01-999Council File # �y��!
Green Sheet # 11365�„
Presented by
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
�O
Referred To Committee Date
1 WHEREAS,thecityofSaintPaulandRamseyCountythroughtheSaintPaul-RamseyCountyDepartmentofPublic
2 Health aze required by Statute to prepaze a Community Health Services Plan and Update for that plan (CHS Plan
3 Update) to receive a Community Health Services subsidy; and,
4 WHEREAS, the 2002-2003 CHS Plan Update was deve]oped by the Saint Paul-Ramsey Count7 Departsnent of
5 Public Health Services Advisory Committee with input from the community; and,
6 Wf�REAS, the 2002-2003 CHS Plan Update and a summary of that Update were made available for public review
7 and comment and the public was notified of that availability; and,
8 VJHEREAS, the Maternal and Child Health Special Proj ects Grant — Saint Paul: 2002-2003 Update Applicarion is
9 required to be submitted to the Minnesota Depariment of Health by the Saint Paul-Ramsey County Department of
10 Public Health and is attached to the CHS Plan Update; and,
11 WI3EREAS, the Community Aealth Services Plan must be approved by the City Council as outiined in the Public
12 Health Joint Powers Agreement; now,
13 THEREFORE BE IT RESOLVED, that the City Gouncil accepts for submission to the Ramsey County Boazd for
14 their apporval and submission to the Minnesota Department of Health the 2002-2003 CHS Plan Update and the
15 Saint Paul Maternal and Child Aealth Grant.
Requested by Department oL
Adoprion Certified by Council Secretary
sy: ''��.^� , -f�.`� _ _ t —
Approved by Mayor: Date �� � LiA3� (
By: �'C�� I
�
Form Approved by City Attomey
�
Approved by Mayor for Submission to Council
�
Adopted by Council: Date �,� �_ � C7 ��
Council
RSON & PF10NE -
�����
GREEN SHEET
o�.qt'1
Council President BosCxom
iT BE ON COUNCILAGFNOA BY (OA7E1
�t. 20, zooi
TOTAL # OF SIGNATURE PA6ES
o[.M,renonFZrorz
No 113652
arv�
❑ CRYAiTGUEY ❑ fJIYpiR1I
❑ AU11L'lM.iERYKFJOYt ❑ R1M1q11L1ERll/1CCTG
❑wroR�oRwsmriu+n ❑
(CLIP ALL LOCATIONS FOR SIGNATURE)
Accepting the 2002-2003 Community Health Services (CHS) Plan Update and the SainC Paul
Maternal and Child Health Grant for submission to the Ramsey County Board for their
approval and submission to the Minnesota Department of Health.
s
PIANNING COMM.tSSlON
CIB COMMI'fSEE
CIVIL SERVICE COMMISSION
f13_1:S Z���
Hasthis Ce«�K� arerwaked under a conhact for thia tlePa�menli
YES NO
Has �is pemoMrtn ever been a atY emDloYee7
YES NO
Dces fhis Pe���� P� a s1a11 r� namallYP�s¢tl bY any artent citY emWoyee7
YES DEO
Is this pe'soNfirtn atarpeted venEO�
YFS NO
OF TRANSACTION S
SOURCE
COSTfliEYENUEBUDGETED�CIRCLE ON�
ACTNI7Y NUMBER
YES NO
(��M
Saint Paul - Ramsey County
Department of Pnblic Health
Ro b Fult Di recxor
4 � -'L°�°1
50 W. Kell6gg 81vd.. Ste. 930
Sairct Pau{, Minr�esota 55102
651-266-2400
l'o: Saint Paul City ncil
From: Robert Fu4ton �
Jane Norbin` �'
Re: Updnte of the 2002-2003 Community Heafth Services Pfan
Llate: September 11, Z001
The Pubfic 1-le¢Ith Joint Powers Agreement requires City Councii approva) of
Community Health Services Pians (Pian/s) nnd their updnfies. The state requires new
Plans every four yenrs and updates every two years. We now seek Counci! approval
of the update to the four-yenr Pian approved by the Council in 1999 (n draft
resolytion a►id Update nre attrsched for your convenience). The Update must next
be npproved by the Ramsey Courity Board and fihen be subm'rtted to fihe Minnesota
Department of Henith by October 31�' of this year.
No new community health problems arose during the update process. Some of the
P1nn's strategies, however, were upda#ed to reflect the P1an's progress and recent
enhancemeofis of the public health operafiing environment, The enhancements
include n minority health grant; Temporary Assistance to Needy Families; Youth Risk
Behavior Endawment 6runt nnd the Adolescent Parenting Program.
�inally, the Ptan incorporates the Maternai and Child Nealth 6rant-Snint Paul:
Z�Q2-2Q03 Update Application.
To develop the Update, the Saint Pnul-Ramsey County Dapar#men# of Public Hea4th
(SPRCDPH) obtained input from staff and the community through a vuriety of
methads, including:
1. Update and analvsis of CHS Plan data.
2. Department-wide review of CHS Proarum Plan strntegies.
Q1-999
September 11, 20Q1
Update of the 2002-2003 Communi#y Health Services Pian
3. Pubiic Notices Public notice of the initint+on af the Update process was
published sn the Saint Paui Pioneer Press in 3anuary 20Q1. Another notice was
published May 13, Z041 ta inform 1'he public of when drafts of the Updnte would
be availabie for inspection. Posi�cards with the newspaper nofiice informatian
were also mnited to the genera! mailing 3ist of the SPRC�PH. A summnry of the
Update has afso been nva+lable on the SPRCDPH World Wide Web site.
4. Public Meeting nnd meetinq of i'he Saint Paul-Ramsev CountY Eommunitv Heatth
Services Advisorv Commififiee. A pubiic meeting was he}d i» conjunction with the
Saint Paul-Ramsey County Commun+ty Healfih Services Advisory Comrnittee
meeting, on June b 200i. The Adv+sory Committee and the public provided
feedback on the Update.
Thank you.
Attnchments:
Draft City Counc+l Resalution
CNS Pian Update Summary
CHS Plan Update
Maternal nnd Child Heai#h Special Pro jecfis Grant - Saint Pnu1:2002-2003 Update
Application
Saint Paul - Ramsey County
Department af Public Health
Rob Fulton, Director
o � -���
50 W. Kellogg Bivd.. Ste. 930
Saint Paul, Minnesota 55102
651-2b6-24Q0
To: Saint Pnui City ncii
�rom: Robert Fulton �
Jane Norbin�"
Re: Update of the ZOOZ-2003 Community Henith Services Plan
flate: September 11, ZOOI
The Public Healfih Joint Powers Agreement requires Gity Counc+l nppraval of
Communifiy Health Services Plnns (Planls) and their updntes. The state requires new
P{ans every four years and updates every two years. We now seek Counci{ approval
of the update to the faur-year Pfan approved by the Council in 1999 (a draft
resolution and Update are afitached for your convenience). The Update must next
be approved by the Ramsey County Board nnd then be submitted to fihe Minnesofia
Department of Health by October 32'� of this year.
No new commun+ty hea{th prob{ems arose during the update pracess. Sorne of the
Plnn's strategies, however, were updated to reflect the Plcan's progress and rece»i
enhancements of the pubtic henith o}�erating environment. �'he enhnncements
include Q minority heafth granfi; Temporary Assistance to Needy Families; Youth Risk
Behavior Endowmenfi 6rant and the Adalescent Parenfiing Program.
Finally, the Plan incorporates the Maternal and Child Necsith Grant-Saint Pau(:
ZOQ2-ZOQ3 Update Appl+ca#ion.
To develop the Update, the Saint Paul-Ramsey County Departmen# of Public Henith
(SPRCDPN) obtained input from staft and the community through a variety of
methods, inciuding:
1. U�date and analvsis of CNS Aian data.
2. Department-wide review of CHS Proaram Pian strateaies.
01
September 11, 200f
Update of the 2002-2003 Community Health Services Plan
3. Public Notices. Public notice of the initiation of fihe Updafie process was
pub!'rshed in the Saint Paui Pioneer Press in January 2002. Another nofiice was
publ'sshed May 13, 2001 to +nform the public of when drafts of the Update would
!�e availnble for inspec#+on. Postcards wifih the newspnper notice intormation
were also mniled to the general mailing list of the 5PRC�PFi. A summary of the
Update has also been avo's4able on the SPRCDPH World Wide Web site.
4. Pub{ic Meetinq nnd meetina of the Saint Paul-Ramsey Coun#�Community Neatth
5ervices Advisor�Committee. A pub{ic meeting was held in conjunct+on with the
5aint Pau{-Ramsey County Community !-lealth Services Advisory Committee
meetiny, on June 6 2(}Ol. The Advisory Gommittee and the public provided
feedback on the Update.
Thank you.
Attnchmenfis:
Draffi City Council Resofution
CHS Plnn Update Summcrry
CH5 Plnn Update
Maternal and Child Heal#h Special Pro jects 6rant - Snint Pau1:20Q2-2003 Update
Application
d�--9�9
2
DRAFT RESOLUTION
CTTY OF SAINT PAUL, MINNESOTA
2002-2003 CHS Pian Update
WHEREAS, the city of Saint Pau1 and Ramsey County through the Saint Paul-Rawsey
County Deparhnent of Public Health are required by Statute to prepaze a Community
Health Services Plan and Update for that plan (CHS Plan Update} to receive a
Community Hea�th Services subsidy; and
10 WHEREAS, the 2002-2003 CHS Plan Update was developed by the Saint Paul-Ramsey
11 County Department of Public Health and the Saint Paul-Ramsey County Community
12 Health Services Advisory Committee with input from the community; and
13
14 WHEREAS, the 2002-2003 CHS Plan Update and a summary of that Update were made
15 available for public review and comment and the public was notified of that availability;
16 and
17
18
19
20
21
22
23
24
25
26
2'7
28
29
VJHEREAS, the Matemal and Child Health Special Projects Crrant — Saint Paul: 2002-
2003 Update Application is required to be submitted to the Minnesota Department of
Heaith by the Saint Paul-Ramsey County Depariment of Public Heaith and is attached to
the CHS Pian Updaxe; and
WI-IEREAS; the Community Health Services Plan must be approved by the City Council
as outlined in the Public Health Joint Powers Agreement;
THEREFORE, BE IT RESOLVED, that the City Council accepts for submission to the
Ramsey County Boazd for their approval and submission to the Minnesota Department of
Health the 2002-2003 CHS P1an Update and the Saint Paui Maternal and Chiid Health
Grant.
ot-999
2000-2003
Saint Paui-Ramsey Coun�ty
Community Health Services Program Pian:
Update Summary
September 12, 2001
Saint Pau!-Ramsey County Department of Public Health
Health Poiicy and Pianning
50 West Keliogg Boulevard; Sufte 930
Saint Paui, Minnesota 55102-1657
Telephone: {651) 266--2403
http://www.co.ramsev.mn. us/P�ndex.htm
t�1-999
TABLE OF CONTENTS
Zaoa2oo3
Saint Paut-Ramsey County
Community Heafth Services Program Plan:
Update Summary
ACKNOW LEDGEMENTS .............................................................................................................................1
INTRODUCTION TO THE UPDATE SUMMARY .........................................................................................2
SUMMARY OF THE CHS PLAN UPDATE PROCESS
..... 3
SUPAMARY OF PUSLIC HEALTH PflOBLEMS THAT EXIST IN THE COMMUNfTY AND GOALS
(OUTCOMES) FOR ADDRESSING THOSE PROBLEMS ...........................................................................5
PUBUC HEALTH PROBLEMS ORGANIZED ACCORDING TO PUBLIC HEALTH PLANNING
CATEGO I ES ............................................................................................................................................... 8
ol -g�g
COMMUNITY HEALTH SERVICES ADVISORY COMMITTEE'
Joan Johnson, Chair
Shana Morrel% Vice Chair
Mary Jo Borden
Lucie Ferrell
�d;FG'E7 ..��
James Haselmann
Gabrieile Lawrence
Susan Mitchell
Shana Marrell
CITY OF SAINT PAUL
Norm Coleman Mayor
Saint Paul Board of Health
Jay Benanav
Jerry Blakely
Dan Bostrom, Chair
Christopher Coleman
Michael Harris
Kathy Lantry
Jim Reiter
Ann Ricketts
John Rossbach
Greg Sheehan
Nancy Whde
Lori Husivedt
Theresa Lang
Gregory W. Bemard
RAMSEY COUIVTY
Paul Kirkwold, County Manager
Ramsev Countv Board of Healfh
Tony Bennett
Jim McDonough
Susan Haigh
Rataei Ortega, Chair
Victona Reinhardt
Janice Rettman
Jan Wiessner
SAINT PAUL — RAMSEYCOUNTY DEPARTMENT OF PUBL/C HEALTH
Rob Fufton, Director
Heaffh Policv and Plannina Section
Jane Norbin, Director, Sharon Borg; Cheryl Burke,• Michael Dean; Barb Nelson
Cover Desian
Barb Vaughan
' Members of CHS Advisory Committee as of March 2001.
CHS PROGRAM PL4N: Acknowledgemems
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'The Minnesota Department of Health requires local public heaith agencies to update their four-year
community health senrices plans at their midpoint. The update includes a summary and a detailed
document. This document is the detailed document.
More intormation regarding cximmunity heatth senrices planning in Ramsey County can be found in the
original Community Heafth Senrices Program Pfan and Assessmerrt Document, both of which are
available on the Worid Wide Web at:
http;l/www.co.ramsev.mn.us/PHlhpp.htm
or
by contacting the Saint Paul Ramsey County Department of Public Health (see cantact information
below).
A Community Health Services Plan Updata Summary is also availab(e through the contact information
provided on this page. The major cromponents of the Summary document are as follows:
❑ A summary of the overall process for updating the 2000-2003 Saint Paui-Ramsev Countv
Communiiv Health Services Plan; and
❑ The updated prob�ems and outcomes from the fufl Update document.
This detailed 2000-2003 Saint Paul-Ramsev Countv CommuniN Health Services Plan Update contains
updated public health problems that exist in Ramsey County, desired outcomes that indicate the problem
is being addressed, and the strategies that wi!! be used by the SPRCDPH to address the problems. This
document is also avaifable through contact information stated on this page.
Further information may be obtained by contacting the Saint Paul-Ramsey County Department of Public
Health:
Saint Paul-Ramsey County Departmeni of Public Health
Health Policy and Planning
50 West Kellogg Boulevard; Suite 930
Saint Paui, Minnesota 55102-1657
Telephone: (651) 266-2403
htto Jlwvaw.co.ramsev.mn.us/PI
ACRONYM
Throughout the CHS Plan documents, the Saint Paul — Ramsey County Department of Public Health is
frequenUy referred to using its acronym: SPRCDPH
PLANNING CATEGORIES
A�mmunity heatth plan is required by state mandate to have twelve planning categories:
CNS PROGRAM PLAN: Introduction
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CHS Planning Categories
Infectious Disease Unintended Pregnan
Chronic/Non-Infectious Disease Pregnancy and Birth
Environmental Heatth
Alcohoi, Tobacco and Other Drugs
Unintended Injury
Violence
Child Growth and DevelopmenY
Disability and Decreased
Independence
Mental Health
Service Deiivery Systems
The twelve pianning categories are used as guides for cotlecting data and organizing the cammunity
assessment and plan documents. Public health problems in the assessment document and strategies for
addressing them in the plan document are organized according to the twelve public health planning
categories.
As required by state statute, the strategies that were developed to address the public health problems are
also identified by the following public heafth topic areas (whose acronyms are indicated on the right-hand
column of the strategy grids).
Public Health Topic Areas
DPC -Disease Prevention and Control FH — Family Health
EMS — Emergency Medical Services HP — Health Promotion
EH — Environmenta! Heafth HH — Home Heafth
CHS PROGRAM PLAN.• lrn�oducfion
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OFTtiE Ck-fs 1't.AFV UADATE Ft��GESS
COLLECTION AND ANALYSIS OF DATA
The Saint Paul-Ramsey Courrty Department of Pubtic Health (SPRCDPH), on an ongoing basis, updates
national, Minnesota, and Ramsey County public health assessment and outcome indicator data. ln
addition to Rs large collection of paper reports, the SPRCDPH maintains a computerized °database of
data° by public heafth planning categories to ease updating and accessing data for analysis. Monitoring
the availabifity and credibility of data that is available on the World Wide Web is also an ongoing activiiy
of the Department.
During the winter and early spring of 2001, SPRCDPH staff analyzed updated assessment and outcome
evaluation data for the need to change the 2000 — 2003 Saint Paul-Ramsev Countv Communitv Health
Services Proaram Plan (GHS Proaram Plan).
DEPARTMEN7TWIDE REVIEW OF CFIS PROGRAM PLAN STRATEGIES
During the winter of 2001, all SPRCDPH staff were provided an opportuniiy to participate in meetings to
comment on CHS Program Plan strategies. These meetings resulted in several lists of proposed edits,
deletions and additions to the existing CHS Plan strategies. Staff refined these lists for clarity, eliminated
duplicate comments and made a final list of proposed strategy cha�ges. The Department's Leadership
Team reviewed the final list of strategy changes for inclusion in the Draft CIiS Proaram Plan Uodate and
then gave the Draft CF{S Program Pfan Update a fina{ review after its consideration of aft public and staff
commenis.
COMMUNITY INPUT
The Ramsey Gounty pubiic was notified of the initiation of the update process in a newspaper notice on
January 24, 2001. Another newspaper notice was published May 13, 2001 to inform the public of the
dates on which drafts of the full and summary versions of the Draft CHS Proaram P1an Update would be
available tor review and comment. The May 13 newspaper notice also stated that a public meeting
regarding the Draft CHS Proaram Plan Update would be heid June 6, 2001, 5:30 p.m. at 555 Cedar
Avenue (Juenemann Building), Saint Paul. Postcards with the newspaper notice information were
mailed to many interested individuals and community groups on a mailing list maintained by the
SPRCDPH. Any interested party may be added to this list by notifying the SPRCDPH. .
The Saint Paul — Ramsey County Communiiy Health Services Advisory Committee was also provided
information on the Draft CHS Propram Plan Update and it conducted the public meeting on June 6"'.
After ciosure of the comment period on June 13, 2001, the SPRCDPH considered all community
comments submitted by that time, inciuding comments submitted at the public meeting on June 6"'.
SUM1VfARY OF CHAI�iGES TO THE CHS PROGRAM PLANi
The SPRCDPH review of data and strategies resulted in some reorgan+zing of problems and probiem
categories.
Changes were also made to improve the clarity of some strategies, to combine similar strategies, to
refiect imptementation of strategies, to delete completed strategies and to add new strategies made
possible by changes in the operating environment of the SPRCDPH.
CNS PROGRAM PLAN: Communily HeaRh Services Planning Process
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4 CHS PROGRAM PLAN: Community Heatth Services Planning ProcQSC
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COU�VT�(
MISSION
The mission of the Saint Paul Ramsey County Department of Pubiic Heafth (SPRCDPH) is to improve,
protect, and promote the health, the environment, and the well being of people in our community.
AREAS OF STRATEGIC FOCUS
To accomplish its Mission, the SPRCDPH concentrates its efforts in the following four Straiegic Focus
Areas:
1. Prevent communicab{e diseases.
2. Promote the health of children, youth and their families.
3. Protect the environment and reduce environmental heaith hazards.
4. Reduce chronic disease.
These areas guide the work of the SPRCDPH.
It is recognized that some services that are mandated by the state as weN as some we are direeted to
perform by elected CounTy officials, may not be included in the Strategic Focus Areas. We will provide
ihese valuabie services, along with the Strategic Focus Area services, with the highest level of quality
and enthusiasm.
These Strategic Focus Areas will be addressed in our Community h4ealth Services Plan and other Board-
approved SPRCDPH pfans using sound policy analysis and planning to guide our specific strategic
direction for our decision making. This process wifl include a careful ana{ysis of public heafth data,
irends, and best practices. W e will pay particular attention to data on disparities in health status that exist
in our community. We will continue to use multiple strategies and methods in our daily work including
individual services, targeted group services, community services and system intervention to achieve our
public health outcomes.
CHS PROGRAM PLAN: Mission of the SPRCDPH
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CHS PROGRAM PLAN: Mission of the SPRCDPH
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Severaf new opportunities have enhanced the abi{ity of the SPRCDPH to implement the CHS Plan.
These new opportunities include a minority health grant; new funding from Temporary Assistance to
Needy Families (TAN�; the Youth Risk Behavior Endowment; and the Adolescent Parenting Program.
These new opportunities are described in the following sections.
Minority Health Gran4
The Minnesota Department of Heafth, Office of Minority Heafth, awarded a grant to the Minneapolis
Department of HeaRh and Family Support to assess and recommend ways to improve the heafth of
minority communfties. This project is a collaborative effort of the nine Community Heaith Service
Agencies in the seven-county Twin Cities Metropolitan Area of Minnesota, which includes Ramsey
County. The SPRCDPH will now have an enhanced ability to "improve data collection, analysis and
reporting of ilinesses among populations of color in Ramsey Couniy' (will — do strategy number one (1)
under "Item E. Health Disparities", page 31 of the CHS Program Plan).
Temporary Assistance 4o Needy Families (TANF)
New funding from Temporary Assistance to Needy Families (7AN� has resulted in a new strategy for
the CHS Program Plan. The Healthy Families Section of the SPRCDPH will act as lead staff for the
strategy, which is stated as follows:
Develop and implement TANF Public Health Home Visiting Program in coordination with other
county departments and community providers to improve child heaith and family functioning, and
promote self-sufficiency among low-income families.
This strategy will impact the CHS Program Plan problem areas of low birth weight and chiid growth and
development.
Youth Risk Behavior Endowment
This program provides resources for addressing youth risk behaviors and wi{I improve the ability of
SPRCDPH to implement strategies for the Program Plan problem areas of infectious disease; alcohol
use; tobacco use; violence; unplanned pregnancies; overweight, inactivity and inadequate nutrition; and
self-destructive behaviors by youth.
Adolescent Parenting Program
This program is a collaboration between SPRCDPH, Ramsey County Human Services, and Model Cities
Community Health Clinic to streamline services for adolescent parents. These services include minor
mom assessments, referrals to community resources, social worker services, transportation, help finding
emergency housing, and access to emergency supplies.
CHS PROGRAM PLAN: Changes in Operating Environment
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8 CHS PROGR,4M PLAN: Changes in Opera6ng Environment
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PROB IFM
1. Emerging and re-emerging infectious diseases threaten the health of the general population in
Ramsey Courriy.
OUTCOMES
1. Ramsey County residents experience decreased disease, disability, and death from emerging and
re-emerging infectious disease.
2. Improved heafth status of +nmates relating to communicable disease in Ramsey Gounty correctional
facilities.
3. Ramsey County community will be prepared to minimize the consequences of biological
emergencies.
4. Ramsey County residents experience decreased disease, disability and death from vaccine-
preventable diseases.
Oui- CHSZ
come Strategies Program
Area
1. Improve coritrot of infectious diseases, inciuding tuberculosis, through improved
1 collection of assessment data, improved outbreak detection, improved investigations, DPC
improved treatment and ciinica! care and screening as needed.
2. Use the Minnesota Department of Health Disease Prevention and Control
1 Common Activities Framework (See Appendix 1) to help guide SPRCDPH's disease DPC
prevention and control activities.
1 3. Collaborate with clinical providers Minnesota Departme�t of Heaith, and federal DPC
agencies on infeciious diseases.
1 4. Assure timely access to STD and HIV counseling, testing, treatment and all DPC
appropriate medical and laboratory assessments.
1 5. Provide health assessments and screenings for communicable diseases in DPC
refugees. FH
i 6. Develop a trained backup tuberculosis team to respond to tuberculosis cases, HP
contact investigations, clinic follow up, and investigations of institutional outbreaks. FH
1 7. Continue to provide perinatal Hepatitis B program. DPC
HP
� 8. Expand and enhance W eb site to provide infiormation on prevention and control of DPC
infectious disease (information on handwashing, for example). HP
� 9. Inform health professionals (inciuding SPRCDPN) and the Ramsey County DPC
2 These program area acronyms are discussed under "Pianning Categories" in the lntroduction section.
CHS PROGRAM PLAN: lnfectious Disease
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community on reportab(e disease trends, incidence and prevalence.
10. As appropriate, provide the following Ramsey Couniy groups with consultations,
educational opportunities and informafion regarding infectious disease prevention
and controi, assessment, treatment and access to treatment, and follow-up:
• Health care providers;
• Correctional faciliry inmates;
• Community residents; and
. City arid County departments.
2
3
f 1. Screen and treat Ramsey County correctional facility inmates for sexually
transmitted diseases and Tuberculasis.
12. Coordinate planning for responses to biological and other public health
emergencies within SPRCDPH and, as appropriate, with other local, sYate, and
national en6ties.
4 I 13. Meet regular(y with school nurses of all districfs fo provide up-fo-date
� immunization informa6on, communication and consultation.
4 � 14. Be a resource to providers about immunization questions and techniques.
4 � 15. Sponsor communiiy immunization educational opportunities twice a year.
16. improve immunization tevels among Ramsey Couniy residents through promotion of:
• increased Ramsey County provider use of the 18 Standards for Pediatric
immunization Practices;
4 � • strengthened rela6onships with providers and community agencies; and
• SPRCDPH staff (WIC, Heafthy Families, House Caqs, and Lead) ident"rfication of
children withou[ up-to-date immunizations and referrais to Child and Teen Check Up
and oiher programs as needed.
4 17. lncrease pnuemococcal vaccine use in high-risk individuals and minority elderly.
4 18. Promote Hepatitis A& B vaccines through Women's Health, Room 111, and
Correctionai HeaRfi.
4 19. Coifaborate to ensure children are immunized and schooi taw requirements are
met
20. Continue SPRCDPH provision of travel immunizations but promote that health
4 plan enroliees obtain travel immuniza�ons from their health plan. Work to increase
public education and level of knowledge about the need for immunizations when
traveling.
4
4
4
4
10
21. Provide immunizations in STD Clinics.
community clinic sites.
in the fail at
23. Provide immunizations to high risk, underinsured and uninsured Ramsey County
residents.
24. Participate in Metro Immunization Registry planning and implementation if state
funding is secured.
CHS PROGRAM PLAN: lnfectious Disease
DPC
DPC
DPC
DPC
HP
DPC
HP
DPC
HP
DPC
DPC
DPC
HP
DPC
FH
DPC
HP
DPC
^HP-
DPC
DPC
HP
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25. Develop and implement plans to improve the coilection, compilation and
4 communication ofi data regarding Ramsey Countys progress toward reaching
immunization-level goals.
4 26. Compile all SPRCDPH immunization data into a common database. DPC
27. Develop regular intemal communication mechanism for staff working with DPC
4 immunizations. Coordinate agency efforts, and share resuits, such as ciinic survey HP
results and immunization rate data.
4 28. Develop or work with MDH on a system to measure rate of up-to-date HP
immunizations at 24 months, including Kindergarten retrospective as one method. FH
4 29. Promote aftemative clinic hours and immunization reminderlrecall systems for 0- DPG
2 year old children. HP
4 30. Provide vaccine to clinics that see children 0-2 years. DPC
HP
4 31. Encourage clinics to do immunization audits of their client populations. DPC
HP
4 32. Identify and support legislative immunization policy. DPC
HP
4 33. Promote interventions identified as "best practices" that motivate families to get H
immunized.
FH
q DPC
34. Work with family centers to provide immunization education and information. HP
FH
Current Strategies That Wil! Be Reduced or Eliminated
1, 4 35. Support and respond to schools curriculum on infectious disease —1 � grade and DPC
other grades. HP
FH
OUTCOME EVALUATION PLAN
Out Outcome Indicator Evaluation
Come
Decreased numbers and rates of reportable
diseases. (STD and HIV related visit rates may
1 1. Numbers and rates of reportable diseases. be increased, as an indicator that persons who
are at increased risk and/or symptomaiic are
aetually seeking diagnosis and treatment.)
2. Number of screens for and treatment of fncreased screens for and treatment of sexually
2 sexually transmitted diseases and TB among transmitted diseases and TB among inmates in
inmates in Ramsey County facilities. Ramsey County facilities.
CHS PROGRAM PLAN: Infectious Disease 11
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3. A plan for response to biotogical and other A plan will be in place and updated for. response
3 public health emergencies. to biological and other pubiic health
emergencies by September 2001.
4. Perc�nt of up-tadate immunizations in the �ncreased percent of children up-to-date with
4 Retrospective fGndergarten Study in Ramsey immunizations in Ramsey County.
County.
5. Percent of children enroifed in PMAP who �ncreased percent of chiidren who are enrolled
4 in PMAP arrc! are up-to-date with
are up-to-date w8h immunizations. immunizations.
12 CHS PRQGRAM PLAN. fnfecchoous Disease
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S. EI�f4RON�l�t�t7"AL Fi�iLTki FiAZAFtQS"
PROS IFM
i. There is an increasing risk of illness due to environmental health hazards in Ramsey Counry.
1. Ramsey County residents have reduced e�osure to lead, and they wilt have reduced biood lead
4evels.
2. Solid and hazardous waste in Ramsey Couniy will be managed in a manner that reduces the risk of
iliness and environmental harm.
3. Persons in Ramsey County will be at reduced risk of illness related to air potlutants indoors and
outdoors.
4. Persons in Ramsey Gounty will be at reduced risk of illness related to food consumption.
5. Persons in Ramsey Couniy will be at reduced risk of iilness related to storage, use and management
of househoid and industrial chemicals.
6. Persons in Ramsey County will be at reduced risk of illness related to contaminants in water.
Out- CHS3
come Strategies Progrem
Area
1. Work with local building officials on environmentat health issuss, including plan
Ail reviews of facilities Iicensed under the delegation agreement with the Minnesota EH
Department of Health.
2. Continue to provide to operators of licensed establishments formal training,
A �� including Food Manager Cert'rfication, Swimming Pool Operators, and Licensed EH
Hazardous Waste Generators. The need to provide training to staff ofi those
establishments will be evaluated and courseslcurricu(a developed, as necessary.
3. Hold an annual Environmental Health training session for all stafF, which will
Ail teach the fundamenta{s of environmental health hazard identification to those staff EH
that have client contact.
4. Work with heafth care providers to raise their awareness of indoor environmental EN
Ail health hazards so that they ran discuss environmentai health with clients, FH
especiafiy wlnerable populations.
5. Develop technical expertise in risk communication, and incorporate
A �� environmental hea{th risk communication messages about risk of iflness due to EH
environmental conditions into informa6on provided to the public and regulated
communiiy.
1 6. Gontinue the Chiidhood Lead Prevention Program and the Lead Hazard EH
3 These program area acronyms are discussed under "Planning Categories" in the Introduction seotion.
CHS PROGRAM PLAN.� Environmenta� HeaRh Hazards 13
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Reduction Program {to the extent funding is available), including the screenings
required by State law, and the fallow-up assessment and enforcement to require
remediation of lead.
HP
1,4,& � 7. Continue to provide laboratory analyses for lead, food, anc! water quality. ' EH
I 8. Provide targeted outreach on househoid hazardous waste (HHW) collection I EH
2,5 services, including pesficides, consistent with the RegionaURamsey County Solid HP
Waste Master Plan.
2 5 9. Provide waste minimization and pollution prevention technical assistance EH
senrices to licensed hazardous waste generators in Ramsey County. tiP
10. Continue to assure compliance with solid and hazardous waste regulations
2 � through the use of education, consultation, tecfinicat assistance, licensing, EH
inspection, and enforcemenY. When providing direct services relating to nutrition,
advise residents about health risks re(ated to consuming fish.
2 I 11. Continue to carry out the strategies outlined in the RegionaVRamsey County � EH
Solid Waste Master Plan, with regard to sotid and hazardous waste.
12. Seek indoor air quality grent funds to be used for raising awareness about and
detecting indoor air quality problems, inctuding physical, biotogical and chemical EH
hazards, and for the promotion of the proper use of carbon monoxide detectors and
radon detectors.
3 � 13. Participate with the Minnesota Indoor Air Qualiiy Coalition to coordinate indoor EH
air quality informafion, especially related to carbon monoxide and radon.
14. Continue to carry out the County's responsibi(ities as outlined in the Detegation
Agreement wfth the Minnesota Department of Neafth for Food, Beverage and
3,4,5,6 Lodging Facilities; manufac[ured home parks; youth camps; the �nnesota Clean EH
tndoor Act in licensed establishments; and the investigation of public heafth
nuisances with the authoriiy provided in Minnesota Statutes, Chapter 145.
4 15. Support Food Irradiation as an important food safety method.
4 16. Work with the cities of Saint Paul, New Brighton, and Maptewood to coordinate
compliance strategies with licensed food service establishments.
17. Continue to give a priority to issues of food safety, and wiil integrate food safeiy
4 messages with other public health messages, especially to wlnerable populations,
and inciuding food safety in non-regulated settings.
18. Examine entering into a Delegation Agreement wiih the Commissioner of
4 Agricufture for the regulation of grocery and cronvenience stores in suburban
Ramsey County.
19. Work with the food senrice industry, the Mirtnesota Department of Health, and
health care providers to explore ways to provide sick leave benefits for employees
of food e is , �have an incentive to oome to
work sick.
20. Work with city of Saint Paul Parks and Recreation; Ramsey Couniy Public
4 Works; and Ramsey County Parks and Recreation to install signs and notices
regarding fish consumption advisories, inoluding notices in languages other than
English.
EH
EH
EH
HP
EH
EH
EH
HP
14 CHS PROGRAM PLAN: Environmen�al Heafth Hazards
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� 21. Work with non-English speaking media and organizations to include notice of EH
fish consumption advisories. HP
22. Collaborate with the Ramsey County Poison Control Center and Minnesota E �
5 Extension Service to develop outreach and education strategies for Ramsey HP
County residents on the safe use, storage and disposal of pesticides.
23. Conduct educational efforts in partnership with others related to safety and EH
6 heatih of private swimming poois and wading poofs, and wilf provide informaiion FH
and services as appropriate. HP
Currerrt Strategies That Wili Be Reciuceci or Eliminated
Not Applicabie
OUTCOIWE EYALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 �. Number of tests showing elevated biood Decreased percerrt of tests showing
lead levels, elevated blood lead levels.
2. The total amount of production-related Decreased amount of total production-
2 waste chemicals released by industries, as related waste chemicals released by
reported in the Toxic Release Inventory, in industries in Ramsey County each year.
Ramsey County.
4 3. Number of food borne i4lnesses reported in Decreased food-borne iliness incidence in
Ramsey County. Ramsey County.
4. Number of signs in various languages at
4 lakes, ponds, sireams and rivers located in Increased number of signs.
Ramsey County with notices regarding fish
consumption advisories.
5. Volume of household hazardous waste that �ncreased volume of household hazardous
5 is managed in Household Hazardous Waste waste is managed in HHW cofleetions.
coAections.
5 6. iVumber ot participants in Household fncreased number of participants in IiHW
Hazardous Waste collections. collections in 2003 compared to 2�00.
6 7. Number of drinking water samples and Increased water samples tested and
results. decreased unsafe leveis found.
CHS PROGRAM PLAN: Environmemal Health Hazards 15
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16 CHS PROGRAM PLAN: Environmenial Heatth Hazarcis
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PROBLEM
1. There is an unacceptable level of interpersonal viole�ce in Ramsey Couniy.
OUTCOME
1. Ramsey County citizens experience less violence.
STRATEGIES
Out CHS°
come Strategies Program
Area
1 1. Continue Ramsey County participation in and facilitation of The Initiative for HP
Violence Free Families and Communities. FN
1 2. Support private, routine screenings for domestic violence with all male and HP
fiemale clients. FH
1 3. Encouwage managed care organizations to provide coverage for emergency HP
department visits made by victims of domestic violence. FH
1 4. tmprove the Ramsey County web site with more information and intemet links HP
regarding abuse and other violence. FH
1 5. {ncrease efforts to teach non-viofent parenting skilis, especially to parents who HP
experienced abuse as children. FH
1 6. Provide existing and new SPRCDPN staff education, training and regular
updates on domestic violence, sexual abuse and other violence, includinq:
. interventions with isolated, high-risk families;
• Development of skifts to focus on individual, community and family HP
strengihs and assets; FH
• Cammunity prevention and intervention resources (such as ParenYs
Anonymous and the taith community); and
. Alternatives to violence for solving problems and conflicts.
1 7. Support community and legislative efforts to prevent youth access to weapons. HP
FH
1 8. Develop cuiturally competent anti-violence education. �
FH
1 9. Continue use of the University of Minnesota Twin Cfties Violence Survey and HP
other indicators and develop trend data from those indicators. FH
1 10. Use the Education Action Team (of the lnitiative for Violence Fee Families and HP
Communities) to increase developmeni of anti-violence and positive parenting FH
programs within school districts.
1 11. Collaborate and share resources with the Ramsey County community HP
" These program area acronyms are discussed under "Planning Categories" in the Introduction section.
GHS PROGRAM PLAN: �olence 17
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(including faith communities and community, recreation and Children's Initiat+ve FH
centers) to develop, coordinate and implement pians to disseminate throughout
Ramsey Couniy and to targeted groups, information on:
. Domestic and other forms of violence;
• The correla6on of domestic and other violence to other public heatth
problems (such as child neglect, unintended pregnancy, low-birth
weight, infant mortaiity, low immunization rates, and sexually
transmitted infections such as HIV}; and
• Nort -violent means for solving probiems.
1 12. Collaborate with faith communities to promote positive aftematives to viofence.
1 13. Support efforts to decrease geographic concentrations of poverry. yP
FH
1 74. Train more people to be members of the Workplace Violence Action Team. yP
Fti
Current Strategies That Wili Be Reduced or Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
Out-
Come
Outcome Indicator
1. Ramsey County homicide rate.
2. Percentage of male students reporting
1 carrying a gun to school (Minnesota Student
Survey).
3. Peroentage ot studeirts reporting b�
1 stabbed or having a gun fired at ti�em
(Minnesota Student Survey}.
4. Percentage of students reporting bei
1 kicked, bitYen, or hit on school property
(Minnesota Studerrt Surveyj.
Evaluation
Decreasing trend in the homicide rate for
Ramsey County beginning in 1999.
Decrease of 1%(from 1998 rate of 5%) by
2001.
Decrease of 1%(from 1998 rate of 4%) by
2001.
Decrease of 3% for males (from 1998 rate of
15%) and .5% of females (from 1998 rate of
3.12%) by 2001.
5. Reported crimes in Ramsey County:
Number of offenses against family or children Decreased number of reported crimes
1 (Minnesota Crime information Rer�ort; MN regarding offenses against family or children.
Bureau of Criminat Apprehension — tocal law
enforcement agency offense information).
6. Number of Ramsey
9 makreatment determinations (Ramsey County ��
Communiry Human Services}. maltreatment determinations.
18 CHS PROGAAM PLAN: volence
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I�
PROB ICM
1. High numbers of Ramsey Gounty residents are overweight and inactive with inadequate nutrdion,
which contributes to chronic diseases.
1. The residents of Ramsey Couniy make lifesiyle changes to prevent chronic disease.
2. Heafth professionals and heafth care providers practice chronic disease prevention with Ramsey
County residents.
3. Ramsey County residents will be average weight, phys+cally active, and eat hea4thy foods.
Out- CHSS
come Strategies Program
Area
1. Increase efforts to partner with targeted population groups regarding chronic DPC
1, 3 diseases and prevention. (Examples: Hypertension within the African American HP
population; Diabetes and Hispanic population). HH
2. Review the current public health education materials on chronic diseases to HP
1, 3 assure that the audiences, desired behavior change, criteria for measuring DPC
success, and educational tools are appropriate.
� 3 3. Strengthen relationships with Ramsey County schools to develop and/or HP
enhance weliness programs. FH
4. Use research and best practices to identify methods for improving the fitness HP� EH
1, 3 and wellness for Ramsey County citizens (such as 5 fruits and vegetables a day, DPC
"Power of Healthy Eating".) �
FH
5. Work with Ramsey Couniy school districts and managers of Ramsey County DPC
� 3 Government 6uildings and programs to provide food-vendor options for bottled HP
water and nutritious foods (e.g. fruits, flavored mllk, and juices) that replace or HH
accompany less nutritious vendor options.
6. F�cplore working with existing efforts to encourage Ramsey County restaurants HP
1, 3 to address large serving sizes at restaura�ts (that contri6ute to waste and to DPC
overweight and inadequate nutrition among Ramsey County residents). EH
1, 3 7. Promote use of 12 Baskets Program by ticensed food establishments. EH
HP
8. Encourage intergenerational activities with Parks and Recreation and community HP
1, 3 centers: such as family walking, softball teams, volleybaN teams, biking events, FH
hiking and swimming events, Intergenerational Tea Parties, etc. HH
1 3 9. Initiate partnering with schools and Minnesota Department of Ghildren Families HP
5 These program area acronyms are discussed under "Ptanning Categories" in the Introduction section.
CHS PROGRAM PLAN.� Heafth Disparities 19
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and Leaming to analyze data on heights and weights of children. DPC
t0. Update pubiic health education and heaith promotion materiats and services HP
1, 3 with current knowledge and use of electronic media (e.g, intemet, phone, and cabie FH
television), yH
DPC
11. Create and maintain chronic disease prevention task force consisting of the
Department of Public Health and community partners to: (1) iderrtify ways to HP
2 coordinate promotion of chronic disease prevention; (2) to coordinate messages; DPC
and (3) establish desired outcomes and performance measures for promotional HH
efforts.
HP
2 12. Identify ways to coordinate the promotion of chronic disease prevention with ��
other Department activities. EH
NH
13. Continue Women's Health Screening Clinic that provides pap tests and HP
2 mammograms through the Minnesota Breast and Cervical Cancer Control FH
Program. DPC
2 14. Continue correctional health that provides health care senrices to individuals in HP
Ramsey County correctional facilities. DPC
2 15. Continue Colposcapy Clinic, which provides low cost evaluation and DPC HP
management of abnormaf pap smears.
2 16. Provide public-health-nurse outreach clinics in public high rises and other sites DPC
to address chronic disease prevention among residents. HP
2 17. Continue Refugee Clinic that screens refugees for health problems.
Current Strategies That Will Be Reduced Or Eliminated
1 18. Continue with Nutrition Services of dietary counseling and Clinical Nutrition HP
Services at 555 Cedar and Community Ciinics.
OUTCOME EVALUATION PLAN
Out- Outcome indicator Evatuation
Come
1, 3 i. Percent adult residenfs reporting Decreased percent of adults reportii
hypertension according to the MN hypertension in the Behaviora! Risk
1, 3 2. Hospitalization rates for children ages 0— Haspitalization rates for children ages 0=�1�'�"'mm'
14 with asthma. with asthma wil! decrease from the f 997 rate of
3.7 per i000 populafion.
are physicaliy Increased percent of adolesCents who are
er week ohvsicallv active for 30 minutes 5 or more �
20 CHS PROGRAM PLAN: Health Dispardies
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CNS PROGRAM PLAN: Health Disparities 21
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22 CHS PROGRAM PLAN: Heafth Dispa+ities
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E: "(-1Ei
PROSLEM
1. Desp'de overail health improvement in Minnesota and Ramsey County, populations of co%r in
Ramsey County continue to experience poo�er health and disproportionately higher rates of illness
and death.
OUTCOME
1. Decreased disparity of health status beiween population groups in Ramsey County.
Out- CHS6
come Strategies Program
Area
� 1. Improve data collection, analysis and reporting of health status among populations
of color in Ramsey County. DPC
2. Expand contacts with communiiy agencies and cultural organizations serving
1 communities of color, for data, information and recommendations regarding health DPC
rare needs and access to heatth care.
� 3. Partner with managed care, heafth care providers and other community groups to HP
target health promotion and prevention to specific popu{ations.
1 4. Support, through Minnesota Public Health Association and Association of HP
Minnesota Counties, legislation to improve access to care by poputations of cofor.
1 5. Support non-discrimination heatth care policies for heafth care services. HP
1 6. Train staff on cultural competency. HP
1 7. Increase community level input from populations of color in development of HP
strategies to address health disparities such as the Healthy Start Project.
1 8. Continue efforts to hire and retain SPRCDPH staff who reflect populations served HP
by SPRCDPH and participaie in Ramsey County Modei Employer efforts.
Current Strategies That WiII Be Reduced or Eliminated
Not Applicable
6 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Heafth Disparities 23
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�� Ouicome lndicator Evaluation
Come
1. Number of Saint Paul-Ramsey County tncreased number of Saint Paul-Ramsey
Department of Public Health programs using �unty Department of Public Health
OMB Statisticat Policv Directive No.15, Race
1 programs using OMB 15 as minimum
and Ethnic Standards for Federa! Statistics and standard for collecting race and ethnicity
Administrative Report to collect race and data on clients served by the program.
ethnicity data on clients served.
1 2. Infant mortality rate by race. Decreased disparity in infanY mortality raYes
between races.
1 3. Immunization rate by race. Decreased disparity in immunization rates
between children of different races.
4. incidence rate for spec'rfic diseases and Decreased disparii�l in incidence rates for
1 conditions by race. specrfic diseases beiween populations of
different races.
1 5. Death rates by race. Decreased dispariry in mortai"ity rates
beiween races.
1 6. Low birth weight by race. Decreased disparity in tow birth weight rates
beiween races.
24 CHS PROGR.QM PLAN: Heafth Disparities
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: PREGIdANCY AN�-BIRTH
tOBLEMS
1. lncreased percentage of births to adolescents and increased number of births thaf resuR from
unintended pregnancies.
2. The percent of iniants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
1. Decreased proportion of births in Ramsey County to adolescents.
2. Decreased proportion of all Ramsey County pregnancies that are unintended.
3. Fewer Ramsey County babies will be born with low birth weight.
Out- CHS'
come Strategies Program
Area
1. Promote women's health, including preconception health, to increase women's
All awareness of the results of healthy and risky behaviors for themselves (and for FH
their fetus when pregnant), and develop culturally appropriate messages.
2. Promote assets in youth and youth development through SPRCDPH
1 participation in the Suburban Ramsey Family Collaborative and the Saint FFt
PauVRamsey County Children's Initiative.
1 3. Partner with or participate in community groups working to lower the rate of low FH
birth weight births in populations of color (e.g. the Healthy Start Program).
1 4. Continue extended W IC hours to facilitate participants access to senrices. FH
5. Continue Public Health Nurse and Nutri6on home visits to pregnant women at HHC
1 risk for poor birth outcomes to provide assessment, health education and referral FH
to community services as needed.
6. Strengthen relationships with community groups, providers and clinics, including
1 Prepaid Medical Assistance Program providers and communiiy clinics to assure
that Ramsey County women have information and access to health care
resources, including medical care, for preconception care as well as prenatal care.
� 7. Continue the role of SPRCDPH as a resource to community groups and �
agencies on "best practice" for adolescent health and youth development.
1 8. Partner with communiiy groups to assure the development and continuation of FH
community-based, comprehensive adolescent pregnancy prevention programs.
' These program area acronyms are discussed under "Planning Categories° in the Introduction section.
CHS PROGRAM PLAN: Pregnancy and Birth 25
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3 9 Deliver intensive home-based services to minor parents through the Adolescent
Parent Program (SPRCDPH, RCCS, and Model Cities, Inc.)
10. Work with the Minnesota Organization on Adolescent Pregnancy, Prevention
and Parenting (MOAPPP), schools and other community groups to increase public �
1 awareness of adolescent pregnancy, to strengthen prevention efforts, and to FH
improve coordination of efforts to decrease the number of adolescent pregnancies
in Ramsey County.
1 11. Support schools' use of comprehensive sexuality education curricula. FH
12. Promote programs (e.g. Dads Make a Difference) that incorporate the
1 importance of dads in raising children, including nurturing their infant children and HP
building resiliency in those children as they grow older.
2 3 13. Support the provision of comprehensive family planning senrices with public FH
heaflh assessment, policy devetopment, planning arid assurance activities.
3 14. Work with existing community efforts to raise awareness of family planning FH
senrices in the community (e.g. the Minnesota Family Planning Hotline).
15. Advocate for and provide reproductive health care including family planning FH
3 services, targeting services to high risk groups, uninsured and underinsured
people. �
3 16. Continue to provide fami�y planning education for new parents who are FH
SPRCDPH clients. HHC
3 17. Continue connecting new parents to communiry resources and providers for FH
women who are served by SPRCDPH programs. HHC
Current Strategies That Will Be Reduced or Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out-
Come
1, 2
1.2
Outcome Indicator
1. Number of births to Ramsey County
adolescents less than 15 of age.
2. Birth rate for Ramsey Couniy adolescents
15-17 years of age.
3. Birth rate for Ramsey County mothers 18-
Evaluation
Decreased birth rate for Ramsey County
adoiescents less than 15 years of age.
Decreased birth rate for Ramsey County
adolescents 15-17 years of age, from 1995-97
rate of 35.1 per 1000 population.
Decreased birth rate for Ramsey County
of 68.9 per 1,000 population.
26 CHS PROGRAM PLAN: Pregnancy and Birth
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Decreased percent of Ramsey County 9"' and
4. Percent of Ramsey County 9"' and 12"' 12"' grade students who report that they have
grade studerrts who complete the Minnesota had sexuai intercourse, from 1998 percents of:
1 2 Student Survey and report that they have 9"' grade females: 23%
had sexual intercourse. 9"' grade males : 30%
12'" grade femates: 47°10
12"' grade males : 51 %.
Increased percent of Ramsey Couniy 9"' and 12'"
grade students who report on Minnesota Student
5. Proportion of sexuaily active 9"' and 12"' Survey that they are sexually active and always
graders in Ramsey County who partioipate in use birth control, from 1998 leve�s of:
j ' 2 the Minnesota Student Surve and re ort +�
Y p 9 grade females: 37%
always using birth control. 9"' grade males: 41 %
12"' grade females: 60%
12"' grade males: 54%.
6. Adolescent pregnancy rates for the 15-17 Decreased pregnancy rates for adolescents in
1 2 and 18-19 year old age groups. Ramsey County, firom the 1995-97 rate of 72.3
per 1,00015-17 and 18-19 year old age groups.
7. Proportion of Public Heatth clients who are �ncrease percer�t of public health ctients who are
Z new parents and receive family planning, new parents and have an identified method of
fiamily planning.
8. Percent of Ramsey County women who Percent of Ramsey County women who
3 initiate prenatal care in first trimester and delivered and whose prenatal care was reported
receive ongoing prenatai care senrices. as adequate or better will increase to 75% by
2003.
9. Percent of fow-birth-weight infants born to 6.6% or fewer of infants born to women
3 pregnant women who have received WIC participating in WIC for 3 months or longer will be
services for 3 months or more. tow birth weight.
10. Percent of low birth weight infants born to Decreased percent of low birth weight infants
3 women served antepartum by Healthy born to women who received home visiting
Families home visiting staff. services from Heatthy Families staff.
3 11. Percent of Ramsey County Iow birth- Percent of Ramsey Couniy low birth-weight
weight births. births will decrease from the 1997 leve4 of 6.7%.
12. Public heaith home-visited clients who �ncreased percent of pregnant public health
3 decrease or qu+t smoking during pregnancy. home-visited-cfients who decrease or quit
smoking during pregnancy.
CN3 PROGRAM PI�IN.� Pregnancy and Birth 27
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28 CHS PRO�RAM PLAN: Pregnancy and Birth
oi-999
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G. UFVINTE[VDED IEVJl1RY
PROBLEM
1. Uninfentional injury is one of the leading causes of death fhroughout a lifetime in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by talls, poisoning,
suffocation, and fire.
OUTCOME
1. Decreased unintended injuries in Ramsey County.
STRATEGlES
Out- CHS$
come Strategies Program
Area
1 1. Obtain data on effective use of car seats (such as rate of compliance with proper HP
installation) to use in health promotion and education activities.
1 2. Develop a method for prioritizing specific unintended injury activities occurring HP
within SPRCDPH.
1 3. Support policies and programs that prevent gun violence, including use of the HP
Gun Violence Action Team to advocate for safe storage of guns.
1 4. Continue coilaboration with the Minnesota Safe Kids Program. HP
5. Continue to support the primary enforcement status of the child restraint system
1 policies of Minnesota Statutes, Chapter 169 (primary enforcement status means a HP
citizen can be stopped and issued a citation for a violation of the child restraint
system law alone without other violations being present).
1 6. Support enforcement of laws pertaining to universal use of car seats, including HP
policies that require babies to be in car seats when going home from a hospital,
7. Continue existing SPRCDPH health promotion and education programs (such as
1 Eariy Childhood and Family Education; Prenatal Education; Safety Camps; and HP
Safe Kid Family Fun Nights.
1 8. Continue provision of or referrals to resources for obtaining smoke detectors. HP
1 9. Provide unintended injury education and other services that are sensitive to HP
racial, ethnic and cultural differences.
1 10. Extend "Local Safe Kids" program to suburban Ramsey County. HP
1 11. Train more people to do car seat assessments and education (hospital staff; fire HP
stations; family centers; etc.)
Current Strategies That Will Be Reduced and Eliminated
g These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Unintended Injury 29
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1 12. Educate persons in general on unintended injury. HP
1 13. Educate and support enforcement of pedestrian law. HP
14. Support construction and maintenance of safe playgrounds including proper
1 supenrision, age-appropriate equipment and education and support of parents HP
seeking new equipment.
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1. Ramsey County Injury Hospitalization and Decreased numbers and percents of injury
Emergency Room E-Code Data for: hospitalization and emergency room use (per E
code data) in Ramsey County for:
a. Falis
a. Falis
1 b. Motor Vehicle Traffic crashes (occupant)
b. Motor Vehicle Traffic crashes (occupant)
c. Poisoning
c. Poisoning
d. Struck by, against (unintentional) d. Struck by, against (unintentional)
e. Overexertion (unintentional) e. Overexertion (unintentional)
2. Estimated Behavioral Risk: Percent of
1 Seat Bett Non-Use (MDH Behavioral risk Decreased estimated percent of non-seatbelt
survey). ��•
1 3. Percent of seatbelt nonuse in motor p�r�sed percent of seatbelt nonuse in
vehicle crashes (Minnesota Health Profiles). motor vehicle crashes.
30 CHS PROGRAM PLAN: Unintended Iniury
ot-99q
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H: MEALTH EFFECTS OF
PROBLENf
1. M lncreasing number of children and adolescenfs in Ramsey County experience the health
eSects that are associated with poverry.
OUTCOME
1. Ramsey County children and adolescents will experience reduced adverse health effects
associated with poverry.
Out- CHS9
come �r�g�� Proqram
Area
1 1. Inform policy makers and others of the relationship between poverty and heafth Hp
status, with Ramsey County specific data.
i 2. Work with housing code enforcement officers to ameliorate conditions that are Hp
cause for condemnations and homelessness.
3. Identify and impiement ways for public heatth staff to join efforts for better
i housing for low income persons, such as supporting assurance efforts for HP
adequate housing, and continuing work with St. Paul Area Goalition for the FH
Hometessness (SPACH).
Current 5trategies That Will Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Gome
1 1. Number of Ramsey County chiidren and Decreased number of Ramsey County chifdren
adolescents in poverty. and adolescents in poverty.
9 These program area acronyms are discussed under "Planning Categories° in the Introduction Section.
CHS PROGRAM PLAN: Heatth Eftects of Poverty 31
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32 CHS PROGRAM PLAN: Heakh Effects of Poverty
_ a �
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L CHF�D NEGLECT
PROB �M
1. An increasing number of cflildren in Ramsey Counry are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
[jlj ti
1. Fewer infants and children who live in Ramsey County will experience negfect
Out- CHS70
come Strategies Program
Area
1 1. Coflaborate with the Ramsey Community Human Services Department to FH
promote the well being of children.
1 2. Partner with community businesses and agencies to create supportive and FH
nurturing public spaces for children and families.
1 3. Participate in collaboratives working to reduce child neglect. FH
HP
1 4. Advocate for the importance of including men in planning and participation in FH
coilaboratives working to reduce child neglect. HP
1 5. Partner with community parent education programs to inciude the role of HP
men in children's lives. FH
6. Advocate that newbom babies leave Ramsey County hospitals with W IC
1 information (ff appiicabie), an appointment for initial well child check up, plans FH
for transportation to the appointment, a digital thermometer (not mercury), and
information about environmentai health hazards in the home.
7. Provide interventions to targeted fami{ies that identify and reinforce the
'I family's strengths, and educate on normal grovuth, development and positive Fti
parenting.
1 8. Promote parent-child attachment through individual-based interventions by FH
HouseCalls, public health nurses, and nutritionists.
1 9. Promote after-school activities for students. HP
10. Promote continuation of commun'rty resources that include strategies for
� reducing child neglect and promote use of those resources, including First Call Hp
for Help and the Teen Parent resource book (Healthy Families Adolescent
Parent Program).
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
10 These program area acronyms are discussed under "Planning Categories" in the introduction Section.
CHS PROGRAM PLAN.� Chifd Neglect 33
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OUTCpME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Number of Ramsey County children who Decreased number of Ramsey County children
experfence substantiated (determined) who e�erience substanfiated (determined)
neglect (Ramsey County Human Services). neglect.
1 2. Number of children who are served by Decreased number of children who are
SPRCDPH staff that e�erience SPRCDPH clients who experience
substanbated negtect. substantiated neglect.
34 CHS PROGRAM PLAN: Child Neglect
oi-999
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J_ ALCOEiOL�kBE�SE �
�oB�nn
1. Alcjohol abuse causes adverse heaith etfects and social problems in Ramsey Courrty. lt negatively
impacGS intended and unintended injury; unplanned pregnancy,• poor birth outcomes child
development; ado%scent heaRh; mental health; vio%nce; infecfious diseases; and chronic diseases.
OIiiCOME
1. Ramsey County residents engage in iess aicohoi abuse.
Out- CHS"
come Strategies Program
Area
i 1. Develop and use consistent SPRCDPH messages regarding alcohoi abuse (for HP
staff training and dissemination to the public).
1 2. Train SPRCDPH staff on alcohol abuse. Hp
1 3. Include updated information about Fetal Alcohol Syndrome and Fetal Alcohoi NP
effects, client education methods, and client screening for risk factors, in orientation
for appropriate new public heafth siaff and in in-service training for existing staff.
1 4. Educate SPRCDPH clients on how aicohol use afifecis fetai devefopment. HP
1 5. Work with community groups to promote awareness and strengthen prevention HP
messages that address the effects of alcohol on birth outcomes.
1 6. Work with Minnesota Join Together to develop a community plan for reducing �P
teen alcohol abuse in Ramsey County.
1 7. Coordinate annua{ly a chemical health workshop for school distriet staff in HP
Ramsey County.
1 8. Partner with heaith care professionals and other professional organizations to HP
encourage all providers to screen patients for alcohol use, including its relationship DPC
to violence.
1 9. Support public policies and laws that prevent alcohol abuse. HP
1 10. Encourage the promotion of alcohol-free gradua5on, homecoming, prom and HP
other social activities for high school and college students.
1 11. Participate in suburban Mayor's Commission Against Drugs (includes cities of HP
Roseville, Fal�n Heights, Lauderdale and Little Canada).
1 12. Continue SPRCDPH staff group for alcohol policy and planning coordination. HP
DPC
" These program area acronyms are discussed under "Planning Categories" in the Introduction seetion.
CHS PROGRAM PLAN: Alcoho! Abuse 35
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Current Strategies 7'hat Will Be Reduced and Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Estimated percent of acute drinkers in By 2004, decrease estimated percent of acute
Ramsey County (MDH Behavioral Risk drinkers from the 1997 estimated perc2nt of 16.1.
Survey).
1 2. Estimated percent of chronic drinkers in By 2004, decrease es5mated percent of chronic
Ramsey Couniy (MDH Behavioral Risk drinkers from the 1997 estimated percent from 2.7.
Survey).
1 3. Percent of 12 grade students reporting By 2004, using the 1997 percent of 12, decrease the
that during the last two weeks, they have percent of 12"' grade students reporting that during
had frve or more drinks in a row once the last hnro weeks, they have had five or more drinks
(Minnesota Student Survey). in a row.
36 CHS PROGRAM PLAN: AlcoholA6use
a�
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K. ACCESS T� H�ALTM CARE
PROBLEM
1. There is a gap between Minnesota Goals and the current number of people in Ramsey County
who have access to medical, dental and mental heafth care.
OUTCOME
1. An increased percentage of Ramsey County residents have improved access to medical, dentai
and mental heafth care services.
Out- CHS'Z
come Strategies Program
Area
1 1. Screen for eligibility and educate eligible uninsured and low income public
health clients on how to enroll in MinnesotaCare and assure clients' participation HP
in MinnesotaCare through follow-up and monitoring of client enrollment.
1 2. Support policies that require health care providers participating in Prepaid FH
Medical Assistance Programs (PMAPs) to have evening and weekend hours. HP
1 3. Form a group to plan the SPRCDPH's roles and responsibilities for providing HP
primary care.
1 4. Advocate that Heaith Plans and third-party payors cover medical, dental and HP
mental health services for families and individuals. FH
HH
1 5. Identify and support actions that improve access to health care by all Ramsey
County residents, including improved access to medical, dental and mental
heafth insurance by low-income individuals and families, improved coordination HP
of services and the removal of other barriers to care (e.g. cultural, transportation
and child care).
1 6. Coordinate with the Ramsey County Community Human Senrices HP
Department, HeaRh Plans and communiiy clinics to increase coverage and HH
improve access to language-appropriate, coordinated mental health senrices for FH
children, adolescents and adults.
1 7. Increase participation of eligible clients in publicly funded services (i.e. Child FH
and Teen Checkups).
8. Develop a transition pian for assuring that injection clinic services are HP
available in the community when SPRCDPH discontinues providing this service DPC
at the Community Mental Health Clinic (CMHC).
� 9. Advocate improved access to preventive dental care for children. DPC
HP
' These program area acronyms are discussed under "Planning Categories" in the Introduction Section.
CHS PROGRAM PLAN: Access to Health Care 37
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1 10. Continue providing assessments for Personal Care Assistant (PCA) HP
recipients in the Medical Assistance Program.
1 11. Continue to screen and case manage elderly and disable clients who are
eligible for the Long-term Care Waivers-Elderly Waiver (EW), Altemative Care HH
(AC), Community PJtemative Care (CAC), and Communiiy Altematives for HP
Disabled Individuals (CADI).
1 12. Promote increased ident'rfication and follow-up for mental heaPth senrices in HP
Ramsey County.
Current Strategies That Wiil Be Reduced and Eliminated
HP
1 13. Discontinue providing the injection clinic services at the Communiry Mental FH
Health Clinic.
DPC
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1 1. Rate per 100,000 Ramsey County residents Increasing rate between 1999 and
enrolled in Minnesota Care in Ramsey Couniy 2003.
1 2. Number PMAP Providers that offer evening and Increasing number of providers who
weekend hours offer evening and weekend hours.
1 Rate of uninsured persons in Ramsey County. Decreased rate of uninsured persons
in Ramsey Couniy.
38 CNS PROGRAM PLAN: Access to Health Care
�i�q9Y
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L. TOEiRCCO U�E
PROB PM
i. Tobacco use is on ths rise among yauth and other select populations in Ramsey County.
C�l�i t�?�]!i I �
1. Ramsey County residents engage in less tobacco use.
Out- CHS73
come ��gi� Prograrti
Area
1 1. Educate public health clients on adverse heaith effects of tobacco, including HP
dental effects. FH
1 2. Coilaborate with state and local pianning and impiemerrtation efforts to Hp
effectively use state tobacco settlement funds and to reduce effects of tobacco FH
among ieens. EH
DPC
1 3. Expiore available behavioral risk data for Ramsey County and if none is HP
available, plan to conduct a risk su+vey for Ramsey County. DPC
FH
1 4. Comply with the Minnesota Clean Indoor Air Act regulat+ons in all licensed food, EH
beverage and lodging facilities. HP
, 1 5. Explore how food, beverage and lodging licensing fees could be adjusted to EH
provide discounts to smoke-free establishments. HP
1 6. Promote the development and enforcement efforts of community organizations' FH
tobacco policies and target market. HP
DPC
1 7. Encourage health care providers to screen ail individuals for tobacco use. FH
DPC
1 8. Update the Ramsey County smoke-free restaurant guide every three years. EH
1 9. Monitor compliance with state statutes regarding tobacco access for Ramsey HP
Gounty municipalities
1 10. Develop an integrated community system for reducing tobacco use in Ramsey HP
County.
Current Strategies That Will Be Reduced and Eliminated
Nat Applicable
' These program area acronyms are discussed under "Pianning Categories" in the Introduction section.
CHS PROGRAM PLAN: Tobacco Use 39
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OUTCOME EVALUATION PIAN
FlNAL�SNNT PAULVERSION OF THE 2000-2UIXi CHS PLAN UPDA'fE
1 1. Percent of female and male 9 grade By 2004, using the 1998 number of 4% as a
students smoking �/2 pack of cigarettes per base, decrease ihe percent of female ancf male
day in the last 30 days. (Minnesota Student 9"' grade students reporting smoking'/z pack of
Survey) cigarettes a day in the last 3Q days.
1 2. Percent of 12 grade males who report By 2004, using tfie T 998 nUmber of 7% as a
using chewing tobacco daily. (Minnesota base, decrease the perceniage of 12"' grade
Student Survey males who report using chewing fobacco daily.
1 3. Percent of 9 Grade female and male By 2004, using the 1998 number of 33% and
tobacco users who report buying tobacco 25% as a base, decrease the percent of 9"'
aY gas stations or convenience stores. grade female and male tobacco users who report
(Minnesota Student Survey) buying tobacco at gas stafions and convenience
stores.
1 4. Estimated percent of current smokers By 2004, using tfte 1997 number of 22.1 °,6 as a
(18 years of age or older) in Ramsey base, decrease the estimated percent of current
Couniy. (Behavioral Risk Assessment; smokers (18 years of age or older) in Ramsey
Minnesota Department of Health} County.
40 CHS PAOGRAM PLAN: TWaacco Use
0�-999
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�ll: �'UBLIC HEALTI-! POL�CY D�fELORIYIIEN� .
PROB IPM
1. There is a lack of capacify and resources devoted to researching, informafion sharing and
developing solutions to public health issues in Ramsey County.
OUTCOME
1. Sufficient capacity to effectively assess, communicate and help develop solutions to Ramsey
County's public heafth problems.
STRATEGIES
Out- CHS�a
come Strategies Program
Area
1. Increase the ability of SPRCDPH to collect and analyze data according to a variety HP
1 of designated geographic areas such as zip code areas, neighborhoods, and census DPC
tract areas.
1 2. Develop methods for communicating research information on emerging and re- HP
emerging public health topics.
3. Coliaborate with data collection organizations that exist outside of SPRCDPH, HP
1 including other inter- and intre- county groups, the state, education institutions and DPC
private, non-profit groups.
1 4. Continue participation in metro area county planning and data groups. HP
1 5. Support improvements in data eollection and reporting efforts of the Minnesota HP
Department of HeaRh.
1 6. Improve capabiliiy at local level for collection and analysis of local data. HP
1 7. Create a database to use current data sources more efficientiy and effectively. HP
1 8. E�lore ways to finance and conduct a behavior risk sunrey of Ramsey County
residents.
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
14 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGR,4M PLAN: Public Heatth Policy Development 41
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OUTCOME EVALUATION PLAN
1 1. Percent of outcome indicator data contained On an annual basis (or as frequently as new
in the Ramsey County CHS Plan that is data is available), data for 100% of outcome
collected on an annual basis (or as frequently indicators contained in the CHS Plan is
as the data is available). collected.
1 2. Percent of CHS Plan outcome indicator data On a biannual basis,100% of outcome data is
that is available in written form for disVibution made available in one or more written reports.
to public health decision makers and other
interested persons.
1 3. Amount of data available for analysis From 2000-2003, 5 data elements are identified
acxording to neighborhood, zip code and and available for analysis according to the
census tract geographic areas. appropriate RC neighborhood, zip code or
census tract area.
42 CHS PROGRAM PLAN: Public Health Policy Development
or'9
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IV: f BF�EASTFEEQIN.G RAT'E
PROBLEM
1. Ramsey County women are indiating and sustaining breastfeeo'ing at a rate lower than the state
and nafional goals.
OUTCOME
1. A higher rate of Ramsey County infants will be breastfed.
Out- CHS15
come Strategies Program
Area
1 1. Develop a coordinated breastfeeding promotion message from Saint Paul — Ramsey
County Department of Public Health. HP
1 2. Build awareness of the benefits of breastfeeding among SPRCDPF{ stafE, and HP
encoura e Public Health staff to rovide ositive feedback to women who breastfeed.
1 3. Continue SPRCDPH promotion of breastfeeding during prenatal contacts, provision HP
of lactation education and support, and referrals of SPRGDPH clients to community HHC
resources for breastfeeding women and teens.
4. Beginning with W IC mothers, continue working to collect data on length of time
mothers breastfeed
1 5. Participate in community-based efforts, including work with clinics, to promote and
support breastfeeding for all women, such as through access to lactation consultants HP
and support in chitd-care settings.
Current Strategies That Will Be Reduced and Eliminated
Not Applicabte
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Number of antepartum women served by �ncreased percent of Public Health clients served
1 Public Health staff who breastfeed in the antepartum who breastfeed in the hospital.
hospita{.
1 2. Duration of breastfeeding by women Increased duration of breastteeding women
receiving WIC services. receiving WIC services.
15 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRRM PL.4N: Breastfeeding Rafe 43
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44 CHS PRO�R,4M PLAN: Breastfeeding Rate
0� -999
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�, O. YOUTH RISK BEHA�IOR
PROBLEM
1. There is an increasing amount of self-destructive behaviors by youth that result in negative health
outcomes in Ramsey Courrty. .
. � .,,=
1. Ramsey County youth engage in fewer or lower levels of self-destructive behaviors that resuft in
negative health outcomes.
Out- GHS76
come
Strategies Program
Area
1 1. Promote asset building in youth development. HP
1 2. Promote healthy attachment and brain development during pregnancy, HP
infancy and childhood.
1 3. Increase education regarding depression in youth and adolescents. HP
1 4. Support efforts of The tnitiative for Violence Free Families and Communities HP
that pertain to behaviors in youth that result in negative health outcomes.
Current Strategies That Wili Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Percentage of Ramsey County 9 grade students who
1 disagree with the statement: I usually feel good about myself By 2004, decrease by 3%.
(Minnesota Student Survey).
� 2. Percent of 12 grade Ramsey Couniy female students who BY 2004, decrease by 3%.
use diet pilis or speed to controi weight (MN Student Survey).
� 3. Percent Ramsey County 9 grade males who report a gY ppp4, decrease by 2%.
suicide attempt in the past year (Minnesota Student Survey).
� 4. Percent Ramsey County 9 grade females who report a gY 2Qpq decrease by 4%.
suicide attempt in the past year (Minnesota Student Survey).
5. Percent of Ramsey County 9"' graders who report feeling BY 2004, increase�the percent off
1 cared about by school staff. Ramsey County 9 graders who report
teeling cared about by school staff.
16 These program area acronyms are discussed under "Planning Categories" in fhe Introduction section.
CHS PROGR,4M PLAN: Service Needs of the Elderly 45
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46 CHS PROGRAM PlAN: Service Needs of the Elderly
Ol-999
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P: SER�/iCE N€EDS O�T,f=1€ ELDERLY
PROBLEM
1. The needs of the growing populafion of peopie age 65 and oider in Ramsey County may
ovenvheim the traditionai response of tamily, the private sector, and govemment.
1. Ramsey Coun�s residents who are older than 65 years of age wili have healthful aging and the
greatest degree ofi independence that is possibfe.
Out- CHS"
Strategies Program
come �,�
1 1. Conti�ue the DepartmenYs involvement with the Seniors Agenda for HH
l�dependent Living program (SAIL) whose mission is to reshape the long-term HP
care system in the East Metro Area, making more community options available DPC
and accessible to `older persons.
1 2. Continue nursing assessments and referrafs under the Health Officer Act for HH
elderly who are classified wtnerable aduits.
1 3. Explore the role of public health in the future aging population with statewide HH
and(or regional efforts. HP
DPC
1 4. Encourage community groups to support healthy aging. HP
1 5. Promote transportation alternatives and inRiatives (e.g. buses and Metro HH
Mobility across county lines, senior rates for cab fares, and legislation to increase HP
funding of fare waivers to enable transportation for shopping).
1 6. Continue and expand effective interventions to prevent poor health outcomes EH
related to environmental safieiy hazards (e.g. injuries from falls). HP
DPC
1 7. in cooperation with Area Agency on Aging, Ramsey Action Programs, and the
Ramsey County Meafs on Wheels Consortium, change Meats On Wheets HH
corrtracts to require Meals on Wheets iVutrition Education, ethnic meal HP
alternatives, and to allow for additional vendors.
1 8. Work with agencies to develop consulting nutritionists in the private sector who HH
will contract with waivers, incentives to work with MA and Waivers. HP
DPC
1 9. Work with Area Agency on Aging for promotion of exercise centers in High HH
Rise and education on strength training for elders and capacity building- HP
community education programs.
1 10. Encourage home care agencies to use persons older tha� 65 as health care ��
workers to help alleviate the shortage of home care workers and as trainers to
" These program area acronyms are discussed under "Pfanning Categories" in the Introduction section.
CHS PROGRAM PLAN: Service Needs of the Elderly 47
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maximize skilis of workers.
1 11. Continue support of Living at Home/Btock Nurse Program or other simiiar HH
programs. HP
1 12. Promote "Mobiie Assisted Living" concept. HH
HP
Current Strategies That Wiil Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN:
1 1. Nursing facitity occupancy rate Decreased nursing faciliry occupancy
rate.
1 2. Regiottal and/or Statewide efforts to e�lore The extent to which the role of Public
role of Public Health. HeaRh has been def+ned/established
for the future population of age 65 and
over.
48 CHS PROGRAM PLAN.• Servic� Needs of the Elderly
0l-999
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DEFINITIONS OF OUTCOME AND OUTCOME INDICATORS
The success of the strategies contained in this CHS Program plan will be evaluated aa:ording to
Ramsey County's outcome-based performance measurement system. The outcome evaluation system
measures sua;ess according to how the community has benefited from the strategies.
Outcomes are benefits the community and individuais experience, and other desired changes in
knowledge, skil)s, attitudes, behavior, condition or status of individuals and populations intended to be
impacted by the strategies.
Outcome indicators are statistics that `indicate' something. They may serve as proxies for the outcome.
Indicators are imperfect and vary in valid'ity and reliability. They were developed by identifying the best
measure of progress toward achieving the desired outcomes. As is demonstrated by the outcome
indicators for the CHS Program Plan strategies, indicators typicaliy are averages, percents and rates.
METHODS FOR EVALUATlNG OUTCOMES
The methods for evaluation are reflected by the `evaluation' portion of the outcome evaluation grids
(contained under each of the problems statement sections) that state specific goals for the outcome
indicators. The data for these evaluation goals will be reported by the SPRCDPH as frequently as the
data is availabte from outside sources or as frequently as d is possible for SPRCDPH to conduct its own
data collection efforts. Outside sources include Minnesota Health Profiles and the Minnesota Student
Survey. Other data sources may include case studies, existing records within the SPRCDPH, focus
groups, interviews, and questionnaires.
Actual data that is collected wiil be compared to the goals for the indicators contained in the outcome
evaluation grids. The comparisons will be used to discuss:
1, whether and the extent to which the strategies are impacting the desired outcomes;
2, how the strategies could be changed to achieve the desired outcomes;
3, whether new strategies need to be designed and implemented; and
4. if other indicators and eva(uation methods would better reflect the success of the strategies.
EVALUATION OF SERVICES PROVIDED THROUGH GRANTS; CONTRACTS AND AGREEMENTS
Consideration of alternative senrice delivery options will be accomplished through increased use of
Request for Proposai (RFP) processes and outcome evaivations for current and future grants, contracts
and agreements.
CHS PROGRAM PLAN.� Explanation of Outcome Eualuation of Strategies 49
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50 CHS PROGRAM PLAN: Explanation of Outcome Eualuallon of SYrategies
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The Saint Paul Ramsey Couniy Department of Public Heaith collaborates with the Minnesota
Department of Heatth in many ways to ac�omplish fts outcome goals and objectives relating to the
Communiry Health Service categories and problems idenfrfied within those categories. The following
table provides a summary of the administrative and program support Ramsey County may need from the
Minnesota Department of Health.
Key to CHS Categories in Following Table
1= Alcrohol, Tobacco and Other Drugs
2= Child Growth and Development
3 = Chronic, Non-Infectious Disease
4= Disability and Decreased Independence
5 = Environmental Conditions
6 = Infectious Disease
7= Mental Health and Mental Illness
8 = Pregnancy and Birth
9 = Service Delivery Systems
10 = Unintended Injury
11 = Unintended Pregnancy
12 = Violence
CHS Categories
AdminiSt�'dtive and Progf2m Support NeEded 1 2 3 4 5 6 7 8 s 10 11 12
Timely, local data and geo coded X X X X X X X X X X X X
Financiai support for early HIV intervention
services X
Shared philosophy regarding importance of public
funded STD/HIV services. X
Training and technical assistance including data
analysis X X X X X X X X X X X X
Full funding for tuberculosis medications. X
Support for the Immunization Registry X X
Funding for the Hepatitis B Perinatal Prevention
Program X X X
Support for universal hepatdis B immunizations. X X
Heafth education materials in multiple languages X X X X X X X X X X X X
Consuttation on coalitions working with chronic
disease prevention and reduction X X X
Ongoing updating of MDH "Strategies for Public
Heatth" book. X X X X X X X X X X X X
Consultations regarding health promotion
messages, dissemination, funding, and X X X X X X X X X X X X
assistance evaluating effectiveness of inessages.
Promotion of health advocacy X
CHS PROGRAM PLAN: Program Support Needed from the Minnesota Department of HeaRh 51
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CHS Categories
Administrative and Program Support Needed 1 2 3 4 5 6 7 8 s 10 71 12
Leadership regarding increased reporting of food
bome illnesses X X
Support for local enforcemerrt of environmental
health regulations X
MDH Disease Control Newsletter with information
on disease prevention and control X X X
Support for groundwater proteetion agreements. X
Advocacy for means of funding lead screening,
lead inspections, workable lead standards, and
other public health funcfions mandated in state X X
statute.
Assistance in the development of a system for
ensuring consistent, accurate physicians and
taborarorfes to report cases of blood lead
poisoning to MDH and appropriate levels of X X
govemment (including non duplicated counts of
cases)
Development of education materials for
hazardous waste generators X
Continued support for and recognition of poverty,
especially geographic areas of concentrated
poverty, as an underlying cause of public health X X X X X X X X X X X X
problems.
increased development and collection of locai
data regarding prevention and incidence ot rases,
including support for local behavioral risk X X X X X X X X X X X X
assessment surveys.
Support for institutionalizing violence prevention
as ongoing activiry of MDH and local public health X X
departments
Leadership and increased opportunities for
counties to leam from each other regarding X X X X X X X X X X X X
ident'rfied pubiic health problems.
Ongoing improvement and expansion of MDH
informafion and data W W W sites. X X X X X X X x x x x x
52 CHS PROGRAM PLAN: Program SuppoR Needed from the Minnesota Department of Heaith
ot-99 y
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APPENDIX 2: �ROB�ENfS ORGA[�1Z�D BY CHS CATEG�RY
PLANNING CATEGORIES
A communiry health plan is required by state mandate to organize its pianning according to rivelve planning
categories as listed below.
Alcohol Tobacco and Other Drugs
Child Growth and Development
Chronic Non-Infectious Disease
Disability and Decreased Independence
Environmental Health
Infectious Disease
Mental Health
Pregnancy and Birth
Service Delivery Systems
Unintended Injury,
Unintended Pregnancy,
Violence
The twelve planning categories are used as guides for collecting data and organizing the community
assessment and plan documents. In addition, Ramsey County chose to use "Youth Risk Behavio�" and
"Child NeglecY' as additional planning categories. The foilowing is a list of the public health problems
organized according to community health planning categories.
ALCOHOL, TOBACCO AND OTHER DRUGS
1. Aicohol abuse causes adverse health effects and social problems in Ramsey County. It negatively
impacts intended and unintended injury; unplanned pregnancy; poor birth outcomes; child development;
adolescent health; mental health; violence; infectious diseases; and chronic diseases.
2. Tobacco use is on the rise among youth and other select populations in Ramsey County.
CHILD GROIKTH AND DEVELOPMENT
See the "Pregnancy and Birth" category.
CHILD NEGLECT
1. An increasing number of children in Ramsey County are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
1. High numbers of Ramsey County residents are ovenveight, inactive and have inadequate nutrition,
which contributes to chronic disease.
DISABILITY AND DECREASED INDEPENDENCE
1. The needs of the growing population of peopie age 65 and older in Ramsey County may ovenvhelm
fhe traditional response of famity, the privafe sector and govemment.
ENVIRONMENTAL CONDITIONS
1. There is an increasing risk of iliness due to environmental health hazards in Ramsey County.
INFECTIOUS DISEASE
1. Emerging and re-emerging infectious diseases threaten the health of the general population Ramsey
Couniy.
CHS PROGRAM PLAN: Probiems Organized by CHS Category 53
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MENTAL HEALTH AND MENTAL ILLNESS
See the categories "Youth Risk Behavio�' and "Service Delivery Systems" (problem number 2).
1. The percent of infants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
2. Ramsey County women are ini�ating and sustaining breastfeeding at a rate lower than the state and
national goals.
3. Increased percentage of births to adolescents and increased number of births that result from
unintended pregnancies.
SERVICE DELNERY SYSTEMS
1. An increasing number of children and adolescents Ramsey County experience the health effects that
are associated with poverty.
2. There is a gap beiween Minnesofa goals and the current number of people in Ramsey County who
have access to medical, dental and mental heaRh care.
3. Despite overall health improvement in Minnesota and Ramsey County, populations of color in
Ramsey Couniy continue to experience poorer health and disproportionately higher rates of illness and
death.
4. There is a lack of capacity and resources devoted to researching, information sharing and developing
solutions to public health issues Ramsey County.
UNINTENDED INJURY
1. Unintentional injury is one of the leading causes of death throughout a life6me in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by falls, poisoning, suffocation,
and fire.
See the "Pregnancy and Birth" category.
VIOLENCE
1. There is an unacceptable level of interpersonal violence in Ramsey County.
YOUTH RISK BEHAYIOR
1. There is an increasing amount of seif-destructive behaviors by youth that result in negative health
outcomes in Ramsey County.
54 CHS PROGRAM PLAN: Problems Organized by CHS Category
Cl!- / �l�f
, , ,. .� ,
PEi�t�IX 3: M/kTERF�lAL.AN�,CFiii_D HEALTFf CCRaF�tT " ;, .:.:;..
CHS PROGRAM PLAN: Youth Risk Behavior Plan Update 55
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a� -49y'
The Saint Paul Board of Health
and
The Saint Paul - Ramsey County Department of Public Health
The Public Health Joint Powers Agreement - JPA, between the City of Saint Paul and Ramsey
County became effective July l, 1997. The JPA forms the Saint Paul - Ramsey County
Department of Public Health and identifies ane Community Health Services Agency for the
Saint Paul - Ramsey County community. However, both Saint Paul and Ramsey County
continue to maintain a Boazd of Health. The Saint Paui Community Health Boazd will consider
issues affecting those services maintained by the City of Saint Paul, which include the Maternai
and Child Health Special Projects Grant. The Saint Paul - Ramsey County Department of Public
Health is the operating agency for the MCH grant.
-i-
p1-�999
Saint Paul Maternal and Child Health
Special Projects Grant Update 2002 - 2003
Table of Contents
Updated Minnesota Department of Health Forms
A . Face Sheet ••• ..........................................................................................
B. Assurances and Agreements ....................................................................
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legisiative Priority, 2002-2003 ..........................
• I. Improved Pregnaucy Outcome Programs .....................................
• II. Family Planning Program .........................................................
• V. Other Programs Previously Funded by a Local Pre-Block
MCH Special Project Grant: Adolescent Health Program ..........
D. Efforts to Reduce Racial Dispariries ......................................................
E. Subgrants/Subcontracts .........................................................................
F. Special Project BudgetlExpendihue Report
• 2002 ................................................................................................
• 2003 ................................................................................................
• Budget Jusrificarion .........................................................................
G. Indirect Cost Allocation for MCHSP ......................................................
H. MCH Special Project Breakout Budget/Final Expenditure Report
By Legislative Priority, 2002-2003 ..........................................................
Program Narrative Update
I. 2002-2003 MCH Special Project Program Update .........
• I. Improved Pregnancy Outcomes Programs
a. HealthStart, Inc . .......................................
b. Face to Face Health and Counseling Center
c. West Side Community Health Center ......
• II. Family Planning Program
Room ....................................................
• V. Adolescent Health Frogram
HealthStart, Inc . ...........................................
.......... 1
.......... 3
.......... 7
.......... 7
.......... 8
.......... 14
.......... 15
••........ 16
.......... 17
.......... 18
.......... 19
.......... 21
.......... 23
.......... 25
.......... 27
.......... 37
.......... 45
.......... 51
.......... 55
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o�-y99
�'s���s�a�ro��o„s A. Minnesota Department of Health Face Sheet
Grant Applicaaun tor. Maternal and Child Aealth Special Projects
1• Applicant Agenty With Which Giant Coahaet is to 6e Ezecured
Legai N�e: SteetAddcess: 310 City Hall, IS West Kellogg Blvd Telephoae Number:
Saint Paul Commuvity HeaIW Board Saint Paul, MN 55102 651266.8560
FAX N�mber. 651266.8574
E�Mail Addcess:
2. D'upctor of Applicant Agency
Name aad Title: Sheet Addtess: 555 Cedar Steet TeLephone Numher,
Rob FuIWn Saiat Paul, MN 55101 651266.2424
Direc[or of Public Health FAX Number: 651.266.1201
�Mail Address: robSutton@co.xanssey.mn.us
3. Flscal Maoagement O�cer of AppticaM Agenry
Name and TiUe: Steet Address: 555 Cedar Street Telephone Numba
Diane Holmgreu Saint Paul, MN 55101 651266.1221
�Hea�ih Adminsua6on Manager FAXN�mmber:651266.1201
E�Mail Add�ess: diave.holmgrn� .(t�coramseY.mn.us
4 • OMn�S �Se��S' ('+Id�ent from number I above)
Name and Title: S�eet Address: 555 Cedaz Street Telephoue Number:
Saint PauL— Ramsey County Depa[mient of �� pau1, MI`155101 651266.1200
FAX Number: 651166.1201
Public Health E-Mail Address:
5. Coniac[ Person for Opentiog Agenty ('fdifferentfrom nwnber2 above)
Name and Tifle: Address: 555 Cedar Street Telephone Number.
Peg Torgerson Saint Paul, MN 55101 651266.1216
MCfI Gtant Coordinator FAX Numba: 651266.1201
E-Mail Address: Peg.torgerson@co.ramsey.mn.us
6. Confact Persou for Forther Informstion on Application (ifd�rentfrom mnnber S above)
Name and Title: Street Address: Telephone Number.( )
FAXNum6er.( )
& Mail Address:
7• Opersdog Agency F5sca1 ContaM (�'di$aent munber 3 above)
Name and TiUe: Stree[ Address: 555 Cedar Street Telephone Number:
Nflce Hagen Saint Paul, MN 55101 651266.1204
FAX Number. 651.2661201
Accouarent ��padress: mike3ageneco.ramsey.mn.us
8. Copies of This ApplicaUon Hsve Been Sent to Ne FaDowing Commmity Health Boards Por Review
(NotApplicable far Cammtmiry Health Bomd(s) ifthe Bomd is the Applicanf)
A¢encv Name
Date Sent
9. Certifinfion
L cenity that the infocmation contained �etein is ttue apd accurate to tha best of my Imowledge and that I submitihis applicarion oa behalf of the applicant agency.
/�i�,����-u �►rP��c1� 4-�3-ai
Sigpatureof irecturofApplicantAgrncy TiUe Dy¢
Fi&01274-OS (3/27) - PART A
-1-
OI-999
B. Assurances and Agreements
BY SIGNATURE, THE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
1. Services wiil be provided in accordance with applicabie state and federal laws, rules and procedures.
2. The agency wil] comply with state and federal requirements relating to privacy of client informauon.
3. The agency wiil comply with the Minnesoca Clean Indoor Air Act which prohibits smoking in MCH Special
Project facilides and ciinics.
4. The agency (iF it has 15 or more employees) and any subconffactors with 15 or more employees will have on
file and available for submission to Minnesota Departrnent of Health (NIDI-n upon request a written non
discriminauon policy containing at teast the following:
"All programs, services, and benefi[s which are administered, authorized, and provided shall be operated in
accordance with the non discriminatory requirements pursuant to Tide VI of the Civil Rights Act of 1964,
Section 504 of the Rehabi]itation Act of 1973, as amended, tf�e Age Discrimination Act of 1975, and the non
discriminatory requirements of the MCH B lock Grant.
No person or persons shall on the ground of race, color, national origin, handicap, age, sex, or religion, be
excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimina6on under
any progazn service or benefit advocated, authorized, or provided by this Department."
5. The agency (if it has 15 or more employees) and any subcontracTOrs with 15 or more employees witl
disseminate information to beneficiaries and the general public that services aze provided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be accompisshed
by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or other
communications designed to acquaint po[ential beneficiaries and [he puMic with progams; and/or
B. Notifying refetral sources in rou[ine letters by including prepazed handouts which state that services and
benefits must be provided in a non discriminatory manner.
Copies of each documen[ disseminated and a description of how these documents have been
disseminated wiil be provided to the MDH uQon reques[.
6. In fitlfilling [he duties and responsibilities of this gran[, the grantee shall comply with the Americans wi[h
Disabilifies Act of 1990, 42 U.S.C. § 12101, et seq., and the regulatioas promulgated pursuant to iL
7. No residency requiremenu for services other than sta[e residence, will be imposed.
8. Services shalI not be denied based on inability to pay.
9. Arrangements shall he made for communications to take place in a language understood by the matemal and
child heal[h service recipient. .
10. All written materials devetoped ro determine client eligibility and to describe services provided under this
grant will be understandable to a person who reads at a seventh grade level using the Flesch Analysis
Readabili[y Scale as required in Minnesota S[a[ute 144.054 (see Appendix 10, Plain Language in Wri[[en
Materials, Minnesota Statute, Section 144.054).
-3-
l 1. The agency will provide services in keeping wi[h program guideli�es of the Minnesota Departmen[ of Health
and guidelines of accepted professional groups such as the American Academy of Pediatrics, American College
of Obscetricians and Gynecologists, and American Pub[ic Heaft[i Association.
12. Upon request, one copy of any subconvact executed as part of the project witl be provided to the Minnesota
Department of Health.
13. The ag�ncy will report accomplishmenrs of the project to the Minnesota Department of Health. Such reporrs
will be submitted no later than 90 days afrer the completion of the calendar year. Upon request, the agency will
provide additional information needed by the Department for evaluation of the projecCs objuuves and methods
and comptiance with any special conditions (see Appendix 18, Program Reporting Requirements for Matemal
and Child Health Special Projects).
24. Grant funds shatl not be used for inpatient services except for high-risk pregnant women and infants.
15. Cash paymenYS shall aot be made to iniended recipients of heat[h services.
16. Grant funds shall not be used for purchase or improvement of land or facilities.
17. Grant funds shall not be used for purchase of equipment costing more than $5,000.00 per unit and with a useful
life exceeding one year.
18. Granf funds shalI not be used for reimbursement for travel and subsistence expenses incurred ouuide tlie state
unless it has received prior written approval from the Minnesota Depamnent of Heatth for such out-of-state
iravel.
19. When applicable, the agency shall provide nonpartisan voter registrarion services and assisfance using fonns
provided by the state to employees of the agency and [he public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Regis�adon).
20. When issuing siatements, press releases, requests for proposals, bid solicitations, and o[her documents
describing projuts and programs funded in whole or in part with federal money, all gantees receiving federal
funds sttall clearly stare (a) ihe percentage of the total cost of the program or project which will be financed with
federal money, and (b) the dollu amount of federal funds for the project or program_
21. The agency will not use �ant funds to pay for a�y item or service (other than an ecnergency item or service)
fumished by an individual or enury convicted of a criminal offense under the Medicare or any state health caze
program (i_e., Medicaid, Maternal and Child Health, or Social Services Blcek Grant programs).
22. Materials developed by Macemal and Child Aealth Speciat Projut �ant and matching funds will be part of the
public domain and will be accessible to the public as £nanciaily reasonable. Materials 8eveloped by the
Maternal and Child Health Special Project grant and matching funds may be reproduced and distributed by the
Project to other agencias and providers for a profit so tong as the revenues from such sale aze credited to the
Special Project budget for expenditure by the Special Project
23. The agency will comply with atl standards relating to fiscal accoun[ability [hat apply to the Minnesota
Department of Aeatth, specifically:
A B�et�e�§�o�s with 'ustification will be submitted to IvIDH for rior a roval whenever:
(1) changes are made in the objectives ro be met in the Matemal and Child Health Special Projec4 or
(2) the cumulative amount of funds vansferred into or out of an operating agency's budget line item
exceeds or is expected to exceed 10% of that approved for the gant yeaz or $2,500.00, whichever
is grea[er.
-4-
oi-599
B. Final expenditure reports are due 90 days after the end of the calendar yea.
C. Grant funds ue used as payment for services only afrer third-party payments, such as from the Medical
Assistance/Medicaid (Title XIX 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 wiil provide for:
(1) Accurate, cursent, and compiete disclosure of the financial stams of the project.
(2) Records which idenafy adequately the source and application of funds for Maternal and Chiid
Health Special Project activities. These records aze to contain information pertaining to project
awazds and aurhorizations, obligations, unobligated balances, liabilities (encumbrances), outlays,
and income.
(3) Effective control over che accountability for all funds, property and other assets. Projects are to
adequately safeguard such asseu and assure that they are used solely for authorized purposes.
(4) Comparison of actual obligations with budget amounts for each activity.
(5) Accounting records which aze supported by source documentation.
(6) Audits which wiil be made by or at the direction of the Minnesota Department of Health (see
Appendix 6, State Audits).
24. Grant funds wili not be used to provide and/or arrange sterilizations without the prior approvai of the
Minnesota Department of E3ealth. Agencies approved to use federal funds to provide and/or arrange for
sterilization aze required to follow federal procedures and to provide written documentation in this regazd
on a quarterly basis. (This procedure is not applicable to provision of infottnation conceming sterilization).
25. The agency assures that in accordance with Section 1352 tiUe 31, U.S. Code no grant funds will be used for
lobbying.
26. The agency will comply with the requirements of the OMB Circular A-87 "Cost Accounang Principles for
State, Locai, and Indian Tribal Governments", Cost Account Principles and the Federai award(s) for which
they apply.
Signature of Chair or V ice-chair of the Communiry Health Board or An Agent Appointed by
Resolutioa of the Community Health Board:
Si�ed By Title Date
� �lrrc.#t/� Q-/��Ol
-5-
o�-�y9
C. MCHSP Summary oF Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
1. Improved Pregna�cy Outcome Program
Agency Name Subgrantee Name {if this report is for subgraMee only)
Saint Paul Commimity Health Board
St. Paui — Ramsey Cty. Dept. of Public Health
Types of Activities/Services
Please check those services provided:
✓ core public health activities not direct service ./ pregnancy testing and referral
./ individualized education/counseling �/ pre-term birth prevention
✓ heafth education/counse{ing in groups ✓ prenatal case management
✓ prenatal medical care ✓ enabling and non-heafth support
✓ ATODJviolence screening ✓ referrai services
✓ breast feeding promotion
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply:
less than 200% of poverty per revised Appendix �/ no fees are charged to persons with
7, or women who are pregnant and determined incomes less than 100% of poverty
eligible for medical assistance (MA) or the
speciaf supplemental food program for women, �/ fees are charged to persons with
infants, and children (WIC) incomes greater than 100°/a of poverty
per pubiic schedule of charges
�/ risk factors listed in Appendix 12 reflecting income, resources and family
size
❑ other risk faetors — please specify:
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chifd Healtfi Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
-7-
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
2. Family Planrtiog Program
Agency Name Subgrentee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St Paul - Ramsey Cty. Dept. of Public Aealth
Types of ActivitieslServices
Please check those services provided:
./ core pubtic heaRh activities not direct ❑ method services
service ❑ task force
./ individualized educatioNcounseling ❑ enabling and non-heaith support
oeducation in schools Oreferral services
❑ other public education
Other- please specify:
Low Income & High Risk Target Population & Fees
Please check those items which apply:
! less than 200°/a of poverty per revised ./ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
✓ risk factors listed in Appendix 12 ❑ fees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specity: schedule of charges reflacting income,
resources and family size
Describe tF�e manner in which the program responds to the needs and priorities for services
identified by the Matemai and Child Heafth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
�
o�-g9y
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
3. Handicapped/Chronlcally Iil Children's Program
Agency Name SubgraMee Name (if this report is for subgreMee only)
Saint Paul Community Health Boazd
St Paul — Ramsey Cty. Dept. of Public Heaith
Types of Activities/Services
Please check those services provided:
❑ core public health activities not direct service ❑ child find/identification
❑ case managemenUservice coordination U early intervention tracking and follow along
❑ home health � assistance to chldren, youth and families in
❑ respite care identifying and locating resources (short-
❑ participation with interagency committee tertn)
❑ IEIC ❑ assistance in establishing medical fiome
❑ children's mental health collaborative Q enabling and non-health support
❑ transition (1422) Q referral services
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply;
❑ less than 200°l0 of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes tess than 100% of poverty
❑ risk factors tisted in Appendix 12 ❑ tees are charged to persons witfi incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family size
b�
Describe the manner in which the program responds to the needs and priorities for
services identified by the Matemal and Child Heaith Advisory Task Force (see revised
Appendix 17). Differences must be described in detail.
C. MCHSP Summary of Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
4. Childhood injury Control Program
Agency Name Subgrantee Name (if this report is for subgrantee only)
Sain[ Paul Community Heakh Boazd
St Paul — Ramsey Cty. Dept. of Public Healffi
Types of ActivitieslServices
Please check those services provided:
❑ core public health activfties not direct service ❑ injury prevention in day care setting
❑ home safety checkiist promotion ❑ injury preven6on in schools
❑ promotion of positive parenting ❑ fartn related injury programs
❑ toddler car seats ❑ enabling and non-heatth support
❑ bicyc(e heimet campaign ❑ referral services
Other - please specify:
Low Income & High Risk Target Population 8 Fees
Please check those items which apply:
❑ less than 200% of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
❑ risk factors listed in Append'a 12 0 tees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family s¢e
Describe the manner in which the program responds to the needs and priorities for
services idenffied by the Matemai and Child HeaRh Advisory Task Force (see
-10-
OI-999
C. MCHSP Summary of Types of Acdvities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
5. infant Health Program (oniy Minneapolis and St Paul):
Agency Name Subgrantee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St. Paul — Ramsey Cty. Dept. of Public Health
-11-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differe�ces must be described in detail.
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
6. Child Health Program (only Minneapolis):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Hea(th Boazd
3t Paui — Ramsey Dept. of PubHc Healffi
-12-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Heatth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
01-9 49
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
7. Dental Health Program (only Goodhue and Wabasha):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Health Boazd
Saim Paul — Ramsey Cty. Dept of Public Heakh
-13-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
C. MCHSP Snmmary of Types of Activities and Services Provided by
Operating Agencies by Legislafive Priority, CY 2002-03
8. Adolescent Health Program (only Minneapolis and St Paul):
Agency Name SubgreMee Name (if this report is for subgrentee only)
Saint Paul Comm�miTy Aea(th Board
St Paul — Ramsey Cty. Dep[. of Public Heatth
-14-
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chiid Health Advisory Task Force (see revised Appendix 77).
Differences must be described in detail.
O�"�JIg
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identfied in the CHS needs assessment are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispaziries impact your matemaVchild population or what is the significance of
dispariries to your population.
Each subconhactor has completed tlus information relating to their program.
See: Program Narrative: l.improved Pregnancy Outcomes: a HealthStart, inc.; b. Face to Face Health and
Counseliug Service, Inc.; c. West Side Community Health Services;
2. Family Plauniug Program: Room 111;
3. Adolescent Health: HealthStart, Inc.
2. List specific MCHSP objectives related to raciaUethnic disparities.
Cacn subcontractor nas completeA tlus mtormahon relahng to their program.
See: Program Narrative: 1.Improved Pregnaucy Outcomes: a HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Pla¢ning Program, Room 111;
3. Adolescent Health: HealthStart, Inc.
3. What strategies wilt be urilized related to the above objectives? Of particulaz interest aze community and
systems strategies/objectives which recognize the potential rote all types of community-based organizarions can
play in the decrease of disparities.
Each subcontractor has completed ttus information relating to their program.
See: Program Narradve: l.improved Pregnancy Outcomes: a. HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Planning Pragram: Room 111;
3. Adolesceut Healt6: HealthStart, Inc.
-15-
E. Subgrants/Subcontracts
1. Please list all subgrantee/subcorrtractors and the award amounts for the two year period CY 2002-03.
All subgrantees are accountable for provision of services as specified by the Community
HeaRh Board and further are accouMable for compliance with applicable federal and state
requirements. Please describe the monitoring procedures the Community Heafth Board p�ans to
utilize in assuring fiscal and program acxourrtability of each of its subgrants. indipte the extent to
which on-site monitoring procedures will be utilized
i o ensiae wac every eaort is maae to actueve the proposed goals and objecrives, the subcontnctor's efforts and
performance will be monitored on a regulaz basis throughout the entire contract period.
Contracts will be written beriveen Saim Paul — Ramsey CouNy Department of Public Health and the
subcontractots indicating specific performance objectives and outcome indicato�. The con4acts will outline the
subcontrecto�s duties, reporting requirements, the monitoring expected/performed by Saint Paul — Ramsey
Coimty Departmem of Public Health, and evaluation indicatrns.
Subcantractors will also be required to provide annual performance reports evaluating their own progrdm, and
assessing progress toward goals and objectives. Both subjective and objective tools will be used by the
subcontractors to ensure that various aspects of their progam aze reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
-16-
2. Monitoring and Evaluation of Subgrantees/Subcontradors
01-�99
F.
Matemai and Child Health (MCH)
P.O. Box 64882
St. Paul, MN 55164-0882
IV. Reimbursement Request $_ Q, A
V. ORIGINAL CERTIFICATtON SIGNATURE
! cartify tl�a4 to the best ofmy knowledge and belief,
Ne data 2ported on this docume�rt is corrpcf and all
6ansactlons that support this repat were made in
accordance wdh applicable Federal and SYate statutes
and rules
A rized (�fficial Date:
- �-/3.a/
SUBMIT A SIGNED ORIGINAL AND 2 COPIES
TO THE ABOVE ADDRESS
6�, �,2��,
Form for MCH Sectioa Grants
Name of Grant Project:
Matetnal & Child Health Special Projects
GraM Year. 2002
Expenditure Period: 01.01.2002 —12312002
"` List Sources and amourtls of °other g2Mee funds
(e.g., local tax, fees, in kind donations, fioundations, etc.)
Fomdations 109,000
L,ocai tax 139,480
$
= �-:n ?,K � ��=EOR MDH USE ONLY_ - � ; �:�-:%'�
Program Approval
Fiscal Year
0�9. #
PO Number
Dollar Amount
-17-
copy, and equipment under $5,000.00
F.
snorzao�
Budget/Eapenditare Farm for MCH Sectiou Grantg
Name of Grerrt Project
Matemal & Child Health Special Projeas
rant Year. 2003
Expenditure Period: 01.012003 —12.31.2003
IV. Reimbursement Request $ Q, A
V. ORIGINAL CERTIFICATION SiGNATURE "' List Sa�rces and amounts of'other 9raMee tunds
(e.g.. Iacal tax, fees, in IdrW donatb�. foundations, eM.)
1 cartify tha� to Uie best ofmy krtawledge and 6elief, Fmmdations 109,000
tlie date ieported on this dacumerrt is conect and a!! Local Ta�c 139,480
fransacfians fhet suppqt this 2pat were mede in $-
accadence wifh applka6le Federal aid Slate stakdes
arMrules. '---._ _. .. -------. . . . �
Auth ' 1 Date:
9 /3-0
SUBMIT A SIGNID ORIGINAL AND 2 COPIES
TO THE ABOVE ADORESS
�
copy, and equipment under $5,000.00
ol-9gy'
Budget Jusrification
The budget justification for each of the projects/subcontractos is included within their budgets
presented in the application narrative.
In addition to the funds proposed for allocation to the subcontractors for Improved Pregnancy
Outcomes and Adolescent Health programs, a portion of the Matemal and Child Health Special
Projects Crrant is budgeted to remain at Saint Paul - Raxuse�County De�artment of Public
Health for Administrative and Core Public Health functions.
Salary/Frin�e�.
Administrative Assistant:
General program oversight,
prepazes and monitors gants,
reviews reports, prepazes annual
reprots, prepazes and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activites
Accounting Tech Il.�
Prepazes budget and expenditure
reports, prepares pay vouchers
and processes grant allocations
Clerk-Typist IV.•
Types grants, contracts and
reports
2002
$14,670
$ 2,850
$ 3,400
$ 2,850
2003
$14,670
$ 2,850
$ 3,400
$ 2,850
Epidemiologist:
Data collection, analysis,
reporting and display
Sup�lies:
TOTAL:
$14,850
$14,850
$ 200 $ 200
$38,820 $38,820
-19-
Budget Detail of Local Match
Local match is identified within each of the subcontractors budgets, as required by MCH
guidelines. Additional local match is provided by the Saint Paul - Ramsey County Department
of Public Heath:
1. Local Tax Levy funds:
• MCH Prenatal Caze at
Community Clinics
2002
$139,480
2003
$139,480
TOTAL:
2. Other Loca1 Funds:
$139,480
$139,480
Other local match is provided by Public Health through the funding of various programs wluch
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health education and well child services. Source of this funding includes
CHS fimding, grants, reimbursements, and patient fees.
�II�
O�-9�i 9
G. Indirect Cost Allocation for MCHSP
Please check one of the fo�s options:
./ 1. Not applicable — No chazges to MCHSP aze for indirect cost.
A�plies to Saint Paul — RamseV Counri Deparhnent of Public Health and West Side Communitv Health Services
J 2. Indirect Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against all
participating programs, includingMCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached
Applies to HealthStart, Inc.
❑ 3. Approved Cost Allocation Process:
Option 1—Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached wluch are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
J 4. MCHSP - Approved Cost Allocation Process:
OpHon 2—Indirect costs aze allocated to the agency's prograzus using the optional Indirect(Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
Applies to Face to Face Health & Counselin2 Service, Inc.
See: Project Narrative for each subcontractor for supporting data for indirect cost allocation.
-21-
o�-9yy
Please read INSTRUCTIONS ON REVERSE side before completing form.
H. MCH SPECIAL PROJECI' BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
By Legisiative Prioriry, CY 2d112-03
Minnesota Depart. of Health
Matemal and Child Health
85 East SeveMh Place
P.O. Box 64852
St Paul, MN 55164-0882
�. name of community Nealth Board: II. TYpE OF REPORT:
� Original Budget
S"°t Paui O Budget Revision #
Grant Year: ❑ F �
2002 EXPenditure Report
Priorities and
Matemal and Child Heaith Special GraM
Medicaf services ............................................................................. $ 196,900
Other heafth activities"' .................................................................. 16,250
Enabling and non health suppart' .................................................. 40,000
Co2 public health activities not dient based ................................... 25,880
ceun v e� euuwr_ oonn_ewu
Famity Planning method services ............................................
Other heafth ac5vities" ..........................................................
Enabling and rron health support' ............................°----°-°°-
Core pubiic heatth ac6vities not Gient based ...........................
PROGRAM
Handicapped/Chronicalty III Children medicai services .....................
Other health activities"` ..................................................................
Enabling and non health support' ..................................................
Core public heal[h ac5vities nM client based ....................°°.°.°-°--
Medical services ..........................................
Other heatth acbvities"' ...............................
Enabling and non heaith suppart' ...............
Core pubiic heatth activities not dient 6ased
Medipl services ..........................................
Other health activities"`.........-°-°--°-------°-°
Enabling and non healih suppoR' ...............
Core p ublic heatth activities not client based
(only Minneapolis, Goodhue and Wabasha)
Medipl services ............................................................................. $
Otherheafthactivities" .................................................................. $
Enabfing and non heaith support' .................................................. $
Core public health activities not Gient based ................................... x
Paul)
Medical services .........................................
Other heaith activities'"' ..............................
Enabiing and non health support' ..............
Core public healih act'rvifies r�ot client based
�I
IV. CERTIFICATION SIGNATURE
I certify that to the best of my knowledge and belief the data reported on this document is correct and all Vansactions that support this
repoR were made in aaordance with applicable Federel statutes.
� ��•U/
Peg Torgerson
651.266.1216
-23-
Please read INSTRUCTIONS ON REVERSE side before completing farm.
H. MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL E:YPENDITURE REPORT
By Legisla4ve Priority, CY 2002-03
Minnesota Depart. of Healtli
Matemal and Chiid Health
85 East Sevenfh Place
P.O. Box 64882
St Paui, MN 55164-0882
�. Name of Community Health Board: 11. TYpE OP REPORT:
�/ Original Budget
S � P � ❑ BudgeL Revision #
Grant Year: ❑ Final Expenditure Report
2003
Priorities and
Medipl services ......................................�--�
Other heaith acfivities" ...............................
Enabling and non healih suppoR' ...............
Core public heatth acdvfies nM dient based
Family Planning method services... .............
Other health activities" ..............................
Enabling and non heaith support' ..............
Core {�blic health actrvities not dient based
Matemal and Child Heaith Special Grent
$ 196,900
PROGRAM
Handicapped/Chronicalty III Chiidren medical services ..................... $
Other health adivi6es° .................................................................. $
Enabling and non heallh support • .................................................. g
Core pubGc health activities not �ent based .................................•• g
CHILDHOOD INJURY CONTROI PROGRAM""'
Medipl services ............................................................................. $
Other health aGiivities" ....................••----........................................ $
EnabGng and non health support ` .................................................. $
Core Public health acbvi8es not dient based ....--- ........................°- x
Medipl services .............................................................................
Other heatth activiBes" ................................................�---..............
Enahling and non health suPPart'....-°---.....-°--° ...........................
Care pu6lic health adivfies not client based .......-°--........--°-..........
f`NII n no nc/�lTel ucel TY oonP_Owu
(oNy Minneapolis, Goodhue and Wabasha)
Medical services ..............................................
Other health activities° ...................................
Enabling and non heatfh suppoR' ...................
Co2 publ'�c health activ�ies not dieni based ....
Paul)
Medical services ..........................................
Otlter health activities"` ...............................
Enabling and nan healih support' ...............
Core public health acWibes not dient based
14%
$ 336,666
IV. CERTIFlCATION SIGNATURE
I cert'rfy that to the best of my knowledge and belief the data repoRed on this dowment is cortect and all transactions that support this
�. /� O
Peg Torge:son
651266.1216
24
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Ol -49 Q
2002 - 2003 MCH Special Project Program Update,
Saint Paul Community Health Board
L Improved Pregaancy Outcome Program
Each of the subcontractors in Saint Paul was requested to review their 2000-2001
program goals and objectives. They were to submit their 2002-2003 Updates with re-
constructed goals and objectives that relate directly to the revised Needs and Priorities for
Services Identified by the Maternal and Child Health Advisory Task Force, 7une 2000. The ten
needs ranked as highest priority aze listed below:
• Reduce drug, alcohol, and tobacco use
• Promote family support and health communiry conditions
• Promote healthy parenting/family development
• Reduce child abuse and neglect
• Reduce teen pregnancy and teen birth rate
• Address the multifaceted needs of teen parents
• Increase percent of children whose disability is identified eazly
• Reduce youth risk behaviors
• Improve mental health of children, youth and parents
• Increase percent of children who receive early intervenrion services
For each of the three subcontractors applying for funds for an Improved Pregnancy Outcome
Program, their reorganized goals and objectives are followed by their statments on reducing
racial disparities, their individual program budget justifications.
• West Side Community Health Services, 153 Concord Street, Saint Paul, MN 55107
• Face to Face Health & Counseling Service, Ina 1165 Arcade Street, Saint Paul, MIV
55106
• HealthStart, Inc., 491 West Universiry Avenue, Saint Paul, MN 55103
II. Family Planning Program
Update: same as far Improved Pregnancy Outcome Programs (above). Re-organized
goals and objectives and other supporting data relate to:
Room 111 -STD Services (as an extension of Family Planning activiries), 555 Cedar Street,
Saint Paul, MN 55101
III. HandicappediChronically IIl Children Program
No update
IV. Childhood Injury Control Progam
No update
-25-
V. Infant Health Program
No update
VL Child HealYh Program
No update
VII. Dentat Health Program
No update
VIII. Adolescent Health Program (only Minneapolis and St. Paul)
Update: same as Improved Pregnancy Outcome Program (above). Re-organized goals
and objectives and other supporting data relate to:
• HealthStart, Inc., 491 West University Avenue, Saint Paul, MN 55103
-26-
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Goal l. The goai of the Improved Pregnancy Outcomes program is to serve the needs of
low-income (less than 275% of poverty} and adolescent pregnant and postpartum women
by providing comprehensive multidisciplinary prenatal caze at its Main clinic site on
University Avenue, and at the Health Start Clinics located at Arlington and AGAPE high
schoois in St. Paul. Services aze designed to address the concerns of adolescents and
women of color.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen parents.
2. Promote healthy parenting/family development.
Objective 1: �rovide comprehensive muitidisciplinary prenatal care to 3501ow-
income adult and adolescent women per year during CYs 2002 and 2003.
MCH 2O02-03 Priority:
1. Promote healthy pazenting/family development.
2. Addtess the multifaceted needs of teen parents.
Objective 2: Fifty-five percent of women who deliver through Health Start will
initiate prenatal caze in the first trimester of pregnancy and 85% of women will
iniriate care by the end of the second isimester of pregnancy.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen pazents.
2. Promote healthy pazenting/faxnily development.
Objective 3: Eighty percent of prenatal patients will receive five or more prenatal visits.
MCH 2O02-03 Priority:
1. Promote healthy pazentingJfamily development.
2. Address the multifaceted needs of teen parents.
Objective 4: By the end of CY 2003, low birth weight (]ess than 2500 grams) rates
will be no greater than S% and pre-Yerm birth rates (less than 37 weeks gestation) will
be no greater than 10%.
MCH 2O02-03 Priority:
1. Promote healthy parenting�family development.
Objective 5: Women smokers will receive help with smoking cessation prior to or
early in pregiancy.
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
Objective 6: Of the prenatai adolescent teens seen by Health Start, 55% wiil begin
care in the first trimester.
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
-27-
Objective 7: Women receiving negative pregnancy test results will be counseled on
the importance of folic acid supplements and other life style issues to enhance healthy
pregnancies and birth outcomes.
MCH 2O02-03 Priority:
1. Promote healthy parenting/fanuly development.
',f�'�
o �-� 4y
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP applicarion, addressing the following:
1. In what ways do raciaVethnic disparities impact your maternaUchild population or
what is the significance of dispazities to youT population:
Raciallethnic disparities have a significant impact on prenatal caze. American-bom women of color,
especially those living in the Twin Cities' urban azea, aze less likely to ieceive adequate prenatal caze than
their counterparts in the suburbs and wlrite women in the metro azea. They aze aLso more likely than
foreigh-born women of color to deliver babies of low birth-weight Barriers to caze include lack of
insurance, lack of beli�f in the value of caze, few provideis of color, language barriers, transportation
problems, lack of child caze, and social isolation.
The laxgest percentage of clients seen by Health Start is African-American (3b.2%), Followed by Asian
(26.2%), Hispanic (8.4%), White (23.2%) and Native American (1/6%). To qualify for caze, pregnant
women must be 19 yeaz old or younger or have incomes below 275% of federal poverty guidelines.
2. List specific MCHSP ob}eclives xelated to taciaVethnic dispazities:
The overall goal ofHealth Start's prenatal program is heakhy mothers and babies. We seek to accomplish
this goal through specific o6jectives that apply to all prenatal clients while addtessing specific dispariries
issues. These objectives include provision of multidisciplinary prenatal caze, increasing the number of
women who seek caze in the first trimester and continue regulaz caze throughout pregnancy, reducrion or
cessation of smoking in pregnancy, and reduced incidence of 1ow birth-weight. We also seek to incxease
numbers of women who understand the importauce of folic acid in prevention of birth defects.
3. 4That strategies will be urilized related to the above objectives.
Health Start staff have yeazs of experience in employing a multidisciplivary approach in worldng with low-
income women, pregnant adolescents, and those with limited financial resources. One of the greatest
barriers to prenatal caze is a lack of insurance and other financial resources. Health Stazt social workers
assess the financial needs of low-income clients and help clients apply for insurance coverage whenever
possble. We provide caze without charge if resources aze not available. Transportation barriers aze
addressed in part through our location in Progtown, a federally designated under-served azea in which a
lazge number of Asian families have settled. We are on a major bus-line and can help clienu arrange for
rides through theu insurers, and pay for the bus or cab rides when needed. Because we realize fl�at
transportation is difficult, we do our best to see all clients, even if they aze late for visits. To encourage
eazly prenatal care, new prenatal clienu aze scheduled for a first appointment within three weeks of their
call. Clienu who miss appoinhnents aze called, sent post-cazds, and visited by an ouheach worker as
needed. Our child-friendly waiting azea includes play-space for preschool age children. Staff at our Main
clinic includes two Hmong women—a medical assistant and ciinic receptionist—who can inteipret as
needed for Hmong clienu. All Main clinic staff aze experienced in working with a culturaily diverse
popularion. Health Start provides continuing education through inservice 4aining and conferences to help
ensure that staff learn about new immigrant populations as they arrive in our azea.
�'�
HEALTH START, INC.
MATERNAL AND CHII.D HEALTH
Il4IPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANIIARY THROUGH DECEMBER, 2002
Mqi0�2
ANNUAL PROGRAM PROGRAM MC}i
LINE ITEM IXPENSE SALARY � suoser suo�er
CIINICAL SERVILES COOR�INATOft
NURSE PRACTITIONER
rvurrtinowsr
SOCIAI, WORKER
INTERPRETER/RECFPIONIST
CLINIC OFFlCE MANACaER
MEDICALASSI5TANT
SUB-TOTAL SALARY
FRINGE BENEFITS @ 21.5%,
0
CONTRACT SERVICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CLINIC X 48 WKS
RENT
PA7IENT CARE
LABORATORYSERVICES
OTNER EXPENSE
PHARMACYSUPPUES
MEDICAL SUPPLIES
OFFtCE SUPPLIES AND OTMER
TRAVEUTRAINING
TELEPHONE
ununEs
PATIENTTRANSPORTATION
TOTAL DIRECT EXPENSE
$
�
$
$
$
$
$
75,192
70,699
49,338
47,237
30,202
33,093
29,453
FEDQtAi, APPROVm INDIRECT CO57' RATE � 35%OF SALARY AND BENEffTS
TOTAL PROGRAM BUDGET DCPENSE
TOTAL MCH GRANT REQUEST
0.20
0.50
0.20
0.10
0.75
0.3Q
0.65
$ 15,038 $ 7,519
$ 35,350 $ 15,907
$ 9,868 $ -
$ 4,724 $ -
$ 22,651 $ 9,060
$ 9,928 $ 3,475
$ 19,144 $ 7,658
$ 116,703 $ 43,6I9
$ 25,091 $ 9,378
$ 56,448 $ 36,69I
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,396
$ 6.598 $ 3,629
$ 2,500 $ 1,258
$ 376,294 $ 278,350
$ 49,628 18,549
$ 425.922
$ 196,900
MATCHING NNDS �?5°J $ 106,4$1
�iZ1�
HEALTH START, INC.
MATFRNAI, AND CHII.D HEAI.TH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2003
o � •44y
MCH0H03
ATiNUAL PR06RAM PAUGRAM MCH
tINE ITEM EXPENSE SALARY FTE BUDGET sUOGEr
CIINICALSERVICESC00RDINA70R � 77,�5 O,ZO $ IS,�L9O $ 7,74�J
NURSEPRACTITIONER $ 72,820 0.5� � 36 $ 1�,5�
Nuramomsr $ 50,818 0.20 $ 10,164 $ -
S�GALNlaRKER $ � ,654 �.1� $ 4 ,865 $ -
INTERPREfER/RECEPIONIST � $ 31,1� 0.7 $ 23,331 $ 9 ,332
CLINICOFFICEMANAGER $ �,�$6 �.3� $ 1�,226 $ 3 ,579
MEDICALASS15fANT $ 30,336 0.65 $ 19,719 $ 7,887
SU&TOTAL SALARY $ 120,204 $ 43,108
PRINGE BENEFITS @ 21.5%
CANTRACT SERYICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CUNIC X4$ WKS
REt�fT
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
TR,4VEL{tRAINING
TELEPHONE
UTILITIES
PATIINT TRANSPORTATION
TOTAL DIRECT EXPENSE
FEDERAIAPPR04ED INDIRECT COST RATE @ 3� OF SALARY AND BENEFiTS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCHIriG fliNDS � 25%
$ 25,844 $ 9,268
$ 56,448 $ 36,691
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,790
$ 6,598 $ 3,959
$ 2,500 $ 1,375
$ 380,548 $ 178,569
51,117 18,331
�
$ 196,900
$ lOJ,916
-31-
G. IndirecY Cost Allocation for MCHSP
Please check one of the four oprions:
� 1. Not applicable — No charges to MCHSP are for indirect cost.
� 2. Indirect Cost Rate Agreement — A Federal negotiated fi�ced rate is to be charged against all
participating programs, including MCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached.
[] 3. Approved Cost AItocation Process:
Option 1—Indirect costs are atlocated to the agency's programs using worksheets developed by the
agency for tius purpose.
Ageucy worksheets and supporting documents are attacfied wIuch are in compliance with
the requirements of the OMB Circalaz A-87 "Cost Accounrittg Principles for State, LocaI,
and Indiatt Tribal Govemments", and the Federal award(sj for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs aze allocated to the agency's progra�ns using the optional Iadirect/Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance wiYh
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Locai, and Indian Tribal Govemments", and the Federal awazd{s) for which they apply.
-32-
oi��r9
�
� DEPARTMENT OF HEAI,TH 8c HUMAP( SEILVICES
Y �.
o �
�"'k
�aa
Raymond J. Martin, Jr_
Psxecutive Director
Health Start
491 West University Avenue
St. Paul, MN 55103-1936
Dear Raymond Martin:
February
� S�PPat CentQ
F'mnual Manag�� �
Divaion o( Cast AHocaIIOa
Cer6ai States Field Office
6, 2 0 O 1 '13Di Yovng Street, Ropm 732
. Dafias, Sexas 75202
� (
FAX- (214}�67-325q
The original and one copy of an indirect cdst Rate Agreement
are enoZosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concsrning
the rate(s) that may be used to support your claim for indirect
costs on granEs ancl contracts with the Eederal Government.
Please have the original signed by an authorized representative
of your organization and zeturn it to me, retaining the copy
for your files. We will seproduce and distribute the Agreement
to the appropsiate awarding. organizations of the Federal
Governmen.t for kheir use.
An indirect cost proposal, together with supporting information,
is required each year to substantiate claims made for indirect
cosCs under grants and contracts awarded by the Federal Government.
Thus; your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation_
Enclosures
Sincerely,
x
\
Me�. Schmidt
Director
Division of Cost Allocation
Central States Field Office
PI�EASE SIG1Q AND RETURN THE ORIGINAL.OF THE RATE AGRESMENT
-33-
NONPROFIT RATS
EIN #= 1411577621A1
ORGANIZATION:
Health Start
491 West University Avenue
St. Pau2
MN 55103-1936
DATE: Febraary 6, 2001
FILING REF.: The preceding
Agreement was dated
NONF`
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Goverament, subjeci to the conditions in Section ISI.
SECTION I: INDIRECT COST RATES*
RATS TYP&S: FI%ED PINAL PROV.(PROVISIONAL) PRED.(PREDF3TSRMINSD)
e
SFF}3CTIVE PERIOD
TYPE FROM TO
PROV. O1/O1/O1 12/3I/02
PROV. O1/O1/02 IINTIL AMBNDED
RATIs(%) LOCATIONS APPLICABLS TO
35.0 On-Site AlZ Programs
IIse same rates and conditions as those cited
for fiscal year ending December 31, 2001.
* sAS& :
Direct salaries and wages includinq a11 fringe benefits.
-34-
at-4 t9
ORGANIZATION:
Health Start
DATS: February 6, 2001
SSCTION II: SPECIAL REMARRS
TREAZ'MSNT OF FR2NG8 BENSFITS
The fringe benefits are charged using a rate(s). Over/under recoveries from actual costs
are adjusted i.n current or fuCure periods. The directly claimed fringe benefits are
listed below_
TREATMENT OF PAID ABSIISCSS •
Vacation, holiday, sick ieave pay and other paid absences are included in salaries and
wages and are claimed on grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the costs of these paid absences are not
made.
Equipment DePinition -
Equipment means an article of nonexpendable, tangible personal propexty having a useful
life of more than one year and an acquisition cost of S1,000 or more per uait.
ERINGE BENEFITS:
FICA
Retirement
Disabi].ity Iasurance
Worker�s Compeasation
Life insurance
Unemployment Insurance
Health Insurance
-35-
ORGANIZATION:
Health Start
AGREEMSNT DATS: February 6, 2002
sscrxox xxx- c�saar.
A. LIMITATIORS -
The ratea in this Agreement are aubject to any atatsstazy or admiaistrative limitat3ous and app2y to a qivea gra¢t, croa[ract or
other agreemeat only to the exteat tLat ftmds aze available. Acceptance of the ratea ia subjeet to the Eollowiag condi�;ona:
(i) Oaly costs iaevrxed by Ghe a��;zatioa wexe ineluded ia its indizeM cost pool as finally accepted: euch eosts are 1ega1
obligations oE the oxganizatioa and aze allowable uadex the govesaing cost pxiaciples; (2) The same costs that Dave been tTea[ed ae
indirect eoets aze aot claimed as dizect coats; (3) Similaz types of croeCS Lave beea aecoxded eonaisteat accounting treatmeat; and
(4) The Snfoxmatioa praoided by the ozgaaizatioa whicA was used to eeta6lish the xates is aot later fo�md to be materially
:�^omplete or i�<cutate by Che Fedexal Govexament. IA euch situations ihe rate(s) would be avbject to renegotiatioa at the
diacretion ot tLe Federal Gooexameai,
B. ACCODNTI56 CRA21G&5
This Agreement ie based on the a<ca�mting aystem puxported bq the oxgaaization to be in effect durisg the Agseemeat period. Chaages
to the methad of accotmtiag for crosts vhich affect the amouat of seimbuTaement resulting from the use of this Agreement require
prioz approval af the authorized represestative of the cogaizant ageacy. Sticlx cLaages iaclude, but are aot 1imiCed Co, r3anges ia
�wm ^*=+ of a partieular Cype af�eaet from iadirect to direcC_ Fai2ure Co obta3s appraval map resu2t ia coat disa2lowaaees.
C. PS%SD RATES .
If a fixed xate is in [his Rgseement, it ia based oa aa astfmate ot the eoets £or the period eavezed by the zate. A2en the aetual
rnsta for thia peziofl aze determined, an adjusimeat will be made to a rate of a fntuxe year(s) to compeasate for the difference
betweea t71e crosta uaed to establiah tIIe fixed rate a�d actval coata.
D. IISB SY OT88R PEDHRl1L nr_urarrae
The zatea in this AgTeement weze appmved 3a accoidance vith the authority ia Office of maaagemeaat and 8adget Cixculaz x-lzz
Cizculaz, and sLOUid be applied to grauts, coatzacts and otLer agrenmenta CoveTed Irq thia Circular, subject to aay limitationx ia A
abaoe. The ozgaaization may pxavide copies of the Agree�ent to other Pedezal Ageacies to give them eazly aotif3cation of tIIe
Agieemeat,
E. OTHER:
IE aay Fedexal contxact, giaat or oU1e.� agTeemeat ie reimbutsiag indirect costa by a means oilaer thaa the appxoved rate(s) in this
Agreemeat, the arganizatioa sLo�aid (I) eaedi.t sneh costs to the af£eMed pxognama, aad (27 apply the approved rate(s) to the
appzopriate base to ideatify the proper amoyyt af iadixect eosts allocable to these progxama.
8Y THS ORGATIIZATION:
Health Start
SY THE COGNTZA2Tf AG&fiCY
OR BEHALI' OP 158 rnnaoar. �pp�.�ryy
(ORGANIZATION) .
I�u.,,�t � � M�. �-
csxcema�) �
RA`fNouo 1". Haz .�
c��
�7�EG�t'��v� D�REC�b�L.
(xxxzs>
lnnxs)
DHPARTMENf OF HCil1LTH AND HOMAN 58R4ICES
(acaeres) 4
vv--� �-� �'�
(51
Merle M. Schmidt
tmse��
nzxzcTOS axvxsxrnv or msx xraocaxxox-
(TITi.8) CENTBIII+ STATES PIBI,➢ OFPICS
(DATS) 5736
�s ,eErxssseraxzvs: MY (Robert ) N. Nq'uven
xe�epn�e: (214) 767-3267
-36-
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A. APPLICATIOIV 1�3ARRATIVE
The Pzeaatal Access Project at Face to Face Health & Counseling Sezvice will utilize outceach efforts and case
*T+?T!a to encouraae and support 150 low income pregnant adolescents and young adults to access prevatal
care aad in¢ease dieir chauces of having a successful ptegnancy. Seveuty of the youth to be sexved will be under
the age of 19, and 75 wiIl be youth of coloi.
1. Outreach and Case Management
GOAL 1 To utilize a sramless, integzated sexvice model to pmvide pienaral caze and to pxomote the healthp
developmeut of families_
MCH 2O02-2003 Priorities
1. Address the multifaceted needs of teen pateuts
2 Reduce youtla risk behaYiors
3. Improve meatal heakh of chil.dxen, youth and parents
Objective: To use a holistic inrake pzocess for assessing needs in all azeas of the lives of our clients and
identifying steeugths they alzeady possess to address these needs.
Pace w Face implemeated a necv inrake pmcess in 1998. The goal was tn addcess the needs of ptegnant
adolescents and young adults holisdcally — not only addressing those direcrlp mlated to theix pregnancy. This
includes, but is not limited to, life and safetp, mental healdi, medical, and education and job aaining needs.
Becoming pregnant as a teen c�n be a sign of more serious issues a youth uright hace, including being homeless,
not attending school regularly or having dropped ou� a histoxy of abuse by or ot3ies re]arional difficulties with
family membets or a boyfriend, chemical abuse and mentai health issues. Depression aad thoughts of suicide aze
not unusual with some clients. It is also important to sealize fl�at these adolesceuts have been sutviving —
sometimes on che srteet — amidst often very difficult citcumsrances. That is why we not only work to idenrify in
a compxehensive mannet aIl of a pregnant adolesceut's needs, but also to idenrifp, affi�m and sttengthen rhe
s2engths they alxeady possess. This is a streugths-based model as opposed to a needs-based model, which has as
its focus the clieuu' defidendes (Le., unmet needs) rathet t6an their stres�gths.
GOAL 2:, To reduce the overall rate of ]ate (third trimestes) or no prenaral care aad to conduct ouu�each ro
in¢ease fixst trimester preaatal caze, espedally amoag pouda of color.
MCH 2O02-2�03 Priarides
1. Pmmote family support and healthp communitp conditions
2. Promore healthy parenting/familp development
3. Increase p�cent of children who receive eazly intervention services
Objectrve L• To increase oux cw�ent efForts to pmvide outreach to youth of color, ensiuing d�at at least 50
pezceat of the prenatal clients aze youth o£ color. African Ametican, Nauve American, F3ispanic,
ox As'a•
Face to Face has reached and seeved a large numbet of pourh of colox throughout all of its progxams. In 1995
thexe wexe 98 deliveries, and neazly half (46 of 98 or 47%) of the deliveries weze to adolescent moms of
color. Face to Face is committed to pmviding cultutally appropriate and accessible sexvices and will continue our
efforts to conduct effective outreach ditected towatd youth of coloi.
Objecrive 2; To follow up with all clients with positive pre�anry tests, induding mal�ng home visits as
necessazy to assute thep receive cate.
-37-
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Face to Face began its ariginal pxeaatal ouueach pmject in �988. These wexe 21 deliveries d�at first yea� and by
1998 d�at numbee grew to 104 deliveries. 'l�is demonsuates a 395% increase in. the aanual nambet of delivaies
since the project's incepdon. It is out belie£ that dvs inctease is ditecdp related to thxee factovs: (1) an i.+r+,��e in
cultutally divexse staf� (2) an incre�asc in owxeach efforts, and (3) an inaease in intensive case *n?�oement
sexvices. Wh31e the need for outirach sezoices continues w be g�eat, Face to Face has xeached its capadty far
sexving clieuu without addiuonal sraffing. Thesefore, rhe pmject eapects to maintain the curtent number of
rlirn visits dn�; the upcoming two-year pmject period
Ol�jecrice 2.• To entnll 50 pecceat of die 70 cliessts who are uuder the age of 19 in prenarat care services daring
dzeir first mmestez of pzegnanry.
During 1998, 51 perceat of the new prenatal clients under the age of 19 began prenatal caze within theix
fixst trimestet. This is a task to which die pxeoatal team is very committed; howevec, the younger clients aze and
the gxeater their risk factozs dae gmater the di£ficulty of xearh; � th� within their fiist ttimestexs. Foz cYample,
only 31% of clients 17 and undu began caze during theiz fust timesten We wi11 focus outreach efforts on
these younges clients.
Objeczive 3: To affect posirioe bitth outcomes in ail c3ients, as measuxed by low bitthweight r�tes of less tban
__ 6.5% for all aee aad ndal2muns secved.
In 1998, the rate of low bitth weights for all age and racial gtoups served by Face to Face was 8.8%. The
objective is to bettex the rate of low bizdi weights di 2002-03. All pteoa1ml clients who have a vsk scoxe of 10
oi highet aze reEeued to a Ramsey Countp Public Health Nucse. One of rhe public heaitii nuxses pazriapates on a
bi montbly basis in care wotdination confecences, and consultation and coozdination happens on aa almost daly
basis. 11vs cootdination has resulted in the numbes of dieuts wirh high-xisk scoxes dea�sing d"� the second
and rhixd trimestexs of pregnancy.
��'.
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Objecrive 4.• To improve attendance at all Ptenatai C]asses, with at least 50% of those receiviag pteaaral cate
atteuding.
The eight-week class is offered m all pteaatal c]iencs, addressing physical cUanges d"� pregnanry, health and
mroirion, preparation for laboi and delivery, emotianal aspecrs of childbirth and new pazeuting postpattum
pxeparatian, pzeparation foz new bzby case, and the importance and "how to's" of birild'mg a support network. In
an attempt to build gzeatec continuity foz the clients aud inccease consistent attendance at pzeaatal dasses, we a]so
hold weekly "Snack and Chat" sessions_ This is infomzal discussion and sapport dme fot clients.
3. Social Sugport
GOAL: To impmve die healdi and wel}ness of pregnant adolescents during pregnancy thmugh in¢eased
social and emotional support and menral health seroices.
MCH 2O02-2003 Priorities
1. Pmmote family support and healdiy community conditions
2 Promote heaithy patenting/family deveiopment
3. Reduce child abuse and neglect
4. Addtess the multifzceted needs of teeu pazents
5. Improve meutal healsh of chiidxen, youth and pasents
6. Inctease p�cent of childsea who zeceive eazly inteivention setvices
Objective Z• To inctease preaatal support sesvices to the pazmets of pregnant women.
One wap to better support pxegnant adolescents 3s to extend ouc prenatal support services — speafically prenatal
classes and "Snack and CliaP' sessions — to the paxmecs of pxeb ant c]ients. 2Ziis will help to reduce any added
sarss the pxegnancy may have put on the pazmex relationslup, thexeby sueagthening the support die pzegxaant
adolescent feels £rom significant re]ationships in her life.
Objective Z.• To provide meutal health counseyng for ptenatal clients and theix paxmexs who aze suuggling
with menral healrh issues, indudin� chemical use, depression, and abuse.
A� ;�, as the complexity of risk factoxs incsrase fot pseaatal clieuts, so does the� need foz menral health sexvices.
Historically, a majoritp of ptenatal clieuts have e�erienced sexual abuse aad chemical use. Most are esmenged
ftom partness ot eaperiencing difficulties in the pattnec telationship. lktany talk about feeliugs of depxession and
even tho��hts of suidde. Ofren the steess of an earlp, unpLwned pregnancy exacesbates the issues that alreadp
are present, and manp of the pmoatal clients request or are in need of counseling. The Dixector of Mental Health
is available for consultation and Face to Face has well-established mental heakh sexvices for clvld abuse suxvivoxs.
Objecttve 3: To ]ink all prenatal clients who deliver thtough Face to Face with ongoing medical cate and
social sesvices for themselvu, cheir infants, and dieit paztnexs.
Most of the ptenaral clients use Childxen's Hospital Pediatric Clinic, Unixed Family Physiciaus or Ramsey Family
Physidans fox their childten s primary medical caxe. 'Iheze wiIl continue to be a focus on s�sengthening case
TM?n? to link clienu in need of primaiy medical caze for their infan[ aud themsetves as well as to othex
needed social sezvices. Face to Face has bwlt mong relationships with many youth serving agendes, and the
outteach woskezs help clients esrablish connecdons wirh appropriaxe setviices. Addirional efforts will be made to
increase the xesouxces available in the community fox pazmecs of pxegn�wt adolescents. We will do assessmeats
of the pattaexs' needs fox supgort and make refe�xaLs when possible. Whea resouxces don t e�st, Face to Face
will work widi the Fathets Rrsouxce Center and othet pouth-sezving agendes to develop collabotttive
pro,gra**++*+;*+a rhat suppotcs healthy pregnancp outcomes.
-39-
0
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP application, addressing tfie foilowing:
1. In what ways do raciaUeihnic disparities impact your matemaUchild population or what is ihe significance of
disparities to yo�u population?
3. What s�ategies will be utilized related to the above objectives? Of particutar �terest aze com�aity and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decxease of disparities.
�l�he hist strategy raw to race uses u to
services. That commitment is visible in
needs of adolescents aud young ad¢its R
commitmenY to haiug staff who are cult
1'iu
agency requiies and provides for all sta4
In addition, in ordu to realize our mi;
values and outcomes. To that end. in
nce, class, etbnicity, sexual c
processthrough which every
A strategy Yace to Nace uses spec�Tic
color. To this end, Face to Face is a
is to reach out to pregnant African-A
rurr¢er, we recessuy e
women azound issues
DLC�2IIt Ot DBLCIIt1II2
i
outcotnes
Ke a co�utrnent to proviamg culuuatly appropnate and access
ty aspect of the agency — from our mission W serve tiie deveIop
are in need of accessible and cnitutaily sensitive setvices to our
of the youth we serve to the
?ace to Face
as uart of an
nsive, flexible and comnvtted to a core
a nzoua of Face to Face staff foffied an
; accorawg m a pnuosopny wat nennes "cuuutai cuversuy to mcmae
er, religion, age and able-bodiedness. 'Chis committee initiated a
elops eauiri eoaLs, which become part of their staff development goals.
�ur pienatal pmgam is effective outreach tazgeted towazd youth of
iting agency ia the Twin Cities Heakhy Start Project, our role in wluch
yoimg women and commect them with appropriate, early prenatal care_
cant for pienatal ouffeach ro youth of color and yommger adolescents.
and a full-time staff person to do outreach to bomeless adolescents who aze
at ou�each tazgeted to specific populations is a very effective shategy to
tarQeted nonulation who seek services, which increases the l�kel�hood of
ois
from the
.�
2. List specific MCt3SP objectives reIated to raciaUetbnic disparities.
or-gqy
Budget Narrative - 2002
Salaries aad Fringe
O.SFI`E Outreach Worker/Case Manager (Vicki D.)
0.5FI'E Outreach Worker/Case Manager (Ashley M.)
0.09FTE Prograzn Director �oel I,.)
Fringe Benefiu (about 18.5°/a of salaries)
Total Salaries and Fringe
Supplies and Expenses
Staff Travel ($136 miles per month X$0.345/mile)
Indirect Costs
Adminiscration (� 1 Y%)
Faciliries (@ 5.5%)
Total Indirect Costs
BUDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-41-
Budget Narrative — 2003
Salaries and Friage
0.5FTE Outreach Worker/Case Ivianager (Vicki D.)
0.5FfE Ouueach Worker/Case Manager (Ashley 1VL)
0.09FTE PrograIIi Director (Joel L.)
Fringe Benefiu (aboui 18.5% of salaries)
Tota1 Salaries and Fringe
Supplies and Eapenses
Staff Travel ($136 mles per month X$0.345/mile)
Indirect Costs
A�miniairaTiOIl �� 1�/0�
Facilities (@ 5.5%)
Total Indirect Costs
BLJDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-42-
o t-qqq
G. Indirect CosY Allocation for MCHSP
Ptease check one of the four options:
❑ i. Not aQQlicable — No charges to MCHSP are for indirect cost_
❑ 2. IndirecY Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against alI
participating programs, including 1VSCHSP.
A signed agreement from covering the current Pederal fiscal year is attached.
❑ 3. Approved Cost Allocation Process:
Option 1 Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Govemments", and the Federal award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs are allocated to the agency's programs using the optional IndirecUCost
Allocation Worksheet on the foilowing page.
MCF3SP worksheets and supporting documents aze attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal award(s) for which they apply.
-43-
INDIRECT! COST ALLOCATtON WORKSHEET
t. Cost item included in tke indirect rate on this worksheer
Telephone, utilities, janitorial, irash, copier 2ease, maintenance, �n�„�.,ce, postage, accounting, annuai
audit, computer consultation, administrative staff
[Examples include rent, telephones, supplies, etc.]
2. Total cost of items in 1. to the agency: $608,168
3. The MCHSP share of the total cost is calculated through use of (check one):
./ a. MCHSP's percent of the total agency staff hours or full-time
b. MCHSP's percent of the total square feet of space occupied by the agency.
a Other — specifY:
and is in compliance with the requirements of the OMB Circulaz A-87 "Cost Accounting
Principles for State, Local, and Indian Tribal Govemments", and the
Federal award(s} for wfiicfi they apply.
4. Calculation of the MCHSP percentage:
rrograms operatea ny tne �ach program's statt, square Ye
agency. or other (circle the criteria you
aze using)
percent of the total (calculated to
the neazest tenth percent, e.g.,
5. MCHSP's proportionate amount: $17,028.70* only requesting $5,638,
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o1-�i99
MCHSP Application Update Narrative 2002-2003
West Side Community Health Services — Improving Pregnancy Outcomes for High
Risk Latino and Hmong Women in St Paul - 2002 - 2003
Goal— The goal of this project is to reduce low birth weight and infant mortality rates in
the St. Pau1 Latino and Hmong populations by providing outreach, tracking positive
pregnancy tests, performing prenatal risk assessments, providing prenatal education, and
coordinating prenatal care and follow-up. This project will supplement existing West
5ide Community Heakh Services (WSCHS) prograzns and staff. The West Side Health
Center (La Clinica�, McDonough Homes Clinic, and Roosevelt Homes Clinic offer
comprehensive health care services on a sliding fee scale. This project will give Latino
and Hmong families �eater access to a full array of services, including well child care,
immunizations, family planning, pazenting, and HNISTD services, as well as linkages by
referral to over 14 other community agencies.
Target Population — This project targets low-income (less than 200% of poverty) Latino
and Hmong teens and women in the following azeas of St. Paul: Riverview (CTs
342,361,310,371,372), Mount Airy (CTs 328,329,330) and Rice Street (CTs 305,314),
Our ciinics aze located in or near these CTs, and the CTs are part of our federally
designated scope of service azea. The majority of our prenatal patient population (85°la
Latino and 14% Hmong) live in these areas. During the grant period, we estimate that
730 Latinas and 120 Hmong women will receive prenatal care through our clinics.
Goal l— To reduce low birth weight and infant mortality rates in the 5t. Paul Latino and
Hmong populations.
MCH 2O02-03 priority:
Promote family support and healthy community conditions.
Objectives:
1. To reduce overall rate of late (third trimester or none) prenatal care among pregnant
Latinas and Hmong women and teens to 10 percent or less.
2. Increase the rate of prenatal care in the first trimester among pregnant Latinas and
Hmong women and teens to 60 percent or more.
3. Provide outreach, education and coordinated follow-up care for high risk pregnant
teens and women.
MCH 2O02-03 priorities:
Reduce teen preo ancy and teen birth rates.
Promote healthy parenting/family development.
-45-
MCHSP Application Updcrte Narrative
Methods:
Project staffwill do an outreach activity at least monthiy. Examples include "Baby
Showers" in tazgeted areas, health fairs, community events such as Cinco de Mayo,
and responding to media requests for interviews by locai newspapers and radio
stations.
2. Project staffwill conduct a series of Spanish-spealdng prenatal education classes
every two months focusing on nutrition, self-care during pregnancy, breastfeeding,
chiid caze and safety, and personal health issues such as family planning, HIV/STDs,
drugs and alcohol, and family violence.
3. Staffin clinic wilt follow-up on a11 positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health educarion
and support imervention, including home visits as appropriate, facilitate follow-up
with any outside referrals made, assisting with scheduling, transportatior� and
interpreting as needed.
Evaluation: Atl patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry irno prenatai care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
results compited annually. Patient satisfaction surveys are done annually, and
additionally, satisfaction with prenatal classes is measured via surveys after each session
is completed. Twenty-five (25) prenatal records are audiYed annually to measure rates of
compliance with prenatal risk assessment, postpartum visits, and newborn follow-up.
This information is reviewed by the Quality Improvement Management Committee
annually to identify and impiement improvement efforts.
Training/Eaperience of Key Staff: Over the past 25 years, staff have demonstrated a
unique abiliry to meet the heatth care needs ofLatinos and Hmong. In 2000, WSCHS
served 14,366 medicat patients, 60% of whom were Latino or Hmong. Services include
bilingual and biculhual staff, transportation through our van, bus or cab voucher, hospital
cue through Regions Hospital, in WIC clinics including immunization outreach,
assistance with Medical Assistance/Minnesota Care applications and enrollmern, and
outreach clinics and education programs in homeless shelters and public housing
developments. These services aze pmvided through a well-estabiished interdisciplinary
case management model. This model helps identify high-risk patients through screenings
and referrals, provides coordination of care, and ensures patientlfamily involvement in
care p anning an .
The perinatal RN health educators aze �cky Kramer and Tely Xiong. The perinatal
heaith educator, Doris Sanchez, is a medical assistant with specialized perinatal and
women's health training. All are bilingual and/or bicultural. Additional project support is
.�
oi-99y
MCHSP Narrative Update AppZication
Provided by Norma Atuesta, RN, nurse manager, and Mary Nesvig,l�ID, medical
director, and other clinical staff through the Perinatal Caze Program.
Linkages:
West Side Community Health Services works with the following organizations in
providing matemai and child health services:
-Regions F3ospital Family Practice Residency Training Program to provide cross-cultural
family medicine training for physicians motivated to work in medically underserved
settings.
-Saint Paul-Ramsey County Department ofPublic Health to assess community needs and
provide services addressing maternal and child heaith issues, behavioral health,
communicable disease, lifestyle/cancer, income/access to care, nutrition and WIC clinics,
and elderly health care.
-Combined efforts with 15 other community clinics to improve health outcomes for
underserved populations in joint efforts through Neighborhood Health Care Network
-Saint Paul Public Housing Agency to provide services, including maternal and child
health, on-site at McDonough and Roosevelt housing developments.
-City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facilities and five outreach sites, and eviction prevention services through the F3ouseCalls
program.
West Side Community Health Services provides comprehensive perinatal care through an
established nurse-midwife program. Any specialty medical caze needed is provided either
on-site or refened to the high-risk OB clinic at Regions Hospital.
Reimbarsement and Fees: A11 reimbursements through the Minnesota Department of
Human Services go directly to support services. Assistance is provided to enroll all
eligible women on Medical Assistance/Minnesota Care. A sliding fee scale is maintained
for those not eligible for assistance. Fees aze discounted incrementally based on family
size and income, from those at or below the poverry level paying nominal or no fees, up
to those exceeding Z00% of the poverty level paying full fees. Patients aze low income
and high risk. No one will be tumed away due to finances.
-47-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessme�t are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispariries impact your maternaVcltild population or what is the significance of
disparities to your population
-late enhy into prenaql care
-culmre and language bazriess to secvice
-increasing Latina teen bixfh raYe
-multiple, closely-spaced pregnancies
-new imudgrants
-growing STI/HIV risk in T atinac
3. Wliaz shategies will be utilized related to the above objecrives? Of pazticulaz inte:est are communiry and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decrease of disparities.
supports
on healthy fan�ily units
-include
.;
2. List specific MCHSP objecrives related to xaciaUethnic disparities.
0�-999
MCHSP Application Update Narrative
Budget:
WSCHS request $16,250 per year to supplement our existing perinatal progam. The
funds 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 — 2002
MCH Request
WSCH5 Match
.3 FTE RN health.educator
(624 hours at $17.54Jhr.)
2 FTE perinatal health educator
{416 hours @ $12.75lhr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
Year Two — 2003
3 FTE RN health educator
(624 hours @$17.54/hr.)
.2 FTE perinatal health educator
(416 hours @ $12.75/hr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
$10,946
5,304
$16,250
MCH Request
$10,946
5,304
$16,250
$236,000
124,800
$360,800
WSCHS Match
$236,000
124.800
$360,800
860 prenatal patients will be seen annually.
42 prenatal classes will be held annually, serving 420 patients and their family members.
86 highest risk patients will receive specific follow-up by the health educator.
An additional 250 teens and women will be reached annually through outreach activities.
There are no DHS or sel, f-pay reimbursements anticipated related to these supplemental
ttctivities.
-49-
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2002-2003 MCH Update Saint Paul - Ramsey County Department of Public Health:
Room 111—STD Services for Adolescents
Goal: Through accessible, confidenrial services to adolescent family planning clients regarding
education, detection and treatment of sexually transmitted diseases, decrease the number of
STDs, particulazly chlamydia and gonorrhea
MCH 2O02-2003 Priority:
1. Reduce youth risk behaviors
2. Increase percent of children who receive early intervention services.
Objective 1. To screen and provide education to 725 adolescents, 19 years of age and
under for sexually transmitted diseases - STDs during each CY 2002 and 2003.
MCH 2O03-2003 Priority:
1. Increase percent of childrett who receive eazly intervention services.
Objective 2. To diagnose and treat idenrified cases.
MCH 2O02-2f103 Priority:
1. Increase percent of children who receive eazly intervenrion services.
2. Reduce youth risk behaviors.
-51-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP appliqtion, addressing the following:
1. In whaz ways do racialletlmic dispazities impact your matemal/child population or what is the significance of
disparities to your population.
higttest rate of gaaorthea in the state. Compating the chlamydia rates of 73:100,000 wlutes to I,769:100,000 blacks,
540:100,OQ0 Americaa In�ians and 314:100,000 Asians, clearly shows the huge dispariry for this ane sexually
transmiued disease. The data aLso shows the lazgest number of cases of chlamydia xcurs in 0-19 year old
females. Gonorrhea in the same age group is the second largest group diagnosed.
3. What strategies will be utilized related to the above objectives? Of particulaz interest aze community and
systems stretegies/objectives wlrich recognize the potential role all types of community-based organizations can
play in the dectease of disparities.
many accessirnury oamers nave oeea removea xoom i i i is iocacen on or near au ma�or ous rouxes. inere u aee
pacldug behind the building. Room 111 has moming, attemaon and evening clinic hours. Clinic services are
offered on a walk-in basis. All Room 111 STD clinic and education services are provided on a donation basis. No
one is denied secvice due to inability to pay.
-52-
2. List specific MCHSP objecrives related ta raciaVethnic disparities.
o�-y�s
Room 111- STD Services
(As an extension of Family Planning activities)
2002 and 2003 MCHSP Crrant Budget 7ustif cation
Postion MCH Funds
CY 2002
Clinic Nurse:
Ptovides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
CY 2003
Clinic Nurse:
Provides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
C�iiiT�i3f��
$45,577
$45,577
Annual Salarv
$58,432
$58,432
-53-
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f�� ��`�� ��� 1�1�1 ���.�� � �.�_ � �.�� I I�� �)�� �i � ili I�'I�I ���� �� I� i i i����l �ili�i i �I li
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i��� �l � � I� j I ��L � � I ��� I��� I i� � � i i � I , i i �I� i � i
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�� � � ( �� _�� � i �� � ��� � ���� i �� ��;li � ���i �� li �I � � �� � 'Il� i �iili i� il� � �I� ' I��
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D►-999
The goals of Health Start's adolescent health program are essentially unchanged
over last year. One minor change is that we have set an overall goai of increasing clinic
visits by 5% rather than targeting males, as we have in previous years. Though we will
continue to focus particular efforts on reaching males, the majoriry of our outreach efforts
aze targeted to all students.
Goal l: The goal of the Adolescent Health Program is to promote good health and
reduce the incidence of unplanned pregnancy, poor nuhition/disordered eating,
depression, chemical abuse and family and relationship pzoblems among adolescerns in
Saint Paul by providing comprehensive health care services at seven high school sites and
two alternafive school sites within the city.
>
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 1: In CY 2002 and 2003, 3,300 junior and senior high students will access
health caze tbrough the school-based clinics each year.
MCH 2O02-03 Priority:
1. Increase percent of children who receive eazly intervention services.
2. Reduce youth risk behaviors.
Objective 2: In CY 2002 and 2003, a healthy lifestyle of physical activity and
healthy food choices will be encouraged by providing 1400 nutrition visits each yeaz
in the azeas of weight control, family plazuung and pregnancy nutrition, disordered
eating, and sports nutrition.
MCH 2O02-03 Priority: '
1. Reduce youth risk behaviors.
2. Increase percent of children who receive eazly intervention services.
Objective 3: Onsite social work counseling/therapy services wili be provided for
1,000 adolescents experiencing depression; chemical abuse; pregnancy; relationship
problems; physical, sexual or emotional abuse andlor oiher stressful conditions each
yeaz in CY 2002 and 2003.
MCH 2O02-03 Priority:
1. Improve mental health of children, youth and pazents.
2. Reduce child abuse and neglect.
Objective 4: Each year in CY 2002 and 2003 we will provide 1,100 teens with an
annual comprehensive preventive heaith exam and risk assessment, including sports
physicals and annual reproductive health exams.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Increase percent of children who receive early intervention services.
-55-
Objecfive 5: Comprehensive family pianning services will be provided £or 1,000
adolescents each yeaz in CY 2002 aud CY 2003.
MCH 2O02-03 Priority:
I. Reduce teen pregnancy and teen birth rate.
2. Reduce youth risk behaviors.
Objecrive 6: At least 1,000 adolescents will be tested for sexually transmitted
infections each year in CY 2002 and CY 2003.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 7: �munization status of studeuts who make visits with a Health Start
nurse practitioner/physician wi11 be assessed. Immunizations will be offered to all
students with incomplete series. Based on previous experience, we expect thai at
ieast 600 adoiescents wi1l be immunized each yeaz in CY 2002 and CY 2003.
MC$ 2002-03 Priority:
1. Promote family support and healthy community conditions,
2. Increase percent of childten who receive early intervention services.
Objective 8: Tobacco use will be assessed and addrassed for 3,300 students each
year in CY 2002 and CY 2003. Tobacco cessation help in the form of individual or
group programs will be availabie in all school sites for those wishing to quit
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
2. Reduce youth risk behaviors.
Objeciive 9: The number of visits to Health Start clinics will increase by 5% in CY
2002 and CY 2003. '
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
2. Reduce youth risk behaviors.
Objective 10: Members of Health Start's multidisciplinary team will provide health
education in classroom, clinic, and small group settings resulting in at least 10,000
educational encounters each year in CY 2002 and CY 2003. Topics will include
pregnancy and pazenting, nutrition, human sexuality, and smoking cessation.
MCH 2O02-03 Priority:
i. Promote family support and hea.ithy community conditions.
2. Reduce youth risk behaviors.
-56-
OI-999
D. Efforts to Reduce Racial Aisparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP application, addressing the following:
1. In what ways do raciaUethnic dasparities mmpact your matemaUchild population or
what is the significance of disparities to your population?
RaciaUeihnic disparities have a significant impact on adolescent caze. In addition to the normal stresses of
maturarion, adolescents of color mus[ also contend with dis 'm;nation They aze also more likely to
experience poverty and its sequelae, including hunger, inadequate housing, exposure to unhealthy
behaviors, and violence. The most common cause of death among teens of wlor is homicide (51.4%); this
compazes with 7.5% among white teens. Not stuprisingly, adolescents of color report mare emotional
dis�ess, including nerrousness, anxiety, discouiagement and depzession than white studenu. More than
half of Native American teens have thought of killing themseives. Black male adolescents are also faz moxe
likely to have a sexually transmitted disease than any other group; e.g. gonorchea rntes among Black males
15-19 aze 70 times that of White teens.
This combination of factors along with tbe normal tendencies of adolescents to engage in risk behavior,
presents challenges to adolescent heaith caze that Health Start's mulridisciplinary model is designed to
meet
2. List specific MCfiSP objectives related to raciaUethnic disparities:
The diversity of St Paul's mainstream public lugh school population is reflecied in the students served in
Health Start clinics. In 1999, 19.6°to of our school-based clinic clients were Asian Americans, 281% were
Black Americaus, 11.8°!o were Iiispanic, 2.2% were Native Americans, 31.7% were Eutopean American,
and 6.6% othex. The overall goal of ouc adolescent health pzogam is to promote good health fox all of the
adolescents we serve, As laid out in the MCH plan for adnlescents, this goal is achieved through meeting
specific objectives related to the nwmber of students receiving nutrition counseling, social work and mental
health services, reproductive health services including testing for sexuslly h�ansmitted diseases, prenaxal
caze and birth control. Objectives aze also set for assessing immunization status, tobacco use, and
participafion of students in health education programs. While these objec6ves do not have specific targets
for the various racial aud ethnic groups, they aze designed to focus on the spec�c azeas where health
disparities e�st.
3. What slrategies will be utilized related to the above objectives?
The core of Health Start's adolescent caze strategy is to overcome baxriers to caze by providing services
where adolescents aze---in schools. We perform reguiaz outreach activities in classrooms to let students
know we're there and we make it easy for them to register and receive caze. We hire staff who enjoy
adolescents and who inczeasingly reflect the diversity of those we serve. In addition to primary caze, we
offer mental health serrices, nuhition counseling and health education on site and at no cost to students or
their families. We address violence and discriurination duough peer mediation groups that teach students
better ways to handle conflicts, and respond to students' need for peer and adult support by establishing
support groups for those who shaze common concems, such as gay students, Asian students, or teen
pazents. Our emphasis on prevention and on teaching teens to bewme better health caze consumers is
designed to prepaze them to make good decisions about theu behavior choices and their health caze
throughout life.
-57-
HEAI,TH START, INC.
MAT'F.RN.�7..AND CBQaav HE.AI.TH
ADOLESCENT $EALTH SERVICES
SCHOOL BASED CLIPi[CS
JANUARY THROUGH DECEM$ER, Z002
MCNSBCO2
'ANNUAt PROGRAM PROGRAM MCH
CiNE ITEM EXPENSE SALARY r euo�er auos�r
NURSE PRACiiT10NER (CEN7RAL)
NURSE PRACATIQNER (COMO)
NURSE PRAC77TONER (HUM60LDn
NURSEPRAC7ITONER(JOHNSON)
NURSE PRACT1770NER (HAR�INU7
socua woexers tcenrnn��
SpCIAL WORKER (CAMO)
SOCIALNqRKER (HUMBOLLI"p
SOCIAL WURKER (JOHMSON)
SOCSAL WORKER (AGAPE7
MEDICAL ASSISTANT (CENTRAL)
MEDICAI /SSISTANT (COMO)
MFDICALl1SSISTANT (HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDIN(7a
MEDIC7LL ASSISTANT CAGAP�
nurnmontsr<cen�a�.)
Nurnmoeisr �coMO�
NuTamanisr�umso��r�
NU'fRITIONIST (lOHNSON}
NUTRITfO NIST (HABOING)
HEAI.Tti EDtICATOR (CEN7RAL)
HEALTH EDUCA70R (CDM03
HEALTFt EDUCATOR (Hl1MB0l,D'n
HEAiTH fDUCATOR (JOHftlSON)
HEAL7H EDUCA70R (HARD1NC7i
HEAI.TH EDUCATOR (AGAPt7
CUNICAL SFRNCES COOROINATOR
SUB-TOTAL SALARY
* annual salary based on 42 week school year
FRINGE BENEFITS @ 21.SoJ,
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
�
51,912
49,543
47,158
47,158
50,400
35,280
34,524
38,069
37,582
38,069
26,393
23,789
24.226
25,099
23,100
25,2aQ
4I,782
37,397
41,782
41,782
36,120
31,b51
40,354
35,549
35,549
35,5Q�9
4A,354
60,732
0.80
0.7Q
0.60
0.60
�.80
0.60
0.60
0.60
0.60
0.30
1.00
0.80
0.60
0.80
I.00
0.20
0.15
0.15
O.Z5
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
$ 41,530 $ 35,300
$ 34,680 $ 29,478
$ 28,295 $ 24,050
$ 28,295 $ 24,050
$ 40.320 $ 34,272
$ 21,168 $ -
$ 20,714 $ -
$ 22,84I $ -
$ 22,549 $ -
$ 11,421 $ -
$ 26,393 $ 22,434
$ 19,031 $ 16,176
$ 14,535 $ I2,355
$ 20,079 $ 17,067
$ 23,1a0 $ 19,635
$ 5.040 $ 4,284
$ 6,267 $ •
$ 5,610 $ -
$ 6,267 $ -
$ 6,267 $ -
$ 5,418 $ -
$ 4,748 $ -
$ 6,053 $ -
$ 5,332 $ -
$ 5,332 $ -
$ 5,332 $ •
$ 4,�35 $ •
$ 6,073 $ 3,037
$ 446,726 $ 242,139
96,046 $ 52,060
OI -45q
'ANNUAL PROGRAM PR06RAM MCff
LINEITEM EXPENSE SALARY cre auo�eT BUDGE!
CONTRACT SERVICE
FAMIIY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNOUNIVERSITYOFMINNESOTAFELLOWCLINICS/'NfC@$120X38WKS $ 9,SZO $ 9,120
FACE TO FACE
SOCIAL WORKER (HARDING)
$23,326
$ 23,326 $ -
$ 26,250 $ 19,688
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRI NTI NG/DUPLICATI NG
TELEPHONE
TRAVEVTRAINING
PATIENT TRANSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROVED INDIRECT COST RATE � 35%OF SALARY AN� BENEFITS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCtI1NG FUNDS � 25°J
-59-
$ 48,825 $ 36,619
$ 15,750 $ 12,600
$ 12,600 $ 10,080
$ 6,825 $ 5,204
$ I0,800 $ 8,64-0
$ 5,250 $ V 4,200
$ 2,100 $ ✓ 1,680
$ 703,618 $ 402,030
189,970 102,970
$ 893,588
$ 505,000
$ 223,397
�ai.za sT�T, nvc.
Nra�rExrrai, nivn c�.0 �ai.�rs
ano�scnrr �ar.'rs sExxvicEs
SCHOOL BASED CLINICS
JANUARY THROUGH DECEMBER, 2003
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
LINE ITEM IXPENSE SAUIRY RE BuoGEr suo�ei
NURSE PRACTITIONER (CENTHAL)
NURSE PRAC7ITIONER (COMO)
NURSE PRACi1TONER (HUM80LDn
NURSEPRACTITONER(JOHNSON)
NURSE PRACTiTIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI. WORKER (CAMO)
SOCIAL WORKER (HUMBOLD'n
SOGALWORKER(JOHNSON)
soau woRxex cncaa�
MEDICAL ASSISTANT (CENTRAL)
M miCAl ASSISiANT (CAMO)
MEDICAL hS5I5TANT (HUMBOLDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISiANT(HqRDING)
MEDICAL ASSfSTANT CAGAP�
Nurrtmorvisr <cennrnn��
nurttmorvisr�coMO>
NUTRITIONIST (HUMBOLDn
NUTRITIONIS7 (JOHNSON)
NUTRITIONIST (HARDING)
HEALTft mUCATOR CCENTRAL)
HFALTH EDUCATOR (COMO)
HEALTH EDUCATOR MUMBOLDn
HEAITH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARD�NG)
HEALTH EDUCATOR (AGAP�
CLINICAL SFRVICES CAORDINATOR
SUB-TOTAL SALARY
• annual salary based on 42 week school year
FRINGE BENEFITS @ 215°J
MCHSHCO3
•ANNUAL PROGRAM PROGRAM MCN
53,469
51,029
48,572
48,572
51,912
36,338
35,560
39,211
38,709
39,2I1
27,185
24,502
24,952
25,852
23,793
25,956
43,035
38,5I9
43,035
43,035
37,204
32,601
41,564
36,615
36,615
36,615
41,564
62,554
0.80
0.70
0.60
0.60
0.80
0.60
0.60
0.50
0.60
0.30
1.00
0.80
0.60
0.80
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
Q.10
0.10
$ 42,775 $ 36,359
$ 35,721 $ 30,363
$ 29,143 $ 24,772
$ 29.143 $ 24,772
$ 41,530 $ 35,300
$ 21,803 $ -
$ 21,336 $ -
$ 23,527 $ -
$ 23,225 $ -
$ 11,763 $ -
$ 27,185 $ 23,107
$ 19,602 $ 16,662
$ 14,971 $ 12,726
$ 20,682 $ 17,579
$ 23,793 $ 20,224
$ 5,191 $ 4,413
$ 6,455 $ -
$ 5.778 $ -
$ 6,455 $ -
$ 6,455 $ -
$ 5,581 $ -
$ 4 $ "
$ 6,235 $ -
$ 5,492 $ •
$ 5,492 $ -
$ 5,492 $ -
$ 4,156 $ -
$ 6,255 $ 3,128
460,128 $ 249,4-04
�.SI�
$ 98,928 $ 53,622
CONTRACT SERVICE
fAMtLY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNO UNIVEf2SIN OF MINNESOTA FELLOW CLINICS/W!C Ca} $120 X 38 WKS
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIEI�T CARE
L460RATORY SERVECES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRIN7ING/DUPLICATING
TELEPHONE
TRAVELlTRAINiNG
PATIENT TR4NSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROYED INOIRECT COST RATE @ 35^J OF SAIARY AND SENEFTTS
TOTAI PROGRAM BUDGET EXPENSE
TOTAL MCH GRANTBEQUEST
MATCHING FUNDS Q 25�
$23,326
$ 9,120 $ 6,&40
$ 23,326 $ -
$ 26,250 $ 18,375
$ 48,825 $ 34,17$
$ 15,750 $ 11,025
$ 12,600 $ 8,820
$ 6,825 $ 4,778
$ 1Q,800 $ 6,756
$ 5,250 $ 3,675
$ 2,100 $ 1,470
$ 719,901 $ 398,941
195,669 106,059
$ 915,571
$ 505,000
$ 228,893
-61-
G. Indirect Cost Allocation for MCHSP
Please check one of the four options:
� 1. NoY applicable—No chazges to MCHSP are for indirect cost.
� 2_ Indirect Cost Rate Agreemeut — A Federal negotiated fixed rate is to be chazged against all
pariicipating programs, includingMCHSP.
A signed ageement from covering the current Federal fiscal year is attached.
� 3. Approved Cost Allocation Process:
Option 1 Indirect costs aze allocated to the agency's pmerams using worksheets developed by the
agency for this purpose.
Agency worksheeYs and supporting documents are attached which aze in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principies for State, Locat,
and Indian Tribal Govemments", and the Federai award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocaiion Process:
Option 2—Indirect cosfs aze ailocated to the agency's pmgrams using the optional IndzrecUCost
AIIocation Wotksfieet on the Following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Govemments", and the Federal awazd(s) for which they apply.
�Y�
. ..
���
Y * DEPARTMEP7T OF HEALTH & HUMAP7 SERVICES
Y �
�;� �+m
Raymond J_ Martin, Jr.
Sxecutive Director
Health SCart
491 We5t University Avenue
St. Paul., MN 55203-I936
Dear Raymond Martin:
February" 6, 2001
�"�m �en� Cmtc
Fimv�l Mam�� �rice
Dimion o[ Cat Apacauoy
Cenhal States Fefd ��
730'i Young Stree; Room 732
6aVias Settas 75202
(214)-767-325t
FAXX (Z'
The original an� one copy of an indixect cost Rate Agreement
are enclosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concerning
t2ie rate(s) that may be used to support your claim for indirect
costs on granCs anti contracts with the Federal 6ovemment.
Piease have the original signed by an authorized representative
of your organization and .return it to me, retaining the copy
for your files. We will reproduce and distribute the Agreement
to the appropriate awarding. organizations of the Federa7.
Government for their use.
An indirect cost proposai, together with supporting information,
is required each year to substantiate claims made for indirect
costs under grants and contracts awarded by the Federal Government.
Thus, your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation.
Enclosures
sincerely,
S
\
Merl M. Schmidt �
Director
Division of Cost Allocation
Central States Field Office
P7�EAS$ SIGN AI3D RETURN TFiE ORIGINAI, OF THE RATE AGREEMENT
or-�y9
��
a
NOHPROFIT R8T& AGREEt�NT
SIN #: 1411577621AI DATE: February 6, Z001
ORGANIZATION: FILING REF.: The preceding
Health Start Agreement was.dated
491 West IIniversity Avenue NONB
St. Paul NIl�7 55103-1936
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Government, subject to the conditions in Sectioa III.
RATS TYPSS= FIBfiD PINAL
$FFECTIZTE PERIOD
TYPS FROM TO
PROV. O1/OI/O1 12/31/O1
PROV. 01/O1/02 IIxTxI, AN�rm&D
x
PROV.{pROVSSIONAL
PRSD.(PRSDSTBRMIN%D)
RATB(%) LOCATIONS APPLICABLB TO
35.0 On-Site A1Z Programs
IIse same rates and conditions as those cited
for fiscal year ending'December 3Z, 2001.
* sASS :
Direct salaries and wages including all fxinge benefits_
.�
.,
Health Start
A
AGREEMENT DATE: February 6, 200Z
�(-959
SBCTION II: SPECIAL RSMARKS
TRSATMFiNT OF FRSNGS B&NBFSTS
The fringe benefits are chazged using a rate(s). Over/under recoveries from actual costs
a=e adjusted i.n cuxrent oz futuse periods. Tfie directly claimed fringe henefits are
listed below.
TREATMENT OF PAID ABSENCES_
vacation, holiday, sick eave pay and othe= paid absences ase included in salaries and
wages and are claimed oa grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the cosCS of these paid absences are not
made.
Equipment nefinition -
Equipment means an article of nonexpendable, tangible personal property having a ssse£ul
Iife of more than one yeax and an acquisition cost of $1,000 ox more per unit_
FRINGfi BENEFITS:
FICA
Retirement
Disability Insurance
Worker�s Compensation
Li£e Insurance
Unemployment Insurance
Health Insurance
-65-
4 +
ORGANIZATION:
Health Start
AGRSEMENT DATS: February 6, ZdOI
A_ LIMITATIONS
The ratea ia Ghis Agreemeu[ are avbjeet Lo a¢y atatutoxy or a�➢ninis[satioe Iimitations aad app2p to a given graat, con[ract or
oCher agreement oaly Go the ex[ent tDat fimds ate available. Acceptance of tlae rates is subject to the follooriag conditioasa
(1) Oaly coats fneurzed by the oxganizatioa were included in 3ts indireet rnst pool as finally accepted: aucII cos[s are legal
obligatioas of the orgaaizatioa aad aze allovable vndex the govexniag mst prineiplea; (2) The same eoats that Dave be¢n ueated as
indirect cos[s aze aoG elaimed ae direct coats; (3) Similaz typea of rnsts have beea accorded coasisteat accomting trea[men[; and
(4) TIIe iafo�atioa provided by Che or9aaizatioa vhieh was used to esiablieh tIIe rates is no[ later found to be matezially
incomQleCe or inaccurate by Che Pedexal Gover�eat. Ea suvi sitvations Ghe rate(s) would be subject to xenegotiatioa at the
discreiion oE tDe Federa2 Goverm�eat.
B. ACCOiRi:fIHG �fNGSS
This Agreement is based on [he accdnntim3 system pisported by the organization to Le ia effeet duriag ihe Agseement periad. CEanges
Co the method of aceouaCiag foz coats vhich afEe<t Che amount of reimbuxsement resulting from the use oE this Agreement zem•;Te
prior approval of the authozized xepreseataCive of tEe co9nizan[ agency_ Sich ehayges inelude, but are aot limited to, cLaages ia
the ^*�+�ing of a paxtieulaz type of croat fxnm iadixect to d3reet. Pail�e to obtain appioval may result in rost disalloxaaces.
C. PIZLD RATES �
if a fued rate ie in this A9reement, it is based on aa eati�te of the rnats fo= the period cavezed by the rate_ 9ihea the a<tval
rnsts for Ghis period are de[ermiaed, an adjustment vi1l be made Co a rate of a futvie year(s3 to compeneate for the d3ffezeaee
between tIIe coste used to establiah tEe fiaed rate aad actval coste_
D. V58 HY OTHEti PED%RAL AGENQBS
The ratee in this Agreemeat were appTOVed in aernsdance aith tIIe authoritp ia office of Ma�gemeat aad Sndget CixCalai A-122
Circular, a� should be applSed [o grants, coatxaets aad otEer agree�ats covesed bg this C$zevlar, svbjeci to avy limitatioas in A
above. The oxgaaitation may provide copies of the Agreement to other Pederal Agesscies ta give them early aotifi<aGioa of tIle
ngreemest.
E. OTHE.¢.: •
Zf aay Pedezal contract, grant or other agzeemeat is zeimbursiag indirect msts by a means other thaa the approved zate(s) ia this
A9reemeat, [La oxganizatioa ehonld (i) cxedit snch crosts to the affeeted pxo9rams, and (2) apply the appzoved rate(s) to [he
appxopria[e base to identi£y the proper amouat of indireet costs alloeable to tlaese programs.
BY T88 OR(�1NIZATSON:
$ealth Staxt
- .. _ Y:� Y�� a�.._ �l•! �r� �
lORGANIZATION) .
���,,.,,,,( J�' f'la,�. �•
(sx 1 •
_ RA`fNouo s_ rtAa=iv. i�
t��
Ex�G�l�f�vr ��REC,'Cb�2
(TSTI.B)
.
�_<__ . / � ti_ �'!�
Mer7.e M. Schmidt
tm��
DSRECl08, DIVISIOS OP COS? ALLOC}STSOA-
(TITL8) CSlITRAL STATES PZELD OFPIC3
fl]AT8)
PebxuasV 6. 2001 � ... .. _.. __�.����
I11AT8) 5]36
�s *+�s�**Txos: MY (RObert ) N�. N4uYen
Telephoae- �2�.4T 767-3267
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CHS PROGR.4M PLAN: Communicab�e Disease Prevention and Controt Common Acthirties Framework 57
01-9 �y
State and Local Pnblic Health
Communicable Disease Prevenrion and Control
Common Activities Framework
PREAMBLE
S/I7/OI
This Framework lays out a minimum set of disease prevention and control activities that are
to be carried out by all local public health agencies and the Minnesota Department of Health.
Background: Infectious disease prevenfion and control (DP&C) includes activities of deteeting acute
and coznmunicable diseases, develaping and implementing prevention of disease transmission, and
implementing control measures during outbreaks. Controlling communicable diseases is perhaps the
oldest and most fundamental public health responsibility. For decades, it was the primary responsibility
oflocal Boards ofHealth and, in fact, the main reason for their creation. Yet, the Local Public HealthAct
(Chapter 145A) and the Department of Health Act (Chapter 144) are ambiguous about respective state
and local authorities for conducting disease prevention and conirol acrivities.
Subdivision 6 of the Locai Public Health Act states, AA board of health shatl make investigations and
reports and obey instructions on :he con�ol of communicabie diseases as the commissioner may direct
under section 144.12, 145A.06, subdivision 2, or 145A.07. Boards of health must cooperate so faz as
practicable to act together to prevent and control epidemics."
Note that this is a requirement oflocal boardr ofhealth whether ornot theyforn� a CommuniryHealth Board or receive
the CHS subsidy.
While intended to allow for fle�bility and varied capacity to address communicabie disease problems,
such broad direction leaues ambiguity anduncertainty abouttherespective roles of state and local public
health. Clearly, both the 2viinnesota Department of Health (MDI-� and local Boards of Health have
assumed a shared responsibility for conducting public health activities.
In 1989, the NIDH DP&C Division and the State Community Health Services Advisozy Committee
(SCHSAC) formed a workgroup to review roles and responsibilities for conducting DP&C activities at
the state and locallevel. The outcome was a DP&C Acooperative agrcement� that formalized some of
1VIDH relationships with local public health
Communicable DP&C Common Activities FYamework: In 1996, another SCHSAC workgroup was
formed, which abolished the old agreement and redefined expected roles and responsibilities for DP&C.
The final report of the workgroup was released in 1998. T1us report, which was
approved by SCHSAC, set standards for DP&C activities to be carried out at the state and local level as
contained in the initial version of the Communicable DP&C Framework of Common Activaties. This
� lays out a miriimum set of DP&C activities that are to be carried ont by ali local public
health agencies and MDH. These activities are to be reflected in state and local community heakh
service (CEIS) plamung efforts. Those agencies that aze currently unable to cazryout these activities are
expected to strive to reach this level. MDH activities listed in the Frunework are to be implemented by
2
MDHInfectiousDiseaseEpidemiologyPreventionandConirol (IDEPC) Division staffinsupportoflocal
public heatth agency DP&C activities. 'I'his Framework also lists DP&C activities that are conducted
joinUy by MDH and local public healYh agencies.
The 1998 version ofthe Framework atso Iisted suggested activities for private heattEi care providers and
health pl�s in support of DP&C pubfic health efforts. The Fraznework as revised (May 2001) focuses
on local public health agency and MDH DP&C activities. Additional discussion with health caze
pmviders and health plans is being planned by the DP&C Leadership Team to detemiine ways they can
support DP&C activities. These activities will then be included in ffie Framework.
The Framework may be used as the foundation for a DP&C workplan for boffi MDH and locai public
health agencies. Yet to be determined is how Iocal public health and 1VIl7H can measure their pmgress
in maintauring and improving DP&C activities as contained in the Fraznework.
DP&C Leadershin Team: Anotherrecommendalionto enhanceffiepartnetship between state and local
public health for disease prevention and control that was made by the SCHSAC workgroup in the 1998
report was to create a DP&C I.eaderslup Team. '
Tfus Team is made ofinembers represenkingregionat andjob specific categories from iocalpublic health
agencies, arepresentative fromeachofthesectionswitUinthe IDEPCDivision, asweIl asarepresentative
from the MDH Community Heatth Services Division. The DP&C I.eadeiship Tea�n meetings are
urtended to provide an ongoing fomm for the review and discussion of how DPBzC activities are
implemented at the state and local leveL The Team meets about five times a yeaz: One co-chair
represents local public health; the other co-chair represents MDH.
TheDP&C Leaderslup Teamwill review the Comcnunicable DP&C Fremework ofCommon Activities
at least everytwo years (in conjunction with the CHS planning cycle} for anyneeded revisions. The next
review will need to be completed by January 2003, in prepararion for the development of locai pubfic
health 2004-2007 CHS Plans.
Recowmendations and updates are brought back to the Commissioner ofHealth and to the SCHSAC as
necessary.
MDH attd locai heaith departments have worked together to carry out the DP&C activities contained in
theFramework,initiallythroughpilotprojects. ToensurethesuccessoftheFramework,t�ainingsessions
aze being held statewide to review the Framework with all locat public health and Ivff)H DP&C staff.
In these sessions participants share ways to enhance the collaborative relationship between MDH and
local agencies.
K:1Xoshare�I.EADERSA1Framework\preamble-Snaiframeworic-wordperfectwpd
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CHS PROGRAM PLAN.' Minnesota Department of Helath Subsidy Applica6on Forms 59
O/" g�9
CHS Subsidy Application Cover Form
Plan Update Cycle 2002-2003
Name of Community Health Board: Ramsey County Community Health Board
Subsidy Request (including core fnnctions fnnding):
2002 CHS 2003 CHS
Subsidy Request Subs R
Totat Commnnity Health Soarfl 2,195,000 2,195,000
CHS Administrator:
Name: Rob Fulton, Saint Paul-Ramsey Counry Departrnent of Public Health
Address: SO West Kellogg Boulevazd; Saint Paul, Minnesota SS 1 Q2-1657
Fiscal Management Officer:
(This is the person and agency to whom the CHS Subsidy check should be sent)
Name: Julie Kleinschmidt, Director, Budget and Accounting, Room 270 Court House
Address: 15 West Kellogg Boulevard; Saint Paul, Minnesota 55102
��nutes\CASPSan2001Update\Sub:idyApplicationForms\SubsidyUpdateCoverFotm\Updatesubsidy app Update Cover fomu.doc
I¢dividual County Breakdowns
2002 - 2003 Update Assurances and Agreements
$Y SIGNATURE, 'I'HE ATJTHORiZED OFFICIAL AGREES AND ASSURES THAT:
1. Services will be provided in accordance with state and federal laws, rules and policies.
2. The Community Health Boazd will comply with state and federal requirements for equal opportunity employment,
3. The Board will comply with staYe and federal requiremenu relating to data privacy or confidentiality of pxotected
information.
4. The Board will provide the Minnesota Department of Health with information referenced in the CHS plan where
applicable.
5. Standards for programs or activities will be used in carrying out affected programs or acrivities where those
standazds exist
6. The requirements for fiill community participarion, as defined in Minnesota Rules 4700.1800, have been met.
7, The Community Health Advisory Committee {or Health Task Force of any Human Services Boazd Advisory
Committee in the wunty where applicable [Minn. Stat. 402.03]), shall meet the composition and reporting
requirements of the Community Health Services Advisory Committee required by Minnesota Statute.
8. The Board will comply with all standards relating to fiscal accountability that apply to the Minnesota Department of
Health, specifically:
A. The local match identified in the budget submission complies with the definition spec�ed in Minn. Stat.
145A.13.
B. The Boazd will submit plan and budget revisions to the Commissioner for prior approval in accordance with
applicable statute, rule, and MDH policy.
C. Reports will be filed with the Commissioner of Health in accordance with applicable statute, rule, and MDH
policy.
D. The Boazd will maintain a Financial Management System that provides:
I) Accutate, current, and complete disclosure of the financial results of each activity.
2) Records thaz idenrify adequately the source and applicarion of funds for subsidy supported activiries. Tfiese
records shall contain information pertaining to subsidy awards and authorizations, obligations, unobligated
balances, liabiliries (encumbrances), outlays and income.
3) Demonstration that the Board has effective control over the accountability for all funds, property and other
assets.
4) Comparison of actual obligations with budget amounu for each activiTy.
5) Accounting records that aze supported by source documentarion.
a�e..by-ar a*.�,rh�direction of the Boazd or the Depar[ment of Health. CHS fmancial
records will be retained unril audited, with the following qua i ca o.
i) The records will be retained beyond this period if audit findings have not heen resolved.
ii) Records for non-expendable property, which was acquired with subsidy funds, will be retained for three
years after its fmal disposirion.
S:N�Iinutes\CHSP1anZ001Update\SubsidyApplicazionForms�AssurancesAndAgreements\UpdateAssurances and Agreemenu.doc
o t-99q
2
2002 - 2003 Update Assurances and Agreements Continued
9. The Boazd will maintain records of the followiug materials for review for the durarion of the Plan. [Note: This does
not preclude other requ9remenu stipulated in the Community Health Boazd's retenrion schedule.]
A. Copies of the Joint Powers Agreement forming the Community Health Boazd.
B. Agreements establishing a Boazd of Health or Boards of Aealth within the azea of the Community Heakh Boazd.
C. Organizaflon chart of the Community Health Boazd structure that idenrifies major program activities, advisory
groups, and lines of authority and accournabIlity.
D. A list oF all city/county local ordinances or other local regula6ons related to community health services revised
within the past two years.
E. Copies of all public meeting notices and minutes.
F. General roster for community health service mailings.
G. Community Health Services Advisory Committee bylaws, meeting norices, minutes and attendance records.
H. Summary of public comments or testimony on the proposed Plan.
I. Copies of conhacts/purchase of service agreements with other organizations.
J. Env'uonmental Heaith, Disease Prevention and Control, and other ageements to exercise the Commissioner of
Health's authority.
Application is made for a subsidy under the provisions of the Local Publlc Health Act in the atnount and for the purposes
stated herein. The Community Health Boazd agrees to comply with conditions and reporting requirements consistent with
applicable Minnesota Statute and Rule.
* SIGNATURE:
TITLE: D'uector of Public Health
DATE: 7 Z�,O�_
*This form must be signed by the Chair or Vice Chair of the Community Health Boazd, or an agent appointed by resolution
of the Community Health Boazd. If signed by an agent, the resolution or motion appointing that agent MCTST be attached for
this subsidy application to be approved.
S:1Minutes\CI-ISPIan200SUpdate\SubsidyApp(icazionFocros�ASSUrancesAndAgreements\UpdareAssurances and Agreements.doc
2002 - 2003 Update Adminis#rative Requirements
This record is to assure that the Community Health Board has addressed the admmish�arive requuements of
the Local Pablic Health Act and its Rules. This form shou[d be completed for the Community Health
Board onlq, not for individual counties. Please answer the following questions.
1. How many members aze there on your Community Health Board?
2. When did your board(s) of health meet during the past year? List the meeting dates.
4. Does your board keep a public record? X Yes No
5. Does your Coxnmunity Heaith Board employ a Medical Consultant? X Yes
Please list the name, address, and telephone number of your medical consultant:
Dr. Neal Holtan; Saint Paul-Ramsey County Department of Public Health; 555 Cedaz Street; Saint
Paul, Minnesota; 55101 Telephone: (651) 292-7713
6. Does your Community Heatth Board have an Advisory Comrnittee? X Yes
How many members does it have? 23 available membeiship positions
Briefly describe on what basis members are appointed (e.g., geographic representation,
provider/consumer, special interest, etc.).
Ten members appointed by the city of Saint Paul. Thirteen members appointed by the Ramsey
County Boazd of Commissionezs_ Each county commissioner appoints one person to represent them.
Six other persons aze appointed to at-lazge seats using the Ramsey County appoinhnent process.
Two of the twenty-three members aze labor representatives who have public health eacperience, one
selected by tha county boazd as one of its thirteen representatives and one selected by the city of
Saint Paul as one of its ten representatives.
7. Does your advisory committee have bylaws or
8. Does your Update describe the process used to encourage full community participation in the
development of the Update? X Yes _ No
S:�Sinutes\CHSPIan2001Updaze�SubsidyApplicationFo�msWdminisuativeRequirementsFOrUpdaze\UpdateAdminisazuve Requirements.doc
3. Does your boazd have written procedures? X Yes No
al-9yy
2001 Update Administrative Requirements Continued
a. Was written notice of the inifiation of the Update development process made to interested
persons, including affected providers, consumers, and locai govemment officials?
2
X Yes No
b. Did this notice include the procedures by which persons may participate in the Pian development
process?
X Yes No
c. Did thi s notice describe how interested persons may obtain a summary of the proposed plan and
how they may review the entire proposed plan?
X Yes _ No
d. On what date(s) was this notice sent to interested persons? 12/16/99
Y
e. Was this notice published in a local newspaper?
Which newspaper(s)?
Newspaper(s) Name
Saint Paul Pioneer Press
Date Published
1( 24((Ol
Saint Paul Pioneer Press
5/13/Ol
X Yes _ No
Copy on file? X Yes , No
Copy on file? X Yes , No
Copy on file? ^ Yes _ No
f. Does your boazd maintain a general mailing roster?
If so, does it contain:
Providers
Consumers
Local Govemment Officials
g. Was notice sent to people on the general mail3ng roster?
9. On what date was the Update available for public review? 5/13/O1
X Yes _No
X Yes _ No
X Yes No
X Yes ^ No
10. On what date was a summary of the Update available to interested persons? 5/21/0
X Yes � No
11. On what date(s) were public meetings held? 6l13/O1
, S:Vvlinutes\CHSPIan2001Update�SubsidyApplicationFottn544dminisValiveRequirementsFofUpdale\UpdateAdministrative Requirements.doc
2001 Update �Idministrative Requirements Contirrued
12. On what date did the Community Health Boazd approve the Update? (Attach meeting mitnutes
andlor resolution):
13. On what date(s) did the County Board(s) approve the Update? (Attack meeting minutes and/or
resolution):
14. On what date(s) did the County Boazd(s) approve the yeaz 2002 CHS budget? (Aitach meeting
minutes and/or resolution): Ramsev Countv Boazd to be approved December, 2001
NOTE: If County Boards have not yet approved ihe budgei, you must subm?i a signed copy of the
budget, along with meeting minutes and/or resolution, no later than January 31, 2002.
3
15. Have you attached a copy of the budget for each of the last two years in the planning cycle (2002-
2003) for each county in your CHS agency? (Subnnitting a combined form for multi-county agencies is
not required, but is recommended.)
2002 X Yes No
2003 X Yes No
16. Have you attached a copy of the staffing form for each of the last two years in the planniug cycle
(2002-2003) for each county in your CHS agency? (Submitting a combined form for mulri-county
agencies is not required, but is recommended.)
2002 X Yes No
2003 X Yes No
Signatnre
CHS Administrator
Date: � 0
S:�Minutes\CHSPIan2001Update�SubsidyApplicationFomssWdministrativeRequiremen[sForUpdaze\UpdateAdministrauve Requirements.doc
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�� Saint Panl - Ram sey County
� Departm ent of Public Health
: \� � Rob Fulton, Director _ _ __
xamccrcoums
50 W. Kellagg Blvd. SYe. 930
gyint pauL, � 55102
651-266-2400
Julq 19, 2001
Community Health Services Administration
Munesota Department of Heaith
To Whom It May Concern:
According to the CHS Subsidy application instructions we must verify the eacgected approvai date
of our Community Health Services budget if that budget wi}1 not be approved by our Board prior
to the October 31 deadline for submitting our CHS subsidy application to the Minnesota
Deparnnent of Health. The purpose of ttris letter is to comply with that requirement.
Tfie Ramsey County's Community Heatth Services budget to be approved by Deceinber 31, 2001
Sincere ,
Robert Fulton, Duector
Saint Paul-Ramsey County Department of Public Heakh
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Council File # �y��!
Green Sheet # 11365�„
Presented by
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
�O
Referred To Committee Date
1 WHEREAS,thecityofSaintPaulandRamseyCountythroughtheSaintPaul-RamseyCountyDepartmentofPublic
2 Health aze required by Statute to prepaze a Community Health Services Plan and Update for that plan (CHS Plan
3 Update) to receive a Community Health Services subsidy; and,
4 WHEREAS, the 2002-2003 CHS Plan Update was deve]oped by the Saint Paul-Ramsey Count7 Departsnent of
5 Public Health Services Advisory Committee with input from the community; and,
6 Wf�REAS, the 2002-2003 CHS Plan Update and a summary of that Update were made available for public review
7 and comment and the public was notified of that availability; and,
8 VJHEREAS, the Maternal and Child Health Special Proj ects Grant — Saint Paul: 2002-2003 Update Applicarion is
9 required to be submitted to the Minnesota Depariment of Health by the Saint Paul-Ramsey County Department of
10 Public Health and is attached to the CHS Plan Update; and,
11 WI3EREAS, the Community Aealth Services Plan must be approved by the City Council as outiined in the Public
12 Health Joint Powers Agreement; now,
13 THEREFORE BE IT RESOLVED, that the City Gouncil accepts for submission to the Ramsey County Boazd for
14 their apporval and submission to the Minnesota Department of Health the 2002-2003 CHS Plan Update and the
15 Saint Paul Maternal and Child Aealth Grant.
Requested by Department oL
Adoprion Certified by Council Secretary
sy: ''��.^� , -f�.`� _ _ t —
Approved by Mayor: Date �� � LiA3� (
By: �'C�� I
�
Form Approved by City Attomey
�
Approved by Mayor for Submission to Council
�
Adopted by Council: Date �,� �_ � C7 ��
Council
RSON & PF10NE -
�����
GREEN SHEET
o�.qt'1
Council President BosCxom
iT BE ON COUNCILAGFNOA BY (OA7E1
�t. 20, zooi
TOTAL # OF SIGNATURE PA6ES
o[.M,renonFZrorz
No 113652
arv�
❑ CRYAiTGUEY ❑ fJIYpiR1I
❑ AU11L'lM.iERYKFJOYt ❑ R1M1q11L1ERll/1CCTG
❑wroR�oRwsmriu+n ❑
(CLIP ALL LOCATIONS FOR SIGNATURE)
Accepting the 2002-2003 Community Health Services (CHS) Plan Update and the SainC Paul
Maternal and Child Health Grant for submission to the Ramsey County Board for their
approval and submission to the Minnesota Department of Health.
s
PIANNING COMM.tSSlON
CIB COMMI'fSEE
CIVIL SERVICE COMMISSION
f13_1:S Z���
Hasthis Ce«�K� arerwaked under a conhact for thia tlePa�menli
YES NO
Has �is pemoMrtn ever been a atY emDloYee7
YES NO
Dces fhis Pe���� P� a s1a11 r� namallYP�s¢tl bY any artent citY emWoyee7
YES DEO
Is this pe'soNfirtn atarpeted venEO�
YFS NO
OF TRANSACTION S
SOURCE
COSTfliEYENUEBUDGETED�CIRCLE ON�
ACTNI7Y NUMBER
YES NO
(��M
Saint Paul - Ramsey County
Department of Pnblic Health
Ro b Fult Di recxor
4 � -'L°�°1
50 W. Kell6gg 81vd.. Ste. 930
Sairct Pau{, Minr�esota 55102
651-266-2400
l'o: Saint Paul City ncil
From: Robert Fu4ton �
Jane Norbin` �'
Re: Updnte of the 2002-2003 Community Heafth Services Pfan
Llate: September 11, Z001
The Pubfic 1-le¢Ith Joint Powers Agreement requires City Councii approva) of
Community Health Services Pians (Pian/s) nnd their updnfies. The state requires new
Plans every four yenrs and updates every two years. We now seek Counci! approval
of the update to the four-yenr Pian approved by the Council in 1999 (n draft
resolytion a►id Update nre attrsched for your convenience). The Update must next
be npproved by the Ramsey Courity Board and fihen be subm'rtted to fihe Minnesota
Department of Henith by October 31�' of this year.
No new community health problems arose during the update process. Some of the
P1nn's strategies, however, were upda#ed to reflect the P1an's progress and recent
enhancemeofis of the public health operafiing environment, The enhancements
include n minority health grant; Temporary Assistance to Needy Families; Youth Risk
Behavior Endawment 6runt nnd the Adolescent Parenting Program.
�inally, the Ptan incorporates the Maternai and Child Nealth 6rant-Snint Paul:
Z�Q2-2Q03 Update Application.
To develop the Update, the Saint Pnul-Ramsey County Dapar#men# of Public Hea4th
(SPRCDPH) obtained input from staff and the community through a vuriety of
methads, including:
1. Update and analvsis of CHS Plan data.
2. Department-wide review of CHS Proarum Plan strntegies.
Q1-999
September 11, 20Q1
Update of the 2002-2003 Communi#y Health Services Pian
3. Pubiic Notices Public notice of the initint+on af the Update process was
published sn the Saint Paui Pioneer Press in 3anuary 20Q1. Another notice was
published May 13, Z041 ta inform 1'he public of when drafts of the Updnte would
be availabie for inspection. Posi�cards with the newspaper nofiice informatian
were also mnited to the genera! mailing 3ist of the SPRC�PH. A summnry of the
Update has afso been nva+lable on the SPRCDPH World Wide Web site.
4. Public Meeting nnd meetinq of i'he Saint Paul-Ramsev CountY Eommunitv Heatth
Services Advisorv Commififiee. A pubiic meeting was he}d i» conjunction with the
Saint Paul-Ramsey County Commun+ty Healfih Services Advisory Comrnittee
meeting, on June b 200i. The Adv+sory Committee and the public provided
feedback on the Update.
Thank you.
Attnchments:
Draft City Counc+l Resalution
CNS Pian Update Summary
CHS Plan Update
Maternal nnd Child Heai#h Special Pro jecfis Grant - Saint Pnu1:2002-2003 Update
Application
Saint Paul - Ramsey County
Department af Public Health
Rob Fulton, Director
o � -���
50 W. Kellogg Bivd.. Ste. 930
Saint Paul, Minnesota 55102
651-2b6-24Q0
To: Saint Pnui City ncii
�rom: Robert Fulton �
Jane Norbin�"
Re: Update of the ZOOZ-2003 Community Henith Services Plan
flate: September 11, ZOOI
The Public Healfih Joint Powers Agreement requires Gity Counc+l nppraval of
Communifiy Health Services Plnns (Planls) and their updntes. The state requires new
P{ans every four years and updates every two years. We now seek Counci{ approval
of the update to the faur-year Pfan approved by the Council in 1999 (a draft
resolution and Update are afitached for your convenience). The Update must next
be approved by the Ramsey County Board nnd then be submitted to fihe Minnesofia
Department of Health by October 32'� of this year.
No new commun+ty hea{th prob{ems arose during the update pracess. Sorne of the
Plnn's strategies, however, were updated to reflect the Plcan's progress and rece»i
enhancements of the pubtic henith o}�erating environment. �'he enhnncements
include Q minority heafth granfi; Temporary Assistance to Needy Families; Youth Risk
Behavior Endowmenfi 6rant and the Adalescent Parenfiing Program.
Finally, the Plan incorporates the Maternal and Child Necsith Grant-Saint Pau(:
ZOQ2-ZOQ3 Update Appl+ca#ion.
To develop the Update, the Saint Paul-Ramsey County Departmen# of Public Henith
(SPRCDPN) obtained input from staft and the community through a variety of
methods, inciuding:
1. U�date and analvsis of CNS Aian data.
2. Department-wide review of CHS Proaram Pian strateaies.
01
September 11, 200f
Update of the 2002-2003 Community Health Services Plan
3. Public Notices. Public notice of the initiation of fihe Updafie process was
pub!'rshed in the Saint Paui Pioneer Press in January 2002. Another nofiice was
publ'sshed May 13, 2001 to +nform the public of when drafts of the Update would
!�e availnble for inspec#+on. Postcards wifih the newspnper notice intormation
were also mniled to the general mailing list of the 5PRC�PFi. A summary of the
Update has also been avo's4able on the SPRCDPH World Wide Web site.
4. Pub{ic Meetinq nnd meetina of the Saint Paul-Ramsey Coun#�Community Neatth
5ervices Advisor�Committee. A pub{ic meeting was held in conjunct+on with the
5aint Pau{-Ramsey County Community !-lealth Services Advisory Committee
meetiny, on June 6 2(}Ol. The Advisory Gommittee and the public provided
feedback on the Update.
Thank you.
Attnchmenfis:
Draffi City Council Resofution
CHS Plnn Update Summcrry
CH5 Plnn Update
Maternal and Child Heal#h Special Pro jects 6rant - Snint Pau1:20Q2-2003 Update
Application
d�--9�9
2
DRAFT RESOLUTION
CTTY OF SAINT PAUL, MINNESOTA
2002-2003 CHS Pian Update
WHEREAS, the city of Saint Pau1 and Ramsey County through the Saint Paul-Rawsey
County Deparhnent of Public Health are required by Statute to prepaze a Community
Health Services Plan and Update for that plan (CHS Plan Update} to receive a
Community Hea�th Services subsidy; and
10 WHEREAS, the 2002-2003 CHS Plan Update was developed by the Saint Paul-Ramsey
11 County Department of Public Health and the Saint Paul-Ramsey County Community
12 Health Services Advisory Committee with input from the community; and
13
14 WHEREAS, the 2002-2003 CHS Plan Update and a summary of that Update were made
15 available for public review and comment and the public was notified of that availability;
16 and
17
18
19
20
21
22
23
24
25
26
2'7
28
29
VJHEREAS, the Matemal and Child Health Special Projects Crrant — Saint Paul: 2002-
2003 Update Application is required to be submitted to the Minnesota Department of
Heaith by the Saint Paul-Ramsey County Depariment of Public Heaith and is attached to
the CHS Pian Updaxe; and
WI-IEREAS; the Community Health Services Plan must be approved by the City Council
as outlined in the Public Health Joint Powers Agreement;
THEREFORE, BE IT RESOLVED, that the City Council accepts for submission to the
Ramsey County Boazd for their approval and submission to the Minnesota Department of
Health the 2002-2003 CHS P1an Update and the Saint Paui Maternal and Chiid Health
Grant.
ot-999
2000-2003
Saint Paui-Ramsey Coun�ty
Community Health Services Program Pian:
Update Summary
September 12, 2001
Saint Pau!-Ramsey County Department of Public Health
Health Poiicy and Pianning
50 West Keliogg Boulevard; Sufte 930
Saint Paui, Minnesota 55102-1657
Telephone: {651) 266--2403
http://www.co.ramsev.mn. us/P�ndex.htm
t�1-999
TABLE OF CONTENTS
Zaoa2oo3
Saint Paut-Ramsey County
Community Heafth Services Program Plan:
Update Summary
ACKNOW LEDGEMENTS .............................................................................................................................1
INTRODUCTION TO THE UPDATE SUMMARY .........................................................................................2
SUMMARY OF THE CHS PLAN UPDATE PROCESS
..... 3
SUPAMARY OF PUSLIC HEALTH PflOBLEMS THAT EXIST IN THE COMMUNfTY AND GOALS
(OUTCOMES) FOR ADDRESSING THOSE PROBLEMS ...........................................................................5
PUBUC HEALTH PROBLEMS ORGANIZED ACCORDING TO PUBLIC HEALTH PLANNING
CATEGO I ES ............................................................................................................................................... 8
ol -g�g
COMMUNITY HEALTH SERVICES ADVISORY COMMITTEE'
Joan Johnson, Chair
Shana Morrel% Vice Chair
Mary Jo Borden
Lucie Ferrell
�d;FG'E7 ..��
James Haselmann
Gabrieile Lawrence
Susan Mitchell
Shana Marrell
CITY OF SAINT PAUL
Norm Coleman Mayor
Saint Paul Board of Health
Jay Benanav
Jerry Blakely
Dan Bostrom, Chair
Christopher Coleman
Michael Harris
Kathy Lantry
Jim Reiter
Ann Ricketts
John Rossbach
Greg Sheehan
Nancy Whde
Lori Husivedt
Theresa Lang
Gregory W. Bemard
RAMSEY COUIVTY
Paul Kirkwold, County Manager
Ramsev Countv Board of Healfh
Tony Bennett
Jim McDonough
Susan Haigh
Rataei Ortega, Chair
Victona Reinhardt
Janice Rettman
Jan Wiessner
SAINT PAUL — RAMSEYCOUNTY DEPARTMENT OF PUBL/C HEALTH
Rob Fufton, Director
Heaffh Policv and Plannina Section
Jane Norbin, Director, Sharon Borg; Cheryl Burke,• Michael Dean; Barb Nelson
Cover Desian
Barb Vaughan
' Members of CHS Advisory Committee as of March 2001.
CHS PROGRAM PL4N: Acknowledgemems
ot-9� f
LASTPRINTED9l11J012:04PM S:VAINUTESYCHSP4AN2IXItUPDATEWPDATEFlNAL4SAINTPAULYERSIONOPiHE2000-2W3CHSPLANURDATE
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u��a
puw aocunneKrs
'The Minnesota Department of Health requires local public heaith agencies to update their four-year
community health senrices plans at their midpoint. The update includes a summary and a detailed
document. This document is the detailed document.
More intormation regarding cximmunity heatth senrices planning in Ramsey County can be found in the
original Community Heafth Senrices Program Pfan and Assessmerrt Document, both of which are
available on the Worid Wide Web at:
http;l/www.co.ramsev.mn.us/PHlhpp.htm
or
by contacting the Saint Paul Ramsey County Department of Public Health (see cantact information
below).
A Community Health Services Plan Updata Summary is also availab(e through the contact information
provided on this page. The major cromponents of the Summary document are as follows:
❑ A summary of the overall process for updating the 2000-2003 Saint Paui-Ramsev Countv
Communiiv Health Services Plan; and
❑ The updated prob�ems and outcomes from the fufl Update document.
This detailed 2000-2003 Saint Paul-Ramsev Countv CommuniN Health Services Plan Update contains
updated public health problems that exist in Ramsey County, desired outcomes that indicate the problem
is being addressed, and the strategies that wi!! be used by the SPRCDPH to address the problems. This
document is also avaifable through contact information stated on this page.
Further information may be obtained by contacting the Saint Paul-Ramsey County Department of Public
Health:
Saint Paul-Ramsey County Departmeni of Public Health
Health Policy and Planning
50 West Kellogg Boulevard; Suite 930
Saint Paui, Minnesota 55102-1657
Telephone: (651) 266-2403
htto Jlwvaw.co.ramsev.mn.us/PI
ACRONYM
Throughout the CHS Plan documents, the Saint Paul — Ramsey County Department of Public Health is
frequenUy referred to using its acronym: SPRCDPH
PLANNING CATEGORIES
A�mmunity heatth plan is required by state mandate to have twelve planning categories:
CNS PROGRAM PLAN: Introduction
LASTPRIN7ED9111l012:04PM S:V�AINUTES\CHSPLAN2l101UPDAlFUPDATEFlNALtSA1NTPAULVER310NOFTHE2000-2
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CHS Planning Categories
Infectious Disease Unintended Pregnan
Chronic/Non-Infectious Disease Pregnancy and Birth
Environmental Heatth
Alcohoi, Tobacco and Other Drugs
Unintended Injury
Violence
Child Growth and DevelopmenY
Disability and Decreased
Independence
Mental Health
Service Deiivery Systems
The twelve pianning categories are used as guides for cotlecting data and organizing the cammunity
assessment and plan documents. Public health problems in the assessment document and strategies for
addressing them in the plan document are organized according to the twelve public health planning
categories.
As required by state statute, the strategies that were developed to address the public health problems are
also identified by the following public heafth topic areas (whose acronyms are indicated on the right-hand
column of the strategy grids).
Public Health Topic Areas
DPC -Disease Prevention and Control FH — Family Health
EMS — Emergency Medical Services HP — Health Promotion
EH — Environmenta! Heafth HH — Home Heafth
CHS PROGRAM PLAN.• lrn�oducfion
O1-gq9
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OFTtiE Ck-fs 1't.AFV UADATE Ft��GESS
COLLECTION AND ANALYSIS OF DATA
The Saint Paul-Ramsey Courrty Department of Pubtic Health (SPRCDPH), on an ongoing basis, updates
national, Minnesota, and Ramsey County public health assessment and outcome indicator data. ln
addition to Rs large collection of paper reports, the SPRCDPH maintains a computerized °database of
data° by public heafth planning categories to ease updating and accessing data for analysis. Monitoring
the availabifity and credibility of data that is available on the World Wide Web is also an ongoing activiiy
of the Department.
During the winter and early spring of 2001, SPRCDPH staff analyzed updated assessment and outcome
evaluation data for the need to change the 2000 — 2003 Saint Paul-Ramsev Countv Communitv Health
Services Proaram Plan (GHS Proaram Plan).
DEPARTMEN7TWIDE REVIEW OF CFIS PROGRAM PLAN STRATEGIES
During the winter of 2001, all SPRCDPH staff were provided an opportuniiy to participate in meetings to
comment on CHS Program Plan strategies. These meetings resulted in several lists of proposed edits,
deletions and additions to the existing CHS Plan strategies. Staff refined these lists for clarity, eliminated
duplicate comments and made a final list of proposed strategy cha�ges. The Department's Leadership
Team reviewed the final list of strategy changes for inclusion in the Draft CIiS Proaram Plan Uodate and
then gave the Draft CF{S Program Pfan Update a fina{ review after its consideration of aft public and staff
commenis.
COMMUNITY INPUT
The Ramsey Gounty pubiic was notified of the initiation of the update process in a newspaper notice on
January 24, 2001. Another newspaper notice was published May 13, 2001 to inform the public of the
dates on which drafts of the full and summary versions of the Draft CHS Proaram P1an Update would be
available tor review and comment. The May 13 newspaper notice also stated that a public meeting
regarding the Draft CHS Proaram Plan Update would be heid June 6, 2001, 5:30 p.m. at 555 Cedar
Avenue (Juenemann Building), Saint Paul. Postcards with the newspaper notice information were
mailed to many interested individuals and community groups on a mailing list maintained by the
SPRCDPH. Any interested party may be added to this list by notifying the SPRCDPH. .
The Saint Paul — Ramsey County Communiiy Health Services Advisory Committee was also provided
information on the Draft CHS Propram Plan Update and it conducted the public meeting on June 6"'.
After ciosure of the comment period on June 13, 2001, the SPRCDPH considered all community
comments submitted by that time, inciuding comments submitted at the public meeting on June 6"'.
SUM1VfARY OF CHAI�iGES TO THE CHS PROGRAM PLANi
The SPRCDPH review of data and strategies resulted in some reorgan+zing of problems and probiem
categories.
Changes were also made to improve the clarity of some strategies, to combine similar strategies, to
refiect imptementation of strategies, to delete completed strategies and to add new strategies made
possible by changes in the operating environment of the SPRCDPH.
CNS PROGRAM PLAN: Communily HeaRh Services Planning Process
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COU�VT�(
MISSION
The mission of the Saint Paul Ramsey County Department of Pubiic Heafth (SPRCDPH) is to improve,
protect, and promote the health, the environment, and the well being of people in our community.
AREAS OF STRATEGIC FOCUS
To accomplish its Mission, the SPRCDPH concentrates its efforts in the following four Straiegic Focus
Areas:
1. Prevent communicab{e diseases.
2. Promote the health of children, youth and their families.
3. Protect the environment and reduce environmental heaith hazards.
4. Reduce chronic disease.
These areas guide the work of the SPRCDPH.
It is recognized that some services that are mandated by the state as weN as some we are direeted to
perform by elected CounTy officials, may not be included in the Strategic Focus Areas. We will provide
ihese valuabie services, along with the Strategic Focus Area services, with the highest level of quality
and enthusiasm.
These Strategic Focus Areas will be addressed in our Community h4ealth Services Plan and other Board-
approved SPRCDPH pfans using sound policy analysis and planning to guide our specific strategic
direction for our decision making. This process wifl include a careful ana{ysis of public heafth data,
irends, and best practices. W e will pay particular attention to data on disparities in health status that exist
in our community. We will continue to use multiple strategies and methods in our daily work including
individual services, targeted group services, community services and system intervention to achieve our
public health outcomes.
CHS PROGRAM PLAN: Mission of the SPRCDPH
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CHS PROGRAM PLAN: Mission of the SPRCDPH
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Severaf new opportunities have enhanced the abi{ity of the SPRCDPH to implement the CHS Plan.
These new opportunities include a minority health grant; new funding from Temporary Assistance to
Needy Families (TAN�; the Youth Risk Behavior Endowment; and the Adolescent Parenting Program.
These new opportunities are described in the following sections.
Minority Health Gran4
The Minnesota Department of Heafth, Office of Minority Heafth, awarded a grant to the Minneapolis
Department of HeaRh and Family Support to assess and recommend ways to improve the heafth of
minority communfties. This project is a collaborative effort of the nine Community Heaith Service
Agencies in the seven-county Twin Cities Metropolitan Area of Minnesota, which includes Ramsey
County. The SPRCDPH will now have an enhanced ability to "improve data collection, analysis and
reporting of ilinesses among populations of color in Ramsey Couniy' (will — do strategy number one (1)
under "Item E. Health Disparities", page 31 of the CHS Program Plan).
Temporary Assistance 4o Needy Families (TANF)
New funding from Temporary Assistance to Needy Families (7AN� has resulted in a new strategy for
the CHS Program Plan. The Healthy Families Section of the SPRCDPH will act as lead staff for the
strategy, which is stated as follows:
Develop and implement TANF Public Health Home Visiting Program in coordination with other
county departments and community providers to improve child heaith and family functioning, and
promote self-sufficiency among low-income families.
This strategy will impact the CHS Program Plan problem areas of low birth weight and chiid growth and
development.
Youth Risk Behavior Endowment
This program provides resources for addressing youth risk behaviors and wi{I improve the ability of
SPRCDPH to implement strategies for the Program Plan problem areas of infectious disease; alcohol
use; tobacco use; violence; unplanned pregnancies; overweight, inactivity and inadequate nutrition; and
self-destructive behaviors by youth.
Adolescent Parenting Program
This program is a collaboration between SPRCDPH, Ramsey County Human Services, and Model Cities
Community Health Clinic to streamline services for adolescent parents. These services include minor
mom assessments, referrals to community resources, social worker services, transportation, help finding
emergency housing, and access to emergency supplies.
CHS PROGRAM PLAN: Changes in Operating Environment
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8 CHS PROGR,4M PLAN: Changes in Opera6ng Environment
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PROB IFM
1. Emerging and re-emerging infectious diseases threaten the health of the general population in
Ramsey Courriy.
OUTCOMES
1. Ramsey County residents experience decreased disease, disability, and death from emerging and
re-emerging infectious disease.
2. Improved heafth status of +nmates relating to communicable disease in Ramsey Gounty correctional
facilities.
3. Ramsey County community will be prepared to minimize the consequences of biological
emergencies.
4. Ramsey County residents experience decreased disease, disability and death from vaccine-
preventable diseases.
Oui- CHSZ
come Strategies Program
Area
1. Improve coritrot of infectious diseases, inciuding tuberculosis, through improved
1 collection of assessment data, improved outbreak detection, improved investigations, DPC
improved treatment and ciinica! care and screening as needed.
2. Use the Minnesota Department of Health Disease Prevention and Control
1 Common Activities Framework (See Appendix 1) to help guide SPRCDPH's disease DPC
prevention and control activities.
1 3. Collaborate with clinical providers Minnesota Departme�t of Heaith, and federal DPC
agencies on infeciious diseases.
1 4. Assure timely access to STD and HIV counseling, testing, treatment and all DPC
appropriate medical and laboratory assessments.
1 5. Provide health assessments and screenings for communicable diseases in DPC
refugees. FH
i 6. Develop a trained backup tuberculosis team to respond to tuberculosis cases, HP
contact investigations, clinic follow up, and investigations of institutional outbreaks. FH
1 7. Continue to provide perinatal Hepatitis B program. DPC
HP
� 8. Expand and enhance W eb site to provide infiormation on prevention and control of DPC
infectious disease (information on handwashing, for example). HP
� 9. Inform health professionals (inciuding SPRCDPN) and the Ramsey County DPC
2 These program area acronyms are discussed under "Pianning Categories" in the lntroduction section.
CHS PROGRAM PLAN: lnfectious Disease
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community on reportab(e disease trends, incidence and prevalence.
10. As appropriate, provide the following Ramsey Couniy groups with consultations,
educational opportunities and informafion regarding infectious disease prevention
and controi, assessment, treatment and access to treatment, and follow-up:
• Health care providers;
• Correctional faciliry inmates;
• Community residents; and
. City arid County departments.
2
3
f 1. Screen and treat Ramsey County correctional facility inmates for sexually
transmitted diseases and Tuberculasis.
12. Coordinate planning for responses to biological and other public health
emergencies within SPRCDPH and, as appropriate, with other local, sYate, and
national en6ties.
4 I 13. Meet regular(y with school nurses of all districfs fo provide up-fo-date
� immunization informa6on, communication and consultation.
4 � 14. Be a resource to providers about immunization questions and techniques.
4 � 15. Sponsor communiiy immunization educational opportunities twice a year.
16. improve immunization tevels among Ramsey Couniy residents through promotion of:
• increased Ramsey County provider use of the 18 Standards for Pediatric
immunization Practices;
4 � • strengthened rela6onships with providers and community agencies; and
• SPRCDPH staff (WIC, Heafthy Families, House Caqs, and Lead) ident"rfication of
children withou[ up-to-date immunizations and referrais to Child and Teen Check Up
and oiher programs as needed.
4 17. lncrease pnuemococcal vaccine use in high-risk individuals and minority elderly.
4 18. Promote Hepatitis A& B vaccines through Women's Health, Room 111, and
Correctionai HeaRfi.
4 19. Coifaborate to ensure children are immunized and schooi taw requirements are
met
20. Continue SPRCDPH provision of travel immunizations but promote that health
4 plan enroliees obtain travel immuniza�ons from their health plan. Work to increase
public education and level of knowledge about the need for immunizations when
traveling.
4
4
4
4
10
21. Provide immunizations in STD Clinics.
community clinic sites.
in the fail at
23. Provide immunizations to high risk, underinsured and uninsured Ramsey County
residents.
24. Participate in Metro Immunization Registry planning and implementation if state
funding is secured.
CHS PROGRAM PLAN: lnfectious Disease
DPC
DPC
DPC
DPC
HP
DPC
HP
DPC
HP
DPC
DPC
DPC
HP
DPC
FH
DPC
HP
DPC
^HP-
DPC
DPC
HP
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25. Develop and implement plans to improve the coilection, compilation and
4 communication ofi data regarding Ramsey Countys progress toward reaching
immunization-level goals.
4 26. Compile all SPRCDPH immunization data into a common database. DPC
27. Develop regular intemal communication mechanism for staff working with DPC
4 immunizations. Coordinate agency efforts, and share resuits, such as ciinic survey HP
results and immunization rate data.
4 28. Develop or work with MDH on a system to measure rate of up-to-date HP
immunizations at 24 months, including Kindergarten retrospective as one method. FH
4 29. Promote aftemative clinic hours and immunization reminderlrecall systems for 0- DPG
2 year old children. HP
4 30. Provide vaccine to clinics that see children 0-2 years. DPC
HP
4 31. Encourage clinics to do immunization audits of their client populations. DPC
HP
4 32. Identify and support legislative immunization policy. DPC
HP
4 33. Promote interventions identified as "best practices" that motivate families to get H
immunized.
FH
q DPC
34. Work with family centers to provide immunization education and information. HP
FH
Current Strategies That Wil! Be Reduced or Eliminated
1, 4 35. Support and respond to schools curriculum on infectious disease —1 � grade and DPC
other grades. HP
FH
OUTCOME EVALUATION PLAN
Out Outcome Indicator Evaluation
Come
Decreased numbers and rates of reportable
diseases. (STD and HIV related visit rates may
1 1. Numbers and rates of reportable diseases. be increased, as an indicator that persons who
are at increased risk and/or symptomaiic are
aetually seeking diagnosis and treatment.)
2. Number of screens for and treatment of fncreased screens for and treatment of sexually
2 sexually transmitted diseases and TB among transmitted diseases and TB among inmates in
inmates in Ramsey County facilities. Ramsey County facilities.
CHS PROGRAM PLAN: Infectious Disease 11
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3. A plan for response to biotogical and other A plan will be in place and updated for. response
3 public health emergencies. to biological and other pubiic health
emergencies by September 2001.
4. Perc�nt of up-tadate immunizations in the �ncreased percent of children up-to-date with
4 Retrospective fGndergarten Study in Ramsey immunizations in Ramsey County.
County.
5. Percent of children enroifed in PMAP who �ncreased percent of chiidren who are enrolled
4 in PMAP arrc! are up-to-date with
are up-to-date w8h immunizations. immunizations.
12 CHS PRQGRAM PLAN. fnfecchoous Disease
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S. EI�f4RON�l�t�t7"AL Fi�iLTki FiAZAFtQS"
PROS IFM
i. There is an increasing risk of illness due to environmental health hazards in Ramsey Counry.
1. Ramsey County residents have reduced e�osure to lead, and they wilt have reduced biood lead
4evels.
2. Solid and hazardous waste in Ramsey Couniy will be managed in a manner that reduces the risk of
iliness and environmental harm.
3. Persons in Ramsey County will be at reduced risk of illness related to air potlutants indoors and
outdoors.
4. Persons in Ramsey Gounty will be at reduced risk of illness related to food consumption.
5. Persons in Ramsey Couniy will be at reduced risk of iilness related to storage, use and management
of househoid and industrial chemicals.
6. Persons in Ramsey County will be at reduced risk of illness related to contaminants in water.
Out- CHS3
come Strategies Progrem
Area
1. Work with local building officials on environmentat health issuss, including plan
Ail reviews of facilities Iicensed under the delegation agreement with the Minnesota EH
Department of Health.
2. Continue to provide to operators of licensed establishments formal training,
A �� including Food Manager Cert'rfication, Swimming Pool Operators, and Licensed EH
Hazardous Waste Generators. The need to provide training to staff ofi those
establishments will be evaluated and courseslcurricu(a developed, as necessary.
3. Hold an annual Environmental Health training session for all stafF, which will
Ail teach the fundamenta{s of environmental health hazard identification to those staff EH
that have client contact.
4. Work with heafth care providers to raise their awareness of indoor environmental EN
Ail health hazards so that they ran discuss environmentai health with clients, FH
especiafiy wlnerable populations.
5. Develop technical expertise in risk communication, and incorporate
A �� environmental hea{th risk communication messages about risk of iflness due to EH
environmental conditions into informa6on provided to the public and regulated
communiiy.
1 6. Gontinue the Chiidhood Lead Prevention Program and the Lead Hazard EH
3 These program area acronyms are discussed under "Planning Categories" in the Introduction seotion.
CHS PROGRAM PLAN.� Environmenta� HeaRh Hazards 13
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Reduction Program {to the extent funding is available), including the screenings
required by State law, and the fallow-up assessment and enforcement to require
remediation of lead.
HP
1,4,& � 7. Continue to provide laboratory analyses for lead, food, anc! water quality. ' EH
I 8. Provide targeted outreach on househoid hazardous waste (HHW) collection I EH
2,5 services, including pesficides, consistent with the RegionaURamsey County Solid HP
Waste Master Plan.
2 5 9. Provide waste minimization and pollution prevention technical assistance EH
senrices to licensed hazardous waste generators in Ramsey County. tiP
10. Continue to assure compliance with solid and hazardous waste regulations
2 � through the use of education, consultation, tecfinicat assistance, licensing, EH
inspection, and enforcemenY. When providing direct services relating to nutrition,
advise residents about health risks re(ated to consuming fish.
2 I 11. Continue to carry out the strategies outlined in the RegionaVRamsey County � EH
Solid Waste Master Plan, with regard to sotid and hazardous waste.
12. Seek indoor air quality grent funds to be used for raising awareness about and
detecting indoor air quality problems, inctuding physical, biotogical and chemical EH
hazards, and for the promotion of the proper use of carbon monoxide detectors and
radon detectors.
3 � 13. Participate with the Minnesota Indoor Air Qualiiy Coalition to coordinate indoor EH
air quality informafion, especially related to carbon monoxide and radon.
14. Continue to carry out the County's responsibi(ities as outlined in the Detegation
Agreement wfth the Minnesota Department of Neafth for Food, Beverage and
3,4,5,6 Lodging Facilities; manufac[ured home parks; youth camps; the �nnesota Clean EH
tndoor Act in licensed establishments; and the investigation of public heafth
nuisances with the authoriiy provided in Minnesota Statutes, Chapter 145.
4 15. Support Food Irradiation as an important food safety method.
4 16. Work with the cities of Saint Paul, New Brighton, and Maptewood to coordinate
compliance strategies with licensed food service establishments.
17. Continue to give a priority to issues of food safety, and wiil integrate food safeiy
4 messages with other public health messages, especially to wlnerable populations,
and inciuding food safety in non-regulated settings.
18. Examine entering into a Delegation Agreement wiih the Commissioner of
4 Agricufture for the regulation of grocery and cronvenience stores in suburban
Ramsey County.
19. Work with the food senrice industry, the Mirtnesota Department of Health, and
health care providers to explore ways to provide sick leave benefits for employees
of food e is , �have an incentive to oome to
work sick.
20. Work with city of Saint Paul Parks and Recreation; Ramsey Couniy Public
4 Works; and Ramsey County Parks and Recreation to install signs and notices
regarding fish consumption advisories, inoluding notices in languages other than
English.
EH
EH
EH
HP
EH
EH
EH
HP
14 CHS PROGRAM PLAN: Environmen�al Heafth Hazards
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� 21. Work with non-English speaking media and organizations to include notice of EH
fish consumption advisories. HP
22. Collaborate with the Ramsey County Poison Control Center and Minnesota E �
5 Extension Service to develop outreach and education strategies for Ramsey HP
County residents on the safe use, storage and disposal of pesticides.
23. Conduct educational efforts in partnership with others related to safety and EH
6 heatih of private swimming poois and wading poofs, and wilf provide informaiion FH
and services as appropriate. HP
Currerrt Strategies That Wili Be Reciuceci or Eliminated
Not Applicabie
OUTCOIWE EYALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 �. Number of tests showing elevated biood Decreased percerrt of tests showing
lead levels, elevated blood lead levels.
2. The total amount of production-related Decreased amount of total production-
2 waste chemicals released by industries, as related waste chemicals released by
reported in the Toxic Release Inventory, in industries in Ramsey County each year.
Ramsey County.
4 3. Number of food borne i4lnesses reported in Decreased food-borne iliness incidence in
Ramsey County. Ramsey County.
4. Number of signs in various languages at
4 lakes, ponds, sireams and rivers located in Increased number of signs.
Ramsey County with notices regarding fish
consumption advisories.
5. Volume of household hazardous waste that �ncreased volume of household hazardous
5 is managed in Household Hazardous Waste waste is managed in HHW cofleetions.
coAections.
5 6. iVumber ot participants in Household fncreased number of participants in IiHW
Hazardous Waste collections. collections in 2003 compared to 2�00.
6 7. Number of drinking water samples and Increased water samples tested and
results. decreased unsafe leveis found.
CHS PROGRAM PLAN: Environmemal Health Hazards 15
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16 CHS PROGRAM PLAN: Environmenial Heatth Hazarcis
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PROBLEM
1. There is an unacceptable level of interpersonal viole�ce in Ramsey Couniy.
OUTCOME
1. Ramsey County citizens experience less violence.
STRATEGIES
Out CHS°
come Strategies Program
Area
1 1. Continue Ramsey County participation in and facilitation of The Initiative for HP
Violence Free Families and Communities. FN
1 2. Support private, routine screenings for domestic violence with all male and HP
fiemale clients. FH
1 3. Encouwage managed care organizations to provide coverage for emergency HP
department visits made by victims of domestic violence. FH
1 4. tmprove the Ramsey County web site with more information and intemet links HP
regarding abuse and other violence. FH
1 5. {ncrease efforts to teach non-viofent parenting skilis, especially to parents who HP
experienced abuse as children. FH
1 6. Provide existing and new SPRCDPN staff education, training and regular
updates on domestic violence, sexual abuse and other violence, includinq:
. interventions with isolated, high-risk families;
• Development of skifts to focus on individual, community and family HP
strengihs and assets; FH
• Cammunity prevention and intervention resources (such as ParenYs
Anonymous and the taith community); and
. Alternatives to violence for solving problems and conflicts.
1 7. Support community and legislative efforts to prevent youth access to weapons. HP
FH
1 8. Develop cuiturally competent anti-violence education. �
FH
1 9. Continue use of the University of Minnesota Twin Cfties Violence Survey and HP
other indicators and develop trend data from those indicators. FH
1 10. Use the Education Action Team (of the lnitiative for Violence Fee Families and HP
Communities) to increase developmeni of anti-violence and positive parenting FH
programs within school districts.
1 11. Collaborate and share resources with the Ramsey County community HP
" These program area acronyms are discussed under "Planning Categories" in the Introduction section.
GHS PROGRAM PLAN: �olence 17
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(including faith communities and community, recreation and Children's Initiat+ve FH
centers) to develop, coordinate and implement pians to disseminate throughout
Ramsey Couniy and to targeted groups, information on:
. Domestic and other forms of violence;
• The correla6on of domestic and other violence to other public heatth
problems (such as child neglect, unintended pregnancy, low-birth
weight, infant mortaiity, low immunization rates, and sexually
transmitted infections such as HIV}; and
• Nort -violent means for solving probiems.
1 12. Collaborate with faith communities to promote positive aftematives to viofence.
1 13. Support efforts to decrease geographic concentrations of poverry. yP
FH
1 74. Train more people to be members of the Workplace Violence Action Team. yP
Fti
Current Strategies That Wili Be Reduced or Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
Out-
Come
Outcome Indicator
1. Ramsey County homicide rate.
2. Percentage of male students reporting
1 carrying a gun to school (Minnesota Student
Survey).
3. Peroentage ot studeirts reporting b�
1 stabbed or having a gun fired at ti�em
(Minnesota Student Survey}.
4. Percentage of students reporting bei
1 kicked, bitYen, or hit on school property
(Minnesota Studerrt Surveyj.
Evaluation
Decreasing trend in the homicide rate for
Ramsey County beginning in 1999.
Decrease of 1%(from 1998 rate of 5%) by
2001.
Decrease of 1%(from 1998 rate of 4%) by
2001.
Decrease of 3% for males (from 1998 rate of
15%) and .5% of females (from 1998 rate of
3.12%) by 2001.
5. Reported crimes in Ramsey County:
Number of offenses against family or children Decreased number of reported crimes
1 (Minnesota Crime information Rer�ort; MN regarding offenses against family or children.
Bureau of Criminat Apprehension — tocal law
enforcement agency offense information).
6. Number of Ramsey
9 makreatment determinations (Ramsey County ��
Communiry Human Services}. maltreatment determinations.
18 CHS PROGAAM PLAN: volence
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I�
PROB ICM
1. High numbers of Ramsey Gounty residents are overweight and inactive with inadequate nutrdion,
which contributes to chronic diseases.
1. The residents of Ramsey Couniy make lifesiyle changes to prevent chronic disease.
2. Heafth professionals and heafth care providers practice chronic disease prevention with Ramsey
County residents.
3. Ramsey County residents will be average weight, phys+cally active, and eat hea4thy foods.
Out- CHSS
come Strategies Program
Area
1. Increase efforts to partner with targeted population groups regarding chronic DPC
1, 3 diseases and prevention. (Examples: Hypertension within the African American HP
population; Diabetes and Hispanic population). HH
2. Review the current public health education materials on chronic diseases to HP
1, 3 assure that the audiences, desired behavior change, criteria for measuring DPC
success, and educational tools are appropriate.
� 3 3. Strengthen relationships with Ramsey County schools to develop and/or HP
enhance weliness programs. FH
4. Use research and best practices to identify methods for improving the fitness HP� EH
1, 3 and wellness for Ramsey County citizens (such as 5 fruits and vegetables a day, DPC
"Power of Healthy Eating".) �
FH
5. Work with Ramsey Couniy school districts and managers of Ramsey County DPC
� 3 Government 6uildings and programs to provide food-vendor options for bottled HP
water and nutritious foods (e.g. fruits, flavored mllk, and juices) that replace or HH
accompany less nutritious vendor options.
6. F�cplore working with existing efforts to encourage Ramsey County restaurants HP
1, 3 to address large serving sizes at restaura�ts (that contri6ute to waste and to DPC
overweight and inadequate nutrition among Ramsey County residents). EH
1, 3 7. Promote use of 12 Baskets Program by ticensed food establishments. EH
HP
8. Encourage intergenerational activities with Parks and Recreation and community HP
1, 3 centers: such as family walking, softball teams, volleybaN teams, biking events, FH
hiking and swimming events, Intergenerational Tea Parties, etc. HH
1 3 9. Initiate partnering with schools and Minnesota Department of Ghildren Families HP
5 These program area acronyms are discussed under "Ptanning Categories" in the Introduction section.
CHS PROGRAM PLAN.� Heafth Disparities 19
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and Leaming to analyze data on heights and weights of children. DPC
t0. Update pubiic health education and heaith promotion materiats and services HP
1, 3 with current knowledge and use of electronic media (e.g, intemet, phone, and cabie FH
television), yH
DPC
11. Create and maintain chronic disease prevention task force consisting of the
Department of Public Health and community partners to: (1) iderrtify ways to HP
2 coordinate promotion of chronic disease prevention; (2) to coordinate messages; DPC
and (3) establish desired outcomes and performance measures for promotional HH
efforts.
HP
2 12. Identify ways to coordinate the promotion of chronic disease prevention with ��
other Department activities. EH
NH
13. Continue Women's Health Screening Clinic that provides pap tests and HP
2 mammograms through the Minnesota Breast and Cervical Cancer Control FH
Program. DPC
2 14. Continue correctional health that provides health care senrices to individuals in HP
Ramsey County correctional facilities. DPC
2 15. Continue Colposcapy Clinic, which provides low cost evaluation and DPC HP
management of abnormaf pap smears.
2 16. Provide public-health-nurse outreach clinics in public high rises and other sites DPC
to address chronic disease prevention among residents. HP
2 17. Continue Refugee Clinic that screens refugees for health problems.
Current Strategies That Will Be Reduced Or Eliminated
1 18. Continue with Nutrition Services of dietary counseling and Clinical Nutrition HP
Services at 555 Cedar and Community Ciinics.
OUTCOME EVALUATION PLAN
Out- Outcome indicator Evatuation
Come
1, 3 i. Percent adult residenfs reporting Decreased percent of adults reportii
hypertension according to the MN hypertension in the Behaviora! Risk
1, 3 2. Hospitalization rates for children ages 0— Haspitalization rates for children ages 0=�1�'�"'mm'
14 with asthma. with asthma wil! decrease from the f 997 rate of
3.7 per i000 populafion.
are physicaliy Increased percent of adolesCents who are
er week ohvsicallv active for 30 minutes 5 or more �
20 CHS PROGRAM PLAN: Health Dispardies
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CNS PROGRAM PLAN: Health Disparities 21
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22 CHS PROGRAM PLAN: Heafth Dispa+ities
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E: "(-1Ei
PROSLEM
1. Desp'de overail health improvement in Minnesota and Ramsey County, populations of co%r in
Ramsey County continue to experience poo�er health and disproportionately higher rates of illness
and death.
OUTCOME
1. Decreased disparity of health status beiween population groups in Ramsey County.
Out- CHS6
come Strategies Program
Area
� 1. Improve data collection, analysis and reporting of health status among populations
of color in Ramsey County. DPC
2. Expand contacts with communiiy agencies and cultural organizations serving
1 communities of color, for data, information and recommendations regarding health DPC
rare needs and access to heatth care.
� 3. Partner with managed care, heafth care providers and other community groups to HP
target health promotion and prevention to specific popu{ations.
1 4. Support, through Minnesota Public Health Association and Association of HP
Minnesota Counties, legislation to improve access to care by poputations of cofor.
1 5. Support non-discrimination heatth care policies for heafth care services. HP
1 6. Train staff on cultural competency. HP
1 7. Increase community level input from populations of color in development of HP
strategies to address health disparities such as the Healthy Start Project.
1 8. Continue efforts to hire and retain SPRCDPH staff who reflect populations served HP
by SPRCDPH and participaie in Ramsey County Modei Employer efforts.
Current Strategies That WiII Be Reduced or Eliminated
Not Applicable
6 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Heafth Disparities 23
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�� Ouicome lndicator Evaluation
Come
1. Number of Saint Paul-Ramsey County tncreased number of Saint Paul-Ramsey
Department of Public Health programs using �unty Department of Public Health
OMB Statisticat Policv Directive No.15, Race
1 programs using OMB 15 as minimum
and Ethnic Standards for Federa! Statistics and standard for collecting race and ethnicity
Administrative Report to collect race and data on clients served by the program.
ethnicity data on clients served.
1 2. Infant mortality rate by race. Decreased disparity in infanY mortality raYes
between races.
1 3. Immunization rate by race. Decreased disparity in immunization rates
between children of different races.
4. incidence rate for spec'rfic diseases and Decreased disparii�l in incidence rates for
1 conditions by race. specrfic diseases beiween populations of
different races.
1 5. Death rates by race. Decreased dispariry in mortai"ity rates
beiween races.
1 6. Low birth weight by race. Decreased disparity in tow birth weight rates
beiween races.
24 CHS PROGR.QM PLAN: Heafth Disparities
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: PREGIdANCY AN�-BIRTH
tOBLEMS
1. lncreased percentage of births to adolescents and increased number of births thaf resuR from
unintended pregnancies.
2. The percent of iniants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
1. Decreased proportion of births in Ramsey County to adolescents.
2. Decreased proportion of all Ramsey County pregnancies that are unintended.
3. Fewer Ramsey County babies will be born with low birth weight.
Out- CHS'
come Strategies Program
Area
1. Promote women's health, including preconception health, to increase women's
All awareness of the results of healthy and risky behaviors for themselves (and for FH
their fetus when pregnant), and develop culturally appropriate messages.
2. Promote assets in youth and youth development through SPRCDPH
1 participation in the Suburban Ramsey Family Collaborative and the Saint FFt
PauVRamsey County Children's Initiative.
1 3. Partner with or participate in community groups working to lower the rate of low FH
birth weight births in populations of color (e.g. the Healthy Start Program).
1 4. Continue extended W IC hours to facilitate participants access to senrices. FH
5. Continue Public Health Nurse and Nutri6on home visits to pregnant women at HHC
1 risk for poor birth outcomes to provide assessment, health education and referral FH
to community services as needed.
6. Strengthen relationships with community groups, providers and clinics, including
1 Prepaid Medical Assistance Program providers and communiiy clinics to assure
that Ramsey County women have information and access to health care
resources, including medical care, for preconception care as well as prenatal care.
� 7. Continue the role of SPRCDPH as a resource to community groups and �
agencies on "best practice" for adolescent health and youth development.
1 8. Partner with communiiy groups to assure the development and continuation of FH
community-based, comprehensive adolescent pregnancy prevention programs.
' These program area acronyms are discussed under "Planning Categories° in the Introduction section.
CHS PROGRAM PLAN: Pregnancy and Birth 25
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3 9 Deliver intensive home-based services to minor parents through the Adolescent
Parent Program (SPRCDPH, RCCS, and Model Cities, Inc.)
10. Work with the Minnesota Organization on Adolescent Pregnancy, Prevention
and Parenting (MOAPPP), schools and other community groups to increase public �
1 awareness of adolescent pregnancy, to strengthen prevention efforts, and to FH
improve coordination of efforts to decrease the number of adolescent pregnancies
in Ramsey County.
1 11. Support schools' use of comprehensive sexuality education curricula. FH
12. Promote programs (e.g. Dads Make a Difference) that incorporate the
1 importance of dads in raising children, including nurturing their infant children and HP
building resiliency in those children as they grow older.
2 3 13. Support the provision of comprehensive family planning senrices with public FH
heaflh assessment, policy devetopment, planning arid assurance activities.
3 14. Work with existing community efforts to raise awareness of family planning FH
senrices in the community (e.g. the Minnesota Family Planning Hotline).
15. Advocate for and provide reproductive health care including family planning FH
3 services, targeting services to high risk groups, uninsured and underinsured
people. �
3 16. Continue to provide fami�y planning education for new parents who are FH
SPRCDPH clients. HHC
3 17. Continue connecting new parents to communiry resources and providers for FH
women who are served by SPRCDPH programs. HHC
Current Strategies That Will Be Reduced or Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out-
Come
1, 2
1.2
Outcome Indicator
1. Number of births to Ramsey County
adolescents less than 15 of age.
2. Birth rate for Ramsey Couniy adolescents
15-17 years of age.
3. Birth rate for Ramsey County mothers 18-
Evaluation
Decreased birth rate for Ramsey County
adoiescents less than 15 years of age.
Decreased birth rate for Ramsey County
adolescents 15-17 years of age, from 1995-97
rate of 35.1 per 1000 population.
Decreased birth rate for Ramsey County
of 68.9 per 1,000 population.
26 CHS PROGRAM PLAN: Pregnancy and Birth
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Decreased percent of Ramsey County 9"' and
4. Percent of Ramsey County 9"' and 12"' 12"' grade students who report that they have
grade studerrts who complete the Minnesota had sexuai intercourse, from 1998 percents of:
1 2 Student Survey and report that they have 9"' grade females: 23%
had sexual intercourse. 9"' grade males : 30%
12'" grade femates: 47°10
12"' grade males : 51 %.
Increased percent of Ramsey Couniy 9"' and 12'"
grade students who report on Minnesota Student
5. Proportion of sexuaily active 9"' and 12"' Survey that they are sexually active and always
graders in Ramsey County who partioipate in use birth control, from 1998 leve�s of:
j ' 2 the Minnesota Student Surve and re ort +�
Y p 9 grade females: 37%
always using birth control. 9"' grade males: 41 %
12"' grade females: 60%
12"' grade males: 54%.
6. Adolescent pregnancy rates for the 15-17 Decreased pregnancy rates for adolescents in
1 2 and 18-19 year old age groups. Ramsey County, firom the 1995-97 rate of 72.3
per 1,00015-17 and 18-19 year old age groups.
7. Proportion of Public Heatth clients who are �ncrease percer�t of public health ctients who are
Z new parents and receive family planning, new parents and have an identified method of
fiamily planning.
8. Percent of Ramsey County women who Percent of Ramsey County women who
3 initiate prenatal care in first trimester and delivered and whose prenatal care was reported
receive ongoing prenatai care senrices. as adequate or better will increase to 75% by
2003.
9. Percent of fow-birth-weight infants born to 6.6% or fewer of infants born to women
3 pregnant women who have received WIC participating in WIC for 3 months or longer will be
services for 3 months or more. tow birth weight.
10. Percent of low birth weight infants born to Decreased percent of low birth weight infants
3 women served antepartum by Healthy born to women who received home visiting
Families home visiting staff. services from Heatthy Families staff.
3 11. Percent of Ramsey County Iow birth- Percent of Ramsey Couniy low birth-weight
weight births. births will decrease from the 1997 leve4 of 6.7%.
12. Public heaith home-visited clients who �ncreased percent of pregnant public health
3 decrease or qu+t smoking during pregnancy. home-visited-cfients who decrease or quit
smoking during pregnancy.
CN3 PROGRAM PI�IN.� Pregnancy and Birth 27
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28 CHS PRO�RAM PLAN: Pregnancy and Birth
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G. UFVINTE[VDED IEVJl1RY
PROBLEM
1. Uninfentional injury is one of the leading causes of death fhroughout a lifetime in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by talls, poisoning,
suffocation, and fire.
OUTCOME
1. Decreased unintended injuries in Ramsey County.
STRATEGlES
Out- CHS$
come Strategies Program
Area
1 1. Obtain data on effective use of car seats (such as rate of compliance with proper HP
installation) to use in health promotion and education activities.
1 2. Develop a method for prioritizing specific unintended injury activities occurring HP
within SPRCDPH.
1 3. Support policies and programs that prevent gun violence, including use of the HP
Gun Violence Action Team to advocate for safe storage of guns.
1 4. Continue coilaboration with the Minnesota Safe Kids Program. HP
5. Continue to support the primary enforcement status of the child restraint system
1 policies of Minnesota Statutes, Chapter 169 (primary enforcement status means a HP
citizen can be stopped and issued a citation for a violation of the child restraint
system law alone without other violations being present).
1 6. Support enforcement of laws pertaining to universal use of car seats, including HP
policies that require babies to be in car seats when going home from a hospital,
7. Continue existing SPRCDPH health promotion and education programs (such as
1 Eariy Childhood and Family Education; Prenatal Education; Safety Camps; and HP
Safe Kid Family Fun Nights.
1 8. Continue provision of or referrals to resources for obtaining smoke detectors. HP
1 9. Provide unintended injury education and other services that are sensitive to HP
racial, ethnic and cultural differences.
1 10. Extend "Local Safe Kids" program to suburban Ramsey County. HP
1 11. Train more people to do car seat assessments and education (hospital staff; fire HP
stations; family centers; etc.)
Current Strategies That Will Be Reduced and Eliminated
g These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Unintended Injury 29
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1 12. Educate persons in general on unintended injury. HP
1 13. Educate and support enforcement of pedestrian law. HP
14. Support construction and maintenance of safe playgrounds including proper
1 supenrision, age-appropriate equipment and education and support of parents HP
seeking new equipment.
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1. Ramsey County Injury Hospitalization and Decreased numbers and percents of injury
Emergency Room E-Code Data for: hospitalization and emergency room use (per E
code data) in Ramsey County for:
a. Falis
a. Falis
1 b. Motor Vehicle Traffic crashes (occupant)
b. Motor Vehicle Traffic crashes (occupant)
c. Poisoning
c. Poisoning
d. Struck by, against (unintentional) d. Struck by, against (unintentional)
e. Overexertion (unintentional) e. Overexertion (unintentional)
2. Estimated Behavioral Risk: Percent of
1 Seat Bett Non-Use (MDH Behavioral risk Decreased estimated percent of non-seatbelt
survey). ��•
1 3. Percent of seatbelt nonuse in motor p�r�sed percent of seatbelt nonuse in
vehicle crashes (Minnesota Health Profiles). motor vehicle crashes.
30 CHS PROGRAM PLAN: Unintended Iniury
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H: MEALTH EFFECTS OF
PROBLENf
1. M lncreasing number of children and adolescenfs in Ramsey County experience the health
eSects that are associated with poverry.
OUTCOME
1. Ramsey County children and adolescents will experience reduced adverse health effects
associated with poverry.
Out- CHS9
come �r�g�� Proqram
Area
1 1. Inform policy makers and others of the relationship between poverty and heafth Hp
status, with Ramsey County specific data.
i 2. Work with housing code enforcement officers to ameliorate conditions that are Hp
cause for condemnations and homelessness.
3. Identify and impiement ways for public heatth staff to join efforts for better
i housing for low income persons, such as supporting assurance efforts for HP
adequate housing, and continuing work with St. Paul Area Goalition for the FH
Hometessness (SPACH).
Current 5trategies That Will Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Gome
1 1. Number of Ramsey County chiidren and Decreased number of Ramsey County chifdren
adolescents in poverty. and adolescents in poverty.
9 These program area acronyms are discussed under "Planning Categories° in the Introduction Section.
CHS PROGRAM PLAN: Heatth Eftects of Poverty 31
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32 CHS PROGRAM PLAN: Heakh Effects of Poverty
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L CHF�D NEGLECT
PROB �M
1. An increasing number of cflildren in Ramsey Counry are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
[jlj ti
1. Fewer infants and children who live in Ramsey County will experience negfect
Out- CHS70
come Strategies Program
Area
1 1. Coflaborate with the Ramsey Community Human Services Department to FH
promote the well being of children.
1 2. Partner with community businesses and agencies to create supportive and FH
nurturing public spaces for children and families.
1 3. Participate in collaboratives working to reduce child neglect. FH
HP
1 4. Advocate for the importance of including men in planning and participation in FH
coilaboratives working to reduce child neglect. HP
1 5. Partner with community parent education programs to inciude the role of HP
men in children's lives. FH
6. Advocate that newbom babies leave Ramsey County hospitals with W IC
1 information (ff appiicabie), an appointment for initial well child check up, plans FH
for transportation to the appointment, a digital thermometer (not mercury), and
information about environmentai health hazards in the home.
7. Provide interventions to targeted fami{ies that identify and reinforce the
'I family's strengths, and educate on normal grovuth, development and positive Fti
parenting.
1 8. Promote parent-child attachment through individual-based interventions by FH
HouseCalls, public health nurses, and nutritionists.
1 9. Promote after-school activities for students. HP
10. Promote continuation of commun'rty resources that include strategies for
� reducing child neglect and promote use of those resources, including First Call Hp
for Help and the Teen Parent resource book (Healthy Families Adolescent
Parent Program).
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
10 These program area acronyms are discussed under "Planning Categories" in the introduction Section.
CHS PROGRAM PLAN.� Chifd Neglect 33
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OUTCpME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Number of Ramsey County children who Decreased number of Ramsey County children
experfence substantiated (determined) who e�erience substanfiated (determined)
neglect (Ramsey County Human Services). neglect.
1 2. Number of children who are served by Decreased number of children who are
SPRCDPH staff that e�erience SPRCDPH clients who experience
substanbated negtect. substantiated neglect.
34 CHS PROGRAM PLAN: Child Neglect
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J_ ALCOEiOL�kBE�SE �
�oB�nn
1. Alcjohol abuse causes adverse heaith etfects and social problems in Ramsey Courrty. lt negatively
impacGS intended and unintended injury; unplanned pregnancy,• poor birth outcomes child
development; ado%scent heaRh; mental health; vio%nce; infecfious diseases; and chronic diseases.
OIiiCOME
1. Ramsey County residents engage in iess aicohoi abuse.
Out- CHS"
come Strategies Program
Area
i 1. Develop and use consistent SPRCDPH messages regarding alcohoi abuse (for HP
staff training and dissemination to the public).
1 2. Train SPRCDPH staff on alcohol abuse. Hp
1 3. Include updated information about Fetal Alcohol Syndrome and Fetal Alcohoi NP
effects, client education methods, and client screening for risk factors, in orientation
for appropriate new public heafth siaff and in in-service training for existing staff.
1 4. Educate SPRCDPH clients on how aicohol use afifecis fetai devefopment. HP
1 5. Work with community groups to promote awareness and strengthen prevention HP
messages that address the effects of alcohol on birth outcomes.
1 6. Work with Minnesota Join Together to develop a community plan for reducing �P
teen alcohol abuse in Ramsey County.
1 7. Coordinate annua{ly a chemical health workshop for school distriet staff in HP
Ramsey County.
1 8. Partner with heaith care professionals and other professional organizations to HP
encourage all providers to screen patients for alcohol use, including its relationship DPC
to violence.
1 9. Support public policies and laws that prevent alcohol abuse. HP
1 10. Encourage the promotion of alcohol-free gradua5on, homecoming, prom and HP
other social activities for high school and college students.
1 11. Participate in suburban Mayor's Commission Against Drugs (includes cities of HP
Roseville, Fal�n Heights, Lauderdale and Little Canada).
1 12. Continue SPRCDPH staff group for alcohol policy and planning coordination. HP
DPC
" These program area acronyms are discussed under "Planning Categories" in the Introduction seetion.
CHS PROGRAM PLAN: Alcoho! Abuse 35
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Current Strategies 7'hat Will Be Reduced and Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Estimated percent of acute drinkers in By 2004, decrease estimated percent of acute
Ramsey County (MDH Behavioral Risk drinkers from the 1997 estimated perc2nt of 16.1.
Survey).
1 2. Estimated percent of chronic drinkers in By 2004, decrease es5mated percent of chronic
Ramsey Couniy (MDH Behavioral Risk drinkers from the 1997 estimated percent from 2.7.
Survey).
1 3. Percent of 12 grade students reporting By 2004, using the 1997 percent of 12, decrease the
that during the last two weeks, they have percent of 12"' grade students reporting that during
had frve or more drinks in a row once the last hnro weeks, they have had five or more drinks
(Minnesota Student Survey). in a row.
36 CHS PROGRAM PLAN: AlcoholA6use
a�
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K. ACCESS T� H�ALTM CARE
PROBLEM
1. There is a gap between Minnesota Goals and the current number of people in Ramsey County
who have access to medical, dental and mental heafth care.
OUTCOME
1. An increased percentage of Ramsey County residents have improved access to medical, dentai
and mental heafth care services.
Out- CHS'Z
come Strategies Program
Area
1 1. Screen for eligibility and educate eligible uninsured and low income public
health clients on how to enroll in MinnesotaCare and assure clients' participation HP
in MinnesotaCare through follow-up and monitoring of client enrollment.
1 2. Support policies that require health care providers participating in Prepaid FH
Medical Assistance Programs (PMAPs) to have evening and weekend hours. HP
1 3. Form a group to plan the SPRCDPH's roles and responsibilities for providing HP
primary care.
1 4. Advocate that Heaith Plans and third-party payors cover medical, dental and HP
mental health services for families and individuals. FH
HH
1 5. Identify and support actions that improve access to health care by all Ramsey
County residents, including improved access to medical, dental and mental
heafth insurance by low-income individuals and families, improved coordination HP
of services and the removal of other barriers to care (e.g. cultural, transportation
and child care).
1 6. Coordinate with the Ramsey County Community Human Senrices HP
Department, HeaRh Plans and communiiy clinics to increase coverage and HH
improve access to language-appropriate, coordinated mental health senrices for FH
children, adolescents and adults.
1 7. Increase participation of eligible clients in publicly funded services (i.e. Child FH
and Teen Checkups).
8. Develop a transition pian for assuring that injection clinic services are HP
available in the community when SPRCDPH discontinues providing this service DPC
at the Community Mental Health Clinic (CMHC).
� 9. Advocate improved access to preventive dental care for children. DPC
HP
' These program area acronyms are discussed under "Planning Categories" in the Introduction Section.
CHS PROGRAM PLAN: Access to Health Care 37
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1 10. Continue providing assessments for Personal Care Assistant (PCA) HP
recipients in the Medical Assistance Program.
1 11. Continue to screen and case manage elderly and disable clients who are
eligible for the Long-term Care Waivers-Elderly Waiver (EW), Altemative Care HH
(AC), Community PJtemative Care (CAC), and Communiiy Altematives for HP
Disabled Individuals (CADI).
1 12. Promote increased ident'rfication and follow-up for mental heaPth senrices in HP
Ramsey County.
Current Strategies That Wiil Be Reduced and Eliminated
HP
1 13. Discontinue providing the injection clinic services at the Communiry Mental FH
Health Clinic.
DPC
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1 1. Rate per 100,000 Ramsey County residents Increasing rate between 1999 and
enrolled in Minnesota Care in Ramsey Couniy 2003.
1 2. Number PMAP Providers that offer evening and Increasing number of providers who
weekend hours offer evening and weekend hours.
1 Rate of uninsured persons in Ramsey County. Decreased rate of uninsured persons
in Ramsey Couniy.
38 CNS PROGRAM PLAN: Access to Health Care
�i�q9Y
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L. TOEiRCCO U�E
PROB PM
i. Tobacco use is on ths rise among yauth and other select populations in Ramsey County.
C�l�i t�?�]!i I �
1. Ramsey County residents engage in less tobacco use.
Out- CHS73
come ��gi� Prograrti
Area
1 1. Educate public health clients on adverse heaith effects of tobacco, including HP
dental effects. FH
1 2. Coilaborate with state and local pianning and impiemerrtation efforts to Hp
effectively use state tobacco settlement funds and to reduce effects of tobacco FH
among ieens. EH
DPC
1 3. Expiore available behavioral risk data for Ramsey County and if none is HP
available, plan to conduct a risk su+vey for Ramsey County. DPC
FH
1 4. Comply with the Minnesota Clean Indoor Air Act regulat+ons in all licensed food, EH
beverage and lodging facilities. HP
, 1 5. Explore how food, beverage and lodging licensing fees could be adjusted to EH
provide discounts to smoke-free establishments. HP
1 6. Promote the development and enforcement efforts of community organizations' FH
tobacco policies and target market. HP
DPC
1 7. Encourage health care providers to screen ail individuals for tobacco use. FH
DPC
1 8. Update the Ramsey County smoke-free restaurant guide every three years. EH
1 9. Monitor compliance with state statutes regarding tobacco access for Ramsey HP
Gounty municipalities
1 10. Develop an integrated community system for reducing tobacco use in Ramsey HP
County.
Current Strategies That Will Be Reduced and Eliminated
Nat Applicable
' These program area acronyms are discussed under "Pianning Categories" in the Introduction section.
CHS PROGRAM PLAN: Tobacco Use 39
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OUTCOME EVALUATION PIAN
FlNAL�SNNT PAULVERSION OF THE 2000-2UIXi CHS PLAN UPDA'fE
1 1. Percent of female and male 9 grade By 2004, using the 1998 number of 4% as a
students smoking �/2 pack of cigarettes per base, decrease ihe percent of female ancf male
day in the last 30 days. (Minnesota Student 9"' grade students reporting smoking'/z pack of
Survey) cigarettes a day in the last 3Q days.
1 2. Percent of 12 grade males who report By 2004, using tfie T 998 nUmber of 7% as a
using chewing tobacco daily. (Minnesota base, decrease the perceniage of 12"' grade
Student Survey males who report using chewing fobacco daily.
1 3. Percent of 9 Grade female and male By 2004, using the 1998 number of 33% and
tobacco users who report buying tobacco 25% as a base, decrease the percent of 9"'
aY gas stations or convenience stores. grade female and male tobacco users who report
(Minnesota Student Survey) buying tobacco at gas stafions and convenience
stores.
1 4. Estimated percent of current smokers By 2004, using tfte 1997 number of 22.1 °,6 as a
(18 years of age or older) in Ramsey base, decrease the estimated percent of current
Couniy. (Behavioral Risk Assessment; smokers (18 years of age or older) in Ramsey
Minnesota Department of Health} County.
40 CHS PAOGRAM PLAN: TWaacco Use
0�-999
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�ll: �'UBLIC HEALTI-! POL�CY D�fELORIYIIEN� .
PROB IPM
1. There is a lack of capacify and resources devoted to researching, informafion sharing and
developing solutions to public health issues in Ramsey County.
OUTCOME
1. Sufficient capacity to effectively assess, communicate and help develop solutions to Ramsey
County's public heafth problems.
STRATEGIES
Out- CHS�a
come Strategies Program
Area
1. Increase the ability of SPRCDPH to collect and analyze data according to a variety HP
1 of designated geographic areas such as zip code areas, neighborhoods, and census DPC
tract areas.
1 2. Develop methods for communicating research information on emerging and re- HP
emerging public health topics.
3. Coliaborate with data collection organizations that exist outside of SPRCDPH, HP
1 including other inter- and intre- county groups, the state, education institutions and DPC
private, non-profit groups.
1 4. Continue participation in metro area county planning and data groups. HP
1 5. Support improvements in data eollection and reporting efforts of the Minnesota HP
Department of HeaRh.
1 6. Improve capabiliiy at local level for collection and analysis of local data. HP
1 7. Create a database to use current data sources more efficientiy and effectively. HP
1 8. E�lore ways to finance and conduct a behavior risk sunrey of Ramsey County
residents.
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
14 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGR,4M PLAN: Public Heatth Policy Development 41
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OUTCOME EVALUATION PLAN
1 1. Percent of outcome indicator data contained On an annual basis (or as frequently as new
in the Ramsey County CHS Plan that is data is available), data for 100% of outcome
collected on an annual basis (or as frequently indicators contained in the CHS Plan is
as the data is available). collected.
1 2. Percent of CHS Plan outcome indicator data On a biannual basis,100% of outcome data is
that is available in written form for disVibution made available in one or more written reports.
to public health decision makers and other
interested persons.
1 3. Amount of data available for analysis From 2000-2003, 5 data elements are identified
acxording to neighborhood, zip code and and available for analysis according to the
census tract geographic areas. appropriate RC neighborhood, zip code or
census tract area.
42 CHS PROGRAM PLAN: Public Health Policy Development
or'9
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IV: f BF�EASTFEEQIN.G RAT'E
PROBLEM
1. Ramsey County women are indiating and sustaining breastfeeo'ing at a rate lower than the state
and nafional goals.
OUTCOME
1. A higher rate of Ramsey County infants will be breastfed.
Out- CHS15
come Strategies Program
Area
1 1. Develop a coordinated breastfeeding promotion message from Saint Paul — Ramsey
County Department of Public Health. HP
1 2. Build awareness of the benefits of breastfeeding among SPRCDPF{ stafE, and HP
encoura e Public Health staff to rovide ositive feedback to women who breastfeed.
1 3. Continue SPRCDPH promotion of breastfeeding during prenatal contacts, provision HP
of lactation education and support, and referrals of SPRGDPH clients to community HHC
resources for breastfeeding women and teens.
4. Beginning with W IC mothers, continue working to collect data on length of time
mothers breastfeed
1 5. Participate in community-based efforts, including work with clinics, to promote and
support breastfeeding for all women, such as through access to lactation consultants HP
and support in chitd-care settings.
Current Strategies That Will Be Reduced and Eliminated
Not Applicabte
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Number of antepartum women served by �ncreased percent of Public Health clients served
1 Public Health staff who breastfeed in the antepartum who breastfeed in the hospital.
hospita{.
1 2. Duration of breastfeeding by women Increased duration of breastteeding women
receiving WIC services. receiving WIC services.
15 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRRM PL.4N: Breastfeeding Rafe 43
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44 CHS PRO�R,4M PLAN: Breastfeeding Rate
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�, O. YOUTH RISK BEHA�IOR
PROBLEM
1. There is an increasing amount of self-destructive behaviors by youth that result in negative health
outcomes in Ramsey Courrty. .
. � .,,=
1. Ramsey County youth engage in fewer or lower levels of self-destructive behaviors that resuft in
negative health outcomes.
Out- GHS76
come
Strategies Program
Area
1 1. Promote asset building in youth development. HP
1 2. Promote healthy attachment and brain development during pregnancy, HP
infancy and childhood.
1 3. Increase education regarding depression in youth and adolescents. HP
1 4. Support efforts of The tnitiative for Violence Free Families and Communities HP
that pertain to behaviors in youth that result in negative health outcomes.
Current Strategies That Wili Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Percentage of Ramsey County 9 grade students who
1 disagree with the statement: I usually feel good about myself By 2004, decrease by 3%.
(Minnesota Student Survey).
� 2. Percent of 12 grade Ramsey Couniy female students who BY 2004, decrease by 3%.
use diet pilis or speed to controi weight (MN Student Survey).
� 3. Percent Ramsey County 9 grade males who report a gY ppp4, decrease by 2%.
suicide attempt in the past year (Minnesota Student Survey).
� 4. Percent Ramsey County 9 grade females who report a gY 2Qpq decrease by 4%.
suicide attempt in the past year (Minnesota Student Survey).
5. Percent of Ramsey County 9"' graders who report feeling BY 2004, increase�the percent off
1 cared about by school staff. Ramsey County 9 graders who report
teeling cared about by school staff.
16 These program area acronyms are discussed under "Planning Categories" in fhe Introduction section.
CHS PROGR,4M PLAN: Service Needs of the Elderly 45
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46 CHS PROGRAM PlAN: Service Needs of the Elderly
Ol-999
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P: SER�/iCE N€EDS O�T,f=1€ ELDERLY
PROBLEM
1. The needs of the growing populafion of peopie age 65 and oider in Ramsey County may
ovenvheim the traditionai response of tamily, the private sector, and govemment.
1. Ramsey Coun�s residents who are older than 65 years of age wili have healthful aging and the
greatest degree ofi independence that is possibfe.
Out- CHS"
Strategies Program
come �,�
1 1. Conti�ue the DepartmenYs involvement with the Seniors Agenda for HH
l�dependent Living program (SAIL) whose mission is to reshape the long-term HP
care system in the East Metro Area, making more community options available DPC
and accessible to `older persons.
1 2. Continue nursing assessments and referrafs under the Health Officer Act for HH
elderly who are classified wtnerable aduits.
1 3. Explore the role of public health in the future aging population with statewide HH
and(or regional efforts. HP
DPC
1 4. Encourage community groups to support healthy aging. HP
1 5. Promote transportation alternatives and inRiatives (e.g. buses and Metro HH
Mobility across county lines, senior rates for cab fares, and legislation to increase HP
funding of fare waivers to enable transportation for shopping).
1 6. Continue and expand effective interventions to prevent poor health outcomes EH
related to environmental safieiy hazards (e.g. injuries from falls). HP
DPC
1 7. in cooperation with Area Agency on Aging, Ramsey Action Programs, and the
Ramsey County Meafs on Wheels Consortium, change Meats On Wheets HH
corrtracts to require Meals on Wheets iVutrition Education, ethnic meal HP
alternatives, and to allow for additional vendors.
1 8. Work with agencies to develop consulting nutritionists in the private sector who HH
will contract with waivers, incentives to work with MA and Waivers. HP
DPC
1 9. Work with Area Agency on Aging for promotion of exercise centers in High HH
Rise and education on strength training for elders and capacity building- HP
community education programs.
1 10. Encourage home care agencies to use persons older tha� 65 as health care ��
workers to help alleviate the shortage of home care workers and as trainers to
" These program area acronyms are discussed under "Pfanning Categories" in the Introduction section.
CHS PROGRAM PLAN: Service Needs of the Elderly 47
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maximize skilis of workers.
1 11. Continue support of Living at Home/Btock Nurse Program or other simiiar HH
programs. HP
1 12. Promote "Mobiie Assisted Living" concept. HH
HP
Current Strategies That Wiil Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN:
1 1. Nursing facitity occupancy rate Decreased nursing faciliry occupancy
rate.
1 2. Regiottal and/or Statewide efforts to e�lore The extent to which the role of Public
role of Public Health. HeaRh has been def+ned/established
for the future population of age 65 and
over.
48 CHS PROGRAM PLAN.• Servic� Needs of the Elderly
0l-999
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� �GTC014/tE-EVALUAI'ION PlANS
DEFINITIONS OF OUTCOME AND OUTCOME INDICATORS
The success of the strategies contained in this CHS Program plan will be evaluated aa:ording to
Ramsey County's outcome-based performance measurement system. The outcome evaluation system
measures sua;ess according to how the community has benefited from the strategies.
Outcomes are benefits the community and individuais experience, and other desired changes in
knowledge, skil)s, attitudes, behavior, condition or status of individuals and populations intended to be
impacted by the strategies.
Outcome indicators are statistics that `indicate' something. They may serve as proxies for the outcome.
Indicators are imperfect and vary in valid'ity and reliability. They were developed by identifying the best
measure of progress toward achieving the desired outcomes. As is demonstrated by the outcome
indicators for the CHS Program Plan strategies, indicators typicaliy are averages, percents and rates.
METHODS FOR EVALUATlNG OUTCOMES
The methods for evaluation are reflected by the `evaluation' portion of the outcome evaluation grids
(contained under each of the problems statement sections) that state specific goals for the outcome
indicators. The data for these evaluation goals will be reported by the SPRCDPH as frequently as the
data is availabte from outside sources or as frequently as d is possible for SPRCDPH to conduct its own
data collection efforts. Outside sources include Minnesota Health Profiles and the Minnesota Student
Survey. Other data sources may include case studies, existing records within the SPRCDPH, focus
groups, interviews, and questionnaires.
Actual data that is collected wiil be compared to the goals for the indicators contained in the outcome
evaluation grids. The comparisons will be used to discuss:
1, whether and the extent to which the strategies are impacting the desired outcomes;
2, how the strategies could be changed to achieve the desired outcomes;
3, whether new strategies need to be designed and implemented; and
4. if other indicators and eva(uation methods would better reflect the success of the strategies.
EVALUATION OF SERVICES PROVIDED THROUGH GRANTS; CONTRACTS AND AGREEMENTS
Consideration of alternative senrice delivery options will be accomplished through increased use of
Request for Proposai (RFP) processes and outcome evaivations for current and future grants, contracts
and agreements.
CHS PROGRAM PLAN.� Explanation of Outcome Eualuation of Strategies 49
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50 CHS PROGRAM PLAN: Explanation of Outcome Eualuallon of SYrategies
ol-99y
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�EatDtX 1. _ AD(11111
[s��f�_���:r
The Saint Paul Ramsey Couniy Department of Public Heaith collaborates with the Minnesota
Department of Heatth in many ways to ac�omplish fts outcome goals and objectives relating to the
Communiry Health Service categories and problems idenfrfied within those categories. The following
table provides a summary of the administrative and program support Ramsey County may need from the
Minnesota Department of Health.
Key to CHS Categories in Following Table
1= Alcrohol, Tobacco and Other Drugs
2= Child Growth and Development
3 = Chronic, Non-Infectious Disease
4= Disability and Decreased Independence
5 = Environmental Conditions
6 = Infectious Disease
7= Mental Health and Mental Illness
8 = Pregnancy and Birth
9 = Service Delivery Systems
10 = Unintended Injury
11 = Unintended Pregnancy
12 = Violence
CHS Categories
AdminiSt�'dtive and Progf2m Support NeEded 1 2 3 4 5 6 7 8 s 10 11 12
Timely, local data and geo coded X X X X X X X X X X X X
Financiai support for early HIV intervention
services X
Shared philosophy regarding importance of public
funded STD/HIV services. X
Training and technical assistance including data
analysis X X X X X X X X X X X X
Full funding for tuberculosis medications. X
Support for the Immunization Registry X X
Funding for the Hepatitis B Perinatal Prevention
Program X X X
Support for universal hepatdis B immunizations. X X
Heafth education materials in multiple languages X X X X X X X X X X X X
Consuttation on coalitions working with chronic
disease prevention and reduction X X X
Ongoing updating of MDH "Strategies for Public
Heatth" book. X X X X X X X X X X X X
Consultations regarding health promotion
messages, dissemination, funding, and X X X X X X X X X X X X
assistance evaluating effectiveness of inessages.
Promotion of health advocacy X
CHS PROGRAM PLAN: Program Support Needed from the Minnesota Department of HeaRh 51
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CHS Categories
Administrative and Program Support Needed 1 2 3 4 5 6 7 8 s 10 71 12
Leadership regarding increased reporting of food
bome illnesses X X
Support for local enforcemerrt of environmental
health regulations X
MDH Disease Control Newsletter with information
on disease prevention and control X X X
Support for groundwater proteetion agreements. X
Advocacy for means of funding lead screening,
lead inspections, workable lead standards, and
other public health funcfions mandated in state X X
statute.
Assistance in the development of a system for
ensuring consistent, accurate physicians and
taborarorfes to report cases of blood lead
poisoning to MDH and appropriate levels of X X
govemment (including non duplicated counts of
cases)
Development of education materials for
hazardous waste generators X
Continued support for and recognition of poverty,
especially geographic areas of concentrated
poverty, as an underlying cause of public health X X X X X X X X X X X X
problems.
increased development and collection of locai
data regarding prevention and incidence ot rases,
including support for local behavioral risk X X X X X X X X X X X X
assessment surveys.
Support for institutionalizing violence prevention
as ongoing activiry of MDH and local public health X X
departments
Leadership and increased opportunities for
counties to leam from each other regarding X X X X X X X X X X X X
ident'rfied pubiic health problems.
Ongoing improvement and expansion of MDH
informafion and data W W W sites. X X X X X X X x x x x x
52 CHS PROGRAM PLAN: Program SuppoR Needed from the Minnesota Department of Heaith
ot-99 y
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--. _. . . - - ; - -�„ . _ . _ . _ . ., . .
APPENDIX 2: �ROB�ENfS ORGA[�1Z�D BY CHS CATEG�RY
PLANNING CATEGORIES
A communiry health plan is required by state mandate to organize its pianning according to rivelve planning
categories as listed below.
Alcohol Tobacco and Other Drugs
Child Growth and Development
Chronic Non-Infectious Disease
Disability and Decreased Independence
Environmental Health
Infectious Disease
Mental Health
Pregnancy and Birth
Service Delivery Systems
Unintended Injury,
Unintended Pregnancy,
Violence
The twelve planning categories are used as guides for collecting data and organizing the community
assessment and plan documents. In addition, Ramsey County chose to use "Youth Risk Behavio�" and
"Child NeglecY' as additional planning categories. The foilowing is a list of the public health problems
organized according to community health planning categories.
ALCOHOL, TOBACCO AND OTHER DRUGS
1. Aicohol abuse causes adverse health effects and social problems in Ramsey County. It negatively
impacts intended and unintended injury; unplanned pregnancy; poor birth outcomes; child development;
adolescent health; mental health; violence; infectious diseases; and chronic diseases.
2. Tobacco use is on the rise among youth and other select populations in Ramsey County.
CHILD GROIKTH AND DEVELOPMENT
See the "Pregnancy and Birth" category.
CHILD NEGLECT
1. An increasing number of children in Ramsey County are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
1. High numbers of Ramsey County residents are ovenveight, inactive and have inadequate nutrition,
which contributes to chronic disease.
DISABILITY AND DECREASED INDEPENDENCE
1. The needs of the growing population of peopie age 65 and older in Ramsey County may ovenvhelm
fhe traditional response of famity, the privafe sector and govemment.
ENVIRONMENTAL CONDITIONS
1. There is an increasing risk of iliness due to environmental health hazards in Ramsey County.
INFECTIOUS DISEASE
1. Emerging and re-emerging infectious diseases threaten the health of the general population Ramsey
Couniy.
CHS PROGRAM PLAN: Probiems Organized by CHS Category 53
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MENTAL HEALTH AND MENTAL ILLNESS
See the categories "Youth Risk Behavio�' and "Service Delivery Systems" (problem number 2).
1. The percent of infants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
2. Ramsey County women are ini�ating and sustaining breastfeeding at a rate lower than the state and
national goals.
3. Increased percentage of births to adolescents and increased number of births that result from
unintended pregnancies.
SERVICE DELNERY SYSTEMS
1. An increasing number of children and adolescents Ramsey County experience the health effects that
are associated with poverty.
2. There is a gap beiween Minnesofa goals and the current number of people in Ramsey County who
have access to medical, dental and mental heaRh care.
3. Despite overall health improvement in Minnesota and Ramsey County, populations of color in
Ramsey Couniy continue to experience poorer health and disproportionately higher rates of illness and
death.
4. There is a lack of capacity and resources devoted to researching, information sharing and developing
solutions to public health issues Ramsey County.
UNINTENDED INJURY
1. Unintentional injury is one of the leading causes of death throughout a life6me in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by falls, poisoning, suffocation,
and fire.
See the "Pregnancy and Birth" category.
VIOLENCE
1. There is an unacceptable level of interpersonal violence in Ramsey County.
YOUTH RISK BEHAYIOR
1. There is an increasing amount of seif-destructive behaviors by youth that result in negative health
outcomes in Ramsey County.
54 CHS PROGRAM PLAN: Problems Organized by CHS Category
Cl!- / �l�f
, , ,. .� ,
PEi�t�IX 3: M/kTERF�lAL.AN�,CFiii_D HEALTFf CCRaF�tT " ;, .:.:;..
CHS PROGRAM PLAN: Youth Risk Behavior Plan Update 55
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�ill��l�ill'i '���I � ��I�� � illl� 'i'I��ill�i �IiI �il I � � �� ��I��IIi � I�I (I�����I I�''��I�I�
a� -49y'
The Saint Paul Board of Health
and
The Saint Paul - Ramsey County Department of Public Health
The Public Health Joint Powers Agreement - JPA, between the City of Saint Paul and Ramsey
County became effective July l, 1997. The JPA forms the Saint Paul - Ramsey County
Department of Public Health and identifies ane Community Health Services Agency for the
Saint Paul - Ramsey County community. However, both Saint Paul and Ramsey County
continue to maintain a Boazd of Health. The Saint Paui Community Health Boazd will consider
issues affecting those services maintained by the City of Saint Paul, which include the Maternai
and Child Health Special Projects Grant. The Saint Paul - Ramsey County Department of Public
Health is the operating agency for the MCH grant.
-i-
p1-�999
Saint Paul Maternal and Child Health
Special Projects Grant Update 2002 - 2003
Table of Contents
Updated Minnesota Department of Health Forms
A . Face Sheet ••• ..........................................................................................
B. Assurances and Agreements ....................................................................
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legisiative Priority, 2002-2003 ..........................
• I. Improved Pregnaucy Outcome Programs .....................................
• II. Family Planning Program .........................................................
• V. Other Programs Previously Funded by a Local Pre-Block
MCH Special Project Grant: Adolescent Health Program ..........
D. Efforts to Reduce Racial Dispariries ......................................................
E. Subgrants/Subcontracts .........................................................................
F. Special Project BudgetlExpendihue Report
• 2002 ................................................................................................
• 2003 ................................................................................................
• Budget Jusrificarion .........................................................................
G. Indirect Cost Allocation for MCHSP ......................................................
H. MCH Special Project Breakout Budget/Final Expenditure Report
By Legislative Priority, 2002-2003 ..........................................................
Program Narrative Update
I. 2002-2003 MCH Special Project Program Update .........
• I. Improved Pregnancy Outcomes Programs
a. HealthStart, Inc . .......................................
b. Face to Face Health and Counseling Center
c. West Side Community Health Center ......
• II. Family Planning Program
Room ....................................................
• V. Adolescent Health Frogram
HealthStart, Inc . ...........................................
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.......... 3
.......... 7
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.......... 14
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••........ 16
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.......... 45
.......... 51
.......... 55
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o�-y99
�'s���s�a�ro��o„s A. Minnesota Department of Health Face Sheet
Grant Applicaaun tor. Maternal and Child Aealth Special Projects
1• Applicant Agenty With Which Giant Coahaet is to 6e Ezecured
Legai N�e: SteetAddcess: 310 City Hall, IS West Kellogg Blvd Telephoae Number:
Saint Paul Commuvity HeaIW Board Saint Paul, MN 55102 651266.8560
FAX N�mber. 651266.8574
E�Mail Addcess:
2. D'upctor of Applicant Agency
Name aad Title: Sheet Addtess: 555 Cedar Steet TeLephone Numher,
Rob FuIWn Saiat Paul, MN 55101 651266.2424
Direc[or of Public Health FAX Number: 651.266.1201
�Mail Address: robSutton@co.xanssey.mn.us
3. Flscal Maoagement O�cer of AppticaM Agenry
Name and TiUe: Steet Address: 555 Cedar Street Telephone Numba
Diane Holmgreu Saint Paul, MN 55101 651266.1221
�Hea�ih Adminsua6on Manager FAXN�mmber:651266.1201
E�Mail Add�ess: diave.holmgrn� .(t�coramseY.mn.us
4 • OMn�S �Se��S' ('+Id�ent from number I above)
Name and Title: S�eet Address: 555 Cedaz Street Telephoue Number:
Saint PauL— Ramsey County Depa[mient of �� pau1, MI`155101 651266.1200
FAX Number: 651166.1201
Public Health E-Mail Address:
5. Coniac[ Person for Opentiog Agenty ('fdifferentfrom nwnber2 above)
Name and Tifle: Address: 555 Cedar Street Telephone Number.
Peg Torgerson Saint Paul, MN 55101 651266.1216
MCfI Gtant Coordinator FAX Numba: 651266.1201
E-Mail Address: Peg.torgerson@co.ramsey.mn.us
6. Confact Persou for Forther Informstion on Application (ifd�rentfrom mnnber S above)
Name and Title: Street Address: Telephone Number.( )
FAXNum6er.( )
& Mail Address:
7• Opersdog Agency F5sca1 ContaM (�'di$aent munber 3 above)
Name and TiUe: Stree[ Address: 555 Cedar Street Telephone Number:
Nflce Hagen Saint Paul, MN 55101 651266.1204
FAX Number. 651.2661201
Accouarent ��padress: mike3ageneco.ramsey.mn.us
8. Copies of This ApplicaUon Hsve Been Sent to Ne FaDowing Commmity Health Boards Por Review
(NotApplicable far Cammtmiry Health Bomd(s) ifthe Bomd is the Applicanf)
A¢encv Name
Date Sent
9. Certifinfion
L cenity that the infocmation contained �etein is ttue apd accurate to tha best of my Imowledge and that I submitihis applicarion oa behalf of the applicant agency.
/�i�,����-u �►rP��c1� 4-�3-ai
Sigpatureof irecturofApplicantAgrncy TiUe Dy¢
Fi&01274-OS (3/27) - PART A
-1-
OI-999
B. Assurances and Agreements
BY SIGNATURE, THE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
1. Services wiil be provided in accordance with applicabie state and federal laws, rules and procedures.
2. The agency wil] comply with state and federal requirements relating to privacy of client informauon.
3. The agency wiil comply with the Minnesoca Clean Indoor Air Act which prohibits smoking in MCH Special
Project facilides and ciinics.
4. The agency (iF it has 15 or more employees) and any subconffactors with 15 or more employees will have on
file and available for submission to Minnesota Departrnent of Health (NIDI-n upon request a written non
discriminauon policy containing at teast the following:
"All programs, services, and benefi[s which are administered, authorized, and provided shall be operated in
accordance with the non discriminatory requirements pursuant to Tide VI of the Civil Rights Act of 1964,
Section 504 of the Rehabi]itation Act of 1973, as amended, tf�e Age Discrimination Act of 1975, and the non
discriminatory requirements of the MCH B lock Grant.
No person or persons shall on the ground of race, color, national origin, handicap, age, sex, or religion, be
excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimina6on under
any progazn service or benefit advocated, authorized, or provided by this Department."
5. The agency (if it has 15 or more employees) and any subcontracTOrs with 15 or more employees witl
disseminate information to beneficiaries and the general public that services aze provided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be accompisshed
by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or other
communications designed to acquaint po[ential beneficiaries and [he puMic with progams; and/or
B. Notifying refetral sources in rou[ine letters by including prepazed handouts which state that services and
benefits must be provided in a non discriminatory manner.
Copies of each documen[ disseminated and a description of how these documents have been
disseminated wiil be provided to the MDH uQon reques[.
6. In fitlfilling [he duties and responsibilities of this gran[, the grantee shall comply with the Americans wi[h
Disabilifies Act of 1990, 42 U.S.C. § 12101, et seq., and the regulatioas promulgated pursuant to iL
7. No residency requiremenu for services other than sta[e residence, will be imposed.
8. Services shalI not be denied based on inability to pay.
9. Arrangements shall he made for communications to take place in a language understood by the matemal and
child heal[h service recipient. .
10. All written materials devetoped ro determine client eligibility and to describe services provided under this
grant will be understandable to a person who reads at a seventh grade level using the Flesch Analysis
Readabili[y Scale as required in Minnesota S[a[ute 144.054 (see Appendix 10, Plain Language in Wri[[en
Materials, Minnesota Statute, Section 144.054).
-3-
l 1. The agency will provide services in keeping wi[h program guideli�es of the Minnesota Departmen[ of Health
and guidelines of accepted professional groups such as the American Academy of Pediatrics, American College
of Obscetricians and Gynecologists, and American Pub[ic Heaft[i Association.
12. Upon request, one copy of any subconvact executed as part of the project witl be provided to the Minnesota
Department of Health.
13. The ag�ncy will report accomplishmenrs of the project to the Minnesota Department of Health. Such reporrs
will be submitted no later than 90 days afrer the completion of the calendar year. Upon request, the agency will
provide additional information needed by the Department for evaluation of the projecCs objuuves and methods
and comptiance with any special conditions (see Appendix 18, Program Reporting Requirements for Matemal
and Child Health Special Projects).
24. Grant funds shatl not be used for inpatient services except for high-risk pregnant women and infants.
15. Cash paymenYS shall aot be made to iniended recipients of heat[h services.
16. Grant funds shall not be used for purchase or improvement of land or facilities.
17. Grant funds shall not be used for purchase of equipment costing more than $5,000.00 per unit and with a useful
life exceeding one year.
18. Granf funds shalI not be used for reimbursement for travel and subsistence expenses incurred ouuide tlie state
unless it has received prior written approval from the Minnesota Depamnent of Heatth for such out-of-state
iravel.
19. When applicable, the agency shall provide nonpartisan voter registrarion services and assisfance using fonns
provided by the state to employees of the agency and [he public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Regis�adon).
20. When issuing siatements, press releases, requests for proposals, bid solicitations, and o[her documents
describing projuts and programs funded in whole or in part with federal money, all gantees receiving federal
funds sttall clearly stare (a) ihe percentage of the total cost of the program or project which will be financed with
federal money, and (b) the dollu amount of federal funds for the project or program_
21. The agency will not use �ant funds to pay for a�y item or service (other than an ecnergency item or service)
fumished by an individual or enury convicted of a criminal offense under the Medicare or any state health caze
program (i_e., Medicaid, Maternal and Child Health, or Social Services Blcek Grant programs).
22. Materials developed by Macemal and Child Aealth Speciat Projut �ant and matching funds will be part of the
public domain and will be accessible to the public as £nanciaily reasonable. Materials 8eveloped by the
Maternal and Child Health Special Project grant and matching funds may be reproduced and distributed by the
Project to other agencias and providers for a profit so tong as the revenues from such sale aze credited to the
Special Project budget for expenditure by the Special Project
23. The agency will comply with atl standards relating to fiscal accoun[ability [hat apply to the Minnesota
Department of Aeatth, specifically:
A B�et�e�§�o�s with 'ustification will be submitted to IvIDH for rior a roval whenever:
(1) changes are made in the objectives ro be met in the Matemal and Child Health Special Projec4 or
(2) the cumulative amount of funds vansferred into or out of an operating agency's budget line item
exceeds or is expected to exceed 10% of that approved for the gant yeaz or $2,500.00, whichever
is grea[er.
-4-
oi-599
B. Final expenditure reports are due 90 days after the end of the calendar yea.
C. Grant funds ue used as payment for services only afrer third-party payments, such as from the Medical
Assistance/Medicaid (Title XIX 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 wiil provide for:
(1) Accurate, cursent, and compiete disclosure of the financial stams of the project.
(2) Records which idenafy adequately the source and application of funds for Maternal and Chiid
Health Special Project activities. These records aze to contain information pertaining to project
awazds and aurhorizations, obligations, unobligated balances, liabilities (encumbrances), outlays,
and income.
(3) Effective control over che accountability for all funds, property and other assets. Projects are to
adequately safeguard such asseu and assure that they are used solely for authorized purposes.
(4) Comparison of actual obligations with budget amounts for each activity.
(5) Accounting records which aze supported by source documentation.
(6) Audits which wiil be made by or at the direction of the Minnesota Department of Health (see
Appendix 6, State Audits).
24. Grant funds wili not be used to provide and/or arrange sterilizations without the prior approvai of the
Minnesota Department of E3ealth. Agencies approved to use federal funds to provide and/or arrange for
sterilization aze required to follow federal procedures and to provide written documentation in this regazd
on a quarterly basis. (This procedure is not applicable to provision of infottnation conceming sterilization).
25. The agency assures that in accordance with Section 1352 tiUe 31, U.S. Code no grant funds will be used for
lobbying.
26. The agency will comply with the requirements of the OMB Circular A-87 "Cost Accounang Principles for
State, Locai, and Indian Tribal Governments", Cost Account Principles and the Federai award(s) for which
they apply.
Signature of Chair or V ice-chair of the Communiry Health Board or An Agent Appointed by
Resolutioa of the Community Health Board:
Si�ed By Title Date
� �lrrc.#t/� Q-/��Ol
-5-
o�-�y9
C. MCHSP Summary oF Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
1. Improved Pregna�cy Outcome Program
Agency Name Subgrantee Name {if this report is for subgraMee only)
Saint Paul Commimity Health Board
St. Paui — Ramsey Cty. Dept. of Public Health
Types of Activities/Services
Please check those services provided:
✓ core public health activities not direct service ./ pregnancy testing and referral
./ individualized education/counseling �/ pre-term birth prevention
✓ heafth education/counse{ing in groups ✓ prenatal case management
✓ prenatal medical care ✓ enabling and non-heafth support
✓ ATODJviolence screening ✓ referrai services
✓ breast feeding promotion
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply:
less than 200% of poverty per revised Appendix �/ no fees are charged to persons with
7, or women who are pregnant and determined incomes less than 100% of poverty
eligible for medical assistance (MA) or the
speciaf supplemental food program for women, �/ fees are charged to persons with
infants, and children (WIC) incomes greater than 100°/a of poverty
per pubiic schedule of charges
�/ risk factors listed in Appendix 12 reflecting income, resources and family
size
❑ other risk faetors — please specify:
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chifd Healtfi Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
-7-
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
2. Family Planrtiog Program
Agency Name Subgrentee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St Paul - Ramsey Cty. Dept. of Public Aealth
Types of ActivitieslServices
Please check those services provided:
./ core pubtic heaRh activities not direct ❑ method services
service ❑ task force
./ individualized educatioNcounseling ❑ enabling and non-heaith support
oeducation in schools Oreferral services
❑ other public education
Other- please specify:
Low Income & High Risk Target Population & Fees
Please check those items which apply:
! less than 200°/a of poverty per revised ./ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
✓ risk factors listed in Appendix 12 ❑ fees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specity: schedule of charges reflacting income,
resources and family size
Describe tF�e manner in which the program responds to the needs and priorities for services
identified by the Matemai and Child Heafth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
�
o�-g9y
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
3. Handicapped/Chronlcally Iil Children's Program
Agency Name SubgraMee Name (if this report is for subgreMee only)
Saint Paul Community Health Boazd
St Paul — Ramsey Cty. Dept. of Public Heaith
Types of Activities/Services
Please check those services provided:
❑ core public health activities not direct service ❑ child find/identification
❑ case managemenUservice coordination U early intervention tracking and follow along
❑ home health � assistance to chldren, youth and families in
❑ respite care identifying and locating resources (short-
❑ participation with interagency committee tertn)
❑ IEIC ❑ assistance in establishing medical fiome
❑ children's mental health collaborative Q enabling and non-health support
❑ transition (1422) Q referral services
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply;
❑ less than 200°l0 of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes tess than 100% of poverty
❑ risk factors tisted in Appendix 12 ❑ tees are charged to persons witfi incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family size
b�
Describe the manner in which the program responds to the needs and priorities for
services identified by the Matemal and Child Heaith Advisory Task Force (see revised
Appendix 17). Differences must be described in detail.
C. MCHSP Summary of Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
4. Childhood injury Control Program
Agency Name Subgrantee Name (if this report is for subgrantee only)
Sain[ Paul Community Heakh Boazd
St Paul — Ramsey Cty. Dept. of Public Healffi
Types of ActivitieslServices
Please check those services provided:
❑ core public health activfties not direct service ❑ injury prevention in day care setting
❑ home safety checkiist promotion ❑ injury preven6on in schools
❑ promotion of positive parenting ❑ fartn related injury programs
❑ toddler car seats ❑ enabling and non-heatth support
❑ bicyc(e heimet campaign ❑ referral services
Other - please specify:
Low Income & High Risk Target Population 8 Fees
Please check those items which apply:
❑ less than 200% of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
❑ risk factors listed in Append'a 12 0 tees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family s¢e
Describe the manner in which the program responds to the needs and priorities for
services idenffied by the Matemai and Child HeaRh Advisory Task Force (see
-10-
OI-999
C. MCHSP Summary of Types of Acdvities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
5. infant Health Program (oniy Minneapolis and St Paul):
Agency Name Subgrantee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St. Paul — Ramsey Cty. Dept. of Public Health
-11-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differe�ces must be described in detail.
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
6. Child Health Program (only Minneapolis):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Hea(th Boazd
3t Paui — Ramsey Dept. of PubHc Healffi
-12-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Heatth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
01-9 49
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
7. Dental Health Program (only Goodhue and Wabasha):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Health Boazd
Saim Paul — Ramsey Cty. Dept of Public Heakh
-13-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
C. MCHSP Snmmary of Types of Activities and Services Provided by
Operating Agencies by Legislafive Priority, CY 2002-03
8. Adolescent Health Program (only Minneapolis and St Paul):
Agency Name SubgreMee Name (if this report is for subgrentee only)
Saint Paul Comm�miTy Aea(th Board
St Paul — Ramsey Cty. Dep[. of Public Heatth
-14-
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chiid Health Advisory Task Force (see revised Appendix 77).
Differences must be described in detail.
O�"�JIg
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identfied in the CHS needs assessment are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispaziries impact your matemaVchild population or what is the significance of
dispariries to your population.
Each subconhactor has completed tlus information relating to their program.
See: Program Narrative: l.improved Pregnancy Outcomes: a HealthStart, inc.; b. Face to Face Health and
Counseliug Service, Inc.; c. West Side Community Health Services;
2. Family Plauniug Program: Room 111;
3. Adolescent Health: HealthStart, Inc.
2. List specific MCHSP objectives related to raciaUethnic disparities.
Cacn subcontractor nas completeA tlus mtormahon relahng to their program.
See: Program Narrative: 1.Improved Pregnaucy Outcomes: a HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Pla¢ning Program, Room 111;
3. Adolescent Health: HealthStart, Inc.
3. What strategies wilt be urilized related to the above objectives? Of particulaz interest aze community and
systems strategies/objectives which recognize the potential rote all types of community-based organizarions can
play in the decrease of disparities.
Each subcontractor has completed ttus information relating to their program.
See: Program Narradve: l.improved Pregnancy Outcomes: a. HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Planning Pragram: Room 111;
3. Adolesceut Healt6: HealthStart, Inc.
-15-
E. Subgrants/Subcontracts
1. Please list all subgrantee/subcorrtractors and the award amounts for the two year period CY 2002-03.
All subgrantees are accountable for provision of services as specified by the Community
HeaRh Board and further are accouMable for compliance with applicable federal and state
requirements. Please describe the monitoring procedures the Community Heafth Board p�ans to
utilize in assuring fiscal and program acxourrtability of each of its subgrants. indipte the extent to
which on-site monitoring procedures will be utilized
i o ensiae wac every eaort is maae to actueve the proposed goals and objecrives, the subcontnctor's efforts and
performance will be monitored on a regulaz basis throughout the entire contract period.
Contracts will be written beriveen Saim Paul — Ramsey CouNy Department of Public Health and the
subcontractots indicating specific performance objectives and outcome indicato�. The con4acts will outline the
subcontrecto�s duties, reporting requirements, the monitoring expected/performed by Saint Paul — Ramsey
Coimty Departmem of Public Health, and evaluation indicatrns.
Subcantractors will also be required to provide annual performance reports evaluating their own progrdm, and
assessing progress toward goals and objectives. Both subjective and objective tools will be used by the
subcontractors to ensure that various aspects of their progam aze reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
-16-
2. Monitoring and Evaluation of Subgrantees/Subcontradors
01-�99
F.
Matemai and Child Health (MCH)
P.O. Box 64882
St. Paul, MN 55164-0882
IV. Reimbursement Request $_ Q, A
V. ORIGINAL CERTIFICATtON SIGNATURE
! cartify tl�a4 to the best ofmy knowledge and belief,
Ne data 2ported on this docume�rt is corrpcf and all
6ansactlons that support this repat were made in
accordance wdh applicable Federal and SYate statutes
and rules
A rized (�fficial Date:
- �-/3.a/
SUBMIT A SIGNED ORIGINAL AND 2 COPIES
TO THE ABOVE ADDRESS
6�, �,2��,
Form for MCH Sectioa Grants
Name of Grant Project:
Matetnal & Child Health Special Projects
GraM Year. 2002
Expenditure Period: 01.01.2002 —12312002
"` List Sources and amourtls of °other g2Mee funds
(e.g., local tax, fees, in kind donations, fioundations, etc.)
Fomdations 109,000
L,ocai tax 139,480
$
= �-:n ?,K � ��=EOR MDH USE ONLY_ - � ; �:�-:%'�
Program Approval
Fiscal Year
0�9. #
PO Number
Dollar Amount
-17-
copy, and equipment under $5,000.00
F.
snorzao�
Budget/Eapenditare Farm for MCH Sectiou Grantg
Name of Grerrt Project
Matemal & Child Health Special Projeas
rant Year. 2003
Expenditure Period: 01.012003 —12.31.2003
IV. Reimbursement Request $ Q, A
V. ORIGINAL CERTIFICATION SiGNATURE "' List Sa�rces and amounts of'other 9raMee tunds
(e.g.. Iacal tax, fees, in IdrW donatb�. foundations, eM.)
1 cartify tha� to Uie best ofmy krtawledge and 6elief, Fmmdations 109,000
tlie date ieported on this dacumerrt is conect and a!! Local Ta�c 139,480
fransacfians fhet suppqt this 2pat were mede in $-
accadence wifh applka6le Federal aid Slate stakdes
arMrules. '---._ _. .. -------. . . . �
Auth ' 1 Date:
9 /3-0
SUBMIT A SIGNID ORIGINAL AND 2 COPIES
TO THE ABOVE ADORESS
�
copy, and equipment under $5,000.00
ol-9gy'
Budget Jusrification
The budget justification for each of the projects/subcontractos is included within their budgets
presented in the application narrative.
In addition to the funds proposed for allocation to the subcontractors for Improved Pregnancy
Outcomes and Adolescent Health programs, a portion of the Matemal and Child Health Special
Projects Crrant is budgeted to remain at Saint Paul - Raxuse�County De�artment of Public
Health for Administrative and Core Public Health functions.
Salary/Frin�e�.
Administrative Assistant:
General program oversight,
prepazes and monitors gants,
reviews reports, prepazes annual
reprots, prepazes and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activites
Accounting Tech Il.�
Prepazes budget and expenditure
reports, prepares pay vouchers
and processes grant allocations
Clerk-Typist IV.•
Types grants, contracts and
reports
2002
$14,670
$ 2,850
$ 3,400
$ 2,850
2003
$14,670
$ 2,850
$ 3,400
$ 2,850
Epidemiologist:
Data collection, analysis,
reporting and display
Sup�lies:
TOTAL:
$14,850
$14,850
$ 200 $ 200
$38,820 $38,820
-19-
Budget Detail of Local Match
Local match is identified within each of the subcontractors budgets, as required by MCH
guidelines. Additional local match is provided by the Saint Paul - Ramsey County Department
of Public Heath:
1. Local Tax Levy funds:
• MCH Prenatal Caze at
Community Clinics
2002
$139,480
2003
$139,480
TOTAL:
2. Other Loca1 Funds:
$139,480
$139,480
Other local match is provided by Public Health through the funding of various programs wluch
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health education and well child services. Source of this funding includes
CHS fimding, grants, reimbursements, and patient fees.
�II�
O�-9�i 9
G. Indirect Cost Allocation for MCHSP
Please check one of the fo�s options:
./ 1. Not applicable — No chazges to MCHSP aze for indirect cost.
A�plies to Saint Paul — RamseV Counri Deparhnent of Public Health and West Side Communitv Health Services
J 2. Indirect Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against all
participating programs, includingMCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached
Applies to HealthStart, Inc.
❑ 3. Approved Cost Allocation Process:
Option 1—Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached wluch are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
J 4. MCHSP - Approved Cost Allocation Process:
OpHon 2—Indirect costs aze allocated to the agency's prograzus using the optional Indirect(Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
Applies to Face to Face Health & Counselin2 Service, Inc.
See: Project Narrative for each subcontractor for supporting data for indirect cost allocation.
-21-
o�-9yy
Please read INSTRUCTIONS ON REVERSE side before completing form.
H. MCH SPECIAL PROJECI' BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
By Legisiative Prioriry, CY 2d112-03
Minnesota Depart. of Health
Matemal and Child Health
85 East SeveMh Place
P.O. Box 64852
St Paul, MN 55164-0882
�. name of community Nealth Board: II. TYpE OF REPORT:
� Original Budget
S"°t Paui O Budget Revision #
Grant Year: ❑ F �
2002 EXPenditure Report
Priorities and
Matemal and Child Heaith Special GraM
Medicaf services ............................................................................. $ 196,900
Other heafth activities"' .................................................................. 16,250
Enabling and non health suppart' .................................................. 40,000
Co2 public health activities not dient based ................................... 25,880
ceun v e� euuwr_ oonn_ewu
Famity Planning method services ............................................
Other heafth ac5vities" ..........................................................
Enabling and rron health support' ............................°----°-°°-
Core pubiic heatth ac6vities not Gient based ...........................
PROGRAM
Handicapped/Chronicalty III Children medicai services .....................
Other health activities"` ..................................................................
Enabling and non health support' ..................................................
Core public heal[h ac5vities nM client based ....................°°.°.°-°--
Medical services ..........................................
Other heatth acbvities"' ...............................
Enabling and non heaith suppart' ...............
Core pubiic heatth activities not dient 6ased
Medipl services ..........................................
Other health activities"`.........-°-°--°-------°-°
Enabling and non healih suppoR' ...............
Core p ublic heatth activities not client based
(only Minneapolis, Goodhue and Wabasha)
Medipl services ............................................................................. $
Otherheafthactivities" .................................................................. $
Enabfing and non heaith support' .................................................. $
Core public health activities not Gient based ................................... x
Paul)
Medical services .........................................
Other heaith activities'"' ..............................
Enabiing and non health support' ..............
Core public healih act'rvifies r�ot client based
�I
IV. CERTIFICATION SIGNATURE
I certify that to the best of my knowledge and belief the data reported on this document is correct and all Vansactions that support this
repoR were made in aaordance with applicable Federel statutes.
� ��•U/
Peg Torgerson
651.266.1216
-23-
Please read INSTRUCTIONS ON REVERSE side before completing farm.
H. MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL E:YPENDITURE REPORT
By Legisla4ve Priority, CY 2002-03
Minnesota Depart. of Healtli
Matemal and Chiid Health
85 East Sevenfh Place
P.O. Box 64882
St Paui, MN 55164-0882
�. Name of Community Health Board: 11. TYpE OP REPORT:
�/ Original Budget
S � P � ❑ BudgeL Revision #
Grant Year: ❑ Final Expenditure Report
2003
Priorities and
Medipl services ......................................�--�
Other heaith acfivities" ...............................
Enabling and non healih suppoR' ...............
Core public heatth acdvfies nM dient based
Family Planning method services... .............
Other health activities" ..............................
Enabling and non heaith support' ..............
Core {�blic health actrvities not dient based
Matemal and Child Heaith Special Grent
$ 196,900
PROGRAM
Handicapped/Chronicalty III Chiidren medical services ..................... $
Other health adivi6es° .................................................................. $
Enabling and non heallh support • .................................................. g
Core pubGc health activities not �ent based .................................•• g
CHILDHOOD INJURY CONTROI PROGRAM""'
Medipl services ............................................................................. $
Other health aGiivities" ....................••----........................................ $
EnabGng and non health support ` .................................................. $
Core Public health acbvi8es not dient based ....--- ........................°- x
Medipl services .............................................................................
Other heatth activiBes" ................................................�---..............
Enahling and non health suPPart'....-°---.....-°--° ...........................
Care pu6lic health adivfies not client based .......-°--........--°-..........
f`NII n no nc/�lTel ucel TY oonP_Owu
(oNy Minneapolis, Goodhue and Wabasha)
Medical services ..............................................
Other health activities° ...................................
Enabling and non heatfh suppoR' ...................
Co2 publ'�c health activ�ies not dieni based ....
Paul)
Medical services ..........................................
Otlter health activities"` ...............................
Enabling and nan healih support' ...............
Core public health acWibes not dient based
14%
$ 336,666
IV. CERTIFlCATION SIGNATURE
I cert'rfy that to the best of my knowledge and belief the data repoRed on this dowment is cortect and all transactions that support this
�. /� O
Peg Torge:son
651266.1216
24
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Ol -49 Q
2002 - 2003 MCH Special Project Program Update,
Saint Paul Community Health Board
L Improved Pregaancy Outcome Program
Each of the subcontractors in Saint Paul was requested to review their 2000-2001
program goals and objectives. They were to submit their 2002-2003 Updates with re-
constructed goals and objectives that relate directly to the revised Needs and Priorities for
Services Identified by the Maternal and Child Health Advisory Task Force, 7une 2000. The ten
needs ranked as highest priority aze listed below:
• Reduce drug, alcohol, and tobacco use
• Promote family support and health communiry conditions
• Promote healthy parenting/family development
• Reduce child abuse and neglect
• Reduce teen pregnancy and teen birth rate
• Address the multifaceted needs of teen parents
• Increase percent of children whose disability is identified eazly
• Reduce youth risk behaviors
• Improve mental health of children, youth and parents
• Increase percent of children who receive early intervenrion services
For each of the three subcontractors applying for funds for an Improved Pregnancy Outcome
Program, their reorganized goals and objectives are followed by their statments on reducing
racial disparities, their individual program budget justifications.
• West Side Community Health Services, 153 Concord Street, Saint Paul, MN 55107
• Face to Face Health & Counseling Service, Ina 1165 Arcade Street, Saint Paul, MIV
55106
• HealthStart, Inc., 491 West Universiry Avenue, Saint Paul, MN 55103
II. Family Planning Program
Update: same as far Improved Pregnancy Outcome Programs (above). Re-organized
goals and objectives and other supporting data relate to:
Room 111 -STD Services (as an extension of Family Planning activiries), 555 Cedar Street,
Saint Paul, MN 55101
III. HandicappediChronically IIl Children Program
No update
IV. Childhood Injury Control Progam
No update
-25-
V. Infant Health Program
No update
VL Child HealYh Program
No update
VII. Dentat Health Program
No update
VIII. Adolescent Health Program (only Minneapolis and St. Paul)
Update: same as Improved Pregnancy Outcome Program (above). Re-organized goals
and objectives and other supporting data relate to:
• HealthStart, Inc., 491 West University Avenue, Saint Paul, MN 55103
-26-
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oHS 99
Goal l. The goai of the Improved Pregnancy Outcomes program is to serve the needs of
low-income (less than 275% of poverty} and adolescent pregnant and postpartum women
by providing comprehensive multidisciplinary prenatal caze at its Main clinic site on
University Avenue, and at the Health Start Clinics located at Arlington and AGAPE high
schoois in St. Paul. Services aze designed to address the concerns of adolescents and
women of color.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen parents.
2. Promote healthy parenting/family development.
Objective 1: �rovide comprehensive muitidisciplinary prenatal care to 3501ow-
income adult and adolescent women per year during CYs 2002 and 2003.
MCH 2O02-03 Priority:
1. Promote healthy pazenting/family development.
2. Addtess the multifaceted needs of teen parents.
Objective 2: Fifty-five percent of women who deliver through Health Start will
initiate prenatal caze in the first trimester of pregnancy and 85% of women will
iniriate care by the end of the second isimester of pregnancy.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen pazents.
2. Promote healthy pazenting/faxnily development.
Objective 3: Eighty percent of prenatal patients will receive five or more prenatal visits.
MCH 2O02-03 Priority:
1. Promote healthy pazentingJfamily development.
2. Address the multifaceted needs of teen parents.
Objective 4: By the end of CY 2003, low birth weight (]ess than 2500 grams) rates
will be no greater than S% and pre-Yerm birth rates (less than 37 weeks gestation) will
be no greater than 10%.
MCH 2O02-03 Priority:
1. Promote healthy parenting�family development.
Objective 5: Women smokers will receive help with smoking cessation prior to or
early in pregiancy.
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
Objective 6: Of the prenatai adolescent teens seen by Health Start, 55% wiil begin
care in the first trimester.
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
-27-
Objective 7: Women receiving negative pregnancy test results will be counseled on
the importance of folic acid supplements and other life style issues to enhance healthy
pregnancies and birth outcomes.
MCH 2O02-03 Priority:
1. Promote healthy parenting/fanuly development.
',f�'�
o �-� 4y
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP applicarion, addressing the following:
1. In what ways do raciaVethnic disparities impact your maternaUchild population or
what is the significance of dispazities to youT population:
Raciallethnic disparities have a significant impact on prenatal caze. American-bom women of color,
especially those living in the Twin Cities' urban azea, aze less likely to ieceive adequate prenatal caze than
their counterparts in the suburbs and wlrite women in the metro azea. They aze aLso more likely than
foreigh-born women of color to deliver babies of low birth-weight Barriers to caze include lack of
insurance, lack of beli�f in the value of caze, few provideis of color, language barriers, transportation
problems, lack of child caze, and social isolation.
The laxgest percentage of clients seen by Health Start is African-American (3b.2%), Followed by Asian
(26.2%), Hispanic (8.4%), White (23.2%) and Native American (1/6%). To qualify for caze, pregnant
women must be 19 yeaz old or younger or have incomes below 275% of federal poverty guidelines.
2. List specific MCHSP ob}eclives xelated to taciaVethnic dispazities:
The overall goal ofHealth Start's prenatal program is heakhy mothers and babies. We seek to accomplish
this goal through specific o6jectives that apply to all prenatal clients while addtessing specific dispariries
issues. These objectives include provision of multidisciplinary prenatal caze, increasing the number of
women who seek caze in the first trimester and continue regulaz caze throughout pregnancy, reducrion or
cessation of smoking in pregnancy, and reduced incidence of 1ow birth-weight. We also seek to incxease
numbers of women who understand the importauce of folic acid in prevention of birth defects.
3. 4That strategies will be urilized related to the above objectives.
Health Start staff have yeazs of experience in employing a multidisciplivary approach in worldng with low-
income women, pregnant adolescents, and those with limited financial resources. One of the greatest
barriers to prenatal caze is a lack of insurance and other financial resources. Health Stazt social workers
assess the financial needs of low-income clients and help clients apply for insurance coverage whenever
possble. We provide caze without charge if resources aze not available. Transportation barriers aze
addressed in part through our location in Progtown, a federally designated under-served azea in which a
lazge number of Asian families have settled. We are on a major bus-line and can help clienu arrange for
rides through theu insurers, and pay for the bus or cab rides when needed. Because we realize fl�at
transportation is difficult, we do our best to see all clients, even if they aze late for visits. To encourage
eazly prenatal care, new prenatal clienu aze scheduled for a first appointment within three weeks of their
call. Clienu who miss appoinhnents aze called, sent post-cazds, and visited by an ouheach worker as
needed. Our child-friendly waiting azea includes play-space for preschool age children. Staff at our Main
clinic includes two Hmong women—a medical assistant and ciinic receptionist—who can inteipret as
needed for Hmong clienu. All Main clinic staff aze experienced in working with a culturaily diverse
popularion. Health Start provides continuing education through inservice 4aining and conferences to help
ensure that staff learn about new immigrant populations as they arrive in our azea.
�'�
HEALTH START, INC.
MATERNAL AND CHII.D HEALTH
Il4IPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANIIARY THROUGH DECEMBER, 2002
Mqi0�2
ANNUAL PROGRAM PROGRAM MC}i
LINE ITEM IXPENSE SALARY � suoser suo�er
CIINICAL SERVILES COOR�INATOft
NURSE PRACTITIONER
rvurrtinowsr
SOCIAI, WORKER
INTERPRETER/RECFPIONIST
CLINIC OFFlCE MANACaER
MEDICALASSI5TANT
SUB-TOTAL SALARY
FRINGE BENEFITS @ 21.5%,
0
CONTRACT SERVICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CLINIC X 48 WKS
RENT
PA7IENT CARE
LABORATORYSERVICES
OTNER EXPENSE
PHARMACYSUPPUES
MEDICAL SUPPLIES
OFFtCE SUPPLIES AND OTMER
TRAVEUTRAINING
TELEPHONE
ununEs
PATIENTTRANSPORTATION
TOTAL DIRECT EXPENSE
$
�
$
$
$
$
$
75,192
70,699
49,338
47,237
30,202
33,093
29,453
FEDQtAi, APPROVm INDIRECT CO57' RATE � 35%OF SALARY AND BENEffTS
TOTAL PROGRAM BUDGET DCPENSE
TOTAL MCH GRANT REQUEST
0.20
0.50
0.20
0.10
0.75
0.3Q
0.65
$ 15,038 $ 7,519
$ 35,350 $ 15,907
$ 9,868 $ -
$ 4,724 $ -
$ 22,651 $ 9,060
$ 9,928 $ 3,475
$ 19,144 $ 7,658
$ 116,703 $ 43,6I9
$ 25,091 $ 9,378
$ 56,448 $ 36,69I
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,396
$ 6.598 $ 3,629
$ 2,500 $ 1,258
$ 376,294 $ 278,350
$ 49,628 18,549
$ 425.922
$ 196,900
MATCHING NNDS �?5°J $ 106,4$1
�iZ1�
HEALTH START, INC.
MATFRNAI, AND CHII.D HEAI.TH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2003
o � •44y
MCH0H03
ATiNUAL PR06RAM PAUGRAM MCH
tINE ITEM EXPENSE SALARY FTE BUDGET sUOGEr
CIINICALSERVICESC00RDINA70R � 77,�5 O,ZO $ IS,�L9O $ 7,74�J
NURSEPRACTITIONER $ 72,820 0.5� � 36 $ 1�,5�
Nuramomsr $ 50,818 0.20 $ 10,164 $ -
S�GALNlaRKER $ � ,654 �.1� $ 4 ,865 $ -
INTERPREfER/RECEPIONIST � $ 31,1� 0.7 $ 23,331 $ 9 ,332
CLINICOFFICEMANAGER $ �,�$6 �.3� $ 1�,226 $ 3 ,579
MEDICALASS15fANT $ 30,336 0.65 $ 19,719 $ 7,887
SU&TOTAL SALARY $ 120,204 $ 43,108
PRINGE BENEFITS @ 21.5%
CANTRACT SERYICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CUNIC X4$ WKS
REt�fT
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
TR,4VEL{tRAINING
TELEPHONE
UTILITIES
PATIINT TRANSPORTATION
TOTAL DIRECT EXPENSE
FEDERAIAPPR04ED INDIRECT COST RATE @ 3� OF SALARY AND BENEFiTS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCHIriG fliNDS � 25%
$ 25,844 $ 9,268
$ 56,448 $ 36,691
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,790
$ 6,598 $ 3,959
$ 2,500 $ 1,375
$ 380,548 $ 178,569
51,117 18,331
�
$ 196,900
$ lOJ,916
-31-
G. IndirecY Cost Allocation for MCHSP
Please check one of the four oprions:
� 1. Not applicable — No charges to MCHSP are for indirect cost.
� 2. Indirect Cost Rate Agreement — A Federal negotiated fi�ced rate is to be charged against all
participating programs, including MCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached.
[] 3. Approved Cost AItocation Process:
Option 1—Indirect costs are atlocated to the agency's programs using worksheets developed by the
agency for tius purpose.
Ageucy worksheets and supporting documents are attacfied wIuch are in compliance with
the requirements of the OMB Circalaz A-87 "Cost Accounrittg Principles for State, LocaI,
and Indiatt Tribal Govemments", and the Federal award(sj for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs aze allocated to the agency's progra�ns using the optional Iadirect/Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance wiYh
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Locai, and Indian Tribal Govemments", and the Federal awazd{s) for which they apply.
-32-
oi��r9
�
� DEPARTMENT OF HEAI,TH 8c HUMAP( SEILVICES
Y �.
o �
�"'k
�aa
Raymond J. Martin, Jr_
Psxecutive Director
Health Start
491 West University Avenue
St. Paul, MN 55103-1936
Dear Raymond Martin:
February
� S�PPat CentQ
F'mnual Manag�� �
Divaion o( Cast AHocaIIOa
Cer6ai States Field Office
6, 2 0 O 1 '13Di Yovng Street, Ropm 732
. Dafias, Sexas 75202
� (
FAX- (214}�67-325q
The original and one copy of an indirect cdst Rate Agreement
are enoZosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concsrning
the rate(s) that may be used to support your claim for indirect
costs on granEs ancl contracts with the Eederal Government.
Please have the original signed by an authorized representative
of your organization and zeturn it to me, retaining the copy
for your files. We will seproduce and distribute the Agreement
to the appropsiate awarding. organizations of the Federal
Governmen.t for kheir use.
An indirect cost proposal, together with supporting information,
is required each year to substantiate claims made for indirect
cosCs under grants and contracts awarded by the Federal Government.
Thus; your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation_
Enclosures
Sincerely,
x
\
Me�. Schmidt
Director
Division of Cost Allocation
Central States Field Office
PI�EASE SIG1Q AND RETURN THE ORIGINAL.OF THE RATE AGRESMENT
-33-
NONPROFIT RATS
EIN #= 1411577621A1
ORGANIZATION:
Health Start
491 West University Avenue
St. Pau2
MN 55103-1936
DATE: Febraary 6, 2001
FILING REF.: The preceding
Agreement was dated
NONF`
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Goverament, subjeci to the conditions in Section ISI.
SECTION I: INDIRECT COST RATES*
RATS TYP&S: FI%ED PINAL PROV.(PROVISIONAL) PRED.(PREDF3TSRMINSD)
e
SFF}3CTIVE PERIOD
TYPE FROM TO
PROV. O1/O1/O1 12/3I/02
PROV. O1/O1/02 IINTIL AMBNDED
RATIs(%) LOCATIONS APPLICABLS TO
35.0 On-Site AlZ Programs
IIse same rates and conditions as those cited
for fiscal year ending December 31, 2001.
* sAS& :
Direct salaries and wages includinq a11 fringe benefits.
-34-
at-4 t9
ORGANIZATION:
Health Start
DATS: February 6, 2001
SSCTION II: SPECIAL REMARRS
TREAZ'MSNT OF FR2NG8 BENSFITS
The fringe benefits are charged using a rate(s). Over/under recoveries from actual costs
are adjusted i.n current or fuCure periods. The directly claimed fringe benefits are
listed below_
TREATMENT OF PAID ABSIISCSS •
Vacation, holiday, sick ieave pay and other paid absences are included in salaries and
wages and are claimed on grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the costs of these paid absences are not
made.
Equipment DePinition -
Equipment means an article of nonexpendable, tangible personal propexty having a useful
life of more than one year and an acquisition cost of S1,000 or more per uait.
ERINGE BENEFITS:
FICA
Retirement
Disabi].ity Iasurance
Worker�s Compeasation
Life insurance
Unemployment Insurance
Health Insurance
-35-
ORGANIZATION:
Health Start
AGREEMSNT DATS: February 6, 2002
sscrxox xxx- c�saar.
A. LIMITATIORS -
The ratea in this Agreement are aubject to any atatsstazy or admiaistrative limitat3ous and app2y to a qivea gra¢t, croa[ract or
other agreemeat only to the exteat tLat ftmds aze available. Acceptance of the ratea ia subjeet to the Eollowiag condi�;ona:
(i) Oaly costs iaevrxed by Ghe a��;zatioa wexe ineluded ia its indizeM cost pool as finally accepted: euch eosts are 1ega1
obligations oE the oxganizatioa and aze allowable uadex the govesaing cost pxiaciples; (2) The same costs that Dave been tTea[ed ae
indirect eoets aze aot claimed as dizect coats; (3) Similaz types of croeCS Lave beea aecoxded eonaisteat accounting treatmeat; and
(4) The Snfoxmatioa praoided by the ozgaaizatioa whicA was used to eeta6lish the xates is aot later fo�md to be materially
:�^omplete or i�<cutate by Che Fedexal Govexament. IA euch situations ihe rate(s) would be avbject to renegotiatioa at the
diacretion ot tLe Federal Gooexameai,
B. ACCODNTI56 CRA21G&5
This Agreement ie based on the a<ca�mting aystem puxported bq the oxgaaization to be in effect durisg the Agseemeat period. Chaages
to the methad of accotmtiag for crosts vhich affect the amouat of seimbuTaement resulting from the use of this Agreement require
prioz approval af the authorized represestative of the cogaizant ageacy. Sticlx cLaages iaclude, but are aot 1imiCed Co, r3anges ia
�wm ^*=+ of a partieular Cype af�eaet from iadirect to direcC_ Fai2ure Co obta3s appraval map resu2t ia coat disa2lowaaees.
C. PS%SD RATES .
If a fixed xate is in [his Rgseement, it ia based oa aa astfmate ot the eoets £or the period eavezed by the zate. A2en the aetual
rnsta for thia peziofl aze determined, an adjusimeat will be made to a rate of a fntuxe year(s) to compeasate for the difference
betweea t71e crosta uaed to establiah tIIe fixed rate a�d actval coata.
D. IISB SY OT88R PEDHRl1L nr_urarrae
The zatea in this AgTeement weze appmved 3a accoidance vith the authority ia Office of maaagemeaat and 8adget Cixculaz x-lzz
Cizculaz, and sLOUid be applied to grauts, coatzacts and otLer agrenmenta CoveTed Irq thia Circular, subject to aay limitationx ia A
abaoe. The ozgaaization may pxavide copies of the Agree�ent to other Pedezal Ageacies to give them eazly aotif3cation of tIIe
Agieemeat,
E. OTHER:
IE aay Fedexal contxact, giaat or oU1e.� agTeemeat ie reimbutsiag indirect costa by a means oilaer thaa the appxoved rate(s) in this
Agreemeat, the arganizatioa sLo�aid (I) eaedi.t sneh costs to the af£eMed pxognama, aad (27 apply the approved rate(s) to the
appzopriate base to ideatify the proper amoyyt af iadixect eosts allocable to these progxama.
8Y THS ORGATIIZATION:
Health Start
SY THE COGNTZA2Tf AG&fiCY
OR BEHALI' OP 158 rnnaoar. �pp�.�ryy
(ORGANIZATION) .
I�u.,,�t � � M�. �-
csxcema�) �
RA`fNouo 1". Haz .�
c��
�7�EG�t'��v� D�REC�b�L.
(xxxzs>
lnnxs)
DHPARTMENf OF HCil1LTH AND HOMAN 58R4ICES
(acaeres) 4
vv--� �-� �'�
(51
Merle M. Schmidt
tmse��
nzxzcTOS axvxsxrnv or msx xraocaxxox-
(TITi.8) CENTBIII+ STATES PIBI,➢ OFPICS
(DATS) 5736
�s ,eErxssseraxzvs: MY (Robert ) N. Nq'uven
xe�epn�e: (214) 767-3267
-36-
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A. APPLICATIOIV 1�3ARRATIVE
The Pzeaatal Access Project at Face to Face Health & Counseling Sezvice will utilize outceach efforts and case
*T+?T!a to encouraae and support 150 low income pregnant adolescents and young adults to access prevatal
care aad in¢ease dieir chauces of having a successful ptegnancy. Seveuty of the youth to be sexved will be under
the age of 19, and 75 wiIl be youth of coloi.
1. Outreach and Case Management
GOAL 1 To utilize a sramless, integzated sexvice model to pmvide pienaral caze and to pxomote the healthp
developmeut of families_
MCH 2O02-2003 Priorities
1. Address the multifaceted needs of teen pateuts
2 Reduce youtla risk behaYiors
3. Improve meatal heakh of chil.dxen, youth and parents
Objective: To use a holistic inrake pzocess for assessing needs in all azeas of the lives of our clients and
identifying steeugths they alzeady possess to address these needs.
Pace w Face implemeated a necv inrake pmcess in 1998. The goal was tn addcess the needs of ptegnant
adolescents and young adults holisdcally — not only addressing those direcrlp mlated to theix pregnancy. This
includes, but is not limited to, life and safetp, mental healdi, medical, and education and job aaining needs.
Becoming pregnant as a teen c�n be a sign of more serious issues a youth uright hace, including being homeless,
not attending school regularly or having dropped ou� a histoxy of abuse by or ot3ies re]arional difficulties with
family membets or a boyfriend, chemical abuse and mentai health issues. Depression aad thoughts of suicide aze
not unusual with some clients. It is also important to sealize fl�at these adolesceuts have been sutviving —
sometimes on che srteet — amidst often very difficult citcumsrances. That is why we not only work to idenrify in
a compxehensive mannet aIl of a pregnant adolesceut's needs, but also to idenrifp, affi�m and sttengthen rhe
s2engths they alxeady possess. This is a streugths-based model as opposed to a needs-based model, which has as
its focus the clieuu' defidendes (Le., unmet needs) rathet t6an their stres�gths.
GOAL 2:, To reduce the overall rate of ]ate (third trimestes) or no prenaral care aad to conduct ouu�each ro
in¢ease fixst trimester preaatal caze, espedally amoag pouda of color.
MCH 2O02-2�03 Priarides
1. Pmmote family support and healthp communitp conditions
2. Promore healthy parenting/familp development
3. Increase p�cent of children who receive eazly intervention services
Objectrve L• To increase oux cw�ent efForts to pmvide outreach to youth of color, ensiuing d�at at least 50
pezceat of the prenatal clients aze youth o£ color. African Ametican, Nauve American, F3ispanic,
ox As'a•
Face to Face has reached and seeved a large numbet of pourh of colox throughout all of its progxams. In 1995
thexe wexe 98 deliveries, and neazly half (46 of 98 or 47%) of the deliveries weze to adolescent moms of
color. Face to Face is committed to pmviding cultutally appropriate and accessible sexvices and will continue our
efforts to conduct effective outreach ditected towatd youth of coloi.
Objecrive 2; To follow up with all clients with positive pre�anry tests, induding mal�ng home visits as
necessazy to assute thep receive cate.
-37-
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Y ��•
Face to Face began its ariginal pxeaatal ouueach pmject in �988. These wexe 21 deliveries d�at first yea� and by
1998 d�at numbee grew to 104 deliveries. 'l�is demonsuates a 395% increase in. the aanual nambet of delivaies
since the project's incepdon. It is out belie£ that dvs inctease is ditecdp related to thxee factovs: (1) an i.+r+,��e in
cultutally divexse staf� (2) an incre�asc in owxeach efforts, and (3) an inaease in intensive case *n?�oement
sexvices. Wh31e the need for outirach sezoices continues w be g�eat, Face to Face has xeached its capadty far
sexving clieuu without addiuonal sraffing. Thesefore, rhe pmject eapects to maintain the curtent number of
rlirn visits dn�; the upcoming two-year pmject period
Ol�jecrice 2.• To entnll 50 pecceat of die 70 cliessts who are uuder the age of 19 in prenarat care services daring
dzeir first mmestez of pzegnanry.
During 1998, 51 perceat of the new prenatal clients under the age of 19 began prenatal caze within theix
fixst trimestet. This is a task to which die pxeoatal team is very committed; howevec, the younger clients aze and
the gxeater their risk factozs dae gmater the di£ficulty of xearh; � th� within their fiist ttimestexs. Foz cYample,
only 31% of clients 17 and undu began caze during theiz fust timesten We wi11 focus outreach efforts on
these younges clients.
Objeczive 3: To affect posirioe bitth outcomes in ail c3ients, as measuxed by low bitthweight r�tes of less tban
__ 6.5% for all aee aad ndal2muns secved.
In 1998, the rate of low bitth weights for all age and racial gtoups served by Face to Face was 8.8%. The
objective is to bettex the rate of low bizdi weights di 2002-03. All pteoa1ml clients who have a vsk scoxe of 10
oi highet aze reEeued to a Ramsey Countp Public Health Nucse. One of rhe public heaitii nuxses pazriapates on a
bi montbly basis in care wotdination confecences, and consultation and coozdination happens on aa almost daly
basis. 11vs cootdination has resulted in the numbes of dieuts wirh high-xisk scoxes dea�sing d"� the second
and rhixd trimestexs of pregnancy.
��'.
oi-9g9
Objecrive 4.• To improve attendance at all Ptenatai C]asses, with at least 50% of those receiviag pteaaral cate
atteuding.
The eight-week class is offered m all pteaatal c]iencs, addressing physical cUanges d"� pregnanry, health and
mroirion, preparation for laboi and delivery, emotianal aspecrs of childbirth and new pazeuting postpattum
pxeparatian, pzeparation foz new bzby case, and the importance and "how to's" of birild'mg a support network. In
an attempt to build gzeatec continuity foz the clients aud inccease consistent attendance at pzeaatal dasses, we a]so
hold weekly "Snack and Chat" sessions_ This is infomzal discussion and sapport dme fot clients.
3. Social Sugport
GOAL: To impmve die healdi and wel}ness of pregnant adolescents during pregnancy thmugh in¢eased
social and emotional support and menral health seroices.
MCH 2O02-2003 Priorities
1. Pmmote family support and healdiy community conditions
2 Promote heaithy patenting/family deveiopment
3. Reduce child abuse and neglect
4. Addtess the multifzceted needs of teeu pazents
5. Improve meutal healsh of chiidxen, youth and pasents
6. Inctease p�cent of childsea who zeceive eazly inteivention setvices
Objective Z• To inctease preaatal support sesvices to the pazmets of pregnant women.
One wap to better support pxegnant adolescents 3s to extend ouc prenatal support services — speafically prenatal
classes and "Snack and CliaP' sessions — to the paxmecs of pxeb ant c]ients. 2Ziis will help to reduce any added
sarss the pxegnancy may have put on the pazmex relationslup, thexeby sueagthening the support die pzegxaant
adolescent feels £rom significant re]ationships in her life.
Objective Z.• To provide meutal health counseyng for ptenatal clients and theix paxmexs who aze suuggling
with menral healrh issues, indudin� chemical use, depression, and abuse.
A� ;�, as the complexity of risk factoxs incsrase fot pseaatal clieuts, so does the� need foz menral health sexvices.
Historically, a majoritp of ptenatal clieuts have e�erienced sexual abuse aad chemical use. Most are esmenged
ftom partness ot eaperiencing difficulties in the pattnec telationship. lktany talk about feeliugs of depxession and
even tho��hts of suidde. Ofren the steess of an earlp, unpLwned pregnancy exacesbates the issues that alreadp
are present, and manp of the pmoatal clients request or are in need of counseling. The Dixector of Mental Health
is available for consultation and Face to Face has well-established mental heakh sexvices for clvld abuse suxvivoxs.
Objecttve 3: To ]ink all prenatal clients who deliver thtough Face to Face with ongoing medical cate and
social sesvices for themselvu, cheir infants, and dieit paztnexs.
Most of the ptenaral clients use Childxen's Hospital Pediatric Clinic, Unixed Family Physiciaus or Ramsey Family
Physidans fox their childten s primary medical caxe. 'Iheze wiIl continue to be a focus on s�sengthening case
TM?n? to link clienu in need of primaiy medical caze for their infan[ aud themsetves as well as to othex
needed social sezvices. Face to Face has bwlt mong relationships with many youth serving agendes, and the
outteach woskezs help clients esrablish connecdons wirh appropriaxe setviices. Addirional efforts will be made to
increase the xesouxces available in the community fox pazmecs of pxegn�wt adolescents. We will do assessmeats
of the pattaexs' needs fox supgort and make refe�xaLs when possible. Whea resouxces don t e�st, Face to Face
will work widi the Fathets Rrsouxce Center and othet pouth-sezving agendes to develop collabotttive
pro,gra**++*+;*+a rhat suppotcs healthy pregnancp outcomes.
-39-
0
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP application, addressing tfie foilowing:
1. In what ways do raciaUeihnic disparities impact your matemaUchild population or what is ihe significance of
disparities to yo�u population?
3. What s�ategies will be utilized related to the above objectives? Of particutar �terest aze com�aity and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decxease of disparities.
�l�he hist strategy raw to race uses u to
services. That commitment is visible in
needs of adolescents aud young ad¢its R
commitmenY to haiug staff who are cult
1'iu
agency requiies and provides for all sta4
In addition, in ordu to realize our mi;
values and outcomes. To that end. in
nce, class, etbnicity, sexual c
processthrough which every
A strategy Yace to Nace uses spec�Tic
color. To this end, Face to Face is a
is to reach out to pregnant African-A
rurr¢er, we recessuy e
women azound issues
DLC�2IIt Ot DBLCIIt1II2
i
outcotnes
Ke a co�utrnent to proviamg culuuatly appropnate and access
ty aspect of the agency — from our mission W serve tiie deveIop
are in need of accessible and cnitutaily sensitive setvices to our
of the youth we serve to the
?ace to Face
as uart of an
nsive, flexible and comnvtted to a core
a nzoua of Face to Face staff foffied an
; accorawg m a pnuosopny wat nennes "cuuutai cuversuy to mcmae
er, religion, age and able-bodiedness. 'Chis committee initiated a
elops eauiri eoaLs, which become part of their staff development goals.
�ur pienatal pmgam is effective outreach tazgeted towazd youth of
iting agency ia the Twin Cities Heakhy Start Project, our role in wluch
yoimg women and commect them with appropriate, early prenatal care_
cant for pienatal ouffeach ro youth of color and yommger adolescents.
and a full-time staff person to do outreach to bomeless adolescents who aze
at ou�each tazgeted to specific populations is a very effective shategy to
tarQeted nonulation who seek services, which increases the l�kel�hood of
ois
from the
.�
2. List specific MCt3SP objectives reIated to raciaUetbnic disparities.
or-gqy
Budget Narrative - 2002
Salaries aad Fringe
O.SFI`E Outreach Worker/Case Manager (Vicki D.)
0.5FI'E Outreach Worker/Case Manager (Ashley M.)
0.09FTE Prograzn Director �oel I,.)
Fringe Benefiu (about 18.5°/a of salaries)
Total Salaries and Fringe
Supplies and Expenses
Staff Travel ($136 miles per month X$0.345/mile)
Indirect Costs
Adminiscration (� 1 Y%)
Faciliries (@ 5.5%)
Total Indirect Costs
BUDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-41-
Budget Narrative — 2003
Salaries and Friage
0.5FTE Outreach Worker/Case Ivianager (Vicki D.)
0.5FfE Ouueach Worker/Case Manager (Ashley 1VL)
0.09FTE PrograIIi Director (Joel L.)
Fringe Benefiu (aboui 18.5% of salaries)
Tota1 Salaries and Fringe
Supplies and Eapenses
Staff Travel ($136 mles per month X$0.345/mile)
Indirect Costs
A�miniairaTiOIl �� 1�/0�
Facilities (@ 5.5%)
Total Indirect Costs
BLJDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-42-
o t-qqq
G. Indirect CosY Allocation for MCHSP
Ptease check one of the four options:
❑ i. Not aQQlicable — No charges to MCHSP are for indirect cost_
❑ 2. IndirecY Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against alI
participating programs, including 1VSCHSP.
A signed agreement from covering the current Pederal fiscal year is attached.
❑ 3. Approved Cost Allocation Process:
Option 1 Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Govemments", and the Federal award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs are allocated to the agency's programs using the optional IndirecUCost
Allocation Worksheet on the foilowing page.
MCF3SP worksheets and supporting documents aze attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal award(s) for which they apply.
-43-
INDIRECT! COST ALLOCATtON WORKSHEET
t. Cost item included in tke indirect rate on this worksheer
Telephone, utilities, janitorial, irash, copier 2ease, maintenance, �n�„�.,ce, postage, accounting, annuai
audit, computer consultation, administrative staff
[Examples include rent, telephones, supplies, etc.]
2. Total cost of items in 1. to the agency: $608,168
3. The MCHSP share of the total cost is calculated through use of (check one):
./ a. MCHSP's percent of the total agency staff hours or full-time
b. MCHSP's percent of the total square feet of space occupied by the agency.
a Other — specifY:
and is in compliance with the requirements of the OMB Circulaz A-87 "Cost Accounting
Principles for State, Local, and Indian Tribal Govemments", and the
Federal award(s} for wfiicfi they apply.
4. Calculation of the MCHSP percentage:
rrograms operatea ny tne �ach program's statt, square Ye
agency. or other (circle the criteria you
aze using)
percent of the total (calculated to
the neazest tenth percent, e.g.,
5. MCHSP's proportionate amount: $17,028.70* only requesting $5,638,
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o1-�i99
MCHSP Application Update Narrative 2002-2003
West Side Community Health Services — Improving Pregnancy Outcomes for High
Risk Latino and Hmong Women in St Paul - 2002 - 2003
Goal— The goal of this project is to reduce low birth weight and infant mortality rates in
the St. Pau1 Latino and Hmong populations by providing outreach, tracking positive
pregnancy tests, performing prenatal risk assessments, providing prenatal education, and
coordinating prenatal care and follow-up. This project will supplement existing West
5ide Community Heakh Services (WSCHS) prograzns and staff. The West Side Health
Center (La Clinica�, McDonough Homes Clinic, and Roosevelt Homes Clinic offer
comprehensive health care services on a sliding fee scale. This project will give Latino
and Hmong families �eater access to a full array of services, including well child care,
immunizations, family planning, pazenting, and HNISTD services, as well as linkages by
referral to over 14 other community agencies.
Target Population — This project targets low-income (less than 200% of poverty) Latino
and Hmong teens and women in the following azeas of St. Paul: Riverview (CTs
342,361,310,371,372), Mount Airy (CTs 328,329,330) and Rice Street (CTs 305,314),
Our ciinics aze located in or near these CTs, and the CTs are part of our federally
designated scope of service azea. The majority of our prenatal patient population (85°la
Latino and 14% Hmong) live in these areas. During the grant period, we estimate that
730 Latinas and 120 Hmong women will receive prenatal care through our clinics.
Goal l— To reduce low birth weight and infant mortality rates in the 5t. Paul Latino and
Hmong populations.
MCH 2O02-03 priority:
Promote family support and healthy community conditions.
Objectives:
1. To reduce overall rate of late (third trimester or none) prenatal care among pregnant
Latinas and Hmong women and teens to 10 percent or less.
2. Increase the rate of prenatal care in the first trimester among pregnant Latinas and
Hmong women and teens to 60 percent or more.
3. Provide outreach, education and coordinated follow-up care for high risk pregnant
teens and women.
MCH 2O02-03 priorities:
Reduce teen preo ancy and teen birth rates.
Promote healthy parenting/family development.
-45-
MCHSP Application Updcrte Narrative
Methods:
Project staffwill do an outreach activity at least monthiy. Examples include "Baby
Showers" in tazgeted areas, health fairs, community events such as Cinco de Mayo,
and responding to media requests for interviews by locai newspapers and radio
stations.
2. Project staffwill conduct a series of Spanish-spealdng prenatal education classes
every two months focusing on nutrition, self-care during pregnancy, breastfeeding,
chiid caze and safety, and personal health issues such as family planning, HIV/STDs,
drugs and alcohol, and family violence.
3. Staffin clinic wilt follow-up on a11 positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health educarion
and support imervention, including home visits as appropriate, facilitate follow-up
with any outside referrals made, assisting with scheduling, transportatior� and
interpreting as needed.
Evaluation: Atl patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry irno prenatai care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
results compited annually. Patient satisfaction surveys are done annually, and
additionally, satisfaction with prenatal classes is measured via surveys after each session
is completed. Twenty-five (25) prenatal records are audiYed annually to measure rates of
compliance with prenatal risk assessment, postpartum visits, and newborn follow-up.
This information is reviewed by the Quality Improvement Management Committee
annually to identify and impiement improvement efforts.
Training/Eaperience of Key Staff: Over the past 25 years, staff have demonstrated a
unique abiliry to meet the heatth care needs ofLatinos and Hmong. In 2000, WSCHS
served 14,366 medicat patients, 60% of whom were Latino or Hmong. Services include
bilingual and biculhual staff, transportation through our van, bus or cab voucher, hospital
cue through Regions Hospital, in WIC clinics including immunization outreach,
assistance with Medical Assistance/Minnesota Care applications and enrollmern, and
outreach clinics and education programs in homeless shelters and public housing
developments. These services aze pmvided through a well-estabiished interdisciplinary
case management model. This model helps identify high-risk patients through screenings
and referrals, provides coordination of care, and ensures patientlfamily involvement in
care p anning an .
The perinatal RN health educators aze �cky Kramer and Tely Xiong. The perinatal
heaith educator, Doris Sanchez, is a medical assistant with specialized perinatal and
women's health training. All are bilingual and/or bicultural. Additional project support is
.�
oi-99y
MCHSP Narrative Update AppZication
Provided by Norma Atuesta, RN, nurse manager, and Mary Nesvig,l�ID, medical
director, and other clinical staff through the Perinatal Caze Program.
Linkages:
West Side Community Health Services works with the following organizations in
providing matemai and child health services:
-Regions F3ospital Family Practice Residency Training Program to provide cross-cultural
family medicine training for physicians motivated to work in medically underserved
settings.
-Saint Paul-Ramsey County Department ofPublic Health to assess community needs and
provide services addressing maternal and child heaith issues, behavioral health,
communicable disease, lifestyle/cancer, income/access to care, nutrition and WIC clinics,
and elderly health care.
-Combined efforts with 15 other community clinics to improve health outcomes for
underserved populations in joint efforts through Neighborhood Health Care Network
-Saint Paul Public Housing Agency to provide services, including maternal and child
health, on-site at McDonough and Roosevelt housing developments.
-City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facilities and five outreach sites, and eviction prevention services through the F3ouseCalls
program.
West Side Community Health Services provides comprehensive perinatal care through an
established nurse-midwife program. Any specialty medical caze needed is provided either
on-site or refened to the high-risk OB clinic at Regions Hospital.
Reimbarsement and Fees: A11 reimbursements through the Minnesota Department of
Human Services go directly to support services. Assistance is provided to enroll all
eligible women on Medical Assistance/Minnesota Care. A sliding fee scale is maintained
for those not eligible for assistance. Fees aze discounted incrementally based on family
size and income, from those at or below the poverry level paying nominal or no fees, up
to those exceeding Z00% of the poverty level paying full fees. Patients aze low income
and high risk. No one will be tumed away due to finances.
-47-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessme�t are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispariries impact your maternaVcltild population or what is the significance of
disparities to your population
-late enhy into prenaql care
-culmre and language bazriess to secvice
-increasing Latina teen bixfh raYe
-multiple, closely-spaced pregnancies
-new imudgrants
-growing STI/HIV risk in T atinac
3. Wliaz shategies will be utilized related to the above objecrives? Of pazticulaz inte:est are communiry and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decrease of disparities.
supports
on healthy fan�ily units
-include
.;
2. List specific MCHSP objecrives related to xaciaUethnic disparities.
0�-999
MCHSP Application Update Narrative
Budget:
WSCHS request $16,250 per year to supplement our existing perinatal progam. The
funds 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 — 2002
MCH Request
WSCH5 Match
.3 FTE RN health.educator
(624 hours at $17.54Jhr.)
2 FTE perinatal health educator
{416 hours @ $12.75lhr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
Year Two — 2003
3 FTE RN health educator
(624 hours @$17.54/hr.)
.2 FTE perinatal health educator
(416 hours @ $12.75/hr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
$10,946
5,304
$16,250
MCH Request
$10,946
5,304
$16,250
$236,000
124,800
$360,800
WSCHS Match
$236,000
124.800
$360,800
860 prenatal patients will be seen annually.
42 prenatal classes will be held annually, serving 420 patients and their family members.
86 highest risk patients will receive specific follow-up by the health educator.
An additional 250 teens and women will be reached annually through outreach activities.
There are no DHS or sel, f-pay reimbursements anticipated related to these supplemental
ttctivities.
-49-
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2002-2003 MCH Update Saint Paul - Ramsey County Department of Public Health:
Room 111—STD Services for Adolescents
Goal: Through accessible, confidenrial services to adolescent family planning clients regarding
education, detection and treatment of sexually transmitted diseases, decrease the number of
STDs, particulazly chlamydia and gonorrhea
MCH 2O02-2003 Priority:
1. Reduce youth risk behaviors
2. Increase percent of children who receive early intervention services.
Objective 1. To screen and provide education to 725 adolescents, 19 years of age and
under for sexually transmitted diseases - STDs during each CY 2002 and 2003.
MCH 2O03-2003 Priority:
1. Increase percent of childrett who receive eazly intervention services.
Objective 2. To diagnose and treat idenrified cases.
MCH 2O02-2f103 Priority:
1. Increase percent of children who receive eazly intervenrion services.
2. Reduce youth risk behaviors.
-51-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP appliqtion, addressing the following:
1. In whaz ways do racialletlmic dispazities impact your matemal/child population or what is the significance of
disparities to your population.
higttest rate of gaaorthea in the state. Compating the chlamydia rates of 73:100,000 wlutes to I,769:100,000 blacks,
540:100,OQ0 Americaa In�ians and 314:100,000 Asians, clearly shows the huge dispariry for this ane sexually
transmiued disease. The data aLso shows the lazgest number of cases of chlamydia xcurs in 0-19 year old
females. Gonorrhea in the same age group is the second largest group diagnosed.
3. What strategies will be utilized related to the above objectives? Of particulaz interest aze community and
systems stretegies/objectives wlrich recognize the potential role all types of community-based organizations can
play in the dectease of disparities.
many accessirnury oamers nave oeea removea xoom i i i is iocacen on or near au ma�or ous rouxes. inere u aee
pacldug behind the building. Room 111 has moming, attemaon and evening clinic hours. Clinic services are
offered on a walk-in basis. All Room 111 STD clinic and education services are provided on a donation basis. No
one is denied secvice due to inability to pay.
-52-
2. List specific MCHSP objecrives related ta raciaVethnic disparities.
o�-y�s
Room 111- STD Services
(As an extension of Family Planning activities)
2002 and 2003 MCHSP Crrant Budget 7ustif cation
Postion MCH Funds
CY 2002
Clinic Nurse:
Ptovides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
CY 2003
Clinic Nurse:
Provides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
C�iiiT�i3f��
$45,577
$45,577
Annual Salarv
$58,432
$58,432
-53-
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D►-999
The goals of Health Start's adolescent health program are essentially unchanged
over last year. One minor change is that we have set an overall goai of increasing clinic
visits by 5% rather than targeting males, as we have in previous years. Though we will
continue to focus particular efforts on reaching males, the majoriry of our outreach efforts
aze targeted to all students.
Goal l: The goal of the Adolescent Health Program is to promote good health and
reduce the incidence of unplanned pregnancy, poor nuhition/disordered eating,
depression, chemical abuse and family and relationship pzoblems among adolescerns in
Saint Paul by providing comprehensive health care services at seven high school sites and
two alternafive school sites within the city.
>
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 1: In CY 2002 and 2003, 3,300 junior and senior high students will access
health caze tbrough the school-based clinics each year.
MCH 2O02-03 Priority:
1. Increase percent of children who receive eazly intervention services.
2. Reduce youth risk behaviors.
Objective 2: In CY 2002 and 2003, a healthy lifestyle of physical activity and
healthy food choices will be encouraged by providing 1400 nutrition visits each yeaz
in the azeas of weight control, family plazuung and pregnancy nutrition, disordered
eating, and sports nutrition.
MCH 2O02-03 Priority: '
1. Reduce youth risk behaviors.
2. Increase percent of children who receive eazly intervention services.
Objective 3: Onsite social work counseling/therapy services wili be provided for
1,000 adolescents experiencing depression; chemical abuse; pregnancy; relationship
problems; physical, sexual or emotional abuse andlor oiher stressful conditions each
yeaz in CY 2002 and 2003.
MCH 2O02-03 Priority:
1. Improve mental health of children, youth and pazents.
2. Reduce child abuse and neglect.
Objective 4: Each year in CY 2002 and 2003 we will provide 1,100 teens with an
annual comprehensive preventive heaith exam and risk assessment, including sports
physicals and annual reproductive health exams.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Increase percent of children who receive early intervention services.
-55-
Objecfive 5: Comprehensive family pianning services will be provided £or 1,000
adolescents each yeaz in CY 2002 aud CY 2003.
MCH 2O02-03 Priority:
I. Reduce teen pregnancy and teen birth rate.
2. Reduce youth risk behaviors.
Objecrive 6: At least 1,000 adolescents will be tested for sexually transmitted
infections each year in CY 2002 and CY 2003.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 7: �munization status of studeuts who make visits with a Health Start
nurse practitioner/physician wi11 be assessed. Immunizations will be offered to all
students with incomplete series. Based on previous experience, we expect thai at
ieast 600 adoiescents wi1l be immunized each yeaz in CY 2002 and CY 2003.
MC$ 2002-03 Priority:
1. Promote family support and healthy community conditions,
2. Increase percent of childten who receive early intervention services.
Objective 8: Tobacco use will be assessed and addrassed for 3,300 students each
year in CY 2002 and CY 2003. Tobacco cessation help in the form of individual or
group programs will be availabie in all school sites for those wishing to quit
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
2. Reduce youth risk behaviors.
Objeciive 9: The number of visits to Health Start clinics will increase by 5% in CY
2002 and CY 2003. '
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
2. Reduce youth risk behaviors.
Objective 10: Members of Health Start's multidisciplinary team will provide health
education in classroom, clinic, and small group settings resulting in at least 10,000
educational encounters each year in CY 2002 and CY 2003. Topics will include
pregnancy and pazenting, nutrition, human sexuality, and smoking cessation.
MCH 2O02-03 Priority:
i. Promote family support and hea.ithy community conditions.
2. Reduce youth risk behaviors.
-56-
OI-999
D. Efforts to Reduce Racial Aisparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP application, addressing the following:
1. In what ways do raciaUethnic dasparities mmpact your matemaUchild population or
what is the significance of disparities to your population?
RaciaUeihnic disparities have a significant impact on adolescent caze. In addition to the normal stresses of
maturarion, adolescents of color mus[ also contend with dis 'm;nation They aze also more likely to
experience poverty and its sequelae, including hunger, inadequate housing, exposure to unhealthy
behaviors, and violence. The most common cause of death among teens of wlor is homicide (51.4%); this
compazes with 7.5% among white teens. Not stuprisingly, adolescents of color report mare emotional
dis�ess, including nerrousness, anxiety, discouiagement and depzession than white studenu. More than
half of Native American teens have thought of killing themseives. Black male adolescents are also faz moxe
likely to have a sexually transmitted disease than any other group; e.g. gonorchea rntes among Black males
15-19 aze 70 times that of White teens.
This combination of factors along with tbe normal tendencies of adolescents to engage in risk behavior,
presents challenges to adolescent heaith caze that Health Start's mulridisciplinary model is designed to
meet
2. List specific MCfiSP objectives related to raciaUethnic disparities:
The diversity of St Paul's mainstream public lugh school population is reflecied in the students served in
Health Start clinics. In 1999, 19.6°to of our school-based clinic clients were Asian Americans, 281% were
Black Americaus, 11.8°!o were Iiispanic, 2.2% were Native Americans, 31.7% were Eutopean American,
and 6.6% othex. The overall goal of ouc adolescent health pzogam is to promote good health fox all of the
adolescents we serve, As laid out in the MCH plan for adnlescents, this goal is achieved through meeting
specific objectives related to the nwmber of students receiving nutrition counseling, social work and mental
health services, reproductive health services including testing for sexuslly h�ansmitted diseases, prenaxal
caze and birth control. Objectives aze also set for assessing immunization status, tobacco use, and
participafion of students in health education programs. While these objec6ves do not have specific targets
for the various racial aud ethnic groups, they aze designed to focus on the spec�c azeas where health
disparities e�st.
3. What slrategies will be utilized related to the above objectives?
The core of Health Start's adolescent caze strategy is to overcome baxriers to caze by providing services
where adolescents aze---in schools. We perform reguiaz outreach activities in classrooms to let students
know we're there and we make it easy for them to register and receive caze. We hire staff who enjoy
adolescents and who inczeasingly reflect the diversity of those we serve. In addition to primary caze, we
offer mental health serrices, nuhition counseling and health education on site and at no cost to students or
their families. We address violence and discriurination duough peer mediation groups that teach students
better ways to handle conflicts, and respond to students' need for peer and adult support by establishing
support groups for those who shaze common concems, such as gay students, Asian students, or teen
pazents. Our emphasis on prevention and on teaching teens to bewme better health caze consumers is
designed to prepaze them to make good decisions about theu behavior choices and their health caze
throughout life.
-57-
HEAI,TH START, INC.
MAT'F.RN.�7..AND CBQaav HE.AI.TH
ADOLESCENT $EALTH SERVICES
SCHOOL BASED CLIPi[CS
JANUARY THROUGH DECEM$ER, Z002
MCNSBCO2
'ANNUAt PROGRAM PROGRAM MCH
CiNE ITEM EXPENSE SALARY r euo�er auos�r
NURSE PRACiiT10NER (CEN7RAL)
NURSE PRACATIQNER (COMO)
NURSE PRAC77TONER (HUM60LDn
NURSEPRAC7ITONER(JOHNSON)
NURSE PRACT1770NER (HAR�INU7
socua woexers tcenrnn��
SpCIAL WORKER (CAMO)
SOCIALNqRKER (HUMBOLLI"p
SOCIAL WURKER (JOHMSON)
SOCSAL WORKER (AGAPE7
MEDICAL ASSISTANT (CENTRAL)
MEDICAI /SSISTANT (COMO)
MFDICALl1SSISTANT (HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDIN(7a
MEDIC7LL ASSISTANT CAGAP�
nurnmontsr<cen�a�.)
Nurnmoeisr �coMO�
NuTamanisr�umso��r�
NU'fRITIONIST (lOHNSON}
NUTRITfO NIST (HABOING)
HEAI.Tti EDtICATOR (CEN7RAL)
HEALTH EDUCA70R (CDM03
HEALTFt EDUCATOR (Hl1MB0l,D'n
HEAiTH fDUCATOR (JOHftlSON)
HEAL7H EDUCA70R (HARD1NC7i
HEAI.TH EDUCATOR (AGAPt7
CUNICAL SFRNCES COOROINATOR
SUB-TOTAL SALARY
* annual salary based on 42 week school year
FRINGE BENEFITS @ 21.SoJ,
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
�
51,912
49,543
47,158
47,158
50,400
35,280
34,524
38,069
37,582
38,069
26,393
23,789
24.226
25,099
23,100
25,2aQ
4I,782
37,397
41,782
41,782
36,120
31,b51
40,354
35,549
35,549
35,5Q�9
4A,354
60,732
0.80
0.7Q
0.60
0.60
�.80
0.60
0.60
0.60
0.60
0.30
1.00
0.80
0.60
0.80
I.00
0.20
0.15
0.15
O.Z5
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
$ 41,530 $ 35,300
$ 34,680 $ 29,478
$ 28,295 $ 24,050
$ 28,295 $ 24,050
$ 40.320 $ 34,272
$ 21,168 $ -
$ 20,714 $ -
$ 22,84I $ -
$ 22,549 $ -
$ 11,421 $ -
$ 26,393 $ 22,434
$ 19,031 $ 16,176
$ 14,535 $ I2,355
$ 20,079 $ 17,067
$ 23,1a0 $ 19,635
$ 5.040 $ 4,284
$ 6,267 $ •
$ 5,610 $ -
$ 6,267 $ -
$ 6,267 $ -
$ 5,418 $ -
$ 4,748 $ -
$ 6,053 $ -
$ 5,332 $ -
$ 5,332 $ -
$ 5,332 $ •
$ 4,�35 $ •
$ 6,073 $ 3,037
$ 446,726 $ 242,139
96,046 $ 52,060
OI -45q
'ANNUAL PROGRAM PR06RAM MCff
LINEITEM EXPENSE SALARY cre auo�eT BUDGE!
CONTRACT SERVICE
FAMIIY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNOUNIVERSITYOFMINNESOTAFELLOWCLINICS/'NfC@$120X38WKS $ 9,SZO $ 9,120
FACE TO FACE
SOCIAL WORKER (HARDING)
$23,326
$ 23,326 $ -
$ 26,250 $ 19,688
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRI NTI NG/DUPLICATI NG
TELEPHONE
TRAVEVTRAINING
PATIENT TRANSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROVED INDIRECT COST RATE � 35%OF SALARY AN� BENEFITS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCtI1NG FUNDS � 25°J
-59-
$ 48,825 $ 36,619
$ 15,750 $ 12,600
$ 12,600 $ 10,080
$ 6,825 $ 5,204
$ I0,800 $ 8,64-0
$ 5,250 $ V 4,200
$ 2,100 $ ✓ 1,680
$ 703,618 $ 402,030
189,970 102,970
$ 893,588
$ 505,000
$ 223,397
�ai.za sT�T, nvc.
Nra�rExrrai, nivn c�.0 �ai.�rs
ano�scnrr �ar.'rs sExxvicEs
SCHOOL BASED CLINICS
JANUARY THROUGH DECEMBER, 2003
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
LINE ITEM IXPENSE SAUIRY RE BuoGEr suo�ei
NURSE PRACTITIONER (CENTHAL)
NURSE PRAC7ITIONER (COMO)
NURSE PRACi1TONER (HUM80LDn
NURSEPRACTITONER(JOHNSON)
NURSE PRACTiTIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI. WORKER (CAMO)
SOCIAL WORKER (HUMBOLD'n
SOGALWORKER(JOHNSON)
soau woRxex cncaa�
MEDICAL ASSISTANT (CENTRAL)
M miCAl ASSISiANT (CAMO)
MEDICAL hS5I5TANT (HUMBOLDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISiANT(HqRDING)
MEDICAL ASSfSTANT CAGAP�
Nurrtmorvisr <cennrnn��
nurttmorvisr�coMO>
NUTRITIONIST (HUMBOLDn
NUTRITIONIS7 (JOHNSON)
NUTRITIONIST (HARDING)
HEALTft mUCATOR CCENTRAL)
HFALTH EDUCATOR (COMO)
HEALTH EDUCATOR MUMBOLDn
HEAITH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARD�NG)
HEALTH EDUCATOR (AGAP�
CLINICAL SFRVICES CAORDINATOR
SUB-TOTAL SALARY
• annual salary based on 42 week school year
FRINGE BENEFITS @ 215°J
MCHSHCO3
•ANNUAL PROGRAM PROGRAM MCN
53,469
51,029
48,572
48,572
51,912
36,338
35,560
39,211
38,709
39,2I1
27,185
24,502
24,952
25,852
23,793
25,956
43,035
38,5I9
43,035
43,035
37,204
32,601
41,564
36,615
36,615
36,615
41,564
62,554
0.80
0.70
0.60
0.60
0.80
0.60
0.60
0.50
0.60
0.30
1.00
0.80
0.60
0.80
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
Q.10
0.10
$ 42,775 $ 36,359
$ 35,721 $ 30,363
$ 29,143 $ 24,772
$ 29.143 $ 24,772
$ 41,530 $ 35,300
$ 21,803 $ -
$ 21,336 $ -
$ 23,527 $ -
$ 23,225 $ -
$ 11,763 $ -
$ 27,185 $ 23,107
$ 19,602 $ 16,662
$ 14,971 $ 12,726
$ 20,682 $ 17,579
$ 23,793 $ 20,224
$ 5,191 $ 4,413
$ 6,455 $ -
$ 5.778 $ -
$ 6,455 $ -
$ 6,455 $ -
$ 5,581 $ -
$ 4 $ "
$ 6,235 $ -
$ 5,492 $ •
$ 5,492 $ -
$ 5,492 $ -
$ 4,156 $ -
$ 6,255 $ 3,128
460,128 $ 249,4-04
�.SI�
$ 98,928 $ 53,622
CONTRACT SERVICE
fAMtLY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNO UNIVEf2SIN OF MINNESOTA FELLOW CLINICS/W!C Ca} $120 X 38 WKS
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIEI�T CARE
L460RATORY SERVECES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRIN7ING/DUPLICATING
TELEPHONE
TRAVELlTRAINiNG
PATIENT TR4NSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROYED INOIRECT COST RATE @ 35^J OF SAIARY AND SENEFTTS
TOTAI PROGRAM BUDGET EXPENSE
TOTAL MCH GRANTBEQUEST
MATCHING FUNDS Q 25�
$23,326
$ 9,120 $ 6,&40
$ 23,326 $ -
$ 26,250 $ 18,375
$ 48,825 $ 34,17$
$ 15,750 $ 11,025
$ 12,600 $ 8,820
$ 6,825 $ 4,778
$ 1Q,800 $ 6,756
$ 5,250 $ 3,675
$ 2,100 $ 1,470
$ 719,901 $ 398,941
195,669 106,059
$ 915,571
$ 505,000
$ 228,893
-61-
G. Indirect Cost Allocation for MCHSP
Please check one of the four options:
� 1. NoY applicable—No chazges to MCHSP are for indirect cost.
� 2_ Indirect Cost Rate Agreemeut — A Federal negotiated fixed rate is to be chazged against all
pariicipating programs, includingMCHSP.
A signed ageement from covering the current Federal fiscal year is attached.
� 3. Approved Cost Allocation Process:
Option 1 Indirect costs aze allocated to the agency's pmerams using worksheets developed by the
agency for this purpose.
Agency worksheeYs and supporting documents are attached which aze in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principies for State, Locat,
and Indian Tribal Govemments", and the Federai award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocaiion Process:
Option 2—Indirect cosfs aze ailocated to the agency's pmgrams using the optional IndzrecUCost
AIIocation Wotksfieet on the Following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Govemments", and the Federal awazd(s) for which they apply.
�Y�
. ..
���
Y * DEPARTMEP7T OF HEALTH & HUMAP7 SERVICES
Y �
�;� �+m
Raymond J_ Martin, Jr.
Sxecutive Director
Health SCart
491 We5t University Avenue
St. Paul., MN 55203-I936
Dear Raymond Martin:
February" 6, 2001
�"�m �en� Cmtc
Fimv�l Mam�� �rice
Dimion o[ Cat Apacauoy
Cenhal States Fefd ��
730'i Young Stree; Room 732
6aVias Settas 75202
(214)-767-325t
FAXX (Z'
The original an� one copy of an indixect cost Rate Agreement
are enclosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concerning
t2ie rate(s) that may be used to support your claim for indirect
costs on granCs anti contracts with the Federal 6ovemment.
Piease have the original signed by an authorized representative
of your organization and .return it to me, retaining the copy
for your files. We will reproduce and distribute the Agreement
to the appropriate awarding. organizations of the Federa7.
Government for their use.
An indirect cost proposai, together with supporting information,
is required each year to substantiate claims made for indirect
costs under grants and contracts awarded by the Federal Government.
Thus, your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation.
Enclosures
sincerely,
S
\
Merl M. Schmidt �
Director
Division of Cost Allocation
Central States Field Office
P7�EAS$ SIGN AI3D RETURN TFiE ORIGINAI, OF THE RATE AGREEMENT
or-�y9
��
a
NOHPROFIT R8T& AGREEt�NT
SIN #: 1411577621AI DATE: February 6, Z001
ORGANIZATION: FILING REF.: The preceding
Health Start Agreement was.dated
491 West IIniversity Avenue NONB
St. Paul NIl�7 55103-1936
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Government, subject to the conditions in Sectioa III.
RATS TYPSS= FIBfiD PINAL
$FFECTIZTE PERIOD
TYPS FROM TO
PROV. O1/OI/O1 12/31/O1
PROV. 01/O1/02 IIxTxI, AN�rm&D
x
PROV.{pROVSSIONAL
PRSD.(PRSDSTBRMIN%D)
RATB(%) LOCATIONS APPLICABLB TO
35.0 On-Site A1Z Programs
IIse same rates and conditions as those cited
for fiscal year ending'December 3Z, 2001.
* sASS :
Direct salaries and wages including all fxinge benefits_
.�
.,
Health Start
A
AGREEMENT DATE: February 6, 200Z
�(-959
SBCTION II: SPECIAL RSMARKS
TRSATMFiNT OF FRSNGS B&NBFSTS
The fringe benefits are chazged using a rate(s). Over/under recoveries from actual costs
a=e adjusted i.n cuxrent oz futuse periods. Tfie directly claimed fringe henefits are
listed below.
TREATMENT OF PAID ABSENCES_
vacation, holiday, sick eave pay and othe= paid absences ase included in salaries and
wages and are claimed oa grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the cosCS of these paid absences are not
made.
Equipment nefinition -
Equipment means an article of nonexpendable, tangible personal property having a ssse£ul
Iife of more than one yeax and an acquisition cost of $1,000 ox more per unit_
FRINGfi BENEFITS:
FICA
Retirement
Disability Insurance
Worker�s Compensation
Li£e Insurance
Unemployment Insurance
Health Insurance
-65-
4 +
ORGANIZATION:
Health Start
AGRSEMENT DATS: February 6, ZdOI
A_ LIMITATIONS
The ratea ia Ghis Agreemeu[ are avbjeet Lo a¢y atatutoxy or a�➢ninis[satioe Iimitations aad app2p to a given graat, con[ract or
oCher agreement oaly Go the ex[ent tDat fimds ate available. Acceptance of tlae rates is subject to the follooriag conditioasa
(1) Oaly coats fneurzed by the oxganizatioa were included in 3ts indireet rnst pool as finally accepted: aucII cos[s are legal
obligatioas of the orgaaizatioa aad aze allovable vndex the govexniag mst prineiplea; (2) The same eoats that Dave be¢n ueated as
indirect cos[s aze aoG elaimed ae direct coats; (3) Similaz typea of rnsts have beea accorded coasisteat accomting trea[men[; and
(4) TIIe iafo�atioa provided by Che or9aaizatioa vhieh was used to esiablieh tIIe rates is no[ later found to be matezially
incomQleCe or inaccurate by Che Pedexal Gover�eat. Ea suvi sitvations Ghe rate(s) would be subject to xenegotiatioa at the
discreiion oE tDe Federa2 Goverm�eat.
B. ACCOiRi:fIHG �fNGSS
This Agreement is based on [he accdnntim3 system pisported by the organization to Le ia effeet duriag ihe Agseement periad. CEanges
Co the method of aceouaCiag foz coats vhich afEe<t Che amount of reimbuxsement resulting from the use oE this Agreement zem•;Te
prior approval of the authozized xepreseataCive of tEe co9nizan[ agency_ Sich ehayges inelude, but are aot limited to, cLaages ia
the ^*�+�ing of a paxtieulaz type of croat fxnm iadixect to d3reet. Pail�e to obtain appioval may result in rost disalloxaaces.
C. PIZLD RATES �
if a fued rate ie in this A9reement, it is based on aa eati�te of the rnats fo= the period cavezed by the rate_ 9ihea the a<tval
rnsts for Ghis period are de[ermiaed, an adjustment vi1l be made Co a rate of a futvie year(s3 to compeneate for the d3ffezeaee
between tIIe coste used to establiah tEe fiaed rate aad actval coste_
D. V58 HY OTHEti PED%RAL AGENQBS
The ratee in this Agreemeat were appTOVed in aernsdance aith tIIe authoritp ia office of Ma�gemeat aad Sndget CixCalai A-122
Circular, a� should be applSed [o grants, coatxaets aad otEer agree�ats covesed bg this C$zevlar, svbjeci to avy limitatioas in A
above. The oxgaaitation may provide copies of the Agreement to other Pederal Agesscies ta give them early aotifi<aGioa of tIle
ngreemest.
E. OTHE.¢.: •
Zf aay Pedezal contract, grant or other agzeemeat is zeimbursiag indirect msts by a means other thaa the approved zate(s) ia this
A9reemeat, [La oxganizatioa ehonld (i) cxedit snch crosts to the affeeted pxo9rams, and (2) apply the appzoved rate(s) to [he
appxopria[e base to identi£y the proper amouat of indireet costs alloeable to tlaese programs.
BY T88 OR(�1NIZATSON:
$ealth Staxt
- .. _ Y:� Y�� a�.._ �l•! �r� �
lORGANIZATION) .
���,,.,,,,( J�' f'la,�. �•
(sx 1 •
_ RA`fNouo s_ rtAa=iv. i�
t��
Ex�G�l�f�vr ��REC,'Cb�2
(TSTI.B)
.
�_<__ . / � ti_ �'!�
Mer7.e M. Schmidt
tm��
DSRECl08, DIVISIOS OP COS? ALLOC}STSOA-
(TITL8) CSlITRAL STATES PZELD OFPIC3
fl]AT8)
PebxuasV 6. 2001 � ... .. _.. __�.����
I11AT8) 5]36
�s *+�s�**Txos: MY (RObert ) N�. N4uYen
Telephoae- �2�.4T 767-3267
�T�
D�
4: ca��iu+�rea��
e entrn rnn.cFari� "
CHS PROGR.4M PLAN: Communicab�e Disease Prevention and Controt Common Acthirties Framework 57
01-9 �y
State and Local Pnblic Health
Communicable Disease Prevenrion and Control
Common Activities Framework
PREAMBLE
S/I7/OI
This Framework lays out a minimum set of disease prevention and control activities that are
to be carried out by all local public health agencies and the Minnesota Department of Health.
Background: Infectious disease prevenfion and control (DP&C) includes activities of deteeting acute
and coznmunicable diseases, develaping and implementing prevention of disease transmission, and
implementing control measures during outbreaks. Controlling communicable diseases is perhaps the
oldest and most fundamental public health responsibility. For decades, it was the primary responsibility
oflocal Boards ofHealth and, in fact, the main reason for their creation. Yet, the Local Public HealthAct
(Chapter 145A) and the Department of Health Act (Chapter 144) are ambiguous about respective state
and local authorities for conducting disease prevention and conirol acrivities.
Subdivision 6 of the Locai Public Health Act states, AA board of health shatl make investigations and
reports and obey instructions on :he con�ol of communicabie diseases as the commissioner may direct
under section 144.12, 145A.06, subdivision 2, or 145A.07. Boards of health must cooperate so faz as
practicable to act together to prevent and control epidemics."
Note that this is a requirement oflocal boardr ofhealth whether ornot theyforn� a CommuniryHealth Board or receive
the CHS subsidy.
While intended to allow for fle�bility and varied capacity to address communicabie disease problems,
such broad direction leaues ambiguity anduncertainty abouttherespective roles of state and local public
health. Clearly, both the 2viinnesota Department of Health (MDI-� and local Boards of Health have
assumed a shared responsibility for conducting public health activities.
In 1989, the NIDH DP&C Division and the State Community Health Services Advisozy Committee
(SCHSAC) formed a workgroup to review roles and responsibilities for conducting DP&C activities at
the state and locallevel. The outcome was a DP&C Acooperative agrcement� that formalized some of
1VIDH relationships with local public health
Communicable DP&C Common Activities FYamework: In 1996, another SCHSAC workgroup was
formed, which abolished the old agreement and redefined expected roles and responsibilities for DP&C.
The final report of the workgroup was released in 1998. T1us report, which was
approved by SCHSAC, set standards for DP&C activities to be carried out at the state and local level as
contained in the initial version of the Communicable DP&C Framework of Common Activaties. This
� lays out a miriimum set of DP&C activities that are to be carried ont by ali local public
health agencies and MDH. These activities are to be reflected in state and local community heakh
service (CEIS) plamung efforts. Those agencies that aze currently unable to cazryout these activities are
expected to strive to reach this level. MDH activities listed in the Frunework are to be implemented by
2
MDHInfectiousDiseaseEpidemiologyPreventionandConirol (IDEPC) Division staffinsupportoflocal
public heatth agency DP&C activities. 'I'his Framework also lists DP&C activities that are conducted
joinUy by MDH and local public healYh agencies.
The 1998 version ofthe Framework atso Iisted suggested activities for private heattEi care providers and
health pl�s in support of DP&C pubfic health efforts. The Fraznework as revised (May 2001) focuses
on local public health agency and MDH DP&C activities. Additional discussion with health caze
pmviders and health plans is being planned by the DP&C Leadership Team to detemiine ways they can
support DP&C activities. These activities will then be included in ffie Framework.
The Framework may be used as the foundation for a DP&C workplan for boffi MDH and locai public
health agencies. Yet to be determined is how Iocal public health and 1VIl7H can measure their pmgress
in maintauring and improving DP&C activities as contained in the Fraznework.
DP&C Leadershin Team: Anotherrecommendalionto enhanceffiepartnetship between state and local
public health for disease prevention and control that was made by the SCHSAC workgroup in the 1998
report was to create a DP&C I.eaderslup Team. '
Tfus Team is made ofinembers represenkingregionat andjob specific categories from iocalpublic health
agencies, arepresentative fromeachofthesectionswitUinthe IDEPCDivision, asweIl asarepresentative
from the MDH Community Heatth Services Division. The DP&C I.eadeiship Tea�n meetings are
urtended to provide an ongoing fomm for the review and discussion of how DPBzC activities are
implemented at the state and local leveL The Team meets about five times a yeaz: One co-chair
represents local public health; the other co-chair represents MDH.
TheDP&C Leaderslup Teamwill review the Comcnunicable DP&C Fremework ofCommon Activities
at least everytwo years (in conjunction with the CHS planning cycle} for anyneeded revisions. The next
review will need to be completed by January 2003, in prepararion for the development of locai pubfic
health 2004-2007 CHS Plans.
Recowmendations and updates are brought back to the Commissioner ofHealth and to the SCHSAC as
necessary.
MDH attd locai heaith departments have worked together to carry out the DP&C activities contained in
theFramework,initiallythroughpilotprojects. ToensurethesuccessoftheFramework,t�ainingsessions
aze being held statewide to review the Framework with all locat public health and Ivff)H DP&C staff.
In these sessions participants share ways to enhance the collaborative relationship between MDH and
local agencies.
K:1Xoshare�I.EADERSA1Framework\preamble-Snaiframeworic-wordperfectwpd
01-9 y9
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CHS PROGRAM PLAN.' Minnesota Department of Helath Subsidy Applica6on Forms 59
O/" g�9
CHS Subsidy Application Cover Form
Plan Update Cycle 2002-2003
Name of Community Health Board: Ramsey County Community Health Board
Subsidy Request (including core fnnctions fnnding):
2002 CHS 2003 CHS
Subsidy Request Subs R
Totat Commnnity Health Soarfl 2,195,000 2,195,000
CHS Administrator:
Name: Rob Fulton, Saint Paul-Ramsey Counry Departrnent of Public Health
Address: SO West Kellogg Boulevazd; Saint Paul, Minnesota SS 1 Q2-1657
Fiscal Management Officer:
(This is the person and agency to whom the CHS Subsidy check should be sent)
Name: Julie Kleinschmidt, Director, Budget and Accounting, Room 270 Court House
Address: 15 West Kellogg Boulevard; Saint Paul, Minnesota 55102
��nutes\CASPSan2001Update\Sub:idyApplicationForms\SubsidyUpdateCoverFotm\Updatesubsidy app Update Cover fomu.doc
I¢dividual County Breakdowns
2002 - 2003 Update Assurances and Agreements
$Y SIGNATURE, 'I'HE ATJTHORiZED OFFICIAL AGREES AND ASSURES THAT:
1. Services will be provided in accordance with state and federal laws, rules and policies.
2. The Community Health Boazd will comply with state and federal requirements for equal opportunity employment,
3. The Board will comply with staYe and federal requiremenu relating to data privacy or confidentiality of pxotected
information.
4. The Board will provide the Minnesota Department of Health with information referenced in the CHS plan where
applicable.
5. Standards for programs or activities will be used in carrying out affected programs or acrivities where those
standazds exist
6. The requirements for fiill community participarion, as defined in Minnesota Rules 4700.1800, have been met.
7, The Community Health Advisory Committee {or Health Task Force of any Human Services Boazd Advisory
Committee in the wunty where applicable [Minn. Stat. 402.03]), shall meet the composition and reporting
requirements of the Community Health Services Advisory Committee required by Minnesota Statute.
8. The Board will comply with all standards relating to fiscal accountability that apply to the Minnesota Department of
Health, specifically:
A. The local match identified in the budget submission complies with the definition spec�ed in Minn. Stat.
145A.13.
B. The Boazd will submit plan and budget revisions to the Commissioner for prior approval in accordance with
applicable statute, rule, and MDH policy.
C. Reports will be filed with the Commissioner of Health in accordance with applicable statute, rule, and MDH
policy.
D. The Boazd will maintain a Financial Management System that provides:
I) Accutate, current, and complete disclosure of the financial results of each activity.
2) Records thaz idenrify adequately the source and applicarion of funds for subsidy supported activiries. Tfiese
records shall contain information pertaining to subsidy awards and authorizations, obligations, unobligated
balances, liabiliries (encumbrances), outlays and income.
3) Demonstration that the Board has effective control over the accountability for all funds, property and other
assets.
4) Comparison of actual obligations with budget amounu for each activiTy.
5) Accounting records that aze supported by source documentarion.
a�e..by-ar a*.�,rh�direction of the Boazd or the Depar[ment of Health. CHS fmancial
records will be retained unril audited, with the following qua i ca o.
i) The records will be retained beyond this period if audit findings have not heen resolved.
ii) Records for non-expendable property, which was acquired with subsidy funds, will be retained for three
years after its fmal disposirion.
S:N�Iinutes\CHSP1anZ001Update\SubsidyApplicazionForms�AssurancesAndAgreements\UpdateAssurances and Agreemenu.doc
o t-99q
2
2002 - 2003 Update Assurances and Agreements Continued
9. The Boazd will maintain records of the followiug materials for review for the durarion of the Plan. [Note: This does
not preclude other requ9remenu stipulated in the Community Health Boazd's retenrion schedule.]
A. Copies of the Joint Powers Agreement forming the Community Health Boazd.
B. Agreements establishing a Boazd of Health or Boards of Aealth within the azea of the Community Heakh Boazd.
C. Organizaflon chart of the Community Health Boazd structure that idenrifies major program activities, advisory
groups, and lines of authority and accournabIlity.
D. A list oF all city/county local ordinances or other local regula6ons related to community health services revised
within the past two years.
E. Copies of all public meeting notices and minutes.
F. General roster for community health service mailings.
G. Community Health Services Advisory Committee bylaws, meeting norices, minutes and attendance records.
H. Summary of public comments or testimony on the proposed Plan.
I. Copies of conhacts/purchase of service agreements with other organizations.
J. Env'uonmental Heaith, Disease Prevention and Control, and other ageements to exercise the Commissioner of
Health's authority.
Application is made for a subsidy under the provisions of the Local Publlc Health Act in the atnount and for the purposes
stated herein. The Community Health Boazd agrees to comply with conditions and reporting requirements consistent with
applicable Minnesota Statute and Rule.
* SIGNATURE:
TITLE: D'uector of Public Health
DATE: 7 Z�,O�_
*This form must be signed by the Chair or Vice Chair of the Community Health Boazd, or an agent appointed by resolution
of the Community Health Boazd. If signed by an agent, the resolution or motion appointing that agent MCTST be attached for
this subsidy application to be approved.
S:1Minutes\CI-ISPIan200SUpdate\SubsidyApp(icazionFocros�ASSUrancesAndAgreements\UpdareAssurances and Agreements.doc
2002 - 2003 Update Adminis#rative Requirements
This record is to assure that the Community Health Board has addressed the admmish�arive requuements of
the Local Pablic Health Act and its Rules. This form shou[d be completed for the Community Health
Board onlq, not for individual counties. Please answer the following questions.
1. How many members aze there on your Community Health Board?
2. When did your board(s) of health meet during the past year? List the meeting dates.
4. Does your board keep a public record? X Yes No
5. Does your Coxnmunity Heaith Board employ a Medical Consultant? X Yes
Please list the name, address, and telephone number of your medical consultant:
Dr. Neal Holtan; Saint Paul-Ramsey County Department of Public Health; 555 Cedaz Street; Saint
Paul, Minnesota; 55101 Telephone: (651) 292-7713
6. Does your Community Heatth Board have an Advisory Comrnittee? X Yes
How many members does it have? 23 available membeiship positions
Briefly describe on what basis members are appointed (e.g., geographic representation,
provider/consumer, special interest, etc.).
Ten members appointed by the city of Saint Paul. Thirteen members appointed by the Ramsey
County Boazd of Commissionezs_ Each county commissioner appoints one person to represent them.
Six other persons aze appointed to at-lazge seats using the Ramsey County appoinhnent process.
Two of the twenty-three members aze labor representatives who have public health eacperience, one
selected by tha county boazd as one of its thirteen representatives and one selected by the city of
Saint Paul as one of its ten representatives.
7. Does your advisory committee have bylaws or
8. Does your Update describe the process used to encourage full community participation in the
development of the Update? X Yes _ No
S:�Sinutes\CHSPIan2001Updaze�SubsidyApplicationFo�msWdminisuativeRequirementsFOrUpdaze\UpdateAdminisazuve Requirements.doc
3. Does your boazd have written procedures? X Yes No
al-9yy
2001 Update Administrative Requirements Continued
a. Was written notice of the inifiation of the Update development process made to interested
persons, including affected providers, consumers, and locai govemment officials?
2
X Yes No
b. Did this notice include the procedures by which persons may participate in the Pian development
process?
X Yes No
c. Did thi s notice describe how interested persons may obtain a summary of the proposed plan and
how they may review the entire proposed plan?
X Yes _ No
d. On what date(s) was this notice sent to interested persons? 12/16/99
Y
e. Was this notice published in a local newspaper?
Which newspaper(s)?
Newspaper(s) Name
Saint Paul Pioneer Press
Date Published
1( 24((Ol
Saint Paul Pioneer Press
5/13/Ol
X Yes _ No
Copy on file? X Yes , No
Copy on file? X Yes , No
Copy on file? ^ Yes _ No
f. Does your boazd maintain a general mailing roster?
If so, does it contain:
Providers
Consumers
Local Govemment Officials
g. Was notice sent to people on the general mail3ng roster?
9. On what date was the Update available for public review? 5/13/O1
X Yes _No
X Yes _ No
X Yes No
X Yes ^ No
10. On what date was a summary of the Update available to interested persons? 5/21/0
X Yes � No
11. On what date(s) were public meetings held? 6l13/O1
, S:Vvlinutes\CHSPIan2001Update�SubsidyApplicationFottn544dminisValiveRequirementsFofUpdale\UpdateAdministrative Requirements.doc
2001 Update �Idministrative Requirements Contirrued
12. On what date did the Community Health Boazd approve the Update? (Attach meeting mitnutes
andlor resolution):
13. On what date(s) did the County Board(s) approve the Update? (Attack meeting minutes and/or
resolution):
14. On what date(s) did the County Boazd(s) approve the yeaz 2002 CHS budget? (Aitach meeting
minutes and/or resolution): Ramsev Countv Boazd to be approved December, 2001
NOTE: If County Boards have not yet approved ihe budgei, you must subm?i a signed copy of the
budget, along with meeting minutes and/or resolution, no later than January 31, 2002.
3
15. Have you attached a copy of the budget for each of the last two years in the planning cycle (2002-
2003) for each county in your CHS agency? (Subnnitting a combined form for multi-county agencies is
not required, but is recommended.)
2002 X Yes No
2003 X Yes No
16. Have you attached a copy of the staffing form for each of the last two years in the planniug cycle
(2002-2003) for each county in your CHS agency? (Submitting a combined form for mulri-county
agencies is not required, but is recommended.)
2002 X Yes No
2003 X Yes No
Signatnre
CHS Administrator
Date: � 0
S:�Minutes\CHSPIan2001Update�SubsidyApplicationFomssWdministrativeRequiremen[sForUpdaze\UpdateAdministrauve Requirements.doc
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�� Saint Panl - Ram sey County
� Departm ent of Public Health
: \� � Rob Fulton, Director _ _ __
xamccrcoums
50 W. Kellagg Blvd. SYe. 930
gyint pauL, � 55102
651-266-2400
Julq 19, 2001
Community Health Services Administration
Munesota Department of Heaith
To Whom It May Concern:
According to the CHS Subsidy application instructions we must verify the eacgected approvai date
of our Community Health Services budget if that budget wi}1 not be approved by our Board prior
to the October 31 deadline for submitting our CHS subsidy application to the Minnesota
Deparnnent of Health. The purpose of ttris letter is to comply with that requirement.
Tfie Ramsey County's Community Heatth Services budget to be approved by Deceinber 31, 2001.
Sincere ,
Robert Fulton, Duector
Saint Paul-Ramsey County Department of Public Heakh
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Council File # �y��!
Green Sheet # 11365�„
Presented by
RESOLUTION
CITY OF SAINT PAUL, MINNESOTA
�O
Referred To Committee Date
1 WHEREAS,thecityofSaintPaulandRamseyCountythroughtheSaintPaul-RamseyCountyDepartmentofPublic
2 Health aze required by Statute to prepaze a Community Health Services Plan and Update for that plan (CHS Plan
3 Update) to receive a Community Health Services subsidy; and,
4 WHEREAS, the 2002-2003 CHS Plan Update was deve]oped by the Saint Paul-Ramsey Count7 Departsnent of
5 Public Health Services Advisory Committee with input from the community; and,
6 Wf�REAS, the 2002-2003 CHS Plan Update and a summary of that Update were made available for public review
7 and comment and the public was notified of that availability; and,
8 VJHEREAS, the Maternal and Child Health Special Proj ects Grant — Saint Paul: 2002-2003 Update Applicarion is
9 required to be submitted to the Minnesota Depariment of Health by the Saint Paul-Ramsey County Department of
10 Public Health and is attached to the CHS Plan Update; and,
11 WI3EREAS, the Community Aealth Services Plan must be approved by the City Council as outiined in the Public
12 Health Joint Powers Agreement; now,
13 THEREFORE BE IT RESOLVED, that the City Gouncil accepts for submission to the Ramsey County Boazd for
14 their apporval and submission to the Minnesota Department of Health the 2002-2003 CHS Plan Update and the
15 Saint Paul Maternal and Child Aealth Grant.
Requested by Department oL
Adoprion Certified by Council Secretary
sy: ''��.^� , -f�.`� _ _ t —
Approved by Mayor: Date �� � LiA3� (
By: �'C�� I
�
Form Approved by City Attomey
�
Approved by Mayor for Submission to Council
�
Adopted by Council: Date �,� �_ � C7 ��
Council
RSON & PF10NE -
�����
GREEN SHEET
o�.qt'1
Council President BosCxom
iT BE ON COUNCILAGFNOA BY (OA7E1
�t. 20, zooi
TOTAL # OF SIGNATURE PA6ES
o[.M,renonFZrorz
No 113652
arv�
❑ CRYAiTGUEY ❑ fJIYpiR1I
❑ AU11L'lM.iERYKFJOYt ❑ R1M1q11L1ERll/1CCTG
❑wroR�oRwsmriu+n ❑
(CLIP ALL LOCATIONS FOR SIGNATURE)
Accepting the 2002-2003 Community Health Services (CHS) Plan Update and the SainC Paul
Maternal and Child Health Grant for submission to the Ramsey County Board for their
approval and submission to the Minnesota Department of Health.
s
PIANNING COMM.tSSlON
CIB COMMI'fSEE
CIVIL SERVICE COMMISSION
f13_1:S Z���
Hasthis Ce«�K� arerwaked under a conhact for thia tlePa�menli
YES NO
Has �is pemoMrtn ever been a atY emDloYee7
YES NO
Dces fhis Pe���� P� a s1a11 r� namallYP�s¢tl bY any artent citY emWoyee7
YES DEO
Is this pe'soNfirtn atarpeted venEO�
YFS NO
OF TRANSACTION S
SOURCE
COSTfliEYENUEBUDGETED�CIRCLE ON�
ACTNI7Y NUMBER
YES NO
(��M
Saint Paul - Ramsey County
Department of Pnblic Health
Ro b Fult Di recxor
4 � -'L°�°1
50 W. Kell6gg 81vd.. Ste. 930
Sairct Pau{, Minr�esota 55102
651-266-2400
l'o: Saint Paul City ncil
From: Robert Fu4ton �
Jane Norbin` �'
Re: Updnte of the 2002-2003 Community Heafth Services Pfan
Llate: September 11, Z001
The Pubfic 1-le¢Ith Joint Powers Agreement requires City Councii approva) of
Community Health Services Pians (Pian/s) nnd their updnfies. The state requires new
Plans every four yenrs and updates every two years. We now seek Counci! approval
of the update to the four-yenr Pian approved by the Council in 1999 (n draft
resolytion a►id Update nre attrsched for your convenience). The Update must next
be npproved by the Ramsey Courity Board and fihen be subm'rtted to fihe Minnesota
Department of Henith by October 31�' of this year.
No new community health problems arose during the update process. Some of the
P1nn's strategies, however, were upda#ed to reflect the P1an's progress and recent
enhancemeofis of the public health operafiing environment, The enhancements
include n minority health grant; Temporary Assistance to Needy Families; Youth Risk
Behavior Endawment 6runt nnd the Adolescent Parenting Program.
�inally, the Ptan incorporates the Maternai and Child Nealth 6rant-Snint Paul:
Z�Q2-2Q03 Update Application.
To develop the Update, the Saint Pnul-Ramsey County Dapar#men# of Public Hea4th
(SPRCDPH) obtained input from staff and the community through a vuriety of
methads, including:
1. Update and analvsis of CHS Plan data.
2. Department-wide review of CHS Proarum Plan strntegies.
Q1-999
September 11, 20Q1
Update of the 2002-2003 Communi#y Health Services Pian
3. Pubiic Notices Public notice of the initint+on af the Update process was
published sn the Saint Paui Pioneer Press in 3anuary 20Q1. Another notice was
published May 13, Z041 ta inform 1'he public of when drafts of the Updnte would
be availabie for inspection. Posi�cards with the newspaper nofiice informatian
were also mnited to the genera! mailing 3ist of the SPRC�PH. A summnry of the
Update has afso been nva+lable on the SPRCDPH World Wide Web site.
4. Public Meeting nnd meetinq of i'he Saint Paul-Ramsev CountY Eommunitv Heatth
Services Advisorv Commififiee. A pubiic meeting was he}d i» conjunction with the
Saint Paul-Ramsey County Commun+ty Healfih Services Advisory Comrnittee
meeting, on June b 200i. The Adv+sory Committee and the public provided
feedback on the Update.
Thank you.
Attnchments:
Draft City Counc+l Resalution
CNS Pian Update Summary
CHS Plan Update
Maternal nnd Child Heai#h Special Pro jecfis Grant - Saint Pnu1:2002-2003 Update
Application
Saint Paul - Ramsey County
Department af Public Health
Rob Fulton, Director
o � -���
50 W. Kellogg Bivd.. Ste. 930
Saint Paul, Minnesota 55102
651-2b6-24Q0
To: Saint Pnui City ncii
�rom: Robert Fulton �
Jane Norbin�"
Re: Update of the ZOOZ-2003 Community Henith Services Plan
flate: September 11, ZOOI
The Public Healfih Joint Powers Agreement requires Gity Counc+l nppraval of
Communifiy Health Services Plnns (Planls) and their updntes. The state requires new
P{ans every four years and updates every two years. We now seek Counci{ approval
of the update to the faur-year Pfan approved by the Council in 1999 (a draft
resolution and Update are afitached for your convenience). The Update must next
be approved by the Ramsey County Board nnd then be submitted to fihe Minnesofia
Department of Health by October 32'� of this year.
No new commun+ty hea{th prob{ems arose during the update pracess. Sorne of the
Plnn's strategies, however, were updated to reflect the Plcan's progress and rece»i
enhancements of the pubtic henith o}�erating environment. �'he enhnncements
include Q minority heafth granfi; Temporary Assistance to Needy Families; Youth Risk
Behavior Endowmenfi 6rant and the Adalescent Parenfiing Program.
Finally, the Plan incorporates the Maternal and Child Necsith Grant-Saint Pau(:
ZOQ2-ZOQ3 Update Appl+ca#ion.
To develop the Update, the Saint Paul-Ramsey County Departmen# of Public Henith
(SPRCDPN) obtained input from staft and the community through a variety of
methods, inciuding:
1. U�date and analvsis of CNS Aian data.
2. Department-wide review of CHS Proaram Pian strateaies.
01
September 11, 200f
Update of the 2002-2003 Community Health Services Plan
3. Public Notices. Public notice of the initiation of fihe Updafie process was
pub!'rshed in the Saint Paui Pioneer Press in January 2002. Another nofiice was
publ'sshed May 13, 2001 to +nform the public of when drafts of the Update would
!�e availnble for inspec#+on. Postcards wifih the newspnper notice intormation
were also mniled to the general mailing list of the 5PRC�PFi. A summary of the
Update has also been avo's4able on the SPRCDPH World Wide Web site.
4. Pub{ic Meetinq nnd meetina of the Saint Paul-Ramsey Coun#�Community Neatth
5ervices Advisor�Committee. A pub{ic meeting was held in conjunct+on with the
5aint Pau{-Ramsey County Community !-lealth Services Advisory Committee
meetiny, on June 6 2(}Ol. The Advisory Gommittee and the public provided
feedback on the Update.
Thank you.
Attnchmenfis:
Draffi City Council Resofution
CHS Plnn Update Summcrry
CH5 Plnn Update
Maternal and Child Heal#h Special Pro jects 6rant - Snint Pau1:20Q2-2003 Update
Application
d�--9�9
2
DRAFT RESOLUTION
CTTY OF SAINT PAUL, MINNESOTA
2002-2003 CHS Pian Update
WHEREAS, the city of Saint Pau1 and Ramsey County through the Saint Paul-Rawsey
County Deparhnent of Public Health are required by Statute to prepaze a Community
Health Services Plan and Update for that plan (CHS Plan Update} to receive a
Community Hea�th Services subsidy; and
10 WHEREAS, the 2002-2003 CHS Plan Update was developed by the Saint Paul-Ramsey
11 County Department of Public Health and the Saint Paul-Ramsey County Community
12 Health Services Advisory Committee with input from the community; and
13
14 WHEREAS, the 2002-2003 CHS Plan Update and a summary of that Update were made
15 available for public review and comment and the public was notified of that availability;
16 and
17
18
19
20
21
22
23
24
25
26
2'7
28
29
VJHEREAS, the Matemal and Child Health Special Projects Crrant — Saint Paul: 2002-
2003 Update Application is required to be submitted to the Minnesota Department of
Heaith by the Saint Paul-Ramsey County Depariment of Public Heaith and is attached to
the CHS Pian Updaxe; and
WI-IEREAS; the Community Health Services Plan must be approved by the City Council
as outlined in the Public Health Joint Powers Agreement;
THEREFORE, BE IT RESOLVED, that the City Council accepts for submission to the
Ramsey County Boazd for their approval and submission to the Minnesota Department of
Health the 2002-2003 CHS P1an Update and the Saint Paui Maternal and Chiid Health
Grant.
ot-999
2000-2003
Saint Paui-Ramsey Coun�ty
Community Health Services Program Pian:
Update Summary
September 12, 2001
Saint Pau!-Ramsey County Department of Public Health
Health Poiicy and Pianning
50 West Keliogg Boulevard; Sufte 930
Saint Paui, Minnesota 55102-1657
Telephone: {651) 266--2403
http://www.co.ramsev.mn. us/P�ndex.htm
t�1-999
TABLE OF CONTENTS
Zaoa2oo3
Saint Paut-Ramsey County
Community Heafth Services Program Plan:
Update Summary
ACKNOW LEDGEMENTS .............................................................................................................................1
INTRODUCTION TO THE UPDATE SUMMARY .........................................................................................2
SUMMARY OF THE CHS PLAN UPDATE PROCESS
..... 3
SUPAMARY OF PUSLIC HEALTH PflOBLEMS THAT EXIST IN THE COMMUNfTY AND GOALS
(OUTCOMES) FOR ADDRESSING THOSE PROBLEMS ...........................................................................5
PUBUC HEALTH PROBLEMS ORGANIZED ACCORDING TO PUBLIC HEALTH PLANNING
CATEGO I ES ............................................................................................................................................... 8
ol -g�g
COMMUNITY HEALTH SERVICES ADVISORY COMMITTEE'
Joan Johnson, Chair
Shana Morrel% Vice Chair
Mary Jo Borden
Lucie Ferrell
�d;FG'E7 ..��
James Haselmann
Gabrieile Lawrence
Susan Mitchell
Shana Marrell
CITY OF SAINT PAUL
Norm Coleman Mayor
Saint Paul Board of Health
Jay Benanav
Jerry Blakely
Dan Bostrom, Chair
Christopher Coleman
Michael Harris
Kathy Lantry
Jim Reiter
Ann Ricketts
John Rossbach
Greg Sheehan
Nancy Whde
Lori Husivedt
Theresa Lang
Gregory W. Bemard
RAMSEY COUIVTY
Paul Kirkwold, County Manager
Ramsev Countv Board of Healfh
Tony Bennett
Jim McDonough
Susan Haigh
Rataei Ortega, Chair
Victona Reinhardt
Janice Rettman
Jan Wiessner
SAINT PAUL — RAMSEYCOUNTY DEPARTMENT OF PUBL/C HEALTH
Rob Fufton, Director
Heaffh Policv and Plannina Section
Jane Norbin, Director, Sharon Borg; Cheryl Burke,• Michael Dean; Barb Nelson
Cover Desian
Barb Vaughan
' Members of CHS Advisory Committee as of March 2001.
CHS PROGRAM PL4N: Acknowledgemems
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u��a
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'The Minnesota Department of Health requires local public heaith agencies to update their four-year
community health senrices plans at their midpoint. The update includes a summary and a detailed
document. This document is the detailed document.
More intormation regarding cximmunity heatth senrices planning in Ramsey County can be found in the
original Community Heafth Senrices Program Pfan and Assessmerrt Document, both of which are
available on the Worid Wide Web at:
http;l/www.co.ramsev.mn.us/PHlhpp.htm
or
by contacting the Saint Paul Ramsey County Department of Public Health (see cantact information
below).
A Community Health Services Plan Updata Summary is also availab(e through the contact information
provided on this page. The major cromponents of the Summary document are as follows:
❑ A summary of the overall process for updating the 2000-2003 Saint Paui-Ramsev Countv
Communiiv Health Services Plan; and
❑ The updated prob�ems and outcomes from the fufl Update document.
This detailed 2000-2003 Saint Paul-Ramsev Countv CommuniN Health Services Plan Update contains
updated public health problems that exist in Ramsey County, desired outcomes that indicate the problem
is being addressed, and the strategies that wi!! be used by the SPRCDPH to address the problems. This
document is also avaifable through contact information stated on this page.
Further information may be obtained by contacting the Saint Paul-Ramsey County Department of Public
Health:
Saint Paul-Ramsey County Departmeni of Public Health
Health Policy and Planning
50 West Kellogg Boulevard; Suite 930
Saint Paui, Minnesota 55102-1657
Telephone: (651) 266-2403
htto Jlwvaw.co.ramsev.mn.us/PI
ACRONYM
Throughout the CHS Plan documents, the Saint Paul — Ramsey County Department of Public Health is
frequenUy referred to using its acronym: SPRCDPH
PLANNING CATEGORIES
A�mmunity heatth plan is required by state mandate to have twelve planning categories:
CNS PROGRAM PLAN: Introduction
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CHS Planning Categories
Infectious Disease Unintended Pregnan
Chronic/Non-Infectious Disease Pregnancy and Birth
Environmental Heatth
Alcohoi, Tobacco and Other Drugs
Unintended Injury
Violence
Child Growth and DevelopmenY
Disability and Decreased
Independence
Mental Health
Service Deiivery Systems
The twelve pianning categories are used as guides for cotlecting data and organizing the cammunity
assessment and plan documents. Public health problems in the assessment document and strategies for
addressing them in the plan document are organized according to the twelve public health planning
categories.
As required by state statute, the strategies that were developed to address the public health problems are
also identified by the following public heafth topic areas (whose acronyms are indicated on the right-hand
column of the strategy grids).
Public Health Topic Areas
DPC -Disease Prevention and Control FH — Family Health
EMS — Emergency Medical Services HP — Health Promotion
EH — Environmenta! Heafth HH — Home Heafth
CHS PROGRAM PLAN.• lrn�oducfion
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OFTtiE Ck-fs 1't.AFV UADATE Ft��GESS
COLLECTION AND ANALYSIS OF DATA
The Saint Paul-Ramsey Courrty Department of Pubtic Health (SPRCDPH), on an ongoing basis, updates
national, Minnesota, and Ramsey County public health assessment and outcome indicator data. ln
addition to Rs large collection of paper reports, the SPRCDPH maintains a computerized °database of
data° by public heafth planning categories to ease updating and accessing data for analysis. Monitoring
the availabifity and credibility of data that is available on the World Wide Web is also an ongoing activiiy
of the Department.
During the winter and early spring of 2001, SPRCDPH staff analyzed updated assessment and outcome
evaluation data for the need to change the 2000 — 2003 Saint Paul-Ramsev Countv Communitv Health
Services Proaram Plan (GHS Proaram Plan).
DEPARTMEN7TWIDE REVIEW OF CFIS PROGRAM PLAN STRATEGIES
During the winter of 2001, all SPRCDPH staff were provided an opportuniiy to participate in meetings to
comment on CHS Program Plan strategies. These meetings resulted in several lists of proposed edits,
deletions and additions to the existing CHS Plan strategies. Staff refined these lists for clarity, eliminated
duplicate comments and made a final list of proposed strategy cha�ges. The Department's Leadership
Team reviewed the final list of strategy changes for inclusion in the Draft CIiS Proaram Plan Uodate and
then gave the Draft CF{S Program Pfan Update a fina{ review after its consideration of aft public and staff
commenis.
COMMUNITY INPUT
The Ramsey Gounty pubiic was notified of the initiation of the update process in a newspaper notice on
January 24, 2001. Another newspaper notice was published May 13, 2001 to inform the public of the
dates on which drafts of the full and summary versions of the Draft CHS Proaram P1an Update would be
available tor review and comment. The May 13 newspaper notice also stated that a public meeting
regarding the Draft CHS Proaram Plan Update would be heid June 6, 2001, 5:30 p.m. at 555 Cedar
Avenue (Juenemann Building), Saint Paul. Postcards with the newspaper notice information were
mailed to many interested individuals and community groups on a mailing list maintained by the
SPRCDPH. Any interested party may be added to this list by notifying the SPRCDPH. .
The Saint Paul — Ramsey County Communiiy Health Services Advisory Committee was also provided
information on the Draft CHS Propram Plan Update and it conducted the public meeting on June 6"'.
After ciosure of the comment period on June 13, 2001, the SPRCDPH considered all community
comments submitted by that time, inciuding comments submitted at the public meeting on June 6"'.
SUM1VfARY OF CHAI�iGES TO THE CHS PROGRAM PLANi
The SPRCDPH review of data and strategies resulted in some reorgan+zing of problems and probiem
categories.
Changes were also made to improve the clarity of some strategies, to combine similar strategies, to
refiect imptementation of strategies, to delete completed strategies and to add new strategies made
possible by changes in the operating environment of the SPRCDPH.
CNS PROGRAM PLAN: Communily HeaRh Services Planning Process
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COU�VT�(
MISSION
The mission of the Saint Paul Ramsey County Department of Pubiic Heafth (SPRCDPH) is to improve,
protect, and promote the health, the environment, and the well being of people in our community.
AREAS OF STRATEGIC FOCUS
To accomplish its Mission, the SPRCDPH concentrates its efforts in the following four Straiegic Focus
Areas:
1. Prevent communicab{e diseases.
2. Promote the health of children, youth and their families.
3. Protect the environment and reduce environmental heaith hazards.
4. Reduce chronic disease.
These areas guide the work of the SPRCDPH.
It is recognized that some services that are mandated by the state as weN as some we are direeted to
perform by elected CounTy officials, may not be included in the Strategic Focus Areas. We will provide
ihese valuabie services, along with the Strategic Focus Area services, with the highest level of quality
and enthusiasm.
These Strategic Focus Areas will be addressed in our Community h4ealth Services Plan and other Board-
approved SPRCDPH pfans using sound policy analysis and planning to guide our specific strategic
direction for our decision making. This process wifl include a careful ana{ysis of public heafth data,
irends, and best practices. W e will pay particular attention to data on disparities in health status that exist
in our community. We will continue to use multiple strategies and methods in our daily work including
individual services, targeted group services, community services and system intervention to achieve our
public health outcomes.
CHS PROGRAM PLAN: Mission of the SPRCDPH
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CHS PROGRAM PLAN: Mission of the SPRCDPH
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Severaf new opportunities have enhanced the abi{ity of the SPRCDPH to implement the CHS Plan.
These new opportunities include a minority health grant; new funding from Temporary Assistance to
Needy Families (TAN�; the Youth Risk Behavior Endowment; and the Adolescent Parenting Program.
These new opportunities are described in the following sections.
Minority Health Gran4
The Minnesota Department of Heafth, Office of Minority Heafth, awarded a grant to the Minneapolis
Department of HeaRh and Family Support to assess and recommend ways to improve the heafth of
minority communfties. This project is a collaborative effort of the nine Community Heaith Service
Agencies in the seven-county Twin Cities Metropolitan Area of Minnesota, which includes Ramsey
County. The SPRCDPH will now have an enhanced ability to "improve data collection, analysis and
reporting of ilinesses among populations of color in Ramsey Couniy' (will — do strategy number one (1)
under "Item E. Health Disparities", page 31 of the CHS Program Plan).
Temporary Assistance 4o Needy Families (TANF)
New funding from Temporary Assistance to Needy Families (7AN� has resulted in a new strategy for
the CHS Program Plan. The Healthy Families Section of the SPRCDPH will act as lead staff for the
strategy, which is stated as follows:
Develop and implement TANF Public Health Home Visiting Program in coordination with other
county departments and community providers to improve child heaith and family functioning, and
promote self-sufficiency among low-income families.
This strategy will impact the CHS Program Plan problem areas of low birth weight and chiid growth and
development.
Youth Risk Behavior Endowment
This program provides resources for addressing youth risk behaviors and wi{I improve the ability of
SPRCDPH to implement strategies for the Program Plan problem areas of infectious disease; alcohol
use; tobacco use; violence; unplanned pregnancies; overweight, inactivity and inadequate nutrition; and
self-destructive behaviors by youth.
Adolescent Parenting Program
This program is a collaboration between SPRCDPH, Ramsey County Human Services, and Model Cities
Community Health Clinic to streamline services for adolescent parents. These services include minor
mom assessments, referrals to community resources, social worker services, transportation, help finding
emergency housing, and access to emergency supplies.
CHS PROGRAM PLAN: Changes in Operating Environment
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8 CHS PROGR,4M PLAN: Changes in Opera6ng Environment
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PROB IFM
1. Emerging and re-emerging infectious diseases threaten the health of the general population in
Ramsey Courriy.
OUTCOMES
1. Ramsey County residents experience decreased disease, disability, and death from emerging and
re-emerging infectious disease.
2. Improved heafth status of +nmates relating to communicable disease in Ramsey Gounty correctional
facilities.
3. Ramsey County community will be prepared to minimize the consequences of biological
emergencies.
4. Ramsey County residents experience decreased disease, disability and death from vaccine-
preventable diseases.
Oui- CHSZ
come Strategies Program
Area
1. Improve coritrot of infectious diseases, inciuding tuberculosis, through improved
1 collection of assessment data, improved outbreak detection, improved investigations, DPC
improved treatment and ciinica! care and screening as needed.
2. Use the Minnesota Department of Health Disease Prevention and Control
1 Common Activities Framework (See Appendix 1) to help guide SPRCDPH's disease DPC
prevention and control activities.
1 3. Collaborate with clinical providers Minnesota Departme�t of Heaith, and federal DPC
agencies on infeciious diseases.
1 4. Assure timely access to STD and HIV counseling, testing, treatment and all DPC
appropriate medical and laboratory assessments.
1 5. Provide health assessments and screenings for communicable diseases in DPC
refugees. FH
i 6. Develop a trained backup tuberculosis team to respond to tuberculosis cases, HP
contact investigations, clinic follow up, and investigations of institutional outbreaks. FH
1 7. Continue to provide perinatal Hepatitis B program. DPC
HP
� 8. Expand and enhance W eb site to provide infiormation on prevention and control of DPC
infectious disease (information on handwashing, for example). HP
� 9. Inform health professionals (inciuding SPRCDPN) and the Ramsey County DPC
2 These program area acronyms are discussed under "Pianning Categories" in the lntroduction section.
CHS PROGRAM PLAN: lnfectious Disease
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community on reportab(e disease trends, incidence and prevalence.
10. As appropriate, provide the following Ramsey Couniy groups with consultations,
educational opportunities and informafion regarding infectious disease prevention
and controi, assessment, treatment and access to treatment, and follow-up:
• Health care providers;
• Correctional faciliry inmates;
• Community residents; and
. City arid County departments.
2
3
f 1. Screen and treat Ramsey County correctional facility inmates for sexually
transmitted diseases and Tuberculasis.
12. Coordinate planning for responses to biological and other public health
emergencies within SPRCDPH and, as appropriate, with other local, sYate, and
national en6ties.
4 I 13. Meet regular(y with school nurses of all districfs fo provide up-fo-date
� immunization informa6on, communication and consultation.
4 � 14. Be a resource to providers about immunization questions and techniques.
4 � 15. Sponsor communiiy immunization educational opportunities twice a year.
16. improve immunization tevels among Ramsey Couniy residents through promotion of:
• increased Ramsey County provider use of the 18 Standards for Pediatric
immunization Practices;
4 � • strengthened rela6onships with providers and community agencies; and
• SPRCDPH staff (WIC, Heafthy Families, House Caqs, and Lead) ident"rfication of
children withou[ up-to-date immunizations and referrais to Child and Teen Check Up
and oiher programs as needed.
4 17. lncrease pnuemococcal vaccine use in high-risk individuals and minority elderly.
4 18. Promote Hepatitis A& B vaccines through Women's Health, Room 111, and
Correctionai HeaRfi.
4 19. Coifaborate to ensure children are immunized and schooi taw requirements are
met
20. Continue SPRCDPH provision of travel immunizations but promote that health
4 plan enroliees obtain travel immuniza�ons from their health plan. Work to increase
public education and level of knowledge about the need for immunizations when
traveling.
4
4
4
4
10
21. Provide immunizations in STD Clinics.
community clinic sites.
in the fail at
23. Provide immunizations to high risk, underinsured and uninsured Ramsey County
residents.
24. Participate in Metro Immunization Registry planning and implementation if state
funding is secured.
CHS PROGRAM PLAN: lnfectious Disease
DPC
DPC
DPC
DPC
HP
DPC
HP
DPC
HP
DPC
DPC
DPC
HP
DPC
FH
DPC
HP
DPC
^HP-
DPC
DPC
HP
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25. Develop and implement plans to improve the coilection, compilation and
4 communication ofi data regarding Ramsey Countys progress toward reaching
immunization-level goals.
4 26. Compile all SPRCDPH immunization data into a common database. DPC
27. Develop regular intemal communication mechanism for staff working with DPC
4 immunizations. Coordinate agency efforts, and share resuits, such as ciinic survey HP
results and immunization rate data.
4 28. Develop or work with MDH on a system to measure rate of up-to-date HP
immunizations at 24 months, including Kindergarten retrospective as one method. FH
4 29. Promote aftemative clinic hours and immunization reminderlrecall systems for 0- DPG
2 year old children. HP
4 30. Provide vaccine to clinics that see children 0-2 years. DPC
HP
4 31. Encourage clinics to do immunization audits of their client populations. DPC
HP
4 32. Identify and support legislative immunization policy. DPC
HP
4 33. Promote interventions identified as "best practices" that motivate families to get H
immunized.
FH
q DPC
34. Work with family centers to provide immunization education and information. HP
FH
Current Strategies That Wil! Be Reduced or Eliminated
1, 4 35. Support and respond to schools curriculum on infectious disease —1 � grade and DPC
other grades. HP
FH
OUTCOME EVALUATION PLAN
Out Outcome Indicator Evaluation
Come
Decreased numbers and rates of reportable
diseases. (STD and HIV related visit rates may
1 1. Numbers and rates of reportable diseases. be increased, as an indicator that persons who
are at increased risk and/or symptomaiic are
aetually seeking diagnosis and treatment.)
2. Number of screens for and treatment of fncreased screens for and treatment of sexually
2 sexually transmitted diseases and TB among transmitted diseases and TB among inmates in
inmates in Ramsey County facilities. Ramsey County facilities.
CHS PROGRAM PLAN: Infectious Disease 11
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3. A plan for response to biotogical and other A plan will be in place and updated for. response
3 public health emergencies. to biological and other pubiic health
emergencies by September 2001.
4. Perc�nt of up-tadate immunizations in the �ncreased percent of children up-to-date with
4 Retrospective fGndergarten Study in Ramsey immunizations in Ramsey County.
County.
5. Percent of children enroifed in PMAP who �ncreased percent of chiidren who are enrolled
4 in PMAP arrc! are up-to-date with
are up-to-date w8h immunizations. immunizations.
12 CHS PRQGRAM PLAN. fnfecchoous Disease
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S. EI�f4RON�l�t�t7"AL Fi�iLTki FiAZAFtQS"
PROS IFM
i. There is an increasing risk of illness due to environmental health hazards in Ramsey Counry.
1. Ramsey County residents have reduced e�osure to lead, and they wilt have reduced biood lead
4evels.
2. Solid and hazardous waste in Ramsey Couniy will be managed in a manner that reduces the risk of
iliness and environmental harm.
3. Persons in Ramsey County will be at reduced risk of illness related to air potlutants indoors and
outdoors.
4. Persons in Ramsey Gounty will be at reduced risk of illness related to food consumption.
5. Persons in Ramsey Couniy will be at reduced risk of iilness related to storage, use and management
of househoid and industrial chemicals.
6. Persons in Ramsey County will be at reduced risk of illness related to contaminants in water.
Out- CHS3
come Strategies Progrem
Area
1. Work with local building officials on environmentat health issuss, including plan
Ail reviews of facilities Iicensed under the delegation agreement with the Minnesota EH
Department of Health.
2. Continue to provide to operators of licensed establishments formal training,
A �� including Food Manager Cert'rfication, Swimming Pool Operators, and Licensed EH
Hazardous Waste Generators. The need to provide training to staff ofi those
establishments will be evaluated and courseslcurricu(a developed, as necessary.
3. Hold an annual Environmental Health training session for all stafF, which will
Ail teach the fundamenta{s of environmental health hazard identification to those staff EH
that have client contact.
4. Work with heafth care providers to raise their awareness of indoor environmental EN
Ail health hazards so that they ran discuss environmentai health with clients, FH
especiafiy wlnerable populations.
5. Develop technical expertise in risk communication, and incorporate
A �� environmental hea{th risk communication messages about risk of iflness due to EH
environmental conditions into informa6on provided to the public and regulated
communiiy.
1 6. Gontinue the Chiidhood Lead Prevention Program and the Lead Hazard EH
3 These program area acronyms are discussed under "Planning Categories" in the Introduction seotion.
CHS PROGRAM PLAN.� Environmenta� HeaRh Hazards 13
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Reduction Program {to the extent funding is available), including the screenings
required by State law, and the fallow-up assessment and enforcement to require
remediation of lead.
HP
1,4,& � 7. Continue to provide laboratory analyses for lead, food, anc! water quality. ' EH
I 8. Provide targeted outreach on househoid hazardous waste (HHW) collection I EH
2,5 services, including pesficides, consistent with the RegionaURamsey County Solid HP
Waste Master Plan.
2 5 9. Provide waste minimization and pollution prevention technical assistance EH
senrices to licensed hazardous waste generators in Ramsey County. tiP
10. Continue to assure compliance with solid and hazardous waste regulations
2 � through the use of education, consultation, tecfinicat assistance, licensing, EH
inspection, and enforcemenY. When providing direct services relating to nutrition,
advise residents about health risks re(ated to consuming fish.
2 I 11. Continue to carry out the strategies outlined in the RegionaVRamsey County � EH
Solid Waste Master Plan, with regard to sotid and hazardous waste.
12. Seek indoor air quality grent funds to be used for raising awareness about and
detecting indoor air quality problems, inctuding physical, biotogical and chemical EH
hazards, and for the promotion of the proper use of carbon monoxide detectors and
radon detectors.
3 � 13. Participate with the Minnesota Indoor Air Qualiiy Coalition to coordinate indoor EH
air quality informafion, especially related to carbon monoxide and radon.
14. Continue to carry out the County's responsibi(ities as outlined in the Detegation
Agreement wfth the Minnesota Department of Neafth for Food, Beverage and
3,4,5,6 Lodging Facilities; manufac[ured home parks; youth camps; the �nnesota Clean EH
tndoor Act in licensed establishments; and the investigation of public heafth
nuisances with the authoriiy provided in Minnesota Statutes, Chapter 145.
4 15. Support Food Irradiation as an important food safety method.
4 16. Work with the cities of Saint Paul, New Brighton, and Maptewood to coordinate
compliance strategies with licensed food service establishments.
17. Continue to give a priority to issues of food safety, and wiil integrate food safeiy
4 messages with other public health messages, especially to wlnerable populations,
and inciuding food safety in non-regulated settings.
18. Examine entering into a Delegation Agreement wiih the Commissioner of
4 Agricufture for the regulation of grocery and cronvenience stores in suburban
Ramsey County.
19. Work with the food senrice industry, the Mirtnesota Department of Health, and
health care providers to explore ways to provide sick leave benefits for employees
of food e is , �have an incentive to oome to
work sick.
20. Work with city of Saint Paul Parks and Recreation; Ramsey Couniy Public
4 Works; and Ramsey County Parks and Recreation to install signs and notices
regarding fish consumption advisories, inoluding notices in languages other than
English.
EH
EH
EH
HP
EH
EH
EH
HP
14 CHS PROGRAM PLAN: Environmen�al Heafth Hazards
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� 21. Work with non-English speaking media and organizations to include notice of EH
fish consumption advisories. HP
22. Collaborate with the Ramsey County Poison Control Center and Minnesota E �
5 Extension Service to develop outreach and education strategies for Ramsey HP
County residents on the safe use, storage and disposal of pesticides.
23. Conduct educational efforts in partnership with others related to safety and EH
6 heatih of private swimming poois and wading poofs, and wilf provide informaiion FH
and services as appropriate. HP
Currerrt Strategies That Wili Be Reciuceci or Eliminated
Not Applicabie
OUTCOIWE EYALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 �. Number of tests showing elevated biood Decreased percerrt of tests showing
lead levels, elevated blood lead levels.
2. The total amount of production-related Decreased amount of total production-
2 waste chemicals released by industries, as related waste chemicals released by
reported in the Toxic Release Inventory, in industries in Ramsey County each year.
Ramsey County.
4 3. Number of food borne i4lnesses reported in Decreased food-borne iliness incidence in
Ramsey County. Ramsey County.
4. Number of signs in various languages at
4 lakes, ponds, sireams and rivers located in Increased number of signs.
Ramsey County with notices regarding fish
consumption advisories.
5. Volume of household hazardous waste that �ncreased volume of household hazardous
5 is managed in Household Hazardous Waste waste is managed in HHW cofleetions.
coAections.
5 6. iVumber ot participants in Household fncreased number of participants in IiHW
Hazardous Waste collections. collections in 2003 compared to 2�00.
6 7. Number of drinking water samples and Increased water samples tested and
results. decreased unsafe leveis found.
CHS PROGRAM PLAN: Environmemal Health Hazards 15
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16 CHS PROGRAM PLAN: Environmenial Heatth Hazarcis
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PROBLEM
1. There is an unacceptable level of interpersonal viole�ce in Ramsey Couniy.
OUTCOME
1. Ramsey County citizens experience less violence.
STRATEGIES
Out CHS°
come Strategies Program
Area
1 1. Continue Ramsey County participation in and facilitation of The Initiative for HP
Violence Free Families and Communities. FN
1 2. Support private, routine screenings for domestic violence with all male and HP
fiemale clients. FH
1 3. Encouwage managed care organizations to provide coverage for emergency HP
department visits made by victims of domestic violence. FH
1 4. tmprove the Ramsey County web site with more information and intemet links HP
regarding abuse and other violence. FH
1 5. {ncrease efforts to teach non-viofent parenting skilis, especially to parents who HP
experienced abuse as children. FH
1 6. Provide existing and new SPRCDPN staff education, training and regular
updates on domestic violence, sexual abuse and other violence, includinq:
. interventions with isolated, high-risk families;
• Development of skifts to focus on individual, community and family HP
strengihs and assets; FH
• Cammunity prevention and intervention resources (such as ParenYs
Anonymous and the taith community); and
. Alternatives to violence for solving problems and conflicts.
1 7. Support community and legislative efforts to prevent youth access to weapons. HP
FH
1 8. Develop cuiturally competent anti-violence education. �
FH
1 9. Continue use of the University of Minnesota Twin Cfties Violence Survey and HP
other indicators and develop trend data from those indicators. FH
1 10. Use the Education Action Team (of the lnitiative for Violence Fee Families and HP
Communities) to increase developmeni of anti-violence and positive parenting FH
programs within school districts.
1 11. Collaborate and share resources with the Ramsey County community HP
" These program area acronyms are discussed under "Planning Categories" in the Introduction section.
GHS PROGRAM PLAN: �olence 17
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(including faith communities and community, recreation and Children's Initiat+ve FH
centers) to develop, coordinate and implement pians to disseminate throughout
Ramsey Couniy and to targeted groups, information on:
. Domestic and other forms of violence;
• The correla6on of domestic and other violence to other public heatth
problems (such as child neglect, unintended pregnancy, low-birth
weight, infant mortaiity, low immunization rates, and sexually
transmitted infections such as HIV}; and
• Nort -violent means for solving probiems.
1 12. Collaborate with faith communities to promote positive aftematives to viofence.
1 13. Support efforts to decrease geographic concentrations of poverry. yP
FH
1 74. Train more people to be members of the Workplace Violence Action Team. yP
Fti
Current Strategies That Wili Be Reduced or Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
Out-
Come
Outcome Indicator
1. Ramsey County homicide rate.
2. Percentage of male students reporting
1 carrying a gun to school (Minnesota Student
Survey).
3. Peroentage ot studeirts reporting b�
1 stabbed or having a gun fired at ti�em
(Minnesota Student Survey}.
4. Percentage of students reporting bei
1 kicked, bitYen, or hit on school property
(Minnesota Studerrt Surveyj.
Evaluation
Decreasing trend in the homicide rate for
Ramsey County beginning in 1999.
Decrease of 1%(from 1998 rate of 5%) by
2001.
Decrease of 1%(from 1998 rate of 4%) by
2001.
Decrease of 3% for males (from 1998 rate of
15%) and .5% of females (from 1998 rate of
3.12%) by 2001.
5. Reported crimes in Ramsey County:
Number of offenses against family or children Decreased number of reported crimes
1 (Minnesota Crime information Rer�ort; MN regarding offenses against family or children.
Bureau of Criminat Apprehension — tocal law
enforcement agency offense information).
6. Number of Ramsey
9 makreatment determinations (Ramsey County ��
Communiry Human Services}. maltreatment determinations.
18 CHS PROGAAM PLAN: volence
o t-999
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PROB ICM
1. High numbers of Ramsey Gounty residents are overweight and inactive with inadequate nutrdion,
which contributes to chronic diseases.
1. The residents of Ramsey Couniy make lifesiyle changes to prevent chronic disease.
2. Heafth professionals and heafth care providers practice chronic disease prevention with Ramsey
County residents.
3. Ramsey County residents will be average weight, phys+cally active, and eat hea4thy foods.
Out- CHSS
come Strategies Program
Area
1. Increase efforts to partner with targeted population groups regarding chronic DPC
1, 3 diseases and prevention. (Examples: Hypertension within the African American HP
population; Diabetes and Hispanic population). HH
2. Review the current public health education materials on chronic diseases to HP
1, 3 assure that the audiences, desired behavior change, criteria for measuring DPC
success, and educational tools are appropriate.
� 3 3. Strengthen relationships with Ramsey County schools to develop and/or HP
enhance weliness programs. FH
4. Use research and best practices to identify methods for improving the fitness HP� EH
1, 3 and wellness for Ramsey County citizens (such as 5 fruits and vegetables a day, DPC
"Power of Healthy Eating".) �
FH
5. Work with Ramsey Couniy school districts and managers of Ramsey County DPC
� 3 Government 6uildings and programs to provide food-vendor options for bottled HP
water and nutritious foods (e.g. fruits, flavored mllk, and juices) that replace or HH
accompany less nutritious vendor options.
6. F�cplore working with existing efforts to encourage Ramsey County restaurants HP
1, 3 to address large serving sizes at restaura�ts (that contri6ute to waste and to DPC
overweight and inadequate nutrition among Ramsey County residents). EH
1, 3 7. Promote use of 12 Baskets Program by ticensed food establishments. EH
HP
8. Encourage intergenerational activities with Parks and Recreation and community HP
1, 3 centers: such as family walking, softball teams, volleybaN teams, biking events, FH
hiking and swimming events, Intergenerational Tea Parties, etc. HH
1 3 9. Initiate partnering with schools and Minnesota Department of Ghildren Families HP
5 These program area acronyms are discussed under "Ptanning Categories" in the Introduction section.
CHS PROGRAM PLAN.� Heafth Disparities 19
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and Leaming to analyze data on heights and weights of children. DPC
t0. Update pubiic health education and heaith promotion materiats and services HP
1, 3 with current knowledge and use of electronic media (e.g, intemet, phone, and cabie FH
television), yH
DPC
11. Create and maintain chronic disease prevention task force consisting of the
Department of Public Health and community partners to: (1) iderrtify ways to HP
2 coordinate promotion of chronic disease prevention; (2) to coordinate messages; DPC
and (3) establish desired outcomes and performance measures for promotional HH
efforts.
HP
2 12. Identify ways to coordinate the promotion of chronic disease prevention with ��
other Department activities. EH
NH
13. Continue Women's Health Screening Clinic that provides pap tests and HP
2 mammograms through the Minnesota Breast and Cervical Cancer Control FH
Program. DPC
2 14. Continue correctional health that provides health care senrices to individuals in HP
Ramsey County correctional facilities. DPC
2 15. Continue Colposcapy Clinic, which provides low cost evaluation and DPC HP
management of abnormaf pap smears.
2 16. Provide public-health-nurse outreach clinics in public high rises and other sites DPC
to address chronic disease prevention among residents. HP
2 17. Continue Refugee Clinic that screens refugees for health problems.
Current Strategies That Will Be Reduced Or Eliminated
1 18. Continue with Nutrition Services of dietary counseling and Clinical Nutrition HP
Services at 555 Cedar and Community Ciinics.
OUTCOME EVALUATION PLAN
Out- Outcome indicator Evatuation
Come
1, 3 i. Percent adult residenfs reporting Decreased percent of adults reportii
hypertension according to the MN hypertension in the Behaviora! Risk
1, 3 2. Hospitalization rates for children ages 0— Haspitalization rates for children ages 0=�1�'�"'mm'
14 with asthma. with asthma wil! decrease from the f 997 rate of
3.7 per i000 populafion.
are physicaliy Increased percent of adolesCents who are
er week ohvsicallv active for 30 minutes 5 or more �
20 CHS PROGRAM PLAN: Health Dispardies
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22 CHS PROGRAM PLAN: Heafth Dispa+ities
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E: "(-1Ei
PROSLEM
1. Desp'de overail health improvement in Minnesota and Ramsey County, populations of co%r in
Ramsey County continue to experience poo�er health and disproportionately higher rates of illness
and death.
OUTCOME
1. Decreased disparity of health status beiween population groups in Ramsey County.
Out- CHS6
come Strategies Program
Area
� 1. Improve data collection, analysis and reporting of health status among populations
of color in Ramsey County. DPC
2. Expand contacts with communiiy agencies and cultural organizations serving
1 communities of color, for data, information and recommendations regarding health DPC
rare needs and access to heatth care.
� 3. Partner with managed care, heafth care providers and other community groups to HP
target health promotion and prevention to specific popu{ations.
1 4. Support, through Minnesota Public Health Association and Association of HP
Minnesota Counties, legislation to improve access to care by poputations of cofor.
1 5. Support non-discrimination heatth care policies for heafth care services. HP
1 6. Train staff on cultural competency. HP
1 7. Increase community level input from populations of color in development of HP
strategies to address health disparities such as the Healthy Start Project.
1 8. Continue efforts to hire and retain SPRCDPH staff who reflect populations served HP
by SPRCDPH and participaie in Ramsey County Modei Employer efforts.
Current Strategies That WiII Be Reduced or Eliminated
Not Applicable
6 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Heafth Disparities 23
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�� Ouicome lndicator Evaluation
Come
1. Number of Saint Paul-Ramsey County tncreased number of Saint Paul-Ramsey
Department of Public Health programs using �unty Department of Public Health
OMB Statisticat Policv Directive No.15, Race
1 programs using OMB 15 as minimum
and Ethnic Standards for Federa! Statistics and standard for collecting race and ethnicity
Administrative Report to collect race and data on clients served by the program.
ethnicity data on clients served.
1 2. Infant mortality rate by race. Decreased disparity in infanY mortality raYes
between races.
1 3. Immunization rate by race. Decreased disparity in immunization rates
between children of different races.
4. incidence rate for spec'rfic diseases and Decreased disparii�l in incidence rates for
1 conditions by race. specrfic diseases beiween populations of
different races.
1 5. Death rates by race. Decreased dispariry in mortai"ity rates
beiween races.
1 6. Low birth weight by race. Decreased disparity in tow birth weight rates
beiween races.
24 CHS PROGR.QM PLAN: Heafth Disparities
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: PREGIdANCY AN�-BIRTH
tOBLEMS
1. lncreased percentage of births to adolescents and increased number of births thaf resuR from
unintended pregnancies.
2. The percent of iniants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
1. Decreased proportion of births in Ramsey County to adolescents.
2. Decreased proportion of all Ramsey County pregnancies that are unintended.
3. Fewer Ramsey County babies will be born with low birth weight.
Out- CHS'
come Strategies Program
Area
1. Promote women's health, including preconception health, to increase women's
All awareness of the results of healthy and risky behaviors for themselves (and for FH
their fetus when pregnant), and develop culturally appropriate messages.
2. Promote assets in youth and youth development through SPRCDPH
1 participation in the Suburban Ramsey Family Collaborative and the Saint FFt
PauVRamsey County Children's Initiative.
1 3. Partner with or participate in community groups working to lower the rate of low FH
birth weight births in populations of color (e.g. the Healthy Start Program).
1 4. Continue extended W IC hours to facilitate participants access to senrices. FH
5. Continue Public Health Nurse and Nutri6on home visits to pregnant women at HHC
1 risk for poor birth outcomes to provide assessment, health education and referral FH
to community services as needed.
6. Strengthen relationships with community groups, providers and clinics, including
1 Prepaid Medical Assistance Program providers and communiiy clinics to assure
that Ramsey County women have information and access to health care
resources, including medical care, for preconception care as well as prenatal care.
� 7. Continue the role of SPRCDPH as a resource to community groups and �
agencies on "best practice" for adolescent health and youth development.
1 8. Partner with communiiy groups to assure the development and continuation of FH
community-based, comprehensive adolescent pregnancy prevention programs.
' These program area acronyms are discussed under "Planning Categories° in the Introduction section.
CHS PROGRAM PLAN: Pregnancy and Birth 25
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3 9 Deliver intensive home-based services to minor parents through the Adolescent
Parent Program (SPRCDPH, RCCS, and Model Cities, Inc.)
10. Work with the Minnesota Organization on Adolescent Pregnancy, Prevention
and Parenting (MOAPPP), schools and other community groups to increase public �
1 awareness of adolescent pregnancy, to strengthen prevention efforts, and to FH
improve coordination of efforts to decrease the number of adolescent pregnancies
in Ramsey County.
1 11. Support schools' use of comprehensive sexuality education curricula. FH
12. Promote programs (e.g. Dads Make a Difference) that incorporate the
1 importance of dads in raising children, including nurturing their infant children and HP
building resiliency in those children as they grow older.
2 3 13. Support the provision of comprehensive family planning senrices with public FH
heaflh assessment, policy devetopment, planning arid assurance activities.
3 14. Work with existing community efforts to raise awareness of family planning FH
senrices in the community (e.g. the Minnesota Family Planning Hotline).
15. Advocate for and provide reproductive health care including family planning FH
3 services, targeting services to high risk groups, uninsured and underinsured
people. �
3 16. Continue to provide fami�y planning education for new parents who are FH
SPRCDPH clients. HHC
3 17. Continue connecting new parents to communiry resources and providers for FH
women who are served by SPRCDPH programs. HHC
Current Strategies That Will Be Reduced or Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out-
Come
1, 2
1.2
Outcome Indicator
1. Number of births to Ramsey County
adolescents less than 15 of age.
2. Birth rate for Ramsey Couniy adolescents
15-17 years of age.
3. Birth rate for Ramsey County mothers 18-
Evaluation
Decreased birth rate for Ramsey County
adoiescents less than 15 years of age.
Decreased birth rate for Ramsey County
adolescents 15-17 years of age, from 1995-97
rate of 35.1 per 1000 population.
Decreased birth rate for Ramsey County
of 68.9 per 1,000 population.
26 CHS PROGRAM PLAN: Pregnancy and Birth
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Decreased percent of Ramsey County 9"' and
4. Percent of Ramsey County 9"' and 12"' 12"' grade students who report that they have
grade studerrts who complete the Minnesota had sexuai intercourse, from 1998 percents of:
1 2 Student Survey and report that they have 9"' grade females: 23%
had sexual intercourse. 9"' grade males : 30%
12'" grade femates: 47°10
12"' grade males : 51 %.
Increased percent of Ramsey Couniy 9"' and 12'"
grade students who report on Minnesota Student
5. Proportion of sexuaily active 9"' and 12"' Survey that they are sexually active and always
graders in Ramsey County who partioipate in use birth control, from 1998 leve�s of:
j ' 2 the Minnesota Student Surve and re ort +�
Y p 9 grade females: 37%
always using birth control. 9"' grade males: 41 %
12"' grade females: 60%
12"' grade males: 54%.
6. Adolescent pregnancy rates for the 15-17 Decreased pregnancy rates for adolescents in
1 2 and 18-19 year old age groups. Ramsey County, firom the 1995-97 rate of 72.3
per 1,00015-17 and 18-19 year old age groups.
7. Proportion of Public Heatth clients who are �ncrease percer�t of public health ctients who are
Z new parents and receive family planning, new parents and have an identified method of
fiamily planning.
8. Percent of Ramsey County women who Percent of Ramsey County women who
3 initiate prenatal care in first trimester and delivered and whose prenatal care was reported
receive ongoing prenatai care senrices. as adequate or better will increase to 75% by
2003.
9. Percent of fow-birth-weight infants born to 6.6% or fewer of infants born to women
3 pregnant women who have received WIC participating in WIC for 3 months or longer will be
services for 3 months or more. tow birth weight.
10. Percent of low birth weight infants born to Decreased percent of low birth weight infants
3 women served antepartum by Healthy born to women who received home visiting
Families home visiting staff. services from Heatthy Families staff.
3 11. Percent of Ramsey County Iow birth- Percent of Ramsey Couniy low birth-weight
weight births. births will decrease from the 1997 leve4 of 6.7%.
12. Public heaith home-visited clients who �ncreased percent of pregnant public health
3 decrease or qu+t smoking during pregnancy. home-visited-cfients who decrease or quit
smoking during pregnancy.
CN3 PROGRAM PI�IN.� Pregnancy and Birth 27
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28 CHS PRO�RAM PLAN: Pregnancy and Birth
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G. UFVINTE[VDED IEVJl1RY
PROBLEM
1. Uninfentional injury is one of the leading causes of death fhroughout a lifetime in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by talls, poisoning,
suffocation, and fire.
OUTCOME
1. Decreased unintended injuries in Ramsey County.
STRATEGlES
Out- CHS$
come Strategies Program
Area
1 1. Obtain data on effective use of car seats (such as rate of compliance with proper HP
installation) to use in health promotion and education activities.
1 2. Develop a method for prioritizing specific unintended injury activities occurring HP
within SPRCDPH.
1 3. Support policies and programs that prevent gun violence, including use of the HP
Gun Violence Action Team to advocate for safe storage of guns.
1 4. Continue coilaboration with the Minnesota Safe Kids Program. HP
5. Continue to support the primary enforcement status of the child restraint system
1 policies of Minnesota Statutes, Chapter 169 (primary enforcement status means a HP
citizen can be stopped and issued a citation for a violation of the child restraint
system law alone without other violations being present).
1 6. Support enforcement of laws pertaining to universal use of car seats, including HP
policies that require babies to be in car seats when going home from a hospital,
7. Continue existing SPRCDPH health promotion and education programs (such as
1 Eariy Childhood and Family Education; Prenatal Education; Safety Camps; and HP
Safe Kid Family Fun Nights.
1 8. Continue provision of or referrals to resources for obtaining smoke detectors. HP
1 9. Provide unintended injury education and other services that are sensitive to HP
racial, ethnic and cultural differences.
1 10. Extend "Local Safe Kids" program to suburban Ramsey County. HP
1 11. Train more people to do car seat assessments and education (hospital staff; fire HP
stations; family centers; etc.)
Current Strategies That Will Be Reduced and Eliminated
g These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRAM PLAN: Unintended Injury 29
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1 12. Educate persons in general on unintended injury. HP
1 13. Educate and support enforcement of pedestrian law. HP
14. Support construction and maintenance of safe playgrounds including proper
1 supenrision, age-appropriate equipment and education and support of parents HP
seeking new equipment.
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1. Ramsey County Injury Hospitalization and Decreased numbers and percents of injury
Emergency Room E-Code Data for: hospitalization and emergency room use (per E
code data) in Ramsey County for:
a. Falis
a. Falis
1 b. Motor Vehicle Traffic crashes (occupant)
b. Motor Vehicle Traffic crashes (occupant)
c. Poisoning
c. Poisoning
d. Struck by, against (unintentional) d. Struck by, against (unintentional)
e. Overexertion (unintentional) e. Overexertion (unintentional)
2. Estimated Behavioral Risk: Percent of
1 Seat Bett Non-Use (MDH Behavioral risk Decreased estimated percent of non-seatbelt
survey). ��•
1 3. Percent of seatbelt nonuse in motor p�r�sed percent of seatbelt nonuse in
vehicle crashes (Minnesota Health Profiles). motor vehicle crashes.
30 CHS PROGRAM PLAN: Unintended Iniury
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H: MEALTH EFFECTS OF
PROBLENf
1. M lncreasing number of children and adolescenfs in Ramsey County experience the health
eSects that are associated with poverry.
OUTCOME
1. Ramsey County children and adolescents will experience reduced adverse health effects
associated with poverry.
Out- CHS9
come �r�g�� Proqram
Area
1 1. Inform policy makers and others of the relationship between poverty and heafth Hp
status, with Ramsey County specific data.
i 2. Work with housing code enforcement officers to ameliorate conditions that are Hp
cause for condemnations and homelessness.
3. Identify and impiement ways for public heatth staff to join efforts for better
i housing for low income persons, such as supporting assurance efforts for HP
adequate housing, and continuing work with St. Paul Area Goalition for the FH
Hometessness (SPACH).
Current 5trategies That Will Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Gome
1 1. Number of Ramsey County chiidren and Decreased number of Ramsey County chifdren
adolescents in poverty. and adolescents in poverty.
9 These program area acronyms are discussed under "Planning Categories° in the Introduction Section.
CHS PROGRAM PLAN: Heatth Eftects of Poverty 31
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32 CHS PROGRAM PLAN: Heakh Effects of Poverty
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L CHF�D NEGLECT
PROB �M
1. An increasing number of cflildren in Ramsey Counry are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
[jlj ti
1. Fewer infants and children who live in Ramsey County will experience negfect
Out- CHS70
come Strategies Program
Area
1 1. Coflaborate with the Ramsey Community Human Services Department to FH
promote the well being of children.
1 2. Partner with community businesses and agencies to create supportive and FH
nurturing public spaces for children and families.
1 3. Participate in collaboratives working to reduce child neglect. FH
HP
1 4. Advocate for the importance of including men in planning and participation in FH
coilaboratives working to reduce child neglect. HP
1 5. Partner with community parent education programs to inciude the role of HP
men in children's lives. FH
6. Advocate that newbom babies leave Ramsey County hospitals with W IC
1 information (ff appiicabie), an appointment for initial well child check up, plans FH
for transportation to the appointment, a digital thermometer (not mercury), and
information about environmentai health hazards in the home.
7. Provide interventions to targeted fami{ies that identify and reinforce the
'I family's strengths, and educate on normal grovuth, development and positive Fti
parenting.
1 8. Promote parent-child attachment through individual-based interventions by FH
HouseCalls, public health nurses, and nutritionists.
1 9. Promote after-school activities for students. HP
10. Promote continuation of commun'rty resources that include strategies for
� reducing child neglect and promote use of those resources, including First Call Hp
for Help and the Teen Parent resource book (Healthy Families Adolescent
Parent Program).
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
10 These program area acronyms are discussed under "Planning Categories" in the introduction Section.
CHS PROGRAM PLAN.� Chifd Neglect 33
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OUTCpME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Number of Ramsey County children who Decreased number of Ramsey County children
experfence substantiated (determined) who e�erience substanfiated (determined)
neglect (Ramsey County Human Services). neglect.
1 2. Number of children who are served by Decreased number of children who are
SPRCDPH staff that e�erience SPRCDPH clients who experience
substanbated negtect. substantiated neglect.
34 CHS PROGRAM PLAN: Child Neglect
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J_ ALCOEiOL�kBE�SE �
�oB�nn
1. Alcjohol abuse causes adverse heaith etfects and social problems in Ramsey Courrty. lt negatively
impacGS intended and unintended injury; unplanned pregnancy,• poor birth outcomes child
development; ado%scent heaRh; mental health; vio%nce; infecfious diseases; and chronic diseases.
OIiiCOME
1. Ramsey County residents engage in iess aicohoi abuse.
Out- CHS"
come Strategies Program
Area
i 1. Develop and use consistent SPRCDPH messages regarding alcohoi abuse (for HP
staff training and dissemination to the public).
1 2. Train SPRCDPH staff on alcohol abuse. Hp
1 3. Include updated information about Fetal Alcohol Syndrome and Fetal Alcohoi NP
effects, client education methods, and client screening for risk factors, in orientation
for appropriate new public heafth siaff and in in-service training for existing staff.
1 4. Educate SPRCDPH clients on how aicohol use afifecis fetai devefopment. HP
1 5. Work with community groups to promote awareness and strengthen prevention HP
messages that address the effects of alcohol on birth outcomes.
1 6. Work with Minnesota Join Together to develop a community plan for reducing �P
teen alcohol abuse in Ramsey County.
1 7. Coordinate annua{ly a chemical health workshop for school distriet staff in HP
Ramsey County.
1 8. Partner with heaith care professionals and other professional organizations to HP
encourage all providers to screen patients for alcohol use, including its relationship DPC
to violence.
1 9. Support public policies and laws that prevent alcohol abuse. HP
1 10. Encourage the promotion of alcohol-free gradua5on, homecoming, prom and HP
other social activities for high school and college students.
1 11. Participate in suburban Mayor's Commission Against Drugs (includes cities of HP
Roseville, Fal�n Heights, Lauderdale and Little Canada).
1 12. Continue SPRCDPH staff group for alcohol policy and planning coordination. HP
DPC
" These program area acronyms are discussed under "Planning Categories" in the Introduction seetion.
CHS PROGRAM PLAN: Alcoho! Abuse 35
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Current Strategies 7'hat Will Be Reduced and Eliminated
Not Applicabie
OUTCOME EVALUATION PLAN
�� Outcome Indicator Evaluation
Come
1 1. Estimated percent of acute drinkers in By 2004, decrease estimated percent of acute
Ramsey County (MDH Behavioral Risk drinkers from the 1997 estimated perc2nt of 16.1.
Survey).
1 2. Estimated percent of chronic drinkers in By 2004, decrease es5mated percent of chronic
Ramsey Couniy (MDH Behavioral Risk drinkers from the 1997 estimated percent from 2.7.
Survey).
1 3. Percent of 12 grade students reporting By 2004, using the 1997 percent of 12, decrease the
that during the last two weeks, they have percent of 12"' grade students reporting that during
had frve or more drinks in a row once the last hnro weeks, they have had five or more drinks
(Minnesota Student Survey). in a row.
36 CHS PROGRAM PLAN: AlcoholA6use
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K. ACCESS T� H�ALTM CARE
PROBLEM
1. There is a gap between Minnesota Goals and the current number of people in Ramsey County
who have access to medical, dental and mental heafth care.
OUTCOME
1. An increased percentage of Ramsey County residents have improved access to medical, dentai
and mental heafth care services.
Out- CHS'Z
come Strategies Program
Area
1 1. Screen for eligibility and educate eligible uninsured and low income public
health clients on how to enroll in MinnesotaCare and assure clients' participation HP
in MinnesotaCare through follow-up and monitoring of client enrollment.
1 2. Support policies that require health care providers participating in Prepaid FH
Medical Assistance Programs (PMAPs) to have evening and weekend hours. HP
1 3. Form a group to plan the SPRCDPH's roles and responsibilities for providing HP
primary care.
1 4. Advocate that Heaith Plans and third-party payors cover medical, dental and HP
mental health services for families and individuals. FH
HH
1 5. Identify and support actions that improve access to health care by all Ramsey
County residents, including improved access to medical, dental and mental
heafth insurance by low-income individuals and families, improved coordination HP
of services and the removal of other barriers to care (e.g. cultural, transportation
and child care).
1 6. Coordinate with the Ramsey County Community Human Senrices HP
Department, HeaRh Plans and communiiy clinics to increase coverage and HH
improve access to language-appropriate, coordinated mental health senrices for FH
children, adolescents and adults.
1 7. Increase participation of eligible clients in publicly funded services (i.e. Child FH
and Teen Checkups).
8. Develop a transition pian for assuring that injection clinic services are HP
available in the community when SPRCDPH discontinues providing this service DPC
at the Community Mental Health Clinic (CMHC).
� 9. Advocate improved access to preventive dental care for children. DPC
HP
' These program area acronyms are discussed under "Planning Categories" in the Introduction Section.
CHS PROGRAM PLAN: Access to Health Care 37
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1 10. Continue providing assessments for Personal Care Assistant (PCA) HP
recipients in the Medical Assistance Program.
1 11. Continue to screen and case manage elderly and disable clients who are
eligible for the Long-term Care Waivers-Elderly Waiver (EW), Altemative Care HH
(AC), Community PJtemative Care (CAC), and Communiiy Altematives for HP
Disabled Individuals (CADI).
1 12. Promote increased ident'rfication and follow-up for mental heaPth senrices in HP
Ramsey County.
Current Strategies That Wiil Be Reduced and Eliminated
HP
1 13. Discontinue providing the injection clinic services at the Communiry Mental FH
Health Clinic.
DPC
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1 1. Rate per 100,000 Ramsey County residents Increasing rate between 1999 and
enrolled in Minnesota Care in Ramsey Couniy 2003.
1 2. Number PMAP Providers that offer evening and Increasing number of providers who
weekend hours offer evening and weekend hours.
1 Rate of uninsured persons in Ramsey County. Decreased rate of uninsured persons
in Ramsey Couniy.
38 CNS PROGRAM PLAN: Access to Health Care
�i�q9Y
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L. TOEiRCCO U�E
PROB PM
i. Tobacco use is on ths rise among yauth and other select populations in Ramsey County.
C�l�i t�?�]!i I �
1. Ramsey County residents engage in less tobacco use.
Out- CHS73
come ��gi� Prograrti
Area
1 1. Educate public health clients on adverse heaith effects of tobacco, including HP
dental effects. FH
1 2. Coilaborate with state and local pianning and impiemerrtation efforts to Hp
effectively use state tobacco settlement funds and to reduce effects of tobacco FH
among ieens. EH
DPC
1 3. Expiore available behavioral risk data for Ramsey County and if none is HP
available, plan to conduct a risk su+vey for Ramsey County. DPC
FH
1 4. Comply with the Minnesota Clean Indoor Air Act regulat+ons in all licensed food, EH
beverage and lodging facilities. HP
, 1 5. Explore how food, beverage and lodging licensing fees could be adjusted to EH
provide discounts to smoke-free establishments. HP
1 6. Promote the development and enforcement efforts of community organizations' FH
tobacco policies and target market. HP
DPC
1 7. Encourage health care providers to screen ail individuals for tobacco use. FH
DPC
1 8. Update the Ramsey County smoke-free restaurant guide every three years. EH
1 9. Monitor compliance with state statutes regarding tobacco access for Ramsey HP
Gounty municipalities
1 10. Develop an integrated community system for reducing tobacco use in Ramsey HP
County.
Current Strategies That Will Be Reduced and Eliminated
Nat Applicable
' These program area acronyms are discussed under "Pianning Categories" in the Introduction section.
CHS PROGRAM PLAN: Tobacco Use 39
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OUTCOME EVALUATION PIAN
FlNAL�SNNT PAULVERSION OF THE 2000-2UIXi CHS PLAN UPDA'fE
1 1. Percent of female and male 9 grade By 2004, using the 1998 number of 4% as a
students smoking �/2 pack of cigarettes per base, decrease ihe percent of female ancf male
day in the last 30 days. (Minnesota Student 9"' grade students reporting smoking'/z pack of
Survey) cigarettes a day in the last 3Q days.
1 2. Percent of 12 grade males who report By 2004, using tfie T 998 nUmber of 7% as a
using chewing tobacco daily. (Minnesota base, decrease the perceniage of 12"' grade
Student Survey males who report using chewing fobacco daily.
1 3. Percent of 9 Grade female and male By 2004, using the 1998 number of 33% and
tobacco users who report buying tobacco 25% as a base, decrease the percent of 9"'
aY gas stations or convenience stores. grade female and male tobacco users who report
(Minnesota Student Survey) buying tobacco at gas stafions and convenience
stores.
1 4. Estimated percent of current smokers By 2004, using tfte 1997 number of 22.1 °,6 as a
(18 years of age or older) in Ramsey base, decrease the estimated percent of current
Couniy. (Behavioral Risk Assessment; smokers (18 years of age or older) in Ramsey
Minnesota Department of Health} County.
40 CHS PAOGRAM PLAN: TWaacco Use
0�-999
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�ll: �'UBLIC HEALTI-! POL�CY D�fELORIYIIEN� .
PROB IPM
1. There is a lack of capacify and resources devoted to researching, informafion sharing and
developing solutions to public health issues in Ramsey County.
OUTCOME
1. Sufficient capacity to effectively assess, communicate and help develop solutions to Ramsey
County's public heafth problems.
STRATEGIES
Out- CHS�a
come Strategies Program
Area
1. Increase the ability of SPRCDPH to collect and analyze data according to a variety HP
1 of designated geographic areas such as zip code areas, neighborhoods, and census DPC
tract areas.
1 2. Develop methods for communicating research information on emerging and re- HP
emerging public health topics.
3. Coliaborate with data collection organizations that exist outside of SPRCDPH, HP
1 including other inter- and intre- county groups, the state, education institutions and DPC
private, non-profit groups.
1 4. Continue participation in metro area county planning and data groups. HP
1 5. Support improvements in data eollection and reporting efforts of the Minnesota HP
Department of HeaRh.
1 6. Improve capabiliiy at local level for collection and analysis of local data. HP
1 7. Create a database to use current data sources more efficientiy and effectively. HP
1 8. E�lore ways to finance and conduct a behavior risk sunrey of Ramsey County
residents.
Current Strategies That Will Be Reduced and Eliminated
Not Applicable
14 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGR,4M PLAN: Public Heatth Policy Development 41
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OUTCOME EVALUATION PLAN
1 1. Percent of outcome indicator data contained On an annual basis (or as frequently as new
in the Ramsey County CHS Plan that is data is available), data for 100% of outcome
collected on an annual basis (or as frequently indicators contained in the CHS Plan is
as the data is available). collected.
1 2. Percent of CHS Plan outcome indicator data On a biannual basis,100% of outcome data is
that is available in written form for disVibution made available in one or more written reports.
to public health decision makers and other
interested persons.
1 3. Amount of data available for analysis From 2000-2003, 5 data elements are identified
acxording to neighborhood, zip code and and available for analysis according to the
census tract geographic areas. appropriate RC neighborhood, zip code or
census tract area.
42 CHS PROGRAM PLAN: Public Health Policy Development
or'9
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IV: f BF�EASTFEEQIN.G RAT'E
PROBLEM
1. Ramsey County women are indiating and sustaining breastfeeo'ing at a rate lower than the state
and nafional goals.
OUTCOME
1. A higher rate of Ramsey County infants will be breastfed.
Out- CHS15
come Strategies Program
Area
1 1. Develop a coordinated breastfeeding promotion message from Saint Paul — Ramsey
County Department of Public Health. HP
1 2. Build awareness of the benefits of breastfeeding among SPRCDPF{ stafE, and HP
encoura e Public Health staff to rovide ositive feedback to women who breastfeed.
1 3. Continue SPRCDPH promotion of breastfeeding during prenatal contacts, provision HP
of lactation education and support, and referrals of SPRGDPH clients to community HHC
resources for breastfeeding women and teens.
4. Beginning with W IC mothers, continue working to collect data on length of time
mothers breastfeed
1 5. Participate in community-based efforts, including work with clinics, to promote and
support breastfeeding for all women, such as through access to lactation consultants HP
and support in chitd-care settings.
Current Strategies That Will Be Reduced and Eliminated
Not Applicabte
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Number of antepartum women served by �ncreased percent of Public Health clients served
1 Public Health staff who breastfeed in the antepartum who breastfeed in the hospital.
hospita{.
1 2. Duration of breastfeeding by women Increased duration of breastteeding women
receiving WIC services. receiving WIC services.
15 These program area acronyms are discussed under "Planning Categories" in the Introduction section.
CHS PROGRRM PL.4N: Breastfeeding Rafe 43
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44 CHS PRO�R,4M PLAN: Breastfeeding Rate
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�, O. YOUTH RISK BEHA�IOR
PROBLEM
1. There is an increasing amount of self-destructive behaviors by youth that result in negative health
outcomes in Ramsey Courrty. .
. � .,,=
1. Ramsey County youth engage in fewer or lower levels of self-destructive behaviors that resuft in
negative health outcomes.
Out- GHS76
come
Strategies Program
Area
1 1. Promote asset building in youth development. HP
1 2. Promote healthy attachment and brain development during pregnancy, HP
infancy and childhood.
1 3. Increase education regarding depression in youth and adolescents. HP
1 4. Support efforts of The tnitiative for Violence Free Families and Communities HP
that pertain to behaviors in youth that result in negative health outcomes.
Current Strategies That Wili Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN
Out- Outcome Indicator Evaluation
Come
1. Percentage of Ramsey County 9 grade students who
1 disagree with the statement: I usually feel good about myself By 2004, decrease by 3%.
(Minnesota Student Survey).
� 2. Percent of 12 grade Ramsey Couniy female students who BY 2004, decrease by 3%.
use diet pilis or speed to controi weight (MN Student Survey).
� 3. Percent Ramsey County 9 grade males who report a gY ppp4, decrease by 2%.
suicide attempt in the past year (Minnesota Student Survey).
� 4. Percent Ramsey County 9 grade females who report a gY 2Qpq decrease by 4%.
suicide attempt in the past year (Minnesota Student Survey).
5. Percent of Ramsey County 9"' graders who report feeling BY 2004, increase�the percent off
1 cared about by school staff. Ramsey County 9 graders who report
teeling cared about by school staff.
16 These program area acronyms are discussed under "Planning Categories" in fhe Introduction section.
CHS PROGR,4M PLAN: Service Needs of the Elderly 45
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46 CHS PROGRAM PlAN: Service Needs of the Elderly
Ol-999
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P: SER�/iCE N€EDS O�T,f=1€ ELDERLY
PROBLEM
1. The needs of the growing populafion of peopie age 65 and oider in Ramsey County may
ovenvheim the traditionai response of tamily, the private sector, and govemment.
1. Ramsey Coun�s residents who are older than 65 years of age wili have healthful aging and the
greatest degree ofi independence that is possibfe.
Out- CHS"
Strategies Program
come �,�
1 1. Conti�ue the DepartmenYs involvement with the Seniors Agenda for HH
l�dependent Living program (SAIL) whose mission is to reshape the long-term HP
care system in the East Metro Area, making more community options available DPC
and accessible to `older persons.
1 2. Continue nursing assessments and referrafs under the Health Officer Act for HH
elderly who are classified wtnerable aduits.
1 3. Explore the role of public health in the future aging population with statewide HH
and(or regional efforts. HP
DPC
1 4. Encourage community groups to support healthy aging. HP
1 5. Promote transportation alternatives and inRiatives (e.g. buses and Metro HH
Mobility across county lines, senior rates for cab fares, and legislation to increase HP
funding of fare waivers to enable transportation for shopping).
1 6. Continue and expand effective interventions to prevent poor health outcomes EH
related to environmental safieiy hazards (e.g. injuries from falls). HP
DPC
1 7. in cooperation with Area Agency on Aging, Ramsey Action Programs, and the
Ramsey County Meafs on Wheels Consortium, change Meats On Wheets HH
corrtracts to require Meals on Wheets iVutrition Education, ethnic meal HP
alternatives, and to allow for additional vendors.
1 8. Work with agencies to develop consulting nutritionists in the private sector who HH
will contract with waivers, incentives to work with MA and Waivers. HP
DPC
1 9. Work with Area Agency on Aging for promotion of exercise centers in High HH
Rise and education on strength training for elders and capacity building- HP
community education programs.
1 10. Encourage home care agencies to use persons older tha� 65 as health care ��
workers to help alleviate the shortage of home care workers and as trainers to
" These program area acronyms are discussed under "Pfanning Categories" in the Introduction section.
CHS PROGRAM PLAN: Service Needs of the Elderly 47
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maximize skilis of workers.
1 11. Continue support of Living at Home/Btock Nurse Program or other simiiar HH
programs. HP
1 12. Promote "Mobiie Assisted Living" concept. HH
HP
Current Strategies That Wiil Be Reduced and Eliminated
Not Applicable
OUTCOME EVALUATION PLAN:
1 1. Nursing facitity occupancy rate Decreased nursing faciliry occupancy
rate.
1 2. Regiottal and/or Statewide efforts to e�lore The extent to which the role of Public
role of Public Health. HeaRh has been def+ned/established
for the future population of age 65 and
over.
48 CHS PROGRAM PLAN.• Servic� Needs of the Elderly
0l-999
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� �GTC014/tE-EVALUAI'ION PlANS
DEFINITIONS OF OUTCOME AND OUTCOME INDICATORS
The success of the strategies contained in this CHS Program plan will be evaluated aa:ording to
Ramsey County's outcome-based performance measurement system. The outcome evaluation system
measures sua;ess according to how the community has benefited from the strategies.
Outcomes are benefits the community and individuais experience, and other desired changes in
knowledge, skil)s, attitudes, behavior, condition or status of individuals and populations intended to be
impacted by the strategies.
Outcome indicators are statistics that `indicate' something. They may serve as proxies for the outcome.
Indicators are imperfect and vary in valid'ity and reliability. They were developed by identifying the best
measure of progress toward achieving the desired outcomes. As is demonstrated by the outcome
indicators for the CHS Program Plan strategies, indicators typicaliy are averages, percents and rates.
METHODS FOR EVALUATlNG OUTCOMES
The methods for evaluation are reflected by the `evaluation' portion of the outcome evaluation grids
(contained under each of the problems statement sections) that state specific goals for the outcome
indicators. The data for these evaluation goals will be reported by the SPRCDPH as frequently as the
data is availabte from outside sources or as frequently as d is possible for SPRCDPH to conduct its own
data collection efforts. Outside sources include Minnesota Health Profiles and the Minnesota Student
Survey. Other data sources may include case studies, existing records within the SPRCDPH, focus
groups, interviews, and questionnaires.
Actual data that is collected wiil be compared to the goals for the indicators contained in the outcome
evaluation grids. The comparisons will be used to discuss:
1, whether and the extent to which the strategies are impacting the desired outcomes;
2, how the strategies could be changed to achieve the desired outcomes;
3, whether new strategies need to be designed and implemented; and
4. if other indicators and eva(uation methods would better reflect the success of the strategies.
EVALUATION OF SERVICES PROVIDED THROUGH GRANTS; CONTRACTS AND AGREEMENTS
Consideration of alternative senrice delivery options will be accomplished through increased use of
Request for Proposai (RFP) processes and outcome evaivations for current and future grants, contracts
and agreements.
CHS PROGRAM PLAN.� Explanation of Outcome Eualuation of Strategies 49
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50 CHS PROGRAM PLAN: Explanation of Outcome Eualuallon of SYrategies
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�EatDtX 1. _ AD(11111
[s��f�_���:r
The Saint Paul Ramsey Couniy Department of Public Heaith collaborates with the Minnesota
Department of Heatth in many ways to ac�omplish fts outcome goals and objectives relating to the
Communiry Health Service categories and problems idenfrfied within those categories. The following
table provides a summary of the administrative and program support Ramsey County may need from the
Minnesota Department of Health.
Key to CHS Categories in Following Table
1= Alcrohol, Tobacco and Other Drugs
2= Child Growth and Development
3 = Chronic, Non-Infectious Disease
4= Disability and Decreased Independence
5 = Environmental Conditions
6 = Infectious Disease
7= Mental Health and Mental Illness
8 = Pregnancy and Birth
9 = Service Delivery Systems
10 = Unintended Injury
11 = Unintended Pregnancy
12 = Violence
CHS Categories
AdminiSt�'dtive and Progf2m Support NeEded 1 2 3 4 5 6 7 8 s 10 11 12
Timely, local data and geo coded X X X X X X X X X X X X
Financiai support for early HIV intervention
services X
Shared philosophy regarding importance of public
funded STD/HIV services. X
Training and technical assistance including data
analysis X X X X X X X X X X X X
Full funding for tuberculosis medications. X
Support for the Immunization Registry X X
Funding for the Hepatitis B Perinatal Prevention
Program X X X
Support for universal hepatdis B immunizations. X X
Heafth education materials in multiple languages X X X X X X X X X X X X
Consuttation on coalitions working with chronic
disease prevention and reduction X X X
Ongoing updating of MDH "Strategies for Public
Heatth" book. X X X X X X X X X X X X
Consultations regarding health promotion
messages, dissemination, funding, and X X X X X X X X X X X X
assistance evaluating effectiveness of inessages.
Promotion of health advocacy X
CHS PROGRAM PLAN: Program Support Needed from the Minnesota Department of HeaRh 51
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CHS Categories
Administrative and Program Support Needed 1 2 3 4 5 6 7 8 s 10 71 12
Leadership regarding increased reporting of food
bome illnesses X X
Support for local enforcemerrt of environmental
health regulations X
MDH Disease Control Newsletter with information
on disease prevention and control X X X
Support for groundwater proteetion agreements. X
Advocacy for means of funding lead screening,
lead inspections, workable lead standards, and
other public health funcfions mandated in state X X
statute.
Assistance in the development of a system for
ensuring consistent, accurate physicians and
taborarorfes to report cases of blood lead
poisoning to MDH and appropriate levels of X X
govemment (including non duplicated counts of
cases)
Development of education materials for
hazardous waste generators X
Continued support for and recognition of poverty,
especially geographic areas of concentrated
poverty, as an underlying cause of public health X X X X X X X X X X X X
problems.
increased development and collection of locai
data regarding prevention and incidence ot rases,
including support for local behavioral risk X X X X X X X X X X X X
assessment surveys.
Support for institutionalizing violence prevention
as ongoing activiry of MDH and local public health X X
departments
Leadership and increased opportunities for
counties to leam from each other regarding X X X X X X X X X X X X
ident'rfied pubiic health problems.
Ongoing improvement and expansion of MDH
informafion and data W W W sites. X X X X X X X x x x x x
52 CHS PROGRAM PLAN: Program SuppoR Needed from the Minnesota Department of Heaith
ot-99 y
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--. _. . . - - ; - -�„ . _ . _ . _ . ., . .
APPENDIX 2: �ROB�ENfS ORGA[�1Z�D BY CHS CATEG�RY
PLANNING CATEGORIES
A communiry health plan is required by state mandate to organize its pianning according to rivelve planning
categories as listed below.
Alcohol Tobacco and Other Drugs
Child Growth and Development
Chronic Non-Infectious Disease
Disability and Decreased Independence
Environmental Health
Infectious Disease
Mental Health
Pregnancy and Birth
Service Delivery Systems
Unintended Injury,
Unintended Pregnancy,
Violence
The twelve planning categories are used as guides for collecting data and organizing the community
assessment and plan documents. In addition, Ramsey County chose to use "Youth Risk Behavio�" and
"Child NeglecY' as additional planning categories. The foilowing is a list of the public health problems
organized according to community health planning categories.
ALCOHOL, TOBACCO AND OTHER DRUGS
1. Aicohol abuse causes adverse health effects and social problems in Ramsey County. It negatively
impacts intended and unintended injury; unplanned pregnancy; poor birth outcomes; child development;
adolescent health; mental health; violence; infectious diseases; and chronic diseases.
2. Tobacco use is on the rise among youth and other select populations in Ramsey County.
CHILD GROIKTH AND DEVELOPMENT
See the "Pregnancy and Birth" category.
CHILD NEGLECT
1. An increasing number of children in Ramsey County are experiencing neglect due to ineffective
parenting and families experiencing chronic stress.
1. High numbers of Ramsey County residents are ovenveight, inactive and have inadequate nutrition,
which contributes to chronic disease.
DISABILITY AND DECREASED INDEPENDENCE
1. The needs of the growing population of peopie age 65 and older in Ramsey County may ovenvhelm
fhe traditional response of famity, the privafe sector and govemment.
ENVIRONMENTAL CONDITIONS
1. There is an increasing risk of iliness due to environmental health hazards in Ramsey County.
INFECTIOUS DISEASE
1. Emerging and re-emerging infectious diseases threaten the health of the general population Ramsey
Couniy.
CHS PROGRAM PLAN: Probiems Organized by CHS Category 53
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MENTAL HEALTH AND MENTAL ILLNESS
See the categories "Youth Risk Behavio�' and "Service Delivery Systems" (problem number 2).
1. The percent of infants in Ramsey County bom with low birth weight is not moving toward Minnesota
and national goals.
2. Ramsey County women are ini�ating and sustaining breastfeeding at a rate lower than the state and
national goals.
3. Increased percentage of births to adolescents and increased number of births that result from
unintended pregnancies.
SERVICE DELNERY SYSTEMS
1. An increasing number of children and adolescents Ramsey County experience the health effects that
are associated with poverty.
2. There is a gap beiween Minnesofa goals and the current number of people in Ramsey County who
have access to medical, dental and mental heaRh care.
3. Despite overall health improvement in Minnesota and Ramsey County, populations of color in
Ramsey Couniy continue to experience poorer health and disproportionately higher rates of illness and
death.
4. There is a lack of capacity and resources devoted to researching, information sharing and developing
solutions to public health issues Ramsey County.
UNINTENDED INJURY
1. Unintentional injury is one of the leading causes of death throughout a life6me in Ramsey County.
Motor vehicle crashes are the leading cause of injury fatalities followed by falls, poisoning, suffocation,
and fire.
See the "Pregnancy and Birth" category.
VIOLENCE
1. There is an unacceptable level of interpersonal violence in Ramsey County.
YOUTH RISK BEHAYIOR
1. There is an increasing amount of seif-destructive behaviors by youth that result in negative health
outcomes in Ramsey County.
54 CHS PROGRAM PLAN: Problems Organized by CHS Category
Cl!- / �l�f
, , ,. .� ,
PEi�t�IX 3: M/kTERF�lAL.AN�,CFiii_D HEALTFf CCRaF�tT " ;, .:.:;..
CHS PROGRAM PLAN: Youth Risk Behavior Plan Update 55
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a� -49y'
The Saint Paul Board of Health
and
The Saint Paul - Ramsey County Department of Public Health
The Public Health Joint Powers Agreement - JPA, between the City of Saint Paul and Ramsey
County became effective July l, 1997. The JPA forms the Saint Paul - Ramsey County
Department of Public Health and identifies ane Community Health Services Agency for the
Saint Paul - Ramsey County community. However, both Saint Paul and Ramsey County
continue to maintain a Boazd of Health. The Saint Paui Community Health Boazd will consider
issues affecting those services maintained by the City of Saint Paul, which include the Maternai
and Child Health Special Projects Grant. The Saint Paul - Ramsey County Department of Public
Health is the operating agency for the MCH grant.
-i-
p1-�999
Saint Paul Maternal and Child Health
Special Projects Grant Update 2002 - 2003
Table of Contents
Updated Minnesota Department of Health Forms
A . Face Sheet ••• ..........................................................................................
B. Assurances and Agreements ....................................................................
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legisiative Priority, 2002-2003 ..........................
• I. Improved Pregnaucy Outcome Programs .....................................
• II. Family Planning Program .........................................................
• V. Other Programs Previously Funded by a Local Pre-Block
MCH Special Project Grant: Adolescent Health Program ..........
D. Efforts to Reduce Racial Dispariries ......................................................
E. Subgrants/Subcontracts .........................................................................
F. Special Project BudgetlExpendihue Report
• 2002 ................................................................................................
• 2003 ................................................................................................
• Budget Jusrificarion .........................................................................
G. Indirect Cost Allocation for MCHSP ......................................................
H. MCH Special Project Breakout Budget/Final Expenditure Report
By Legislative Priority, 2002-2003 ..........................................................
Program Narrative Update
I. 2002-2003 MCH Special Project Program Update .........
• I. Improved Pregnancy Outcomes Programs
a. HealthStart, Inc . .......................................
b. Face to Face Health and Counseling Center
c. West Side Community Health Center ......
• II. Family Planning Program
Room ....................................................
• V. Adolescent Health Frogram
HealthStart, Inc . ...........................................
.......... 1
.......... 3
.......... 7
.......... 7
.......... 8
.......... 14
.......... 15
••........ 16
.......... 17
.......... 18
.......... 19
.......... 21
.......... 23
.......... 25
.......... 27
.......... 37
.......... 45
.......... 51
.......... 55
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o�-y99
�'s���s�a�ro��o„s A. Minnesota Department of Health Face Sheet
Grant Applicaaun tor. Maternal and Child Aealth Special Projects
1• Applicant Agenty With Which Giant Coahaet is to 6e Ezecured
Legai N�e: SteetAddcess: 310 City Hall, IS West Kellogg Blvd Telephoae Number:
Saint Paul Commuvity HeaIW Board Saint Paul, MN 55102 651266.8560
FAX N�mber. 651266.8574
E�Mail Addcess:
2. D'upctor of Applicant Agency
Name aad Title: Sheet Addtess: 555 Cedar Steet TeLephone Numher,
Rob FuIWn Saiat Paul, MN 55101 651266.2424
Direc[or of Public Health FAX Number: 651.266.1201
�Mail Address: robSutton@co.xanssey.mn.us
3. Flscal Maoagement O�cer of AppticaM Agenry
Name and TiUe: Steet Address: 555 Cedar Street Telephone Numba
Diane Holmgreu Saint Paul, MN 55101 651266.1221
�Hea�ih Adminsua6on Manager FAXN�mmber:651266.1201
E�Mail Add�ess: diave.holmgrn� .(t�coramseY.mn.us
4 • OMn�S �Se��S' ('+Id�ent from number I above)
Name and Title: S�eet Address: 555 Cedaz Street Telephoue Number:
Saint PauL— Ramsey County Depa[mient of �� pau1, MI`155101 651266.1200
FAX Number: 651166.1201
Public Health E-Mail Address:
5. Coniac[ Person for Opentiog Agenty ('fdifferentfrom nwnber2 above)
Name and Tifle: Address: 555 Cedar Street Telephone Number.
Peg Torgerson Saint Paul, MN 55101 651266.1216
MCfI Gtant Coordinator FAX Numba: 651266.1201
E-Mail Address: Peg.torgerson@co.ramsey.mn.us
6. Confact Persou for Forther Informstion on Application (ifd�rentfrom mnnber S above)
Name and Title: Street Address: Telephone Number.( )
FAXNum6er.( )
& Mail Address:
7• Opersdog Agency F5sca1 ContaM (�'di$aent munber 3 above)
Name and TiUe: Stree[ Address: 555 Cedar Street Telephone Number:
Nflce Hagen Saint Paul, MN 55101 651266.1204
FAX Number. 651.2661201
Accouarent ��padress: mike3ageneco.ramsey.mn.us
8. Copies of This ApplicaUon Hsve Been Sent to Ne FaDowing Commmity Health Boards Por Review
(NotApplicable far Cammtmiry Health Bomd(s) ifthe Bomd is the Applicanf)
A¢encv Name
Date Sent
9. Certifinfion
L cenity that the infocmation contained �etein is ttue apd accurate to tha best of my Imowledge and that I submitihis applicarion oa behalf of the applicant agency.
/�i�,����-u �►rP��c1� 4-�3-ai
Sigpatureof irecturofApplicantAgrncy TiUe Dy¢
Fi&01274-OS (3/27) - PART A
-1-
OI-999
B. Assurances and Agreements
BY SIGNATURE, THE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
1. Services wiil be provided in accordance with applicabie state and federal laws, rules and procedures.
2. The agency wil] comply with state and federal requirements relating to privacy of client informauon.
3. The agency wiil comply with the Minnesoca Clean Indoor Air Act which prohibits smoking in MCH Special
Project facilides and ciinics.
4. The agency (iF it has 15 or more employees) and any subconffactors with 15 or more employees will have on
file and available for submission to Minnesota Departrnent of Health (NIDI-n upon request a written non
discriminauon policy containing at teast the following:
"All programs, services, and benefi[s which are administered, authorized, and provided shall be operated in
accordance with the non discriminatory requirements pursuant to Tide VI of the Civil Rights Act of 1964,
Section 504 of the Rehabi]itation Act of 1973, as amended, tf�e Age Discrimination Act of 1975, and the non
discriminatory requirements of the MCH B lock Grant.
No person or persons shall on the ground of race, color, national origin, handicap, age, sex, or religion, be
excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimina6on under
any progazn service or benefit advocated, authorized, or provided by this Department."
5. The agency (if it has 15 or more employees) and any subcontracTOrs with 15 or more employees witl
disseminate information to beneficiaries and the general public that services aze provided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be accompisshed
by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or other
communications designed to acquaint po[ential beneficiaries and [he puMic with progams; and/or
B. Notifying refetral sources in rou[ine letters by including prepazed handouts which state that services and
benefits must be provided in a non discriminatory manner.
Copies of each documen[ disseminated and a description of how these documents have been
disseminated wiil be provided to the MDH uQon reques[.
6. In fitlfilling [he duties and responsibilities of this gran[, the grantee shall comply with the Americans wi[h
Disabilifies Act of 1990, 42 U.S.C. § 12101, et seq., and the regulatioas promulgated pursuant to iL
7. No residency requiremenu for services other than sta[e residence, will be imposed.
8. Services shalI not be denied based on inability to pay.
9. Arrangements shall he made for communications to take place in a language understood by the matemal and
child heal[h service recipient. .
10. All written materials devetoped ro determine client eligibility and to describe services provided under this
grant will be understandable to a person who reads at a seventh grade level using the Flesch Analysis
Readabili[y Scale as required in Minnesota S[a[ute 144.054 (see Appendix 10, Plain Language in Wri[[en
Materials, Minnesota Statute, Section 144.054).
-3-
l 1. The agency will provide services in keeping wi[h program guideli�es of the Minnesota Departmen[ of Health
and guidelines of accepted professional groups such as the American Academy of Pediatrics, American College
of Obscetricians and Gynecologists, and American Pub[ic Heaft[i Association.
12. Upon request, one copy of any subconvact executed as part of the project witl be provided to the Minnesota
Department of Health.
13. The ag�ncy will report accomplishmenrs of the project to the Minnesota Department of Health. Such reporrs
will be submitted no later than 90 days afrer the completion of the calendar year. Upon request, the agency will
provide additional information needed by the Department for evaluation of the projecCs objuuves and methods
and comptiance with any special conditions (see Appendix 18, Program Reporting Requirements for Matemal
and Child Health Special Projects).
24. Grant funds shatl not be used for inpatient services except for high-risk pregnant women and infants.
15. Cash paymenYS shall aot be made to iniended recipients of heat[h services.
16. Grant funds shall not be used for purchase or improvement of land or facilities.
17. Grant funds shall not be used for purchase of equipment costing more than $5,000.00 per unit and with a useful
life exceeding one year.
18. Granf funds shalI not be used for reimbursement for travel and subsistence expenses incurred ouuide tlie state
unless it has received prior written approval from the Minnesota Depamnent of Heatth for such out-of-state
iravel.
19. When applicable, the agency shall provide nonpartisan voter registrarion services and assisfance using fonns
provided by the state to employees of the agency and [he public as required by Minnesota Statutes, 1987
Supplement, Section 201.162 (see Appendix 9, Requiremenu for Voter Regis�adon).
20. When issuing siatements, press releases, requests for proposals, bid solicitations, and o[her documents
describing projuts and programs funded in whole or in part with federal money, all gantees receiving federal
funds sttall clearly stare (a) ihe percentage of the total cost of the program or project which will be financed with
federal money, and (b) the dollu amount of federal funds for the project or program_
21. The agency will not use �ant funds to pay for a�y item or service (other than an ecnergency item or service)
fumished by an individual or enury convicted of a criminal offense under the Medicare or any state health caze
program (i_e., Medicaid, Maternal and Child Health, or Social Services Blcek Grant programs).
22. Materials developed by Macemal and Child Aealth Speciat Projut �ant and matching funds will be part of the
public domain and will be accessible to the public as £nanciaily reasonable. Materials 8eveloped by the
Maternal and Child Health Special Project grant and matching funds may be reproduced and distributed by the
Project to other agencias and providers for a profit so tong as the revenues from such sale aze credited to the
Special Project budget for expenditure by the Special Project
23. The agency will comply with atl standards relating to fiscal accoun[ability [hat apply to the Minnesota
Department of Aeatth, specifically:
A B�et�e�§�o�s with 'ustification will be submitted to IvIDH for rior a roval whenever:
(1) changes are made in the objectives ro be met in the Matemal and Child Health Special Projec4 or
(2) the cumulative amount of funds vansferred into or out of an operating agency's budget line item
exceeds or is expected to exceed 10% of that approved for the gant yeaz or $2,500.00, whichever
is grea[er.
-4-
oi-599
B. Final expenditure reports are due 90 days after the end of the calendar yea.
C. Grant funds ue used as payment for services only afrer third-party payments, such as from the Medical
Assistance/Medicaid (Title XIX 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 wiil provide for:
(1) Accurate, cursent, and compiete disclosure of the financial stams of the project.
(2) Records which idenafy adequately the source and application of funds for Maternal and Chiid
Health Special Project activities. These records aze to contain information pertaining to project
awazds and aurhorizations, obligations, unobligated balances, liabilities (encumbrances), outlays,
and income.
(3) Effective control over che accountability for all funds, property and other assets. Projects are to
adequately safeguard such asseu and assure that they are used solely for authorized purposes.
(4) Comparison of actual obligations with budget amounts for each activity.
(5) Accounting records which aze supported by source documentation.
(6) Audits which wiil be made by or at the direction of the Minnesota Department of Health (see
Appendix 6, State Audits).
24. Grant funds wili not be used to provide and/or arrange sterilizations without the prior approvai of the
Minnesota Department of E3ealth. Agencies approved to use federal funds to provide and/or arrange for
sterilization aze required to follow federal procedures and to provide written documentation in this regazd
on a quarterly basis. (This procedure is not applicable to provision of infottnation conceming sterilization).
25. The agency assures that in accordance with Section 1352 tiUe 31, U.S. Code no grant funds will be used for
lobbying.
26. The agency will comply with the requirements of the OMB Circular A-87 "Cost Accounang Principles for
State, Locai, and Indian Tribal Governments", Cost Account Principles and the Federai award(s) for which
they apply.
Signature of Chair or V ice-chair of the Communiry Health Board or An Agent Appointed by
Resolutioa of the Community Health Board:
Si�ed By Title Date
� �lrrc.#t/� Q-/��Ol
-5-
o�-�y9
C. MCHSP Summary oF Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
1. Improved Pregna�cy Outcome Program
Agency Name Subgrantee Name {if this report is for subgraMee only)
Saint Paul Commimity Health Board
St. Paui — Ramsey Cty. Dept. of Public Health
Types of Activities/Services
Please check those services provided:
✓ core public health activities not direct service ./ pregnancy testing and referral
./ individualized education/counseling �/ pre-term birth prevention
✓ heafth education/counse{ing in groups ✓ prenatal case management
✓ prenatal medical care ✓ enabling and non-heafth support
✓ ATODJviolence screening ✓ referrai services
✓ breast feeding promotion
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply:
less than 200% of poverty per revised Appendix �/ no fees are charged to persons with
7, or women who are pregnant and determined incomes less than 100% of poverty
eligible for medical assistance (MA) or the
speciaf supplemental food program for women, �/ fees are charged to persons with
infants, and children (WIC) incomes greater than 100°/a of poverty
per pubiic schedule of charges
�/ risk factors listed in Appendix 12 reflecting income, resources and family
size
❑ other risk faetors — please specify:
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chifd Healtfi Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
-7-
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
2. Family Planrtiog Program
Agency Name Subgrentee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St Paul - Ramsey Cty. Dept. of Public Aealth
Types of ActivitieslServices
Please check those services provided:
./ core pubtic heaRh activities not direct ❑ method services
service ❑ task force
./ individualized educatioNcounseling ❑ enabling and non-heaith support
oeducation in schools Oreferral services
❑ other public education
Other- please specify:
Low Income & High Risk Target Population & Fees
Please check those items which apply:
! less than 200°/a of poverty per revised ./ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
✓ risk factors listed in Appendix 12 ❑ fees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specity: schedule of charges reflacting income,
resources and family size
Describe tF�e manner in which the program responds to the needs and priorities for services
identified by the Matemai and Child Heafth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
�
o�-g9y
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
3. Handicapped/Chronlcally Iil Children's Program
Agency Name SubgraMee Name (if this report is for subgreMee only)
Saint Paul Community Health Boazd
St Paul — Ramsey Cty. Dept. of Public Heaith
Types of Activities/Services
Please check those services provided:
❑ core public health activities not direct service ❑ child find/identification
❑ case managemenUservice coordination U early intervention tracking and follow along
❑ home health � assistance to chldren, youth and families in
❑ respite care identifying and locating resources (short-
❑ participation with interagency committee tertn)
❑ IEIC ❑ assistance in establishing medical fiome
❑ children's mental health collaborative Q enabling and non-health support
❑ transition (1422) Q referral services
Other - please specify:
Low Income 8 High Risk Target Population 8 Fees
Please check those items which apply;
❑ less than 200°l0 of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes tess than 100% of poverty
❑ risk factors tisted in Appendix 12 ❑ tees are charged to persons witfi incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family size
b�
Describe the manner in which the program responds to the needs and priorities for
services identified by the Matemal and Child Heaith Advisory Task Force (see revised
Appendix 17). Differences must be described in detail.
C. MCHSP Summary of Types of Activifies and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
4. Childhood injury Control Program
Agency Name Subgrantee Name (if this report is for subgrantee only)
Sain[ Paul Community Heakh Boazd
St Paul — Ramsey Cty. Dept. of Public Healffi
Types of ActivitieslServices
Please check those services provided:
❑ core public health activfties not direct service ❑ injury prevention in day care setting
❑ home safety checkiist promotion ❑ injury preven6on in schools
❑ promotion of positive parenting ❑ fartn related injury programs
❑ toddler car seats ❑ enabling and non-heatth support
❑ bicyc(e heimet campaign ❑ referral services
Other - please specify:
Low Income & High Risk Target Population 8 Fees
Please check those items which apply:
❑ less than 200% of poverty per revised ❑ no fees are charged to persons with
Appendix 7 incomes less than 100% of poverty
❑ risk factors listed in Append'a 12 0 tees are charged to persons with incomes
greater than 100% of poverty per public
❑ other risk factors — please specify: schedule of charges reflecting income,
resources and family s¢e
Describe the manner in which the program responds to the needs and priorities for
services idenffied by the Matemai and Child HeaRh Advisory Task Force (see
-10-
OI-999
C. MCHSP Summary of Types of Acdvities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
5. infant Health Program (oniy Minneapolis and St Paul):
Agency Name Subgrantee Name (if this report is for subgrantee only)
Saint Paul Community Health Boazd
St. Paul — Ramsey Cty. Dept. of Public Health
-11-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differe�ces must be described in detail.
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
6. Child Health Program (only Minneapolis):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Hea(th Boazd
3t Paui — Ramsey Dept. of PubHc Healffi
-12-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Heatth Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
01-9 49
C. MCHSP Summary of Types of Activities and Services Provided by
Operating Agencies by Legislative Priority, CY 2002-03
7. Dental Health Program (only Goodhue and Wabasha):
Agency Name SubgraMee Name (if this report is for subgrantee only)
Saint Paul Commimity Health Boazd
Saim Paul — Ramsey Cty. Dept of Public Heakh
-13-
Describe the manner in which the program responds to the needs and priorities for services
ident�ed by the Matemal and Child Health Advisory Task Force (see revised Appendix 17).
Differences must be described in detail.
C. MCHSP Snmmary of Types of Activities and Services Provided by
Operating Agencies by Legislafive Priority, CY 2002-03
8. Adolescent Health Program (only Minneapolis and St Paul):
Agency Name SubgreMee Name (if this report is for subgrentee only)
Saint Paul Comm�miTy Aea(th Board
St Paul — Ramsey Cty. Dep[. of Public Heatth
-14-
Describe the manner in which the program responds to the needs and priorities for services
identified by the Matemal and Chiid Health Advisory Task Force (see revised Appendix 77).
Differences must be described in detail.
O�"�JIg
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identfied in the CHS needs assessment are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispaziries impact your matemaVchild population or what is the significance of
dispariries to your population.
Each subconhactor has completed tlus information relating to their program.
See: Program Narrative: l.improved Pregnancy Outcomes: a HealthStart, inc.; b. Face to Face Health and
Counseliug Service, Inc.; c. West Side Community Health Services;
2. Family Plauniug Program: Room 111;
3. Adolescent Health: HealthStart, Inc.
2. List specific MCHSP objectives related to raciaUethnic disparities.
Cacn subcontractor nas completeA tlus mtormahon relahng to their program.
See: Program Narrative: 1.Improved Pregnaucy Outcomes: a HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Pla¢ning Program, Room 111;
3. Adolescent Health: HealthStart, Inc.
3. What strategies wilt be urilized related to the above objectives? Of particulaz interest aze community and
systems strategies/objectives which recognize the potential rote all types of community-based organizarions can
play in the decrease of disparities.
Each subcontractor has completed ttus information relating to their program.
See: Program Narradve: l.improved Pregnancy Outcomes: a. HealthStart, Inc.; b. Face to Face Health and
Counseling service, Inc.; c. West Side Community Health Services;
2. Family Planning Pragram: Room 111;
3. Adolesceut Healt6: HealthStart, Inc.
-15-
E. Subgrants/Subcontracts
1. Please list all subgrantee/subcorrtractors and the award amounts for the two year period CY 2002-03.
All subgrantees are accountable for provision of services as specified by the Community
HeaRh Board and further are accouMable for compliance with applicable federal and state
requirements. Please describe the monitoring procedures the Community Heafth Board p�ans to
utilize in assuring fiscal and program acxourrtability of each of its subgrants. indipte the extent to
which on-site monitoring procedures will be utilized
i o ensiae wac every eaort is maae to actueve the proposed goals and objecrives, the subcontnctor's efforts and
performance will be monitored on a regulaz basis throughout the entire contract period.
Contracts will be written beriveen Saim Paul — Ramsey CouNy Department of Public Health and the
subcontractots indicating specific performance objectives and outcome indicato�. The con4acts will outline the
subcontrecto�s duties, reporting requirements, the monitoring expected/performed by Saint Paul — Ramsey
Coimty Departmem of Public Health, and evaluation indicatrns.
Subcantractors will also be required to provide annual performance reports evaluating their own progrdm, and
assessing progress toward goals and objectives. Both subjective and objective tools will be used by the
subcontractors to ensure that various aspects of their progam aze reviewed.
Annual on-site monitoring to assure both fiscal and program accountability is conducted.
-16-
2. Monitoring and Evaluation of Subgrantees/Subcontradors
01-�99
F.
Matemai and Child Health (MCH)
P.O. Box 64882
St. Paul, MN 55164-0882
IV. Reimbursement Request $_ Q, A
V. ORIGINAL CERTIFICATtON SIGNATURE
! cartify tl�a4 to the best ofmy knowledge and belief,
Ne data 2ported on this docume�rt is corrpcf and all
6ansactlons that support this repat were made in
accordance wdh applicable Federal and SYate statutes
and rules
A rized (�fficial Date:
- �-/3.a/
SUBMIT A SIGNED ORIGINAL AND 2 COPIES
TO THE ABOVE ADDRESS
6�, �,2��,
Form for MCH Sectioa Grants
Name of Grant Project:
Matetnal & Child Health Special Projects
GraM Year. 2002
Expenditure Period: 01.01.2002 —12312002
"` List Sources and amourtls of °other g2Mee funds
(e.g., local tax, fees, in kind donations, fioundations, etc.)
Fomdations 109,000
L,ocai tax 139,480
$
= �-:n ?,K � ��=EOR MDH USE ONLY_ - � ; �:�-:%'�
Program Approval
Fiscal Year
0�9. #
PO Number
Dollar Amount
-17-
copy, and equipment under $5,000.00
F.
snorzao�
Budget/Eapenditare Farm for MCH Sectiou Grantg
Name of Grerrt Project
Matemal & Child Health Special Projeas
rant Year. 2003
Expenditure Period: 01.012003 —12.31.2003
IV. Reimbursement Request $ Q, A
V. ORIGINAL CERTIFICATION SiGNATURE "' List Sa�rces and amounts of'other 9raMee tunds
(e.g.. Iacal tax, fees, in IdrW donatb�. foundations, eM.)
1 cartify tha� to Uie best ofmy krtawledge and 6elief, Fmmdations 109,000
tlie date ieported on this dacumerrt is conect and a!! Local Ta�c 139,480
fransacfians fhet suppqt this 2pat were mede in $-
accadence wifh applka6le Federal aid Slate stakdes
arMrules. '---._ _. .. -------. . . . �
Auth ' 1 Date:
9 /3-0
SUBMIT A SIGNID ORIGINAL AND 2 COPIES
TO THE ABOVE ADORESS
�
copy, and equipment under $5,000.00
ol-9gy'
Budget Jusrification
The budget justification for each of the projects/subcontractos is included within their budgets
presented in the application narrative.
In addition to the funds proposed for allocation to the subcontractors for Improved Pregnancy
Outcomes and Adolescent Health programs, a portion of the Matemal and Child Health Special
Projects Crrant is budgeted to remain at Saint Paul - Raxuse�County De�artment of Public
Health for Administrative and Core Public Health functions.
Salary/Frin�e�.
Administrative Assistant:
General program oversight,
prepazes and monitors gants,
reviews reports, prepazes annual
reprots, prepazes and monitors
contracts, meetings and site
reviews with subcontractors
Accountant:
Reviews financial reports,
participates in on-site sub-
contractor monitoring
activites
Accounting Tech Il.�
Prepazes budget and expenditure
reports, prepares pay vouchers
and processes grant allocations
Clerk-Typist IV.•
Types grants, contracts and
reports
2002
$14,670
$ 2,850
$ 3,400
$ 2,850
2003
$14,670
$ 2,850
$ 3,400
$ 2,850
Epidemiologist:
Data collection, analysis,
reporting and display
Sup�lies:
TOTAL:
$14,850
$14,850
$ 200 $ 200
$38,820 $38,820
-19-
Budget Detail of Local Match
Local match is identified within each of the subcontractors budgets, as required by MCH
guidelines. Additional local match is provided by the Saint Paul - Ramsey County Department
of Public Heath:
1. Local Tax Levy funds:
• MCH Prenatal Caze at
Community Clinics
2002
$139,480
2003
$139,480
TOTAL:
2. Other Loca1 Funds:
$139,480
$139,480
Other local match is provided by Public Health through the funding of various programs wluch
contribute to maternal and child health, including family planning, immunizations, lead
screening, nutrition, health education and well child services. Source of this funding includes
CHS fimding, grants, reimbursements, and patient fees.
�II�
O�-9�i 9
G. Indirect Cost Allocation for MCHSP
Please check one of the fo�s options:
./ 1. Not applicable — No chazges to MCHSP aze for indirect cost.
A�plies to Saint Paul — RamseV Counri Deparhnent of Public Health and West Side Communitv Health Services
J 2. Indirect Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against all
participating programs, includingMCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached
Applies to HealthStart, Inc.
❑ 3. Approved Cost Allocation Process:
Option 1—Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached wluch are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
J 4. MCHSP - Approved Cost Allocation Process:
OpHon 2—Indirect costs aze allocated to the agency's prograzus using the optional Indirect(Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal awazd(s) for wluch they apply.
Applies to Face to Face Health & Counselin2 Service, Inc.
See: Project Narrative for each subcontractor for supporting data for indirect cost allocation.
-21-
o�-9yy
Please read INSTRUCTIONS ON REVERSE side before completing form.
H. MCH SPECIAL PROJECI' BREAKOUT BUDGET/FINAL EXPENDITURE REPORT
By Legisiative Prioriry, CY 2d112-03
Minnesota Depart. of Health
Matemal and Child Health
85 East SeveMh Place
P.O. Box 64852
St Paul, MN 55164-0882
�. name of community Nealth Board: II. TYpE OF REPORT:
� Original Budget
S"°t Paui O Budget Revision #
Grant Year: ❑ F �
2002 EXPenditure Report
Priorities and
Matemal and Child Heaith Special GraM
Medicaf services ............................................................................. $ 196,900
Other heafth activities"' .................................................................. 16,250
Enabling and non health suppart' .................................................. 40,000
Co2 public health activities not dient based ................................... 25,880
ceun v e� euuwr_ oonn_ewu
Famity Planning method services ............................................
Other heafth ac5vities" ..........................................................
Enabling and rron health support' ............................°----°-°°-
Core pubiic heatth ac6vities not Gient based ...........................
PROGRAM
Handicapped/Chronicalty III Children medicai services .....................
Other health activities"` ..................................................................
Enabling and non health support' ..................................................
Core public heal[h ac5vities nM client based ....................°°.°.°-°--
Medical services ..........................................
Other heatth acbvities"' ...............................
Enabling and non heaith suppart' ...............
Core pubiic heatth activities not dient 6ased
Medipl services ..........................................
Other health activities"`.........-°-°--°-------°-°
Enabling and non healih suppoR' ...............
Core p ublic heatth activities not client based
(only Minneapolis, Goodhue and Wabasha)
Medipl services ............................................................................. $
Otherheafthactivities" .................................................................. $
Enabfing and non heaith support' .................................................. $
Core public health activities not Gient based ................................... x
Paul)
Medical services .........................................
Other heaith activities'"' ..............................
Enabiing and non health support' ..............
Core public healih act'rvifies r�ot client based
�I
IV. CERTIFICATION SIGNATURE
I certify that to the best of my knowledge and belief the data reported on this document is correct and all Vansactions that support this
repoR were made in aaordance with applicable Federel statutes.
� ��•U/
Peg Torgerson
651.266.1216
-23-
Please read INSTRUCTIONS ON REVERSE side before completing farm.
H. MCH SPECIAL PROJECT BREAKOUT BUDGET/FINAL E:YPENDITURE REPORT
By Legisla4ve Priority, CY 2002-03
Minnesota Depart. of Healtli
Matemal and Chiid Health
85 East Sevenfh Place
P.O. Box 64882
St Paui, MN 55164-0882
�. Name of Community Health Board: 11. TYpE OP REPORT:
�/ Original Budget
S � P � ❑ BudgeL Revision #
Grant Year: ❑ Final Expenditure Report
2003
Priorities and
Medipl services ......................................�--�
Other heaith acfivities" ...............................
Enabling and non healih suppoR' ...............
Core public heatth acdvfies nM dient based
Family Planning method services... .............
Other health activities" ..............................
Enabling and non heaith support' ..............
Core {�blic health actrvities not dient based
Matemal and Child Heaith Special Grent
$ 196,900
PROGRAM
Handicapped/Chronicalty III Chiidren medical services ..................... $
Other health adivi6es° .................................................................. $
Enabling and non heallh support • .................................................. g
Core pubGc health activities not �ent based .................................•• g
CHILDHOOD INJURY CONTROI PROGRAM""'
Medipl services ............................................................................. $
Other health aGiivities" ....................••----........................................ $
EnabGng and non health support ` .................................................. $
Core Public health acbvi8es not dient based ....--- ........................°- x
Medipl services .............................................................................
Other heatth activiBes" ................................................�---..............
Enahling and non health suPPart'....-°---.....-°--° ...........................
Care pu6lic health adivfies not client based .......-°--........--°-..........
f`NII n no nc/�lTel ucel TY oonP_Owu
(oNy Minneapolis, Goodhue and Wabasha)
Medical services ..............................................
Other health activities° ...................................
Enabling and non heatfh suppoR' ...................
Co2 publ'�c health activ�ies not dieni based ....
Paul)
Medical services ..........................................
Otlter health activities"` ...............................
Enabling and nan healih support' ...............
Core public health acWibes not dient based
14%
$ 336,666
IV. CERTIFlCATION SIGNATURE
I cert'rfy that to the best of my knowledge and belief the data repoRed on this dowment is cortect and all transactions that support this
�. /� O
Peg Torge:son
651266.1216
24
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Ol -49 Q
2002 - 2003 MCH Special Project Program Update,
Saint Paul Community Health Board
L Improved Pregaancy Outcome Program
Each of the subcontractors in Saint Paul was requested to review their 2000-2001
program goals and objectives. They were to submit their 2002-2003 Updates with re-
constructed goals and objectives that relate directly to the revised Needs and Priorities for
Services Identified by the Maternal and Child Health Advisory Task Force, 7une 2000. The ten
needs ranked as highest priority aze listed below:
• Reduce drug, alcohol, and tobacco use
• Promote family support and health communiry conditions
• Promote healthy parenting/family development
• Reduce child abuse and neglect
• Reduce teen pregnancy and teen birth rate
• Address the multifaceted needs of teen parents
• Increase percent of children whose disability is identified eazly
• Reduce youth risk behaviors
• Improve mental health of children, youth and parents
• Increase percent of children who receive early intervenrion services
For each of the three subcontractors applying for funds for an Improved Pregnancy Outcome
Program, their reorganized goals and objectives are followed by their statments on reducing
racial disparities, their individual program budget justifications.
• West Side Community Health Services, 153 Concord Street, Saint Paul, MN 55107
• Face to Face Health & Counseling Service, Ina 1165 Arcade Street, Saint Paul, MIV
55106
• HealthStart, Inc., 491 West Universiry Avenue, Saint Paul, MN 55103
II. Family Planning Program
Update: same as far Improved Pregnancy Outcome Programs (above). Re-organized
goals and objectives and other supporting data relate to:
Room 111 -STD Services (as an extension of Family Planning activiries), 555 Cedar Street,
Saint Paul, MN 55101
III. HandicappediChronically IIl Children Program
No update
IV. Childhood Injury Control Progam
No update
-25-
V. Infant Health Program
No update
VL Child HealYh Program
No update
VII. Dentat Health Program
No update
VIII. Adolescent Health Program (only Minneapolis and St. Paul)
Update: same as Improved Pregnancy Outcome Program (above). Re-organized goals
and objectives and other supporting data relate to:
• HealthStart, Inc., 491 West University Avenue, Saint Paul, MN 55103
-26-
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oHS 99
Goal l. The goai of the Improved Pregnancy Outcomes program is to serve the needs of
low-income (less than 275% of poverty} and adolescent pregnant and postpartum women
by providing comprehensive multidisciplinary prenatal caze at its Main clinic site on
University Avenue, and at the Health Start Clinics located at Arlington and AGAPE high
schoois in St. Paul. Services aze designed to address the concerns of adolescents and
women of color.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen parents.
2. Promote healthy parenting/family development.
Objective 1: �rovide comprehensive muitidisciplinary prenatal care to 3501ow-
income adult and adolescent women per year during CYs 2002 and 2003.
MCH 2O02-03 Priority:
1. Promote healthy pazenting/family development.
2. Addtess the multifaceted needs of teen parents.
Objective 2: Fifty-five percent of women who deliver through Health Start will
initiate prenatal caze in the first trimester of pregnancy and 85% of women will
iniriate care by the end of the second isimester of pregnancy.
MCH 2O02-03 Priority:
1. Address the multifaceted needs of teen pazents.
2. Promote healthy pazenting/faxnily development.
Objective 3: Eighty percent of prenatal patients will receive five or more prenatal visits.
MCH 2O02-03 Priority:
1. Promote healthy pazentingJfamily development.
2. Address the multifaceted needs of teen parents.
Objective 4: By the end of CY 2003, low birth weight (]ess than 2500 grams) rates
will be no greater than S% and pre-Yerm birth rates (less than 37 weeks gestation) will
be no greater than 10%.
MCH 2O02-03 Priority:
1. Promote healthy parenting�family development.
Objective 5: Women smokers will receive help with smoking cessation prior to or
early in pregiancy.
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
Objective 6: Of the prenatai adolescent teens seen by Health Start, 55% wiil begin
care in the first trimester.
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
-27-
Objective 7: Women receiving negative pregnancy test results will be counseled on
the importance of folic acid supplements and other life style issues to enhance healthy
pregnancies and birth outcomes.
MCH 2O02-03 Priority:
1. Promote healthy parenting/fanuly development.
',f�'�
o �-� 4y
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP applicarion, addressing the following:
1. In what ways do raciaVethnic disparities impact your maternaUchild population or
what is the significance of dispazities to youT population:
Raciallethnic disparities have a significant impact on prenatal caze. American-bom women of color,
especially those living in the Twin Cities' urban azea, aze less likely to ieceive adequate prenatal caze than
their counterparts in the suburbs and wlrite women in the metro azea. They aze aLso more likely than
foreigh-born women of color to deliver babies of low birth-weight Barriers to caze include lack of
insurance, lack of beli�f in the value of caze, few provideis of color, language barriers, transportation
problems, lack of child caze, and social isolation.
The laxgest percentage of clients seen by Health Start is African-American (3b.2%), Followed by Asian
(26.2%), Hispanic (8.4%), White (23.2%) and Native American (1/6%). To qualify for caze, pregnant
women must be 19 yeaz old or younger or have incomes below 275% of federal poverty guidelines.
2. List specific MCHSP ob}eclives xelated to taciaVethnic dispazities:
The overall goal ofHealth Start's prenatal program is heakhy mothers and babies. We seek to accomplish
this goal through specific o6jectives that apply to all prenatal clients while addtessing specific dispariries
issues. These objectives include provision of multidisciplinary prenatal caze, increasing the number of
women who seek caze in the first trimester and continue regulaz caze throughout pregnancy, reducrion or
cessation of smoking in pregnancy, and reduced incidence of 1ow birth-weight. We also seek to incxease
numbers of women who understand the importauce of folic acid in prevention of birth defects.
3. 4That strategies will be urilized related to the above objectives.
Health Start staff have yeazs of experience in employing a multidisciplivary approach in worldng with low-
income women, pregnant adolescents, and those with limited financial resources. One of the greatest
barriers to prenatal caze is a lack of insurance and other financial resources. Health Stazt social workers
assess the financial needs of low-income clients and help clients apply for insurance coverage whenever
possble. We provide caze without charge if resources aze not available. Transportation barriers aze
addressed in part through our location in Progtown, a federally designated under-served azea in which a
lazge number of Asian families have settled. We are on a major bus-line and can help clienu arrange for
rides through theu insurers, and pay for the bus or cab rides when needed. Because we realize fl�at
transportation is difficult, we do our best to see all clients, even if they aze late for visits. To encourage
eazly prenatal care, new prenatal clienu aze scheduled for a first appointment within three weeks of their
call. Clienu who miss appoinhnents aze called, sent post-cazds, and visited by an ouheach worker as
needed. Our child-friendly waiting azea includes play-space for preschool age children. Staff at our Main
clinic includes two Hmong women—a medical assistant and ciinic receptionist—who can inteipret as
needed for Hmong clienu. All Main clinic staff aze experienced in working with a culturaily diverse
popularion. Health Start provides continuing education through inservice 4aining and conferences to help
ensure that staff learn about new immigrant populations as they arrive in our azea.
�'�
HEALTH START, INC.
MATERNAL AND CHII.D HEALTH
Il4IPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANIIARY THROUGH DECEMBER, 2002
Mqi0�2
ANNUAL PROGRAM PROGRAM MC}i
LINE ITEM IXPENSE SALARY � suoser suo�er
CIINICAL SERVILES COOR�INATOft
NURSE PRACTITIONER
rvurrtinowsr
SOCIAI, WORKER
INTERPRETER/RECFPIONIST
CLINIC OFFlCE MANACaER
MEDICALASSI5TANT
SUB-TOTAL SALARY
FRINGE BENEFITS @ 21.5%,
0
CONTRACT SERVICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CLINIC X 48 WKS
RENT
PA7IENT CARE
LABORATORYSERVICES
OTNER EXPENSE
PHARMACYSUPPUES
MEDICAL SUPPLIES
OFFtCE SUPPLIES AND OTMER
TRAVEUTRAINING
TELEPHONE
ununEs
PATIENTTRANSPORTATION
TOTAL DIRECT EXPENSE
$
�
$
$
$
$
$
75,192
70,699
49,338
47,237
30,202
33,093
29,453
FEDQtAi, APPROVm INDIRECT CO57' RATE � 35%OF SALARY AND BENEffTS
TOTAL PROGRAM BUDGET DCPENSE
TOTAL MCH GRANT REQUEST
0.20
0.50
0.20
0.10
0.75
0.3Q
0.65
$ 15,038 $ 7,519
$ 35,350 $ 15,907
$ 9,868 $ -
$ 4,724 $ -
$ 22,651 $ 9,060
$ 9,928 $ 3,475
$ 19,144 $ 7,658
$ 116,703 $ 43,6I9
$ 25,091 $ 9,378
$ 56,448 $ 36,69I
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,396
$ 6.598 $ 3,629
$ 2,500 $ 1,258
$ 376,294 $ 278,350
$ 49,628 18,549
$ 425.922
$ 196,900
MATCHING NNDS �?5°J $ 106,4$1
�iZ1�
HEALTH START, INC.
MATFRNAI, AND CHII.D HEAI.TH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 2003
o � •44y
MCH0H03
ATiNUAL PR06RAM PAUGRAM MCH
tINE ITEM EXPENSE SALARY FTE BUDGET sUOGEr
CIINICALSERVICESC00RDINA70R � 77,�5 O,ZO $ IS,�L9O $ 7,74�J
NURSEPRACTITIONER $ 72,820 0.5� � 36 $ 1�,5�
Nuramomsr $ 50,818 0.20 $ 10,164 $ -
S�GALNlaRKER $ � ,654 �.1� $ 4 ,865 $ -
INTERPREfER/RECEPIONIST � $ 31,1� 0.7 $ 23,331 $ 9 ,332
CLINICOFFICEMANAGER $ �,�$6 �.3� $ 1�,226 $ 3 ,579
MEDICALASS15fANT $ 30,336 0.65 $ 19,719 $ 7,887
SU&TOTAL SALARY $ 120,204 $ 43,108
PRINGE BENEFITS @ 21.5%
CANTRACT SERYICE
CERTIFIED NURSE MIDWIFE CLINICS
SIX CNM CLINIC/WK @$196/CUNIC X4$ WKS
REt�fT
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
TR,4VEL{tRAINING
TELEPHONE
UTILITIES
PATIINT TRANSPORTATION
TOTAL DIRECT EXPENSE
FEDERAIAPPR04ED INDIRECT COST RATE @ 3� OF SALARY AND BENEFiTS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCHIriG fliNDS � 25%
$ 25,844 $ 9,268
$ 56,448 $ 36,691
$ 35,025 $ 10,507
$ 40,950 $ 30,713
$ 45,000 $ 22,500
$ 8,627 $ 4,314
$ 25,640 $ 10,256
$ 7,723 $ 3,089
$ 5,990 $ 2,790
$ 6,598 $ 3,959
$ 2,500 $ 1,375
$ 380,548 $ 178,569
51,117 18,331
�
$ 196,900
$ lOJ,916
-31-
G. IndirecY Cost Allocation for MCHSP
Please check one of the four oprions:
� 1. Not applicable — No charges to MCHSP are for indirect cost.
� 2. Indirect Cost Rate Agreement — A Federal negotiated fi�ced rate is to be charged against all
participating programs, including MCHSP.
A signed agreement from covering the current Federal fiscal yeaz is attached.
[] 3. Approved Cost AItocation Process:
Option 1—Indirect costs are atlocated to the agency's programs using worksheets developed by the
agency for tius purpose.
Ageucy worksheets and supporting documents are attacfied wIuch are in compliance with
the requirements of the OMB Circalaz A-87 "Cost Accounrittg Principles for State, LocaI,
and Indiatt Tribal Govemments", and the Federal award(sj for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs aze allocated to the agency's progra�ns using the optional Iadirect/Cost
Allocation Worksheet on the following page.
MCHSP worksheets and supporting documents are attached which are in compliance wiYh
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Locai, and Indian Tribal Govemments", and the Federal awazd{s) for which they apply.
-32-
oi��r9
�
� DEPARTMENT OF HEAI,TH 8c HUMAP( SEILVICES
Y �.
o �
�"'k
�aa
Raymond J. Martin, Jr_
Psxecutive Director
Health Start
491 West University Avenue
St. Paul, MN 55103-1936
Dear Raymond Martin:
February
� S�PPat CentQ
F'mnual Manag�� �
Divaion o( Cast AHocaIIOa
Cer6ai States Field Office
6, 2 0 O 1 '13Di Yovng Street, Ropm 732
. Dafias, Sexas 75202
� (
FAX- (214}�67-325q
The original and one copy of an indirect cdst Rate Agreement
are enoZosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concsrning
the rate(s) that may be used to support your claim for indirect
costs on granEs ancl contracts with the Eederal Government.
Please have the original signed by an authorized representative
of your organization and zeturn it to me, retaining the copy
for your files. We will seproduce and distribute the Agreement
to the appropsiate awarding. organizations of the Federal
Governmen.t for kheir use.
An indirect cost proposal, together with supporting information,
is required each year to substantiate claims made for indirect
cosCs under grants and contracts awarded by the Federal Government.
Thus; your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation_
Enclosures
Sincerely,
x
\
Me�. Schmidt
Director
Division of Cost Allocation
Central States Field Office
PI�EASE SIG1Q AND RETURN THE ORIGINAL.OF THE RATE AGRESMENT
-33-
NONPROFIT RATS
EIN #= 1411577621A1
ORGANIZATION:
Health Start
491 West University Avenue
St. Pau2
MN 55103-1936
DATE: Febraary 6, 2001
FILING REF.: The preceding
Agreement was dated
NONF`
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Goverament, subjeci to the conditions in Section ISI.
SECTION I: INDIRECT COST RATES*
RATS TYP&S: FI%ED PINAL PROV.(PROVISIONAL) PRED.(PREDF3TSRMINSD)
e
SFF}3CTIVE PERIOD
TYPE FROM TO
PROV. O1/O1/O1 12/3I/02
PROV. O1/O1/02 IINTIL AMBNDED
RATIs(%) LOCATIONS APPLICABLS TO
35.0 On-Site AlZ Programs
IIse same rates and conditions as those cited
for fiscal year ending December 31, 2001.
* sAS& :
Direct salaries and wages includinq a11 fringe benefits.
-34-
at-4 t9
ORGANIZATION:
Health Start
DATS: February 6, 2001
SSCTION II: SPECIAL REMARRS
TREAZ'MSNT OF FR2NG8 BENSFITS
The fringe benefits are charged using a rate(s). Over/under recoveries from actual costs
are adjusted i.n current or fuCure periods. The directly claimed fringe benefits are
listed below_
TREATMENT OF PAID ABSIISCSS •
Vacation, holiday, sick ieave pay and other paid absences are included in salaries and
wages and are claimed on grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the costs of these paid absences are not
made.
Equipment DePinition -
Equipment means an article of nonexpendable, tangible personal propexty having a useful
life of more than one year and an acquisition cost of S1,000 or more per uait.
ERINGE BENEFITS:
FICA
Retirement
Disabi].ity Iasurance
Worker�s Compeasation
Life insurance
Unemployment Insurance
Health Insurance
-35-
ORGANIZATION:
Health Start
AGREEMSNT DATS: February 6, 2002
sscrxox xxx- c�saar.
A. LIMITATIORS -
The ratea in this Agreement are aubject to any atatsstazy or admiaistrative limitat3ous and app2y to a qivea gra¢t, croa[ract or
other agreemeat only to the exteat tLat ftmds aze available. Acceptance of the ratea ia subjeet to the Eollowiag condi�;ona:
(i) Oaly costs iaevrxed by Ghe a��;zatioa wexe ineluded ia its indizeM cost pool as finally accepted: euch eosts are 1ega1
obligations oE the oxganizatioa and aze allowable uadex the govesaing cost pxiaciples; (2) The same costs that Dave been tTea[ed ae
indirect eoets aze aot claimed as dizect coats; (3) Similaz types of croeCS Lave beea aecoxded eonaisteat accounting treatmeat; and
(4) The Snfoxmatioa praoided by the ozgaaizatioa whicA was used to eeta6lish the xates is aot later fo�md to be materially
:�^omplete or i�<cutate by Che Fedexal Govexament. IA euch situations ihe rate(s) would be avbject to renegotiatioa at the
diacretion ot tLe Federal Gooexameai,
B. ACCODNTI56 CRA21G&5
This Agreement ie based on the a<ca�mting aystem puxported bq the oxgaaization to be in effect durisg the Agseemeat period. Chaages
to the methad of accotmtiag for crosts vhich affect the amouat of seimbuTaement resulting from the use of this Agreement require
prioz approval af the authorized represestative of the cogaizant ageacy. Sticlx cLaages iaclude, but are aot 1imiCed Co, r3anges ia
�wm ^*=+ of a partieular Cype af�eaet from iadirect to direcC_ Fai2ure Co obta3s appraval map resu2t ia coat disa2lowaaees.
C. PS%SD RATES .
If a fixed xate is in [his Rgseement, it ia based oa aa astfmate ot the eoets £or the period eavezed by the zate. A2en the aetual
rnsta for thia peziofl aze determined, an adjusimeat will be made to a rate of a fntuxe year(s) to compeasate for the difference
betweea t71e crosta uaed to establiah tIIe fixed rate a�d actval coata.
D. IISB SY OT88R PEDHRl1L nr_urarrae
The zatea in this AgTeement weze appmved 3a accoidance vith the authority ia Office of maaagemeaat and 8adget Cixculaz x-lzz
Cizculaz, and sLOUid be applied to grauts, coatzacts and otLer agrenmenta CoveTed Irq thia Circular, subject to aay limitationx ia A
abaoe. The ozgaaization may pxavide copies of the Agree�ent to other Pedezal Ageacies to give them eazly aotif3cation of tIIe
Agieemeat,
E. OTHER:
IE aay Fedexal contxact, giaat or oU1e.� agTeemeat ie reimbutsiag indirect costa by a means oilaer thaa the appxoved rate(s) in this
Agreemeat, the arganizatioa sLo�aid (I) eaedi.t sneh costs to the af£eMed pxognama, aad (27 apply the approved rate(s) to the
appzopriate base to ideatify the proper amoyyt af iadixect eosts allocable to these progxama.
8Y THS ORGATIIZATION:
Health Start
SY THE COGNTZA2Tf AG&fiCY
OR BEHALI' OP 158 rnnaoar. �pp�.�ryy
(ORGANIZATION) .
I�u.,,�t � � M�. �-
csxcema�) �
RA`fNouo 1". Haz .�
c��
�7�EG�t'��v� D�REC�b�L.
(xxxzs>
lnnxs)
DHPARTMENf OF HCil1LTH AND HOMAN 58R4ICES
(acaeres) 4
vv--� �-� �'�
(51
Merle M. Schmidt
tmse��
nzxzcTOS axvxsxrnv or msx xraocaxxox-
(TITi.8) CENTBIII+ STATES PIBI,➢ OFPICS
(DATS) 5736
�s ,eErxssseraxzvs: MY (Robert ) N. Nq'uven
xe�epn�e: (214) 767-3267
-36-
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ot-449
A. APPLICATIOIV 1�3ARRATIVE
The Pzeaatal Access Project at Face to Face Health & Counseling Sezvice will utilize outceach efforts and case
*T+?T!a to encouraae and support 150 low income pregnant adolescents and young adults to access prevatal
care aad in¢ease dieir chauces of having a successful ptegnancy. Seveuty of the youth to be sexved will be under
the age of 19, and 75 wiIl be youth of coloi.
1. Outreach and Case Management
GOAL 1 To utilize a sramless, integzated sexvice model to pmvide pienaral caze and to pxomote the healthp
developmeut of families_
MCH 2O02-2003 Priorities
1. Address the multifaceted needs of teen pateuts
2 Reduce youtla risk behaYiors
3. Improve meatal heakh of chil.dxen, youth and parents
Objective: To use a holistic inrake pzocess for assessing needs in all azeas of the lives of our clients and
identifying steeugths they alzeady possess to address these needs.
Pace w Face implemeated a necv inrake pmcess in 1998. The goal was tn addcess the needs of ptegnant
adolescents and young adults holisdcally — not only addressing those direcrlp mlated to theix pregnancy. This
includes, but is not limited to, life and safetp, mental healdi, medical, and education and job aaining needs.
Becoming pregnant as a teen c�n be a sign of more serious issues a youth uright hace, including being homeless,
not attending school regularly or having dropped ou� a histoxy of abuse by or ot3ies re]arional difficulties with
family membets or a boyfriend, chemical abuse and mentai health issues. Depression aad thoughts of suicide aze
not unusual with some clients. It is also important to sealize fl�at these adolesceuts have been sutviving —
sometimes on che srteet — amidst often very difficult citcumsrances. That is why we not only work to idenrify in
a compxehensive mannet aIl of a pregnant adolesceut's needs, but also to idenrifp, affi�m and sttengthen rhe
s2engths they alxeady possess. This is a streugths-based model as opposed to a needs-based model, which has as
its focus the clieuu' defidendes (Le., unmet needs) rathet t6an their stres�gths.
GOAL 2:, To reduce the overall rate of ]ate (third trimestes) or no prenaral care aad to conduct ouu�each ro
in¢ease fixst trimester preaatal caze, espedally amoag pouda of color.
MCH 2O02-2�03 Priarides
1. Pmmote family support and healthp communitp conditions
2. Promore healthy parenting/familp development
3. Increase p�cent of children who receive eazly intervention services
Objectrve L• To increase oux cw�ent efForts to pmvide outreach to youth of color, ensiuing d�at at least 50
pezceat of the prenatal clients aze youth o£ color. African Ametican, Nauve American, F3ispanic,
ox As'a•
Face to Face has reached and seeved a large numbet of pourh of colox throughout all of its progxams. In 1995
thexe wexe 98 deliveries, and neazly half (46 of 98 or 47%) of the deliveries weze to adolescent moms of
color. Face to Face is committed to pmviding cultutally appropriate and accessible sexvices and will continue our
efforts to conduct effective outreach ditected towatd youth of coloi.
Objecrive 2; To follow up with all clients with positive pre�anry tests, induding mal�ng home visits as
necessazy to assute thep receive cate.
-37-
• - • - • •. w� "�• 4 • • •• �• • i��.• i�4 ♦ �� � .I �• � • •� ��' MY. .4 .�•
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I•' •,' ••••.- 1•a.... ..•a�..,....•n..• 1• ...•.... •- ... u' '• •
• u �• • ,�• •u• - �a�7•' • - ' u. - r,y• - .�• •�• -
" � � • � • • • � . i\ \� \� • t� �1 • �� �� � • . � • � �� ✓. " • �r �• �� �� R • • ♦ •
Y ��•
Face to Face began its ariginal pxeaatal ouueach pmject in �988. These wexe 21 deliveries d�at first yea� and by
1998 d�at numbee grew to 104 deliveries. 'l�is demonsuates a 395% increase in. the aanual nambet of delivaies
since the project's incepdon. It is out belie£ that dvs inctease is ditecdp related to thxee factovs: (1) an i.+r+,��e in
cultutally divexse staf� (2) an incre�asc in owxeach efforts, and (3) an inaease in intensive case *n?�oement
sexvices. Wh31e the need for outirach sezoices continues w be g�eat, Face to Face has xeached its capadty far
sexving clieuu without addiuonal sraffing. Thesefore, rhe pmject eapects to maintain the curtent number of
rlirn visits dn�; the upcoming two-year pmject period
Ol�jecrice 2.• To entnll 50 pecceat of die 70 cliessts who are uuder the age of 19 in prenarat care services daring
dzeir first mmestez of pzegnanry.
During 1998, 51 perceat of the new prenatal clients under the age of 19 began prenatal caze within theix
fixst trimestet. This is a task to which die pxeoatal team is very committed; howevec, the younger clients aze and
the gxeater their risk factozs dae gmater the di£ficulty of xearh; � th� within their fiist ttimestexs. Foz cYample,
only 31% of clients 17 and undu began caze during theiz fust timesten We wi11 focus outreach efforts on
these younges clients.
Objeczive 3: To affect posirioe bitth outcomes in ail c3ients, as measuxed by low bitthweight r�tes of less tban
__ 6.5% for all aee aad ndal2muns secved.
In 1998, the rate of low bitth weights for all age and racial gtoups served by Face to Face was 8.8%. The
objective is to bettex the rate of low bizdi weights di 2002-03. All pteoa1ml clients who have a vsk scoxe of 10
oi highet aze reEeued to a Ramsey Countp Public Health Nucse. One of rhe public heaitii nuxses pazriapates on a
bi montbly basis in care wotdination confecences, and consultation and coozdination happens on aa almost daly
basis. 11vs cootdination has resulted in the numbes of dieuts wirh high-xisk scoxes dea�sing d"� the second
and rhixd trimestexs of pregnancy.
��'.
oi-9g9
Objecrive 4.• To improve attendance at all Ptenatai C]asses, with at least 50% of those receiviag pteaaral cate
atteuding.
The eight-week class is offered m all pteaatal c]iencs, addressing physical cUanges d"� pregnanry, health and
mroirion, preparation for laboi and delivery, emotianal aspecrs of childbirth and new pazeuting postpattum
pxeparatian, pzeparation foz new bzby case, and the importance and "how to's" of birild'mg a support network. In
an attempt to build gzeatec continuity foz the clients aud inccease consistent attendance at pzeaatal dasses, we a]so
hold weekly "Snack and Chat" sessions_ This is infomzal discussion and sapport dme fot clients.
3. Social Sugport
GOAL: To impmve die healdi and wel}ness of pregnant adolescents during pregnancy thmugh in¢eased
social and emotional support and menral health seroices.
MCH 2O02-2003 Priorities
1. Pmmote family support and healdiy community conditions
2 Promote heaithy patenting/family deveiopment
3. Reduce child abuse and neglect
4. Addtess the multifzceted needs of teeu pazents
5. Improve meutal healsh of chiidxen, youth and pasents
6. Inctease p�cent of childsea who zeceive eazly inteivention setvices
Objective Z• To inctease preaatal support sesvices to the pazmets of pregnant women.
One wap to better support pxegnant adolescents 3s to extend ouc prenatal support services — speafically prenatal
classes and "Snack and CliaP' sessions — to the paxmecs of pxeb ant c]ients. 2Ziis will help to reduce any added
sarss the pxegnancy may have put on the pazmex relationslup, thexeby sueagthening the support die pzegxaant
adolescent feels £rom significant re]ationships in her life.
Objective Z.• To provide meutal health counseyng for ptenatal clients and theix paxmexs who aze suuggling
with menral healrh issues, indudin� chemical use, depression, and abuse.
A� ;�, as the complexity of risk factoxs incsrase fot pseaatal clieuts, so does the� need foz menral health sexvices.
Historically, a majoritp of ptenatal clieuts have e�erienced sexual abuse aad chemical use. Most are esmenged
ftom partness ot eaperiencing difficulties in the pattnec telationship. lktany talk about feeliugs of depxession and
even tho��hts of suidde. Ofren the steess of an earlp, unpLwned pregnancy exacesbates the issues that alreadp
are present, and manp of the pmoatal clients request or are in need of counseling. The Dixector of Mental Health
is available for consultation and Face to Face has well-established mental heakh sexvices for clvld abuse suxvivoxs.
Objecttve 3: To ]ink all prenatal clients who deliver thtough Face to Face with ongoing medical cate and
social sesvices for themselvu, cheir infants, and dieit paztnexs.
Most of the ptenaral clients use Childxen's Hospital Pediatric Clinic, Unixed Family Physiciaus or Ramsey Family
Physidans fox their childten s primary medical caxe. 'Iheze wiIl continue to be a focus on s�sengthening case
TM?n? to link clienu in need of primaiy medical caze for their infan[ aud themsetves as well as to othex
needed social sezvices. Face to Face has bwlt mong relationships with many youth serving agendes, and the
outteach woskezs help clients esrablish connecdons wirh appropriaxe setviices. Addirional efforts will be made to
increase the xesouxces available in the community fox pazmecs of pxegn�wt adolescents. We will do assessmeats
of the pattaexs' needs fox supgort and make refe�xaLs when possible. Whea resouxces don t e�st, Face to Face
will work widi the Fathets Rrsouxce Center and othet pouth-sezving agendes to develop collabotttive
pro,gra**++*+;*+a rhat suppotcs healthy pregnancp outcomes.
-39-
0
D. Efforts to Reduce Racial Disparities
CI' 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP application, addressing tfie foilowing:
1. In what ways do raciaUeihnic disparities impact your matemaUchild population or what is ihe significance of
disparities to yo�u population?
3. What s�ategies will be utilized related to the above objectives? Of particutar �terest aze com�aity and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decxease of disparities.
�l�he hist strategy raw to race uses u to
services. That commitment is visible in
needs of adolescents aud young ad¢its R
commitmenY to haiug staff who are cult
1'iu
agency requiies and provides for all sta4
In addition, in ordu to realize our mi;
values and outcomes. To that end. in
nce, class, etbnicity, sexual c
processthrough which every
A strategy Yace to Nace uses spec�Tic
color. To this end, Face to Face is a
is to reach out to pregnant African-A
rurr¢er, we recessuy e
women azound issues
DLC�2IIt Ot DBLCIIt1II2
i
outcotnes
Ke a co�utrnent to proviamg culuuatly appropnate and access
ty aspect of the agency — from our mission W serve tiie deveIop
are in need of accessible and cnitutaily sensitive setvices to our
of the youth we serve to the
?ace to Face
as uart of an
nsive, flexible and comnvtted to a core
a nzoua of Face to Face staff foffied an
; accorawg m a pnuosopny wat nennes "cuuutai cuversuy to mcmae
er, religion, age and able-bodiedness. 'Chis committee initiated a
elops eauiri eoaLs, which become part of their staff development goals.
�ur pienatal pmgam is effective outreach tazgeted towazd youth of
iting agency ia the Twin Cities Heakhy Start Project, our role in wluch
yoimg women and commect them with appropriate, early prenatal care_
cant for pienatal ouffeach ro youth of color and yommger adolescents.
and a full-time staff person to do outreach to bomeless adolescents who aze
at ou�each tazgeted to specific populations is a very effective shategy to
tarQeted nonulation who seek services, which increases the l�kel�hood of
ois
from the
.�
2. List specific MCt3SP objectives reIated to raciaUetbnic disparities.
or-gqy
Budget Narrative - 2002
Salaries aad Fringe
O.SFI`E Outreach Worker/Case Manager (Vicki D.)
0.5FI'E Outreach Worker/Case Manager (Ashley M.)
0.09FTE Prograzn Director �oel I,.)
Fringe Benefiu (about 18.5°/a of salaries)
Total Salaries and Fringe
Supplies and Expenses
Staff Travel ($136 miles per month X$0.345/mile)
Indirect Costs
Adminiscration (� 1 Y%)
Faciliries (@ 5.5%)
Total Indirect Costs
BUDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-41-
Budget Narrative — 2003
Salaries and Friage
0.5FTE Outreach Worker/Case Ivianager (Vicki D.)
0.5FfE Ouueach Worker/Case Manager (Ashley 1VL)
0.09FTE PrograIIi Director (Joel L.)
Fringe Benefiu (aboui 18.5% of salaries)
Tota1 Salaries and Fringe
Supplies and Eapenses
Staff Travel ($136 mles per month X$0.345/mile)
Indirect Costs
A�miniairaTiOIl �� 1�/0�
Facilities (@ 5.5%)
Total Indirect Costs
BLJDGET TOTAL
12,493
12,139
3,927
5,241
33,800
562
3,737
1,901
5,638
$40,000
-42-
o t-qqq
G. Indirect CosY Allocation for MCHSP
Ptease check one of the four options:
❑ i. Not aQQlicable — No charges to MCHSP are for indirect cost_
❑ 2. IndirecY Cost Rate Agreement — A Federal negotiated fixed rate is to be charged against alI
participating programs, including 1VSCHSP.
A signed agreement from covering the current Pederal fiscal year is attached.
❑ 3. Approved Cost Allocation Process:
Option 1 Indirect costs are allocated to the agency's programs using worksheets developed by the
agency for this purpose.
Agency worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State, Local,
and Indian Tribal Govemments", and the Federal award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocation Process:
Option 2 Indirect costs are allocated to the agency's programs using the optional IndirecUCost
Allocation Worksheet on the foilowing page.
MCF3SP worksheets and supporting documents aze attached which are in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Governments", and the Federal award(s) for which they apply.
-43-
INDIRECT! COST ALLOCATtON WORKSHEET
t. Cost item included in tke indirect rate on this worksheer
Telephone, utilities, janitorial, irash, copier 2ease, maintenance, �n�„�.,ce, postage, accounting, annuai
audit, computer consultation, administrative staff
[Examples include rent, telephones, supplies, etc.]
2. Total cost of items in 1. to the agency: $608,168
3. The MCHSP share of the total cost is calculated through use of (check one):
./ a. MCHSP's percent of the total agency staff hours or full-time
b. MCHSP's percent of the total square feet of space occupied by the agency.
a Other — specifY:
and is in compliance with the requirements of the OMB Circulaz A-87 "Cost Accounting
Principles for State, Local, and Indian Tribal Govemments", and the
Federal award(s} for wfiicfi they apply.
4. Calculation of the MCHSP percentage:
rrograms operatea ny tne �ach program's statt, square Ye
agency. or other (circle the criteria you
aze using)
percent of the total (calculated to
the neazest tenth percent, e.g.,
5. MCHSP's proportionate amount: $17,028.70* only requesting $5,638,
��
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o1-�i99
MCHSP Application Update Narrative 2002-2003
West Side Community Health Services — Improving Pregnancy Outcomes for High
Risk Latino and Hmong Women in St Paul - 2002 - 2003
Goal— The goal of this project is to reduce low birth weight and infant mortality rates in
the St. Pau1 Latino and Hmong populations by providing outreach, tracking positive
pregnancy tests, performing prenatal risk assessments, providing prenatal education, and
coordinating prenatal care and follow-up. This project will supplement existing West
5ide Community Heakh Services (WSCHS) prograzns and staff. The West Side Health
Center (La Clinica�, McDonough Homes Clinic, and Roosevelt Homes Clinic offer
comprehensive health care services on a sliding fee scale. This project will give Latino
and Hmong families �eater access to a full array of services, including well child care,
immunizations, family planning, pazenting, and HNISTD services, as well as linkages by
referral to over 14 other community agencies.
Target Population — This project targets low-income (less than 200% of poverty) Latino
and Hmong teens and women in the following azeas of St. Paul: Riverview (CTs
342,361,310,371,372), Mount Airy (CTs 328,329,330) and Rice Street (CTs 305,314),
Our ciinics aze located in or near these CTs, and the CTs are part of our federally
designated scope of service azea. The majority of our prenatal patient population (85°la
Latino and 14% Hmong) live in these areas. During the grant period, we estimate that
730 Latinas and 120 Hmong women will receive prenatal care through our clinics.
Goal l— To reduce low birth weight and infant mortality rates in the 5t. Paul Latino and
Hmong populations.
MCH 2O02-03 priority:
Promote family support and healthy community conditions.
Objectives:
1. To reduce overall rate of late (third trimester or none) prenatal care among pregnant
Latinas and Hmong women and teens to 10 percent or less.
2. Increase the rate of prenatal care in the first trimester among pregnant Latinas and
Hmong women and teens to 60 percent or more.
3. Provide outreach, education and coordinated follow-up care for high risk pregnant
teens and women.
MCH 2O02-03 priorities:
Reduce teen preo ancy and teen birth rates.
Promote healthy parenting/family development.
-45-
MCHSP Application Updcrte Narrative
Methods:
Project staffwill do an outreach activity at least monthiy. Examples include "Baby
Showers" in tazgeted areas, health fairs, community events such as Cinco de Mayo,
and responding to media requests for interviews by locai newspapers and radio
stations.
2. Project staffwill conduct a series of Spanish-spealdng prenatal education classes
every two months focusing on nutrition, self-care during pregnancy, breastfeeding,
chiid caze and safety, and personal health issues such as family planning, HIV/STDs,
drugs and alcohol, and family violence.
3. Staffin clinic wilt follow-up on a11 positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health educarion
and support imervention, including home visits as appropriate, facilitate follow-up
with any outside referrals made, assisting with scheduling, transportatior� and
interpreting as needed.
Evaluation: Atl patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry irno prenatai care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
results compited annually. Patient satisfaction surveys are done annually, and
additionally, satisfaction with prenatal classes is measured via surveys after each session
is completed. Twenty-five (25) prenatal records are audiYed annually to measure rates of
compliance with prenatal risk assessment, postpartum visits, and newborn follow-up.
This information is reviewed by the Quality Improvement Management Committee
annually to identify and impiement improvement efforts.
Training/Eaperience of Key Staff: Over the past 25 years, staff have demonstrated a
unique abiliry to meet the heatth care needs ofLatinos and Hmong. In 2000, WSCHS
served 14,366 medicat patients, 60% of whom were Latino or Hmong. Services include
bilingual and biculhual staff, transportation through our van, bus or cab voucher, hospital
cue through Regions Hospital, in WIC clinics including immunization outreach,
assistance with Medical Assistance/Minnesota Care applications and enrollmern, and
outreach clinics and education programs in homeless shelters and public housing
developments. These services aze pmvided through a well-estabiished interdisciplinary
case management model. This model helps identify high-risk patients through screenings
and referrals, provides coordination of care, and ensures patientlfamily involvement in
care p anning an .
The perinatal RN health educators aze �cky Kramer and Tely Xiong. The perinatal
heaith educator, Doris Sanchez, is a medical assistant with specialized perinatal and
women's health training. All are bilingual and/or bicultural. Additional project support is
.�
oi-99y
MCHSP Narrative Update AppZication
Provided by Norma Atuesta, RN, nurse manager, and Mary Nesvig,l�ID, medical
director, and other clinical staff through the Perinatal Caze Program.
Linkages:
West Side Community Health Services works with the following organizations in
providing matemai and child health services:
-Regions F3ospital Family Practice Residency Training Program to provide cross-cultural
family medicine training for physicians motivated to work in medically underserved
settings.
-Saint Paul-Ramsey County Department ofPublic Health to assess community needs and
provide services addressing maternal and child heaith issues, behavioral health,
communicable disease, lifestyle/cancer, income/access to care, nutrition and WIC clinics,
and elderly health care.
-Combined efforts with 15 other community clinics to improve health outcomes for
underserved populations in joint efforts through Neighborhood Health Care Network
-Saint Paul Public Housing Agency to provide services, including maternal and child
health, on-site at McDonough and Roosevelt housing developments.
-City of Saint Paul in providing clinics in three homeless shelters/transitional housing
facilities and five outreach sites, and eviction prevention services through the F3ouseCalls
program.
West Side Community Health Services provides comprehensive perinatal care through an
established nurse-midwife program. Any specialty medical caze needed is provided either
on-site or refened to the high-risk OB clinic at Regions Hospital.
Reimbarsement and Fees: A11 reimbursements through the Minnesota Department of
Human Services go directly to support services. Assistance is provided to enroll all
eligible women on Medical Assistance/Minnesota Care. A sliding fee scale is maintained
for those not eligible for assistance. Fees aze discounted incrementally based on family
size and income, from those at or below the poverry level paying nominal or no fees, up
to those exceeding Z00% of the poverty level paying full fees. Patients aze low income
and high risk. No one will be tumed away due to finances.
-47-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessme�t are being addressed in the
MCHSP application, addressing the following:
1. In what ways do raciallethnic dispariries impact your maternaVcltild population or what is the significance of
disparities to your population
-late enhy into prenaql care
-culmre and language bazriess to secvice
-increasing Latina teen bixfh raYe
-multiple, closely-spaced pregnancies
-new imudgrants
-growing STI/HIV risk in T atinac
3. Wliaz shategies will be utilized related to the above objecrives? Of pazticulaz inte:est are communiry and
systems strategies/objectives which recognize the potential role all types of community-based organizations can
play in the decrease of disparities.
supports
on healthy fan�ily units
-include
.;
2. List specific MCHSP objecrives related to xaciaUethnic disparities.
0�-999
MCHSP Application Update Narrative
Budget:
WSCHS request $16,250 per year to supplement our existing perinatal progam. The
funds 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 — 2002
MCH Request
WSCH5 Match
.3 FTE RN health.educator
(624 hours at $17.54Jhr.)
2 FTE perinatal health educator
{416 hours @ $12.75lhr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
Year Two — 2003
3 FTE RN health educator
(624 hours @$17.54/hr.)
.2 FTE perinatal health educator
(416 hours @ $12.75/hr.)
4.0 FTE nurse midwives
4.0 nursing staff/perinatal support
Total
$10,946
5,304
$16,250
MCH Request
$10,946
5,304
$16,250
$236,000
124,800
$360,800
WSCHS Match
$236,000
124.800
$360,800
860 prenatal patients will be seen annually.
42 prenatal classes will be held annually, serving 420 patients and their family members.
86 highest risk patients will receive specific follow-up by the health educator.
An additional 250 teens and women will be reached annually through outreach activities.
There are no DHS or sel, f-pay reimbursements anticipated related to these supplemental
ttctivities.
-49-
�I �I�� 1 ��{�jil�;l I',I �I�i�'���I ' �i i il�� �il��������fl�f �i�'i��jl I �I,;�jl� Iji�l !I!! �I!�I � jl� !!I,
tII,M I��� �� � i�l � � �I�� + ��I i i ��l I� � �'li I -I � �I : r IFt I I
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2002-2003 MCH Update Saint Paul - Ramsey County Department of Public Health:
Room 111—STD Services for Adolescents
Goal: Through accessible, confidenrial services to adolescent family planning clients regarding
education, detection and treatment of sexually transmitted diseases, decrease the number of
STDs, particulazly chlamydia and gonorrhea
MCH 2O02-2003 Priority:
1. Reduce youth risk behaviors
2. Increase percent of children who receive early intervention services.
Objective 1. To screen and provide education to 725 adolescents, 19 years of age and
under for sexually transmitted diseases - STDs during each CY 2002 and 2003.
MCH 2O03-2003 Priority:
1. Increase percent of childrett who receive eazly intervention services.
Objective 2. To diagnose and treat idenrified cases.
MCH 2O02-2f103 Priority:
1. Increase percent of children who receive eazly intervenrion services.
2. Reduce youth risk behaviors.
-51-
D. Efforts to Reduce Racial Disparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being addressed in the
MCHSP appliqtion, addressing the following:
1. In whaz ways do racialletlmic dispazities impact your matemal/child population or what is the significance of
disparities to your population.
higttest rate of gaaorthea in the state. Compating the chlamydia rates of 73:100,000 wlutes to I,769:100,000 blacks,
540:100,OQ0 Americaa In�ians and 314:100,000 Asians, clearly shows the huge dispariry for this ane sexually
transmiued disease. The data aLso shows the lazgest number of cases of chlamydia xcurs in 0-19 year old
females. Gonorrhea in the same age group is the second largest group diagnosed.
3. What strategies will be utilized related to the above objectives? Of particulaz interest aze community and
systems stretegies/objectives wlrich recognize the potential role all types of community-based organizations can
play in the dectease of disparities.
many accessirnury oamers nave oeea removea xoom i i i is iocacen on or near au ma�or ous rouxes. inere u aee
pacldug behind the building. Room 111 has moming, attemaon and evening clinic hours. Clinic services are
offered on a walk-in basis. All Room 111 STD clinic and education services are provided on a donation basis. No
one is denied secvice due to inability to pay.
-52-
2. List specific MCHSP objecrives related ta raciaVethnic disparities.
o�-y�s
Room 111- STD Services
(As an extension of Family Planning activities)
2002 and 2003 MCHSP Crrant Budget 7ustif cation
Postion MCH Funds
CY 2002
Clinic Nurse:
Ptovides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
CY 2003
Clinic Nurse:
Provides screening, diagnosis,
education, treatment and referral
to adolescents for STDs @ $28.09/hour
salary and fringe
.22 FTE $12,855
C�iiiT�i3f��
$45,577
$45,577
Annual Salarv
$58,432
$58,432
-53-
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D►-999
The goals of Health Start's adolescent health program are essentially unchanged
over last year. One minor change is that we have set an overall goai of increasing clinic
visits by 5% rather than targeting males, as we have in previous years. Though we will
continue to focus particular efforts on reaching males, the majoriry of our outreach efforts
aze targeted to all students.
Goal l: The goal of the Adolescent Health Program is to promote good health and
reduce the incidence of unplanned pregnancy, poor nuhition/disordered eating,
depression, chemical abuse and family and relationship pzoblems among adolescerns in
Saint Paul by providing comprehensive health care services at seven high school sites and
two alternafive school sites within the city.
>
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 1: In CY 2002 and 2003, 3,300 junior and senior high students will access
health caze tbrough the school-based clinics each year.
MCH 2O02-03 Priority:
1. Increase percent of children who receive eazly intervention services.
2. Reduce youth risk behaviors.
Objective 2: In CY 2002 and 2003, a healthy lifestyle of physical activity and
healthy food choices will be encouraged by providing 1400 nutrition visits each yeaz
in the azeas of weight control, family plazuung and pregnancy nutrition, disordered
eating, and sports nutrition.
MCH 2O02-03 Priority: '
1. Reduce youth risk behaviors.
2. Increase percent of children who receive eazly intervention services.
Objective 3: Onsite social work counseling/therapy services wili be provided for
1,000 adolescents experiencing depression; chemical abuse; pregnancy; relationship
problems; physical, sexual or emotional abuse andlor oiher stressful conditions each
yeaz in CY 2002 and 2003.
MCH 2O02-03 Priority:
1. Improve mental health of children, youth and pazents.
2. Reduce child abuse and neglect.
Objective 4: Each year in CY 2002 and 2003 we will provide 1,100 teens with an
annual comprehensive preventive heaith exam and risk assessment, including sports
physicals and annual reproductive health exams.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Increase percent of children who receive early intervention services.
-55-
Objecfive 5: Comprehensive family pianning services will be provided £or 1,000
adolescents each yeaz in CY 2002 aud CY 2003.
MCH 2O02-03 Priority:
I. Reduce teen pregnancy and teen birth rate.
2. Reduce youth risk behaviors.
Objecrive 6: At least 1,000 adolescents will be tested for sexually transmitted
infections each year in CY 2002 and CY 2003.
MCH 2O02-03 Priority:
1. Reduce youth risk behaviors.
2. Reduce teen pregnancy and teen birth rate.
Objective 7: �munization status of studeuts who make visits with a Health Start
nurse practitioner/physician wi11 be assessed. Immunizations will be offered to all
students with incomplete series. Based on previous experience, we expect thai at
ieast 600 adoiescents wi1l be immunized each yeaz in CY 2002 and CY 2003.
MC$ 2002-03 Priority:
1. Promote family support and healthy community conditions,
2. Increase percent of childten who receive early intervention services.
Objective 8: Tobacco use will be assessed and addrassed for 3,300 students each
year in CY 2002 and CY 2003. Tobacco cessation help in the form of individual or
group programs will be availabie in all school sites for those wishing to quit
MCH 2O02-03 Priority:
1. Reduce drug, alcohol, and tobacco use.
2. Reduce youth risk behaviors.
Objeciive 9: The number of visits to Health Start clinics will increase by 5% in CY
2002 and CY 2003. '
MCH 2O02-03 Priority:
1. Increase percent of children who receive early intervention services.
2. Reduce youth risk behaviors.
Objective 10: Members of Health Start's multidisciplinary team will provide health
education in classroom, clinic, and small group settings resulting in at least 10,000
educational encounters each year in CY 2002 and CY 2003. Topics will include
pregnancy and pazenting, nutrition, human sexuality, and smoking cessation.
MCH 2O02-03 Priority:
i. Promote family support and hea.ithy community conditions.
2. Reduce youth risk behaviors.
-56-
OI-999
D. Efforts to Reduce Racial Aisparities
CY 2002-03
Describe how disparities identified in the CHS needs assessment are being
addressed in the MCHSP application, addressing the following:
1. In what ways do raciaUethnic dasparities mmpact your matemaUchild population or
what is the significance of disparities to your population?
RaciaUeihnic disparities have a significant impact on adolescent caze. In addition to the normal stresses of
maturarion, adolescents of color mus[ also contend with dis 'm;nation They aze also more likely to
experience poverty and its sequelae, including hunger, inadequate housing, exposure to unhealthy
behaviors, and violence. The most common cause of death among teens of wlor is homicide (51.4%); this
compazes with 7.5% among white teens. Not stuprisingly, adolescents of color report mare emotional
dis�ess, including nerrousness, anxiety, discouiagement and depzession than white studenu. More than
half of Native American teens have thought of killing themseives. Black male adolescents are also faz moxe
likely to have a sexually transmitted disease than any other group; e.g. gonorchea rntes among Black males
15-19 aze 70 times that of White teens.
This combination of factors along with tbe normal tendencies of adolescents to engage in risk behavior,
presents challenges to adolescent heaith caze that Health Start's mulridisciplinary model is designed to
meet
2. List specific MCfiSP objectives related to raciaUethnic disparities:
The diversity of St Paul's mainstream public lugh school population is reflecied in the students served in
Health Start clinics. In 1999, 19.6°to of our school-based clinic clients were Asian Americans, 281% were
Black Americaus, 11.8°!o were Iiispanic, 2.2% were Native Americans, 31.7% were Eutopean American,
and 6.6% othex. The overall goal of ouc adolescent health pzogam is to promote good health fox all of the
adolescents we serve, As laid out in the MCH plan for adnlescents, this goal is achieved through meeting
specific objectives related to the nwmber of students receiving nutrition counseling, social work and mental
health services, reproductive health services including testing for sexuslly h�ansmitted diseases, prenaxal
caze and birth control. Objectives aze also set for assessing immunization status, tobacco use, and
participafion of students in health education programs. While these objec6ves do not have specific targets
for the various racial aud ethnic groups, they aze designed to focus on the spec�c azeas where health
disparities e�st.
3. What slrategies will be utilized related to the above objectives?
The core of Health Start's adolescent caze strategy is to overcome baxriers to caze by providing services
where adolescents aze---in schools. We perform reguiaz outreach activities in classrooms to let students
know we're there and we make it easy for them to register and receive caze. We hire staff who enjoy
adolescents and who inczeasingly reflect the diversity of those we serve. In addition to primary caze, we
offer mental health serrices, nuhition counseling and health education on site and at no cost to students or
their families. We address violence and discriurination duough peer mediation groups that teach students
better ways to handle conflicts, and respond to students' need for peer and adult support by establishing
support groups for those who shaze common concems, such as gay students, Asian students, or teen
pazents. Our emphasis on prevention and on teaching teens to bewme better health caze consumers is
designed to prepaze them to make good decisions about theu behavior choices and their health caze
throughout life.
-57-
HEAI,TH START, INC.
MAT'F.RN.�7..AND CBQaav HE.AI.TH
ADOLESCENT $EALTH SERVICES
SCHOOL BASED CLIPi[CS
JANUARY THROUGH DECEM$ER, Z002
MCNSBCO2
'ANNUAt PROGRAM PROGRAM MCH
CiNE ITEM EXPENSE SALARY r euo�er auos�r
NURSE PRACiiT10NER (CEN7RAL)
NURSE PRACATIQNER (COMO)
NURSE PRAC77TONER (HUM60LDn
NURSEPRAC7ITONER(JOHNSON)
NURSE PRACT1770NER (HAR�INU7
socua woexers tcenrnn��
SpCIAL WORKER (CAMO)
SOCIALNqRKER (HUMBOLLI"p
SOCIAL WURKER (JOHMSON)
SOCSAL WORKER (AGAPE7
MEDICAL ASSISTANT (CENTRAL)
MEDICAI /SSISTANT (COMO)
MFDICALl1SSISTANT (HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDIN(7a
MEDIC7LL ASSISTANT CAGAP�
nurnmontsr<cen�a�.)
Nurnmoeisr �coMO�
NuTamanisr�umso��r�
NU'fRITIONIST (lOHNSON}
NUTRITfO NIST (HABOING)
HEAI.Tti EDtICATOR (CEN7RAL)
HEALTH EDUCA70R (CDM03
HEALTFt EDUCATOR (Hl1MB0l,D'n
HEAiTH fDUCATOR (JOHftlSON)
HEAL7H EDUCA70R (HARD1NC7i
HEAI.TH EDUCATOR (AGAPt7
CUNICAL SFRNCES COOROINATOR
SUB-TOTAL SALARY
* annual salary based on 42 week school year
FRINGE BENEFITS @ 21.SoJ,
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
�
51,912
49,543
47,158
47,158
50,400
35,280
34,524
38,069
37,582
38,069
26,393
23,789
24.226
25,099
23,100
25,2aQ
4I,782
37,397
41,782
41,782
36,120
31,b51
40,354
35,549
35,549
35,5Q�9
4A,354
60,732
0.80
0.7Q
0.60
0.60
�.80
0.60
0.60
0.60
0.60
0.30
1.00
0.80
0.60
0.80
I.00
0.20
0.15
0.15
O.Z5
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.10
0.10
$ 41,530 $ 35,300
$ 34,680 $ 29,478
$ 28,295 $ 24,050
$ 28,295 $ 24,050
$ 40.320 $ 34,272
$ 21,168 $ -
$ 20,714 $ -
$ 22,84I $ -
$ 22,549 $ -
$ 11,421 $ -
$ 26,393 $ 22,434
$ 19,031 $ 16,176
$ 14,535 $ I2,355
$ 20,079 $ 17,067
$ 23,1a0 $ 19,635
$ 5.040 $ 4,284
$ 6,267 $ •
$ 5,610 $ -
$ 6,267 $ -
$ 6,267 $ -
$ 5,418 $ -
$ 4,748 $ -
$ 6,053 $ -
$ 5,332 $ -
$ 5,332 $ -
$ 5,332 $ •
$ 4,�35 $ •
$ 6,073 $ 3,037
$ 446,726 $ 242,139
96,046 $ 52,060
OI -45q
'ANNUAL PROGRAM PR06RAM MCff
LINEITEM EXPENSE SALARY cre auo�eT BUDGE!
CONTRACT SERVICE
FAMIIY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNOUNIVERSITYOFMINNESOTAFELLOWCLINICS/'NfC@$120X38WKS $ 9,SZO $ 9,120
FACE TO FACE
SOCIAL WORKER (HARDING)
$23,326
$ 23,326 $ -
$ 26,250 $ 19,688
PATIENT CARE
LABORATORYSERVICES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRI NTI NG/DUPLICATI NG
TELEPHONE
TRAVEVTRAINING
PATIENT TRANSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROVED INDIRECT COST RATE � 35%OF SALARY AN� BENEFITS
TOTAL PROGRAM BUDGET EXPENSE
TOTAL MCH GRANT REQUEST
MATCtI1NG FUNDS � 25°J
-59-
$ 48,825 $ 36,619
$ 15,750 $ 12,600
$ 12,600 $ 10,080
$ 6,825 $ 5,204
$ I0,800 $ 8,64-0
$ 5,250 $ V 4,200
$ 2,100 $ ✓ 1,680
$ 703,618 $ 402,030
189,970 102,970
$ 893,588
$ 505,000
$ 223,397
�ai.za sT�T, nvc.
Nra�rExrrai, nivn c�.0 �ai.�rs
ano�scnrr �ar.'rs sExxvicEs
SCHOOL BASED CLINICS
JANUARY THROUGH DECEMBER, 2003
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
LINE ITEM IXPENSE SAUIRY RE BuoGEr suo�ei
NURSE PRACTITIONER (CENTHAL)
NURSE PRAC7ITIONER (COMO)
NURSE PRACi1TONER (HUM80LDn
NURSEPRACTITONER(JOHNSON)
NURSE PRACTiTIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI. WORKER (CAMO)
SOCIAL WORKER (HUMBOLD'n
SOGALWORKER(JOHNSON)
soau woRxex cncaa�
MEDICAL ASSISTANT (CENTRAL)
M miCAl ASSISiANT (CAMO)
MEDICAL hS5I5TANT (HUMBOLDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISiANT(HqRDING)
MEDICAL ASSfSTANT CAGAP�
Nurrtmorvisr <cennrnn��
nurttmorvisr�coMO>
NUTRITIONIST (HUMBOLDn
NUTRITIONIS7 (JOHNSON)
NUTRITIONIST (HARDING)
HEALTft mUCATOR CCENTRAL)
HFALTH EDUCATOR (COMO)
HEALTH EDUCATOR MUMBOLDn
HEAITH EDUCATOR (JOHNSON)
HEALTH EDUCATOR (HARD�NG)
HEALTH EDUCATOR (AGAP�
CLINICAL SFRVICES CAORDINATOR
SUB-TOTAL SALARY
• annual salary based on 42 week school year
FRINGE BENEFITS @ 215°J
MCHSHCO3
•ANNUAL PROGRAM PROGRAM MCN
53,469
51,029
48,572
48,572
51,912
36,338
35,560
39,211
38,709
39,2I1
27,185
24,502
24,952
25,852
23,793
25,956
43,035
38,5I9
43,035
43,035
37,204
32,601
41,564
36,615
36,615
36,615
41,564
62,554
0.80
0.70
0.60
0.60
0.80
0.60
0.60
0.50
0.60
0.30
1.00
0.80
0.60
0.80
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
0.15
Q.10
0.10
$ 42,775 $ 36,359
$ 35,721 $ 30,363
$ 29,143 $ 24,772
$ 29.143 $ 24,772
$ 41,530 $ 35,300
$ 21,803 $ -
$ 21,336 $ -
$ 23,527 $ -
$ 23,225 $ -
$ 11,763 $ -
$ 27,185 $ 23,107
$ 19,602 $ 16,662
$ 14,971 $ 12,726
$ 20,682 $ 17,579
$ 23,793 $ 20,224
$ 5,191 $ 4,413
$ 6,455 $ -
$ 5.778 $ -
$ 6,455 $ -
$ 6,455 $ -
$ 5,581 $ -
$ 4 $ "
$ 6,235 $ -
$ 5,492 $ •
$ 5,492 $ -
$ 5,492 $ -
$ 4,156 $ -
$ 6,255 $ 3,128
460,128 $ 249,4-04
�.SI�
$ 98,928 $ 53,622
CONTRACT SERVICE
fAMtLY PRACTICE PHYSICIAN/NURSE MIDWIFE
TNO UNIVEf2SIN OF MINNESOTA FELLOW CLINICS/W!C Ca} $120 X 38 WKS
FACE TO FACE
SOCIAL WORKER (HARDING)
PATIEI�T CARE
L460RATORY SERVECES
OTHER EXPENSE
PHARMACYSUPPLIES
MEDICAL SUPPLIES
OFFICE SUPPLIES AND OTHER
PRIN7ING/DUPLICATING
TELEPHONE
TRAVELlTRAINiNG
PATIENT TR4NSPORTATION/CAURIER
TOTAL DIRECT EXPENSE
FEDERAL APPROYED INOIRECT COST RATE @ 35^J OF SAIARY AND SENEFTTS
TOTAI PROGRAM BUDGET EXPENSE
TOTAL MCH GRANTBEQUEST
MATCHING FUNDS Q 25�
$23,326
$ 9,120 $ 6,&40
$ 23,326 $ -
$ 26,250 $ 18,375
$ 48,825 $ 34,17$
$ 15,750 $ 11,025
$ 12,600 $ 8,820
$ 6,825 $ 4,778
$ 1Q,800 $ 6,756
$ 5,250 $ 3,675
$ 2,100 $ 1,470
$ 719,901 $ 398,941
195,669 106,059
$ 915,571
$ 505,000
$ 228,893
-61-
G. Indirect Cost Allocation for MCHSP
Please check one of the four options:
� 1. NoY applicable—No chazges to MCHSP are for indirect cost.
� 2_ Indirect Cost Rate Agreemeut — A Federal negotiated fixed rate is to be chazged against all
pariicipating programs, includingMCHSP.
A signed ageement from covering the current Federal fiscal year is attached.
� 3. Approved Cost Allocation Process:
Option 1 Indirect costs aze allocated to the agency's pmerams using worksheets developed by the
agency for this purpose.
Agency worksheeYs and supporting documents are attached which aze in compliance with
the requirements of the OMB Circular A-87 "Cost Accounting Principies for State, Locat,
and Indian Tribal Govemments", and the Federai award(s) for which they apply.
� 4. MCHSP - Approved Cost Allocaiion Process:
Option 2—Indirect cosfs aze ailocated to the agency's pmgrams using the optional IndzrecUCost
AIIocation Wotksfieet on the Following page.
MCHSP worksheets and supporting documents are attached which are in compliance with
the requirements of the OMB Circulaz A-87 "Cost Accounting Principles for State,
Local, and Indian Tribal Govemments", and the Federal awazd(s) for which they apply.
�Y�
. ..
���
Y * DEPARTMEP7T OF HEALTH & HUMAP7 SERVICES
Y �
�;� �+m
Raymond J_ Martin, Jr.
Sxecutive Director
Health SCart
491 We5t University Avenue
St. Paul., MN 55203-I936
Dear Raymond Martin:
February" 6, 2001
�"�m �en� Cmtc
Fimv�l Mam�� �rice
Dimion o[ Cat Apacauoy
Cenhal States Fefd ��
730'i Young Stree; Room 732
6aVias Settas 75202
(214)-767-325t
FAXX (Z'
The original an� one copy of an indixect cost Rate Agreement
are enclosed. This Agreement reflects an understanding reached
between your organization and a member of my staff concerning
t2ie rate(s) that may be used to support your claim for indirect
costs on granCs anti contracts with the Federal 6ovemment.
Piease have the original signed by an authorized representative
of your organization and .return it to me, retaining the copy
for your files. We will reproduce and distribute the Agreement
to the appropriate awarding. organizations of the Federa7.
Government for their use.
An indirect cost proposai, together with supporting information,
is required each year to substantiate claims made for indirect
costs under grants and contracts awarded by the Federal Government.
Thus, your next proposal based on actual costs for the fiscal
year ending December 31, 2001 is due in our office by June 30, 2002.
Thank you for your cooperation.
Enclosures
sincerely,
S
\
Merl M. Schmidt �
Director
Division of Cost Allocation
Central States Field Office
P7�EAS$ SIGN AI3D RETURN TFiE ORIGINAI, OF THE RATE AGREEMENT
or-�y9
��
a
NOHPROFIT R8T& AGREEt�NT
SIN #: 1411577621AI DATE: February 6, Z001
ORGANIZATION: FILING REF.: The preceding
Health Start Agreement was.dated
491 West IIniversity Avenue NONB
St. Paul NIl�7 55103-1936
The rates approved in this agreement are for use on grants, contracts and other
agreements with the Federal Government, subject to the conditions in Sectioa III.
RATS TYPSS= FIBfiD PINAL
$FFECTIZTE PERIOD
TYPS FROM TO
PROV. O1/OI/O1 12/31/O1
PROV. 01/O1/02 IIxTxI, AN�rm&D
x
PROV.{pROVSSIONAL
PRSD.(PRSDSTBRMIN%D)
RATB(%) LOCATIONS APPLICABLB TO
35.0 On-Site A1Z Programs
IIse same rates and conditions as those cited
for fiscal year ending'December 3Z, 2001.
* sASS :
Direct salaries and wages including all fxinge benefits_
.�
.,
Health Start
A
AGREEMENT DATE: February 6, 200Z
�(-959
SBCTION II: SPECIAL RSMARKS
TRSATMFiNT OF FRSNGS B&NBFSTS
The fringe benefits are chazged using a rate(s). Over/under recoveries from actual costs
a=e adjusted i.n cuxrent oz futuse periods. Tfie directly claimed fringe henefits are
listed below.
TREATMENT OF PAID ABSENCES_
vacation, holiday, sick eave pay and othe= paid absences ase included in salaries and
wages and are claimed oa grants, contracts and other agreements as part of the normal cost
for salaries and wages. Separate claims for the cosCS of these paid absences are not
made.
Equipment nefinition -
Equipment means an article of nonexpendable, tangible personal property having a ssse£ul
Iife of more than one yeax and an acquisition cost of $1,000 ox more per unit_
FRINGfi BENEFITS:
FICA
Retirement
Disability Insurance
Worker�s Compensation
Li£e Insurance
Unemployment Insurance
Health Insurance
-65-
4 +
ORGANIZATION:
Health Start
AGRSEMENT DATS: February 6, ZdOI
A_ LIMITATIONS
The ratea ia Ghis Agreemeu[ are avbjeet Lo a¢y atatutoxy or a�➢ninis[satioe Iimitations aad app2p to a given graat, con[ract or
oCher agreement oaly Go the ex[ent tDat fimds ate available. Acceptance of tlae rates is subject to the follooriag conditioasa
(1) Oaly coats fneurzed by the oxganizatioa were included in 3ts indireet rnst pool as finally accepted: aucII cos[s are legal
obligatioas of the orgaaizatioa aad aze allovable vndex the govexniag mst prineiplea; (2) The same eoats that Dave be¢n ueated as
indirect cos[s aze aoG elaimed ae direct coats; (3) Similaz typea of rnsts have beea accorded coasisteat accomting trea[men[; and
(4) TIIe iafo�atioa provided by Che or9aaizatioa vhieh was used to esiablieh tIIe rates is no[ later found to be matezially
incomQleCe or inaccurate by Che Pedexal Gover�eat. Ea suvi sitvations Ghe rate(s) would be subject to xenegotiatioa at the
discreiion oE tDe Federa2 Goverm�eat.
B. ACCOiRi:fIHG �fNGSS
This Agreement is based on [he accdnntim3 system pisported by the organization to Le ia effeet duriag ihe Agseement periad. CEanges
Co the method of aceouaCiag foz coats vhich afEe<t Che amount of reimbuxsement resulting from the use oE this Agreement zem•;Te
prior approval of the authozized xepreseataCive of tEe co9nizan[ agency_ Sich ehayges inelude, but are aot limited to, cLaages ia
the ^*�+�ing of a paxtieulaz type of croat fxnm iadixect to d3reet. Pail�e to obtain appioval may result in rost disalloxaaces.
C. PIZLD RATES �
if a fued rate ie in this A9reement, it is based on aa eati�te of the rnats fo= the period cavezed by the rate_ 9ihea the a<tval
rnsts for Ghis period are de[ermiaed, an adjustment vi1l be made Co a rate of a futvie year(s3 to compeneate for the d3ffezeaee
between tIIe coste used to establiah tEe fiaed rate aad actval coste_
D. V58 HY OTHEti PED%RAL AGENQBS
The ratee in this Agreemeat were appTOVed in aernsdance aith tIIe authoritp ia office of Ma�gemeat aad Sndget CixCalai A-122
Circular, a� should be applSed [o grants, coatxaets aad otEer agree�ats covesed bg this C$zevlar, svbjeci to avy limitatioas in A
above. The oxgaaitation may provide copies of the Agreement to other Pederal Agesscies ta give them early aotifi<aGioa of tIle
ngreemest.
E. OTHE.¢.: •
Zf aay Pedezal contract, grant or other agzeemeat is zeimbursiag indirect msts by a means other thaa the approved zate(s) ia this
A9reemeat, [La oxganizatioa ehonld (i) cxedit snch crosts to the affeeted pxo9rams, and (2) apply the appzoved rate(s) to [he
appxopria[e base to identi£y the proper amouat of indireet costs alloeable to tlaese programs.
BY T88 OR(�1NIZATSON:
$ealth Staxt
- .. _ Y:� Y�� a�.._ �l•! �r� �
lORGANIZATION) .
���,,.,,,,( J�' f'la,�. �•
(sx 1 •
_ RA`fNouo s_ rtAa=iv. i�
t��
Ex�G�l�f�vr ��REC,'Cb�2
(TSTI.B)
.
�_<__ . / � ti_ �'!�
Mer7.e M. Schmidt
tm��
DSRECl08, DIVISIOS OP COS? ALLOC}STSOA-
(TITL8) CSlITRAL STATES PZELD OFPIC3
fl]AT8)
PebxuasV 6. 2001 � ... .. _.. __�.����
I11AT8) 5]36
�s *+�s�**Txos: MY (RObert ) N�. N4uYen
Telephoae- �2�.4T 767-3267
�T�
D�
4: ca��iu+�rea��
e entrn rnn.cFari� "
CHS PROGR.4M PLAN: Communicab�e Disease Prevention and Controt Common Acthirties Framework 57
01-9 �y
State and Local Pnblic Health
Communicable Disease Prevenrion and Control
Common Activities Framework
PREAMBLE
S/I7/OI
This Framework lays out a minimum set of disease prevention and control activities that are
to be carried out by all local public health agencies and the Minnesota Department of Health.
Background: Infectious disease prevenfion and control (DP&C) includes activities of deteeting acute
and coznmunicable diseases, develaping and implementing prevention of disease transmission, and
implementing control measures during outbreaks. Controlling communicable diseases is perhaps the
oldest and most fundamental public health responsibility. For decades, it was the primary responsibility
oflocal Boards ofHealth and, in fact, the main reason for their creation. Yet, the Local Public HealthAct
(Chapter 145A) and the Department of Health Act (Chapter 144) are ambiguous about respective state
and local authorities for conducting disease prevention and conirol acrivities.
Subdivision 6 of the Locai Public Health Act states, AA board of health shatl make investigations and
reports and obey instructions on :he con�ol of communicabie diseases as the commissioner may direct
under section 144.12, 145A.06, subdivision 2, or 145A.07. Boards of health must cooperate so faz as
practicable to act together to prevent and control epidemics."
Note that this is a requirement oflocal boardr ofhealth whether ornot theyforn� a CommuniryHealth Board or receive
the CHS subsidy.
While intended to allow for fle�bility and varied capacity to address communicabie disease problems,
such broad direction leaues ambiguity anduncertainty abouttherespective roles of state and local public
health. Clearly, both the 2viinnesota Department of Health (MDI-� and local Boards of Health have
assumed a shared responsibility for conducting public health activities.
In 1989, the NIDH DP&C Division and the State Community Health Services Advisozy Committee
(SCHSAC) formed a workgroup to review roles and responsibilities for conducting DP&C activities at
the state and locallevel. The outcome was a DP&C Acooperative agrcement� that formalized some of
1VIDH relationships with local public health
Communicable DP&C Common Activities FYamework: In 1996, another SCHSAC workgroup was
formed, which abolished the old agreement and redefined expected roles and responsibilities for DP&C.
The final report of the workgroup was released in 1998. T1us report, which was
approved by SCHSAC, set standards for DP&C activities to be carried out at the state and local level as
contained in the initial version of the Communicable DP&C Framework of Common Activaties. This
� lays out a miriimum set of DP&C activities that are to be carried ont by ali local public
health agencies and MDH. These activities are to be reflected in state and local community heakh
service (CEIS) plamung efforts. Those agencies that aze currently unable to cazryout these activities are
expected to strive to reach this level. MDH activities listed in the Frunework are to be implemented by
2
MDHInfectiousDiseaseEpidemiologyPreventionandConirol (IDEPC) Division staffinsupportoflocal
public heatth agency DP&C activities. 'I'his Framework also lists DP&C activities that are conducted
joinUy by MDH and local public healYh agencies.
The 1998 version ofthe Framework atso Iisted suggested activities for private heattEi care providers and
health pl�s in support of DP&C pubfic health efforts. The Fraznework as revised (May 2001) focuses
on local public health agency and MDH DP&C activities. Additional discussion with health caze
pmviders and health plans is being planned by the DP&C Leadership Team to detemiine ways they can
support DP&C activities. These activities will then be included in ffie Framework.
The Framework may be used as the foundation for a DP&C workplan for boffi MDH and locai public
health agencies. Yet to be determined is how Iocal public health and 1VIl7H can measure their pmgress
in maintauring and improving DP&C activities as contained in the Fraznework.
DP&C Leadershin Team: Anotherrecommendalionto enhanceffiepartnetship between state and local
public health for disease prevention and control that was made by the SCHSAC workgroup in the 1998
report was to create a DP&C I.eaderslup Team. '
Tfus Team is made ofinembers represenkingregionat andjob specific categories from iocalpublic health
agencies, arepresentative fromeachofthesectionswitUinthe IDEPCDivision, asweIl asarepresentative
from the MDH Community Heatth Services Division. The DP&C I.eadeiship Tea�n meetings are
urtended to provide an ongoing fomm for the review and discussion of how DPBzC activities are
implemented at the state and local leveL The Team meets about five times a yeaz: One co-chair
represents local public health; the other co-chair represents MDH.
TheDP&C Leaderslup Teamwill review the Comcnunicable DP&C Fremework ofCommon Activities
at least everytwo years (in conjunction with the CHS planning cycle} for anyneeded revisions. The next
review will need to be completed by January 2003, in prepararion for the development of locai pubfic
health 2004-2007 CHS Plans.
Recowmendations and updates are brought back to the Commissioner ofHealth and to the SCHSAC as
necessary.
MDH attd locai heaith departments have worked together to carry out the DP&C activities contained in
theFramework,initiallythroughpilotprojects. ToensurethesuccessoftheFramework,t�ainingsessions
aze being held statewide to review the Framework with all locat public health and Ivff)H DP&C staff.
In these sessions participants share ways to enhance the collaborative relationship between MDH and
local agencies.
K:1Xoshare�I.EADERSA1Framework\preamble-Snaiframeworic-wordperfectwpd
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CHS PROGRAM PLAN.' Minnesota Department of Helath Subsidy Applica6on Forms 59
O/" g�9
CHS Subsidy Application Cover Form
Plan Update Cycle 2002-2003
Name of Community Health Board: Ramsey County Community Health Board
Subsidy Request (including core fnnctions fnnding):
2002 CHS 2003 CHS
Subsidy Request Subs R
Totat Commnnity Health Soarfl 2,195,000 2,195,000
CHS Administrator:
Name: Rob Fulton, Saint Paul-Ramsey Counry Departrnent of Public Health
Address: SO West Kellogg Boulevazd; Saint Paul, Minnesota SS 1 Q2-1657
Fiscal Management Officer:
(This is the person and agency to whom the CHS Subsidy check should be sent)
Name: Julie Kleinschmidt, Director, Budget and Accounting, Room 270 Court House
Address: 15 West Kellogg Boulevard; Saint Paul, Minnesota 55102
��nutes\CASPSan2001Update\Sub:idyApplicationForms\SubsidyUpdateCoverFotm\Updatesubsidy app Update Cover fomu.doc
I¢dividual County Breakdowns
2002 - 2003 Update Assurances and Agreements
$Y SIGNATURE, 'I'HE ATJTHORiZED OFFICIAL AGREES AND ASSURES THAT:
1. Services will be provided in accordance with state and federal laws, rules and policies.
2. The Community Health Boazd will comply with state and federal requirements for equal opportunity employment,
3. The Board will comply with staYe and federal requiremenu relating to data privacy or confidentiality of pxotected
information.
4. The Board will provide the Minnesota Department of Health with information referenced in the CHS plan where
applicable.
5. Standards for programs or activities will be used in carrying out affected programs or acrivities where those
standazds exist
6. The requirements for fiill community participarion, as defined in Minnesota Rules 4700.1800, have been met.
7, The Community Health Advisory Committee {or Health Task Force of any Human Services Boazd Advisory
Committee in the wunty where applicable [Minn. Stat. 402.03]), shall meet the composition and reporting
requirements of the Community Health Services Advisory Committee required by Minnesota Statute.
8. The Board will comply with all standards relating to fiscal accountability that apply to the Minnesota Department of
Health, specifically:
A. The local match identified in the budget submission complies with the definition spec�ed in Minn. Stat.
145A.13.
B. The Boazd will submit plan and budget revisions to the Commissioner for prior approval in accordance with
applicable statute, rule, and MDH policy.
C. Reports will be filed with the Commissioner of Health in accordance with applicable statute, rule, and MDH
policy.
D. The Boazd will maintain a Financial Management System that provides:
I) Accutate, current, and complete disclosure of the financial results of each activity.
2) Records thaz idenrify adequately the source and applicarion of funds for subsidy supported activiries. Tfiese
records shall contain information pertaining to subsidy awards and authorizations, obligations, unobligated
balances, liabiliries (encumbrances), outlays and income.
3) Demonstration that the Board has effective control over the accountability for all funds, property and other
assets.
4) Comparison of actual obligations with budget amounu for each activiTy.
5) Accounting records that aze supported by source documentarion.
a�e..by-ar a*.�,rh�direction of the Boazd or the Depar[ment of Health. CHS fmancial
records will be retained unril audited, with the following qua i ca o.
i) The records will be retained beyond this period if audit findings have not heen resolved.
ii) Records for non-expendable property, which was acquired with subsidy funds, will be retained for three
years after its fmal disposirion.
S:N�Iinutes\CHSP1anZ001Update\SubsidyApplicazionForms�AssurancesAndAgreements\UpdateAssurances and Agreemenu.doc
o t-99q
2
2002 - 2003 Update Assurances and Agreements Continued
9. The Boazd will maintain records of the followiug materials for review for the durarion of the Plan. [Note: This does
not preclude other requ9remenu stipulated in the Community Health Boazd's retenrion schedule.]
A. Copies of the Joint Powers Agreement forming the Community Health Boazd.
B. Agreements establishing a Boazd of Health or Boards of Aealth within the azea of the Community Heakh Boazd.
C. Organizaflon chart of the Community Health Boazd structure that idenrifies major program activities, advisory
groups, and lines of authority and accournabIlity.
D. A list oF all city/county local ordinances or other local regula6ons related to community health services revised
within the past two years.
E. Copies of all public meeting notices and minutes.
F. General roster for community health service mailings.
G. Community Health Services Advisory Committee bylaws, meeting norices, minutes and attendance records.
H. Summary of public comments or testimony on the proposed Plan.
I. Copies of conhacts/purchase of service agreements with other organizations.
J. Env'uonmental Heaith, Disease Prevention and Control, and other ageements to exercise the Commissioner of
Health's authority.
Application is made for a subsidy under the provisions of the Local Publlc Health Act in the atnount and for the purposes
stated herein. The Community Health Boazd agrees to comply with conditions and reporting requirements consistent with
applicable Minnesota Statute and Rule.
* SIGNATURE:
TITLE: D'uector of Public Health
DATE: 7 Z�,O�_
*This form must be signed by the Chair or Vice Chair of the Community Health Boazd, or an agent appointed by resolution
of the Community Health Boazd. If signed by an agent, the resolution or motion appointing that agent MCTST be attached for
this subsidy application to be approved.
S:1Minutes\CI-ISPIan200SUpdate\SubsidyApp(icazionFocros�ASSUrancesAndAgreements\UpdareAssurances and Agreements.doc
2002 - 2003 Update Adminis#rative Requirements
This record is to assure that the Community Health Board has addressed the admmish�arive requuements of
the Local Pablic Health Act and its Rules. This form shou[d be completed for the Community Health
Board onlq, not for individual counties. Please answer the following questions.
1. How many members aze there on your Community Health Board?
2. When did your board(s) of health meet during the past year? List the meeting dates.
4. Does your board keep a public record? X Yes No
5. Does your Coxnmunity Heaith Board employ a Medical Consultant? X Yes
Please list the name, address, and telephone number of your medical consultant:
Dr. Neal Holtan; Saint Paul-Ramsey County Department of Public Health; 555 Cedaz Street; Saint
Paul, Minnesota; 55101 Telephone: (651) 292-7713
6. Does your Community Heatth Board have an Advisory Comrnittee? X Yes
How many members does it have? 23 available membeiship positions
Briefly describe on what basis members are appointed (e.g., geographic representation,
provider/consumer, special interest, etc.).
Ten members appointed by the city of Saint Paul. Thirteen members appointed by the Ramsey
County Boazd of Commissionezs_ Each county commissioner appoints one person to represent them.
Six other persons aze appointed to at-lazge seats using the Ramsey County appoinhnent process.
Two of the twenty-three members aze labor representatives who have public health eacperience, one
selected by tha county boazd as one of its thirteen representatives and one selected by the city of
Saint Paul as one of its ten representatives.
7. Does your advisory committee have bylaws or
8. Does your Update describe the process used to encourage full community participation in the
development of the Update? X Yes _ No
S:�Sinutes\CHSPIan2001Updaze�SubsidyApplicationFo�msWdminisuativeRequirementsFOrUpdaze\UpdateAdminisazuve Requirements.doc
3. Does your boazd have written procedures? X Yes No
al-9yy
2001 Update Administrative Requirements Continued
a. Was written notice of the inifiation of the Update development process made to interested
persons, including affected providers, consumers, and locai govemment officials?
2
X Yes No
b. Did this notice include the procedures by which persons may participate in the Pian development
process?
X Yes No
c. Did thi s notice describe how interested persons may obtain a summary of the proposed plan and
how they may review the entire proposed plan?
X Yes _ No
d. On what date(s) was this notice sent to interested persons? 12/16/99
Y
e. Was this notice published in a local newspaper?
Which newspaper(s)?
Newspaper(s) Name
Saint Paul Pioneer Press
Date Published
1( 24((Ol
Saint Paul Pioneer Press
5/13/Ol
X Yes _ No
Copy on file? X Yes , No
Copy on file? X Yes , No
Copy on file? ^ Yes _ No
f. Does your boazd maintain a general mailing roster?
If so, does it contain:
Providers
Consumers
Local Govemment Officials
g. Was notice sent to people on the general mail3ng roster?
9. On what date was the Update available for public review? 5/13/O1
X Yes _No
X Yes _ No
X Yes No
X Yes ^ No
10. On what date was a summary of the Update available to interested persons? 5/21/0
X Yes � No
11. On what date(s) were public meetings held? 6l13/O1
, S:Vvlinutes\CHSPIan2001Update�SubsidyApplicationFottn544dminisValiveRequirementsFofUpdale\UpdateAdministrative Requirements.doc
2001 Update �Idministrative Requirements Contirrued
12. On what date did the Community Health Boazd approve the Update? (Attach meeting mitnutes
andlor resolution):
13. On what date(s) did the County Board(s) approve the Update? (Attack meeting minutes and/or
resolution):
14. On what date(s) did the County Boazd(s) approve the yeaz 2002 CHS budget? (Aitach meeting
minutes and/or resolution): Ramsev Countv Boazd to be approved December, 2001
NOTE: If County Boards have not yet approved ihe budgei, you must subm?i a signed copy of the
budget, along with meeting minutes and/or resolution, no later than January 31, 2002.
3
15. Have you attached a copy of the budget for each of the last two years in the planning cycle (2002-
2003) for each county in your CHS agency? (Subnnitting a combined form for multi-county agencies is
not required, but is recommended.)
2002 X Yes No
2003 X Yes No
16. Have you attached a copy of the staffing form for each of the last two years in the planniug cycle
(2002-2003) for each county in your CHS agency? (Submitting a combined form for mulri-county
agencies is not required, but is recommended.)
2002 X Yes No
2003 X Yes No
Signatnre
CHS Administrator
Date: � 0
S:�Minutes\CHSPIan2001Update�SubsidyApplicationFomssWdministrativeRequiremen[sForUpdaze\UpdateAdministrauve Requirements.doc
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�� Saint Panl - Ram sey County
� Departm ent of Public Health
: \� � Rob Fulton, Director _ _ __
xamccrcoums
50 W. Kellagg Blvd. SYe. 930
gyint pauL, � 55102
651-266-2400
Julq 19, 2001
Community Health Services Administration
Munesota Department of Heaith
To Whom It May Concern:
According to the CHS Subsidy application instructions we must verify the eacgected approvai date
of our Community Health Services budget if that budget wi}1 not be approved by our Board prior
to the October 31 deadline for submitting our CHS subsidy application to the Minnesota
Deparnnent of Health. The purpose of ttris letter is to comply with that requirement.
Tfie Ramsey County's Community Heatth Services budget to be approved by Deceinber 31, 2001.
Sincere ,
Robert Fulton, Duector
Saint Paul-Ramsey County Department of Public Heakh
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