs Previous Funded by a Local Pre-Btoek MCH Speeial Projeet Grant - SQeciTy Programs:
a Dental Health Program
❑ InfanUChild Health Progrom
8] Adolescent Health Program
Geogrephic area served: �ity of Saint Pau? and .Ramsay County
Types of ActivitieslServiees
Please eheck those services provided:
C�3 core pubiic health activities not direct service
❑ enabling and non-heaith support
List services provided:
�
Describe the target population(s) relative to age, income, and risk fiactors consistent wfth program efigibifity
guidelines found in Appendix 12. The target popufation(s) shouVd be the specific group(s), including estimated
numbers, that the MCH Special Projeci proposes to serve using the MCHSP grant and other resources.
See Application Narrative
Describe the manner in which the progrem responds to the needs and priorities for services identified by the
Matemal and Chitd Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
See Application Narrative
L J
T
�.
' • 1��Q�2O� • j - Saint Paul Co�unity I _
� __ _ - Health Board �
1111CHSP-SUMMARY,OF TYPES C3F --
. __ . . ...: ...... .
- , CflMMUNITY HEALTIi - -
ACTlV�T1ES �►NLl SERVIGES�.; . . so�s�n �cas� :
= PR OVIDED B�t OPERP�T�NG: s aint Paul - Ramsey Co �
.: __.,_ ->.. t Department of Public H lth
. :.'wr_�w�r��e teV:1 Ft�1C1 �TtV�::.
" ; ilvv nv�a.v a :
. .PR10RiTY :-f�ra���ir�m��$> '
DEFINITIONS:
Enabiin�and Non-Health Su000rt refers to senrices provided directly to the Gient to atiain, access or use
heaith services rather than to provide a service specifically aimed at improving health. The kids of services
inctude transportation to and from health services, transiation of information into the ciienYs first language,
child care while receiving health care services, outreach to MCH populations, and assistance in seeking or
attaining health services.
Core Public Health Aetivfties Not Dired service refers to fiealth system activities which are not attributabie to
services provided to individual clients. These inWude but are not limfted to:
Assessment
colleet and analyze data and disseminate assessment results
Policy Devetopment and Planning
develop plans
provide advocacy
establish guidelines
Assurance
develop, implement, and support community health promotion programs
deveiop, monitor and support standards for access and quality
impiement and support targeted outreach and service coordination
co!laboratioNcooperation wiih other service providers
C�
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BUDGET NSTIFICATION
�
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Budget justification for each of the projects/subgrantees is included within their budgeu presented
in the application narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Matemal and Child Health Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey Commty Department of Public Health
for Administrative and Core Public Health functions.
SalarX/Fritige:
Administrative Assistant:
General program oversight,
prepares and monitors grants,
reviews reports, prepazes annual
reports, prepares and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activities
1'11
$13,549
$ 2,554
2001
$13,836
$ 2,631
Accounting Tech 77:
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV:
Types grants, conuacts and
reports
Epidemiologist:
Data collection, analysis,
reporting and display
Su�lies:
TOTAL:
$ 5,185
$ 3,576
$14,276
150
$25,014
$ 5,341
$ 3,683
$14,276
250
$25,741
23
BUDGET DETAIL OF LOCAL MATCH
Local match is identified within each of the subgrantees budgets, as required by MCH guidelines. �
Addiuonal local match is also provided by the Saint Paul - Raznsey County Department of Public
Health:
1'ITI 1�1
1. Local Tax L.evy Funds:
� MCH Prenatal Care at Community $134,480 $139,480
Clinics
TOTAL:
$139,480 $139,480
2. Other Local Funds:
Other local match is provided by Public Health through the funding of various programs which
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health educarion and well child services. Source of this funding includes
CHS funding, grants, reimbursements, and patient fees.
C�
�
`�
_ � ��� �a
.
Please read INSTRUCTIONS ON REVERSE side before wmpleting form.
CY 2000-0'1 MCH SPEClAL PROJEGT BREAKOUT BUDGETlFINAL EXPENDITURE REPORT
�����^^ I. Name of Gommun'rty Heatth Soard: Saint Paul
waeew am Cnaa Heam
H5 Eaa Se.anu� Psx
p�O� eos � Grent Year. 2000
v,.,o�+aoc�. w+ss,sdoeaz
III. BUDGET/EXPENDfTURE 1TEMS
Le isiative Priorities and Com onents Matemal and C
'
IMPROVED PREGNANCY OUTCOME PROGRAM 196, 951
� .................... •-�---.............
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non heatth suppoR' . . . . . . . . . . . . . • . - - • • • � . - • -
.................� 24,470
FAMILY PLANNING PROGRAM
..............................
Other health activities"' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non hea�th suppoR' . . . . . . . . . . . . . . . . . . . . . . ...
fiANDiCAPPEDfCFIRONICAILY ILL CHILDREN'S PROGRAM
�
Ha'ndicapyaCktxo[ucally�Ctt�dren�risdxa�'3ervse ..................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r�
L.�
Enabling and non health suppoR` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . _
INFANT NEALTH PROGRAM (Mpis./St. Paul onty)
�itaatiftetlica7senmses .....................................
Otherhealth activities" ..................................
Enabling and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
CHILDIADOLESCENT HEALTH PROGRAM
ChiWhood injury control services . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental health services (Goodhue-Wabasha onty) . . . . . . . .. . ...
Ch'%i3 �."ad�esiant.�ane�Cat`ss:wiass tlA�1s75t�3>ai�l orilY3 . . . . . . . . . .
Chiid & adolescent other health activities" . . . . . . . . . . . . . . . . . .
Child 8 adoiescent enablin9 and non health support' . . . . . . . . . .
Core oublic health activities not ciient based 820
........... 14 '
Rh etlucalionlravnsaii�, othe� protesswrtal serviees �transportation, translaLOn, cAildcare, outreach, etc.
CERTIF�CATION SIGNATURE
TYPE OF REPORT:
Ori9inal Butl9et
Butlget Revision #
that to tne hest ot my knowledge antl belief the tlata reponetl on this tlowment a corteet and ail Vansaetions that suDPO� this repon were matle in
nce with apD���DIe Fetlerel statutes.
�
OfCicial:
Name oi Person Who Completed this F ortn:
Date:
Phone: 651-292-7712
25
Please reatl INSTRUCTIONS ON REVERSE side before eompleting fortn.
CY 2000-01 MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
��a�"^ 1. Name of Communiry Hea(th Board:
�,.,,,,��ec�ee�,m, Saint Paul
85 EW � �� ��
°- GrantYear. z001
M:�aors. mrr ss,sweez
111. BUDGETlEXPENDITURE ITEMS
Le isiative Priorities and Com nents Matemal and C
A. IMPROVED PREGNANCY OUTCOME PROGRAM 196 , 951
.K ,. .., ._. _
ti - .........................................
Other health acGvities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non health support` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activiUes not cuent basea . . . . . . . . . . . . . . . . .
FAMILY PLANNING PROGRAM
:.... �..
Faiiiilti�latii?�g�ieftiad : . .: . . . . . . . . . . . • - - - . — . . . . . . . . . . . .
Oiher hea)th activdies" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
HANDICAPPEDICHRONICALLY ILL CHILDREN'S PROGRAM
_ ._
Haiidi�pDeif7itiSaiuc23l;y:�zL�dreti me7�iseivse . . . . . . . . . . . . . . . . . .
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . . .
INFANT HEALTH PROGRAM (Mpis.ISt Paul ony)
kYar"3arei('�seavue� .....................................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
CH{LD(ADOLESCENT HEAL7H PROGRAM
Childhood injury conVOl services . . . . . . . . . . . . . . . . • . . . . . . . . .
DeMal health services (Goodhue-Wabasha onry) . . .. . . . . . . . . .
�6ffi•s�Otesceet,p�e�Cai�teitiioes:{3�D7s.�Si�?aiu : .. ...... . ... .. .. .
Child & adolescent other heafth activities" . . . . . . . . . . . . . . . . . .
40
25,016
402,247
114,612
Chiid 8 adolescent enabling and non heatth support' ........:: 15, 001
Core pubiic health activities not client based . . . . . . . . . . . . . . .
1M etlucatioNwunseling, ot�er professional services 't2nspoMJfion. trenslation, chiWp2, outreae�, Mc
CERTIFICATION SIGNATURE
TYPE OF REPORT:
Original Budget
BudgM Revision #_
to tne best ot my knowtetlge and oeliet tne daW reportetl on Snis dowment is Wrrect antl aU franssctions t�at support tl�is repon were made in
wRh apPlieaDle Fetlerel statutes.
Official:
Name of Person Who Completed this Form:
Date:
Phone:
` J
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❑
COMMUNITY ASSESSMENT
�
�
Application Narrative ` �� _ � � ',� �
--�
� COMMUNITY ASSESSMENT
A broad-based assessment of community health needs and resources in Saint Paul and Ramsey
County was conducted beginning in the fall of 1998 as part of the development of the 2000-2003
Saint Paul-Ramsey County Community Health Services Plan.
Data Collecrion
The community health assessment process included collection of data regazding the Community
Health Services topic azeas. Staff obtained over 300 data items from state agencies, local
government, federal government, and private sources. Public health data is becoming more readily
accessible via the W W W, but data is not necessarily valid because it is available on the W W W.
Data regazding similaz or exactly the same phenomenon can be collected from several different
sources and so professional judgment was used to determine credibility of data.
It is also possible to collect many volumes of data on the topics of interest. Staff also used
professional judgement to determine the amount of data to gather for analysis. The priority for data
collection was to obtain reseazch data performed using populations or samples of populations living
in Ramsey County and Saint Paul where available. Wherever, possible, however, it is helpful to
compaze local data with regional, state, and national data. Regional, state, and national data were
collected whenever feasible. When local data was nonexistent or not reliable, regional, state and
national data were used.
� Data Analvsis
Role of Staff : The next step in the assessment process after collecting data, was analysis of the data
to identify public health problems in Saint Paul and Ramsey Counry. Staff performed some
preliminary analysis of data as they created graphics and assembled the data into formats usable for
further analysis. Staff analysis concentrated on identifying trends and comparisons to Minnesota
Goals (goals regazding the topics established by the Minnesota Department of Health), and did not
include the identification of specific public health problems.
Data Analysis Team: After considering several alternatives for analyzing the data the Department
organized a data analysis team consisting of internal and external volunteers with expertise in data
analysis, the public health topic azeas, and the health of minority populations. The data analysis
team met five times. One or more new CHS planning topics was considered at each meeting. Data
regarding the topic was provided to the data analysis team prior to each meeting.
The chazge of the data analysis team was as follows:
The Data Team wiil develop a list of problem azeas that keep our community from
experiencing an optimal level of health. Problem areas must:
- show a gap between Healthy People 2000 goals or Minnesota Public Health
Goals and Ramsey County data, or
� - be supported by data.
27
Application Narrarive
Identification of Public Health Problem Areas
At the end of each meeting conciusions of the data analysis team were summarized for clarification
and accuracy. Staff translated these conclusions into statements of problem azeas for review by the �
data analysis team at its next meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of public health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem area statements tfien became the basis of the neait step in the assessment phase:
review and prioritization of the problem azea statements by the greater Ramsey County community.
Review of Problem areas by the Ramsey County Communitv
After staff and the volunteer data analysis team developed the list of problem areas, staff developed,
with input from the Ramsey County Boazd, a list of community groups to review the problem areas.
These community groups were asked to review the probtem azeas to be sure the data analysis team
did not miss the identification of 'vnportant public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County govemment staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services pIanning process was described and
participants in the meeting provided verbal feedback to staff regarding the list of problem areas. At
the end of each meeting, group patticipants helped to prioritize the problem azeas by circling on the
paper the five azeas they thought were most important for ttte Saint Paul - Ramsey County
Departrnent of Public Health to address. They were also allowed to add problem areas not on the �
original list.
Identification of Public Health Problem Areas
At the end of each meeting conclusions of the data analysis team were sununarized for clarification
and accuracy. Staff translated these conclusions into statemenu of problem azeas for review by the
data analysis teazn at its ne7ct meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of pubiic health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem azea statements then became the basis of the neact step in the assessment phase:
review and prioritization of the problem area statements by the greater Ramsey County commuruty.
Review of Problem azeas b�the Ramsey County Community
After staff and the volunteer data analysis team developed the list of problem azeas, staff developed,
with input from the Ramsey Couniy Board, a list of community groups to review the problem azeas.
These community groups were asked to review the problem azeas to be sure the data analysis team
did not miss the identification of important public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County government staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services planning process was described and �
participants in the meeting provided verbal feedback to staff regazding the list of problem azeas. At
28
Application Narrative �y'� 7 � �
'—�
the end of each meeting, group participants heiped to prioritize the problem areas by circling on the
paper the five areas they thought were most important for the Saint Paul - Ramsey County
. Department of Public Health to address. They were also allowed to add probiem azeas not on the
original list. ,
Summary of Communi InDUt
The Saint Paul - Ramsey County Department of Public Health held 41 community meetings
involving over 400 people. The infotmation heard from ihe community groups can be summarized
as follows:
* General support for the identified problems azeas
* Issues most often discussed:
Access to health caze;
Access to safe child care;
Alcohol;
Asthma, diabetes and heart disease;
Environmental concems;
Health effects on children living in poverry;
Need for population based data;
Overweight, sedentary lifestyle;
Teen births;
Violence;and
� Youth and adult mental health.
Priorities Identified by the Community:
Access to health care;
Access to safe childcare;
Alcohol use;
Health effects of children living poverry;
Increasing levels of violence;
Lack of populations based data;
Low birth weight babies;
Teen births;
Unhealthy lifestyle; and
Youth and adult mental health.
Review of Problem Areas by Healttt Dep�rtment Staff
Reports of the community input were written and provided to the SP-RCDPH Leadership Team.
The Leadership team used the communiry anput as a guide for its review, discussion and
prioritization of the problem areas. Next, all public health staff were provided the opporiunity to
review and comment on the prioritized list. Staff review and comments were used to ensure that the
team had considered as much information and as much up to date informarion as was possible.
. Development of Final List of Problem Statements
The fina] step in the process for identifying community health problems was to make a final list of
problem siatements organized by the twelve community health services planning categories. The
F�
Application Narrative
fmal list of problem statements were drafted by SP-RCDPH staff to reflect as well as possible input
from the community, input from staff of the Saint Pau2 - Ramsey Counry Department of Public
Health, and a final review of updates of data from sources originally consulted during initial data �
collection efforts.
The public health problems which were idenfified and formed the basis of the Problem Statements
in the 2000-01 Matemal Child Health Special Projects Crrant, are liste@ as follows:
Saint Paul — Ramsey County Department of Public Health
Community Health Service Plan Problem Statements 2000 — 2003
Community Health Services Plan Assessment
AlcohoI abuse causes adverse heakh effects and social problems in our communiry. It
negatively impacts intended and unintended injury; unplanned pregnancy; poor birth
outcomes; child development; adolescent health; mental health; violence; infecrious
diseases;and chronic diseases.
Tobacco use is on the rise among youth and other select poputations.
Chronic diseases aze among the most prevalent, costly, and preventable of all health
problems in Ramsey County.
The percent of infants in Ramsey County bom with low birthweight is not moving toward
Minnesota and National goals. �
The percentage of births to adolescent mothers in Ramsey County is increasing while
national and state percentages aze going down.
An increasing number of children and adolescents experience the health effects that aze
associated with poverty.
There is a gap between Minnesota goals and the ciurent number of people in Ramsey
County who have access to medical, dental and mental health caze.
Despite overaIl health improvement in Minnesota, populations of color continue to
experience poorer health and disproportionately higher rates of illness and death.
Unintentional injury is one of the leading causes of death throughout a lifetime. Motor
vehicle crashes aze the leading cause of injury fatalities followed by falls, poisoning,
suffocation, and fire.
There is an increase in the number of births in Ramsey County that result from unintended
pregnancies. Some unintended pregnancies are associated with medical and social probletns
which later affect children and families.
There is an unacceptable level of interpersonal violence.
�
30
Application Narrative �- � �? � "�_
a
There is an increasing number of children experiencing chronic neglect due to ineffective
parenting and families experiencing chronic stress.
� Census Data
Wlrile census data from 1990 is likely not completely indicarive of the current environment in our
community, until the 2000 census results aze released, it conrinues to be the best measure for a
variety of indicators. In relationship to poverty, which is often linked to many poor health
outcomes, the 1990 census data indicates that :
• Eight census tracts in Saint Paul have a level of 40% or more persons with incomes
below the poverty level, with an additional nine census tracts with a level of 30% -
39.9% of persons with incomes below poverty level.
• Five census tracts in Saint Paul realized an increase of over 20% in the number of
persons living below poverty between 1980 and 1990.
Program Response to Minnesota MCH Priorities
The Saint Paul - Ramsey County Department of Public Health has identified improving
pregnancy outcomes as a maternai and child health service priority for Saint Paul. The 20Q0-
2003 Community Health Services Plan identified twenty-one health problems as high priority. A
number of problems related to improving pregnancy outcomes were identified among these high
� priority problems including:
• The percentage of infants in Ramsey County bom with low birthweight is not
moving towazd Minnesota and national goals.
• Ramsey County women are initiating and sustaining breastfeeding at a rate lower
than the state and national goals.
• The percentage of births to adolescent mothers in Ramsey Counry is increasing
while national and state percentages are going down.
Data reported in the Minnesota Health Profiles provided by the Minnesota Deparlment of Health
and the Saint Paul - Ramsey County Community Health Services Plan also reveals that:
• Percent of Premature singleton Births (less than 37 weeks gestation) for Saint Paul
is 7.6 compared to 8.0 for the State of Minnesota (1997).
• Percent of women receiving late (3rd trimester) or no prenatal care in 1997 is 5.6
in Saint Paul compared to 2.9 for the State of Minnesota (1995: 6.2 in Saint Paul
compared to 4.0 for the State of Minnesota).
� • Percent of women receiving late (3rd uimester) or no prenatal care is higher for
American Indians (11.1 %), African Americans (91%), Asians (12.5%) and teens
(9.8%). (1995: 8.3%, 10.7%, 13.6% and I0.5% respectively).
31
Narrative
• For 1995-1997, the 3 year average infant death rate of infants born to American
Indian women (12.0) and African American women (13.4) is much tugher �
compared to the rate for Saint Paul (8.8) and the 5 year average for the State of
Minnesota (6.6 for 1993-I997).
• The incidence of low birthweight singleton births in Saint Paul increased from 4.8
in 1992 to 5.5 in 2997.
• The incidence of low birthweight births for African Americans increased from
12.0 in 1993 to 12.4 in 1997.
Ttus data also indicates t6at due to the increasing efforts to improve pregnaucy outcomes, we
have seen some positive results such as:
• The current three year rate for infant mortatiry in Saint Paul of 8.8 (1995-1997}
has improved compared to the three year rate of 9.1 for 1990-1992.
• The incidence of first trimester prenatal care continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993, 69.9 % in 1995 and 71.7% in 1997 for Saint
Paul women.
• The incidence of fust trnnester caze for Saint Paul Native American women
continues to increased from 36% in 1988, to 37% in 1991, 54% in 1993, to 63.9% �
in 1995 but declined in 1997 to 52.4%.
While technology has improved to a11ow caze and treatment of some high risk births, it is much
more efficient, cost-effective and less stressful to place dollazs and efforts on improving
pregnancy outcomes so that the advanced technology does not need to be used.
Data indicate that some specific Planning Districts in Saint Paul have poorer birth outcomes and
may benefit from increased levels of tazgeoed outreach and service. These neighborhoods, all
within the City of Saint Paul, inciude: Thomas-Dale, Summit-University, SunrayBattle Creek,
Riverview, Dayton's Bluff and North End.
In addition to the focus being placed on improved pregnancy outcomes, adolescent health
continues to be a focus, primarily through the Adolescent Health Program, utilizing school based
ciinics operated by Health Start, Inc. and previously funded by the preblock grant pzogram, will
continue to be supported through MCH funding. Some funding for adolescent health services
will also be maintained at Public Health for seacually transmitted disease services provided to
adolescents in Room 111. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgotten population. In fact, a number of issues specifccally related ta adolescent health aze
included in the Community Health Services Plan as priority health problems, including:
+ The percentage of births to adolescent mothers in Ramsey County is increasing �
while national and state percentages aze going down.
32
Narrative
� ���
• Tobacco use is on ihe rise among youth and select populations.
� • High number of children, adolescents and adults are overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effecu that
are associated with poverty.
Several more problems within the list of twenty-one high priozity problems do not mention
adolescents specifically, but that population is clearly identified as being affected by the following
problems as well:
• Emerging and re-emerging infectious diseases threaten the health of the generai
population (including immunizations and STDs).
• There is a gap between Minnesota goals and the current number of people in
Ramsey County who have access to medical, dental and mental health issues.
• Despite overall health improvement in Minnesota, populations of color continue to
experience poorer heath and disproportionately higher rates of illness and death.
� There is an increase in the number of births in Ramsey County that result from
. unwanted pregnancies. Unwanted pregnancies are associated with medical and
social problems which later affect children and families.
• There is an unacceptable level of intetpersonal violence.
Through the community assessment completed as part of the CHS planning process, it was
identified that there are resources available within the community to meet the needs in the areas of
family planning, handicapped/chronically ill children and childhood injury conuol, including
resources targeted to these problems within our own Department through Ramsey County
MCHSP funds as well as other funding. Based on this assessment, no funding is requested for
these areas through the Saint Paul Maternal and Child Health Special Project Grant. However,
these areas will continue to be monitored by Saint Paul - Ramsey County Department of Public
Healih to ensure that resources exist to handle the various health problems and issues in each
area.
The provision of services addressing improved pregnancy outcomes will be primarily
subcontracted to vazious community-based providers who were identified through a process of
request for proposals. The Saint Paul - Ramsey County Department of Public Health has chosen
to subcontract for the majority of services in an effort to utilize established agencies and
organizations who have proven to be effective and eff'icient in their delivery of services and which
are located within the target areas and/or seroe target populations. Additionally, subcontracting
� with existing agencies inimi�es start-up costs and duplication of services. It is hoped that this
process and the services provided by the subgrantees will also help ensure that
culturally-sensitive, continuous caze is provided to high risk populations.
33
Apptication Narrative
See additional information on the subcontracting/subgrantee process in Attachment B. Members of
the Community Health Services Advisory Committee participated in this review process. On
August 4, 1999, the Matemal Child Health Special Projects grant application was reviewed by ihe •
Saint Paul — Ramsey County Community Health Services Advisory Committee. Committee
members were invited to provide input.
Various information regazding the community assessment is displayed in the figures on the
following pages.
��
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Application Narrative
W ' 7 7 �
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Community Description Figure 3: Percent Chiidren Receiving Public Assistance
c
d
0
�
d
a
C3Ramsey County 1991 1992 1993 1994 1995 1996
■ Minnesota Year
SOURCE: RC DepaRment of Human Services
�
35
Community Description Table 13: Poverty Indicators
Percent of Children Receiving Public Assistance
Application Narrative
Community Description Figure 4: Families With Children Below Poverty by Census 7ract
and Commissioner District
Ramsey County
Single Parent Families with Children
Below Poverty
by Census Tract and Commissioner District
i
�
�.. J
# Single Parent Famiiies
below poverty
Ctnws rz2sho
0-32
33 � 93
�94•241
� 242 � 464
� 465-829
Source: 1990 Census 428/99bn
36
1,
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7
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Application Narrative
Community Description Pigure 6: Racial Distribution of Persons Poverly,1990
Racial Distribution
of Persons in Poverty, 1990
% total poverty
� White
Af rican
American
�Asian
� Ame rican
hdian
Source: U.S. Census, Ramsey County Policy Anaysis Division
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Q'k 20% 40% 60% 80% l00%
Narrative
til3
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1997 Metro Selected Natality and Mortality Statis6cs - Minnesota Metro Counties
County Population
Live Births
Fertiiity Rate
Birth Rate
% Out of Wedlock Births
% Less Than 37 Weeks-All
% Under2500 �rams-AIl
% 3rd Trimester Care or none
Infant Deaths, Total
Induced Abortions
infant mortality rate per 1,000 birfhs
Birfh Rate 3yr Avg 15-17
Birfh Rate 3yr Avg 18-19
Birth Rate 3Year Ave 15-19
Pregnancy Rate 3yr Avg 15-17
Pregnancy Rate 3yrAvg 1&19
Pregnancy Rate 3yr Avg 1519
% Under 2500 gm-Singieton
% Less Than 37 Wks-Singleton
°/01 st Trimester Care
Abortion Rate
SOURCE: MeVo SPSS Users Group
Anoka Carver Dakota Hennepin Ramsey Scott Washington
286673 63198 334585 1053178 454354 76078
4234 1029 5126 15459 7435 1342
60.8 70.7 67.1 59.8 64.0 75.8
14.8 16.3 15.3 14.7 15.4 17.6
22.0 12.5 17.5 27.8 32.5 13.0
7.6 7.6 72 8.3 7.6 9.1
5.8 5.1 5.2 6.6 6.7 5.2
2.0 1.5 1.3 4.1 4.4 1.0
25 5 23 115 49 3
970 139 1003 5110 2379 190
5.9 4.9 4.5 7.4 6.6 22
14.7 11.2 122 26.6 35.1 13.3
53.2 45.3 48.4 55.6 68.9 36.3
27.8 22.5 23.8 38.4 50.9 20.6
25.7 192 21.5 41.9 49.8 19.9
84.9 64.4 80.3 95.4 1012 63.6
45.9 34.2 40.4 63.9 72.3 33.8
42 3.8 4.0 5.0 4.9 3.2
6.6 7.1 6.8 7.7 72 7.9
84.3 90.0 87.9 82.5 78.0 87.9
13.7 9.5 11.7 19.5 20.1 10.7
191548
2686
592
14.0
15.1
7.9
5.6
1.1
7
463
2.6
9.3
37.7
17.8
19.0
65.8
33.0
4.3
7.3
91.2
9.9
39
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IMPROVED PREGNANCY OUTCOMES
n
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Application Narrative
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W- v
� IMPROVED PREGNANCY OUTCOMES
PROBLEMS
Poor pregnancy outcomes has been identified through a community assessment as a high priority
public health problem in Saint Paul by the Saint Paul - Ramsey County Department of Public
Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in some populations
• ongoing problem of infant mortality despite decreasing infant mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal alcohol
effects and other birth defects
The rates of infant mortality, low birth weight and pre-term deliveries for the City of Saint Paul
� are higher than suburban Ramsey County and the State overall. Specific areas within the City
have been targeted by each subgrantee and the Aepartment as geographic areas to be served in
response to previous high rates of poor pregnancy outcomes.
One factor contributing to poor pregnancy outcomes, including high infant mortality, premature
birth, and low birthweight births, is late or no entry into prenatal care. Again, the targeted
areas and populations within ffie City of Saint Paul have a higher percentage of women who
begin prenatal care late (third tr'vnester) or who receive none at all than suburban Ramsey
County and the State overall. Certain Saint Paul neighborhoods have especially high rates of
late prenatal care.
The following graphics display various data related to low birthweight, trimester of entry into
prenatal care, and infant mortality rates.
�
40
Application Narrative
Low 8irth Weight Bab+es Figure 8: Low Birth Weight Trends
Low Birth Weight Trends
�
� � o.o^�
�
�
a s.o°�
0
�
N 8.O°k
c
.�c 7.0°k
N
m 6.0%
�
� 5.0°�
L
�
d �{.�%
3
� 3.0%
0
�
N Z.O%
c
= 1.0°k
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0 0.0°k
Source: MDH: MN HeaHh Proiiles, MN Healih Statistics
� �sas
� 1988
_=�.� 1990
� �997
� 7993
� i99a
Q 1995
>�� 1996
� 1997 i
low Birth Weight Babies figure 2: Low 8irth Weight Births Metro Counties
1997 Low Birth Weight Births
Seven County Metropotitan Qrea
e.o^s
�.o��
6.0%
5.0%
4.0 %
3.0%
2.0%
t.Q%
0.0°h
Percentof all inf�nts born weighing less than 2500 grams
SOU¢e: MN HE2�1G PrGtileS. M N Health StetistiCs
.
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41
Minnesota Rams�y County Saint Paul
Anoka Bekota Ramsey wasn+ngtpn
Carver NennEpin SCOtt
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Application Narrative __ ;-� � �
Low Birth Weight Singleton Rates
Ramsey County Muniapa{ities and Saint Paul Planning Districts
199�1997
. =r.�n+a�zic��r
--- °. 3.1
�,` -
'N6nnesa2 2004 Goal : 3.5 LB1h' Birth Rale
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LeJ�'Rate= w.m a t.e✓+5��ciem �nns ve �co s.igem snns
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(V T T
Application Narrative
Maternal and child health activities funded through the Maternal and Child Health Special Projects
Crrant aze monitored quarterly, and more thoroughly evaluated on an annual basis. A report
assessing the activities of the current project in 1998 was completed for the Minnesota Department �
of Health. Since current comprehensive data on Saint Paul health indicators is not readily
available, it is difficult to fully assess the impact of present progranis at this time. However, based
on the data received from the programs, the following swumary informarion from 1998 programs
receiving MCH funding to improve pregnancy outcomes is available:
• 1,827 clients were seen for prenatal services
• 54% of the 1110 clients who delivered in 1998 received prenatal care in the fust
trimester of pregnancy
• 15 fetai deaths were idenrified
• 3 neonatal deaths occurred
• 46 births were below 2500 grams
From this assessment, it is cleaz that on-going efforts need to be made to help ensure early and
continuous prenatal care, especially among some minority populations.
PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES �
Saini Paul - Ramsey County Department of Public Health's Improved Pregnancy Outcome
Prbgram for the City of Saint Paul responds to the goals and priorities for services identified by
the MCH Advisory Task Force. The Program addresses both the goal of promoting improved
birth outcoures and promoting healthy adolescents. To achieve these goals Saint Paul - Ramsey
County Department of Public Health has identified priorities consistent with the following MCH
Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatai care in the first trunester
• sensitivity to cultural diversiry for improved pregnancy outcomes
These priorities will be addressed through the objectives and methods idenrified by three
community agencies approved for funding by the MCH Special Project Funds Proposal Review
Committee. Once again, Saint Paul - Ramsey County Department of Public Health subcontracts
the majority of Saint Paul MCH funding to community organizations to increase access to
services, and to increase the likelihood that culturally sensitive caze is available to the S
population. The agencies recommended to receive funding through the Saint Paul MCHSP
_ _..
49
ApplicationNarrative ` ;`j 7 7
Grant are: Health Start, Inc.; Face To Face Health and Counseling Service, Inc.; and West Side
Community Health Services.
.
The programs of these agencies provide a variety of inethods which are targeted to increase the
percentage of women receiving prenatal care in the first trimester, ensure continuous prenatal
caze, education and case management, reduce infant mortality, and decrease low birthweight
births. Additionally, the programs of these agencies will provide services to residents of some
of the highest risk Saint Paul neighborhoods.
I1
�. J
•
so
Nazrative
INVENTORY OF SERVICES
From the inventory which was completed, it has been idetttified that there are a number of �
agencies providing prenatal care in Saint Paul, in addition to independent practitioners. An
inventory of agencies providing prenatal caze, primarily those providing the options of care on a
sliding fee, including the target population served and the services provided, is included in
Attachment A.
In April of 1992, the Prepaid Medicai Assistance Program (PMAP) was implemented in Ramsey
County. There are cutrently four health plans availabie, including Hea]thParmers, U-Care,
Medica and Blue Plus. Individuals who are newly applying for Medical Assistance aze being
placed into this system.
The system has unproved, but there are still issues of denied services, confusion regarding
where a person can receive services and clients choosing not to seek services due to the
confusion. Special populations may need special attention to initialiy maneuver ttuough this
system. The Saint Paul - Ramsey County Deparmnent of Public Health will continue to advocate
for accessible care for ali populations.
•
�
51
Application Narrative � �� ,_ i } 7 �'j
GOALS OF THE PROJECT
�
The overall goal of the projects which will be supported through the Matemal and Child Health
Special Projects grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBdECTIVES OF TI� PROJECT
�
A number of objectives have been established for the Improving Pregnancy Outcome project
including:
1.
�
To reduce the overall rate of late (3rd trimester or none) prenatal caze (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1%) women.
To unprove the infant mortality rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average),
and American Indian (12.0 for 1995-97 3 year average); and
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 yeaz average), American Indian rate (13.4 for 1995-
97 3 year average).
To reduce the rate of Saint Paul low bir[hweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7 % 6.7 %
White low birthweight �6.9 % �.3 %
African American low birthweight 12.4% 12.1%
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low 5.4 % � 5.0%
birthweight
� 4. To conduct outreach efforts to pregnant teenagers to increase the rate of first trunester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
52
Applicarion Narrative
with a special emphasis on outreach to minority teens. {For births to women less than 20
yeazs of age in 1997, 52,4% in Saint Paul, and 55.3% in all of Ramsey County began
prenataI care in the first uimester}. �
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Boazd through the
Saint Paul - Ramsey County Department of Public Health are low-income (less than 200% of
poverry) Saint Paul women at high risk for poor pregnancy outcomes, as defined by legislative
parameters. This incIudes, but is not limited to, teenage and minority women residing in St.
Paul.
Addirional MCH Special Project Funding beyond the pre-block grant funding to Heatth Start,
Inc. was made available to community organizations through a Request for Proposals process.
This process and the target popularion specific to each subgrantee selected, as well as the
objecrives, methods, training/experience of staff, linkages, reimbursemendfees and budgets will
be described in the following section tided, "Subgrantee Information."
i
!
53
��- �73
�
SUBGRANTEE INFORMATION
�
�
Narrative
SUBGRANTEE SOLICITATION PROCESS
� � �
� To determine the agencies with whom a subcontract would be established, a solicitation process
for both the Saint Paul and Ramsey Courny Maternal & Child Health Special Projects Granu
was conducted beginning in June of 1999. A Request for Proposals was sent to 37 agencies
which may have had an interest in participating in the project, and a public notice was published
in the Saint Paul Pioneer Press.
Three proposals for programs to improve pregnancy outcomes were received by the deadline.
The proposals were reviewed by Public Health siaff and an ad hoc subcommittee including
representatives of the Saint Paul - Ramsey County Community Aealth Services Advisory
Committee.
An evaluation form similar to the Minnesota Department of Health evaluation form was used to
evaluate the proposals which were received. The results of reviews completed by the review
committee indicated that each merited some funding. The projects which were chosen for
funding would ensure that some services were provided in each of the target health planning
areas and focused on target populations with as little duplication as possible. Two of the
proposals will be funded by the Saint Paul MCHSP grant, and one will be funded by the Ramsey
� County MCHSP grant.
The details of the RFP, a sununary list of the proposals received, and the evaluation tool used
aze described in Attachment B.
5UBGRANTEES
Specific information on each of the projects to be supported through the Maternal and Child
Health Special Project Grant for improving pregnancy outcomes is provided on the following
pages. Each project has specific target populations, objectives (which include projected service
levels), and methods, but all projects are working towazd the same goal of improving pregnancy
outcomes for residents of Saint Paul. Copies of the full proposals submitted by each of the
grantees are available the from Saint Paul - Ramsey County Department of Public Health upon
request.
The following table indicates the projects which are proposed for funding and for which a
complete program description follows.
�
54
Apptication Narrative
AC'ENCIES PROPOSED FOR FUNDING/SUBGRANI'S
See individual subgrantee information for Budget Justifications on each project.
Amount Reauested
AGENCY Total: Yr. i: Yr.2:
Face to
Face
West Side
Amount Awarded
Total: Yr. i: Yr. 2:
:� 11� �� �11 �1 �11 :1 �11 �1 �►� �� 1��
32,500 16,250 16,250 32,500 16,250 16,250
Health
Start 393,902 196,951 196,951 393,902 196,951 196,951
(IPO)
Health
Start 1,010,070 505,035 505,035 1,010,070 505,035 505,035
(Adol)
Room 111 24,374 12,550 11,842 24,374 12,550 11,824
(SPRCDPH -
Adol)
Face To Face is requesting funding to continue the'vr outreach efforts and case management.
West Side is requesting funding primarily for outreach, perinatal care coordination, risk assessment and
tracking.
Health Start receives non-competirive funding as a pre-block grant provider to provide both improved
pregnancy outcome services through ouueach and prenatal caze, and adolescent health services through
school based clinics.
Room 111 will provide sexually transmitted disease services to adolescents.
��
��
�
55
Narrative
, .-,
MOIVITORINGlEVALUATION OF SUBGRANTEES
• To ensure that every effort is made to achieve the proposed goals and objecuves, the subgrantees
efforts and performance will be monitored on a regular basis throughout the contract period.
Contracts will be written between Saint Paul - Ramsey County Department of Public Health and
the subgrantees indicating specific performance objecuves and outcome indicators. The contracts
will oufline the subgrantee duties, reporting requirements, the monitoring expected/performed by
Saint Paul - Ramsey County Degartment of Public Health, and evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective tools
will be used by the subgrantees to ensure that various aspects of their program are reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
PROGRAM EVALUATION
. Data will be sought from various sources, both nationally and locally, including the Minnesota
Department of Health, to monitor pregnancy outcome trends. Tlus data will be used to analyze
the impact that the project has had on the goals and objectives for the project throughout the two
year period. Since summary data is frequently available on a two yeaz delayed basis, progress
toward the objectives may be difficult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
• age of client
� race and ethniciry of clients
• residence of clients
• time of entry into prenatal care
• number of fetal deaths
• number of neonatal deaths
• number of infants with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs aze appropriately
� impacting pregnancy outcomes. Based on this evaluation, services and programs may need to be
modified or refocused to maximize the likelihood that the objectives and goals are met.
56
Application Narrative � '�` _ ,'� "J 7�
J
� Health Start, Inc - Im�roving Pregnancy Outcomes
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive Maternal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes. Health
Start, Inc. is an organization specializing in maternal, infant and adolescent health caze services to
high risk populations for disease or disability due to economic, social or medical conditions, and
to reduce morbidity and mortality in these populations.
Health Start proposes to continue to serve the needs of low-income (less than 200% of poverry)
and adolescent pregnant and postpartum women. Health Start will provide multi disciplinary,
comprehensive prenatal caze. Prenatal care offered to students in the high schools facilitates eazly
entry into prenatal care. This component of the Health Start program addresses the City of Saint
Paul's Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and women of color.
Tar e� t Popularion - The clients targeted to be served will be those at risk for prenatal and birth
complications who would, without accessible and high quality services, continue to experience the
multiple problems associated with high risk pregnancies. Prenatal care is provided in eight school
� based clinics in St. Paul, so adolescents, especially minority adolescents will be a focus. In 1998
Health Start saw 325 adolescent prenatal patients in it nine sites for 2260 visits (which represents
roughly one-third of reported teen pregnancies in St. Paul), and 174 adult women, 46% of whom
were African-American, 3.4% were Asian and 4% were American Indian. Women in these
groups who smoke will also be targeted for special prenatal or preconception interventions.
Obiectives -
1. Provide comprehensive multidisciplinary prenatal care to 500 high risk young adult and
adolescent women per yeaz during CY 2000 and 2001.
2. 55% of women who deliver through Health Start will initiate prenatal care in the first trimester
of pregnancy and 85% of women will initiate caze by the end of the second trimester of
pregnancy.
3. 80% of prenatal paUents will received five or more prenatal visits.
4. By December 31, 2001 low birth weight (less than 2500 grams) rates will be no greater than
� 8% and pre-term birth rates (less than 37 weeks gestation) will be no greater than 10%.
57
Application Narrative
5. Women smokers will receive help with smoking cessation methods prior to or eazly in
pregnancy.
6. The incidence of low-birth weight infants born to adolescents followed through high school �
clinics will be no greater than 7% by the end of CY 2001.
7. Of the adolescent teens seen in school based or OB/Gyn clinics, 55% will begin caze by the
first trimester.
8. All prenatal patieuts will have an initial nutrition assessment with folic acid supplements
offered to uninsured women and all others as necessary.
Methods -
• A full range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 491 Universiry Avenue West, and eight school-based clinics. This
will ensure accessibiliry and acceptability for clients seeking prenatal care.
• Prenatal and postpartum caze will follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since �
1967. This includes social work and nutrition professionals routinely available during
regular clinic hours to handle the various non-medical aad medical risk factors.
• All clients will be assessed for high-risk conditions using the Minnesota Pregnancy
Assessment Form at the initial visit and 36 weeks. Appropriate prevenrive management will
be provided for all clients.
• Clients will be assessed for risk for HIV/STD infection and individualized prevention
education will be provided. HIV/STD testing will Ue provided on site.
• All ciients will receive a nutrition assessment, conducted by a Health Start nutdrionist.
Clients will be certified for WIC at the clinic visit and educated about the importance of
appropriate weight gain during pregnancy for optimum birthweight. Clients with specific
nutrition concerns, e.g. diabetes managemeni, anemia, weight control, etc. will receive
ongoing nutrition education and counseling throughout their prenatai care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Fanuly and relationship issues, housing and financial concerns, chemical use, and !
issues of physical, se�al and emorional abuse are included as part of the assessment.
58
� �7�.�
Application Narrative , � r U
Clients with no source of payment for medical care will receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and
� support within the clinic setting and will refer to outside agencies and services as needed.
• Patients who smoke will be encouraged to cut back or stop during pregnancy through access
to self help information and specially written motivation materials designed for the patienYs
willingness to change status. The "Ask & Advise" intervention will start early in pregnancy
or prior to conception, though education given to family planners or patients receiving a
pregnancy test from FIealth Start.
• All clierns delivering through Health Start will be eligible for family planning services for
24 months after the baby's birth, regazdless of ability to pay. After this period, clients who
are uninsured will be asked to pay according to the sliding fee scale.
• Health Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency care at Regions Hospital.
• Project clients will be assisted in locating a medical home for their new baby, if needed.
Eligible new parents will be invited to participate in one of Health Start's intensive parenting
� programs, designed either for drug or alcohol-exposed infants or minor mothers.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based clinics and University Avenue clinic.
• Clients in need of specialized medical service will be referred to Regions Hospital or other
providers as appropriate.
• Clients will receive individualized prenatal education in clinic and will be invited to attend
the weekly prenatal classes at Regions Hospital.
� Prenatal and postpartum clients who fail appointments will be followed-up by telephone and
maIl to help ensure that they receive needed health care services. A community outreach
worker is available for home visits to clients who repeatedly fair prenatal appointments.
• Language interpreters and interpreters for the deaf will be available in clinic and by phone
as needed, using either in-house or community interpreter resources.
� � Although most clients will fmd the clinic sites easily accessible, Health Start will provide
bus tokens or cab cazds when needed.
59
Application Narrative
Evaluation -
Intended Outcomes and Methodologies for the project to Improve Pregnancy Outcomes:
A. Does the multidisciplinary model of prenatal care designed for socially at-risk women help to
improve pregnancy outcomes?
Criteria/Methodologies: Health Start will compare birthweight, gestauonal age, risk level, race ,
SFS, and onset and duration or prenatal care with a comparison group which does not receive this
model of prenatal caze. Health Start tracks approximately 1,700 deliveries at Regions Hospital
each year. Of these, approximately 300 are deliveries to Health Start patients. The remainder is
non Health Start patients and provides an important comparison group for determining birth
outcome data. Information collected and reported includes date of delivery, provider
classification, race, risk score, marital status, trimester that care was initiated, and the number of
prenatal visits made. Infant data includes APGAR's at 5 minutes, birthweight and gestarional age.
B. Can Health Stan contri6ute to lowering low binhweighZ rates for women of color, especially
African American women?
Criteria/Methodologies: Health Start will compare birthweights by race within its deliveries to
city averages, over a three year time span.
Use of Evaluation Results: Informarion from evaluation efforts will be given to the quality
assurance committee, the quality management team, and the clinical management team. They
may be used to formulate changes in intervention, to stimulate further analysis for underlying
causes, or suggest areas for a quality improvement project. Evaluarion results are disseminated to
providers via periodic provider meetings, clinic tams via team coordinator meetings, the Board of
Directors at board meetings semiannually. They are also used to moYivate staff and to stimulate a
work culture of continuous quality improvement.
Trainin�/Experience of Staff - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff aze professional health care personnel with special
expertise in maternal and child health or adolescence. The majority have had more than five
yeazs eacperience. All staff are evaluated at least once a year. Clinic staff aze aiso subject to
anuual peer review.
Staff are supervised by the executive director, associate director, medical d'uector, OB medical
director orteam coordinators. Medical providers are credentialed according to standards ofthe
major health plans. Carol Wlute, M.A., is the executive d'uector of Health Start and is
responsible for the overall management and direction of the project, as well as extemal relations
�
�
.
:1]
�� � 7 3 Applicarion Narrative � � � '°" '�
and long-range planning. Dr. Chris Reif is the medical d'uector, is on the staff of the Family
Medicine Department at Regions Hospital, and is responsible for overall medical direction. Dr.
� Donna Anderson, on the staff of the Health Partners Obstetrics and Gynecology Department, is
the OB medical director and works with the medical d'uector to provide consultation on OB/GYN
practices, as well as providing clinical supervision for OB/GYN nurse practitioner staff. They
are advised by a clinical management team made up of representatives from the various
professional disciplines,in prenatal and adolescentservices of Health Start. Richard Duffm has
been the associate d'uector for five years and manages the school based clinics. Jeanne Rancone,
PNP, PHN, is the new Clinical Services Coordinator, overseeing clinical services for adolescent,
prenatal, and pediatric care. Jeanne has been with Health Start for five yeazs.
Continuing educauon needs of staff are assessed and maintenance of credentials through
continuing education is monitored.
Li es - Health Start has well developed linkages that include a wide variery of health care
providers, educational programs, and social service agencies. Tlus referral network allows staff
to individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs azise. Key linkages include HealthPartners/Regions
Hospital - most physicians and midwives are contracted through HealthPartners, who also provide
� back-up for prenatal care and referrals for prunary care services and OB specialry services not
provided by Health Start.
Health Start works collaboratively with Saint Paul - Ramsey County Public Health nurses to
extend services to pregnant women in the communiry. Public health nurses meet regularly with
Health Start to identify clients needing home-based services and to share information that will
enhance patient care.
At delivery, new parents are referred to Health Start's pediatric clinic, which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location near I.exington and University,
the usefulness of providing pediatric care at a different neighborhood site as an incentive for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediauic
services aze discontinued by Health Start, cases management to hop connect new mothers to
appropriate medical homes for their babies in the communiry will be maintained.
Eligible clients are also refened to the Befriender Program, run in collaboration with Children's
Home Society, the Partnership Program, a collaboration with Saint Paul School's Early
� Childhood and Family Education (ECFE), or the CARES Project, also run collaboratively with
ECFE. These programs all provide intensive counseling, support, andlor group education for
G1��
Narrative
high risk parents.
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g., .
general medical care or adopuon counseling), written referrals will be made to community clinics
or other resources within a convenient geographic area.
Health Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliarions with
and/or refer to the following agencies and task forces (partial list only):
Children's Home Society of Minnesota, Early Childhood and Family Education (ECFE),
HouseCalls, Frogtown Family Resource Center, HealthPartners and Regions Hospital, Ramsey
County Human Services Child Protecrive/Minor Moms Services, Saint Paul - Ramsey Counry
Department of Public Health, Rondo Family Resource Center, Neighborhood Aealth Care
Network, Saint Paul Public Schools, WIC Food Supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. All clients aze low-income (200% of poverry or
less). Clients are billed, however, by Regions Hospital and Ramsey Clinic for hospital charges
such as labor and delivery and selected tests and procedures. �
MCH funding allows Health Start to provide prenatal care for clients who have no Uvrd parry
source of payment. For Health Start clients eligible for medical assistance or MinnesotaCaze,
staff wilI assist them with the application process. Health Start has contracts with all of the
PMAP providers. Any other applicable third parties are billed whenever possible. Insurance
revenue pays for approximately 45 % of E3ealUt Start's prenataUfamily planning clinics services
and 15 % of adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client has
no third parry payor, a sliding fee scale is used to determine her fee for family planning services.
Funds will be requested from the State of Minnesota Family Planning Special Projects to continue
the provision of family planning services in the next biennium.
�
62
.
u
�J
Application Nazrative
HEALTH START, INC. ,� .. Mc �eoo
���..� �� �.�.� ~- :� 7 3
I.�IPROVED PREGNANCY OUTCOME YROGRAM BUDGET
J3t�'UARY THROUGH DECEMBER, 2000
ANNUAL PROGRAM PR06RA/A MCH
LNE TTEM EXPENSE sne.nm' F're BUDGET BUDGET
CLMGL SERV�CES COORDINA70R
CSMLTiY COORDINATOR
N,Ri pRpL71T10NER
K�E PRpCTiT10NER
7�taSTERID NURSE
tTRSEPRACiTIIONER (AGAPE)
�zrr+�mornsr
krrRmor+�sr
OLIIRrt10NlST (AGAFE)
7Z(iRI71pN1$T (FRLIN6TON)
}�J�L7F1 EpUCATOR (ACaAPE)
sx�r•.i woR�R
SY1Al WORKEfi
tJ,.� MANhGER (AGAPEJ
If.�i-�?REfER
��
LLMG CLERK
��ICqLlSSISTANT
w� :u sss,stnrn
5
5
5
5
$
5
$
$
$
S
S
5
5
5
$
5
$
S
5
56,791
54,912
57,404
52,'189
45,760
47,'133
46,738
43,681
43,681
43,638
40,915
39,'142
44,970
34,275
28,628
23,160
zo,zoa
21,302
24,321
0.40
0.'10
0.60
0.'10
1.00
020
0.25
0.20
0.'I S
0.15
0.15
0.15
0.15
0.20
0.'10
0.25
o.ao
0.10
0.70
$ 7L.717 S 13,630
$ 5,491 5 3,295
$ 34,442 5 20,665
$ 5,219 $ 3,131
$ as.�so s 2�,ass
$ 9,427 5 7,070
$ ��,684 5 2,92�
� 8,736 $ 6,552
y 6,552 S 4,914
g 6,� � 4,582
$ 6,137 5 4,603
$ rJ.B�� $ 4,s9�
$ 6,745 $ 5,3�
� 6,855 S 5,141
$ 2,863 $ 1,431
$ 5,790 $ 4,632
g '16,163 $ 8,082
g 2,130 $ �,�
g 17,025 $ 8,512
SUB-TOTAL SALARY
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
RAMSEY CLINIC PHYSICIAN/NURSE MIDWIFE
pNE p91GYN GHYSICIAN CUNICSIWK �$495 X 42 WKS
TWO FAMILY PRACTICE CLINICSIWK � 5305 X 36 WKS
FIVE CNM CLINICANK (a� 3165/CUNIC X 42 WKS
RENT
PATIENT CARE
LAB, U17RASOUND,X-RAY
OTHER EXPENSE
MEDICA710WDRUGS (INCLUDINGARLINGTON)
MIDICAL SUPPLIES
OFFICE SUPPLIES
EQUIPMENT
7RAINING
PF21N"f ING/DUPLICATING
pf,T{EN7 TRANSPORTATION
T07AL DIRECT EXPENSE
@IDIRECT EXPENSE @ 16°k
TOTALPROGRAM EXPENSE
tOtAi MCli GRAM REQUEST
YATCHING PUNDS � 75Y.
���
$ 226,154 $ 137,776
$ 45,231 $ 27,555
$ 20,790 $ 4,158
$ 21,960 $ 4,392
g 34,650 $ 6,930
$ 33,500 5 '
$ 17,500 $ 10,500
$ 14,000 $ 3,500
$ 5,000 $ 989
$ 5,500 S 550
$ 2,500 S -
$ 1,000 5 -
� 500 5 -
$ '1,20� 5 60�
$ 429,484 $ 196.951
$ 68,717 S
$ 498.202 $ 196.95'1
$ 196,951
g 49,238
Applicauon Nazrative
HEALTH START INC- Mc�oeor
MATERNAL AND CHILD HEALTH
IlVIPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2001
ANNUAL PROGRAM PROGRAM MGH
UNE 1TEM EXPENSE Saum' F're suoG� BUDGET
CUNICAL SERVICES COORDINATOR
C4NICAL SERVICES COOR�INATOR
NURSE PRAC7Ri0NER
NURSE PR1CT7'f101JER
REGISTERED NURSE
NURSE PRACTRIONER (AGAPE)
raurammasr
r�urnmo�nsT
nWrRmorusT tawvFl
r+urnmoMSr cr�vuN�ror+�
NEpLTli EDUCATOR (AGAPE)
socva woa�R
SOCIAL WORI�R
CASEMANA6ER (AGAPE)
IN7ERPRETER
LOURIER
cur+ic c�K
MEDICAL ASSIS7ANT
MEDICAL ASSISTANT
$
S
$
S
$
S
$
S
$
5
$
$
5
$
s
$
5
$
$
57,631
55,724
58,252
52,960
47,133
50,753
46,738
44,328
44,326
44,293
41,520
39,720
44,970
39,781
zs,os�
23,502
20,503
2'1.617
24,680
0.40
0.10
0.60
0.10
1.00
0.20
0.25
0.20
0.15
0,15
0.15
0.15
0.15
0.20
o.io
0.25
0.80
0.10
0.70
$ 23,052 S '13,831
3 5,572 5 3.343
$ 34,951 $ 20,971
$ 5.296 $ 3,178
$ 47,'133 5 28,280
$ 10,151 S 7,10�J
� »,ggq $ 4,674
S 8,865 S 3,546
5 6,649 $ 4.654
$ 6�644 $ '1,651
$ 6,718 5 4,360
g g,g58 5 3,575
$ 6,745 5 4,047
5 6,956 5 4,869
5 2,905 5 1,453
� 5,876 5 4,700
$ 16,402 $ $,20�
$ 2,162 S 1,081
$ 17.276 S 8,638
SUB-TOTALSALARY
FRINGE BENEPITS � 20%
CONTRACT SERVICE
RAMSEY CUNIC PHYSICIANINURSE MIDWIFE
ONE OBtGYN PHYSICIAN CLINICSIWK � 5520 X 42 WKS
TWO FAMILY PR4CTICE CLINICSIWK @ 5320 X 36 WKS
FIVE CNM Cl.INICANK � 5775/CL7MIC X 42 WKS
RENT
PATIENT CARE
LAB, UL7R4SOUND, X-iZAY
OTHER EXPENSE
MmICAT10NIDRUGS (INCLUDING ARLINGTOI�
MmICAL SUPPLIES
OFFICE SUPPLfES
EOUIPMENT
'fRPJNING
PRINiiNGIDUPLICATING
PATEM TRANSPOR7A710N
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ t6%
TOTALPROGRAM EXPENSE
70TAL MLN GRANT REOUE57
MATCMNG FUNDS � 25:G
0
5 230,506 5 135,157
$ 46,101 5 27,031
$ 21,840 S 4 .�
S 23,040 5 4,608
$ 36,750 S 7,350
$ 35,175 5 -
$ '18,375 5 11,025
$ 14.700 S 3,675
$ 5,250 $ �,�
$ 5,775 5 �,�
5 2,625 $ '
$ 1.050 $ -
$ $2$ $ -
$ 1,260 S 630
$ 442,972 $ 196,951
$ 70,876 S
S 5'l3.848 S 196,951
$ 49,238
$ '196.951
•
L J
C J
�
C�
�
Narrative
Face To Face Health And Counseling Service. Inc. - Project Connect -- Prenatal
Access Project
Face to Face Health and Counseling Service is proposing to continue its program aimed at
reaching high risk, pregnant adolescents with comprehensive fust trimester prenatal care services,
which have resulted in a higher rate of healthy birth outcomes_ Face To Face has historically
been a strong supporter of a comprehensive service approach for high risk youth, and is
continually moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach efforts and case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with
case management has proven to be very successful in (1) improving rates of fust trimester
prenatal care and reducing low birthweight rates; (2) providing social support and linking clients
to other needed support services; (3) ensuring clients receive high quality, continuous, and
comprehensive prenatal care; (4) involving clients in self help, the prenatal education program,
and in receiving needed group support; and (5) continuing to support the involvement of
pregnancy partners during the pregnancy.
Tar eg t Po�ulation - Face To Face will continue to serve a minimum of 1501ow income (less than
200% of poverty), pregnant adolescents and young adults between 11 and 21 yeazs of age (70 of
whom will be under the age of 19). At least 50% will be youth of color: African American, Native
American, Hispanic or Asian.
Goa1s/ Objectives -
Project Goal: The Prenatal Access Project at Face To Face will utilize outreach efforts and case
management to encourage and support pregnant adolescents to access prenatal caze so as to increase
their chances of having a successful pregnancy.
OUTREACH & CASE MANAGEMENT
Goal: To utilize a seamless, integrated service model to provide prenatal care.
Objective 1: To use a holistic intake process for assessing needs in all areas of the lives or our
clients and identifying strengths they already possess to address these needs.
Goal: To reduce the overall rate of late (third trimester) or no prenatal caze and to conduct
65
Application Narrative
outreach to increase the fust trimester prenatal care, especially among minority teens.
ObjecUve 1: To increase current efforts to provide ouTreach to youth of color, ensuring that at least �
50% of the prenatal clients aze youth of color: African American, Narive Amezican, Hispanic or
Asian.
Objective 2: To follow up with all clients with positive pregnancy tests, including making home
visits as necessary to assure they receive caze.
PRENATAL CARE
Goal: To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian and Asian teens.
Objective 1: To provide 150 pregnant adolescent and young adults -- 70 of whozn will be under the
age of 19 with holistic and comprehensive prenatal caze which is accessible, appropriate, effective
and which is coordinated with other community resources and integrated with the clients' individuat
life situation.
Objective 2: To enro1150% of the 70 clients who are under the age of 19 in prenatal caze services �
during their first trimester of pregnancy.
Objective 3: To begin to affect positive birth outcomes in all clients, as measured by low birth
weight rates of less than 6.5% for all age and racial groups served.
Objective 4: To improve attendance at all prenatal classes, with at least 50% of those enrolled in
prenatal services attending.
SOCIAL SUPPORT
Goal: To improve the health & wellness of pregnant adolescents during pregnancy through
increased social and emorional support and mental health services.
Objective 1: To increase prenatal support services to pregnancy and pazenting partners of pregnant
women.
Objective 2: To provide mental heath counseling for prenatal clients and their pregnancy and
parenting partners who are struggling with mentat health issues, including chemical use, depression •
and abuse.
..
� -,� ,�
Application I�3arrative �
Objective 3: To link all the prenatal clients who deliver through Face To Face with ongoing primary
medical caze for themselves and theu infants, and social services for the infant, mother and
• pregnancy and pazenting partners.
Methods/Activities - Three components aze used in the approach taken by Face To Face in
addressing the needs of pregnant adolescents in St. Paul, including:
Outreach & Case Management: The primary component of this project continues to be the
outreach youth worker to link high risk pregnant young women under the age of 21 with
prenatal care, counseling, support, advocacy, education, basic living needs, and other
resources. Staff will follow up on all positive pregnancy tests. Outreach workers provide
intensive case mgmt for the prenatal clients, help organize and advocate for services and aze
available 24 hours a day if there is an emergency. An outreach worker serves as a support
person for the client, and is often the one person who listens to a client to strengthen her
eatisting support network and build new relationships where needed.
Prenatal Care: Free pregnancy testing is offered four days a week, and the clinic follows up
on each positive result. Comprehensive and sensitive prenatal caze services aze offered at
Face to Face through a team of professionals including the outreach worker, prenatal program
� coordinator, nurse practitioners, physicians and a nutritionist. All of these members of the
team meet before and after the weekly prenatal clinic in order to ensure effective case planning
and follow-through with each client.
Social Support: Mental health services provided through these grant funds will include
assessments, short-term counseling and the development of peer support networks for the
pregnant adolescent and their pregnancy and pazenting partners. Mental health assessments
will be done for the pregnant adolescent and a caze plan will be established for the adolescent
which may include provision of short term counseling, referral far longer term counseling or
psychiatric services, a plan for establishing and/or maintaining emotional support and support
in achieving the plan. The goal is to strengthen the ability of the pregnancy and pazenting
partner to participate in and be able to support the pregnant adolescent in the pregnancy.
Evaluation - Face to Face programs and services are evaluated on several levels, as follows:
1. The Face to Face Board of Directors sets the vision and monitors the standazds and d'uection
of the agency through monthly board meetings and the work of board committees. Board
� committees evaluate the overall functioning of program azeas and addresses important issues of
d'uection, policy and relationships with other community agencies as well as funding.
:.�ll
Apptication Narrative
2. Progress reports are prepared by staff for review by all funding entities as required by each
source. An nnportant source of informauon for these reports is the organization's comprehensive
database system. This database is extensive, comprised of quanritarive and qualitative .
measurements of client informauon including: registration informauon, e�tensive intake
informarion, health history, complete visit records, attendance and credits, referrals, follow-up
data (lab results, termination status, etc.), and some case management data.
3. As part of trying to integrate all of the experiences Face to Face provides, a key activiry has
been to develop an intake process that provides useful information to assess the overall needs of
each youth. At part of this process, the agency is collecting information to take into account the
physical, social, emotional and cognitive aspects of adolescent's development.
Traininng/Experience - The outreach worker is Teretha Robinson, who came to Face To Face from
Saint Paul I'WCA. While at the YWCA, Teretha worked as a Senior Case Manager, conducting
screening and information and referral for homeless families. Case Management duties included
goal setting and education, negotiating client contractual arrangements, community
networking/service coordination.
Vicki Talaua is a second prenatal outreach worker who came to Face To Face last year from the
Healthy Start pmgram in Anoka, Minnesota. She previousty served as an intem with Face to .
Face from 1997 through June 1998. Ms. Talapa has a B.A. degree in Human Relationships from
the University of Minnesota
Clinic Manager Yaren Kramer serves as the OB/Gyn nurse practiuoner for the project. Karen
began her work with Face to Face in 1997 and was promoted to Clinical Manager early im 1999.
Sfie has over twenty years of nursing experience and is also currenfly affiliated with Regions
Hospital HIV programs as Women's Health Nurse Pracutioner providing caze for women with
HIV and AIDS.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Regions Hospital. Both are backed up by their respective
organizauons, and both bring many years of experience providing prenatal caze services.
The Medical Director is Chris Reif, M.D. Dr. Reif is also the Medical Director for Health Start
school-based clinics, is on the faculty at Regions Hospital, has worked in a variety of community-
based clinics and has directed Saint Paul's innovative Health Care for the Homeless project.
Continuing education needs of staff aze assessed and maintenance of credentials through �
continuing educaUon is monitored.
m
� �, � �
. -- � 3
Application Nazrative
Linkaees - Face To Face is committed to building working service networks with agencies,
individuals, coalitions, and systems. Evidence of this is our Academy program, which is a
� private/public partnership between Face To Face and the Saint Paul Public Schools. Further, in
the Sgring of 1993, Face To Face and Saint Paul Youth Service Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buIlding.
The Face To Face Prenatal clinic has built strong working relationships with a number of other
relevant maternal and child health service providers. These include: Maternal Child Project,
Ramsey County Public Health Nurses, Ramsey County Child Protection, WIC, MELD,
Children's Hospital Pediatric Clinic, Health Start's Hazding Clinic, Ramsey County SELF and
Minor Mothers Programs, and the Diabetes Clinic at United Hospital. A Ramsey County
Nutritionist is available at Face to Face prenatal clinics.
Clients aze referred for ultrasound, non suess tests, biophysical profiles and colposcopies. In
cases of refertals, the nursing staff contacts the referral source to set an appointment and inform
the client of time and date. In most cases, a written referral form is given to clients to take to a
referral appointment. If transportation to the refenal appointment is an issue for the client the
outreach worker will either provide bus tokens, tazi vouchers, or a ride - depending on the
situation. Follow-up is done by clinic staff to ensure that the client has carried through on the
referral.
� Reimbursement and Fees - The vast majoriry of our clients have been eligible for Medical
Assistance (and prepaid Medical Assistance). During 1998, 162 of 194 clients coming to Face to
Face for prenatal care were enrolled in Medical Assistance (Prepaid usually). Most who come for
care aze not yet connected with Medical Assistance.
Face to Face bills MA for prenatal caze, although none of the reimbursements cover the costs of
outreach. If a client is not eligible for any third party reimbursement, she is then charged fees
according to the sliding fee scale.
Budeet - A complete budget and justification for the Face To Face program follows.
�
CS:
Application Narrarive
Faco to FacY Health Counsaling Sexvice, �sc.
co�aoc/� �sot z000
Connect Program � To�
xEPENOE
Family Planning Special Project S 7,�80
HOD Special Needs Housing S 9•Z82
MDH HZV/STD OuYreacb 5 18,118
Adolescent Pazenting Program 5 57,039
MCH $ -0�,000 S 40,000
Family Support Pzoject � S 103,867
HOPE S 10,757
Subtotal Governmeat S 246.843
Puzehaee o£ Sarviea 5 23,600
Foundation/COZporation 5 29.900
Fasa S Third Pazty 5 2,000
Otbex, Misc. i Intezoet S -
To Be Asieed S d7,590
gpg�, • $ G0,000 S 349,933
EJ�£NSES
Pzoject Coordinator (TR) S 2,363 S 5,908
Wtzeach Wozkez iVDT) S 19,690 S 19,521
Wtreach Forkezs fMV7 5 12,5B8 5 23,275
Total Salaries 5 28,591 S 139,732
Fzinqe S 5,146 S 26, 599
Tm�pozazy Pessonnel 5 -
Coatznct Staff 5 -
Coasultaats S 4,400
Clieat f�ezgeacy Aasistance S 750
Clieat Pass TIIzwgA S 1D0,000
rzoqzam Suppiy 5 3,500
OE£ice Supplies S 1,000
p� S 4,600
Reat 5 '
Telephone $ 5,700
Posiage S 35
Membezship Dues $ �
wtsiae Pzintin9 S .1,350
Inside Pzintinq 5 920
StaEf Tsaoel 5 562 5 2,OOU
Clieai Txaoel S 1,600
Coa£ezencea, Tzaining 5 5,000
Adve-cising 5 900
Subsczip2ions 5 '
subiotal Exp�ns• 5 39,299 S 298.036
p�tiaiatzation Spzead S 3,800 5 47,166
Facilities Spzead S 1,901 5 4,731
TpTAL E78ENSE S 40,000 S 399,933
70
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xJi99/lSH00 7/3/99
Application Narrative
: -- :� 7 3 .
• Face to Fsce Health Counseling Service
Sudget Narrative
2000
BUDGET NARRATIVE
Total Salaries:
Portion of Connect Program staff salaries paid by MCH grant.
Project Coordinator - .08 £TE
Outreach Worker - .60 FT£
Outieach Worker - •50 FTE
Fringe Benefits:
Based on 188 of MCH portion oP staf£ salaries. Includes medical,
dental, FICA, li£e, etc.
Sta£f Travel:
.
Based on MCH portion 11.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 staf£ x.31/mile.
Faoility Costs:
Based on 6� of MCH portion of budget. Includes telephone, utilities,
janitorial, trash, building repais 6 supply, taxes, insurance,
telephone system & copier le�se, and maintenance.
Administrative/Management Ovezhead:
Includes general of£ice supply, insurance, postage, accounting,
annual audit, computer consultation, and administrative &
management staff and £ringe benefits.
•
71
Application Narrative
Faca to Face 8ralth Counsalinq
Conaoct Bsogram � T
.
REVEt��E
Family Plannin9 Speci�l P:ojeci S B
AOD Special Nee25 Housing S 9,560
H)e aN/STD wtreach S 18,662
olescent Paren2ing Proczam S 58,750
�g S 40,000 S 91.200
Family Suppozt Yroject 5 306,983
gppg 5 11,080
Subtoul Gwarmwnt 5 25<,Y<8
Porc7usa of Sorviu S Z6,308
FouLtlat3oA/COSpetatioa 5 30,797
Faes s Taizd Yarty 5 2,060
OtLCZ, Misc. i Iasazest 5 -
So ea Raitcd 5 62.632
gpy�, 5 d0,00D $ 35d,065
fXPEN5E5
Projett Coozdinator (TR) 5 2,3E3 5 5,908
WtzeaU Woskes (V,7T) S 10,640 5 19,521
Wtzeach Workezs (1.N1 5 11,588 S 23,175
Tosal Salaziee S 28,591 5 139,732
Franqe 5 5,196 5 25,152
Teaqozary Pezawuiel 5 -
Conuaci StaSS S �
c,n:,u:�„c, s a, 532
Climt Emezaenry Assissa�cc 5 �73
Uimt Pass Snreuqn 5 103.000
Yroqzw Supply 5 3, 605
oiSi<e supplaes 5 1,030
g� 5 0,738
Rmt S �
7elepnone 5 5,871
Pos:see 5 36
MmDezaAip Dues 5 -
Outsiae Yranssag 5 1,391
Iasiee Pr3aung S 998
StaSS zzavel S 562 5 2,060
usmc r:avei 5 1,648
CmiSUeaces. Tzalxung 5 5.150
Atl�rozcasing 5 927
sveaezipsswu 5 -
yspusu ssp�n.• 5 35,299 5 300,591
:tzation Spreatl 5 3.800 5 48.581
Facilliaes Spzeatl 5 1.901 5 4,873
SriTU E7�ENSE 5 d0,000 5 35a,0a5
co�.ez� saaQ.c zooi •
�
•
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Narrative
� ,�_ �73
. Face to Face Health Counseling Sexvice
Hudget Narzatioe
2001
SIID6ET 2IARRATIVE
Total Salaries:
Portion o£ Connect Program st«£ salaries paid by MCH grant.
Project Coordinator - .08 FTE
Outreach Worker - .60 FT£
Outreach Worker - .50 FTE
Fringe Bene£its:
Based on 18$ of MCH postion o: staf£ salaries. Includes medical,
dental, FICA, life, etc.
Sta££ Travel:
�
Based on MCH portion (1.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 sta££ x.31Jmile.
Facility Costs:
Based on 6$ of MCH poztion oP budget. Includes telephone, utilities,
janitorial, trash, building repair 5 supply, taxes, insurance,
telephone system 6 copier lease, and maintenance.
Administrative/Management Overhead:
Includes genes�l office supply, insurance, postage, accounting,
annual audit, computer consultztion, and administrative 6
management staff and fringe bene£its.
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Narrative
West Side Community Health Clinic - Improving Pregna�icy Outcomes for High •
Risk Latinos and Asians in Saint Paul
Goal - The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul L.atino and Southeast Asian populauons by providing outreach, tracking all positive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by existing West Side Community Clinic staff and services. The
clinic offers comprehensive health care services on a sliding fee scale. Tlus project will give
Latino and Southeast Asian families greater access to a full array of services inciuding well child
care, immunizations, family planning, parenting, and STD services as well as linkages by referral
to over 14 other community agencies.
Tar ep t Population - This project will target low ittcome pess than 200 % of poverty) Latino and
Southeast Asian women in the following azeas of St. Paul: Riverview (CTs 342, 361, 370, 371,
372), Mount Airy (CTs 328, 329, 330) and Rice Street (CTs 305, 314). These azeas include the
highest concentrations of Latino and Southeast Asians in the city.
Prolect Goal - To reduce low birthweight and infant mortality rates in the St. Paul Latino and
Southeast Asian populations. �
Obiectives -
1. To reduce overall rate of late (third trimester or none) prenatal caze among pregnant Latinas and
SEA teens and women to 10 percent or less.
2. Increase the rate of prenatal caze in the first himester among pregnant Latinas and SEA teens and
women to 60 percent or more.
Meth s -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted azeas, health education fair for teens as part the McDonough recreation
program, assistance in clinic enrollment at WIC sites at McDonough and West Side, and
responding to media requests for interviews by local newspapers and radio stations.
2. Project staff will conduct Spanish-spealdng and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safety, and personal health issues such as family planning, STDs, drugs and alcohol, �
and family violence.
'I4
Narrative
"'73_ ,�,
3. Staff in clinic will follow-up on all positive pregnancy tests and identify highest-risk
• perinatal patients, providing focused language and culture-specific health education and
support interventions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportation, and interpreting as needed.
Evaluation - All patient data is logged and entered into a computerized data system. Data kept
includes demograplucs, trimester of entry into prenatal care, types and numbers of services used,
and pregnancy outcomes. Information is reviewed periodically, and project results will be
compiled annually. Addirionally, patient satisfaction surveys are done semi-annually.
3atisfaction with prenatal classes will be measured via surveys after each services. Twenty-five
(25) prenatal records are audited quarterly to measure rates of compliance with prenatal risk
assessment, post partum visits, and newbom follow-up. This information will be reviewed
quarterly by the Quality Management Committee to identify and implement focused improvement
efforts.
Trainin�*(Fxnerience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability to meet the health needs of Hispanics and Southeast Asians. In 1996, WSCHC served over
12,800 medical patients, 75% were Aispanic or Southeast Asian. Services include bilingual and
� bicultural staff, transportation through our van, bus or cab voucher, hospital care through Regions
Hospital, in WIC clinics including immunizauon outreach assistance with Medical
Assistance/Minnesota Care applications and outreach clinics and education programs in homeless
shelter, public housing developments and a high school. These services are provided through a
well established interdisciplinary case management model. This model helps identify high-risk
patients through screenings and refenals, provides coordination of care, and ensures patient
involvement in care planning and choosing ueatment options.
The Perinatal Aealth Educator{Coordinator, Isolina Soto RN (.4 FTE) has worked at West Side
Community Health Services since 1993 and has over 20 years of nursing experience.
The Hmong Perinatal Health Educator, Youa Vang (.1 FTE) has a BS in Biology and has worked
with the Hmong community in a vaziety of roles for the past four years, including as a child
developer/ESL Tutor (Hmong), and at West side as a Health Educator.
Additional project support will be provided by the Nurse Manager, Jane Johnson, RN, the
Medical Director, Mary Nesvig, MD and other clinical staff through the Perinatal Caze
• Management Committee.
L' a es - West Side Connmunity Health Center works with the following organizations in
75
Narrarive
providing maternal and child health services:
• Regions Hospital Family Pracrice Residency Program to provide cross-cultural family •
medicine training for physicians motivated to work in high-need under served settings.
• Saint Paul - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Child Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, elderly health caze, life style/cancer
and dental care.
� Combined efforts with 16 other community clinics to improve health outcomes for
underserved populations through joint efforts through the Neighborhood Health Care
Network.
• Saint Paul - Ramsey Counry Department of Public Health to provide nutrition education and
immunizations in conjuncuon with WIC sites and home visits to pregnant women and
infants.
• Saint Paul Public Housing Agency to grovide services, including maternal child health, on-
site at McDonough and Roosevelt housing developments.
• City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facitities and five outreach sites.
West Side Community Health Services provides comprefiensive perinatal care. Any specialty
medical caze needed is provided either on-site or refened the high zisk OB clinic at Regions
Hospital. All medical referrals aze done on a referral form and followed-up via computerized
tracking.
Reimbursement and Fees - All reimbursements through the Minnesota Department of Human
Services go d"uectly to support services. Assistance is provided to enroll all eligible women on
Medical Assistance/MinnesotaCaze. A sliding fee scale is maintained for those not eligible for
assistance. Fees are discounted incrementally based on family income, from those at or below the
poverry level paying nominal or no fees, up to those exceeding 200% of the poverty level paying
full fees. Patients aze high risk, low-income (200% of poverty or less). No one will be turned
away due to finances.
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Narrative
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Bud�et - A budget and justification for the West Side Communiry Health Services proposal
foliows.
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77
Application Narrative
Maternal and Child Health (MC� Funds
West Side Community Healti� Center
�
Budaet
WSCHS is requesting 516,250 per year to supplement our existing perinatai progam.
The fimds will allow us to utilize bilinguaUbicultural perinatal health educators as focused
and integral components of our overall program.
Following is the project budget with noted WSCHS match:
Year One - Z000
MCH Reauest WSCHS Match
.4 FTE Perinatal Health Educator/Coordinator
832 hours at �16.34/bour
1 FTE Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing stafflperinatal support
TOTAL
Year Two - 2001
$13,600
2,650
$16,250
MCH Reaaest
.4 FTE Perinatal Health Educator/Coordinator
832 hours at $1634/hour
1 FT'E Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
$13,600
2,650
�16,250
$107,000
62,400
$269,400
WSCHS Match
$107,000
62,400
$169,400
Eight hundred prenatal patients will be seen annually.
Seventy-two prenatal classes will be held, serving an expected 350 patients.
Seventy-five highest risk patients �sill receive specific follow-up by the heatih educator.
An additiona1250 teens and women will be reached through outreach activities.
There are no DHS or self-pay reimbursements anticipated re]ated to tl�ese supp]emental
activities.
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ADOLESCENT HEALTH PROGRAM
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Narrative
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child Health
Special Project Grant funding for adolescent health services. Some funding will also be targeted
to services for adolescents through Room 111 at ihe SainR Paul - Ramsey County Department of
Public Health. The community assessment for adolescent health utilizes information prepazed by
Health Start from their assessment, as well as information from the Saint Paul - Ramsey County
2000-2003 Community Health Services Plan Community Assessment.
As mentioned eazlier, adolescent health continues to be a focus, primazily through the
Adolescent Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock grant program. This program will continue to be supported
through MCH funding. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgonen gopulation. In fact, a number of issues specifically related to adolescent health are
included in the Saint Paul - Ramsey County 2000 - 2003 Community Health Services Plan as
priority health problems, including:
• The percentage of births to adolescent mothers in Ramsey County is increasing
while national and state percentages aze going down.
• Tobacco use is on the rise among youth and select populations.
� High number of children, adolescents and adults aze overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effects that
aze associated with poverry.
�
Several more problems within the list of twenty-one high priority problems do not mention
adolescents specificially, but that population is clearly identified as being affected by the following
problems as well:
Emerging and re-emerging infectious diseases threaten the health of the general
population (including immunizations and STDs).
There is a gap between Minnesota goals and the cuzrent number of people in Ramsey
79
Application Narrative
County who have access to medical, dental and mental health issues.
• Despite overall health unprovement in Minnesota, populations of color continue to �
experience poorer heath and disproportionately higher rates of illness and death.
• There is an increase in the number of birFhs in Ramsey County that result from
unintended pregnancies. Some unintended pregnancies are associated with medical
and social problems which later affect children and families.
• There is an unacceptable level of interpersonal violence.
Adolescent health status indicators have shown improvement in some azeas and deterioration in
others in the last five years, Alcohol use has started to drop, as have reported rates of sexual activity
among teens. Pregnancy rates among teens nationally aze dropping, especially due to increased use
of contraceptives and a decrease in amount of sexual activity. They aze still too lugh in Saint Paul,
especially among African-American youth. Rates of physical activity are decreasing for older teens,
wlule obesity is increasing. Tobacco use has increased draznaticatly, especially among White,
Hispanic, and Native Amezican youth. Mortality from violence - suicide, depression and car
crashes - is unacceptably high.
PROGRAM RESPONSE TO MCH PRIORITIES
The Adolescent Health Program responds to the goals and priorities for services adopted by the
State Matemal and Child Health Advisory Task Force. The goal of the Adolescent Health Program
through Health Start is to promote a positive health status and reduce the incidence of unplanned
pregnancy, nutrition problems, depression, chemical abuse and family and relationship problems
among adolescents in Saint Paul. To achieve these goals, Health Start, Inc. has i@entified priorities
consistent with the following MCH Advisory Task Force priorities:
• reduce infant mortality
� reduce the percent of low birthweight infants
• reduce adolescent pregnancy rates
• reduce unintended pregnancies
• provide access to preventive services
• reduce chemical use in adolescents
• reduce infecrious diseases
• promote good nutrition practices
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Application Narrative ^@ � % 3
These priorities will be addressed through the objectives and methods identified by Health Start's,
Adolescent Health Program. Methods to address these priorities include comprehensive health
. services that aze accessible and acceptable to high school age adolescents including nutrition
education and counseling, and psychosocial assessment and ongoing counseling. Extensive health
education is provided individually and in group education settings. Referrals aze made when
necessary.
The services provided for the Adolescent Health component in Room 111 will focus on the MCH
priority to reduce infectious diseases.
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Agplication Narrative
�
Teen Pregnancy Rate
15 -19 Year Olds
1995 - 97
•
Number pregnancies per 1,000 females this age group
Source: MDH
SPRCDPH, Mealth Policy 8 Planning
.
82
Minnesota Ramsey County Saint Paul
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Nazrative
Teen Pregnancy Rate
1993 - 1995
�
��. �7�
� 15-17 year olds
� � 8-19 year olds
15-197 year oids
Teen Pregnancy Rate: Number pregnancies per 7,000 temales in age group
' Source: MDH: MN Meatth Profites
SPRCDPH, HeaIN Policy & Planning
�
Teen Pregnancy Rate
1995 - 1997
�
� i 5-17 year olds
� 18-19 year olds
15-19 year olds
�
Teen Pregnancy Rate: Number pregnancies per 7,000 females in age group
Source: MDH: MN Heatth Profiles
SPRCDPH, Health Policy 8 Planning
8/'12/99
83
C:�Program FileslSPSS\TeenPreg9597.spo
Minnesota Ramsey County
Minnesota Ramsey County
Narrative
3 Year Teen Birth Rate
1993 - 1995
-.-o.
�.�.�., - ..
18-t9 year olds
� 15-t8 year oids
Teen Birth Rate: Number births per 1,000 females in age group
Source: MDH: MN Health Profiles
3 Year Teen 8irth Rate
1995 - 1997
..
.,.,., - ..
18-19 year olds
�'15-19 year oids
•
�
Teen Birth Rate: Number births per 1,000 females in age group �
Source: MDH: MN Health Profiles _
gi12/gg C:�Program FilesGSPSS\TeenBRaie9395.spo
84
Minnesota Ramsey County
Minnesota Ramsey County
�� n - 7
Application Narrative '-� �J ! �
Sexually transmitted diseases continue to be a concem in the adolescent population. The largest
percentage of cases of chlamydia aze females ages 0-19, followed by ages 20-29. Between 1992
� and 1995 there was a downward trend in rates of chlamydia in Minnesota, Ramsey County and
Saint Paul. However in 1996 and 1997 in St. Paul and Raznsey County the rates increased. The
second lazgest age group diagnosed with gonoahea is 0-19 yeaz olds.
Chlamydia 1992-1997
Case Rates per 100,000 Population
500.0
a a00.0
0
n
0
a 300.0
0
c
� 200.0
m
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m
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m
N
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V 0.0
•
YEARS
81992
� 7 993
Qi89d
� 7 995
\\ 7996
� 1997
Source:MOH.SPRCDPH
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Saint Paui Ramsey County Minnesota US
Application Narrative
Health Start. Inc. - Adolescent Health Program
Adolescents require services tailored to meet their specific needs and developmental levels. The
services must be accessible, accepiable and confidenfial in order to be effecrive. For these reasons,
Health Start provides comprehensive adolescent health services within the school setting at all seven
pub�ic high schools in Saint Paul: Hazding, Como Park, Central, Johnson Seniot High Schoot,
Highland Pazk Junior/Senior High School, Humboldt Junior/Senior High School and Arlington
Senior High SchooI. In addition to these seven scfiooI-based clinics, Heaith Start provides prenatal
and family planning services for pregnant and parenting teens at AGAPE Alternative School and
other health services (not including prenatal) at Guadalupe Area Project.
During CY 1998 school yeaz, students again demonstrated their need for clinic services by using
current services extensively. A total of 3,460 students made 14,141 clinic visits, generating over
18,817 encounters with various professional staff. This is a 5.6% increase in visits over 1997.
•
For many students, the Health Start school-based clinics aze their only source of health care. For
many others, the school-based clinics aze the important link that enables Yhem to obtain access to
other ea�isting community health care resources. Data from 1998 school yeaz (information available
at first visit) revealed that of student's families, 26% had medical assistance, 16.5% had private •
insurance, 57% had no known billable 3rd party source of payment, and 1% had MinnesotaCaze.
Goal - The goal of the Adolescent Health Program is to promote a positive health status and reduce
the incidence of unplanned pregnancy, nutrition problems, depression, chemical abuse and family
and relarionship problems among adolescents in Saint Paul by providing comprehensive health care
services at seven high School sites and two altemative school sites within the City.
Tar e¢ t Population - The clients targeted to be served by the Health Start Adolescent Health
Program aze adolescents living in the City of Saint Paul. The following demographic data describes
this population:
• 39.8% White
29.1 % African American
8.4% Hispanic/Latino
2.2 % American Indian
16.5 % Asian
4.0% Other
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Application Narrative -� � 7
• Age in School - 27.7% 18 years and above
24.3% 17 yeazs
� 22.1 % 16 years
21.9% 14-15 years
4.0% 12-13 years
In addition, an average of 53 % of all high school students are reported as eligible for free and
reduced school lunches, indicating low economic status.
O'ectives - The following objectives have been established for the Adolescent Health Program in
order to achieve the goal:
1. In CY 2000 and 2001, 3300 junior and senior high students will access health caze
through the school-based clinics each yeaz.
2. In CY 2000 and 2001, the healthy lifestyle of physical activity and a balanced diet will be
encouraged by providing 200 nuuition visits related to sports nutrition, weight conuol or
eating disorders.
� 3. Onsite counseling will be provided for 1,000 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, sexual or
emotional abuse each year in CY 2000 and 2001.
4. 1000 teens will receive an annual comprehensive preventive health exam and risk
assessment, including sports physicals and annual reproductive health exams.
5. At least 85 % of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a pregnancy prevention plan. Decision making, sexuality
counseling, and family planning services will be provided for 1,QQQ adolescents each year
in 2000 and 2001.
6. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in CY 2000 and 2001. (From 863 in 1998).
7. The number of hepatitis B immunizations given will increase by 10% in CY 2000 and
2001 (From 501 in 1998).
.
8. An "Ask and Advise" smoking assessment will be implemented for 75% of teens using
F:�17
Applicarion Narrative
clinic medical services in CY 2000. In CY 2001 an "Assist and Connect" component will
be added for 100% of teens expressing a desire to quit or decrease tobacco use.
�
The number of males being seen in clinics will increase by 10% in CY 2001 over CY
1998.
10. 7,000 group education contacts will be provided in clinic and in selected classrooms by all
members of the interdisciplinary team on health education activiues such as prenatal and
parenting classes, weight control classes, human sexuality programs, an@ smoking
cessation, in order to maximize the understanding and practice of positive health
behaviors.
Methods -
• All new students will be assessed for helath and behavior risks, following GAPS assessment
guidelines, detailing medical and family history, behaviors and feelings. This form will
provide staff with background data necessary for providing good caze and for triaging clients
to appropriate staff
• Physical examinarions, health screening and assessments, diagnosis and treatment of acute and
minor illness, and family planning visits w�l be provided on site by a nurse practitioner or �
physician.
• A Health Start health educator, nurse practitioner or social worker will provide decision-
ma[ting counseling and family pIanning eduarion and counseling to adolescents requesting
these services.
• A certified nurse midwife, or physician will provide prentaU care in eight of nine clinic sites
for those students choosing to receive caze through the Health Start program.
• Health Start staff will provide risk assessment, prevention education, and screening on site for
all STDs, inclutling FIIV infection. Health Start will provide new non-invasive urin-based
testing for gonorrhea and chlamydia when appropriate.
• Health Start staff will serve as adolescent health resources to teachers, school staff and youth
workers in their classroom and other groups.
• Health Start will work collaboratively with the health plans serving St. Paul students to �
maximize reimbursements for services and communicate with or refer students into
appropriate sources of caze.
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Narrative ' " f j
• Health Start will participate in the Neighborhood Health Care Network in efforts to increase
. e�ciency through joint purchasing and to increase third parry reimbursement through joint
contracting as part of a primary caze network.
Evaluation - Clients at school-based clinics are assessed annually for satisfaction with Health Start
services, using a standardized format and automated s»mmarization. The same form is used by
the Neighborhood I3ealth Care Network. Satisfaction levels are compared with primary care
community clurics and four other adolescent specialty programs in the Metro azea. Automated
encounter forms gather the demographic data, visit, procedure, and diagnostic code data, and site
of service. These data can be queried to provide data on types and quantity of services used, as
well as target population reached by age, race and income level and special need.
In order to determin if famly planning and reproductive heltah services can be provided
effectively in a school setting, conuaceptive use compliance will be uacked to compaze results
before dispensing on site to afrer dispensing on site, by CY 2001. This will be accomplished by
chart review.
To help detez�min if there is any measureable impact of use of school based clinic services on
school performance/attendance, Health Start plans to replicate a study conelating school based
� clunc enrollment and intensity of use with school performance meaures done in 1993. (Klein,
McCord et all, Journal of Adolescent Health) The principal investigator of that study has
tentativley agreed to be the P.I. on the replication study. Funds are being sought through private
foundations to pay for the study in CY 2000. This would be a retrospective study.
Information from evaluation efforts will be given to the quality assurance committee, the qualty
managemnet team, and the clinical management team. They may be used to formulate changes in
intervention, to stimulate fiu�ther analysis for underlying causes, or suggest areas for a quality
improvement project. Evaluation results are disseminated to providers via periodicy provider
meetings, clinc temas via team coordinator meetings, the board of directors at board meetings
semiannually. They are slo used to motivate staff and to stimulate a work culture of continuous
quality improvement.
Training & Experience - Health Start has provided maternal and child health services in Saint
Paul since 1967. All Health Start staff are professional health care personnel with special
expertise in maternal and child health. The majority have had more than five yeazs experience.
All staff aze evaluated at least once a year. Cinical staff are also subject to annual peer review.
• Staff are supervised by the executive director, associate director, medical duector, OB medical
d"uector,or team leaders. Mecical providers are credentialed according to standazds of the major
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Narrative
health plans.
Carol White, M.A., is the execuuve director of Health Start and is responsible for the overall .
management and direction of the project, as well as external relations and long-range planning.
Dr, Chris Reif, a member of the Family Medicine Department at HealthPartners/Regions
Hospital, is tiie medical d'uector and responsible for overall medical direction. Dr. Donna
Anderson, on the staff of the HealthPartners Obstetrics and Gynecology Department, is ffie OB
medical director and works with the medical director to provide consultation on OB/GYN
pracuces, as well as providing clinical supervision for OB/GYN nurse practitioner staff. A
clinical management team made up of representatives from the various professional disciplines, in
prenatal and adolescent services of Health Start advises management staff. Richard Duffin,
M.A., has been the associate director fo�ve years and manages the school based clinics. 7eanne
Rancone, PNP, PHN, is the Clinical Services Coordinator, overseeing clinical services for
adolescent, prenatal, and pediatric care. 7eanne has been with Health Start for five years.
Li a es - Heaith Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. This referral network allows staff to
individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs arise. Key linkages include: HealthPartners/Regions
Hospital - most physiciaus and midwives are contracted through HelathPartaers, who also provide �
back-up for prenatal care and refeaals for primary care services and OB specialty services not
provided by HealthStart.
Health Start works collaboratively with Saint Paul-Ramsey County Public Health nurses to extend
services to pregnant women in the community. Public health nurses meet regularly with Health
Start to identify clients needing home-based services and to share information that will enhance
patient caze.
At delivery, new parents are referred to Health Start's pediatric clinic which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location neaz Le�ngton and University,
the usefulness of providing pediatric care at a different neighborhood sit as an incentify for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediatric
services are discontinued by Helath Start, case managment to help conneci new mothers to
approrpiate mecial homes for their babies in the community will be maintained.
Eligible clients aze also referred to the Befriender Program, run in collaborauon with Children's •
Home Society which offers volunteer mentors to young or struggling mothers. Health Sart also
refers to two parenting/home-visiting groups, which are coIlaborarions witfi St. Paul Schoolc
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Application Narrative � � ` � � �
Early Childhood and Family Education (ECVE). One is funded by Ramsey County Family
Preservation Services to prevent child abuse and need for foster care in minor mons. The other,
� cailed the CARES Project, is designed for parenu with drug exposed children and with cantinuing
difficulties with substance abuse. These programs all provide intensive counseling, support,
and/or group education for high-risk pazents_
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), written referrals will be made to communiry clinics
or other resources within a convenient geographic area.
In the school-based clinics, the linkage with the school nurse is very close. Often, space is shared
and refenals go back and forth during the day. Relations with other school personnel aze also
pursued. A school board member always serves on the Health Start board of directors.
Aealth Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliations with
andlor refer to the following agencies and task forces (partial list):
Children's Home society of Minnesota, Early Childhood and Family Education (ECFE),
� HouseCalls, Frogtown Family Resource Center,HeaZthPanners and Regions Hospital, Ramsey
County Human Services Child Protection/Minor Moms Services, Saint Paul - Ramsey
Depart»2ent of Public Health, Rondo Family Resource Center, Neighborhood Health Care
Nenvork, Saint Paul Public Schools, tiVIC Food supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. Patients are low income (200% of federal poverty
or less). MCH funding allows Health Start to provide prenatal care for clients who have no third
party source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. Health Start has conuacts with all of the PMAP providers.
Any other applicable third parties are billed whenever possible. Insurance revenue pays for
approximately 45 % of Health Start's prenataUfamily planning clinic services, and 15 % or
adolescent health services at school based clinics. No one will be turned away due to lack of
financial resources.
Health Start provides fannily planning care to clients for 24 months after delive .ry uusing MCH
and Fanuly Planing Special Project funds. If a client has no third party payor, a sliding fee scale
is used to determine her fee for family plazming services. Funds will be requested from the State
� of Minnesota Family Planning Special Projects to continue the provision of family planning
services in the next biennium. An increase in these funds in CY 98 and 99 allowed Helath Start
91
Application Narrative
to offer continueation family planing services to graQuating high school stu@ents on a sliding fee
basis.
Subgrants/Subcontracts - Health Start subcontracts for the provision of physician, certified nurse- �
midwife services and social worker services with several community providers including:
HealthPartners, and Face To Face Health & Counseling Service, Inc, The Health Start Medical
Director and Associate Medical Director are responsible for supervision, protocols, and general
medical direction for all medical personnel involved in the prenatal/postpartum and adolescent
health programs.
Bud�et Justification - Health Start, Inc. will receive $505,035 in 2000 and $505,035 in2001 to
support the Adolescent Aealth Program through school-based c2inics. The total budget and
just�cation for the budget follows.
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Application Narrauve y U
• HEALTH START, INC.
MATERN.AI. f1ND C�+D H�' .a11.TH
ADOLESCETT AEALTH SERVICES
SCHOOL BASED CLINIC3
JAl�'UARY TIiROUGH DECEMBER, 2000
MCHSBC00
•ANNUAL PROGRAM PROGRAM MCX
LINE ITEM EXPENSE SALARY F'rE euDCe'r suoc�'r
NURSE PR4CTRIONER (CENTW+L)
NURSE PRACTfT10NER (COMO)
NURSEPRACTRONER(HUMBOLD�
NURSE PRACTRIONER (JOIiNSON)
NURSEPRACTRIONER(HARDING)
NURSE PRACTRIONER (ARLINGTON)
NURSE PRACTRIONER (GAP)
SOCIAL WORKER (CENTRAL)
SOCL4L WORKER (COMO)
SOCV1 WORKER (tiVMBOLD�
. SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE M4NAGER(AGAP�
� MED�CAL. ASSISTANT (CENTRAL)
MEpICAL ASSISTANT lCOMO)
MEDICAL ASSISTANT (HUMBOLD�
MEDICAL ASSISTANT (JOHNSON)
MEDICALASSISTANT (HARDMG)
MEDICAL ASSISTANT (AGAP�
MEDICAL A5515TANT (ARLINGTON)
MEDICAL ASSISTANT (GAP)
NUTRSTIONIST (CENTRAL)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOLD�
NUTRRIONIST (JOHNSON)
NUTRRIONIST (HARD�NG)
NUTRITIONIST (ARLfNGTON)
NUTRRION15T (GAP)
NEALTN EDUCATOR (CENTRAI)
NEALTN EDUCATOR (COMO)
HEALTM EDUCATOR(HUMBOLDT)
NEALTN EDUCATOR (JOHNSO�
HEAITN EDUCATOR (HARDING)
MEALTH EDUCATOR (AGAPEj
MEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GA�
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
�
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
S
$
$
$
S
$
$
$
S
$
$
40,320
47,'124
41,966
42,672
40,320
40,992
47,124
35,902
32,038
35,330
34,759
28,510
33,768
19,606
19,034
19,606
20,765
18,362
'18,413
18,413
18,413
34,759
35,246
37,750
34,759
35,246
35,246
33,869
28,980
32,558
30,818
28,980
32,558
32,558
26,998
33,163
44,554
0.80
0.80
�.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
1.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
0.10
0.1�
0.10
0.05
0.15
0.10
O.iO
$ 32.256 $ 25,805
$ 37,699 $ 30,159
$ 33,573 $ 26,858
$ 27,737 $ 22,189
$ 32,256 $ 25,805
g 36,893 $ -
$ 8,247 $ -
$ 14,361 $ 13,643
$ 12,815 $ 12,174
$ 21,198 $ 20,138
$ 13,904 $ 13,208
$ 14,255 S -
g 25,326 $ -
g 19,606 $ 15,684
$ 19,034 $ 15,228
$ 19,606 S 15,684
$ 20,765 S 16,612
$ 18,362 $ 14,690
$ 3,683 $ -
$ 18,413 $ -
$ 13,810 $ -
$ 5,214 $ 5,214
$ 5,287 $ 5,287
$ 5,662 $ 5,662
$ 5,214 $ 5.214
$ 5,287 $ 5,287
$ 5,287 5 -
$ 3,387 $ -
$ Z,S98 $ 2,898
$ 3,258 5 3,256
5 3,082 $ 3,082
$ 2,89$ $ 2,89$
$ 3,256 $ 3,256
a'W �,628 .� '
$ 4,OSD $ -
$ 3,316 $ -
$ 4,455 S 4,455
� SUB TOTAL SALARY
' annual salary based on 42 week school year
FRINGE BENEFITS @ 20°k
93
$ 507,974 S 314,388
$ �0� ,595 $ s2,s7e
Application ATarrative
Health Start
Adolescent Health Services
CY 2000 Budget
r�
�J
ANIiUAL pROGRAM pRpGRp�A MCH
LINE ITEM EXPENSE SALARY Fre s��ET B��ET
CONTRACT SERVICE
FAMILY PRACTICE PHYSICIAWNURSE MtDWIFE
NINE PHYSICIAN CLINICS/WK @ 5305 X 34 WKS
THREE CNM CUNICNVK @ S'720/CUN1C X 34 WKS
PEDIATRICNURSEASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-RAY
OTHER EXPENSE
nneoic�+nowoRUCs
MEDIGAL SUPPLIES
OFFlCE SUPPUES
PRINTING/DUPLICATING
EQUIPMENT
TRAINING
PATIENT TRANSPORTATIOWCOURIER
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ 16%
TOTAL PROGRAAA EXPENSE
TOTAL MCH GRAN7 RE�UEST
MATCHING FUNDS @ 2S6
$33,537
HIGHL�ST�'D SCHOOL BASED CLINIC FUNDED BY SEPERATE GRANT SOURCE
g 93,330 $ 55,998
$ 12,240 $ 7.344
g 5.191 $ 3,115
g 33,537 $ 16.768
$ 35,000 $ 17,500•
$ 21,000 $ 12.600
$ 8,500 $ 4,944
$ �2.000 $ �,200
$ 2,500 $ 1,500
g 5,000 $ -
$ '1,5DD $ -
$ 2.000 $ $00
g g41,366 $ 505,035
g 134,619 S -
$ 975,985 S 505,035
$ 505,035
$ 126,259
\J
t��'
Application Narrative "' � � ✓
� HEALTH START, INC.
MATERhAL AND CHIL.D HEAI.TH
ADOLESCEIv'T HEALTH SERVICES
SCHOOL BASED CLINICS
JANLTARY Tf�II20UGH DECEMBER, 2001
MGNSBCOt
•ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SAL4RY F're euoG� B�o�ET
NURSE PRACTRIONER (CEMRAL)
NURSE PRACTRIONER (COMO)
NURSE PRACTfTONER(NUMBOLD�
NURSE PR4CTRIONER (JONNSON)
NURSE PRAC7iT10NER (NARDiNG)
NURSE PR4CTRIONER (ARLINGTON)
NURSE PRACTRIONER (GA�
SOCI4L WORKER (GENTRAy
SOCt4L WORKER (GOMO)
SOCIP.I WORKER (HUMBQLDT)
SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE MANAGER (AGAP�
MEDICAL ASSISTANT (CENTRAL)
� MEDICALASSISTANT(COMO)
MEDICAL ASSISTANT (HUMBOLDT)
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASStSTANT (H0.RDING)
MEDICAI ASSISTANT (AGAP�
MEDICAI ASSISTAM (ARLMGTON)
MEDICAL ASSISTANT (GAP)
NUTRRIONIST (CENTR4L)
NUTRITION15T (COMOj
NUTRfTIONIST (NUMBOLO�
NUTRRIONIST (JOHNSON)
NUTRTT10N15T (W+RDING)
NUTRRIONIST (ARLINGTON)
NUTRRIONI57 (GA�
HEALTN EDUCATOR (CENTRAL)
HEALTN EDUCATOR (COMO)
NEALTH EDUCATOR (NUM80LD'f)
HEALTH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARDING)
HEALTH EDUCATOR (AGAP�
HEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GAP)
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
$
$
$
$
$
$
$
$
$
41,530
48,538
43,225
43,952
41,530
42,222
48,538
36,979
32,999
36,390
35,802
29,365
34,781
20,194
19,605
2o,�sa
21.388
18,913
18,965
18,965
'18,965
35,802
36,304
38,882
35,802
36,304
36,304
34,885
29,849
33,535
30,818
29,849
33,535
33,535
27,808
34,158
45,890
0.80
0.80
0.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
�.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.10
0.05
0.15
0.10
0.10
$ 33,224 $ 26,579
$ 38,830 $ 31,064
$ 34,580 $ 27,664
$ 28,569 .� 22,8r'J$
$ 33,224 $ 26,579
$ 38,000 $ -
$ 8,494 $ '
g 14,791 $ 13,312
$ 13,199 $ 11,880
$ 21,834 S 19,651
$ 14,321 $ 12,889
$ 14,682 $ • -
$ 26,�86 S '
$ 20,194 $ 16,155
$ 19,605 $ 15,684
$ 20,194 $ 16,155
$ 21,388 S 17,110
$ 18,913 $ 15,131
$ 3,793 $ -
$ 18,965 5 -
$ '{4,� $ -
$ 5,370 $ 4,296
$ 5,446 $ 4,356
$ 5,832 $ 4,666
$ 5,370 S 4,296
$ 5,446 $ 4,356
$ 5�446 $ -
$ 3,488 $ -
$ 2,985 $ 2,688
$ 3,354 $ 3,018
s s,os2 $ z,na
$ 2,985 $ 2,686
$ 3,354 $ 3,018
$ 1,677 $ -
$ 4,171 $ -
$ 3,416 S -
$ 4,589 $ 4,589
� SUS TOTAt SALARY
' annual salary based on 42 week schooi year
FRINGE BENEFITS Ca 20°h
$ 523,120 $ 313,451
$ 104,fi24 $ 62,690
95
Application Narrarive
Health Start
Adolescent Health Services
CY 2001 Budget
�
ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE sn�n�' Fse BuocEr euocEr
CONTRACT SERVICE
FAMILY PfiACTICE PHYSICIAWNURSE MIDWiFE
NINE PHYSICL4N CUNICSNJK @$320 X34 WKS
THREE CNM CUNICANK @ S'125�CLINIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-R4Y
OTHER EXPENSE
MEDICATION/DRtJGS
MEDICAL SUPPLIES
OFFlCE SUPPLIES
PRINTINGIDUPLICATING
EQUIPMENT
TRAINING
PA7IENT TRANSPORTATIOWCOURIER
TOTAL DtREC7 EXPENSE
INDIRECT EXPENSE @ 16°k
TOTAL PROGRAM EXPENSE
TOTAL MCH 6RANT REQUEST
MATCHING FUNDS � 25k
$34,546
H1GHLnND SCHOOL BASID CLIAIIC FUNDID BY SEPERwTE GRnNf SOURCE
$ 97.920 $ 58,752
$ 12,750 $ 7,650
$ 5,348 $ 3,209
$ 34,546 $ 20,728
$ 36,750 $ 18,375 �
$ 22,050 $ 9,��
$ 8,925 $ 3,570
$ 12,600 $ 5,040
$ 2,625 $ 1,050
$ 5250 $ -
$ 1,575 $ -
$ 2,100 $ 840
$ 870.183 $ 505,035
S '139.229 $ -
$ 1,009,413 $ 505,035
$ 505,035
$ 126,259
�
.�
� � �' 3
Appiication Narrative " ��
.
�
.
Room 111- Saint Paul - Ramsey County Department of Public Health - STD
Services to Adolescents
Since 1971, Public Health's Room 111 has provided for se�cually transmitted disease (STD)
diagnosis, treatment, refenal, follow-up and epidemiologic investigation. Room 111 was the fust
publicly funded "VD" clinic in the State of Minnesota. Room 111 has idenufied and attempted to
address changing challenges and focuses of STDs. Providing these services in an accessible and
confidential manner aze key goals of this program. Walk-in services are available as aze morning,
afternoon and evening hours of service.
Goal - To provide accessible, confidential services to adolescents regarding education, detection
and treatment of sexually transmitted diseases.
Tar�et Population - The clients targeted to be served are adolescents, primarily through 19 years
of age.
Obiectives -
1. To screen and provide education to 725 adolescents, 19 years of age and under for
sexually transmitted diseases (STDs) during each CY 2000 and 2001.
2.
3.
To diagnose and treat idenf'ied cases of STDs.
To decrease each year in CY 2000 and 2001, the number of cases of STDs, particulazly
chlamydia and gonorrhea, in adolescents.
Metho s -
• Clinic nurses who see clients in Room 111 will provide accessible, co�dential diagnosis,
education, treatment, referral and followup of STDs in adolescents.
• Clinic nurses will provide education on the prevenuon of STDs.
Evaluation - Encounter data gathering demographic data, visit, procedure, and diagnostic code
data are collected for each visit. These elements can be queried to provide data on types and
quantity of services used, as well as target population reached by age and race.
Communiry data trends will also be assessed to determine trends of STD rates in adolescents.
97
Application Narrative
• Training & Ex er� ience - Room 111 clinic is staffed by three or four nurses who aze highly skilled
STD cluricians. All staff have completed MDH-provided HIV counseling and testing uaining and
attend appropriate continuing education courses on a regular basis. The cluricians include: .
JoEllen Neitzke, RN who has worked as a clinic nurse at public health for 26 years; Sandy
Rooney, RN, who has 17 years of experience at public health; Laura Diedrich, RN, a clinic
nurse at public health for the past 14 years; and Alice Williams, PHN who has been with public
health working in Room 111 for the past seven years.
Linkaees - Public Health's Room 111 has well-developed linkages that include a wide variety of
health care providers, educarional programs, and social service agencies. This refenal network
allows staff to provide care and referrals for clients as needed. Some of the primary linkages
include HealthPartners/Regions Hospital, ffie Minnesota Department of Health, other public
health programs and correctional institutions.
Reimbursement and Fees - Because of the confidential and sensitive nature of the serivices
provided, Room 111 provides services on a donation basis. The adolescents who aze seen aze low
income (200% of federal poverty or less). Third parties are biiled whenever possible.
Subgrants/Subconuacts - Room 111 contracts for the provision of a Medical Director and
physician services with HealthPartners. The Medical Director is responsible for protocols and �
general medical direction for the programs.
Budget Justification - Room 111 will receive $12,550 in 2000 and $11,824 in 2001 to support
STD services to adolescents. The totai budget and justification for the budget follows.
•
�
Application Narrative
� � n
. . ��73�
�
�
•
Room 111 - Adolescent Health STD Services
2000 and 2001 MCHSP Grant Budget
Position MCH �nds Other F�nds Total Funds
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, ueahnent and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
22 FTE 12,550
43,906
$ 56,456
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, treatment and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
21 FTE 11,824
44,632
$56,456
..
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ATTACHi��NT B
� SOLICTTATION PROCESS FOR SUBGRANTS
Notification of the availability of funding was provided to qualified programs in the area through
a direct mailing of a Request for Proposals (RFP) to 37 agencies and a public notice placed in the
Saint Paul Pioneer Press on June 4, 1999 The process for selection of priority program
components and the process for selecting the requests (evaluarion criteria) included in the grant
applicauon are explained in the following RFP. The public nouce, a list of agencies receiving
the direct mailing, and a list of the agencies requesting subgrants are also included in this
attachment.
�
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104
NOTICE OF AVAILABILITY OF MATERNAL & CHII,D HEALTH (MCI� FUNDS
AND REQUEST FOR PROPOSALS (RFP)
ISSUED NNE 2, 1999 �
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
�YUu� li� /:\:��
The Saint Paul-Ramsey County Department of Public Health invites community health service
providers and related organizations to submit proposals to conduct maternal and chiid health
projects for:
improving pregnancy outcomes through outreach, referral and/or the direct
provision of prenatal caze for low income/high risk individuals during the period
of January 1, 2000 - December 31, 2001.
The Saint Paul-Ramsey County Department of Public Health will designate up to $140,000 in
State Maternal & Child Heaith Special Project funds over this two-year period to support selected
proposals addressing improved pregnancy outcomes. Proposals are due at 555 Cedar Street,
Attention: Sharon Alt by 4:00 p.m. �esday Ja1y 6, 1949.
An MCH ad hoc task force including representation of the Community Health Services Advisory �
Committee and addiuonal appropriate agencies will review the proposals and make
recommendations to the Board of Health for approval. Approved proposals will be included in
the Saint Paul or Ramsey County Maternal & Child Health Speciai Project Application to the
MN Deparnnent of Health.
Applicants for these competitive grant funds must show evidence of 501 � 3 status, or be local
government agencies_ Applicants must also meet the eligibility requirements and proposal
guidelines outlined in the following instructions, and be in compliance with attached assurances
and agreements.
USE OF MCH SPECIAL PROJECT FUNDS
Based on an assessment of community needs, Tfie Saint Paul - Ramsey County Department of
Public Health is choosing to focus the available funds on projects for improving pregnancy
outcomes. Public Health will allocate up to $70,000 each year for this purpose, targeted to
populations described in the MCH Priorities section of the RFP. Outreach, referral and duect
services may be provided in a variety of settings. At least one awarded project will serve
pregnant women in suburban Ramsey County. �
105
r�� ''�3
AttachmPntc - ' U
.
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•
All applicants must demonsuate in-kind contributions equal to a minimum of 25 % of the grant
request. Proposals must comply wiffi the legislative definitions of eligible services and the MCH
services priorities.
Applicants may request funds for up to two years or less during the period of 1/1J2000 -
12/31/Ol. It is anticipated that 2� projects will be funded with grant awards ranging from
$15,000 -$35,000 per year. Proposals may be for either one-time only projects or projects
requiring some source of continuation funds. NOTE: MCA funds cannot be guaranteed beyond
12/31/Ol and should not be relied on for continuation of the project beyond 12/31/Ol. If state
funds to public health are reduced during the grant cycle, this reduction may be passed on to
subgrantees.
MCH PRIORTTIES
Improved Pregnancy Outcomes
To reduce the overall rate of late (3rd trimester or none) prenatal care (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1 %) women.
To nnprove the infant mortaliry rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average), and
American Indian (12.0 for 1995-97 3 yeaz average); and
��
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 year average), American Indian rate (13.4 for 1995-97
3 year average).
To reduce the rate of Saint Paul low birthweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7.5% 6.7%
White low bir[hweight 6.9% 63%
African American low birthweight 12.4% 12.1 %�
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low birthweight 5.4% 5.0%
106
4. To conduct ouueach efforts to pregnant teenagers to increase the rate of first trimester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
with a special emphasis on outreach to minority teens. (For births to women less than 20
years of age in 1997, 52.4 % in Saint Paul, and 55.3 % in all of Runsey Counry began
prenatal caze in the fust trimester).
�;�•� �;u:
The proposal should consist of a narrative descripuon limited to ten pages which describes the
project in the following format:
i. Project Title
2. Name & Address of Applicant
3.
4.
5.
6.
7.
Contact Person - Name and Phone Number
Agency/Organization Description and Mission Statement
Amount Requested and Project Period
Project Abstr¢ct (I page)
Project Narrative
a.
Q
c.
�
e.
Goai Statement
Ta�et Popularion - describe the target population relative to age, income and risk
factors, and include an estimate of the number of individuals to be served.
Obiectives - specific statements of what is to be accomplished during the project
period; objectives should be time-specific, realisric, and stated in measurable
terms.
Methods - describe the specific activiries by which objectives will be achieved;
include how and why activities were selected, and how procedures for refenal and
follow-up will be incorporated into services provided.
Evaluation - describe the intended outcomes of the project, and the methodologies
to be used to analyze the impact the project has had (outcomes) on the problem
.
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n !� �'1 '7
- 11 Y
�
�
Training/Experience of Key Staff - sum*nari�e; one page - resume may be attached
�
�
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S•
h.
over time, so that the projecYs effectiveness may be assessed. The projecYs
outcome, objectives and evaluauon plans need not be limited to the two year grant
cycle. The evaluation plan should include evaluation questions, data to be
collected and use of evaluation results.
Linka s- describe the linkages with other relevant maternal and child health
service providers in the project service azea. Include a procedure for written
referrals for service needs not addressed by project.
Reimbursements and Fees - describe plan for use of reimbursements from the
Department of Human Services (Minnesota Health Caze Programs). If fees are to
be charged to clients, please describe the sliding fee schedule to be used.
Budget - Include a detailed project budget itemizing:
Personnel and other costs
Cost per unit of service provided and total units of service to be provided.
Expenditures and revenue including reimbursements from DHS (Minnesota Health
Care Programs) and patient fees.
In-kind contributions
Budgets must be completed separately for each calendar year.
Attachments
Proof of 501(c)3 status (if not a unit of local govemment)
List of Board if Directors if non-profit organization
Key Project staff resumes or job descriptions if position is vacant.
SUBMISSION OF PROPOSALS
Bight copies of the proposal should be submitted by 4:00 p.m., July 6, 1999 to Sharon Alt at 555
Cedar Street, St. Paul, MN 55101. Questions about this announcement may be directed to
MaryLou Egan at 651-266-8025.
Minimum Requirements
For a proposal to be considered valid it must be:
108
• Submitted in writing, with required copies provided
• Submitted on time
• Signed by an officer of the organization who can be held accountable for all representauons
Proposal Preparation
The response to this RFP must include an original and seven copies of the proposal. The first
page of the original must have the original signature of the officer who will be accountable for all
representations. Unsigned proposals may be considered invalid.
EVALUATION / REVIEW PROCESS
An MCH ad hoc task force including representation of the Community Health Services Advisory
Committee and additional appropriate agencies will review proposals and make recommendations
to staff and the full Advisory Committee. The CHS Advisory Committee will review these
recommendations and advise the Saint Paul Board of Health and the Ramsey County Board of
Commissioners about proposals recommended for funding. Proposals approved by these bodies
will be incorporated into the DepartmenYs MCH Special Project Application to be sent to the
Minnesota Department of Health.
Proposal Review Criteria
All applicants must demonstrate their ability and willingness to meet all of the requiremenu of
the State and County. All applications for the MCH funding through the Saint Paul - Ramsey
County Department of Public Health must meet all of the requirements contained in this
document. All qualified applications will be judges based on the criteria and specifications
oudined in this RFP. Please see attached list of review criteria and ranking (pages 7-8).
Timetable
The MCH planning timetable is as follows:
7/6/99
7/7/99 - 7/21/99
8/4/99
Aug/Sept1999
9/15/99
Proposals must be submitted by 4:00 PM .
Review and selection of proposais by MCI� Review Committee
CHS Advisory Committee review of MCH Plan
Approval by Saint Paul Boazd of Health and Ramsey County Boazd
of Commissioners
MCH Plan sent to Minnesota Dept of Health
Applicants will be nofified of funding decisions by August 30, 1999.
L__�
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109
AtYar}�mAnte '`� � � / �
- _ �T�_
Upon approval by the Minnesota Department of Health (MDH), Public Health staff will develop
contracts with the approved applicant agencies for the project services. Approved projects will
. be required to submit monthly or quarterly reports (as specified in the contract) and expenditure
reports to obtain reimbursement. A copy of the reports required by the MDH are enclosed in the
RFP (pages 9-12). Actual reporting requirements may vary.
•
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110
AFFIDAVIT OF PUBLICATION
STATE OF MINNESOTA
COUNTY OF RAMSEY
JOANIE M. PUTZ
being duly sworn on oath, says: that she is,
and during all times herein state has been,
Cterk of Northwest Pubtications, Inc.,
Publisher of the newspaper known as the
Saint Paul Pioneer Press, a newspaper of
generai circulation within the City of Saint
Paul and the County of Ramsey.
THAT the notice hereto attached was cut
from the columns of said newspaper and
was printed and pubtished therein on the
following dates: �
�
4'" day of June 1999 •
newspaper ref tJlad �l : 14790
`Z�v�c�iiv/ e /
Subscribed and swom to before me is
7'" day of June 1999
P IC
Washington County, Minnesota
My commission expires January 31, 2000
� KAY/;S.flRCME e
•,` H071JiYPUBl1C.A6;i�LSCTA
�4 WASHING'fOt:COUt,1T1'
S!y Co�Mkh E�€y'vts din.37. i!n; .
M'if+�►isi� t�
111
� � ��
_
AGAPE
360 COLBORNE ST
S� UL MN 55102
ARLINGTON HOL3SE
951 E STH ST
ST PAUL MN 55106
BETIIESDA FAMILY PRAC CLIAIIC
590 PARK ST SUIT'E 310
ST PAiJL MN 55103
BOOTH BROWN HOUSE
1471 COMO AVE
ST PpUL MN 55108
ANN RICKETI'S
FACE "f0 FACE HEALTH & COUNSEL
11 K3 ARCADE ST
ST pAUL MN 55106
TH� LOFT TEEN CENTER
10F3 IGLEHART AVE
ST pAUL MN 55104
I�ANCY BRIGGS
NQRTH END HEALTH CENTER
li� MAMTOBA ST
ST PAUL MN 55117
KEGIONS HOSPITAL PEDS CLINIC
680)ACKSONST
ST PAUL MN 55101
SETON CENTER
1_?6 LJNIVERSITY AVE W
ST PAUL MN 55104
2.1:�VIS BREHM
�1'EST S[DE HEALTH CENTER
1�_ CONCORD ST
ST PAUL MN 55107
CATHOLIC CHARIT'IES OF ST PAUL
215 OLD 6T'H ST
ST PAiJL MN 55102
PEG LABORE
FAMII.Y TREE CLII�TIC
1619 DAYTON AVE
ST PAUL MN 55104
LUTf�RAN SOCIAL SERV OF MN
STATE CENTER
2485 COMO AVE
ST PALTL. MN 55108
PLANNED PARENTHOOD OF MN
1700 RICE ST
ST PAiJL MN 55113
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PALTI. MN 55102
iJNITED FAMII,Y HEALTH CENTER
545 W 7TH ST
ST PAUL MN 551�2
AVfER7CAN INDIAN FAMIl,Y CENTER CAPITOL COMMUNITY SERVICES
5?9 WELLS NORTHBND
STPALJLMN 55701 ]021MARIONST
ST PAtJI. MN 55117
'f COMMUNI'J'IES FAM SERVICE
3 COPE AVE B SUITE C
I�LiPLEWOOD MN 55109
FAMILY SERV OF GREATER ST PAUL
166 E 4T'H ST #330
ST PAUL MN 55101
CERTIFIED NURSE N�WIVES
RAMSEYFOUNDATTON
640 7ACKSON ST
ST PAIJL MN 55101
CAROL WHITE
HEALTH START INC
491 W LTNIVERSITY AVE
ST PALTI, MN 55103-1936
BARTON WARREN
MODEL CITLES HEALTH CENTER
430 N DALE ST
ST PAiJL MN 55103
REGIONS HOSPITAL OB/GYN CLINIC
640 JACKSON ST
ST PALTL, MN 55101
STPAUL WOMAN'S CLINIC
1690 iJNIVERSITI' AVE
ST PAUL MN 55104
iJNITED HOSPITAL-MOD CLINIC
333 N SMITA ST
ST PAUL MN 55102
DEPT OF INDIAN WORK
7611 SUMMITAVE
ST PALTI, MN 55105
LAO FAMILY COMMUNITY
320 N UNIVERSITY AVE
ST PAtIL MN 55103
112
AtYachmPntc
MAIZTIN LUTf�R KING/HALLIE Q MERRIAM PARK COMM CENTER MERRICK COMD4UNITY SERVICES �
BROWN CENTER 2000 ST ANIHONY AVE 715 EDGERTON ST
270 KENT ST ST PAUL MN 55104 ST PAUL MN 55101
ST PAUL MN 55102
NEIGHBORHOOD HOUSE
t79 ROBIE
ST PAL1L MN 55107
NORTHWEST YOUTH & FAMII.Y SERV
3490 LEXII�TGTON AVE N
SHOREVIEW MN 55126
iJNITED FAMII.Y PRACTICE/EIELPING
HAND HEAL7�-I CENTER
545 W 7TH ST
ST PAUL MN 55102
WEST 7TH COMMUNITY CENTER
265 ONEIDA
ST PAL7L MN 55102
WII,DER SERV TO CHII,DREN & FAM
919 LAFOND AVE
ST PAiJL MN 55104
r 1
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n ^ � i �
- iJ
Agencies Submitting Proposals for Subgrants
, The following community agencies submitted proposals to Saint Paul - Ramsey Counry
Department of Public Health by the deadiine:
1. Face to Face Health and Counseling Service, Inc.
1165 Arcade Street
Saint Paul, Minnesota 55106
2. Health Start, Inc.
491 West University Avenue
Saint Paul, Minnesota 55103
3. North End Health Center, Inc.
153 Manitoba Avenue
Saim Paul, MN 55117
4. West Side Community Health Cemer, Inc.
153 Concord Street
� Saint Paul, Minnesota 55107
�
114
REQUESTS FOR MCH SPECIAL PROJECT FUNDS
for Improved Pregnancy Outcomes
Agency:
Amount requested:
Target population:
Proposal:
Face to Face Health and Counseling Service
$80,000 - Y1: $40,000 Y2: $40,000
L.ow income adolescents, 50% of wluch will be youth of color; Dayton's
Bluff, Sunimit University, Thomas Dale, Riverview
Continue outreach/case management program; provide outreach,
pregnancy testing, education and counseling, prenatal care, risk
assessment
Agency: North End Medical Center, Inc.
Amount requested: $36,842 - Yl: $18,574 Y2: $18,268
Tazget population: Low income, high risk women in the North End/Rice Street areas of St.
Paul and lst ring suburbs including Roseville, Vadnais Heights, Little
Proposal:
Canada, Maplewood, North St. Paul and White Bear Lake, with priority
to teens and African-American and Native American women of ali ages.
Outreach to promote early prenatal care, linking persons to care,
decreasing tobacco, alcohol and drug use.
Agency: West Side Community Health Center, Inc.
Amount requested: $32,500 - Yl: $16,250 Y2: $16,250
Tazget population: Hispanic and Southeast Asian women, ages 13-35, in specific census
tracts in 3aint Paul that have the highest concentrations of Hispanic and
Southeast Asians.
Proposal:
Agency:
Amount requested:
Tazget population:
Proposal:
Ouueach, tracking of positive pregnancy tests, prenatai risk assessments,
and coor@inating services.
HealthStart, Inc.
$1,403,972 - Yl: $'753,236 Y2: $753,236
High risk, low-income adolescents and women at high risk for prenatal
and birth complications, with a focus on minorities.
Outreach, education and comprehensive, multi disciplinary prenatal care
and comprehensive health care services at high school sites.
�
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115
�`, �' r a
— U I l
AGENCY NAME:
. REVIEWED BY:
SAINT PAUL - RAMSEY COUNTY DEPARI'MENT OF PUBLIC HEALTH
MCH COMPETTTIVE GRANT
REVIEW CRITERIA
�.J
�
POOR SATI5 EXCEL
I. APPLICATION
A. Is in accordance with Saint Paul - Ramsey Coun 1 2 3 4 5
Department of Public Health MCH priorities
B. Proposes services targeted to low-income high
risk individuals in targeted areas 1 2 3 4 5
C. Is cleazly written and the format facilitates
review 1 2 3 4 5
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, racial/ethnic distribution, and
eligibility criteria 1 2 3 4 5
B. The applicant can demonstrate past successful
experience working with target populations 1 2 3 4 5
C. Low-income, e.g. <20Q% of poverty or women
who are pregnant and determined eligible for M.A. or
WIC 1 2 3 4 5
D. Identify risk criteria consistent with MDH
guidelines 1 2 3 4 5
III. OBJECTIVES
A. Described 1 2 3 4 5
B. Related to priorities 1 2 3 4 5
C. Realistic 1 2 3 4 5
116
d trarhmPntc
D. Time Specific 1 2 3 4 5
E. Measurable 1 2 3 4 5
F. Identify ciient's or community's needs, not the
ap plic anY s 1 2 3 4 5
POOR SATLS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted public health
pracrice 1 2 3 4 5
F. Maxitnizes use of aIternarive health care
providers where appropriate 1 2 3 4 5
G. Likely to achieve objecrives 1 2 3 4 5
V. EVALUATION
A. Ali activities which warrant evaluarion are
identified 1 2 3 4 5
B. Methods for collecting the data aze describe and
are feasible 1 2 3 4 5
C. Gives evidence that evaluarion results will be
used for program management decisions 1 2 3 4 5
D_ Collects data which relate to the objectives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objecrive as well as subjecrive 1 2 3 4 5
117
_ .._
' ': ��
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VI. TRAINING/EXPERIENCE
A. Indication of work experience, training, and
qualifications for staff direcfly involved in the project is
included 1 2 3 4 5
B. Plan(s) to identify and address continuing
education needs of staff 1 2 3 4 5
VII. LINKAGES
A. Linkages and referral arrangements with other
community service providers are described and relate to
goals, objectives, and methods 1 2 3 4 5
B. Description of current or anticipated
cooperative agreements to minimi�e potential
� for duplication
C. Plans for or descriptions of ongoing
collaborative activities with providers such as
participation on task forces, committees, etc.
D. Applicant can show experience in successful
follow-up on referrals
VIII. BUDGET
A. Budget items are justified in terms of project
activities
B. Complete
C. Provides a rationale for formula/process for
calculation of items
•
POOR �SATIS IEXCEL
1 2 3
1 2 3
1 2 3
1 2
1 2
1 2
3
3
3
4 5
4 5
4 5
4 5
4 5
4 5
118
D. Amount of funding requested is appropriate •
for the level of service and objecrives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonstrated in kind contributions ��
of at least 25% of the grant request
F. Are mathematically correct
G. Indicates plans to obtain and use DHS
reimbursements (Medical Assistance,
MNCare)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDITIONAL CONIl�4ENTS/RECOMNNIEEIVDATIONS:
�
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119 -
CawcilFde# Q 1 � 0 � �
ORIGINAL
:�
RESOLUTION
OF SAINT PAUL, MINNESOTA
Pcesented By
Refermd To
1
2
3
4
5
6
7
8
9
10
71
12
13
14
15
16
17
18
19
zo
21
22
23
24
Green Sheet # 103701
Committee: Date
WHEREAS, the City of Saint Paul seeks to improve the health of high risk, low-income
mothers and infants, and adolescents; and
WHEREAS, the Minnesota Department of Health accepts application grants from
Community Health Boards for programs which provide health services to high risk
pregnant women and children in Saint Paul; and
WHEREAS, the City of Saint Paul is a designated Community Health Board identified
by State Statute 145.882 Subd.3 to receive Maternal and Child Health funding; and
WHEREAS, the City of Saint Paul wilf submit a grant to the Minnesota Department of
Health to fund programs to improve pregnancy outcomes and to improve adolescent
health; and
WHEREAS, the operating agency for this grant will be the Saint Paul - Ramsey County
Department of Public Health;
THEREFORE, BE IT RESOLVED, that the Saint Paul Board of Health supports the grant
application and subsequent contract with the Minnesota Department of Health for the
Saint Paul Maternal and Child Health Block Grant, and authorizes proper City Officials
to contract on its behalf with the Minnesota Department of Health.
by Department of:
Adoption �rtified by Council
BY� I
Approved by
By: _
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Date f`7"' �yT / Appr Mayot for Submi ion to CouncIl
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AdoptedbyCouncIl: Date��,_g,� ����
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Public Health
Diane
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GREEN SHEET
ov.Rr�r ow�art
No 103701
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(CLJP ALL LOCATIONS FOR SIGNATURE)
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8/20(99
TOTAL # OF SIGNATURE PAGES 1
signatures on a Resolution for Board of Health support of the 2000-2001 Saint Paul
nal and Child Health grant application to the Minnesota Department of Health.
PLANNING COMM1SSlON
d6 COMMITTEE
CNIL SERVICE fAMMISSION
� �s��"5 �
/
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ta �his tlepartment'7
�wt no�mallypoaaeasetl bY aM' curteM oitlt empbv�7
INITIATWGPROBLEMISSUE.OPPORIUNITY(WIq,WIH[,Wl�en.W11He,WFIy) '1�12 C1t�T Ot J31Tlt Yaui, thT011gh Yllb11C iieatin W11.L
submit a grant proposal to the Minnesota Department of Health for funding of services to
improve pregnancy outcomes and improve adolescent health. By State Statute,Maternal and Child
Health Special Project Grant funding is designated to Che Saint Pau1 Board of Health. Through
the Public Health Joint Powers Agreement, the City of Saint Paul retains a Board of Health.
The operating agency for the_administration of this grant and these programs is the Saint Paul
The City will xeceive funding to help assure that pxenatal and other sexvices are provided
to high risk, low-income populations.
The health status of Saint Paul residents may improve.
Saint Paul residents will have greater access eo health care for these services.
NONE
Funding will not be received to support the above mentioned activities.
amouw70vsanwsncr�w+5 7 ,fi2�.1 53
sounceState of Minnesota
(O6�WN)
COS7/ttEVFNUE St70GETED (CIRCLE ON�
ncrrvm NuMS�
YES NO
Caura:�1 R�sea�ch Center
aR-�3
From: Nancy Anderson
l'o: jerryb, baribeau, gerrym, colemanc, barbb, leschj,...
Date: 8/18/9911:50am
Subject: SOARD OF PUBLIC NEAITH MEETlNG.
Councilmembers - FYI:
The City Council wili meet as the Board of Public Healtb on Wednesday, September 8, 1999, immediately foflowing
the regular City Council Meeting.
The agenda item will be: A resolution supporting the 2000-2001 Saint Paul Matemal and Child Health grant
application to the Minnesota Department of Health.
Please add this meeting date and time to your calendar.
Nancy Anderson
CC: CAO.Atlorney.byrne, TMSD.TMS.devine, TMSD.TMS.hans...
S �� �
� ��
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99-�73
�
MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
�
IMPROVED PREGNANCY OUTCOMES
AND
AD�LESCENT HEALTH
Z000 - 2001
Submitted by:
SAINT PAUL COMMITNITY HEALTH BOARD
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR STREET
ST. PAUL, MN 55141
,
The Saint Paul Board of Health
�a � The Saint Paul - Ramsey County Depardnent of Pubiic Health
The public health joint powers agreement between the City of Saint Paul and Ramsey
County became effective July 1, 1997. The Joint Powers Agreement forms the Saint Paul -
Ramsey County Deparnnent of Public Health and idenufies one Community Health Services
Agency for the Saint Paul - Ramsey County community. However, both Saint Paul and
Ramsey Counry witl maintain a Board of Heaith. The Saint Paul Community Health Boazd
wili consider issues affecting those services maintained by the Ciry of Saint Paul, which will
include the Maternal and Child Health Special Projects Grant. The Sairn Paul - Ramsey
Couaty Department of Public Health becomes the operating agency for the MCH grant.
n
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� SAINT PAUL MATERNAL AND CffiLD HEA��',�; ;
SPECIAL PROJECTS GRANT 2000-2001
Table of Contents
Page(s)
MINNESOTA DEPARTMENT OF HEALTH FORMS
FaceSheet .............................................................. 1-2
ProjectInformation ....................................................... 3-4
Evidence of Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Assurances and Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8
Certification Conceming Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1�
Certification Regarding Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Efforts to Reduce Racial Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Subgrants/Subcontracts ................................................. 13-14
Services Provided By L,egislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 5-20
Budgets 2000 and 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-22
� BudgetJustification ....................................................... 23
Budget Detail of Local Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Budget By Legislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-26
APPLICATION NAItRATIVE
COMMUNITY ASSESSMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-39
IMPROVED PREGNANCY OUTCOMES
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Q-49
Program Response to Minnesota MCH Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49-50
Inventory of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Project ..............................................................52
ProjectObjectives ....................................................... 52-53
Project Tazget Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
SUBGRANTEE INF012MATION
Subgrantee Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54-56
Health Start,Inc . .................................................... 57-64
Face to Face Health & Counseling Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65-73
� West Side Community Health Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74-7&
Table of Contents
(Continued}
ADOLESCENT HEALTH PROGT2AM
Community Assessment/Problem Statement/Response to MCH Priorities . . . . . . . . . . . . . 79-85
�
Health Start, Inc.
Goalofthe Project .......................................................86
TargetPopularion ..................................................... 86-87
Objectives ........................................................... 87-88
MeYhods............................................................ 88-89
Evaluation..............................................................89
Training/Experience ................................................... 89-90
Linkages............................................................ 90-91
Reimbursementand Fees ............................................... 91-92
Subgrants/Subcontracts ...................................................92
BudgetJustification ..........................................•••.........92
Budgets-2000 and 2001 ................................................ 93-96
Room111 ............................................................. 97-99 •
ATTACHMENTS
Attachment A - Inventory of Community Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100-103
Attachment B - Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104-119
r�
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� �
MINNESOTA DEPARTMENT OF HEALTH �
FORMS
�
C�
�See
of
�Grent Applieation for. �
Maternal and Child Health Special Projects
1. Appliwnt Ageney With Which Gnnt ConLact is to be Exeeuted
LegaiName: StreetAddress:310 City Hall, 15 W. Kellogg Bl
Saint Paul, rIN 55102
Saint Paul Co�unity E-MailAddress:
Health Board
2 Director of Appiicant Agency
555 Cedar Street
Name and TiUe: Sveet Adtlress: Saint Paul, NIN 55101
Rob Fulton E-MailAddress: rob.fulton@co.ramsey.mn.us
Director of Public Health
3. Fiscal Management O�cer of Applieant Ageney
NameandTitle: 5lreetAddress:555 Cedar Street
Diane Holmgren Saint Paul, MN 55101
IHealth Administration E-MailAddress:diane.holmgren@ci.stpaul.mn.us
4. Operating Age�cy (it diHe2nt fiom number 1 above)
NameandTitle: I StreetAddress:555 Cedar Street
>aint Paul - Ramsey Countyl ,�aint Paul, MI� 55101
1e�artment of Public E-MailAddress.
5. Contact Person for Operating Agency (if diHe2nf from number 2 a4ove)
Name and Title: � Street Address:
�iane Holmgren I E-Mail Address:
see 9l3 above)
6. Contact Person for Further Infortnation on Appiieation (if diHerent fmm 5 a6ove)
Name and 7itte: Streel Atldress:
Siane Holmgren E-MailAddress:
;see 1l3 above)
99� 8?3
ad Teiepeone ( 5 )266-856
�� 65� 266-8574
7etephone ( 5 )266-242
F,qX6 5 j 222-2770 '
Telephone6 j292-��1
F �b s j222-2770
Te�ephone�� )292-771
FqX6 5 j2 22-2770
Telephone ( )
FAX ( )
Telephone ( )
FAX ( )
— __
7 ��p�i�ti�9,4�iency F:'isc31'Coiifac! _
�fdifleranffromnumbarSabove3 StreetAddcesa:� - _ . � . _ � . .. -.� .7elephone( ) .
nfame aoC Te�e: : . : .
E-Maif Address " - �. " . . . FAX { � )
$��lte+�..P.aytnBttSs',� - .
e
(dd�flerenttmmnumberlabovej� - SVeetAUdress: 3�3 �edar�St�eet?,• Te7ephone{.�
t�ameandTiUe: Saint Paul i`SN SS10i ��651222-277fl
4ichael Hagen E-Mail Address: � j
9. Copies of This Appiication Have Been Sent to the Followin9 Community Fiealth Boards for Review
(NOt Applicable for Communiry Health Board(s) if tbe 8oard is fhe Applicant)
Aaenw iJame Date Sent
tU. Certifieation
t ceRify that the information contained herein is Vue and accu2te to the best of my knowledge and that I submit this appiiption on behalf of
the appli nt age .� _�� r/
� / 1���
Signature ot Direclot oi AppiiWnt Agenty T� ���
A
1
Instrucfions for Completiag Face Sheet
Please Type or print all items on tLe Grant Application Form Face Sheet
Applicants please note: The application fo:m has been designed to be used on all Special Project granu administered by the
Minnesota Deparcment of Heahh. If you have questions, or need assistance in completing the
application form, please contact the program Manager or Consultan2 idrntified u responsibte for the
grant
Applicant Agency
I,egal name of the agency autt�orized w enter into a grani contract with the Minnesota Departrnent of Health, e.g., North
Woods Community Health Board.
2. DireMOr of the Applicant Agency
Person responsible for directing the applicant agency.
3. Fiscal Management O�eer of Applicant Agenc�
i
The chief fiscal officer for the recipient of funds who has primary responsibiJity for grant and subsid,v funds expendimre and
reporting. If rhe applicant agency is a Communirv Health Board, the Fiscal Management �cer must be the same person
who is identified as the Fiscal Manaeement Officer in the Boazd's Community Health Service Plan.
4. Operatine Agency
Complete only if other than the applicant agency tisted in namber ] above.
5. Contact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this project
6. Coatact Person for Fnrtber Iniormaaon
�
Person who may be contacted for detailed informarion concerning the appiicaaon or the project if different from number 5
above.
Person in openting agency who may be contacted regarding fescal matters if different ftom 5.
8. �ere�a '� es#S
�� �:.
Address where MDH sbould mail paymenu if different than 1.
9. Copies of this Apptication $ave Been Sent to the Following Communiq� Hea1tL Boards for Review
Provide copies of this application and any subsequent revisions to the appropriate community health boards as required by
the individual insavctions_
] 0. Sigaatum of Director of Applicant Agency
Provide original signamre and date. �
Z
��-�73 �-
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�SaRwerseSideforLuwaions MinnesotaDepartmentofHealth{MD�
Project Information Sheet for Special Projects
NameofMAHProgzam: Matemal and Child Aealth Special Projects Grant
1. ProjectInformation Saint Paul Community Health Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Public Health
Beginning Dau: End Date: Minaaota Tar I.D. No.: Federal I.D. Number. Social Security Number.
O1/O1/2000 12/31(2001 802-7226 41-6005875
Project Funds Requested: Local Match Provided:
Yeaz I Year 2 Ye�l eaz
$ 810,07� $ 810,077 $ 467,993 $ 4b7,993
Service Area (city, county, or counties):
City of Saint Pau1
2. *?ou-� � aii �iarus - SO1.C3 Copy Attached
❑ Yes � Not Appiicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence o,fComptia,fce Fo,m)
❑ No ❑ Yes � Not Applicable
4. �rmative Action
Tbe agency fias a certiicate from tbe Commissiouer of Auman Rights, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Applicable Because:
❑ 7'otal Convact is $] 00,00 or Less
❑ Agenc;� Hu 40 or Fewer Full-Time Employees
in MinneSOEa
� Uniu of Local Govemment
❑ Indian Reservation
� HE-01274.05(3/99j-PARTB
1CA 1bb42S
Instructions for Completing Project Tnformation Sheet for Speciat Projects �
Please type or print all items on t6e Yroject Informa6on Sheet for Special Yrojects.
Applications please note: The application fozm has been designed to be used on all Speciai Project grants
adminiscered by the Mmnesota Department of Health. If you have questions, or need
assistance in complering tl�e application form, please contaet the Progcam Manger oz
Consultant identified as responsible for the gzant
Projeet Information
ptovide name of applieant agency, beginning and ead date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicabie), or Social Securiry Number, aad geographic service azea. List the totai
amount requested for each year for Project Funds Requested and Local Match Provided. Please refer to
individual instrucrions for each special project grant to deteraane if local match requ'uements aze needed.
2. Non-Profit Status - SQ1.C3 Copy Attxchment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit instituvon, corpontion or organization.
Worker's Compensation
Minaesota Statutes, ChapteT 176, forbids the Commissioner of Health from enteriag into any contract until �
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requiremenu from the contractor. Complete the form entided "Evidence of Compliance" and
retum it with your grant application.
4. �rmative Actioa
Minnesota Statutes, Section 363.073, says "For all contraets for goods and services in excess of S I00,000,
no depamnent or agency of the state shall accept any bid oz proposal for a contract or agreement from any
business having more than 40 futl-rime employees within this state oa a single working day during the
previous 12 months, unless tUe firm or business has an affnmative action plan for the employmenY of
minoriry persons, women, and qualified disabled individuais, submitted to the commissioner of human
rights for approval. No depamnent or agency ofrhe state shal] eacecute any such contract or a�eement until
theaffirmativeactionplanhasbeenapprovedbythecommissionerofhumanrighu. Receiptofacerrificate
ofcompIiance issued by the commissioner sball signify that a firm orbusiness has an affim3ative action plan
that has been approved by t6e commissioner." If the grant or contract you propose meets the "in excess of
$100,000" criterion and youz agency meexs the "more than 40 fu11-time employees" criterion, a CertiScate
of Compliance must accompany your proposal, unless your agency is exempt If you have questions about
the Certificate of Compliance, please contact the:
Minnesota Department of Human Righu
Contract Compliance
Army Corps of Engineers Centre
190 East Fifth Street, Suite 700
St Paul, IviN 55101
(651) 296-5663
�
� �-- �73
� P Pleacc 7ype or Print
Minnesota Aepartment of Health
Evidence of Compliance
State ]aw forbids the Commissioner of Health from entering into any grant conttaet until the Commissioner
receives acceptable evidence of compliaace with workers' compensation insurance coverage requiremenu from
the gantee. The e�cception to this requirement is a self-employed grantee who has no employees. An employee,
as defined by M.S. 176.01 I, subd. 9, is any person who performs services for another for hire, including minors
and family members.
Ifyou do not fali within the exception and you wish to enter into a grant contract with the Commissioner of Health,
you must fumish acceptabie evidence of compliance with worker's compensation coverage in any one of the
following four ways:
1.
F�
Attach a certificate of insurance (supplied by your workers' compensation carrier) to this Evidence of
Compiiance form; or
If you are self-insured, attach to this E��idence of Compliance form, a written order from ihe Minnesota
Commissioner of Commerce ailowing you to self-insure; or
3. Ifyou aze seif-insuted and you aze a state agency or a municipal subdivision of the state, pursuant to M.S.
176.181, subd. 2, and aze not required to obtain a written order from the Commissioner of Commerce,
circle this entire statement and sign and date the form below in the space provided; or
� 4. Fill in the
�--
'
Name and Addrcss of Grantee'S Insurzncc Camer.
and si2n and date
Gronuc's insurana Policy Number.
HE-0327a-05 (3l99) • PAR7 C
1C M )a0.428
I afftrm that all ofthe employ¢es oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are covered by ihe workers' compensation ensu�ance policy fisted above.
ASSURANCES AND AGREEMENTS
�
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES ?.I�'D ASSURES THAT:
1. Services will be provided in accordance with appiicable state and federal laws, rules and proce@ures.
2. The agency will comply with state and federa] requiremenu relating to privacy of client information.
The agency will comply with the Minnesota Clean Indoor Air Act w3vch prohibits smoking in MCH Special
Projeet facilibes and clinics.
4. The agency (if it has I S or more empioyees} and any subcontractors with 15 or more employees will have
on file and available for submission to Minnesota Department of Heatth {IvIDI� upon re.quest a written non
discrimination policy containing at least the following:
"All pmgrams, services, and benefits which are administered, authorized, and provided shaIl be
operated in accordance with the tton discriminatory requirements pursuant to Titte VI of the Civil
Rights Act of 1964, Section 504 of the Rehabilitarion Act of 1973, as aznended, the Age
Discrimination Act of 1975, and the non discriminatory requiremenrs of the MCH Block GzanL
No person or persons shalI on ihe ground ofrace, color, national origin, handicap, age, sex, or religion,
be excluded from participation in, be denied the benefits of, orbe otherwise subjected to discrimination �
under any program service or benefit advocated, autl�orized, or provided by this Department."
5. The agency (if it has I S or more employees) and any subconu�actors with 15 or more employees will
disseminate information to bene8ciarics and the generat public that services are provided in a non
diseriminatory mannez in compliance with civil rights statutes and regutations. Tlus may be accomplished
by:
A. Including a handout containing civi] rights policies in any brochures, pamphleu, or other
communications designed ta acquaintpotential beneSciaries andthepublicwith pmgrams; and/or
B. Notifying refemi sources in routine letters by inctuding prepared handouts which state that
services and benefiu must be provided in a non discriminatory manner.
Copies of each document disseminated and a description of how these documents have been
disseminated will be provided to the MI�H upon request.
6. In futfilling the duties and responsibiliaes of this grant, the grantee shall comply with the Americans with
Disabilives Act of 1990, 42 U.S.C. § 12101, et seq., and the regutatians promulgated pursuant to it.
No residency requirements for services other xhan state residence, wili be imposed.
S. Services shatl not be denied based on inabiliry to pay. -
� =%- �73
�
9. Atiangemenu shal] be made for communications to take place in a language understood by the matemal and
child health service recipient
10. All written materials developed to determine client eligibility and to describe services provided undez this
gant will be understandable to a person w3�o reads at a seventh grade ]evel using the Flesch Analysis
Readability Scale as required in Minnesota Statute 144.054 (see Appendix 10, Plain Language in Written
Mazerials, Minnesota Statute, Secuon 144.054).
11_ T'heagencywillprovideservicesinkeepingwithprogramguidelinesoftheMinnesotaDepamnentofHealth
and gwdelines of accepted professionai goups such as the American Academy of Pediatrics, American
College of Obstetricians and Gynecologiscs, and American Public Health Association.
12. Upon request, one copy of any subcontract executed as part of the project wiil be provided to the Minnesota
Department of Health.
13. TheagencywillreportaccomplistunenuoftheprojecttotheMinnesotaDepartmentofHealth. Suchreports
will be submitted no later than 90 days after the compietion of the calendaz yeaz. Upon request, the agency
will provide additional information needed b}° the Department for evaluation ofthe projecYs objectives and
methods and compliance with any special conditions (see Appendix 18, Program Reporting Requiremenu
for Matemal and Clri]d Health Special Projecu).
14.
� 15.
I6.
.
Grant funds shall not be used for inpatient services except for high-risk pregnant women and infanu.
Cash paymenu shail not be made to intended recipients of health services.
Grant funds shal] not be used for purchase or improvement of ]and or facilities.
17. Grant funds shall not be used for purchaze of equipment costing more than $5,000.00 per nnit and v.9th a
usefui life exceeding one year. '
18. Grant funds shall not be used for reimbursement for travel and subsistence expenses incurred outside the
state unless it has received prior written appzoval from the Minnesota Department of Health for such out-of-
state travel.
19. VJhen appiicable, the agency shal] provide nonpartisan voter registration services and assistance using fonns
pmvided by the state to employees of the a2ency and the public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Registration).
20. VJhen issuing statemenu, press releases, requests for proposa3s, bid solicitations, and other documenu
describing projeets and programs funded in whole or in part with federal money, al] grantees receiving
federal funds shall clearly state (a) the percentage of the total cost of the prograzn or projeet which v.�ill be
financed with federal money, and (b) the dollaz amount of federal funds for the project or program.
21. The agency will not use grant funds to pay for any item or service (other than an emergency item or service)
fiunis3�ed by an individual ot entity convicted of a critninal o$ense under the Medicare or any staze health
care program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant programs).
22. Materials developed by Matemal and Child Health Specia] Project grant and matching fimds will be part
of the public domain and will be ac�essible to the pubiic as financially reasonable. Materials developed by
the Matema] and Child Health Specia] Project grant and matchittg funds may be reproduced and distributed
by the Project to otl�er agencies and providers for a profit so long as [he revenues from such sale aze credited �
to the Specia] Project budget for expenditure by the Special Project
23. The agency will comP1Y W'ith all standa''�S reiating to frscai accountability that apply to the Minnesota
Deparcment of Health, specifically:
A. Budget revisions with justificarion will be submitted to MI7H for prior approval whenever:
(1) changes are made in the objectives to be met in the MatemaI and Chiid Health Special
Project, or
(2) the cumulative amouat of funds uansfeaed into or out of an operating agency's budget line
iiem exceeds or is expected to exceed 10% of that approved for the grant year or 52,500.00,
whichever is greater.
B. Final expenditure reports aze due 90 days after the end of the calendar yeaz.
C. Graat funds are used as payment for services only aftez third-party payments, snch as from the
Medical Assistance/Medicaid (I'itle }�X SSA), Children's . Health Plan/MinnesotaCare
reimbursement programs of the Minnesota Department of Human Services and private insurance
are utilized:
D. Project financial management systems will provide for:
(i) Accvrate, current, and complete disclosure ofthe financiai status ofthe project. �
(2) Records which identify adequately the source and application offunds for Materaal and Chiid
Heaith Special Project acti��ives. These records aze to contain information pertaining to
project awards and authorizations, obligations, unobIigated batances, tiabilities
(encumbrances), oudays, and income.
(3) Effective control over the accountability for all funds, property and other asseu. Projecu aze
to adequately safeguard such assets and assure that they aze used solely for authorized
purposes.
(4) Comparison of actual obtigations with bu@get amounts for each activity.
(5} Accounting records which are supported by source documentation.
(6) Audiu which wiil be made by or ai the direction of the Minnesota Department of Health (see
Append' 6, State udits).
Signature of Chair or Vice�chair Of t6� unity Healtb Board or An Agent Appointed by Reso►ution
of th ommunity H Iih Board:
, e � �
� �� � .
�
CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT GRANT
FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
CHECK ONLY ONE BOX:
Q
No
sterili7aflon
provided
�
Xes
sterilization
provided
MCH Special Project grant funds will not be used during CY 199&-99 to
provide and/or azrange sterilizarions. If a client is merely referred to another
health care provider, this provision of information is not consideTed to
„ azT�S�S" a sterilization.
MCH Specia] Project grant funds will be used to provide and(or arrange
sterilizations during CY 1948-99. Agencies wkrich use MCH Special Project
grant funds to pay for a ptocedure or related purpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requuemenu described eisewhere in this document.
� T certify that to the besi ofmy knowledge the above information is correct, and that if this stanu changes, formal
notification in this regard will be sent to the Section Manager, Matemal and Child Health Section, Minnesota
Department of Health, Minneapolis.
Signatum of Director
of Appiicant Agency:
Tit3e:
Date:
L�J
Director of Public Health
9
Iastructions for Completing Certification
Coacerning Use of MCH Special Prnjeet Grant Funds
to Promote and/or Arrange Steritizations
All federal Public Health Service supported progams including the Matemai and Child Health Services Block
Crrant progrun, which use federal funds to provide and/or arrange for sterilization are required to follow federa]
procedures and to provide written documentation in this regard on a quarterly basis.
MCH Special Projects (MCHSP) xnay obiain an exemption from this reporting requirement by signing a
certificaLion that their agency is not using MCFiSP funds to provide and/or amange sterilizations. (If a client is
merely provided infoxmation and refetred, this is aot reported.) Reporting is requzred if MCHSP funds aze used
in some fotm of participation (paying for the procedure, providing transportation, matong an appointment with
another health provider, or detailed counseling beyond simple provision of information).
All Community Health Boazds aze required to complete the Certification. For agencies wlvch do not provide
sterilizations, no fiuther action will be needed dsuing CY 1998-99. The agencies which indicate they do provide
sterilizations must adhere to specific federal service and reporting requirements described elsewhere in this
document
��
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10
�'�-�573
• CERTIFICATIOT REGARDAVG LOBBYIlVG
The undersigned certifies, to the best of his or her knowiedge and belief that:
(1) No federel appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempring to influence an ofFicez or an employee of any agency, a
member of congess, an officer or an empioyee of any agency, a member of congress, an officer or
employee of congress, or an empIoyee of a member of congress in connec�ion with the awazding of
any fedeml con�act, the making of ang federal grant, the making of any federal loan, the entering into
of any cooperative agreement, and the eatension, continuation, renewal, amendment, of modification
of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or eraployee of any agency, a member of congress,
an officer or employee of congress, or an employee of a member of congress in connection with this
federal contract, gzant, loan, or cooperative a}eement, the undersigned shali complete and submit
Standard Forcn-111, "Discloswe Form to Report Lobbying," in accordance with its inshvctions.
(3) The undersi�ed shall require that the language of this certification be included in the awazd
documents fos al] subawazds at ail tiers {including subcontraeu), subgranu, and contracts under 2rants,
loans and cooperative agreemenu) and that all subrecipienu shal] certify and disclose accordingly.
T1ris certificaGon is a material representation of fact upon which reliance was placed when this transaction was
� made or entered into. Submission of this certification is a prerequisite for making or entering into tlus transacvon
imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shail be
subject to a civi] penalty of not less than $10,000 and not more than � 1 Q0,000 for each such failure.
Rob Fulton, Director of Public Aealth
Name of Authorized Individual
S^int p^ l- Ramsek Cnvntv_�,�artment nf Publir Health
Name & Address of Organi7ation 555 Cedar Street
Saint Paul, MI3 55101
.
11
Efforts to Reduce Racial Disparities
I. Describe how the CHS needs assessment used available data to analyze the extent to �
which the CHS area has disparities in risk facfors and health status between MCH
populations of color and the majority popularioa.
Whenever available, data is analyzed by numerous factors, including race. It is particularly
important that this data be available for Saint Paul specifically as this is where the majority
of the populations of color in Ramsey County reside. Through the Community Assessment
for the Saint Paul - Ramsey County 2000-2003 CHS Plan, data was nsed by the data analysis
team to identify that disparities of health status exist in our community. Tkris has been
identified as a high priority problem: "Despite overall health improvement in Miimesota,
popnlations of color continue to experience poorer health and disproportionately higher rates
of illness and death".
II. Within the populations to be provided services by the MCHSP during CY 2000-Oi,
what raciaUeYhnic disparities were identified.
As is shown in the data and graphics in the community assessment portion of this grant,
populations of color aze identified as having disparities related to late enhy into prenatal
care and infant mortality.
•
III. What strategies and objectives have been established to reduce sign�cant dispariHes?
Of particular interest are community and systems strategies/objectives wlrich recognize
the potential roie all types of community-based organizations can ptay in the decrease
of disparities.
One primary strategy u6lized by the Saint Paul MCHSP Grant to reduce dispariries is to
contract with community providers for services to improve pregiancy outcomes and address
adolescent health issues. These providers, who have years of experience, aze accessible to a
variety of the population by location as welt as the presence of bilingual, culturally specific
and/or culturally sensitive staff. The linkages that these agencies have with other
community agencies help to support their efforts to decrease the disparities of heahh status.
Additional information on each of the subcontractors specific objectives/methods and
strategies is detailed within the Application Narrative.
�
12
�'�� �73
� Subgrants/Subcontracts - Solicitation Process and Monitoring
Guidelines for Subganting Process are contained in Appendix 16. Onlv other Qovemment and nonvrofit
aeencies f501 C31 are elieible to nartici�ate in this Qrocess
NOTE: T'he process for conducting tLe subgranUsubcontracts solicitation is specifically stated in the
state MCH Law. The process must be carefully conducted as specified and documented as described
below.
Solicitation Process
a Please summarize the procedures used to plan and implement the required subgranting process
including the process for selection of prioriry program acrivities to be solicited of other providers and
deternvnauon of funds availab]e for this purpose.
See Attachment B
� b. Please provide documentation that notification of the availability of funding was provided to al]
qualified progrntns in 1he Community Health board azea including those of nonprofit and other public
agencies and Indian reservations. This docwnentarion must include evidence of d'uect mailings to
providers and evidence of pubiication of pertinent information in newspapers of general circulation in
the community health services azea.
See Attachment B
c. Please list all public and nonprofit agencies which requested subgrants of the Community Health
Board indicating which requests were inciuded in the grant application.
See Attachment'B
d. Please explain how priorities were established for selecting the requests included in the grant
application.
� See Attact�ment B
13
�
e. Please list the criteria tl�e Community Health Boazd used to seleet the requests included in the grant
application.
See Attachment B
2. Monitoring and Evaluation of Subgrantees/Subconhactors
All subgantees aze accountable for provision of services as specified by the Community
Health Baard and further are accountable for compliance with applicable federa] and state
requirements. Please describe the monitoring procedures ihe Commurdty Health Boazd pZans to utilize
in assuring fiscal and progam accountability of each of its subgrants. Indicate the extent to which on-
site monitoring procedures will be utilized.
See Application Narrative - Subgrantee In£ormation
3. Please list all subgrantee/subcontractors selected and the award amounts for the two year period CY
2000-01.
SubgranteelSubcontractor CY 2000-2009 Award Amount
�.�
�7_
�
I4
�'' �73
. , '�flL��'Z�V� � Saint Paul Community �
- Health Board
__ ,
1VICHSP SUMMARY. OF TYP�S:4� ,:.. coMMUN»r Hea�.r�
„, .
., ,
`` AC�'IVlTIES-AND,.S�RVIGES, ` Boa�t�tct�s� -
PR41tIDE� B�( OP�RATlNG ` s aint Paul - Ramsey Co ��
-- -- - '` Department of Public H alth
A�LiENCIES �Y LE�7ISLAT�VE � pPE12A�lNG AGENCY -
, °PRIQR1T1l . _ t�fa�reren�f.�m�H$� '
'exampies of operating agency incfude county, school district, Indian reservation, nonprofit health agency, etc.
fmproved Pregnancy Outcome Program
Geographic area served: -
Citv of Saint Paul and Ramsey County- -__
�
Types ef ActivitieslServices
Please cheek those serviees provided:
� core public heatth activities not direct service 7�%pregnancy testing and referral
l� individualized educalionlcounseling ]�,pre-term biRh prevention
� health education/wunseling in groups }�prenatai case management
� prenatal medical care }� enabling and non-health support
Other - ptease specify:
Describe the target popuiation(s) refative to age, income, and risk factors consistent with program et+gibility
guidelines found in Appendix 12. The target population(s) should be the specific group(s), including estimated
numbers, that the MCH Special Project proposes to serve using the MCHSP grant and other resources.
See subgrantee information within Narrative Application
Describe the manner in which the progtam responds to the needs and priorities for services idertt�ed by the
Matemal and Child Health Advisory Task Force (see Appendix 77). Differences must be described in detaif.
See Narrative Application
r
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15
- 200�
1111CHSP SUMM�
, = ACT11/)TlE� �
PR01/li?ED �
; " A�ENCiES 8
. ���
(fl,� Saint Paul Co�unity �
-- - Health Board
OF TYPES �F : ,�aMnnuN�n:yFa.� : _
1 SERVICE� : . � soa� tc�s�.
)QERATlNG s aint Paul - Ramsey Co t
Department of Public H I
E�7�SLAT�VE' °:: -
-
ITY . ,--->. .:.1BilifferentlromCHS)- ---
11, Famity Planning Progrem
Geographic area served:
Types of Actiritiesl5ervices
Please cF�eck those services provided:
❑ wre pubiic health activities not direct service O method services
p individuai"¢ed educatioNcounseling ❑ task force
� education in schools ' ❑ enabling and rton-health supporf
O other public education �f��`�?�'
Other - p�ease specify:
Describe the target population(s} relative to age, income, and risk factors consisieni with program eligibil'dy
guidelines iound in Appendix 92. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Special Project praposes to serve using the MCHSP grant and other resources.
Describe the manner in which the program responds to the needs and priorities for services identified by ihe
Matema! and Child Healih Advisory Task Force (see Appendix 17). Differences must be described in de;ail.
�
�
�
16
����; �73
�
� _: -2�Q��204� Saint Paul Community
.
Health Board
MCHSP; SUNIMARY. OF ° connnnuNmr �EC,�.zH -
_
A��'!1/{T1ES AND'.S.E.RVIG�S ° ' BoA�e �ct�s? . :
PROVIDED BY OPERATING: �. Sa�nt Paul - Ramsey �ou ty
,:.
Department of Public He lt�i
A�ENCfES;BY LEGiSLATlV�
.. . ! .. � 7t1 � .. I � V aQ�rlarir�� ���r�cv
: �iilV�1:1 7 __ _ ,' ;` -(HdiHerentfromCHBj'
ill_ HandicaocedlCAronically 111 Children's Program
�
Describe the manner in which the program responds to the needs and priorities for services ident�ed by tfie
Matemal and Child Heaith Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
17
Describe the target population{s) relative to age, income, and risk factors consistent with program eiigibii'ity
guidetines found in Appendix 12. The target population(s) shouid be the specific group(s), including estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
>;:
. . 1111CHSP S
` A�TI1/1
PROVI
�l�7�N�
Z���� • _ Saint Pau1 Community
- - Health Board
_ -
MiVIARY �F TYPES'OF , _ '
,,. • : , , . _ . ..:. ; �OMMUNI7Y HEALTti .
IES 1�ND'S�RVICES=° - soArin {ct�s�
ED BY OPERATiNG;' = s aint Pau2 - Ramsey Cou ty
Department of Public He Yh
S BY LEGISLATIVE;
t , flPEitATING AG�b[CY' _
,; .
P���Rl� . ? ' , (ifdifterentiromCH� __
�
IV. Childhood lnjury ConUol Program
Describe the manner in which the program responds to the needs and priorities for services ident�ed by the
Matemai and Child Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
�
�
Describe ihe target population(s) relative to age, income, and risk factors consistent with program eligibility
guidelines found in Appendix 12. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
°� �W :�73 ��
� �� _ 20D0-
MCHSP SllMIV1AF
j ' PR01l1DED BY OP
AGENCIE�:BY lEt
. P.RiflR1�'
x
� Saint Paul Community �
ealth Board
� TYPES OF -
COMMI3NIT1'.HEf1LTH _ :
:V�GES_-� `BOA�2DjCH$).
�'�'���" Saint Pau1 - Ramsey Co nty .
- Department of Public H a1Lh
l.ATlVE -
, .. __ .
: OPERA7ING AGENCY'_ ` - ° .. -
' , °° ' �if diHerant#rom CHB) -° " .
V. Other Programs Previous Funded by a Local Pre-Btoek MCH Speeial Projeet Grant - SQeciTy Programs:
a Dental Health Program
❑ InfanUChild Health Progrom
8] Adolescent Health Program
Geogrephic area served: �ity of Saint Pau? and .Ramsay County
Types of ActivitieslServiees
Please eheck those services provided:
C�3 core pubiic health activities not direct service
❑ enabling and non-heaith support
List services provided:
�
Describe the target population(s) relative to age, income, and risk fiactors consistent wfth program efigibifity
guidelines found in Appendix 12. The target popufation(s) shouVd be the specific group(s), including estimated
numbers, that the MCH Special Projeci proposes to serve using the MCHSP grant and other resources.
See Application Narrative
Describe the manner in which the progrem responds to the needs and priorities for services identified by the
Matemal and Chitd Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
See Application Narrative
L J
T
�.
' • 1��Q�2O� • j - Saint Paul Co�unity I _
� __ _ - Health Board �
1111CHSP-SUMMARY,OF TYPES C3F --
. __ . . ...: ...... .
- , CflMMUNITY HEALTIi - -
ACTlV�T1ES �►NLl SERVIGES�.; . . so�s�n �cas� :
= PR OVIDED B�t OPERP�T�NG: s aint Paul - Ramsey Co �
.: __.,_ ->.. t Department of Public H lth
. :.'wr_�w�r��e teV:1 Ft�1C1 �TtV�::.
" ; ilvv nv�a.v a :
. .PR10RiTY :-f�ra���ir�m��$> '
DEFINITIONS:
Enabiin�and Non-Health Su000rt refers to senrices provided directly to the Gient to atiain, access or use
heaith services rather than to provide a service specifically aimed at improving health. The kids of services
inctude transportation to and from health services, transiation of information into the ciienYs first language,
child care while receiving health care services, outreach to MCH populations, and assistance in seeking or
attaining health services.
Core Public Health Aetivfties Not Dired service refers to fiealth system activities which are not attributabie to
services provided to individual clients. These inWude but are not limfted to:
Assessment
colleet and analyze data and disseminate assessment results
Policy Devetopment and Planning
develop plans
provide advocacy
establish guidelines
Assurance
develop, implement, and support community health promotion programs
deveiop, monitor and support standards for access and quality
impiement and support targeted outreach and service coordination
co!laboratioNcooperation wiih other service providers
C�
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BUDGET NSTIFICATION
�
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Budget justification for each of the projects/subgrantees is included within their budgeu presented
in the application narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Matemal and Child Health Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey Commty Department of Public Health
for Administrative and Core Public Health functions.
SalarX/Fritige:
Administrative Assistant:
General program oversight,
prepares and monitors grants,
reviews reports, prepazes annual
reports, prepares and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activities
1'11
$13,549
$ 2,554
2001
$13,836
$ 2,631
Accounting Tech 77:
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV:
Types grants, conuacts and
reports
Epidemiologist:
Data collection, analysis,
reporting and display
Su�lies:
TOTAL:
$ 5,185
$ 3,576
$14,276
150
$25,014
$ 5,341
$ 3,683
$14,276
250
$25,741
23
BUDGET DETAIL OF LOCAL MATCH
Local match is identified within each of the subgrantees budgets, as required by MCH guidelines. �
Addiuonal local match is also provided by the Saint Paul - Raznsey County Department of Public
Health:
1'ITI 1�1
1. Local Tax L.evy Funds:
� MCH Prenatal Care at Community $134,480 $139,480
Clinics
TOTAL:
$139,480 $139,480
2. Other Local Funds:
Other local match is provided by Public Health through the funding of various programs which
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health educarion and well child services. Source of this funding includes
CHS funding, grants, reimbursements, and patient fees.
C�
�
`�
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.
Please read INSTRUCTIONS ON REVERSE side before wmpleting form.
CY 2000-0'1 MCH SPEClAL PROJEGT BREAKOUT BUDGETlFINAL EXPENDITURE REPORT
�����^^ I. Name of Gommun'rty Heatth Soard: Saint Paul
waeew am Cnaa Heam
H5 Eaa Se.anu� Psx
p�O� eos � Grent Year. 2000
v,.,o�+aoc�. w+ss,sdoeaz
III. BUDGET/EXPENDfTURE 1TEMS
Le isiative Priorities and Com onents Matemal and C
'
IMPROVED PREGNANCY OUTCOME PROGRAM 196, 951
� .................... •-�---.............
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non heatth suppoR' . . . . . . . . . . . . . • . - - • • • � . - • -
.................� 24,470
FAMILY PLANNING PROGRAM
..............................
Other health activities"' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non hea�th suppoR' . . . . . . . . . . . . . . . . . . . . . . ...
fiANDiCAPPEDfCFIRONICAILY ILL CHILDREN'S PROGRAM
�
Ha'ndicapyaCktxo[ucally�Ctt�dren�risdxa�'3ervse ..................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r�
L.�
Enabling and non health suppoR` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . _
INFANT NEALTH PROGRAM (Mpis./St. Paul onty)
�itaatiftetlica7senmses .....................................
Otherhealth activities" ..................................
Enabling and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
CHILDIADOLESCENT HEALTH PROGRAM
ChiWhood injury control services . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental health services (Goodhue-Wabasha onty) . . . . . . . .. . ...
Ch'%i3 �."ad�esiant.�ane�Cat`ss:wiass tlA�1s75t�3>ai�l orilY3 . . . . . . . . . .
Chiid & adolescent other health activities" . . . . . . . . . . . . . . . . . .
Child 8 adoiescent enablin9 and non health support' . . . . . . . . . .
Core oublic health activities not ciient based 820
........... 14 '
Rh etlucalionlravnsaii�, othe� protesswrtal serviees �transportation, translaLOn, cAildcare, outreach, etc.
CERTIF�CATION SIGNATURE
TYPE OF REPORT:
Ori9inal Butl9et
Butlget Revision #
that to tne hest ot my knowledge antl belief the tlata reponetl on this tlowment a corteet and ail Vansaetions that suDPO� this repon were matle in
nce with apD���DIe Fetlerel statutes.
�
OfCicial:
Name oi Person Who Completed this F ortn:
Date:
Phone: 651-292-7712
25
Please reatl INSTRUCTIONS ON REVERSE side before eompleting fortn.
CY 2000-01 MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
��a�"^ 1. Name of Communiry Hea(th Board:
�,.,,,,��ec�ee�,m, Saint Paul
85 EW � �� ��
°- GrantYear. z001
M:�aors. mrr ss,sweez
111. BUDGETlEXPENDITURE ITEMS
Le isiative Priorities and Com nents Matemal and C
A. IMPROVED PREGNANCY OUTCOME PROGRAM 196 , 951
.K ,. .., ._. _
ti - .........................................
Other health acGvities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non health support` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activiUes not cuent basea . . . . . . . . . . . . . . . . .
FAMILY PLANNING PROGRAM
:.... �..
Faiiiilti�latii?�g�ieftiad : . .: . . . . . . . . . . . • - - - . — . . . . . . . . . . . .
Oiher hea)th activdies" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
HANDICAPPEDICHRONICALLY ILL CHILDREN'S PROGRAM
_ ._
Haiidi�pDeif7itiSaiuc23l;y:�zL�dreti me7�iseivse . . . . . . . . . . . . . . . . . .
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . . .
INFANT HEALTH PROGRAM (Mpis.ISt Paul ony)
kYar"3arei('�seavue� .....................................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
CH{LD(ADOLESCENT HEAL7H PROGRAM
Childhood injury conVOl services . . . . . . . . . . . . . . . . • . . . . . . . . .
DeMal health services (Goodhue-Wabasha onry) . . .. . . . . . . . . .
�6ffi•s�Otesceet,p�e�Cai�teitiioes:{3�D7s.�Si�?aiu : .. ...... . ... .. .. .
Child & adolescent other heafth activities" . . . . . . . . . . . . . . . . . .
40
25,016
402,247
114,612
Chiid 8 adolescent enabling and non heatth support' ........:: 15, 001
Core pubiic health activities not client based . . . . . . . . . . . . . . .
1M etlucatioNwunseling, ot�er professional services 't2nspoMJfion. trenslation, chiWp2, outreae�, Mc
CERTIFICATION SIGNATURE
TYPE OF REPORT:
Original Budget
BudgM Revision #_
to tne best ot my knowtetlge and oeliet tne daW reportetl on Snis dowment is Wrrect antl aU franssctions t�at support tl�is repon were made in
wRh apPlieaDle Fetlerel statutes.
Official:
Name of Person Who Completed this Form:
Date:
Phone:
` J
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❑
COMMUNITY ASSESSMENT
�
�
Application Narrative ` �� _ � � ',� �
--�
� COMMUNITY ASSESSMENT
A broad-based assessment of community health needs and resources in Saint Paul and Ramsey
County was conducted beginning in the fall of 1998 as part of the development of the 2000-2003
Saint Paul-Ramsey County Community Health Services Plan.
Data Collecrion
The community health assessment process included collection of data regazding the Community
Health Services topic azeas. Staff obtained over 300 data items from state agencies, local
government, federal government, and private sources. Public health data is becoming more readily
accessible via the W W W, but data is not necessarily valid because it is available on the W W W.
Data regazding similaz or exactly the same phenomenon can be collected from several different
sources and so professional judgment was used to determine credibility of data.
It is also possible to collect many volumes of data on the topics of interest. Staff also used
professional judgement to determine the amount of data to gather for analysis. The priority for data
collection was to obtain reseazch data performed using populations or samples of populations living
in Ramsey County and Saint Paul where available. Wherever, possible, however, it is helpful to
compaze local data with regional, state, and national data. Regional, state, and national data were
collected whenever feasible. When local data was nonexistent or not reliable, regional, state and
national data were used.
� Data Analvsis
Role of Staff : The next step in the assessment process after collecting data, was analysis of the data
to identify public health problems in Saint Paul and Ramsey Counry. Staff performed some
preliminary analysis of data as they created graphics and assembled the data into formats usable for
further analysis. Staff analysis concentrated on identifying trends and comparisons to Minnesota
Goals (goals regazding the topics established by the Minnesota Department of Health), and did not
include the identification of specific public health problems.
Data Analysis Team: After considering several alternatives for analyzing the data the Department
organized a data analysis team consisting of internal and external volunteers with expertise in data
analysis, the public health topic azeas, and the health of minority populations. The data analysis
team met five times. One or more new CHS planning topics was considered at each meeting. Data
regarding the topic was provided to the data analysis team prior to each meeting.
The chazge of the data analysis team was as follows:
The Data Team wiil develop a list of problem azeas that keep our community from
experiencing an optimal level of health. Problem areas must:
- show a gap between Healthy People 2000 goals or Minnesota Public Health
Goals and Ramsey County data, or
� - be supported by data.
27
Application Narrarive
Identification of Public Health Problem Areas
At the end of each meeting conciusions of the data analysis team were summarized for clarification
and accuracy. Staff translated these conclusions into statements of problem azeas for review by the �
data analysis team at its next meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of public health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem area statements tfien became the basis of the neait step in the assessment phase:
review and prioritization of the problem azea statements by the greater Ramsey County community.
Review of Problem areas by the Ramsey County Communitv
After staff and the volunteer data analysis team developed the list of problem areas, staff developed,
with input from the Ramsey County Boazd, a list of community groups to review the problem areas.
These community groups were asked to review the probtem azeas to be sure the data analysis team
did not miss the identification of 'vnportant public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County govemment staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services pIanning process was described and
participants in the meeting provided verbal feedback to staff regarding the list of problem areas. At
the end of each meeting, group patticipants helped to prioritize the problem azeas by circling on the
paper the five azeas they thought were most important for ttte Saint Paul - Ramsey County
Departrnent of Public Health to address. They were also allowed to add problem areas not on the �
original list.
Identification of Public Health Problem Areas
At the end of each meeting conclusions of the data analysis team were sununarized for clarification
and accuracy. Staff translated these conclusions into statemenu of problem azeas for review by the
data analysis teazn at its ne7ct meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of pubiic health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem azea statements then became the basis of the neact step in the assessment phase:
review and prioritization of the problem area statements by the greater Ramsey County commuruty.
Review of Problem azeas b�the Ramsey County Community
After staff and the volunteer data analysis team developed the list of problem azeas, staff developed,
with input from the Ramsey Couniy Board, a list of community groups to review the problem azeas.
These community groups were asked to review the problem azeas to be sure the data analysis team
did not miss the identification of important public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County government staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services planning process was described and �
participants in the meeting provided verbal feedback to staff regazding the list of problem azeas. At
28
Application Narrative �y'� 7 � �
'—�
the end of each meeting, group participants heiped to prioritize the problem areas by circling on the
paper the five areas they thought were most important for the Saint Paul - Ramsey County
. Department of Public Health to address. They were also allowed to add probiem azeas not on the
original list. ,
Summary of Communi InDUt
The Saint Paul - Ramsey County Department of Public Health held 41 community meetings
involving over 400 people. The infotmation heard from ihe community groups can be summarized
as follows:
* General support for the identified problems azeas
* Issues most often discussed:
Access to health caze;
Access to safe child care;
Alcohol;
Asthma, diabetes and heart disease;
Environmental concems;
Health effects on children living in poverry;
Need for population based data;
Overweight, sedentary lifestyle;
Teen births;
Violence;and
� Youth and adult mental health.
Priorities Identified by the Community:
Access to health care;
Access to safe childcare;
Alcohol use;
Health effects of children living poverry;
Increasing levels of violence;
Lack of populations based data;
Low birth weight babies;
Teen births;
Unhealthy lifestyle; and
Youth and adult mental health.
Review of Problem Areas by Healttt Dep�rtment Staff
Reports of the community input were written and provided to the SP-RCDPH Leadership Team.
The Leadership team used the communiry anput as a guide for its review, discussion and
prioritization of the problem areas. Next, all public health staff were provided the opporiunity to
review and comment on the prioritized list. Staff review and comments were used to ensure that the
team had considered as much information and as much up to date informarion as was possible.
. Development of Final List of Problem Statements
The fina] step in the process for identifying community health problems was to make a final list of
problem siatements organized by the twelve community health services planning categories. The
F�
Application Narrative
fmal list of problem statements were drafted by SP-RCDPH staff to reflect as well as possible input
from the community, input from staff of the Saint Pau2 - Ramsey Counry Department of Public
Health, and a final review of updates of data from sources originally consulted during initial data �
collection efforts.
The public health problems which were idenfified and formed the basis of the Problem Statements
in the 2000-01 Matemal Child Health Special Projects Crrant, are liste@ as follows:
Saint Paul — Ramsey County Department of Public Health
Community Health Service Plan Problem Statements 2000 — 2003
Community Health Services Plan Assessment
AlcohoI abuse causes adverse heakh effects and social problems in our communiry. It
negatively impacts intended and unintended injury; unplanned pregnancy; poor birth
outcomes; child development; adolescent health; mental health; violence; infecrious
diseases;and chronic diseases.
Tobacco use is on the rise among youth and other select poputations.
Chronic diseases aze among the most prevalent, costly, and preventable of all health
problems in Ramsey County.
The percent of infants in Ramsey County bom with low birthweight is not moving toward
Minnesota and National goals. �
The percentage of births to adolescent mothers in Ramsey County is increasing while
national and state percentages aze going down.
An increasing number of children and adolescents experience the health effects that aze
associated with poverty.
There is a gap between Minnesota goals and the ciurent number of people in Ramsey
County who have access to medical, dental and mental health caze.
Despite overaIl health improvement in Minnesota, populations of color continue to
experience poorer health and disproportionately higher rates of illness and death.
Unintentional injury is one of the leading causes of death throughout a lifetime. Motor
vehicle crashes aze the leading cause of injury fatalities followed by falls, poisoning,
suffocation, and fire.
There is an increase in the number of births in Ramsey County that result from unintended
pregnancies. Some unintended pregnancies are associated with medical and social probletns
which later affect children and families.
There is an unacceptable level of interpersonal violence.
�
30
Application Narrative �- � �? � "�_
a
There is an increasing number of children experiencing chronic neglect due to ineffective
parenting and families experiencing chronic stress.
� Census Data
Wlrile census data from 1990 is likely not completely indicarive of the current environment in our
community, until the 2000 census results aze released, it conrinues to be the best measure for a
variety of indicators. In relationship to poverty, which is often linked to many poor health
outcomes, the 1990 census data indicates that :
• Eight census tracts in Saint Paul have a level of 40% or more persons with incomes
below the poverty level, with an additional nine census tracts with a level of 30% -
39.9% of persons with incomes below poverty level.
• Five census tracts in Saint Paul realized an increase of over 20% in the number of
persons living below poverty between 1980 and 1990.
Program Response to Minnesota MCH Priorities
The Saint Paul - Ramsey County Department of Public Health has identified improving
pregnancy outcomes as a maternai and child health service priority for Saint Paul. The 20Q0-
2003 Community Health Services Plan identified twenty-one health problems as high priority. A
number of problems related to improving pregnancy outcomes were identified among these high
� priority problems including:
• The percentage of infants in Ramsey County bom with low birthweight is not
moving towazd Minnesota and national goals.
• Ramsey County women are initiating and sustaining breastfeeding at a rate lower
than the state and national goals.
• The percentage of births to adolescent mothers in Ramsey Counry is increasing
while national and state percentages are going down.
Data reported in the Minnesota Health Profiles provided by the Minnesota Deparlment of Health
and the Saint Paul - Ramsey County Community Health Services Plan also reveals that:
• Percent of Premature singleton Births (less than 37 weeks gestation) for Saint Paul
is 7.6 compared to 8.0 for the State of Minnesota (1997).
• Percent of women receiving late (3rd trimester) or no prenatal care in 1997 is 5.6
in Saint Paul compared to 2.9 for the State of Minnesota (1995: 6.2 in Saint Paul
compared to 4.0 for the State of Minnesota).
� • Percent of women receiving late (3rd uimester) or no prenatal care is higher for
American Indians (11.1 %), African Americans (91%), Asians (12.5%) and teens
(9.8%). (1995: 8.3%, 10.7%, 13.6% and I0.5% respectively).
31
Narrative
• For 1995-1997, the 3 year average infant death rate of infants born to American
Indian women (12.0) and African American women (13.4) is much tugher �
compared to the rate for Saint Paul (8.8) and the 5 year average for the State of
Minnesota (6.6 for 1993-I997).
• The incidence of low birthweight singleton births in Saint Paul increased from 4.8
in 1992 to 5.5 in 2997.
• The incidence of low birthweight births for African Americans increased from
12.0 in 1993 to 12.4 in 1997.
Ttus data also indicates t6at due to the increasing efforts to improve pregnaucy outcomes, we
have seen some positive results such as:
• The current three year rate for infant mortatiry in Saint Paul of 8.8 (1995-1997}
has improved compared to the three year rate of 9.1 for 1990-1992.
• The incidence of first trimester prenatal care continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993, 69.9 % in 1995 and 71.7% in 1997 for Saint
Paul women.
• The incidence of fust trnnester caze for Saint Paul Native American women
continues to increased from 36% in 1988, to 37% in 1991, 54% in 1993, to 63.9% �
in 1995 but declined in 1997 to 52.4%.
While technology has improved to a11ow caze and treatment of some high risk births, it is much
more efficient, cost-effective and less stressful to place dollazs and efforts on improving
pregnancy outcomes so that the advanced technology does not need to be used.
Data indicate that some specific Planning Districts in Saint Paul have poorer birth outcomes and
may benefit from increased levels of tazgeoed outreach and service. These neighborhoods, all
within the City of Saint Paul, inciude: Thomas-Dale, Summit-University, SunrayBattle Creek,
Riverview, Dayton's Bluff and North End.
In addition to the focus being placed on improved pregnancy outcomes, adolescent health
continues to be a focus, primarily through the Adolescent Health Program, utilizing school based
ciinics operated by Health Start, Inc. and previously funded by the preblock grant pzogram, will
continue to be supported through MCH funding. Some funding for adolescent health services
will also be maintained at Public Health for seacually transmitted disease services provided to
adolescents in Room 111. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgotten population. In fact, a number of issues specifccally related ta adolescent health aze
included in the Community Health Services Plan as priority health problems, including:
+ The percentage of births to adolescent mothers in Ramsey County is increasing �
while national and state percentages aze going down.
32
Narrative
� ���
• Tobacco use is on ihe rise among youth and select populations.
� • High number of children, adolescents and adults are overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effecu that
are associated with poverty.
Several more problems within the list of twenty-one high priozity problems do not mention
adolescents specifically, but that population is clearly identified as being affected by the following
problems as well:
• Emerging and re-emerging infectious diseases threaten the health of the generai
population (including immunizations and STDs).
• There is a gap between Minnesota goals and the current number of people in
Ramsey County who have access to medical, dental and mental health issues.
• Despite overall health improvement in Minnesota, populations of color continue to
experience poorer heath and disproportionately higher rates of illness and death.
� There is an increase in the number of births in Ramsey County that result from
. unwanted pregnancies. Unwanted pregnancies are associated with medical and
social problems which later affect children and families.
• There is an unacceptable level of intetpersonal violence.
Through the community assessment completed as part of the CHS planning process, it was
identified that there are resources available within the community to meet the needs in the areas of
family planning, handicapped/chronically ill children and childhood injury conuol, including
resources targeted to these problems within our own Department through Ramsey County
MCHSP funds as well as other funding. Based on this assessment, no funding is requested for
these areas through the Saint Paul Maternal and Child Health Special Project Grant. However,
these areas will continue to be monitored by Saint Paul - Ramsey County Department of Public
Healih to ensure that resources exist to handle the various health problems and issues in each
area.
The provision of services addressing improved pregnancy outcomes will be primarily
subcontracted to vazious community-based providers who were identified through a process of
request for proposals. The Saint Paul - Ramsey County Department of Public Health has chosen
to subcontract for the majority of services in an effort to utilize established agencies and
organizations who have proven to be effective and eff'icient in their delivery of services and which
are located within the target areas and/or seroe target populations. Additionally, subcontracting
� with existing agencies inimi�es start-up costs and duplication of services. It is hoped that this
process and the services provided by the subgrantees will also help ensure that
culturally-sensitive, continuous caze is provided to high risk populations.
33
Apptication Narrative
See additional information on the subcontracting/subgrantee process in Attachment B. Members of
the Community Health Services Advisory Committee participated in this review process. On
August 4, 1999, the Matemal Child Health Special Projects grant application was reviewed by ihe •
Saint Paul — Ramsey County Community Health Services Advisory Committee. Committee
members were invited to provide input.
Various information regazding the community assessment is displayed in the figures on the
following pages.
��
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Application Narrative
W ' 7 7 �
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LJ
Community Description Figure 3: Percent Chiidren Receiving Public Assistance
c
d
0
�
d
a
C3Ramsey County 1991 1992 1993 1994 1995 1996
■ Minnesota Year
SOURCE: RC DepaRment of Human Services
�
35
Community Description Table 13: Poverty Indicators
Percent of Children Receiving Public Assistance
Application Narrative
Community Description Figure 4: Families With Children Below Poverty by Census 7ract
and Commissioner District
Ramsey County
Single Parent Families with Children
Below Poverty
by Census Tract and Commissioner District
i
�
�.. J
# Single Parent Famiiies
below poverty
Ctnws rz2sho
0-32
33 � 93
�94•241
� 242 � 464
� 465-829
Source: 1990 Census 428/99bn
36
1,
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7
i
�
Application Narrative
Community Description Pigure 6: Racial Distribution of Persons Poverly,1990
Racial Distribution
of Persons in Poverty, 1990
% total poverty
� White
Af rican
American
�Asian
� Ame rican
hdian
Source: U.S. Census, Ramsey County Policy Anaysis Division
��
L�
.
�
Q'k 20% 40% 60% 80% l00%
Narrative
til3
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1997 Metro Selected Natality and Mortality Statis6cs - Minnesota Metro Counties
County Population
Live Births
Fertiiity Rate
Birth Rate
% Out of Wedlock Births
% Less Than 37 Weeks-All
% Under2500 �rams-AIl
% 3rd Trimester Care or none
Infant Deaths, Total
Induced Abortions
infant mortality rate per 1,000 birfhs
Birfh Rate 3yr Avg 15-17
Birfh Rate 3yr Avg 18-19
Birth Rate 3Year Ave 15-19
Pregnancy Rate 3yr Avg 15-17
Pregnancy Rate 3yrAvg 1&19
Pregnancy Rate 3yr Avg 1519
% Under 2500 gm-Singieton
% Less Than 37 Wks-Singleton
°/01 st Trimester Care
Abortion Rate
SOURCE: MeVo SPSS Users Group
Anoka Carver Dakota Hennepin Ramsey Scott Washington
286673 63198 334585 1053178 454354 76078
4234 1029 5126 15459 7435 1342
60.8 70.7 67.1 59.8 64.0 75.8
14.8 16.3 15.3 14.7 15.4 17.6
22.0 12.5 17.5 27.8 32.5 13.0
7.6 7.6 72 8.3 7.6 9.1
5.8 5.1 5.2 6.6 6.7 5.2
2.0 1.5 1.3 4.1 4.4 1.0
25 5 23 115 49 3
970 139 1003 5110 2379 190
5.9 4.9 4.5 7.4 6.6 22
14.7 11.2 122 26.6 35.1 13.3
53.2 45.3 48.4 55.6 68.9 36.3
27.8 22.5 23.8 38.4 50.9 20.6
25.7 192 21.5 41.9 49.8 19.9
84.9 64.4 80.3 95.4 1012 63.6
45.9 34.2 40.4 63.9 72.3 33.8
42 3.8 4.0 5.0 4.9 3.2
6.6 7.1 6.8 7.7 72 7.9
84.3 90.0 87.9 82.5 78.0 87.9
13.7 9.5 11.7 19.5 20.1 10.7
191548
2686
592
14.0
15.1
7.9
5.6
1.1
7
463
2.6
9.3
37.7
17.8
19.0
65.8
33.0
4.3
7.3
91.2
9.9
39
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IMPROVED PREGNANCY OUTCOMES
n
�
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Application Narrative
�
W- v
� IMPROVED PREGNANCY OUTCOMES
PROBLEMS
Poor pregnancy outcomes has been identified through a community assessment as a high priority
public health problem in Saint Paul by the Saint Paul - Ramsey County Department of Public
Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in some populations
• ongoing problem of infant mortality despite decreasing infant mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal alcohol
effects and other birth defects
The rates of infant mortality, low birth weight and pre-term deliveries for the City of Saint Paul
� are higher than suburban Ramsey County and the State overall. Specific areas within the City
have been targeted by each subgrantee and the Aepartment as geographic areas to be served in
response to previous high rates of poor pregnancy outcomes.
One factor contributing to poor pregnancy outcomes, including high infant mortality, premature
birth, and low birthweight births, is late or no entry into prenatal care. Again, the targeted
areas and populations within ffie City of Saint Paul have a higher percentage of women who
begin prenatal care late (third tr'vnester) or who receive none at all than suburban Ramsey
County and the State overall. Certain Saint Paul neighborhoods have especially high rates of
late prenatal care.
The following graphics display various data related to low birthweight, trimester of entry into
prenatal care, and infant mortality rates.
�
40
Application Narrative
Low 8irth Weight Bab+es Figure 8: Low Birth Weight Trends
Low Birth Weight Trends
�
� � o.o^�
�
�
a s.o°�
0
�
N 8.O°k
c
.�c 7.0°k
N
m 6.0%
�
� 5.0°�
L
�
d �{.�%
3
� 3.0%
0
�
N Z.O%
c
= 1.0°k
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0 0.0°k
Source: MDH: MN HeaHh Proiiles, MN Healih Statistics
� �sas
� 1988
_=�.� 1990
� �997
� 7993
� i99a
Q 1995
>�� 1996
� 1997 i
low Birth Weight Babies figure 2: Low 8irth Weight Births Metro Counties
1997 Low Birth Weight Births
Seven County Metropotitan Qrea
e.o^s
�.o��
6.0%
5.0%
4.0 %
3.0%
2.0%
t.Q%
0.0°h
Percentof all inf�nts born weighing less than 2500 grams
SOU¢e: MN HE2�1G PrGtileS. M N Health StetistiCs
.
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41
Minnesota Rams�y County Saint Paul
Anoka Bekota Ramsey wasn+ngtpn
Carver NennEpin SCOtt
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Application Narrative __ ;-� � �
Low Birth Weight Singleton Rates
Ramsey County Muniapa{ities and Saint Paul Planning Districts
199�1997
. =r.�n+a�zic��r
--- °. 3.1
�,` -
'N6nnesa2 2004 Goal : 3.5 LB1h' Birth Rale
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Application Narrative
Maternal and child health activities funded through the Maternal and Child Health Special Projects
Crrant aze monitored quarterly, and more thoroughly evaluated on an annual basis. A report
assessing the activities of the current project in 1998 was completed for the Minnesota Department �
of Health. Since current comprehensive data on Saint Paul health indicators is not readily
available, it is difficult to fully assess the impact of present progranis at this time. However, based
on the data received from the programs, the following swumary informarion from 1998 programs
receiving MCH funding to improve pregnancy outcomes is available:
• 1,827 clients were seen for prenatal services
• 54% of the 1110 clients who delivered in 1998 received prenatal care in the fust
trimester of pregnancy
• 15 fetai deaths were idenrified
• 3 neonatal deaths occurred
• 46 births were below 2500 grams
From this assessment, it is cleaz that on-going efforts need to be made to help ensure early and
continuous prenatal care, especially among some minority populations.
PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES �
Saini Paul - Ramsey County Department of Public Health's Improved Pregnancy Outcome
Prbgram for the City of Saint Paul responds to the goals and priorities for services identified by
the MCH Advisory Task Force. The Program addresses both the goal of promoting improved
birth outcoures and promoting healthy adolescents. To achieve these goals Saint Paul - Ramsey
County Department of Public Health has identified priorities consistent with the following MCH
Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatai care in the first trunester
• sensitivity to cultural diversiry for improved pregnancy outcomes
These priorities will be addressed through the objectives and methods idenrified by three
community agencies approved for funding by the MCH Special Project Funds Proposal Review
Committee. Once again, Saint Paul - Ramsey County Department of Public Health subcontracts
the majority of Saint Paul MCH funding to community organizations to increase access to
services, and to increase the likelihood that culturally sensitive caze is available to the S
population. The agencies recommended to receive funding through the Saint Paul MCHSP
_ _..
49
ApplicationNarrative ` ;`j 7 7
Grant are: Health Start, Inc.; Face To Face Health and Counseling Service, Inc.; and West Side
Community Health Services.
.
The programs of these agencies provide a variety of inethods which are targeted to increase the
percentage of women receiving prenatal care in the first trimester, ensure continuous prenatal
caze, education and case management, reduce infant mortality, and decrease low birthweight
births. Additionally, the programs of these agencies will provide services to residents of some
of the highest risk Saint Paul neighborhoods.
I1
�. J
•
so
Nazrative
INVENTORY OF SERVICES
From the inventory which was completed, it has been idetttified that there are a number of �
agencies providing prenatal care in Saint Paul, in addition to independent practitioners. An
inventory of agencies providing prenatal caze, primarily those providing the options of care on a
sliding fee, including the target population served and the services provided, is included in
Attachment A.
In April of 1992, the Prepaid Medicai Assistance Program (PMAP) was implemented in Ramsey
County. There are cutrently four health plans availabie, including Hea]thParmers, U-Care,
Medica and Blue Plus. Individuals who are newly applying for Medical Assistance aze being
placed into this system.
The system has unproved, but there are still issues of denied services, confusion regarding
where a person can receive services and clients choosing not to seek services due to the
confusion. Special populations may need special attention to initialiy maneuver ttuough this
system. The Saint Paul - Ramsey County Deparmnent of Public Health will continue to advocate
for accessible care for ali populations.
•
�
51
Application Narrative � �� ,_ i } 7 �'j
GOALS OF THE PROJECT
�
The overall goal of the projects which will be supported through the Matemal and Child Health
Special Projects grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBdECTIVES OF TI� PROJECT
�
A number of objectives have been established for the Improving Pregnancy Outcome project
including:
1.
�
To reduce the overall rate of late (3rd trimester or none) prenatal caze (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1%) women.
To unprove the infant mortality rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average),
and American Indian (12.0 for 1995-97 3 year average); and
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 yeaz average), American Indian rate (13.4 for 1995-
97 3 year average).
To reduce the rate of Saint Paul low bir[hweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7 % 6.7 %
White low birthweight �6.9 % �.3 %
African American low birthweight 12.4% 12.1%
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low 5.4 % � 5.0%
birthweight
� 4. To conduct outreach efforts to pregnant teenagers to increase the rate of first trunester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
52
Applicarion Narrative
with a special emphasis on outreach to minority teens. {For births to women less than 20
yeazs of age in 1997, 52,4% in Saint Paul, and 55.3% in all of Ramsey County began
prenataI care in the first uimester}. �
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Boazd through the
Saint Paul - Ramsey County Department of Public Health are low-income (less than 200% of
poverry) Saint Paul women at high risk for poor pregnancy outcomes, as defined by legislative
parameters. This incIudes, but is not limited to, teenage and minority women residing in St.
Paul.
Addirional MCH Special Project Funding beyond the pre-block grant funding to Heatth Start,
Inc. was made available to community organizations through a Request for Proposals process.
This process and the target popularion specific to each subgrantee selected, as well as the
objecrives, methods, training/experience of staff, linkages, reimbursemendfees and budgets will
be described in the following section tided, "Subgrantee Information."
i
!
53
��- �73
�
SUBGRANTEE INFORMATION
�
�
Narrative
SUBGRANTEE SOLICITATION PROCESS
� � �
� To determine the agencies with whom a subcontract would be established, a solicitation process
for both the Saint Paul and Ramsey Courny Maternal & Child Health Special Projects Granu
was conducted beginning in June of 1999. A Request for Proposals was sent to 37 agencies
which may have had an interest in participating in the project, and a public notice was published
in the Saint Paul Pioneer Press.
Three proposals for programs to improve pregnancy outcomes were received by the deadline.
The proposals were reviewed by Public Health siaff and an ad hoc subcommittee including
representatives of the Saint Paul - Ramsey County Community Aealth Services Advisory
Committee.
An evaluation form similar to the Minnesota Department of Health evaluation form was used to
evaluate the proposals which were received. The results of reviews completed by the review
committee indicated that each merited some funding. The projects which were chosen for
funding would ensure that some services were provided in each of the target health planning
areas and focused on target populations with as little duplication as possible. Two of the
proposals will be funded by the Saint Paul MCHSP grant, and one will be funded by the Ramsey
� County MCHSP grant.
The details of the RFP, a sununary list of the proposals received, and the evaluation tool used
aze described in Attachment B.
5UBGRANTEES
Specific information on each of the projects to be supported through the Maternal and Child
Health Special Project Grant for improving pregnancy outcomes is provided on the following
pages. Each project has specific target populations, objectives (which include projected service
levels), and methods, but all projects are working towazd the same goal of improving pregnancy
outcomes for residents of Saint Paul. Copies of the full proposals submitted by each of the
grantees are available the from Saint Paul - Ramsey County Department of Public Health upon
request.
The following table indicates the projects which are proposed for funding and for which a
complete program description follows.
�
54
Apptication Narrative
AC'ENCIES PROPOSED FOR FUNDING/SUBGRANI'S
See individual subgrantee information for Budget Justifications on each project.
Amount Reauested
AGENCY Total: Yr. i: Yr.2:
Face to
Face
West Side
Amount Awarded
Total: Yr. i: Yr. 2:
:� 11� �� �11 �1 �11 :1 �11 �1 �►� �� 1��
32,500 16,250 16,250 32,500 16,250 16,250
Health
Start 393,902 196,951 196,951 393,902 196,951 196,951
(IPO)
Health
Start 1,010,070 505,035 505,035 1,010,070 505,035 505,035
(Adol)
Room 111 24,374 12,550 11,842 24,374 12,550 11,824
(SPRCDPH -
Adol)
Face To Face is requesting funding to continue the'vr outreach efforts and case management.
West Side is requesting funding primarily for outreach, perinatal care coordination, risk assessment and
tracking.
Health Start receives non-competirive funding as a pre-block grant provider to provide both improved
pregnancy outcome services through ouueach and prenatal caze, and adolescent health services through
school based clinics.
Room 111 will provide sexually transmitted disease services to adolescents.
��
��
�
55
Narrative
, .-,
MOIVITORINGlEVALUATION OF SUBGRANTEES
• To ensure that every effort is made to achieve the proposed goals and objecuves, the subgrantees
efforts and performance will be monitored on a regular basis throughout the contract period.
Contracts will be written between Saint Paul - Ramsey County Department of Public Health and
the subgrantees indicating specific performance objecuves and outcome indicators. The contracts
will oufline the subgrantee duties, reporting requirements, the monitoring expected/performed by
Saint Paul - Ramsey County Degartment of Public Health, and evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective tools
will be used by the subgrantees to ensure that various aspects of their program are reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
PROGRAM EVALUATION
. Data will be sought from various sources, both nationally and locally, including the Minnesota
Department of Health, to monitor pregnancy outcome trends. Tlus data will be used to analyze
the impact that the project has had on the goals and objectives for the project throughout the two
year period. Since summary data is frequently available on a two yeaz delayed basis, progress
toward the objectives may be difficult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
• age of client
� race and ethniciry of clients
• residence of clients
• time of entry into prenatal care
• number of fetal deaths
• number of neonatal deaths
• number of infants with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs aze appropriately
� impacting pregnancy outcomes. Based on this evaluation, services and programs may need to be
modified or refocused to maximize the likelihood that the objectives and goals are met.
56
Application Narrative � '�` _ ,'� "J 7�
J
� Health Start, Inc - Im�roving Pregnancy Outcomes
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive Maternal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes. Health
Start, Inc. is an organization specializing in maternal, infant and adolescent health caze services to
high risk populations for disease or disability due to economic, social or medical conditions, and
to reduce morbidity and mortality in these populations.
Health Start proposes to continue to serve the needs of low-income (less than 200% of poverry)
and adolescent pregnant and postpartum women. Health Start will provide multi disciplinary,
comprehensive prenatal caze. Prenatal care offered to students in the high schools facilitates eazly
entry into prenatal care. This component of the Health Start program addresses the City of Saint
Paul's Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and women of color.
Tar e� t Popularion - The clients targeted to be served will be those at risk for prenatal and birth
complications who would, without accessible and high quality services, continue to experience the
multiple problems associated with high risk pregnancies. Prenatal care is provided in eight school
� based clinics in St. Paul, so adolescents, especially minority adolescents will be a focus. In 1998
Health Start saw 325 adolescent prenatal patients in it nine sites for 2260 visits (which represents
roughly one-third of reported teen pregnancies in St. Paul), and 174 adult women, 46% of whom
were African-American, 3.4% were Asian and 4% were American Indian. Women in these
groups who smoke will also be targeted for special prenatal or preconception interventions.
Obiectives -
1. Provide comprehensive multidisciplinary prenatal care to 500 high risk young adult and
adolescent women per yeaz during CY 2000 and 2001.
2. 55% of women who deliver through Health Start will initiate prenatal care in the first trimester
of pregnancy and 85% of women will initiate caze by the end of the second trimester of
pregnancy.
3. 80% of prenatal paUents will received five or more prenatal visits.
4. By December 31, 2001 low birth weight (less than 2500 grams) rates will be no greater than
� 8% and pre-term birth rates (less than 37 weeks gestation) will be no greater than 10%.
57
Application Narrative
5. Women smokers will receive help with smoking cessation methods prior to or eazly in
pregnancy.
6. The incidence of low-birth weight infants born to adolescents followed through high school �
clinics will be no greater than 7% by the end of CY 2001.
7. Of the adolescent teens seen in school based or OB/Gyn clinics, 55% will begin caze by the
first trimester.
8. All prenatal patieuts will have an initial nutrition assessment with folic acid supplements
offered to uninsured women and all others as necessary.
Methods -
• A full range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 491 Universiry Avenue West, and eight school-based clinics. This
will ensure accessibiliry and acceptability for clients seeking prenatal care.
• Prenatal and postpartum caze will follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since �
1967. This includes social work and nutrition professionals routinely available during
regular clinic hours to handle the various non-medical aad medical risk factors.
• All clients will be assessed for high-risk conditions using the Minnesota Pregnancy
Assessment Form at the initial visit and 36 weeks. Appropriate prevenrive management will
be provided for all clients.
• Clients will be assessed for risk for HIV/STD infection and individualized prevention
education will be provided. HIV/STD testing will Ue provided on site.
• All ciients will receive a nutrition assessment, conducted by a Health Start nutdrionist.
Clients will be certified for WIC at the clinic visit and educated about the importance of
appropriate weight gain during pregnancy for optimum birthweight. Clients with specific
nutrition concerns, e.g. diabetes managemeni, anemia, weight control, etc. will receive
ongoing nutrition education and counseling throughout their prenatai care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Fanuly and relationship issues, housing and financial concerns, chemical use, and !
issues of physical, se�al and emorional abuse are included as part of the assessment.
58
� �7�.�
Application Narrative , � r U
Clients with no source of payment for medical care will receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and
� support within the clinic setting and will refer to outside agencies and services as needed.
• Patients who smoke will be encouraged to cut back or stop during pregnancy through access
to self help information and specially written motivation materials designed for the patienYs
willingness to change status. The "Ask & Advise" intervention will start early in pregnancy
or prior to conception, though education given to family planners or patients receiving a
pregnancy test from FIealth Start.
• All clierns delivering through Health Start will be eligible for family planning services for
24 months after the baby's birth, regazdless of ability to pay. After this period, clients who
are uninsured will be asked to pay according to the sliding fee scale.
• Health Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency care at Regions Hospital.
• Project clients will be assisted in locating a medical home for their new baby, if needed.
Eligible new parents will be invited to participate in one of Health Start's intensive parenting
� programs, designed either for drug or alcohol-exposed infants or minor mothers.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based clinics and University Avenue clinic.
• Clients in need of specialized medical service will be referred to Regions Hospital or other
providers as appropriate.
• Clients will receive individualized prenatal education in clinic and will be invited to attend
the weekly prenatal classes at Regions Hospital.
� Prenatal and postpartum clients who fail appointments will be followed-up by telephone and
maIl to help ensure that they receive needed health care services. A community outreach
worker is available for home visits to clients who repeatedly fair prenatal appointments.
• Language interpreters and interpreters for the deaf will be available in clinic and by phone
as needed, using either in-house or community interpreter resources.
� � Although most clients will fmd the clinic sites easily accessible, Health Start will provide
bus tokens or cab cazds when needed.
59
Application Narrative
Evaluation -
Intended Outcomes and Methodologies for the project to Improve Pregnancy Outcomes:
A. Does the multidisciplinary model of prenatal care designed for socially at-risk women help to
improve pregnancy outcomes?
Criteria/Methodologies: Health Start will compare birthweight, gestauonal age, risk level, race ,
SFS, and onset and duration or prenatal care with a comparison group which does not receive this
model of prenatal caze. Health Start tracks approximately 1,700 deliveries at Regions Hospital
each year. Of these, approximately 300 are deliveries to Health Start patients. The remainder is
non Health Start patients and provides an important comparison group for determining birth
outcome data. Information collected and reported includes date of delivery, provider
classification, race, risk score, marital status, trimester that care was initiated, and the number of
prenatal visits made. Infant data includes APGAR's at 5 minutes, birthweight and gestarional age.
B. Can Health Stan contri6ute to lowering low binhweighZ rates for women of color, especially
African American women?
Criteria/Methodologies: Health Start will compare birthweights by race within its deliveries to
city averages, over a three year time span.
Use of Evaluation Results: Informarion from evaluation efforts will be given to the quality
assurance committee, the quality management team, and the clinical management team. They
may be used to formulate changes in intervention, to stimulate further analysis for underlying
causes, or suggest areas for a quality improvement project. Evaluarion results are disseminated to
providers via periodic provider meetings, clinic tams via team coordinator meetings, the Board of
Directors at board meetings semiannually. They are also used to moYivate staff and to stimulate a
work culture of continuous quality improvement.
Trainin�/Experience of Staff - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff aze professional health care personnel with special
expertise in maternal and child health or adolescence. The majority have had more than five
yeazs eacperience. All staff are evaluated at least once a year. Clinic staff aze aiso subject to
anuual peer review.
Staff are supervised by the executive director, associate director, medical d'uector, OB medical
director orteam coordinators. Medical providers are credentialed according to standards ofthe
major health plans. Carol Wlute, M.A., is the executive d'uector of Health Start and is
responsible for the overall management and direction of the project, as well as extemal relations
�
�
.
:1]
�� � 7 3 Applicarion Narrative � � � '°" '�
and long-range planning. Dr. Chris Reif is the medical d'uector, is on the staff of the Family
Medicine Department at Regions Hospital, and is responsible for overall medical direction. Dr.
� Donna Anderson, on the staff of the Health Partners Obstetrics and Gynecology Department, is
the OB medical director and works with the medical d'uector to provide consultation on OB/GYN
practices, as well as providing clinical supervision for OB/GYN nurse practitioner staff. They
are advised by a clinical management team made up of representatives from the various
professional disciplines,in prenatal and adolescentservices of Health Start. Richard Duffm has
been the associate d'uector for five years and manages the school based clinics. Jeanne Rancone,
PNP, PHN, is the new Clinical Services Coordinator, overseeing clinical services for adolescent,
prenatal, and pediatric care. Jeanne has been with Health Start for five yeazs.
Continuing educauon needs of staff are assessed and maintenance of credentials through
continuing education is monitored.
Li es - Health Start has well developed linkages that include a wide variery of health care
providers, educational programs, and social service agencies. Tlus referral network allows staff
to individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs azise. Key linkages include HealthPartners/Regions
Hospital - most physicians and midwives are contracted through HealthPartners, who also provide
� back-up for prenatal care and referrals for prunary care services and OB specialry services not
provided by Health Start.
Health Start works collaboratively with Saint Paul - Ramsey County Public Health nurses to
extend services to pregnant women in the communiry. Public health nurses meet regularly with
Health Start to identify clients needing home-based services and to share information that will
enhance patient care.
At delivery, new parents are referred to Health Start's pediatric clinic, which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location near I.exington and University,
the usefulness of providing pediatric care at a different neighborhood site as an incentive for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediauic
services aze discontinued by Health Start, cases management to hop connect new mothers to
appropriate medical homes for their babies in the communiry will be maintained.
Eligible clients are also refened to the Befriender Program, run in collaboration with Children's
Home Society, the Partnership Program, a collaboration with Saint Paul School's Early
� Childhood and Family Education (ECFE), or the CARES Project, also run collaboratively with
ECFE. These programs all provide intensive counseling, support, andlor group education for
G1��
Narrative
high risk parents.
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g., .
general medical care or adopuon counseling), written referrals will be made to community clinics
or other resources within a convenient geographic area.
Health Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliarions with
and/or refer to the following agencies and task forces (partial list only):
Children's Home Society of Minnesota, Early Childhood and Family Education (ECFE),
HouseCalls, Frogtown Family Resource Center, HealthPartners and Regions Hospital, Ramsey
County Human Services Child Protecrive/Minor Moms Services, Saint Paul - Ramsey Counry
Department of Public Health, Rondo Family Resource Center, Neighborhood Aealth Care
Network, Saint Paul Public Schools, WIC Food Supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. All clients aze low-income (200% of poverry or
less). Clients are billed, however, by Regions Hospital and Ramsey Clinic for hospital charges
such as labor and delivery and selected tests and procedures. �
MCH funding allows Health Start to provide prenatal care for clients who have no Uvrd parry
source of payment. For Health Start clients eligible for medical assistance or MinnesotaCaze,
staff wilI assist them with the application process. Health Start has contracts with all of the
PMAP providers. Any other applicable third parties are billed whenever possible. Insurance
revenue pays for approximately 45 % of E3ealUt Start's prenataUfamily planning clinics services
and 15 % of adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client has
no third parry payor, a sliding fee scale is used to determine her fee for family planning services.
Funds will be requested from the State of Minnesota Family Planning Special Projects to continue
the provision of family planning services in the next biennium.
�
62
.
u
�J
Application Nazrative
HEALTH START, INC. ,� .. Mc �eoo
���..� �� �.�.� ~- :� 7 3
I.�IPROVED PREGNANCY OUTCOME YROGRAM BUDGET
J3t�'UARY THROUGH DECEMBER, 2000
ANNUAL PROGRAM PR06RA/A MCH
LNE TTEM EXPENSE sne.nm' F're BUDGET BUDGET
CLMGL SERV�CES COORDINA70R
CSMLTiY COORDINATOR
N,Ri pRpL71T10NER
K�E PRpCTiT10NER
7�taSTERID NURSE
tTRSEPRACiTIIONER (AGAPE)
�zrr+�mornsr
krrRmor+�sr
OLIIRrt10NlST (AGAFE)
7Z(iRI71pN1$T (FRLIN6TON)
}�J�L7F1 EpUCATOR (ACaAPE)
sx�r•.i woR�R
SY1Al WORKEfi
tJ,.� MANhGER (AGAPEJ
If.�i-�?REfER
��
LLMG CLERK
��ICqLlSSISTANT
w� :u sss,stnrn
5
5
5
5
$
5
$
$
$
S
S
5
5
5
$
5
$
S
5
56,791
54,912
57,404
52,'189
45,760
47,'133
46,738
43,681
43,681
43,638
40,915
39,'142
44,970
34,275
28,628
23,160
zo,zoa
21,302
24,321
0.40
0.'10
0.60
0.'10
1.00
020
0.25
0.20
0.'I S
0.15
0.15
0.15
0.15
0.20
0.'10
0.25
o.ao
0.10
0.70
$ 7L.717 S 13,630
$ 5,491 5 3,295
$ 34,442 5 20,665
$ 5,219 $ 3,131
$ as.�so s 2�,ass
$ 9,427 5 7,070
$ ��,684 5 2,92�
� 8,736 $ 6,552
y 6,552 S 4,914
g 6,� � 4,582
$ 6,137 5 4,603
$ rJ.B�� $ 4,s9�
$ 6,745 $ 5,3�
� 6,855 S 5,141
$ 2,863 $ 1,431
$ 5,790 $ 4,632
g '16,163 $ 8,082
g 2,130 $ �,�
g 17,025 $ 8,512
SUB-TOTAL SALARY
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
RAMSEY CLINIC PHYSICIAN/NURSE MIDWIFE
pNE p91GYN GHYSICIAN CUNICSIWK �$495 X 42 WKS
TWO FAMILY PRACTICE CLINICSIWK � 5305 X 36 WKS
FIVE CNM CLINICANK (a� 3165/CUNIC X 42 WKS
RENT
PATIENT CARE
LAB, U17RASOUND,X-RAY
OTHER EXPENSE
MEDICA710WDRUGS (INCLUDINGARLINGTON)
MIDICAL SUPPLIES
OFFICE SUPPLIES
EQUIPMENT
7RAINING
PF21N"f ING/DUPLICATING
pf,T{EN7 TRANSPORTATION
T07AL DIRECT EXPENSE
@IDIRECT EXPENSE @ 16°k
TOTALPROGRAM EXPENSE
tOtAi MCli GRAM REQUEST
YATCHING PUNDS � 75Y.
���
$ 226,154 $ 137,776
$ 45,231 $ 27,555
$ 20,790 $ 4,158
$ 21,960 $ 4,392
g 34,650 $ 6,930
$ 33,500 5 '
$ 17,500 $ 10,500
$ 14,000 $ 3,500
$ 5,000 $ 989
$ 5,500 S 550
$ 2,500 S -
$ 1,000 5 -
� 500 5 -
$ '1,20� 5 60�
$ 429,484 $ 196.951
$ 68,717 S
$ 498.202 $ 196.95'1
$ 196,951
g 49,238
Applicauon Nazrative
HEALTH START INC- Mc�oeor
MATERNAL AND CHILD HEALTH
IlVIPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2001
ANNUAL PROGRAM PROGRAM MGH
UNE 1TEM EXPENSE Saum' F're suoG� BUDGET
CUNICAL SERVICES COORDINATOR
C4NICAL SERVICES COOR�INATOR
NURSE PRAC7Ri0NER
NURSE PR1CT7'f101JER
REGISTERED NURSE
NURSE PRACTRIONER (AGAPE)
raurammasr
r�urnmo�nsT
nWrRmorusT tawvFl
r+urnmoMSr cr�vuN�ror+�
NEpLTli EDUCATOR (AGAPE)
socva woa�R
SOCIAL WORI�R
CASEMANA6ER (AGAPE)
IN7ERPRETER
LOURIER
cur+ic c�K
MEDICAL ASSIS7ANT
MEDICAL ASSISTANT
$
S
$
S
$
S
$
S
$
5
$
$
5
$
s
$
5
$
$
57,631
55,724
58,252
52,960
47,133
50,753
46,738
44,328
44,326
44,293
41,520
39,720
44,970
39,781
zs,os�
23,502
20,503
2'1.617
24,680
0.40
0.10
0.60
0.10
1.00
0.20
0.25
0.20
0.15
0,15
0.15
0.15
0.15
0.20
o.io
0.25
0.80
0.10
0.70
$ 23,052 S '13,831
3 5,572 5 3.343
$ 34,951 $ 20,971
$ 5.296 $ 3,178
$ 47,'133 5 28,280
$ 10,151 S 7,10�J
� »,ggq $ 4,674
S 8,865 S 3,546
5 6,649 $ 4.654
$ 6�644 $ '1,651
$ 6,718 5 4,360
g g,g58 5 3,575
$ 6,745 5 4,047
5 6,956 5 4,869
5 2,905 5 1,453
� 5,876 5 4,700
$ 16,402 $ $,20�
$ 2,162 S 1,081
$ 17.276 S 8,638
SUB-TOTALSALARY
FRINGE BENEPITS � 20%
CONTRACT SERVICE
RAMSEY CUNIC PHYSICIANINURSE MIDWIFE
ONE OBtGYN PHYSICIAN CLINICSIWK � 5520 X 42 WKS
TWO FAMILY PR4CTICE CLINICSIWK @ 5320 X 36 WKS
FIVE CNM Cl.INICANK � 5775/CL7MIC X 42 WKS
RENT
PATIENT CARE
LAB, UL7R4SOUND, X-iZAY
OTHER EXPENSE
MmICAT10NIDRUGS (INCLUDING ARLINGTOI�
MmICAL SUPPLIES
OFFICE SUPPLfES
EOUIPMENT
'fRPJNING
PRINiiNGIDUPLICATING
PATEM TRANSPOR7A710N
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ t6%
TOTALPROGRAM EXPENSE
70TAL MLN GRANT REOUE57
MATCMNG FUNDS � 25:G
0
5 230,506 5 135,157
$ 46,101 5 27,031
$ 21,840 S 4 .�
S 23,040 5 4,608
$ 36,750 S 7,350
$ 35,175 5 -
$ '18,375 5 11,025
$ 14.700 S 3,675
$ 5,250 $ �,�
$ 5,775 5 �,�
5 2,625 $ '
$ 1.050 $ -
$ $2$ $ -
$ 1,260 S 630
$ 442,972 $ 196,951
$ 70,876 S
S 5'l3.848 S 196,951
$ 49,238
$ '196.951
•
L J
C J
�
C�
�
Narrative
Face To Face Health And Counseling Service. Inc. - Project Connect -- Prenatal
Access Project
Face to Face Health and Counseling Service is proposing to continue its program aimed at
reaching high risk, pregnant adolescents with comprehensive fust trimester prenatal care services,
which have resulted in a higher rate of healthy birth outcomes_ Face To Face has historically
been a strong supporter of a comprehensive service approach for high risk youth, and is
continually moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach efforts and case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with
case management has proven to be very successful in (1) improving rates of fust trimester
prenatal care and reducing low birthweight rates; (2) providing social support and linking clients
to other needed support services; (3) ensuring clients receive high quality, continuous, and
comprehensive prenatal care; (4) involving clients in self help, the prenatal education program,
and in receiving needed group support; and (5) continuing to support the involvement of
pregnancy partners during the pregnancy.
Tar eg t Po�ulation - Face To Face will continue to serve a minimum of 1501ow income (less than
200% of poverty), pregnant adolescents and young adults between 11 and 21 yeazs of age (70 of
whom will be under the age of 19). At least 50% will be youth of color: African American, Native
American, Hispanic or Asian.
Goa1s/ Objectives -
Project Goal: The Prenatal Access Project at Face To Face will utilize outreach efforts and case
management to encourage and support pregnant adolescents to access prenatal caze so as to increase
their chances of having a successful pregnancy.
OUTREACH & CASE MANAGEMENT
Goal: To utilize a seamless, integrated service model to provide prenatal care.
Objective 1: To use a holistic intake process for assessing needs in all areas of the lives or our
clients and identifying strengths they already possess to address these needs.
Goal: To reduce the overall rate of late (third trimester) or no prenatal caze and to conduct
65
Application Narrative
outreach to increase the fust trimester prenatal care, especially among minority teens.
ObjecUve 1: To increase current efforts to provide ouTreach to youth of color, ensuring that at least �
50% of the prenatal clients aze youth of color: African American, Narive Amezican, Hispanic or
Asian.
Objective 2: To follow up with all clients with positive pregnancy tests, including making home
visits as necessary to assure they receive caze.
PRENATAL CARE
Goal: To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian and Asian teens.
Objective 1: To provide 150 pregnant adolescent and young adults -- 70 of whozn will be under the
age of 19 with holistic and comprehensive prenatal caze which is accessible, appropriate, effective
and which is coordinated with other community resources and integrated with the clients' individuat
life situation.
Objective 2: To enro1150% of the 70 clients who are under the age of 19 in prenatal caze services �
during their first trimester of pregnancy.
Objective 3: To begin to affect positive birth outcomes in all clients, as measured by low birth
weight rates of less than 6.5% for all age and racial groups served.
Objective 4: To improve attendance at all prenatal classes, with at least 50% of those enrolled in
prenatal services attending.
SOCIAL SUPPORT
Goal: To improve the health & wellness of pregnant adolescents during pregnancy through
increased social and emorional support and mental health services.
Objective 1: To increase prenatal support services to pregnancy and pazenting partners of pregnant
women.
Objective 2: To provide mental heath counseling for prenatal clients and their pregnancy and
parenting partners who are struggling with mentat health issues, including chemical use, depression •
and abuse.
..
� -,� ,�
Application I�3arrative �
Objective 3: To link all the prenatal clients who deliver through Face To Face with ongoing primary
medical caze for themselves and theu infants, and social services for the infant, mother and
• pregnancy and pazenting partners.
Methods/Activities - Three components aze used in the approach taken by Face To Face in
addressing the needs of pregnant adolescents in St. Paul, including:
Outreach & Case Management: The primary component of this project continues to be the
outreach youth worker to link high risk pregnant young women under the age of 21 with
prenatal care, counseling, support, advocacy, education, basic living needs, and other
resources. Staff will follow up on all positive pregnancy tests. Outreach workers provide
intensive case mgmt for the prenatal clients, help organize and advocate for services and aze
available 24 hours a day if there is an emergency. An outreach worker serves as a support
person for the client, and is often the one person who listens to a client to strengthen her
eatisting support network and build new relationships where needed.
Prenatal Care: Free pregnancy testing is offered four days a week, and the clinic follows up
on each positive result. Comprehensive and sensitive prenatal caze services aze offered at
Face to Face through a team of professionals including the outreach worker, prenatal program
� coordinator, nurse practitioners, physicians and a nutritionist. All of these members of the
team meet before and after the weekly prenatal clinic in order to ensure effective case planning
and follow-through with each client.
Social Support: Mental health services provided through these grant funds will include
assessments, short-term counseling and the development of peer support networks for the
pregnant adolescent and their pregnancy and pazenting partners. Mental health assessments
will be done for the pregnant adolescent and a caze plan will be established for the adolescent
which may include provision of short term counseling, referral far longer term counseling or
psychiatric services, a plan for establishing and/or maintaining emotional support and support
in achieving the plan. The goal is to strengthen the ability of the pregnancy and pazenting
partner to participate in and be able to support the pregnant adolescent in the pregnancy.
Evaluation - Face to Face programs and services are evaluated on several levels, as follows:
1. The Face to Face Board of Directors sets the vision and monitors the standazds and d'uection
of the agency through monthly board meetings and the work of board committees. Board
� committees evaluate the overall functioning of program azeas and addresses important issues of
d'uection, policy and relationships with other community agencies as well as funding.
:.�ll
Apptication Narrative
2. Progress reports are prepared by staff for review by all funding entities as required by each
source. An nnportant source of informauon for these reports is the organization's comprehensive
database system. This database is extensive, comprised of quanritarive and qualitative .
measurements of client informauon including: registration informauon, e�tensive intake
informarion, health history, complete visit records, attendance and credits, referrals, follow-up
data (lab results, termination status, etc.), and some case management data.
3. As part of trying to integrate all of the experiences Face to Face provides, a key activiry has
been to develop an intake process that provides useful information to assess the overall needs of
each youth. At part of this process, the agency is collecting information to take into account the
physical, social, emotional and cognitive aspects of adolescent's development.
Traininng/Experience - The outreach worker is Teretha Robinson, who came to Face To Face from
Saint Paul I'WCA. While at the YWCA, Teretha worked as a Senior Case Manager, conducting
screening and information and referral for homeless families. Case Management duties included
goal setting and education, negotiating client contractual arrangements, community
networking/service coordination.
Vicki Talaua is a second prenatal outreach worker who came to Face To Face last year from the
Healthy Start pmgram in Anoka, Minnesota. She previousty served as an intem with Face to .
Face from 1997 through June 1998. Ms. Talapa has a B.A. degree in Human Relationships from
the University of Minnesota
Clinic Manager Yaren Kramer serves as the OB/Gyn nurse practiuoner for the project. Karen
began her work with Face to Face in 1997 and was promoted to Clinical Manager early im 1999.
Sfie has over twenty years of nursing experience and is also currenfly affiliated with Regions
Hospital HIV programs as Women's Health Nurse Pracutioner providing caze for women with
HIV and AIDS.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Regions Hospital. Both are backed up by their respective
organizauons, and both bring many years of experience providing prenatal caze services.
The Medical Director is Chris Reif, M.D. Dr. Reif is also the Medical Director for Health Start
school-based clinics, is on the faculty at Regions Hospital, has worked in a variety of community-
based clinics and has directed Saint Paul's innovative Health Care for the Homeless project.
Continuing education needs of staff aze assessed and maintenance of credentials through �
continuing educaUon is monitored.
m
� �, � �
. -- � 3
Application Nazrative
Linkaees - Face To Face is committed to building working service networks with agencies,
individuals, coalitions, and systems. Evidence of this is our Academy program, which is a
� private/public partnership between Face To Face and the Saint Paul Public Schools. Further, in
the Sgring of 1993, Face To Face and Saint Paul Youth Service Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buIlding.
The Face To Face Prenatal clinic has built strong working relationships with a number of other
relevant maternal and child health service providers. These include: Maternal Child Project,
Ramsey County Public Health Nurses, Ramsey County Child Protection, WIC, MELD,
Children's Hospital Pediatric Clinic, Health Start's Hazding Clinic, Ramsey County SELF and
Minor Mothers Programs, and the Diabetes Clinic at United Hospital. A Ramsey County
Nutritionist is available at Face to Face prenatal clinics.
Clients aze referred for ultrasound, non suess tests, biophysical profiles and colposcopies. In
cases of refertals, the nursing staff contacts the referral source to set an appointment and inform
the client of time and date. In most cases, a written referral form is given to clients to take to a
referral appointment. If transportation to the refenal appointment is an issue for the client the
outreach worker will either provide bus tokens, tazi vouchers, or a ride - depending on the
situation. Follow-up is done by clinic staff to ensure that the client has carried through on the
referral.
� Reimbursement and Fees - The vast majoriry of our clients have been eligible for Medical
Assistance (and prepaid Medical Assistance). During 1998, 162 of 194 clients coming to Face to
Face for prenatal care were enrolled in Medical Assistance (Prepaid usually). Most who come for
care aze not yet connected with Medical Assistance.
Face to Face bills MA for prenatal caze, although none of the reimbursements cover the costs of
outreach. If a client is not eligible for any third party reimbursement, she is then charged fees
according to the sliding fee scale.
Budeet - A complete budget and justification for the Face To Face program follows.
�
CS:
Application Narrarive
Faco to FacY Health Counsaling Sexvice, �sc.
co�aoc/� �sot z000
Connect Program � To�
xEPENOE
Family Planning Special Project S 7,�80
HOD Special Needs Housing S 9•Z82
MDH HZV/STD OuYreacb 5 18,118
Adolescent Pazenting Program 5 57,039
MCH $ -0�,000 S 40,000
Family Support Pzoject � S 103,867
HOPE S 10,757
Subtotal Governmeat S 246.843
Puzehaee o£ Sarviea 5 23,600
Foundation/COZporation 5 29.900
Fasa S Third Pazty 5 2,000
Otbex, Misc. i Intezoet S -
To Be Asieed S d7,590
gpg�, • $ G0,000 S 349,933
EJ�£NSES
Pzoject Coordinator (TR) S 2,363 S 5,908
Wtzeach Wozkez iVDT) S 19,690 S 19,521
Wtreach Forkezs fMV7 5 12,5B8 5 23,275
Total Salaries 5 28,591 S 139,732
Fzinqe S 5,146 S 26, 599
Tm�pozazy Pessonnel 5 -
Coatznct Staff 5 -
Coasultaats S 4,400
Clieat f�ezgeacy Aasistance S 750
Clieat Pass TIIzwgA S 1D0,000
rzoqzam Suppiy 5 3,500
OE£ice Supplies S 1,000
p� S 4,600
Reat 5 '
Telephone $ 5,700
Posiage S 35
Membezship Dues $ �
wtsiae Pzintin9 S .1,350
Inside Pzintinq 5 920
StaEf Tsaoel 5 562 5 2,OOU
Clieai Txaoel S 1,600
Coa£ezencea, Tzaining 5 5,000
Adve-cising 5 900
Subsczip2ions 5 '
subiotal Exp�ns• 5 39,299 S 298.036
p�tiaiatzation Spzead S 3,800 5 47,166
Facilities Spzead S 1,901 5 4,731
TpTAL E78ENSE S 40,000 S 399,933
70
��
�
`�
xJi99/lSH00 7/3/99
Application Narrative
: -- :� 7 3 .
• Face to Fsce Health Counseling Service
Sudget Narrative
2000
BUDGET NARRATIVE
Total Salaries:
Portion of Connect Program staff salaries paid by MCH grant.
Project Coordinator - .08 £TE
Outreach Worker - .60 FT£
Outieach Worker - •50 FTE
Fringe Benefits:
Based on 188 of MCH portion oP staf£ salaries. Includes medical,
dental, FICA, li£e, etc.
Sta£f Travel:
.
Based on MCH portion 11.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 staf£ x.31/mile.
Faoility Costs:
Based on 6� of MCH portion of budget. Includes telephone, utilities,
janitorial, trash, building repais 6 supply, taxes, insurance,
telephone system & copier le�se, and maintenance.
Administrative/Management Ovezhead:
Includes general of£ice supply, insurance, postage, accounting,
annual audit, computer consultation, and administrative &
management staff and £ringe benefits.
•
71
Application Narrative
Faca to Face 8ralth Counsalinq
Conaoct Bsogram � T
.
REVEt��E
Family Plannin9 Speci�l P:ojeci S B
AOD Special Nee25 Housing S 9,560
H)e aN/STD wtreach S 18,662
olescent Paren2ing Proczam S 58,750
�g S 40,000 S 91.200
Family Suppozt Yroject 5 306,983
gppg 5 11,080
Subtoul Gwarmwnt 5 25<,Y<8
Porc7usa of Sorviu S Z6,308
FouLtlat3oA/COSpetatioa 5 30,797
Faes s Taizd Yarty 5 2,060
OtLCZ, Misc. i Iasazest 5 -
So ea Raitcd 5 62.632
gpy�, 5 d0,00D $ 35d,065
fXPEN5E5
Projett Coozdinator (TR) 5 2,3E3 5 5,908
WtzeaU Woskes (V,7T) S 10,640 5 19,521
Wtzeach Workezs (1.N1 5 11,588 S 23,175
Tosal Salaziee S 28,591 5 139,732
Franqe 5 5,196 5 25,152
Teaqozary Pezawuiel 5 -
Conuaci StaSS S �
c,n:,u:�„c, s a, 532
Climt Emezaenry Assissa�cc 5 �73
Uimt Pass Snreuqn 5 103.000
Yroqzw Supply 5 3, 605
oiSi<e supplaes 5 1,030
g� 5 0,738
Rmt S �
7elepnone 5 5,871
Pos:see 5 36
MmDezaAip Dues 5 -
Outsiae Yranssag 5 1,391
Iasiee Pr3aung S 998
StaSS zzavel S 562 5 2,060
usmc r:avei 5 1,648
CmiSUeaces. Tzalxung 5 5.150
Atl�rozcasing 5 927
sveaezipsswu 5 -
yspusu ssp�n.• 5 35,299 5 300,591
:tzation Spreatl 5 3.800 5 48.581
Facilliaes Spzeatl 5 1.901 5 4,873
SriTU E7�ENSE 5 d0,000 5 35a,0a5
co�.ez� saaQ.c zooi •
�
•
��
Narrative
� ,�_ �73
. Face to Face Health Counseling Sexvice
Hudget Narzatioe
2001
SIID6ET 2IARRATIVE
Total Salaries:
Portion o£ Connect Program st«£ salaries paid by MCH grant.
Project Coordinator - .08 FTE
Outreach Worker - .60 FT£
Outreach Worker - .50 FTE
Fringe Bene£its:
Based on 18$ of MCH postion o: staf£ salaries. Includes medical,
dental, FICA, life, etc.
Sta££ Travel:
�
Based on MCH portion (1.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 sta££ x.31Jmile.
Facility Costs:
Based on 6$ of MCH poztion oP budget. Includes telephone, utilities,
janitorial, trash, building repair 5 supply, taxes, insurance,
telephone system 6 copier lease, and maintenance.
Administrative/Management Overhead:
Includes genes�l office supply, insurance, postage, accounting,
annual audit, computer consultztion, and administrative 6
management staff and fringe bene£its.
�
73
Narrative
West Side Community Health Clinic - Improving Pregna�icy Outcomes for High •
Risk Latinos and Asians in Saint Paul
Goal - The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul L.atino and Southeast Asian populauons by providing outreach, tracking all positive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by existing West Side Community Clinic staff and services. The
clinic offers comprehensive health care services on a sliding fee scale. Tlus project will give
Latino and Southeast Asian families greater access to a full array of services inciuding well child
care, immunizations, family planning, parenting, and STD services as well as linkages by referral
to over 14 other community agencies.
Tar ep t Population - This project will target low ittcome pess than 200 % of poverty) Latino and
Southeast Asian women in the following azeas of St. Paul: Riverview (CTs 342, 361, 370, 371,
372), Mount Airy (CTs 328, 329, 330) and Rice Street (CTs 305, 314). These azeas include the
highest concentrations of Latino and Southeast Asians in the city.
Prolect Goal - To reduce low birthweight and infant mortality rates in the St. Paul Latino and
Southeast Asian populations. �
Obiectives -
1. To reduce overall rate of late (third trimester or none) prenatal caze among pregnant Latinas and
SEA teens and women to 10 percent or less.
2. Increase the rate of prenatal caze in the first himester among pregnant Latinas and SEA teens and
women to 60 percent or more.
Meth s -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted azeas, health education fair for teens as part the McDonough recreation
program, assistance in clinic enrollment at WIC sites at McDonough and West Side, and
responding to media requests for interviews by local newspapers and radio stations.
2. Project staff will conduct Spanish-spealdng and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safety, and personal health issues such as family planning, STDs, drugs and alcohol, �
and family violence.
'I4
Narrative
"'73_ ,�,
3. Staff in clinic will follow-up on all positive pregnancy tests and identify highest-risk
• perinatal patients, providing focused language and culture-specific health education and
support interventions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportation, and interpreting as needed.
Evaluation - All patient data is logged and entered into a computerized data system. Data kept
includes demograplucs, trimester of entry into prenatal care, types and numbers of services used,
and pregnancy outcomes. Information is reviewed periodically, and project results will be
compiled annually. Addirionally, patient satisfaction surveys are done semi-annually.
3atisfaction with prenatal classes will be measured via surveys after each services. Twenty-five
(25) prenatal records are audited quarterly to measure rates of compliance with prenatal risk
assessment, post partum visits, and newbom follow-up. This information will be reviewed
quarterly by the Quality Management Committee to identify and implement focused improvement
efforts.
Trainin�*(Fxnerience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability to meet the health needs of Hispanics and Southeast Asians. In 1996, WSCHC served over
12,800 medical patients, 75% were Aispanic or Southeast Asian. Services include bilingual and
� bicultural staff, transportation through our van, bus or cab voucher, hospital care through Regions
Hospital, in WIC clinics including immunizauon outreach assistance with Medical
Assistance/Minnesota Care applications and outreach clinics and education programs in homeless
shelter, public housing developments and a high school. These services are provided through a
well established interdisciplinary case management model. This model helps identify high-risk
patients through screenings and refenals, provides coordination of care, and ensures patient
involvement in care planning and choosing ueatment options.
The Perinatal Aealth Educator{Coordinator, Isolina Soto RN (.4 FTE) has worked at West Side
Community Health Services since 1993 and has over 20 years of nursing experience.
The Hmong Perinatal Health Educator, Youa Vang (.1 FTE) has a BS in Biology and has worked
with the Hmong community in a vaziety of roles for the past four years, including as a child
developer/ESL Tutor (Hmong), and at West side as a Health Educator.
Additional project support will be provided by the Nurse Manager, Jane Johnson, RN, the
Medical Director, Mary Nesvig, MD and other clinical staff through the Perinatal Caze
• Management Committee.
L' a es - West Side Connmunity Health Center works with the following organizations in
75
Narrarive
providing maternal and child health services:
• Regions Hospital Family Pracrice Residency Program to provide cross-cultural family •
medicine training for physicians motivated to work in high-need under served settings.
• Saint Paul - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Child Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, elderly health caze, life style/cancer
and dental care.
� Combined efforts with 16 other community clinics to improve health outcomes for
underserved populations through joint efforts through the Neighborhood Health Care
Network.
• Saint Paul - Ramsey Counry Department of Public Health to provide nutrition education and
immunizations in conjuncuon with WIC sites and home visits to pregnant women and
infants.
• Saint Paul Public Housing Agency to grovide services, including maternal child health, on-
site at McDonough and Roosevelt housing developments.
• City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facitities and five outreach sites.
West Side Community Health Services provides comprefiensive perinatal care. Any specialty
medical caze needed is provided either on-site or refened the high zisk OB clinic at Regions
Hospital. All medical referrals aze done on a referral form and followed-up via computerized
tracking.
Reimbursement and Fees - All reimbursements through the Minnesota Department of Human
Services go d"uectly to support services. Assistance is provided to enroll all eligible women on
Medical Assistance/MinnesotaCaze. A sliding fee scale is maintained for those not eligible for
assistance. Fees are discounted incrementally based on family income, from those at or below the
poverry level paying nominal or no fees, up to those exceeding 200% of the poverty level paying
full fees. Patients aze high risk, low-income (200% of poverty or less). No one will be turned
away due to finances.
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Narrative
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Bud�et - A budget and justification for the West Side Communiry Health Services proposal
foliows.
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Application Narrative
Maternal and Child Health (MC� Funds
West Side Community Healti� Center
�
Budaet
WSCHS is requesting 516,250 per year to supplement our existing perinatai progam.
The fimds will allow us to utilize bilinguaUbicultural perinatal health educators as focused
and integral components of our overall program.
Following is the project budget with noted WSCHS match:
Year One - Z000
MCH Reauest WSCHS Match
.4 FTE Perinatal Health Educator/Coordinator
832 hours at �16.34/bour
1 FTE Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing stafflperinatal support
TOTAL
Year Two - 2001
$13,600
2,650
$16,250
MCH Reaaest
.4 FTE Perinatal Health Educator/Coordinator
832 hours at $1634/hour
1 FT'E Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
$13,600
2,650
�16,250
$107,000
62,400
$269,400
WSCHS Match
$107,000
62,400
$169,400
Eight hundred prenatal patients will be seen annually.
Seventy-two prenatal classes will be held, serving an expected 350 patients.
Seventy-five highest risk patients �sill receive specific follow-up by the heatih educator.
An additiona1250 teens and women will be reached through outreach activities.
There are no DHS or self-pay reimbursements anticipated re]ated to tl�ese supp]emental
activities.
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ADOLESCENT HEALTH PROGRAM
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Narrative
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child Health
Special Project Grant funding for adolescent health services. Some funding will also be targeted
to services for adolescents through Room 111 at ihe SainR Paul - Ramsey County Department of
Public Health. The community assessment for adolescent health utilizes information prepazed by
Health Start from their assessment, as well as information from the Saint Paul - Ramsey County
2000-2003 Community Health Services Plan Community Assessment.
As mentioned eazlier, adolescent health continues to be a focus, primazily through the
Adolescent Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock grant program. This program will continue to be supported
through MCH funding. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgonen gopulation. In fact, a number of issues specifically related to adolescent health are
included in the Saint Paul - Ramsey County 2000 - 2003 Community Health Services Plan as
priority health problems, including:
• The percentage of births to adolescent mothers in Ramsey County is increasing
while national and state percentages aze going down.
• Tobacco use is on the rise among youth and select populations.
� High number of children, adolescents and adults aze overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effects that
aze associated with poverry.
�
Several more problems within the list of twenty-one high priority problems do not mention
adolescents specificially, but that population is clearly identified as being affected by the following
problems as well:
Emerging and re-emerging infectious diseases threaten the health of the general
population (including immunizations and STDs).
There is a gap between Minnesota goals and the cuzrent number of people in Ramsey
79
Application Narrative
County who have access to medical, dental and mental health issues.
• Despite overall health unprovement in Minnesota, populations of color continue to �
experience poorer heath and disproportionately higher rates of illness and death.
• There is an increase in the number of birFhs in Ramsey County that result from
unintended pregnancies. Some unintended pregnancies are associated with medical
and social problems which later affect children and families.
• There is an unacceptable level of interpersonal violence.
Adolescent health status indicators have shown improvement in some azeas and deterioration in
others in the last five years, Alcohol use has started to drop, as have reported rates of sexual activity
among teens. Pregnancy rates among teens nationally aze dropping, especially due to increased use
of contraceptives and a decrease in amount of sexual activity. They aze still too lugh in Saint Paul,
especially among African-American youth. Rates of physical activity are decreasing for older teens,
wlule obesity is increasing. Tobacco use has increased draznaticatly, especially among White,
Hispanic, and Native Amezican youth. Mortality from violence - suicide, depression and car
crashes - is unacceptably high.
PROGRAM RESPONSE TO MCH PRIORITIES
The Adolescent Health Program responds to the goals and priorities for services adopted by the
State Matemal and Child Health Advisory Task Force. The goal of the Adolescent Health Program
through Health Start is to promote a positive health status and reduce the incidence of unplanned
pregnancy, nutrition problems, depression, chemical abuse and family and relationship problems
among adolescents in Saint Paul. To achieve these goals, Health Start, Inc. has i@entified priorities
consistent with the following MCH Advisory Task Force priorities:
• reduce infant mortality
� reduce the percent of low birthweight infants
• reduce adolescent pregnancy rates
• reduce unintended pregnancies
• provide access to preventive services
• reduce chemical use in adolescents
• reduce infecrious diseases
• promote good nutrition practices
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Application Narrative ^@ � % 3
These priorities will be addressed through the objectives and methods identified by Health Start's,
Adolescent Health Program. Methods to address these priorities include comprehensive health
. services that aze accessible and acceptable to high school age adolescents including nutrition
education and counseling, and psychosocial assessment and ongoing counseling. Extensive health
education is provided individually and in group education settings. Referrals aze made when
necessary.
The services provided for the Adolescent Health component in Room 111 will focus on the MCH
priority to reduce infectious diseases.
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Agplication Narrative
�
Teen Pregnancy Rate
15 -19 Year Olds
1995 - 97
•
Number pregnancies per 1,000 females this age group
Source: MDH
SPRCDPH, Mealth Policy 8 Planning
.
82
Minnesota Ramsey County Saint Paul
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Nazrative
Teen Pregnancy Rate
1993 - 1995
�
��. �7�
� 15-17 year olds
� � 8-19 year olds
15-197 year oids
Teen Pregnancy Rate: Number pregnancies per 7,000 temales in age group
' Source: MDH: MN Meatth Profites
SPRCDPH, HeaIN Policy & Planning
�
Teen Pregnancy Rate
1995 - 1997
�
� i 5-17 year olds
� 18-19 year olds
15-19 year olds
�
Teen Pregnancy Rate: Number pregnancies per 7,000 females in age group
Source: MDH: MN Heatth Profiles
SPRCDPH, Health Policy 8 Planning
8/'12/99
83
C:�Program FileslSPSS\TeenPreg9597.spo
Minnesota Ramsey County
Minnesota Ramsey County
Narrative
3 Year Teen Birth Rate
1993 - 1995
-.-o.
�.�.�., - ..
18-t9 year olds
� 15-t8 year oids
Teen Birth Rate: Number births per 1,000 females in age group
Source: MDH: MN Health Profiles
3 Year Teen 8irth Rate
1995 - 1997
..
.,.,., - ..
18-19 year olds
�'15-19 year oids
•
�
Teen Birth Rate: Number births per 1,000 females in age group �
Source: MDH: MN Health Profiles _
gi12/gg C:�Program FilesGSPSS\TeenBRaie9395.spo
84
Minnesota Ramsey County
Minnesota Ramsey County
�� n - 7
Application Narrative '-� �J ! �
Sexually transmitted diseases continue to be a concem in the adolescent population. The largest
percentage of cases of chlamydia aze females ages 0-19, followed by ages 20-29. Between 1992
� and 1995 there was a downward trend in rates of chlamydia in Minnesota, Ramsey County and
Saint Paul. However in 1996 and 1997 in St. Paul and Raznsey County the rates increased. The
second lazgest age group diagnosed with gonoahea is 0-19 yeaz olds.
Chlamydia 1992-1997
Case Rates per 100,000 Population
500.0
a a00.0
0
n
0
a 300.0
0
c
� 200.0
m
n
m
� i oo.o
m
N
�
V 0.0
•
YEARS
81992
� 7 993
Qi89d
� 7 995
\\ 7996
� 1997
Source:MOH.SPRCDPH
/ 1
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Saint Paui Ramsey County Minnesota US
Application Narrative
Health Start. Inc. - Adolescent Health Program
Adolescents require services tailored to meet their specific needs and developmental levels. The
services must be accessible, accepiable and confidenfial in order to be effecrive. For these reasons,
Health Start provides comprehensive adolescent health services within the school setting at all seven
pub�ic high schools in Saint Paul: Hazding, Como Park, Central, Johnson Seniot High Schoot,
Highland Pazk Junior/Senior High School, Humboldt Junior/Senior High School and Arlington
Senior High SchooI. In addition to these seven scfiooI-based clinics, Heaith Start provides prenatal
and family planning services for pregnant and parenting teens at AGAPE Alternative School and
other health services (not including prenatal) at Guadalupe Area Project.
During CY 1998 school yeaz, students again demonstrated their need for clinic services by using
current services extensively. A total of 3,460 students made 14,141 clinic visits, generating over
18,817 encounters with various professional staff. This is a 5.6% increase in visits over 1997.
•
For many students, the Health Start school-based clinics aze their only source of health care. For
many others, the school-based clinics aze the important link that enables Yhem to obtain access to
other ea�isting community health care resources. Data from 1998 school yeaz (information available
at first visit) revealed that of student's families, 26% had medical assistance, 16.5% had private •
insurance, 57% had no known billable 3rd party source of payment, and 1% had MinnesotaCaze.
Goal - The goal of the Adolescent Health Program is to promote a positive health status and reduce
the incidence of unplanned pregnancy, nutrition problems, depression, chemical abuse and family
and relarionship problems among adolescents in Saint Paul by providing comprehensive health care
services at seven high School sites and two altemative school sites within the City.
Tar e¢ t Population - The clients targeted to be served by the Health Start Adolescent Health
Program aze adolescents living in the City of Saint Paul. The following demographic data describes
this population:
• 39.8% White
29.1 % African American
8.4% Hispanic/Latino
2.2 % American Indian
16.5 % Asian
4.0% Other
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Application Narrative -� � 7
• Age in School - 27.7% 18 years and above
24.3% 17 yeazs
� 22.1 % 16 years
21.9% 14-15 years
4.0% 12-13 years
In addition, an average of 53 % of all high school students are reported as eligible for free and
reduced school lunches, indicating low economic status.
O'ectives - The following objectives have been established for the Adolescent Health Program in
order to achieve the goal:
1. In CY 2000 and 2001, 3300 junior and senior high students will access health caze
through the school-based clinics each yeaz.
2. In CY 2000 and 2001, the healthy lifestyle of physical activity and a balanced diet will be
encouraged by providing 200 nuuition visits related to sports nutrition, weight conuol or
eating disorders.
� 3. Onsite counseling will be provided for 1,000 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, sexual or
emotional abuse each year in CY 2000 and 2001.
4. 1000 teens will receive an annual comprehensive preventive health exam and risk
assessment, including sports physicals and annual reproductive health exams.
5. At least 85 % of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a pregnancy prevention plan. Decision making, sexuality
counseling, and family planning services will be provided for 1,QQQ adolescents each year
in 2000 and 2001.
6. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in CY 2000 and 2001. (From 863 in 1998).
7. The number of hepatitis B immunizations given will increase by 10% in CY 2000 and
2001 (From 501 in 1998).
.
8. An "Ask and Advise" smoking assessment will be implemented for 75% of teens using
F:�17
Applicarion Narrative
clinic medical services in CY 2000. In CY 2001 an "Assist and Connect" component will
be added for 100% of teens expressing a desire to quit or decrease tobacco use.
�
The number of males being seen in clinics will increase by 10% in CY 2001 over CY
1998.
10. 7,000 group education contacts will be provided in clinic and in selected classrooms by all
members of the interdisciplinary team on health education activiues such as prenatal and
parenting classes, weight control classes, human sexuality programs, an@ smoking
cessation, in order to maximize the understanding and practice of positive health
behaviors.
Methods -
• All new students will be assessed for helath and behavior risks, following GAPS assessment
guidelines, detailing medical and family history, behaviors and feelings. This form will
provide staff with background data necessary for providing good caze and for triaging clients
to appropriate staff
• Physical examinarions, health screening and assessments, diagnosis and treatment of acute and
minor illness, and family planning visits w�l be provided on site by a nurse practitioner or �
physician.
• A Health Start health educator, nurse practitioner or social worker will provide decision-
ma[ting counseling and family pIanning eduarion and counseling to adolescents requesting
these services.
• A certified nurse midwife, or physician will provide prentaU care in eight of nine clinic sites
for those students choosing to receive caze through the Health Start program.
• Health Start staff will provide risk assessment, prevention education, and screening on site for
all STDs, inclutling FIIV infection. Health Start will provide new non-invasive urin-based
testing for gonorrhea and chlamydia when appropriate.
• Health Start staff will serve as adolescent health resources to teachers, school staff and youth
workers in their classroom and other groups.
• Health Start will work collaboratively with the health plans serving St. Paul students to �
maximize reimbursements for services and communicate with or refer students into
appropriate sources of caze.
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Narrative ' " f j
• Health Start will participate in the Neighborhood Health Care Network in efforts to increase
. e�ciency through joint purchasing and to increase third parry reimbursement through joint
contracting as part of a primary caze network.
Evaluation - Clients at school-based clinics are assessed annually for satisfaction with Health Start
services, using a standardized format and automated s»mmarization. The same form is used by
the Neighborhood I3ealth Care Network. Satisfaction levels are compared with primary care
community clurics and four other adolescent specialty programs in the Metro azea. Automated
encounter forms gather the demographic data, visit, procedure, and diagnostic code data, and site
of service. These data can be queried to provide data on types and quantity of services used, as
well as target population reached by age, race and income level and special need.
In order to determin if famly planning and reproductive heltah services can be provided
effectively in a school setting, conuaceptive use compliance will be uacked to compaze results
before dispensing on site to afrer dispensing on site, by CY 2001. This will be accomplished by
chart review.
To help detez�min if there is any measureable impact of use of school based clinic services on
school performance/attendance, Health Start plans to replicate a study conelating school based
� clunc enrollment and intensity of use with school performance meaures done in 1993. (Klein,
McCord et all, Journal of Adolescent Health) The principal investigator of that study has
tentativley agreed to be the P.I. on the replication study. Funds are being sought through private
foundations to pay for the study in CY 2000. This would be a retrospective study.
Information from evaluation efforts will be given to the quality assurance committee, the qualty
managemnet team, and the clinical management team. They may be used to formulate changes in
intervention, to stimulate fiu�ther analysis for underlying causes, or suggest areas for a quality
improvement project. Evaluation results are disseminated to providers via periodicy provider
meetings, clinc temas via team coordinator meetings, the board of directors at board meetings
semiannually. They are slo used to motivate staff and to stimulate a work culture of continuous
quality improvement.
Training & Experience - Health Start has provided maternal and child health services in Saint
Paul since 1967. All Health Start staff are professional health care personnel with special
expertise in maternal and child health. The majority have had more than five yeazs experience.
All staff aze evaluated at least once a year. Cinical staff are also subject to annual peer review.
• Staff are supervised by the executive director, associate director, medical duector, OB medical
d"uector,or team leaders. Mecical providers are credentialed according to standazds of the major
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Narrative
health plans.
Carol White, M.A., is the execuuve director of Health Start and is responsible for the overall .
management and direction of the project, as well as external relations and long-range planning.
Dr, Chris Reif, a member of the Family Medicine Department at HealthPartners/Regions
Hospital, is tiie medical d'uector and responsible for overall medical direction. Dr. Donna
Anderson, on the staff of the HealthPartners Obstetrics and Gynecology Department, is ffie OB
medical director and works with the medical director to provide consultation on OB/GYN
pracuces, as well as providing clinical supervision for OB/GYN nurse practitioner staff. A
clinical management team made up of representatives from the various professional disciplines, in
prenatal and adolescent services of Health Start advises management staff. Richard Duffin,
M.A., has been the associate director fo�ve years and manages the school based clinics. 7eanne
Rancone, PNP, PHN, is the Clinical Services Coordinator, overseeing clinical services for
adolescent, prenatal, and pediatric care. 7eanne has been with Health Start for five years.
Li a es - Heaith Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. This referral network allows staff to
individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs arise. Key linkages include: HealthPartners/Regions
Hospital - most physiciaus and midwives are contracted through HelathPartaers, who also provide �
back-up for prenatal care and refeaals for primary care services and OB specialty services not
provided by HealthStart.
Health Start works collaboratively with Saint Paul-Ramsey County Public Health nurses to extend
services to pregnant women in the community. Public health nurses meet regularly with Health
Start to identify clients needing home-based services and to share information that will enhance
patient caze.
At delivery, new parents are referred to Health Start's pediatric clinic which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location neaz Le�ngton and University,
the usefulness of providing pediatric care at a different neighborhood sit as an incentify for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediatric
services are discontinued by Helath Start, case managment to help conneci new mothers to
approrpiate mecial homes for their babies in the community will be maintained.
Eligible clients aze also referred to the Befriender Program, run in collaborauon with Children's •
Home Society which offers volunteer mentors to young or struggling mothers. Health Sart also
refers to two parenting/home-visiting groups, which are coIlaborarions witfi St. Paul Schoolc
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Application Narrative � � ` � � �
Early Childhood and Family Education (ECVE). One is funded by Ramsey County Family
Preservation Services to prevent child abuse and need for foster care in minor mons. The other,
� cailed the CARES Project, is designed for parenu with drug exposed children and with cantinuing
difficulties with substance abuse. These programs all provide intensive counseling, support,
and/or group education for high-risk pazents_
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), written referrals will be made to communiry clinics
or other resources within a convenient geographic area.
In the school-based clinics, the linkage with the school nurse is very close. Often, space is shared
and refenals go back and forth during the day. Relations with other school personnel aze also
pursued. A school board member always serves on the Health Start board of directors.
Aealth Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliations with
andlor refer to the following agencies and task forces (partial list):
Children's Home society of Minnesota, Early Childhood and Family Education (ECFE),
� HouseCalls, Frogtown Family Resource Center,HeaZthPanners and Regions Hospital, Ramsey
County Human Services Child Protection/Minor Moms Services, Saint Paul - Ramsey
Depart»2ent of Public Health, Rondo Family Resource Center, Neighborhood Health Care
Nenvork, Saint Paul Public Schools, tiVIC Food supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. Patients are low income (200% of federal poverty
or less). MCH funding allows Health Start to provide prenatal care for clients who have no third
party source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. Health Start has conuacts with all of the PMAP providers.
Any other applicable third parties are billed whenever possible. Insurance revenue pays for
approximately 45 % of Health Start's prenataUfamily planning clinic services, and 15 % or
adolescent health services at school based clinics. No one will be turned away due to lack of
financial resources.
Health Start provides fannily planning care to clients for 24 months after delive .ry uusing MCH
and Fanuly Planing Special Project funds. If a client has no third party payor, a sliding fee scale
is used to determine her fee for family plazming services. Funds will be requested from the State
� of Minnesota Family Planning Special Projects to continue the provision of family planning
services in the next biennium. An increase in these funds in CY 98 and 99 allowed Helath Start
91
Application Narrative
to offer continueation family planing services to graQuating high school stu@ents on a sliding fee
basis.
Subgrants/Subcontracts - Health Start subcontracts for the provision of physician, certified nurse- �
midwife services and social worker services with several community providers including:
HealthPartners, and Face To Face Health & Counseling Service, Inc, The Health Start Medical
Director and Associate Medical Director are responsible for supervision, protocols, and general
medical direction for all medical personnel involved in the prenatal/postpartum and adolescent
health programs.
Bud�et Justification - Health Start, Inc. will receive $505,035 in 2000 and $505,035 in2001 to
support the Adolescent Aealth Program through school-based c2inics. The total budget and
just�cation for the budget follows.
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Application Narrauve y U
• HEALTH START, INC.
MATERN.AI. f1ND C�+D H�' .a11.TH
ADOLESCETT AEALTH SERVICES
SCHOOL BASED CLINIC3
JAl�'UARY TIiROUGH DECEMBER, 2000
MCHSBC00
•ANNUAL PROGRAM PROGRAM MCX
LINE ITEM EXPENSE SALARY F'rE euDCe'r suoc�'r
NURSE PR4CTRIONER (CENTW+L)
NURSE PRACTfT10NER (COMO)
NURSEPRACTRONER(HUMBOLD�
NURSE PRACTRIONER (JOIiNSON)
NURSEPRACTRIONER(HARDING)
NURSE PRACTRIONER (ARLINGTON)
NURSE PRACTRIONER (GAP)
SOCIAL WORKER (CENTRAL)
SOCL4L WORKER (COMO)
SOCV1 WORKER (tiVMBOLD�
. SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE M4NAGER(AGAP�
� MED�CAL. ASSISTANT (CENTRAL)
MEpICAL ASSISTANT lCOMO)
MEDICAL ASSISTANT (HUMBOLD�
MEDICAL ASSISTANT (JOHNSON)
MEDICALASSISTANT (HARDMG)
MEDICAL ASSISTANT (AGAP�
MEDICAL A5515TANT (ARLINGTON)
MEDICAL ASSISTANT (GAP)
NUTRSTIONIST (CENTRAL)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOLD�
NUTRRIONIST (JOHNSON)
NUTRRIONIST (HARD�NG)
NUTRITIONIST (ARLfNGTON)
NUTRRION15T (GAP)
NEALTN EDUCATOR (CENTRAI)
NEALTN EDUCATOR (COMO)
HEALTM EDUCATOR(HUMBOLDT)
NEALTN EDUCATOR (JOHNSO�
HEAITN EDUCATOR (HARDING)
MEALTH EDUCATOR (AGAPEj
MEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GA�
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
�
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
S
$
$
$
S
$
$
$
S
$
$
40,320
47,'124
41,966
42,672
40,320
40,992
47,124
35,902
32,038
35,330
34,759
28,510
33,768
19,606
19,034
19,606
20,765
18,362
'18,413
18,413
18,413
34,759
35,246
37,750
34,759
35,246
35,246
33,869
28,980
32,558
30,818
28,980
32,558
32,558
26,998
33,163
44,554
0.80
0.80
�.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
1.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
0.10
0.1�
0.10
0.05
0.15
0.10
O.iO
$ 32.256 $ 25,805
$ 37,699 $ 30,159
$ 33,573 $ 26,858
$ 27,737 $ 22,189
$ 32,256 $ 25,805
g 36,893 $ -
$ 8,247 $ -
$ 14,361 $ 13,643
$ 12,815 $ 12,174
$ 21,198 $ 20,138
$ 13,904 $ 13,208
$ 14,255 S -
g 25,326 $ -
g 19,606 $ 15,684
$ 19,034 $ 15,228
$ 19,606 S 15,684
$ 20,765 S 16,612
$ 18,362 $ 14,690
$ 3,683 $ -
$ 18,413 $ -
$ 13,810 $ -
$ 5,214 $ 5,214
$ 5,287 $ 5,287
$ 5,662 $ 5,662
$ 5,214 $ 5.214
$ 5,287 $ 5,287
$ 5,287 5 -
$ 3,387 $ -
$ Z,S98 $ 2,898
$ 3,258 5 3,256
5 3,082 $ 3,082
$ 2,89$ $ 2,89$
$ 3,256 $ 3,256
a'W �,628 .� '
$ 4,OSD $ -
$ 3,316 $ -
$ 4,455 S 4,455
� SUB TOTAL SALARY
' annual salary based on 42 week school year
FRINGE BENEFITS @ 20°k
93
$ 507,974 S 314,388
$ �0� ,595 $ s2,s7e
Application ATarrative
Health Start
Adolescent Health Services
CY 2000 Budget
r�
�J
ANIiUAL pROGRAM pRpGRp�A MCH
LINE ITEM EXPENSE SALARY Fre s��ET B��ET
CONTRACT SERVICE
FAMILY PRACTICE PHYSICIAWNURSE MtDWIFE
NINE PHYSICIAN CLINICS/WK @ 5305 X 34 WKS
THREE CNM CUNICNVK @ S'720/CUN1C X 34 WKS
PEDIATRICNURSEASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-RAY
OTHER EXPENSE
nneoic�+nowoRUCs
MEDIGAL SUPPLIES
OFFlCE SUPPUES
PRINTING/DUPLICATING
EQUIPMENT
TRAINING
PATIENT TRANSPORTATIOWCOURIER
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ 16%
TOTAL PROGRAAA EXPENSE
TOTAL MCH GRAN7 RE�UEST
MATCHING FUNDS @ 2S6
$33,537
HIGHL�ST�'D SCHOOL BASED CLINIC FUNDED BY SEPERATE GRANT SOURCE
g 93,330 $ 55,998
$ 12,240 $ 7.344
g 5.191 $ 3,115
g 33,537 $ 16.768
$ 35,000 $ 17,500•
$ 21,000 $ 12.600
$ 8,500 $ 4,944
$ �2.000 $ �,200
$ 2,500 $ 1,500
g 5,000 $ -
$ '1,5DD $ -
$ 2.000 $ $00
g g41,366 $ 505,035
g 134,619 S -
$ 975,985 S 505,035
$ 505,035
$ 126,259
\J
t��'
Application Narrative "' � � ✓
� HEALTH START, INC.
MATERhAL AND CHIL.D HEAI.TH
ADOLESCEIv'T HEALTH SERVICES
SCHOOL BASED CLINICS
JANLTARY Tf�II20UGH DECEMBER, 2001
MGNSBCOt
•ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SAL4RY F're euoG� B�o�ET
NURSE PRACTRIONER (CEMRAL)
NURSE PRACTRIONER (COMO)
NURSE PRACTfTONER(NUMBOLD�
NURSE PR4CTRIONER (JONNSON)
NURSE PRAC7iT10NER (NARDiNG)
NURSE PR4CTRIONER (ARLINGTON)
NURSE PRACTRIONER (GA�
SOCI4L WORKER (GENTRAy
SOCt4L WORKER (GOMO)
SOCIP.I WORKER (HUMBQLDT)
SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE MANAGER (AGAP�
MEDICAL ASSISTANT (CENTRAL)
� MEDICALASSISTANT(COMO)
MEDICAL ASSISTANT (HUMBOLDT)
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASStSTANT (H0.RDING)
MEDICAI ASSISTANT (AGAP�
MEDICAI ASSISTAM (ARLMGTON)
MEDICAL ASSISTANT (GAP)
NUTRRIONIST (CENTR4L)
NUTRITION15T (COMOj
NUTRfTIONIST (NUMBOLO�
NUTRRIONIST (JOHNSON)
NUTRTT10N15T (W+RDING)
NUTRRIONIST (ARLINGTON)
NUTRRIONI57 (GA�
HEALTN EDUCATOR (CENTRAL)
HEALTN EDUCATOR (COMO)
NEALTH EDUCATOR (NUM80LD'f)
HEALTH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARDING)
HEALTH EDUCATOR (AGAP�
HEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GAP)
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
$
$
$
$
$
$
$
$
$
41,530
48,538
43,225
43,952
41,530
42,222
48,538
36,979
32,999
36,390
35,802
29,365
34,781
20,194
19,605
2o,�sa
21.388
18,913
18,965
18,965
'18,965
35,802
36,304
38,882
35,802
36,304
36,304
34,885
29,849
33,535
30,818
29,849
33,535
33,535
27,808
34,158
45,890
0.80
0.80
0.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
�.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.10
0.05
0.15
0.10
0.10
$ 33,224 $ 26,579
$ 38,830 $ 31,064
$ 34,580 $ 27,664
$ 28,569 .� 22,8r'J$
$ 33,224 $ 26,579
$ 38,000 $ -
$ 8,494 $ '
g 14,791 $ 13,312
$ 13,199 $ 11,880
$ 21,834 S 19,651
$ 14,321 $ 12,889
$ 14,682 $ • -
$ 26,�86 S '
$ 20,194 $ 16,155
$ 19,605 $ 15,684
$ 20,194 $ 16,155
$ 21,388 S 17,110
$ 18,913 $ 15,131
$ 3,793 $ -
$ 18,965 5 -
$ '{4,� $ -
$ 5,370 $ 4,296
$ 5,446 $ 4,356
$ 5,832 $ 4,666
$ 5,370 S 4,296
$ 5,446 $ 4,356
$ 5�446 $ -
$ 3,488 $ -
$ 2,985 $ 2,688
$ 3,354 $ 3,018
s s,os2 $ z,na
$ 2,985 $ 2,686
$ 3,354 $ 3,018
$ 1,677 $ -
$ 4,171 $ -
$ 3,416 S -
$ 4,589 $ 4,589
� SUS TOTAt SALARY
' annual salary based on 42 week schooi year
FRINGE BENEFITS Ca 20°h
$ 523,120 $ 313,451
$ 104,fi24 $ 62,690
95
Application Narrarive
Health Start
Adolescent Health Services
CY 2001 Budget
�
ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE sn�n�' Fse BuocEr euocEr
CONTRACT SERVICE
FAMILY PfiACTICE PHYSICIAWNURSE MIDWiFE
NINE PHYSICL4N CUNICSNJK @$320 X34 WKS
THREE CNM CUNICANK @ S'125�CLINIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-R4Y
OTHER EXPENSE
MEDICATION/DRtJGS
MEDICAL SUPPLIES
OFFlCE SUPPLIES
PRINTINGIDUPLICATING
EQUIPMENT
TRAINING
PA7IENT TRANSPORTATIOWCOURIER
TOTAL DtREC7 EXPENSE
INDIRECT EXPENSE @ 16°k
TOTAL PROGRAM EXPENSE
TOTAL MCH 6RANT REQUEST
MATCHING FUNDS � 25k
$34,546
H1GHLnND SCHOOL BASID CLIAIIC FUNDID BY SEPERwTE GRnNf SOURCE
$ 97.920 $ 58,752
$ 12,750 $ 7,650
$ 5,348 $ 3,209
$ 34,546 $ 20,728
$ 36,750 $ 18,375 �
$ 22,050 $ 9,��
$ 8,925 $ 3,570
$ 12,600 $ 5,040
$ 2,625 $ 1,050
$ 5250 $ -
$ 1,575 $ -
$ 2,100 $ 840
$ 870.183 $ 505,035
S '139.229 $ -
$ 1,009,413 $ 505,035
$ 505,035
$ 126,259
�
.�
� � �' 3
Appiication Narrative " ��
.
�
.
Room 111- Saint Paul - Ramsey County Department of Public Health - STD
Services to Adolescents
Since 1971, Public Health's Room 111 has provided for se�cually transmitted disease (STD)
diagnosis, treatment, refenal, follow-up and epidemiologic investigation. Room 111 was the fust
publicly funded "VD" clinic in the State of Minnesota. Room 111 has idenufied and attempted to
address changing challenges and focuses of STDs. Providing these services in an accessible and
confidential manner aze key goals of this program. Walk-in services are available as aze morning,
afternoon and evening hours of service.
Goal - To provide accessible, confidential services to adolescents regarding education, detection
and treatment of sexually transmitted diseases.
Tar�et Population - The clients targeted to be served are adolescents, primarily through 19 years
of age.
Obiectives -
1. To screen and provide education to 725 adolescents, 19 years of age and under for
sexually transmitted diseases (STDs) during each CY 2000 and 2001.
2.
3.
To diagnose and treat idenf'ied cases of STDs.
To decrease each year in CY 2000 and 2001, the number of cases of STDs, particulazly
chlamydia and gonorrhea, in adolescents.
Metho s -
• Clinic nurses who see clients in Room 111 will provide accessible, co�dential diagnosis,
education, treatment, referral and followup of STDs in adolescents.
• Clinic nurses will provide education on the prevenuon of STDs.
Evaluation - Encounter data gathering demographic data, visit, procedure, and diagnostic code
data are collected for each visit. These elements can be queried to provide data on types and
quantity of services used, as well as target population reached by age and race.
Communiry data trends will also be assessed to determine trends of STD rates in adolescents.
97
Application Narrative
• Training & Ex er� ience - Room 111 clinic is staffed by three or four nurses who aze highly skilled
STD cluricians. All staff have completed MDH-provided HIV counseling and testing uaining and
attend appropriate continuing education courses on a regular basis. The cluricians include: .
JoEllen Neitzke, RN who has worked as a clinic nurse at public health for 26 years; Sandy
Rooney, RN, who has 17 years of experience at public health; Laura Diedrich, RN, a clinic
nurse at public health for the past 14 years; and Alice Williams, PHN who has been with public
health working in Room 111 for the past seven years.
Linkaees - Public Health's Room 111 has well-developed linkages that include a wide variety of
health care providers, educarional programs, and social service agencies. This refenal network
allows staff to provide care and referrals for clients as needed. Some of the primary linkages
include HealthPartners/Regions Hospital, ffie Minnesota Department of Health, other public
health programs and correctional institutions.
Reimbursement and Fees - Because of the confidential and sensitive nature of the serivices
provided, Room 111 provides services on a donation basis. The adolescents who aze seen aze low
income (200% of federal poverty or less). Third parties are biiled whenever possible.
Subgrants/Subconuacts - Room 111 contracts for the provision of a Medical Director and
physician services with HealthPartners. The Medical Director is responsible for protocols and �
general medical direction for the programs.
Budget Justification - Room 111 will receive $12,550 in 2000 and $11,824 in 2001 to support
STD services to adolescents. The totai budget and justification for the budget follows.
•
�
Application Narrative
� � n
. . ��73�
�
�
•
Room 111 - Adolescent Health STD Services
2000 and 2001 MCHSP Grant Budget
Position MCH �nds Other F�nds Total Funds
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, ueahnent and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
22 FTE 12,550
43,906
$ 56,456
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, treatment and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
21 FTE 11,824
44,632
$56,456
..
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ATTACHi��NT B
� SOLICTTATION PROCESS FOR SUBGRANTS
Notification of the availability of funding was provided to qualified programs in the area through
a direct mailing of a Request for Proposals (RFP) to 37 agencies and a public notice placed in the
Saint Paul Pioneer Press on June 4, 1999 The process for selection of priority program
components and the process for selecting the requests (evaluarion criteria) included in the grant
applicauon are explained in the following RFP. The public nouce, a list of agencies receiving
the direct mailing, and a list of the agencies requesting subgrants are also included in this
attachment.
�
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104
NOTICE OF AVAILABILITY OF MATERNAL & CHII,D HEALTH (MCI� FUNDS
AND REQUEST FOR PROPOSALS (RFP)
ISSUED NNE 2, 1999 �
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
�YUu� li� /:\:��
The Saint Paul-Ramsey County Department of Public Health invites community health service
providers and related organizations to submit proposals to conduct maternal and chiid health
projects for:
improving pregnancy outcomes through outreach, referral and/or the direct
provision of prenatal caze for low income/high risk individuals during the period
of January 1, 2000 - December 31, 2001.
The Saint Paul-Ramsey County Department of Public Health will designate up to $140,000 in
State Maternal & Child Heaith Special Project funds over this two-year period to support selected
proposals addressing improved pregnancy outcomes. Proposals are due at 555 Cedar Street,
Attention: Sharon Alt by 4:00 p.m. �esday Ja1y 6, 1949.
An MCH ad hoc task force including representation of the Community Health Services Advisory �
Committee and addiuonal appropriate agencies will review the proposals and make
recommendations to the Board of Health for approval. Approved proposals will be included in
the Saint Paul or Ramsey County Maternal & Child Health Speciai Project Application to the
MN Deparnnent of Health.
Applicants for these competitive grant funds must show evidence of 501 � 3 status, or be local
government agencies_ Applicants must also meet the eligibility requirements and proposal
guidelines outlined in the following instructions, and be in compliance with attached assurances
and agreements.
USE OF MCH SPECIAL PROJECT FUNDS
Based on an assessment of community needs, Tfie Saint Paul - Ramsey County Department of
Public Health is choosing to focus the available funds on projects for improving pregnancy
outcomes. Public Health will allocate up to $70,000 each year for this purpose, targeted to
populations described in the MCH Priorities section of the RFP. Outreach, referral and duect
services may be provided in a variety of settings. At least one awarded project will serve
pregnant women in suburban Ramsey County. �
105
r�� ''�3
AttachmPntc - ' U
.
�
•
All applicants must demonsuate in-kind contributions equal to a minimum of 25 % of the grant
request. Proposals must comply wiffi the legislative definitions of eligible services and the MCH
services priorities.
Applicants may request funds for up to two years or less during the period of 1/1J2000 -
12/31/Ol. It is anticipated that 2� projects will be funded with grant awards ranging from
$15,000 -$35,000 per year. Proposals may be for either one-time only projects or projects
requiring some source of continuation funds. NOTE: MCA funds cannot be guaranteed beyond
12/31/Ol and should not be relied on for continuation of the project beyond 12/31/Ol. If state
funds to public health are reduced during the grant cycle, this reduction may be passed on to
subgrantees.
MCH PRIORTTIES
Improved Pregnancy Outcomes
To reduce the overall rate of late (3rd trimester or none) prenatal care (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1 %) women.
To nnprove the infant mortaliry rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average), and
American Indian (12.0 for 1995-97 3 yeaz average); and
��
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 year average), American Indian rate (13.4 for 1995-97
3 year average).
To reduce the rate of Saint Paul low birthweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7.5% 6.7%
White low bir[hweight 6.9% 63%
African American low birthweight 12.4% 12.1 %�
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low birthweight 5.4% 5.0%
106
4. To conduct ouueach efforts to pregnant teenagers to increase the rate of first trimester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
with a special emphasis on outreach to minority teens. (For births to women less than 20
years of age in 1997, 52.4 % in Saint Paul, and 55.3 % in all of Runsey Counry began
prenatal caze in the fust trimester).
�;�•� �;u:
The proposal should consist of a narrative descripuon limited to ten pages which describes the
project in the following format:
i. Project Title
2. Name & Address of Applicant
3.
4.
5.
6.
7.
Contact Person - Name and Phone Number
Agency/Organization Description and Mission Statement
Amount Requested and Project Period
Project Abstr¢ct (I page)
Project Narrative
a.
Q
c.
�
e.
Goai Statement
Ta�et Popularion - describe the target population relative to age, income and risk
factors, and include an estimate of the number of individuals to be served.
Obiectives - specific statements of what is to be accomplished during the project
period; objectives should be time-specific, realisric, and stated in measurable
terms.
Methods - describe the specific activiries by which objectives will be achieved;
include how and why activities were selected, and how procedures for refenal and
follow-up will be incorporated into services provided.
Evaluation - describe the intended outcomes of the project, and the methodologies
to be used to analyze the impact the project has had (outcomes) on the problem
.
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n !� �'1 '7
- 11 Y
�
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Training/Experience of Key Staff - sum*nari�e; one page - resume may be attached
�
�
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S•
h.
over time, so that the projecYs effectiveness may be assessed. The projecYs
outcome, objectives and evaluauon plans need not be limited to the two year grant
cycle. The evaluation plan should include evaluation questions, data to be
collected and use of evaluation results.
Linka s- describe the linkages with other relevant maternal and child health
service providers in the project service azea. Include a procedure for written
referrals for service needs not addressed by project.
Reimbursements and Fees - describe plan for use of reimbursements from the
Department of Human Services (Minnesota Health Caze Programs). If fees are to
be charged to clients, please describe the sliding fee schedule to be used.
Budget - Include a detailed project budget itemizing:
Personnel and other costs
Cost per unit of service provided and total units of service to be provided.
Expenditures and revenue including reimbursements from DHS (Minnesota Health
Care Programs) and patient fees.
In-kind contributions
Budgets must be completed separately for each calendar year.
Attachments
Proof of 501(c)3 status (if not a unit of local govemment)
List of Board if Directors if non-profit organization
Key Project staff resumes or job descriptions if position is vacant.
SUBMISSION OF PROPOSALS
Bight copies of the proposal should be submitted by 4:00 p.m., July 6, 1999 to Sharon Alt at 555
Cedar Street, St. Paul, MN 55101. Questions about this announcement may be directed to
MaryLou Egan at 651-266-8025.
Minimum Requirements
For a proposal to be considered valid it must be:
108
• Submitted in writing, with required copies provided
• Submitted on time
• Signed by an officer of the organization who can be held accountable for all representauons
Proposal Preparation
The response to this RFP must include an original and seven copies of the proposal. The first
page of the original must have the original signature of the officer who will be accountable for all
representations. Unsigned proposals may be considered invalid.
EVALUATION / REVIEW PROCESS
An MCH ad hoc task force including representation of the Community Health Services Advisory
Committee and additional appropriate agencies will review proposals and make recommendations
to staff and the full Advisory Committee. The CHS Advisory Committee will review these
recommendations and advise the Saint Paul Board of Health and the Ramsey County Board of
Commissioners about proposals recommended for funding. Proposals approved by these bodies
will be incorporated into the DepartmenYs MCH Special Project Application to be sent to the
Minnesota Department of Health.
Proposal Review Criteria
All applicants must demonstrate their ability and willingness to meet all of the requiremenu of
the State and County. All applications for the MCH funding through the Saint Paul - Ramsey
County Department of Public Health must meet all of the requirements contained in this
document. All qualified applications will be judges based on the criteria and specifications
oudined in this RFP. Please see attached list of review criteria and ranking (pages 7-8).
Timetable
The MCH planning timetable is as follows:
7/6/99
7/7/99 - 7/21/99
8/4/99
Aug/Sept1999
9/15/99
Proposals must be submitted by 4:00 PM .
Review and selection of proposais by MCI� Review Committee
CHS Advisory Committee review of MCH Plan
Approval by Saint Paul Boazd of Health and Ramsey County Boazd
of Commissioners
MCH Plan sent to Minnesota Dept of Health
Applicants will be nofified of funding decisions by August 30, 1999.
L__�
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109
AtYar}�mAnte '`� � � / �
- _ �T�_
Upon approval by the Minnesota Department of Health (MDH), Public Health staff will develop
contracts with the approved applicant agencies for the project services. Approved projects will
. be required to submit monthly or quarterly reports (as specified in the contract) and expenditure
reports to obtain reimbursement. A copy of the reports required by the MDH are enclosed in the
RFP (pages 9-12). Actual reporting requirements may vary.
•
�
110
AFFIDAVIT OF PUBLICATION
STATE OF MINNESOTA
COUNTY OF RAMSEY
JOANIE M. PUTZ
being duly sworn on oath, says: that she is,
and during all times herein state has been,
Cterk of Northwest Pubtications, Inc.,
Publisher of the newspaper known as the
Saint Paul Pioneer Press, a newspaper of
generai circulation within the City of Saint
Paul and the County of Ramsey.
THAT the notice hereto attached was cut
from the columns of said newspaper and
was printed and pubtished therein on the
following dates: �
�
4'" day of June 1999 •
newspaper ref tJlad �l : 14790
`Z�v�c�iiv/ e /
Subscribed and swom to before me is
7'" day of June 1999
P IC
Washington County, Minnesota
My commission expires January 31, 2000
� KAY/;S.flRCME e
•,` H071JiYPUBl1C.A6;i�LSCTA
�4 WASHING'fOt:COUt,1T1'
S!y Co�Mkh E�€y'vts din.37. i!n; .
M'if+�►isi� t�
111
� � ��
_
AGAPE
360 COLBORNE ST
S� UL MN 55102
ARLINGTON HOL3SE
951 E STH ST
ST PAUL MN 55106
BETIIESDA FAMILY PRAC CLIAIIC
590 PARK ST SUIT'E 310
ST PAiJL MN 55103
BOOTH BROWN HOUSE
1471 COMO AVE
ST PpUL MN 55108
ANN RICKETI'S
FACE "f0 FACE HEALTH & COUNSEL
11 K3 ARCADE ST
ST pAUL MN 55106
TH� LOFT TEEN CENTER
10F3 IGLEHART AVE
ST pAUL MN 55104
I�ANCY BRIGGS
NQRTH END HEALTH CENTER
li� MAMTOBA ST
ST PAUL MN 55117
KEGIONS HOSPITAL PEDS CLINIC
680)ACKSONST
ST PAUL MN 55101
SETON CENTER
1_?6 LJNIVERSITY AVE W
ST PAUL MN 55104
2.1:�VIS BREHM
�1'EST S[DE HEALTH CENTER
1�_ CONCORD ST
ST PAUL MN 55107
CATHOLIC CHARIT'IES OF ST PAUL
215 OLD 6T'H ST
ST PAiJL MN 55102
PEG LABORE
FAMII.Y TREE CLII�TIC
1619 DAYTON AVE
ST PAUL MN 55104
LUTf�RAN SOCIAL SERV OF MN
STATE CENTER
2485 COMO AVE
ST PALTL. MN 55108
PLANNED PARENTHOOD OF MN
1700 RICE ST
ST PAiJL MN 55113
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PALTI. MN 55102
iJNITED FAMII,Y HEALTH CENTER
545 W 7TH ST
ST PAUL MN 551�2
AVfER7CAN INDIAN FAMIl,Y CENTER CAPITOL COMMUNITY SERVICES
5?9 WELLS NORTHBND
STPALJLMN 55701 ]021MARIONST
ST PAtJI. MN 55117
'f COMMUNI'J'IES FAM SERVICE
3 COPE AVE B SUITE C
I�LiPLEWOOD MN 55109
FAMILY SERV OF GREATER ST PAUL
166 E 4T'H ST #330
ST PAUL MN 55101
CERTIFIED NURSE N�WIVES
RAMSEYFOUNDATTON
640 7ACKSON ST
ST PAIJL MN 55101
CAROL WHITE
HEALTH START INC
491 W LTNIVERSITY AVE
ST PALTI, MN 55103-1936
BARTON WARREN
MODEL CITLES HEALTH CENTER
430 N DALE ST
ST PAiJL MN 55103
REGIONS HOSPITAL OB/GYN CLINIC
640 JACKSON ST
ST PALTL, MN 55101
STPAUL WOMAN'S CLINIC
1690 iJNIVERSITI' AVE
ST PAUL MN 55104
iJNITED HOSPITAL-MOD CLINIC
333 N SMITA ST
ST PAUL MN 55102
DEPT OF INDIAN WORK
7611 SUMMITAVE
ST PALTI, MN 55105
LAO FAMILY COMMUNITY
320 N UNIVERSITY AVE
ST PAtIL MN 55103
112
AtYachmPntc
MAIZTIN LUTf�R KING/HALLIE Q MERRIAM PARK COMM CENTER MERRICK COMD4UNITY SERVICES �
BROWN CENTER 2000 ST ANIHONY AVE 715 EDGERTON ST
270 KENT ST ST PAUL MN 55104 ST PAUL MN 55101
ST PAUL MN 55102
NEIGHBORHOOD HOUSE
t79 ROBIE
ST PAL1L MN 55107
NORTHWEST YOUTH & FAMII.Y SERV
3490 LEXII�TGTON AVE N
SHOREVIEW MN 55126
iJNITED FAMII.Y PRACTICE/EIELPING
HAND HEAL7�-I CENTER
545 W 7TH ST
ST PAUL MN 55102
WEST 7TH COMMUNITY CENTER
265 ONEIDA
ST PAL7L MN 55102
WII,DER SERV TO CHII,DREN & FAM
919 LAFOND AVE
ST PAiJL MN 55104
r 1
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113
n ^ � i �
- iJ
Agencies Submitting Proposals for Subgrants
, The following community agencies submitted proposals to Saint Paul - Ramsey Counry
Department of Public Health by the deadiine:
1. Face to Face Health and Counseling Service, Inc.
1165 Arcade Street
Saint Paul, Minnesota 55106
2. Health Start, Inc.
491 West University Avenue
Saint Paul, Minnesota 55103
3. North End Health Center, Inc.
153 Manitoba Avenue
Saim Paul, MN 55117
4. West Side Community Health Cemer, Inc.
153 Concord Street
� Saint Paul, Minnesota 55107
�
114
REQUESTS FOR MCH SPECIAL PROJECT FUNDS
for Improved Pregnancy Outcomes
Agency:
Amount requested:
Target population:
Proposal:
Face to Face Health and Counseling Service
$80,000 - Y1: $40,000 Y2: $40,000
L.ow income adolescents, 50% of wluch will be youth of color; Dayton's
Bluff, Sunimit University, Thomas Dale, Riverview
Continue outreach/case management program; provide outreach,
pregnancy testing, education and counseling, prenatal care, risk
assessment
Agency: North End Medical Center, Inc.
Amount requested: $36,842 - Yl: $18,574 Y2: $18,268
Tazget population: Low income, high risk women in the North End/Rice Street areas of St.
Paul and lst ring suburbs including Roseville, Vadnais Heights, Little
Proposal:
Canada, Maplewood, North St. Paul and White Bear Lake, with priority
to teens and African-American and Native American women of ali ages.
Outreach to promote early prenatal care, linking persons to care,
decreasing tobacco, alcohol and drug use.
Agency: West Side Community Health Center, Inc.
Amount requested: $32,500 - Yl: $16,250 Y2: $16,250
Tazget population: Hispanic and Southeast Asian women, ages 13-35, in specific census
tracts in 3aint Paul that have the highest concentrations of Hispanic and
Southeast Asians.
Proposal:
Agency:
Amount requested:
Tazget population:
Proposal:
Ouueach, tracking of positive pregnancy tests, prenatai risk assessments,
and coor@inating services.
HealthStart, Inc.
$1,403,972 - Yl: $'753,236 Y2: $753,236
High risk, low-income adolescents and women at high risk for prenatal
and birth complications, with a focus on minorities.
Outreach, education and comprehensive, multi disciplinary prenatal care
and comprehensive health care services at high school sites.
�
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115
�`, �' r a
— U I l
AGENCY NAME:
. REVIEWED BY:
SAINT PAUL - RAMSEY COUNTY DEPARI'MENT OF PUBLIC HEALTH
MCH COMPETTTIVE GRANT
REVIEW CRITERIA
�.J
�
POOR SATI5 EXCEL
I. APPLICATION
A. Is in accordance with Saint Paul - Ramsey Coun 1 2 3 4 5
Department of Public Health MCH priorities
B. Proposes services targeted to low-income high
risk individuals in targeted areas 1 2 3 4 5
C. Is cleazly written and the format facilitates
review 1 2 3 4 5
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, racial/ethnic distribution, and
eligibility criteria 1 2 3 4 5
B. The applicant can demonstrate past successful
experience working with target populations 1 2 3 4 5
C. Low-income, e.g. <20Q% of poverty or women
who are pregnant and determined eligible for M.A. or
WIC 1 2 3 4 5
D. Identify risk criteria consistent with MDH
guidelines 1 2 3 4 5
III. OBJECTIVES
A. Described 1 2 3 4 5
B. Related to priorities 1 2 3 4 5
C. Realistic 1 2 3 4 5
116
d trarhmPntc
D. Time Specific 1 2 3 4 5
E. Measurable 1 2 3 4 5
F. Identify ciient's or community's needs, not the
ap plic anY s 1 2 3 4 5
POOR SATLS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted public health
pracrice 1 2 3 4 5
F. Maxitnizes use of aIternarive health care
providers where appropriate 1 2 3 4 5
G. Likely to achieve objecrives 1 2 3 4 5
V. EVALUATION
A. Ali activities which warrant evaluarion are
identified 1 2 3 4 5
B. Methods for collecting the data aze describe and
are feasible 1 2 3 4 5
C. Gives evidence that evaluarion results will be
used for program management decisions 1 2 3 4 5
D_ Collects data which relate to the objectives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objecrive as well as subjecrive 1 2 3 4 5
117
_ .._
' ': ��
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•
VI. TRAINING/EXPERIENCE
A. Indication of work experience, training, and
qualifications for staff direcfly involved in the project is
included 1 2 3 4 5
B. Plan(s) to identify and address continuing
education needs of staff 1 2 3 4 5
VII. LINKAGES
A. Linkages and referral arrangements with other
community service providers are described and relate to
goals, objectives, and methods 1 2 3 4 5
B. Description of current or anticipated
cooperative agreements to minimi�e potential
� for duplication
C. Plans for or descriptions of ongoing
collaborative activities with providers such as
participation on task forces, committees, etc.
D. Applicant can show experience in successful
follow-up on referrals
VIII. BUDGET
A. Budget items are justified in terms of project
activities
B. Complete
C. Provides a rationale for formula/process for
calculation of items
•
POOR �SATIS IEXCEL
1 2 3
1 2 3
1 2 3
1 2
1 2
1 2
3
3
3
4 5
4 5
4 5
4 5
4 5
4 5
118
D. Amount of funding requested is appropriate •
for the level of service and objecrives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonstrated in kind contributions ��
of at least 25% of the grant request
F. Are mathematically correct
G. Indicates plans to obtain and use DHS
reimbursements (Medical Assistance,
MNCare)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDITIONAL CONIl�4ENTS/RECOMNNIEEIVDATIONS:
�
�
119 -
CawcilFde# Q 1 � 0 � �
ORIGINAL
:�
RESOLUTION
OF SAINT PAUL, MINNESOTA
Pcesented By
Refermd To
1
2
3
4
5
6
7
8
9
10
71
12
13
14
15
16
17
18
19
zo
21
22
23
24
Green Sheet # 103701
Committee: Date
WHEREAS, the City of Saint Paul seeks to improve the health of high risk, low-income
mothers and infants, and adolescents; and
WHEREAS, the Minnesota Department of Health accepts application grants from
Community Health Boards for programs which provide health services to high risk
pregnant women and children in Saint Paul; and
WHEREAS, the City of Saint Paul is a designated Community Health Board identified
by State Statute 145.882 Subd.3 to receive Maternal and Child Health funding; and
WHEREAS, the City of Saint Paul wilf submit a grant to the Minnesota Department of
Health to fund programs to improve pregnancy outcomes and to improve adolescent
health; and
WHEREAS, the operating agency for this grant will be the Saint Paul - Ramsey County
Department of Public Health;
THEREFORE, BE IT RESOLVED, that the Saint Paul Board of Health supports the grant
application and subsequent contract with the Minnesota Department of Health for the
Saint Paul Maternal and Child Health Block Grant, and authorizes proper City Officials
to contract on its behalf with the Minnesota Department of Health.
by Department of:
Adoption �rtified by Council
BY� I
Approved by
By: _
r�lf�[`/rN�� 1 ,/e .
� - � �_'
�� �.� . . . ,�
f .
Date f`7"' �yT / Appr Mayot for Submi ion to CouncIl
� /' � BY: ����.
AdoptedbyCouncIl: Date��,_g,� ����
qa-t�3
Public Health
Diane
P 5
GREEN SHEET
ov.Rr�r ow�art
No 103701
r;�u= r_=�
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❑3 wwra.�m�zaon.� 6 �rwJU,e�.cc.a
����..���� ❑
(CLJP ALL LOCATIONS FOR SIGNATURE)
�,���
8/20(99
TOTAL # OF SIGNATURE PAGES 1
signatures on a Resolution for Board of Health support of the 2000-2001 Saint Paul
nal and Child Health grant application to the Minnesota Department of Health.
PLANNING COMM1SSlON
d6 COMMITTEE
CNIL SERVICE fAMMISSION
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ta �his tlepartment'7
�wt no�mallypoaaeasetl bY aM' curteM oitlt empbv�7
INITIATWGPROBLEMISSUE.OPPORIUNITY(WIq,WIH[,Wl�en.W11He,WFIy) '1�12 C1t�T Ot J31Tlt Yaui, thT011gh Yllb11C iieatin W11.L
submit a grant proposal to the Minnesota Department of Health for funding of services to
improve pregnancy outcomes and improve adolescent health. By State Statute,Maternal and Child
Health Special Project Grant funding is designated to Che Saint Pau1 Board of Health. Through
the Public Health Joint Powers Agreement, the City of Saint Paul retains a Board of Health.
The operating agency for the_administration of this grant and these programs is the Saint Paul
The City will xeceive funding to help assure that pxenatal and other sexvices are provided
to high risk, low-income populations.
The health status of Saint Paul residents may improve.
Saint Paul residents will have greater access eo health care for these services.
NONE
Funding will not be received to support the above mentioned activities.
amouw70vsanwsncr�w+5 7 ,fi2�.1 53
sounceState of Minnesota
(O6�WN)
COS7/ttEVFNUE St70GETED (CIRCLE ON�
ncrrvm NuMS�
YES NO
Caura:�1 R�sea�ch Center
aR-�3
From: Nancy Anderson
l'o: jerryb, baribeau, gerrym, colemanc, barbb, leschj,...
Date: 8/18/9911:50am
Subject: SOARD OF PUBLIC NEAITH MEETlNG.
Councilmembers - FYI:
The City Council wili meet as the Board of Public Healtb on Wednesday, September 8, 1999, immediately foflowing
the regular City Council Meeting.
The agenda item will be: A resolution supporting the 2000-2001 Saint Paul Matemal and Child Health grant
application to the Minnesota Department of Health.
Please add this meeting date and time to your calendar.
Nancy Anderson
CC: CAO.Atlorney.byrne, TMSD.TMS.devine, TMSD.TMS.hans...
S �� �
� ��
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99-�73
�
MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
�
IMPROVED PREGNANCY OUTCOMES
AND
AD�LESCENT HEALTH
Z000 - 2001
Submitted by:
SAINT PAUL COMMITNITY HEALTH BOARD
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR STREET
ST. PAUL, MN 55141
,
The Saint Paul Board of Health
�a � The Saint Paul - Ramsey County Depardnent of Pubiic Health
The public health joint powers agreement between the City of Saint Paul and Ramsey
County became effective July 1, 1997. The Joint Powers Agreement forms the Saint Paul -
Ramsey County Deparnnent of Public Health and idenufies one Community Health Services
Agency for the Saint Paul - Ramsey County community. However, both Saint Paul and
Ramsey Counry witl maintain a Board of Heaith. The Saint Paul Community Health Boazd
wili consider issues affecting those services maintained by the Ciry of Saint Paul, which will
include the Maternal and Child Health Special Projects Grant. The Sairn Paul - Ramsey
Couaty Department of Public Health becomes the operating agency for the MCH grant.
n
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� SAINT PAUL MATERNAL AND CffiLD HEA��',�; ;
SPECIAL PROJECTS GRANT 2000-2001
Table of Contents
Page(s)
MINNESOTA DEPARTMENT OF HEALTH FORMS
FaceSheet .............................................................. 1-2
ProjectInformation ....................................................... 3-4
Evidence of Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Assurances and Agreements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-8
Certification Conceming Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1�
Certification Regarding Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Efforts to Reduce Racial Disparities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Subgrants/Subcontracts ................................................. 13-14
Services Provided By L,egislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 5-20
Budgets 2000 and 2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21-22
� BudgetJustification ....................................................... 23
Budget Detail of Local Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Budget By Legislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25-26
APPLICATION NAItRATIVE
COMMUNITY ASSESSMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27-39
IMPROVED PREGNANCY OUTCOMES
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Q-49
Program Response to Minnesota MCH Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49-50
Inventory of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Project ..............................................................52
ProjectObjectives ....................................................... 52-53
Project Tazget Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
SUBGRANTEE INF012MATION
Subgrantee Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54-56
Health Start,Inc . .................................................... 57-64
Face to Face Health & Counseling Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65-73
� West Side Community Health Center . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74-7&
Table of Contents
(Continued}
ADOLESCENT HEALTH PROGT2AM
Community Assessment/Problem Statement/Response to MCH Priorities . . . . . . . . . . . . . 79-85
�
Health Start, Inc.
Goalofthe Project .......................................................86
TargetPopularion ..................................................... 86-87
Objectives ........................................................... 87-88
MeYhods............................................................ 88-89
Evaluation..............................................................89
Training/Experience ................................................... 89-90
Linkages............................................................ 90-91
Reimbursementand Fees ............................................... 91-92
Subgrants/Subcontracts ...................................................92
BudgetJustification ..........................................•••.........92
Budgets-2000 and 2001 ................................................ 93-96
Room111 ............................................................. 97-99 •
ATTACHMENTS
Attachment A - Inventory of Community Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100-103
Attachment B - Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104-119
r�
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� �
MINNESOTA DEPARTMENT OF HEALTH �
FORMS
�
C�
�See
of
�Grent Applieation for. �
Maternal and Child Health Special Projects
1. Appliwnt Ageney With Which Gnnt ConLact is to be Exeeuted
LegaiName: StreetAddress:310 City Hall, 15 W. Kellogg Bl
Saint Paul, rIN 55102
Saint Paul Co�unity E-MailAddress:
Health Board
2 Director of Appiicant Agency
555 Cedar Street
Name and TiUe: Sveet Adtlress: Saint Paul, NIN 55101
Rob Fulton E-MailAddress: rob.fulton@co.ramsey.mn.us
Director of Public Health
3. Fiscal Management O�cer of Applieant Ageney
NameandTitle: 5lreetAddress:555 Cedar Street
Diane Holmgren Saint Paul, MN 55101
IHealth Administration E-MailAddress:diane.holmgren@ci.stpaul.mn.us
4. Operating Age�cy (it diHe2nt fiom number 1 above)
NameandTitle: I StreetAddress:555 Cedar Street
>aint Paul - Ramsey Countyl ,�aint Paul, MI� 55101
1e�artment of Public E-MailAddress.
5. Contact Person for Operating Agency (if diHe2nf from number 2 a4ove)
Name and Title: � Street Address:
�iane Holmgren I E-Mail Address:
see 9l3 above)
6. Contact Person for Further Infortnation on Appiieation (if diHerent fmm 5 a6ove)
Name and 7itte: Streel Atldress:
Siane Holmgren E-MailAddress:
;see 1l3 above)
99� 8?3
ad Teiepeone ( 5 )266-856
�� 65� 266-8574
7etephone ( 5 )266-242
F,qX6 5 j 222-2770 '
Telephone6 j292-��1
F �b s j222-2770
Te�ephone�� )292-771
FqX6 5 j2 22-2770
Telephone ( )
FAX ( )
Telephone ( )
FAX ( )
— __
7 ��p�i�ti�9,4�iency F:'isc31'Coiifac! _
�fdifleranffromnumbarSabove3 StreetAddcesa:� - _ . � . _ � . .. -.� .7elephone( ) .
nfame aoC Te�e: : . : .
E-Maif Address " - �. " . . . FAX { � )
$��lte+�..P.aytnBttSs',� - .
e
(dd�flerenttmmnumberlabovej� - SVeetAUdress: 3�3 �edar�St�eet?,• Te7ephone{.�
t�ameandTiUe: Saint Paul i`SN SS10i ��651222-277fl
4ichael Hagen E-Mail Address: � j
9. Copies of This Appiication Have Been Sent to the Followin9 Community Fiealth Boards for Review
(NOt Applicable for Communiry Health Board(s) if tbe 8oard is fhe Applicant)
Aaenw iJame Date Sent
tU. Certifieation
t ceRify that the information contained herein is Vue and accu2te to the best of my knowledge and that I submit this appiiption on behalf of
the appli nt age .� _�� r/
� / 1���
Signature ot Direclot oi AppiiWnt Agenty T� ���
A
1
Instrucfions for Completiag Face Sheet
Please Type or print all items on tLe Grant Application Form Face Sheet
Applicants please note: The application fo:m has been designed to be used on all Special Project granu administered by the
Minnesota Deparcment of Heahh. If you have questions, or need assistance in completing the
application form, please contact the program Manager or Consultan2 idrntified u responsibte for the
grant
Applicant Agency
I,egal name of the agency autt�orized w enter into a grani contract with the Minnesota Departrnent of Health, e.g., North
Woods Community Health Board.
2. DireMOr of the Applicant Agency
Person responsible for directing the applicant agency.
3. Fiscal Management O�eer of Applicant Agenc�
i
The chief fiscal officer for the recipient of funds who has primary responsibiJity for grant and subsid,v funds expendimre and
reporting. If rhe applicant agency is a Communirv Health Board, the Fiscal Management �cer must be the same person
who is identified as the Fiscal Manaeement Officer in the Boazd's Community Health Service Plan.
4. Operatine Agency
Complete only if other than the applicant agency tisted in namber ] above.
5. Contact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this project
6. Coatact Person for Fnrtber Iniormaaon
�
Person who may be contacted for detailed informarion concerning the appiicaaon or the project if different from number 5
above.
Person in openting agency who may be contacted regarding fescal matters if different ftom 5.
8. �ere�a '� es#S
�� �:.
Address where MDH sbould mail paymenu if different than 1.
9. Copies of this Apptication $ave Been Sent to the Following Communiq� Hea1tL Boards for Review
Provide copies of this application and any subsequent revisions to the appropriate community health boards as required by
the individual insavctions_
] 0. Sigaatum of Director of Applicant Agency
Provide original signamre and date. �
Z
��-�73 �-
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�SaRwerseSideforLuwaions MinnesotaDepartmentofHealth{MD�
Project Information Sheet for Special Projects
NameofMAHProgzam: Matemal and Child Aealth Special Projects Grant
1. ProjectInformation Saint Paul Community Health Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Public Health
Beginning Dau: End Date: Minaaota Tar I.D. No.: Federal I.D. Number. Social Security Number.
O1/O1/2000 12/31(2001 802-7226 41-6005875
Project Funds Requested: Local Match Provided:
Yeaz I Year 2 Ye�l eaz
$ 810,07� $ 810,077 $ 467,993 $ 4b7,993
Service Area (city, county, or counties):
City of Saint Pau1
2. *?ou-� � aii �iarus - SO1.C3 Copy Attached
❑ Yes � Not Appiicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence o,fComptia,fce Fo,m)
❑ No ❑ Yes � Not Applicable
4. �rmative Action
Tbe agency fias a certiicate from tbe Commissiouer of Auman Rights, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Applicable Because:
❑ 7'otal Convact is $] 00,00 or Less
❑ Agenc;� Hu 40 or Fewer Full-Time Employees
in MinneSOEa
� Uniu of Local Govemment
❑ Indian Reservation
� HE-01274.05(3/99j-PARTB
1CA 1bb42S
Instructions for Completing Project Tnformation Sheet for Speciat Projects �
Please type or print all items on t6e Yroject Informa6on Sheet for Special Yrojects.
Applications please note: The application fozm has been designed to be used on all Speciai Project grants
adminiscered by the Mmnesota Department of Health. If you have questions, or need
assistance in complering tl�e application form, please contaet the Progcam Manger oz
Consultant identified as responsible for the gzant
Projeet Information
ptovide name of applieant agency, beginning and ead date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicabie), or Social Securiry Number, aad geographic service azea. List the totai
amount requested for each year for Project Funds Requested and Local Match Provided. Please refer to
individual instrucrions for each special project grant to deteraane if local match requ'uements aze needed.
2. Non-Profit Status - SQ1.C3 Copy Attxchment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit instituvon, corpontion or organization.
Worker's Compensation
Minaesota Statutes, ChapteT 176, forbids the Commissioner of Health from enteriag into any contract until �
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requiremenu from the contractor. Complete the form entided "Evidence of Compliance" and
retum it with your grant application.
4. �rmative Actioa
Minnesota Statutes, Section 363.073, says "For all contraets for goods and services in excess of S I00,000,
no depamnent or agency of the state shall accept any bid oz proposal for a contract or agreement from any
business having more than 40 futl-rime employees within this state oa a single working day during the
previous 12 months, unless tUe firm or business has an affnmative action plan for the employmenY of
minoriry persons, women, and qualified disabled individuais, submitted to the commissioner of human
rights for approval. No depamnent or agency ofrhe state shal] eacecute any such contract or a�eement until
theaffirmativeactionplanhasbeenapprovedbythecommissionerofhumanrighu. Receiptofacerrificate
ofcompIiance issued by the commissioner sball signify that a firm orbusiness has an affim3ative action plan
that has been approved by t6e commissioner." If the grant or contract you propose meets the "in excess of
$100,000" criterion and youz agency meexs the "more than 40 fu11-time employees" criterion, a CertiScate
of Compliance must accompany your proposal, unless your agency is exempt If you have questions about
the Certificate of Compliance, please contact the:
Minnesota Department of Human Righu
Contract Compliance
Army Corps of Engineers Centre
190 East Fifth Street, Suite 700
St Paul, IviN 55101
(651) 296-5663
�
� �-- �73
� P Pleacc 7ype or Print
Minnesota Aepartment of Health
Evidence of Compliance
State ]aw forbids the Commissioner of Health from entering into any grant conttaet until the Commissioner
receives acceptable evidence of compliaace with workers' compensation insurance coverage requiremenu from
the gantee. The e�cception to this requirement is a self-employed grantee who has no employees. An employee,
as defined by M.S. 176.01 I, subd. 9, is any person who performs services for another for hire, including minors
and family members.
Ifyou do not fali within the exception and you wish to enter into a grant contract with the Commissioner of Health,
you must fumish acceptabie evidence of compliance with worker's compensation coverage in any one of the
following four ways:
1.
F�
Attach a certificate of insurance (supplied by your workers' compensation carrier) to this Evidence of
Compiiance form; or
If you are self-insured, attach to this E��idence of Compliance form, a written order from ihe Minnesota
Commissioner of Commerce ailowing you to self-insure; or
3. Ifyou aze seif-insuted and you aze a state agency or a municipal subdivision of the state, pursuant to M.S.
176.181, subd. 2, and aze not required to obtain a written order from the Commissioner of Commerce,
circle this entire statement and sign and date the form below in the space provided; or
� 4. Fill in the
�--
'
Name and Addrcss of Grantee'S Insurzncc Camer.
and si2n and date
Gronuc's insurana Policy Number.
HE-0327a-05 (3l99) • PAR7 C
1C M )a0.428
I afftrm that all ofthe employ¢es oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are covered by ihe workers' compensation ensu�ance policy fisted above.
ASSURANCES AND AGREEMENTS
�
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES ?.I�'D ASSURES THAT:
1. Services will be provided in accordance with appiicable state and federal laws, rules and proce@ures.
2. The agency will comply with state and federa] requiremenu relating to privacy of client information.
The agency will comply with the Minnesota Clean Indoor Air Act w3vch prohibits smoking in MCH Special
Projeet facilibes and clinics.
4. The agency (if it has I S or more empioyees} and any subcontractors with 15 or more employees will have
on file and available for submission to Minnesota Department of Heatth {IvIDI� upon re.quest a written non
discrimination policy containing at least the following:
"All pmgrams, services, and benefits which are administered, authorized, and provided shaIl be
operated in accordance with the tton discriminatory requirements pursuant to Titte VI of the Civil
Rights Act of 1964, Section 504 of the Rehabilitarion Act of 1973, as aznended, the Age
Discrimination Act of 1975, and the non discriminatory requiremenrs of the MCH Block GzanL
No person or persons shalI on ihe ground ofrace, color, national origin, handicap, age, sex, or religion,
be excluded from participation in, be denied the benefits of, orbe otherwise subjected to discrimination �
under any program service or benefit advocated, autl�orized, or provided by this Department."
5. The agency (if it has I S or more employees) and any subconu�actors with 15 or more employees will
disseminate information to bene8ciarics and the generat public that services are provided in a non
diseriminatory mannez in compliance with civil rights statutes and regutations. Tlus may be accomplished
by:
A. Including a handout containing civi] rights policies in any brochures, pamphleu, or other
communications designed ta acquaintpotential beneSciaries andthepublicwith pmgrams; and/or
B. Notifying refemi sources in routine letters by inctuding prepared handouts which state that
services and benefiu must be provided in a non discriminatory manner.
Copies of each document disseminated and a description of how these documents have been
disseminated will be provided to the MI�H upon request.
6. In futfilling the duties and responsibiliaes of this grant, the grantee shall comply with the Americans with
Disabilives Act of 1990, 42 U.S.C. § 12101, et seq., and the regutatians promulgated pursuant to it.
No residency requirements for services other xhan state residence, wili be imposed.
S. Services shatl not be denied based on inabiliry to pay. -
� =%- �73
�
9. Atiangemenu shal] be made for communications to take place in a language understood by the matemal and
child health service recipient
10. All written materials developed to determine client eligibility and to describe services provided undez this
gant will be understandable to a person w3�o reads at a seventh grade ]evel using the Flesch Analysis
Readability Scale as required in Minnesota Statute 144.054 (see Appendix 10, Plain Language in Written
Mazerials, Minnesota Statute, Secuon 144.054).
11_ T'heagencywillprovideservicesinkeepingwithprogramguidelinesoftheMinnesotaDepamnentofHealth
and gwdelines of accepted professionai goups such as the American Academy of Pediatrics, American
College of Obstetricians and Gynecologiscs, and American Public Health Association.
12. Upon request, one copy of any subcontract executed as part of the project wiil be provided to the Minnesota
Department of Health.
13. TheagencywillreportaccomplistunenuoftheprojecttotheMinnesotaDepartmentofHealth. Suchreports
will be submitted no later than 90 days after the compietion of the calendaz yeaz. Upon request, the agency
will provide additional information needed b}° the Department for evaluation ofthe projecYs objectives and
methods and compliance with any special conditions (see Appendix 18, Program Reporting Requiremenu
for Matemal and Clri]d Health Special Projecu).
14.
� 15.
I6.
.
Grant funds shall not be used for inpatient services except for high-risk pregnant women and infanu.
Cash paymenu shail not be made to intended recipients of health services.
Grant funds shal] not be used for purchase or improvement of ]and or facilities.
17. Grant funds shall not be used for purchaze of equipment costing more than $5,000.00 per nnit and v.9th a
usefui life exceeding one year. '
18. Grant funds shall not be used for reimbursement for travel and subsistence expenses incurred outside the
state unless it has received prior written appzoval from the Minnesota Department of Health for such out-of-
state travel.
19. VJhen appiicable, the agency shal] provide nonpartisan voter registration services and assistance using fonns
pmvided by the state to employees of the a2ency and the public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Registration).
20. VJhen issuing statemenu, press releases, requests for proposa3s, bid solicitations, and other documenu
describing projeets and programs funded in whole or in part with federal money, al] grantees receiving
federal funds shall clearly state (a) the percentage of the total cost of the prograzn or projeet which v.�ill be
financed with federal money, and (b) the dollaz amount of federal funds for the project or program.
21. The agency will not use grant funds to pay for any item or service (other than an emergency item or service)
fiunis3�ed by an individual ot entity convicted of a critninal o$ense under the Medicare or any staze health
care program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant programs).
22. Materials developed by Matemal and Child Health Specia] Project grant and matching fimds will be part
of the public domain and will be ac�essible to the pubiic as financially reasonable. Materials developed by
the Matema] and Child Health Specia] Project grant and matchittg funds may be reproduced and distributed
by the Project to otl�er agencies and providers for a profit so long as [he revenues from such sale aze credited �
to the Specia] Project budget for expenditure by the Special Project
23. The agency will comP1Y W'ith all standa''�S reiating to frscai accountability that apply to the Minnesota
Deparcment of Health, specifically:
A. Budget revisions with justificarion will be submitted to MI7H for prior approval whenever:
(1) changes are made in the objectives to be met in the MatemaI and Chiid Health Special
Project, or
(2) the cumulative amouat of funds uansfeaed into or out of an operating agency's budget line
iiem exceeds or is expected to exceed 10% of that approved for the grant year or 52,500.00,
whichever is greater.
B. Final expenditure reports aze due 90 days after the end of the calendar yeaz.
C. Graat funds are used as payment for services only aftez third-party payments, snch as from the
Medical Assistance/Medicaid (I'itle }�X SSA), Children's . Health Plan/MinnesotaCare
reimbursement programs of the Minnesota Department of Human Services and private insurance
are utilized:
D. Project financial management systems will provide for:
(i) Accvrate, current, and complete disclosure ofthe financiai status ofthe project. �
(2) Records which identify adequately the source and application offunds for Materaal and Chiid
Heaith Special Project acti��ives. These records aze to contain information pertaining to
project awards and authorizations, obligations, unobIigated batances, tiabilities
(encumbrances), oudays, and income.
(3) Effective control over the accountability for all funds, property and other asseu. Projecu aze
to adequately safeguard such assets and assure that they aze used solely for authorized
purposes.
(4) Comparison of actual obtigations with bu@get amounts for each activity.
(5} Accounting records which are supported by source documentation.
(6) Audiu which wiil be made by or ai the direction of the Minnesota Department of Health (see
Append' 6, State udits).
Signature of Chair or Vice�chair Of t6� unity Healtb Board or An Agent Appointed by Reso►ution
of th ommunity H Iih Board:
, e � �
� �� � .
�
CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT GRANT
FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
CHECK ONLY ONE BOX:
Q
No
sterili7aflon
provided
�
Xes
sterilization
provided
MCH Special Project grant funds will not be used during CY 199&-99 to
provide and/or azrange sterilizarions. If a client is merely referred to another
health care provider, this provision of information is not consideTed to
„ azT�S�S" a sterilization.
MCH Specia] Project grant funds will be used to provide and(or arrange
sterilizations during CY 1948-99. Agencies wkrich use MCH Special Project
grant funds to pay for a ptocedure or related purpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requuemenu described eisewhere in this document.
� T certify that to the besi ofmy knowledge the above information is correct, and that if this stanu changes, formal
notification in this regard will be sent to the Section Manager, Matemal and Child Health Section, Minnesota
Department of Health, Minneapolis.
Signatum of Director
of Appiicant Agency:
Tit3e:
Date:
L�J
Director of Public Health
9
Iastructions for Completing Certification
Coacerning Use of MCH Special Prnjeet Grant Funds
to Promote and/or Arrange Steritizations
All federal Public Health Service supported progams including the Matemai and Child Health Services Block
Crrant progrun, which use federal funds to provide and/or arrange for sterilization are required to follow federa]
procedures and to provide written documentation in this regard on a quarterly basis.
MCH Special Projects (MCHSP) xnay obiain an exemption from this reporting requirement by signing a
certificaLion that their agency is not using MCFiSP funds to provide and/or amange sterilizations. (If a client is
merely provided infoxmation and refetred, this is aot reported.) Reporting is requzred if MCHSP funds aze used
in some fotm of participation (paying for the procedure, providing transportation, matong an appointment with
another health provider, or detailed counseling beyond simple provision of information).
All Community Health Boazds aze required to complete the Certification. For agencies wlvch do not provide
sterilizations, no fiuther action will be needed dsuing CY 1998-99. The agencies which indicate they do provide
sterilizations must adhere to specific federal service and reporting requirements described elsewhere in this
document
��
l J
r .__
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10
�'�-�573
• CERTIFICATIOT REGARDAVG LOBBYIlVG
The undersigned certifies, to the best of his or her knowiedge and belief that:
(1) No federel appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempring to influence an ofFicez or an employee of any agency, a
member of congess, an officer or an empioyee of any agency, a member of congress, an officer or
employee of congress, or an empIoyee of a member of congress in connec�ion with the awazding of
any fedeml con�act, the making of ang federal grant, the making of any federal loan, the entering into
of any cooperative agreement, and the eatension, continuation, renewal, amendment, of modification
of any federal contract, grant, loan, or cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or eraployee of any agency, a member of congress,
an officer or employee of congress, or an employee of a member of congress in connection with this
federal contract, gzant, loan, or cooperative a}eement, the undersigned shali complete and submit
Standard Forcn-111, "Discloswe Form to Report Lobbying," in accordance with its inshvctions.
(3) The undersi�ed shall require that the language of this certification be included in the awazd
documents fos al] subawazds at ail tiers {including subcontraeu), subgranu, and contracts under 2rants,
loans and cooperative agreemenu) and that all subrecipienu shal] certify and disclose accordingly.
T1ris certificaGon is a material representation of fact upon which reliance was placed when this transaction was
� made or entered into. Submission of this certification is a prerequisite for making or entering into tlus transacvon
imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shail be
subject to a civi] penalty of not less than $10,000 and not more than � 1 Q0,000 for each such failure.
Rob Fulton, Director of Public Aealth
Name of Authorized Individual
S^int p^ l- Ramsek Cnvntv_�,�artment nf Publir Health
Name & Address of Organi7ation 555 Cedar Street
Saint Paul, MI3 55101
.
11
Efforts to Reduce Racial Disparities
I. Describe how the CHS needs assessment used available data to analyze the extent to �
which the CHS area has disparities in risk facfors and health status between MCH
populations of color and the majority popularioa.
Whenever available, data is analyzed by numerous factors, including race. It is particularly
important that this data be available for Saint Paul specifically as this is where the majority
of the populations of color in Ramsey County reside. Through the Community Assessment
for the Saint Paul - Ramsey County 2000-2003 CHS Plan, data was nsed by the data analysis
team to identify that disparities of health status exist in our community. Tkris has been
identified as a high priority problem: "Despite overall health improvement in Miimesota,
popnlations of color continue to experience poorer health and disproportionately higher rates
of illness and death".
II. Within the populations to be provided services by the MCHSP during CY 2000-Oi,
what raciaUeYhnic disparities were identified.
As is shown in the data and graphics in the community assessment portion of this grant,
populations of color aze identified as having disparities related to late enhy into prenatal
care and infant mortality.
•
III. What strategies and objectives have been established to reduce sign�cant dispariHes?
Of particular interest are community and systems strategies/objectives wlrich recognize
the potential roie all types of community-based organizations can ptay in the decrease
of disparities.
One primary strategy u6lized by the Saint Paul MCHSP Grant to reduce dispariries is to
contract with community providers for services to improve pregiancy outcomes and address
adolescent health issues. These providers, who have years of experience, aze accessible to a
variety of the population by location as welt as the presence of bilingual, culturally specific
and/or culturally sensitive staff. The linkages that these agencies have with other
community agencies help to support their efforts to decrease the disparities of heahh status.
Additional information on each of the subcontractors specific objectives/methods and
strategies is detailed within the Application Narrative.
�
12
�'�� �73
� Subgrants/Subcontracts - Solicitation Process and Monitoring
Guidelines for Subganting Process are contained in Appendix 16. Onlv other Qovemment and nonvrofit
aeencies f501 C31 are elieible to nartici�ate in this Qrocess
NOTE: T'he process for conducting tLe subgranUsubcontracts solicitation is specifically stated in the
state MCH Law. The process must be carefully conducted as specified and documented as described
below.
Solicitation Process
a Please summarize the procedures used to plan and implement the required subgranting process
including the process for selection of prioriry program acrivities to be solicited of other providers and
deternvnauon of funds availab]e for this purpose.
See Attachment B
� b. Please provide documentation that notification of the availability of funding was provided to al]
qualified progrntns in 1he Community Health board azea including those of nonprofit and other public
agencies and Indian reservations. This docwnentarion must include evidence of d'uect mailings to
providers and evidence of pubiication of pertinent information in newspapers of general circulation in
the community health services azea.
See Attachment B
c. Please list all public and nonprofit agencies which requested subgrants of the Community Health
Board indicating which requests were inciuded in the grant application.
See Attachment'B
d. Please explain how priorities were established for selecting the requests included in the grant
application.
� See Attact�ment B
13
�
e. Please list the criteria tl�e Community Health Boazd used to seleet the requests included in the grant
application.
See Attachment B
2. Monitoring and Evaluation of Subgrantees/Subconhactors
All subgantees aze accountable for provision of services as specified by the Community
Health Baard and further are accountable for compliance with applicable federa] and state
requirements. Please describe the monitoring procedures ihe Commurdty Health Boazd pZans to utilize
in assuring fiscal and progam accountability of each of its subgrants. Indicate the extent to which on-
site monitoring procedures will be utilized.
See Application Narrative - Subgrantee In£ormation
3. Please list all subgrantee/subcontractors selected and the award amounts for the two year period CY
2000-01.
SubgranteelSubcontractor CY 2000-2009 Award Amount
�.�
�7_
�
I4
�'' �73
. , '�flL��'Z�V� � Saint Paul Community �
- Health Board
__ ,
1VICHSP SUMMARY. OF TYP�S:4� ,:.. coMMUN»r Hea�.r�
„, .
., ,
`` AC�'IVlTIES-AND,.S�RVIGES, ` Boa�t�tct�s� -
PR41tIDE� B�( OP�RATlNG ` s aint Paul - Ramsey Co ��
-- -- - '` Department of Public H alth
A�LiENCIES �Y LE�7ISLAT�VE � pPE12A�lNG AGENCY -
, °PRIQR1T1l . _ t�fa�reren�f.�m�H$� '
'exampies of operating agency incfude county, school district, Indian reservation, nonprofit health agency, etc.
fmproved Pregnancy Outcome Program
Geographic area served: -
Citv of Saint Paul and Ramsey County- -__
�
Types ef ActivitieslServices
Please cheek those serviees provided:
� core public heatth activities not direct service 7�%pregnancy testing and referral
l� individualized educalionlcounseling ]�,pre-term biRh prevention
� health education/wunseling in groups }�prenatai case management
� prenatal medical care }� enabling and non-health support
Other - ptease specify:
Describe the target popuiation(s) refative to age, income, and risk factors consistent with program et+gibility
guidelines found in Appendix 12. The target population(s) should be the specific group(s), including estimated
numbers, that the MCH Special Project proposes to serve using the MCHSP grant and other resources.
See subgrantee information within Narrative Application
Describe the manner in which the progtam responds to the needs and priorities for services idertt�ed by the
Matemal and Child Health Advisory Task Force (see Appendix 77). Differences must be described in detaif.
See Narrative Application
r
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15
- 200�
1111CHSP SUMM�
, = ACT11/)TlE� �
PR01/li?ED �
; " A�ENCiES 8
. ���
(fl,� Saint Paul Co�unity �
-- - Health Board
OF TYPES �F : ,�aMnnuN�n:yFa.� : _
1 SERVICE� : . � soa� tc�s�.
)QERATlNG s aint Paul - Ramsey Co t
Department of Public H I
E�7�SLAT�VE' °:: -
-
ITY . ,--->. .:.1BilifferentlromCHS)- ---
11, Famity Planning Progrem
Geographic area served:
Types of Actiritiesl5ervices
Please cF�eck those services provided:
❑ wre pubiic health activities not direct service O method services
p individuai"¢ed educatioNcounseling ❑ task force
� education in schools ' ❑ enabling and rton-health supporf
O other public education �f��`�?�'
Other - p�ease specify:
Describe the target population(s} relative to age, income, and risk factors consisieni with program eligibil'dy
guidelines iound in Appendix 92. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Special Project praposes to serve using the MCHSP grant and other resources.
Describe the manner in which the program responds to the needs and priorities for services identified by ihe
Matema! and Child Healih Advisory Task Force (see Appendix 17). Differences must be described in de;ail.
�
�
�
16
����; �73
�
� _: -2�Q��204� Saint Paul Community
.
Health Board
MCHSP; SUNIMARY. OF ° connnnuNmr �EC,�.zH -
_
A��'!1/{T1ES AND'.S.E.RVIG�S ° ' BoA�e �ct�s? . :
PROVIDED BY OPERATING: �. Sa�nt Paul - Ramsey �ou ty
,:.
Department of Public He lt�i
A�ENCfES;BY LEGiSLATlV�
.. . ! .. � 7t1 � .. I � V aQ�rlarir�� ���r�cv
: �iilV�1:1 7 __ _ ,' ;` -(HdiHerentfromCHBj'
ill_ HandicaocedlCAronically 111 Children's Program
�
Describe the manner in which the program responds to the needs and priorities for services ident�ed by tfie
Matemal and Child Heaith Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
17
Describe the target population{s) relative to age, income, and risk factors consistent with program eiigibii'ity
guidetines found in Appendix 12. The target population(s) shouid be the specific group(s), including estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
>;:
. . 1111CHSP S
` A�TI1/1
PROVI
�l�7�N�
Z���� • _ Saint Pau1 Community
- - Health Board
_ -
MiVIARY �F TYPES'OF , _ '
,,. • : , , . _ . ..:. ; �OMMUNI7Y HEALTti .
IES 1�ND'S�RVICES=° - soArin {ct�s�
ED BY OPERATiNG;' = s aint Pau2 - Ramsey Cou ty
Department of Public He Yh
S BY LEGISLATIVE;
t , flPEitATING AG�b[CY' _
,; .
P���Rl� . ? ' , (ifdifterentiromCH� __
�
IV. Childhood lnjury ConUol Program
Describe the manner in which the program responds to the needs and priorities for services ident�ed by the
Matemai and Child Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
�
�
�
Describe ihe target population(s) relative to age, income, and risk factors consistent with program eligibility
guidelines found in Appendix 12. The target population(s) shouid be the specific group(s), inciuding estimated
numbers, that the MCH Speciai Project proposes to serve using the MCHSP grant and other resources.
°� �W :�73 ��
� �� _ 20D0-
MCHSP SllMIV1AF
j ' PR01l1DED BY OP
AGENCIE�:BY lEt
. P.RiflR1�'
x
� Saint Paul Community �
ealth Board
� TYPES OF -
COMMI3NIT1'.HEf1LTH _ :
:V�GES_-� `BOA�2DjCH$).
�'�'���" Saint Pau1 - Ramsey Co nty .
- Department of Public H a1Lh
l.ATlVE -
, .. __ .
: OPERA7ING AGENCY'_ ` - ° .. -
' , °° ' �if diHerant#rom CHB) -° " .
V. Other Programs Previous Funded by a Local Pre-Btoek MCH Speeial Projeet Grant - SQeciTy Programs:
a Dental Health Program
❑ InfanUChild Health Progrom
8] Adolescent Health Program
Geogrephic area served: �ity of Saint Pau? and .Ramsay County
Types of ActivitieslServiees
Please eheck those services provided:
C�3 core pubiic health activities not direct service
❑ enabling and non-heaith support
List services provided:
�
Describe the target population(s) relative to age, income, and risk fiactors consistent wfth program efigibifity
guidelines found in Appendix 12. The target popufation(s) shouVd be the specific group(s), including estimated
numbers, that the MCH Special Projeci proposes to serve using the MCHSP grant and other resources.
See Application Narrative
Describe the manner in which the progrem responds to the needs and priorities for services identified by the
Matemal and Chitd Health Advisory Task Force (see Appendix 17). Differences must be described in detail.
See Application Narrative
L J
T
�.
' • 1��Q�2O� • j - Saint Paul Co�unity I _
� __ _ - Health Board �
1111CHSP-SUMMARY,OF TYPES C3F --
. __ . . ...: ...... .
- , CflMMUNITY HEALTIi - -
ACTlV�T1ES �►NLl SERVIGES�.; . . so�s�n �cas� :
= PR OVIDED B�t OPERP�T�NG: s aint Paul - Ramsey Co �
.: __.,_ ->.. t Department of Public H lth
. :.'wr_�w�r��e teV:1 Ft�1C1 �TtV�::.
" ; ilvv nv�a.v a :
. .PR10RiTY :-f�ra���ir�m��$> '
DEFINITIONS:
Enabiin�and Non-Health Su000rt refers to senrices provided directly to the Gient to atiain, access or use
heaith services rather than to provide a service specifically aimed at improving health. The kids of services
inctude transportation to and from health services, transiation of information into the ciienYs first language,
child care while receiving health care services, outreach to MCH populations, and assistance in seeking or
attaining health services.
Core Public Health Aetivfties Not Dired service refers to fiealth system activities which are not attributabie to
services provided to individual clients. These inWude but are not limfted to:
Assessment
colleet and analyze data and disseminate assessment results
Policy Devetopment and Planning
develop plans
provide advocacy
establish guidelines
Assurance
develop, implement, and support community health promotion programs
deveiop, monitor and support standards for access and quality
impiement and support targeted outreach and service coordination
co!laboratioNcooperation wiih other service providers
C�
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BUDGET NSTIFICATION
�
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Budget justification for each of the projects/subgrantees is included within their budgeu presented
in the application narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Matemal and Child Health Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey Commty Department of Public Health
for Administrative and Core Public Health functions.
SalarX/Fritige:
Administrative Assistant:
General program oversight,
prepares and monitors grants,
reviews reports, prepazes annual
reports, prepares and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activities
1'11
$13,549
$ 2,554
2001
$13,836
$ 2,631
Accounting Tech 77:
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV:
Types grants, conuacts and
reports
Epidemiologist:
Data collection, analysis,
reporting and display
Su�lies:
TOTAL:
$ 5,185
$ 3,576
$14,276
150
$25,014
$ 5,341
$ 3,683
$14,276
250
$25,741
23
BUDGET DETAIL OF LOCAL MATCH
Local match is identified within each of the subgrantees budgets, as required by MCH guidelines. �
Addiuonal local match is also provided by the Saint Paul - Raznsey County Department of Public
Health:
1'ITI 1�1
1. Local Tax L.evy Funds:
� MCH Prenatal Care at Community $134,480 $139,480
Clinics
TOTAL:
$139,480 $139,480
2. Other Local Funds:
Other local match is provided by Public Health through the funding of various programs which
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health educarion and well child services. Source of this funding includes
CHS funding, grants, reimbursements, and patient fees.
C�
�
`�
_ � ��� �a
.
Please read INSTRUCTIONS ON REVERSE side before wmpleting form.
CY 2000-0'1 MCH SPEClAL PROJEGT BREAKOUT BUDGETlFINAL EXPENDITURE REPORT
�����^^ I. Name of Gommun'rty Heatth Soard: Saint Paul
waeew am Cnaa Heam
H5 Eaa Se.anu� Psx
p�O� eos � Grent Year. 2000
v,.,o�+aoc�. w+ss,sdoeaz
III. BUDGET/EXPENDfTURE 1TEMS
Le isiative Priorities and Com onents Matemal and C
'
IMPROVED PREGNANCY OUTCOME PROGRAM 196, 951
� .................... •-�---.............
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non heatth suppoR' . . . . . . . . . . . . . • . - - • • • � . - • -
.................� 24,470
FAMILY PLANNING PROGRAM
..............................
Other health activities"' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non hea�th suppoR' . . . . . . . . . . . . . . . . . . . . . . ...
fiANDiCAPPEDfCFIRONICAILY ILL CHILDREN'S PROGRAM
�
Ha'ndicapyaCktxo[ucally�Ctt�dren�risdxa�'3ervse ..................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
r�
L.�
Enabling and non health suppoR` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . _
INFANT NEALTH PROGRAM (Mpis./St. Paul onty)
�itaatiftetlica7senmses .....................................
Otherhealth activities" ..................................
Enabling and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
CHILDIADOLESCENT HEALTH PROGRAM
ChiWhood injury control services . . . . . . . . . . . . . . . . . . . . . . . . . .
Dental health services (Goodhue-Wabasha onty) . . . . . . . .. . ...
Ch'%i3 �."ad�esiant.�ane�Cat`ss:wiass tlA�1s75t�3>ai�l orilY3 . . . . . . . . . .
Chiid & adolescent other health activities" . . . . . . . . . . . . . . . . . .
Child 8 adoiescent enablin9 and non health support' . . . . . . . . . .
Core oublic health activities not ciient based 820
........... 14 '
Rh etlucalionlravnsaii�, othe� protesswrtal serviees �transportation, translaLOn, cAildcare, outreach, etc.
CERTIF�CATION SIGNATURE
TYPE OF REPORT:
Ori9inal Butl9et
Butlget Revision #
that to tne hest ot my knowledge antl belief the tlata reponetl on this tlowment a corteet and ail Vansaetions that suDPO� this repon were matle in
nce with apD���DIe Fetlerel statutes.
�
OfCicial:
Name oi Person Who Completed this F ortn:
Date:
Phone: 651-292-7712
25
Please reatl INSTRUCTIONS ON REVERSE side before eompleting fortn.
CY 2000-01 MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
��a�"^ 1. Name of Communiry Hea(th Board:
�,.,,,,��ec�ee�,m, Saint Paul
85 EW � �� ��
°- GrantYear. z001
M:�aors. mrr ss,sweez
111. BUDGETlEXPENDITURE ITEMS
Le isiative Priorities and Com nents Matemal and C
A. IMPROVED PREGNANCY OUTCOME PROGRAM 196 , 951
.K ,. .., ._. _
ti - .........................................
Other health acGvities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non health support` . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activiUes not cuent basea . . . . . . . . . . . . . . . . .
FAMILY PLANNING PROGRAM
:.... �..
Faiiiilti�latii?�g�ieftiad : . .: . . . . . . . . . . . • - - - . — . . . . . . . . . . . .
Oiher hea)th activdies" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
HANDICAPPEDICHRONICALLY ILL CHILDREN'S PROGRAM
_ ._
Haiidi�pDeif7itiSaiuc23l;y:�zL�dreti me7�iseivse . . . . . . . . . . . . . . . . . .
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabiing and non health support' . . . . . . . . . . . . . . . . . . . . . . . . .
Core public health activities not client based . . . . . . . . . . . . . . . . .
INFANT HEALTH PROGRAM (Mpis.ISt Paul ony)
kYar"3arei('�seavue� .....................................
Other health activities" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Enabling and non heatth support' .........................
CH{LD(ADOLESCENT HEAL7H PROGRAM
Childhood injury conVOl services . . . . . . . . . . . . . . . . • . . . . . . . . .
DeMal health services (Goodhue-Wabasha onry) . . .. . . . . . . . . .
�6ffi•s�Otesceet,p�e�Cai�teitiioes:{3�D7s.�Si�?aiu : .. ...... . ... .. .. .
Child & adolescent other heafth activities" . . . . . . . . . . . . . . . . . .
40
25,016
402,247
114,612
Chiid 8 adolescent enabling and non heatth support' ........:: 15, 001
Core pubiic health activities not client based . . . . . . . . . . . . . . .
1M etlucatioNwunseling, ot�er professional services 't2nspoMJfion. trenslation, chiWp2, outreae�, Mc
CERTIFICATION SIGNATURE
TYPE OF REPORT:
Original Budget
BudgM Revision #_
to tne best ot my knowtetlge and oeliet tne daW reportetl on Snis dowment is Wrrect antl aU franssctions t�at support tl�is repon were made in
wRh apPlieaDle Fetlerel statutes.
Official:
Name of Person Who Completed this Form:
Date:
Phone:
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❑
COMMUNITY ASSESSMENT
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Application Narrative ` �� _ � � ',� �
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� COMMUNITY ASSESSMENT
A broad-based assessment of community health needs and resources in Saint Paul and Ramsey
County was conducted beginning in the fall of 1998 as part of the development of the 2000-2003
Saint Paul-Ramsey County Community Health Services Plan.
Data Collecrion
The community health assessment process included collection of data regazding the Community
Health Services topic azeas. Staff obtained over 300 data items from state agencies, local
government, federal government, and private sources. Public health data is becoming more readily
accessible via the W W W, but data is not necessarily valid because it is available on the W W W.
Data regazding similaz or exactly the same phenomenon can be collected from several different
sources and so professional judgment was used to determine credibility of data.
It is also possible to collect many volumes of data on the topics of interest. Staff also used
professional judgement to determine the amount of data to gather for analysis. The priority for data
collection was to obtain reseazch data performed using populations or samples of populations living
in Ramsey County and Saint Paul where available. Wherever, possible, however, it is helpful to
compaze local data with regional, state, and national data. Regional, state, and national data were
collected whenever feasible. When local data was nonexistent or not reliable, regional, state and
national data were used.
� Data Analvsis
Role of Staff : The next step in the assessment process after collecting data, was analysis of the data
to identify public health problems in Saint Paul and Ramsey Counry. Staff performed some
preliminary analysis of data as they created graphics and assembled the data into formats usable for
further analysis. Staff analysis concentrated on identifying trends and comparisons to Minnesota
Goals (goals regazding the topics established by the Minnesota Department of Health), and did not
include the identification of specific public health problems.
Data Analysis Team: After considering several alternatives for analyzing the data the Department
organized a data analysis team consisting of internal and external volunteers with expertise in data
analysis, the public health topic azeas, and the health of minority populations. The data analysis
team met five times. One or more new CHS planning topics was considered at each meeting. Data
regarding the topic was provided to the data analysis team prior to each meeting.
The chazge of the data analysis team was as follows:
The Data Team wiil develop a list of problem azeas that keep our community from
experiencing an optimal level of health. Problem areas must:
- show a gap between Healthy People 2000 goals or Minnesota Public Health
Goals and Ramsey County data, or
� - be supported by data.
27
Application Narrarive
Identification of Public Health Problem Areas
At the end of each meeting conciusions of the data analysis team were summarized for clarification
and accuracy. Staff translated these conclusions into statements of problem azeas for review by the �
data analysis team at its next meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of public health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem area statements tfien became the basis of the neait step in the assessment phase:
review and prioritization of the problem azea statements by the greater Ramsey County community.
Review of Problem areas by the Ramsey County Communitv
After staff and the volunteer data analysis team developed the list of problem areas, staff developed,
with input from the Ramsey County Boazd, a list of community groups to review the problem areas.
These community groups were asked to review the probtem azeas to be sure the data analysis team
did not miss the identification of 'vnportant public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County govemment staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services pIanning process was described and
participants in the meeting provided verbal feedback to staff regarding the list of problem areas. At
the end of each meeting, group patticipants helped to prioritize the problem azeas by circling on the
paper the five azeas they thought were most important for ttte Saint Paul - Ramsey County
Departrnent of Public Health to address. They were also allowed to add problem areas not on the �
original list.
Identification of Public Health Problem Areas
At the end of each meeting conclusions of the data analysis team were sununarized for clarification
and accuracy. Staff translated these conclusions into statemenu of problem azeas for review by the
data analysis teazn at its ne7ct meeting.
At the conclusion of all of the meetings of the data analysis team, a draft list of pubiic health
problem area statements were submitted to the data analysis team for their review and approval.
This list of problem azea statements then became the basis of the neact step in the assessment phase:
review and prioritization of the problem area statements by the greater Ramsey County commuruty.
Review of Problem azeas b�the Ramsey County Community
After staff and the volunteer data analysis team developed the list of problem azeas, staff developed,
with input from the Ramsey Couniy Board, a list of community groups to review the problem azeas.
These community groups were asked to review the problem azeas to be sure the data analysis team
did not miss the identification of important public health problems and to help prioritize the
problem azeas. Over 200 community groups were asked to participate, including groups
representing city government, school districts, Ramsey County government staff groups, youth
groups, disability groups, senior groups, professional groups and others.
During each meeting, the community health services planning process was described and �
participants in the meeting provided verbal feedback to staff regazding the list of problem azeas. At
28
Application Narrative �y'� 7 � �
'—�
the end of each meeting, group participants heiped to prioritize the problem areas by circling on the
paper the five areas they thought were most important for the Saint Paul - Ramsey County
. Department of Public Health to address. They were also allowed to add probiem azeas not on the
original list. ,
Summary of Communi InDUt
The Saint Paul - Ramsey County Department of Public Health held 41 community meetings
involving over 400 people. The infotmation heard from ihe community groups can be summarized
as follows:
* General support for the identified problems azeas
* Issues most often discussed:
Access to health caze;
Access to safe child care;
Alcohol;
Asthma, diabetes and heart disease;
Environmental concems;
Health effects on children living in poverry;
Need for population based data;
Overweight, sedentary lifestyle;
Teen births;
Violence;and
� Youth and adult mental health.
Priorities Identified by the Community:
Access to health care;
Access to safe childcare;
Alcohol use;
Health effects of children living poverry;
Increasing levels of violence;
Lack of populations based data;
Low birth weight babies;
Teen births;
Unhealthy lifestyle; and
Youth and adult mental health.
Review of Problem Areas by Healttt Dep�rtment Staff
Reports of the community input were written and provided to the SP-RCDPH Leadership Team.
The Leadership team used the communiry anput as a guide for its review, discussion and
prioritization of the problem areas. Next, all public health staff were provided the opporiunity to
review and comment on the prioritized list. Staff review and comments were used to ensure that the
team had considered as much information and as much up to date informarion as was possible.
. Development of Final List of Problem Statements
The fina] step in the process for identifying community health problems was to make a final list of
problem siatements organized by the twelve community health services planning categories. The
F�
Application Narrative
fmal list of problem statements were drafted by SP-RCDPH staff to reflect as well as possible input
from the community, input from staff of the Saint Pau2 - Ramsey Counry Department of Public
Health, and a final review of updates of data from sources originally consulted during initial data �
collection efforts.
The public health problems which were idenfified and formed the basis of the Problem Statements
in the 2000-01 Matemal Child Health Special Projects Crrant, are liste@ as follows:
Saint Paul — Ramsey County Department of Public Health
Community Health Service Plan Problem Statements 2000 — 2003
Community Health Services Plan Assessment
AlcohoI abuse causes adverse heakh effects and social problems in our communiry. It
negatively impacts intended and unintended injury; unplanned pregnancy; poor birth
outcomes; child development; adolescent health; mental health; violence; infecrious
diseases;and chronic diseases.
Tobacco use is on the rise among youth and other select poputations.
Chronic diseases aze among the most prevalent, costly, and preventable of all health
problems in Ramsey County.
The percent of infants in Ramsey County bom with low birthweight is not moving toward
Minnesota and National goals. �
The percentage of births to adolescent mothers in Ramsey County is increasing while
national and state percentages aze going down.
An increasing number of children and adolescents experience the health effects that aze
associated with poverty.
There is a gap between Minnesota goals and the ciurent number of people in Ramsey
County who have access to medical, dental and mental health caze.
Despite overaIl health improvement in Minnesota, populations of color continue to
experience poorer health and disproportionately higher rates of illness and death.
Unintentional injury is one of the leading causes of death throughout a lifetime. Motor
vehicle crashes aze the leading cause of injury fatalities followed by falls, poisoning,
suffocation, and fire.
There is an increase in the number of births in Ramsey County that result from unintended
pregnancies. Some unintended pregnancies are associated with medical and social probletns
which later affect children and families.
There is an unacceptable level of interpersonal violence.
�
30
Application Narrative �- � �? � "�_
a
There is an increasing number of children experiencing chronic neglect due to ineffective
parenting and families experiencing chronic stress.
� Census Data
Wlrile census data from 1990 is likely not completely indicarive of the current environment in our
community, until the 2000 census results aze released, it conrinues to be the best measure for a
variety of indicators. In relationship to poverty, which is often linked to many poor health
outcomes, the 1990 census data indicates that :
• Eight census tracts in Saint Paul have a level of 40% or more persons with incomes
below the poverty level, with an additional nine census tracts with a level of 30% -
39.9% of persons with incomes below poverty level.
• Five census tracts in Saint Paul realized an increase of over 20% in the number of
persons living below poverty between 1980 and 1990.
Program Response to Minnesota MCH Priorities
The Saint Paul - Ramsey County Department of Public Health has identified improving
pregnancy outcomes as a maternai and child health service priority for Saint Paul. The 20Q0-
2003 Community Health Services Plan identified twenty-one health problems as high priority. A
number of problems related to improving pregnancy outcomes were identified among these high
� priority problems including:
• The percentage of infants in Ramsey County bom with low birthweight is not
moving towazd Minnesota and national goals.
• Ramsey County women are initiating and sustaining breastfeeding at a rate lower
than the state and national goals.
• The percentage of births to adolescent mothers in Ramsey Counry is increasing
while national and state percentages are going down.
Data reported in the Minnesota Health Profiles provided by the Minnesota Deparlment of Health
and the Saint Paul - Ramsey County Community Health Services Plan also reveals that:
• Percent of Premature singleton Births (less than 37 weeks gestation) for Saint Paul
is 7.6 compared to 8.0 for the State of Minnesota (1997).
• Percent of women receiving late (3rd trimester) or no prenatal care in 1997 is 5.6
in Saint Paul compared to 2.9 for the State of Minnesota (1995: 6.2 in Saint Paul
compared to 4.0 for the State of Minnesota).
� • Percent of women receiving late (3rd uimester) or no prenatal care is higher for
American Indians (11.1 %), African Americans (91%), Asians (12.5%) and teens
(9.8%). (1995: 8.3%, 10.7%, 13.6% and I0.5% respectively).
31
Narrative
• For 1995-1997, the 3 year average infant death rate of infants born to American
Indian women (12.0) and African American women (13.4) is much tugher �
compared to the rate for Saint Paul (8.8) and the 5 year average for the State of
Minnesota (6.6 for 1993-I997).
• The incidence of low birthweight singleton births in Saint Paul increased from 4.8
in 1992 to 5.5 in 2997.
• The incidence of low birthweight births for African Americans increased from
12.0 in 1993 to 12.4 in 1997.
Ttus data also indicates t6at due to the increasing efforts to improve pregnaucy outcomes, we
have seen some positive results such as:
• The current three year rate for infant mortatiry in Saint Paul of 8.8 (1995-1997}
has improved compared to the three year rate of 9.1 for 1990-1992.
• The incidence of first trimester prenatal care continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993, 69.9 % in 1995 and 71.7% in 1997 for Saint
Paul women.
• The incidence of fust trnnester caze for Saint Paul Native American women
continues to increased from 36% in 1988, to 37% in 1991, 54% in 1993, to 63.9% �
in 1995 but declined in 1997 to 52.4%.
While technology has improved to a11ow caze and treatment of some high risk births, it is much
more efficient, cost-effective and less stressful to place dollazs and efforts on improving
pregnancy outcomes so that the advanced technology does not need to be used.
Data indicate that some specific Planning Districts in Saint Paul have poorer birth outcomes and
may benefit from increased levels of tazgeoed outreach and service. These neighborhoods, all
within the City of Saint Paul, inciude: Thomas-Dale, Summit-University, SunrayBattle Creek,
Riverview, Dayton's Bluff and North End.
In addition to the focus being placed on improved pregnancy outcomes, adolescent health
continues to be a focus, primarily through the Adolescent Health Program, utilizing school based
ciinics operated by Health Start, Inc. and previously funded by the preblock grant pzogram, will
continue to be supported through MCH funding. Some funding for adolescent health services
will also be maintained at Public Health for seacually transmitted disease services provided to
adolescents in Room 111. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgotten population. In fact, a number of issues specifccally related ta adolescent health aze
included in the Community Health Services Plan as priority health problems, including:
+ The percentage of births to adolescent mothers in Ramsey County is increasing �
while national and state percentages aze going down.
32
Narrative
� ���
• Tobacco use is on ihe rise among youth and select populations.
� • High number of children, adolescents and adults are overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effecu that
are associated with poverty.
Several more problems within the list of twenty-one high priozity problems do not mention
adolescents specifically, but that population is clearly identified as being affected by the following
problems as well:
• Emerging and re-emerging infectious diseases threaten the health of the generai
population (including immunizations and STDs).
• There is a gap between Minnesota goals and the current number of people in
Ramsey County who have access to medical, dental and mental health issues.
• Despite overall health improvement in Minnesota, populations of color continue to
experience poorer heath and disproportionately higher rates of illness and death.
� There is an increase in the number of births in Ramsey County that result from
. unwanted pregnancies. Unwanted pregnancies are associated with medical and
social problems which later affect children and families.
• There is an unacceptable level of intetpersonal violence.
Through the community assessment completed as part of the CHS planning process, it was
identified that there are resources available within the community to meet the needs in the areas of
family planning, handicapped/chronically ill children and childhood injury conuol, including
resources targeted to these problems within our own Department through Ramsey County
MCHSP funds as well as other funding. Based on this assessment, no funding is requested for
these areas through the Saint Paul Maternal and Child Health Special Project Grant. However,
these areas will continue to be monitored by Saint Paul - Ramsey County Department of Public
Healih to ensure that resources exist to handle the various health problems and issues in each
area.
The provision of services addressing improved pregnancy outcomes will be primarily
subcontracted to vazious community-based providers who were identified through a process of
request for proposals. The Saint Paul - Ramsey County Department of Public Health has chosen
to subcontract for the majority of services in an effort to utilize established agencies and
organizations who have proven to be effective and eff'icient in their delivery of services and which
are located within the target areas and/or seroe target populations. Additionally, subcontracting
� with existing agencies inimi�es start-up costs and duplication of services. It is hoped that this
process and the services provided by the subgrantees will also help ensure that
culturally-sensitive, continuous caze is provided to high risk populations.
33
Apptication Narrative
See additional information on the subcontracting/subgrantee process in Attachment B. Members of
the Community Health Services Advisory Committee participated in this review process. On
August 4, 1999, the Matemal Child Health Special Projects grant application was reviewed by ihe •
Saint Paul — Ramsey County Community Health Services Advisory Committee. Committee
members were invited to provide input.
Various information regazding the community assessment is displayed in the figures on the
following pages.
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Application Narrative
W ' 7 7 �
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Community Description Figure 3: Percent Chiidren Receiving Public Assistance
c
d
0
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d
a
C3Ramsey County 1991 1992 1993 1994 1995 1996
■ Minnesota Year
SOURCE: RC DepaRment of Human Services
�
35
Community Description Table 13: Poverty Indicators
Percent of Children Receiving Public Assistance
Application Narrative
Community Description Figure 4: Families With Children Below Poverty by Census 7ract
and Commissioner District
Ramsey County
Single Parent Families with Children
Below Poverty
by Census Tract and Commissioner District
i
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# Single Parent Famiiies
below poverty
Ctnws rz2sho
0-32
33 � 93
�94•241
� 242 � 464
� 465-829
Source: 1990 Census 428/99bn
36
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Application Narrative
Community Description Pigure 6: Racial Distribution of Persons Poverly,1990
Racial Distribution
of Persons in Poverty, 1990
% total poverty
� White
Af rican
American
�Asian
� Ame rican
hdian
Source: U.S. Census, Ramsey County Policy Anaysis Division
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Q'k 20% 40% 60% 80% l00%
Narrative
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1997 Metro Selected Natality and Mortality Statis6cs - Minnesota Metro Counties
County Population
Live Births
Fertiiity Rate
Birth Rate
% Out of Wedlock Births
% Less Than 37 Weeks-All
% Under2500 �rams-AIl
% 3rd Trimester Care or none
Infant Deaths, Total
Induced Abortions
infant mortality rate per 1,000 birfhs
Birfh Rate 3yr Avg 15-17
Birfh Rate 3yr Avg 18-19
Birth Rate 3Year Ave 15-19
Pregnancy Rate 3yr Avg 15-17
Pregnancy Rate 3yrAvg 1&19
Pregnancy Rate 3yr Avg 1519
% Under 2500 gm-Singieton
% Less Than 37 Wks-Singleton
°/01 st Trimester Care
Abortion Rate
SOURCE: MeVo SPSS Users Group
Anoka Carver Dakota Hennepin Ramsey Scott Washington
286673 63198 334585 1053178 454354 76078
4234 1029 5126 15459 7435 1342
60.8 70.7 67.1 59.8 64.0 75.8
14.8 16.3 15.3 14.7 15.4 17.6
22.0 12.5 17.5 27.8 32.5 13.0
7.6 7.6 72 8.3 7.6 9.1
5.8 5.1 5.2 6.6 6.7 5.2
2.0 1.5 1.3 4.1 4.4 1.0
25 5 23 115 49 3
970 139 1003 5110 2379 190
5.9 4.9 4.5 7.4 6.6 22
14.7 11.2 122 26.6 35.1 13.3
53.2 45.3 48.4 55.6 68.9 36.3
27.8 22.5 23.8 38.4 50.9 20.6
25.7 192 21.5 41.9 49.8 19.9
84.9 64.4 80.3 95.4 1012 63.6
45.9 34.2 40.4 63.9 72.3 33.8
42 3.8 4.0 5.0 4.9 3.2
6.6 7.1 6.8 7.7 72 7.9
84.3 90.0 87.9 82.5 78.0 87.9
13.7 9.5 11.7 19.5 20.1 10.7
191548
2686
592
14.0
15.1
7.9
5.6
1.1
7
463
2.6
9.3
37.7
17.8
19.0
65.8
33.0
4.3
7.3
91.2
9.9
39
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IMPROVED PREGNANCY OUTCOMES
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Application Narrative
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� IMPROVED PREGNANCY OUTCOMES
PROBLEMS
Poor pregnancy outcomes has been identified through a community assessment as a high priority
public health problem in Saint Paul by the Saint Paul - Ramsey County Department of Public
Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in some populations
• ongoing problem of infant mortality despite decreasing infant mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal alcohol
effects and other birth defects
The rates of infant mortality, low birth weight and pre-term deliveries for the City of Saint Paul
� are higher than suburban Ramsey County and the State overall. Specific areas within the City
have been targeted by each subgrantee and the Aepartment as geographic areas to be served in
response to previous high rates of poor pregnancy outcomes.
One factor contributing to poor pregnancy outcomes, including high infant mortality, premature
birth, and low birthweight births, is late or no entry into prenatal care. Again, the targeted
areas and populations within ffie City of Saint Paul have a higher percentage of women who
begin prenatal care late (third tr'vnester) or who receive none at all than suburban Ramsey
County and the State overall. Certain Saint Paul neighborhoods have especially high rates of
late prenatal care.
The following graphics display various data related to low birthweight, trimester of entry into
prenatal care, and infant mortality rates.
�
40
Application Narrative
Low 8irth Weight Bab+es Figure 8: Low Birth Weight Trends
Low Birth Weight Trends
�
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a s.o°�
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c
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N
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Source: MDH: MN HeaHh Proiiles, MN Healih Statistics
� �sas
� 1988
_=�.� 1990
� �997
� 7993
� i99a
Q 1995
>�� 1996
� 1997 i
low Birth Weight Babies figure 2: Low 8irth Weight Births Metro Counties
1997 Low Birth Weight Births
Seven County Metropotitan Qrea
e.o^s
�.o��
6.0%
5.0%
4.0 %
3.0%
2.0%
t.Q%
0.0°h
Percentof all inf�nts born weighing less than 2500 grams
SOU¢e: MN HE2�1G PrGtileS. M N Health StetistiCs
.
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41
Minnesota Rams�y County Saint Paul
Anoka Bekota Ramsey wasn+ngtpn
Carver NennEpin SCOtt
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Application Narrative __ ;-� � �
Low Birth Weight Singleton Rates
Ramsey County Muniapa{ities and Saint Paul Planning Districts
199�1997
. =r.�n+a�zic��r
--- °. 3.1
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'N6nnesa2 2004 Goal : 3.5 LB1h' Birth Rale
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Application Narrative
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HP2oon ��ar an�u
HP2000: Healthy People national goal for year 2000
Source: MDH: MN Health Profiles
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Application Narrative
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(V T T
Application Narrative
Maternal and child health activities funded through the Maternal and Child Health Special Projects
Crrant aze monitored quarterly, and more thoroughly evaluated on an annual basis. A report
assessing the activities of the current project in 1998 was completed for the Minnesota Department �
of Health. Since current comprehensive data on Saint Paul health indicators is not readily
available, it is difficult to fully assess the impact of present progranis at this time. However, based
on the data received from the programs, the following swumary informarion from 1998 programs
receiving MCH funding to improve pregnancy outcomes is available:
• 1,827 clients were seen for prenatal services
• 54% of the 1110 clients who delivered in 1998 received prenatal care in the fust
trimester of pregnancy
• 15 fetai deaths were idenrified
• 3 neonatal deaths occurred
• 46 births were below 2500 grams
From this assessment, it is cleaz that on-going efforts need to be made to help ensure early and
continuous prenatal care, especially among some minority populations.
PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES �
Saini Paul - Ramsey County Department of Public Health's Improved Pregnancy Outcome
Prbgram for the City of Saint Paul responds to the goals and priorities for services identified by
the MCH Advisory Task Force. The Program addresses both the goal of promoting improved
birth outcoures and promoting healthy adolescents. To achieve these goals Saint Paul - Ramsey
County Department of Public Health has identified priorities consistent with the following MCH
Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatai care in the first trunester
• sensitivity to cultural diversiry for improved pregnancy outcomes
These priorities will be addressed through the objectives and methods idenrified by three
community agencies approved for funding by the MCH Special Project Funds Proposal Review
Committee. Once again, Saint Paul - Ramsey County Department of Public Health subcontracts
the majority of Saint Paul MCH funding to community organizations to increase access to
services, and to increase the likelihood that culturally sensitive caze is available to the S
population. The agencies recommended to receive funding through the Saint Paul MCHSP
_ _..
49
ApplicationNarrative ` ;`j 7 7
Grant are: Health Start, Inc.; Face To Face Health and Counseling Service, Inc.; and West Side
Community Health Services.
.
The programs of these agencies provide a variety of inethods which are targeted to increase the
percentage of women receiving prenatal care in the first trimester, ensure continuous prenatal
caze, education and case management, reduce infant mortality, and decrease low birthweight
births. Additionally, the programs of these agencies will provide services to residents of some
of the highest risk Saint Paul neighborhoods.
I1
�. J
•
so
Nazrative
INVENTORY OF SERVICES
From the inventory which was completed, it has been idetttified that there are a number of �
agencies providing prenatal care in Saint Paul, in addition to independent practitioners. An
inventory of agencies providing prenatal caze, primarily those providing the options of care on a
sliding fee, including the target population served and the services provided, is included in
Attachment A.
In April of 1992, the Prepaid Medicai Assistance Program (PMAP) was implemented in Ramsey
County. There are cutrently four health plans availabie, including Hea]thParmers, U-Care,
Medica and Blue Plus. Individuals who are newly applying for Medical Assistance aze being
placed into this system.
The system has unproved, but there are still issues of denied services, confusion regarding
where a person can receive services and clients choosing not to seek services due to the
confusion. Special populations may need special attention to initialiy maneuver ttuough this
system. The Saint Paul - Ramsey County Deparmnent of Public Health will continue to advocate
for accessible care for ali populations.
•
�
51
Application Narrative � �� ,_ i } 7 �'j
GOALS OF THE PROJECT
�
The overall goal of the projects which will be supported through the Matemal and Child Health
Special Projects grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBdECTIVES OF TI� PROJECT
�
A number of objectives have been established for the Improving Pregnancy Outcome project
including:
1.
�
To reduce the overall rate of late (3rd trimester or none) prenatal caze (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1%) women.
To unprove the infant mortality rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average),
and American Indian (12.0 for 1995-97 3 year average); and
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 yeaz average), American Indian rate (13.4 for 1995-
97 3 year average).
To reduce the rate of Saint Paul low bir[hweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7 % 6.7 %
White low birthweight �6.9 % �.3 %
African American low birthweight 12.4% 12.1%
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low 5.4 % � 5.0%
birthweight
� 4. To conduct outreach efforts to pregnant teenagers to increase the rate of first trunester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
52
Applicarion Narrative
with a special emphasis on outreach to minority teens. {For births to women less than 20
yeazs of age in 1997, 52,4% in Saint Paul, and 55.3% in all of Ramsey County began
prenataI care in the first uimester}. �
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Boazd through the
Saint Paul - Ramsey County Department of Public Health are low-income (less than 200% of
poverry) Saint Paul women at high risk for poor pregnancy outcomes, as defined by legislative
parameters. This incIudes, but is not limited to, teenage and minority women residing in St.
Paul.
Addirional MCH Special Project Funding beyond the pre-block grant funding to Heatth Start,
Inc. was made available to community organizations through a Request for Proposals process.
This process and the target popularion specific to each subgrantee selected, as well as the
objecrives, methods, training/experience of staff, linkages, reimbursemendfees and budgets will
be described in the following section tided, "Subgrantee Information."
i
!
53
��- �73
�
SUBGRANTEE INFORMATION
�
�
Narrative
SUBGRANTEE SOLICITATION PROCESS
� � �
� To determine the agencies with whom a subcontract would be established, a solicitation process
for both the Saint Paul and Ramsey Courny Maternal & Child Health Special Projects Granu
was conducted beginning in June of 1999. A Request for Proposals was sent to 37 agencies
which may have had an interest in participating in the project, and a public notice was published
in the Saint Paul Pioneer Press.
Three proposals for programs to improve pregnancy outcomes were received by the deadline.
The proposals were reviewed by Public Health siaff and an ad hoc subcommittee including
representatives of the Saint Paul - Ramsey County Community Aealth Services Advisory
Committee.
An evaluation form similar to the Minnesota Department of Health evaluation form was used to
evaluate the proposals which were received. The results of reviews completed by the review
committee indicated that each merited some funding. The projects which were chosen for
funding would ensure that some services were provided in each of the target health planning
areas and focused on target populations with as little duplication as possible. Two of the
proposals will be funded by the Saint Paul MCHSP grant, and one will be funded by the Ramsey
� County MCHSP grant.
The details of the RFP, a sununary list of the proposals received, and the evaluation tool used
aze described in Attachment B.
5UBGRANTEES
Specific information on each of the projects to be supported through the Maternal and Child
Health Special Project Grant for improving pregnancy outcomes is provided on the following
pages. Each project has specific target populations, objectives (which include projected service
levels), and methods, but all projects are working towazd the same goal of improving pregnancy
outcomes for residents of Saint Paul. Copies of the full proposals submitted by each of the
grantees are available the from Saint Paul - Ramsey County Department of Public Health upon
request.
The following table indicates the projects which are proposed for funding and for which a
complete program description follows.
�
54
Apptication Narrative
AC'ENCIES PROPOSED FOR FUNDING/SUBGRANI'S
See individual subgrantee information for Budget Justifications on each project.
Amount Reauested
AGENCY Total: Yr. i: Yr.2:
Face to
Face
West Side
Amount Awarded
Total: Yr. i: Yr. 2:
:� 11� �� �11 �1 �11 :1 �11 �1 �►� �� 1��
32,500 16,250 16,250 32,500 16,250 16,250
Health
Start 393,902 196,951 196,951 393,902 196,951 196,951
(IPO)
Health
Start 1,010,070 505,035 505,035 1,010,070 505,035 505,035
(Adol)
Room 111 24,374 12,550 11,842 24,374 12,550 11,824
(SPRCDPH -
Adol)
Face To Face is requesting funding to continue the'vr outreach efforts and case management.
West Side is requesting funding primarily for outreach, perinatal care coordination, risk assessment and
tracking.
Health Start receives non-competirive funding as a pre-block grant provider to provide both improved
pregnancy outcome services through ouueach and prenatal caze, and adolescent health services through
school based clinics.
Room 111 will provide sexually transmitted disease services to adolescents.
��
��
�
55
Narrative
, .-,
MOIVITORINGlEVALUATION OF SUBGRANTEES
• To ensure that every effort is made to achieve the proposed goals and objecuves, the subgrantees
efforts and performance will be monitored on a regular basis throughout the contract period.
Contracts will be written between Saint Paul - Ramsey County Department of Public Health and
the subgrantees indicating specific performance objecuves and outcome indicators. The contracts
will oufline the subgrantee duties, reporting requirements, the monitoring expected/performed by
Saint Paul - Ramsey County Degartment of Public Health, and evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective tools
will be used by the subgrantees to ensure that various aspects of their program are reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
PROGRAM EVALUATION
. Data will be sought from various sources, both nationally and locally, including the Minnesota
Department of Health, to monitor pregnancy outcome trends. Tlus data will be used to analyze
the impact that the project has had on the goals and objectives for the project throughout the two
year period. Since summary data is frequently available on a two yeaz delayed basis, progress
toward the objectives may be difficult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
• age of client
� race and ethniciry of clients
• residence of clients
• time of entry into prenatal care
• number of fetal deaths
• number of neonatal deaths
• number of infants with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs aze appropriately
� impacting pregnancy outcomes. Based on this evaluation, services and programs may need to be
modified or refocused to maximize the likelihood that the objectives and goals are met.
56
Application Narrative � '�` _ ,'� "J 7�
J
� Health Start, Inc - Im�roving Pregnancy Outcomes
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive Maternal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes. Health
Start, Inc. is an organization specializing in maternal, infant and adolescent health caze services to
high risk populations for disease or disability due to economic, social or medical conditions, and
to reduce morbidity and mortality in these populations.
Health Start proposes to continue to serve the needs of low-income (less than 200% of poverry)
and adolescent pregnant and postpartum women. Health Start will provide multi disciplinary,
comprehensive prenatal caze. Prenatal care offered to students in the high schools facilitates eazly
entry into prenatal care. This component of the Health Start program addresses the City of Saint
Paul's Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and women of color.
Tar e� t Popularion - The clients targeted to be served will be those at risk for prenatal and birth
complications who would, without accessible and high quality services, continue to experience the
multiple problems associated with high risk pregnancies. Prenatal care is provided in eight school
� based clinics in St. Paul, so adolescents, especially minority adolescents will be a focus. In 1998
Health Start saw 325 adolescent prenatal patients in it nine sites for 2260 visits (which represents
roughly one-third of reported teen pregnancies in St. Paul), and 174 adult women, 46% of whom
were African-American, 3.4% were Asian and 4% were American Indian. Women in these
groups who smoke will also be targeted for special prenatal or preconception interventions.
Obiectives -
1. Provide comprehensive multidisciplinary prenatal care to 500 high risk young adult and
adolescent women per yeaz during CY 2000 and 2001.
2. 55% of women who deliver through Health Start will initiate prenatal care in the first trimester
of pregnancy and 85% of women will initiate caze by the end of the second trimester of
pregnancy.
3. 80% of prenatal paUents will received five or more prenatal visits.
4. By December 31, 2001 low birth weight (less than 2500 grams) rates will be no greater than
� 8% and pre-term birth rates (less than 37 weeks gestation) will be no greater than 10%.
57
Application Narrative
5. Women smokers will receive help with smoking cessation methods prior to or eazly in
pregnancy.
6. The incidence of low-birth weight infants born to adolescents followed through high school �
clinics will be no greater than 7% by the end of CY 2001.
7. Of the adolescent teens seen in school based or OB/Gyn clinics, 55% will begin caze by the
first trimester.
8. All prenatal patieuts will have an initial nutrition assessment with folic acid supplements
offered to uninsured women and all others as necessary.
Methods -
• A full range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 491 Universiry Avenue West, and eight school-based clinics. This
will ensure accessibiliry and acceptability for clients seeking prenatal care.
• Prenatal and postpartum caze will follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since �
1967. This includes social work and nutrition professionals routinely available during
regular clinic hours to handle the various non-medical aad medical risk factors.
• All clients will be assessed for high-risk conditions using the Minnesota Pregnancy
Assessment Form at the initial visit and 36 weeks. Appropriate prevenrive management will
be provided for all clients.
• Clients will be assessed for risk for HIV/STD infection and individualized prevention
education will be provided. HIV/STD testing will Ue provided on site.
• All ciients will receive a nutrition assessment, conducted by a Health Start nutdrionist.
Clients will be certified for WIC at the clinic visit and educated about the importance of
appropriate weight gain during pregnancy for optimum birthweight. Clients with specific
nutrition concerns, e.g. diabetes managemeni, anemia, weight control, etc. will receive
ongoing nutrition education and counseling throughout their prenatai care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Fanuly and relationship issues, housing and financial concerns, chemical use, and !
issues of physical, se�al and emorional abuse are included as part of the assessment.
58
� �7�.�
Application Narrative , � r U
Clients with no source of payment for medical care will receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and
� support within the clinic setting and will refer to outside agencies and services as needed.
• Patients who smoke will be encouraged to cut back or stop during pregnancy through access
to self help information and specially written motivation materials designed for the patienYs
willingness to change status. The "Ask & Advise" intervention will start early in pregnancy
or prior to conception, though education given to family planners or patients receiving a
pregnancy test from FIealth Start.
• All clierns delivering through Health Start will be eligible for family planning services for
24 months after the baby's birth, regazdless of ability to pay. After this period, clients who
are uninsured will be asked to pay according to the sliding fee scale.
• Health Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency care at Regions Hospital.
• Project clients will be assisted in locating a medical home for their new baby, if needed.
Eligible new parents will be invited to participate in one of Health Start's intensive parenting
� programs, designed either for drug or alcohol-exposed infants or minor mothers.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based clinics and University Avenue clinic.
• Clients in need of specialized medical service will be referred to Regions Hospital or other
providers as appropriate.
• Clients will receive individualized prenatal education in clinic and will be invited to attend
the weekly prenatal classes at Regions Hospital.
� Prenatal and postpartum clients who fail appointments will be followed-up by telephone and
maIl to help ensure that they receive needed health care services. A community outreach
worker is available for home visits to clients who repeatedly fair prenatal appointments.
• Language interpreters and interpreters for the deaf will be available in clinic and by phone
as needed, using either in-house or community interpreter resources.
� � Although most clients will fmd the clinic sites easily accessible, Health Start will provide
bus tokens or cab cazds when needed.
59
Application Narrative
Evaluation -
Intended Outcomes and Methodologies for the project to Improve Pregnancy Outcomes:
A. Does the multidisciplinary model of prenatal care designed for socially at-risk women help to
improve pregnancy outcomes?
Criteria/Methodologies: Health Start will compare birthweight, gestauonal age, risk level, race ,
SFS, and onset and duration or prenatal care with a comparison group which does not receive this
model of prenatal caze. Health Start tracks approximately 1,700 deliveries at Regions Hospital
each year. Of these, approximately 300 are deliveries to Health Start patients. The remainder is
non Health Start patients and provides an important comparison group for determining birth
outcome data. Information collected and reported includes date of delivery, provider
classification, race, risk score, marital status, trimester that care was initiated, and the number of
prenatal visits made. Infant data includes APGAR's at 5 minutes, birthweight and gestarional age.
B. Can Health Stan contri6ute to lowering low binhweighZ rates for women of color, especially
African American women?
Criteria/Methodologies: Health Start will compare birthweights by race within its deliveries to
city averages, over a three year time span.
Use of Evaluation Results: Informarion from evaluation efforts will be given to the quality
assurance committee, the quality management team, and the clinical management team. They
may be used to formulate changes in intervention, to stimulate further analysis for underlying
causes, or suggest areas for a quality improvement project. Evaluarion results are disseminated to
providers via periodic provider meetings, clinic tams via team coordinator meetings, the Board of
Directors at board meetings semiannually. They are also used to moYivate staff and to stimulate a
work culture of continuous quality improvement.
Trainin�/Experience of Staff - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff aze professional health care personnel with special
expertise in maternal and child health or adolescence. The majority have had more than five
yeazs eacperience. All staff are evaluated at least once a year. Clinic staff aze aiso subject to
anuual peer review.
Staff are supervised by the executive director, associate director, medical d'uector, OB medical
director orteam coordinators. Medical providers are credentialed according to standards ofthe
major health plans. Carol Wlute, M.A., is the executive d'uector of Health Start and is
responsible for the overall management and direction of the project, as well as extemal relations
�
�
.
:1]
�� � 7 3 Applicarion Narrative � � � '°" '�
and long-range planning. Dr. Chris Reif is the medical d'uector, is on the staff of the Family
Medicine Department at Regions Hospital, and is responsible for overall medical direction. Dr.
� Donna Anderson, on the staff of the Health Partners Obstetrics and Gynecology Department, is
the OB medical director and works with the medical d'uector to provide consultation on OB/GYN
practices, as well as providing clinical supervision for OB/GYN nurse practitioner staff. They
are advised by a clinical management team made up of representatives from the various
professional disciplines,in prenatal and adolescentservices of Health Start. Richard Duffm has
been the associate d'uector for five years and manages the school based clinics. Jeanne Rancone,
PNP, PHN, is the new Clinical Services Coordinator, overseeing clinical services for adolescent,
prenatal, and pediatric care. Jeanne has been with Health Start for five yeazs.
Continuing educauon needs of staff are assessed and maintenance of credentials through
continuing education is monitored.
Li es - Health Start has well developed linkages that include a wide variery of health care
providers, educational programs, and social service agencies. Tlus referral network allows staff
to individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs azise. Key linkages include HealthPartners/Regions
Hospital - most physicians and midwives are contracted through HealthPartners, who also provide
� back-up for prenatal care and referrals for prunary care services and OB specialry services not
provided by Health Start.
Health Start works collaboratively with Saint Paul - Ramsey County Public Health nurses to
extend services to pregnant women in the communiry. Public health nurses meet regularly with
Health Start to identify clients needing home-based services and to share information that will
enhance patient care.
At delivery, new parents are referred to Health Start's pediatric clinic, which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location near I.exington and University,
the usefulness of providing pediatric care at a different neighborhood site as an incentive for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediauic
services aze discontinued by Health Start, cases management to hop connect new mothers to
appropriate medical homes for their babies in the communiry will be maintained.
Eligible clients are also refened to the Befriender Program, run in collaboration with Children's
Home Society, the Partnership Program, a collaboration with Saint Paul School's Early
� Childhood and Family Education (ECFE), or the CARES Project, also run collaboratively with
ECFE. These programs all provide intensive counseling, support, andlor group education for
G1��
Narrative
high risk parents.
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g., .
general medical care or adopuon counseling), written referrals will be made to community clinics
or other resources within a convenient geographic area.
Health Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliarions with
and/or refer to the following agencies and task forces (partial list only):
Children's Home Society of Minnesota, Early Childhood and Family Education (ECFE),
HouseCalls, Frogtown Family Resource Center, HealthPartners and Regions Hospital, Ramsey
County Human Services Child Protecrive/Minor Moms Services, Saint Paul - Ramsey Counry
Department of Public Health, Rondo Family Resource Center, Neighborhood Aealth Care
Network, Saint Paul Public Schools, WIC Food Supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. All clients aze low-income (200% of poverry or
less). Clients are billed, however, by Regions Hospital and Ramsey Clinic for hospital charges
such as labor and delivery and selected tests and procedures. �
MCH funding allows Health Start to provide prenatal care for clients who have no Uvrd parry
source of payment. For Health Start clients eligible for medical assistance or MinnesotaCaze,
staff wilI assist them with the application process. Health Start has contracts with all of the
PMAP providers. Any other applicable third parties are billed whenever possible. Insurance
revenue pays for approximately 45 % of E3ealUt Start's prenataUfamily planning clinics services
and 15 % of adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client has
no third parry payor, a sliding fee scale is used to determine her fee for family planning services.
Funds will be requested from the State of Minnesota Family Planning Special Projects to continue
the provision of family planning services in the next biennium.
�
62
.
u
�J
Application Nazrative
HEALTH START, INC. ,� .. Mc �eoo
���..� �� �.�.� ~- :� 7 3
I.�IPROVED PREGNANCY OUTCOME YROGRAM BUDGET
J3t�'UARY THROUGH DECEMBER, 2000
ANNUAL PROGRAM PR06RA/A MCH
LNE TTEM EXPENSE sne.nm' F're BUDGET BUDGET
CLMGL SERV�CES COORDINA70R
CSMLTiY COORDINATOR
N,Ri pRpL71T10NER
K�E PRpCTiT10NER
7�taSTERID NURSE
tTRSEPRACiTIIONER (AGAPE)
�zrr+�mornsr
krrRmor+�sr
OLIIRrt10NlST (AGAFE)
7Z(iRI71pN1$T (FRLIN6TON)
}�J�L7F1 EpUCATOR (ACaAPE)
sx�r•.i woR�R
SY1Al WORKEfi
tJ,.� MANhGER (AGAPEJ
If.�i-�?REfER
��
LLMG CLERK
��ICqLlSSISTANT
w� :u sss,stnrn
5
5
5
5
$
5
$
$
$
S
S
5
5
5
$
5
$
S
5
56,791
54,912
57,404
52,'189
45,760
47,'133
46,738
43,681
43,681
43,638
40,915
39,'142
44,970
34,275
28,628
23,160
zo,zoa
21,302
24,321
0.40
0.'10
0.60
0.'10
1.00
020
0.25
0.20
0.'I S
0.15
0.15
0.15
0.15
0.20
0.'10
0.25
o.ao
0.10
0.70
$ 7L.717 S 13,630
$ 5,491 5 3,295
$ 34,442 5 20,665
$ 5,219 $ 3,131
$ as.�so s 2�,ass
$ 9,427 5 7,070
$ ��,684 5 2,92�
� 8,736 $ 6,552
y 6,552 S 4,914
g 6,� � 4,582
$ 6,137 5 4,603
$ rJ.B�� $ 4,s9�
$ 6,745 $ 5,3�
� 6,855 S 5,141
$ 2,863 $ 1,431
$ 5,790 $ 4,632
g '16,163 $ 8,082
g 2,130 $ �,�
g 17,025 $ 8,512
SUB-TOTAL SALARY
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
RAMSEY CLINIC PHYSICIAN/NURSE MIDWIFE
pNE p91GYN GHYSICIAN CUNICSIWK �$495 X 42 WKS
TWO FAMILY PRACTICE CLINICSIWK � 5305 X 36 WKS
FIVE CNM CLINICANK (a� 3165/CUNIC X 42 WKS
RENT
PATIENT CARE
LAB, U17RASOUND,X-RAY
OTHER EXPENSE
MEDICA710WDRUGS (INCLUDINGARLINGTON)
MIDICAL SUPPLIES
OFFICE SUPPLIES
EQUIPMENT
7RAINING
PF21N"f ING/DUPLICATING
pf,T{EN7 TRANSPORTATION
T07AL DIRECT EXPENSE
@IDIRECT EXPENSE @ 16°k
TOTALPROGRAM EXPENSE
tOtAi MCli GRAM REQUEST
YATCHING PUNDS � 75Y.
���
$ 226,154 $ 137,776
$ 45,231 $ 27,555
$ 20,790 $ 4,158
$ 21,960 $ 4,392
g 34,650 $ 6,930
$ 33,500 5 '
$ 17,500 $ 10,500
$ 14,000 $ 3,500
$ 5,000 $ 989
$ 5,500 S 550
$ 2,500 S -
$ 1,000 5 -
� 500 5 -
$ '1,20� 5 60�
$ 429,484 $ 196.951
$ 68,717 S
$ 498.202 $ 196.95'1
$ 196,951
g 49,238
Applicauon Nazrative
HEALTH START INC- Mc�oeor
MATERNAL AND CHILD HEALTH
IlVIPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2001
ANNUAL PROGRAM PROGRAM MGH
UNE 1TEM EXPENSE Saum' F're suoG� BUDGET
CUNICAL SERVICES COORDINATOR
C4NICAL SERVICES COOR�INATOR
NURSE PRAC7Ri0NER
NURSE PR1CT7'f101JER
REGISTERED NURSE
NURSE PRACTRIONER (AGAPE)
raurammasr
r�urnmo�nsT
nWrRmorusT tawvFl
r+urnmoMSr cr�vuN�ror+�
NEpLTli EDUCATOR (AGAPE)
socva woa�R
SOCIAL WORI�R
CASEMANA6ER (AGAPE)
IN7ERPRETER
LOURIER
cur+ic c�K
MEDICAL ASSIS7ANT
MEDICAL ASSISTANT
$
S
$
S
$
S
$
S
$
5
$
$
5
$
s
$
5
$
$
57,631
55,724
58,252
52,960
47,133
50,753
46,738
44,328
44,326
44,293
41,520
39,720
44,970
39,781
zs,os�
23,502
20,503
2'1.617
24,680
0.40
0.10
0.60
0.10
1.00
0.20
0.25
0.20
0.15
0,15
0.15
0.15
0.15
0.20
o.io
0.25
0.80
0.10
0.70
$ 23,052 S '13,831
3 5,572 5 3.343
$ 34,951 $ 20,971
$ 5.296 $ 3,178
$ 47,'133 5 28,280
$ 10,151 S 7,10�J
� »,ggq $ 4,674
S 8,865 S 3,546
5 6,649 $ 4.654
$ 6�644 $ '1,651
$ 6,718 5 4,360
g g,g58 5 3,575
$ 6,745 5 4,047
5 6,956 5 4,869
5 2,905 5 1,453
� 5,876 5 4,700
$ 16,402 $ $,20�
$ 2,162 S 1,081
$ 17.276 S 8,638
SUB-TOTALSALARY
FRINGE BENEPITS � 20%
CONTRACT SERVICE
RAMSEY CUNIC PHYSICIANINURSE MIDWIFE
ONE OBtGYN PHYSICIAN CLINICSIWK � 5520 X 42 WKS
TWO FAMILY PR4CTICE CLINICSIWK @ 5320 X 36 WKS
FIVE CNM Cl.INICANK � 5775/CL7MIC X 42 WKS
RENT
PATIENT CARE
LAB, UL7R4SOUND, X-iZAY
OTHER EXPENSE
MmICAT10NIDRUGS (INCLUDING ARLINGTOI�
MmICAL SUPPLIES
OFFICE SUPPLfES
EOUIPMENT
'fRPJNING
PRINiiNGIDUPLICATING
PATEM TRANSPOR7A710N
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ t6%
TOTALPROGRAM EXPENSE
70TAL MLN GRANT REOUE57
MATCMNG FUNDS � 25:G
0
5 230,506 5 135,157
$ 46,101 5 27,031
$ 21,840 S 4 .�
S 23,040 5 4,608
$ 36,750 S 7,350
$ 35,175 5 -
$ '18,375 5 11,025
$ 14.700 S 3,675
$ 5,250 $ �,�
$ 5,775 5 �,�
5 2,625 $ '
$ 1.050 $ -
$ $2$ $ -
$ 1,260 S 630
$ 442,972 $ 196,951
$ 70,876 S
S 5'l3.848 S 196,951
$ 49,238
$ '196.951
•
L J
C J
�
C�
�
Narrative
Face To Face Health And Counseling Service. Inc. - Project Connect -- Prenatal
Access Project
Face to Face Health and Counseling Service is proposing to continue its program aimed at
reaching high risk, pregnant adolescents with comprehensive fust trimester prenatal care services,
which have resulted in a higher rate of healthy birth outcomes_ Face To Face has historically
been a strong supporter of a comprehensive service approach for high risk youth, and is
continually moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach efforts and case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with
case management has proven to be very successful in (1) improving rates of fust trimester
prenatal care and reducing low birthweight rates; (2) providing social support and linking clients
to other needed support services; (3) ensuring clients receive high quality, continuous, and
comprehensive prenatal care; (4) involving clients in self help, the prenatal education program,
and in receiving needed group support; and (5) continuing to support the involvement of
pregnancy partners during the pregnancy.
Tar eg t Po�ulation - Face To Face will continue to serve a minimum of 1501ow income (less than
200% of poverty), pregnant adolescents and young adults between 11 and 21 yeazs of age (70 of
whom will be under the age of 19). At least 50% will be youth of color: African American, Native
American, Hispanic or Asian.
Goa1s/ Objectives -
Project Goal: The Prenatal Access Project at Face To Face will utilize outreach efforts and case
management to encourage and support pregnant adolescents to access prenatal caze so as to increase
their chances of having a successful pregnancy.
OUTREACH & CASE MANAGEMENT
Goal: To utilize a seamless, integrated service model to provide prenatal care.
Objective 1: To use a holistic intake process for assessing needs in all areas of the lives or our
clients and identifying strengths they already possess to address these needs.
Goal: To reduce the overall rate of late (third trimester) or no prenatal caze and to conduct
65
Application Narrative
outreach to increase the fust trimester prenatal care, especially among minority teens.
ObjecUve 1: To increase current efforts to provide ouTreach to youth of color, ensuring that at least �
50% of the prenatal clients aze youth of color: African American, Narive Amezican, Hispanic or
Asian.
Objective 2: To follow up with all clients with positive pregnancy tests, including making home
visits as necessary to assure they receive caze.
PRENATAL CARE
Goal: To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian and Asian teens.
Objective 1: To provide 150 pregnant adolescent and young adults -- 70 of whozn will be under the
age of 19 with holistic and comprehensive prenatal caze which is accessible, appropriate, effective
and which is coordinated with other community resources and integrated with the clients' individuat
life situation.
Objective 2: To enro1150% of the 70 clients who are under the age of 19 in prenatal caze services �
during their first trimester of pregnancy.
Objective 3: To begin to affect positive birth outcomes in all clients, as measured by low birth
weight rates of less than 6.5% for all age and racial groups served.
Objective 4: To improve attendance at all prenatal classes, with at least 50% of those enrolled in
prenatal services attending.
SOCIAL SUPPORT
Goal: To improve the health & wellness of pregnant adolescents during pregnancy through
increased social and emorional support and mental health services.
Objective 1: To increase prenatal support services to pregnancy and pazenting partners of pregnant
women.
Objective 2: To provide mental heath counseling for prenatal clients and their pregnancy and
parenting partners who are struggling with mentat health issues, including chemical use, depression •
and abuse.
..
� -,� ,�
Application I�3arrative �
Objective 3: To link all the prenatal clients who deliver through Face To Face with ongoing primary
medical caze for themselves and theu infants, and social services for the infant, mother and
• pregnancy and pazenting partners.
Methods/Activities - Three components aze used in the approach taken by Face To Face in
addressing the needs of pregnant adolescents in St. Paul, including:
Outreach & Case Management: The primary component of this project continues to be the
outreach youth worker to link high risk pregnant young women under the age of 21 with
prenatal care, counseling, support, advocacy, education, basic living needs, and other
resources. Staff will follow up on all positive pregnancy tests. Outreach workers provide
intensive case mgmt for the prenatal clients, help organize and advocate for services and aze
available 24 hours a day if there is an emergency. An outreach worker serves as a support
person for the client, and is often the one person who listens to a client to strengthen her
eatisting support network and build new relationships where needed.
Prenatal Care: Free pregnancy testing is offered four days a week, and the clinic follows up
on each positive result. Comprehensive and sensitive prenatal caze services aze offered at
Face to Face through a team of professionals including the outreach worker, prenatal program
� coordinator, nurse practitioners, physicians and a nutritionist. All of these members of the
team meet before and after the weekly prenatal clinic in order to ensure effective case planning
and follow-through with each client.
Social Support: Mental health services provided through these grant funds will include
assessments, short-term counseling and the development of peer support networks for the
pregnant adolescent and their pregnancy and pazenting partners. Mental health assessments
will be done for the pregnant adolescent and a caze plan will be established for the adolescent
which may include provision of short term counseling, referral far longer term counseling or
psychiatric services, a plan for establishing and/or maintaining emotional support and support
in achieving the plan. The goal is to strengthen the ability of the pregnancy and pazenting
partner to participate in and be able to support the pregnant adolescent in the pregnancy.
Evaluation - Face to Face programs and services are evaluated on several levels, as follows:
1. The Face to Face Board of Directors sets the vision and monitors the standazds and d'uection
of the agency through monthly board meetings and the work of board committees. Board
� committees evaluate the overall functioning of program azeas and addresses important issues of
d'uection, policy and relationships with other community agencies as well as funding.
:.�ll
Apptication Narrative
2. Progress reports are prepared by staff for review by all funding entities as required by each
source. An nnportant source of informauon for these reports is the organization's comprehensive
database system. This database is extensive, comprised of quanritarive and qualitative .
measurements of client informauon including: registration informauon, e�tensive intake
informarion, health history, complete visit records, attendance and credits, referrals, follow-up
data (lab results, termination status, etc.), and some case management data.
3. As part of trying to integrate all of the experiences Face to Face provides, a key activiry has
been to develop an intake process that provides useful information to assess the overall needs of
each youth. At part of this process, the agency is collecting information to take into account the
physical, social, emotional and cognitive aspects of adolescent's development.
Traininng/Experience - The outreach worker is Teretha Robinson, who came to Face To Face from
Saint Paul I'WCA. While at the YWCA, Teretha worked as a Senior Case Manager, conducting
screening and information and referral for homeless families. Case Management duties included
goal setting and education, negotiating client contractual arrangements, community
networking/service coordination.
Vicki Talaua is a second prenatal outreach worker who came to Face To Face last year from the
Healthy Start pmgram in Anoka, Minnesota. She previousty served as an intem with Face to .
Face from 1997 through June 1998. Ms. Talapa has a B.A. degree in Human Relationships from
the University of Minnesota
Clinic Manager Yaren Kramer serves as the OB/Gyn nurse practiuoner for the project. Karen
began her work with Face to Face in 1997 and was promoted to Clinical Manager early im 1999.
Sfie has over twenty years of nursing experience and is also currenfly affiliated with Regions
Hospital HIV programs as Women's Health Nurse Pracutioner providing caze for women with
HIV and AIDS.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Regions Hospital. Both are backed up by their respective
organizauons, and both bring many years of experience providing prenatal caze services.
The Medical Director is Chris Reif, M.D. Dr. Reif is also the Medical Director for Health Start
school-based clinics, is on the faculty at Regions Hospital, has worked in a variety of community-
based clinics and has directed Saint Paul's innovative Health Care for the Homeless project.
Continuing education needs of staff aze assessed and maintenance of credentials through �
continuing educaUon is monitored.
m
� �, � �
. -- � 3
Application Nazrative
Linkaees - Face To Face is committed to building working service networks with agencies,
individuals, coalitions, and systems. Evidence of this is our Academy program, which is a
� private/public partnership between Face To Face and the Saint Paul Public Schools. Further, in
the Sgring of 1993, Face To Face and Saint Paul Youth Service Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buIlding.
The Face To Face Prenatal clinic has built strong working relationships with a number of other
relevant maternal and child health service providers. These include: Maternal Child Project,
Ramsey County Public Health Nurses, Ramsey County Child Protection, WIC, MELD,
Children's Hospital Pediatric Clinic, Health Start's Hazding Clinic, Ramsey County SELF and
Minor Mothers Programs, and the Diabetes Clinic at United Hospital. A Ramsey County
Nutritionist is available at Face to Face prenatal clinics.
Clients aze referred for ultrasound, non suess tests, biophysical profiles and colposcopies. In
cases of refertals, the nursing staff contacts the referral source to set an appointment and inform
the client of time and date. In most cases, a written referral form is given to clients to take to a
referral appointment. If transportation to the refenal appointment is an issue for the client the
outreach worker will either provide bus tokens, tazi vouchers, or a ride - depending on the
situation. Follow-up is done by clinic staff to ensure that the client has carried through on the
referral.
� Reimbursement and Fees - The vast majoriry of our clients have been eligible for Medical
Assistance (and prepaid Medical Assistance). During 1998, 162 of 194 clients coming to Face to
Face for prenatal care were enrolled in Medical Assistance (Prepaid usually). Most who come for
care aze not yet connected with Medical Assistance.
Face to Face bills MA for prenatal caze, although none of the reimbursements cover the costs of
outreach. If a client is not eligible for any third party reimbursement, she is then charged fees
according to the sliding fee scale.
Budeet - A complete budget and justification for the Face To Face program follows.
�
CS:
Application Narrarive
Faco to FacY Health Counsaling Sexvice, �sc.
co�aoc/� �sot z000
Connect Program � To�
xEPENOE
Family Planning Special Project S 7,�80
HOD Special Needs Housing S 9•Z82
MDH HZV/STD OuYreacb 5 18,118
Adolescent Pazenting Program 5 57,039
MCH $ -0�,000 S 40,000
Family Support Pzoject � S 103,867
HOPE S 10,757
Subtotal Governmeat S 246.843
Puzehaee o£ Sarviea 5 23,600
Foundation/COZporation 5 29.900
Fasa S Third Pazty 5 2,000
Otbex, Misc. i Intezoet S -
To Be Asieed S d7,590
gpg�, • $ G0,000 S 349,933
EJ�£NSES
Pzoject Coordinator (TR) S 2,363 S 5,908
Wtzeach Wozkez iVDT) S 19,690 S 19,521
Wtreach Forkezs fMV7 5 12,5B8 5 23,275
Total Salaries 5 28,591 S 139,732
Fzinqe S 5,146 S 26, 599
Tm�pozazy Pessonnel 5 -
Coatznct Staff 5 -
Coasultaats S 4,400
Clieat f�ezgeacy Aasistance S 750
Clieat Pass TIIzwgA S 1D0,000
rzoqzam Suppiy 5 3,500
OE£ice Supplies S 1,000
p� S 4,600
Reat 5 '
Telephone $ 5,700
Posiage S 35
Membezship Dues $ �
wtsiae Pzintin9 S .1,350
Inside Pzintinq 5 920
StaEf Tsaoel 5 562 5 2,OOU
Clieai Txaoel S 1,600
Coa£ezencea, Tzaining 5 5,000
Adve-cising 5 900
Subsczip2ions 5 '
subiotal Exp�ns• 5 39,299 S 298.036
p�tiaiatzation Spzead S 3,800 5 47,166
Facilities Spzead S 1,901 5 4,731
TpTAL E78ENSE S 40,000 S 399,933
70
��
�
`�
xJi99/lSH00 7/3/99
Application Narrative
: -- :� 7 3 .
• Face to Fsce Health Counseling Service
Sudget Narrative
2000
BUDGET NARRATIVE
Total Salaries:
Portion of Connect Program staff salaries paid by MCH grant.
Project Coordinator - .08 £TE
Outreach Worker - .60 FT£
Outieach Worker - •50 FTE
Fringe Benefits:
Based on 188 of MCH portion oP staf£ salaries. Includes medical,
dental, FICA, li£e, etc.
Sta£f Travel:
.
Based on MCH portion 11.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 staf£ x.31/mile.
Faoility Costs:
Based on 6� of MCH portion of budget. Includes telephone, utilities,
janitorial, trash, building repais 6 supply, taxes, insurance,
telephone system & copier le�se, and maintenance.
Administrative/Management Ovezhead:
Includes general of£ice supply, insurance, postage, accounting,
annual audit, computer consultation, and administrative &
management staff and £ringe benefits.
•
71
Application Narrative
Faca to Face 8ralth Counsalinq
Conaoct Bsogram � T
.
REVEt��E
Family Plannin9 Speci�l P:ojeci S B
AOD Special Nee25 Housing S 9,560
H)e aN/STD wtreach S 18,662
olescent Paren2ing Proczam S 58,750
�g S 40,000 S 91.200
Family Suppozt Yroject 5 306,983
gppg 5 11,080
Subtoul Gwarmwnt 5 25<,Y<8
Porc7usa of Sorviu S Z6,308
FouLtlat3oA/COSpetatioa 5 30,797
Faes s Taizd Yarty 5 2,060
OtLCZ, Misc. i Iasazest 5 -
So ea Raitcd 5 62.632
gpy�, 5 d0,00D $ 35d,065
fXPEN5E5
Projett Coozdinator (TR) 5 2,3E3 5 5,908
WtzeaU Woskes (V,7T) S 10,640 5 19,521
Wtzeach Workezs (1.N1 5 11,588 S 23,175
Tosal Salaziee S 28,591 5 139,732
Franqe 5 5,196 5 25,152
Teaqozary Pezawuiel 5 -
Conuaci StaSS S �
c,n:,u:�„c, s a, 532
Climt Emezaenry Assissa�cc 5 �73
Uimt Pass Snreuqn 5 103.000
Yroqzw Supply 5 3, 605
oiSi<e supplaes 5 1,030
g� 5 0,738
Rmt S �
7elepnone 5 5,871
Pos:see 5 36
MmDezaAip Dues 5 -
Outsiae Yranssag 5 1,391
Iasiee Pr3aung S 998
StaSS zzavel S 562 5 2,060
usmc r:avei 5 1,648
CmiSUeaces. Tzalxung 5 5.150
Atl�rozcasing 5 927
sveaezipsswu 5 -
yspusu ssp�n.• 5 35,299 5 300,591
:tzation Spreatl 5 3.800 5 48.581
Facilliaes Spzeatl 5 1.901 5 4,873
SriTU E7�ENSE 5 d0,000 5 35a,0a5
co�.ez� saaQ.c zooi •
�
•
��
Narrative
� ,�_ �73
. Face to Face Health Counseling Sexvice
Hudget Narzatioe
2001
SIID6ET 2IARRATIVE
Total Salaries:
Portion o£ Connect Program st«£ salaries paid by MCH grant.
Project Coordinator - .08 FTE
Outreach Worker - .60 FT£
Outreach Worker - .50 FTE
Fringe Bene£its:
Based on 18$ of MCH postion o: staf£ salaries. Includes medical,
dental, FICA, life, etc.
Sta££ Travel:
�
Based on MCH portion (1.0 FTE or .67) of 150 miles per month
x 12 months x 1.5 sta££ x.31Jmile.
Facility Costs:
Based on 6$ of MCH poztion oP budget. Includes telephone, utilities,
janitorial, trash, building repair 5 supply, taxes, insurance,
telephone system 6 copier lease, and maintenance.
Administrative/Management Overhead:
Includes genes�l office supply, insurance, postage, accounting,
annual audit, computer consultztion, and administrative 6
management staff and fringe bene£its.
�
73
Narrative
West Side Community Health Clinic - Improving Pregna�icy Outcomes for High •
Risk Latinos and Asians in Saint Paul
Goal - The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul L.atino and Southeast Asian populauons by providing outreach, tracking all positive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by existing West Side Community Clinic staff and services. The
clinic offers comprehensive health care services on a sliding fee scale. Tlus project will give
Latino and Southeast Asian families greater access to a full array of services inciuding well child
care, immunizations, family planning, parenting, and STD services as well as linkages by referral
to over 14 other community agencies.
Tar ep t Population - This project will target low ittcome pess than 200 % of poverty) Latino and
Southeast Asian women in the following azeas of St. Paul: Riverview (CTs 342, 361, 370, 371,
372), Mount Airy (CTs 328, 329, 330) and Rice Street (CTs 305, 314). These azeas include the
highest concentrations of Latino and Southeast Asians in the city.
Prolect Goal - To reduce low birthweight and infant mortality rates in the St. Paul Latino and
Southeast Asian populations. �
Obiectives -
1. To reduce overall rate of late (third trimester or none) prenatal caze among pregnant Latinas and
SEA teens and women to 10 percent or less.
2. Increase the rate of prenatal caze in the first himester among pregnant Latinas and SEA teens and
women to 60 percent or more.
Meth s -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted azeas, health education fair for teens as part the McDonough recreation
program, assistance in clinic enrollment at WIC sites at McDonough and West Side, and
responding to media requests for interviews by local newspapers and radio stations.
2. Project staff will conduct Spanish-spealdng and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safety, and personal health issues such as family planning, STDs, drugs and alcohol, �
and family violence.
'I4
Narrative
"'73_ ,�,
3. Staff in clinic will follow-up on all positive pregnancy tests and identify highest-risk
• perinatal patients, providing focused language and culture-specific health education and
support interventions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportation, and interpreting as needed.
Evaluation - All patient data is logged and entered into a computerized data system. Data kept
includes demograplucs, trimester of entry into prenatal care, types and numbers of services used,
and pregnancy outcomes. Information is reviewed periodically, and project results will be
compiled annually. Addirionally, patient satisfaction surveys are done semi-annually.
3atisfaction with prenatal classes will be measured via surveys after each services. Twenty-five
(25) prenatal records are audited quarterly to measure rates of compliance with prenatal risk
assessment, post partum visits, and newbom follow-up. This information will be reviewed
quarterly by the Quality Management Committee to identify and implement focused improvement
efforts.
Trainin�*(Fxnerience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability to meet the health needs of Hispanics and Southeast Asians. In 1996, WSCHC served over
12,800 medical patients, 75% were Aispanic or Southeast Asian. Services include bilingual and
� bicultural staff, transportation through our van, bus or cab voucher, hospital care through Regions
Hospital, in WIC clinics including immunizauon outreach assistance with Medical
Assistance/Minnesota Care applications and outreach clinics and education programs in homeless
shelter, public housing developments and a high school. These services are provided through a
well established interdisciplinary case management model. This model helps identify high-risk
patients through screenings and refenals, provides coordination of care, and ensures patient
involvement in care planning and choosing ueatment options.
The Perinatal Aealth Educator{Coordinator, Isolina Soto RN (.4 FTE) has worked at West Side
Community Health Services since 1993 and has over 20 years of nursing experience.
The Hmong Perinatal Health Educator, Youa Vang (.1 FTE) has a BS in Biology and has worked
with the Hmong community in a vaziety of roles for the past four years, including as a child
developer/ESL Tutor (Hmong), and at West side as a Health Educator.
Additional project support will be provided by the Nurse Manager, Jane Johnson, RN, the
Medical Director, Mary Nesvig, MD and other clinical staff through the Perinatal Caze
• Management Committee.
L' a es - West Side Connmunity Health Center works with the following organizations in
75
Narrarive
providing maternal and child health services:
• Regions Hospital Family Pracrice Residency Program to provide cross-cultural family •
medicine training for physicians motivated to work in high-need under served settings.
• Saint Paul - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Child Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, elderly health caze, life style/cancer
and dental care.
� Combined efforts with 16 other community clinics to improve health outcomes for
underserved populations through joint efforts through the Neighborhood Health Care
Network.
• Saint Paul - Ramsey Counry Department of Public Health to provide nutrition education and
immunizations in conjuncuon with WIC sites and home visits to pregnant women and
infants.
• Saint Paul Public Housing Agency to grovide services, including maternal child health, on-
site at McDonough and Roosevelt housing developments.
• City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facitities and five outreach sites.
West Side Community Health Services provides comprefiensive perinatal care. Any specialty
medical caze needed is provided either on-site or refened the high zisk OB clinic at Regions
Hospital. All medical referrals aze done on a referral form and followed-up via computerized
tracking.
Reimbursement and Fees - All reimbursements through the Minnesota Department of Human
Services go d"uectly to support services. Assistance is provided to enroll all eligible women on
Medical Assistance/MinnesotaCaze. A sliding fee scale is maintained for those not eligible for
assistance. Fees are discounted incrementally based on family income, from those at or below the
poverry level paying nominal or no fees, up to those exceeding 200% of the poverty level paying
full fees. Patients aze high risk, low-income (200% of poverty or less). No one will be turned
away due to finances.
�
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Narrative
`��-v
Bud�et - A budget and justification for the West Side Communiry Health Services proposal
foliows.
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77
Application Narrative
Maternal and Child Health (MC� Funds
West Side Community Healti� Center
�
Budaet
WSCHS is requesting 516,250 per year to supplement our existing perinatai progam.
The fimds will allow us to utilize bilinguaUbicultural perinatal health educators as focused
and integral components of our overall program.
Following is the project budget with noted WSCHS match:
Year One - Z000
MCH Reauest WSCHS Match
.4 FTE Perinatal Health Educator/Coordinator
832 hours at �16.34/bour
1 FTE Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing stafflperinatal support
TOTAL
Year Two - 2001
$13,600
2,650
$16,250
MCH Reaaest
.4 FTE Perinatal Health Educator/Coordinator
832 hours at $1634/hour
1 FT'E Perinatal Health Educator
208 hours at $12.75/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
$13,600
2,650
�16,250
$107,000
62,400
$269,400
WSCHS Match
$107,000
62,400
$169,400
Eight hundred prenatal patients will be seen annually.
Seventy-two prenatal classes will be held, serving an expected 350 patients.
Seventy-five highest risk patients �sill receive specific follow-up by the heatih educator.
An additiona1250 teens and women will be reached through outreach activities.
There are no DHS or self-pay reimbursements anticipated re]ated to tl�ese supp]emental
activities.
�_�
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n ��tJ� ° �
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ADOLESCENT HEALTH PROGRAM
�
�
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C�
Narrative
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child Health
Special Project Grant funding for adolescent health services. Some funding will also be targeted
to services for adolescents through Room 111 at ihe SainR Paul - Ramsey County Department of
Public Health. The community assessment for adolescent health utilizes information prepazed by
Health Start from their assessment, as well as information from the Saint Paul - Ramsey County
2000-2003 Community Health Services Plan Community Assessment.
As mentioned eazlier, adolescent health continues to be a focus, primazily through the
Adolescent Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock grant program. This program will continue to be supported
through MCH funding. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk and
often forgonen gopulation. In fact, a number of issues specifically related to adolescent health are
included in the Saint Paul - Ramsey County 2000 - 2003 Community Health Services Plan as
priority health problems, including:
• The percentage of births to adolescent mothers in Ramsey County is increasing
while national and state percentages aze going down.
• Tobacco use is on the rise among youth and select populations.
� High number of children, adolescents and adults aze overweight, inactive and have
inadequate nutrition.
• An increasing number of children and adolescents experience the health effects that
aze associated with poverry.
�
Several more problems within the list of twenty-one high priority problems do not mention
adolescents specificially, but that population is clearly identified as being affected by the following
problems as well:
Emerging and re-emerging infectious diseases threaten the health of the general
population (including immunizations and STDs).
There is a gap between Minnesota goals and the cuzrent number of people in Ramsey
79
Application Narrative
County who have access to medical, dental and mental health issues.
• Despite overall health unprovement in Minnesota, populations of color continue to �
experience poorer heath and disproportionately higher rates of illness and death.
• There is an increase in the number of birFhs in Ramsey County that result from
unintended pregnancies. Some unintended pregnancies are associated with medical
and social problems which later affect children and families.
• There is an unacceptable level of interpersonal violence.
Adolescent health status indicators have shown improvement in some azeas and deterioration in
others in the last five years, Alcohol use has started to drop, as have reported rates of sexual activity
among teens. Pregnancy rates among teens nationally aze dropping, especially due to increased use
of contraceptives and a decrease in amount of sexual activity. They aze still too lugh in Saint Paul,
especially among African-American youth. Rates of physical activity are decreasing for older teens,
wlule obesity is increasing. Tobacco use has increased draznaticatly, especially among White,
Hispanic, and Native Amezican youth. Mortality from violence - suicide, depression and car
crashes - is unacceptably high.
PROGRAM RESPONSE TO MCH PRIORITIES
The Adolescent Health Program responds to the goals and priorities for services adopted by the
State Matemal and Child Health Advisory Task Force. The goal of the Adolescent Health Program
through Health Start is to promote a positive health status and reduce the incidence of unplanned
pregnancy, nutrition problems, depression, chemical abuse and family and relationship problems
among adolescents in Saint Paul. To achieve these goals, Health Start, Inc. has i@entified priorities
consistent with the following MCH Advisory Task Force priorities:
• reduce infant mortality
� reduce the percent of low birthweight infants
• reduce adolescent pregnancy rates
• reduce unintended pregnancies
• provide access to preventive services
• reduce chemical use in adolescents
• reduce infecrious diseases
• promote good nutrition practices
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Application Narrative ^@ � % 3
These priorities will be addressed through the objectives and methods identified by Health Start's,
Adolescent Health Program. Methods to address these priorities include comprehensive health
. services that aze accessible and acceptable to high school age adolescents including nutrition
education and counseling, and psychosocial assessment and ongoing counseling. Extensive health
education is provided individually and in group education settings. Referrals aze made when
necessary.
The services provided for the Adolescent Health component in Room 111 will focus on the MCH
priority to reduce infectious diseases.
�
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81
Agplication Narrative
�
Teen Pregnancy Rate
15 -19 Year Olds
1995 - 97
•
Number pregnancies per 1,000 females this age group
Source: MDH
SPRCDPH, Mealth Policy 8 Planning
.
82
Minnesota Ramsey County Saint Paul
I�J
Nazrative
Teen Pregnancy Rate
1993 - 1995
�
��. �7�
� 15-17 year olds
� � 8-19 year olds
15-197 year oids
Teen Pregnancy Rate: Number pregnancies per 7,000 temales in age group
' Source: MDH: MN Meatth Profites
SPRCDPH, HeaIN Policy & Planning
�
Teen Pregnancy Rate
1995 - 1997
�
� i 5-17 year olds
� 18-19 year olds
15-19 year olds
�
Teen Pregnancy Rate: Number pregnancies per 7,000 females in age group
Source: MDH: MN Heatth Profiles
SPRCDPH, Health Policy 8 Planning
8/'12/99
83
C:�Program FileslSPSS\TeenPreg9597.spo
Minnesota Ramsey County
Minnesota Ramsey County
Narrative
3 Year Teen Birth Rate
1993 - 1995
-.-o.
�.�.�., - ..
18-t9 year olds
� 15-t8 year oids
Teen Birth Rate: Number births per 1,000 females in age group
Source: MDH: MN Health Profiles
3 Year Teen 8irth Rate
1995 - 1997
..
.,.,., - ..
18-19 year olds
�'15-19 year oids
•
�
Teen Birth Rate: Number births per 1,000 females in age group �
Source: MDH: MN Health Profiles _
gi12/gg C:�Program FilesGSPSS\TeenBRaie9395.spo
84
Minnesota Ramsey County
Minnesota Ramsey County
�� n - 7
Application Narrative '-� �J ! �
Sexually transmitted diseases continue to be a concem in the adolescent population. The largest
percentage of cases of chlamydia aze females ages 0-19, followed by ages 20-29. Between 1992
� and 1995 there was a downward trend in rates of chlamydia in Minnesota, Ramsey County and
Saint Paul. However in 1996 and 1997 in St. Paul and Raznsey County the rates increased. The
second lazgest age group diagnosed with gonoahea is 0-19 yeaz olds.
Chlamydia 1992-1997
Case Rates per 100,000 Population
500.0
a a00.0
0
n
0
a 300.0
0
c
� 200.0
m
n
m
� i oo.o
m
N
�
V 0.0
•
YEARS
81992
� 7 993
Qi89d
� 7 995
\\ 7996
� 1997
Source:MOH.SPRCDPH
/ 1
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Saint Paui Ramsey County Minnesota US
Application Narrative
Health Start. Inc. - Adolescent Health Program
Adolescents require services tailored to meet their specific needs and developmental levels. The
services must be accessible, accepiable and confidenfial in order to be effecrive. For these reasons,
Health Start provides comprehensive adolescent health services within the school setting at all seven
pub�ic high schools in Saint Paul: Hazding, Como Park, Central, Johnson Seniot High Schoot,
Highland Pazk Junior/Senior High School, Humboldt Junior/Senior High School and Arlington
Senior High SchooI. In addition to these seven scfiooI-based clinics, Heaith Start provides prenatal
and family planning services for pregnant and parenting teens at AGAPE Alternative School and
other health services (not including prenatal) at Guadalupe Area Project.
During CY 1998 school yeaz, students again demonstrated their need for clinic services by using
current services extensively. A total of 3,460 students made 14,141 clinic visits, generating over
18,817 encounters with various professional staff. This is a 5.6% increase in visits over 1997.
•
For many students, the Health Start school-based clinics aze their only source of health care. For
many others, the school-based clinics aze the important link that enables Yhem to obtain access to
other ea�isting community health care resources. Data from 1998 school yeaz (information available
at first visit) revealed that of student's families, 26% had medical assistance, 16.5% had private •
insurance, 57% had no known billable 3rd party source of payment, and 1% had MinnesotaCaze.
Goal - The goal of the Adolescent Health Program is to promote a positive health status and reduce
the incidence of unplanned pregnancy, nutrition problems, depression, chemical abuse and family
and relarionship problems among adolescents in Saint Paul by providing comprehensive health care
services at seven high School sites and two altemative school sites within the City.
Tar e¢ t Population - The clients targeted to be served by the Health Start Adolescent Health
Program aze adolescents living in the City of Saint Paul. The following demographic data describes
this population:
• 39.8% White
29.1 % African American
8.4% Hispanic/Latino
2.2 % American Indian
16.5 % Asian
4.0% Other
.
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Application Narrative -� � 7
• Age in School - 27.7% 18 years and above
24.3% 17 yeazs
� 22.1 % 16 years
21.9% 14-15 years
4.0% 12-13 years
In addition, an average of 53 % of all high school students are reported as eligible for free and
reduced school lunches, indicating low economic status.
O'ectives - The following objectives have been established for the Adolescent Health Program in
order to achieve the goal:
1. In CY 2000 and 2001, 3300 junior and senior high students will access health caze
through the school-based clinics each yeaz.
2. In CY 2000 and 2001, the healthy lifestyle of physical activity and a balanced diet will be
encouraged by providing 200 nuuition visits related to sports nutrition, weight conuol or
eating disorders.
� 3. Onsite counseling will be provided for 1,000 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, sexual or
emotional abuse each year in CY 2000 and 2001.
4. 1000 teens will receive an annual comprehensive preventive health exam and risk
assessment, including sports physicals and annual reproductive health exams.
5. At least 85 % of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a pregnancy prevention plan. Decision making, sexuality
counseling, and family planning services will be provided for 1,QQQ adolescents each year
in 2000 and 2001.
6. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in CY 2000 and 2001. (From 863 in 1998).
7. The number of hepatitis B immunizations given will increase by 10% in CY 2000 and
2001 (From 501 in 1998).
.
8. An "Ask and Advise" smoking assessment will be implemented for 75% of teens using
F:�17
Applicarion Narrative
clinic medical services in CY 2000. In CY 2001 an "Assist and Connect" component will
be added for 100% of teens expressing a desire to quit or decrease tobacco use.
�
The number of males being seen in clinics will increase by 10% in CY 2001 over CY
1998.
10. 7,000 group education contacts will be provided in clinic and in selected classrooms by all
members of the interdisciplinary team on health education activiues such as prenatal and
parenting classes, weight control classes, human sexuality programs, an@ smoking
cessation, in order to maximize the understanding and practice of positive health
behaviors.
Methods -
• All new students will be assessed for helath and behavior risks, following GAPS assessment
guidelines, detailing medical and family history, behaviors and feelings. This form will
provide staff with background data necessary for providing good caze and for triaging clients
to appropriate staff
• Physical examinarions, health screening and assessments, diagnosis and treatment of acute and
minor illness, and family planning visits w�l be provided on site by a nurse practitioner or �
physician.
• A Health Start health educator, nurse practitioner or social worker will provide decision-
ma[ting counseling and family pIanning eduarion and counseling to adolescents requesting
these services.
• A certified nurse midwife, or physician will provide prentaU care in eight of nine clinic sites
for those students choosing to receive caze through the Health Start program.
• Health Start staff will provide risk assessment, prevention education, and screening on site for
all STDs, inclutling FIIV infection. Health Start will provide new non-invasive urin-based
testing for gonorrhea and chlamydia when appropriate.
• Health Start staff will serve as adolescent health resources to teachers, school staff and youth
workers in their classroom and other groups.
• Health Start will work collaboratively with the health plans serving St. Paul students to �
maximize reimbursements for services and communicate with or refer students into
appropriate sources of caze.
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Narrative ' " f j
• Health Start will participate in the Neighborhood Health Care Network in efforts to increase
. e�ciency through joint purchasing and to increase third parry reimbursement through joint
contracting as part of a primary caze network.
Evaluation - Clients at school-based clinics are assessed annually for satisfaction with Health Start
services, using a standardized format and automated s»mmarization. The same form is used by
the Neighborhood I3ealth Care Network. Satisfaction levels are compared with primary care
community clurics and four other adolescent specialty programs in the Metro azea. Automated
encounter forms gather the demographic data, visit, procedure, and diagnostic code data, and site
of service. These data can be queried to provide data on types and quantity of services used, as
well as target population reached by age, race and income level and special need.
In order to determin if famly planning and reproductive heltah services can be provided
effectively in a school setting, conuaceptive use compliance will be uacked to compaze results
before dispensing on site to afrer dispensing on site, by CY 2001. This will be accomplished by
chart review.
To help detez�min if there is any measureable impact of use of school based clinic services on
school performance/attendance, Health Start plans to replicate a study conelating school based
� clunc enrollment and intensity of use with school performance meaures done in 1993. (Klein,
McCord et all, Journal of Adolescent Health) The principal investigator of that study has
tentativley agreed to be the P.I. on the replication study. Funds are being sought through private
foundations to pay for the study in CY 2000. This would be a retrospective study.
Information from evaluation efforts will be given to the quality assurance committee, the qualty
managemnet team, and the clinical management team. They may be used to formulate changes in
intervention, to stimulate fiu�ther analysis for underlying causes, or suggest areas for a quality
improvement project. Evaluation results are disseminated to providers via periodicy provider
meetings, clinc temas via team coordinator meetings, the board of directors at board meetings
semiannually. They are slo used to motivate staff and to stimulate a work culture of continuous
quality improvement.
Training & Experience - Health Start has provided maternal and child health services in Saint
Paul since 1967. All Health Start staff are professional health care personnel with special
expertise in maternal and child health. The majority have had more than five yeazs experience.
All staff aze evaluated at least once a year. Cinical staff are also subject to annual peer review.
• Staff are supervised by the executive director, associate director, medical duector, OB medical
d"uector,or team leaders. Mecical providers are credentialed according to standazds of the major
�
Narrative
health plans.
Carol White, M.A., is the execuuve director of Health Start and is responsible for the overall .
management and direction of the project, as well as external relations and long-range planning.
Dr, Chris Reif, a member of the Family Medicine Department at HealthPartners/Regions
Hospital, is tiie medical d'uector and responsible for overall medical direction. Dr. Donna
Anderson, on the staff of the HealthPartners Obstetrics and Gynecology Department, is ffie OB
medical director and works with the medical director to provide consultation on OB/GYN
pracuces, as well as providing clinical supervision for OB/GYN nurse practitioner staff. A
clinical management team made up of representatives from the various professional disciplines, in
prenatal and adolescent services of Health Start advises management staff. Richard Duffin,
M.A., has been the associate director fo�ve years and manages the school based clinics. 7eanne
Rancone, PNP, PHN, is the Clinical Services Coordinator, overseeing clinical services for
adolescent, prenatal, and pediatric care. 7eanne has been with Health Start for five years.
Li a es - Heaith Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. This referral network allows staff to
individualize care plans to meet the specific needs of each client. New linkages and referral
sources are identified or developed as needs arise. Key linkages include: HealthPartners/Regions
Hospital - most physiciaus and midwives are contracted through HelathPartaers, who also provide �
back-up for prenatal care and refeaals for primary care services and OB specialty services not
provided by HealthStart.
Health Start works collaboratively with Saint Paul-Ramsey County Public Health nurses to extend
services to pregnant women in the community. Public health nurses meet regularly with Health
Start to identify clients needing home-based services and to share information that will enhance
patient caze.
At delivery, new parents are referred to Health Start's pediatric clinic which operates with a
shared service agreement on the Regions Hospital campus. As Regions pediatrics is leaving the
hospital at the end of 1999 and moving to a community location neaz Le�ngton and University,
the usefulness of providing pediatric care at a different neighborhood sit as an incentify for new
mothers to delay another pregnancy at least two yeazs has come into question. If pediatric
services are discontinued by Helath Start, case managment to help conneci new mothers to
approrpiate mecial homes for their babies in the community will be maintained.
Eligible clients aze also referred to the Befriender Program, run in collaborauon with Children's •
Home Society which offers volunteer mentors to young or struggling mothers. Health Sart also
refers to two parenting/home-visiting groups, which are coIlaborarions witfi St. Paul Schoolc
.�
Application Narrative � � ` � � �
Early Childhood and Family Education (ECVE). One is funded by Ramsey County Family
Preservation Services to prevent child abuse and need for foster care in minor mons. The other,
� cailed the CARES Project, is designed for parenu with drug exposed children and with cantinuing
difficulties with substance abuse. These programs all provide intensive counseling, support,
and/or group education for high-risk pazents_
When psychosocial or health care needs are identified that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), written referrals will be made to communiry clinics
or other resources within a convenient geographic area.
In the school-based clinics, the linkage with the school nurse is very close. Often, space is shared
and refenals go back and forth during the day. Relations with other school personnel aze also
pursued. A school board member always serves on the Health Start board of directors.
Aealth Start is committed to extending services to the community and m;nimi�ing duplication by
collaborating with many agencies and programs. Health Start will maintain affiliations with
andlor refer to the following agencies and task forces (partial list):
Children's Home society of Minnesota, Early Childhood and Family Education (ECFE),
� HouseCalls, Frogtown Family Resource Center,HeaZthPanners and Regions Hospital, Ramsey
County Human Services Child Protection/Minor Moms Services, Saint Paul - Ramsey
Depart»2ent of Public Health, Rondo Family Resource Center, Neighborhood Health Care
Nenvork, Saint Paul Public Schools, tiVIC Food supplement Program.
Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no
charge or on a sliding fee scale to its patients. Patients are low income (200% of federal poverty
or less). MCH funding allows Health Start to provide prenatal care for clients who have no third
party source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. Health Start has conuacts with all of the PMAP providers.
Any other applicable third parties are billed whenever possible. Insurance revenue pays for
approximately 45 % of Health Start's prenataUfamily planning clinic services, and 15 % or
adolescent health services at school based clinics. No one will be turned away due to lack of
financial resources.
Health Start provides fannily planning care to clients for 24 months after delive .ry uusing MCH
and Fanuly Planing Special Project funds. If a client has no third party payor, a sliding fee scale
is used to determine her fee for family plazming services. Funds will be requested from the State
� of Minnesota Family Planning Special Projects to continue the provision of family planning
services in the next biennium. An increase in these funds in CY 98 and 99 allowed Helath Start
91
Application Narrative
to offer continueation family planing services to graQuating high school stu@ents on a sliding fee
basis.
Subgrants/Subcontracts - Health Start subcontracts for the provision of physician, certified nurse- �
midwife services and social worker services with several community providers including:
HealthPartners, and Face To Face Health & Counseling Service, Inc, The Health Start Medical
Director and Associate Medical Director are responsible for supervision, protocols, and general
medical direction for all medical personnel involved in the prenatal/postpartum and adolescent
health programs.
Bud�et Justification - Health Start, Inc. will receive $505,035 in 2000 and $505,035 in2001 to
support the Adolescent Aealth Program through school-based c2inics. The total budget and
just�cation for the budget follows.
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��3
Application Narrauve y U
• HEALTH START, INC.
MATERN.AI. f1ND C�+D H�' .a11.TH
ADOLESCETT AEALTH SERVICES
SCHOOL BASED CLINIC3
JAl�'UARY TIiROUGH DECEMBER, 2000
MCHSBC00
•ANNUAL PROGRAM PROGRAM MCX
LINE ITEM EXPENSE SALARY F'rE euDCe'r suoc�'r
NURSE PR4CTRIONER (CENTW+L)
NURSE PRACTfT10NER (COMO)
NURSEPRACTRONER(HUMBOLD�
NURSE PRACTRIONER (JOIiNSON)
NURSEPRACTRIONER(HARDING)
NURSE PRACTRIONER (ARLINGTON)
NURSE PRACTRIONER (GAP)
SOCIAL WORKER (CENTRAL)
SOCL4L WORKER (COMO)
SOCV1 WORKER (tiVMBOLD�
. SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE M4NAGER(AGAP�
� MED�CAL. ASSISTANT (CENTRAL)
MEpICAL ASSISTANT lCOMO)
MEDICAL ASSISTANT (HUMBOLD�
MEDICAL ASSISTANT (JOHNSON)
MEDICALASSISTANT (HARDMG)
MEDICAL ASSISTANT (AGAP�
MEDICAL A5515TANT (ARLINGTON)
MEDICAL ASSISTANT (GAP)
NUTRSTIONIST (CENTRAL)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOLD�
NUTRRIONIST (JOHNSON)
NUTRRIONIST (HARD�NG)
NUTRITIONIST (ARLfNGTON)
NUTRRION15T (GAP)
NEALTN EDUCATOR (CENTRAI)
NEALTN EDUCATOR (COMO)
HEALTM EDUCATOR(HUMBOLDT)
NEALTN EDUCATOR (JOHNSO�
HEAITN EDUCATOR (HARDING)
MEALTH EDUCATOR (AGAPEj
MEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GA�
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
�
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
S
$
$
$
S
$
$
$
S
$
$
40,320
47,'124
41,966
42,672
40,320
40,992
47,124
35,902
32,038
35,330
34,759
28,510
33,768
19,606
19,034
19,606
20,765
18,362
'18,413
18,413
18,413
34,759
35,246
37,750
34,759
35,246
35,246
33,869
28,980
32,558
30,818
28,980
32,558
32,558
26,998
33,163
44,554
0.80
0.80
�.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
1.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
0.10
0.1�
0.10
0.05
0.15
0.10
O.iO
$ 32.256 $ 25,805
$ 37,699 $ 30,159
$ 33,573 $ 26,858
$ 27,737 $ 22,189
$ 32,256 $ 25,805
g 36,893 $ -
$ 8,247 $ -
$ 14,361 $ 13,643
$ 12,815 $ 12,174
$ 21,198 $ 20,138
$ 13,904 $ 13,208
$ 14,255 S -
g 25,326 $ -
g 19,606 $ 15,684
$ 19,034 $ 15,228
$ 19,606 S 15,684
$ 20,765 S 16,612
$ 18,362 $ 14,690
$ 3,683 $ -
$ 18,413 $ -
$ 13,810 $ -
$ 5,214 $ 5,214
$ 5,287 $ 5,287
$ 5,662 $ 5,662
$ 5,214 $ 5.214
$ 5,287 $ 5,287
$ 5,287 5 -
$ 3,387 $ -
$ Z,S98 $ 2,898
$ 3,258 5 3,256
5 3,082 $ 3,082
$ 2,89$ $ 2,89$
$ 3,256 $ 3,256
a'W �,628 .� '
$ 4,OSD $ -
$ 3,316 $ -
$ 4,455 S 4,455
� SUB TOTAL SALARY
' annual salary based on 42 week school year
FRINGE BENEFITS @ 20°k
93
$ 507,974 S 314,388
$ �0� ,595 $ s2,s7e
Application ATarrative
Health Start
Adolescent Health Services
CY 2000 Budget
r�
�J
ANIiUAL pROGRAM pRpGRp�A MCH
LINE ITEM EXPENSE SALARY Fre s��ET B��ET
CONTRACT SERVICE
FAMILY PRACTICE PHYSICIAWNURSE MtDWIFE
NINE PHYSICIAN CLINICS/WK @ 5305 X 34 WKS
THREE CNM CUNICNVK @ S'720/CUN1C X 34 WKS
PEDIATRICNURSEASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-RAY
OTHER EXPENSE
nneoic�+nowoRUCs
MEDIGAL SUPPLIES
OFFlCE SUPPUES
PRINTING/DUPLICATING
EQUIPMENT
TRAINING
PATIENT TRANSPORTATIOWCOURIER
TOTAL DIRECT EXPENSE
INDIRECT EXPENSE @ 16%
TOTAL PROGRAAA EXPENSE
TOTAL MCH GRAN7 RE�UEST
MATCHING FUNDS @ 2S6
$33,537
HIGHL�ST�'D SCHOOL BASED CLINIC FUNDED BY SEPERATE GRANT SOURCE
g 93,330 $ 55,998
$ 12,240 $ 7.344
g 5.191 $ 3,115
g 33,537 $ 16.768
$ 35,000 $ 17,500•
$ 21,000 $ 12.600
$ 8,500 $ 4,944
$ �2.000 $ �,200
$ 2,500 $ 1,500
g 5,000 $ -
$ '1,5DD $ -
$ 2.000 $ $00
g g41,366 $ 505,035
g 134,619 S -
$ 975,985 S 505,035
$ 505,035
$ 126,259
\J
t��'
Application Narrative "' � � ✓
� HEALTH START, INC.
MATERhAL AND CHIL.D HEAI.TH
ADOLESCEIv'T HEALTH SERVICES
SCHOOL BASED CLINICS
JANLTARY Tf�II20UGH DECEMBER, 2001
MGNSBCOt
•ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SAL4RY F're euoG� B�o�ET
NURSE PRACTRIONER (CEMRAL)
NURSE PRACTRIONER (COMO)
NURSE PRACTfTONER(NUMBOLD�
NURSE PR4CTRIONER (JONNSON)
NURSE PRAC7iT10NER (NARDiNG)
NURSE PR4CTRIONER (ARLINGTON)
NURSE PRACTRIONER (GA�
SOCI4L WORKER (GENTRAy
SOCt4L WORKER (GOMO)
SOCIP.I WORKER (HUMBQLDT)
SOCIAL WORKER (JOHNSON)
SOCIAL WORKER (ARLINGTON)
CASE MANAGER (AGAP�
MEDICAL ASSISTANT (CENTRAL)
� MEDICALASSISTANT(COMO)
MEDICAL ASSISTANT (HUMBOLDT)
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASStSTANT (H0.RDING)
MEDICAI ASSISTANT (AGAP�
MEDICAI ASSISTAM (ARLMGTON)
MEDICAL ASSISTANT (GAP)
NUTRRIONIST (CENTR4L)
NUTRITION15T (COMOj
NUTRfTIONIST (NUMBOLO�
NUTRRIONIST (JOHNSON)
NUTRTT10N15T (W+RDING)
NUTRRIONIST (ARLINGTON)
NUTRRIONI57 (GA�
HEALTN EDUCATOR (CENTRAL)
HEALTN EDUCATOR (COMO)
NEALTH EDUCATOR (NUM80LD'f)
HEALTH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARDING)
HEALTH EDUCATOR (AGAP�
HEALTH EDUCATOR (ARLINGTON)
HEALTH EDUCATOR (GAP)
IXECUTNE DIRECTOR
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
S
$
$
$
$
$
$
$
$
$
$
$
$
$
41,530
48,538
43,225
43,952
41,530
42,222
48,538
36,979
32,999
36,390
35,802
29,365
34,781
20,194
19,605
2o,�sa
21.388
18,913
18,965
18,965
'18,965
35,802
36,304
38,882
35,802
36,304
36,304
34,885
29,849
33,535
30,818
29,849
33,535
33,535
27,808
34,158
45,890
0.80
0.80
0.80
0.65
0.80
0.90
0.18
0.40
0.40
0.60
0.40
0.50
0.75
1.00
1.00
1.00
1.00
1.00
0.20
�.00
0.75
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.10
0.05
0.15
0.10
0.10
$ 33,224 $ 26,579
$ 38,830 $ 31,064
$ 34,580 $ 27,664
$ 28,569 .� 22,8r'J$
$ 33,224 $ 26,579
$ 38,000 $ -
$ 8,494 $ '
g 14,791 $ 13,312
$ 13,199 $ 11,880
$ 21,834 S 19,651
$ 14,321 $ 12,889
$ 14,682 $ • -
$ 26,�86 S '
$ 20,194 $ 16,155
$ 19,605 $ 15,684
$ 20,194 $ 16,155
$ 21,388 S 17,110
$ 18,913 $ 15,131
$ 3,793 $ -
$ 18,965 5 -
$ '{4,� $ -
$ 5,370 $ 4,296
$ 5,446 $ 4,356
$ 5,832 $ 4,666
$ 5,370 S 4,296
$ 5,446 $ 4,356
$ 5�446 $ -
$ 3,488 $ -
$ 2,985 $ 2,688
$ 3,354 $ 3,018
s s,os2 $ z,na
$ 2,985 $ 2,686
$ 3,354 $ 3,018
$ 1,677 $ -
$ 4,171 $ -
$ 3,416 S -
$ 4,589 $ 4,589
� SUS TOTAt SALARY
' annual salary based on 42 week schooi year
FRINGE BENEFITS Ca 20°h
$ 523,120 $ 313,451
$ 104,fi24 $ 62,690
95
Application Narrarive
Health Start
Adolescent Health Services
CY 2001 Budget
�
ANNUAL PROGRAM PROGRAM MCH
LINE ITEM EXPENSE sn�n�' Fse BuocEr euocEr
CONTRACT SERVICE
FAMILY PfiACTICE PHYSICIAWNURSE MIDWiFE
NINE PHYSICL4N CUNICSNJK @$320 X34 WKS
THREE CNM CUNICANK @ S'125�CLINIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON)
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIENT CARE
LAB, ULTRASOUND, X-R4Y
OTHER EXPENSE
MEDICATION/DRtJGS
MEDICAL SUPPLIES
OFFlCE SUPPLIES
PRINTINGIDUPLICATING
EQUIPMENT
TRAINING
PA7IENT TRANSPORTATIOWCOURIER
TOTAL DtREC7 EXPENSE
INDIRECT EXPENSE @ 16°k
TOTAL PROGRAM EXPENSE
TOTAL MCH 6RANT REQUEST
MATCHING FUNDS � 25k
$34,546
H1GHLnND SCHOOL BASID CLIAIIC FUNDID BY SEPERwTE GRnNf SOURCE
$ 97.920 $ 58,752
$ 12,750 $ 7,650
$ 5,348 $ 3,209
$ 34,546 $ 20,728
$ 36,750 $ 18,375 �
$ 22,050 $ 9,��
$ 8,925 $ 3,570
$ 12,600 $ 5,040
$ 2,625 $ 1,050
$ 5250 $ -
$ 1,575 $ -
$ 2,100 $ 840
$ 870.183 $ 505,035
S '139.229 $ -
$ 1,009,413 $ 505,035
$ 505,035
$ 126,259
�
.�
� � �' 3
Appiication Narrative " ��
.
�
.
Room 111- Saint Paul - Ramsey County Department of Public Health - STD
Services to Adolescents
Since 1971, Public Health's Room 111 has provided for se�cually transmitted disease (STD)
diagnosis, treatment, refenal, follow-up and epidemiologic investigation. Room 111 was the fust
publicly funded "VD" clinic in the State of Minnesota. Room 111 has idenufied and attempted to
address changing challenges and focuses of STDs. Providing these services in an accessible and
confidential manner aze key goals of this program. Walk-in services are available as aze morning,
afternoon and evening hours of service.
Goal - To provide accessible, confidential services to adolescents regarding education, detection
and treatment of sexually transmitted diseases.
Tar�et Population - The clients targeted to be served are adolescents, primarily through 19 years
of age.
Obiectives -
1. To screen and provide education to 725 adolescents, 19 years of age and under for
sexually transmitted diseases (STDs) during each CY 2000 and 2001.
2.
3.
To diagnose and treat idenf'ied cases of STDs.
To decrease each year in CY 2000 and 2001, the number of cases of STDs, particulazly
chlamydia and gonorrhea, in adolescents.
Metho s -
• Clinic nurses who see clients in Room 111 will provide accessible, co�dential diagnosis,
education, treatment, referral and followup of STDs in adolescents.
• Clinic nurses will provide education on the prevenuon of STDs.
Evaluation - Encounter data gathering demographic data, visit, procedure, and diagnostic code
data are collected for each visit. These elements can be queried to provide data on types and
quantity of services used, as well as target population reached by age and race.
Communiry data trends will also be assessed to determine trends of STD rates in adolescents.
97
Application Narrative
• Training & Ex er� ience - Room 111 clinic is staffed by three or four nurses who aze highly skilled
STD cluricians. All staff have completed MDH-provided HIV counseling and testing uaining and
attend appropriate continuing education courses on a regular basis. The cluricians include: .
JoEllen Neitzke, RN who has worked as a clinic nurse at public health for 26 years; Sandy
Rooney, RN, who has 17 years of experience at public health; Laura Diedrich, RN, a clinic
nurse at public health for the past 14 years; and Alice Williams, PHN who has been with public
health working in Room 111 for the past seven years.
Linkaees - Public Health's Room 111 has well-developed linkages that include a wide variety of
health care providers, educarional programs, and social service agencies. This refenal network
allows staff to provide care and referrals for clients as needed. Some of the primary linkages
include HealthPartners/Regions Hospital, ffie Minnesota Department of Health, other public
health programs and correctional institutions.
Reimbursement and Fees - Because of the confidential and sensitive nature of the serivices
provided, Room 111 provides services on a donation basis. The adolescents who aze seen aze low
income (200% of federal poverty or less). Third parties are biiled whenever possible.
Subgrants/Subconuacts - Room 111 contracts for the provision of a Medical Director and
physician services with HealthPartners. The Medical Director is responsible for protocols and �
general medical direction for the programs.
Budget Justification - Room 111 will receive $12,550 in 2000 and $11,824 in 2001 to support
STD services to adolescents. The totai budget and justification for the budget follows.
•
�
Application Narrative
� � n
. . ��73�
�
�
•
Room 111 - Adolescent Health STD Services
2000 and 2001 MCHSP Grant Budget
Position MCH �nds Other F�nds Total Funds
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, ueahnent and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
22 FTE 12,550
43,906
$ 56,456
CY 2000
Clinic Nurse
To provide screening, diagnosis,
education, treatment and refenal
to adolescents for STDs @ $27.14/hour
salary and fringe
21 FTE 11,824
44,632
$56,456
..
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ATTACHi��NT B
� SOLICTTATION PROCESS FOR SUBGRANTS
Notification of the availability of funding was provided to qualified programs in the area through
a direct mailing of a Request for Proposals (RFP) to 37 agencies and a public notice placed in the
Saint Paul Pioneer Press on June 4, 1999 The process for selection of priority program
components and the process for selecting the requests (evaluarion criteria) included in the grant
applicauon are explained in the following RFP. The public nouce, a list of agencies receiving
the direct mailing, and a list of the agencies requesting subgrants are also included in this
attachment.
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104
NOTICE OF AVAILABILITY OF MATERNAL & CHII,D HEALTH (MCI� FUNDS
AND REQUEST FOR PROPOSALS (RFP)
ISSUED NNE 2, 1999 �
SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH
�YUu� li� /:\:��
The Saint Paul-Ramsey County Department of Public Health invites community health service
providers and related organizations to submit proposals to conduct maternal and chiid health
projects for:
improving pregnancy outcomes through outreach, referral and/or the direct
provision of prenatal caze for low income/high risk individuals during the period
of January 1, 2000 - December 31, 2001.
The Saint Paul-Ramsey County Department of Public Health will designate up to $140,000 in
State Maternal & Child Heaith Special Project funds over this two-year period to support selected
proposals addressing improved pregnancy outcomes. Proposals are due at 555 Cedar Street,
Attention: Sharon Alt by 4:00 p.m. �esday Ja1y 6, 1949.
An MCH ad hoc task force including representation of the Community Health Services Advisory �
Committee and addiuonal appropriate agencies will review the proposals and make
recommendations to the Board of Health for approval. Approved proposals will be included in
the Saint Paul or Ramsey County Maternal & Child Health Speciai Project Application to the
MN Deparnnent of Health.
Applicants for these competitive grant funds must show evidence of 501 � 3 status, or be local
government agencies_ Applicants must also meet the eligibility requirements and proposal
guidelines outlined in the following instructions, and be in compliance with attached assurances
and agreements.
USE OF MCH SPECIAL PROJECT FUNDS
Based on an assessment of community needs, Tfie Saint Paul - Ramsey County Department of
Public Health is choosing to focus the available funds on projects for improving pregnancy
outcomes. Public Health will allocate up to $70,000 each year for this purpose, targeted to
populations described in the MCH Priorities section of the RFP. Outreach, referral and duect
services may be provided in a variety of settings. At least one awarded project will serve
pregnant women in suburban Ramsey County. �
105
r�� ''�3
AttachmPntc - ' U
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All applicants must demonsuate in-kind contributions equal to a minimum of 25 % of the grant
request. Proposals must comply wiffi the legislative definitions of eligible services and the MCH
services priorities.
Applicants may request funds for up to two years or less during the period of 1/1J2000 -
12/31/Ol. It is anticipated that 2� projects will be funded with grant awards ranging from
$15,000 -$35,000 per year. Proposals may be for either one-time only projects or projects
requiring some source of continuation funds. NOTE: MCA funds cannot be guaranteed beyond
12/31/Ol and should not be relied on for continuation of the project beyond 12/31/Ol. If state
funds to public health are reduced during the grant cycle, this reduction may be passed on to
subgrantees.
MCH PRIORTTIES
Improved Pregnancy Outcomes
To reduce the overall rate of late (3rd trimester or none) prenatal care (Saint Paul: 5.6%
in 1997) with a special emphasis on pregnant teens (8.7 %), and all pregnant African
American (8.0%), Native American (10.0%), and Asian (11.1 %) women.
To nnprove the infant mortaliry rate for Saint Paul (8.8 for 1995-97 3 year average) with
a special emphasis on African American women (13.4 for 1995-1997 3 year average), and
American Indian (12.0 for 1995-97 3 yeaz average); and
��
The infant mortality rate for Ramsey County (7.5 for 1995-97 3 year average), African
American rate (14.2 for 1995-97 3 year average), American Indian rate (13.4 for 1995-97
3 year average).
To reduce the rate of Saint Paul low birthweight infants in Saint Paul and Ramsey
County.
1997
Saint Paul
1997
Ramsey County
Overall low birthweight 7.5% 6.7%
White low bir[hweight 6.9% 63%
African American low birthweight 12.4% 12.1 %�
American Indian low birthweight 10.0% 10.7%
Asian/Pacific Islander low birthweight 5.4% 5.0%
106
4. To conduct ouueach efforts to pregnant teenagers to increase the rate of first trimester
prenatal care (in St. Paul and suburban Ramsey County pregnant women under age 20
with a special emphasis on outreach to minority teens. (For births to women less than 20
years of age in 1997, 52.4 % in Saint Paul, and 55.3 % in all of Runsey Counry began
prenatal caze in the fust trimester).
�;�•� �;u:
The proposal should consist of a narrative descripuon limited to ten pages which describes the
project in the following format:
i. Project Title
2. Name & Address of Applicant
3.
4.
5.
6.
7.
Contact Person - Name and Phone Number
Agency/Organization Description and Mission Statement
Amount Requested and Project Period
Project Abstr¢ct (I page)
Project Narrative
a.
Q
c.
�
e.
Goai Statement
Ta�et Popularion - describe the target population relative to age, income and risk
factors, and include an estimate of the number of individuals to be served.
Obiectives - specific statements of what is to be accomplished during the project
period; objectives should be time-specific, realisric, and stated in measurable
terms.
Methods - describe the specific activiries by which objectives will be achieved;
include how and why activities were selected, and how procedures for refenal and
follow-up will be incorporated into services provided.
Evaluation - describe the intended outcomes of the project, and the methodologies
to be used to analyze the impact the project has had (outcomes) on the problem
.
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n !� �'1 '7
- 11 Y
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Training/Experience of Key Staff - sum*nari�e; one page - resume may be attached
�
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h.
over time, so that the projecYs effectiveness may be assessed. The projecYs
outcome, objectives and evaluauon plans need not be limited to the two year grant
cycle. The evaluation plan should include evaluation questions, data to be
collected and use of evaluation results.
Linka s- describe the linkages with other relevant maternal and child health
service providers in the project service azea. Include a procedure for written
referrals for service needs not addressed by project.
Reimbursements and Fees - describe plan for use of reimbursements from the
Department of Human Services (Minnesota Health Caze Programs). If fees are to
be charged to clients, please describe the sliding fee schedule to be used.
Budget - Include a detailed project budget itemizing:
Personnel and other costs
Cost per unit of service provided and total units of service to be provided.
Expenditures and revenue including reimbursements from DHS (Minnesota Health
Care Programs) and patient fees.
In-kind contributions
Budgets must be completed separately for each calendar year.
Attachments
Proof of 501(c)3 status (if not a unit of local govemment)
List of Board if Directors if non-profit organization
Key Project staff resumes or job descriptions if position is vacant.
SUBMISSION OF PROPOSALS
Bight copies of the proposal should be submitted by 4:00 p.m., July 6, 1999 to Sharon Alt at 555
Cedar Street, St. Paul, MN 55101. Questions about this announcement may be directed to
MaryLou Egan at 651-266-8025.
Minimum Requirements
For a proposal to be considered valid it must be:
108
• Submitted in writing, with required copies provided
• Submitted on time
• Signed by an officer of the organization who can be held accountable for all representauons
Proposal Preparation
The response to this RFP must include an original and seven copies of the proposal. The first
page of the original must have the original signature of the officer who will be accountable for all
representations. Unsigned proposals may be considered invalid.
EVALUATION / REVIEW PROCESS
An MCH ad hoc task force including representation of the Community Health Services Advisory
Committee and additional appropriate agencies will review proposals and make recommendations
to staff and the full Advisory Committee. The CHS Advisory Committee will review these
recommendations and advise the Saint Paul Board of Health and the Ramsey County Board of
Commissioners about proposals recommended for funding. Proposals approved by these bodies
will be incorporated into the DepartmenYs MCH Special Project Application to be sent to the
Minnesota Department of Health.
Proposal Review Criteria
All applicants must demonstrate their ability and willingness to meet all of the requiremenu of
the State and County. All applications for the MCH funding through the Saint Paul - Ramsey
County Department of Public Health must meet all of the requirements contained in this
document. All qualified applications will be judges based on the criteria and specifications
oudined in this RFP. Please see attached list of review criteria and ranking (pages 7-8).
Timetable
The MCH planning timetable is as follows:
7/6/99
7/7/99 - 7/21/99
8/4/99
Aug/Sept1999
9/15/99
Proposals must be submitted by 4:00 PM .
Review and selection of proposais by MCI� Review Committee
CHS Advisory Committee review of MCH Plan
Approval by Saint Paul Boazd of Health and Ramsey County Boazd
of Commissioners
MCH Plan sent to Minnesota Dept of Health
Applicants will be nofified of funding decisions by August 30, 1999.
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109
AtYar}�mAnte '`� � � / �
- _ �T�_
Upon approval by the Minnesota Department of Health (MDH), Public Health staff will develop
contracts with the approved applicant agencies for the project services. Approved projects will
. be required to submit monthly or quarterly reports (as specified in the contract) and expenditure
reports to obtain reimbursement. A copy of the reports required by the MDH are enclosed in the
RFP (pages 9-12). Actual reporting requirements may vary.
•
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110
AFFIDAVIT OF PUBLICATION
STATE OF MINNESOTA
COUNTY OF RAMSEY
JOANIE M. PUTZ
being duly sworn on oath, says: that she is,
and during all times herein state has been,
Cterk of Northwest Pubtications, Inc.,
Publisher of the newspaper known as the
Saint Paul Pioneer Press, a newspaper of
generai circulation within the City of Saint
Paul and the County of Ramsey.
THAT the notice hereto attached was cut
from the columns of said newspaper and
was printed and pubtished therein on the
following dates: �
�
4'" day of June 1999 •
newspaper ref tJlad �l : 14790
`Z�v�c�iiv/ e /
Subscribed and swom to before me is
7'" day of June 1999
P IC
Washington County, Minnesota
My commission expires January 31, 2000
� KAY/;S.flRCME e
•,` H071JiYPUBl1C.A6;i�LSCTA
�4 WASHING'fOt:COUt,1T1'
S!y Co�Mkh E�€y'vts din.37. i!n; .
M'if+�►isi� t�
111
� � ��
_
AGAPE
360 COLBORNE ST
S� UL MN 55102
ARLINGTON HOL3SE
951 E STH ST
ST PAUL MN 55106
BETIIESDA FAMILY PRAC CLIAIIC
590 PARK ST SUIT'E 310
ST PAiJL MN 55103
BOOTH BROWN HOUSE
1471 COMO AVE
ST PpUL MN 55108
ANN RICKETI'S
FACE "f0 FACE HEALTH & COUNSEL
11 K3 ARCADE ST
ST pAUL MN 55106
TH� LOFT TEEN CENTER
10F3 IGLEHART AVE
ST pAUL MN 55104
I�ANCY BRIGGS
NQRTH END HEALTH CENTER
li� MAMTOBA ST
ST PAUL MN 55117
KEGIONS HOSPITAL PEDS CLINIC
680)ACKSONST
ST PAUL MN 55101
SETON CENTER
1_?6 LJNIVERSITY AVE W
ST PAUL MN 55104
2.1:�VIS BREHM
�1'EST S[DE HEALTH CENTER
1�_ CONCORD ST
ST PAUL MN 55107
CATHOLIC CHARIT'IES OF ST PAUL
215 OLD 6T'H ST
ST PAiJL MN 55102
PEG LABORE
FAMII.Y TREE CLII�TIC
1619 DAYTON AVE
ST PAUL MN 55104
LUTf�RAN SOCIAL SERV OF MN
STATE CENTER
2485 COMO AVE
ST PALTL. MN 55108
PLANNED PARENTHOOD OF MN
1700 RICE ST
ST PAiJL MN 55113
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PALTI. MN 55102
iJNITED FAMII,Y HEALTH CENTER
545 W 7TH ST
ST PAUL MN 551�2
AVfER7CAN INDIAN FAMIl,Y CENTER CAPITOL COMMUNITY SERVICES
5?9 WELLS NORTHBND
STPALJLMN 55701 ]021MARIONST
ST PAtJI. MN 55117
'f COMMUNI'J'IES FAM SERVICE
3 COPE AVE B SUITE C
I�LiPLEWOOD MN 55109
FAMILY SERV OF GREATER ST PAUL
166 E 4T'H ST #330
ST PAUL MN 55101
CERTIFIED NURSE N�WIVES
RAMSEYFOUNDATTON
640 7ACKSON ST
ST PAIJL MN 55101
CAROL WHITE
HEALTH START INC
491 W LTNIVERSITY AVE
ST PALTI, MN 55103-1936
BARTON WARREN
MODEL CITLES HEALTH CENTER
430 N DALE ST
ST PAiJL MN 55103
REGIONS HOSPITAL OB/GYN CLINIC
640 JACKSON ST
ST PALTL, MN 55101
STPAUL WOMAN'S CLINIC
1690 iJNIVERSITI' AVE
ST PAUL MN 55104
iJNITED HOSPITAL-MOD CLINIC
333 N SMITA ST
ST PAUL MN 55102
DEPT OF INDIAN WORK
7611 SUMMITAVE
ST PALTI, MN 55105
LAO FAMILY COMMUNITY
320 N UNIVERSITY AVE
ST PAtIL MN 55103
112
AtYachmPntc
MAIZTIN LUTf�R KING/HALLIE Q MERRIAM PARK COMM CENTER MERRICK COMD4UNITY SERVICES �
BROWN CENTER 2000 ST ANIHONY AVE 715 EDGERTON ST
270 KENT ST ST PAUL MN 55104 ST PAUL MN 55101
ST PAUL MN 55102
NEIGHBORHOOD HOUSE
t79 ROBIE
ST PAL1L MN 55107
NORTHWEST YOUTH & FAMII.Y SERV
3490 LEXII�TGTON AVE N
SHOREVIEW MN 55126
iJNITED FAMII.Y PRACTICE/EIELPING
HAND HEAL7�-I CENTER
545 W 7TH ST
ST PAUL MN 55102
WEST 7TH COMMUNITY CENTER
265 ONEIDA
ST PAL7L MN 55102
WII,DER SERV TO CHII,DREN & FAM
919 LAFOND AVE
ST PAiJL MN 55104
r 1
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n ^ � i �
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Agencies Submitting Proposals for Subgrants
, The following community agencies submitted proposals to Saint Paul - Ramsey Counry
Department of Public Health by the deadiine:
1. Face to Face Health and Counseling Service, Inc.
1165 Arcade Street
Saint Paul, Minnesota 55106
2. Health Start, Inc.
491 West University Avenue
Saint Paul, Minnesota 55103
3. North End Health Center, Inc.
153 Manitoba Avenue
Saim Paul, MN 55117
4. West Side Community Health Cemer, Inc.
153 Concord Street
� Saint Paul, Minnesota 55107
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REQUESTS FOR MCH SPECIAL PROJECT FUNDS
for Improved Pregnancy Outcomes
Agency:
Amount requested:
Target population:
Proposal:
Face to Face Health and Counseling Service
$80,000 - Y1: $40,000 Y2: $40,000
L.ow income adolescents, 50% of wluch will be youth of color; Dayton's
Bluff, Sunimit University, Thomas Dale, Riverview
Continue outreach/case management program; provide outreach,
pregnancy testing, education and counseling, prenatal care, risk
assessment
Agency: North End Medical Center, Inc.
Amount requested: $36,842 - Yl: $18,574 Y2: $18,268
Tazget population: Low income, high risk women in the North End/Rice Street areas of St.
Paul and lst ring suburbs including Roseville, Vadnais Heights, Little
Proposal:
Canada, Maplewood, North St. Paul and White Bear Lake, with priority
to teens and African-American and Native American women of ali ages.
Outreach to promote early prenatal care, linking persons to care,
decreasing tobacco, alcohol and drug use.
Agency: West Side Community Health Center, Inc.
Amount requested: $32,500 - Yl: $16,250 Y2: $16,250
Tazget population: Hispanic and Southeast Asian women, ages 13-35, in specific census
tracts in 3aint Paul that have the highest concentrations of Hispanic and
Southeast Asians.
Proposal:
Agency:
Amount requested:
Tazget population:
Proposal:
Ouueach, tracking of positive pregnancy tests, prenatai risk assessments,
and coor@inating services.
HealthStart, Inc.
$1,403,972 - Yl: $'753,236 Y2: $753,236
High risk, low-income adolescents and women at high risk for prenatal
and birth complications, with a focus on minorities.
Outreach, education and comprehensive, multi disciplinary prenatal care
and comprehensive health care services at high school sites.
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�`, �' r a
— U I l
AGENCY NAME:
. REVIEWED BY:
SAINT PAUL - RAMSEY COUNTY DEPARI'MENT OF PUBLIC HEALTH
MCH COMPETTTIVE GRANT
REVIEW CRITERIA
�.J
�
POOR SATI5 EXCEL
I. APPLICATION
A. Is in accordance with Saint Paul - Ramsey Coun 1 2 3 4 5
Department of Public Health MCH priorities
B. Proposes services targeted to low-income high
risk individuals in targeted areas 1 2 3 4 5
C. Is cleazly written and the format facilitates
review 1 2 3 4 5
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, racial/ethnic distribution, and
eligibility criteria 1 2 3 4 5
B. The applicant can demonstrate past successful
experience working with target populations 1 2 3 4 5
C. Low-income, e.g. <20Q% of poverty or women
who are pregnant and determined eligible for M.A. or
WIC 1 2 3 4 5
D. Identify risk criteria consistent with MDH
guidelines 1 2 3 4 5
III. OBJECTIVES
A. Described 1 2 3 4 5
B. Related to priorities 1 2 3 4 5
C. Realistic 1 2 3 4 5
116
d trarhmPntc
D. Time Specific 1 2 3 4 5
E. Measurable 1 2 3 4 5
F. Identify ciient's or community's needs, not the
ap plic anY s 1 2 3 4 5
POOR SATLS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted public health
pracrice 1 2 3 4 5
F. Maxitnizes use of aIternarive health care
providers where appropriate 1 2 3 4 5
G. Likely to achieve objecrives 1 2 3 4 5
V. EVALUATION
A. Ali activities which warrant evaluarion are
identified 1 2 3 4 5
B. Methods for collecting the data aze describe and
are feasible 1 2 3 4 5
C. Gives evidence that evaluarion results will be
used for program management decisions 1 2 3 4 5
D_ Collects data which relate to the objectives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objecrive as well as subjecrive 1 2 3 4 5
117
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VI. TRAINING/EXPERIENCE
A. Indication of work experience, training, and
qualifications for staff direcfly involved in the project is
included 1 2 3 4 5
B. Plan(s) to identify and address continuing
education needs of staff 1 2 3 4 5
VII. LINKAGES
A. Linkages and referral arrangements with other
community service providers are described and relate to
goals, objectives, and methods 1 2 3 4 5
B. Description of current or anticipated
cooperative agreements to minimi�e potential
� for duplication
C. Plans for or descriptions of ongoing
collaborative activities with providers such as
participation on task forces, committees, etc.
D. Applicant can show experience in successful
follow-up on referrals
VIII. BUDGET
A. Budget items are justified in terms of project
activities
B. Complete
C. Provides a rationale for formula/process for
calculation of items
•
POOR �SATIS IEXCEL
1 2 3
1 2 3
1 2 3
1 2
1 2
1 2
3
3
3
4 5
4 5
4 5
4 5
4 5
4 5
118
D. Amount of funding requested is appropriate •
for the level of service and objecrives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonstrated in kind contributions ��
of at least 25% of the grant request
F. Are mathematically correct
G. Indicates plans to obtain and use DHS
reimbursements (Medical Assistance,
MNCare)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDITIONAL CONIl�4ENTS/RECOMNNIEEIVDATIONS:
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