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95-992ORf�I�!�� I��J ��1� �� rresearect sy Referred To �F�# 9s=�'yz.- GieenSheet# 30586 WHEREAS, the City of Saint Paul seeks to improve the health of high risk, low-income mothers and infants, and adolescents; and WHEREAS, the Minnesota Department of Health accepts application grants from Community Health Boards for programs which provide health services to high risk pregnant women and children in Saint Paul; and WHEREAS, the City of Saint Paul will submit a grant to the Minnesota Department of Health to fund programs to improve pregnancy outcomes and to improve adolescent health; THEREFORE, BE IT RESOLVED, that the Saint Paul Board of Health supports the grant application of Saint Paul Public Health and subsequent contract with the Minnesota Department of Health for the Maternal and Chiid Health Block Grant, and authorizes proper City Officials to contract on its behalf with the Minnesota Department of Health. � Chi1d Health Block D, that contract ant is r n of the the Saint Paul Board of Healt wi.th the Minnesota Deoartmen at that be taken in re . � Yeas Navs Absent ea� � _ Grimm Guenn �� _ �— Harris Mesard � — Rettman — unI' 7 e �' — T — Adopted by Council: Date , �, 0 Adoptio CeRified by Council Secr By � - � �- _ �,.,-,� Approved by � Requested by Department of: Saint Paul to � � �� Form ppr ed � '�y �y�kyrnay '� f �� B " �G � - ?- � .i o �..�a-�r-- i G, Approved Mayor� Sub ' i n to Council ly 'i -� By , � RESOLUTION / CITY OF SAINT PAUL, MINNESOTA Public Health Diane Holmgren 292-7712 NUST BE ON CAUNCIL AGENDA BY (DATE) Scheduled for 8/16(95 8/4/95 NIIYBEP FOR NOUTING �� = ��G GREEN SHEET �1° 3 0 5�16 INITIAUDATE iNlTlql/ppTE DEPARTMENTDIFE �CITYCOUNCIL CISY ATTORNEY � CITY CLERK BUDG� DIRECTOF � FIN. & MGT. SERVICES Dlfl. MAYOR (OR A$$ISTAtdT) � TOTAL # OF SIGNATURE PAGES i (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION RE�UESTED: City signatures on a Resolution for Board of Health support of the 1996-1997 Saint Paul N.aternal and Child Health grant application to the Minnesota Department of Health. or _ PLANNING CAMMISSIINJ __ CIVIL SERVICE COMMISSION _ G�B COMMITTEE _ _ STAFF _ _ DISTRICTCOURT _ SUPPORTS WHICH COUNCIL O&IECTIVE? PERSONAL SERVICE CONTHAC7S MUSTANSWER TXE FOLLOWING �UESTIONS: 1. Has this personlfirm ever worked under a coMract for Mis department? - VES NO 2. Has this personffirm ever been a ciry employee? YES NO 3. Does ihis person/firm possess a skill not normally possessetl by any current ciry empioyee? YES NO Explein ell yes answers on separete sheet antl attech to green sheet PROBLEM, ISSUE, OPPORTUNITV (Who, What, When, Where, Why�: The City of Saint Paul, through Saint Paul P}��ac �QaltH will submit a grant proposal to the Minnesota Department of Health for funding of"� ��x'"'c'es to improve pregnancy outcomes and improve adolescent health. �� d9 1995 ��U� „ �, � , x �'-. a � �„ ��.��: , ,.__- ' The City will receive funding to help assure that prenatal and other services are provided to high risk, low-income populations. ' The health status of Saint Paul residents may improve. ' Saint Paul residents will have greater access to health care for these services. NONE AE�G � 1995 ,: ..... �4„ .� F ��. � . ,. .� ' a • a ,. fi � } � ►; �, ' Funding will not be received to support the above mentioned activities. ' Access to health care will not be improved. TOTAL AMOUNT OFTRANSACTION $ 1, 641, O56 COST/REVENUE BUDGETED (C�RCLE ONE) YES NO FUNDIHG SOURCE State Of Mlririesota ACTIVITV NUMBEFi FMANClAI INFORMATIO'N: (E%PLAIN) tn��" '�wSA ��4d�n ° a 9�� /'��/J_ ��i �i��jv_ 9s ��-. MATERNAL AND CI3II.D HEALTH SPECIAL PROJECTS GRANT FOR IMPROVED PREGNANCY OUTCOMES AND ADOLESCENT HEALTH 1996-1997 Submitted by: 5AINT PAUL PUBLIC HEALTH 555 CEDAR STREET ST. PAiJL, MN 55101 l! � � � � � � � �J �9 � � � � � � � SAINT PAUL MATERNAL AND CHILD HEALTH SPECIAL PR03ECTS GRANT 1996-1997 Tabie of Contents MINNESOTA DEPARTMENl' OF HEALT'H FORMS Face Sheet Project Information Evidence of Compliance Services Provided By Legislative Priority Certification Concerning Sterilization Certification Regarding Lobbying Assurances and Agreements APPLICATION NARRATIVE COMMUNITY ASSESSMENT IMPROVED PREGNANCY OUTCOMES Problem Statement Program Response to Minnesota MCH Priorities Inventory of Services Goals Objectives Target Population Solicitation Process Subgrantees Health Start, Inc. Face to Face Health & Counseling Service Model Cities Health Center, Inc. American Indian Health Clinic ADOLESCENT HEALTH PROGRAM Problem Statement Goal of the Project Target Populaltion Objectives Methods Training/Experience Linkages Reimbursement and Fees Budget Justification Monitoring/Evaluauon of Subgrantee Program Evaluation Budgets - 1996 and 1997 �� -'�� Page(s) 1 3 5 7 9 11 13 - 17 19-29 31-37 37 - 38 39 40 40 40 41-43 45 - 53 55 - 59 61-67 69 - 73 75 75 75 76 76-78 ' 78 78 - 79 79 80 80 80-81 82 - 87 �J ��/�� BUDGET AND FINAL EXPENDITURE FORMS Budget Justification Budget Detail of Local Match 1996 Budget Form 1997 Budget Form 1996 Budget by Legislative Priority 1997 Budget by Legislative Priority ATTACI�4IENTS 89 90 91 92 93 94 Attachment A- Inventory of Community Resources 95 - 99 At[achment B- Solitation Process 101 -112 � ❑ � ! f! �� -�� MINNESOTA DEPARTMENT OF HEALTH FORMS � � � � � � I C� � � � � � �_� � � � � � � � � I � �' i � � � j � � � MINNESOTA DEPARTMENT OF HEALTH Grant Application For MCH SPECIAL PROJECTS ��_��, Face Sheet 1. Appficant Agency Legal Name Address Phone City of Saint Paul 555 Cedar Street Public Health Saint Paul, MN 55101 612)292-7712 2. Director of Applicant Agency Name/TiUe Address Phone Neal Holtan, P1.D.,M.P.H. 555 Cedar Street Acting Public Health Director Saint Paul, MN 55101 612 292-7712 3. Fiscai Management OfFicer of A licant Agency NameTtie Address Phone Neal Holtan, M.D.,M.P.H. 555 Cedar Street Acting Public Health Director Saint Paul, MN 55101 (512 292-7712 4. Operating Agency (if different from number 1) NamelTitle Address Phone ( 5. MCN Coordinator for Operatirag Agency Name(Tit1e Address Phone Diane Holmgren 555 Cedar Street Health Administration Mana er Saint Paul, MN 55101 612 292-7712 6. Contact Person for Furthsr Information on Ap lication (if different from number 5) NameTtle Address Phone Carolyn Weber 555 Cedar Street Administrative Assistant Saint Paul, MN 55101 61 292-7749 7. Copies of this application have been sent to the foliowing Community Health Boards for review: � Community Health A enc Name(s N/A Date Sent Board(s)—N/A if the Board is the Applicant 8. i certify that the information contained herein is true and accurate to the best of my knowledge and that i submft this a lication on behalf of fhe a licant a enc . SignaNreolDirectoro(AppficantAgenry rme actin Public Health Date �j /n ,/ g b n /,� i' I / ir / �re�/ � Directvr -� '7� 1 Instructions for Completing Face Sheet /1� _!1/1� , �) 4.� �.. 2. 3. � 5. � 7 �;� PLEASE TYPE OR PRINT ALL ITEMS ON THE GRANT APPLICATION FOR(vi FACE SHEET � Aoolicant AaencY Legal name of the agency authorized fo enter into a contract with the Minnesota Department of � Health, e.g., North Woods Community Health Board. Director of the Ao�ficant Aqen� Person responsible for directing the applicant agency. Fiscal Manaqement O�cer of Aoolicant Aoencv The chief fiscai o�cer for the recipient of funds who has primary responsibility for grant ana subsidy funds expenditure and reporting. if the applicant agency is a Community Health Board, the Fiscaf Managemenf Officer musf be tf�e same person who is identified as the Fiscal Management Officer in the Board's Community Health Service Plan. Operatino Aaen� Complete oniy if other than the applicant agency listed in number i. MCH Coordinator for Ooeratina Aaencv Person who may be contacted concerning questions about implementation of this project. Contact Person for Further information Person who may be contacted for defailed information concerning the applicatiort or the project if different from 5. Co�ies of This A��licafion Have Been Sent to tfie Followina Community Health boards for Review Provide copies of this application and any subsequent revisions to the appropriate Community Heaith Board as required by the individual instructions. Si9nafure of Dir=c+=�?f Ao�licant Agencv Provide original s�: =-d date. '! lCANTS PLEASE NOTE 7he application form has been de� 'o be used on all Special Project grants administered by the � Department of Heaith. !f you have c,�.. �•ons, or need assistance in completing the appfication form, piease contact the Program Manager or Consuitant identified as responsibie for the grant. , ' i � � � � � i � � 2. � /i 3. j � 4. � � � � � � MiNNESOTA DEPARTMENT OF HEALTH PROJECT INFORMATION FOR MCH SPECIAL PROJECTS ��-��L 1. Project (nformation: APPLICANT AGENCY City of Saint Paul - Public Health BEGINNING DATE END DATE PROJECT FUNDS REQUESTED January l, 1996 December 31, 1997 Year1 Year2 820 582 $820 582 SERVICE AREA (City, County or Counties) LOCAL MATCH PROVIDED Year 1 Year 2 City of Saint Paul and Suburban Ramsey County $208,959 $208,959 MN TAX t.D.# 802-5095 FED. I.D.# (If applicable) 41-600521 Non-Profit Status: 501.C3 Copy Attached: Yes Not Applicable x Evidence of Workers' Compensation Insurance: Attached: Yes Affirmative Action: No Not Applicabie x The agency has a certificate from the Commissioner of Human Rights, pursuant to M.S. 363.073: Attached: Yes No x Not Applicabie Because: (a) Totai Contract is $50,000 or Less (b) Agency Has 20 or Fewer Full-Time Empioyees x (c) Units of Local Gove�nment (d) (ndian Reservation 3 Instructions for Completing Project Information Sheet for Specia# Projects , PLEASE TYPE OR PRINT ALL ITEMS ON THE PROJECT INFORMATION SHEET FORM � Proiect Information t�� `� Pro�ide name of applicant agency, beginning and end date of the project, the project's eeosraphic sen•ice area� Federal ID tVurnber (if applicabte), Minaesota Tax ID Uumber, or Sociat Security Number. Proiect Funds Reauested and l.ocal Match Provided � List the total amount requested for each yeu. Please refer to individual instructions for each special project erant to detemune if loca! match requirements aze needed. � 2. Non-Profit Status Check appropriate anscver. Agencies other than a governmental unit are required to file a SOl.C3 form with th� application as evidence the agency is a non-profit institution, corporation or organization. 3. Worker's Comaensation Minnesota Statutes Chapter 176, forbids the comaussioner of Health from entering into any contract until the Commissioner receives acceptable evidence of compliance with workers' compensation insurance coverag� requirements from the contractor. Complete the form entitled "Evidence of CompIiance" (see next page) aa retum it with your grant application. 4. Affirmative Acfion � Minnesota Statutes, Section 363.0'73, says the ComIIUSSioner of Heaith shall not "...receive, enter into, or accept any bid or proposal for a conuact nor execute any contract for goods, services, or the perFormance of anv� function, or any a2reement to transfer funds for any reason in excess of 550,000 with any person having more than 20 full-time employees in Minnesota at any time during the previous 12 months, unless the person has an a�rmati��e action ptan for the emptoyment of minority persoas, women, and tfie disabled tfiat has been approved� by the commissioner of human rights. Receipt of a certificate of compliance issued by the commissioner shall simify that a person has an a�rmative action plan that has been approved by the commissioner." If the grant or contract you propose meets the "in excess of 550,000" criterion and your agency meets the "more than 20 full-i time employees' criterion, a Certificate of Compliance must accompany your proposal, unless your agency is exempt. If you have questions about the Certificate of Compliance, contact: M'innesota Department of Human Rights, Contract Compliance 500 Bremer Tower, 7th Place and ivlinnesota Sireet St. Paul, MN 55101 Telephone: (612) 296-5663 APPLICANTS PLEASE NOTE � L� � The application form has been designed to be used on all Speciai Project grants adminisfered by the � Department of Health. if you have questions, or need assistance in completing the application form, piease contact the Program Manager or Consultant identified as responsible for the grant. � � 4 � �� EVIDENCE OF COMPLIANCE `� �' `1`1�i State law forbids the Commissioner of Health from entering into any contract until the Commissioner receives acceptabie evidence of compliance with workers' compe�sation insurance coverage requirements from the contractor. The exception to this requirement is a seif-empioyed contracfor who h�s no employees. An employee, as defined by M.S. 176.011, subd. 9, is any person who performs services for another for hire, including minors and family members. If you do not fall within the exception and you wish to enter into a contract with the Commissioner of Health, you czn fumish acceptabie evidence of compliance with workers' compensation coverage in any one of the foilowing four ways: 'I. Attach a certificate of insurance (supplied by your workers' compensation carrier) to this Exhibit; or 2. If you are seff-insured, attach a written order froin the Minnesota Commissioner of Commerce aliowing you to self-insure to this Exhibit; or 3. -- � If you are self-insured and you are a state zgency or a municipai subdivision of the state, pursuant to � M.S. 176.181, subd. 2, and are not required to obtain a written order from the Commissioner of Commerce, circie this entire item and sign and date the form below in the space provided; or � --�/ � 4. Fiii in the information for each item below and sign in the space provided: (a) � (b) � � (c) � (d) � � � � � � Name of Contractor's Insurance Carrier: Address of Contractor's insurance Carrier: Contractor's Insurance Policy Number: I affirm that ail the employees of (Contractor's Name) are covered by the workers compensation insurance policy listed above. Signed by: �� C`f�='"�`�--- Titie: Date: Acting Public Health Director 3�t5 5 MCHSP SUMMARY OF TYPES OF ACTIVITLES AND SERVICES PROVIDED BY OPERA.TING AGENCIES BY LEGISLATIVE PRIORITY Improved Pregnancy Geographic area ser Types of Activkies/Services core public health activities not direct service individualized education/counseling health education/counseling in groups arenatal medkal care � II Familv Plannina Proqram I SAINT PAUL PUBLIC HEALTH I CONIMUNITY HE�LTH BOARD cca� '�^-�?�L Y� OPERATING AGENCY* (H different from CHB) pregnancy testing and referral pre-term birth prevention prenatal case management � Geo raphic area served: ' Types of Ac2ivities/Services Please check those services rovided: ❑ core public health activities not direct service ❑ method services ❑ individualized education/counseling ❑ task force ❑ education in schools ❑ enabling and non-health support ❑ other ubiic education Other - lease s eci : , III. ' Handicapped/Chronically 111 Children's � � MCHSP SUMMARY OF TYPES OF ACTIVITIES AND SERVICES PROVIDED BY OPERATING AGENCIES BY LEGISLATNE PRIORITY COMi4tliNITY HE2.LTH BOARD �cHB� Q5- °�Q2 OPER2;TING AGEtiCY' (x ditrerrne from cHSI tV. Chiidhood Injury Control P Geooraohic area served� 7ypes of Activities/Services Please Check those serviens erev core public health activi�es not direct service home safety awareness promotion of positive parenting toddler car seats . bicycle helmet camoaian injury prevention in day care setting injury prevention in schools farm related injury programs enabling and non-heatth support V. Other Programs Previous Funded by a Local Pre-Biock MCH Special Project Grant - Specify Programs: ❑ Dental Health Program 0 Infant/Chiid Health Program �Adolescent Health Program area se � Saint Paui Pubiic Schools Types of AdivitieslServices core pubGc heahh activities not direct service list services ' exampies of operating agency include county, school district, Indian reservation, non profit health agency, etc. 0 r 1 � � , � L J l� � � � � � � � � � ' � J-�� CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT GRANT FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS CHECK ONLY ONE BOX: MCH Special Project grant funds wili not be used during CY 1996-97 x to provide and/or arrange sterilizations. lf a client is merely referred to another health care provider, this provision of information is not No considered to "arranging" a sterilization. sterilization provided ❑ MCH Special Project grant funds will be used to provide and/or arrange sterilizations d�ring CY 1996-97. Agencies which use MCH Special Project grant funds to pay for a procedure or related purpose, Yes such as provision of transportation or detailed counseling, must adhere sterilization to specific federal service and reporting requirements described provided elsewhere in this document. I certify that to the best of my knowiedge the above information is correct, and that if this status changes, formai notification in this regard will be sent to the Section Manager, Maternal and Chiid Health Section, Minnesota Department of Health, Minneapolis. Signature of Director of Applicant Agency: Title: Date: ��-�k -f (��--�d Actine Public Health Director �' �3 �a� t 9 q�-q4� � Instructions for Compieting Certification � Canceming Use of MCH Special Project Grant Funds to Promote and/or Arrange Sterilizations � AH federal Public Health Service supported programs, inciuding fhe Maternal and Child Healtt� Services 81ock Grant program, which use federat funds to provide andior arrange for steri(izatior� are required to foilow federal procedures and to provide written documentation in this regard on a quarterly basis. � MCH Special Projects (MCHSP) may obtain an exemption from this reporting requirement by signing a certification that their agency is not using MCNSP funds to provide and/or arrange sterilizations.� (If a client is merely provided information and referred, this is not reported.) Reporting is required if MCtiSP funds are used in some form of participation (paying for the procedure, providing transportation, making an appointment with another health'provider, or detailed counseling beyondl simple provision of information). Ali Community Health Boards are required to complete the Certification. For agencies which do not� provide sterilizations, no further action will be needed during CY 1996-97. The agencies which indicate they do provide sterilizations must adhere to specific federal service and reporting� requirements described elsewhere in this document.. � � � � � LJ � � � lo , r � � � � � � � � � � � � � � � � � � a� -�� CERTffICATIO�t REGF.RDING LOBBYI�;G The undersigned certifies, to the best of his or her knowledee and belief that: (1) No federal appropriated funds have been paid or wi11 be paid, by or on behaif of the undersiened, to any person for influencing or attempting to influence an officer or an employee of any agency, a member of congress, an officer or an employee of any aeency, a member of coneress, an officer or employee of coneress, or an employee of a member of coneress in connection with the awarding of any federat contract, the making of any federai grant, the making of any fedezal loan, the entering into of any cooperative aereement, and the extension, continuation, renewal, amendment, of modification of any federal contract, grant, loan, or cooperative agreement. (2) If any funds other than federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a member of congress, an officer or employee of congress, or an employee of a member of coneress in connection with this federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-111, "Disclosure Form to Report Lobbying," in accordance with its instructions. (3) The undersigned shall require that the lan2uaee of this certification be included in the award documents for all subawazds at all tiers (including subcontracts), subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordin¢lv. I'his certification is a material representation of fact upon wluch reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this uansaction imposed by Section 1352, Title 31, U. S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than �10,000 and not more than �100,000 for each such failure. I�—�e� ��----- signatuie g�3 �� Date Neal Holtan, M.D.,M.P.A. Name of Authorized Individual Saint Paul Public Health 555 Cedar Street Saint Paul, MN 55101 Nazne and Address of Organization li � � � � �F'�l`�� ASSUF�ANCES AND AGREEMENTS BY SIG2ZATIIRE� THB JiIIR'HORI3ED OFFICSl,L AGRBBS 2i27D ?,88IIRE8 THAT: , , 1. Services will be provided in accordance with applicable state and federal laws, rules and procedures. r � � � �J � LJ � � � � � � � 2. The agency wi1Z co�ply with state and federal requirements relating to privacy of client information. 3. The agency will coaply with the Minnesota Clean Indoor Air Act uhich prohibits smoking in MCH � Special Project facilities and clinics. . The agency (if it has 15 or more employees) and any subcontractors with 15 or aore"employees Will have on file and available for submission to Minnesota Department of Health (2�H) upon request a written non discrimination policy containing at least the following: . "All progra�s, services, and benefits which are � administered, authorized, and provided shall be operated in accordance with the non discriminatory requirements pursuant to Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discriaination Act of 1975, and the non discriminatory requirements of the MCH Block Gzant. Pio person or persons shall o national origin, handicap, excluded from participation i: or be othersaise subjecte3 � program service ar benefit provided by this Department." i the ground of race, color, age, sex, or religion, be i, be denied the benefits of, :o discrimination under any advocated, authorized, or 5. The agency (if it has 25 or more employees) and any subcontractors With 15 or more employees will disseminate information to beneficiaries and the cjeneral public that services are provided in a non discriminatory manner in compliance with civil zights statutes and regulations. This may be accomplished by: . 'A. Znc2udinq a handout containing civil rights policies in � any brochures, pamphlets, or other communications 'designed �to acquaint potential beneficiaries and the � public with programs; andJor 13 - �5-qq2 B. Notifyinq referral sources in routine Ietters by inc2udinq prepared handouts which state that services and benefits must be provided in a non discriminatory manner.� Copies of each document disseminated and a description of how these documents have` been disseminated will be provided to the MDH upon request. ' 6. In fulfilling the duties and responsibilities of this grant, the grantee shall: comply with the Americans with Di-sabilities Act of 1990, 42 U.S.C. $12101, et seq., and the regulations promulgated pursuant to it. - 7. No_ residency requirements-for services othei than state residence, will be imposed. � 8. Services shall not be denied based on inability to pay. 9, Arrangements shall be aade for communications to take place in a language understood by the maternal and child health service recipient. 10. All written materials develope3 to determine client eligibility and to describe services provided under this grant will be understzndable to a person who reads at a seventh grade level using the Flesch Analysis Readability Scale as required in Hinnesota Statute 144.054 (see Appendix 15; Plain Lanquage in Hritten Materials, Minnesota Statute, Section 144.054). li. The agency will provide services in keeping guide3ines of the Minnesota Department of guidelines of accepte3 professional groups - American Academy of Pediatrics, American Obstetricians and Gynecologists, and American Association. . ' with program Health and such " as the College of Pub].ic Health 12. Upon request, one eopy of any subcontract executed as part of the project will be provided to the Minnesota Department . of Health. 13. The aqency will report accomplishments of the project the Minnesota Department of Health. Such reports will be submitted no later than 90 days after the completion of the calendar year. Upon request, the agency will provide additidnal information needed_ by the ' Department - for evaluation of the project�s objectives and methods and "compliance vith any special conditions (see Appendix 13, Program Reportinq Requirements fort3aternal and Child Health Special Projects). � Z4 � � ' 14. � 15. � 15. C J � � � � � '-' � � r � � � L� � � �� Grant funds shall not be used for inpatient services except for high-risk pregnant voaen and infants. . Cash payments shall not be made to intended recipients of health services. • � Grant funds shall not be used for purchase or improveaent of land or facilities. 17. Grant funds shall not be used for puzchase of equipment costing more than $5,900.00 per unit and with a useful life exceeciing one year. 18. Grant funds shall not be used for reimbursement for travel and subsistence expenses incurred outside the state unless it has received prior written approval fzom the Minnesota Department of Health for such out-of-state travel. ig, When applicable, the agency shall provide rionpartisan voter registration services and assistance usinq forms provided by the state to eaployees of the agency and the public as required by Minnesota Statutes, 1987 Supplement, Section ' 201.162 (see Appendix 12, Requirements for. Voter Registration). 20. When issuing statements, press releases, requests for progosals, bid solicitations, and other documents describinq projects and proqrams funded in whole or in part with federal money, all grantees receiving federal funds shall clearly state (a) the percentage of the total cost o€ the program or projeet which vill be financed with federal money, and (b) the dollar amount of federal funds for the project or prograa: • 21. The agency will not use grant funds to pay for any item or service (other�than an emergency item or service) furnished by an individual or entity convicted of a criminal offense under the Medicare or any state health care program (i.e., Medicaid, Maternal and Child Health, or Social Services Block Grant programs)• 22. Materials developed by Maternal and Child Health Special Project grant and matchinq funds will be part of the public - domain and will be accessible to the public as financially reasonable. Materials developed by the Maternal and Child Health Special Project gzant and matching funds may be reproduced and distributed by the Project to other agencies and providers for a profit so long as the revenues from such sale are credited to the Special Project budget for expenditure by the Special Project. . d 15 q� 23. Tha agency will comply with all standards relatinq to fiscal accountability that apply to the Minnesota Depart�ent of Health, specifically: A. Budget ravisions With justification will be submitted to I�IDH for prior appzoval whenever: B. C. �7.� changes are made in the objectives to be met in the Maternal and Child Aealth Special Project, or •(2} the cumulative amount of�funds transfeired into or out of an operating aqency's budget line item exceeds or is expected to exceed 10� of that _ approved for the grant year or $2,500.00, whichever � is greater. . An expenditure report will be completed and filed with the Minnesota Depart=ent of Health no late a�eT folloWinq the end of each calendar year qu expenditure reports zre due 90 days after the end of the calendar year. , Grant funds are used as payment for services only after third-party paynents, such as from the 2�edical Assistance/Medicaid (Title XZX SSA), Children's Health Plan/MinnesotaCare zeinbursement programs af the Minnesota Department of Human Services and private insurance aze utilized. . . D. Project financial manageaent systems will provide for: (1) Accurate, current, and complete disclosure of the financial�status of the project. (2) Records which i�entify adequately the source and . application of funds for Y.aternal and Child Health Special Projecc. activities. These zecords are to contain inforsation pertaining• to project aWards and authorizations, obligations, unobligated . balances, liabilities (encumbrances), outlays, and • income. � - (3j Effective control over the accountability for all funds, property and other assets. Projects are to adequately safeguard such assets and assure that they aze used solely for authorized purposes. (4) Comparison �of actual obligations with budget amounts for each activity.. (5) Accounting records which are supported by source documentation. '� ❑ �� _ � � � � , � � � , , , ' I !J � , 16 • ! q � -��2 (6) Audits Which vill be made by or at the direCtion of the Hinnesota Departaent of Health (see Appendix . 17, State Audits). • � SZGttATURE OF CHAIR OR VZCE-CFiAIR � . , OF THE COMHL�NITY HEAI�TH BO?12D OR AN AG£NT APPOINTED BY RESOLUTION , -a^ A/ •% �,_ OF THE COM*fUNITY HEAI�T'3 BOP.RD: //(� c� c`f� ' TITLE: Acting Public Health Director / DATE: g J q� TITLE: ' DaIE: 0 0 � 17 � '. �'�,, COMMUNITY ASSESSMENT , � � � � L , u � � � LJ � � r � , � � COMMUT'ITY ASSESSiVIENT ��'' A broad-based assessment of community health needs and resources in Saint Paul was conducted beginning in the fall of 1994 as part of the development of the 1996- 1999, Saint Paul-Ramsey County Community Health Services Plan. Throughout this planning process, and as we proceed to pian for the future, Saint Paul Public Health continues to identify issues which contribute to poor health outcomes. The CHS Advisory Committee also identified a number of primary issues which underlie and are frequently the root causes for the discrete public health problems identified in the Community Assessment. Specifically, these issues aze: • Poverty and Racism - all of which lead to hopelessness, income dispazities and polarization between classes. This polarization teazs at the sociaUcultural fabric of our community, making public health intervention increasingly challen�ing. The Advisory Committee and staff also identified svstem orobiems which underlie and compound the problems. These system problems are: 1. Integrated health caze and social service system for all children and families in Saint Paul and Ramsey County, especially children at risk aze lacking. 2. The complexity of ihe chansin� heaith care system in Saint Paul and Ramsey County has resulted in lack of access to health caze for certain populations and the lack of stable funding for public health .services, including prevention. 3. Communication of heaith and environmental risks, and how these realities affect or impact a person's personal behavior needs improvement. Census data from 1990 indicates that: • Eight census tracts in Saint Paul have a level of 40% or more persons with incomes below the poverty level, with an additional nine census tracts with a level of 30% - 39.9% of persons with incomes below poverty level. • Five census tracts in Saint Paul realized an increase of over 20% in the number of persons living below poverty between 1980 and 1990. As a result of this assessment, Saint Paul Public Health has identified 'unproving pregnancy outcomes as a maternal and child health service priority for Saint Paul. The 1996-1999 Community Health Services Plan identified twenty health problems as the highest priority. An additional thirteen high prit�rity problems were identified as were three service delivery system problems. A number of problems related to 19 �5 -�q`� improving pregnancy outcomes were identified among these high priority problems including: High rates of low birthweight infants and preterm deliveries in some populations Ongoing problem of Infant Mortality despite decreasing infant mortality rates Low rates of breastfed newboms and infants in Saint Paut and Ramsey County Data reported in the 1994 Minnesota Health Profiles provided by the Minnesota Department of Health also reveais that in 1993: - • Percent of Premature Births (less than 37 weeks gestation) for Saint Paul is 103, compazed to 9.7 for the State of Minnesota. • Percent of women receiving late (3rd trimester) or no prenatai caze is 7.2 in Saint Paul, compazed to S.1 for the State of Minnesota. • The infant death rate of 9.7 for American Indian women remains higher than the State average of 7.5, even through the rate for Saint Paul women dropped to 4.9. • The incidence of low birthweight births for Narive American womer. increased from 8.8% in 1991 to 11.1% in 1993, and for Asian women it increased from 4.8% to 6.8% • The incidence �f 3rd �imester caze increased from 12.6% in 1991 for Native American women to 13.8% in 1993. This dafa atso indicates that due to the increasing efforts to improve pregnancy outcomes, we have seen some positive results such as: • Incidence of low birthweight births has decreased for African American women from 14% in 1991 to 12% in 1993, and for aIl Saint Paul women from 7.2% in 1991 to 6.7% in 1993. The incidence of lst trimester prenatal caze increased from 56% in 1988 to 62% in 1991, and 67% in 1993 for Saint Paul women. The incidence of lst trimester caze for Saint Paul Native American women increased from 36% in 1988, 37% in 1991 to 54% in 1993. While technology has improved to allow caze and treatmant of some high risk births, it is much more efficient, cost-effective and less stressful to place dollazs and efforts � a�-�� on improvin� pregnancy outcomes so that the advanced technology does not need to be used. Data indicate that some specific health planning azeas in Saint Paul have poorer birth outcomes and may benefit from increased levels of targeted outreach and service. These health planning azeas, all within the City of Saint Paui, include: Thomas-Dale, Suminit-Dale, Downtown Saint Paul, Riverview, Dayton's Bluff, Mount Airy and Rice Street. In addition to the focus being placed on improved pregnancy outcomes, the Adolescent Heaith Program, utilizing school based clinics operated by Health Start, Inc. and previously funded by the Oprebiock grant program, will continue to be supported through MCH funding. Adolescent health continues to be a concem within the community, and the need remains for accessible, efficient and effective service to this potentiaily high risk and often forgotten population. In fact, a number of issues specifically related to adolescent health aze included in the Community Health Services Plan as priority health problems, including: ' • High incidence of deaths and disabilities due to unintentional injuries in persons of all ages, and persons between the ages of 15-24 in particular. • High incidence of suicide and homicide deaths among people ages 15- 24. • Hiah incidence of death and injury due to availability of firearms • High rate of unintended pregnancy among teens • Increasin� prevalence of chronic illness/disabilities associated with smoking/tobacco use in teens • High rate of STD's in adolescents 15-19 years of age • High incidence of physical and sexual abuse Through the community assessment completed as part of the CHS planning process, it was identified that there are resources available within the community to meet the needs in the azeas of family plannin2, handicapped/chronically ill children and childhood injury control. Based on this assessment, no funding is requested for these areas through the Maternal and Child Health Special Project Grant. However, these azeas wiil continue to be monitored by Saint Paul Public Health to ensure that resources exist to handle the various health problems and issues in each area. � The provision of services addressing improved pre2nancy outcomes will be subcontracted to various community-based providers who were identified throueh a process of request for proposals. Saint Paul Public Health has chosen to subcontract ,�, for services in an effort to utilize established agencies and organizations who have 21 4�-�� proven to be effective and efficient in their delivery of services and which aze located within the target areas. Additionaliy, subcontracting with e�cisting agencies , minimizes start-up costs and duplication of services. It is hoped that this process and the services provided by the subgrantees will also help ensure that culturaily-sensitive, continuous caze is provided to high risk populations. , Vazious information regazding the community assessment is displayed in the figures on the following pages. � , � 1 1 ! t ! � � 1 � [ � J � 22 �u j sl o ' o =� o � c F: n v ° n � �. m � Hz¢{y Rag�YM ' O �Q+i�Li O � � ,y�- z C Y�.�. i Dl e �c-. .z-� 2 i n 0 n O � � s n ° 1 O ��, � � S � � m � � � � I � aoe�M ard � aR0 N � � � n bVd I � ��d i ? \ I G� " � � a o ' '^� C � O ` I n S 61 � I � V �� o Wc.�H i e 0 �c v � �� 1 � � i wor u 1 PNEA 3 ° � 5 �� ue3 � d� n 5 N d < �� N I O I � W�...§g rn°�. � mi � �� z� 1 sreorcts 1?FL "� �``ST ¢IO3�50 6 \ \Q�a'°±, � '-' m � � s \\l�»c x g c� n�v� ^ euo�aiA / :NY� �HI uI � !O th (� c ' C� ('1 I t7 I \ n �^ L I V01 UIXd'. \ � ,_va: n ` m I � U N � Bui1�X �N � m � paa5 E € � J �auas�zK w � m ' N 1[I � C! t'J MBwRj � � � +Wd e � � �'f � m I e CYe'anii� � n u9a:0 N � < n z5e� ��r ��-��12 YdX �:T9^d TnYL ]c:FS � / � W � W � � � %` � � V � H � � ii� _ � O W d o 0 0 0 < a H a� a> a> � o 0 a uf ti� E°; N T' o L � O N W a � O O O� y �W a o 0 0 0 � � N V � O C M N r= �Q �W ��!�;I oa Z m � � W t/� �N � � W � a� �_ Z � b 6 m z O � 23 x� � ,��,o. �e: - -�� `S ' � '�aw g v au ;v �`"'""'- (: fai sm �, ss+ ;aal m ` �; ; �' � � � [ '�� !�� YO � lv 1._ . J � at � ' ;` .'.." y � �' i m I yq I�' �.. 's'. a � r, 3 � I ' � ._ �`� i �� I xx i am I a6t i xs i asc i av i ao 9ca f6 9]6.01 Census Tract 3>5 mm m ' ��-`�� , i �. ,�o � j � �, i �m � '^ ! ,,,.@ k �� l,�j a,.o. ,'�'r�r�€ 3 . i� � a s „ • i l �� 8f6@ vs 1 � . � au .� ais �..� � as ran � � + :. r, '� � :p' ; � .yy.:<�. � u�ia .�.r E �; vcm � anm °'- i.�s � a.cn � � � �., .s - .„.s " 1 anoa�. �' � ::,;�" � Y : 8R N ' n�ot � � �� ,� . , � �. � ; �..m � �r naw aer €' ,�-. G O F.. �n;�,. �� ,., .. : - � ✓v � .. 1980 to 1990 � ,� I GROWTH IN POVERTY CNiViGE IN PERCEM OP PERSONS �^ WllN INCOMEBFLOW ➢OYEATY LFYII (Sa��E US.CENAQWAi�AN `� � 1 , - incnaseoverzo � � ; Hb2oincrtase . ♦ � 6 b t0lnereasa � � �� Cliange petNeen -5 6 �5 � �`j Gcroseof6ermore � ey 1990 in Saint Paul, the nvmbez of persons unaer pove-ty level wzs 9S�StS<`, 538 moze thaa , [he number in 1980. The •povez.y zzte' -- the percent of pezsons with incomes below poverty level -- increased fzom 118 to 174 in St. Paul duzing the decade of the 1980s, a fii£ference of 6 pezcentage points. This pezcentaae point , diffezence is the measure of chznge charted on this page by census tract. 9na11 changes (£rom -5 to .5) weze not charted. . , i � 1 1 rctnurto er: s... vd wc� w.0 ' -20 -'10 0 +10 �20 +30 +40 Perterhage point ehange in poverty, 1980.90 24 ,� � - ��'� SAL\T P�UL RESIDENT LI��E BIRTHS BY ET�ZCITY A��D RACE, I990 . Tohl Lnr Tsen- Ovt of Lthlno Ethnicify H» hirlh aQsd Wed- Drenaial of Rate � 6irths rai�t mother Iodc � �se /�� C2CE5 . . . VYhif . . . . . . Ason...... Black.. ... HisGy+ie . . . . ' Am.lndian . . . Uniawwn . . . A�� YdCES . . . While...... Asian...... Blxk. .... Hispanic . . . . Am.lndoa . . . Unimown... 5�37 33l 631 17�5 366 3371 167 793 565 112 835 56 131 165 157 678 E3 1?6 658 77 289 32 55 . 139 1? 87 5 16 63 • 9 27 3 0 5 � PERGENT OF R.^.CE/ET1iNIC TOTAL . SOO.C! 6.St 12.Oi 33.St 7.<i 100.Ot S.Ck 8.7t 'sB.G► 3.3t 100.04 6.7} 15.%4 :9.Ei iB.Et 100.Ct . 13.1f 71•%i 77.`g 12-�t 100.C1 7.Et 19.Ck <8-+i B•i4 IOO.C9 5.74 18.tE 72.it i0.3i 100.Ct 7.<i O.Oi '_B._t 1C.E4 SOURCE Sac3 Paii RL6c FieaRh � 25 � Am. Indian � � Asian B Hispanic ❑ White �i RI��4 q�-�� LIVE EIRTHS a'ITH TEEN MOTHERS Il`T 1990 Of a115,23 i live birtIts in St. Panl. 631 (12.Ia'o) had teen mothers. Health Ptanning Area Thomas-Dale 2o ex Daytons Bluff � ta.sx ( i i � Summit•Dale t5.sx � � PhaIen Park , ; t a.8x ( Riverview ta.zz ` � Rice Street �� t4.1X � I Mt. Airy �� ta.ox � Battle Gee � > > • � � Hayden Heights, � ��X � � Hazel Park, 9.3x � , Midway 8-9% � West 7th Street 8.5x � Hamline, �•�+ � Highland Par 7-ox � � � � Como Park �� B��x I I ! 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Ci i - ieeBelYM neiPueLi 6i M n- �_ m>z°�. Z d co Nli ; :" 2 � � � � o � t � �� 65+' M i � _' > N ..,.,-,. �Y�Y p a < { p x - . �US � � � � � � � �� -"� G- o � - a o � '•+ ' i a � �� o � M � � �� ' � }� ��E � ' � �� m j �j� � �a�� ,NEa 'rl H �� 0 � � r �� \ \ � � a O \\\ � ISdIOj � fT � O ' { � O �p � �� !'I N � �_� � � ;�� M N ,� � � t'a re � _ a. � M } �� $ � L � � ' � � � � � ,° N � ~ 9 > � a _ _„ n � '" M ` � � a � � _ - O _ �. . � .Z r- '�- _ � Q'�� q�+ \ � � � , W � o r n � r a. _ � N h.' �� m r �•� N O r'a N � J 3 > o o � � �� w o�uo O � tc � ' \\ ��; ° = i \ �; � �� - c�� 1�� ! ��` � � � � � � W o watsaM a \ � M t. W .,`\� \ � O r � � � � ° �m� 3 °' � � " � "'= �\�� O °' .. erza 1 �" � e'�'�° y s`� J 0. \ �� \ �_ . �� ._,`:f . ;�� euous � � � �o'° \. N \ N . � v \ N � v�i : � \� , b v � \�\� t+l �\ tn w o 6 , Qm � �'4 ��'�S�s� , W. al � \ m uo wal y `yi� �'� i �� y S'�� -�� N �•' N ap '�p ' CI f7 I CJ W ` ..�� '33€�R '��. � ? N eulw¢N \ ' auT�eFl e7wwa G3 �� {y�`� c �' e � � � y E ��g3�� k�� co 3 h�s�' � 6uiIHUS m w5 ` \ � � �B'!`�"�'v�� , I N � �[ {+ ULeY$ ' y ` � O �j \ \ N E�" 3 3'"°,i Q m {p `� 3. C. J t0 a t� • �'�� auPlV � V1 �NWS�aH� v�i �� NF � M S � � m s��.. O . � � o � im � fD ¢b °+ V m oc � � � Q � �c � �Ys'..�.,.�{fl $� �� m iaud ty @ ioud M rn ' Welanal� i� . � C�i o � � puelenel� � �' y � _ O °' J uVa�7 N P tC <' tG o n � O 0: � m P � LL � I � / � � � , / �� / 0' o�erw3 � 2g ��-��. yp;eaH OtjSnd SnFd ]ti?e5 �3JY�05 O O n �I � oauuu � 0 � ^�; � _ � c.z •� � n : ' apeWtl I � �:... i:`_L ^� � =_ � - . : � \ � ; � � 'i M $ N O [ ' 4;� � n -- H e� n O n o a � c t�1 � 'y p�euuay � Y ' _ o �' : � � i n M \ N � � S , M O ��G� �, � �� i ,� O �U r � � N � o � O �` M `:� N �—+ /� i � ' �C�S� o n c/�-:�� l v � 1�f �� H O o < ', pN Ep M . '� � � N ,c � a � ��\\\ M � < � �".O w N h �o � M M " oiv0 � \��. � "\� `,�\\�� ` \\\ � \ alsaM 1 �p P � �D d � � ��\ � � c � � trl `S \l� � �eica�sp � M \ _, J \ � � _ � '.," � ; \ i - m ^ f�q � �.��`� � �� U . N � N � � M "'� . e � 0i � �M m a � ; � N � �: r ; r m r� � n; n n ; � . . —'_ uq6m:al� � _ i N I 1 � ' � �y n aui�weH � � � Z N —i . —"_- _ dvqweN i 2Qwo�aG', m M.. j a� � � � �� - � � S oI � ; M �, I �� N J . — "_'___6�iiau5 i M --_o i E �o g n auimtl N --- in ty ' �'+ �'_ p � � � � N .a' ?ry = :. � .. � �- 1 Ql Y ,M � /(� MI z � / ' �� -- f f7 t7 i � — M3WRj : � � I � � / :` s_ - �oua � n / r o I � � e D�¢N�al� e t'� � c+ 9 I O . I —_'__-mla]p'--___ � , n N � � � n u'� t� M � � / / Ctl} • K' Cit � Q Q N N � L � Z p, � � � � > ' � � G. � o 0 o p F' O� � � a � Z ?' � � o a� � ` � ° \ C V W O ° � r- �o � � V �\�� Z b 29 ��-�� IMPROVED PREGNANCY OUTCOMES ' ' ' , , , , ' ' ' 301 601 � ` An 319, 332 , 6�6 Midway PROBLEM STATEMENT 306.07, 306.02. 309, 370, 37 7, 375, 376 Poor pregnancy outcomes has been identified through a community assessment as a high priority public health problem in Saint Paul by the Saint Paul-Ramsey County Community Health Services Advisory Committee and staff from Saint Paui Public Health. The problems which were identified include: • high rates of low birthweight infants and preterm deliveries in some populations • ongoing probiem of infant mortality despite decreasing infant mortality rates • low rates of breast fed newboms and infants Although the Infant Mortality Rate in Saint Paul declined in 1993, the small numbers make it difficult to determine if there is an ongoing trend of decreased infant mortality. Until additional data is available the Health Planning Areas of Thomas-Dale, Smnmit-Dale, Dov��ntown St. Paul, Riverview, Dayton's Bluff, Mount Airy and Rice Street have been targeted as the specific geographic azeas to be served in response to previous high rates of poor pregnancy outcomes. 302, 303, 304, 312 602 Como Park 305,308, 313, 314 . 603 ` Rice St :. ` 607 324.325.� ... � ,. Hamline 326, 327 �08 333, 334, 348, 349, 350, 351, 352, 363, 364, 365 612 Macalester 362, 375, 376.01, 376.02 615 Highland Park . 374.02, 374.03,374.04 361, 370, 371, 372 617 Riverview 618 ' Battle Creek CITY of SAINT PAUL Health Planning Areas and constituent census tracts � Targeted for high rates of poor pregnancy oufcome Thomas-Dale 935; 336, 337, 338, 339, 3C0 353, 354, 355, 356, 357, 358 V!J Sum�riit-Dale� 359, 360, 366, 367, 368, 369 616 W. 7th St. 604 Phalen Park � � - `I� L 307.02, 307.03, 307.04 605 F�ayden Heights , 3ll, 33i, 344, 345, , � _346.07, 346.02 610 Dayfon's Biuff 378.01, 318.02, 347.01. 347.02 -.611 Hazel Park 609. Mt Airy :' 342 614 �wntown-�:` � 31 95-qq2 y� � � � � t d CO E CD � t � � � "y s a •� y v> •` O = �'p °�oa � m M G O . � R � R A N do � �e � Vi - <,. � •E� MM �w:: �at I� = w 3 � L � �ti A M �f M F ° r� � �a3 m I�I ry L m QI �33 N C� � �Cr � v9 q [7 o q = ^ n �U [�I a � °' Q y � j � � e Q ^ � R r �� F d�a � �£o a °` w Q _�r r N ¢ F oN� � w e �: - .., a � � �m° � C�� •y � W E Y r-. 3 01 C Z aa— d � � WZ R T �1 �? y rn Z M O.� � p�j L C � °n A �> � � �o 0 W LL � E � � C Q � N P pC� ' � a � N � d N ^ 0' �' � .. en% � � '+ . H � a � o � � - e � � =° ss N � C � � � ly � � `° � a �, � o� � � .ri '" � - .. � O O � e=i tlr �: n h�l O � - 4�1 r m � e%, : ^ y .. a °� ^ U C � � rl y� `C � � � o � � � .. �D Q trl � �� N � ^ � _ �� ,.r g� N � � ti .r ^ .: N ■ O� ^ � � � O� � � e.� m � � _ .. � � e� � ., � ry _ o ., � N _ _ o c� .r — — N N H N � O N V q � q n N "+ w � ti a � x m F� � e x ; a = �� a � V a ° � � � 32 ��-�� LOW BIRTHWEIGHT INFANTS IN 1991 Health Planning Areas of Ramsey County RAMSEY COt RAMSEY SUB! SAINT PAUL Ramsey Suburbs Littie Canada White Bear Lake NorTh St. Paul WhRe Bear TownshiQ Mapiewood Falcon Heights Vadnais Heights Shoreview New BrighTon Roseville 3.0% Arden Hiils z•9% St. Anthon o.o°� (o) Gem Lake o.o� (ol � Lauderdale o.o% �o� � North Oaks o.o�r �o� � City of Saint Paul Phalen Pcrk Daytons Bluff Mt. AirY Hazel Park Summit-Dale Downtown Rice Sfreet Hayden Heights Macalester Riverview Thomas-Dale Highland Park BotHe Creek Como WesF 7fh ! Mi� St. Anfhony �� 6.2% (577) � � 4.SYo (738) �� 72% (373J �� 6.7% (9) �� 5.9°k (29J � 5.2% (9) � 5.0% (3) � 4.8% (24J � 4.8% /5) � 4.6% (9J � a.avo (n) 3.8% (8J 3.7°� (71J � T� s.z^.� � �� 76�� 4.4% (77) 3.6°k (2) �� 9.4% (53) � 9.2% (50J �� 9.1% �7)J �� 9.1 % (25J � S.5% (46J s.o°� (2) � 7.a% (2s) � �.o�ro ��s� � 6.8% (35J 6.5°k (22) 6.4% (73) 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% Percent with birthweight under 2500 grams (Number with low birthweight is in parens) SOUHCE: Saint PauZ PubIic Health 33 -- q5-�qZ _� .. � -�� . PRII1iATURE LIVE BIRTHS IN MIA'R�ESOTA� 1980-1991 �{[� 3fi0Ai 1f71 1q0 lfff 311i S1tT ifi[ lflt 1Mi ifi2 1fi3 iNl S1f0 MINHESOTA • � � LMBNlIKT+�� O/.tf� O.Oi] C].fR {Z�fO ti.9�S �S.1Q {S.�R Cl.�12 Ci.R3 �5.55! i�.511 t�.iSi O.IU d.dp�pjpi' '�li,� �O.A1 ].553 O.tO 7.]09 ].�]] ].25� ).3it ).]Ji ].tif 0.2tt J.DSt ].StO D.�iO r.,c„rw,e;m..�— . s.e� s.�� sn� a.� s.e� s.o� s.o� a.�a �.N s.o� a.�� s.a� sa� RAMSEY COUM7Y � ' � - - uneirtr47�� '" a�.isc �.nr �.aso a.sa - �.nu �.»s �.=es s.�a �.eu �.Tis �.�sc v.aa �.«s �oo,,.e:e, 'per s.as sis u� os av �u us as �n �a ac s3e �so p«aaayM.,;p't_ s.0 i.z� s.0 s.�t s.i� s.ca s.o� s.ea s.�� c.o� s.0 ao s.s� SAiM PAUL - � . QSOUprRbiN`+'F`i—� ` ].f15� S• �]� 5, 335 S• �Sf s• l3f ••) t 5• ]2f S• 3ti S• if3 •• �li 5• �03 5• ]N ,• 11) P��y� f.�� l.3� f.N Lt\ 0.N f.ft f.5� 5.5\ S.R f.3\ i.a� 9.3� i.p saMSer weuRes. �. ur.e�nr�io�.• ac.zsi �.e» �.ma a.zn s.ue a.»� o.us �.ioa �.oss t.�sc :.e�� z.sa xn�� ppn.�rn :qer i.�a ue iu ia� w u� ia zze zas ue su i�i iu P.m��io.tim^i�c— �.n� �.s� �.w a.z� a.w �.a� s.z� a.z� �.v� s.s� of� s.o� a.q HENNEP{N COUttFY � Linalnh.i •✓ � lo.i'_f l l.t3s 1]• »t li•!sa '[.�` 25. 00] 1L• f�c :S• BS 1S•taf It., ; l � • taf :t• �s1 la• tic s2'00 pen �eN PMyr}�piyy�.y„-� S_R Li� S.N s.N s.9� 5.9� s.N s.s\ S.q SJt sd� s.N S.H M�Nwearous LMe�nlyT••� u.�u c.t:a s.az a.ca� f.ua s.ov� s.su a.as s.QSS c.13a (.z�s (.us s.f�1 Q�ypOrnpiy�v6phL_ 5.59G SL2 S3] 50=. SC[ �ri A! �50 �Cf ]f) 4R lU �# P�eMbrtiM`�'F'L_ ].3� �.5� ].H ].S� 1.H LOt 9.N" 6H [.51 f.5� i.�� 9.2\ �.q . wenN�H weuRSs u.es�xna,Tb� ui.sn iaaav :aus 10.C6� 1C.11] �.so� �.o� s.xn �.aea �.soe �.�3 �.�sa �.:za Qlopy�neiNw6�c� s.]u ��] o• ui s.o �lc axs �as aaf �+s a•n .�oo �z� Pw�tbmRw�.M-- �.�� .]\ �.3\ . t.]\ �.�� l.�\ �.'_t �.f� 5.0� 5.3� 5.�� .t� 3.3� SOUxE �tPatAP�ETC}i�iN n�..�..� ...,.t.. ?5�0 arams s.o% a.oz �.ox c.ox s.os s.ox 1.07f �1 n � 34 -- t ��-�� One factor contributing to poor pregnancy outcomes, including high infant mortality, , premature birth, and low birthweight births, is late or no entry into prenatal care. Again, the targeted Health Planning Areas within the City of St. Paul have a higher percentage of �vomen who begin prenatal caze late (third trimester) or who receive , none at all than suburban Ramsey County and the State overall. Certain St. Paul neighborhoods have especially high rates of late prenatal care. ' ,� LATE OR NO PRENATAL CARE in 1990 Overall, 7.4% of mothers did not begin prenatai care untii the third trimester, or received no prenatal care at all. Mt. Air Thomas-Dai Rice Stree Midwa Downtow Daytons BIu1 Rivervie� Summit-Dal Phalen Par St. Anthony Par West 7th Stree Battle Cree Hayden Height Hamlin Highland Par Hazel Par', Macaleste Como Parl � ' HEALTH PLANNING AREA i y 20.6 % e i 13.5 % } 13.7 % y �o.�i ❑ i io.oi f i s.si ( y 9.5 % I I e szi k s.oi I I j( 6.9 % t 5.9 % { I4.9% I I i 5 4.5 % 3.6°le L 32% c a.oi r 2.oi ( 7.3% I I o.ox s.oq io.ox �s.o% zo.ox 2s.o% LATE or NO PRENATAL CARE � SOURCE: Saint Paul Public HeaNh 35 IJ ' L� fl ��-q�z Matemal and child health activities funded through the Maternal and Child Health Special Projects Grant are monitored quarterly, and more thoroughly evaluated on an annual basis. A report assessing the activities of the current project in 1994 was completed for the Minnesota Department of Health. Since current comprehensive data on Saint Paui health indicators is not readily available, it is difficult to fully assess the impact of present programs at this time. However, based on the data received from the programs, the following summary information from 1994 programs receiving MCH funding to improve pregnancy outcomes is available: • 3,252 clients were seen for prenatal services ' • 54% of the 1270 clients who delivered in 1994 received prenatal care in the first trimester of pregnancy • 3 fetal deaths were identified , • 3 neonatal deaths occurred • 45 births were below 2500 grams From this assessment, it is clear that on-going efforts need to be made to help ensure early and continuous prenatal care, especially amon� some minority populations. PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES St. Paul Public Health's Improved Pregnancy Outcome Program responds to the goals and priorities for services identified by the MCH Advisory Task Force in the Health Plan for the Mothers and Children of Minnesota, 1990 and year 2000 Update. The Program addresses both the goal of reducing infant mortality in Minnesota and of assurin� universal access to preventive health services. To achieve these goals Saint Paul Public Health has identified priorities consistent with the following MCH Task Force priorities: • reduce infant mortality • reduce the percentage of low birthweight births • increase the percentage of women receiving prenatal care in the first trimester • provision of prenatal caze services that aze sensitive to cultural diversity These priorities wili be addressed through the objectives and methods identified by the community agencies approved for funding by the MCH Special Project Funds Proposal Review Committee. Once again, Saint Paul Public Health subcontracts MCH funding to community organizations to increase access to services; and to increase the likelihood that culturally sensitive caze is available to the population. The agencies recommended to receive funding aze Health Start, Inc.; Model Cities Health Center, Inc.; Face To Face Health and Counseling Service, Inc.; and American Indian Health Clinic. The programs of these agencies provide a variety of inethods which are tazgeted to increase the percentage of women receiving prenatal caze in the first trimester, ensure 37 q5-qq2 1 continuous prenatal care, education and case management, reduce infant mortality, and decrease low birthweight births. Additionally, the programs of these three agencies will provide services to the residents of the highest risk Saint Paul , neighborhoods. �_l ' � ' ' ' ' ' LJ ,. 1 � ' � 1 ' ' , � 38 ��-�� INVENTORY OF SERVICES From the inventory which was completed, it has been identified that there aze a number of agencies providing prenatai care in St. Paul, in addition to independent practitioners. An inventory of agencies providing prenatal care, primarily those providing the options of care on a sliding fee, including the target population served and the services provided, is included in Attachment A. In April of 1992, the Prepaid Medical Assistance Program (PMAP) was impiemented in Ramsey Counry. T'hree health plans are available, including Ramsey Care/NWNL, U-Care, and Blue Plus. Individuals who are newiy applying for Medical Assistance are being placed into this system at the present time. Other persons who were currentiy on Medical Assistance in April will be phased into this system as their enrollment is reassessed. Saint Paul Public Health has already seen evidence that the PMAP program in Ramsey County may adversely impact the ability to access health care for some special populations. At Saint Paul Public Health we became aware of a 25 year old pregnant Hmong woman who had been refused prenatal care because she did not have her permanent card and could not recail what program she had signed up for. At the time we became aware of the problem, she had not yet received her permanent card and there had been a lapse of five weeks in being able to initiate prenatal care. We aze concerned about issues of this sort, and fear that many more clients will actually be denied services, or choose not to seek services due to confusion. Special populations may need special attention to uutially maneuver through this new system. Saint Paul Public Heaith will continue to advocate for accessible care for all populations. �F GOALS OF THE PROJECT `� ��1 L T'he overall goal of the projects which will be supported through the Maternal and Child Health Special Projects grant is: To improve pregnancy outcomes of high risk, low income women residing in Saint Paul. OBJECTIVES OF THE PROJECT Although the infant mortality rate (IMIZ) in Saint Paul declined in 1993 for ail racial groups, it must be remembered that a change in a relatively smail number of deaths can have a lazge impact on the rate of deaths. Rates averaged over three to five yeazs reduce the validity of the rate in any one yeaz. A number of objectives have been established for the Improving Pregnancy Outcome project including: 1. To make progress towazd the goal of improving the overall St. Paul infant mortaliTy rate ( 4.9/1000 in 1993) with a special emphasis on African American, Native American and Asian women. 2. To make progress towazd the goal of reducing the rate of St. Paul low birthweight infants from 6.6% in 1993 to 4.0% by 1999 with a special emphasis on African American, Native American and Asian women. 3. To conduct outreach efforts to pregnant teenagers to increase the rate of first trimester prenatal caze from 49.1% in 1993 to 55% in St Paul pregnant women under age 20 by 1999, with a special emphasis on outteach to minority teens. 4. To make progress towazd the goal of reducing the overall rate of late (3rd — trimester or none) prenatal care from 7.2% in 1993 to 4.5% in 1999, with a � special emphasis on pregnant teens and all pregnant African American, Native American and Asian women. TARGET POPULATION � 1 The ciients targeted by programs funded by Saint Paui Public Health aze low income t (less than 200% of poverty) Saint Paul women at high risk for poor pregnancy outcomes, as defined by legislative parameters. This includes, but is not limited to, � 40 ' C � f ��;,-��Z teenage and minority women residing in the aforementioned health planning areas (HPA's) of Ramsey Counry. The targeted HPA's were selected on the basis of their historically high rates of infant mortality and late or no entry into prenatal care. ' The target population specific to each subgrantee selected, as weli as the objectives, methods, traininglexperience of staff, linkages, reimbursement and fees and budgets will be described separately for each subgrantee. � � L� � � � ' �� r i � � � �I � SOLICTI'ATION PROCESS To determine the agencies with whom a subcontract would be established, a solicitation process was conducted beginning in May of 1995. A Request for Proposals was sent to 30 agencies which may have had an interest in participating in the project, and a public notice was published in the Saint Paul Pioneer Press. Four proposals for programs to improve pregnancy outcomes were received by the deadline. The proposals were reviewed by Saint Paul Public Health and an ad hoc subcommittee including representatives of the Saint Paul - Ramsey County Community Health Services Advisory Committee. An evaluation form similar to the Minnesota Department of Health evaluation form was used to evaluate the proposals which were received. The results of reviews completed by the review committee indicated that three projects scored consistentiy high, and that each merited some funding. As a result, three projects were partially funded, with the awarded agencies asked to revise their budgets, objectives and methods as necessary. Additionally, the projects which were chosen for funding would ensure that some services were provided in each of the target health planning areas with as little duplication as possible. The details of the RFP, tool used are described summary list of the proposals received, and the evaluation in Attachment B. SUBGRANTEES Specific information on each of the projects to be supported through the Maternal and Chiid Health Special Project Grant for improving pregnancy outcomes is provided on the following pages. Each project has specific target populations, objectives (which include projected service levels), and methods, but al] projects are working toward the same goal of improving pregnancy outcomes for residents of Saint Paul. Copies of the full proposals submitted by each of the grantees are available from Saint Paul Public Health upon request. The foliowing table indicates the projecu which are praposed for funding and for which a complete program description foilows. [41 �5- a�� AGENCIES PROPOSED FOR FUNDING/SUBGRANTS Agency Health Start (IPO) Model Cities Face to Face American Indian Health Clinic Amount Requested Total: yr.l: 424,744 220,186 Amount Awazded yr.2: Totat: yr.l: yr.2: 204,558 424,744 220,186 204,558 72,718 36,359 36,359 40,000 20,000 20,000 94,833 46,584 48,249 80,000 40,000 40,000 25,744 12,872 12,872 20,000 10,000 10,000 H e a I t h 1,032,118 508,245 523,873 1,032,118 508,245 523,873 Start (AdoI Health) Health Start receives non-competitive funding as a pre-bIock grant provider to provide both improved pregnancy outcome services through outreach and prenatal caze, and adolescent health services through school based clinics. Model Cities is receiving funding primarily for outreach and transportation. Pace to Face is receiving funding to continue their outreach/case management program. American Indian Health Clinic is receiving funding for case management, pazenting education and in-home nursing services. � 42 � � L � � � � �' �� MONITORI\'G/EVALUATION OF SUBGRANTEES � � - �� To ensure that every effort is made to achieve the proposed goals and objectives, the subgrantees efforts and performance will be monitored on a regular basis throughout the contract period. Contracts will be written between Saint Paul Public Health and the subgrantees indicating specific performance objectives and outcome indicators. The contracts will outline the subgrantee duties, reporting requirements, the monitorin� expected/performed by Saint Paul Public Health, and evaluation indicators. Subgrantees will also be required to provide annuai performance reports evaluating their own program, and assessing progress towazd goals and objectives. Both subjective and objective tools will be used by the subgrantees to ensure that various aspects of their program aze reviewed. PROGRAM EVALUATION Data will be sought from vazious sources, both nationally and locally, including the Minnesota Department of Health, to monitor pregnancy outcome trends. This data will be used to analyze the impact that the project has had on the goals and objectives for the project throu�hout the two year period. Since summary data is frequently available on a two year delayed basis, progress towazd the objectives may be difficult to measure on a timely basis. In addition, data will be collected from each subgrantee to identify: • age of clients • race and ethnicity of clients • residence of clients • time of entry into prenatal caze • number of fetal deaths • number of neonatal deaths • number of infants with birth weights less than 2500 grams The evaluation results will be used to identify whether or not current programs aze � appropriately impacting pregnancy outcomes. Based on this evaluation, services and programs may need to be modified or refocused to maximize the likelihood that the objectives and goals aze met. � f � � 43 Q�'�� SUBGRANTEE INFORMATION � � � � � ,� Sub�rantee A- Health Start, Inc. ��'�� Health Start, Inc., as a Pre-Block grant provider of services, continues to receive Maternal and Child Health Special Project Grant funding for services to improve pregnancy outcomes. Health Start, Inc. is an organization specia?izing in health services to high risk populations, including pregnant women, infants and adolescents. Approximately 650 clienu per year aze served at both hospital and community-based clinics. Services are designed to improve pregnancy outcomes and reduce infant morbidity and mortality for low-income women and adolescents. In addition to medical and nursing caze, services are offered to help pregnant women make changes in their behaviors to help ensure a healthy baby at birth, to handle poor family or social situations, and to postpone subsequent pregnancies. � Target Population - Persons who are at high risk for prenatai and birth complications who would, without accessible and high quality services, continue to experience the multiple problems associated with high risk pregnancies. Client representation is comprised primazily � (7�%) of St. Paul women, where 85% of the clients will be single, 30% will be of age 19 or less, 50% will be minority women, ] 00% will have family incomes at 200% of poverty or less, and 75% will be high risk as determined by the Edwards Risk Assessment Score. � Objectives - I. Health Start will provide comprehensive multidisciplinary prenatal care to 500 high risk adult and adolescent women per year during 1996 and 1997. � � �' 2. 50% of women who deliver through Health Start will initiate prenatal care in the first trimester of pregnancy and 85% of women will initiate caze by the end of the second trimester or pregnancy. 3. Prenatal education group classes will be provided to 350 prenatal clients per year during 1996 and 1997. 4. By December 31, 1997, low-birthweight (less than 2500 grams) rates will be no greater � than 9 percent and preterm birth rates (less than 37 weeks gestation) will be no greater than 10 percent. � � � � � Methods - • A fuli range of coinprehensive interdisciplinary prenatal services will be provided to clients in seven half-day clinics at Saint Paul Ramsey Medical Center, the Saint Paui Public Health Center, and Family Tree. This will ensure accessibility and acceptability for clients seeking prenatal care. • Prenatal and postpartum care will follow the comprehensive Health Start model, using the 45 �5-�� established protocols and methods that have proven effective with high-risk clients since 1967. - Al2 clients will be assessed for high-risk conditions using ihe Edwards Risk Scoring System or other acceptable scoring instrument at the initial visit and 36 weeks. Appropriate preventive management will be provided for all clients. • All clients will receive a life-style assessment, which focuses on life-style behaviors such as smoking, alcohol, and chemical use which place women at risk for poor birth outcomes. • Clients will also be assessed for risk for HIV infection and individualized prevention education will be provided. HIV tesring will be provided on site. • All clients will receive a nutrition assessment, conducted by a Health Start nutritionist. Clients will be certified for WIC at the clinic visit. Clients with specific nutriYion concems, e.g. diabetes management, anemia, weight control, etc. will receive ongoing nutrition education and counseling throughout their prenatal care. • All clients wili receive a psychosocial assessment, conducted by a Health Start perinatal sociai worker. Family and relationship issues, housing and financial concems, chemical use, and issues of physicaI, sexuaI and emotional abuse are included as part of the assessment. Clients with no source of pa}�nent for medical care will receive help in applying for medical assistance and other financial aid. Social workers will provide ongoing counseling and support within the clinic setting and will refer to outside agencies and services as needed. • All clients delivering through Health Start wili receive family pianning services for 24 months after the baby's birth. After this period, clients will be referred to another sliding fee provider. • Health Start staff will arrange for labor and delivery, post-delivery hospital caze and other needed emergency caze at St. Paul - Ramsey Medical Center. Infants of project clients will receive 18 months of pediatric care through Heaith Start's pediatric component and if �� eligibie, will be invited to participate in one of Health Start's intensive parenting programs, including support services for infants exposed to alcohol and drugs in utero. • Outreach services will be provided for pregnant women. • Health Start staff will nerivork with and refer clients to other agencies, resources and services in the community (e.g. Ramsey County Public Heaith nurses, Community Human Service, WIC, food shelves, emergency sheiter, additional counseling, Family Resource Center, etc.) as needed according to already established protocols. . • Clients in need of specialized medical services such as cardiology, endocrinology, and genetic counseling wiil be refesed to St. Paui - Ramsey Medical Center or other providers as appropriate. • Clients will receive individualized prenatal education in clinic and will be invited to attend the weekly Health Start prenatal ciasses at St. Paul Ramsey Medical Center. 46 � � � L� [J � ��-�� • Prenatal and postpartum clients who fail appointments will be followed-up by telephone and mail to help ensure that they receive needed health care services. • Language interpreters and interpreters for the deaf will be available in clinic and by phone during non-clinic hours as needed. • Although most clients will find the clinic sites easily accessible, Health Start will provide bus tokens or cab cazds when needed. Evaluation -Health Start uses an IBM compatible personal computer to enter and maintain its data set. Health Start's management information system enables Health Start to track patients on an individual basis as well as maintain data on various client groups. Evaluation consists of the following components: � • Compazison of birth outcome data for Health Start births and non-Health Start births. • Number of women initiating prenatal caze in each trimester will be monitored, as � well as numbers of preterm births and low-birthweight babies. • Data regarding the infants of the women delivering through this project will be collected. � • Data will be analyzed on a quarterly basis, with trends noted and necessazy program modifications made. � � � � � � � !J I J� � TraininglEzaerience of Staff - Health Start has provided maternal and child health services in St. Paul since 1967. All Health Start staff are professionai health caze personnel with special expertise in maternal and child health. The majority have had more than five yeazs experience. All staff are evaluated at least once a yeaz. Staff aze supervised by the executive director, associate director, medical director, associate medical director, and team leaders. Donna Zimmerman is the executive director of Health Start and is responsible for the overall management and direction of the project, as well as external relations and long-range pianning. Dr. Chris Reif is the medical director, is on the staff of the Family Medicine Department at St. Paul-Ramsey Medical Center, and is responsible for overall medical direction. Dr. Carol Ball, on the staff of the Obstetrics and Gynecology Department at St. Paul - Ramsey Medical Center, is the associate medical director and works with the medical director to provide consultation on OB/GI'N practices, as well as providing clinical supervision for OB/GI'N nurse practitioner staff. Staff continue to update their knowledge and skills by attending relevant workshops and conferences. LinkaQes - Health Start has well developed linkages that include a wide vaziety of health care providers, educational programs, and social service agencies. Referrals aze made by Health Start staff to other programs and other agencies to Heaith Start. This referral network allows staff to individualize caze plans to meet the specific needs of each client. New a� linkages and referral sources aze identified or developed as needs azise. q� _qq `� At delivery, new pazents aze refened to Health Start's pediatric clinic, Well-child and acute caze visits, augmented by interdisciplinary services, aze provided. Eligible clients aze also referred to the Befriender Program, run in collaboration with Children's Home Society, the Partnership Program, a coilaboration with Saint Paul School's Eazly Childhood and Family Education (ECFE), or the CARES Project, also run collaborarively with ECFE. These programs all provide intensive counseling, support, and/or group education for high risk pazents. When psychosocial or health caze needs are identified that cannot be met by Health Start (e.g., general medical caze or adoption counseling), written referrals wiil be made to community clinics or other resources within a convenient geographic azea Health Start works collaborarively with Ramsey County Public Health nurses to extend services to pregnant women in the community. Public health nurses meet regularly with Health Start to identify clients needing home based services and to shaze information that will enhance patient caze. Health Start is committed to extending services to the community and minimizing duplication by collaborating with many agencies and programs. Health Start will maintain �liations with and/or refer to the following agencies and task forces: • Child Abuse Prevention Task Force • Chiidren's Home Society of Minnesota • Eariy Childhood and Family Education (ECFE) • Frogtown Family Resource Center • Maternal-Child Substance Abuse Council • Ramsey Clinic Associates • Ramsey County Hiunan Services • Ramsey County Nursing Service • Ramsey County Maternal Child Project • Rondo Family Resource Center • SAFPLAN • St. Paul Public Health Infant Morcality Task Force • St. Paul Public Schools • St. Paul - Ramsey Medical Center • WIC Food Supplement Program .. � Reimbursement and Fees - Health Start provides prenatal and adolescent healYh services at no charge or on a sliding fee scale to its patients. Clients aze billed, however, by Saint Paul- Ramsey Medical Center and Ramsey Clinic for hospital chazges such as labor and delivery and selected tests and procedures. MCH funding allows Health Start to provide prenatal caze for clients who have no third party source of payment. For Health Start clients eligible for medicat assistance, staff will assist them with the application process. Health Start has contracts with all of the PMAP � � � � � l� �� '��-�'�� providers. Any other applicable third parties aze billed whenever possible. Health Start provides family planning care to clients for 24 months afrer delivery. If a ciient has no third party payor, a sliding fee scale is used to determine her fee for family planning services. Funds will be requested from the State of h4innesota Family Planning Special Projects to continue the provision of family planning services in the next biennium. SubarantsJSubcontracts - Health Start subcontracu for the provision of physician and certified nurse midwife services with the following groups: Ramsey Clinic Associates, West Side Health Center and the University of Minnesota. The Health Start Medical Director and Associate Medical Director aze responsible for supervision, protocols, and general medicai direction for all medical personnel involved in the prenatal/postpartum and adolesceni programs. Budget Justification - Health Start will receive $220,186 in 1996 and $204,558 in 1997 to support their proposed program to improve pregnancy outcomes. These funds will be used primazily for ouireach, education and prenatal caze activities. The total budget and justification for the project follows. 49 �� - �Q� H � C;, r � � � p � � o� , � M � � ° Y.s � ~ � Q a �� z �a s �� a a X it! t= W � o , � � , , m � U _ � '� � � � .� `^ a V z � Y �- '� < � � r � � � < c • W G = �` :' � a - � . v: � N � L R � � _� w N � t ' j C . O � � � ! � • o � I�¢fi ., _ � Q =�4 � x � � �� a L E � � t �� 4 Y � i �� W +� �� ¢ � ��..s� � � ��2�� ` �� ° �000U0 S �U^0�;� _ � : �, � � o � M n !- � o� n -' � 1 ^ � . � �� Q �� •� �� _� E_�� a �� i � . � �� =� �_� 3�5 > � � i � �� s i �� P` �Si � � � ; 3 �� ►- e' s s �� €=�� , � � � Z � • � � � a t�p. w ¢ �� LL = fi � � � � � � � e�� o � > ev ei f 1 D — �, . � � � � � N � � ^ i � i 8 50 ��J NEALTH START, INC. MATERNA.LAND CHILD HEALTr! Ih7PROVED PREGtvANCY OUTCOhSE FROGP,Af�( BUDGET JANUARYTHROUGH DECEMBER 1996 ANNUAL PROGPVaM PftOGR.V.S F.�Oi LINE ITEM DCPENSE srvAar t� suocET a�ocer ��/+��`�+��' S56.973 0.7 539.881 523.629 r�E aw+cmiot�n 549,317 0.7 534,522 520,713 MI�CiE PRP.CiiTONER 554261 0.1 55.426 55.426 r�zsE aw.C'rmot.�t 544252 0.2 58.850 55.310 rur�7anxsT 546.740 0.6 528.044 516.826 ��1 539.376 02 57.875 57.875 r�u"n+IDUCaTOFt 537.049 O.t 53.705 53,334 �n+EOUC1.7oa 531,720 02 56.344 56.344 ��TM �ATOa S31.882 02 56.376 55.420 soctn�woar.� 539,376 0.1 53,938 53,150 SOCV1 WOF+7CER 544.365 0.1 54.497 54.497 tt�1i�ErER S25.817 0.4 510.327 57.229 a�p-� Sc6,025 0.8 520.820 514.574 MEotc�+t./�sstsialJi 519.282 0.7 573.497 59.448 ti�o+c'-a-.osssTaxi 520,353 0.1 52.035 57 221 SUB-TOTAL SALARY FRINGE BENEFITS @ 20J CONTRACT SEAVICE � RAMSEY CLINIC PHYSICIAN/NURSE MIDWIFc FNE OBtGI'iJ PhYS1�tJ axJlcsM'K � S+3ox e2 WKs iwo CNM aYJICSM� g� st3LY0.tt�nC x ez v✓Ks PATIENT CARE LAB, ULTRQSOUND, X•R4Y COURIER SERVICE RENT OTHER EXPENSE MEDICATION/DRUGS MEDICALSUPPUES OFFICE SUPPUES PRi NT I N G/D U PLICATI N G PATIENT TR4NSPORTATION TOTAL DIRECT DCPENSE INDIRECT DCPENSE a� 16% TOTA.L FFOGFLlM EXFENSE 80.5FD ON 1S90 AUDIT TOTAL MOi GRAN7 REQUESf TOTAL MEDIGLL ASStSTANCE MATCH TOTAL FAMILY PL4NNWC SYc�AL PROJECi MATOi TOTAL MATONNG FUNOS 5796.137 5135297 539.227 527.059 $90.300 5?$,}Zp 511.340 52.835 541200 5 i 4.420 � S9.300 50 55,885 SO s�z.000 sa,ass 55.000 SO 57.500 50 5500 50 51.500 50 54i3,890 522D.186 Sb6222 SD 5480,112 5220,186 5220.186 530,000 $ZS,OOo $$6.000 r, 5 � O U 4 a � (1 � � � c, � � � \ ti � ', ,n c � v� � � O G1' � � G ^ R � N1 � �' rg � �, �.. � � � a . a � o � G a > w � � � � W � o � � � � � .. . o � : .. � � � o � w �g �s `"� �s a w � W � � 0 n = m p � r U � o W , o - z C' '^ O �..i O N a < � � U ..� y ?�G � W a < � � V E F F LL � W � c F � a - �, v W N � � � � L a � �/ � _� w N � r j i • C O N � o � � t t � 0 ��¢� W �r .t � � ¢ � � t � � � � � �� O �� W � 6 d �' �^ 6 � �� e �� S �� 19,,0000 _ 52 ��' ��- • J S�� O �� '� �� a � � �� a:�$ �'�� $ ' & � c�+ 3 � .. � � J r } � f � � �� _ � � _ € �� I l � �� =� t. I � HEALTH START, INC. MATERNALAND CHILD iiEALTH Ih1PRQ�!EL� PREGNA.�!CY OUTC�ME PRC�GRA.M BUDGET JANUARYTHF?OUGH DECEMBER 1997 � � ��,- � � ANYVAL PROGRAM PROGRAM MC}i LiNE ITEM E>�ENSE 5ntnaY FrE BuocEr suocFr NURSE PRACTfC10��'ER(TEAM LERDER NURSE PRAG7RtONER NVRSEPRACTRONER NVRSE PRACi(TIONER NVTRRIONtST DIETICIMI t-�a_ Foucarort 1-IEALIIi EDUC/�TOR x�ns�Tr+mucnTOR SOGAL woRKER Soan�woax� uJTERPP.FfER a¢�c aFwc MEDICAL ASSISTfNfi MF_DICAL ASSISTANT 558.682 55o.79s 555.889 545.580 548.142 540,558 538,160 532.672 S32.838 540.558 54&.314 $26.591 Sc ,806 519,860 520,963 0.7 0.7 0.1 02 0.6 02 O.i 02 02 0.7 0.1 0.4 0.8 0.7 0.1 54�,078 520,539 535.557 521,334 SS.S8S 55,589 $9.116 $$,470 528.8R5 �77.331 58.112 54.056 53.816 53.434 56.534 56.534 56,566 $5,583 54.056 53.245 54.631 52,316 S70.637 55,318 521.445 510.722 S13.302 59.731 S2.046 S1258 SUB-TOTAL SALARY FRItJGE BENEFITS @ 20% CONTRACT SERVICE RAMSEY CLINiC PHYSICIAN/NURSE MIDWIFE FNE 06�GYN PIiYSiCYJJ CLLNICSjJJK @ 5445 X 42 WKS �vro cnm� wv�csnvK � St aara.wiC x a2 v,�s PATIENT CARE LAB, ULTRASOUND.X-RAY COURfER SEftV{CE REN7 OTHER DCPENSE MEDICATION/DRUGS MEOICAL SUPPLIES OFFICE SUPPLIES PRI NT I N G1D U PLI CATI N G PATIENT TRANSPORTATION TOTAL DIRECT IXPENSE INDIRECT DCPENSE Qa 16% TOTAL PROGF'tAM EXPENSE BASED ON 1994 AVDl7 TOTALMCH GRANTAEQUESi TOTAL MEDIC'AL ASS15iANCE MhTC}I TOTAL FAMILY %A7�lNItJG SPEdW_ PROJECi MAT6i TOTAL f.4ATCHih3G FUNDS 53 5202.021 5122,460 S40.404 524.442 593.450 537,330 511.760 52.940 542.436 St2.731 ' 59.579 50 56,062 $0 S12.360 54.555 55.150 50 51.545 50 5515 SO S1,545 50 �426,827 5204,558 568292 SO 5495,120 5204.558 5204.558 525,000 530,000 555.000 I � � 1 �� 1�. -�g � Subgrantee B- Face To Face Health And Counseling Service, Inc. - Project Connect -- Prenatal Access Project Face To Face has been providing intensive outreach, advocacy, case management services for pregnant and pazenting adolescents since 1987. Face To Face has historically been a strong supporter of a comprehensive service approach for high risk youth, and is continually moving closer to a fully comprehensive, integrated service model. Face to Face realized its mission and holistic approach through many programs. Tareet Population - Low income adolescents, 50% of which will be youth of color, SO% will be from ihe Eastside, primarily Dayton's Bluff, 10% from Sununit University and Thomas Dale, and 10% from Riverview neighborhoods. Half wili be 17 yeazs of age or younger. � Objectives - � � � � � � � F_� � � [� Obiective 1: To provide 170 pregnant adolescent and young women -- 140 of whom are under the age of 21 -- with holistic and comprehensive prenatal care services which aze accessible, appropriate, effective, and which aze coordinated with other community resources and integrated with the clients' individual life situations. Obiective 2: To enroll 60% of the 140 clients under the age of 21 during their first trimester of pregnancy. Objective 3: To provide outreach to youth of color and ensure that at least 50% of the prenatal clients are youth of color - African American, Native American, Hispanic, or Asian. Obiective 4: To provide outreach to high risk youth on the Eastside, and ensure that at least 40% of the prenatal clients are from the Dayton's Bluff and Phalen azeas. Obiective 5: To enroll 60% of the 140 clients under the age of 21 during their first trimester of pregnancy. Obiective 6: To attempt to effect positive birth outcomes in all clients, as measured by low birthweight rates of less than 6.5% for all age and racial groups served. Obiective 7: To provide Prenatal Class for all prenatal clients, with at least 70% of the 85 prenatal clients participating in the classes. Obiective 8: To provide mental health counseling for prenatal clients who aze struggling with mentai health issues - includin$ chemical use, depression, and abuse. Objective 9: To link all the prenatal clients who deliver tluough Face To Face with ongoing primary care for their infants, and social services for the infant, mom and pregnancy partner. 55 �� 'Q � Methods - The primary component of this propose project continues to be the outreach youth worker approach to link high risk pregnant young women under the age of 21 with prenatal care, counseling, support, advocacy, education, basic living needs, and a wealth of appropriate resources. Various methods include: • Serving as a link between youth and service providers • The outreach worker also provided intensive case management for the prenatal clients • A critical role of the ouireach worker is building strong linkages with other service providers • Informational and support components aze other key components. An eight week prenatal class is offered four times a yeaz. "Snack and Chat", and informal discussion, informational and support gathering, is offered each week during prenatal clinic. • Free pregnancy testing is offered two days a week • Outreach workers provide pregnancy test "on the sireets" as well • A core method for reaching our goal of healthy babies for high risk youth, is comprehensive and sensitive prenatal caze services. Evaluation - Face to Face maintains a database management system, which collects data on client registration (demographics); health histories; the visits including diag�oses, lab tests and procedures; foilow-up information on positive lab resuits; a prenatal follow-up sheet that collects intake and follow-up risk scoring, pregnancy outcomes in terms of birthweight and other outcomes, and information on clients who did not deliver througfi Face to Face. Also information on outreach visits is collected including length of time with client and reason for visit. From these data we can track both process and outcome measures. Foliow-up information on the status of those who "dropped out" of Face to Faces's prenatal program is maintained, and permits the agency to better ensure that no client will be "lost to follow-up". Finally, good pregnancy outcome data is available, altowing us to identify variabies which might lead to poorer outcomes (infections, drug use, etc.) Training/Exaerience - The outreach worker is Laura LaCroix, who came to Face To Face in June of 1993. She has a Bachelor of Arts in Youth Studies from the University of Minnesota, and worked as a residential counselor wiTh high risk youth at The Bridge For Runaway Youth for three yeazs before joining us. Tuesday Spinks is a second prenatal outreach worker who is part-time Matemal and Chiid Health and part-time CISS. Tuesday came to Face to Face in July 1994 from the City, Inc. in Minneapolis where she was a teacher and family worker. Tuesday is a Master's candidate in counseling. • The Ob/Gyn nurse practitioner is Barbaza Taylor, who came to Face To Face in January of 1994. Bazbaza worked in HealthStart's school based clinics and prenatal clinics for over I S yeazs, and for two yeazs worked with the Adolescent Health Program at the University of Minnesota. ImmediateIy before coming to Face to Face, Bazbara was working with the Youth and AIDS Project and Lutheran Social Services mini-clinic in an altemative school. 56 � � � �"�'�� The family practice nurse practitioner is Sue Garger, who has been with Face To Face since June of 1989. She had been Director of Health Services at Carleton College and Saint Mary's College before joining the Face To Face team. She is a graduate of the Nurse Practitioner Program at Bringham Young University, has a BSN from Winona State University, and is a Certified Adult Iv'urse Practitioner. The two prenatal care providers aze Dr. Katie Guthrie from United Family Physicians in � Saint Paul, and Maria Pederson with Ramsey Nurse Midwives. Both aze backed up by their respective organizations, and both bring many yeazs of experience providing prenatal caze services. Linka�es - Face To Face is committed to building working service networks with agencies, individuals, coalitions, and systems. Evidence of this is our Academy program, which is a private/public partnership between Face To Face and the Saint Paul Public Schools. Further, in the Spring of 1993, Face To Face and Saint Paul Youth Service Bureau became co-located services when they both moved into Face To Face's newly purchased and renovated building. The Face To Face Prenatal clinic has built strong working relationships with a number of other relevant maternal and child health service providers. These include: Maternal Child Project, Ramsey County Public Health Nurses, Ramsey County Child Protection, WIC, MELD, Children's Hospital Pediatric Clinic, Health Start's Harding Clinic, Ramsey County SELF and Minor Mothers Programs, and the Diabetes Clinic at United Hospital. Clients aze referred for ultrasound, non stress tests, biophysical profiles and colposcopies. In cases of referrals, the nursing staff contacts the referral source to set an appointment and inform the client of time and date. In most cases, a written referral form is given to clients to take to a referral appointment. If transportation to the referral appointment is an issue for the client the outreach worker will either provide bus tokens, ta�ci vouchers, or a ride - depending on the situation. Follow-up is done by clinic staff to ensure that the client has carried through on the referral. Additional linkages will be developed with the Father's Resource Center and other agencies which work with adolescent males and other parent partners. � Reimbursement and Fees - The vast majority of our clients have been eligible for Medical Assistance (and prepaid Medical Assistance). � If a client is not eligible for any third party reimbursement, she is then charged fees according to our sliding fee scale. For clients below 100% of poverty, there is no chazge. Fore clients over 100%, the fees range from 10% to 100% based on income. � � � � � As of June of 1993, we became a UCare provider and a Ramsey Caze provider. for prenatal services. By Fall of this year, we should become Allina providers. Budeet - A complete budget and justification for the Face To Face program foliows. 57 q�-��12. t996 Maforna( & ChFtd Haafth Granf 7oTAl ---'--"--" °--�U(VDiNG 9�URCES - �irti PROJECT =- -_-- 3RD CITYlCNTY MARCHO TOBE F7E SALARIES DETntI BUDGE7 :':N1CH::�: GISS PARTY GRANTS DIMES IN-KIND RAISED D.50 RojettCoorClRenamlEEU�aIOr,LLaCrof t3,000 - :::;s;�; 780 �220 0.50 Outreacn Waker, L LaCrdx 73,000 '�'�; x�?D�� 5,200 1.00 Outrea�h WIXker, T. Spinks 23.<00 'i-'37;a00: 9,000 1.000 0.40 NurseRaclfBmer,S.CiarDer 17,920 77,920 0.30 Mktliol laD Tetri, P.7lvush 6,600 6,600 0.30 MeEltaf Assafant, EKOrtekaas 5,�00 5p00 020 Re9lstereC Nurse, W.Derman 6,080 6,080 O.gp pecepHatist,lN.Sfdz �,500 a.500 0.35 ClfniCASS�staM,LFlS�er 9,363 _ 9.363 0.30 Ciini<Q�e�1or,B.Tay�a 1f,850 11,850 O.aO Statisticall9�Iing 5uperxsim 10,000 - 10,000 0.50 9ning SDedalists, D.Lee 9,000 9.000 0.08 Assotlale precior, 0.Merrigan 3200 3,200 0.15 Socal Worket 4,800 1.800 O.pq �.1¢ettat Oirecta. Dr.JOnnsm 3.760 9.760 020 Omtt CoorCinata, J.CniiCS 5,000 5,000 0.03 YdunteerCOOrtlinatct 7B0 :'-;.'.''::;:' 180 SuMOtafSxJUies f150,653 �::l29;?60:. 59,000 569,133 i78,300 f<220 SO 520,200 RiNGE BEN EFITS @ 18.5'G 27.871 �.; ;';3,!C2: 7,665 12,901 3?B6 781 0 3,737 ONSULTANTS/CONTMCT STAFP: NutriUmist 8,000 3,000 5,000 RamzeyClirti<Physieans 13,300 /3,300 UniteOFamqyRaWttR�ysklans 17,000 77.000 9lling CansWia�S 2.500 2.500 s�ruofNCO,u�ma,ar 2a,eoo .� TAFF TRAYEL: 700 miles pe� monV� z ��'�:•. V 12 mmfis x t.5 siatt:.30 Aer mile 540 �; '%:�;s' . 222 LIENT TRPVEI: Bus passes @ 5480, plus cdG tare @ 5300 780 �' `:� 7LO�: LIETITEMEHCaFNCYEXPENSES 600 �; 600 U PPLY COSTS: LaD �ests & laC zupDties 6,500 6,500 Meeiml & e�wn room zupplies 3,000 3,000 ow C,eneral oMCe suppYes Z.g00 2 500 Pagers antl supDlles � a00 �:�}200: 200 qienfulCasOUnES - 78,000 18,000 SuDtolal5upp/y So,a00 ? RINTINGCOSTS: 1,200 ;� 1.200 LPMCTICEINSURMiCECOSTS � 1.300 i 1,300 nauncosrs: �o,oas :�:'>:3:4os[ , 7,065 NDIRECTCOSTSe�OMINOVERNFAD 15,793 '�:�({l.��' 9,693 5.000 TOTALPROJEC7EDCOSTS t274,002 :�'L,4Q:000:� f70,666 5712.434 i31,3T9 f6,007 f23,000 551,524 i � . �$ � � � j � � � � � � � � � � � � � � � � � q �=�-��Z � t947 Matarnal & Chtld Hoalih �ran! TOTAL ------"_-'-°'-----'---"--FUNDING SflURCES----"'--------°-----'---'- Ar,tt pRO.lECT <: 3RD GITYlCNiY MARCHO TOBE FTE SALARIES DEr�� BUDGET :�:tAC}i�::�� CISS PARTY GRANiS DIMES It�4KIND RAISED 6 800 0.50 Ro�eclCOOrO)Re�atalECUCatu,LlaCrd 13,618 .»a+000�� 8�8 , 6,809 0.50 OuCeafT Wttkef, L. LaGdY 13,618 '>{ t.00 OuveaCiWttker,T.Spinks 2a,512 ::�:57�511: 9,00a 2,OQ� 0.40 NurzeRactltlmeq56arDer �87�� 8'7?� 0.30 MeEital LaD Tetti. P.Ttwsn 6 91l 6.9t4 0.20 Medical AssistanC E.KOrtekaaz 5,65T 5,657 020 Reg�sterea Nurse, w.aerman 6,369 6,369 4.71� t,71a 0.30 RecepOwst, M.Stdz g,808 035 Clin�cASSlstant,L.FlSner 9,808 �5,555 ' 0.30 Cnrri<Precta,B.Tayla 15,555 f 0 <75 t 0,a75 O.aO StatlsMal(9uingSUperv�sion 9�Z8 0.50 Biling Speaalists, D.Lee 9<28 0 OB Assoaate Oireclor, R.MerBgan 3,352 3,352 5,028 5,028 0 15 SoGa� Worker 3,939 O.Od AheCicdl Qtectd, IX JMnsm 3.939 5,238 0.10 Ot(ce CarElnata, J.C�ilas 5.238 ::::;: :;i:;:; 81 T 0.03 VdvnleerCOOramalu 8 �� """' SuMOta/gaferles 5157.809 `'�:f?E,33f` 59,000 E7<.000 E19J70 Sd,800 EO E22,522 FRINGEBENEFITS@iB.Sx 29,795 ::':'.6,379'� 1,665 13,690 8.546 888 0 d,167 ONSUL7ANTS(CONTPACTSTAFF: � �� 5,100 NutritiMist 8,200 RamseyClimcPh}sidans 13,800 73,800 UniteC Famlly RaCllcs Pnys�darts 72.000 72,000 glhng Cmsultanis i.000 �,000 SuDtota/COnsuJta#s 35,000 � TAFF TRAVEL: 100 miles pet mmih x :�:�::; 12 m Mihs x 1.5 5tdi/ s.30 per mila 540 : LIE4TTRAVEt: Buspasses@Sa80,plus :�:�:�: tB0 o� tare @ 5200 )80 � �'� �?o?.� LIENT EMERGENCY E%PENSES 800 � :':''� � uPPLY COSTS: 6,BOa Ls� tes¢ S IaD supplies 6,800 8,200 Medwal 6 exam toom Supplies 3,200 Oeneral ornce supplies 2,600 :;<:;' 2.600 Pagers antl suppiles <00 �`• �!�?' Ci�ent ultra sauntls 20,000 20,000 guA'Ot.LSUppfy 33,000 � RINTIYO COSTS: 1,200 � 1.200 �p{�nCTICEINSUMNCECOSTS 7,500 �: 7,500 ApLITY COSTS: 10.450 :::�;:�,??Q�: 7 a50 NDIRELTCOSTS6ADMINOYEAM�D 16,653 � +��{:1b0�: 10,155 S,d00 TOTAL PROJECTED COSTS 5286.927 '''S,.dil�060:: 510,666 Si17.690 S32�S71 56,688 525,'100 f55.019 � 59 �� Subgrantee C- Model Cities Health Center, Inc. - Imnroved Pre2nancv Outcome Proeram Model Cities Health Center, Inc. is committed to improving the health and general well-being of underserved populations. For over tu�enty-eight yeazs, the health center has provided health and social services to indigenous community residents residing in the Summit- University and Thomas-Dale and neighborhoods of the inner city of St. Paul. Since 1986 Model Cities Health Center has provided perinatal services to high risk females, traditionally lacking access to primary medicai caze. Target Population - The intent is to reach women who aze not accessing services or need additional supports to insure pregnancy outcome either through clinical, educational, support, or outreach services. Strategy I: Case Finding and Community Outreach Objectives/Methods - Program Objectives: 1. By December 31, 1997, to collaborate with at least ten community organizations which provide community housing/shelter, education, family service, chemical dependency, and child caze services to high risk African American and Hmong female community residents. These community organizations include: Ramsey County Health & Human Services Department, Saint Paul Public Health, WIC Nutritional Supplement Program, area hospitals and managed caze entities, community clinics, and African American & Hmong community organizations in the service azea. � 2. By December 31, 1997, to identify and serve at least 10 percent additional underserved females within the service area and user population who are at high risk for preterm delivery or poor birth outcomes. 3. By December 31, 1997, to increase the overall rate of prenatals receiving prenatal care in the first trimester from 50 percent to 65 percent. These objectives remain consistent for teen prenatals. By December 31, 1997, to increase the rate of Hmong prenatals receiving prenatal care in the first trimester from 27 percent to 45 percent. Program Methods: A. Two Outreach Workers will assist in casefinding and community outreach/education activities. A.25 FTE Hmong Outreach/Interpreter will work directly with the Hmong community. An additional .25 FTE African American Outreach Worker will work with the African American community. The outreach workers will aid pregnant teens and single female heads of household in accessing prenatal caze by arranging for van transportation, bus tokens, or cab faze; and enrollment in. clinical care, education, and coordinating on-going staff support. 61 ��-�� B. Collaboration with public housing, churches, public health, hospitals, community ciinics, youth serving, and other African American organizations will occur by the African American Outreach Worker to reach high risk underserved women and teens, follow-up on women who have been lost in the system, and to assist in accessing clinicat and social support services at the Health Center. C. Collaboration with public housing, public heaith, hospitals, communiry clinics, youth serving and other Hmong community organizations will occur by the Hmong Outreach/Interpreter to promote first trimes£er entry for prenaYal care, ihe importance of immunizations, well child caze, family planning, and pazenting education. The Hmong Outreach/Interpreter will follow-up with women lost to follow-up and assist in accessing clinical and social support services at the Health Center. The Hmong Outreach/Interpreter will network with the Refugee Task Force, Hmong Women's Support Network, and Asian Battered women's task force. Ongoing advocacy and education will occur with Labor & Delivery at Saint Paul Ramsey Medical Center. D. Link with Model Cities Family Development Center for social services, mental health, stride, home-based chemical health treatment, family's first, and eazly childhood services. Strategy II. Clinical Interventions Program Objectives: 1. By December 31, 1497, to provide comprehensive prenatal clinical care and education to 200 women of childbearing age who aze considered high risk for social, economic, or health reasons. 2. By December 31, 1997, to increase from 31 percent to 45 percent the number of prenatal ciients receiving eight (8) appointments. Emphasis will be placed on beginning prenatal care in the first trimester and continuing care through family planning education foliowing labor and delivery. �� 3. By December 31, 1997, to provide English and Hmong speaking Lamaze Childbirth Education Classes or ongoing heaith education to at least 85 percent of prenatals on proper nutrition, effects of alcohol, tobacco, and other drug use during pregiancy, personal empowerment, expectations of labor and delivery, personal finances and education, and coping with increased family size and responsibilities. 4. By December 31, 1997, to ensure 85 percent compliance with immunizations, well child checks, and pazenting educafion for English and Hmong-speaking prenatals.in the health Program Methods A. Case management and tracking services will continue for 100 percent of Hmong and English speaking prenatals to ensure appointment compl'iance, positive birth outcomes, 62 ��-�� reduction of low and very low birth weight rates (LBW, VLB�, and reduction of infant mortality. B. Immunizations, EPSDT, and well child developmental checks will continue for 100 percent to be tracked and monitored by the Clinic Care Coordinator in a timely manner to ensure compliance among enrolled infants and children. C. Linkage with Model Cities Family Development (MCFDC) will be provided for social service assessments of all high risk prenatals, including social service representatives on site during prenatal care days. Need for crisis intervention services will also be accessed for high risk prenatals with unstable, abusive family pattems. D. Referrals to chemical health education programs and counseling services will be provided to all prenatals and to family members with chemical abuse concems to encourage chemical abstinence. Refenals for Rule 25 chemical heaith assessmentlevaluation, case-managed entrance for treatment services, enrollment in community aftercare programs, and provision of chemically fre� housing for receovering women and their children will also be provided. 1 E. English and Hmong-speaking Lamaze Childbirth Education Ciasses and ongoing health education will be provided to prenatals on proper nutrition, reductionielimination of alcohol, tobacco, and other drug use during pregnancy, expectations of labor and � delivery, personal financial and education planning, empowerment, and planning/managing increased family size and family responsibility. � F. Continued collaboration with a consortium of health caze services. � III. Reduce Barriers to Care Preventing High Risk Women from Receiving Ongoing Education and Prenatal Care Services � Program Objectives: � � � � 1. By December 31, 1997, to enhance access to care by providing transportation for prenatal caze, immunizations and well child appointments for females and their children. 2. By December 31, 1997, to offer continuous tracking and confirmation of prenatal caze in addition to immunizations, well child checks, and ongoing education by systematic scheduling and provision of home visits to high risk women to ensure medical compliance for females and their children. 3. By December 31, 1997, work ciosely with managed caze entities on culturally appropriate � services patient understanding of policies and procedures, and follow-up homevisits for lack of compliance issues. � � � 4. By December 31, 1997, to ensure enrollment of 100 percent eligible uninsured prenatals in RamseyCaze and 100 percent uninsured children in MinnesotaCare. 63 Program Methods: ��-qq� A. Transportation to all prenatal appointments and/or childbirth education activities will be provided to any female enrolled in clinical caze, Lamaze childbirth education sessions, or 1:1 patient nutrition, social services, or related services. B. Collaborafion with community organizations, associations, and neighborhood groups will be provided to emphasize eazly first trimester entrance to prenatal caze. When needed perinatal clients will have access of health center van or taxi services, and enrollment into RamseyCare and MinnesotaCaze managed caze programs. All needed enrollment information will be provided and advocacy is available if necessary. C. Pregnancy testing and education at the initial prenatal appointment will be provided in addition to scheduling a return prenatal visit within two weeks of pregnancy confirmation to ensure ongoing eazly prenatal caze. Prenatal education on alcohol, tobacco, and other drug use will be provided to all prenatals throughout their pregnancy by service providers. D. Social and crisis intervention services will be provided through Model Cities.Family Development Center (MCFDC) to provide food, clothing, and housing/furniture assistance to prenatals as welt as home visits by social workers. E. Hospital tours will be provided to community residents to dispel feazs of high medical technology and minimization of self control and direction in the medical delivery system. Evaluation - Quarterly perinatal audits will be performed by the Health Educator to assess case fmding efforts and compliance with prenatal caze/appoinhnent maintenance. Follow-up contracu (home visits, telephone, and written correspondence) will be tracked and monitored. Results will be presented to the Perinatal Case Management Team during bi-weekly meetings for review and suggestions for improved caze and additional community linkages. Quarterly chart reviews will be performed to monitor number of patient visits, entrance to caze, education visits, and outcome data. Perinatal patient satisfaction surveys will be completed annualIy to determine satisfaction with clinical and social services, to expIore unmet client needs, and to determine successful methods of case-finding. Perinatal statistics aze managed by the Health Educator. These statistics include monitoring of indicators known to be principal factors such as low birth weight and infant mortality rate. Fetai deaths, SAB, and low/very low birth weight aze also monitored on an ongoing basis. Perinatal health care status also includes compilation of patients receiving family planning education, and HIV/AIDS education, testing, and service coordination. Training/Exoerience - On going staff development including continuing education and attendance at local, regional, or national conferences is provided by the health center for providers, clinical, program, and support staff. Cultural sensitivity training is also ongoing for all perinatal staff. Ongoing enrollment of perinatal staff in local conferences and workshops targeting high risk clients, collaboration of health/sociaUcommunity services, and '�" � � � �� `"I�Z improved provider/patient relationships are encouraged. Monthly staff in-services aze conducted on a wide vaziety of health caze subjects including HIV prevention and transmission, safety standards, patient communication, and mental health of high risk families occur throughout the program year. See attachment of biographical sketches of key personnel. � Linkaees - Ongoing case management coordination, multi-disciplinary service delivery, expanded support and education services, and provision of transpor[ation aze key components of the proposed perinatal delivery system. � � !� � � � � � �� Modei Cities Family Development Center plays a significant role in supporting prenatal females, infants and children. Mental health and social support services aze provided to all women, children, and their families. A peer-based Women's Group also provides ongoing befriending and social support to women striving to develop their own social support networks. Reimbursement and Clinical Fees - Model Cities reimbuzsement and clinical fee system bills RamseyCare, UCare, MinnesotaCaze, and private insurance for the clinical costs of heaith care. Uninsured patients can apply for sliding fee, which can discount medical caze from 20 percent to 80 percent, depending upon family size and income. No one, however, is ever refused caze due to lack of financial support. In 1994, 84 percent of Model Cities prenatals were enrolled in Medical Assistance and 5 percent had insurance upon entry. Of the remaining 11 percent that were uninsured at the time of entry, all became eligible for MA after confirmation of pregnancy. Refenals to Ramsey County financial assistance are provided and advocates aze available if necessary. Women who do not have insurance or do not qualify for RamseyCare can receive help through the Perinatal Caze Initiative. The remainder of provider and staff salazies is covered by federal, state, county, and city grants. Budeet - A complete budget and justification for the Model Cities program follows. 65 A-6 BIOGR�PHICAL S��TCHES OF �EY PERSON\EL Ceceila Nemah, Health Educa[or q � -qQ� Ms. Nemah receivecl her professional nursin� diploma from F'uestone Health Services, Hospital School of Nursin� in I3arbel, Liberia West Africa in 1969. She was a junior sociology major at Booker Washington Institute from 1982 -1985 at the University of Liberia, in West Africa. From 1971 to 1990, Ms. Nemah worked with The Family Planning Associatioa of Lii�exia servia� as the National Program Coordinator from 1985 to 1990. Ms. Nemzh worked for four yeazs as a practical nurse and home health aid in Newazk, Newy Jersey and in St PauI, Minnestoa. Ms. Nemah joined the staff at Model Cities Health Center as Aeattfi Educator in May of 1994. She works closely with pe,•cinatal clients in case managemeut, assurina compliance, and family planniag post paRUm. Ms. Nemah is also the coordinator of the Supportive Cornpanion Program. Barbnra Leone, .t�LD., Family Praetice Physician Dr. Leone received Ler undergacluate education at the University of Minneso� (197?) wLere si�e greduated in the Lonors pm�dm, receiving a baccalaureate degrce in Antl�ropoloey. Ha undergraduate medical haining was at Hazvazd Medical Schaol whete she received ha M.D. in 1983. Dr. Leone completed her medical residency in family prac6ce at Bethesda Luthecan Medical Center, an affiliate of the University oF Minnesota in 1956. Since tfien, Dr. Leone has worked at Mode2 Cities Aealth Cznter in matemal and chiid health and was inshumental in implementing tl�e Perinatal Delivery System. Dr. Leone is a mzmber of the Minnesota Academy of Family Physicians in addition to the Minnesota Mzdicai Association and the Raa�sey Counry Madical Sociery. Dr. Leone is an active community member and serves on the Board of Directors of tfie New Beginnin, Center. She is a Junior Church Tzacfier at the River of Life Cluistian Center in SL Paul, In 1993, she traveled to China for an intemational confzrence on Women's Health and presented a paper on "Comprehensive Perincual C�e for an Underserved Population ° Dr. Leone serves as faculty � the Unitirrisry of�nnesora Medical School x�here she teaches a course in HIV/qIDS Deu Yang, Oulreaeh R'orker/In[erpreter his Yans szrves as tte health center s prenatal outreach worker for ail Hmons patients at tl�e health center. Ms. Yans has a I�TUrsing AssistanPs Cerrificate from the Minnesota Tachnical Institute and is working towazcLs becoming a licensed Practical Nurse. She has extensive Imowled�e and experience bridsing Hmon� traditional and American health caze practices. Ms. Yang frequenfly speaY,s on "Hmong Wan� Mzn�", Fresh Air Radio' weekly Hmong Information Pro�am, and is an active member of the Minnesota Refu�ee Task Force, Hmon� Women's SuppoR Nzhvork, Minnesota Department of Health's TB Tuk Force, and Minnesota Hepatiris B Coalition. Ms. Yane has made numerous presentations on culhttat diversity in the Twin Cities and has educated many health care professionals on Hmon� eulmre and appropriate use of interpreters. Janet S. Howard, Director of Pragram SuppoK Services Ms. Howazd receivzd her undcrsraduate de`*ree in Social Work from the University of North Dakota in Grand Forks in 197,�. After workin� in county and state medicaf social services in North DaF:ota for thrrz and a half years she moved to Minnesota. ,4is. Howard worked at Settremi Health Center in Northeast hlinnrapolis coordinating heatth edacation prosracns and later as its' Director from 1977-1983. For a brief time, she served as a Resource Development Consultant for the St. Paul Runxy - Rrtired Senior Volunteer Pro�ani. For four yeus, she was Executi��e Director of ACT, a statewide salf advocacy organi7ation for the developmzntally disabled. Iater she worked for thz Minnzapolis Public Housing Autbority as a social worker ui rcntal administration. Ms. Howazd has been an advisor, consuttant, boazd membzr to a number of Twin City based non-proht and public or:anizations. In 1989, she participated in tLe LeadeisLip and Public Policy Seminar at tht Huhzit H. Humphrey Institute of Piiblic Affaus ai tha Univarsity of Minnesota. Ms. Howazd joined the staff of Model Cities H�ih Center ia April of 1992 as Program Manaser. Ms. Howard has szrved as a committee member of Project LID, and infant mortaliry study � oup in Minnzapolis and St. Paul. 56e is a mamber of Alwsa Intarnational of St. Paul, a biisiness aud prof�.ssionat women's sv�vice organization. Robbie Col[ins, Ajrican American Outreach �3'orker �is. Coilins has a ten-year commitment to workin� with tv�h risk youth, Ix�inning with her leadarship at the Martin Luther Kin_� Center in 1973 as a teacher's aide for cumculuu✓activities. She has been with Model Ciaes clients for five years, most recentty in the role of an outreach worker for the hzalth and family development center. Ms. Collins worl:s closeIy with hi h risk African Amzricxn families, with womtn in :tn odgoin__ peer-6ased Wvme�t's Group, lxfriends and svpports prenatals in Supporti�r Canpania�t Servrres, aad is a Iongstandine memlxr and contriUutor to River oF Lik Christian Centzr. � � Page eight ��-�� VII-A. Improved Pregnancy Outcome PROGRAM BUDGET, 1996-1997 � The two-yeu project budget totals �84 $40,000 of which is being requested in MCH funding and and the remaining $44,304 ro be covered by Model Cides Health Cen[er (MCHC). � A. LINE ITEM DETAIL: YEAR 1 YEAR II YRS I& II YR I YR II 2-YR � d1�11 d�.F1� T.S2.Tdl� b1�F1 M�11� T�LTgZ� ToTA7 PERSONNEL: Hmong Outreach Worker 5,496 - � (..25 FTE) - African American Outreach 5,496 Worker (.25 FT'E) Family Practice Physician (.10 FTE) 6,800 � Nurse Practitioner (.10 FTE) 4-200 Dir. of Programs (.08 FI'E) 2,626 Nuhi6onist (.OS FTE) ---- 1,950 MCFDC Social Workers - 3,0?A 1 (.10 FTE) SUBTOTAL: 16 , 614 15,974 � FRINGE BENEFITS/ 2,996 3,514 FICA: (22 percen[) 6. SUPPLIES: � Clinical Medical -0- -4 Pharmacy -0- -0. Laboratory -0- -4 � Office 100 50 Records/Tncldng -0- -0- SUBTOTAL: 100 50 � 6. OTHER OPERATING EXPENSES: Patient Transportation 500 450 Patien[Educadon 43 100 � Printing 200 -Q Postage -0- 50 Mileage (local travel) 500 -0- Telephones & Beepers 225 -0- � SUBTOTAL: 1,568 600 TOTAL DIRECT COSTS: 18,182 20,138 � INDIRECT COSTS 1,818 2,013 @ 10 percent): � TOTAL PROJECT COSTS: $20,000 22,151 � � � 5,496 5,496 5,496 5,496 6,800 4,200 2,626 2,626 1,950 - 3,024 - 29,592 16,614 6,510 2,996 -0- -0- -0- 150 -0- 150 � -4 -0- 100 � 100 - 5,496 - 5,496 6,800 6,800 4,200 4,200 2,626 1,950 1,950 3,024 3,0?A 15,974 29,592 3,514 6,510 -0- -0- -0- 50 -0- 50 950 500 450 143 43 100 200 200 -0- so -a so 500 500 -0- 225 225 -4- 2,068 1,568 600 38,320 18,182 20,138 3,832 1,818 2,013 42,151 20,000 22,151 67 -0- -0- -0- 150 -0- 150 950 143 200 so 500 225 2,068 38,320 10,992 10,992 13,600 8,400 5,252 3,900 6,048 59,184 13,020 -0- -0- -0- 300 -0- 300 1,900 286 400 100 1000 450 4,136 76,640 3,832 7,664 42,152 84,304 � Subgrantee D- American Indian Health Clinic - Healthv Babies Project 1 � � �� The project will build upon prenatal caze provided at the American Indian Health Clinic by coordinating sociai work and community support services provided by clinic staff with the addition of community health nursing services to provide case management, pazenting education, and in-home nursing services. The project will serve 75 prenatal women per year, for each of two yeazs. Tareet Population - American Indian population and other low-income, underserved, high � risk pregnant women in the community of Dayton's Bluff and the Saint Paul lower eastside, many who are under 20 yeazs of age. Objectives - 1. Provide 172 home nursing visits to perinatal patients by the end of each project yeaz. 2. Provide 297 individual hours of parenting education to prenatal patients by the end of each project period. 3. Decrease the average Prenatal Risk Assessment risk factor score for high risk pregnancy between the initial visit and the 28 week visit. Methods - • A community heaith nurse will provide case management and coordination of inedical, nursing, and social work services to high risk prenatal patients and home nursing caze and education to overcome the barriers to a healthy pregnancy among the prenatal patient population. • Staff will also provide parenting and outreach to increase the information, knowledge, and availability of prenatal care to the tazget population and community. • Supportive prenatal caze services will be coordinated with the physician or nurse-midwife responsible for each prenatal patient's care. • The clinic computerized practice management system will be used to track and follow-up referrals and services on a routine basis, as well as document services provided. • Referrals for outside services such as chemical dependency treatment, housing, clothing and food will be made to coliaborating agencies. � Evaluation - Success will be measured by patient satisfaction surveys, quality assurance � committee meetings and monthly and annual compazisons of actuai services to objectives. The results aze used to improve services. The results of the last survey in the spring of 1995 � � .• � 5 - q�2 indicated that overall the patients gave the Clinic staff and services a grade of "very good". The Clinic Quality Assurance Committee meets monthly to review the quality of the Clinic services and make recommendations on improving quality. The Clinic also participates in reviews and evaluations with Medica and HealttiPartners as a part of their annual credentialing and evaluation review for network participation. Actual performance in terms of patient visits is compazed against the annual CIinic objecflves on a monthly basis. The quality assurance committee is beginning development of outcome indicators for various clinical services. Trainin¢/Experience - Nurse Midwife (Pam Glenn, C.N.M.): M.S.N: Midwifery, 1986. Certified Nurse Midwife since 1986. Nurse midwife at the American Indian Heaith Clinic since 1990. Call coverage at Saint Paul-Ramsey Medical Center for community nurse- midwife clinical sites. Family Practice Pfiysician (John Foxen, M.D.): Boazd Certified in FamiIy Practice since 1976. Medical Director and full-time family pracrice physician at the American Indian Health Clinic beginning April, 1995. Practice includes uncomplicated obstetrics. Community Health Nurse (C. Van Hecke, RN.): Currently pursuing B.SN. Native American registered nurse with in-home nursing experience and infant care training. Presently provides limited in-home nursing and.education services to perinatal patients upon midwife referral. Social Worker (Barbara Briseno, B.A.): Native American social worker at the American Indian Health Clinic since 1992 providing social support counseling, in-home services, and social service. Community Support Counselor (Deb Puryeaz, B.A.): Completing M.A. in counseling. Previous counseling and assistance with social and community support and assistance programs, eligibility, and advocacy. „ Linkaees - The American Indian Aealth Clinic has agreements with the Saint Paul-Ramsey Midwife and Obstetrics program to provide onsite prenatal caze at the American Indian Health Clinic and to provide deliveries at Saint Paul-Ramsey Medical Center. The Clinic also has an agreement with Bethesda Family Physicians to provide deliveries at Saint Joseph's Hospital. Clinic staff works cooperatively with Ramsey County Public Health Nursing to coordinate public health nursing home visits to perinatal patients and to provide ongoing prenatal classes at the Clinic. The Clinic routinely refers perinatal ciients to the Saint Paul WIC program, Juel Fairbanks Chemical Dependency program, and other social service agencies, as appropriate. Clients receive services from the Clinic social worker, community support counselor, and psychologists, as needed. The Cl'uuc is a member of the East Metro Community Health Network and the East Side Health Coalition, developing and coordinating services with other community clinics and Saint Paul Eastside health and human services organizaYions. The Clinic has procedures for refenals and follow-up for services not directly provided onsite, provides transportation to the referral agency if necessary, and foliow-up when 70 � appropriate. For prenatal caze, copies of the medical record and progress notes are routinely � sent one month prior to the delivering midwife or physician. �'�, J �J 7�` � Reimbursement and Fees - Fees will be charged for reimbursable services under Minnesota Health Caze Programs. Ali clients without health coverage will be chazged on a sliding payment scale based on the federal poverty guidelines (see attachments). Revenue collected � from health caze programs will be used to further the goals of the project, specifically to increase the number of hours per week the staff are available to provide maternal and child health services. � Bu_ deet - A budget and justification for the American Indian Health Clinic budget follows. I�� C_J � 71 ��-q�2 7. Budget 1996 Grant Request Inkind Total Personnel: Community Health Nurse S 8,065 S 2,495 SIq5� (532,000/yearX 33%) Benefits: Benefits @ 24% of salary $ 1,935 S 599 S 2,5# ($10,560X 24%) Mileaae: 100 miles/week X 52 weeks X 5.25/mile S 1,300 S 1,3�U Total: 510,000 S 4,394 514,�1 A total of 469 units of service will be provided by project staff during the 1996 project year. ,, American In ian Hea th linic Healthy Babies Project 72 Budget 1997 ��-��Z Grant Request Inkind Total Personnel: Community Health Nurse S 8,065 S 2,495 51Q5BJ (532,000/year X 33%) Benefits: Benefits @ 24% of salary S 1,935 S 599 S 2,a# fS10,560X 24%) Mileaae: 100 mileslweek X 52 weeks X 5.25/mile 5 1,300 S 1,3�0 Total: 510,000 S 4,394 514,� A total of 469 units of service will be provided by project staff during the 1997 project year. � American In ian Hea th linic Healthy abies ro�ect 1 73 � � � � ��-�� ADOLESCENT HEALTH PROGRAM � � � � � � � � � � � � � � �� ADOLESCENT HEALTH PROGRAM �;�I��L Health Start, Inc., as a Pre-Block grant ptovider, continues to receive Maternal and Child Health Special Project Grant funding for adolescent health services, and has prepared the following assessment of adolescent health in St. Paul. Problem Statement - Adolescents have a wide vaziety of needs specific to their age group. � While they are still in the process of development, many adolescents exhibit health problems that are closely associated with social factors including poor decision making and � conflict-resolution skills, low self-esteem, isolation and alienation from others, and lack of basic knowledge about their own health. It is well documented that adolescence is a time of risk-taking and is often mazked by an inability to obtain access to traditional health care � delivery systems. This is corroborated by the reseazch done by the University of Minnesota Adolescent Health Program which surveyed the physical and emotional health status and needs of over 35,000 Minnesota teens. Because of this, adolescents require services tailored to meet their specific needs. The services must be accessible, acceptable and available in order to be effective. For these reasons, Health Start provide comprehensive adolescent health services within the school setting at six public high schools in St. Paul: Hazding, Como Park, Central, Johnson and Humboldt Junior/Senior High. In addition to these five clinics, Health Start provides prenatal and family planning services for pregnant and pazenting teens at AGAPE Alternative School and counseling and support services for high-risk youth at the remaining mainstream public high school (Highland Park). During CY 1994 school yeaz, students again demonstrated theu need for clinic services by using current services extensively. A total of 2,911 students made 12,933 visits, generating over 20,000 encounters with staff. For many students, the Health Start school-based clinics are their only source of health caze. For many others, the school based clinics are the important link that enables them to obtain access to other existing community health care resources. Data from 1994 school yeaz revealed that of studenYs families, 28% had medical assistance, 25% had private insurance, 43% had no 3rd party source of pay, and 4% had MinnesotaCare. Goal - The goal of the Adolescent Health Program is to promote a positive health status and reduce the incidence of unplanned pregnancy, nutrition problems, depression, chemical abuse and family and relationship problems among adolescents in St. Paul by providing comprehensive health care services at six sites and prenatal and family planning services at one alternative school site within the City. � Tar�et Population - The clients targeted to be served by the Health Start Adolescent Health Program are adolescents living in the City of St. Paul. The following demographic data describes this population: � �J � Minority Groups - 58% Grade in School - 23°/a Grade 12 75 24% Crrade i l 25% Grade 10 19% Grade 9 9% Junioz High & other Gender - q5 -q�Z � 67% Female 33% Male Objectives - The following objectives have been established for the Adolescent Health Program in order to achieve the goal: 1. 2,800 junior and senior high students wili make visits to the school-based clinics each year in CY 1996 and 1997. 2. Physical examinations, health assessments and screening, and reproductive health services will be provided in 8,000 student visits each year in 1996 and 1997. 3. Psychosocial evaluation and diagnostic assessments and ongoing counseling will be provided for 1,100 adolescents at risk for depression, chemical misuse, pregnancy, relationship problems, school problems, and/or physical, sexual or emotional abuse each yeaz in 1496 and 1997. 4. Decision making counseling and family planning services will be provided for 1,000 adolescents each yeaz in 1996 and 1997. 5. The number of males using family planning services in the six high school clinics will be increased by 5% by December 31, 1997. 6. Nutrition education and counseling will be provided for 1200 adolescents each yeaz in 1996 and 1997. 7. The incidence of preterm births and low-birthweight infants born to adolescents followed through the high school clinics will be no greater than ten percent and seven percent respectively by the end of CY 1997. Methods - • Comprehensive services that aze accessible and acceptable to high school age adolescents will be provided in clinics physically located within the schoal building of at least six St. Paul schools: Johnson, Hazding, Central, Como Pazk High School, Highland Junior/Senior High School and Humboldt 7unior/Senior High School. In addition, prenatal and family planning services for pregnant and pazenting teens will be provided at AGAPE Altemative School. During the covrse of tteis grant, additional clinics will be added. • Clinics will be open daily during school hours, and for at least on half hour before school opens and one half hour after school closes. � � 76 � � � � � �� • Interdisciplinary health caze services will be provided to adolescents enrolled in the high schools. These services are offered to address the diverse health needs of students. • Students registering for clinic services will be asked to complete a history form that details medicai and family history, behaviors and feelings. T'his form will provide staff with background data necessary for providing good caze and for triaging clients to appropriate staff. • Physical examinations, health screening and assessment, diagnosis and treatment of acute and minor illness, and simple laboratory tests will be provided on site by a nurse practitioner, family physician and/or pediatrician. • Nutrition education and counseling, including identification and counseling of students � with weight control issues, eating disorders, athletic and general nutrition needs will be provided by a Health Start nutritionist. � � � • Psychosocial assessment and ongoing counseling about relationship and family issues, physical, sexual, and emotional abuse issues, pregnancy, chemical use, depression, eating disorders, school problems and financial and housing problems will be provided by the clinic social worker. • Decision-making counseling and family planning education and counseling will be provided to adolescents requesting these services by a Health Start health educator. � • Reproductive health services of family planning counseling, examinations and prescriptions, testing and treatment of sexually transmitted diseases and pregnancy testing and counseling will be provided in clinic by the nurse practitioner. �' � LJ �J , � � � �� • Prenatal caze will be provided in each clinic by a certified nurse midwife, or family physician for those students choosing to deliver through the Health Start program. • Health Start staff will provide risk assessment and prevention education for all STDs, �� including AIDS. • Extensive health education activities such as prenatal and parenting classes, weight control classes, and human sexuality programs will be offered in order to maximize the understanding and practice of positive heaith behaviors. • Individuai and group education will be provided in clinic and in selected classrooms by all members of the interdisciplinary team. • Health educators will provide education and consultation services in human sexuality for junior and senior high adolescents in St. Paul Public Schools. • Health Start staff will work with school personnel to offer education, counseling and referral in the azea of chemical dependency. • Education programs for groups of adolescents with special needs will be developed and 77 ��J implemented as needed (i.e. leaming disabled, English as a second language, adjudicated youth). • Health Start staff will serve as resources to teachers and youth workers in the development of educational programs for adolescents and will offer iraining to other professionals in the areas of matemal and child health adolescent health caze, and human sexuality education. • Pazents will be involved in the program's adolescent services through telephone contacts, community meetings and other outreach activities. • Clients will be referred to other sources of caze as needed in order to ensure continuity of caze for adolescents and to maintain coordination and integration with other existing health, social service and educational programs for adolescents. • Students wiil be invited to participate in patient satisfaction surveys. • Staff will work with Saint Paul Public Schools in terms of provision of a broader array of school health services as appropriate. • Health Start will work collaboratively with the health plans serving Saint Paul students to maximize reimbursements for services and communicate/refer students into appropriate sources of caze. Training & Experience- Heaith Start has provided maternal and child health services in Saint Paul since 1967. All Health Start staff are professionai health care personnel with special expertise in maternal and child health. The majority have had more than five yeazs experience. Ali staff are evaluated at least once a yeaz. Staff are supervised by the executive director, associate director, medical director, associate medical director, and team leaders. Donna Zimmerman is executive director of Health Start and is responsible for the overall management and direction of the project, as welI as extemal relations and long-range plauning. Dr. Chris Reif, a member of the Family Medicine Department at Saint Paul-Racnsey Medical Center, is the medical director and responsible for overall medical direction. Dr. Carol Ball, on the staff of the Obstetrics and Gynecology Departrnent at Saint Paul-Ramsey Medical Center, is the associate medical director and works with the medical director to provide consultation on OB/GYN practices, as weli as providing clinical supervision for OB/GI'N nurse practitioner staff. Staff continue to update their knowledge and skills by attending relevant workshops and conferences. Linkaees - Health Start has well-developed linkages that include a wide variety of health caze providers, educational pzograms, and social service agencies. Referrals aze made by Health Start staff to other programs and aze made by other agencies to Health Start. This referral network allows staff to individualize caze plans to meet the specific needs of each client. New linkages and refenal sources aze identified or developed as needs azise. � �� "�, _ �+�' � Health Start works collaboratively with Ramsey County Public Health nurses to extend services to pregnant women in the community. Public health nurses meet regulazly with Health Start to identify clients needing home-based services and to shaze information that will enhance patient caze. At delivery, new patents aze refened to Health Start's pediatric clinic. Well-child and acute caze visits, augmented by interdisciplinary services, are provided. Eligible clients aze also referred to the Befriender Program, run in coilaboration with Children's Home Society, the Partnership Program, a collaboration with Saint Paul School's Early Childhood and Family Education (ECFE), or the CARES Project, also tun collaboratively with ECFE. These programs all provide intensive counseling, support, and/or group education for high risk pazents. When psychosocial or heaith caze needs aze identified that cannot be met by Health Start (e.g., general medical care or adoption counseling), written referrals will be made to community clinics or other resources within a convenient geographic azea. Health Start is committed to extending services to the community and minimizing duplication by collaborating wiih many agencies and programs. Health Start will maintain affiliations with and/or refer to the following agencies and task forces: • Chiid Abuse Prevention Task Force • Children's Home Society of Minnesota • Eazly Childhood and Family Education (ECFE) • East Metro Community Clinic Network/Community Clinic Consortium • Frogtown Family Resource Center • Ramsey Clinic Associates • Ramsey County Human Services • Ramsey County Public Health Department • Ramsey County Maternal Child Project • Rondo Family Resource Center • SAFPLAN • Saint Paul Public Health �� • Saint Paul Public Schools • Saint Paul - Ramsey Medical Center/Health Partners • Task Force on Health Caze for Homeless Adolescents • WIC Food Supplement Program Reimbursement and Fees - Health Start provides prenatal and adolescent health services at no charge or on a sliding fee scale to its patients. Clients aze billed, however, by Saint Paul- Ramsey Medical Center and Ramsey Clinic for hospital chazges such as labor and delivery and selected tests and procedures. MCH fixnding allows Health Start to provide prenatal caze for clients who have no third party source of payment. For Health Start clients eligible for medical assistance, staff will assist them with the application process. Health Start has contracts with all of the PMAP providers. Any other applicable third parties aze billed whenever possible. 79 � , � f: �, Health Start provides family planning care to clients for 24 months after delivery. If a client has no third party payor, a sliding fee scale is used to deternune her fee for family planning services. Funds wili be requested from the State of Minnesota Family Pianning Special Projects to continue the provision of fanuly planning services in the next biennium. Sub¢rants/Subcontracts - Health Start subcontracts for the provision of physician and certified nurse-midwife services with the following groups: Ramsey Clinic Associates, West Side Community Health Center and the University of Minnesota. The Health Start Medical Director and Associate Medical Director aze responsible for supervision, protocols, and general medical direction for all medical personnel involved in the prenatal/postpartum and adolescent health programs Budget Justification - Health Start, Inc. will receive $508,245 in 1996 and 523,873 in 1997 to support the Adolescent Health Program. through school based clinics. The total budget and jusflfication for the budget fotlows. MonitoringlEvaluation of Subgrantees - To ensure that every effort is made to achieve the proposed goals and objectives, Health Start's efforts and performance will be monitored on a regulaz basis throughout the contract period. A contract will be written between Saint Paul Public Health and Health Start indicating specific performance objectives and outcome indicators. The contract will oudine Health Start's duties, reporting requirements, the monitoring expected/performed by Saint Paul Public Health and evaluation indicators. Health Start will also be required to provide an annual performance report evaluating their own program and assessing progress towazd goals and objectives. Both subjective and objective tools will be used by Health Start to ensuze that virivally every aspect of their program is reviewed. � Program Evaluation - Health Start uses an IBM compatible personal computer to enter and maintain its data set. Health Start's management information system enables Health Start to track patients on an individual basis as well as maintain data on various client goups. Via the daily encounter form, information will be recorded at every patient visit about reasoxis for visit, the type(s} of services provided, and health caze provider(s) working with the patient including: • number of clients served • age of clients • race and ethnicity of clients • number of physical exams and health assessments performed • number of group education/counseling sessions held, and number of persons served • number of psychosocial evaluations/diagnostic assessments performed • number of counseling visits Data will be analyzed on a quarterly basis. Trends will be noted and necessary program � IJ �� I modifications will be made. Each quarter, a report will be submitted that describes the following: • Number of new high risk, low income pregnant women served. , • Number of clients served in the school-based clinic program. • Demographics of Heaith Start clients (age, race, residency). • Interdisciplinary services by component. � • Birth outcomes. • Clients wili be assessed for satisfaction with Health Start services. � , � , , !J L � , � � � � G � � �� : , �� ««« �� I �� a � � c � < � � r v ! ` N � e � S �+ � 1 � �� i a � �• �� i � �� s� �� a� ��._� � �s� � �� - �� g � y i A '�� m * �s � r � r z � �� ; . � � W ; r N � � W � � _ Y O� � 9 � C C V N T 9 u v Q� = 3j .° � i I O ��. O ST �a c3 9 Q ; o �� o:,s= s a000�i� � o= _ '� m ��:�� ' �� a:�� ,�� ._ � m �� i � � _ �_ � � � � � 3 r w � y � Z = � w � _ � � �{ �, �, x N � nl H � � � o ° r m� � � � w A � r x H r A � � .{{�� H � � � in o z O � � n L O � � w "{ G � w c w C z & v � � _ m X .� �m Q �= Z � s �3 v < s� �� o • � �o ; � m � � � m � � � � o z I ,..� H � I .__�._�--- '-' � m � •• w - t p� r P O � � � v • o � �bb o �, r t� "� � x � m � C a H 3 ' e ' HEALTH START, INC. I�iATEFtNALAND CHfLD IiEALTH ADOLESCENT HE,4LTH SERVICES SCHOOL BASED CLINICS JAtVUARYTNROUGH DECEMBER i396 a��° �� AkNUAL PROGP.AM PROGRAM Mpi � LINE ITEM EXPENSE sauv3v � auDCEr ewcEr M1RSE PHt��Cif(IONER (CEtJfRAL) � MIRSEPRACiR10NER(COMO) M1RSE PRACTTTONER (F�0.JMBOtD� NURSE PRACiff10NER (JOh7JS0t� , NURSE PR4CTR10NEIi (HARDUJGI MXiSE PFiAGTRIONER (AGAAEj soaa� wowc� (cErrrw.�� socu,� wo��rz (caao) , SOqAL WORKER (HUMBOLD'n soaa� WoaKEa (�oFwson� CASE MANAGER (RGhPE) , MEDICAL ASSISTANi (CQJTRAL) MEDICAL ASSISTRKi (COMO) AAEDIC4L {tSSISTfWT (HUMBOLDT) � MEDICAL ASSISTANT (JOtiNSOt� MF�H'.AL ASSiSTANi (tiARDWG) MEDICAL ASSIS'fAN'f (AGAPE) � NlliRfTlONIST (CENTRAL) Nurwnor�usT (coMO) NUiRITiONIST (IiUF✓BOLD"I� � NUTRffIONIST(JOHNSONJ NUTWT70NIST (I�AP.DMG) MIIfRfTIOt�NST (AGAPE) HEALTH mUG4TOR (CEt�fiRAl) � rsEa�niEOUCa7or;�coMO� r�u7rt mucnTOa �HVtiseow� IiEALTH EDUf'ATOR (JOIiNSONj , HEALTH mUCATOR (HAPAING) I-IEPITH EDVCATOR (AGAPE) �arrn� owECTOFt ' � � � � � SUB-TOTAL SALARY FRINGE BENEFITS � ZO% 535.742 543.826 535.742 $35.742 541.078 �;i5.742 535,303 536.668 �35,325 $26,040 53D.897 �14.280 $15.960 516,A39 577,546 $21.020 $15,950 $37.804 535,257 537,751 $37.804 535251 S31,804 5L5.751 �37 211 $29.324 �29.324 �29.499 529.32A 543.269 CONTRACT SERVICE FAMILY PRACTICE PHYSICIAN/NURSE MIDWIFE E�GHT PHYSICIAN CLINICS7�NK � 5280 X 34 WKS TNO CNM CLINICSI�A/K �a $135lCLINICX34 WKS PEDIATRIC NURSE ASSOCiATE (JOHNSON) FACE TO FACE SOC(AL WORKER {HARDING} 529298 PATIENT CARE LAB. ULTRASOUND. X-RAY COURIER SERVICE 0.8 0.8 0.7 0.5 0.7 02 0.3 0.3 0.4 0.5 0,6 1.0 0.9 0.75 0.9 1.0 0.1 0.15 0.15 0.7 5 0.15 0.15 0.05 0.1 0.1 0.1 0.1 o.� 0.05 0.1 528.594 535.061 525.019 $77.871 528.754 $7.5 48 S� 0.771 571.000 574.730 S13,020 518,538 $14280 514.364 512.329 Si $.791 $21,020 51,596 54.771 S5,288 ss.sss 54.771 55.288 $1.590 S2.575 S3.121 52.392 52.992 sz.sw 57.436 $4,927 528.594 535.061 525,013 517.877 $28.754 $0 510.777 511.000 �i 4.130 513,020 50 $14280 514.364 572.329 515.791 �21.020 $0 S4.771 55.288 S5.663 $4.771 55.288 50 52.575 53.121 $2.992 52.892 s2.sso � $4.927 $337,772 5307.343 567.542 561.469 576.160 560,928 59.180 $A.SSO 54.847 54.847 529298 528.298 �27.630 516223 517.562 58731 83 � ��-��. RNNUAL PROGRAM PROGRAM MQi UNE ITEM DSPENSE SatnaY FrE euDCEf BUDGET OTHER EXPENSE MEDICATION/DRUGS MEDICAL SUPPLJES OFFICE SUPPLIES PRINTING/DUPL ICA7�NG PATIENT TRANSPORTATION TOTAL DIRECT EXPENSE INDIRECT EXPENSE a� 16% TOTAL PROGRAM EXPENSE eASFn ora �ssa awrr TOTAL MQi GRANf REQUEST TOTAL MEDICAL AS515TANCE MATCH TOTAL MATQ-f OTFiER SOURCES TOTAL AS,4TCi-1 HIGFiLfWa NiG1i SCNOOL BASED CiJNIC FlJNtJEQ 8Y SEAERATE GWiKf 511,670 54.668 s�z.000 ss.000 510.0� 52.500 52.5W $0 52.000 S1.600 5602.100 5508245 596.336 50 �698.436 5508245 5508.245 ,, �� r�� / IiJ � , C� LJ , � ' , , ' � � � a , � � � i HEALTH START. INC. MATERNALAhiD CHILD HEALTH ADOLESCENT HEALTH SERVICES SCHOOL BASED CL1NlCS J;,NUARY 7}iROUGfi DECEMBER, 1997 Q�` �� ANNUAL PROGRNA PqOGqqM {,�Q.{ LINE ITEM EXPENSE savwr � auocEr eu�cEr tJiIRSE PRACTTfx11.�R (CEN7F;pL) t�uRSE aRa.crma.�R (coµoj NVRSE PRACiffONFA (HUMBOLpT) M1R..E PRACiTTIONER (JOFNISOi� NURSE PR4CiRlUtdaQ� (F'IPRDWG) M7FGE PRACiST10NER (AGAPE) soaa� woa�cFn �cexrwa� sOGAL WORKER (CDA40) socw. wowcEa �an.�o�n soara wovx�n �.�orwsor� CASE MPNAGEP, (AGAPE) MEDtC1J. ASSSTMfT (CENTRqL) MEDICAL ASSISTANT (COMOJ MEDICAL ASSISTAM (HVMBOLDTj MEDICRL ASSISTPNT (JOFRJSOl� MEDICALASStSTPNT (i'JWpiNG) MFDICAL ASSISTAN'f (AGApE) NUTRff10NtSi (CEMfiA1j NUTPITIONtST (COMOJ NUTWTIOMS7 (HUMBOLD� rnnwnonnsr (.mr-wsor.� MfiRtT10NIST (FNRDNVG) NUTPJTIOMST (AGAPE) r�a�rtt EoucaTOa �ca r�xn-i eoucaTaz �cor,�o) �uni eou�TOa Mur,�so�o� FiEAL7H EDUCA70R (JOFCJSON) IgJ+LTH EDUG470R (HAP,DINGJ 1 EDVCATOF (AGAPE) D�CUTNE DIRECfOR 535.814 545.141 Si6.814 53b.814 542,3�0 Si6,814 536.980 537.768 536,385 526.82i 531.824 $14.768 $16.439 576.332 518.072 521,651 516.439 532.758 536.3D9 538.884 532.758 536,303 532.758 526.524 532.147 530.822 530.822 :;i0.384 530.822 S50.747 0.8 0.8 0.7 0.5 0.7 0.2 0.3 0.3 0.4 0.5 o.s 1.0 0.9 0.75 0.9 1.0 0.1 0.15 0.15 0.15 0.15 0.1 S 0.05 O.i 0.1 0.1 0.1 0.1 0.05 0.1 529.451 Si6.113 525.770 S18.407 523.617 S7.363 571,094 317.330 514.554 S13,411 s�s.osc St 4.708 S14,795 57 2.694 516.265 S21.655 51.644 54.914 55,446 �5.833 54.914 55,446 S1,638 S2.652 33.215 53.082 53.082 53.038 5i.54i 55.075 524.455 536.113 S25.770 558.407 529.617 50 511.094 S71.330 S14,554 S13.411 SO 514.708 S14,735 S12.689 S76.265 S25.651 SO 54.914 S5.446 55.833 54.914 55.446 50 52.652 53215 53,082 53.082 S3.038 50 $5.075 SUB-T07AL SALARY FRINGE BENEFITS Qa 20% CON7RACT SERVICE FAMILY PRACTICE PHYSICIAN/NURSE MIDWIFE EIGH7 PHYSIGAN CLINI(�S/1NK Qa 5230 X 34 WKS TNOCNMCLINICSANK o�5140/CLINICX34WK5 PEDIATRIC NURSE ASSOGYATE (JOHNSON) FACE TO FACE SOCIAI WORKER (HARDItSG) 530,177 PATIENT CARE LAB, ULTRASOUND, X-RAY COURtER SERVICE ' � 5,?47.843 5316.563 569,563 563,313 578.880 363.104 59.520 �4.760 54.492 54.392 sao.i77 sso.m 522,279 516,709 S58.088 58.044 85 � ��- � a � a a W a W � � � n Z W a x w 1 W (9 C _ m U W � � a J Q � U W 0 . � N � � G w � w � � � � 2 _ � � � .� _ � � � � � � � �� o `- �, -, �- v � � � � 2 � fr � • � _ � (�� a W � 4 . � �� a �� x ��]00�0 = V ��.`n —% � � � . � �� o ��i� � �� ;� E_�� II�� &�� =R� �� > ( � d > � I, �� M �� { Z � � ,,. P� .�J � � � � q�--c�� ANNUAL PF?OGRAAt PROGFlAM MQi LINE ITEM EXPENSE SuAHY FfE euocEr BUDGET OTHER EXPENSE MEDICATION/DRUGS MEDICAL SUPPL(ES OFFICE SUPPLIES PRINTI NG/DUPLICATING PATIENT TRANSPORTATION TOTAL DIRECT EXPENSE INDIRECT EXPENSE a� T6% TOTAL PROGHAM EXPENSE BASED ON 1959 AVDR TOTAI MCH GRANT REQVEST TOTAL ME�IG4L ASSISTANt� MHTCN TOTAL MATCti 07HER SOURCES TOTAL MATCN FHGHLAND SU-tOOL BASEO CllNIC FUNOED BY SEPERATE GRAMT 512.020 54.808 $12.360 ' S6J80 $10.300 52.575 52.575 50 52.060 $1.648 S620.663 �y523.873 539.306 50 $719.969 5523.873 $523.873 e $'f 00.000 $35.000 5135.000 peqe: � L 1 1 �� t Q�-��L � BUDGET DETAIL AND EXPENDITURE FORMS 1 � � 1 E� � 1 � � 1 1 �2 ��-�� BUDGET NSTIFTCATION Budget justification for each of the subgrantees is included within their budgeu previously presented in the narrative. In addition to the funds proposed for aliocation to the subgrantees for improved pregnancy outcomes and adolescent health programs, a portion of the maternal and Child Health Special Projecu Grant is budgeted to remain at Saint Paul Public Health for Adminisuative Costs. 1996 Sala , /r�Frin�e: 14.5% Carolyn Weber, Adminisuative Assistant $68,390 $ 9,916 10% Kathy Mohrland, Accounting Tech IV at $66,109 3.5 % Sharon Ait, Clerk-Typist III at $40,270 Audit: $ 6,611 $ 1,409 $ 4,161 1997 $ 9,916 $ 6,611 $ 1,409 $ 4,161 TOTAL ADMINISTRATIVE COST: $22,097 $22,097 � � a t� BUDGET DETAIL OF LOCAL MATCH I.ocal match is identified at a minimum 25% level within each of the subgrantees budgets, as required by MCH guidelines. Additional local match is also provided by the City of Saint Paul: 1996 1997 ' i. Local Tas Levy Funds: • MCH Prenatal Care at Community Clinics $139,480 $139,480 • Community Outreach and Services (Nutridon, social work and lab) • Participation in Project LID • Assessment (includes data collection analysis and reporting TOTAL: 2. Other I.ocal Funds: $ 36,352 $ 36,352 $ 2,485 $ 30,642 $ 2,485 $ 30,642 $208,959 $208,959 Other local match is provided by the City of Saint Paul through the funding of various programs which contribute to maternal and child health, including family planning, i�nunizations, lead screening, nutrition, health education and well child services. Source of this funding includes CHS funding, grants, reimbursements, and patient fees. � � ' e � � ' � � � � ,C N JJ �--1 'i ' � ft3 C N F Q x O b a � � W � ` � U � 9 � W 'm ro -�+ rn � o � , � .. ^" � a � m� �- �'.� m �� G • > °O • N Z I O� N b n`m � W zc � � wa a X � � '"� w c� � � � � r ,� � U � ; W '� 7 � 0 � � � U d N � J a, ' � ' N U ° LLa � � � � � �; � � ' .. a � � � �cn y t+ a� . o+�a 0 b a. , � Q p 9 4J m m m Q U m y� w � a� m Ul >.'� � ri � it1 _ t6 y �jU y u1 Uv] ' W — N s � > O W T = C ' � o � a � O � I Q ¢ � Z = G S m m O O�^ W O v ae �¢ m (q Q C � m � � o� �n ¢ ooE o n f�i N m Z a 9 m C W C 0 ? e u o � e ¢ m � m= x a 0 c`o � ui u`�i ti � m c m w � : n c t i 3 °' _ e� � �a 9 > � m s ��i+r'm x gt�o C �v � G $ OmQOLL � �_° =N �faO�O❑ � c v n p c � � a �� na�'? - � 91 '��-�� 0 � m � ; _ ��; �� W a N v � � O q c m�r 2 m N C7 a �a 3 N � � 0 U 2 � q ti p p� b b � r, � � y V om� ,� � t e F. �8m� W � U `oWm� � m E m � 2 ° o3`a m p m V t in q R Q � � m h O '� � ° � d� S ..��, m o � m $a8 � m H ll m \ � �� c M ` O�o 0 N � o ��j J 0 C7 $ c N LL �� 0 !1 N � � c 3 zH ogo � 2 �- � N C � � � °og N C x O V C � ° m m m 0 `m .i y � L t0 0 O � � � O N O _ ry � U J b � m ` '^ U ' L m �C O C y p � O �� O O � �� m N F � � N N C �C� 0 J C � � O "'� O m � � U N � C O = � Y a J OI � > � � > J ri z � � n � � � .c Q Y e� tna 3 = q y � h � �6 O. 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F .� c� H v, a a� x N a ¢ � � � � � � � z A � � 0 � � �� w Qz a y � F � a� � =N¢ � [�1 � a a°z d' U a v� c �U � � -�� 99 � , ll � , � , , , !l , � ' i C� i 1 � C ATTACHMENT B Solicitation Process for Subgrants �1�-��- Notification of the availability of funding was provided to qualified programs in the azea through a direct mailing of a Request for Proposals (RFP) to 30 agencies and a pubiic notice placed in the Saint Paul Pioneer Press on May 22, 1995. The process for selection of priority program componenu and the process for selecting the requests (evaluation criteria) included in the grant application are explained in the following RFP. The public notice, a list of agencies receiving the direct mailing, and a list of the agencies requesting subgrants aze also included in this attachment. �o� NOTICE OF AVAILABILITY OF MATERNAL & CHII.D HEALTH (MCI� FUNDS ,p � AND REQUEST FOR PROPOSALS (RFP) �I � `�� ISSLTED MAY 22, 1995 SAINT PAUL PUBLIC HEALTH SUMMARY Saint Paul Public Heaitk invites community health service providers and related orgazuzations to submit proposals to wnduct maternal and child health projects for: improving pregnancy outcomes through outreach, referral and/or the direct provision of prenatal care for low income/high risk individuals in targeted neighborhoods during the period of January 1, 1996 - December 31, 1997. The City of Saint Paui tiirough its Pubtic Health Department will designate up to $140,000 in State Matemal & Child Health Special Project funds over this two-year period to support selected proposals addressing improved pregnancy outcomes. Proposals are due at Saint Paul Public Health by 4:00 p.m. July 3, 1995. An MCH ad hoc task force including representation of the Community Health Services Advisory Committee and additional appropriate agencies will review the proposals and make recommendations to the Boazd of Health for approvat. Proposais approved by the St. Paul Board of Health will be included in the Saint Paul Maternal & Child Health Special Project Application to the MN Department of Health. Organizations interested in applying for these competitive gant funds must show evidence of 501 (c) 3 status, or be local government agencies. Applicants must also meet th� eligibility requuemenu and proposal guidelines outlined in the following instructions, and be in compliance with attached assurances and agreements. MCH SPECIAL PROJECT FUNDS FOR SAINT PAUL According to State law, MCH Special Project funds may be used to address any or all of the foliowing statewide program priorities: improved pregnancy outcomes, family planning, hazidicapped or chronically ill children, and childhood injury control. Based on an assessment of community needs, Saint Paut Public Health is choosing to focus the available funds on projects for improving pregnancy outcomes. Saint Paul Public Health will allocate up to $7Q,000 each year for this purpose, targeted but not limited to residents in any or all of the following azeas: Thomas-Dale, Summit-Dale, Downtown Saint Paul, Riverview, Dayton's Bluff, Mount Airy and Rice Street. Outreach, referral and d'uect services may be provided in a variety of settings. All applicants must demonstrate a minimum in-kind contributions equal to 25% of the grant request. Proposals must comply with the legislative defuutions of eligible services and the Saint Paul MCH services priorities. 102 � , ' ' , 1�J L� ' �� _ ��`L . �, Applicants may request funds for up to two yeazs or less during the period of 1/1/96 - 12/31/97. Proposals may be for one-time only projects or may be projects that would require some source of continuation funds. However, MCH funds from Saint Paul cannot be guazanteed beyond 12/31l97 and should not be relied on for continuation of the project beyond 12/31/97. SAINT PAUL MCH PRIORITIES Improved Pregnancy Outcomes • To reduce the overall rate of late (3rd trimester or none) prenatal caze (Saint Paul: 7.2% in 1993) with a special emphasis on pregnant teens (12.1%), and all pregnant African American (10.9%), Na6ve American (13.6%), and Asian (17.7%) women. • To improve Saint Paul infant mortality (4.9/1000 in 1993) with a special emphasis on African American women (5.2/1000), American Indian (9.7/1000) and Asian (6.8/1000). • To reduce the rate of Saint Paul low birthweight infants from (6.6% in 1993; State of MN 5.5% in 1993) with a special emphasis on African American (12.0%), Native American (11.1%) and Asian (6.8%) women. , • To conduct outreach efforts to pregnant teenagers to increase the rate of first trimester prenatal care (49.1% in 1993) in St. Paul pregnant women under age 20 with a special emphasis on outreach to minority teens. � PROPOSAL FORMAT , , C J l� ' ' � ' CJ The proposal should consist of a narrative description limited to ten pages which describes the project in the following format: 1. Project Title 2. Name & Address of Applicant 3. Contact Person - Name and Phone Number 4. Amount Requested and Project Period 5. Project Abstract (1 page) 6. Project Narrative a. Tareet Pouulation - deseribe the target population relative to age, income and risk factors, and include an estimate of the number of individuals to be served. b. Obiectives - specific statements of what is to be aceomplished during the project 103 ��'�� period; objectives should be time-specific, realistic, and stated in measurable terms. c. Methods - describe the specific acrivities by which objectives will be achieved; include how and why activities were selected, and how procedures for referral and follow-up will be incorporated into services provided. d. Evaluation - describe the methodologies to be used to analyze the impact of the e. Trainine/Exnerience of Kev Staff - summarize; one page - resume may be attached f. Linka¢es - describe the linkages with other relevant matemal and child health service providers in the project service azea. Include a procedure for written referrals for service needs not addressed by project g. Reimbursements and Fees - describe plan for use of reimbursements from the Department of Human Services (Minnesota Health Care Programs). If fees aze to be charged to clients, please describe the sliding fee schedule to be used. 7. Budget - Include a detailed project budget itemizing personnel and other costs or a cost per unit of service provided. Expenditures and revenue should be identified for this project within the budget, including estimated reimbursements from DHS (Minnesota Healih Care Programs) and patient fees. Budget forms must be completed for each calendaz yeaz. T'he totai units of service to be provided during the project period must also be stated. PROPOSED DEADLINE - REVIEW PROCESS Eight copies of the proposal should be submitted by 4:00 p.m., July 3, 1945 to Cazotyn Weber, Saint Paul Public Health, 555 Cedaz Street, Saint Paul, MN 55101. Questions about this announcement may be directed to Cazolyn Weber, 292-7749. An MCH ad hoc task force including representation of the Community Healtk 3ervices Advisory Committee and additional appropriate agencies will review proposals and make recommendations to the full Advisory Committee. The CHS Advisory Committee will review these recommendations and advise the Saint Paul Board of Health about proposals recommended for funding. Proposals approved by the Saint Pan1 Board of Health will be incorporated into the CiTy's MCH Special Project Application to be sent to the Minnesota Department of Aealth. The MCH planning timetable is as follows: 1/1/95 - 5/1/95 5/22/95 Anatyze MCH data for Saint Paul to determine priorities in relationship to State and local priorities Mail RFP 104 1 � , ' , ' , , ' ' , , C J , ' , ' ' �i 7/3/95 Proposals due � � `� � � 7/5/95 - 7/28/95 Review and selection of proposals by MCH Review Committee 8/2/95 8/9/95 CHS Advisory Committee review of MCH Plan Saint Paul Boazd of Health action 9/IS/95 MCH Plan sent to Minnesota Dept of Health Upon approval by the Minnesota Deparnnent of Health (IvIDI�, Saint Paul Public Health staff will develop city contracts with the approved applicant agencies for the project services. Approved projects will be required to submit monthly or quarterly reports (as specified in the contract) and expenditure reports to obtain reimbursement. A copy of the reports required by the MDH are enclosed in the RFP. Actual reporting requirements may vary. If desired, monthly payments based upon expenditures or units of services provided may be negotiated. 0 e 105 AFFIDAVIT OF PUBLICATION I . 1� STATE OF MINNESOTA COUNTY OF RAMSEY ROSEMARY J FRANg be� r dnly sworn on oaf.fi, -says: that fie is, and during all times herein stated hae been, Clerk of Northwest Pnblications, Inc., publisher of the newepaper knowa as the Saint Panl Pioneer Press, a newspaper of general circalation within the City of St Paul and the Connty of Ramsey. That the Notice hereto attached was cut firom tfie calumns cf said a�z-.vspaper and was pr.::ted and published therein on the following dates: 22ad day of May lq 95 day of ,19 ` day of , 19 _ day of ,19 ` day of , 19 — day of ,19 — day of ,19 — t� Subscribed and swom to before me this 30th , �ay of May 95 19 � , Notary Public ' Washington County, Minnesota My commission expires January 31 � Zp 00 � �l�4A�t�{�yy�4�F4.GASAR4MRAkX � -,��,. � KAY iw!. �^-.t f ^'r."G t � ^7t iAYPUpUC�; ; s;x � � t� `_. � tNASHING70?d C�'�NrYA. � ► ►Knc �� ► ►«f►9��v� 106 ' ST PAUL WOMAN'S CLINIC 1690 UNIVERSITY AVE ' ST PAUL MN 55104 , LUTHERAN SOC SERV OF MN 1201 PAYNE AVE ' ST PAUL MN 55101 I CATHOLIC CHAR OF ST PAUL 215 OLD 6T'H ST ' ST PAUL MN 55102 BOOTH BROWN HOUSE 1471 COMO AVE � ST PAUL MN 55108 , THE LOF!' TEEN CENTER ' 1063 IGLEHART AVE ST PAUL MN 55104 ' ANN RICKETTS FACE TO FACE CLINIC , 1165 ARCADE ST ST PAUL MN 55106 , LJ UNI7'ED FAMILY PRACT'ICE 545 W TTH ST ST PAUL MN 55106 COMMONHEALTH CLINIC 13961 N 60TH ST STILLWATER MN 55082 � JOANNE KENDRICK ST PAUL/RAMSEY NUTRITION PROGRAM ST PAUL PUBLIC HEALTH DONNA ZIMMERMAN HEALTfi START INC 590 PARK SUITE 208 ST PAUL MN 55103-1843 YOUTH SERVICE BUREAU 1619 DAYTON AVE ST PAUL MN 55104 ARLINGTON HOUSE 704 E LARPENTEUR AVE ST PAUL MN 55117 ST PAUL PUBLIC SCHOOLS 360 COLBORNE ST ST PAUL MN 55102 SETON CENTER 436 MAIN ST ST PAUL MN 55102 FAMILY PHY HEALTFI CENTER 579 WELLS ST ST PAUL MN 55301 PEG LABORE FAMILY TREE CLINIC 1619 DAYTON AVE ST PAUL MN 55102 MODEL CTCIES HEALTH CENTER 430 N DALE ST ST PAUL MN 55103 ST PAUL RAMSEY OB/GYN CLINIC 640 7ACKSON ST ST PAUL MN 55101 PLANNED PARENTHOOD OF MINNESOTA 1700 RICE ST ST PAUL MN 55113 CER'I'IFIED NURSE MIDWII'ES RAMSEY FOUNDATION 640JACKSON ST ST PAUL MN 55301 RGAPE � � ^ � � � 1290 ARCADE ST ST PAUL MN 55106 MARY ELLEN SMITH LEAD PROGRAM ST PAUL PUBLIC HEALTH BETHESDA FAM PRAC'fiCE CLINIC 590 PARK ST SUITE 310 ST PAUL MN 55103 UNITED HOSPITAL-MOD CLINIC 333 N SMITFI ST ST PAUL MN 55102 MARY O'CONNELL 1NTEGttATED HOME CARE 475 ETNA ST SUITE 3 ST PAUL MN 55306 WEST SIDE FFEALTH CENTER 153 CONCORD ST ST PAUL MN 55107 CHILDREN'S HOME SOCIETY OF MtNNESOTA 2230 COMO AVE ST PAUL MN 55108 NANCY SRIGGS NORTH END HEALTH CEN'!'ER 135 MANITOBA ST ST PAUL MN 55117 ST PAUL RAMSEY PEDIAT'RIC CLINIC 640 JACKSON ST ST PAUL MN 55101 Ntcxa ntt�sz'ex AMERICAN INDIAN CLINIC 947 PAYNE AVE ST PAUL MN 55101 107 � °� "�q� Agencies Submitting Proposals for Subgrants The following community agencies submitted proposals to Saint Paul Pubiic Health by the deadline: 1. Face to Face Health and Counseling Service, Inc. 1165 Arcade Street Saint Paul, Minnesota 55106 2. Health Start, Inc. 590 Pazk Suite 208 � Saint Paul, Minnesota 55103 3. Model Cities Health Center, Inc. 430 North Dale Street Saint Paul, Minnesota 55103 4. North End Medical Center 135 Manitoba Street Saint Paul, Minnesota 55117 � 108 1 REQUESTS FOR MCH SPECIAL PROJECT FUNDS , for Improved Pregnancy Outcomes Total $ available each yeaz: $70,000 ��`-�� L� Agency: Face to Face Health and Counseling Service Amount requested: $94,833 - Yl: $46,584 Y2: $48,249 Target population: Low income adolescents, 50% of which wiil be youth of color; Dayton's Bluff, Summit University, Thomas Dale, Riverview Proposal: Continue outreach/case management program; provide outreach, pregnancy testing, education and counseling, prenatal caze, risk assessment Agency: Model Cities Health Center Amount requested: $72,718 - YI: $36,359 Y2: $36,359 Target population: African American and Hmong and women Summit-Dale, Thomas-Dale Proposal: Case finding, case management and incentives program for first trimester prenatal enrollment, transportation, chemical health education, social work assessments, enrollment into managed caze and nutritional services. Agency: North End Medical Center Amount requested: $10,950 - YI: $6,058 Y2: 4,892 Tazget population: Low-income or uninsured women, I 5-40 yeazs of age in the Rice St. and Mt. Airy neighborhoods. Proposal: Program to increase community awareness to importance of eazly prenatal caze, development of health materiais, provision of incentives to seek caze, transportation and child care to support access. Agency: American Indian Health Clinic Amount requested: $25,744 YI: $12,872 Y2: $12,872 Target population: American Indian and low-income Dayton's Bluff and lower eastside. Proposal: Case management, pazenting education, in-home nursing services in addition to coordination of social work and community support services 109 "1 �' �`7 � AGLNCY NAME: REVILWLD BY: SAINT PAUL MCii COMPBTITIVE GRANT REVIEW CRiTERIA POOR SATIS EXCEL I. � APPLICATION A. Is in accordance with City MCH priorities 1 2 3 4 5 B. Proposes services targeted to low-income high risk individuals in targeted areas 1 2 3 4 5 C. Is clearly written and the format facilifates review 1 2 3 4 5 II. TARGET POPULATION A. Is described including the number of individuals to be served, racialletimic distribution and eligibility criteria 1 2 3 4 5 B. The applican[ can demonstrate past successfut experience working witl� target populations 1 2 3 4 5 C. I.ow-income, e.g. <200% of poverty or women wUo aze pregnant and detern2ined eligible for M.A. or WIC 1 2 3 4 5 D. Idendfy risk criteria consistent with MDH guidelines 1 2 3 4 5 III. OBIECTIVES A. Described 1 2 3 4 5 B. Related to priorides 1 2 3 4 5 C. Realis6c 1 2 3' 4 5 D. Time Specific 1 2 3 4 5 E. MeasuraUle 1 2 3 4 5 F. Idenfify clienYs or community's needs, not the appHcant's 1_, 2 3 4 5 ' ' � , il0 Ll ��-�i�� u , L l LI ' � ' ' t � , ' � ' � i � ' POOR SATIS EXCEL IV. METHODS A. Described 1 2 3 4 5 B. Relale to objective 1 2 3 4 5 C. Include procedure for referral and follow-up 1 2 3 4 5 D. Describe how services wili be accessiUle to target population 1 2 3 4 5 E. Are consisFent with accepted public health practice 1 2 3 4 5 F. Maximizes use of alternative health care providers where appropriate 1 2 3 4 5 G. Likely to achieve objectives 1 2 3 4 5 V. EVALUATION A. All activities wliich warrant evaluation aze identified 1 2 3 4 5 B. Methods for coliecdng Ule data are described and are feasible 1 2 3 4 5 C. Gives evidence that evalua[ion resul[s will be used for program maz�agement decisions 1 2 3 4 5 D. Collects data which relate to the oUjectives 1 2 3 4 5 E. Methods for analyzing data are described 1 2 3 4 5 F. Is oUjective as �vell as subjective 1 2 3 4 5 VI. TRAINING/EXPERIENCE A. Indication of work experience, training and qualifications for staff direcUy involved in the project is included 1 2 3 4 5 B. Plan(s) to identify and address continuing education needs of staff 1 2 3• 4 5 VII. LINKAGES A. Linkages and referral azra��gements with otl�er community service providers are described and relate to goals, objectives and methods 1 2 3 4 5 111 /� r- /e T �. � �' � �� nooit � sn•ris ( LxcLL B. llcscrip[ioc► of curreut or anlicipaled cooperative agreemeuls to miiiimize poleiitial for duplication 1 2 3 4 5 C. Plans for or descriptions of ongoing collaborative activilies wiUi providers sucli as p�uGcipalion on task forces, commillees, eta 1 2 3 4 g D. Applicant cari show experieuce in successful follow-up on referrals 1 2 3 4 5 VI1I. BUllGLT A. Budget ilems aze justified in terms of project activities I 2 3 4 $ B. Complete 1 2 3 4 5 C. Frovides a rationale for fortnula/process for calculation of items 1 2 3 4 $. D. Amount of fwiding requested is appropriate for tl�e level of service a��d objectives identified 1 2 3 4 5 YLS NO COMMLN'fS L. Ageucy l�as dcmonstralcd in kind contributions of al least 25% of the grant rcquest P. Are maU�emaLicaily correct G. Indicates pla��s to obtain and use DHS reimburscmenLS (Medical Assislance, Cliildren's lieallh Plan) H. lndicates sliding fce scliedule lo be used if - fees are to be cf�arged to clients. * ADDIITONAL COA4MLNTSJItLCOMIvILNllA'T10NS: Recommend tl�is grant to be funded: y es no At what funding level Please list strengths and weaknesses of proposal and how proposal could be improved (use back of page for additional space) � 112