97-1098Council File # `� � ����
Green Sheet # 36255
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Presented By
Referred To
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 Child Health Block Grant, and authorizes proper City Officials to contract on its
behalf with the Minnesota Department of Health.
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Bosuom
Collins �
Huris
Meeard
Morton ��
Thune
Adopted by Council:
Navs Absent
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Certified by Council Secretary
sy: �
Approved by
By: � � �
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c( � � For ppro ed / �' b �y / �� C / i "ty A ey / p'
BY����// ' 7-C � f �Y `L%
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Approved by Mayor for Submission to Council
—�— BY � ``° �
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA �
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DEPARTMENT/OFFICE/CAUNCIL DATE INRIATED � V� 3 6 2 5 5
Pub��� Aealth 8/26/97 GREEN SHEET _
CONTACT PEflSON 8 PHONE INITI INRIAVDATE
EPAflTMENTDIRECTO�TC I CRYCAUNGL
��
Diane H011lt ren 292-7712 ���'N �CITYATfORNEY OCIT'CLERK
NUYBEfi FOR
MUST BE ON COUNdLAGENDA BV (DAT� p��� BU�GET DIfiECTOR � PIN. & MGT. SERVICES DIR.
Scheduled for 9/3/97 � �"""Y°R�°R'�ssisr''r'n �
TOTAL # OF SIGNATURE PAGES 1 (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION FiEQUESTED:
City signatures on a Resolution for Board of Health support of the 1998-1999 Saint Paul
Maternal and Child Health grant application to the Minnesota Department of Health.
RECOMMENDAnONS: Approve (A) rn Reject (i1) pEFSONAL SERVECE CONTHACTS Mt1ST ANSWER TNE FOLLOWYNG QUES710NS:
_ PLANNING CqMMiS$ION _ CML SERVICE COMMISSION 1_ Has this person/firm ever worked under a coMrac[ for fhis tlepartmeM? �
_ CIB COMMITIEE _ VES NO
—�� — 2. Has Mis perso�rm ever been a city employee?
VES NO
_ DIS7fiICT COUR7 _ 3. Does this personHirm possess a skill not normally possessetl by any curreM c'Ry employee?
SUPPOA75wHiCHCAUNCROHJEC7IVE? � YES NO
Explain all yes answers on seperete aheet anA ettaeh to green sheet
INITIATINCa PROBLEM, iSSUE, OPPoRTUNIN (VJho, What, When. Where, Why):
The City of Saint Paul, through Public Health will submit a grant proposal to the Minnesota
Department of Health for funding of services to improve pregnancy outcomes and improve
adoTescent health.
ADVANTAGES IF APPROVED:
' 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.
DISADVANTAGES IPAPPROVED: �
NONE
y��«9.�`�� '����?�i �1Y�i
�;;�;; 2 ? 1�97
DISADVANTAGES IF NOT APPROVED:
' Funding will not be received to support the above mentioned activities.
' Access to health care wi11 not be improved.
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TOTAL AMOUNT OF TRANSACTION $ 1� 62Z , 332 COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE Stat2 Of Ninne50td qCTIVITV NUMBER 58324/33248
FINANCIAL INPORMATION: (EXPLAIN)
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�:. I�� Memorandum
CITY OF SAINT PAUL
August 26, 1997
TO: Nancy Anderson
City Council Offices
FR: Diane Holmgren
Public Health
RE: Materials for September 3, 1997 Boazd of Health Meeting
Enclosed are the materials for the September 3, 1997, Boazd of Health meeting,
including:
• Agenda
• Copy of one Resolution
• Copies of the 1998-1999 Maternal and Child Health Grant
The first two agenda items are contingent on the Resolution making it through
signatures in time. I will follow-up with you by phone regarding the status of these
as they pragress.
Thank you for all of your assistance.
If you have any questions, please contact me at 292-7712.
DH/sea
WINDO W S.DOS�SFAU2ESOLUTMROG-GRANT
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From: Nancy Anderson
To: jerryb, gerrym, baribeav
nate: 8/25/97 3:OOpm
Subjflct: BOARD OF HEALTH MEETING.
davet, chuckr, barbb, mi...
A Board o£ Health Meeting has been scheduled for Wednesday, September 3, 1997
following the 3:3� p_m. City Council Meeting. The topic for your approval is the
"Maternal and Child Health Grant°.
Please mark you calendars.
CC: gerrys, marye, Admin.C50.£ran, Admin.CSO.debbie, I...
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MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
IMPROVED PREGNANCY OUTCOMES
• AND
ADOLESCENT HEALTH
1998-1999
Submitted by:
SAIl\'T PAUL COMMLTNITY HEALTH BOARD .
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SAINT PAUL - RA.rISEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR S'TREET
ST. PAUL, MN 55101
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SAINT PAIIL MATERNAI, AND CgILD HEALTS
SPECIAL PROJECTS GRANT 1998-1999
Table of Contents
MINNESOTA DEPARTi�NT OF HEALTH FORMS
Face Sheet
Project Infor.nation
Evidence of Compliance
Services Provided By Legislative Priority
Certification Concerning Sterilization
Certification Regarding Lobbying
Assurances and Agreements
APPLICATION NARRATIVE
COD4ITJNITY ASSESSMENT
=MPROVED PREGNANCY OIITCOMES
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
Model Cities Health
West Side Community
& Counseling Service
Center, Inc.
Health Center
ADOLESCEtQT HEAI.TH PROGRAM
Problem Statement
Goal of the Project
Target Population
Objectives
Methods
Training/Experience
Linkages
Reimbursement and Fees
Budget Justification
Monitoring/Evaluation of Subgrante
Program Evaluation
Budgets - 1998 and 1999
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BUDGET AND FZNAL EXPENDITURE FORMS
Budget Justification
Budget Detail of Local Match
1998 Budget Form
1999 Budget Form
1998 Budget by Legislative Priority
1999 Budget by Legislative Priority
ATTACE�IENTS
Attachment A- Inventory of Community Resources
Attachment B - Solitation Process
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MINNESOTA DEPARTMENT OF HEALTH FORMS
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PSee Revase Sidc for ituwcuons
�t Application for:
;Iaternal and Child Health Special Projects
1. Applipnt Agency With Wttich Grant ContraM is to be Ezecuted
Legal Nmnc. Strat ?.ddress:
Saint Paul Co�unity 310 City Ha11 '
Health Board Saint Paul, .IN 55102
E-Mail Address: '
Minnesota Department of Health ` r_ l " ��
Face Sheet
Telephone Nmnba:
�612 � 266-8560
12 )
2. Director of Applicant Agency
xmme and Tttle:
Rob Fulton
Public Health Directo:
Strat Addras:
555 Cedar Street
Saint Paul, 4IN 55101
E-Mail Addms:
Telepho� Numbrr.
�612 � 292-7712
FAXDIumbc
(612) 222-2770
3. Fiscal Management Otficer of Applicant Agency
Name and Titk: , I Strat Address:
Diane Holmgren � 555 Cedar Street
Health Administratior. Kana er Saint Paul, MN 55101
E-Mail Addcas:
4. Operating Agency ('fdifferenr from rrumber 1 above)
Name and Title: Strat Addras:
Saint Paul — Ramsey County 555 Cedar Street
Department of Public 3ealt Saint Paul, MN 55101
E-Mai! Addras:
5_ Contact Person for Operating Agency ('fdifferentfrom mrmber 2 above)
Name md TiUe:
Addr�SS:
E-Mait Addrcss:
6. Contact Penon for Further Inlormation on Application ('fdifferent from mrmber 5 aboveJ
Name and Title: Strat Addless:
Carolyn Weber 555 Cedar Street
Administrative Assistant Saint Paul, MN 55101
E- Mail Add'ess:
7. Copies of This Application Have Been Seflt to the Rolbwing Communiry Heatth Boards for Review
(NotApplicabfrjw CommwiryHealth Bcmd(sJ ijthe Bo�d is BrApplr�muj
A2encv Name
TdephoneNumber.
�612� 292-7749
FAX Numbec:
cFt2> ���-2��n
Tdeptwne Ninnbu:
�612� 292-7712
FAX Nwnbec:
(612) 222-2770
Tekphone Number.
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FAX Nmnber:
( )
Telephone Num6a:
�612�292—�749
FAXNumber.
(612)222-2770
Date Sent
8. Certiication
1 eertify t6at the infom�etion m m is true and accurate m the bat of my 1mowledBe md thu I submit tdis appliaaon on behalf ofthe applicant agmry.
_ • /�������l//A/� • Director � ,Z,(p �1
Signanve ofDiiator of Applicant Agevry T�� �
E-0[2740M1f3/9T A
ICR 346428
Instructions for Completing Face Sheet •
Please Type or print all items on tfie Grant Application Form Face Sheet
Aoplicants please note: The appIication form has been desi�ed to be used on all Special Project granu administe:
by the Nfinnesota Deparcment of Heaith. If you have questions, or need assistance
completing the application form, piease contact the program Nfanager or Consultant identif:
as responsible for the grant. .
Applicant Agency
Legai name of the ageacy aathorized to enter into a grant contract with the Minnesota Department of Health, e.
North Woods Community Health Board. ,
2- Director of the Applicant Agency
Person responsible for direcfing the applicani agency.
3. Fiscal Management Officer of Appticant Agency
The chief fiscal officer for the recipient of funds who has primary responsibility for grant and subsidy func
expenditure and reporting. If the applicant agency is a Community Health Board, the Fiscal Managemen�c
must be the same person who is identified as the Fiscal Management Officer in the Board's Communi a1-
Service Plan.
4. Operating Agency
Complete onty if other than the applicaat agency listed in number 1 above.
5. Coatact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this projeci.
6. Contact Person for Further Information
Person who may be contacted for detailed infozmation conceming the application or the project if different fron
number 5 above.
Copies of this AppIication Have Been Sent to the Following Community Health Boards for Review
Provide copies of this apptication and any subsequent revisions to the appropriate community health boards a
required by the individual instructions.
�• Signature of Director of Applicant Agency
Provide original signaYure and date.
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� P SreAeverse5ideforins¢uctioas MinnesotaDepartmentofHealth(NIDI�
• Project Information Sheet far Special Projects
NameofI��HProgram: :taternal and Child Health Special Projects Grant
1. ProjectInformation saint Paul Co�unity Healch Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Pubiic Health
Beginning Date: End Daze: Minnaota Tax I.D. No.: Federal 1.D. Number: Social Security Number:
O1/O1/98 12/31/94 802-722�i 41-b005875
Project Funds Requested: I,ocal Match Provided: �
Yeaz 1 Year 2 Yeaz i Yeaz 2
$ 808,695 �P 813,637 $ 202,959 $ 202,959
Service Area (city, county, or counties): �
City of Saint Paul
. Non-Pro�t Status - SOi.C3 Copy Attached
� Yes � Not Applicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence ofComplianceForm)
❑ No ❑ Yes � Not Applicable
4. Affirmative Acrion
The agency has a certificate from the Commiuioner of Human Rigdts, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Appiicable Because:
❑ Total Coatract is SSQ00 or Less
❑ Ageary Has 20 or Fewer Full-Time Employees
� Units of Local Govunment
❑ Indian Reservation
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HE-01274-04 (3/97) -PART B
IC N 140-425
Instructions for Completing Project Information Sheet for Special Projects �
Please Type or Print all items on the Project Information Sheet for Special Projects
Appticatioas ��Iease note: The appIication form has been designed to be used on all Special Project grants
administered by the Minnesota Department of Health. ff you have questions, or need
assistance in completing the application form, piease contact the Program Maneer or
Consultant identified as responsible for the grant.
Project Information
Provide name of appIicant agency, beginning and end date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicable), or Social Security Number, and geographic service azea. List the total
amount requested for each year for Project Funds Requested and LocaI Match Provided. PIease refer to
individuai instructions for each special project gant to determine if local match requirements aze needed.
2. Non-Profit Status - SO1.C3 Copy Attachment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit institution, corporation or organization.
3. Worker's Compensation •
Minnesota Statutes, Chapter 176, forbids the Commissioner of Health from entering into any contract until
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requirements from the contractor. Complete the form entided "Evidence of Compliance" and retum
it with your grant application.
4. Affirmative Action
Minnesota Statutes, Section 363.073, says the Commissioner of Health shall not."... receive, enter into, or
accept any bid or proposal for a contract nor execute any contract for goods, services, or the performance of
any function, or any agreement to transfer funds for any reason in excess of $50,000 with any person having
more than 20 fuil-time employees in Minnesota at any time during the previous 12 monttu, unless the person
has an a�mative action plan for the employment ofminority persons, women, and the disabled that has been
approved by the commissioner of human rights. Receipt of a certificate of compliance issued by the
commissioner shall signify that a person has an affirmatiye action plan that has been approved by the
commissioner." If the grant or contract you propose meets the "in excess of $50,000" criterion and your
ageacy meets the "more than 20 full-time employees" criterion, a Certificate of Compliaace must accompany
your proposal, unless your agency is exempt If you have questions about the Certificate of Compliance,
please contact the:
Minnesota Depamnent of Humaa Rights
Con�act Compliance
Army Corps of Engineers Ceater
190 East Fifth S�eet
Suite 700
St Paul, MN 55101
(612) 296-5663
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� Plczcc Typc or Pnnc
Evidence of CompIiance
State law forbids the Commis;ioner of Health from entering into any grant contract until the Commissioner
receives acceptable evidence ei compliance with workers' compensation in�,Ta„ce coverage requirements from
the gantee. The exceprion to this requirement is a self=employed grantee who has 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 esception and you wish to enter into a grant contract with the Commissioner of
Health, you must frunish acceptable evidence of compliance with worker's compensation covemge in any one of
the following four ways: ' ,
1.
�
If you aze self-insured and you are a state agency or a municipal 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, circle
this entire statement and sign and date the form below in the space provided; or
4. Fill in the informa�on for each
Name and .4ddras of Granta's Irswance Carria:
and date the form in the space provided
��Gcantee's Insuronce Poliry Numbu:
Ia�rm that al1 ofthe employees oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are eovered by the workets' compensation insurance policy listed above.
s�a s
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Attach a certificate of insurance (supplied by your workers' compensation cazrier) to this Evidence of
Compliance form; or
If you aze self-insured, zttach to this Evidence of Compliance form, a written order from the Minnesota
Commissioner of Comm:rce allowing you to self-insure; or
Minnesota Department of Health
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Director
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HE-0I274-04 (3/97)-PART C
IC N 140-M12S
-i
� MCHSP SI:�P✓IlVIARY OF
ES OF ACTIVITIES AND SERVICES
PR.OVIDED BY OPERATING AGENCIES
BY LEGISLATIVE PRIORITY
Saint Paul Co�unity Health
corrnr�m �aL� Boaxv
c�)
Saint Paul — Ramsey County
OPERATING AGE1�iCY�
(if difterent from CHB�
I. Improved Pregnancy Outcome
served: � City of Saint Paul
Types of Activities/Services
core pubiic hcalth aaivities not directe: to individuals
individualized education/counseling
health education/counseling in groups
pregnancy testing and referrn!
prc-term birth provention
prenatal case management
III. Aandicapped/Chronicall� Ill
GeoQraphic area served: r
Types of Activities/Services
core public health activities not dirocud w individuals ❑ case identification and referral
cau managemrnt ❑ case monitoring and hacldng
home health/respite care ❑ assistance in obtaining health cate financing
school health uchnical consultation ❑ assistance in obtainin
g primary care services
II. Family Planning ProQram
MCHSP SL�►ZMARy OF
TYPES OF ACTIVITIES AND SERVICES
PROVIDED BY OPEl�>T'ING AGENCIES
BY LEGISLATIVE PRIORITy
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comnKUxi� xEai.� soaRn
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OPERATING AGEi�iCY'�
�f di}Tennt from CHB)
N.
Childhood Injiuy Controt
Geographic azea served:
Typa of Activiries/Servica
Ptease c6eck theen s'e,�:�.� ..�....�
core public healch activities not direcmd to individuals
home safety awazeness
promotion of positive parenting
toddler car seau
Tu
injury prevention in day care setting
inJury Prevention in schools
farm relaud injury programs
enabling and non-health suppoct
Other Programs Previous Funded by a Local Pre-Block MCH Special Project Grant - Specify Programs:
❑ Dental Heaith Program
❑ InfanUChild Health Program
� Adolescent Health Program
Types of Activitic�slServices
core p�blic health activities not directed to individuals
examples of operating agency include county, school dis�ict, Iadian reservation, non profit health agency,
etc.
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CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT
GR°j?�iT FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
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CHECK ONLY 0�1E BOX:
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No
sterilization
grovided
❑
Yes
steriIization
grovided
:LfCH Special Project grant fuads wiil not be used during CY 1998-99 to
provide and/or arrange sterilizations. If a client is merely referred to another
health care provider, this provision of information is not considered to
"ananging" a sterilization.
MCH Special Project grant funds will be used to provide and/or arrange
sterilizations during CY 1998-99. Agencies which use MCH Special Project
gant funds to gay for a procedure or related pucpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requirements described elsewhere in this document.
I certify that to the best of my knowiedge the above information is coaect, and that if this status changes,
formal notification in this regazd wili be sent to the Section Manager, Matemal and Cluld Health Section,
Minnesota Department of Health, Minneapolis.
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Signature ofDirector
of Applicant Agency:
Title:
Date:
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Instructions for Completing Certification
Concemiag Use ai'�TCH Special Project Grant Funds
to Promote aad/or Anange Sterilizations
AIl federai PubIic Health Service supported programs, including the Matemal and Child Heatth Services
Block Grant progr�m, which use federal funds to provide and/or azrange for sterilization aze required to
follow fedeial procedures and to pmvide tvritien doctunentation in this regard on a quarterty basis.
MCH Special Projects (MCHSP) may obtain an exemption from tt}is reporting requirement by signing a
cer�frcation that ttieir agency is not using MCHSP funds to provide and/or arrange sterilizations. (If a client
is merely provided information and referred, this is not reported.) Reporting is required if MCHSP funds
aze used in some form of participation (paying for the procedure, providing traasportation, making an
appointment with another health provider, or detailed counseling beyond simpte provision of information).
All Cominunity Heatth Boards aze required to complete the Certification. For agencies which do not
provide sterilizations, no further action will be needed during CY 1998-99. The agencies which indicate
they do provide sterilizations must adhere to specific federal service and reporting requirements @escribed
elsewhere in this document
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CERTIFICATION REGARDING LOBBI'�1G
The undersigned certifies, to the best of his or her knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or an employee of any agency,
a member of congess, an officer or an employee of any agency, a member of congress, an officer
or employee of congess, or aa employee of a member of congress in connection with the awazding
of any federal contract, the making of any federal gant, ihe making of any federal loan, the
eniering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
of inodification of any federal contract, grant, loan, or cooperative agreement. .
(2) ffany 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 congzess, or an employee of a member of congress in connection with
this fedezal contract, grant, loan, or cooperative agreement, the undersigned shall complete and
submit Standard Form-i l i, "Disclosure Form to Report Lobb}�ng," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the awazd
• documents for all subawazds at all tiers (including subcontracts), sub�ants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reIiance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction 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.
Signature
$�� R1
Date
Rob Fulton, Director
Name of Authorized Individual
• Saint Paul - Ramsev County Department of Public Health
Name and Address of Organization 555 Cedar street
Saint Paul, iIN 55101
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ASSURANCES AND AGREEMENTS
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
Services will be provided in accordance with appiicable state and federal laws, rules and procedures.
2. The agency will comply with state and federal requirements relating to privacy of clieat information.
'The agency will comply with the Minnesota Clean Indoor Air Act which prohibits smoking in MCH
Special Project facilities and clinics.
4. The agency (if it has 15 or more empioyees) and any subcontractors with 15 or more employees will
have on file and available for submission to Minnesota Department of Health (IvIDI-n upon request a
written non discrimination policy containing at least the following:
• "All progzanis, services, and benefits which aze administeted, authorized, and provided shail be
opeiazed 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
Discrimination Act of 1975, and the non discriminatory requirements of the MCH Block Grant.
No person or persons shall on the ground of race, color, nationat origin, handicap, age, sex, or
religion, be excluded from participation in, be denied the benefits of, or be otherwise subjected
to discrimination under any prograzn service or benefit advocated, authorized, or provided by this
Deparnnent."
5. The agency (if it has 15 or more employees) and any subconttactdrs with 15 or more employees will
disseminate information to beneficiaries and the general public that services aze pmvided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be
accomplished by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or othez
communications designed to acquaint potential beneficiaries and the public with progams;
and/or
B. Notifying referral sources in routine letters by including prepared handouts which state that
• services aad benefiu musc 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 IVIDH upon request.
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6. In fulfilIing the duties and responsibilities of this grant, the gr��tee shall comply with the Americans
with Disabilities Act af 2 940, 42 U.S.C. § I2I01, et seq., and the regulations promulgated pursuant to
it.
7. No residency requiremeats for services other than state residence, wiIl be imposed.
8. Services shaI1 not be denied based on inability to pay.
9. Arrangements shall be made for communications to take place in a language understood by the
matemal and cIuld heaIth service recipient.
io• All written materials developed to determine client eligibility and to describe services pmvided under
this grant wiIl be understandable to a person who reads at a seventh grade level using the Flesch
"Analysis Readability Scale as required in Minnesota Statute 144.Q54 (see Appendix I0, Ptain
Language in Written Materials, Minnesota Statute, Section 144.054}.
11. The agency will provide services in keeping with prograrn guidelines of ihe Minnesota Department
of Health and guidelines of accepted professional groups such as the American Academy of Pediatrics,
American CoIlege of Obsteh and Gynecologists, and American Pubiic Health Associatio�
12. Upon request, one copy of any subcon�act executed as part of the project will be provided to the
Minnesota Department of Health.
I3. The agency wilI report accomplishments of the project to the Minnesota Department of Health. Such
reports will be submitted no later than 90 days afier the completion of the catendar yeaz. Upon
request, the agency will provide additional information needed by the Depamnent for evaluation of
the project's objectives and methods and compliance with any special conditions (see Appendix 17,
Program Reporting Requirements for Matemat and Child Heatth Special Ptojects).
14. G2ant funds shatl not be used for inpatient services except for high risk gregnant women and infants.
15. Cash payments shall not be made to intended recipients ofhealth services.
I6. Grant funds shall not be used for purchase or improvement of land or facilities.
17• Grant funds shall not be used for punchase of equipment costing more thaa $5,000.00 per uniY and with
a usefut life exceeding one year.
18. Giant funds shall not be used for reimbursement for travel and subsistence expenses incuired ou e
the state uniess it has received prior written approval from the Minnesota Department of Healtt�
such out-of-state �avel.
19. Whea applicable, ihe agency sha11 provide nonpartisan voter registratioa services and assistance using
forms provided by the state to employees of the agency and the public as reqnired by Minuesota
Statutes, 1987 Supplement, Section 202.162 (see Appendix 9, Requirements for Voter Registratio�).
�-�- �oa�
•
20. When issuing statemenis, press releases, requests for proposals, bid soIicitations, and other documents
desczibing projects and prograzns funded in vr'-nle or in part with federat money, ail grantees receiving
federal funds shall ctearly state (a) the percentage of the tatal cost of the program or project which will
be financed with federai money, and (b) the dollar amount of federal funds for the proj ect or progam.
21. The a�ency will not use graat funds to pay for any item or service (other than an emergency item or
service) furaished by an individual or entity convicted of a criminai offense under the Medicare or any
state health cue program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant
programs).
22. Materials de�•eloped by Matemal and Child Health Special Project grant and matching funds wili be
part of the public domain and will be accessible to the public as financially reasonable. Materials
developed b� the �+fatemal and Child Health Speciai Project grant and matching funds may be
feproduced and distributed by the Project to other agencies and providers for a profit so long as the
revenues from such sale aze credited to the Special Project budget for expenditure by the Special
Project.
23. The agency will compiy with all standards relating to fiscal accountahility that apply to the Minnesota
Department of Health, specifically:
• A. Bud;et revisions with justification will be submitted to IvIDH for prior approval whenever:
(1) changes aze made in the objectives to be met in the Matemal and Chiid Health Special
Pmject, or
(2) the cumulative amount of funds uansferred into or out of an operating agency's budget
line item exceeds or is expected to exceed 10% of that approved for the grant year or
52,500.00, whichever is greater.
B. Final expenditure reports are due 90 days after the end of the calendar yeaz.
C. Grant funds are used as payment for services only after third-party payments, such as from
the Medical Assistance/Medicaid (Title XXI�CC SSA), Children's Health Pian/MinnesataCare
reimbutsement progratns of the Minnesota Department of Human Services and private
insuiance aze utilized.
D. Project financial management systems wi11 provide for.
(1) Accurate, cuirent, and complete disclosure of the financial status of the p%ject.
(2) Records which identify adequatety the source and application of funds for Matemal and
. Child Health Special Project activities. These records are to contain information
pertaining to project awazds and authorizations, obligations, unobligated balances,
liabilities (encumbrances), outlays, and income.
�
(3) Effective control over the accountability for al1 fuads, p; -•�erty and other assets.
Projects aze to adequately safeguard such assets and assure that they are used solely for
authorized purposes.
(4) Comparison of actual obtigations with budget amounu for each activity.
(5) Accounting records which are supported by source documentation.
{6) Audiu which will be made by or at the direction of the Minnesota Department of Health
(see Appendix 6, State Audits}. ,
SIGNANRE OF CHAIR OR VICE-CHAIR
OF THE COMM[.TrTTI'y HEAI,T'H gp,q� OR
AN AGENT APPOINTED BY RESOLUTION
OF TI� COMMUNITy HEAI,TH BOARD:
��2'����
TTTLE:
DATE:
� Iti rPrro3
�'�2 L�'� 7
•
•
a�. a �oag
•
�
COMMUlvITY ASSESSMENT
n
��
a� - �a�g
•
CONIlVILtNITY ASSESSi�IEP3T
A broad-based assessment of community health needs and resources in Saint Paul was
conducted be�innins in the fall of 1994 as part of the development v: the 1996-1999,
Saint Paul-Ramsey Counry Community Health Services Plan. Throughout this
planning process. and as we proceed to plan for the future, issues will be identified
which contribute to poor health outcomes. The CHS Advisory Committee idenrified a
number of primary issues which underlie and aze frequently the root causes for the
discrete public health problems identified in the Community Assessment. Specifically,
these issues are:
• Poverty and Racism - all of which lead to hopelessness, income disparities and •
polarizacion between classes.
This polarization tears at the socialtcultural fabric of our community, making public
health intervention increasingly chalienging.
The Advisory Committee and staff also identified system problems which underlie and
compound the problems. These system problems are:
i. Integrated health care and social service system for all children and families in
• Saint Paul and Ramsey County, especially children at risk are lacking.
2. The complexiry of the changing health care system in Saint Paul and Ramsey
County has resulted in lack of access to heaith care for certain populations and
the lack of stable funding for public health services, inciuding prevention.
3. Communication of health and environmentai 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%a or more persons with
incomes below the poverry level, with an additional nine census tracts with a
level of 30% - 39.9% of persons with incomes below poverty level.
• Five census uacts in Saint Paul realized an increase of over 20% in the
number of persons living below poverty between 1980 and 1990.
A significant change occuring in the community has been the public health joint
powers agreement between the City of Saint Paul and Ramsey County, effective 7uly
1, 1997. The Joint Powers Agreement was developed over approximately two years
before being approved by the Saint paul City Council and the Ramsey County Board
� of Commissioners in December 1996. the Joint Powers Agreement forms the Saint
Paul - Ramsey counry Department of Public Health. The 7oini Powers Agreement
idenufies one Community Health Services Agency for the Saint Paul - Ramsey County
community. However, both Saint Paul and Ramsey Counry will maintain a Board of •
Health. The Saint Paul Community HeaIth Board witl consider issues affecting those
services maintained by the City of Saint Paul, which will include the Maternal and
Child Health Speciai Projects Grant. Saint Paul - Ramsey County Department of
Public Health becomes the operating agency for the MCH grant.
Additional assessments has been completed at part of the preparation of the Saint Paul
- Ramsey County Couununity Heaith Services Plan Update for 1998-1999. As a result
of this assessment, Saint Paul - Ramsey County Department of Public Health has
identified improving preanancy outcomes as a maternal and child health service
prioriry for Saint Paul. The 1996-1999 Community Health Services Plan identified
twenty health problems as the highest priority. An additional thirteen high priority
problems were identified as were three service delivery system problems. A number
of problems related to improving pregnancy outcomes were identified among these
high priority problems including:
� High rates of low birthweighi stfants and preterm deliveries in some
populations
• Ongoing problem of Infant Mortality despite decreasing infant mortality rates
• Low rates of breastfed newborns and infants in Saint Paul and Ramsey County •
Data reported in the 1996 Minnesota Health Profiles provided by the Minnesota
Department of Health and the Saint Paul - Ramsey County Communiry Health
Services Plan Update for 1998-1999 also reveals that in 1995:
� Percent of Premature Births (less than 37 weeks gestation) for Saint Paul is
10.5 compared to 8.7 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is 6.2 in
Saint Paui compared to 4.0 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is higher
for American Indians (8.3), African Americans (10.7), Asians (13.6) and teens
(10.5) compared to Saint Paul aT 6.2.
• The iafant death rate of infants born to American Indian women (24,4) and
African American women (13.7) is much higher compared to the rate for Saint
Paul (9.4) and the State of Minnesota (8.2).
• The incide�e of 2ow birthweight births in Saint Paul increased from 6.7 in
1993 to 7,3 in 1995. •
• The incidence of low birthweight births for African Americans increased from
22.0 in I993 to 14.4 in 1995.
a�� �oq�
• This data also indicates that due to the increasing efforts to improve pregnancy
outcomes, we have seen some positive results such as:
� The cunent five year rate for infant mortality in Saint Paul of 7.4 has
improved compazed to the previous five year rate of 10.6.
• The incidence of lst trimester prenatal caze continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993 and 69.9 % in 1995 for Saint Paul
women.
� The incidence of ist trimester care for Saint Paul Native American women
continues to increase from 36% in 1988, to 37% in 1991, 54% in 1993 and
63.9 % in 1995. �
While technology has improved to allow care and treaunent of some high risk births,
it is much more efficient, cost-effective and less stressful to place dollars and efforts
on improving pregnancy outcomes so that the advanced technology does not need to be
used.
Data indicate that some specific health planning areas in Saint Paul have poorer birth
outcomes and may benefit from increased levels of targeted outreach and service.
• These health planning areas, all within the City of Saint Paul, include: Thomas-Dale,
Sununit-Dale, Downtown Saint Paul, Riverview, Dayton's Biuff, Mount Airy and Rice
Sueet.
In addition to the focus being placed on unproved pregnancy outcomes, the Adolescent
Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock 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, e�cient and effective service to this
potentially high risk and often forgotten population. In fact, a number of issues
specifically related to adolescent health are included in the Community Health Services
Plan as priority health probiems, 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.
• High incidence of death and injury due to availability of fuearms
• High rate of unintended pregnancy among teens
• • Increasing 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
Tfirough the community assessment completed as part of the CHS planning process, it
was identified that there are resources available within the community to meet the
needs in the areas of famiIy planning, handicapped/chronically ill children and
childhood injury conuol. Based on ttris assessment, no funding is requested for these
azeas through the Maternal and Child FIealth Speciat Project Grant. However, these
areas will continue to be monitored by Saint Paul - Ramsey County Department of
Public Heatth to ensure that resources exist to handIe t6e various health problems and
issues in each azea.
�
The provision of services addressing improved pregnancy outcomes will be
subconuacted to various communiry-based providers who were identified through a
process of request for proposals. Saint Paul - Ramsey County Department of Public
Health has chosen to subconuact for services in an effort to utitize estabtished
agencies and organizations who have proven to be effective and efficient in their
delivery of services and which are located within the target areas. Additionally,
subcontracting with existing agencies minimizes start-up costs and duplication of
services. Itis hoped that this process and the services provided by the subgrantees �
will also help ensure that culturally-sensitive, continuous care is provided to high risk
populations.
Various information regazding the community assessment is displayed in the figures on
the following pages.
•
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1993-1995 Saint Paul & Ramsey County
3 Yr.Teen Pregnancy & Teen Birth Rates
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3 YR. Teen Birth Rate
Ramsey County 1993-1995
3 YR. TEEN PREGNANCY RATE
LOCATION
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•
IlVIPROVED PREGNANCY OUTCOMES
�
�
q�- �o�g
PROBLEM STATEi�i�iT
•
Poor pregnancy outcomes has been identified tbrough a community assessment as a
high priority public health problem in Saint Paul by the Saint Paul-Ramsey Counry
Community Health Services Advisory Committee and staff from Saint Paul - Ramsey
County Department of Public Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in
some populations
• ongoing problem of infant mortaliry despite decreasing infant
mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal
aicohol effects and other birth defects
•
•
The rates of infant mortality, low birth weight and pre-term deliveries for the City of
Saint Pau1 are higher than suburban Ramsey County and the State overall. The Health
Planning Areas of Thomas-Dale, Summit-Dale, Downtown St. Paul, Riverview,
Dayton's Bluff, Mount Airy and Rice Sueet have been targeted as the specific
geographic areas to be served in response to previous high rates of poor pregnancy
outcomes.
601
319. 332 �
6�6
Midway
3oz. soa ao�. s,z
602
Como Park
607
Hamline
m. �t.. sse. 3as. 3so.
351. 35z.363. 3st.3ss
612
Maca/ester
3ez. ns. sra.w. naoz
�. �eo. aee.3cr. �ea.3es
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W. 7th St
3os.oi. 3os.oz �.
310, 371, 375, 376
604
Pha/en Park
3s,. aro. an. arz
617
Rivenriew
sy5 CtTY of SAINT PAUL
Highland Park Health Planning Areas
and constituent census tracts
� Targeted for high mtes of
Poor Pre9nonry ovkome
x�.oz 3o�.m. x�.aa
6U5
Hayden Heights
,.�,� 318.01.31602,
3a7.01.347.02
611
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Park
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618
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•
RAMSEY COUNTY: BiRTHS
% Premature & % Low Birth Weight
._. i
. �, �
�
x;
y- ' � � 59
Ramsey County:Prenatal Care
First Trimester
�:�
��
w �,
ZO O%
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• � vremawrc
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�Ramfay
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•
t986 7988 7991 1993 1994 7995
1990 1995
Heatthy Pgople 2000 Goai is 90 % Source:MDH
�
Ramsey County
Healthy People 2000 Goal 7.0
Source:MDH
Osw�x
o,NO�
�5�,�
��rte
�.o
�
U
City of Saint Paul
Infant Mortality Rate by Race
Saurce:MDH
� eua�
ii �
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� v�rtme
u
Infant MoRality Rate by Race
Healthy People 2000 Goai �.0
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. One factor contributing to poor preanancy outcomes, including high infant mortality,
premature birrh, and low birthweight births, is late or no entry into prenatal care.
A�ain, the targeted Health Plannin� Areas within the City of Saint Paul have a higher
percentage o_` women who begin prenatal care late (third trimester) or who receive
none at ali than suburban Ramsey County and the State overall. Certain Saint Pau]
neighborhoods have especially high rates of late prenatal care.
LATE OR NO PRENATAL CARE in -1990
Overall, 7.4% of mothers did not begin prenatal care until
the third trimester, or received no prenatai care at all.
HEALTH PLANNING AREA
Mt. Airy
Thomas-Dale
•
•
Rice Street �
Midway �
Downtown r
Daytons Bluff �
Riverview �
Summit-Dale r
Phalen Park �
T
St. Mthony Park r
West 7th SUeet �
Battle Creek �
Hayden Heights �
Hamiine - 3b'
Hightand Park � s.z�
i
Hazel Park � a.a o
Maeatester � 2.o^r,
Como Park � ��3 =
i o.� �
io.oi
� B.0 %
� 6.9%
■ s.sv,
4.9 %
13.
O.OX S.OX 10.0% I5.0%
LATE or NO PRENATAL CARE
20.6 %
20.OX
25.0X
SOURCE 58int Paul Pub6c Heaith
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� Maternal and child health activities funded through the Maternal and Child Health
Special Projects Grant are monitored quarterly, and more thoroughly evaluated on an
annuai basis. A report assessin� the activities of the current project in 1996 was
compieted for the Minnes�:^. Department of Health. Since current comprehensive data
on Saint Paul health indicators is not readily available, it is dif£cuit to fully assess the
impact of present pro�rams at this time. However, based on the data received from
the pro�rams, the foliowing summary information from 1996 programs receiving
MCH fundin� to improve pregnancy outcomes is availabie:
• 1,246 clien[s were seen for prenatal services
• 44% of the 548 clients who delivered in 1996 received prenatai care in the
first trimester of pregnancy
• 4 fetal deaths were identified
� 2 neonatai deaths occurred
• 35 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 among some minority populations.
� PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES
Saint Paul - Ramsey County Department of Pubiic Health's Improved Pregnancy
Outcome Pro�ram for the City of Saint Paul 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 assuring
universal access to preventive health services. To achieve these goals Saint Paul -
Ramsey County Department of Public Health has identified priorities consistent with
the foliowang MCH Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatal caze in the first trimester
• provision of prenatal care services that are sensitive to cultural diversity
These priorities will be addressed through the objectives and methods identified by the
by staff in the Refugee/Preventive Medicine Program at Saint Paul - Ramsey County
Department of Public Health and four community agencies approved for funding by
the MCH Special Project Funds Proposal Review Committee. Once again, Saint Paul
- Ramsey County Deparcment of Public Health subcontracts the majority of MCH
funding to community organizations to increase access to services, and to increase the
� likelihood that culturally sensitive care is available to the population. The agencies
recommended to receive funding are Health Start, Inc.; Model Cities Health Center
Inc.; Face To Face Health and Counseling Service, Inc.; and West Side Community
Aealth Center.
The programs of these agencies provide a variety of inetl �ds which are targeted to
increase the percenrage of women receiving prenatal care in the fusttrimester, ensure
continuous prenacal care, education and case management, reduce infant mortality, and
decrease low birthweieht bir[hs. AdditionalIy, the programs of these four agencies
will provide services to the residents of the highest risk Saint Paul neighborhoods.
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INVE1�"fORY OF SERVICES
From the inventory which was completed, it has been identified that there aze a
number of agencies providing prenatal c,:re in St. Paul, in addition to independent
practitioners. An inventory of agencies providing prenatal care, priruarily those
providing the opuons of care on a sliding fee, including the target populauon served
and the services provided, is included in Attachment A.
In April of 1992, the Prepaid Medical Assistance Program (PMAP) was implemented
in Ramsey County. There are currently four health plans available, including
HealthPartners, U-Care, Medica and Blue Plus. Individuals who are newly applying
for Medical Assistance are being placed into this system at the present time.
The system has improved, but there are still issues of denied services, confusion
regarding where a person can receive services and clients choosing not to seek
services due to the confusion. Special populations may need special attention to
initially maneuver through this new system. Saint Paul - Ramsey Counry Department
of Public Health will continue to advocate for accessible care for all populations.
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GOALS OF THE PROJECT
The overali goal of the projecu which will be supnorted through the Maternal and
Child Health Special Projecu grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBJECTIVES OF THE PI20JECT
A number of objectives have been established for the Improving Pregnancy Outcome
project including:
1. To make progress toward ihe goal of improving the overall 3aint Paul infant
mortality rate ( 9.4/1000 in 1995) with a special emphasis on African
American, Native American and Asian women.
2. To make progress toward che goal of reducing the rate of St. Paul low
• birthweight infants from 7.3% in 1995 to 4.0% by 1999 with a special
emphasis on African American, Native American and Asian women.
3. To conduct ouueach efforts to pregnant teenagers to increase the rate of first
trunester prenatal care ( 56% in 1995) in Saint Paul pregnant women under age
20 with a special emphasis on outreach to minoriry teens.
4. To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 6.2% in 1995 to 4.5%a in 1999, with a
special emphasis on pregnant teens and all pregnant African American, Native
American and Asian women.
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Board
through the Saint Paul - Ramsey Counry Department of Public Heatlh are low income
(less than 200% of poverry) Saint Paul women at high risk for poor pregnancy
outcomes, as defined by legislative pazameters. This includes, but is not limited to,
teenage and minority women residing in the aforementioned health planning areas
• (HPA's) of Ramsey County. The targeted HPA's were selected on the basis of their
historically high rates of infant mortality and late or no eniry into prenatal care.
The Refu�ee/Preventive Medicine Program at Saint Paul - Ramsey Department of •
Public Health will be using a very small amount of the Maternal and Child Health
dollars to partially fund their Improved Pregnancy Outcome Program which is
described below.
Goal - To improve birth outcomes of high risk low-income pregnant women in Saint
Paul trough early comprehensive prenatai care.
Target Poputation - Low-income prenatal women enrolled in Saint Paul - Ramsey
County Department of Public Health Refugee/Preventive Medicine Clinic.
Objectives -
1. Comprehensive multidisiplianary prenatal care will be provided to 100% of
prenatal clients enrolled in the Refugee/Prevenuve Medicine Clinic.
2. By 12/31/99, 85% of prenatais wili be rated "healthy" by their 3rd trunester as
measured by health status indicators.
3. Ongoing health education will be provided on an individual and small group basis
to 100% of all prenatal patients.
4. By 12/31/99, 95% of prenatal clients will initiate prenatal care during their lst •
trimester.
5. By 12/31/99, low-birth weight (less than 2500 grams) rates will be no greater than
0.1�.
6. By 12/31/99, the infani death mortality will be no greater than 0.1%.
Methods -
� Clinic and ouueach staff will be trained to provide culturally competent health
information.
• The outreach worker will provide health information which wi11 include proper
nutrition, elimination of alcohol and drug use during pregnancy, family planning
educarion and personal, financial and education pIanning.
• As part of case management and follow-up, an outreach worker wili make at least
six home visits to each prenatal client as part of the case management and follow-
up program.
• Arrangemenu for uansportation will be made through the patient's Health Plan for •
those who have uansportation needs.
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• Evaluation - The case manager will provide reports on a quarterly basis including
number of homevisiu and telephone contacts per patient. There will be quality
improvement monitoring of alll postpartums to meausre outcomes durin� their
pregnancy period including care and status of all delivered inf� '-
Trainin�/Eamerience of Staff -
Xia Lor Vang is an Outreach/Health and Education Assistant. She received inservice
training for Western medicines and treatment through the University of Minnesota
from 1981-1986. she also complete Health Interpreter Training at the Universiry of
Minnesota in 1989. Xia has worked as a nutrition assistant, interpreter and outreach ,
worker with prenatal patients and their families for many years. She has attended and
participated in many Hmong conferences and other in-services on cultural diversity in
the Twin Cities and has received high awards for her community work.
Florida Stevens is a Public Heaith Nurse receiving her Bachelor of Science in nursing
in the Phillippines in 1965. She joined the exchange program for nurses at the May
Clinic and St. Mary's Hospital in rochester, Minnesota from 1967 to 1971. She has
had extensive hospital experience as a staff nurse, manager/supervisor and project
coordinator. She joined Saint Paul Public Health in 1994 as a perinatal hepatitis
• coordinator and later as program manager for Refugee/Preventive Medicine Ciinic.
She has worked ciosely with prenatal clients in case management, assuring quality
outcomes since 1995.
Jonnalyn Belocura, M.D. is a Family Practice Physician. She graduated from
Medical School in 1991. Dr. Belocura came tothe University of Minnesota in 1993 -
1996 to specialize in Family Practice. She practices at Model Cities Health Center
and at Saint Paui - Ramsey County Depar[ment of Public Heatlh Refugee/Preventive
Medicine Clinic.
Diane Vankante, M.D. came to the United States in 1991 from Croatia. She took her
rsidency in Family Practice at I3orth Memorial Hospital from the Universiry of
Minnesota from 1993-1996. Dr. Vakante practices at Model Cities Health Center and
at Saint Paul - Ramsey County Department of Public Heaith Refugee/Preventive
Medicine Clinic.
Linkaees - The Refugee/Preventive Medicine Clinic at Saint Paul - Ramsey County
Department of Public Health provides on-site prenatal care. Clinic staff and the
ouueach worker work collaboratively with the public health nurses, WIC and Optional
Home Care for home visits and other patient needs. The clinic has agreements with
Bethesda Family Practice matemity staff and St. Joseph's Hospital for provision of
• patient deliveries. All patients records and updated progress notes aze sent to St.
Joseph's Hospital at twenty-eight weeks and prior to delivery date.
Reimbursement and Fees - The prenatai clienu are eligible for Medical Assistance, •
specifically U-Care Managed Care. the Clinic has been a U-Care provider since
BudEet - A complete budget and justification follows.
The remainder and majority of available MCH Special Project Funding beyond the
pre-block grant funding to HealthStart, Inc. was made available to community
organizations through a Request for Proposals process. This process and the target
population specific to each subgrantee selected, as well as the objecuves, methods, '
training/experienc of staff, linkages, reimbursement/fees and budgets will be described
in the following section tided, "Subgrantee Information".
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REFLTGEE AND PREVEiVTIVE CLII�IIC F1'iVANCIAL SUMi1�1ARY
1998 iv1ATERNAL A1VD CHILD HEALTH GRANT
Salaries/W Bene�its Maternal Child SPRCPH Totai Salaries
Health W/ Benefits
3 HmoneJL,ao HEA
Outreach Staff
� Travel Expense
3 � PF�N Case Mana�er
$ 7,517.00 $ 12,157.00
1,450.83
17,410.40
.2 Consultant/Z family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
REFUGEE AND PREVENTIVE CLI1vIC FINANCIAL SUMMARY
1999 MATERNAL AND CHILD HEALTH GRANT
n
U
FTE Salaries WBenefits
3 Hmong/Lao HEA
Outreach Staff
Travel Expense
.3 PHN Case Manager
SPRCPH
$ 7,517.00
1,450.83
Total Salaries
W/ Benefits
$ 12,151.00
17,410.40
.2 Consultant/2 family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
Finsum
$4,640.00
360.00
Maternal Child
Health
$4,640.00
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SUBGRANTEE INFORMATION
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SUBGRANTEE SOLICITATION PROCESS
To determine the agencies with whom a subcontract would be established, a
solicitation process was conducted beginning in May of 1997. 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 Public Health and an ad hoc subcommittee
including representatives of ffie Saint Paul - Ramsey County Communiry Health
Services Advisory Committee. ,
An evaluation form similar to the Minnesota Depar[ment 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 consistently
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, a summary list of the proposals received, and the evaluation
tool used are described in Attachment B.
SUBGRANTEES
Specific information on each of the projects to be supported through the Maternal and
Child Health Special Project Grant for improving pregnancy outcomes is provided on
the foliowing pages. Each project has specific target populations, objectives (which
include projected service levels), and methods, but all projects aze working towazd the
same goal of improving pregnancy outcomes for residents of Saint Paul. Copies of the
full proposals submitted by each of the grantees are available from Saint Paul Public
Health upon request.
The foliowing table indicates the projects which aze proposed for funding and for
which a complete program description follows.
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AGENCY
Model
Cities
Face to
Face
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr.l: Yr.2: Total: Yr.l: Yr.2:
62,430 31,215 31,215 60,132 30,066 30,066
80,000 40,000 40,000 7�,054 38,527 38,527
West Side 28,000 14,000 14,000 26,980 13,490 13,490
Health
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Start 409,042 204,521 204,521 393,902 196,951 196,951
(IPO)
Health •
Start 1,04�,820 523,910 523,910 1,010,070 505,035 505,035
(Adoi)
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesting funding primarily for outreach, education and tracking.
Health Start receives non-competirive funding as a pre-block grant pzovider to provide both
improved pregnancy outcome services through outreach and prenatal caze, and adolescent
health services through school based clinics.
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, MONTTORIIVG/EVALUAT'ION 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 regulaz basic throughout the
contract period.
Contracu will be written between Saint Paul - Ramsey County Department of Public Health
and the subgrantees indicating specific performance objectives and outcome indicators. The
contracts will oudine the subgrantee duties, reporting requirements, the monitoring
expected/performed by Saint Paul - Ramsey County Department of Public Health, and
evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective
tools will be used by the subgrantees to ensure that various aspecu of their program are
reviewed.
PROGRAM EVALUATION
Data will be sought from various sources, both nationaily and locally, including the Minnesota
. Department of Health, to monitor pregnancy outcome uends. This data will be used to
analyze the impact that the project has had on the goals and objectives for the project
throughout the two yeaz period. Since summary data is frequenUy available on a two year
delayed basis, progress toward the objectives may be di�cult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
* age of client
* race and ethnicity of clients
* residence of clients
* time of entry into prenatal care
* number of fetal deaths
* number of neonatal deaths
* number of infanu with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs are
appropriately impacting pregnancy outcomes. Based on this evaluation, services and programs
may need to be modified or refocused to maximize the likelihood that the objectives and goals
are met.
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. Subgrantee A- Aealth Start. Inc.
FIealth Start, Inc., as a Pre-Block grant provider of services, continues to receive Matemal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes.
Health Stazt, Inc. is an organization specializing in maternal, infant and adolescent health care
services to high risk popularions for disease or disability due to economic, social or medical
conditions, and to reduce morbidity and mortality in these populations.
Heaith Start proposes to continue to serve the �eds of low income and adolescent pregnant
and postpartum women. Health Start will provide multidisciplinary, comprehensive prenatal
care at hospital and school based out-patient clinics. Prenatal care offered to students in the
high schools facilitates early entry into prenatal care. This component of the Health Start
program addresses the City of Saint Paul's Pvlaternal and Child Health priority of improved
pregnancy outcomes, emphasizing adolescents and adult women of color.
TarEet Population - The clients targeted to be served will be those at high risk for prenatal
and birth complications who would, without accessible and high quality services, continue to
experience the multiple problems associated with high risk pregnancies. Since Health Start
provides prenatal caze in eight school based clinic sites in Saint Paul, adolescents, especially
minority adolescents, wili be a focus. In 1996 Heatlh Start saw 183 prenatal clients ( 70%
• were minority teens) in the schools for 762 visits. In addition, women who smoke will be
targeted for special prenatal or preconception intervenrions.
Objectives -
1. Health Start will provide comprehensive multidiscipiinary prenatal care to 500 adult and
adolescent women per year during 1998 and 1999.
2. Of women who deliver through Health Start, 55% will prenatal care in the fust trimester of
pregnancy and 85 % of women will initiate care by the end of the second trimester of
pregnancy.
3. No more than 10% of adolescents who are referred to other primary care physicians for
prenatal care will start prenatal care in the third trimester.
4. By December 31, 1999, low-birthweight (less than 2500 grams) rates will be no greater
than 9 percent and preterm birth rates (less thatn 37 weeks gestation) will be no greater than
10 percent.
5. Women who smoke will receive help with smoking cessation methods prior to or early in
conception.
• 6. The incidence of pre-term births and low-birthweight infants bom to adolescents followed
through the high school clinics wili be no greater than 10% and 7% respectively by December
31, 1999.
Methods -
• A futl range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 5aint Paul Ramsey Medical Center (Regions Hospital) and eight
school-based clinics. This wi11 ensure accessibility and acceptability for clients seeking
prenatal care.
• Prenatal and postpartum care wiil follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since 1967.
• All clients wiil be assessed for high-risk condiuons using the Edwards Risk Scoring System
or Minnesota Pregnancy Assessment Form 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-sryle behaviors such as
smoking, alcohoi, and chemical use, and nutruition wluch place women at risk for poor birth
outcomes.
u
• Clients will also be assessed for risk for HIV infecrion and individualized prevention !
education will be provided. HIV testing will be provided on site.
• All clients will receive a nntrition assessment, conducted by a Health Start nutafionist.
Clienu will be certified for WIC at the clinic visit. Clients with specific nutrition concerns,
e.g, diabetes management, anemia, weight control, etc. wi11 receive ongoing nutririon
education and counseling throughout their prenatal care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Family and relationship issues, fiousing and financial concerns, chemical use, and
issues of physical, sexual and emodonal abuse aze included as part of the assessment. Clients
with no source of payment for medical caze wilI receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and support
within the clinic seCting and wiII refer to outside agencies and services as needed.
• Patienu who smoke wilI be encouraged to counE back or stop during pregnancy through
access to self help information, such as Health Partners "smoking dragon" calendar, and
referrals. Intervention will take place eaziy in pregnancy or prior to conception, through
e@ucation given to family planners or patients receiving a negative pregnancy test from Health
Start.
• All clienu delivering through Health Start will receive family planning services for 24 •
months after the baby's birth. After this period, clients will be referred to another sliding fee
provider.
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• • I�Iealth Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency caze at St. Paul - Ramsey Medical Center.
• Infants of project clients will receive 24 months of pediatric care through Health Start's
pediatric component and if eligible, will be invited to ganicipate in one of IIealth Start's
intensive pazenting proQrams, including support services for infants e�osed to alcohol and
drugs in utero.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based cluucs and Saint Paul Ramsey Medical Center.
• Clienu in need of specialized medical service will be referred to St. Paul - Ramsey Medical •
Center or other providers as appropriate.
• Clients will receive individualized prenatal educauon in clinic and will be invited to attend
the weekly Aealth Stazt prenatal classes at St. Paul Ramsey Medical Center.
• Prenatal and postparCUm clienu 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 fmd the ciinic sites easily accessible, Health Start will provide
bus tokens or cab cards when needed.
Evaluation - Health Start will compaze birthweight, gestation age, risk level, and onset and
duration of prenaal care with a comparison group which dces not receive a multidisciplinary
modei of prenatal care. Numbers of women initiating prenatal care in each trimester will be
monitored, as well as rnimbers of pre-term births and low-birthweight babies. These can be
compared to city averages, as well as the comparison group of higher risk women.
Health Start wIll compare onset of prenatai care in sutdents seen in school-based clinics with
the average for adolescents cited in the Saint Paul Matemal and Child Aealth priorities. Birth
outcomes of the three groups will also be compared, whereverthe data from non-IIealth Start
patients can be released or gathered.
Health Start will track rate of second pregnancies within a two year span after delivery, along
with preconception and early concepdon interventions regazding risk behaviors and nutrition.
Information from evaluation efforts will be given to the qualiry assurance committee, the
quality management team, and the clinical management team. They may be used to formulate
• changes in intervention, to stimulate further analysis for underlying causes, or suggest areas
for a quality improvement project. Evaluation results aze disseminated to providers via
periodic provider meetings, clinic teams via team coordinator meetings, the Board of Directors
at semiannual boazd meetings. Tkey are also used to morivate stafff and to stimulate a worlc �
cuiture of continuous quality improvement.
Training/Eaverience of Staff - Heatt� Start has provided maternal and child health services in
St. Paul siace 1967, A21 Health Start staff aze professional health care personnel with special
expertise in maternai and child health or adolescence. The majoriry have had more than fve
years experience. AII staff aze evaluated at least once a year,
Staff aze supervised by the executive director, associate director, medical director, associate
medical director or team coordinators. Medicat provders aze credentailed according to
standards of the major health plans. Carol White, M,A., is ttie executive director of Health
Start and is responsible for the overal2 management and d'uecdon of the project, as well as
external retations and long-range planning. Dr. Chris Reif is the medicai director, is on the
staff of the Family Medicine Department at St. Paui-Ramsey Medical Center, and is
responsible for overall medical direction. Dr. Carol Ball, on the staff of the Obstetrics and
Gynecology Deparanent at St. Paul - Ramsey Medical Center, is the associate medical director
and works with the medical director to provide consultation on OB/GYN practices, as well as
providing clinical supervision ;: r OB/GYN nurse practitioner staff. They are advised by a
clinical management team maue up of represeratives fr:�m the various professional discipiines,
in prenatai and adotescent services of HealtFt Sta Ric: 3rd Duffin has bee;� the assoeiate �
direcior for t1u years and manages the school ba .3 cii: ics. Jeanne Ranc��e, PNP, pHN, is
the new Ciinical Services Coordinator, overseeing clinicR! senicPC fc: adolescent, prenaial,
and pediatric care. Jeanne has been with Healt: 5��- _;�� ye �
Summary of qualifications and experience of key staff are attached.
Linkaees - geaitfi Start has well developed linkages that include a w4de variety of health
care providers, educational programs, and social service agencies. This referrat network
allows staff to individualize care plans to meet ihe spec�c needs of each client. New linkages
and zeferral sources aze identified or developed as needs arise. Healih Start receives inkind
donations of space and telephones from Saint Pau2 Raznsey Medical Center. Physicians and
midwivesaze contracted from Ramsey Famity Clinics, who aiso provide back-up for prenatal
care.
Heattti Start works coIIaboratively with Ramsey County public Heatth nurses to extend
services to preganant women in the communit� public health muses meet reg�arty with
HeaIth Start to identify clients needing home-based services and to share information that wffi
enhance patient care.
At delivery, new parenu are referred to Health Start's pediatric clinic. Well-child and acute �
care visiu, augmented by interdiscipiinary services, aze provided. Eligible clients are also
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� referred to the Befriender Program, run in collaboration with Children's Home Society, the
Panrzership Program, a collaboration with Saint Paul School's Early Childhood and Family
Educauon (ECFE), or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, andlor group education for high risk
parenu.
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When psychosocial or health care needs are iden�ed that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), wriuen 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 minimi�ing duplication
by collaborating with many agencies and programs. Health Start will maintain aff'�liations with •
and/or refer to the following agencies and task forces (partial list only}:
Children's Home Sociery, Early Childhood and Family Education (ECFE), HouseCalls,
Frogtown Family Resource Center, Raznsey Clinic Associates, Ramsey Couty Human Services
Family Preservation Project, Saint Paul - Ramsey County Department of Public Health, rondo
Family Resouce Center, Neighborhood Health Caze Network, Saint Paul Public Schools, St.
Paui-Ramsey Medical Center/I-Iealth Partners, PACER Transition to Work Project, 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. Ciients are billed, however, by Saint Paul-
Ramsey Medical Center and Ramsey Clinic for hospital charges such as labor and deli�ery and
selected tests and procedures.
MCH funding allows Health Start to provide prenatal caze for clients who have no third parry
source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. FIealth Start has contracts with all of the PMAP providers.
Any other applicable third parties aze billed whenever possibie. Insurance revenue pays for
approximately 25 % of Health Start's prenatal and adolescent health sservices.
Health Start provides family planning care to clients for 24 months after 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 Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium.
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Health Start Key Staff
Carol White, nLa is the e�ecuti�e director of Heatth Start, Inc. She w•as hired in June,
1996, by the boazd of directors. She has a masters of arts from Stanford L'niversity� in
early chiidhood education. She has five yeus experience in health care management, ten
years totat management experience in non-profit mana�ement. She has a�ritten and
pubIished training materials and cuiricula on child abuse and family violence.
Christopher Reif, MD, MPH has been the medical director of Health Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey b4edical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currentty on the advisory board of the American Medicai Association's Cruidelines for
Adolescent Prevention Services (GAPS).
Richard Duffin, MA has been the associate director of Heatth Start since 1994. He is
responsible for school based ctinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty yeazs experience in managing
human service organizations, with special experience in mental health and developmental
disabilities.
�
Jeanne Rancone, PNP, MPH is the cfinical services coordinator for Heaith Start. She is •
reponsible for maternal child health, family planning and adolescenY service clinical
objectives as well as overall coordination of clinical services and standazds in a multi-site
environment. She has 14 yeazs of clinical nursing and public health nursing, and ttuee
years experience at Heaith Start as a pediatric nurse practitioner and team coordinator at
H'ighland High School clinic.
•
.
�
•
.
HEALTH START, INC.
MATERNAL AND CHILD HEALTH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 1998
$228,075 $135,182
AHNUAI PR09RAM PROGRAM MCfi
LINE REM EXPENSE SALARY Fre suo�er suo��r
CLINICAL SERVICES COORDINATOR
NURSE PRACTITIONER
NURSE PRACTITIONER
NURSE PRACTf170NER
NURSE PRACTITONER (AGAPE)
NUTRITION�ST
NUTRITION�ST
NU7RITIONIST (AGAPE)
NUTRI7tONfST (ARUNCa70N)
HEALTH E�UCATOR
HEALTH EDUCA70R (AGAPE)
HEAITH EWCATOR
SOCIAL WORKER
SOCIAL WORKER
CASE MANAGER (AGAPE)
INTERPRETER
GUNIC CLERK
MEDICAL ASSISTANT
MEDICAI ASSISTANT
$49,712
$52,312
���
$45,760
$45,760
$46,738
$4�.766
$35,360
$35,36�
$33,821
$33,821
$37,045
$41,766
$44,9��
$32,777
$27, 373
$27,602
$2�,80�
$2�,59�
0.50
0.70
0.6�
0.20
0.20
0.60
0.20
0.15
0.15
0.10
0.15
0.20
0.10
0.10
020
0.10
0.80
0.70
0.10
$24,856 $14,914
$36.618 517,760
$28,167 $14,084
$9,152 $5,034
$9,152 $5,49'I
$28,043 511,217
$8,353 $7,518
$5,304 $3,182
$5,3Q4 $3,182
$3,382 $3,044
$5,073 $5,073 .
$7,409 $3,704
$4,177 $3,341
$4,497 $4.497
$6,555 $3,933
$2,737 $1,916
$22,081 $15,457 �
$15,055 $10,539
$2,159 $1,295
SUB-TOTAL SALARY
FRINGE BENEFfTS �d 20°!0
CONTRACT SERVICE
RAMSEY CLtNiC PHYSICtANlNURSE MIDWIEE
THREE OB/GYN PHYSICIAN CLINICSNYK @$472 X 42 WKS
N!O FAMIIY PRACiiCE CUNICSIWK �$286 X 36 WKS
ONE CNM CUNICNJK �$160/CLINIC X 42 WKS
PATIENT CARE
LAB. ULTRASOUND, X-RAY
COURIERSERVICE (INCLUDINGAGaa�
OTHER EXPENSE
MEDICATIONIDRUGS (INCLUDING ARLINGTON)
MEDICAL SUPPLIES
OFFICE SUPPLIES
PRlNTlNG/DUPLICATiNG
PATIENT TRANSPOR7ATION
TOTAL DIRECT ExpENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAI MCH GRAHT REQUEST
TOTAL MATCH � 25%
MATCH = 50%FPSP FUNDS, 50%MEDICAL ASSISTANCE REVENUE
��1�(Oa�
MCH0898
$45,615 $27,036
$59,472 $14,868
$20,592 $5,148
$s,72o $ti ,613
$30,000 $7,500
$9,982 $2,104
$14,000 $3,500
$5,150 SO
$1,575 $0
$500 $0
$2,000 $0
$423,681 $196,951
$67,789 $0
$491,470 $196,951
$196,951
$49,238
a�-�oag
• Sub�rantee B- Face To Face Aealth And Counseling Service. Inc. - Project Connect —
Prenatal Access Proiect
Face _� Face Health and Counseling Service is proposing to continue its program aimed ai
reaching high risk, preenant adolescents with comprehensive first trimester prenatal care
services, which have resulted in a higher rate of healthy birth outcomes. Face To Face has
historicaily been a strong supporter of a comprehensive service approach for high risk youth,
and is continuaily moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach effortsand case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with ,
case manaement has proven to be very successful in (1) improving rates of fust uimester
prenatal caze and reducing low birthweight rates; (2) providing social support and linking
clients to other needed support services; (3) ensuring clients receive high quality, continuous,
and comprehensive prenatal care; (4) involving clients in self help, the prenatal education
program, and in receiving needed group support, and (5) continuing to support the
involvement of pregnancy partneres during tbe pregnancy. This year, staff hope to also (6)
increase ouueach efforts, especially among young women of color, and (7) strengthen ties to
the SafeZone Drop-In Center.
• Target Pooulation - I.ow income adolescents, fifty percent of which will be youth of color:
African American, Native American, Hispanic, or Asian. Fifty percent will be from the
Eastside, primarily Dayton's Blnff, ten percent from Summit University and Thomas Dale,
and ten percent from Riverview neighborhoods. Half will be 17 years of age or younger.
OUTREACA AND CASE MANAGEMENT
Goal - To strengthen our seamless, integrated service model, reduce the overall rate of late
(third trimester) or no prenatal care and to conduct outreach to increase the fust trimester
prenatal caze, especially among minioriry teens.
O.b�'ectives -
i. To use our new holistic intake process for assessing needs in all areas of the lives of our
clienu and identifying strengths they already possess to address these needs.
2. To increase the coordination of client cases through improved administrative procedures and
oversight.
3. To increase our current efforts to provide outreach to youth of color, ensuring that at least
• SQ percent of the prenatal clients aze youth of color - African Amercian, Native American,
Hispanic, or Asian.
Methods -
• An outreach worker will meet immediately with each new prenatal client to offer help with
immediate issues, trasport clients to other services, make home visits, help with crises and
advocate for other services.
• Youth outreach workers will provide street outreach for homeless youth and will connect
young pregnant women with Face To Face's prenatal program.
• putreach workers will provide intensive case management for prenatal clients fielping to
organize and advocate for needed services. �
• putreach workers will build linkages with other service providers to gain greater
accessibiliry and establish a broad network of resources for clients.
PRENATAL CARE
Goals - To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian, and Asian teens.
Objectives -
1. To provide 190 pregnant adolescent and young women -- 135 of whom are under the age of
21 -- with holistic and comprehensive prenatal care services which are accessible, appropriate,
effective and which are coordinated with other community resources and integrated with the
clinets' individual life situarions.
2. To enroll 50 percent of the 135 clienu who are under the age of 21 in prenatal caze
services during their first trimester of pregnancy.
3. To begin to affect positive birth outcomes in all clients, as measured by low birthweight
rates of less than 6.5% for all age and racial groups served.
4. To improve attendance at all Prenatal Classes, with at least 50% of those enrolled in pre-
natal services attending.
Methods -
• Free pregnancy testing will be offered four days a week.
�
•
• An outreach worker will provide counseling after pregnancy testing resuits and connect
ciienu with prenatal care if necessary. •
• Pregnancy test will be provided "on the streets" as well as at a clinic site.
q� -(o��
• • A team approach to comprehensive sensitive prenatal care services will be provided with
team members meeting before and after weekly prenatal clinic in order to insure effective case
planning.
SOCIAL SUPPORT
Goal - To improve the health and wellness of pregnant adolescents during pregnanCy through
increased social and emotional support and mental health services.
Obiectives -
1. To increase pre-natal support services to pregnancy and aprenting partners of pregnant
women.
2. To provide mental health counseling for prenatal clients and their pregnancy and pazenting
partners who are struggling with mental health issues, inctuding chemical use, depression,
and abuse.
3. To link all the prenatal clients who deliver through Face To Face with on going primary
medical care for themselves and their infants, and social services for the infant, mother,
and pregnancy and parenting partners.
• Methods -
• Mental health assessments, short-term counseling, peer support networks will be provided
as well as a plan for estabiishing and/or maintaining emotional support for the preganant
adolescent and their pregnancy and pazenting partners.
Evaluation - Face to Face maintains a database management system, which collects data on
client registration (demographics); health histories; the visits including diagnoses, lab tests and
procedures; follow-up information on positive lab results; a prenatal follow-up sheet that
collects intake and foliow-up risk scoring, pregnancy outcomes in terms of birthweight and
other outcomes, and information on clients who did not deliver through Face to Face. Also
information on outreach visits is coilected including length of time with client and reason for
visit. From these data we can track both process and outcome measures. Follow-up
information on the status of those who "dropped out" of Face to Faces's prenatal program is
maintained, and pernnits the agency to bet[er ensure that no client will be"lost to follow-up".
Finally, good pregnancy outcome data is avaiiable, allowing us to identify variables which
might lead to poorer outcomes (infecrions, drug use, etc.)
Trainina(Experience - The outreach worker is I.aura 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 years before joining us.
Tuesday Spinks is a second prenatal outreach worker who is part-time Matemal and Child •
Heatth 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 fanuly worker. Tuesday is a Master's candidate in
counseling.
The Ob/Gyn nurse practitioner is Bazbara Taylor, who came to Face To Face in January of
1994. Barbara worked in HeaIthStart's school based clinics and prenatal clinics for over IS
years, and for two years worked with the Adolescent Health Program at the University of
Minnesota. Immediately before coming to Face to Face, Barbara was working with the Youth
and AIDS Project and Lutheran Social Services mini-clinic in an alternacive school.
The family practice nurse practitioner is Sue Garger, who has been with Face To Face since �
June of 1989. She had been Director of Heaith Services at Carleton College and Saint Mary's
College before joining the Face To Face teazn. She is a graduate of the Nurse Practitioner
Program at Bringham Young University, has a BSN from Winona State TJniversity, and is a
Certified Adult Nurse Pracuuoner.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Ramsey Nurse Midwives. Both are backed up by their
respective organizations, and both bring many years of experience providing prenatal care
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 Sainc Paut Public Schools "rurther,
in the Spring of 1993, Face To Face and Saint Paul Youth Ser�;c;: Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buiIding.
The Face To Face Prenatal clinic has buiit strong working relationships with a number of
other relevant maternal and child health service providers. These incl�de: Maternal Child
Pmiect, Raazsey County Public Health Nurses, Ramsey Counry Child ProtecUOn, WIC,
MELD, Children's Hospital Pediatric Clinic, Iiealth Start's Harding Clinic, Ramsey County
SELF and Minor Mothers Pmgrams, and the Diabetes Clinic at iTnited Hospital.
Clients aze referred for ultrasound, non stress tests, biophysical pxof�les and colposcopies. In
cases of refenals, the nursing staff contacts the refemat 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 refemdl appointment. If transportation to the referral appointment is an issue for the
client the outreach worker will either provide bus tokens, taxi vouchers, or a ride - depending
on the situation. Follow-up is done by ciinic staff to ensure that the client has carried through
on the referral.
Additional liakages wi2t be developed with tiie Fatfier's Resource Center and other agencies
which work with adolescent males and other pazent partners.
Reimbursement and Fees - The vast majority of our clienu have been eligible for Medical •
Assistance (and prepaid Medical Assistance).
q�l -io q,�
� If a client is not eligible for any thircl party reimbursement, she is then charaed fees according
to our sliding fee scale. For clients below 100% of poverty, there is no charge. 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 jusrification for the Face To Face program follows.
�
•
Acv�sta svocsr useevssr __ •
MATERNAL 8 CHlLD NEALTHFUNDINC3
For the Year 7998
TOTAL FUNDING SOURCES
PROJECT MCN MCH ]RD PARTY MARCX OF SHELTERING CI7Y/CNTY TO BE
FTE SACARIES BUDGET FTE RECUEST INSURANCE DIMES IN-KINO ARMSFOUND GRANTS R1USE0
020 Projec[ LoorCinata, 7.ROtx�sart 5,908 0.08 2,3B$ • 3,545
�.80 OutreachWOrker,T.Spinks 19.521 OSS 73,42p 6,1�0
t.00 OutreaCtiWOrka.new 23,775 0.50 77,588 tt,58B
0.35 Nurse Pract/Clinic Dir., PNelson 16,709 t0,000 6.709
0.3G MeGical (a6 Tecnnican. P.ThrusM 7,063 5.000 2,063
030 Metlipl Auisbnt, E.Kartekaas 6,327 5,400 ��3Z7
020 MeEiplASSistant,L.Bahn 4,717 3,ppp �
020 RN,N.DeWaiC 6,573 5.000 ��573
OdB SuOemsioNASSO0.Dtr,R.Merrigan 7,958 - 4,958 3,U00
020 OfficeManageqJ.Cndtls , 5,530 5.530
0.35 RKeO��st M.SWItz 5,552 5.652 •
O.4Z gillingManaper.T.Patregnani t5,703 15,�03 -
0.4U BiOingqu6tan4LFis�er 8,920 g,9Zp
Q.10 Sacial Warker, K.BuQiey �,017 O,Df7
0.03 Mediwl0'vecWr 2,%6 - Z,9fi6
0.03 VolunteerCOOrCinaWr.S.ESkierka 886 �
741.026 2T,371 77.729 3.000 . 886 /6.806 2t,233
FRINGEBENEFIT5�.78% 25,385 4,927 t2,9tt 540 - t59 3,025 3,822
CONSOLTANTS/CONTRAC7 STAFF:
NuNtion�st 4,000 4,000
RamseyClinicP�ysidans 14,OU0 t4,000
Unitetl Family Practice Physicuns 72,000 12,000
Inlems & Volunteers 8,500 8,500
STAFF TRAVEL: 750 mtles per mo x
t2mo'Sx1S5faRx.3tpermde B37 $sy 2
GUENT TRP.VEL; indutles Eus loken3
antl w05 as neeEeE. 600 �
CLIENT EMERGENCY EXPENSES 800 ��
SUPPLY COSTS:
W � tesLS 8 lab supplies 7,�00 5,000 2,0�0
MeEicalB exam room supplies 2,000 2,000
Gene2/oRCesupphes p,i00
2,500
PageR 8 supPlies 60� 600
Client UIt2 SounCS (5350 x fi5 Uients) 22,750 ?2,750
PRINTING 8 POSTAGE 7,800 - t,800
MALPRACTICE INSURANCE t,500 - � �
SubWfal S 245,297 S -32.880 S 170.6a0 5 3.540 5 3t,250 5 t,045 S 35.d37 S 30.530
FACILRYCO5T3 t4.T78 _ __7,900 ' " ' S.000 7.878
Indutles tUephane. utqities, janROtial, tr9sh, -
Euiitlin9 �Oair & supOb. ��. �suran[e, -
tefephone system 8 copier Wse, anC --
mamtenance person. - -
AUMINlMGMTlOVERXEAD 3{,g{Z .- 3,787 7,360 - . - B 23215
Ancfudes qeneral atfice suppty, 0/O and - --
fieUiryinsuranee,pasiape,acmunting, - - --
annua! audik �ntl2isin9 8 prcflrdmmer _ - -- -
wnsuipn4 anE atlminisintive and - -
ma�a emmtSWftanANeirMn e�eneft6. -- - -
TOTAL PROJECTED COSTS S�d,35T S 38,527 S 112,000 S 3.540 S 37,25� S l,045 S 46,43! S 81,
rr qqpws etrknnrn9s
a�-�aa�
u
u.is�o s�oast �ecan�sr
MATERNAL & CHfLD HEALTH FUNDING
For the Year 1999
TOTAL FUNDlNG SOURCES
PROJECT MCH MCH � 1R0 PARTY MARCX OF SXELTERING CITYICNTY TO BE
FTE SALARIES BUDGET FTE REQUEST INSURANCE GINES IN-K1ND ARMSFOUND GRANTS RpISED
010 Praject CooMfnamr. T.ROCinson 6,086 0.08 2,434 . 3,651
0.80 OubeaN Worker, T.Spinks 20,106 0.55 13,823 5,zgg
1.00 OutreachWOrker.new 23.8)0 0.67 11,247 12.623
0.35 Nurst PrdNCliniC D'u.. P.Nelson 17,210 t0,000 7310
0.30 MeEieal LaD TeUfniaan, P.TTruSh 7,275 - 5,000 z,275
0.30 MetlinlASSisian4E.Kanekaas 6.517 5.0�0 t,517
020 Medicai Assistant, L.9ohn 0241 3,OOD 7,24t
020 RN. N.DebVaiE 6,T/0 5,797 �,573
0.18 Supervis�ONA55ac.Drc, R.Mertigd� B.1% 5.196 3,000
0.20 ORCe Manageq J.C�dES 5,696 5,696
0.35 Recephonis4 M.StoIC 5,821 5,821
0.42 Bilimg Manager, T.PaNegnani 76,176 76,176 �
0.40 BiilinpA55istan4L.Fisher 9.187 9.187
0.70 Social Wo�er, K.Buckley d,738 6,138
0.03 Medicai D�rector 3,055 3,055
0.03 Volunteer CdoMmaror, S.ESkierka 913 9/3
165256 27,504 73.326 3,000 • 913 17,956 22,558
FRINGE BENEFITS � tBY. 26,146 4,951 73,199 540 - i64 3.232 0,060
CONSULTANTS/CONTRACTSTAFf:
NuMtiomst 4,100 y,000 700
Ramsey Clinic Phys�cians 14,400 14,000 . 600
United Fam�ly Proctice P�ys¢ians 12,300 12,000 300
Intems b Volunteers 9,000 g,500 5U0
STAFF TRAVEI: 150 miles per ma z
12 mo's z t.5 staR z.31 per mile 837 562 275
CLIENT TRAVEL: Inclutles bus /okens
anC nDS as neeaetl. 650 650
CLIENT EMERGENCY EXPENSES 850 850
SUPPLY LO5T5:
La7 tests 8 IaC supplies 7,500 5,000 p,500
Metliwl S exam room supplies 2.200 Z,000 200
General �ce suOP�ies 2,300 p,300
Pagers 8 supplies 600 5pp
G�ent UNra Sounds (5350 x 65 ciknts7 22,750 22,150
PRINTING 8 POSTAGE 7,800 1,800
MALPRACTICE INSURANCE 1,550 400 1,t50
SuDWta� S 252,239 E 33,017 S 712.525 S 3,560 5 31,250 5 1.077 5 35,486 S 35.343
FACILITYCOSTS i5,134 1,900 - • • 5,000 8234
Includes telep�one, utlhUes, janitorial, tras�,
buAGing repair 8 5u0C�Y. �xes. i05uance, -
tUepl�ane system S tGpier kau, and
maintenance ptrson. _ -
ADMINlMGMi/OVERHEAD 35,314 3,810 7,600 _ _ • 6,000 24.70a
InGUAeS Oeneral otflte SuOD�Y. D/0 and - '
fideliry insu2nce, posWge, accou�W+p, -
annual autlit, funErai5in0 6 pra9�mmer
consuttan4 anQ administrative and "
mana ementstaHanGNeirhin eDenefiLS.
TOTAG. PROJECTED COSTS S 302,887 S 38,52T S 116,�25 S 3,540 S 3t,250 S 1,077 S 46,488 j 87,881
bal ptlu� aktM1ntlNe
Q� - ia�.g
• Subsrantee C- vlodel Cities Health Center. Inc. - Improved Pregnancv Outcome
Proeram
The goal of this project is to improve birth outcomes au,. �� the target area population by
focusing on early entrance into coordinated, case-managed clinical services which offer
preventive education. The fundamental goals of this Pregnancy Outcome Program are to
improve birth outcomes and neonatal development, to increase accessibility to early prenantal
care of underserved hiQehrisk African Americans and Hmong females of childbearing ages and
to reduce the over-all rnte of late (3rd trimester or none) prenatal care.
Target Population - This project will serve Afican American, Hmong and European
American women who reside in the Summit- University/Thomas-Dale communities or the
surrounding area who are high risk underserved women and teens. The intent is to reach
women who aze not accessing services or need addirional supports to insure pregnancy
outcome either through clinical, educational, support, or outreach services.
Strateg,y I: Case Finding and Community Outreach
Objectives -
• 1. By December 31, 1999, to identify and collaborate with at least ten community
organizations which provide community housingfshelter, food and clothing assistance,
chemical dependencc treatment and education to high risk African American and Hmong
female community residenu.
2. By December 31, 1999. to increase the overall rate of prenatals receiving prenatal care in
the first trimester fram 50 percent to 65 percent. These objectives remain consistent for
teen prenantals. By December 31, 1999, toincrease the rate of Hmong prenatals receiving
prenatal care in the first trimester from 20% to 45 % and increase African American entry
from 50% to 65 % in ihe first trimester.
3. By December 31, 1997, to increase number of hospital and home visits of African
American prenatal patienu and teens, to 200 per year, to ensure compliance on early
prenatal care, well child check and two week post partum check.
Methods -
A. Two Outreach Workers will assist in casefinding and community outreach/education
activities. A 3 FTE Hmong Outreach/Interpreter will work direcfly with the Hmong
community. An additional .4 FTE Health EducatorlOutreach Worker will work with the
• African American community. The outreach workers will foliow-up with positive
pregnancy tests, aid pregnant teens and single female heads of household in accessing
prenatal care by arcanging for van transportation, bus tokens, cab fare or managed caze
transportation. Outreach workers wi1I be an advocate and link patients with public •
assistance or Minnesota Care to ensure access to prenatal caze.
$. Collaboration with public housing, churches, public health, hospitals, community
clinics, youth serving, and other African American organizations will occur by the Health
Educator/putreach Worker to reach high risk underserved women aad teens, follow-up on
women who have been lost in the system, and to assist in accessing clinical, financial and
social suppori services. The Health Educator/Outreach Worker will develop a tracking
system to follow referrals for social service needs.
C. Collaboration with public housing, public health, hospitals, community clinics, youth '
serving and other Hmong community organizations will occur by the Hmong
Outreach/Interpreter to promote first trimester entry for prenatal care, the importance of
immunizations, well chiid care, family planning, and parenting education. The Hmong
Outreach/Interpreter wil1 foIlow-up with womer. inst to foIIow-up a��d assist in accessing
clinical and social support services at the Iiza!ai �en�;,r. T'ne Hmong
Outreach/Interpreter wi11 network with the Refu�ee Tssk 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 and
Saint Joseph's Hospital.
D. Improve referral of services with Mode1 Cities Famity Development Center for social •
services, mental health, stride, home-based chemical health treatment, family's first, and
early childhood services by conducting a social history on 100% of prenatal clients and
developing tracking system to ensure social needs aze being met.
E. To increase community awareness of early prenatal care by airing 10 radio spots on both
African American and Hmong American local radio stations by December 31,1999.
Submit two columns to Asian American Press, Frogtown Forum, Native American
Newspaper and Insight News explaining the importance of early prenatai care by
December 31, 1999.
Strategy II. Clinical Interventions
Objectives -
1. By December 31, 1999, to provide comprehensive prenatal clinical care and edncation to
200 women of childbearing ages.
2. By December 31, 1999, to incrase average frequency of prenataY appointmems to seven (7)
appointments. Emphasis will be placed on beginning prenatai care in the first trimester and
continuing care through family planning education foilowing labor and delivery.
3, By December 31, 1999, to provide Engiish and Hmong speaking Lamaze Childbirth •
Education Classes or ongoing health education to at least 65 percent of prenatals on proper
nutdtion, effects of aIcohoi, tobacco, and other drug use during pregnancy, personal
�� - io��
• empowerment, expectations of labor and delivery, personal finances and education, and
coping with increased family size and responsibilities.
4. By December 31, 1999, to provide one-to-one counseling on smok;ug cessation to 100% of
all prenatal smokers and to offer smoking cessation classes 3 times per yeaz.
Methods -
A. Case management and tracking services will continue for 1Q0 percent of Hmong and
English speaking prenatals to ensure appointment compliance, positive birth outcomes,
reduction of low and very low birth weight rates (LBW, VLBW), and reduction of infant
mortaliry.
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 cluldren.
C. Linkage with Model Cities Family Development (MCFDC) will be provided for social
service assessmenu of ail 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 patterns.
D. Referrals to chemical health education programs and counseling services will be provided
to all prenatals and to family members with chemical abuse concerns to encourage
chemical abstinence. Referrals for Rule 25 chemical health assessmenUevaluation, case-
managed entrance for treatment seroices, enrollment in community aftercare programs,
and provision of chemically free housing for receovering women and their children will
also be provided.
E. English and Hmong-speaking Lamaze Childbirth Education Classes and ongoing health
education will be provided to prenatals on proper nutrition, reduction/elimination of
alcohoi, 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. Coniinued collaboration with a consortium of health care services.
III. Reduce Barriers to Care Preventing High Risk Women from Receiving Ongoing
Education and Prenatal Caze Services
Obiectives -
.
i. By December 31, 1999, to enhance access to caze by providing van transportation for
prenatat care, immunizations and welt child appointments for females and their children. •
2. By December 31, 1999, to offer continuous tracking and conffrmation of prenatai caze in
addition to immunizarions, well cuud checks, and ongoing education by systematic
schednling, bi-weelcly inter-disciplinary team meetings and pmvision of home visits to higfi
risk women to ensure medical compliance for females and their children.
3. By December 31, 1999, work closely with managed caze entities on culturally appropriate
services patient understanding of policies and procedures, and follow-up in changes in
ctinic assignments and incentive programs.
4. By December 31, 1999, to ensure enrollment of 100 percent eligible uninsured prenatals in '
Medical Assistance/Minnesota Caze or access to use of sliding fee scale for those who are
uninsured.
5. By December 31, 1999, to develop brochures and educational materials in Hmong language
on the following topics: nutrition, acute sick child (diarthea and fever), newbom care,
growth and development, vision and hearing, and dental health.
Ojectives -
A. Transportation to all prenatal appointments and/or cfiildbirth education activities will be •
provided to any female enrolled in clurical care, Lamaze cYuldbirth education sessions, or
2:1 patient nutrition, sociat services, or reIated services.
B. Collaboration with commnniry organizations, associations, and neighborhood groups wit2
be provided to emphasize early first trimester entrance to prenatal caze. When needed
perinatal clients will have access of health center van or taxi services, anQ enrollmeat into
Medical Assistance and MinnesotaCaze managed caze programs. All needed enrollment
inforniation 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 retum prenatal visit within two weeks of pregnancy confirmation
to ensure ongoing early prenatal care. 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 wiIl be provided through Model Cities Family
Development Center (MCFDC) to provide food, clothing, and housing/furaiture assistance
to prenatals as weil as home visits by sociat workers.
E. Hospital tours will be pravided to communiry residents to dispel fears of higfi medicat
technology and *nin;mi�ation of self control and direction in the medical delivery system.
Oualitv Assurance And Evaluation Methodol� - Quarterly perinatal audits will be .
performed by the Program Coordinator to assess case finding efforts and compliance with
prenatal care/appointment maintenance. Follom-up conuacts (home visits, telephone, and
��-1oa�
• 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 care and additional community linkages. !�uarterly
chart reviews will be performed to monitor number of patient visits, entrance to care,
education visits, and outcome data. Perinatal patient satisfaction surveys will be completed
annually to determine satisfac6on with clinical and social services, to explore unmet client
needs, and to deteimine successful methods of case-finding.
Perinatal statistics aze managed by the Program Coordinator. These statistics include
monitoring of indicators known to be principal factors such as low birth weight and infant
mortality rate. Fetal deaths, SAB, and low/very low birth weight are 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.
Trainin�/Elmerience Of Kev Staff - 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 suppore s[aff. G�itural sensitiviry 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/sociallcommunity services, and
improved provider/patient relationships are encouraged. Monthly staff in-services are
conducted on a wide variety of health care 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.
Linkages Between Proposed Proiect And Ongoing Perinatal Deliverv - Ongoing case
management coordination, multi-disciplinary service delivery, expanded support and education
services, and provision of transportation are key components of the proposed perinatal delivery
system.
Model Cities Family Development Center piays a significant role in supporting prenatal
females, infants and children. Social support services aze provided to ail women, children,
and their families. The volunteer based program Supportive Companion provides ongoing
befriending and support to women throughout pregnancy, labor and delivery.
Reimbursement and Clinical Fees - Model Cities reimbursement and clinical fee system bills
MinnesotaCaze, Medical Assistance enudes and private insurance for the clinical costs of
health care. Uninsured patients can apply for sliding fee, which can discount medical care
from 20 percent io 80 percent, depending upon family size and income.
In 1996, 88 percent of Model Cities prenatals were enrolled in Medical Assistance and 5
percent had insurance upon entry. Of the remaining 8 percent that were uninsured at the tiuie
. of entry, all became eligible for MA after confirmation of pregnancy. The remainder of
provider and staff salaries is covered by federal, state, county, and city grants.
•
�� - l��
VII. Improved Pregnancy Outcome PROGRAM BUDGET,1998-1999
The two-year project budget total $78,672, $60,298 of which is being requested in MCH
funding and the remaining $18,374 to be covered by Model Cities Health Center
(MCHC).
A. LINE ITEM DETAIL:
Personnel
Hmong Ouveach
Worker (3 FI'E)
Health Ed/Outreach
Worker (.4 F7E)
Famity practice
Physician (.1 FTE)
Nurse Prectitioner
(.I FI'E)
Program Coord.
(.I FTE)
Subtotal
• Fringe Benefits/
FICA:(12 percent}
Suppiies:
Clincal
Medical
Pharmacy
Laboratory
O�ce
Rewrds(I'racking
Subtotal
Other Operating
Expenses:
Patient Transport.
Patient Education
Printing
Postage
Mi(eage (local)
Telephone &
Beeper
Subtotal
, Total Direct Costs:
Indirect Costr @ 10
percent
• TOTALPROJECT
COSTS:
Yr.I Yr.I Yr.I
MCH MCHC Total
7,313 7,313
8,957 8,957
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272. 25,787
4,293 1,380. 5,673
-0- -0- -0-
-0- -0- -0-
-0- -0- -0-
300 ]00 400
A- .0- �_
300 100 400 �
],000 450 1,450
750� ]00 850
500 -0- 500
-0- 50 -0-
750 -0- 750
300 -0- 300
3,300 600 3,900
27,408 8,352 35,760
2,�41 835 3,576
330,I49 59,iS7 539,336
Yr.II Yr.II Yr.II
MCH MCHC Total
7,313 7,313
8,957 8,95'7
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272 25,787
4,293 1,380 5,673
-0- -0- -0-
-0- -0. -0-
-0- -0- -0-
300 100 400
-0- -0. -0-
300 100 400
1,000 450 1,450
750 100 750
500 -0- $p0
-0- 50 -0-
750 -0- 750
300 -0- ' 300
3,300 600 3,900
27,4Q8 8,352 35,760
2,741 835 3,576
530,149 39,187 539,336
Yr. I & II
Totat
14,626
19,502
8,320
4,224
6,490
51,574
11,346
-0- �
-0-
-0-
S00 • ,
-0-
800 ;
2,900
1,700
1,600
100
1,500
600
7,800
71,520
7,152
S7S,672
�,� - �Qa�
• Suhgrantee D- West Side Community Health Clinic - Improving Pre�►ancv Outcomes for
High Risk Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul Hispanic and South Fzst Asian populations by providing outreach, tracking all posirive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by eusting West Side Community Clinic staff and services. The
clinic offers comprehensive health caze services on a sliding fee scale. This pmject will give
Hispanic and Southeast Asian families greater access to a full array of services inciuding well
child caze, immuni2ations, family planning, pazenting, and STD services as well as linkages
by refeaal to over fourteen other community agencies.
Target Ponulation - This project will target pregnant Hispanic and South East Asian women,
ages 13-35 years, in specific census tracts in Saint Paul that have the highest concentrations of
Hispanic and South East Asians.
Obiectives -
Reduce overall rate of late (third trunester or none) prenatal care among pregnant FIispanic
and South East Asian teens and women to 10 percent or less by December 31, 1999.
� 2. Increase the rate of prenatal care in the first trimester among pregnant Hispanic and South
East Asian teens and women to 60 percent or more by December 31, 1999.
Methods -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted areas, health education fair for teens as part the McDonough
recreation program, assistance in clinic enrollment at WIC sites at McDonough and West
Side, and responding to media requests for interviews by local newspapers and radio
stations.
Project staff will conduct Spanish-speaking and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safery, and personal health issues susch as family planning, STDs, drugs and alcohol,
and family violence.
Staff in clinic will follow up on all positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health education and
support intervemions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportaiton, and intetpreting as needed.
• Evaluation - All patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry into prenatal care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
resulu wiil be compiled annually. Additionally, patient sarisfaction surveys are done semi- •
annually. Satisfaction with prenatal classes wiIl be meausred via surveys after each servies.
Twenty five (25) prenatal records aze audited quarterly to measure rates �f compliance with
prenatal risk assessment, post partum visiu, and newbom follow-up. Ttris mformation will be
reviewed quarterly by the Quality Management Committee to identify and implement focused
improvement efforts.
Training/Escperience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability in meeting the health needs of Hispanics and Southeast Asians. In 1996, WSCHC
served over 12,800 medical patients, 75 percent wer Hispanic or Southeast Asian. Services
include bilingual and biculural staff, transportation through our van, bus or cab voucher,
hospital care through St. Paul Ramsey Medical Center, on WIC clinics including immunization•
outreach Assistance with MA/MN Care applications and outreach clinics and education
programs in homeless shelter, public housing developments and a highschool. These services
aze provided through a well-established interdisciplinary case managemeni malet.. This model
helps identify lugh-risk patients ttuough screenings and referrals, provides coordination of
caze, and ensures paaent involvement in care glanning and choosing treatmeat options.
Resumes of key staff are attached.
Linka�es - West Side Comutunity Health Center works with the following organizations in �
providing maternal and chiId health services:
St. Paul Ramsey Family Practice Residency Program to provide cross-cultural family
medicine training for physicians motivated to work in hing-need underserved settings.
Saint Paui - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Cluld Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, eelderly health care, life
style/cancer and dental care.
Combined efforts with 17 other community clinics to improve pregnancy outcomes through
inaovative prog�ramm�ng usiug community ttealth workers.
Saint Paut - Ramsey Counry Department of Public Health to provide mrtrition education
and immunizations in conjunction with WIC sites and home visits to prenant women and
infanu.
Saint Paul Public Housing Agency to provide services, inciuding maternal child health, on-
site at McDonough and Roosevelt housing developments.
City of Saint Paul in providing clinics in six homeless sheiters and a battered woman's •
shelter.
The Clinic provides comprehensive perinatal care. Any specialty medicai caze needed is
�� - �� b
• provided either o4-site at monthly high-risk OB clinic or by referral to St. Paul Ramsey
Medical Center. all medical referrals are done on a referral form and followed-up via
computerized �acking.
Reimbursement and Fees - All reimbursemenu through the Minnesota Department of Human
Services go direcfly to support services. Assistance is provided to enroll all eligible women
on Medical Assistance. A sliding fee scale is maintained for those not eligible for assistance.
Fees are discounted incrementally based on family income, from those at or below the poverty
level paying nominal or no fees, up to those exceeding 200 percent of the poverry level paying
full fees.
Budeet - A budget and justification for the West Side Community Aealth Clinic budget
follows.
�
n
LJ
Saint Paul Public Health
Matemal and Child Heahh (MCE� Funds
West Side Community Health Center
6-27-97
-8-
Bu et (Revised 8/15/97)
We are requesting $13,490 per year to supplement our e�risling perinatal program The
funds w�l allow us to ut�ize b�inguallbicuttural perinatal health educators as focused and
integral components of our overall program. •
Following is the project budget with noted W SCHC match:
Year One - 1998
. i FTE Perinatal Coordivator
208 hours at $IS/hour
.4 FTE Periaatal Heahh Educator
832 hours at $1239/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursmg staff/perinatal support
TOTAL
Year Two - 1999
.1 FTE Perinatal Coordinator
208 hours at $15/hour
.4 FTE Perinatal FIeakh Educator
&32 hours at $12.39/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
MCH Request
$ 3,2Q0
10,290
$13,490
MCH Reauest
$ 3,200
I0,290
$13,490
WSCHC Match
$ 88,000
39,500
$127,500
WSCHC Match
$ 88,000
39,500
$127,500
Four hundred fifty I�spanic and SEA preaatal patients w�l be seea annualty
Thirry two prenatal classes w$1 be held, serving an expected 250 patients.
F"ifty highest risk patieats w�l r�eive specific follow up by the heatth educator.
An additional 150 teens and women will be reached through outreach activities.
n
U
�
There aze no DHS or self-pay reimbursements anticipated related to these supplemental •
activities.
G� - l��
•
ADOLESCENT HEALTH PROGRAM
�
��
!
��
�
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child
Health Special Project Grant funding for adolescent health services, and has prepared the
foliowing assessment of adolescent health in St. Paul.
Unmet Needs - Adolescent health status indicators have shown improvement in some areas
and deterioration in others in the last five years. Alcohol use had started to drop, as have
reported rates of sexual activity among teens. Pregnancy rates among teens aze dropping,
especially due to increased use of contraceptives. They are stIll too high in Saint Paul, ,
especially among African-American youth. Rates of physical activity aze decreasing for older
teens, while obesity is increasing. Tobacco use has increased dramatically, especially among
White, Hispanic, and Native American youth. Martality from violence - sucicide, depression
and car crashes - is unacceptably high.
Adolescents require services tailored to meet their specific needs and developmentai levels.
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 seven pubiic high schools in Saint Paul: Harding, Como Park, Cenual, Johnson
Senior High School, Highland Park Junior/Senior Aigh School and Humboldt 7uniorlSenior
• High. By Fall 1997, Heaith Start will pzovidethe same level of services at the new Arlington
Senior Aigh School. Tn addition to these seven school-based ciinics, Health Start provides
prenatal and family planning services for pregnant and parenting teens at AGAPE Aiternative
School and other health services (not including grenatal) at Guadalupe Area Pro}ect.
During CY 1996 school year, students again demonstrated their need for clinic services by
using current services extensively. A total of 3,053 students made 13,391 visits, generating
over 24,500 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 caze resources. Data from 1996 school year
revealed that of studenYs families, 32% had medical assistance, 19% had private insurance,
48% had no 3rd party source of pay, and 1% had MinnesotaCare.
Program Response To MCH Priorities - The Adolescent Health Program responds to the
goals and priorities for services adopted by the State Maternal and Child Health Advisory Task
Force. The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unpianned pregnancy, nutrition problems, depression, chemical abuse
and family and relationship problems among adolescents in Saint Paul. to achieve these goals,
• Health Start, Inc. has identified prioritiies consistent with the following MCH Advisory Task
Force priorities:
-reduce infant mortaliry
-reduce the percent of low birthweight infants
-reduce adolescent pregnancy rates
-reduce unintended pregnancies
-provide access to preventive services
-reduce chemicai abuse in adolescents
-reduce infecuous diseases
-promote good nutrition practices
These priorities will be addressed through the objectives and methods identified by Health
Star[, Inc.'s Adolescent Health Proa am. Methods to adQress ihese priorities include
comprehensive health services that are accessible and acceptable to high school age adolescents
inc]uding nutrition education aad counseling and psychosocial assessment and ongoing
counseling. Extensive health education is provided individually and in group education
settings. Referrals are made when aecessary.
�
Goal - The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unptanned pregnancy, nutrition prob2ems, depression, chemical abuse
and family and relationship problems among adolescents in St. Paul by providing
comprehensive heatth care services at seven high School sites and two atternative school site •
within the City.
Target Ponulation - The clients targeted to be served by the Health Start Adolescent Health
Program are ado2escents living in the Ciry of St. Paul. The following demographic data
describes this population:
Minority Groups -
Age in School -
Gender -
.�•.
39 % 18 years and above
26 % 17 years
22 % 16 years
10% 14 years and under
72 % Female
28% Male
Obiectives - The following objectives have been established for the Adolescent Aealth
Program in order to achieve the goal:
�
1. In CY 1998 and 1999, 3,000 junior and senior high students will make visits to the school-
a� - �a��
• based clinics each year
2. In 1998 and 1999, the healthy lifestyle of physical activity and a balanced diet will be
°ncouraged by providing 350 sports physicals and 600 nutrition visiu related to sports
nutrition, weight control or eating disorders.
3. Onsite counseling will be provided for 1,100 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, seacual or
emotional abuse each year in 1998 and 1999.
4. At least 85% of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a contraceptive method or plan. Decision making, sexuality_
counseliing, and family planniing services will be provided for 1000 adolescents each year
in 1998 and 1999.
5. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in 1998 and 1999 from 1400 in 1996.
6. The number of hepatitis B immunizations given wiil increase 10% in 1998 and 1999 from
434 in 1996.
• 7. The number of students who report smoking wili drop 10% in one targeted high school in
Saint Paul by December 31, 1999.
Methods -
• At least $100,000 in additional funding for school based clinics will be secured in 1998 and
1999 to support expanded access for teens in Arlington High School, AGAPE Alternative
School and Guadalupe Area Project Alternative School.
• Assess for risk, 85% of all new students, following GAPS assessment guidelines, that
details medical and fanuly history, behaviors and feelings. this form will provide staff with
background data necessary for providing good care and for triagin clients to appropriate
staff.
• Provide 8,000 physical examinations, health screening and assessments, diagnosis and
ueaunent of acute and minor illness, and family planning visits on site by a nurse
practitioner, family physiscian andlor pediatrician.
• By 7anuary 1, 1998, Health Staft will hire a male-focused outreach worker/health educator
to encourage participation in sports and use of the clinic for sports physicals, Hepatitis B
vaccination, screening for chlamydia and other STIs, involvement in avoiding pregnancy,
• and other heaith issues of concem to male students.
• Beginning Ianuary 1, 1998, increase access to health care for students with chronic •
illnessess or disabilities by a collaboration with PACER and school nurses to help high
school special needs studenu to transition from school to work and independeat living.
• Decision-making counseling and family planning education and counseling will be provided
to adolescents requesting these services by a Health Start health educator.
� Pick-up of prescribed contraceptives and completion of Depo Provera shot appointments
will be tracked in order to maintain at least an 80% treatment compliance rate.
• Health Start staff wiil provide risk assessment, prevention education, and screening on site ,
for afl STIs, including HIV infection.
• Members of the interdisciplinary team will provide 7,000 individual and group education
contacts in selected classrooms on health education activiites such as prenatal and parenting
classes, weight conuol classes, and human sexuality programs, in order to maximize the
understanding and practice of positive health behaviors.
• Health Start will seek to partner with Health Partners Center for Health Promotion and St.
Paul District school nurses and teaching staff to target at least one high school for a
smoking prevention and intervention campaign in the school for a two year period, staning
January 1, 1998. .
• Health Start staff will serve as adolescent health resources to teachers and youth workers in
their classrooms and other groups.
• Pregnant teens who see another primary caze provider for prenatal care will be tracked to
see that prenatal care is started, maintained, and whenever possible, what were the birth
outcomes.
• Health Start will work collaboratively with the healih plans serving Saint Paul students to
maximize reimbursemenu for services and communicate with or refer students into
appropriate sources of care.
Evaluation - CIienu at school-based clinics aze assessed annually for satisfaction with Health
Start services, using a standazdized format and automated summarization. the same form is
used by the Neighborhood heatth Care Network. Satisfaction Ievels are compared with
primary care community clinics and four other adolescent specialty programs in the Metro
azea. Automated encounter forms gather the demographic data, visit, procedure, and
diagnostic code data, and site of service. These data can be queried to provide data on
typesand quantity of services sued, as well as target population reached by age, race and
income level and special need. •
An encounter form will track the number of students accessing family planning services.
Health Start's Quality Assurance and Clinical Management Team wiil annually measure
��l - lQ��
• through random chart audit the percent of students with a negative pr o°nancy test who
received birth control information and a method before leaving the clinic. They wiIl aiso
measurethe picY-up rate for first time and follow-up contraceptive prescriptions and Depo
Provera appointnaeus kept via random chart audit.
IIealih Start will measure the ability of its staff to reach a large number of students through
classroom, individual and other group methods for topics related to healthy lifestyle. It will
also measure the abiliry to increase the number of studenu presenting for Hep B vaccination
through increased outreach.
An anti-smoking campaisn targeting a high school and involving multipie messages aand types
of interventions will attempt to measure baseline smoking rates at onset of the campaign and
two years later on a population basis. this methodology will depend on the willingness and
ability of the high school administration to assess several grades of students. If that is not
possible, Health Start will assessits own patient population at onset and two years later, using
a modified encounter form.
Training & Experience - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff are professional health cate personnel with
. special expertise in matemal and child health. The majority have had more than five years
experience. All staff are evaluated at least once a year.
Staff are supervised by the executive director, associate director, medical director, associate
medical director, and team leaders. Carol White, M.A., is the executive director of Health
Start and is responsible for the overail management and direction of the project, as well as
external relations and long-range planning. Dr. Chris Reif, a member of the Family Medicine
Department at Saint Paul-Ramsey Medical Center, is the medical director and responsible for
overall medical d'uection. Dr. Carol Ball, on the staff of the Obstetrics and Gynecology
Department at Saint Paul-Ramsey Medical Center, is the associate medical d'uector and works
with the medical director to provide consultation on OB/GYN practices, as well as providing
clinical supervision for OB/GYN nurse practitioner staff. iThey are adivsed by a clinical
management team made up of representatives from the various professional discipliines, in
prenatal and adolescent services of health Start. Richard Duffm has been the associate d'uector
for three years and managesthe school based clinics. Jeanne Rancone, PNP, PAN, is the new
Clinical Services Coordinator, overseeing clinical services for adolescent, prenatal, and
pediatric care. Jeanne has been with Health Start for three years.
Summary of qualifications and experience of key staff are attached.
Linka¢es - Health Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. Referrals aze made by Health
• Start staff to other programs and aze made by other agencies to Health Start. This referrai
network allows staff to individualize care plans to meet the specific needs of each client. New
linkages and referral sources are identified or developed as needs arise.
Heatih Start works collaboratively with Ramsey County Public Health nurses to exiend •
services to pregnant women in the comtnuniry. Public health nurses meet regularly with
Health Starc to identify clients needing fiome-based services and to share information that will
enhance patient care.
At delivery, new pazents are referred to Health Start's pediatric clinic. Well-child and acute
care visiu, aug�nented by interdisciplinary services, are provided. Eligible clients are also
referred to the Befriender Program, run in collaboration with Children's Home Society, the
Partnership Program, a collaboration with Saint Paul School's �arly Childhood and FamiIv
Education (ECF'E}, or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, and/or �-oup education For high risk •
parenis.
When psychosocial or hea7th care needs are ideniifed 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 area.
In the school-bsed clinics, the linkage with the school nurse is very close. Often, space is
shared and refenaIs go back and forth during the day. Realations with other school personnel
are also pursued. A school board member always serveson the health Start board of directors.
Health Start is committed to extending services to the community and *r�inimi��g duplication •
by collaborating with many agencies and programs. Health Start wili ncaintain affiliations with
and/or refer to the following agencies and task forces (partial list)
Chiidren's Home society of Minnesota, Farly Childhood and Family Education (ECFE),
Housecalls, Frogtown Family Resource Center, Ramsey Ciinic Associates, Ramsey
County Human Services Family Preservation Project, Saint Paul - Ramsey Department of
Public Aealth, rondo Family Resource Center, Neighborhood Health Care Network, St.
Paul Public Schools, St. Paul-Ramsey rnedicat Center/Heatth Partners, PACER Transition
to Work Project, 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. MCH funding atlows Health Start to
provide prenatal care for clients who have no third party source of payment. For Health Start
clients eligible for medical assistance, staff wili assist them with the applicauon process.
Health Start has conuacts with all of the PMAP providers. Any other applicable third parties
aze billed whenever possible. Insurance reveaue pays for agproximately 25 % of Health Start's
prenatal and adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client
has no third parry payor, a sliding fee scale is used to determine her fee for family planning •
services. Funds will be requested from the State of Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium,
��- iaa�
• Subgrants/Subcontracts - Health Start subcontracts for the provision of physician and
certified nurse-midwife services with the foliowing groups: Ramsey Clinic Associates, West
Side Community Health Center and the Universiry of Minnesota. The Health Start Medical
Director and Associate Medicsi T.?irector are 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
justification for the budget follows.
.
•
�
Health Start Key Staff
Carol �i'hite, AL4 is the esecuti�e director of Health Start, Inc. She «as hired in June,
1996, by the board of directors. She has a rnasters of arts from Stanford L'niversity in
early childhood education. She has five years experience in health care management, ten
years total managemeni experience in non-profit mana�ement. She has «ritten and
pubIished trainins materials and curricula on child abuse and fatttily violence.
Christopher Reif, MD, MPIi has been the medical director of I-Iealth Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey hiedical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currently on the advisory boazd of the American Medical Association's Grridelines for
'Adolescent Prevention Services (Gr�PSJ.
Richard Duffen, 11iA has been the associate director of Heatth Start since 1944. He is
responsible for school based cIinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty years experience in managing •
human service organizations, with special experience in mentaI health and developmental
disabilities.
Jeanne Rancone, PNP, MPH is the ciinical services coordinator for Health Start. She is •
reponsible £ot maternal child health, family planning and adolescent service clinical
objectives as well as overall coordination of clinicai services and standards in a multi-site
environment. She has I4 yeazs of clinical nursing and public health nursing, and three
years experience at Health Start as a pediatric nurse practitioner and team coordinator at
Highland High Schooi clinic.
•
.
HEALTH START, INC.
� MATERNAL AND CHILD HEALTN
� ADOLESCENT HEALTH SERVICES
SCHOOL BASED CLINICS
JANUARY THROUGIi DECEMBER, 1998
�
•
q� -tc�
MCHSBC96
'ANNUAL � PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SALARY F'rE euoGET Bu�Ger
NURSE PR4CTRIONER (CENTRAL7
NURSE PRACTITIONER (COMO)
NURSEPRACTfiONER(HUMBOLDn
NURSE PR4CTITtONEF�(JOHNS�N)
NURSE PRACTRIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI WORKER (COMO)
SOCIAL WORKER (HUMBOLDn
SOCIAL WORKER (lOHNSON)
CASE M4NAGER(AGAP�
MEDICAL ASSISTANT (CENTRAL)
MEDICAL ASSISTANT (COMO)
MEDICALASSISTANT(HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDING)
MEDICAL ASSISTANT (AGAPE)
NUTRRIONIST(CENTR4L)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOIDn
NUTRITIONIST (JOHNSON)
NUTRITIONIST (HAROfNGj
HEALTH EDUCATOR(CENTRAL)
HEALTHEDUCATOR(COMO)
HEALTHEDUCATOR(HUMBOLDT)
HEALTHEDUCATOR(JOHNSON)
HEALTHfiDUCATOR(NARDING)
HEAlTHEOUCATOR(AGAP�
IXECUTNE DIRECTOR
$37,296
$43,596
$37,918
$37,2t 2
$42,773
$35,902
$29,316
$35,330
$33,734
$32,777
$16,934
$17,354
$16,447
$18,614
$22,294
$16,447
$33,734
$35,246
$37,750
$33,734
$35,246
$27,317
$31,618
$29,921
$29,921
$31,298
$29,921
$43,260
0.80
0.80
0.80
Q.65
0.90
0.40
0.40
0.60
0.40
0.80
1.00
1.00
1.00
1.00
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.05
0.10
$29,837
$��8�
$30,334
$24,188
$38,496
$14,361
$� �,�26
$21,198
$13,494
$26,22�
$16,934
$17,354
$16,447
$18,614
$22�2�
$3,289
$5,060
$5,287
$s,ss2
$5,060
$5,287
$2,732
$3,162
$2,992
$z,ss2
$3,130
$1,496
$4,326
$23,869
$27.90'I
$24,26�
$19,350
$30,796
$11,489
$9,381
$16,959
$t�,795
$0
$13,548
$17,354
$�4,$OZ
$18,614
$22,294
$�
$5,060
$5,287
$s,ss2
$5,060
$5.287
$2,732
$3,162
$2,992
sa,ssz
$3,13�
$0
$4,326
SUB-TOTAL SALARY
` annuai salary based on 42 week schooV year
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
FAMILY PRACTICE PHYSiCIAWNURSE M1DWiFE
EIGHT PHYSICUW CUNICSNVK @ 5286 X 34 WKS
ONE CNM CUNICNVlC @$'160.�CUNIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON}
FACE TO FACE
SOCIAL WORKER (HARDING) $32,569
PATIENT CARE
LAB, ULTRASOUND, X-RAY
COURIER SERVICE
$386,851
$307,111
$77,370 561,422
$77.792 $42,786
$5,440 $4,080
$4,893 $3,670
$32,569 $24,426
$22,279 $16,709
$29,945 $22,459
,
n
LJ
ANNUAL PROGRAM PROGRAM MCH
LINE 1TEM EXPENSE SAIARY FrE g�p�� B�p��
OTHER EXPENSE
MED�CATIOWDRUGS
MEDICAL SUPPLlES
OFFICE SUPPLIES
PRI NTING/DUPLICATING
PATIENT TRANSPORTATION
TOTAL DlRECT EXPENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAL MCH GRANT REQUEST
TOTAL MATCH � 25°k
HICaHLAND SCHOOL BASED CL�NIC FUNDED BY SEPERATE GRANT SOURCE
$15,000 $11,100
$12,725 56,373
$10,600 $3,180
$2,575 $0
$2,150 $1,720
5680,188 $505,035
$108,830 $0
$789,019 $505,035
$505,035
�
$126,259
�
�1- lG�i�6
•
BUDGET DETAIL AND EXPENDITURE FORMS
�
�
q�,- ��.�
•
•
BUDGET NSTIFICATION
Budget justification for each of the subgrantees is included within their budgets previously
presented in the narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Maternal and Child Aealth Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey County Department of Public
Health for Adminisuative Costs.
..;
1999
Sala /Fringe:
Administrative Assistant
Genezai program oversite,
prepares and monitors
grants, analyses reports,
prepares annual reports,
prepares and monitors
contracts, meetings and site
reviews with subcontractors
$ 9,171
$ 9,271
Accounting Tech IV
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV
Types grants, contracts and
reports
�Dlies:
Audit:
7,417
r�:
100
TOTAL ADMINISTRATIVE COST: 19,626
•
7,514
3,472
150
4,161
24,568
BUDGET DETAIL OF LOCAL MATCH
Local match is identified at a minnnum 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:
1. Local Tax L,evy Funds:
• MCH Prenatal Care at Communiry
Clinics
� Community Ouueach and Services
(Nutrition, social work and lab)
• Participation in Project LID
• Assessment
(includes data collection
analysis and reporting)
TOTAL:
2. Other Local Funds:
1998 1999
$139,480 $139,480
$ 34,352 $ 34,352
$ 2,485 $ 2,485
$ 26,642 $ 26,642
$202,959 $202,959
Other local match is provided by the City of Saint Paul through the funding of various
programs which contr3bute to maternal and child health, including family planning,
immunizations, lead screening, nutrition, heaith education and well child services. Source
of this funding includes CHS funding, grants, reimbursements, and patient fees.
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•
•
•
a �aa�
•
ATTACfIl�IENT B
Solicita6on Process for Subgrants
�
Notification of the availability of funding was provided to qualified programs in the azea
through a d'uect mailing of a Request for Proposals (RFP) to 30 agencies and a public norice
placed in the St. Paul Pioneer Press on May 22, 1997. The process for selection of priority
program componenLS and the process for selecting the requests (evaluation criteria) included in
the grant application aze elcplained in the following RFP. The public notice, a list of agencies
receiving the d'uect mailing, and a list of the agencies requesting subgrants are also included in
this attachment.
•
PUBLIC NOTICE OF AVAII.ABILITY OF FUNDS FOR •
MATERNAL AND C�iII.D HEALTH SERVICES
The City of Saint Paul intends to subcon�act up to $120,000 to Saint Paul agencies through
the Minnesota Department of Heaith Maternal and Child Health Formula Block grant for
calendar years 1998-1999. These funds may be used to conduct projects for improving
pregnancy outcomes through outreach, referral and/or the direct provision of prenatal care.
Based upon an assessment of Maternal and Child Heaith (MC� needs in Saint Paul, the City
is interested in subcontracting with outside agencies to provide prenatal health care and
outreach services for lugh risk and low income women. Organizations interested in providing
these sezvices will be asked to develop a proposal following Minnesota Deparoment of Health
as well as Saint Paul Public Health guidelines. Interested organizations should contact.Carolyri
Weber, St. Paul Public Heaith, 555 Cedar Street, St. Paul, MN 55101 (292-7749). Proposals
are due to the above address by 4:00 p.m. on June 30, 1997. The RFP for these funds was
also mailed or distributed to 29 organizations/individuals who are interested in public health
issues or who provide maternal and child health services to lugh risk and low income women.
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 for funding.
�
n
U
•
AFFIDAVIT OF PUBLICATION
5TATE OF MINNESOTA
CO �?NTY OF RAMSEY
�� - ��a�
< I�r4-.��I� �1 l�.�L�� ,being
duly sw rn on oath, says: that he is, �a a,�
all times herein stated has been, Clerk of
Northwest Pnblications, Inc., publisher of tfie
newspaper known as the Saint Paul Pioneer
Press, a aewspaper of general circnlation within
the City of St Paul and the County of Ramsey.
That the Notice hereto attached was cut fiwm the
columns of esid newspaper and was printed and
pubIished thereia on the following dates:
`� day of �_ , 19 �
�
•
day of , 19 _
dayof ,19—
day of , 19 —
day of , 19 —
day of , 19 _
day of , 19 _
�
Su scribed and sworn to before me 's
��day of �} �y , 19�
Nocary Public
«�S���a��r County, Minnesota
My com.»;c�ion expires � 3� , 20 O O
TL:
� r�z�,o-' �iviiYi:,' .. , :H
� `:i:" �'s'.nSH1�;= _ f:
�'l:�'� � ia; t�:i.a`.i'>ii: � " � �i �`y;ri. �i.�.�f`.:. y
ti y
zrvsrvar�7r�-r:a,�rvv7vvc,vvvs•rstx
sr PAUi, woMnx�s cr.�c
1690 UNIVERSTPl' AVE
ST PAUL MN 55104
LUTHERADI SOC SERV OF MN
1201 PAYNE AVE
ST PAUL MN 55101
CATHOLIC CHAR OF ST PAUL
2I5 OLD 6TH ST
ST PAUL MN 55102
BOOTfi BROWN FIOUSE
1471 COMO AVE
ST PAUL MN 55108
THE LOFT TEEN CENTER
1063 IGLEHART AVE
ST PAUL MN SSI04
ANN RICKETTS
FACE TO FACE CLIAIIC
I165 ARCADE ST
ST PAUL MN 55106
UNITED FAM HEALTH CEN
sas w rrti sr
ST PAUL MN 55102
COMMONFiEALTH CLINIC
13961 N 60TH ST
STII,LWATER MN 55082
JOANNE ICEATDRICK
SI PAULRAMSEY
NUTRITION PROGRAM
ST PAUL PUBLIC HEALTH
YOUTH SIItVICE BUREAU
2167 ARCADE ST
ST PAUL MN 55106
ARLINGTON HOUSE
95l E. STH ST
ST PAUL MN 55106
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PAUL MN 55102
SETON CENFER
1276 UNIVERSITY AVE W
ST PAUL MN 55104
FAMII,Y PHY HEALTIi CEN
579 WELLS ST
ST PAUL MN SSIOI
PEG LABORE
FAMILY TREE CLINIC
1619 DAYTON AVE
ST PAUL MN 55102
BEVERLY HAWIQNS
MODEL CITIES H C
430 N DALE ST
ST PAUL MN 55103
ST PAUL ItAM OB/GYN CL
640 JACKSON ST
ST PAUL MN 55101
PALNNED PARENT
MINNESOTA
1700 RICE ST
ST PAUL MN 55113
C�Fa
CAROL WHITE CERTgZED NURSE MIDWIVES
HEALTH SfART INC RAMSEY FOUNDATION
590 PARK SUTfE 208 640 JACKSON ST
ST PALTL MN 55103-1843 ST PAUL MN 55101
AGAPE
360 COLBORNE ST
ST PAUL MN 55102
MARY ELLEN SMITH
LEAD PROGRA114
ST PAUL PUBLIC HEALTH
•�
BETHESDA FAM PRAC CLINIC
590 PARK $T' SiRTB 310
ST PAUL MN 55103
UNITED HOSPITAL-M�D CLINIC
333 N SMIT'H ST
ST pAUL MN 55102
MARY O'CONNELL
INTEGRATED HOME CARE
475 ETNA ST SUITE 3 •
ST PAUL MN 55106
MARVIS BREHM
WEST SIDE HEALTH CENTER
153 CQNCORD ST
ST PAUL MN 55107
CHII,DREN'S HOME SOCIETY
OF MINNESOTA
2230 COMO AVE
Sf'. PALJL MIV 55108
NANCY BRIGGS
NORTH END HFALTH CETTTER
135 MANTIOBA ST
ST PAUL MN 55117
ST PALJL RAM PEDS CLINIC
640 JACKSON ST
ST PALTL bSN 55101
•
•
�.�1-�oQ�
AGENCY NAME:
REVIEWED BY:
SAINT PAUL
MCH COMPETITIVE GRANT
REVIEW CRTTERIA
I. APPLICATION
A. Is in accordance with City MCH priorifies
B. Proposes services targeted to low-income high
risk individuais in targeted azeas
C. Is clearly written and the format facilitates
review
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, raciallethnic distribution and
eligibility criteria
B. T'he applicant can demonstrate past successful
experience worldng with target populations
C. Low-income, e.g. <200% of poverty or women
who are pregnant and determined eligible for
M.A. or WIC
D. Identify risk criteria consistent with MDI�
guidelines
III. OBJECT'IVES
A. Described
B. Related to priorities
C. Realistic
D. Time Specific
E. Measurable
F. Identify clienYs or community's needs, not the
applicanYs
POOR
1 2
1 2
1 2
1 2
1 2
1 2
1
1
1
i
1
1
1
2
2
2
2
2
2
2
SATIS
3
3
3
EXCEI,
4 5
4 5
4 5
3 4
3 4
3 4
3
3
3
3
3
3
3
4
0
�
�
�
�
�
5
5
5
5
5
5
5
5
5
5
POOR SATIS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted pnblic 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 acrivities which warrant evaluation are
identified 1 2 3 4 5
B. Methods for collecting the data aze described
and aze feasible 1 2 3 4 5
C. Gives evidence that evaluation results will be
used for program management decisions 1 2 3 4 5
D. Collects data which relate to the objecfives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objective as well as subjective 1 2 3 4 5
VI. TRAINING/EXPERIENCE
A. Indication of work experience, training and
qualifications for staff d'uecfly 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 refemal arrangements wiih other
community service providers ue described
and relate to goals, objecrives and methods 1 2 3 4 5
' ��- [Oq.�
,.�
' POOR SATIS EXCEL
B. Description of current or anricipated
cooperative agreements to m;n;m;�P potential
for duplication 1 2 3 4 5
C. Plans for or descriptious of ongoing
collaborative acriviries with providers such as
participation on task forces, committees, etc. 1 2 3 4 5
D. Applicant can show experience in successful
follow-up on refeaals 1 2 3 4 5
VIII. BUDGET
A. Budget items are justified in terms of project '
activifies 1 2 3 4 5
B. Complete 1 2 3 4 5
C. Provides a rationale for farmula/process for
calculation of items 1 2 3 4 5
D. Amount of funding requested is appropriate
for the levei of service and objectives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonsuated in ldnd contributions
of at least 25 % of the grant request
F. Are mathematically correct
G. Indicates pians to obiain and use DHS
reimbursements (Medical Assistance,
Children's Health Pian)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDTITONAL CONII�IENTS/RECONIMENDATIONS:
�
,
q�- lo��
MATERNAL AND CHILD HEALTH FORMULA SPEC{AL PROJECTS - 1998-1999
CITY OF SAINTPAUL
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Model Cities Health Center, Inc. - Improved Pregnancy Outcome Program
The goal of this project is to improve birth outcomes among the target area population
by focusing on eariy entrance into coordinated, case-managed clinical services which
offer preventive education. The fundamental goals of this Pregnancy Outcome
Program are to improve birth outcomes and neonatal development, to increase
- accessibility to early prenatal care of underserved high risk African Americans and
Hmong females of chiidbearing ages and to reduce the over-all rate of late (3rd
trimester or none) prenatal care.
Total -$60,132 Year 1- 530,066 Year 2- 530,066
Face To Face Health and Counseling Service - Prenatal Access Project
Face To Face Health and Counseling Service is proposing to continue its program
aimed at reaching high risk, pregnant adolescents with comprehensive first trimester
prenatal care services, which have resulted in a higher rate of healthy birth outcomes.
Face To Face has historicaily 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. This project utilizes outreach efforts and
case management to encourage and support pregnant adolescents to access prenatal
care so as to increase their chances of having a successfuf pregnancy.
Total - 577.054 Year 1- 538,527 Year 2- 538,527
West Side Community Health Clinic - Improving Pregnancy Outcomes for High Risk
Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the
Saint Paul Hispanic and Southeast Asian populations by providing outreach, tracking
all positive pregnancy tests, performing prenatal risk assessments and coordinating
prenatal care. This project will be supplemented by existing West Side Community
Clinic staff and services. The clinic offers comprehensive health care services on a
sliding fee scale. This project will give Hispanic and Southeast Asian families greater
access to a full array of services including well child care, immunizations, family ,
planning, parenting, and STD services as well as linkages by referral to over fourteen
other community agencies.
Total - 526,980 Year 1- 513,490 Year 2- 513,490
�.� - (��
Health Start, Inc. - Improved Pregnancy Outcome
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive
Maternal and Child Health Special Project Grant funding for services to improve
pregnancy outcomes. Health Start, Inc. is an organization specializing in maternal,
infant and adolescent health care services to high risk populations. Its goal is to
improve the health status of women, children and youth who are at risk for disease
or disability due to economic, social or medical conditions, and to reduce morbidity
and mortality in this populations. "
Health Start proposes to continue to serve the needs of low income and adolescent
pregnant and postpartum women. Health Start will provide multidisciplinary,
comprehensive prenatal care at hospital and school based out-patient clinics. Prenatal
care offered to students in the high schools facilitates early entry into prenatal care.
This component of the Health Start program addresses the City of Saint Paul's
Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and adult women of color.
Total - 5393,902 Year 1-$196,951 Year 2- S196,951
Health Start, ►nc. - Adolescent Health Program
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 Saint Paul
by providing comprehensive health care services at seven high school sites and two
alternative school sites within the City.
Total - 51,010,070 Year 1- 5505,035 Year 2- 5505,035
AGBNCY
Modei
Cities
Face to
Face
West Side
Health
Start
(IPO)
Health
Start
(Adol)
a�-io��
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr. 1: Yr.2: Total: Yr. 1: Yr.2:
62,430 31,215
80,000 40,000
28,000 14,000
31,215 60,132 30,066
40,000 77,054 38,527
14,000 26,980 13,490
30,066
38,527
13,490
409,042 204,521 204,521 393,902 196,951 196,951
1,047,820 523,910 523,910 1,010,070 505,035 505,035
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesdng funding prunarily for outreach, education and tracking.
Health Start receives non-competitive funding as a pre-block grant provider to provide both
improved pregnancy outcome services through ouueach and prenatai care, and adolescent
health services through school based clinics.
Council File # `� � ����
Green Sheet # 36255
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Presented By
Referred To
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 Child Health Block Grant, and authorizes proper City Officials to contract on its
behalf with the Minnesota Department of Health.
m v rLsz—�
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Bosuom
Collins �
Huris
Meeard
Morton ��
Thune
Adopted by Council:
Navs Absent
�
Certified by Council Secretary
sy: �
Approved by
By: � � �
-� - �� 1-�. - .
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c( � � For ppro ed / �' b �y / �� C / i "ty A ey / p'
BY����// ' 7-C � f �Y `L%
�,�-.� ` /�
_ ,.
Approved by Mayor for Submission to Council
—�— BY � ``° �
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA �
�t'l -bq.8'
DEPARTMENT/OFFICE/CAUNCIL DATE INRIATED � V� 3 6 2 5 5
Pub��� Aealth 8/26/97 GREEN SHEET _
CONTACT PEflSON 8 PHONE INITI INRIAVDATE
EPAflTMENTDIRECTO�TC I CRYCAUNGL
��
Diane H011lt ren 292-7712 ���'N �CITYATfORNEY OCIT'CLERK
NUYBEfi FOR
MUST BE ON COUNdLAGENDA BV (DAT� p��� BU�GET DIfiECTOR � PIN. & MGT. SERVICES DIR.
Scheduled for 9/3/97 � �"""Y°R�°R'�ssisr''r'n �
TOTAL # OF SIGNATURE PAGES 1 (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION FiEQUESTED:
City signatures on a Resolution for Board of Health support of the 1998-1999 Saint Paul
Maternal and Child Health grant application to the Minnesota Department of Health.
RECOMMENDAnONS: Approve (A) rn Reject (i1) pEFSONAL SERVECE CONTHACTS Mt1ST ANSWER TNE FOLLOWYNG QUES710NS:
_ PLANNING CqMMiS$ION _ CML SERVICE COMMISSION 1_ Has this person/firm ever worked under a coMrac[ for fhis tlepartmeM? �
_ CIB COMMITIEE _ VES NO
—�� — 2. Has Mis perso�rm ever been a city employee?
VES NO
_ DIS7fiICT COUR7 _ 3. Does this personHirm possess a skill not normally possessetl by any curreM c'Ry employee?
SUPPOA75wHiCHCAUNCROHJEC7IVE? � YES NO
Explain all yes answers on seperete aheet anA ettaeh to green sheet
INITIATINCa PROBLEM, iSSUE, OPPoRTUNIN (VJho, What, When. Where, Why):
The City of Saint Paul, through Public Health will submit a grant proposal to the Minnesota
Department of Health for funding of services to improve pregnancy outcomes and improve
adoTescent health.
ADVANTAGES IF APPROVED:
' 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.
DISADVANTAGES IPAPPROVED: �
NONE
y��«9.�`�� '����?�i �1Y�i
�;;�;; 2 ? 1�97
DISADVANTAGES IF NOT APPROVED:
' Funding will not be received to support the above mentioned activities.
' Access to health care wi11 not be improved.
��� `
TOTAL AMOUNT OF TRANSACTION $ 1� 62Z , 332 COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE Stat2 Of Ninne50td qCTIVITV NUMBER 58324/33248
FINANCIAL INPORMATION: (EXPLAIN)
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�:. I�� Memorandum
CITY OF SAINT PAUL
August 26, 1997
TO: Nancy Anderson
City Council Offices
FR: Diane Holmgren
Public Health
RE: Materials for September 3, 1997 Boazd of Health Meeting
Enclosed are the materials for the September 3, 1997, Boazd of Health meeting,
including:
• Agenda
• Copy of one Resolution
• Copies of the 1998-1999 Maternal and Child Health Grant
The first two agenda items are contingent on the Resolution making it through
signatures in time. I will follow-up with you by phone regarding the status of these
as they pragress.
Thank you for all of your assistance.
If you have any questions, please contact me at 292-7712.
DH/sea
WINDO W S.DOS�SFAU2ESOLUTMROG-GRANT
1 ��;
From: Nancy Anderson
To: jerryb, gerrym, baribeav
nate: 8/25/97 3:OOpm
Subjflct: BOARD OF HEALTH MEETING.
davet, chuckr, barbb, mi...
A Board o£ Health Meeting has been scheduled for Wednesday, September 3, 1997
following the 3:3� p_m. City Council Meeting. The topic for your approval is the
"Maternal and Child Health Grant°.
Please mark you calendars.
CC: gerrys, marye, Admin.C50.£ran, Admin.CSO.debbie, I...
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MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
IMPROVED PREGNANCY OUTCOMES
• AND
ADOLESCENT HEALTH
1998-1999
Submitted by:
SAIl\'T PAUL COMMLTNITY HEALTH BOARD .
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SAINT PAUL - RA.rISEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR S'TREET
ST. PAUL, MN 55101
•
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SAINT PAIIL MATERNAI, AND CgILD HEALTS
SPECIAL PROJECTS GRANT 1998-1999
Table of Contents
MINNESOTA DEPARTi�NT OF HEALTH FORMS
Face Sheet
Project Infor.nation
Evidence of Compliance
Services Provided By Legislative Priority
Certification Concerning Sterilization
Certification Regarding Lobbying
Assurances and Agreements
APPLICATION NARRATIVE
COD4ITJNITY ASSESSMENT
=MPROVED PREGNANCY OIITCOMES
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
Model Cities Health
West Side Community
& Counseling Service
Center, Inc.
Health Center
ADOLESCEtQT HEAI.TH PROGRAM
Problem Statement
Goal of the Project
Target Population
Objectives
Methods
Training/Experience
Linkages
Reimbursement and Fees
Budget Justification
Monitoring/Evaluation of Subgrante
Program Evaluation
Budgets - 1998 and 1999
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BUDGET AND FZNAL EXPENDITURE FORMS
Budget Justification
Budget Detail of Local Match
1998 Budget Form
1999 Budget Form
1998 Budget by Legislative Priority
1999 Budget by Legislative Priority
ATTACE�IENTS
Attachment A- Inventory of Community Resources
Attachment B - Solitation Process
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MINNESOTA DEPARTMENT OF HEALTH FORMS
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PSee Revase Sidc for ituwcuons
�t Application for:
;Iaternal and Child Health Special Projects
1. Applipnt Agency With Wttich Grant ContraM is to be Ezecuted
Legal Nmnc. Strat ?.ddress:
Saint Paul Co�unity 310 City Ha11 '
Health Board Saint Paul, .IN 55102
E-Mail Address: '
Minnesota Department of Health ` r_ l " ��
Face Sheet
Telephone Nmnba:
�612 � 266-8560
12 )
2. Director of Applicant Agency
xmme and Tttle:
Rob Fulton
Public Health Directo:
Strat Addras:
555 Cedar Street
Saint Paul, 4IN 55101
E-Mail Addms:
Telepho� Numbrr.
�612 � 292-7712
FAXDIumbc
(612) 222-2770
3. Fiscal Management Otficer of Applicant Agency
Name and Titk: , I Strat Address:
Diane Holmgren � 555 Cedar Street
Health Administratior. Kana er Saint Paul, MN 55101
E-Mail Addcas:
4. Operating Agency ('fdifferenr from rrumber 1 above)
Name and Title: Strat Addras:
Saint Paul — Ramsey County 555 Cedar Street
Department of Public 3ealt Saint Paul, MN 55101
E-Mai! Addras:
5_ Contact Person for Operating Agency ('fdifferentfrom mrmber 2 above)
Name md TiUe:
Addr�SS:
E-Mait Addrcss:
6. Contact Penon for Further Inlormation on Application ('fdifferent from mrmber 5 aboveJ
Name and Title: Strat Addless:
Carolyn Weber 555 Cedar Street
Administrative Assistant Saint Paul, MN 55101
E- Mail Add'ess:
7. Copies of This Application Have Been Seflt to the Rolbwing Communiry Heatth Boards for Review
(NotApplicabfrjw CommwiryHealth Bcmd(sJ ijthe Bo�d is BrApplr�muj
A2encv Name
TdephoneNumber.
�612� 292-7749
FAX Numbec:
cFt2> ���-2��n
Tdeptwne Ninnbu:
�612� 292-7712
FAX Nwnbec:
(612) 222-2770
Tekphone Number.
� )
FAX Nmnber:
( )
Telephone Num6a:
�612�292—�749
FAXNumber.
(612)222-2770
Date Sent
8. Certiication
1 eertify t6at the infom�etion m m is true and accurate m the bat of my 1mowledBe md thu I submit tdis appliaaon on behalf ofthe applicant agmry.
_ • /�������l//A/� • Director � ,Z,(p �1
Signanve ofDiiator of Applicant Agevry T�� �
E-0[2740M1f3/9T A
ICR 346428
Instructions for Completing Face Sheet •
Please Type or print all items on tfie Grant Application Form Face Sheet
Aoplicants please note: The appIication form has been desi�ed to be used on all Special Project granu administe:
by the Nfinnesota Deparcment of Heaith. If you have questions, or need assistance
completing the application form, piease contact the program Nfanager or Consultant identif:
as responsible for the grant. .
Applicant Agency
Legai name of the ageacy aathorized to enter into a grant contract with the Minnesota Department of Health, e.
North Woods Community Health Board. ,
2- Director of the Applicant Agency
Person responsible for direcfing the applicani agency.
3. Fiscal Management Officer of Appticant Agency
The chief fiscal officer for the recipient of funds who has primary responsibility for grant and subsidy func
expenditure and reporting. If the applicant agency is a Community Health Board, the Fiscal Managemen�c
must be the same person who is identified as the Fiscal Management Officer in the Board's Communi a1-
Service Plan.
4. Operating Agency
Complete onty if other than the applicaat agency listed in number 1 above.
5. Coatact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this projeci.
6. Contact Person for Further Information
Person who may be contacted for detailed infozmation conceming the application or the project if different fron
number 5 above.
Copies of this AppIication Have Been Sent to the Following Community Health Boards for Review
Provide copies of this apptication and any subsequent revisions to the appropriate community health boards a
required by the individual instructions.
�• Signature of Director of Applicant Agency
Provide original signaYure and date.
•
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� P SreAeverse5ideforins¢uctioas MinnesotaDepartmentofHealth(NIDI�
• Project Information Sheet far Special Projects
NameofI��HProgram: :taternal and Child Health Special Projects Grant
1. ProjectInformation saint Paul Co�unity Healch Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Pubiic Health
Beginning Date: End Daze: Minnaota Tax I.D. No.: Federal 1.D. Number: Social Security Number:
O1/O1/98 12/31/94 802-722�i 41-b005875
Project Funds Requested: I,ocal Match Provided: �
Yeaz 1 Year 2 Yeaz i Yeaz 2
$ 808,695 �P 813,637 $ 202,959 $ 202,959
Service Area (city, county, or counties): �
City of Saint Paul
. Non-Pro�t Status - SOi.C3 Copy Attached
� Yes � Not Applicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence ofComplianceForm)
❑ No ❑ Yes � Not Applicable
4. Affirmative Acrion
The agency has a certificate from the Commiuioner of Human Rigdts, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Appiicable Because:
❑ Total Coatract is SSQ00 or Less
❑ Ageary Has 20 or Fewer Full-Time Employees
� Units of Local Govunment
❑ Indian Reservation
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HE-01274-04 (3/97) -PART B
IC N 140-425
Instructions for Completing Project Information Sheet for Special Projects �
Please Type or Print all items on the Project Information Sheet for Special Projects
Appticatioas ��Iease note: The appIication form has been designed to be used on all Special Project grants
administered by the Minnesota Department of Health. ff you have questions, or need
assistance in completing the application form, piease contact the Program Maneer or
Consultant identified as responsible for the grant.
Project Information
Provide name of appIicant agency, beginning and end date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicable), or Social Security Number, and geographic service azea. List the total
amount requested for each year for Project Funds Requested and LocaI Match Provided. PIease refer to
individuai instructions for each special project gant to determine if local match requirements aze needed.
2. Non-Profit Status - SO1.C3 Copy Attachment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit institution, corporation or organization.
3. Worker's Compensation •
Minnesota Statutes, Chapter 176, forbids the Commissioner of Health from entering into any contract until
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requirements from the contractor. Complete the form entided "Evidence of Compliance" and retum
it with your grant application.
4. Affirmative Action
Minnesota Statutes, Section 363.073, says the Commissioner of Health shall not."... receive, enter into, or
accept any bid or proposal for a contract nor execute any contract for goods, services, or the performance of
any function, or any agreement to transfer funds for any reason in excess of $50,000 with any person having
more than 20 fuil-time employees in Minnesota at any time during the previous 12 monttu, unless the person
has an a�mative action plan for the employment ofminority persons, women, and the disabled that has been
approved by the commissioner of human rights. Receipt of a certificate of compliance issued by the
commissioner shall signify that a person has an affirmatiye action plan that has been approved by the
commissioner." If the grant or contract you propose meets the "in excess of $50,000" criterion and your
ageacy meets the "more than 20 full-time employees" criterion, a Certificate of Compliaace must accompany
your proposal, unless your agency is exempt If you have questions about the Certificate of Compliance,
please contact the:
Minnesota Depamnent of Humaa Rights
Con�act Compliance
Army Corps of Engineers Ceater
190 East Fifth S�eet
Suite 700
St Paul, MN 55101
(612) 296-5663
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� Plczcc Typc or Pnnc
Evidence of CompIiance
State law forbids the Commis;ioner of Health from entering into any grant contract until the Commissioner
receives acceptable evidence ei compliance with workers' compensation in�,Ta„ce coverage requirements from
the gantee. The exceprion to this requirement is a self=employed grantee who has 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 esception and you wish to enter into a grant contract with the Commissioner of
Health, you must frunish acceptable evidence of compliance with worker's compensation covemge in any one of
the following four ways: ' ,
1.
�
If you aze self-insured and you are a state agency or a municipal 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, circle
this entire statement and sign and date the form below in the space provided; or
4. Fill in the informa�on for each
Name and .4ddras of Granta's Irswance Carria:
and date the form in the space provided
��Gcantee's Insuronce Poliry Numbu:
Ia�rm that al1 ofthe employees oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are eovered by the workets' compensation insurance policy listed above.
s�a s
��
Attach a certificate of insurance (supplied by your workers' compensation cazrier) to this Evidence of
Compliance form; or
If you aze self-insured, zttach to this Evidence of Compliance form, a written order from the Minnesota
Commissioner of Comm:rce allowing you to self-insure; or
Minnesota Department of Health
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Director
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HE-0I274-04 (3/97)-PART C
IC N 140-M12S
-i
� MCHSP SI:�P✓IlVIARY OF
ES OF ACTIVITIES AND SERVICES
PR.OVIDED BY OPERATING AGENCIES
BY LEGISLATIVE PRIORITY
Saint Paul Co�unity Health
corrnr�m �aL� Boaxv
c�)
Saint Paul — Ramsey County
OPERATING AGE1�iCY�
(if difterent from CHB�
I. Improved Pregnancy Outcome
served: � City of Saint Paul
Types of Activities/Services
core pubiic hcalth aaivities not directe: to individuals
individualized education/counseling
health education/counseling in groups
pregnancy testing and referrn!
prc-term birth provention
prenatal case management
III. Aandicapped/Chronicall� Ill
GeoQraphic area served: r
Types of Activities/Services
core public health activities not dirocud w individuals ❑ case identification and referral
cau managemrnt ❑ case monitoring and hacldng
home health/respite care ❑ assistance in obtaining health cate financing
school health uchnical consultation ❑ assistance in obtainin
g primary care services
II. Family Planning ProQram
MCHSP SL�►ZMARy OF
TYPES OF ACTIVITIES AND SERVICES
PROVIDED BY OPEl�>T'ING AGENCIES
BY LEGISLATIVE PRIORITy
i ��
comnKUxi� xEai.� soaRn
�c��
� �
OPERATING AGEi�iCY'�
�f di}Tennt from CHB)
N.
Childhood Injiuy Controt
Geographic azea served:
Typa of Activiries/Servica
Ptease c6eck theen s'e,�:�.� ..�....�
core public healch activities not direcmd to individuals
home safety awazeness
promotion of positive parenting
toddler car seau
Tu
injury prevention in day care setting
inJury Prevention in schools
farm relaud injury programs
enabling and non-health suppoct
Other Programs Previous Funded by a Local Pre-Block MCH Special Project Grant - Specify Programs:
❑ Dental Heaith Program
❑ InfanUChild Health Program
� Adolescent Health Program
Types of Activitic�slServices
core p�blic health activities not directed to individuals
examples of operating agency include county, school dis�ict, Iadian reservation, non profit health agency,
etc.
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CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT
GR°j?�iT FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
•
CHECK ONLY 0�1E BOX:
�
No
sterilization
grovided
❑
Yes
steriIization
grovided
:LfCH Special Project grant fuads wiil not be used during CY 1998-99 to
provide and/or arrange sterilizations. If a client is merely referred to another
health care provider, this provision of information is not considered to
"ananging" a sterilization.
MCH Special Project grant funds will be used to provide and/or arrange
sterilizations during CY 1998-99. Agencies which use MCH Special Project
gant funds to gay for a procedure or related pucpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requirements described elsewhere in this document.
I certify that to the best of my knowiedge the above information is coaect, and that if this status changes,
formal notification in this regazd wili be sent to the Section Manager, Matemal and Cluld Health Section,
Minnesota Department of Health, Minneapolis.
�
Signature ofDirector
of Applicant Agency:
Title:
Date:
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Instructions for Completing Certification
Concemiag Use ai'�TCH Special Project Grant Funds
to Promote aad/or Anange Sterilizations
AIl federai PubIic Health Service supported programs, including the Matemal and Child Heatth Services
Block Grant progr�m, which use federal funds to provide and/or azrange for sterilization aze required to
follow fedeial procedures and to pmvide tvritien doctunentation in this regard on a quarterty basis.
MCH Special Projects (MCHSP) may obtain an exemption from tt}is reporting requirement by signing a
cer�frcation that ttieir agency is not using MCHSP funds to provide and/or arrange sterilizations. (If a client
is merely provided information and referred, this is not reported.) Reporting is required if MCHSP funds
aze used in some form of participation (paying for the procedure, providing traasportation, making an
appointment with another health provider, or detailed counseling beyond simpte provision of information).
All Cominunity Heatth Boards aze required to complete the Certification. For agencies which do not
provide sterilizations, no further action will be needed during CY 1998-99. The agencies which indicate
they do provide sterilizations must adhere to specific federal service and reporting requirements @escribed
elsewhere in this document
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CERTIFICATION REGARDING LOBBI'�1G
The undersigned certifies, to the best of his or her knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or an employee of any agency,
a member of congess, an officer or an employee of any agency, a member of congress, an officer
or employee of congess, or aa employee of a member of congress in connection with the awazding
of any federal contract, the making of any federal gant, ihe making of any federal loan, the
eniering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
of inodification of any federal contract, grant, loan, or cooperative agreement. .
(2) ffany 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 congzess, or an employee of a member of congress in connection with
this fedezal contract, grant, loan, or cooperative agreement, the undersigned shall complete and
submit Standard Form-i l i, "Disclosure Form to Report Lobb}�ng," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the awazd
• documents for all subawazds at all tiers (including subcontracts), sub�ants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reIiance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction 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.
Signature
$�� R1
Date
Rob Fulton, Director
Name of Authorized Individual
• Saint Paul - Ramsev County Department of Public Health
Name and Address of Organization 555 Cedar street
Saint Paul, iIN 55101
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ASSURANCES AND AGREEMENTS
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
Services will be provided in accordance with appiicable state and federal laws, rules and procedures.
2. The agency will comply with state and federal requirements relating to privacy of clieat information.
'The agency will comply with the Minnesota Clean Indoor Air Act which prohibits smoking in MCH
Special Project facilities and clinics.
4. The agency (if it has 15 or more empioyees) and any subcontractors with 15 or more employees will
have on file and available for submission to Minnesota Department of Health (IvIDI-n upon request a
written non discrimination policy containing at least the following:
• "All progzanis, services, and benefits which aze administeted, authorized, and provided shail be
opeiazed 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
Discrimination Act of 1975, and the non discriminatory requirements of the MCH Block Grant.
No person or persons shall on the ground of race, color, nationat origin, handicap, age, sex, or
religion, be excluded from participation in, be denied the benefits of, or be otherwise subjected
to discrimination under any prograzn service or benefit advocated, authorized, or provided by this
Deparnnent."
5. The agency (if it has 15 or more employees) and any subconttactdrs with 15 or more employees will
disseminate information to beneficiaries and the general public that services aze pmvided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be
accomplished by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or othez
communications designed to acquaint potential beneficiaries and the public with progams;
and/or
B. Notifying referral sources in routine letters by including prepared handouts which state that
• services aad benefiu musc 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 IVIDH upon request.
�
6. In fulfilIing the duties and responsibilities of this grant, the gr��tee shall comply with the Americans
with Disabilities Act af 2 940, 42 U.S.C. § I2I01, et seq., and the regulations promulgated pursuant to
it.
7. No residency requiremeats for services other than state residence, wiIl be imposed.
8. Services shaI1 not be denied based on inability to pay.
9. Arrangements shall be made for communications to take place in a language understood by the
matemal and cIuld heaIth service recipient.
io• All written materials developed to determine client eligibility and to describe services pmvided under
this grant wiIl be understandable to a person who reads at a seventh grade level using the Flesch
"Analysis Readability Scale as required in Minnesota Statute 144.Q54 (see Appendix I0, Ptain
Language in Written Materials, Minnesota Statute, Section 144.054}.
11. The agency will provide services in keeping with prograrn guidelines of ihe Minnesota Department
of Health and guidelines of accepted professional groups such as the American Academy of Pediatrics,
American CoIlege of Obsteh and Gynecologists, and American Pubiic Health Associatio�
12. Upon request, one copy of any subcon�act executed as part of the project will be provided to the
Minnesota Department of Health.
I3. The agency wilI report accomplishments of the project to the Minnesota Department of Health. Such
reports will be submitted no later than 90 days afier the completion of the catendar yeaz. Upon
request, the agency will provide additional information needed by the Depamnent for evaluation of
the project's objectives and methods and compliance with any special conditions (see Appendix 17,
Program Reporting Requirements for Matemat and Child Heatth Special Ptojects).
14. G2ant funds shatl not be used for inpatient services except for high risk gregnant women and infants.
15. Cash payments shall not be made to intended recipients ofhealth services.
I6. Grant funds shall not be used for purchase or improvement of land or facilities.
17• Grant funds shall not be used for punchase of equipment costing more thaa $5,000.00 per uniY and with
a usefut life exceeding one year.
18. Giant funds shall not be used for reimbursement for travel and subsistence expenses incuired ou e
the state uniess it has received prior written approval from the Minnesota Department of Healtt�
such out-of-state �avel.
19. Whea applicable, ihe agency sha11 provide nonpartisan voter registratioa services and assistance using
forms provided by the state to employees of the agency and the public as reqnired by Minuesota
Statutes, 1987 Supplement, Section 202.162 (see Appendix 9, Requirements for Voter Registratio�).
�-�- �oa�
•
20. When issuing statemenis, press releases, requests for proposals, bid soIicitations, and other documents
desczibing projects and prograzns funded in vr'-nle or in part with federat money, ail grantees receiving
federal funds shall ctearly state (a) the percentage of the tatal cost of the program or project which will
be financed with federai money, and (b) the dollar amount of federal funds for the proj ect or progam.
21. The a�ency will not use graat funds to pay for any item or service (other than an emergency item or
service) furaished by an individual or entity convicted of a criminai offense under the Medicare or any
state health cue program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant
programs).
22. Materials de�•eloped by Matemal and Child Health Special Project grant and matching funds wili be
part of the public domain and will be accessible to the public as financially reasonable. Materials
developed b� the �+fatemal and Child Health Speciai Project grant and matching funds may be
feproduced and distributed by the Project to other agencies and providers for a profit so long as the
revenues from such sale aze credited to the Special Project budget for expenditure by the Special
Project.
23. The agency will compiy with all standards relating to fiscal accountahility that apply to the Minnesota
Department of Health, specifically:
• A. Bud;et revisions with justification will be submitted to IvIDH for prior approval whenever:
(1) changes aze made in the objectives to be met in the Matemal and Chiid Health Special
Pmject, or
(2) the cumulative amount of funds uansferred into or out of an operating agency's budget
line item exceeds or is expected to exceed 10% of that approved for the grant year or
52,500.00, whichever is greater.
B. Final expenditure reports are due 90 days after the end of the calendar yeaz.
C. Grant funds are used as payment for services only after third-party payments, such as from
the Medical Assistance/Medicaid (Title XXI�CC SSA), Children's Health Pian/MinnesataCare
reimbutsement progratns of the Minnesota Department of Human Services and private
insuiance aze utilized.
D. Project financial management systems wi11 provide for.
(1) Accurate, cuirent, and complete disclosure of the financial status of the p%ject.
(2) Records which identify adequatety the source and application of funds for Matemal and
. Child Health Special Project activities. These records are to contain information
pertaining to project awazds and authorizations, obligations, unobligated balances,
liabilities (encumbrances), outlays, and income.
�
(3) Effective control over the accountability for al1 fuads, p; -•�erty and other assets.
Projects aze to adequately safeguard such assets and assure that they are used solely for
authorized purposes.
(4) Comparison of actual obtigations with budget amounu for each activity.
(5) Accounting records which are supported by source documentation.
{6) Audiu which will be made by or at the direction of the Minnesota Department of Health
(see Appendix 6, State Audits}. ,
SIGNANRE OF CHAIR OR VICE-CHAIR
OF THE COMM[.TrTTI'y HEAI,T'H gp,q� OR
AN AGENT APPOINTED BY RESOLUTION
OF TI� COMMUNITy HEAI,TH BOARD:
��2'����
TTTLE:
DATE:
� Iti rPrro3
�'�2 L�'� 7
•
•
a�. a �oag
•
�
COMMUlvITY ASSESSMENT
n
��
a� - �a�g
•
CONIlVILtNITY ASSESSi�IEP3T
A broad-based assessment of community health needs and resources in Saint Paul was
conducted be�innins in the fall of 1994 as part of the development v: the 1996-1999,
Saint Paul-Ramsey Counry Community Health Services Plan. Throughout this
planning process. and as we proceed to plan for the future, issues will be identified
which contribute to poor health outcomes. The CHS Advisory Committee idenrified a
number of primary issues which underlie and aze frequently the root causes for the
discrete public health problems identified in the Community Assessment. Specifically,
these issues are:
• Poverty and Racism - all of which lead to hopelessness, income disparities and •
polarizacion between classes.
This polarization tears at the socialtcultural fabric of our community, making public
health intervention increasingly chalienging.
The Advisory Committee and staff also identified system problems which underlie and
compound the problems. These system problems are:
i. Integrated health care and social service system for all children and families in
• Saint Paul and Ramsey County, especially children at risk are lacking.
2. The complexiry of the changing health care system in Saint Paul and Ramsey
County has resulted in lack of access to heaith care for certain populations and
the lack of stable funding for public health services, inciuding prevention.
3. Communication of health and environmentai 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%a or more persons with
incomes below the poverry level, with an additional nine census tracts with a
level of 30% - 39.9% of persons with incomes below poverty level.
• Five census uacts in Saint Paul realized an increase of over 20% in the
number of persons living below poverty between 1980 and 1990.
A significant change occuring in the community has been the public health joint
powers agreement between the City of Saint Paul and Ramsey County, effective 7uly
1, 1997. The Joint Powers Agreement was developed over approximately two years
before being approved by the Saint paul City Council and the Ramsey County Board
� of Commissioners in December 1996. the Joint Powers Agreement forms the Saint
Paul - Ramsey counry Department of Public Health. The 7oini Powers Agreement
idenufies one Community Health Services Agency for the Saint Paul - Ramsey County
community. However, both Saint Paul and Ramsey Counry will maintain a Board of •
Health. The Saint Paul Community HeaIth Board witl consider issues affecting those
services maintained by the City of Saint Paul, which will include the Maternal and
Child Health Speciai Projects Grant. Saint Paul - Ramsey County Department of
Public Health becomes the operating agency for the MCH grant.
Additional assessments has been completed at part of the preparation of the Saint Paul
- Ramsey County Couununity Heaith Services Plan Update for 1998-1999. As a result
of this assessment, Saint Paul - Ramsey County Department of Public Health has
identified improving preanancy outcomes as a maternal and child health service
prioriry for Saint Paul. The 1996-1999 Community Health Services Plan identified
twenty health problems as the highest priority. An additional thirteen high priority
problems were identified as were three service delivery system problems. A number
of problems related to improving pregnancy outcomes were identified among these
high priority problems including:
� High rates of low birthweighi stfants and preterm deliveries in some
populations
• Ongoing problem of Infant Mortality despite decreasing infant mortality rates
• Low rates of breastfed newborns and infants in Saint Paul and Ramsey County •
Data reported in the 1996 Minnesota Health Profiles provided by the Minnesota
Department of Health and the Saint Paul - Ramsey County Communiry Health
Services Plan Update for 1998-1999 also reveals that in 1995:
� Percent of Premature Births (less than 37 weeks gestation) for Saint Paul is
10.5 compared to 8.7 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is 6.2 in
Saint Paui compared to 4.0 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is higher
for American Indians (8.3), African Americans (10.7), Asians (13.6) and teens
(10.5) compared to Saint Paul aT 6.2.
• The iafant death rate of infants born to American Indian women (24,4) and
African American women (13.7) is much higher compared to the rate for Saint
Paul (9.4) and the State of Minnesota (8.2).
• The incide�e of 2ow birthweight births in Saint Paul increased from 6.7 in
1993 to 7,3 in 1995. •
• The incidence of low birthweight births for African Americans increased from
22.0 in I993 to 14.4 in 1995.
a�� �oq�
• This data also indicates that due to the increasing efforts to improve pregnancy
outcomes, we have seen some positive results such as:
� The cunent five year rate for infant mortality in Saint Paul of 7.4 has
improved compazed to the previous five year rate of 10.6.
• The incidence of lst trimester prenatal caze continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993 and 69.9 % in 1995 for Saint Paul
women.
� The incidence of ist trimester care for Saint Paul Native American women
continues to increase from 36% in 1988, to 37% in 1991, 54% in 1993 and
63.9 % in 1995. �
While technology has improved to allow care and treaunent of some high risk births,
it is much more efficient, cost-effective and less stressful to place dollars and efforts
on improving pregnancy outcomes so that the advanced technology does not need to be
used.
Data indicate that some specific health planning areas in Saint Paul have poorer birth
outcomes and may benefit from increased levels of targeted outreach and service.
• These health planning areas, all within the City of Saint Paul, include: Thomas-Dale,
Sununit-Dale, Downtown Saint Paul, Riverview, Dayton's Biuff, Mount Airy and Rice
Sueet.
In addition to the focus being placed on unproved pregnancy outcomes, the Adolescent
Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock 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, e�cient and effective service to this
potentially high risk and often forgotten population. In fact, a number of issues
specifically related to adolescent health are included in the Community Health Services
Plan as priority health probiems, 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.
• High incidence of death and injury due to availability of fuearms
• High rate of unintended pregnancy among teens
• • Increasing 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
Tfirough the community assessment completed as part of the CHS planning process, it
was identified that there are resources available within the community to meet the
needs in the areas of famiIy planning, handicapped/chronically ill children and
childhood injury conuol. Based on ttris assessment, no funding is requested for these
azeas through the Maternal and Child FIealth Speciat Project Grant. However, these
areas will continue to be monitored by Saint Paul - Ramsey County Department of
Public Heatth to ensure that resources exist to handIe t6e various health problems and
issues in each azea.
�
The provision of services addressing improved pregnancy outcomes will be
subconuacted to various communiry-based providers who were identified through a
process of request for proposals. Saint Paul - Ramsey County Department of Public
Health has chosen to subconuact for services in an effort to utitize estabtished
agencies and organizations who have proven to be effective and efficient in their
delivery of services and which are located within the target areas. Additionally,
subcontracting with existing agencies minimizes start-up costs and duplication of
services. Itis hoped that this process and the services provided by the subgrantees �
will also help ensure that culturally-sensitive, continuous care is provided to high risk
populations.
Various information regazding the community assessment is displayed in the figures on
the following pages.
•
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3 YR. Teen Birth Rate
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3 YR. TEEN PREGNANCY RATE
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•
IlVIPROVED PREGNANCY OUTCOMES
�
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q�- �o�g
PROBLEM STATEi�i�iT
•
Poor pregnancy outcomes has been identified tbrough a community assessment as a
high priority public health problem in Saint Paul by the Saint Paul-Ramsey Counry
Community Health Services Advisory Committee and staff from Saint Paul - Ramsey
County Department of Public Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in
some populations
• ongoing problem of infant mortaliry despite decreasing infant
mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal
aicohol effects and other birth defects
•
•
The rates of infant mortality, low birth weight and pre-term deliveries for the City of
Saint Pau1 are higher than suburban Ramsey County and the State overall. The Health
Planning Areas of Thomas-Dale, Summit-Dale, Downtown St. Paul, Riverview,
Dayton's Bluff, Mount Airy and Rice Sueet have been targeted as the specific
geographic areas to be served in response to previous high rates of poor pregnancy
outcomes.
601
319. 332 �
6�6
Midway
3oz. soa ao�. s,z
602
Como Park
607
Hamline
m. �t.. sse. 3as. 3so.
351. 35z.363. 3st.3ss
612
Maca/ester
3ez. ns. sra.w. naoz
�. �eo. aee.3cr. �ea.3es
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3os.oi. 3os.oz �.
310, 371, 375, 376
604
Pha/en Park
3s,. aro. an. arz
617
Rivenriew
sy5 CtTY of SAINT PAUL
Highland Park Health Planning Areas
and constituent census tracts
� Targeted for high mtes of
Poor Pre9nonry ovkome
x�.oz 3o�.m. x�.aa
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Hayden Heights
,.�,� 318.01.31602,
3a7.01.347.02
611
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374.0; 37t.p9,374.06
618
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RAMSEY COUNTY: BiRTHS
% Premature & % Low Birth Weight
._. i
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y- ' � � 59
Ramsey County:Prenatal Care
First Trimester
�:�
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ZO O%
�014
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t986 7988 7991 1993 1994 7995
1990 1995
Heatthy Pgople 2000 Goai is 90 % Source:MDH
�
Ramsey County
Healthy People 2000 Goal 7.0
Source:MDH
Osw�x
o,NO�
�5�,�
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City of Saint Paul
Infant Mortality Rate by Race
Saurce:MDH
� eua�
ii �
� s�vome
� v�rtme
u
Infant MoRality Rate by Race
Healthy People 2000 Goai �.0
�� -io��
. One factor contributing to poor preanancy outcomes, including high infant mortality,
premature birrh, and low birthweight births, is late or no entry into prenatal care.
A�ain, the targeted Health Plannin� Areas within the City of Saint Paul have a higher
percentage o_` women who begin prenatal care late (third trimester) or who receive
none at ali than suburban Ramsey County and the State overall. Certain Saint Pau]
neighborhoods have especially high rates of late prenatal care.
LATE OR NO PRENATAL CARE in -1990
Overall, 7.4% of mothers did not begin prenatal care until
the third trimester, or received no prenatai care at all.
HEALTH PLANNING AREA
Mt. Airy
Thomas-Dale
•
•
Rice Street �
Midway �
Downtown r
Daytons Bluff �
Riverview �
Summit-Dale r
Phalen Park �
T
St. Mthony Park r
West 7th SUeet �
Battle Creek �
Hayden Heights �
Hamiine - 3b'
Hightand Park � s.z�
i
Hazel Park � a.a o
Maeatester � 2.o^r,
Como Park � ��3 =
i o.� �
io.oi
� B.0 %
� 6.9%
■ s.sv,
4.9 %
13.
O.OX S.OX 10.0% I5.0%
LATE or NO PRENATAL CARE
20.6 %
20.OX
25.0X
SOURCE 58int Paul Pub6c Heaith
q�-�o��
� Maternal and child health activities funded through the Maternal and Child Health
Special Projects Grant are monitored quarterly, and more thoroughly evaluated on an
annuai basis. A report assessin� the activities of the current project in 1996 was
compieted for the Minnes�:^. Department of Health. Since current comprehensive data
on Saint Paul health indicators is not readily available, it is dif£cuit to fully assess the
impact of present pro�rams at this time. However, based on the data received from
the pro�rams, the foliowing summary information from 1996 programs receiving
MCH fundin� to improve pregnancy outcomes is availabie:
• 1,246 clien[s were seen for prenatal services
• 44% of the 548 clients who delivered in 1996 received prenatai care in the
first trimester of pregnancy
• 4 fetal deaths were identified
� 2 neonatai deaths occurred
• 35 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 among some minority populations.
� PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES
Saint Paul - Ramsey County Department of Pubiic Health's Improved Pregnancy
Outcome Pro�ram for the City of Saint Paul 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 assuring
universal access to preventive health services. To achieve these goals Saint Paul -
Ramsey County Department of Public Health has identified priorities consistent with
the foliowang MCH Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatal caze in the first trimester
• provision of prenatal care services that are sensitive to cultural diversity
These priorities will be addressed through the objectives and methods identified by the
by staff in the Refugee/Preventive Medicine Program at Saint Paul - Ramsey County
Department of Public Health and four community agencies approved for funding by
the MCH Special Project Funds Proposal Review Committee. Once again, Saint Paul
- Ramsey County Deparcment of Public Health subcontracts the majority of MCH
funding to community organizations to increase access to services, and to increase the
� likelihood that culturally sensitive care is available to the population. The agencies
recommended to receive funding are Health Start, Inc.; Model Cities Health Center
Inc.; Face To Face Health and Counseling Service, Inc.; and West Side Community
Aealth Center.
The programs of these agencies provide a variety of inetl �ds which are targeted to
increase the percenrage of women receiving prenatal care in the fusttrimester, ensure
continuous prenacal care, education and case management, reduce infant mortality, and
decrease low birthweieht bir[hs. AdditionalIy, the programs of these four agencies
will provide services to the residents of the highest risk Saint Paul neighborhoods.
�
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INVE1�"fORY OF SERVICES
From the inventory which was completed, it has been identified that there aze a
number of agencies providing prenatal c,:re in St. Paul, in addition to independent
practitioners. An inventory of agencies providing prenatal care, priruarily those
providing the opuons of care on a sliding fee, including the target populauon served
and the services provided, is included in Attachment A.
In April of 1992, the Prepaid Medical Assistance Program (PMAP) was implemented
in Ramsey County. There are currently four health plans available, including
HealthPartners, U-Care, Medica and Blue Plus. Individuals who are newly applying
for Medical Assistance are being placed into this system at the present time.
The system has improved, but there are still issues of denied services, confusion
regarding where a person can receive services and clients choosing not to seek
services due to the confusion. Special populations may need special attention to
initially maneuver through this new system. Saint Paul - Ramsey Counry Department
of Public Health will continue to advocate for accessible care for all populations.
•
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GOALS OF THE PROJECT
The overali goal of the projecu which will be supnorted through the Maternal and
Child Health Special Projecu grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBJECTIVES OF THE PI20JECT
A number of objectives have been established for the Improving Pregnancy Outcome
project including:
1. To make progress toward ihe goal of improving the overall 3aint Paul infant
mortality rate ( 9.4/1000 in 1995) with a special emphasis on African
American, Native American and Asian women.
2. To make progress toward che goal of reducing the rate of St. Paul low
• birthweight infants from 7.3% in 1995 to 4.0% by 1999 with a special
emphasis on African American, Native American and Asian women.
3. To conduct ouueach efforts to pregnant teenagers to increase the rate of first
trunester prenatal care ( 56% in 1995) in Saint Paul pregnant women under age
20 with a special emphasis on outreach to minoriry teens.
4. To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 6.2% in 1995 to 4.5%a in 1999, with a
special emphasis on pregnant teens and all pregnant African American, Native
American and Asian women.
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Board
through the Saint Paul - Ramsey Counry Department of Public Heatlh are low income
(less than 200% of poverry) Saint Paul women at high risk for poor pregnancy
outcomes, as defined by legislative pazameters. This includes, but is not limited to,
teenage and minority women residing in the aforementioned health planning areas
• (HPA's) of Ramsey County. The targeted HPA's were selected on the basis of their
historically high rates of infant mortality and late or no eniry into prenatal care.
The Refu�ee/Preventive Medicine Program at Saint Paul - Ramsey Department of •
Public Health will be using a very small amount of the Maternal and Child Health
dollars to partially fund their Improved Pregnancy Outcome Program which is
described below.
Goal - To improve birth outcomes of high risk low-income pregnant women in Saint
Paul trough early comprehensive prenatai care.
Target Poputation - Low-income prenatal women enrolled in Saint Paul - Ramsey
County Department of Public Health Refugee/Preventive Medicine Clinic.
Objectives -
1. Comprehensive multidisiplianary prenatal care will be provided to 100% of
prenatal clients enrolled in the Refugee/Prevenuve Medicine Clinic.
2. By 12/31/99, 85% of prenatais wili be rated "healthy" by their 3rd trunester as
measured by health status indicators.
3. Ongoing health education will be provided on an individual and small group basis
to 100% of all prenatal patients.
4. By 12/31/99, 95% of prenatal clients will initiate prenatal care during their lst •
trimester.
5. By 12/31/99, low-birth weight (less than 2500 grams) rates will be no greater than
0.1�.
6. By 12/31/99, the infani death mortality will be no greater than 0.1%.
Methods -
� Clinic and ouueach staff will be trained to provide culturally competent health
information.
• The outreach worker will provide health information which wi11 include proper
nutrition, elimination of alcohol and drug use during pregnancy, family planning
educarion and personal, financial and education pIanning.
• As part of case management and follow-up, an outreach worker wili make at least
six home visits to each prenatal client as part of the case management and follow-
up program.
• Arrangemenu for uansportation will be made through the patient's Health Plan for •
those who have uansportation needs.
�� - �oa�
• Evaluation - The case manager will provide reports on a quarterly basis including
number of homevisiu and telephone contacts per patient. There will be quality
improvement monitoring of alll postpartums to meausre outcomes durin� their
pregnancy period including care and status of all delivered inf� '-
Trainin�/Eamerience of Staff -
Xia Lor Vang is an Outreach/Health and Education Assistant. She received inservice
training for Western medicines and treatment through the University of Minnesota
from 1981-1986. she also complete Health Interpreter Training at the Universiry of
Minnesota in 1989. Xia has worked as a nutrition assistant, interpreter and outreach ,
worker with prenatal patients and their families for many years. She has attended and
participated in many Hmong conferences and other in-services on cultural diversity in
the Twin Cities and has received high awards for her community work.
Florida Stevens is a Public Heaith Nurse receiving her Bachelor of Science in nursing
in the Phillippines in 1965. She joined the exchange program for nurses at the May
Clinic and St. Mary's Hospital in rochester, Minnesota from 1967 to 1971. She has
had extensive hospital experience as a staff nurse, manager/supervisor and project
coordinator. She joined Saint Paul Public Health in 1994 as a perinatal hepatitis
• coordinator and later as program manager for Refugee/Preventive Medicine Ciinic.
She has worked ciosely with prenatal clients in case management, assuring quality
outcomes since 1995.
Jonnalyn Belocura, M.D. is a Family Practice Physician. She graduated from
Medical School in 1991. Dr. Belocura came tothe University of Minnesota in 1993 -
1996 to specialize in Family Practice. She practices at Model Cities Health Center
and at Saint Paui - Ramsey County Depar[ment of Public Heatlh Refugee/Preventive
Medicine Clinic.
Diane Vankante, M.D. came to the United States in 1991 from Croatia. She took her
rsidency in Family Practice at I3orth Memorial Hospital from the Universiry of
Minnesota from 1993-1996. Dr. Vakante practices at Model Cities Health Center and
at Saint Paul - Ramsey County Department of Public Heaith Refugee/Preventive
Medicine Clinic.
Linkaees - The Refugee/Preventive Medicine Clinic at Saint Paul - Ramsey County
Department of Public Health provides on-site prenatal care. Clinic staff and the
ouueach worker work collaboratively with the public health nurses, WIC and Optional
Home Care for home visits and other patient needs. The clinic has agreements with
Bethesda Family Practice matemity staff and St. Joseph's Hospital for provision of
• patient deliveries. All patients records and updated progress notes aze sent to St.
Joseph's Hospital at twenty-eight weeks and prior to delivery date.
Reimbursement and Fees - The prenatai clienu are eligible for Medical Assistance, •
specifically U-Care Managed Care. the Clinic has been a U-Care provider since
BudEet - A complete budget and justification follows.
The remainder and majority of available MCH Special Project Funding beyond the
pre-block grant funding to HealthStart, Inc. was made available to community
organizations through a Request for Proposals process. This process and the target
population specific to each subgrantee selected, as well as the objecuves, methods, '
training/experienc of staff, linkages, reimbursement/fees and budgets will be described
in the following section tided, "Subgrantee Information".
�
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FT'E
REFLTGEE AND PREVEiVTIVE CLII�IIC F1'iVANCIAL SUMi1�1ARY
1998 iv1ATERNAL A1VD CHILD HEALTH GRANT
Salaries/W Bene�its Maternal Child SPRCPH Totai Salaries
Health W/ Benefits
3 HmoneJL,ao HEA
Outreach Staff
� Travel Expense
3 � PF�N Case Mana�er
$ 7,517.00 $ 12,157.00
1,450.83
17,410.40
.2 Consultant/Z family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
REFUGEE AND PREVENTIVE CLI1vIC FINANCIAL SUMMARY
1999 MATERNAL AND CHILD HEALTH GRANT
n
U
FTE Salaries WBenefits
3 Hmong/Lao HEA
Outreach Staff
Travel Expense
.3 PHN Case Manager
SPRCPH
$ 7,517.00
1,450.83
Total Salaries
W/ Benefits
$ 12,151.00
17,410.40
.2 Consultant/2 family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
Finsum
$4,640.00
360.00
Maternal Child
Health
$4,640.00
.� ��,
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SUBGRANTEE INFORMATION
�
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SUBGRANTEE SOLICITATION PROCESS
To determine the agencies with whom a subcontract would be established, a
solicitation process was conducted beginning in May of 1997. 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 Public Health and an ad hoc subcommittee
including representatives of ffie Saint Paul - Ramsey County Communiry Health
Services Advisory Committee. ,
An evaluation form similar to the Minnesota Depar[ment 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 consistently
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, a summary list of the proposals received, and the evaluation
tool used are described in Attachment B.
SUBGRANTEES
Specific information on each of the projects to be supported through the Maternal and
Child Health Special Project Grant for improving pregnancy outcomes is provided on
the foliowing pages. Each project has specific target populations, objectives (which
include projected service levels), and methods, but all projects aze working towazd the
same goal of improving pregnancy outcomes for residents of Saint Paul. Copies of the
full proposals submitted by each of the grantees are available from Saint Paul Public
Health upon request.
The foliowing table indicates the projects which aze proposed for funding and for
which a complete program description follows.
�
AGENCY
Model
Cities
Face to
Face
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr.l: Yr.2: Total: Yr.l: Yr.2:
62,430 31,215 31,215 60,132 30,066 30,066
80,000 40,000 40,000 7�,054 38,527 38,527
West Side 28,000 14,000 14,000 26,980 13,490 13,490
Health
�
Start 409,042 204,521 204,521 393,902 196,951 196,951
(IPO)
Health •
Start 1,04�,820 523,910 523,910 1,010,070 505,035 505,035
(Adoi)
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesting funding primarily for outreach, education and tracking.
Health Start receives non-competirive funding as a pre-block grant pzovider to provide both
improved pregnancy outcome services through outreach and prenatal caze, and adolescent
health services through school based clinics.
�
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, MONTTORIIVG/EVALUAT'ION 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 regulaz basic throughout the
contract period.
Contracu will be written between Saint Paul - Ramsey County Department of Public Health
and the subgrantees indicating specific performance objectives and outcome indicators. The
contracts will oudine the subgrantee duties, reporting requirements, the monitoring
expected/performed by Saint Paul - Ramsey County Department of Public Health, and
evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective
tools will be used by the subgrantees to ensure that various aspecu of their program are
reviewed.
PROGRAM EVALUATION
Data will be sought from various sources, both nationaily and locally, including the Minnesota
. Department of Health, to monitor pregnancy outcome uends. This data will be used to
analyze the impact that the project has had on the goals and objectives for the project
throughout the two yeaz period. Since summary data is frequenUy available on a two year
delayed basis, progress toward the objectives may be di�cult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
* age of client
* race and ethnicity of clients
* residence of clients
* time of entry into prenatal care
* number of fetal deaths
* number of neonatal deaths
* number of infanu with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs are
appropriately impacting pregnancy outcomes. Based on this evaluation, services and programs
may need to be modified or refocused to maximize the likelihood that the objectives and goals
are met.
•
�� - (0��
. Subgrantee A- Aealth Start. Inc.
FIealth Start, Inc., as a Pre-Block grant provider of services, continues to receive Matemal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes.
Health Stazt, Inc. is an organization specializing in maternal, infant and adolescent health care
services to high risk popularions for disease or disability due to economic, social or medical
conditions, and to reduce morbidity and mortality in these populations.
Heaith Start proposes to continue to serve the �eds of low income and adolescent pregnant
and postpartum women. Health Start will provide multidisciplinary, comprehensive prenatal
care at hospital and school based out-patient clinics. Prenatal care offered to students in the
high schools facilitates early entry into prenatal care. This component of the Health Start
program addresses the City of Saint Paul's Pvlaternal and Child Health priority of improved
pregnancy outcomes, emphasizing adolescents and adult women of color.
TarEet Population - The clients targeted to be served will be those at high risk for prenatal
and birth complications who would, without accessible and high quality services, continue to
experience the multiple problems associated with high risk pregnancies. Since Health Start
provides prenatal caze in eight school based clinic sites in Saint Paul, adolescents, especially
minority adolescents, wili be a focus. In 1996 Heatlh Start saw 183 prenatal clients ( 70%
• were minority teens) in the schools for 762 visits. In addition, women who smoke will be
targeted for special prenatal or preconception intervenrions.
Objectives -
1. Health Start will provide comprehensive multidiscipiinary prenatal care to 500 adult and
adolescent women per year during 1998 and 1999.
2. Of women who deliver through Health Start, 55% will prenatal care in the fust trimester of
pregnancy and 85 % of women will initiate care by the end of the second trimester of
pregnancy.
3. No more than 10% of adolescents who are referred to other primary care physicians for
prenatal care will start prenatal care in the third trimester.
4. By December 31, 1999, low-birthweight (less than 2500 grams) rates will be no greater
than 9 percent and preterm birth rates (less thatn 37 weeks gestation) will be no greater than
10 percent.
5. Women who smoke will receive help with smoking cessation methods prior to or early in
conception.
• 6. The incidence of pre-term births and low-birthweight infants bom to adolescents followed
through the high school clinics wili be no greater than 10% and 7% respectively by December
31, 1999.
Methods -
• A futl range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 5aint Paul Ramsey Medical Center (Regions Hospital) and eight
school-based clinics. This wi11 ensure accessibility and acceptability for clients seeking
prenatal care.
• Prenatal and postpartum care wiil follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since 1967.
• All clients wiil be assessed for high-risk condiuons using the Edwards Risk Scoring System
or Minnesota Pregnancy Assessment Form 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-sryle behaviors such as
smoking, alcohoi, and chemical use, and nutruition wluch place women at risk for poor birth
outcomes.
u
• Clients will also be assessed for risk for HIV infecrion and individualized prevention !
education will be provided. HIV testing will be provided on site.
• All clients will receive a nntrition assessment, conducted by a Health Start nutafionist.
Clienu will be certified for WIC at the clinic visit. Clients with specific nutrition concerns,
e.g, diabetes management, anemia, weight control, etc. wi11 receive ongoing nutririon
education and counseling throughout their prenatal care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Family and relationship issues, fiousing and financial concerns, chemical use, and
issues of physical, sexual and emodonal abuse aze included as part of the assessment. Clients
with no source of payment for medical caze wilI receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and support
within the clinic seCting and wiII refer to outside agencies and services as needed.
• Patienu who smoke wilI be encouraged to counE back or stop during pregnancy through
access to self help information, such as Health Partners "smoking dragon" calendar, and
referrals. Intervention will take place eaziy in pregnancy or prior to conception, through
e@ucation given to family planners or patients receiving a negative pregnancy test from Health
Start.
• All clienu delivering through Health Start will receive family planning services for 24 •
months after the baby's birth. After this period, clients will be referred to another sliding fee
provider.
��- �o�
• • I�Iealth Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency caze at St. Paul - Ramsey Medical Center.
• Infants of project clients will receive 24 months of pediatric care through Health Start's
pediatric component and if eligible, will be invited to ganicipate in one of IIealth Start's
intensive pazenting proQrams, including support services for infants e�osed to alcohol and
drugs in utero.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based cluucs and Saint Paul Ramsey Medical Center.
• Clienu in need of specialized medical service will be referred to St. Paul - Ramsey Medical •
Center or other providers as appropriate.
• Clients will receive individualized prenatal educauon in clinic and will be invited to attend
the weekly Aealth Stazt prenatal classes at St. Paul Ramsey Medical Center.
• Prenatal and postparCUm clienu 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 fmd the ciinic sites easily accessible, Health Start will provide
bus tokens or cab cards when needed.
Evaluation - Health Start will compaze birthweight, gestation age, risk level, and onset and
duration of prenaal care with a comparison group which dces not receive a multidisciplinary
modei of prenatal care. Numbers of women initiating prenatal care in each trimester will be
monitored, as well as rnimbers of pre-term births and low-birthweight babies. These can be
compared to city averages, as well as the comparison group of higher risk women.
Health Start wIll compare onset of prenatai care in sutdents seen in school-based clinics with
the average for adolescents cited in the Saint Paul Matemal and Child Aealth priorities. Birth
outcomes of the three groups will also be compared, whereverthe data from non-IIealth Start
patients can be released or gathered.
Health Start will track rate of second pregnancies within a two year span after delivery, along
with preconception and early concepdon interventions regazding risk behaviors and nutrition.
Information from evaluation efforts will be given to the qualiry assurance committee, the
quality management team, and the clinical management team. They may be used to formulate
• changes in intervention, to stimulate further analysis for underlying causes, or suggest areas
for a quality improvement project. Evaluation results aze disseminated to providers via
periodic provider meetings, clinic teams via team coordinator meetings, the Board of Directors
at semiannual boazd meetings. Tkey are also used to morivate stafff and to stimulate a worlc �
cuiture of continuous quality improvement.
Training/Eaverience of Staff - Heatt� Start has provided maternal and child health services in
St. Paul siace 1967, A21 Health Start staff aze professional health care personnel with special
expertise in maternai and child health or adolescence. The majoriry have had more than fve
years experience. AII staff aze evaluated at least once a year,
Staff aze supervised by the executive director, associate director, medical director, associate
medical director or team coordinators. Medicat provders aze credentailed according to
standards of the major health plans. Carol White, M,A., is ttie executive director of Health
Start and is responsible for the overal2 management and d'uecdon of the project, as well as
external retations and long-range planning. Dr. Chris Reif is the medicai director, is on the
staff of the Family Medicine Department at St. Paui-Ramsey Medical Center, and is
responsible for overall medical direction. Dr. Carol Ball, on the staff of the Obstetrics and
Gynecology Deparanent at St. Paul - Ramsey Medical Center, is the associate medical director
and works with the medical director to provide consultation on OB/GYN practices, as well as
providing clinical supervision ;: r OB/GYN nurse practitioner staff. They are advised by a
clinical management team maue up of represeratives fr:�m the various professional discipiines,
in prenatai and adotescent services of HealtFt Sta Ric: 3rd Duffin has bee;� the assoeiate �
direcior for t1u years and manages the school ba .3 cii: ics. Jeanne Ranc��e, PNP, pHN, is
the new Ciinical Services Coordinator, overseeing clinicR! senicPC fc: adolescent, prenaial,
and pediatric care. Jeanne has been with Healt: 5��- _;�� ye �
Summary of qualifications and experience of key staff are attached.
Linkaees - geaitfi Start has well developed linkages that include a w4de variety of health
care providers, educational programs, and social service agencies. This referrat network
allows staff to individualize care plans to meet ihe spec�c needs of each client. New linkages
and zeferral sources aze identified or developed as needs arise. Healih Start receives inkind
donations of space and telephones from Saint Pau2 Raznsey Medical Center. Physicians and
midwivesaze contracted from Ramsey Famity Clinics, who aiso provide back-up for prenatal
care.
Heattti Start works coIIaboratively with Ramsey County public Heatth nurses to extend
services to preganant women in the communit� public health muses meet reg�arty with
HeaIth Start to identify clients needing home-based services and to share information that wffi
enhance patient care.
At delivery, new parenu are referred to Health Start's pediatric clinic. Well-child and acute �
care visiu, augmented by interdiscipiinary services, aze provided. Eligible clients are also
i
l ��•
.
� referred to the Befriender Program, run in collaboration with Children's Home Society, the
Panrzership Program, a collaboration with Saint Paul School's Early Childhood and Family
Educauon (ECFE), or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, andlor group education for high risk
parenu.
�
When psychosocial or health care needs are iden�ed that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), wriuen 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 minimi�ing duplication
by collaborating with many agencies and programs. Health Start will maintain aff'�liations with •
and/or refer to the following agencies and task forces (partial list only}:
Children's Home Sociery, Early Childhood and Family Education (ECFE), HouseCalls,
Frogtown Family Resource Center, Raznsey Clinic Associates, Ramsey Couty Human Services
Family Preservation Project, Saint Paul - Ramsey County Department of Public Health, rondo
Family Resouce Center, Neighborhood Health Caze Network, Saint Paul Public Schools, St.
Paui-Ramsey Medical Center/I-Iealth Partners, PACER Transition to Work Project, 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. Ciients are billed, however, by Saint Paul-
Ramsey Medical Center and Ramsey Clinic for hospital charges such as labor and deli�ery and
selected tests and procedures.
MCH funding allows Health Start to provide prenatal caze for clients who have no third parry
source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. FIealth Start has contracts with all of the PMAP providers.
Any other applicable third parties aze billed whenever possibie. Insurance revenue pays for
approximately 25 % of Health Start's prenatal and adolescent health sservices.
Health Start provides family planning care to clients for 24 months after 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 Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium.
r�
U
Health Start Key Staff
Carol White, nLa is the e�ecuti�e director of Heatth Start, Inc. She w•as hired in June,
1996, by the boazd of directors. She has a masters of arts from Stanford L'niversity� in
early chiidhood education. She has five yeus experience in health care management, ten
years totat management experience in non-profit mana�ement. She has a�ritten and
pubIished training materials and cuiricula on child abuse and family violence.
Christopher Reif, MD, MPH has been the medical director of Health Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey b4edical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currentty on the advisory board of the American Medicai Association's Cruidelines for
Adolescent Prevention Services (GAPS).
Richard Duffin, MA has been the associate director of Heatth Start since 1994. He is
responsible for school based ctinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty yeazs experience in managing
human service organizations, with special experience in mental health and developmental
disabilities.
�
Jeanne Rancone, PNP, MPH is the cfinical services coordinator for Heaith Start. She is •
reponsible for maternal child health, family planning and adolescenY service clinical
objectives as well as overall coordination of clinical services and standazds in a multi-site
environment. She has 14 yeazs of clinical nursing and public health nursing, and ttuee
years experience at Heaith Start as a pediatric nurse practitioner and team coordinator at
H'ighland High School clinic.
•
.
�
•
.
HEALTH START, INC.
MATERNAL AND CHILD HEALTH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 1998
$228,075 $135,182
AHNUAI PR09RAM PROGRAM MCfi
LINE REM EXPENSE SALARY Fre suo�er suo��r
CLINICAL SERVICES COORDINATOR
NURSE PRACTITIONER
NURSE PRACTITIONER
NURSE PRACTf170NER
NURSE PRACTITONER (AGAPE)
NUTRITION�ST
NUTRITION�ST
NU7RITIONIST (AGAPE)
NUTRI7tONfST (ARUNCa70N)
HEALTH E�UCATOR
HEALTH EDUCA70R (AGAPE)
HEAITH EWCATOR
SOCIAL WORKER
SOCIAL WORKER
CASE MANAGER (AGAPE)
INTERPRETER
GUNIC CLERK
MEDICAL ASSISTANT
MEDICAI ASSISTANT
$49,712
$52,312
���
$45,760
$45,760
$46,738
$4�.766
$35,360
$35,36�
$33,821
$33,821
$37,045
$41,766
$44,9��
$32,777
$27, 373
$27,602
$2�,80�
$2�,59�
0.50
0.70
0.6�
0.20
0.20
0.60
0.20
0.15
0.15
0.10
0.15
0.20
0.10
0.10
020
0.10
0.80
0.70
0.10
$24,856 $14,914
$36.618 517,760
$28,167 $14,084
$9,152 $5,034
$9,152 $5,49'I
$28,043 511,217
$8,353 $7,518
$5,304 $3,182
$5,3Q4 $3,182
$3,382 $3,044
$5,073 $5,073 .
$7,409 $3,704
$4,177 $3,341
$4,497 $4.497
$6,555 $3,933
$2,737 $1,916
$22,081 $15,457 �
$15,055 $10,539
$2,159 $1,295
SUB-TOTAL SALARY
FRINGE BENEFfTS �d 20°!0
CONTRACT SERVICE
RAMSEY CLtNiC PHYSICtANlNURSE MIDWIEE
THREE OB/GYN PHYSICIAN CLINICSNYK @$472 X 42 WKS
N!O FAMIIY PRACiiCE CUNICSIWK �$286 X 36 WKS
ONE CNM CUNICNJK �$160/CLINIC X 42 WKS
PATIENT CARE
LAB. ULTRASOUND, X-RAY
COURIERSERVICE (INCLUDINGAGaa�
OTHER EXPENSE
MEDICATIONIDRUGS (INCLUDING ARLINGTON)
MEDICAL SUPPLIES
OFFICE SUPPLIES
PRlNTlNG/DUPLICATiNG
PATIENT TRANSPOR7ATION
TOTAL DIRECT ExpENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAI MCH GRAHT REQUEST
TOTAL MATCH � 25%
MATCH = 50%FPSP FUNDS, 50%MEDICAL ASSISTANCE REVENUE
��1�(Oa�
MCH0898
$45,615 $27,036
$59,472 $14,868
$20,592 $5,148
$s,72o $ti ,613
$30,000 $7,500
$9,982 $2,104
$14,000 $3,500
$5,150 SO
$1,575 $0
$500 $0
$2,000 $0
$423,681 $196,951
$67,789 $0
$491,470 $196,951
$196,951
$49,238
a�-�oag
• Sub�rantee B- Face To Face Aealth And Counseling Service. Inc. - Project Connect —
Prenatal Access Proiect
Face _� Face Health and Counseling Service is proposing to continue its program aimed ai
reaching high risk, preenant adolescents with comprehensive first trimester prenatal care
services, which have resulted in a higher rate of healthy birth outcomes. Face To Face has
historicaily been a strong supporter of a comprehensive service approach for high risk youth,
and is continuaily moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach effortsand case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with ,
case manaement has proven to be very successful in (1) improving rates of fust uimester
prenatal caze and reducing low birthweight rates; (2) providing social support and linking
clients to other needed support services; (3) ensuring clients receive high quality, continuous,
and comprehensive prenatal care; (4) involving clients in self help, the prenatal education
program, and in receiving needed group support, and (5) continuing to support the
involvement of pregnancy partneres during tbe pregnancy. This year, staff hope to also (6)
increase ouueach efforts, especially among young women of color, and (7) strengthen ties to
the SafeZone Drop-In Center.
• Target Pooulation - I.ow income adolescents, fifty percent of which will be youth of color:
African American, Native American, Hispanic, or Asian. Fifty percent will be from the
Eastside, primarily Dayton's Blnff, ten percent from Summit University and Thomas Dale,
and ten percent from Riverview neighborhoods. Half will be 17 years of age or younger.
OUTREACA AND CASE MANAGEMENT
Goal - To strengthen our seamless, integrated service model, reduce the overall rate of late
(third trimester) or no prenatal care and to conduct outreach to increase the fust trimester
prenatal caze, especially among minioriry teens.
O.b�'ectives -
i. To use our new holistic intake process for assessing needs in all areas of the lives of our
clienu and identifying strengths they already possess to address these needs.
2. To increase the coordination of client cases through improved administrative procedures and
oversight.
3. To increase our current efforts to provide outreach to youth of color, ensuring that at least
• SQ percent of the prenatal clients aze youth of color - African Amercian, Native American,
Hispanic, or Asian.
Methods -
• An outreach worker will meet immediately with each new prenatal client to offer help with
immediate issues, trasport clients to other services, make home visits, help with crises and
advocate for other services.
• Youth outreach workers will provide street outreach for homeless youth and will connect
young pregnant women with Face To Face's prenatal program.
• putreach workers will provide intensive case management for prenatal clients fielping to
organize and advocate for needed services. �
• putreach workers will build linkages with other service providers to gain greater
accessibiliry and establish a broad network of resources for clients.
PRENATAL CARE
Goals - To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian, and Asian teens.
Objectives -
1. To provide 190 pregnant adolescent and young women -- 135 of whom are under the age of
21 -- with holistic and comprehensive prenatal care services which are accessible, appropriate,
effective and which are coordinated with other community resources and integrated with the
clinets' individual life situarions.
2. To enroll 50 percent of the 135 clienu who are under the age of 21 in prenatal caze
services during their first trimester of pregnancy.
3. To begin to affect positive birth outcomes in all clients, as measured by low birthweight
rates of less than 6.5% for all age and racial groups served.
4. To improve attendance at all Prenatal Classes, with at least 50% of those enrolled in pre-
natal services attending.
Methods -
• Free pregnancy testing will be offered four days a week.
�
•
• An outreach worker will provide counseling after pregnancy testing resuits and connect
ciienu with prenatal care if necessary. •
• Pregnancy test will be provided "on the streets" as well as at a clinic site.
q� -(o��
• • A team approach to comprehensive sensitive prenatal care services will be provided with
team members meeting before and after weekly prenatal clinic in order to insure effective case
planning.
SOCIAL SUPPORT
Goal - To improve the health and wellness of pregnant adolescents during pregnanCy through
increased social and emotional support and mental health services.
Obiectives -
1. To increase pre-natal support services to pregnancy and aprenting partners of pregnant
women.
2. To provide mental health counseling for prenatal clients and their pregnancy and pazenting
partners who are struggling with mental health issues, inctuding chemical use, depression,
and abuse.
3. To link all the prenatal clients who deliver through Face To Face with on going primary
medical care for themselves and their infants, and social services for the infant, mother,
and pregnancy and parenting partners.
• Methods -
• Mental health assessments, short-term counseling, peer support networks will be provided
as well as a plan for estabiishing and/or maintaining emotional support for the preganant
adolescent and their pregnancy and pazenting partners.
Evaluation - Face to Face maintains a database management system, which collects data on
client registration (demographics); health histories; the visits including diagnoses, lab tests and
procedures; follow-up information on positive lab results; a prenatal follow-up sheet that
collects intake and foliow-up risk scoring, pregnancy outcomes in terms of birthweight and
other outcomes, and information on clients who did not deliver through Face to Face. Also
information on outreach visits is coilected including length of time with client and reason for
visit. From these data we can track both process and outcome measures. Follow-up
information on the status of those who "dropped out" of Face to Faces's prenatal program is
maintained, and pernnits the agency to bet[er ensure that no client will be"lost to follow-up".
Finally, good pregnancy outcome data is avaiiable, allowing us to identify variables which
might lead to poorer outcomes (infecrions, drug use, etc.)
Trainina(Experience - The outreach worker is I.aura 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 years before joining us.
Tuesday Spinks is a second prenatal outreach worker who is part-time Matemal and Child •
Heatth 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 fanuly worker. Tuesday is a Master's candidate in
counseling.
The Ob/Gyn nurse practitioner is Bazbara Taylor, who came to Face To Face in January of
1994. Barbara worked in HeaIthStart's school based clinics and prenatal clinics for over IS
years, and for two years worked with the Adolescent Health Program at the University of
Minnesota. Immediately before coming to Face to Face, Barbara was working with the Youth
and AIDS Project and Lutheran Social Services mini-clinic in an alternacive school.
The family practice nurse practitioner is Sue Garger, who has been with Face To Face since �
June of 1989. She had been Director of Heaith Services at Carleton College and Saint Mary's
College before joining the Face To Face teazn. She is a graduate of the Nurse Practitioner
Program at Bringham Young University, has a BSN from Winona State TJniversity, and is a
Certified Adult Nurse Pracuuoner.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Ramsey Nurse Midwives. Both are backed up by their
respective organizations, and both bring many years of experience providing prenatal care
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 Sainc Paut Public Schools "rurther,
in the Spring of 1993, Face To Face and Saint Paul Youth Ser�;c;: Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buiIding.
The Face To Face Prenatal clinic has buiit strong working relationships with a number of
other relevant maternal and child health service providers. These incl�de: Maternal Child
Pmiect, Raazsey County Public Health Nurses, Ramsey Counry Child ProtecUOn, WIC,
MELD, Children's Hospital Pediatric Clinic, Iiealth Start's Harding Clinic, Ramsey County
SELF and Minor Mothers Pmgrams, and the Diabetes Clinic at iTnited Hospital.
Clients aze referred for ultrasound, non stress tests, biophysical pxof�les and colposcopies. In
cases of refenals, the nursing staff contacts the refemat 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 refemdl appointment. If transportation to the referral appointment is an issue for the
client the outreach worker will either provide bus tokens, taxi vouchers, or a ride - depending
on the situation. Follow-up is done by ciinic staff to ensure that the client has carried through
on the referral.
Additional liakages wi2t be developed with tiie Fatfier's Resource Center and other agencies
which work with adolescent males and other pazent partners.
Reimbursement and Fees - The vast majority of our clienu have been eligible for Medical •
Assistance (and prepaid Medical Assistance).
q�l -io q,�
� If a client is not eligible for any thircl party reimbursement, she is then charaed fees according
to our sliding fee scale. For clients below 100% of poverty, there is no charge. 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 jusrification for the Face To Face program follows.
�
•
Acv�sta svocsr useevssr __ •
MATERNAL 8 CHlLD NEALTHFUNDINC3
For the Year 7998
TOTAL FUNDING SOURCES
PROJECT MCN MCH ]RD PARTY MARCX OF SHELTERING CI7Y/CNTY TO BE
FTE SACARIES BUDGET FTE RECUEST INSURANCE DIMES IN-KINO ARMSFOUND GRANTS R1USE0
020 Projec[ LoorCinata, 7.ROtx�sart 5,908 0.08 2,3B$ • 3,545
�.80 OutreachWOrker,T.Spinks 19.521 OSS 73,42p 6,1�0
t.00 OutreaCtiWOrka.new 23,775 0.50 77,588 tt,58B
0.35 Nurse Pract/Clinic Dir., PNelson 16,709 t0,000 6.709
0.3G MeGical (a6 Tecnnican. P.ThrusM 7,063 5.000 2,063
030 Metlipl Auisbnt, E.Kartekaas 6,327 5,400 ��3Z7
020 MeEiplASSistant,L.Bahn 4,717 3,ppp �
020 RN,N.DeWaiC 6,573 5.000 ��573
OdB SuOemsioNASSO0.Dtr,R.Merrigan 7,958 - 4,958 3,U00
020 OfficeManageqJ.Cndtls , 5,530 5.530
0.35 RKeO��st M.SWItz 5,552 5.652 •
O.4Z gillingManaper.T.Patregnani t5,703 15,�03 -
0.4U BiOingqu6tan4LFis�er 8,920 g,9Zp
Q.10 Sacial Warker, K.BuQiey �,017 O,Df7
0.03 Mediwl0'vecWr 2,%6 - Z,9fi6
0.03 VolunteerCOOrCinaWr.S.ESkierka 886 �
741.026 2T,371 77.729 3.000 . 886 /6.806 2t,233
FRINGEBENEFIT5�.78% 25,385 4,927 t2,9tt 540 - t59 3,025 3,822
CONSOLTANTS/CONTRAC7 STAFF:
NuNtion�st 4,000 4,000
RamseyClinicP�ysidans 14,OU0 t4,000
Unitetl Family Practice Physicuns 72,000 12,000
Inlems & Volunteers 8,500 8,500
STAFF TRAVEL: 750 mtles per mo x
t2mo'Sx1S5faRx.3tpermde B37 $sy 2
GUENT TRP.VEL; indutles Eus loken3
antl w05 as neeEeE. 600 �
CLIENT EMERGENCY EXPENSES 800 ��
SUPPLY COSTS:
W � tesLS 8 lab supplies 7,�00 5,000 2,0�0
MeEicalB exam room supplies 2,000 2,000
Gene2/oRCesupphes p,i00
2,500
PageR 8 supPlies 60� 600
Client UIt2 SounCS (5350 x fi5 Uients) 22,750 ?2,750
PRINTING 8 POSTAGE 7,800 - t,800
MALPRACTICE INSURANCE t,500 - � �
SubWfal S 245,297 S -32.880 S 170.6a0 5 3.540 5 3t,250 5 t,045 S 35.d37 S 30.530
FACILRYCO5T3 t4.T78 _ __7,900 ' " ' S.000 7.878
Indutles tUephane. utqities, janROtial, tr9sh, -
Euiitlin9 �Oair & supOb. ��. �suran[e, -
tefephone system 8 copier Wse, anC --
mamtenance person. - -
AUMINlMGMTlOVERXEAD 3{,g{Z .- 3,787 7,360 - . - B 23215
Ancfudes qeneral atfice suppty, 0/O and - --
fieUiryinsuranee,pasiape,acmunting, - - --
annua! audik �ntl2isin9 8 prcflrdmmer _ - -- -
wnsuipn4 anE atlminisintive and - -
ma�a emmtSWftanANeirMn e�eneft6. -- - -
TOTAL PROJECTED COSTS S�d,35T S 38,527 S 112,000 S 3.540 S 37,25� S l,045 S 46,43! S 81,
rr qqpws etrknnrn9s
a�-�aa�
u
u.is�o s�oast �ecan�sr
MATERNAL & CHfLD HEALTH FUNDING
For the Year 1999
TOTAL FUNDlNG SOURCES
PROJECT MCH MCH � 1R0 PARTY MARCX OF SXELTERING CITYICNTY TO BE
FTE SALARIES BUDGET FTE REQUEST INSURANCE GINES IN-K1ND ARMSFOUND GRANTS RpISED
010 Praject CooMfnamr. T.ROCinson 6,086 0.08 2,434 . 3,651
0.80 OubeaN Worker, T.Spinks 20,106 0.55 13,823 5,zgg
1.00 OutreachWOrker.new 23.8)0 0.67 11,247 12.623
0.35 Nurst PrdNCliniC D'u.. P.Nelson 17,210 t0,000 7310
0.30 MeEieal LaD TeUfniaan, P.TTruSh 7,275 - 5,000 z,275
0.30 MetlinlASSisian4E.Kanekaas 6.517 5.0�0 t,517
020 Medicai Assistant, L.9ohn 0241 3,OOD 7,24t
020 RN. N.DebVaiE 6,T/0 5,797 �,573
0.18 Supervis�ONA55ac.Drc, R.Mertigd� B.1% 5.196 3,000
0.20 ORCe Manageq J.C�dES 5,696 5,696
0.35 Recephonis4 M.StoIC 5,821 5,821
0.42 Bilimg Manager, T.PaNegnani 76,176 76,176 �
0.40 BiilinpA55istan4L.Fisher 9.187 9.187
0.70 Social Wo�er, K.Buckley d,738 6,138
0.03 Medicai D�rector 3,055 3,055
0.03 Volunteer CdoMmaror, S.ESkierka 913 9/3
165256 27,504 73.326 3,000 • 913 17,956 22,558
FRINGE BENEFITS � tBY. 26,146 4,951 73,199 540 - i64 3.232 0,060
CONSULTANTS/CONTRACTSTAFf:
NuMtiomst 4,100 y,000 700
Ramsey Clinic Phys�cians 14,400 14,000 . 600
United Fam�ly Proctice P�ys¢ians 12,300 12,000 300
Intems b Volunteers 9,000 g,500 5U0
STAFF TRAVEI: 150 miles per ma z
12 mo's z t.5 staR z.31 per mile 837 562 275
CLIENT TRAVEL: Inclutles bus /okens
anC nDS as neeaetl. 650 650
CLIENT EMERGENCY EXPENSES 850 850
SUPPLY LO5T5:
La7 tests 8 IaC supplies 7,500 5,000 p,500
Metliwl S exam room supplies 2.200 Z,000 200
General �ce suOP�ies 2,300 p,300
Pagers 8 supplies 600 5pp
G�ent UNra Sounds (5350 x 65 ciknts7 22,750 22,150
PRINTING 8 POSTAGE 7,800 1,800
MALPRACTICE INSURANCE 1,550 400 1,t50
SuDWta� S 252,239 E 33,017 S 712.525 S 3,560 5 31,250 5 1.077 5 35,486 S 35.343
FACILITYCOSTS i5,134 1,900 - • • 5,000 8234
Includes telep�one, utlhUes, janitorial, tras�,
buAGing repair 8 5u0C�Y. �xes. i05uance, -
tUepl�ane system S tGpier kau, and
maintenance ptrson. _ -
ADMINlMGMi/OVERHEAD 35,314 3,810 7,600 _ _ • 6,000 24.70a
InGUAeS Oeneral otflte SuOD�Y. D/0 and - '
fideliry insu2nce, posWge, accou�W+p, -
annual autlit, funErai5in0 6 pra9�mmer
consuttan4 anQ administrative and "
mana ementstaHanGNeirhin eDenefiLS.
TOTAG. PROJECTED COSTS S 302,887 S 38,52T S 116,�25 S 3,540 S 3t,250 S 1,077 S 46,488 j 87,881
bal ptlu� aktM1ntlNe
Q� - ia�.g
• Subsrantee C- vlodel Cities Health Center. Inc. - Improved Pregnancv Outcome
Proeram
The goal of this project is to improve birth outcomes au,. �� the target area population by
focusing on early entrance into coordinated, case-managed clinical services which offer
preventive education. The fundamental goals of this Pregnancy Outcome Program are to
improve birth outcomes and neonatal development, to increase accessibility to early prenantal
care of underserved hiQehrisk African Americans and Hmong females of childbearing ages and
to reduce the over-all rnte of late (3rd trimester or none) prenatal care.
Target Population - This project will serve Afican American, Hmong and European
American women who reside in the Summit- University/Thomas-Dale communities or the
surrounding area who are high risk underserved women and teens. The intent is to reach
women who aze not accessing services or need addirional supports to insure pregnancy
outcome either through clinical, educational, support, or outreach services.
Strateg,y I: Case Finding and Community Outreach
Objectives -
• 1. By December 31, 1999, to identify and collaborate with at least ten community
organizations which provide community housingfshelter, food and clothing assistance,
chemical dependencc treatment and education to high risk African American and Hmong
female community residenu.
2. By December 31, 1999. to increase the overall rate of prenatals receiving prenatal care in
the first trimester fram 50 percent to 65 percent. These objectives remain consistent for
teen prenantals. By December 31, 1999, toincrease the rate of Hmong prenatals receiving
prenatal care in the first trimester from 20% to 45 % and increase African American entry
from 50% to 65 % in ihe first trimester.
3. By December 31, 1997, to increase number of hospital and home visits of African
American prenatal patienu and teens, to 200 per year, to ensure compliance on early
prenatal care, well child check and two week post partum check.
Methods -
A. Two Outreach Workers will assist in casefinding and community outreach/education
activities. A 3 FTE Hmong Outreach/Interpreter will work direcfly with the Hmong
community. An additional .4 FTE Health EducatorlOutreach Worker will work with the
• African American community. The outreach workers will foliow-up with positive
pregnancy tests, aid pregnant teens and single female heads of household in accessing
prenatal care by arcanging for van transportation, bus tokens, cab fare or managed caze
transportation. Outreach workers wi1I be an advocate and link patients with public •
assistance or Minnesota Care to ensure access to prenatal caze.
$. Collaboration with public housing, churches, public health, hospitals, community
clinics, youth serving, and other African American organizations will occur by the Health
Educator/putreach Worker to reach high risk underserved women aad teens, follow-up on
women who have been lost in the system, and to assist in accessing clinical, financial and
social suppori services. The Health Educator/Outreach Worker will develop a tracking
system to follow referrals for social service needs.
C. Collaboration with public housing, public health, hospitals, community clinics, youth '
serving and other Hmong community organizations will occur by the Hmong
Outreach/Interpreter to promote first trimester entry for prenatal care, the importance of
immunizations, well chiid care, family planning, and parenting education. The Hmong
Outreach/Interpreter wil1 foIlow-up with womer. inst to foIIow-up a��d assist in accessing
clinical and social support services at the Iiza!ai �en�;,r. T'ne Hmong
Outreach/Interpreter wi11 network with the Refu�ee Tssk 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 and
Saint Joseph's Hospital.
D. Improve referral of services with Mode1 Cities Famity Development Center for social •
services, mental health, stride, home-based chemical health treatment, family's first, and
early childhood services by conducting a social history on 100% of prenatal clients and
developing tracking system to ensure social needs aze being met.
E. To increase community awareness of early prenatal care by airing 10 radio spots on both
African American and Hmong American local radio stations by December 31,1999.
Submit two columns to Asian American Press, Frogtown Forum, Native American
Newspaper and Insight News explaining the importance of early prenatai care by
December 31, 1999.
Strategy II. Clinical Interventions
Objectives -
1. By December 31, 1999, to provide comprehensive prenatal clinical care and edncation to
200 women of childbearing ages.
2. By December 31, 1999, to incrase average frequency of prenataY appointmems to seven (7)
appointments. Emphasis will be placed on beginning prenatai care in the first trimester and
continuing care through family planning education foilowing labor and delivery.
3, By December 31, 1999, to provide Engiish and Hmong speaking Lamaze Childbirth •
Education Classes or ongoing health education to at least 65 percent of prenatals on proper
nutdtion, effects of aIcohoi, tobacco, and other drug use during pregnancy, personal
�� - io��
• empowerment, expectations of labor and delivery, personal finances and education, and
coping with increased family size and responsibilities.
4. By December 31, 1999, to provide one-to-one counseling on smok;ug cessation to 100% of
all prenatal smokers and to offer smoking cessation classes 3 times per yeaz.
Methods -
A. Case management and tracking services will continue for 1Q0 percent of Hmong and
English speaking prenatals to ensure appointment compliance, positive birth outcomes,
reduction of low and very low birth weight rates (LBW, VLBW), and reduction of infant
mortaliry.
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 cluldren.
C. Linkage with Model Cities Family Development (MCFDC) will be provided for social
service assessmenu of ail 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 patterns.
D. Referrals to chemical health education programs and counseling services will be provided
to all prenatals and to family members with chemical abuse concerns to encourage
chemical abstinence. Referrals for Rule 25 chemical health assessmenUevaluation, case-
managed entrance for treatment seroices, enrollment in community aftercare programs,
and provision of chemically free housing for receovering women and their children will
also be provided.
E. English and Hmong-speaking Lamaze Childbirth Education Classes and ongoing health
education will be provided to prenatals on proper nutrition, reduction/elimination of
alcohoi, 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. Coniinued collaboration with a consortium of health care services.
III. Reduce Barriers to Care Preventing High Risk Women from Receiving Ongoing
Education and Prenatal Caze Services
Obiectives -
.
i. By December 31, 1999, to enhance access to caze by providing van transportation for
prenatat care, immunizations and welt child appointments for females and their children. •
2. By December 31, 1999, to offer continuous tracking and conffrmation of prenatai caze in
addition to immunizarions, well cuud checks, and ongoing education by systematic
schednling, bi-weelcly inter-disciplinary team meetings and pmvision of home visits to higfi
risk women to ensure medical compliance for females and their children.
3. By December 31, 1999, work closely with managed caze entities on culturally appropriate
services patient understanding of policies and procedures, and follow-up in changes in
ctinic assignments and incentive programs.
4. By December 31, 1999, to ensure enrollment of 100 percent eligible uninsured prenatals in '
Medical Assistance/Minnesota Caze or access to use of sliding fee scale for those who are
uninsured.
5. By December 31, 1999, to develop brochures and educational materials in Hmong language
on the following topics: nutrition, acute sick child (diarthea and fever), newbom care,
growth and development, vision and hearing, and dental health.
Ojectives -
A. Transportation to all prenatal appointments and/or cfiildbirth education activities will be •
provided to any female enrolled in clurical care, Lamaze cYuldbirth education sessions, or
2:1 patient nutrition, sociat services, or reIated services.
B. Collaboration with commnniry organizations, associations, and neighborhood groups wit2
be provided to emphasize early first trimester entrance to prenatal caze. When needed
perinatal clients will have access of health center van or taxi services, anQ enrollmeat into
Medical Assistance and MinnesotaCaze managed caze programs. All needed enrollment
inforniation 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 retum prenatal visit within two weeks of pregnancy confirmation
to ensure ongoing early prenatal care. 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 wiIl be provided through Model Cities Family
Development Center (MCFDC) to provide food, clothing, and housing/furaiture assistance
to prenatals as weil as home visits by sociat workers.
E. Hospital tours will be pravided to communiry residents to dispel fears of higfi medicat
technology and *nin;mi�ation of self control and direction in the medical delivery system.
Oualitv Assurance And Evaluation Methodol� - Quarterly perinatal audits will be .
performed by the Program Coordinator to assess case finding efforts and compliance with
prenatal care/appointment maintenance. Follom-up conuacts (home visits, telephone, and
��-1oa�
• 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 care and additional community linkages. !�uarterly
chart reviews will be performed to monitor number of patient visits, entrance to care,
education visits, and outcome data. Perinatal patient satisfaction surveys will be completed
annually to determine satisfac6on with clinical and social services, to explore unmet client
needs, and to deteimine successful methods of case-finding.
Perinatal statistics aze managed by the Program Coordinator. These statistics include
monitoring of indicators known to be principal factors such as low birth weight and infant
mortality rate. Fetal deaths, SAB, and low/very low birth weight are 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.
Trainin�/Elmerience Of Kev Staff - 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 suppore s[aff. G�itural sensitiviry 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/sociallcommunity services, and
improved provider/patient relationships are encouraged. Monthly staff in-services are
conducted on a wide variety of health care 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.
Linkages Between Proposed Proiect And Ongoing Perinatal Deliverv - Ongoing case
management coordination, multi-disciplinary service delivery, expanded support and education
services, and provision of transportation are key components of the proposed perinatal delivery
system.
Model Cities Family Development Center piays a significant role in supporting prenatal
females, infants and children. Social support services aze provided to ail women, children,
and their families. The volunteer based program Supportive Companion provides ongoing
befriending and support to women throughout pregnancy, labor and delivery.
Reimbursement and Clinical Fees - Model Cities reimbursement and clinical fee system bills
MinnesotaCaze, Medical Assistance enudes and private insurance for the clinical costs of
health care. Uninsured patients can apply for sliding fee, which can discount medical care
from 20 percent io 80 percent, depending upon family size and income.
In 1996, 88 percent of Model Cities prenatals were enrolled in Medical Assistance and 5
percent had insurance upon entry. Of the remaining 8 percent that were uninsured at the tiuie
. of entry, all became eligible for MA after confirmation of pregnancy. The remainder of
provider and staff salaries is covered by federal, state, county, and city grants.
•
�� - l��
VII. Improved Pregnancy Outcome PROGRAM BUDGET,1998-1999
The two-year project budget total $78,672, $60,298 of which is being requested in MCH
funding and the remaining $18,374 to be covered by Model Cities Health Center
(MCHC).
A. LINE ITEM DETAIL:
Personnel
Hmong Ouveach
Worker (3 FI'E)
Health Ed/Outreach
Worker (.4 F7E)
Famity practice
Physician (.1 FTE)
Nurse Prectitioner
(.I FI'E)
Program Coord.
(.I FTE)
Subtotal
• Fringe Benefits/
FICA:(12 percent}
Suppiies:
Clincal
Medical
Pharmacy
Laboratory
O�ce
Rewrds(I'racking
Subtotal
Other Operating
Expenses:
Patient Transport.
Patient Education
Printing
Postage
Mi(eage (local)
Telephone &
Beeper
Subtotal
, Total Direct Costs:
Indirect Costr @ 10
percent
• TOTALPROJECT
COSTS:
Yr.I Yr.I Yr.I
MCH MCHC Total
7,313 7,313
8,957 8,957
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272. 25,787
4,293 1,380. 5,673
-0- -0- -0-
-0- -0- -0-
-0- -0- -0-
300 ]00 400
A- .0- �_
300 100 400 �
],000 450 1,450
750� ]00 850
500 -0- 500
-0- 50 -0-
750 -0- 750
300 -0- 300
3,300 600 3,900
27,408 8,352 35,760
2,�41 835 3,576
330,I49 59,iS7 539,336
Yr.II Yr.II Yr.II
MCH MCHC Total
7,313 7,313
8,957 8,95'7
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272 25,787
4,293 1,380 5,673
-0- -0- -0-
-0- -0. -0-
-0- -0- -0-
300 100 400
-0- -0. -0-
300 100 400
1,000 450 1,450
750 100 750
500 -0- $p0
-0- 50 -0-
750 -0- 750
300 -0- ' 300
3,300 600 3,900
27,4Q8 8,352 35,760
2,741 835 3,576
530,149 39,187 539,336
Yr. I & II
Totat
14,626
19,502
8,320
4,224
6,490
51,574
11,346
-0- �
-0-
-0-
S00 • ,
-0-
800 ;
2,900
1,700
1,600
100
1,500
600
7,800
71,520
7,152
S7S,672
�,� - �Qa�
• Suhgrantee D- West Side Community Health Clinic - Improving Pre�►ancv Outcomes for
High Risk Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul Hispanic and South Fzst Asian populations by providing outreach, tracking all posirive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by eusting West Side Community Clinic staff and services. The
clinic offers comprehensive health caze services on a sliding fee scale. This pmject will give
Hispanic and Southeast Asian families greater access to a full array of services inciuding well
child caze, immuni2ations, family planning, pazenting, and STD services as well as linkages
by refeaal to over fourteen other community agencies.
Target Ponulation - This project will target pregnant Hispanic and South East Asian women,
ages 13-35 years, in specific census tracts in Saint Paul that have the highest concentrations of
Hispanic and South East Asians.
Obiectives -
Reduce overall rate of late (third trunester or none) prenatal care among pregnant FIispanic
and South East Asian teens and women to 10 percent or less by December 31, 1999.
� 2. Increase the rate of prenatal care in the first trimester among pregnant Hispanic and South
East Asian teens and women to 60 percent or more by December 31, 1999.
Methods -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted areas, health education fair for teens as part the McDonough
recreation program, assistance in clinic enrollment at WIC sites at McDonough and West
Side, and responding to media requests for interviews by local newspapers and radio
stations.
Project staff will conduct Spanish-speaking and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safery, and personal health issues susch as family planning, STDs, drugs and alcohol,
and family violence.
Staff in clinic will follow up on all positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health education and
support intervemions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportaiton, and intetpreting as needed.
• Evaluation - All patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry into prenatal care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
resulu wiil be compiled annually. Additionally, patient sarisfaction surveys are done semi- •
annually. Satisfaction with prenatal classes wiIl be meausred via surveys after each servies.
Twenty five (25) prenatal records aze audited quarterly to measure rates �f compliance with
prenatal risk assessment, post partum visiu, and newbom follow-up. Ttris mformation will be
reviewed quarterly by the Quality Management Committee to identify and implement focused
improvement efforts.
Training/Escperience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability in meeting the health needs of Hispanics and Southeast Asians. In 1996, WSCHC
served over 12,800 medical patients, 75 percent wer Hispanic or Southeast Asian. Services
include bilingual and biculural staff, transportation through our van, bus or cab voucher,
hospital care through St. Paul Ramsey Medical Center, on WIC clinics including immunization•
outreach Assistance with MA/MN Care applications and outreach clinics and education
programs in homeless shelter, public housing developments and a highschool. These services
aze provided through a well-established interdisciplinary case managemeni malet.. This model
helps identify lugh-risk patients ttuough screenings and referrals, provides coordination of
caze, and ensures paaent involvement in care glanning and choosing treatmeat options.
Resumes of key staff are attached.
Linka�es - West Side Comutunity Health Center works with the following organizations in �
providing maternal and chiId health services:
St. Paul Ramsey Family Practice Residency Program to provide cross-cultural family
medicine training for physicians motivated to work in hing-need underserved settings.
Saint Paui - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Cluld Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, eelderly health care, life
style/cancer and dental care.
Combined efforts with 17 other community clinics to improve pregnancy outcomes through
inaovative prog�ramm�ng usiug community ttealth workers.
Saint Paut - Ramsey Counry Department of Public Health to provide mrtrition education
and immunizations in conjunction with WIC sites and home visits to prenant women and
infanu.
Saint Paul Public Housing Agency to provide services, inciuding maternal child health, on-
site at McDonough and Roosevelt housing developments.
City of Saint Paul in providing clinics in six homeless sheiters and a battered woman's •
shelter.
The Clinic provides comprehensive perinatal care. Any specialty medicai caze needed is
�� - �� b
• provided either o4-site at monthly high-risk OB clinic or by referral to St. Paul Ramsey
Medical Center. all medical referrals are done on a referral form and followed-up via
computerized �acking.
Reimbursement and Fees - All reimbursemenu through the Minnesota Department of Human
Services go direcfly to support services. Assistance is provided to enroll all eligible women
on Medical Assistance. A sliding fee scale is maintained for those not eligible for assistance.
Fees are discounted incrementally based on family income, from those at or below the poverty
level paying nominal or no fees, up to those exceeding 200 percent of the poverry level paying
full fees.
Budeet - A budget and justification for the West Side Community Aealth Clinic budget
follows.
�
n
LJ
Saint Paul Public Health
Matemal and Child Heahh (MCE� Funds
West Side Community Health Center
6-27-97
-8-
Bu et (Revised 8/15/97)
We are requesting $13,490 per year to supplement our e�risling perinatal program The
funds w�l allow us to ut�ize b�inguallbicuttural perinatal health educators as focused and
integral components of our overall program. •
Following is the project budget with noted W SCHC match:
Year One - 1998
. i FTE Perinatal Coordivator
208 hours at $IS/hour
.4 FTE Periaatal Heahh Educator
832 hours at $1239/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursmg staff/perinatal support
TOTAL
Year Two - 1999
.1 FTE Perinatal Coordinator
208 hours at $15/hour
.4 FTE Perinatal FIeakh Educator
&32 hours at $12.39/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
MCH Request
$ 3,2Q0
10,290
$13,490
MCH Reauest
$ 3,200
I0,290
$13,490
WSCHC Match
$ 88,000
39,500
$127,500
WSCHC Match
$ 88,000
39,500
$127,500
Four hundred fifty I�spanic and SEA preaatal patients w�l be seea annualty
Thirry two prenatal classes w$1 be held, serving an expected 250 patients.
F"ifty highest risk patieats w�l r�eive specific follow up by the heatth educator.
An additional 150 teens and women will be reached through outreach activities.
n
U
�
There aze no DHS or self-pay reimbursements anticipated related to these supplemental •
activities.
G� - l��
•
ADOLESCENT HEALTH PROGRAM
�
��
!
��
�
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child
Health Special Project Grant funding for adolescent health services, and has prepared the
foliowing assessment of adolescent health in St. Paul.
Unmet Needs - Adolescent health status indicators have shown improvement in some areas
and deterioration in others in the last five years. Alcohol use had started to drop, as have
reported rates of sexual activity among teens. Pregnancy rates among teens aze dropping,
especially due to increased use of contraceptives. They are stIll too high in Saint Paul, ,
especially among African-American youth. Rates of physical activity aze decreasing for older
teens, while obesity is increasing. Tobacco use has increased dramatically, especially among
White, Hispanic, and Native American youth. Martality from violence - sucicide, depression
and car crashes - is unacceptably high.
Adolescents require services tailored to meet their specific needs and developmentai levels.
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 seven pubiic high schools in Saint Paul: Harding, Como Park, Cenual, Johnson
Senior High School, Highland Park Junior/Senior Aigh School and Humboldt 7uniorlSenior
• High. By Fall 1997, Heaith Start will pzovidethe same level of services at the new Arlington
Senior Aigh School. Tn addition to these seven school-based ciinics, Health Start provides
prenatal and family planning services for pregnant and parenting teens at AGAPE Aiternative
School and other health services (not including grenatal) at Guadalupe Area Pro}ect.
During CY 1996 school year, students again demonstrated their need for clinic services by
using current services extensively. A total of 3,053 students made 13,391 visits, generating
over 24,500 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 caze resources. Data from 1996 school year
revealed that of studenYs families, 32% had medical assistance, 19% had private insurance,
48% had no 3rd party source of pay, and 1% had MinnesotaCare.
Program Response To MCH Priorities - The Adolescent Health Program responds to the
goals and priorities for services adopted by the State Maternal and Child Health Advisory Task
Force. The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unpianned pregnancy, nutrition problems, depression, chemical abuse
and family and relationship problems among adolescents in Saint Paul. to achieve these goals,
• Health Start, Inc. has identified prioritiies consistent with the following MCH Advisory Task
Force priorities:
-reduce infant mortaliry
-reduce the percent of low birthweight infants
-reduce adolescent pregnancy rates
-reduce unintended pregnancies
-provide access to preventive services
-reduce chemicai abuse in adolescents
-reduce infecuous diseases
-promote good nutrition practices
These priorities will be addressed through the objectives and methods identified by Health
Star[, Inc.'s Adolescent Health Proa am. Methods to adQress ihese priorities include
comprehensive health services that are accessible and acceptable to high school age adolescents
inc]uding nutrition education aad counseling and psychosocial assessment and ongoing
counseling. Extensive health education is provided individually and in group education
settings. Referrals are made when aecessary.
�
Goal - The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unptanned pregnancy, nutrition prob2ems, depression, chemical abuse
and family and relationship problems among adolescents in St. Paul by providing
comprehensive heatth care services at seven high School sites and two atternative school site •
within the City.
Target Ponulation - The clients targeted to be served by the Health Start Adolescent Health
Program are ado2escents living in the Ciry of St. Paul. The following demographic data
describes this population:
Minority Groups -
Age in School -
Gender -
.�•.
39 % 18 years and above
26 % 17 years
22 % 16 years
10% 14 years and under
72 % Female
28% Male
Obiectives - The following objectives have been established for the Adolescent Aealth
Program in order to achieve the goal:
�
1. In CY 1998 and 1999, 3,000 junior and senior high students will make visits to the school-
a� - �a��
• based clinics each year
2. In 1998 and 1999, the healthy lifestyle of physical activity and a balanced diet will be
°ncouraged by providing 350 sports physicals and 600 nutrition visiu related to sports
nutrition, weight control or eating disorders.
3. Onsite counseling will be provided for 1,100 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, seacual or
emotional abuse each year in 1998 and 1999.
4. At least 85% of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a contraceptive method or plan. Decision making, sexuality_
counseliing, and family planniing services will be provided for 1000 adolescents each year
in 1998 and 1999.
5. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in 1998 and 1999 from 1400 in 1996.
6. The number of hepatitis B immunizations given wiil increase 10% in 1998 and 1999 from
434 in 1996.
• 7. The number of students who report smoking wili drop 10% in one targeted high school in
Saint Paul by December 31, 1999.
Methods -
• At least $100,000 in additional funding for school based clinics will be secured in 1998 and
1999 to support expanded access for teens in Arlington High School, AGAPE Alternative
School and Guadalupe Area Project Alternative School.
• Assess for risk, 85% of all new students, following GAPS assessment guidelines, that
details medical and fanuly history, behaviors and feelings. this form will provide staff with
background data necessary for providing good care and for triagin clients to appropriate
staff.
• Provide 8,000 physical examinations, health screening and assessments, diagnosis and
ueaunent of acute and minor illness, and family planning visits on site by a nurse
practitioner, family physiscian andlor pediatrician.
• By 7anuary 1, 1998, Health Staft will hire a male-focused outreach worker/health educator
to encourage participation in sports and use of the clinic for sports physicals, Hepatitis B
vaccination, screening for chlamydia and other STIs, involvement in avoiding pregnancy,
• and other heaith issues of concem to male students.
• Beginning Ianuary 1, 1998, increase access to health care for students with chronic •
illnessess or disabilities by a collaboration with PACER and school nurses to help high
school special needs studenu to transition from school to work and independeat living.
• Decision-making counseling and family planning education and counseling will be provided
to adolescents requesting these services by a Health Start health educator.
� Pick-up of prescribed contraceptives and completion of Depo Provera shot appointments
will be tracked in order to maintain at least an 80% treatment compliance rate.
• Health Start staff wiil provide risk assessment, prevention education, and screening on site ,
for afl STIs, including HIV infection.
• Members of the interdisciplinary team will provide 7,000 individual and group education
contacts in selected classrooms on health education activiites such as prenatal and parenting
classes, weight conuol classes, and human sexuality programs, in order to maximize the
understanding and practice of positive health behaviors.
• Health Start will seek to partner with Health Partners Center for Health Promotion and St.
Paul District school nurses and teaching staff to target at least one high school for a
smoking prevention and intervention campaign in the school for a two year period, staning
January 1, 1998. .
• Health Start staff will serve as adolescent health resources to teachers and youth workers in
their classrooms and other groups.
• Pregnant teens who see another primary caze provider for prenatal care will be tracked to
see that prenatal care is started, maintained, and whenever possible, what were the birth
outcomes.
• Health Start will work collaboratively with the healih plans serving Saint Paul students to
maximize reimbursemenu for services and communicate with or refer students into
appropriate sources of care.
Evaluation - CIienu at school-based clinics aze assessed annually for satisfaction with Health
Start services, using a standazdized format and automated summarization. the same form is
used by the Neighborhood heatth Care Network. Satisfaction Ievels are compared with
primary care community clinics and four other adolescent specialty programs in the Metro
azea. Automated encounter forms gather the demographic data, visit, procedure, and
diagnostic code data, and site of service. These data can be queried to provide data on
typesand quantity of services sued, as well as target population reached by age, race and
income level and special need. •
An encounter form will track the number of students accessing family planning services.
Health Start's Quality Assurance and Clinical Management Team wiil annually measure
��l - lQ��
• through random chart audit the percent of students with a negative pr o°nancy test who
received birth control information and a method before leaving the clinic. They wiIl aiso
measurethe picY-up rate for first time and follow-up contraceptive prescriptions and Depo
Provera appointnaeus kept via random chart audit.
IIealih Start will measure the ability of its staff to reach a large number of students through
classroom, individual and other group methods for topics related to healthy lifestyle. It will
also measure the abiliry to increase the number of studenu presenting for Hep B vaccination
through increased outreach.
An anti-smoking campaisn targeting a high school and involving multipie messages aand types
of interventions will attempt to measure baseline smoking rates at onset of the campaign and
two years later on a population basis. this methodology will depend on the willingness and
ability of the high school administration to assess several grades of students. If that is not
possible, Health Start will assessits own patient population at onset and two years later, using
a modified encounter form.
Training & Experience - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff are professional health cate personnel with
. special expertise in matemal and child health. The majority have had more than five years
experience. All staff are evaluated at least once a year.
Staff are supervised by the executive director, associate director, medical director, associate
medical director, and team leaders. Carol White, M.A., is the executive director of Health
Start and is responsible for the overail management and direction of the project, as well as
external relations and long-range planning. Dr. Chris Reif, a member of the Family Medicine
Department at Saint Paul-Ramsey Medical Center, is the medical director and responsible for
overall medical d'uection. Dr. Carol Ball, on the staff of the Obstetrics and Gynecology
Department at Saint Paul-Ramsey Medical Center, is the associate medical d'uector and works
with the medical director to provide consultation on OB/GYN practices, as well as providing
clinical supervision for OB/GYN nurse practitioner staff. iThey are adivsed by a clinical
management team made up of representatives from the various professional discipliines, in
prenatal and adolescent services of health Start. Richard Duffm has been the associate d'uector
for three years and managesthe school based clinics. Jeanne Rancone, PNP, PAN, is the new
Clinical Services Coordinator, overseeing clinical services for adolescent, prenatal, and
pediatric care. Jeanne has been with Health Start for three years.
Summary of qualifications and experience of key staff are attached.
Linka¢es - Health Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. Referrals aze made by Health
• Start staff to other programs and aze made by other agencies to Health Start. This referrai
network allows staff to individualize care plans to meet the specific needs of each client. New
linkages and referral sources are identified or developed as needs arise.
Heatih Start works collaboratively with Ramsey County Public Health nurses to exiend •
services to pregnant women in the comtnuniry. Public health nurses meet regularly with
Health Starc to identify clients needing fiome-based services and to share information that will
enhance patient care.
At delivery, new pazents are referred to Health Start's pediatric clinic. Well-child and acute
care visiu, aug�nented by interdisciplinary services, are provided. Eligible clients are also
referred to the Befriender Program, run in collaboration with Children's Home Society, the
Partnership Program, a collaboration with Saint Paul School's �arly Childhood and FamiIv
Education (ECF'E}, or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, and/or �-oup education For high risk •
parenis.
When psychosocial or hea7th care needs are ideniifed 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 area.
In the school-bsed clinics, the linkage with the school nurse is very close. Often, space is
shared and refenaIs go back and forth during the day. Realations with other school personnel
are also pursued. A school board member always serveson the health Start board of directors.
Health Start is committed to extending services to the community and *r�inimi��g duplication •
by collaborating with many agencies and programs. Health Start wili ncaintain affiliations with
and/or refer to the following agencies and task forces (partial list)
Chiidren's Home society of Minnesota, Farly Childhood and Family Education (ECFE),
Housecalls, Frogtown Family Resource Center, Ramsey Ciinic Associates, Ramsey
County Human Services Family Preservation Project, Saint Paul - Ramsey Department of
Public Aealth, rondo Family Resource Center, Neighborhood Health Care Network, St.
Paul Public Schools, St. Paul-Ramsey rnedicat Center/Heatth Partners, PACER Transition
to Work Project, 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. MCH funding atlows Health Start to
provide prenatal care for clients who have no third party source of payment. For Health Start
clients eligible for medical assistance, staff wili assist them with the applicauon process.
Health Start has conuacts with all of the PMAP providers. Any other applicable third parties
aze billed whenever possible. Insurance reveaue pays for agproximately 25 % of Health Start's
prenatal and adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client
has no third parry payor, a sliding fee scale is used to determine her fee for family planning •
services. Funds will be requested from the State of Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium,
��- iaa�
• Subgrants/Subcontracts - Health Start subcontracts for the provision of physician and
certified nurse-midwife services with the foliowing groups: Ramsey Clinic Associates, West
Side Community Health Center and the Universiry of Minnesota. The Health Start Medical
Director and Associate Medicsi T.?irector are 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
justification for the budget follows.
.
•
�
Health Start Key Staff
Carol �i'hite, AL4 is the esecuti�e director of Health Start, Inc. She «as hired in June,
1996, by the board of directors. She has a rnasters of arts from Stanford L'niversity in
early childhood education. She has five years experience in health care management, ten
years total managemeni experience in non-profit mana�ement. She has «ritten and
pubIished trainins materials and curricula on child abuse and fatttily violence.
Christopher Reif, MD, MPIi has been the medical director of I-Iealth Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey hiedical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currently on the advisory boazd of the American Medical Association's Grridelines for
'Adolescent Prevention Services (Gr�PSJ.
Richard Duffen, 11iA has been the associate director of Heatth Start since 1944. He is
responsible for school based cIinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty years experience in managing •
human service organizations, with special experience in mentaI health and developmental
disabilities.
Jeanne Rancone, PNP, MPH is the ciinical services coordinator for Health Start. She is •
reponsible £ot maternal child health, family planning and adolescent service clinical
objectives as well as overall coordination of clinicai services and standards in a multi-site
environment. She has I4 yeazs of clinical nursing and public health nursing, and three
years experience at Health Start as a pediatric nurse practitioner and team coordinator at
Highland High Schooi clinic.
•
.
HEALTH START, INC.
� MATERNAL AND CHILD HEALTN
� ADOLESCENT HEALTH SERVICES
SCHOOL BASED CLINICS
JANUARY THROUGIi DECEMBER, 1998
�
•
q� -tc�
MCHSBC96
'ANNUAL � PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SALARY F'rE euoGET Bu�Ger
NURSE PR4CTRIONER (CENTRAL7
NURSE PRACTITIONER (COMO)
NURSEPRACTfiONER(HUMBOLDn
NURSE PR4CTITtONEF�(JOHNS�N)
NURSE PRACTRIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI WORKER (COMO)
SOCIAL WORKER (HUMBOLDn
SOCIAL WORKER (lOHNSON)
CASE M4NAGER(AGAP�
MEDICAL ASSISTANT (CENTRAL)
MEDICAL ASSISTANT (COMO)
MEDICALASSISTANT(HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDING)
MEDICAL ASSISTANT (AGAPE)
NUTRRIONIST(CENTR4L)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOIDn
NUTRITIONIST (JOHNSON)
NUTRITIONIST (HAROfNGj
HEALTH EDUCATOR(CENTRAL)
HEALTHEDUCATOR(COMO)
HEALTHEDUCATOR(HUMBOLDT)
HEALTHEDUCATOR(JOHNSON)
HEALTHfiDUCATOR(NARDING)
HEAlTHEOUCATOR(AGAP�
IXECUTNE DIRECTOR
$37,296
$43,596
$37,918
$37,2t 2
$42,773
$35,902
$29,316
$35,330
$33,734
$32,777
$16,934
$17,354
$16,447
$18,614
$22,294
$16,447
$33,734
$35,246
$37,750
$33,734
$35,246
$27,317
$31,618
$29,921
$29,921
$31,298
$29,921
$43,260
0.80
0.80
0.80
Q.65
0.90
0.40
0.40
0.60
0.40
0.80
1.00
1.00
1.00
1.00
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.05
0.10
$29,837
$��8�
$30,334
$24,188
$38,496
$14,361
$� �,�26
$21,198
$13,494
$26,22�
$16,934
$17,354
$16,447
$18,614
$22�2�
$3,289
$5,060
$5,287
$s,ss2
$5,060
$5,287
$2,732
$3,162
$2,992
$z,ss2
$3,130
$1,496
$4,326
$23,869
$27.90'I
$24,26�
$19,350
$30,796
$11,489
$9,381
$16,959
$t�,795
$0
$13,548
$17,354
$�4,$OZ
$18,614
$22,294
$�
$5,060
$5,287
$s,ss2
$5,060
$5.287
$2,732
$3,162
$2,992
sa,ssz
$3,13�
$0
$4,326
SUB-TOTAL SALARY
` annuai salary based on 42 week schooV year
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
FAMILY PRACTICE PHYSiCIAWNURSE M1DWiFE
EIGHT PHYSICUW CUNICSNVK @ 5286 X 34 WKS
ONE CNM CUNICNVlC @$'160.�CUNIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON}
FACE TO FACE
SOCIAL WORKER (HARDING) $32,569
PATIENT CARE
LAB, ULTRASOUND, X-RAY
COURIER SERVICE
$386,851
$307,111
$77,370 561,422
$77.792 $42,786
$5,440 $4,080
$4,893 $3,670
$32,569 $24,426
$22,279 $16,709
$29,945 $22,459
,
n
LJ
ANNUAL PROGRAM PROGRAM MCH
LINE 1TEM EXPENSE SAIARY FrE g�p�� B�p��
OTHER EXPENSE
MED�CATIOWDRUGS
MEDICAL SUPPLlES
OFFICE SUPPLIES
PRI NTING/DUPLICATING
PATIENT TRANSPORTATION
TOTAL DlRECT EXPENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAL MCH GRANT REQUEST
TOTAL MATCH � 25°k
HICaHLAND SCHOOL BASED CL�NIC FUNDED BY SEPERATE GRANT SOURCE
$15,000 $11,100
$12,725 56,373
$10,600 $3,180
$2,575 $0
$2,150 $1,720
5680,188 $505,035
$108,830 $0
$789,019 $505,035
$505,035
�
$126,259
�
�1- lG�i�6
•
BUDGET DETAIL AND EXPENDITURE FORMS
�
�
q�,- ��.�
•
•
BUDGET NSTIFICATION
Budget justification for each of the subgrantees is included within their budgets previously
presented in the narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Maternal and Child Aealth Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey County Department of Public
Health for Adminisuative Costs.
..;
1999
Sala /Fringe:
Administrative Assistant
Genezai program oversite,
prepares and monitors
grants, analyses reports,
prepares annual reports,
prepares and monitors
contracts, meetings and site
reviews with subcontractors
$ 9,171
$ 9,271
Accounting Tech IV
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV
Types grants, contracts and
reports
�Dlies:
Audit:
7,417
r�:
100
TOTAL ADMINISTRATIVE COST: 19,626
•
7,514
3,472
150
4,161
24,568
BUDGET DETAIL OF LOCAL MATCH
Local match is identified at a minnnum 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:
1. Local Tax L,evy Funds:
• MCH Prenatal Care at Communiry
Clinics
� Community Ouueach and Services
(Nutrition, social work and lab)
• Participation in Project LID
• Assessment
(includes data collection
analysis and reporting)
TOTAL:
2. Other Local Funds:
1998 1999
$139,480 $139,480
$ 34,352 $ 34,352
$ 2,485 $ 2,485
$ 26,642 $ 26,642
$202,959 $202,959
Other local match is provided by the City of Saint Paul through the funding of various
programs which contr3bute to maternal and child health, including family planning,
immunizations, lead screening, nutrition, heaith education and well child services. Source
of this funding includes CHS funding, grants, reimbursements, and patient fees.
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•
•
•
a �aa�
•
ATTACfIl�IENT B
Solicita6on Process for Subgrants
�
Notification of the availability of funding was provided to qualified programs in the azea
through a d'uect mailing of a Request for Proposals (RFP) to 30 agencies and a public norice
placed in the St. Paul Pioneer Press on May 22, 1997. The process for selection of priority
program componenLS and the process for selecting the requests (evaluation criteria) included in
the grant application aze elcplained in the following RFP. The public notice, a list of agencies
receiving the d'uect mailing, and a list of the agencies requesting subgrants are also included in
this attachment.
•
PUBLIC NOTICE OF AVAII.ABILITY OF FUNDS FOR •
MATERNAL AND C�iII.D HEALTH SERVICES
The City of Saint Paul intends to subcon�act up to $120,000 to Saint Paul agencies through
the Minnesota Department of Heaith Maternal and Child Health Formula Block grant for
calendar years 1998-1999. These funds may be used to conduct projects for improving
pregnancy outcomes through outreach, referral and/or the direct provision of prenatal care.
Based upon an assessment of Maternal and Child Heaith (MC� needs in Saint Paul, the City
is interested in subcontracting with outside agencies to provide prenatal health care and
outreach services for lugh risk and low income women. Organizations interested in providing
these sezvices will be asked to develop a proposal following Minnesota Deparoment of Health
as well as Saint Paul Public Health guidelines. Interested organizations should contact.Carolyri
Weber, St. Paul Public Heaith, 555 Cedar Street, St. Paul, MN 55101 (292-7749). Proposals
are due to the above address by 4:00 p.m. on June 30, 1997. The RFP for these funds was
also mailed or distributed to 29 organizations/individuals who are interested in public health
issues or who provide maternal and child health services to lugh risk and low income women.
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 for funding.
�
n
U
•
AFFIDAVIT OF PUBLICATION
5TATE OF MINNESOTA
CO �?NTY OF RAMSEY
�� - ��a�
< I�r4-.��I� �1 l�.�L�� ,being
duly sw rn on oath, says: that he is, �a a,�
all times herein stated has been, Clerk of
Northwest Pnblications, Inc., publisher of tfie
newspaper known as the Saint Paul Pioneer
Press, a aewspaper of general circnlation within
the City of St Paul and the County of Ramsey.
That the Notice hereto attached was cut fiwm the
columns of esid newspaper and was printed and
pubIished thereia on the following dates:
`� day of �_ , 19 �
�
•
day of , 19 _
dayof ,19—
day of , 19 —
day of , 19 —
day of , 19 _
day of , 19 _
�
Su scribed and sworn to before me 's
��day of �} �y , 19�
Nocary Public
«�S���a��r County, Minnesota
My com.»;c�ion expires � 3� , 20 O O
TL:
� r�z�,o-' �iviiYi:,' .. , :H
� `:i:" �'s'.nSH1�;= _ f:
�'l:�'� � ia; t�:i.a`.i'>ii: � " � �i �`y;ri. �i.�.�f`.:. y
ti y
zrvsrvar�7r�-r:a,�rvv7vvc,vvvs•rstx
sr PAUi, woMnx�s cr.�c
1690 UNIVERSTPl' AVE
ST PAUL MN 55104
LUTHERADI SOC SERV OF MN
1201 PAYNE AVE
ST PAUL MN 55101
CATHOLIC CHAR OF ST PAUL
2I5 OLD 6TH ST
ST PAUL MN 55102
BOOTfi BROWN FIOUSE
1471 COMO AVE
ST PAUL MN 55108
THE LOFT TEEN CENTER
1063 IGLEHART AVE
ST PAUL MN SSI04
ANN RICKETTS
FACE TO FACE CLIAIIC
I165 ARCADE ST
ST PAUL MN 55106
UNITED FAM HEALTH CEN
sas w rrti sr
ST PAUL MN 55102
COMMONFiEALTH CLINIC
13961 N 60TH ST
STII,LWATER MN 55082
JOANNE ICEATDRICK
SI PAULRAMSEY
NUTRITION PROGRAM
ST PAUL PUBLIC HEALTH
YOUTH SIItVICE BUREAU
2167 ARCADE ST
ST PAUL MN 55106
ARLINGTON HOUSE
95l E. STH ST
ST PAUL MN 55106
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PAUL MN 55102
SETON CENFER
1276 UNIVERSITY AVE W
ST PAUL MN 55104
FAMII,Y PHY HEALTIi CEN
579 WELLS ST
ST PAUL MN SSIOI
PEG LABORE
FAMILY TREE CLINIC
1619 DAYTON AVE
ST PAUL MN 55102
BEVERLY HAWIQNS
MODEL CITIES H C
430 N DALE ST
ST PAUL MN 55103
ST PAUL ItAM OB/GYN CL
640 JACKSON ST
ST PAUL MN 55101
PALNNED PARENT
MINNESOTA
1700 RICE ST
ST PAUL MN 55113
C�Fa
CAROL WHITE CERTgZED NURSE MIDWIVES
HEALTH SfART INC RAMSEY FOUNDATION
590 PARK SUTfE 208 640 JACKSON ST
ST PALTL MN 55103-1843 ST PAUL MN 55101
AGAPE
360 COLBORNE ST
ST PAUL MN 55102
MARY ELLEN SMITH
LEAD PROGRA114
ST PAUL PUBLIC HEALTH
•�
BETHESDA FAM PRAC CLINIC
590 PARK $T' SiRTB 310
ST PAUL MN 55103
UNITED HOSPITAL-M�D CLINIC
333 N SMIT'H ST
ST pAUL MN 55102
MARY O'CONNELL
INTEGRATED HOME CARE
475 ETNA ST SUITE 3 •
ST PAUL MN 55106
MARVIS BREHM
WEST SIDE HEALTH CENTER
153 CQNCORD ST
ST PAUL MN 55107
CHII,DREN'S HOME SOCIETY
OF MINNESOTA
2230 COMO AVE
Sf'. PALJL MIV 55108
NANCY BRIGGS
NORTH END HFALTH CETTTER
135 MANTIOBA ST
ST PAUL MN 55117
ST PALJL RAM PEDS CLINIC
640 JACKSON ST
ST PALTL bSN 55101
•
•
�.�1-�oQ�
AGENCY NAME:
REVIEWED BY:
SAINT PAUL
MCH COMPETITIVE GRANT
REVIEW CRTTERIA
I. APPLICATION
A. Is in accordance with City MCH priorifies
B. Proposes services targeted to low-income high
risk individuais in targeted azeas
C. Is clearly written and the format facilitates
review
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, raciallethnic distribution and
eligibility criteria
B. T'he applicant can demonstrate past successful
experience worldng with target populations
C. Low-income, e.g. <200% of poverty or women
who are pregnant and determined eligible for
M.A. or WIC
D. Identify risk criteria consistent with MDI�
guidelines
III. OBJECT'IVES
A. Described
B. Related to priorities
C. Realistic
D. Time Specific
E. Measurable
F. Identify clienYs or community's needs, not the
applicanYs
POOR
1 2
1 2
1 2
1 2
1 2
1 2
1
1
1
i
1
1
1
2
2
2
2
2
2
2
SATIS
3
3
3
EXCEI,
4 5
4 5
4 5
3 4
3 4
3 4
3
3
3
3
3
3
3
4
0
�
�
�
�
�
5
5
5
5
5
5
5
5
5
5
POOR SATIS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted pnblic 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 acrivities which warrant evaluation are
identified 1 2 3 4 5
B. Methods for collecting the data aze described
and aze feasible 1 2 3 4 5
C. Gives evidence that evaluation results will be
used for program management decisions 1 2 3 4 5
D. Collects data which relate to the objecfives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objective as well as subjective 1 2 3 4 5
VI. TRAINING/EXPERIENCE
A. Indication of work experience, training and
qualifications for staff d'uecfly 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 refemal arrangements wiih other
community service providers ue described
and relate to goals, objecrives and methods 1 2 3 4 5
' ��- [Oq.�
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' POOR SATIS EXCEL
B. Description of current or anricipated
cooperative agreements to m;n;m;�P potential
for duplication 1 2 3 4 5
C. Plans for or descriptious of ongoing
collaborative acriviries with providers such as
participation on task forces, committees, etc. 1 2 3 4 5
D. Applicant can show experience in successful
follow-up on refeaals 1 2 3 4 5
VIII. BUDGET
A. Budget items are justified in terms of project '
activifies 1 2 3 4 5
B. Complete 1 2 3 4 5
C. Provides a rationale for farmula/process for
calculation of items 1 2 3 4 5
D. Amount of funding requested is appropriate
for the levei of service and objectives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonsuated in ldnd contributions
of at least 25 % of the grant request
F. Are mathematically correct
G. Indicates pians to obiain and use DHS
reimbursements (Medical Assistance,
Children's Health Pian)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDTITONAL CONII�IENTS/RECONIMENDATIONS:
�
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MATERNAL AND CHILD HEALTH FORMULA SPEC{AL PROJECTS - 1998-1999
CITY OF SAINTPAUL
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Model Cities Health Center, Inc. - Improved Pregnancy Outcome Program
The goal of this project is to improve birth outcomes among the target area population
by focusing on eariy entrance into coordinated, case-managed clinical services which
offer preventive education. The fundamental goals of this Pregnancy Outcome
Program are to improve birth outcomes and neonatal development, to increase
- accessibility to early prenatal care of underserved high risk African Americans and
Hmong females of chiidbearing ages and to reduce the over-all rate of late (3rd
trimester or none) prenatal care.
Total -$60,132 Year 1- 530,066 Year 2- 530,066
Face To Face Health and Counseling Service - Prenatal Access Project
Face To Face Health and Counseling Service is proposing to continue its program
aimed at reaching high risk, pregnant adolescents with comprehensive first trimester
prenatal care services, which have resulted in a higher rate of healthy birth outcomes.
Face To Face has historicaily 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. This project utilizes outreach efforts and
case management to encourage and support pregnant adolescents to access prenatal
care so as to increase their chances of having a successfuf pregnancy.
Total - 577.054 Year 1- 538,527 Year 2- 538,527
West Side Community Health Clinic - Improving Pregnancy Outcomes for High Risk
Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the
Saint Paul Hispanic and Southeast Asian populations by providing outreach, tracking
all positive pregnancy tests, performing prenatal risk assessments and coordinating
prenatal care. This project will be supplemented by existing West Side Community
Clinic staff and services. The clinic offers comprehensive health care services on a
sliding fee scale. This project will give Hispanic and Southeast Asian families greater
access to a full array of services including well child care, immunizations, family ,
planning, parenting, and STD services as well as linkages by referral to over fourteen
other community agencies.
Total - 526,980 Year 1- 513,490 Year 2- 513,490
�.� - (��
Health Start, Inc. - Improved Pregnancy Outcome
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive
Maternal and Child Health Special Project Grant funding for services to improve
pregnancy outcomes. Health Start, Inc. is an organization specializing in maternal,
infant and adolescent health care services to high risk populations. Its goal is to
improve the health status of women, children and youth who are at risk for disease
or disability due to economic, social or medical conditions, and to reduce morbidity
and mortality in this populations. "
Health Start proposes to continue to serve the needs of low income and adolescent
pregnant and postpartum women. Health Start will provide multidisciplinary,
comprehensive prenatal care at hospital and school based out-patient clinics. Prenatal
care offered to students in the high schools facilitates early entry into prenatal care.
This component of the Health Start program addresses the City of Saint Paul's
Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and adult women of color.
Total - 5393,902 Year 1-$196,951 Year 2- S196,951
Health Start, ►nc. - Adolescent Health Program
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 Saint Paul
by providing comprehensive health care services at seven high school sites and two
alternative school sites within the City.
Total - 51,010,070 Year 1- 5505,035 Year 2- 5505,035
AGBNCY
Modei
Cities
Face to
Face
West Side
Health
Start
(IPO)
Health
Start
(Adol)
a�-io��
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr. 1: Yr.2: Total: Yr. 1: Yr.2:
62,430 31,215
80,000 40,000
28,000 14,000
31,215 60,132 30,066
40,000 77,054 38,527
14,000 26,980 13,490
30,066
38,527
13,490
409,042 204,521 204,521 393,902 196,951 196,951
1,047,820 523,910 523,910 1,010,070 505,035 505,035
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesdng funding prunarily for outreach, education and tracking.
Health Start receives non-competitive funding as a pre-block grant provider to provide both
improved pregnancy outcome services through ouueach and prenatai care, and adolescent
health services through school based clinics.
Council File # `� � ����
Green Sheet # 36255
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Presented By
Referred To
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 Child Health Block Grant, and authorizes proper City Officials to contract on its
behalf with the Minnesota Department of Health.
m v rLsz—�
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Bosuom
Collins �
Huris
Meeard
Morton ��
Thune
Adopted by Council:
Navs Absent
�
Certified by Council Secretary
sy: �
Approved by
By: � � �
-� - �� 1-�. - .
��� � I ��'�.�
c( � � For ppro ed / �' b �y / �� C / i "ty A ey / p'
BY����// ' 7-C � f �Y `L%
�,�-.� ` /�
_ ,.
Approved by Mayor for Submission to Council
—�— BY � ``° �
RESOLUTION
CITY OF SAINT PAUL, NIINNESOTA �
�t'l -bq.8'
DEPARTMENT/OFFICE/CAUNCIL DATE INRIATED � V� 3 6 2 5 5
Pub��� Aealth 8/26/97 GREEN SHEET _
CONTACT PEflSON 8 PHONE INITI INRIAVDATE
EPAflTMENTDIRECTO�TC I CRYCAUNGL
��
Diane H011lt ren 292-7712 ���'N �CITYATfORNEY OCIT'CLERK
NUYBEfi FOR
MUST BE ON COUNdLAGENDA BV (DAT� p��� BU�GET DIfiECTOR � PIN. & MGT. SERVICES DIR.
Scheduled for 9/3/97 � �"""Y°R�°R'�ssisr''r'n �
TOTAL # OF SIGNATURE PAGES 1 (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION FiEQUESTED:
City signatures on a Resolution for Board of Health support of the 1998-1999 Saint Paul
Maternal and Child Health grant application to the Minnesota Department of Health.
RECOMMENDAnONS: Approve (A) rn Reject (i1) pEFSONAL SERVECE CONTHACTS Mt1ST ANSWER TNE FOLLOWYNG QUES710NS:
_ PLANNING CqMMiS$ION _ CML SERVICE COMMISSION 1_ Has this person/firm ever worked under a coMrac[ for fhis tlepartmeM? �
_ CIB COMMITIEE _ VES NO
—�� — 2. Has Mis perso�rm ever been a city employee?
VES NO
_ DIS7fiICT COUR7 _ 3. Does this personHirm possess a skill not normally possessetl by any curreM c'Ry employee?
SUPPOA75wHiCHCAUNCROHJEC7IVE? � YES NO
Explain all yes answers on seperete aheet anA ettaeh to green sheet
INITIATINCa PROBLEM, iSSUE, OPPoRTUNIN (VJho, What, When. Where, Why):
The City of Saint Paul, through Public Health will submit a grant proposal to the Minnesota
Department of Health for funding of services to improve pregnancy outcomes and improve
adoTescent health.
ADVANTAGES IF APPROVED:
' 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.
DISADVANTAGES IPAPPROVED: �
NONE
y��«9.�`�� '����?�i �1Y�i
�;;�;; 2 ? 1�97
DISADVANTAGES IF NOT APPROVED:
' Funding will not be received to support the above mentioned activities.
' Access to health care wi11 not be improved.
��� `
TOTAL AMOUNT OF TRANSACTION $ 1� 62Z , 332 COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIHG SOURCE Stat2 Of Ninne50td qCTIVITV NUMBER 58324/33248
FINANCIAL INPORMATION: (EXPLAIN)
q�- �oag
�:. I�� Memorandum
CITY OF SAINT PAUL
August 26, 1997
TO: Nancy Anderson
City Council Offices
FR: Diane Holmgren
Public Health
RE: Materials for September 3, 1997 Boazd of Health Meeting
Enclosed are the materials for the September 3, 1997, Boazd of Health meeting,
including:
• Agenda
• Copy of one Resolution
• Copies of the 1998-1999 Maternal and Child Health Grant
The first two agenda items are contingent on the Resolution making it through
signatures in time. I will follow-up with you by phone regarding the status of these
as they pragress.
Thank you for all of your assistance.
If you have any questions, please contact me at 292-7712.
DH/sea
WINDO W S.DOS�SFAU2ESOLUTMROG-GRANT
1 ��;
From: Nancy Anderson
To: jerryb, gerrym, baribeav
nate: 8/25/97 3:OOpm
Subjflct: BOARD OF HEALTH MEETING.
davet, chuckr, barbb, mi...
A Board o£ Health Meeting has been scheduled for Wednesday, September 3, 1997
following the 3:3� p_m. City Council Meeting. The topic for your approval is the
"Maternal and Child Health Grant°.
Please mark you calendars.
CC: gerrys, marye, Admin.C50.£ran, Admin.CSO.debbie, I...
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•
MATERNAL AND CHILD HEALTH
SPECIAL PROJECTS GRANT
FOR
IMPROVED PREGNANCY OUTCOMES
• AND
ADOLESCENT HEALTH
1998-1999
Submitted by:
SAIl\'T PAUL COMMLTNITY HEALTH BOARD .
��- �oag
SAINT PAUL - RA.rISEY COUNTY DEPARTMENT OF PUBLIC HEALTH
555 CEDAR S'TREET
ST. PAUL, MN 55101
•
•
SAINT PAIIL MATERNAI, AND CgILD HEALTS
SPECIAL PROJECTS GRANT 1998-1999
Table of Contents
MINNESOTA DEPARTi�NT OF HEALTH FORMS
Face Sheet
Project Infor.nation
Evidence of Compliance
Services Provided By Legislative Priority
Certification Concerning Sterilization
Certification Regarding Lobbying
Assurances and Agreements
APPLICATION NARRATIVE
COD4ITJNITY ASSESSMENT
=MPROVED PREGNANCY OIITCOMES
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
Model Cities Health
West Side Community
& Counseling Service
Center, Inc.
Health Center
ADOLESCEtQT HEAI.TH PROGRAM
Problem Statement
Goal of the Project
Target Population
Objectives
Methods
Training/Experience
Linkages
Reimbursement and Fees
Budget Justification
Monitoring/Evaluation of Subgrante
Program Evaluation
Budgets - 1998 and 1999
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BUDGET AND FZNAL EXPENDITURE FORMS
Budget Justification
Budget Detail of Local Match
1998 Budget Form
1999 Budget Form
1998 Budget by Legislative Priority
1999 Budget by Legislative Priority
ATTACE�IENTS
Attachment A- Inventory of Community Resources
Attachment B - Solitation Process
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MINNESOTA DEPARTMENT OF HEALTH FORMS
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PSee Revase Sidc for ituwcuons
�t Application for:
;Iaternal and Child Health Special Projects
1. Applipnt Agency With Wttich Grant ContraM is to be Ezecuted
Legal Nmnc. Strat ?.ddress:
Saint Paul Co�unity 310 City Ha11 '
Health Board Saint Paul, .IN 55102
E-Mail Address: '
Minnesota Department of Health ` r_ l " ��
Face Sheet
Telephone Nmnba:
�612 � 266-8560
12 )
2. Director of Applicant Agency
xmme and Tttle:
Rob Fulton
Public Health Directo:
Strat Addras:
555 Cedar Street
Saint Paul, 4IN 55101
E-Mail Addms:
Telepho� Numbrr.
�612 � 292-7712
FAXDIumbc
(612) 222-2770
3. Fiscal Management Otficer of Applicant Agency
Name and Titk: , I Strat Address:
Diane Holmgren � 555 Cedar Street
Health Administratior. Kana er Saint Paul, MN 55101
E-Mail Addcas:
4. Operating Agency ('fdifferenr from rrumber 1 above)
Name and Title: Strat Addras:
Saint Paul — Ramsey County 555 Cedar Street
Department of Public 3ealt Saint Paul, MN 55101
E-Mai! Addras:
5_ Contact Person for Operating Agency ('fdifferentfrom mrmber 2 above)
Name md TiUe:
Addr�SS:
E-Mait Addrcss:
6. Contact Penon for Further Inlormation on Application ('fdifferent from mrmber 5 aboveJ
Name and Title: Strat Addless:
Carolyn Weber 555 Cedar Street
Administrative Assistant Saint Paul, MN 55101
E- Mail Add'ess:
7. Copies of This Application Have Been Seflt to the Rolbwing Communiry Heatth Boards for Review
(NotApplicabfrjw CommwiryHealth Bcmd(sJ ijthe Bo�d is BrApplr�muj
A2encv Name
TdephoneNumber.
�612� 292-7749
FAX Numbec:
cFt2> ���-2��n
Tdeptwne Ninnbu:
�612� 292-7712
FAX Nwnbec:
(612) 222-2770
Tekphone Number.
� )
FAX Nmnber:
( )
Telephone Num6a:
�612�292—�749
FAXNumber.
(612)222-2770
Date Sent
8. Certiication
1 eertify t6at the infom�etion m m is true and accurate m the bat of my 1mowledBe md thu I submit tdis appliaaon on behalf ofthe applicant agmry.
_ • /�������l//A/� • Director � ,Z,(p �1
Signanve ofDiiator of Applicant Agevry T�� �
E-0[2740M1f3/9T A
ICR 346428
Instructions for Completing Face Sheet •
Please Type or print all items on tfie Grant Application Form Face Sheet
Aoplicants please note: The appIication form has been desi�ed to be used on all Special Project granu administe:
by the Nfinnesota Deparcment of Heaith. If you have questions, or need assistance
completing the application form, piease contact the program Nfanager or Consultant identif:
as responsible for the grant. .
Applicant Agency
Legai name of the ageacy aathorized to enter into a grant contract with the Minnesota Department of Health, e.
North Woods Community Health Board. ,
2- Director of the Applicant Agency
Person responsible for direcfing the applicani agency.
3. Fiscal Management Officer of Appticant Agency
The chief fiscal officer for the recipient of funds who has primary responsibility for grant and subsidy func
expenditure and reporting. If the applicant agency is a Community Health Board, the Fiscal Managemen�c
must be the same person who is identified as the Fiscal Management Officer in the Board's Communi a1-
Service Plan.
4. Operating Agency
Complete onty if other than the applicaat agency listed in number 1 above.
5. Coatact Person for Operating Agency
Person who may be contacted conceming questions about implementation of this projeci.
6. Contact Person for Further Information
Person who may be contacted for detailed infozmation conceming the application or the project if different fron
number 5 above.
Copies of this AppIication Have Been Sent to the Following Community Health Boards for Review
Provide copies of this apptication and any subsequent revisions to the appropriate community health boards a
required by the individual instructions.
�• Signature of Director of Applicant Agency
Provide original signaYure and date.
•
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� P SreAeverse5ideforins¢uctioas MinnesotaDepartmentofHealth(NIDI�
• Project Information Sheet far Special Projects
NameofI��HProgram: :taternal and Child Health Special Projects Grant
1. ProjectInformation saint Paul Co�unity Healch Board
ApplicantAgencyName: Saint Paul - Ramsey County Department of Pubiic Health
Beginning Date: End Daze: Minnaota Tax I.D. No.: Federal 1.D. Number: Social Security Number:
O1/O1/98 12/31/94 802-722�i 41-b005875
Project Funds Requested: I,ocal Match Provided: �
Yeaz 1 Year 2 Yeaz i Yeaz 2
$ 808,695 �P 813,637 $ 202,959 $ 202,959
Service Area (city, county, or counties): �
City of Saint Paul
. Non-Pro�t Status - SOi.C3 Copy Attached
� Yes � Not Applicable
3. Evidence of Workers' Compensation Insurance Attached (see Evidence ofComplianceForm)
❑ No ❑ Yes � Not Applicable
4. Affirmative Acrion
The agency has a certificate from the Commiuioner of Human Rigdts, Pursuant to M.S. 363.073 Attached
❑ No ❑ Yes � Not Appiicable Because:
❑ Total Coatract is SSQ00 or Less
❑ Ageary Has 20 or Fewer Full-Time Employees
� Units of Local Govunment
❑ Indian Reservation
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HE-01274-04 (3/97) -PART B
IC N 140-425
Instructions for Completing Project Information Sheet for Special Projects �
Please Type or Print all items on the Project Information Sheet for Special Projects
Appticatioas ��Iease note: The appIication form has been designed to be used on all Special Project grants
administered by the Minnesota Department of Health. ff you have questions, or need
assistance in completing the application form, piease contact the Program Maneer or
Consultant identified as responsible for the grant.
Project Information
Provide name of appIicant agency, beginning and end date of the project, Minnesota Ta�c I.D. Number,
Federal I.D. Number (if appiicable), or Social Security Number, and geographic service azea. List the total
amount requested for each year for Project Funds Requested and LocaI Match Provided. PIease refer to
individuai instructions for each special project gant to determine if local match requirements aze needed.
2. Non-Profit Status - SO1.C3 Copy Attachment
Check appropriate answer. Agencies other than a govemmental unit aze required to file a SO1.C3 form with
the application as evidence the agency is a non-profit institution, corporation or organization.
3. Worker's Compensation •
Minnesota Statutes, Chapter 176, forbids the Commissioner of Health from entering into any contract until
the Commissioner receives acceptable evidence of compliance with worker's compensation insurance
coverage requirements from the contractor. Complete the form entided "Evidence of Compliance" and retum
it with your grant application.
4. Affirmative Action
Minnesota Statutes, Section 363.073, says the Commissioner of Health shall not."... receive, enter into, or
accept any bid or proposal for a contract nor execute any contract for goods, services, or the performance of
any function, or any agreement to transfer funds for any reason in excess of $50,000 with any person having
more than 20 fuil-time employees in Minnesota at any time during the previous 12 monttu, unless the person
has an a�mative action plan for the employment ofminority persons, women, and the disabled that has been
approved by the commissioner of human rights. Receipt of a certificate of compliance issued by the
commissioner shall signify that a person has an affirmatiye action plan that has been approved by the
commissioner." If the grant or contract you propose meets the "in excess of $50,000" criterion and your
ageacy meets the "more than 20 full-time employees" criterion, a Certificate of Compliaace must accompany
your proposal, unless your agency is exempt If you have questions about the Certificate of Compliance,
please contact the:
Minnesota Depamnent of Humaa Rights
Con�act Compliance
Army Corps of Engineers Ceater
190 East Fifth S�eet
Suite 700
St Paul, MN 55101
(612) 296-5663
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� Plczcc Typc or Pnnc
Evidence of CompIiance
State law forbids the Commis;ioner of Health from entering into any grant contract until the Commissioner
receives acceptable evidence ei compliance with workers' compensation in�,Ta„ce coverage requirements from
the gantee. The exceprion to this requirement is a self=employed grantee who has 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 esception and you wish to enter into a grant contract with the Commissioner of
Health, you must frunish acceptable evidence of compliance with worker's compensation covemge in any one of
the following four ways: ' ,
1.
�
If you aze self-insured and you are a state agency or a municipal 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, circle
this entire statement and sign and date the form below in the space provided; or
4. Fill in the informa�on for each
Name and .4ddras of Granta's Irswance Carria:
and date the form in the space provided
��Gcantee's Insuronce Poliry Numbu:
Ia�rm that al1 ofthe employees oJ Saint Paul - Ramsey County Department of Public Health
(Grantee's Name)
are eovered by the workets' compensation insurance policy listed above.
s�a s
��
Attach a certificate of insurance (supplied by your workers' compensation cazrier) to this Evidence of
Compliance form; or
If you aze self-insured, zttach to this Evidence of Compliance form, a written order from the Minnesota
Commissioner of Comm:rce allowing you to self-insure; or
Minnesota Department of Health
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Director
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HE-0I274-04 (3/97)-PART C
IC N 140-M12S
-i
� MCHSP SI:�P✓IlVIARY OF
ES OF ACTIVITIES AND SERVICES
PR.OVIDED BY OPERATING AGENCIES
BY LEGISLATIVE PRIORITY
Saint Paul Co�unity Health
corrnr�m �aL� Boaxv
c�)
Saint Paul — Ramsey County
OPERATING AGE1�iCY�
(if difterent from CHB�
I. Improved Pregnancy Outcome
served: � City of Saint Paul
Types of Activities/Services
core pubiic hcalth aaivities not directe: to individuals
individualized education/counseling
health education/counseling in groups
pregnancy testing and referrn!
prc-term birth provention
prenatal case management
III. Aandicapped/Chronicall� Ill
GeoQraphic area served: r
Types of Activities/Services
core public health activities not dirocud w individuals ❑ case identification and referral
cau managemrnt ❑ case monitoring and hacldng
home health/respite care ❑ assistance in obtaining health cate financing
school health uchnical consultation ❑ assistance in obtainin
g primary care services
II. Family Planning ProQram
MCHSP SL�►ZMARy OF
TYPES OF ACTIVITIES AND SERVICES
PROVIDED BY OPEl�>T'ING AGENCIES
BY LEGISLATIVE PRIORITy
i ��
comnKUxi� xEai.� soaRn
�c��
� �
OPERATING AGEi�iCY'�
�f di}Tennt from CHB)
N.
Childhood Injiuy Controt
Geographic azea served:
Typa of Activiries/Servica
Ptease c6eck theen s'e,�:�.� ..�....�
core public healch activities not direcmd to individuals
home safety awazeness
promotion of positive parenting
toddler car seau
Tu
injury prevention in day care setting
inJury Prevention in schools
farm relaud injury programs
enabling and non-health suppoct
Other Programs Previous Funded by a Local Pre-Block MCH Special Project Grant - Specify Programs:
❑ Dental Heaith Program
❑ InfanUChild Health Program
� Adolescent Health Program
Types of Activitic�slServices
core p�blic health activities not directed to individuals
examples of operating agency include county, school dis�ict, Iadian reservation, non profit health agency,
etc.
•
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CERTIFICATION CONCERNING USE OF MCH SPECIAL PROJECT
GR°j?�iT FUNDS TO PROVIDE AND/OR ARRANGE STERILIZATIONS
•
CHECK ONLY 0�1E BOX:
�
No
sterilization
grovided
❑
Yes
steriIization
grovided
:LfCH Special Project grant fuads wiil not be used during CY 1998-99 to
provide and/or arrange sterilizations. If a client is merely referred to another
health care provider, this provision of information is not considered to
"ananging" a sterilization.
MCH Special Project grant funds will be used to provide and/or arrange
sterilizations during CY 1998-99. Agencies which use MCH Special Project
gant funds to gay for a procedure or related pucpose, such as provision of
transportation or detailed counseling, must adhere to specific federal service
and reporting requirements described elsewhere in this document.
I certify that to the best of my knowiedge the above information is coaect, and that if this status changes,
formal notification in this regazd wili be sent to the Section Manager, Matemal and Cluld Health Section,
Minnesota Department of Health, Minneapolis.
�
Signature ofDirector
of Applicant Agency:
Title:
Date:
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Instructions for Completing Certification
Concemiag Use ai'�TCH Special Project Grant Funds
to Promote aad/or Anange Sterilizations
AIl federai PubIic Health Service supported programs, including the Matemal and Child Heatth Services
Block Grant progr�m, which use federal funds to provide and/or azrange for sterilization aze required to
follow fedeial procedures and to pmvide tvritien doctunentation in this regard on a quarterty basis.
MCH Special Projects (MCHSP) may obtain an exemption from tt}is reporting requirement by signing a
cer�frcation that ttieir agency is not using MCHSP funds to provide and/or arrange sterilizations. (If a client
is merely provided information and referred, this is not reported.) Reporting is required if MCHSP funds
aze used in some form of participation (paying for the procedure, providing traasportation, making an
appointment with another health provider, or detailed counseling beyond simpte provision of information).
All Cominunity Heatth Boards aze required to complete the Certification. For agencies which do not
provide sterilizations, no further action will be needed during CY 1998-99. The agencies which indicate
they do provide sterilizations must adhere to specific federal service and reporting requirements @escribed
elsewhere in this document
•
•
q�-loq�
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CERTIFICATION REGARDING LOBBI'�1G
The undersigned certifies, to the best of his or her knowledge and belief that:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned,
to any person for influencing or attempting to influence an officer or an employee of any agency,
a member of congess, an officer or an employee of any agency, a member of congress, an officer
or employee of congess, or aa employee of a member of congress in connection with the awazding
of any federal contract, the making of any federal gant, ihe making of any federal loan, the
eniering into of any cooperative agreement, and the extension, continuation, renewal, amendment,
of inodification of any federal contract, grant, loan, or cooperative agreement. .
(2) ffany 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 congzess, or an employee of a member of congress in connection with
this fedezal contract, grant, loan, or cooperative agreement, the undersigned shall complete and
submit Standard Form-i l i, "Disclosure Form to Report Lobb}�ng," in accordance with its
instructions.
(3) The undersigned shall require that the language of this certification be included in the awazd
• documents for all subawazds at all tiers (including subcontracts), sub�ants, and contracts under
grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
This certification is a material representation of fact upon which reIiance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction 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.
Signature
$�� R1
Date
Rob Fulton, Director
Name of Authorized Individual
• Saint Paul - Ramsev County Department of Public Health
Name and Address of Organization 555 Cedar street
Saint Paul, iIN 55101
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ASSURANCES AND AGREEMENTS
BY SIGNATURE, TFIE AUTHORIZED OFFICIAL AGREES AND ASSURES THAT:
Services will be provided in accordance with appiicable state and federal laws, rules and procedures.
2. The agency will comply with state and federal requirements relating to privacy of clieat information.
'The agency will comply with the Minnesota Clean Indoor Air Act which prohibits smoking in MCH
Special Project facilities and clinics.
4. The agency (if it has 15 or more empioyees) and any subcontractors with 15 or more employees will
have on file and available for submission to Minnesota Department of Health (IvIDI-n upon request a
written non discrimination policy containing at least the following:
• "All progzanis, services, and benefits which aze administeted, authorized, and provided shail be
opeiazed 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
Discrimination Act of 1975, and the non discriminatory requirements of the MCH Block Grant.
No person or persons shall on the ground of race, color, nationat origin, handicap, age, sex, or
religion, be excluded from participation in, be denied the benefits of, or be otherwise subjected
to discrimination under any prograzn service or benefit advocated, authorized, or provided by this
Deparnnent."
5. The agency (if it has 15 or more employees) and any subconttactdrs with 15 or more employees will
disseminate information to beneficiaries and the general public that services aze pmvided in a non
discriminatory manner in compliance with civil rights statutes and regulations. This may be
accomplished by:
A. Including a handout containing civil rights policies in any brochures, pamphlets, or othez
communications designed to acquaint potential beneficiaries and the public with progams;
and/or
B. Notifying referral sources in routine letters by including prepared handouts which state that
• services aad benefiu musc 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 IVIDH upon request.
�
6. In fulfilIing the duties and responsibilities of this grant, the gr��tee shall comply with the Americans
with Disabilities Act af 2 940, 42 U.S.C. § I2I01, et seq., and the regulations promulgated pursuant to
it.
7. No residency requiremeats for services other than state residence, wiIl be imposed.
8. Services shaI1 not be denied based on inability to pay.
9. Arrangements shall be made for communications to take place in a language understood by the
matemal and cIuld heaIth service recipient.
io• All written materials developed to determine client eligibility and to describe services pmvided under
this grant wiIl be understandable to a person who reads at a seventh grade level using the Flesch
"Analysis Readability Scale as required in Minnesota Statute 144.Q54 (see Appendix I0, Ptain
Language in Written Materials, Minnesota Statute, Section 144.054}.
11. The agency will provide services in keeping with prograrn guidelines of ihe Minnesota Department
of Health and guidelines of accepted professional groups such as the American Academy of Pediatrics,
American CoIlege of Obsteh and Gynecologists, and American Pubiic Health Associatio�
12. Upon request, one copy of any subcon�act executed as part of the project will be provided to the
Minnesota Department of Health.
I3. The agency wilI report accomplishments of the project to the Minnesota Department of Health. Such
reports will be submitted no later than 90 days afier the completion of the catendar yeaz. Upon
request, the agency will provide additional information needed by the Depamnent for evaluation of
the project's objectives and methods and compliance with any special conditions (see Appendix 17,
Program Reporting Requirements for Matemat and Child Heatth Special Ptojects).
14. G2ant funds shatl not be used for inpatient services except for high risk gregnant women and infants.
15. Cash payments shall not be made to intended recipients ofhealth services.
I6. Grant funds shall not be used for purchase or improvement of land or facilities.
17• Grant funds shall not be used for punchase of equipment costing more thaa $5,000.00 per uniY and with
a usefut life exceeding one year.
18. Giant funds shall not be used for reimbursement for travel and subsistence expenses incuired ou e
the state uniess it has received prior written approval from the Minnesota Department of Healtt�
such out-of-state �avel.
19. Whea applicable, ihe agency sha11 provide nonpartisan voter registratioa services and assistance using
forms provided by the state to employees of the agency and the public as reqnired by Minuesota
Statutes, 1987 Supplement, Section 202.162 (see Appendix 9, Requirements for Voter Registratio�).
�-�- �oa�
•
20. When issuing statemenis, press releases, requests for proposals, bid soIicitations, and other documents
desczibing projects and prograzns funded in vr'-nle or in part with federat money, ail grantees receiving
federal funds shall ctearly state (a) the percentage of the tatal cost of the program or project which will
be financed with federai money, and (b) the dollar amount of federal funds for the proj ect or progam.
21. The a�ency will not use graat funds to pay for any item or service (other than an emergency item or
service) furaished by an individual or entity convicted of a criminai offense under the Medicare or any
state health cue program (i.e., Medicaid, Matemal and Child Health, or Social Services Block Grant
programs).
22. Materials de�•eloped by Matemal and Child Health Special Project grant and matching funds wili be
part of the public domain and will be accessible to the public as financially reasonable. Materials
developed b� the �+fatemal and Child Health Speciai Project grant and matching funds may be
feproduced and distributed by the Project to other agencies and providers for a profit so long as the
revenues from such sale aze credited to the Special Project budget for expenditure by the Special
Project.
23. The agency will compiy with all standards relating to fiscal accountahility that apply to the Minnesota
Department of Health, specifically:
• A. Bud;et revisions with justification will be submitted to IvIDH for prior approval whenever:
(1) changes aze made in the objectives to be met in the Matemal and Chiid Health Special
Pmject, or
(2) the cumulative amount of funds uansferred into or out of an operating agency's budget
line item exceeds or is expected to exceed 10% of that approved for the grant year or
52,500.00, whichever is greater.
B. Final expenditure reports are due 90 days after the end of the calendar yeaz.
C. Grant funds are used as payment for services only after third-party payments, such as from
the Medical Assistance/Medicaid (Title XXI�CC SSA), Children's Health Pian/MinnesataCare
reimbutsement progratns of the Minnesota Department of Human Services and private
insuiance aze utilized.
D. Project financial management systems wi11 provide for.
(1) Accurate, cuirent, and complete disclosure of the financial status of the p%ject.
(2) Records which identify adequatety the source and application of funds for Matemal and
. Child Health Special Project activities. These records are to contain information
pertaining to project awazds and authorizations, obligations, unobligated balances,
liabilities (encumbrances), outlays, and income.
�
(3) Effective control over the accountability for al1 fuads, p; -•�erty and other assets.
Projects aze to adequately safeguard such assets and assure that they are used solely for
authorized purposes.
(4) Comparison of actual obtigations with budget amounu for each activity.
(5) Accounting records which are supported by source documentation.
{6) Audiu which will be made by or at the direction of the Minnesota Department of Health
(see Appendix 6, State Audits}. ,
SIGNANRE OF CHAIR OR VICE-CHAIR
OF THE COMM[.TrTTI'y HEAI,T'H gp,q� OR
AN AGENT APPOINTED BY RESOLUTION
OF TI� COMMUNITy HEAI,TH BOARD:
��2'����
TTTLE:
DATE:
� Iti rPrro3
�'�2 L�'� 7
•
•
a�. a �oag
•
�
COMMUlvITY ASSESSMENT
n
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a� - �a�g
•
CONIlVILtNITY ASSESSi�IEP3T
A broad-based assessment of community health needs and resources in Saint Paul was
conducted be�innins in the fall of 1994 as part of the development v: the 1996-1999,
Saint Paul-Ramsey Counry Community Health Services Plan. Throughout this
planning process. and as we proceed to plan for the future, issues will be identified
which contribute to poor health outcomes. The CHS Advisory Committee idenrified a
number of primary issues which underlie and aze frequently the root causes for the
discrete public health problems identified in the Community Assessment. Specifically,
these issues are:
• Poverty and Racism - all of which lead to hopelessness, income disparities and •
polarizacion between classes.
This polarization tears at the socialtcultural fabric of our community, making public
health intervention increasingly chalienging.
The Advisory Committee and staff also identified system problems which underlie and
compound the problems. These system problems are:
i. Integrated health care and social service system for all children and families in
• Saint Paul and Ramsey County, especially children at risk are lacking.
2. The complexiry of the changing health care system in Saint Paul and Ramsey
County has resulted in lack of access to heaith care for certain populations and
the lack of stable funding for public health services, inciuding prevention.
3. Communication of health and environmentai 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%a or more persons with
incomes below the poverry level, with an additional nine census tracts with a
level of 30% - 39.9% of persons with incomes below poverty level.
• Five census uacts in Saint Paul realized an increase of over 20% in the
number of persons living below poverty between 1980 and 1990.
A significant change occuring in the community has been the public health joint
powers agreement between the City of Saint Paul and Ramsey County, effective 7uly
1, 1997. The Joint Powers Agreement was developed over approximately two years
before being approved by the Saint paul City Council and the Ramsey County Board
� of Commissioners in December 1996. the Joint Powers Agreement forms the Saint
Paul - Ramsey counry Department of Public Health. The 7oini Powers Agreement
idenufies one Community Health Services Agency for the Saint Paul - Ramsey County
community. However, both Saint Paul and Ramsey Counry will maintain a Board of •
Health. The Saint Paul Community HeaIth Board witl consider issues affecting those
services maintained by the City of Saint Paul, which will include the Maternal and
Child Health Speciai Projects Grant. Saint Paul - Ramsey County Department of
Public Health becomes the operating agency for the MCH grant.
Additional assessments has been completed at part of the preparation of the Saint Paul
- Ramsey County Couununity Heaith Services Plan Update for 1998-1999. As a result
of this assessment, Saint Paul - Ramsey County Department of Public Health has
identified improving preanancy outcomes as a maternal and child health service
prioriry for Saint Paul. The 1996-1999 Community Health Services Plan identified
twenty health problems as the highest priority. An additional thirteen high priority
problems were identified as were three service delivery system problems. A number
of problems related to improving pregnancy outcomes were identified among these
high priority problems including:
� High rates of low birthweighi stfants and preterm deliveries in some
populations
• Ongoing problem of Infant Mortality despite decreasing infant mortality rates
• Low rates of breastfed newborns and infants in Saint Paul and Ramsey County •
Data reported in the 1996 Minnesota Health Profiles provided by the Minnesota
Department of Health and the Saint Paul - Ramsey County Communiry Health
Services Plan Update for 1998-1999 also reveals that in 1995:
� Percent of Premature Births (less than 37 weeks gestation) for Saint Paul is
10.5 compared to 8.7 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is 6.2 in
Saint Paui compared to 4.0 for the State of Minnesota.
• Percent of women receiving late (3rd trimester) or no prenatal care is higher
for American Indians (8.3), African Americans (10.7), Asians (13.6) and teens
(10.5) compared to Saint Paul aT 6.2.
• The iafant death rate of infants born to American Indian women (24,4) and
African American women (13.7) is much higher compared to the rate for Saint
Paul (9.4) and the State of Minnesota (8.2).
• The incide�e of 2ow birthweight births in Saint Paul increased from 6.7 in
1993 to 7,3 in 1995. •
• The incidence of low birthweight births for African Americans increased from
22.0 in I993 to 14.4 in 1995.
a�� �oq�
• This data also indicates that due to the increasing efforts to improve pregnancy
outcomes, we have seen some positive results such as:
� The cunent five year rate for infant mortality in Saint Paul of 7.4 has
improved compazed to the previous five year rate of 10.6.
• The incidence of lst trimester prenatal caze continues to increase from 56% in
1988, to 62% in 1991, 67% in 1993 and 69.9 % in 1995 for Saint Paul
women.
� The incidence of ist trimester care for Saint Paul Native American women
continues to increase from 36% in 1988, to 37% in 1991, 54% in 1993 and
63.9 % in 1995. �
While technology has improved to allow care and treaunent of some high risk births,
it is much more efficient, cost-effective and less stressful to place dollars and efforts
on improving pregnancy outcomes so that the advanced technology does not need to be
used.
Data indicate that some specific health planning areas in Saint Paul have poorer birth
outcomes and may benefit from increased levels of targeted outreach and service.
• These health planning areas, all within the City of Saint Paul, include: Thomas-Dale,
Sununit-Dale, Downtown Saint Paul, Riverview, Dayton's Biuff, Mount Airy and Rice
Sueet.
In addition to the focus being placed on unproved pregnancy outcomes, the Adolescent
Health Program, utilizing school based clinics operated by Health Start, Inc. and
previously funded by the preblock 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, e�cient and effective service to this
potentially high risk and often forgotten population. In fact, a number of issues
specifically related to adolescent health are included in the Community Health Services
Plan as priority health probiems, 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.
• High incidence of death and injury due to availability of fuearms
• High rate of unintended pregnancy among teens
• • Increasing 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
Tfirough the community assessment completed as part of the CHS planning process, it
was identified that there are resources available within the community to meet the
needs in the areas of famiIy planning, handicapped/chronically ill children and
childhood injury conuol. Based on ttris assessment, no funding is requested for these
azeas through the Maternal and Child FIealth Speciat Project Grant. However, these
areas will continue to be monitored by Saint Paul - Ramsey County Department of
Public Heatth to ensure that resources exist to handIe t6e various health problems and
issues in each azea.
�
The provision of services addressing improved pregnancy outcomes will be
subconuacted to various communiry-based providers who were identified through a
process of request for proposals. Saint Paul - Ramsey County Department of Public
Health has chosen to subconuact for services in an effort to utitize estabtished
agencies and organizations who have proven to be effective and efficient in their
delivery of services and which are located within the target areas. Additionally,
subcontracting with existing agencies minimizes start-up costs and duplication of
services. Itis hoped that this process and the services provided by the subgrantees �
will also help ensure that culturally-sensitive, continuous care is provided to high risk
populations.
Various information regazding the community assessment is displayed in the figures on
the following pages.
•
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3 YR. TEEN PREGNANCY RATE
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IlVIPROVED PREGNANCY OUTCOMES
�
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PROBLEM STATEi�i�iT
•
Poor pregnancy outcomes has been identified tbrough a community assessment as a
high priority public health problem in Saint Paul by the Saint Paul-Ramsey Counry
Community Health Services Advisory Committee and staff from Saint Paul - Ramsey
County Department of Public Health. The problems which were identified include:
• high rates of low birth weight infants and pre-term deliveries in
some populations
• ongoing problem of infant mortaliry despite decreasing infant
mortality rates
• low rates of breast fed newborns and infants
• alcohol use by pregnant women is causing fetal alcohol syndrome, fetal
aicohol effects and other birth defects
•
•
The rates of infant mortality, low birth weight and pre-term deliveries for the City of
Saint Pau1 are higher than suburban Ramsey County and the State overall. The Health
Planning Areas of Thomas-Dale, Summit-Dale, Downtown St. Paul, Riverview,
Dayton's Bluff, Mount Airy and Rice Sueet have been targeted as the specific
geographic areas to be served in response to previous high rates of poor pregnancy
outcomes.
601
319. 332 �
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Como Park
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604
Pha/en Park
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Rivenriew
sy5 CtTY of SAINT PAUL
Highland Park Health Planning Areas
and constituent census tracts
� Targeted for high mtes of
Poor Pre9nonry ovkome
x�.oz 3o�.m. x�.aa
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Hayden Heights
,.�,� 318.01.31602,
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RAMSEY COUNTY: BiRTHS
% Premature & % Low Birth Weight
._. i
. �, �
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y- ' � � 59
Ramsey County:Prenatal Care
First Trimester
�:�
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t986 7988 7991 1993 1994 7995
1990 1995
Heatthy Pgople 2000 Goai is 90 % Source:MDH
�
Ramsey County
Healthy People 2000 Goal 7.0
Source:MDH
Osw�x
o,NO�
�5�,�
��rte
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City of Saint Paul
Infant Mortality Rate by Race
Saurce:MDH
� eua�
ii �
� s�vome
� v�rtme
u
Infant MoRality Rate by Race
Healthy People 2000 Goai �.0
�� -io��
. One factor contributing to poor preanancy outcomes, including high infant mortality,
premature birrh, and low birthweight births, is late or no entry into prenatal care.
A�ain, the targeted Health Plannin� Areas within the City of Saint Paul have a higher
percentage o_` women who begin prenatal care late (third trimester) or who receive
none at ali than suburban Ramsey County and the State overall. Certain Saint Pau]
neighborhoods have especially high rates of late prenatal care.
LATE OR NO PRENATAL CARE in -1990
Overall, 7.4% of mothers did not begin prenatal care until
the third trimester, or received no prenatai care at all.
HEALTH PLANNING AREA
Mt. Airy
Thomas-Dale
•
•
Rice Street �
Midway �
Downtown r
Daytons Bluff �
Riverview �
Summit-Dale r
Phalen Park �
T
St. Mthony Park r
West 7th SUeet �
Battle Creek �
Hayden Heights �
Hamiine - 3b'
Hightand Park � s.z�
i
Hazel Park � a.a o
Maeatester � 2.o^r,
Como Park � ��3 =
i o.� �
io.oi
� B.0 %
� 6.9%
■ s.sv,
4.9 %
13.
O.OX S.OX 10.0% I5.0%
LATE or NO PRENATAL CARE
20.6 %
20.OX
25.0X
SOURCE 58int Paul Pub6c Heaith
q�-�o��
� Maternal and child health activities funded through the Maternal and Child Health
Special Projects Grant are monitored quarterly, and more thoroughly evaluated on an
annuai basis. A report assessin� the activities of the current project in 1996 was
compieted for the Minnes�:^. Department of Health. Since current comprehensive data
on Saint Paul health indicators is not readily available, it is dif£cuit to fully assess the
impact of present pro�rams at this time. However, based on the data received from
the pro�rams, the foliowing summary information from 1996 programs receiving
MCH fundin� to improve pregnancy outcomes is availabie:
• 1,246 clien[s were seen for prenatal services
• 44% of the 548 clients who delivered in 1996 received prenatai care in the
first trimester of pregnancy
• 4 fetal deaths were identified
� 2 neonatai deaths occurred
• 35 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 among some minority populations.
� PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES
Saint Paul - Ramsey County Department of Pubiic Health's Improved Pregnancy
Outcome Pro�ram for the City of Saint Paul 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 assuring
universal access to preventive health services. To achieve these goals Saint Paul -
Ramsey County Department of Public Health has identified priorities consistent with
the foliowang MCH Task Force priorities:
• reduce infant mortality
• reduce the percentage of low birthweight births
• increase the percentage of women receiving prenatal caze in the first trimester
• provision of prenatal care services that are sensitive to cultural diversity
These priorities will be addressed through the objectives and methods identified by the
by staff in the Refugee/Preventive Medicine Program at Saint Paul - Ramsey County
Department of Public Health and four community agencies approved for funding by
the MCH Special Project Funds Proposal Review Committee. Once again, Saint Paul
- Ramsey County Deparcment of Public Health subcontracts the majority of MCH
funding to community organizations to increase access to services, and to increase the
� likelihood that culturally sensitive care is available to the population. The agencies
recommended to receive funding are Health Start, Inc.; Model Cities Health Center
Inc.; Face To Face Health and Counseling Service, Inc.; and West Side Community
Aealth Center.
The programs of these agencies provide a variety of inetl �ds which are targeted to
increase the percenrage of women receiving prenatal care in the fusttrimester, ensure
continuous prenacal care, education and case management, reduce infant mortality, and
decrease low birthweieht bir[hs. AdditionalIy, the programs of these four agencies
will provide services to the residents of the highest risk Saint Paul neighborhoods.
�
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•
�
INVE1�"fORY OF SERVICES
From the inventory which was completed, it has been identified that there aze a
number of agencies providing prenatal c,:re in St. Paul, in addition to independent
practitioners. An inventory of agencies providing prenatal care, priruarily those
providing the opuons of care on a sliding fee, including the target populauon served
and the services provided, is included in Attachment A.
In April of 1992, the Prepaid Medical Assistance Program (PMAP) was implemented
in Ramsey County. There are currently four health plans available, including
HealthPartners, U-Care, Medica and Blue Plus. Individuals who are newly applying
for Medical Assistance are being placed into this system at the present time.
The system has improved, but there are still issues of denied services, confusion
regarding where a person can receive services and clients choosing not to seek
services due to the confusion. Special populations may need special attention to
initially maneuver through this new system. Saint Paul - Ramsey Counry Department
of Public Health will continue to advocate for accessible care for all populations.
•
q� - ���
•
GOALS OF THE PROJECT
The overali goal of the projecu which will be supnorted through the Maternal and
Child Health Special Projecu grant is:
To improve pregnancy outcomes of high risk, low income women residing in Saint
Paul.
OBJECTIVES OF THE PI20JECT
A number of objectives have been established for the Improving Pregnancy Outcome
project including:
1. To make progress toward ihe goal of improving the overall 3aint Paul infant
mortality rate ( 9.4/1000 in 1995) with a special emphasis on African
American, Native American and Asian women.
2. To make progress toward che goal of reducing the rate of St. Paul low
• birthweight infants from 7.3% in 1995 to 4.0% by 1999 with a special
emphasis on African American, Native American and Asian women.
3. To conduct ouueach efforts to pregnant teenagers to increase the rate of first
trunester prenatal care ( 56% in 1995) in Saint Paul pregnant women under age
20 with a special emphasis on outreach to minoriry teens.
4. To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 6.2% in 1995 to 4.5%a in 1999, with a
special emphasis on pregnant teens and all pregnant African American, Native
American and Asian women.
TARGET POPULATION
The clients targeted by programs funded by the Saint Paul Community Health Board
through the Saint Paul - Ramsey Counry Department of Public Heatlh are low income
(less than 200% of poverry) Saint Paul women at high risk for poor pregnancy
outcomes, as defined by legislative pazameters. This includes, but is not limited to,
teenage and minority women residing in the aforementioned health planning areas
• (HPA's) of Ramsey County. The targeted HPA's were selected on the basis of their
historically high rates of infant mortality and late or no eniry into prenatal care.
The Refu�ee/Preventive Medicine Program at Saint Paul - Ramsey Department of •
Public Health will be using a very small amount of the Maternal and Child Health
dollars to partially fund their Improved Pregnancy Outcome Program which is
described below.
Goal - To improve birth outcomes of high risk low-income pregnant women in Saint
Paul trough early comprehensive prenatai care.
Target Poputation - Low-income prenatal women enrolled in Saint Paul - Ramsey
County Department of Public Health Refugee/Preventive Medicine Clinic.
Objectives -
1. Comprehensive multidisiplianary prenatal care will be provided to 100% of
prenatal clients enrolled in the Refugee/Prevenuve Medicine Clinic.
2. By 12/31/99, 85% of prenatais wili be rated "healthy" by their 3rd trunester as
measured by health status indicators.
3. Ongoing health education will be provided on an individual and small group basis
to 100% of all prenatal patients.
4. By 12/31/99, 95% of prenatal clients will initiate prenatal care during their lst •
trimester.
5. By 12/31/99, low-birth weight (less than 2500 grams) rates will be no greater than
0.1�.
6. By 12/31/99, the infani death mortality will be no greater than 0.1%.
Methods -
� Clinic and ouueach staff will be trained to provide culturally competent health
information.
• The outreach worker will provide health information which wi11 include proper
nutrition, elimination of alcohol and drug use during pregnancy, family planning
educarion and personal, financial and education pIanning.
• As part of case management and follow-up, an outreach worker wili make at least
six home visits to each prenatal client as part of the case management and follow-
up program.
• Arrangemenu for uansportation will be made through the patient's Health Plan for •
those who have uansportation needs.
�� - �oa�
• Evaluation - The case manager will provide reports on a quarterly basis including
number of homevisiu and telephone contacts per patient. There will be quality
improvement monitoring of alll postpartums to meausre outcomes durin� their
pregnancy period including care and status of all delivered inf� '-
Trainin�/Eamerience of Staff -
Xia Lor Vang is an Outreach/Health and Education Assistant. She received inservice
training for Western medicines and treatment through the University of Minnesota
from 1981-1986. she also complete Health Interpreter Training at the Universiry of
Minnesota in 1989. Xia has worked as a nutrition assistant, interpreter and outreach ,
worker with prenatal patients and their families for many years. She has attended and
participated in many Hmong conferences and other in-services on cultural diversity in
the Twin Cities and has received high awards for her community work.
Florida Stevens is a Public Heaith Nurse receiving her Bachelor of Science in nursing
in the Phillippines in 1965. She joined the exchange program for nurses at the May
Clinic and St. Mary's Hospital in rochester, Minnesota from 1967 to 1971. She has
had extensive hospital experience as a staff nurse, manager/supervisor and project
coordinator. She joined Saint Paul Public Health in 1994 as a perinatal hepatitis
• coordinator and later as program manager for Refugee/Preventive Medicine Ciinic.
She has worked ciosely with prenatal clients in case management, assuring quality
outcomes since 1995.
Jonnalyn Belocura, M.D. is a Family Practice Physician. She graduated from
Medical School in 1991. Dr. Belocura came tothe University of Minnesota in 1993 -
1996 to specialize in Family Practice. She practices at Model Cities Health Center
and at Saint Paui - Ramsey County Depar[ment of Public Heatlh Refugee/Preventive
Medicine Clinic.
Diane Vankante, M.D. came to the United States in 1991 from Croatia. She took her
rsidency in Family Practice at I3orth Memorial Hospital from the Universiry of
Minnesota from 1993-1996. Dr. Vakante practices at Model Cities Health Center and
at Saint Paul - Ramsey County Department of Public Heaith Refugee/Preventive
Medicine Clinic.
Linkaees - The Refugee/Preventive Medicine Clinic at Saint Paul - Ramsey County
Department of Public Health provides on-site prenatal care. Clinic staff and the
ouueach worker work collaboratively with the public health nurses, WIC and Optional
Home Care for home visits and other patient needs. The clinic has agreements with
Bethesda Family Practice matemity staff and St. Joseph's Hospital for provision of
• patient deliveries. All patients records and updated progress notes aze sent to St.
Joseph's Hospital at twenty-eight weeks and prior to delivery date.
Reimbursement and Fees - The prenatai clienu are eligible for Medical Assistance, •
specifically U-Care Managed Care. the Clinic has been a U-Care provider since
BudEet - A complete budget and justification follows.
The remainder and majority of available MCH Special Project Funding beyond the
pre-block grant funding to HealthStart, Inc. was made available to community
organizations through a Request for Proposals process. This process and the target
population specific to each subgrantee selected, as well as the objecuves, methods, '
training/experienc of staff, linkages, reimbursement/fees and budgets will be described
in the following section tided, "Subgrantee Information".
�
•
q�- �Q�
�
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FT'E
REFLTGEE AND PREVEiVTIVE CLII�IIC F1'iVANCIAL SUMi1�1ARY
1998 iv1ATERNAL A1VD CHILD HEALTH GRANT
Salaries/W Bene�its Maternal Child SPRCPH Totai Salaries
Health W/ Benefits
3 HmoneJL,ao HEA
Outreach Staff
� Travel Expense
3 � PF�N Case Mana�er
$ 7,517.00 $ 12,157.00
1,450.83
17,410.40
.2 Consultant/Z family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
REFUGEE AND PREVENTIVE CLI1vIC FINANCIAL SUMMARY
1999 MATERNAL AND CHILD HEALTH GRANT
n
U
FTE Salaries WBenefits
3 Hmong/Lao HEA
Outreach Staff
Travel Expense
.3 PHN Case Manager
SPRCPH
$ 7,517.00
1,450.83
Total Salaries
W/ Benefits
$ 12,151.00
17,410.40
.2 Consultant/2 family 2,25333 27,040.00
Practice physicians (Without benefits)
Total Project Cost $5,000.00 $11,221.16 $ 56,607.40
Finsum
$4,640.00
360.00
Maternal Child
Health
$4,640.00
.� ��,
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•
�
SUBGRANTEE INFORMATION
�
q"I. �l�l�
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SUBGRANTEE SOLICITATION PROCESS
To determine the agencies with whom a subcontract would be established, a
solicitation process was conducted beginning in May of 1997. 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 Public Health and an ad hoc subcommittee
including representatives of ffie Saint Paul - Ramsey County Communiry Health
Services Advisory Committee. ,
An evaluation form similar to the Minnesota Depar[ment 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 consistently
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, a summary list of the proposals received, and the evaluation
tool used are described in Attachment B.
SUBGRANTEES
Specific information on each of the projects to be supported through the Maternal and
Child Health Special Project Grant for improving pregnancy outcomes is provided on
the foliowing pages. Each project has specific target populations, objectives (which
include projected service levels), and methods, but all projects aze working towazd the
same goal of improving pregnancy outcomes for residents of Saint Paul. Copies of the
full proposals submitted by each of the grantees are available from Saint Paul Public
Health upon request.
The foliowing table indicates the projects which aze proposed for funding and for
which a complete program description follows.
�
AGENCY
Model
Cities
Face to
Face
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr.l: Yr.2: Total: Yr.l: Yr.2:
62,430 31,215 31,215 60,132 30,066 30,066
80,000 40,000 40,000 7�,054 38,527 38,527
West Side 28,000 14,000 14,000 26,980 13,490 13,490
Health
�
Start 409,042 204,521 204,521 393,902 196,951 196,951
(IPO)
Health •
Start 1,04�,820 523,910 523,910 1,010,070 505,035 505,035
(Adoi)
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesting funding primarily for outreach, education and tracking.
Health Start receives non-competirive funding as a pre-block grant pzovider to provide both
improved pregnancy outcome services through outreach and prenatal caze, and adolescent
health services through school based clinics.
�
ri �� �
, MONTTORIIVG/EVALUAT'ION 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 regulaz basic throughout the
contract period.
Contracu will be written between Saint Paul - Ramsey County Department of Public Health
and the subgrantees indicating specific performance objectives and outcome indicators. The
contracts will oudine the subgrantee duties, reporting requirements, the monitoring
expected/performed by Saint Paul - Ramsey County Department of Public Health, and
evaluation indicators.
Subgrantees will also be required to provide annual performance reports evaluating their own
program, and assessing progress toward goals and objectives. Both subjective and objective
tools will be used by the subgrantees to ensure that various aspecu of their program are
reviewed.
PROGRAM EVALUATION
Data will be sought from various sources, both nationaily and locally, including the Minnesota
. Department of Health, to monitor pregnancy outcome uends. This data will be used to
analyze the impact that the project has had on the goals and objectives for the project
throughout the two yeaz period. Since summary data is frequenUy available on a two year
delayed basis, progress toward the objectives may be di�cult to measure on a timely basis.
In addition, data will be collected from each subgrantee to identify:
* age of client
* race and ethnicity of clients
* residence of clients
* time of entry into prenatal care
* number of fetal deaths
* number of neonatal deaths
* number of infanu with birth weights less than 2500 grazns
The evaluation results will be used to identify whether or not current programs are
appropriately impacting pregnancy outcomes. Based on this evaluation, services and programs
may need to be modified or refocused to maximize the likelihood that the objectives and goals
are met.
•
�� - (0��
. Subgrantee A- Aealth Start. Inc.
FIealth Start, Inc., as a Pre-Block grant provider of services, continues to receive Matemal and
Child Health Special Project Grant funding for services to improve pregnancy outcomes.
Health Stazt, Inc. is an organization specializing in maternal, infant and adolescent health care
services to high risk popularions for disease or disability due to economic, social or medical
conditions, and to reduce morbidity and mortality in these populations.
Heaith Start proposes to continue to serve the �eds of low income and adolescent pregnant
and postpartum women. Health Start will provide multidisciplinary, comprehensive prenatal
care at hospital and school based out-patient clinics. Prenatal care offered to students in the
high schools facilitates early entry into prenatal care. This component of the Health Start
program addresses the City of Saint Paul's Pvlaternal and Child Health priority of improved
pregnancy outcomes, emphasizing adolescents and adult women of color.
TarEet Population - The clients targeted to be served will be those at high risk for prenatal
and birth complications who would, without accessible and high quality services, continue to
experience the multiple problems associated with high risk pregnancies. Since Health Start
provides prenatal caze in eight school based clinic sites in Saint Paul, adolescents, especially
minority adolescents, wili be a focus. In 1996 Heatlh Start saw 183 prenatal clients ( 70%
• were minority teens) in the schools for 762 visits. In addition, women who smoke will be
targeted for special prenatal or preconception intervenrions.
Objectives -
1. Health Start will provide comprehensive multidiscipiinary prenatal care to 500 adult and
adolescent women per year during 1998 and 1999.
2. Of women who deliver through Health Start, 55% will prenatal care in the fust trimester of
pregnancy and 85 % of women will initiate care by the end of the second trimester of
pregnancy.
3. No more than 10% of adolescents who are referred to other primary care physicians for
prenatal care will start prenatal care in the third trimester.
4. By December 31, 1999, low-birthweight (less than 2500 grams) rates will be no greater
than 9 percent and preterm birth rates (less thatn 37 weeks gestation) will be no greater than
10 percent.
5. Women who smoke will receive help with smoking cessation methods prior to or early in
conception.
• 6. The incidence of pre-term births and low-birthweight infants bom to adolescents followed
through the high school clinics wili be no greater than 10% and 7% respectively by December
31, 1999.
Methods -
• A futl range of comprehensive interdisciplinary prenatal services will be provided to clients
in six half-day clinics at 5aint Paul Ramsey Medical Center (Regions Hospital) and eight
school-based clinics. This wi11 ensure accessibility and acceptability for clients seeking
prenatal care.
• Prenatal and postpartum care wiil follow the comprehensive Health Start model, using the
established protocols and methods that have proven effective with high-risk clients since 1967.
• All clients wiil be assessed for high-risk condiuons using the Edwards Risk Scoring System
or Minnesota Pregnancy Assessment Form 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-sryle behaviors such as
smoking, alcohoi, and chemical use, and nutruition wluch place women at risk for poor birth
outcomes.
u
• Clients will also be assessed for risk for HIV infecrion and individualized prevention !
education will be provided. HIV testing will be provided on site.
• All clients will receive a nntrition assessment, conducted by a Health Start nutafionist.
Clienu will be certified for WIC at the clinic visit. Clients with specific nutrition concerns,
e.g, diabetes management, anemia, weight control, etc. wi11 receive ongoing nutririon
education and counseling throughout their prenatal care.
• All clients will receive a psychosocial assessment, conducted by a Health Start social
worker. Family and relationship issues, fiousing and financial concerns, chemical use, and
issues of physical, sexual and emodonal abuse aze included as part of the assessment. Clients
with no source of payment for medical caze wilI receive help in applying for medical
assistance and other financial aid. Social workers will provide ongoing counseling and support
within the clinic seCting and wiII refer to outside agencies and services as needed.
• Patienu who smoke wilI be encouraged to counE back or stop during pregnancy through
access to self help information, such as Health Partners "smoking dragon" calendar, and
referrals. Intervention will take place eaziy in pregnancy or prior to conception, through
e@ucation given to family planners or patients receiving a negative pregnancy test from Health
Start.
• All clienu delivering through Health Start will receive family planning services for 24 •
months after the baby's birth. After this period, clients will be referred to another sliding fee
provider.
��- �o�
• • I�Iealth Start staff will arrange for labor and delivery, post-delivery hospital care and other
needed emergency caze at St. Paul - Ramsey Medical Center.
• Infants of project clients will receive 24 months of pediatric care through Health Start's
pediatric component and if eligible, will be invited to ganicipate in one of IIealth Start's
intensive pazenting proQrams, including support services for infants e�osed to alcohol and
drugs in utero.
• Outreach services will be provided for pregnant women via free pregnancy tests at school
based cluucs and Saint Paul Ramsey Medical Center.
• Clienu in need of specialized medical service will be referred to St. Paul - Ramsey Medical •
Center or other providers as appropriate.
• Clients will receive individualized prenatal educauon in clinic and will be invited to attend
the weekly Aealth Stazt prenatal classes at St. Paul Ramsey Medical Center.
• Prenatal and postparCUm clienu 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 fmd the ciinic sites easily accessible, Health Start will provide
bus tokens or cab cards when needed.
Evaluation - Health Start will compaze birthweight, gestation age, risk level, and onset and
duration of prenaal care with a comparison group which dces not receive a multidisciplinary
modei of prenatal care. Numbers of women initiating prenatal care in each trimester will be
monitored, as well as rnimbers of pre-term births and low-birthweight babies. These can be
compared to city averages, as well as the comparison group of higher risk women.
Health Start wIll compare onset of prenatai care in sutdents seen in school-based clinics with
the average for adolescents cited in the Saint Paul Matemal and Child Aealth priorities. Birth
outcomes of the three groups will also be compared, whereverthe data from non-IIealth Start
patients can be released or gathered.
Health Start will track rate of second pregnancies within a two year span after delivery, along
with preconception and early concepdon interventions regazding risk behaviors and nutrition.
Information from evaluation efforts will be given to the qualiry assurance committee, the
quality management team, and the clinical management team. They may be used to formulate
• changes in intervention, to stimulate further analysis for underlying causes, or suggest areas
for a quality improvement project. Evaluation results aze disseminated to providers via
periodic provider meetings, clinic teams via team coordinator meetings, the Board of Directors
at semiannual boazd meetings. Tkey are also used to morivate stafff and to stimulate a worlc �
cuiture of continuous quality improvement.
Training/Eaverience of Staff - Heatt� Start has provided maternal and child health services in
St. Paul siace 1967, A21 Health Start staff aze professional health care personnel with special
expertise in maternai and child health or adolescence. The majoriry have had more than fve
years experience. AII staff aze evaluated at least once a year,
Staff aze supervised by the executive director, associate director, medical director, associate
medical director or team coordinators. Medicat provders aze credentailed according to
standards of the major health plans. Carol White, M,A., is ttie executive director of Health
Start and is responsible for the overal2 management and d'uecdon of the project, as well as
external retations and long-range planning. Dr. Chris Reif is the medicai director, is on the
staff of the Family Medicine Department at St. Paui-Ramsey Medical Center, and is
responsible for overall medical direction. Dr. Carol Ball, on the staff of the Obstetrics and
Gynecology Deparanent at St. Paul - Ramsey Medical Center, is the associate medical director
and works with the medical director to provide consultation on OB/GYN practices, as well as
providing clinical supervision ;: r OB/GYN nurse practitioner staff. They are advised by a
clinical management team maue up of represeratives fr:�m the various professional discipiines,
in prenatai and adotescent services of HealtFt Sta Ric: 3rd Duffin has bee;� the assoeiate �
direcior for t1u years and manages the school ba .3 cii: ics. Jeanne Ranc��e, PNP, pHN, is
the new Ciinical Services Coordinator, overseeing clinicR! senicPC fc: adolescent, prenaial,
and pediatric care. Jeanne has been with Healt: 5��- _;�� ye �
Summary of qualifications and experience of key staff are attached.
Linkaees - geaitfi Start has well developed linkages that include a w4de variety of health
care providers, educational programs, and social service agencies. This referrat network
allows staff to individualize care plans to meet ihe spec�c needs of each client. New linkages
and zeferral sources aze identified or developed as needs arise. Healih Start receives inkind
donations of space and telephones from Saint Pau2 Raznsey Medical Center. Physicians and
midwivesaze contracted from Ramsey Famity Clinics, who aiso provide back-up for prenatal
care.
Heattti Start works coIIaboratively with Ramsey County public Heatth nurses to extend
services to preganant women in the communit� public health muses meet reg�arty with
HeaIth Start to identify clients needing home-based services and to share information that wffi
enhance patient care.
At delivery, new parenu are referred to Health Start's pediatric clinic. Well-child and acute �
care visiu, augmented by interdiscipiinary services, aze provided. Eligible clients are also
i
l ��•
.
� referred to the Befriender Program, run in collaboration with Children's Home Society, the
Panrzership Program, a collaboration with Saint Paul School's Early Childhood and Family
Educauon (ECFE), or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, andlor group education for high risk
parenu.
�
When psychosocial or health care needs are iden�ed that cannot be met by Health Start (e.g.,
general medical care or adoption counseling), wriuen 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 minimi�ing duplication
by collaborating with many agencies and programs. Health Start will maintain aff'�liations with •
and/or refer to the following agencies and task forces (partial list only}:
Children's Home Sociery, Early Childhood and Family Education (ECFE), HouseCalls,
Frogtown Family Resource Center, Raznsey Clinic Associates, Ramsey Couty Human Services
Family Preservation Project, Saint Paul - Ramsey County Department of Public Health, rondo
Family Resouce Center, Neighborhood Health Caze Network, Saint Paul Public Schools, St.
Paui-Ramsey Medical Center/I-Iealth Partners, PACER Transition to Work Project, 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. Ciients are billed, however, by Saint Paul-
Ramsey Medical Center and Ramsey Clinic for hospital charges such as labor and deli�ery and
selected tests and procedures.
MCH funding allows Health Start to provide prenatal caze for clients who have no third parry
source of payment. For Health Start clients eligible for medical assistance, staff will assist
them with the application process. FIealth Start has contracts with all of the PMAP providers.
Any other applicable third parties aze billed whenever possibie. Insurance revenue pays for
approximately 25 % of Health Start's prenatal and adolescent health sservices.
Health Start provides family planning care to clients for 24 months after 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 Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium.
r�
U
Health Start Key Staff
Carol White, nLa is the e�ecuti�e director of Heatth Start, Inc. She w•as hired in June,
1996, by the boazd of directors. She has a masters of arts from Stanford L'niversity� in
early chiidhood education. She has five yeus experience in health care management, ten
years totat management experience in non-profit mana�ement. She has a�ritten and
pubIished training materials and cuiricula on child abuse and family violence.
Christopher Reif, MD, MPH has been the medical director of Health Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey b4edical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currentty on the advisory board of the American Medicai Association's Cruidelines for
Adolescent Prevention Services (GAPS).
Richard Duffin, MA has been the associate director of Heatth Start since 1994. He is
responsible for school based ctinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty yeazs experience in managing
human service organizations, with special experience in mental health and developmental
disabilities.
�
Jeanne Rancone, PNP, MPH is the cfinical services coordinator for Heaith Start. She is •
reponsible for maternal child health, family planning and adolescenY service clinical
objectives as well as overall coordination of clinical services and standazds in a multi-site
environment. She has 14 yeazs of clinical nursing and public health nursing, and ttuee
years experience at Heaith Start as a pediatric nurse practitioner and team coordinator at
H'ighland High School clinic.
•
.
�
•
.
HEALTH START, INC.
MATERNAL AND CHILD HEALTH
IMPROVED PREGNANCY OUTCOME PROGRAM BUDGET
JANUARY THROUGH DECEMBER, 1998
$228,075 $135,182
AHNUAI PR09RAM PROGRAM MCfi
LINE REM EXPENSE SALARY Fre suo�er suo��r
CLINICAL SERVICES COORDINATOR
NURSE PRACTITIONER
NURSE PRACTITIONER
NURSE PRACTf170NER
NURSE PRACTITONER (AGAPE)
NUTRITION�ST
NUTRITION�ST
NU7RITIONIST (AGAPE)
NUTRI7tONfST (ARUNCa70N)
HEALTH E�UCATOR
HEALTH EDUCA70R (AGAPE)
HEAITH EWCATOR
SOCIAL WORKER
SOCIAL WORKER
CASE MANAGER (AGAPE)
INTERPRETER
GUNIC CLERK
MEDICAL ASSISTANT
MEDICAI ASSISTANT
$49,712
$52,312
���
$45,760
$45,760
$46,738
$4�.766
$35,360
$35,36�
$33,821
$33,821
$37,045
$41,766
$44,9��
$32,777
$27, 373
$27,602
$2�,80�
$2�,59�
0.50
0.70
0.6�
0.20
0.20
0.60
0.20
0.15
0.15
0.10
0.15
0.20
0.10
0.10
020
0.10
0.80
0.70
0.10
$24,856 $14,914
$36.618 517,760
$28,167 $14,084
$9,152 $5,034
$9,152 $5,49'I
$28,043 511,217
$8,353 $7,518
$5,304 $3,182
$5,3Q4 $3,182
$3,382 $3,044
$5,073 $5,073 .
$7,409 $3,704
$4,177 $3,341
$4,497 $4.497
$6,555 $3,933
$2,737 $1,916
$22,081 $15,457 �
$15,055 $10,539
$2,159 $1,295
SUB-TOTAL SALARY
FRINGE BENEFfTS �d 20°!0
CONTRACT SERVICE
RAMSEY CLtNiC PHYSICtANlNURSE MIDWIEE
THREE OB/GYN PHYSICIAN CLINICSNYK @$472 X 42 WKS
N!O FAMIIY PRACiiCE CUNICSIWK �$286 X 36 WKS
ONE CNM CUNICNJK �$160/CLINIC X 42 WKS
PATIENT CARE
LAB. ULTRASOUND, X-RAY
COURIERSERVICE (INCLUDINGAGaa�
OTHER EXPENSE
MEDICATIONIDRUGS (INCLUDING ARLINGTON)
MEDICAL SUPPLIES
OFFICE SUPPLIES
PRlNTlNG/DUPLICATiNG
PATIENT TRANSPOR7ATION
TOTAL DIRECT ExpENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAI MCH GRAHT REQUEST
TOTAL MATCH � 25%
MATCH = 50%FPSP FUNDS, 50%MEDICAL ASSISTANCE REVENUE
��1�(Oa�
MCH0898
$45,615 $27,036
$59,472 $14,868
$20,592 $5,148
$s,72o $ti ,613
$30,000 $7,500
$9,982 $2,104
$14,000 $3,500
$5,150 SO
$1,575 $0
$500 $0
$2,000 $0
$423,681 $196,951
$67,789 $0
$491,470 $196,951
$196,951
$49,238
a�-�oag
• Sub�rantee B- Face To Face Aealth And Counseling Service. Inc. - Project Connect —
Prenatal Access Proiect
Face _� Face Health and Counseling Service is proposing to continue its program aimed ai
reaching high risk, preenant adolescents with comprehensive first trimester prenatal care
services, which have resulted in a higher rate of healthy birth outcomes. Face To Face has
historicaily been a strong supporter of a comprehensive service approach for high risk youth,
and is continuaily moving closer to a fully comprehensive, integrated service model.
The Prenatal Access Project utilizes outreach effortsand case management to encourage and
support pregnant adolescents to access prenatal care so as to increase their chances of having a
successful pregnancy. Staff strongly believe that the concept of youth outreach combined with ,
case manaement has proven to be very successful in (1) improving rates of fust uimester
prenatal caze and reducing low birthweight rates; (2) providing social support and linking
clients to other needed support services; (3) ensuring clients receive high quality, continuous,
and comprehensive prenatal care; (4) involving clients in self help, the prenatal education
program, and in receiving needed group support, and (5) continuing to support the
involvement of pregnancy partneres during tbe pregnancy. This year, staff hope to also (6)
increase ouueach efforts, especially among young women of color, and (7) strengthen ties to
the SafeZone Drop-In Center.
• Target Pooulation - I.ow income adolescents, fifty percent of which will be youth of color:
African American, Native American, Hispanic, or Asian. Fifty percent will be from the
Eastside, primarily Dayton's Blnff, ten percent from Summit University and Thomas Dale,
and ten percent from Riverview neighborhoods. Half will be 17 years of age or younger.
OUTREACA AND CASE MANAGEMENT
Goal - To strengthen our seamless, integrated service model, reduce the overall rate of late
(third trimester) or no prenatal care and to conduct outreach to increase the fust trimester
prenatal caze, especially among minioriry teens.
O.b�'ectives -
i. To use our new holistic intake process for assessing needs in all areas of the lives of our
clienu and identifying strengths they already possess to address these needs.
2. To increase the coordination of client cases through improved administrative procedures and
oversight.
3. To increase our current efforts to provide outreach to youth of color, ensuring that at least
• SQ percent of the prenatal clients aze youth of color - African Amercian, Native American,
Hispanic, or Asian.
Methods -
• An outreach worker will meet immediately with each new prenatal client to offer help with
immediate issues, trasport clients to other services, make home visits, help with crises and
advocate for other services.
• Youth outreach workers will provide street outreach for homeless youth and will connect
young pregnant women with Face To Face's prenatal program.
• putreach workers will provide intensive case management for prenatal clients fielping to
organize and advocate for needed services. �
• putreach workers will build linkages with other service providers to gain greater
accessibiliry and establish a broad network of resources for clients.
PRENATAL CARE
Goals - To reduce the rate of low birth-weight infants and the infant mortality rate, especially
among African-American, American Indian, and Asian teens.
Objectives -
1. To provide 190 pregnant adolescent and young women -- 135 of whom are under the age of
21 -- with holistic and comprehensive prenatal care services which are accessible, appropriate,
effective and which are coordinated with other community resources and integrated with the
clinets' individual life situarions.
2. To enroll 50 percent of the 135 clienu who are under the age of 21 in prenatal caze
services during their first trimester of pregnancy.
3. To begin to affect positive birth outcomes in all clients, as measured by low birthweight
rates of less than 6.5% for all age and racial groups served.
4. To improve attendance at all Prenatal Classes, with at least 50% of those enrolled in pre-
natal services attending.
Methods -
• Free pregnancy testing will be offered four days a week.
�
•
• An outreach worker will provide counseling after pregnancy testing resuits and connect
ciienu with prenatal care if necessary. •
• Pregnancy test will be provided "on the streets" as well as at a clinic site.
q� -(o��
• • A team approach to comprehensive sensitive prenatal care services will be provided with
team members meeting before and after weekly prenatal clinic in order to insure effective case
planning.
SOCIAL SUPPORT
Goal - To improve the health and wellness of pregnant adolescents during pregnanCy through
increased social and emotional support and mental health services.
Obiectives -
1. To increase pre-natal support services to pregnancy and aprenting partners of pregnant
women.
2. To provide mental health counseling for prenatal clients and their pregnancy and pazenting
partners who are struggling with mental health issues, inctuding chemical use, depression,
and abuse.
3. To link all the prenatal clients who deliver through Face To Face with on going primary
medical care for themselves and their infants, and social services for the infant, mother,
and pregnancy and parenting partners.
• Methods -
• Mental health assessments, short-term counseling, peer support networks will be provided
as well as a plan for estabiishing and/or maintaining emotional support for the preganant
adolescent and their pregnancy and pazenting partners.
Evaluation - Face to Face maintains a database management system, which collects data on
client registration (demographics); health histories; the visits including diagnoses, lab tests and
procedures; follow-up information on positive lab results; a prenatal follow-up sheet that
collects intake and foliow-up risk scoring, pregnancy outcomes in terms of birthweight and
other outcomes, and information on clients who did not deliver through Face to Face. Also
information on outreach visits is coilected including length of time with client and reason for
visit. From these data we can track both process and outcome measures. Follow-up
information on the status of those who "dropped out" of Face to Faces's prenatal program is
maintained, and pernnits the agency to bet[er ensure that no client will be"lost to follow-up".
Finally, good pregnancy outcome data is avaiiable, allowing us to identify variables which
might lead to poorer outcomes (infecrions, drug use, etc.)
Trainina(Experience - The outreach worker is I.aura 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 years before joining us.
Tuesday Spinks is a second prenatal outreach worker who is part-time Matemal and Child •
Heatth 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 fanuly worker. Tuesday is a Master's candidate in
counseling.
The Ob/Gyn nurse practitioner is Bazbara Taylor, who came to Face To Face in January of
1994. Barbara worked in HeaIthStart's school based clinics and prenatal clinics for over IS
years, and for two years worked with the Adolescent Health Program at the University of
Minnesota. Immediately before coming to Face to Face, Barbara was working with the Youth
and AIDS Project and Lutheran Social Services mini-clinic in an alternacive school.
The family practice nurse practitioner is Sue Garger, who has been with Face To Face since �
June of 1989. She had been Director of Heaith Services at Carleton College and Saint Mary's
College before joining the Face To Face teazn. She is a graduate of the Nurse Practitioner
Program at Bringham Young University, has a BSN from Winona State TJniversity, and is a
Certified Adult Nurse Pracuuoner.
The two prenatal care providers are Dr. Katie Guthrie from United Family Physicians in Saint
Paul, and Maria Pederson with Ramsey Nurse Midwives. Both are backed up by their
respective organizations, and both bring many years of experience providing prenatal care
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 Sainc Paut Public Schools "rurther,
in the Spring of 1993, Face To Face and Saint Paul Youth Ser�;c;: Bureau became co-located
services when they both moved into Face To Face's newly purchased and renovated buiIding.
The Face To Face Prenatal clinic has buiit strong working relationships with a number of
other relevant maternal and child health service providers. These incl�de: Maternal Child
Pmiect, Raazsey County Public Health Nurses, Ramsey Counry Child ProtecUOn, WIC,
MELD, Children's Hospital Pediatric Clinic, Iiealth Start's Harding Clinic, Ramsey County
SELF and Minor Mothers Pmgrams, and the Diabetes Clinic at iTnited Hospital.
Clients aze referred for ultrasound, non stress tests, biophysical pxof�les and colposcopies. In
cases of refenals, the nursing staff contacts the refemat 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 refemdl appointment. If transportation to the referral appointment is an issue for the
client the outreach worker will either provide bus tokens, taxi vouchers, or a ride - depending
on the situation. Follow-up is done by ciinic staff to ensure that the client has carried through
on the referral.
Additional liakages wi2t be developed with tiie Fatfier's Resource Center and other agencies
which work with adolescent males and other pazent partners.
Reimbursement and Fees - The vast majority of our clienu have been eligible for Medical •
Assistance (and prepaid Medical Assistance).
q�l -io q,�
� If a client is not eligible for any thircl party reimbursement, she is then charaed fees according
to our sliding fee scale. For clients below 100% of poverty, there is no charge. 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 jusrification for the Face To Face program follows.
�
•
Acv�sta svocsr useevssr __ •
MATERNAL 8 CHlLD NEALTHFUNDINC3
For the Year 7998
TOTAL FUNDING SOURCES
PROJECT MCN MCH ]RD PARTY MARCX OF SHELTERING CI7Y/CNTY TO BE
FTE SACARIES BUDGET FTE RECUEST INSURANCE DIMES IN-KINO ARMSFOUND GRANTS R1USE0
020 Projec[ LoorCinata, 7.ROtx�sart 5,908 0.08 2,3B$ • 3,545
�.80 OutreachWOrker,T.Spinks 19.521 OSS 73,42p 6,1�0
t.00 OutreaCtiWOrka.new 23,775 0.50 77,588 tt,58B
0.35 Nurse Pract/Clinic Dir., PNelson 16,709 t0,000 6.709
0.3G MeGical (a6 Tecnnican. P.ThrusM 7,063 5.000 2,063
030 Metlipl Auisbnt, E.Kartekaas 6,327 5,400 ��3Z7
020 MeEiplASSistant,L.Bahn 4,717 3,ppp �
020 RN,N.DeWaiC 6,573 5.000 ��573
OdB SuOemsioNASSO0.Dtr,R.Merrigan 7,958 - 4,958 3,U00
020 OfficeManageqJ.Cndtls , 5,530 5.530
0.35 RKeO��st M.SWItz 5,552 5.652 •
O.4Z gillingManaper.T.Patregnani t5,703 15,�03 -
0.4U BiOingqu6tan4LFis�er 8,920 g,9Zp
Q.10 Sacial Warker, K.BuQiey �,017 O,Df7
0.03 Mediwl0'vecWr 2,%6 - Z,9fi6
0.03 VolunteerCOOrCinaWr.S.ESkierka 886 �
741.026 2T,371 77.729 3.000 . 886 /6.806 2t,233
FRINGEBENEFIT5�.78% 25,385 4,927 t2,9tt 540 - t59 3,025 3,822
CONSOLTANTS/CONTRAC7 STAFF:
NuNtion�st 4,000 4,000
RamseyClinicP�ysidans 14,OU0 t4,000
Unitetl Family Practice Physicuns 72,000 12,000
Inlems & Volunteers 8,500 8,500
STAFF TRAVEL: 750 mtles per mo x
t2mo'Sx1S5faRx.3tpermde B37 $sy 2
GUENT TRP.VEL; indutles Eus loken3
antl w05 as neeEeE. 600 �
CLIENT EMERGENCY EXPENSES 800 ��
SUPPLY COSTS:
W � tesLS 8 lab supplies 7,�00 5,000 2,0�0
MeEicalB exam room supplies 2,000 2,000
Gene2/oRCesupphes p,i00
2,500
PageR 8 supPlies 60� 600
Client UIt2 SounCS (5350 x fi5 Uients) 22,750 ?2,750
PRINTING 8 POSTAGE 7,800 - t,800
MALPRACTICE INSURANCE t,500 - � �
SubWfal S 245,297 S -32.880 S 170.6a0 5 3.540 5 3t,250 5 t,045 S 35.d37 S 30.530
FACILRYCO5T3 t4.T78 _ __7,900 ' " ' S.000 7.878
Indutles tUephane. utqities, janROtial, tr9sh, -
Euiitlin9 �Oair & supOb. ��. �suran[e, -
tefephone system 8 copier Wse, anC --
mamtenance person. - -
AUMINlMGMTlOVERXEAD 3{,g{Z .- 3,787 7,360 - . - B 23215
Ancfudes qeneral atfice suppty, 0/O and - --
fieUiryinsuranee,pasiape,acmunting, - - --
annua! audik �ntl2isin9 8 prcflrdmmer _ - -- -
wnsuipn4 anE atlminisintive and - -
ma�a emmtSWftanANeirMn e�eneft6. -- - -
TOTAL PROJECTED COSTS S�d,35T S 38,527 S 112,000 S 3.540 S 37,25� S l,045 S 46,43! S 81,
rr qqpws etrknnrn9s
a�-�aa�
u
u.is�o s�oast �ecan�sr
MATERNAL & CHfLD HEALTH FUNDING
For the Year 1999
TOTAL FUNDlNG SOURCES
PROJECT MCH MCH � 1R0 PARTY MARCX OF SXELTERING CITYICNTY TO BE
FTE SALARIES BUDGET FTE REQUEST INSURANCE GINES IN-K1ND ARMSFOUND GRANTS RpISED
010 Praject CooMfnamr. T.ROCinson 6,086 0.08 2,434 . 3,651
0.80 OubeaN Worker, T.Spinks 20,106 0.55 13,823 5,zgg
1.00 OutreachWOrker.new 23.8)0 0.67 11,247 12.623
0.35 Nurst PrdNCliniC D'u.. P.Nelson 17,210 t0,000 7310
0.30 MeEieal LaD TeUfniaan, P.TTruSh 7,275 - 5,000 z,275
0.30 MetlinlASSisian4E.Kanekaas 6.517 5.0�0 t,517
020 Medicai Assistant, L.9ohn 0241 3,OOD 7,24t
020 RN. N.DebVaiE 6,T/0 5,797 �,573
0.18 Supervis�ONA55ac.Drc, R.Mertigd� B.1% 5.196 3,000
0.20 ORCe Manageq J.C�dES 5,696 5,696
0.35 Recephonis4 M.StoIC 5,821 5,821
0.42 Bilimg Manager, T.PaNegnani 76,176 76,176 �
0.40 BiilinpA55istan4L.Fisher 9.187 9.187
0.70 Social Wo�er, K.Buckley d,738 6,138
0.03 Medicai D�rector 3,055 3,055
0.03 Volunteer CdoMmaror, S.ESkierka 913 9/3
165256 27,504 73.326 3,000 • 913 17,956 22,558
FRINGE BENEFITS � tBY. 26,146 4,951 73,199 540 - i64 3.232 0,060
CONSULTANTS/CONTRACTSTAFf:
NuMtiomst 4,100 y,000 700
Ramsey Clinic Phys�cians 14,400 14,000 . 600
United Fam�ly Proctice P�ys¢ians 12,300 12,000 300
Intems b Volunteers 9,000 g,500 5U0
STAFF TRAVEI: 150 miles per ma z
12 mo's z t.5 staR z.31 per mile 837 562 275
CLIENT TRAVEL: Inclutles bus /okens
anC nDS as neeaetl. 650 650
CLIENT EMERGENCY EXPENSES 850 850
SUPPLY LO5T5:
La7 tests 8 IaC supplies 7,500 5,000 p,500
Metliwl S exam room supplies 2.200 Z,000 200
General �ce suOP�ies 2,300 p,300
Pagers 8 supplies 600 5pp
G�ent UNra Sounds (5350 x 65 ciknts7 22,750 22,150
PRINTING 8 POSTAGE 7,800 1,800
MALPRACTICE INSURANCE 1,550 400 1,t50
SuDWta� S 252,239 E 33,017 S 712.525 S 3,560 5 31,250 5 1.077 5 35,486 S 35.343
FACILITYCOSTS i5,134 1,900 - • • 5,000 8234
Includes telep�one, utlhUes, janitorial, tras�,
buAGing repair 8 5u0C�Y. �xes. i05uance, -
tUepl�ane system S tGpier kau, and
maintenance ptrson. _ -
ADMINlMGMi/OVERHEAD 35,314 3,810 7,600 _ _ • 6,000 24.70a
InGUAeS Oeneral otflte SuOD�Y. D/0 and - '
fideliry insu2nce, posWge, accou�W+p, -
annual autlit, funErai5in0 6 pra9�mmer
consuttan4 anQ administrative and "
mana ementstaHanGNeirhin eDenefiLS.
TOTAG. PROJECTED COSTS S 302,887 S 38,52T S 116,�25 S 3,540 S 3t,250 S 1,077 S 46,488 j 87,881
bal ptlu� aktM1ntlNe
Q� - ia�.g
• Subsrantee C- vlodel Cities Health Center. Inc. - Improved Pregnancv Outcome
Proeram
The goal of this project is to improve birth outcomes au,. �� the target area population by
focusing on early entrance into coordinated, case-managed clinical services which offer
preventive education. The fundamental goals of this Pregnancy Outcome Program are to
improve birth outcomes and neonatal development, to increase accessibility to early prenantal
care of underserved hiQehrisk African Americans and Hmong females of childbearing ages and
to reduce the over-all rnte of late (3rd trimester or none) prenatal care.
Target Population - This project will serve Afican American, Hmong and European
American women who reside in the Summit- University/Thomas-Dale communities or the
surrounding area who are high risk underserved women and teens. The intent is to reach
women who aze not accessing services or need addirional supports to insure pregnancy
outcome either through clinical, educational, support, or outreach services.
Strateg,y I: Case Finding and Community Outreach
Objectives -
• 1. By December 31, 1999, to identify and collaborate with at least ten community
organizations which provide community housingfshelter, food and clothing assistance,
chemical dependencc treatment and education to high risk African American and Hmong
female community residenu.
2. By December 31, 1999. to increase the overall rate of prenatals receiving prenatal care in
the first trimester fram 50 percent to 65 percent. These objectives remain consistent for
teen prenantals. By December 31, 1999, toincrease the rate of Hmong prenatals receiving
prenatal care in the first trimester from 20% to 45 % and increase African American entry
from 50% to 65 % in ihe first trimester.
3. By December 31, 1997, to increase number of hospital and home visits of African
American prenatal patienu and teens, to 200 per year, to ensure compliance on early
prenatal care, well child check and two week post partum check.
Methods -
A. Two Outreach Workers will assist in casefinding and community outreach/education
activities. A 3 FTE Hmong Outreach/Interpreter will work direcfly with the Hmong
community. An additional .4 FTE Health EducatorlOutreach Worker will work with the
• African American community. The outreach workers will foliow-up with positive
pregnancy tests, aid pregnant teens and single female heads of household in accessing
prenatal care by arcanging for van transportation, bus tokens, cab fare or managed caze
transportation. Outreach workers wi1I be an advocate and link patients with public •
assistance or Minnesota Care to ensure access to prenatal caze.
$. Collaboration with public housing, churches, public health, hospitals, community
clinics, youth serving, and other African American organizations will occur by the Health
Educator/putreach Worker to reach high risk underserved women aad teens, follow-up on
women who have been lost in the system, and to assist in accessing clinical, financial and
social suppori services. The Health Educator/Outreach Worker will develop a tracking
system to follow referrals for social service needs.
C. Collaboration with public housing, public health, hospitals, community clinics, youth '
serving and other Hmong community organizations will occur by the Hmong
Outreach/Interpreter to promote first trimester entry for prenatal care, the importance of
immunizations, well chiid care, family planning, and parenting education. The Hmong
Outreach/Interpreter wil1 foIlow-up with womer. inst to foIIow-up a��d assist in accessing
clinical and social support services at the Iiza!ai �en�;,r. T'ne Hmong
Outreach/Interpreter wi11 network with the Refu�ee Tssk 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 and
Saint Joseph's Hospital.
D. Improve referral of services with Mode1 Cities Famity Development Center for social •
services, mental health, stride, home-based chemical health treatment, family's first, and
early childhood services by conducting a social history on 100% of prenatal clients and
developing tracking system to ensure social needs aze being met.
E. To increase community awareness of early prenatal care by airing 10 radio spots on both
African American and Hmong American local radio stations by December 31,1999.
Submit two columns to Asian American Press, Frogtown Forum, Native American
Newspaper and Insight News explaining the importance of early prenatai care by
December 31, 1999.
Strategy II. Clinical Interventions
Objectives -
1. By December 31, 1999, to provide comprehensive prenatal clinical care and edncation to
200 women of childbearing ages.
2. By December 31, 1999, to incrase average frequency of prenataY appointmems to seven (7)
appointments. Emphasis will be placed on beginning prenatai care in the first trimester and
continuing care through family planning education foilowing labor and delivery.
3, By December 31, 1999, to provide Engiish and Hmong speaking Lamaze Childbirth •
Education Classes or ongoing health education to at least 65 percent of prenatals on proper
nutdtion, effects of aIcohoi, tobacco, and other drug use during pregnancy, personal
�� - io��
• empowerment, expectations of labor and delivery, personal finances and education, and
coping with increased family size and responsibilities.
4. By December 31, 1999, to provide one-to-one counseling on smok;ug cessation to 100% of
all prenatal smokers and to offer smoking cessation classes 3 times per yeaz.
Methods -
A. Case management and tracking services will continue for 1Q0 percent of Hmong and
English speaking prenatals to ensure appointment compliance, positive birth outcomes,
reduction of low and very low birth weight rates (LBW, VLBW), and reduction of infant
mortaliry.
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 cluldren.
C. Linkage with Model Cities Family Development (MCFDC) will be provided for social
service assessmenu of ail 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 patterns.
D. Referrals to chemical health education programs and counseling services will be provided
to all prenatals and to family members with chemical abuse concerns to encourage
chemical abstinence. Referrals for Rule 25 chemical health assessmenUevaluation, case-
managed entrance for treatment seroices, enrollment in community aftercare programs,
and provision of chemically free housing for receovering women and their children will
also be provided.
E. English and Hmong-speaking Lamaze Childbirth Education Classes and ongoing health
education will be provided to prenatals on proper nutrition, reduction/elimination of
alcohoi, 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. Coniinued collaboration with a consortium of health care services.
III. Reduce Barriers to Care Preventing High Risk Women from Receiving Ongoing
Education and Prenatal Caze Services
Obiectives -
.
i. By December 31, 1999, to enhance access to caze by providing van transportation for
prenatat care, immunizations and welt child appointments for females and their children. •
2. By December 31, 1999, to offer continuous tracking and conffrmation of prenatai caze in
addition to immunizarions, well cuud checks, and ongoing education by systematic
schednling, bi-weelcly inter-disciplinary team meetings and pmvision of home visits to higfi
risk women to ensure medical compliance for females and their children.
3. By December 31, 1999, work closely with managed caze entities on culturally appropriate
services patient understanding of policies and procedures, and follow-up in changes in
ctinic assignments and incentive programs.
4. By December 31, 1999, to ensure enrollment of 100 percent eligible uninsured prenatals in '
Medical Assistance/Minnesota Caze or access to use of sliding fee scale for those who are
uninsured.
5. By December 31, 1999, to develop brochures and educational materials in Hmong language
on the following topics: nutrition, acute sick child (diarthea and fever), newbom care,
growth and development, vision and hearing, and dental health.
Ojectives -
A. Transportation to all prenatal appointments and/or cfiildbirth education activities will be •
provided to any female enrolled in clurical care, Lamaze cYuldbirth education sessions, or
2:1 patient nutrition, sociat services, or reIated services.
B. Collaboration with commnniry organizations, associations, and neighborhood groups wit2
be provided to emphasize early first trimester entrance to prenatal caze. When needed
perinatal clients will have access of health center van or taxi services, anQ enrollmeat into
Medical Assistance and MinnesotaCaze managed caze programs. All needed enrollment
inforniation 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 retum prenatal visit within two weeks of pregnancy confirmation
to ensure ongoing early prenatal care. 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 wiIl be provided through Model Cities Family
Development Center (MCFDC) to provide food, clothing, and housing/furaiture assistance
to prenatals as weil as home visits by sociat workers.
E. Hospital tours will be pravided to communiry residents to dispel fears of higfi medicat
technology and *nin;mi�ation of self control and direction in the medical delivery system.
Oualitv Assurance And Evaluation Methodol� - Quarterly perinatal audits will be .
performed by the Program Coordinator to assess case finding efforts and compliance with
prenatal care/appointment maintenance. Follom-up conuacts (home visits, telephone, and
��-1oa�
• 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 care and additional community linkages. !�uarterly
chart reviews will be performed to monitor number of patient visits, entrance to care,
education visits, and outcome data. Perinatal patient satisfaction surveys will be completed
annually to determine satisfac6on with clinical and social services, to explore unmet client
needs, and to deteimine successful methods of case-finding.
Perinatal statistics aze managed by the Program Coordinator. These statistics include
monitoring of indicators known to be principal factors such as low birth weight and infant
mortality rate. Fetal deaths, SAB, and low/very low birth weight are 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.
Trainin�/Elmerience Of Kev Staff - 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 suppore s[aff. G�itural sensitiviry 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/sociallcommunity services, and
improved provider/patient relationships are encouraged. Monthly staff in-services are
conducted on a wide variety of health care 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.
Linkages Between Proposed Proiect And Ongoing Perinatal Deliverv - Ongoing case
management coordination, multi-disciplinary service delivery, expanded support and education
services, and provision of transportation are key components of the proposed perinatal delivery
system.
Model Cities Family Development Center piays a significant role in supporting prenatal
females, infants and children. Social support services aze provided to ail women, children,
and their families. The volunteer based program Supportive Companion provides ongoing
befriending and support to women throughout pregnancy, labor and delivery.
Reimbursement and Clinical Fees - Model Cities reimbursement and clinical fee system bills
MinnesotaCaze, Medical Assistance enudes and private insurance for the clinical costs of
health care. Uninsured patients can apply for sliding fee, which can discount medical care
from 20 percent io 80 percent, depending upon family size and income.
In 1996, 88 percent of Model Cities prenatals were enrolled in Medical Assistance and 5
percent had insurance upon entry. Of the remaining 8 percent that were uninsured at the tiuie
. of entry, all became eligible for MA after confirmation of pregnancy. The remainder of
provider and staff salaries is covered by federal, state, county, and city grants.
•
�� - l��
VII. Improved Pregnancy Outcome PROGRAM BUDGET,1998-1999
The two-year project budget total $78,672, $60,298 of which is being requested in MCH
funding and the remaining $18,374 to be covered by Model Cities Health Center
(MCHC).
A. LINE ITEM DETAIL:
Personnel
Hmong Ouveach
Worker (3 FI'E)
Health Ed/Outreach
Worker (.4 F7E)
Famity practice
Physician (.1 FTE)
Nurse Prectitioner
(.I FI'E)
Program Coord.
(.I FTE)
Subtotal
• Fringe Benefits/
FICA:(12 percent}
Suppiies:
Clincal
Medical
Pharmacy
Laboratory
O�ce
Rewrds(I'racking
Subtotal
Other Operating
Expenses:
Patient Transport.
Patient Education
Printing
Postage
Mi(eage (local)
Telephone &
Beeper
Subtotal
, Total Direct Costs:
Indirect Costr @ 10
percent
• TOTALPROJECT
COSTS:
Yr.I Yr.I Yr.I
MCH MCHC Total
7,313 7,313
8,957 8,957
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272. 25,787
4,293 1,380. 5,673
-0- -0- -0-
-0- -0- -0-
-0- -0- -0-
300 ]00 400
A- .0- �_
300 100 400 �
],000 450 1,450
750� ]00 850
500 -0- 500
-0- 50 -0-
750 -0- 750
300 -0- 300
3,300 600 3,900
27,408 8,352 35,760
2,�41 835 3,576
330,I49 59,iS7 539,336
Yr.II Yr.II Yr.II
MCH MCHC Total
7,313 7,313
8,957 8,95'7
4,160 4,160
2,112 2,112
3,245 3,245
19,515 6,272 25,787
4,293 1,380 5,673
-0- -0- -0-
-0- -0. -0-
-0- -0- -0-
300 100 400
-0- -0. -0-
300 100 400
1,000 450 1,450
750 100 750
500 -0- $p0
-0- 50 -0-
750 -0- 750
300 -0- ' 300
3,300 600 3,900
27,4Q8 8,352 35,760
2,741 835 3,576
530,149 39,187 539,336
Yr. I & II
Totat
14,626
19,502
8,320
4,224
6,490
51,574
11,346
-0- �
-0-
-0-
S00 • ,
-0-
800 ;
2,900
1,700
1,600
100
1,500
600
7,800
71,520
7,152
S7S,672
�,� - �Qa�
• Suhgrantee D- West Side Community Health Clinic - Improving Pre�►ancv Outcomes for
High Risk Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the Saint
Paul Hispanic and South Fzst Asian populations by providing outreach, tracking all posirive
pregnancy tests, performing prenatal risk assessments and coordinating prenatal care . This
project will be supplemented by eusting West Side Community Clinic staff and services. The
clinic offers comprehensive health caze services on a sliding fee scale. This pmject will give
Hispanic and Southeast Asian families greater access to a full array of services inciuding well
child caze, immuni2ations, family planning, pazenting, and STD services as well as linkages
by refeaal to over fourteen other community agencies.
Target Ponulation - This project will target pregnant Hispanic and South East Asian women,
ages 13-35 years, in specific census tracts in Saint Paul that have the highest concentrations of
Hispanic and South East Asians.
Obiectives -
Reduce overall rate of late (third trunester or none) prenatal care among pregnant FIispanic
and South East Asian teens and women to 10 percent or less by December 31, 1999.
� 2. Increase the rate of prenatal care in the first trimester among pregnant Hispanic and South
East Asian teens and women to 60 percent or more by December 31, 1999.
Methods -
1. Project staff will do an outreach activity at least monthly. Examples include: "Baby
Showers" in targeted areas, health education fair for teens as part the McDonough
recreation program, assistance in clinic enrollment at WIC sites at McDonough and West
Side, and responding to media requests for interviews by local newspapers and radio
stations.
Project staff will conduct Spanish-speaking and Hmong-speaking prenatal classes on a
quarterly basis focusing on nutrition, self-care during pregnancy, breastfeeding, child caze
and safery, and personal health issues susch as family planning, STDs, drugs and alcohol,
and family violence.
Staff in clinic will follow up on all positive pregnancy tests and identify highest-risk
perinatal patients, providing focused language and culture-specific health education and
support intervemions, including home visits as appropriate, facilitate follow-up with any
outside referrals made, assisting with scheduling, transportaiton, and intetpreting as needed.
• Evaluation - All patient data is logged and entered into a computerized data system. Data
kept includes demographics, trimester of entry into prenatal care, types and numbers of
services used, and pregnancy outcomes. Information is reviewed periodically, and project
resulu wiil be compiled annually. Additionally, patient sarisfaction surveys are done semi- •
annually. Satisfaction with prenatal classes wiIl be meausred via surveys after each servies.
Twenty five (25) prenatal records aze audited quarterly to measure rates �f compliance with
prenatal risk assessment, post partum visiu, and newbom follow-up. Ttris mformation will be
reviewed quarterly by the Quality Management Committee to identify and implement focused
improvement efforts.
Training/Escperience of Key Staff - Over the past 20 years, staff have demonstrated a unique
ability in meeting the health needs of Hispanics and Southeast Asians. In 1996, WSCHC
served over 12,800 medical patients, 75 percent wer Hispanic or Southeast Asian. Services
include bilingual and biculural staff, transportation through our van, bus or cab voucher,
hospital care through St. Paul Ramsey Medical Center, on WIC clinics including immunization•
outreach Assistance with MA/MN Care applications and outreach clinics and education
programs in homeless shelter, public housing developments and a highschool. These services
aze provided through a well-established interdisciplinary case managemeni malet.. This model
helps identify lugh-risk patients ttuough screenings and referrals, provides coordination of
caze, and ensures paaent involvement in care glanning and choosing treatmeat options.
Resumes of key staff are attached.
Linka�es - West Side Comutunity Health Center works with the following organizations in �
providing maternal and chiId health services:
St. Paul Ramsey Family Practice Residency Program to provide cross-cultural family
medicine training for physicians motivated to work in hing-need underserved settings.
Saint Paui - Ramsey County Department of Public Health to assess community needs and
provide services addressing Maternal and Cluld Health issues, chemical dependency,
communicable disease, income/access to care, nutrition, eelderly health care, life
style/cancer and dental care.
Combined efforts with 17 other community clinics to improve pregnancy outcomes through
inaovative prog�ramm�ng usiug community ttealth workers.
Saint Paut - Ramsey Counry Department of Public Health to provide mrtrition education
and immunizations in conjunction with WIC sites and home visits to prenant women and
infanu.
Saint Paul Public Housing Agency to provide services, inciuding maternal child health, on-
site at McDonough and Roosevelt housing developments.
City of Saint Paul in providing clinics in six homeless sheiters and a battered woman's •
shelter.
The Clinic provides comprehensive perinatal care. Any specialty medicai caze needed is
�� - �� b
• provided either o4-site at monthly high-risk OB clinic or by referral to St. Paul Ramsey
Medical Center. all medical referrals are done on a referral form and followed-up via
computerized �acking.
Reimbursement and Fees - All reimbursemenu through the Minnesota Department of Human
Services go direcfly to support services. Assistance is provided to enroll all eligible women
on Medical Assistance. A sliding fee scale is maintained for those not eligible for assistance.
Fees are discounted incrementally based on family income, from those at or below the poverty
level paying nominal or no fees, up to those exceeding 200 percent of the poverry level paying
full fees.
Budeet - A budget and justification for the West Side Community Aealth Clinic budget
follows.
�
n
LJ
Saint Paul Public Health
Matemal and Child Heahh (MCE� Funds
West Side Community Health Center
6-27-97
-8-
Bu et (Revised 8/15/97)
We are requesting $13,490 per year to supplement our e�risling perinatal program The
funds w�l allow us to ut�ize b�inguallbicuttural perinatal health educators as focused and
integral components of our overall program. •
Following is the project budget with noted W SCHC match:
Year One - 1998
. i FTE Perinatal Coordivator
208 hours at $IS/hour
.4 FTE Periaatal Heahh Educator
832 hours at $1239/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursmg staff/perinatal support
TOTAL
Year Two - 1999
.1 FTE Perinatal Coordinator
208 hours at $15/hour
.4 FTE Perinatal FIeakh Educator
&32 hours at $12.39/hour
2.0 FTE Nurse Midwives
2.0 FTE Nursing staff/perinatal support
TOTAL
MCH Request
$ 3,2Q0
10,290
$13,490
MCH Reauest
$ 3,200
I0,290
$13,490
WSCHC Match
$ 88,000
39,500
$127,500
WSCHC Match
$ 88,000
39,500
$127,500
Four hundred fifty I�spanic and SEA preaatal patients w�l be seea annualty
Thirry two prenatal classes w$1 be held, serving an expected 250 patients.
F"ifty highest risk patieats w�l r�eive specific follow up by the heatth educator.
An additional 150 teens and women will be reached through outreach activities.
n
U
�
There aze no DHS or self-pay reimbursements anticipated related to these supplemental •
activities.
G� - l��
•
ADOLESCENT HEALTH PROGRAM
�
��
!
��
�
ADOLESCENT HEALTH PROGRAM
Health Start, Inc., as a Pre-Block grant provider, continues to receive Maternal and Child
Health Special Project Grant funding for adolescent health services, and has prepared the
foliowing assessment of adolescent health in St. Paul.
Unmet Needs - Adolescent health status indicators have shown improvement in some areas
and deterioration in others in the last five years. Alcohol use had started to drop, as have
reported rates of sexual activity among teens. Pregnancy rates among teens aze dropping,
especially due to increased use of contraceptives. They are stIll too high in Saint Paul, ,
especially among African-American youth. Rates of physical activity aze decreasing for older
teens, while obesity is increasing. Tobacco use has increased dramatically, especially among
White, Hispanic, and Native American youth. Martality from violence - sucicide, depression
and car crashes - is unacceptably high.
Adolescents require services tailored to meet their specific needs and developmentai levels.
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 seven pubiic high schools in Saint Paul: Harding, Como Park, Cenual, Johnson
Senior High School, Highland Park Junior/Senior Aigh School and Humboldt 7uniorlSenior
• High. By Fall 1997, Heaith Start will pzovidethe same level of services at the new Arlington
Senior Aigh School. Tn addition to these seven school-based ciinics, Health Start provides
prenatal and family planning services for pregnant and parenting teens at AGAPE Aiternative
School and other health services (not including grenatal) at Guadalupe Area Pro}ect.
During CY 1996 school year, students again demonstrated their need for clinic services by
using current services extensively. A total of 3,053 students made 13,391 visits, generating
over 24,500 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 caze resources. Data from 1996 school year
revealed that of studenYs families, 32% had medical assistance, 19% had private insurance,
48% had no 3rd party source of pay, and 1% had MinnesotaCare.
Program Response To MCH Priorities - The Adolescent Health Program responds to the
goals and priorities for services adopted by the State Maternal and Child Health Advisory Task
Force. The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unpianned pregnancy, nutrition problems, depression, chemical abuse
and family and relationship problems among adolescents in Saint Paul. to achieve these goals,
• Health Start, Inc. has identified prioritiies consistent with the following MCH Advisory Task
Force priorities:
-reduce infant mortaliry
-reduce the percent of low birthweight infants
-reduce adolescent pregnancy rates
-reduce unintended pregnancies
-provide access to preventive services
-reduce chemicai abuse in adolescents
-reduce infecuous diseases
-promote good nutrition practices
These priorities will be addressed through the objectives and methods identified by Health
Star[, Inc.'s Adolescent Health Proa am. Methods to adQress ihese priorities include
comprehensive health services that are accessible and acceptable to high school age adolescents
inc]uding nutrition education aad counseling and psychosocial assessment and ongoing
counseling. Extensive health education is provided individually and in group education
settings. Referrals are made when aecessary.
�
Goal - The goal of the Adolescent Health Program is to promote a positive health status and
reduce the incidence of unptanned pregnancy, nutrition prob2ems, depression, chemical abuse
and family and relationship problems among adolescents in St. Paul by providing
comprehensive heatth care services at seven high School sites and two atternative school site •
within the City.
Target Ponulation - The clients targeted to be served by the Health Start Adolescent Health
Program are ado2escents living in the Ciry of St. Paul. The following demographic data
describes this population:
Minority Groups -
Age in School -
Gender -
.�•.
39 % 18 years and above
26 % 17 years
22 % 16 years
10% 14 years and under
72 % Female
28% Male
Obiectives - The following objectives have been established for the Adolescent Aealth
Program in order to achieve the goal:
�
1. In CY 1998 and 1999, 3,000 junior and senior high students will make visits to the school-
a� - �a��
• based clinics each year
2. In 1998 and 1999, the healthy lifestyle of physical activity and a balanced diet will be
°ncouraged by providing 350 sports physicals and 600 nutrition visiu related to sports
nutrition, weight control or eating disorders.
3. Onsite counseling will be provided for 1,100 adolescents at risk for depression, chemical
misuse, pregnancy, relationship problems, school problems, and/or physical, seacual or
emotional abuse each year in 1998 and 1999.
4. At least 85% of student patients who have a negative pregnancy test and who are not
desiring pregnancy will have an identified plan for continuing reproductive health care and
will leave the visit with a contraceptive method or plan. Decision making, sexuality_
counseliing, and family planniing services will be provided for 1000 adolescents each year
in 1998 and 1999.
5. The number of teens being screened for chlamydia, including asymptomatic males, will
increase 10% in 1998 and 1999 from 1400 in 1996.
6. The number of hepatitis B immunizations given wiil increase 10% in 1998 and 1999 from
434 in 1996.
• 7. The number of students who report smoking wili drop 10% in one targeted high school in
Saint Paul by December 31, 1999.
Methods -
• At least $100,000 in additional funding for school based clinics will be secured in 1998 and
1999 to support expanded access for teens in Arlington High School, AGAPE Alternative
School and Guadalupe Area Project Alternative School.
• Assess for risk, 85% of all new students, following GAPS assessment guidelines, that
details medical and fanuly history, behaviors and feelings. this form will provide staff with
background data necessary for providing good care and for triagin clients to appropriate
staff.
• Provide 8,000 physical examinations, health screening and assessments, diagnosis and
ueaunent of acute and minor illness, and family planning visits on site by a nurse
practitioner, family physiscian andlor pediatrician.
• By 7anuary 1, 1998, Health Staft will hire a male-focused outreach worker/health educator
to encourage participation in sports and use of the clinic for sports physicals, Hepatitis B
vaccination, screening for chlamydia and other STIs, involvement in avoiding pregnancy,
• and other heaith issues of concem to male students.
• Beginning Ianuary 1, 1998, increase access to health care for students with chronic •
illnessess or disabilities by a collaboration with PACER and school nurses to help high
school special needs studenu to transition from school to work and independeat living.
• Decision-making counseling and family planning education and counseling will be provided
to adolescents requesting these services by a Health Start health educator.
� Pick-up of prescribed contraceptives and completion of Depo Provera shot appointments
will be tracked in order to maintain at least an 80% treatment compliance rate.
• Health Start staff wiil provide risk assessment, prevention education, and screening on site ,
for afl STIs, including HIV infection.
• Members of the interdisciplinary team will provide 7,000 individual and group education
contacts in selected classrooms on health education activiites such as prenatal and parenting
classes, weight conuol classes, and human sexuality programs, in order to maximize the
understanding and practice of positive health behaviors.
• Health Start will seek to partner with Health Partners Center for Health Promotion and St.
Paul District school nurses and teaching staff to target at least one high school for a
smoking prevention and intervention campaign in the school for a two year period, staning
January 1, 1998. .
• Health Start staff will serve as adolescent health resources to teachers and youth workers in
their classrooms and other groups.
• Pregnant teens who see another primary caze provider for prenatal care will be tracked to
see that prenatal care is started, maintained, and whenever possible, what were the birth
outcomes.
• Health Start will work collaboratively with the healih plans serving Saint Paul students to
maximize reimbursemenu for services and communicate with or refer students into
appropriate sources of care.
Evaluation - CIienu at school-based clinics aze assessed annually for satisfaction with Health
Start services, using a standazdized format and automated summarization. the same form is
used by the Neighborhood heatth Care Network. Satisfaction Ievels are compared with
primary care community clinics and four other adolescent specialty programs in the Metro
azea. Automated encounter forms gather the demographic data, visit, procedure, and
diagnostic code data, and site of service. These data can be queried to provide data on
typesand quantity of services sued, as well as target population reached by age, race and
income level and special need. •
An encounter form will track the number of students accessing family planning services.
Health Start's Quality Assurance and Clinical Management Team wiil annually measure
��l - lQ��
• through random chart audit the percent of students with a negative pr o°nancy test who
received birth control information and a method before leaving the clinic. They wiIl aiso
measurethe picY-up rate for first time and follow-up contraceptive prescriptions and Depo
Provera appointnaeus kept via random chart audit.
IIealih Start will measure the ability of its staff to reach a large number of students through
classroom, individual and other group methods for topics related to healthy lifestyle. It will
also measure the abiliry to increase the number of studenu presenting for Hep B vaccination
through increased outreach.
An anti-smoking campaisn targeting a high school and involving multipie messages aand types
of interventions will attempt to measure baseline smoking rates at onset of the campaign and
two years later on a population basis. this methodology will depend on the willingness and
ability of the high school administration to assess several grades of students. If that is not
possible, Health Start will assessits own patient population at onset and two years later, using
a modified encounter form.
Training & Experience - Health Start has provided maternal and child health services in
Saint Paul since 1967. All Health Start staff are professional health cate personnel with
. special expertise in matemal and child health. The majority have had more than five years
experience. All staff are evaluated at least once a year.
Staff are supervised by the executive director, associate director, medical director, associate
medical director, and team leaders. Carol White, M.A., is the executive director of Health
Start and is responsible for the overail management and direction of the project, as well as
external relations and long-range planning. Dr. Chris Reif, a member of the Family Medicine
Department at Saint Paul-Ramsey Medical Center, is the medical director and responsible for
overall medical d'uection. Dr. Carol Ball, on the staff of the Obstetrics and Gynecology
Department at Saint Paul-Ramsey Medical Center, is the associate medical d'uector and works
with the medical director to provide consultation on OB/GYN practices, as well as providing
clinical supervision for OB/GYN nurse practitioner staff. iThey are adivsed by a clinical
management team made up of representatives from the various professional discipliines, in
prenatal and adolescent services of health Start. Richard Duffm has been the associate d'uector
for three years and managesthe school based clinics. Jeanne Rancone, PNP, PAN, is the new
Clinical Services Coordinator, overseeing clinical services for adolescent, prenatal, and
pediatric care. Jeanne has been with Health Start for three years.
Summary of qualifications and experience of key staff are attached.
Linka¢es - Health Start has well-developed linkages that include a wide variety of health care
providers, educational programs, and social service agencies. Referrals aze made by Health
• Start staff to other programs and aze made by other agencies to Health Start. This referrai
network allows staff to individualize care plans to meet the specific needs of each client. New
linkages and referral sources are identified or developed as needs arise.
Heatih Start works collaboratively with Ramsey County Public Health nurses to exiend •
services to pregnant women in the comtnuniry. Public health nurses meet regularly with
Health Starc to identify clients needing fiome-based services and to share information that will
enhance patient care.
At delivery, new pazents are referred to Health Start's pediatric clinic. Well-child and acute
care visiu, aug�nented by interdisciplinary services, are provided. Eligible clients are also
referred to the Befriender Program, run in collaboration with Children's Home Society, the
Partnership Program, a collaboration with Saint Paul School's �arly Childhood and FamiIv
Education (ECF'E}, or the CARES Project, also run collaborarively with ECFE. These
programs all provide intensive counseling, support, and/or �-oup education For high risk •
parenis.
When psychosocial or hea7th care needs are ideniifed 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 area.
In the school-bsed clinics, the linkage with the school nurse is very close. Often, space is
shared and refenaIs go back and forth during the day. Realations with other school personnel
are also pursued. A school board member always serveson the health Start board of directors.
Health Start is committed to extending services to the community and *r�inimi��g duplication •
by collaborating with many agencies and programs. Health Start wili ncaintain affiliations with
and/or refer to the following agencies and task forces (partial list)
Chiidren's Home society of Minnesota, Farly Childhood and Family Education (ECFE),
Housecalls, Frogtown Family Resource Center, Ramsey Ciinic Associates, Ramsey
County Human Services Family Preservation Project, Saint Paul - Ramsey Department of
Public Aealth, rondo Family Resource Center, Neighborhood Health Care Network, St.
Paul Public Schools, St. Paul-Ramsey rnedicat Center/Heatth Partners, PACER Transition
to Work Project, 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. MCH funding atlows Health Start to
provide prenatal care for clients who have no third party source of payment. For Health Start
clients eligible for medical assistance, staff wili assist them with the applicauon process.
Health Start has conuacts with all of the PMAP providers. Any other applicable third parties
aze billed whenever possible. Insurance reveaue pays for agproximately 25 % of Health Start's
prenatal and adolescent health services.
Health Start provides family planning care to clients for 24 months after delivery. If a client
has no third parry payor, a sliding fee scale is used to determine her fee for family planning •
services. Funds will be requested from the State of Minnesota Family Planning Special
Projects to continue the provision of family planning services in the next biennium,
��- iaa�
• Subgrants/Subcontracts - Health Start subcontracts for the provision of physician and
certified nurse-midwife services with the foliowing groups: Ramsey Clinic Associates, West
Side Community Health Center and the Universiry of Minnesota. The Health Start Medical
Director and Associate Medicsi T.?irector are 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
justification for the budget follows.
.
•
�
Health Start Key Staff
Carol �i'hite, AL4 is the esecuti�e director of Health Start, Inc. She «as hired in June,
1996, by the board of directors. She has a rnasters of arts from Stanford L'niversity in
early childhood education. She has five years experience in health care management, ten
years total managemeni experience in non-profit mana�ement. She has «ritten and
pubIished trainins materials and curricula on child abuse and fatttily violence.
Christopher Reif, MD, MPIi has been the medical director of I-Iealth Start, Inc, since
1987. He is also the director of community medicine at St. Paul Ramsey hiedical Center
and a clinical associate professor at the University of Minnesota Medical School. He is
currently on the advisory boazd of the American Medical Association's Grridelines for
'Adolescent Prevention Services (Gr�PSJ.
Richard Duffen, 11iA has been the associate director of Heatth Start since 1944. He is
responsible for school based cIinic operations. He has a masters degree in Human
Development from University of Kansas. He has twenty years experience in managing •
human service organizations, with special experience in mentaI health and developmental
disabilities.
Jeanne Rancone, PNP, MPH is the ciinical services coordinator for Health Start. She is •
reponsible £ot maternal child health, family planning and adolescent service clinical
objectives as well as overall coordination of clinicai services and standards in a multi-site
environment. She has I4 yeazs of clinical nursing and public health nursing, and three
years experience at Health Start as a pediatric nurse practitioner and team coordinator at
Highland High Schooi clinic.
•
.
HEALTH START, INC.
� MATERNAL AND CHILD HEALTN
� ADOLESCENT HEALTH SERVICES
SCHOOL BASED CLINICS
JANUARY THROUGIi DECEMBER, 1998
�
•
q� -tc�
MCHSBC96
'ANNUAL � PROGRAM PROGRAM MCH
LINE ITEM EXPENSE SALARY F'rE euoGET Bu�Ger
NURSE PR4CTRIONER (CENTRAL7
NURSE PRACTITIONER (COMO)
NURSEPRACTfiONER(HUMBOLDn
NURSE PR4CTITtONEF�(JOHNS�N)
NURSE PRACTRIONER (HARDING)
SOCIAL WORKER (CENTRAL)
SOCIAI WORKER (COMO)
SOCIAL WORKER (HUMBOLDn
SOCIAL WORKER (lOHNSON)
CASE M4NAGER(AGAP�
MEDICAL ASSISTANT (CENTRAL)
MEDICAL ASSISTANT (COMO)
MEDICALASSISTANT(HUMBOIDn
MEDICAL ASSISTANT (JOHNSON)
MEDICAL ASSISTANT (HARDING)
MEDICAL ASSISTANT (AGAPE)
NUTRRIONIST(CENTR4L)
NUTRRIONIST (COMO)
NUTRRIONIST (HUMBOIDn
NUTRITIONIST (JOHNSON)
NUTRITIONIST (HAROfNGj
HEALTH EDUCATOR(CENTRAL)
HEALTHEDUCATOR(COMO)
HEALTHEDUCATOR(HUMBOLDT)
HEALTHEDUCATOR(JOHNSON)
HEALTHfiDUCATOR(NARDING)
HEAlTHEOUCATOR(AGAP�
IXECUTNE DIRECTOR
$37,296
$43,596
$37,918
$37,2t 2
$42,773
$35,902
$29,316
$35,330
$33,734
$32,777
$16,934
$17,354
$16,447
$18,614
$22,294
$16,447
$33,734
$35,246
$37,750
$33,734
$35,246
$27,317
$31,618
$29,921
$29,921
$31,298
$29,921
$43,260
0.80
0.80
0.80
Q.65
0.90
0.40
0.40
0.60
0.40
0.80
1.00
1.00
1.00
1.00
1.00
0.20
0.15
0.15
0.15
0.15
0.15
0.10
0.10
0.10
o.�o
0.10
0.05
0.10
$29,837
$��8�
$30,334
$24,188
$38,496
$14,361
$� �,�26
$21,198
$13,494
$26,22�
$16,934
$17,354
$16,447
$18,614
$22�2�
$3,289
$5,060
$5,287
$s,ss2
$5,060
$5,287
$2,732
$3,162
$2,992
$z,ss2
$3,130
$1,496
$4,326
$23,869
$27.90'I
$24,26�
$19,350
$30,796
$11,489
$9,381
$16,959
$t�,795
$0
$13,548
$17,354
$�4,$OZ
$18,614
$22,294
$�
$5,060
$5,287
$s,ss2
$5,060
$5.287
$2,732
$3,162
$2,992
sa,ssz
$3,13�
$0
$4,326
SUB-TOTAL SALARY
` annuai salary based on 42 week schooV year
FRINGE BENEFITS @ 20%
CONTRACT SERVICE
FAMILY PRACTICE PHYSiCIAWNURSE M1DWiFE
EIGHT PHYSICUW CUNICSNVK @ 5286 X 34 WKS
ONE CNM CUNICNVlC @$'160.�CUNIC X 34 WKS
PEDIATRIC NURSE ASSOCIATE (JOHNSON}
FACE TO FACE
SOCIAL WORKER (HARDING) $32,569
PATIENT CARE
LAB, ULTRASOUND, X-RAY
COURIER SERVICE
$386,851
$307,111
$77,370 561,422
$77.792 $42,786
$5,440 $4,080
$4,893 $3,670
$32,569 $24,426
$22,279 $16,709
$29,945 $22,459
,
n
LJ
ANNUAL PROGRAM PROGRAM MCH
LINE 1TEM EXPENSE SAIARY FrE g�p�� B�p��
OTHER EXPENSE
MED�CATIOWDRUGS
MEDICAL SUPPLlES
OFFICE SUPPLIES
PRI NTING/DUPLICATING
PATIENT TRANSPORTATION
TOTAL DlRECT EXPENSE
INDIRECT EXPENSE @ 16%
BASED ON 1996 AUDIT
TOTAL PROGRAM EXPENSE
TOTAL MCH GRANT REQUEST
TOTAL MATCH � 25°k
HICaHLAND SCHOOL BASED CL�NIC FUNDED BY SEPERATE GRANT SOURCE
$15,000 $11,100
$12,725 56,373
$10,600 $3,180
$2,575 $0
$2,150 $1,720
5680,188 $505,035
$108,830 $0
$789,019 $505,035
$505,035
�
$126,259
�
�1- lG�i�6
•
BUDGET DETAIL AND EXPENDITURE FORMS
�
�
q�,- ��.�
•
•
BUDGET NSTIFICATION
Budget justification for each of the subgrantees is included within their budgets previously
presented in the narrative.
In addition to the funds proposed for allocation to the subgrantees for improved pregnancy
outcomes and adolescent health programs, a portion of the Maternal and Child Aealth Special
Projects Grant is budgeted to remain at Saint Paul - Ramsey County Department of Public
Health for Adminisuative Costs.
..;
1999
Sala /Fringe:
Administrative Assistant
Genezai program oversite,
prepares and monitors
grants, analyses reports,
prepares annual reports,
prepares and monitors
contracts, meetings and site
reviews with subcontractors
$ 9,171
$ 9,271
Accounting Tech IV
Prepares budget and expenditure
reports, prepares pay vouchers and
processes grant allocations
Clerk-Typist IV
Types grants, contracts and
reports
�Dlies:
Audit:
7,417
r�:
100
TOTAL ADMINISTRATIVE COST: 19,626
•
7,514
3,472
150
4,161
24,568
BUDGET DETAIL OF LOCAL MATCH
Local match is identified at a minnnum 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:
1. Local Tax L,evy Funds:
• MCH Prenatal Care at Communiry
Clinics
� Community Ouueach and Services
(Nutrition, social work and lab)
• Participation in Project LID
• Assessment
(includes data collection
analysis and reporting)
TOTAL:
2. Other Local Funds:
1998 1999
$139,480 $139,480
$ 34,352 $ 34,352
$ 2,485 $ 2,485
$ 26,642 $ 26,642
$202,959 $202,959
Other local match is provided by the City of Saint Paul through the funding of various
programs which contr3bute to maternal and child health, including family planning,
immunizations, lead screening, nutrition, heaith education and well child services. Source
of this funding includes CHS funding, grants, reimbursements, and patient fees.
•
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•
ATTACfIl�IENT B
Solicita6on Process for Subgrants
�
Notification of the availability of funding was provided to qualified programs in the azea
through a d'uect mailing of a Request for Proposals (RFP) to 30 agencies and a public norice
placed in the St. Paul Pioneer Press on May 22, 1997. The process for selection of priority
program componenLS and the process for selecting the requests (evaluation criteria) included in
the grant application aze elcplained in the following RFP. The public notice, a list of agencies
receiving the d'uect mailing, and a list of the agencies requesting subgrants are also included in
this attachment.
•
PUBLIC NOTICE OF AVAII.ABILITY OF FUNDS FOR •
MATERNAL AND C�iII.D HEALTH SERVICES
The City of Saint Paul intends to subcon�act up to $120,000 to Saint Paul agencies through
the Minnesota Department of Heaith Maternal and Child Health Formula Block grant for
calendar years 1998-1999. These funds may be used to conduct projects for improving
pregnancy outcomes through outreach, referral and/or the direct provision of prenatal care.
Based upon an assessment of Maternal and Child Heaith (MC� needs in Saint Paul, the City
is interested in subcontracting with outside agencies to provide prenatal health care and
outreach services for lugh risk and low income women. Organizations interested in providing
these sezvices will be asked to develop a proposal following Minnesota Deparoment of Health
as well as Saint Paul Public Health guidelines. Interested organizations should contact.Carolyri
Weber, St. Paul Public Heaith, 555 Cedar Street, St. Paul, MN 55101 (292-7749). Proposals
are due to the above address by 4:00 p.m. on June 30, 1997. The RFP for these funds was
also mailed or distributed to 29 organizations/individuals who are interested in public health
issues or who provide maternal and child health services to lugh risk and low income women.
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 for funding.
�
n
U
•
AFFIDAVIT OF PUBLICATION
5TATE OF MINNESOTA
CO �?NTY OF RAMSEY
�� - ��a�
< I�r4-.��I� �1 l�.�L�� ,being
duly sw rn on oath, says: that he is, �a a,�
all times herein stated has been, Clerk of
Northwest Pnblications, Inc., publisher of tfie
newspaper known as the Saint Paul Pioneer
Press, a aewspaper of general circnlation within
the City of St Paul and the County of Ramsey.
That the Notice hereto attached was cut fiwm the
columns of esid newspaper and was printed and
pubIished thereia on the following dates:
`� day of �_ , 19 �
�
•
day of , 19 _
dayof ,19—
day of , 19 —
day of , 19 —
day of , 19 _
day of , 19 _
�
Su scribed and sworn to before me 's
��day of �} �y , 19�
Nocary Public
«�S���a��r County, Minnesota
My com.»;c�ion expires � 3� , 20 O O
TL:
� r�z�,o-' �iviiYi:,' .. , :H
� `:i:" �'s'.nSH1�;= _ f:
�'l:�'� � ia; t�:i.a`.i'>ii: � " � �i �`y;ri. �i.�.�f`.:. y
ti y
zrvsrvar�7r�-r:a,�rvv7vvc,vvvs•rstx
sr PAUi, woMnx�s cr.�c
1690 UNIVERSTPl' AVE
ST PAUL MN 55104
LUTHERADI SOC SERV OF MN
1201 PAYNE AVE
ST PAUL MN 55101
CATHOLIC CHAR OF ST PAUL
2I5 OLD 6TH ST
ST PAUL MN 55102
BOOTfi BROWN FIOUSE
1471 COMO AVE
ST PAUL MN 55108
THE LOFT TEEN CENTER
1063 IGLEHART AVE
ST PAUL MN SSI04
ANN RICKETTS
FACE TO FACE CLIAIIC
I165 ARCADE ST
ST PAUL MN 55106
UNITED FAM HEALTH CEN
sas w rrti sr
ST PAUL MN 55102
COMMONFiEALTH CLINIC
13961 N 60TH ST
STII,LWATER MN 55082
JOANNE ICEATDRICK
SI PAULRAMSEY
NUTRITION PROGRAM
ST PAUL PUBLIC HEALTH
YOUTH SIItVICE BUREAU
2167 ARCADE ST
ST PAUL MN 55106
ARLINGTON HOUSE
95l E. STH ST
ST PAUL MN 55106
ST PAUL PUBLIC SCHOOLS
360 COLBORNE ST
ST PAUL MN 55102
SETON CENFER
1276 UNIVERSITY AVE W
ST PAUL MN 55104
FAMII,Y PHY HEALTIi CEN
579 WELLS ST
ST PAUL MN SSIOI
PEG LABORE
FAMILY TREE CLINIC
1619 DAYTON AVE
ST PAUL MN 55102
BEVERLY HAWIQNS
MODEL CITIES H C
430 N DALE ST
ST PAUL MN 55103
ST PAUL ItAM OB/GYN CL
640 JACKSON ST
ST PAUL MN 55101
PALNNED PARENT
MINNESOTA
1700 RICE ST
ST PAUL MN 55113
C�Fa
CAROL WHITE CERTgZED NURSE MIDWIVES
HEALTH SfART INC RAMSEY FOUNDATION
590 PARK SUTfE 208 640 JACKSON ST
ST PALTL MN 55103-1843 ST PAUL MN 55101
AGAPE
360 COLBORNE ST
ST PAUL MN 55102
MARY ELLEN SMITH
LEAD PROGRA114
ST PAUL PUBLIC HEALTH
•�
BETHESDA FAM PRAC CLINIC
590 PARK $T' SiRTB 310
ST PAUL MN 55103
UNITED HOSPITAL-M�D CLINIC
333 N SMIT'H ST
ST pAUL MN 55102
MARY O'CONNELL
INTEGRATED HOME CARE
475 ETNA ST SUITE 3 •
ST PAUL MN 55106
MARVIS BREHM
WEST SIDE HEALTH CENTER
153 CQNCORD ST
ST PAUL MN 55107
CHII,DREN'S HOME SOCIETY
OF MINNESOTA
2230 COMO AVE
Sf'. PALJL MIV 55108
NANCY BRIGGS
NORTH END HFALTH CETTTER
135 MANTIOBA ST
ST PAUL MN 55117
ST PALJL RAM PEDS CLINIC
640 JACKSON ST
ST PALTL bSN 55101
•
•
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AGENCY NAME:
REVIEWED BY:
SAINT PAUL
MCH COMPETITIVE GRANT
REVIEW CRTTERIA
I. APPLICATION
A. Is in accordance with City MCH priorifies
B. Proposes services targeted to low-income high
risk individuais in targeted azeas
C. Is clearly written and the format facilitates
review
II. TARGET POPULATION
A. Is described including the number of individuals
to be served, raciallethnic distribution and
eligibility criteria
B. T'he applicant can demonstrate past successful
experience worldng with target populations
C. Low-income, e.g. <200% of poverty or women
who are pregnant and determined eligible for
M.A. or WIC
D. Identify risk criteria consistent with MDI�
guidelines
III. OBJECT'IVES
A. Described
B. Related to priorities
C. Realistic
D. Time Specific
E. Measurable
F. Identify clienYs or community's needs, not the
applicanYs
POOR
1 2
1 2
1 2
1 2
1 2
1 2
1
1
1
i
1
1
1
2
2
2
2
2
2
2
SATIS
3
3
3
EXCEI,
4 5
4 5
4 5
3 4
3 4
3 4
3
3
3
3
3
3
3
4
0
�
�
�
�
�
5
5
5
5
5
5
5
5
5
5
POOR SATIS EXCEL
IV. METHODS
A. Described 1 2 3 4 5
B. Relate to objective 1 2 3 4 5
C. Include procedure for referral and follow-up 1 2 3 4 5
D. Describe how services will be accessible to
target population 1 2 3 4 5
E. Are consistent with accepted pnblic 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 acrivities which warrant evaluation are
identified 1 2 3 4 5
B. Methods for collecting the data aze described
and aze feasible 1 2 3 4 5
C. Gives evidence that evaluation results will be
used for program management decisions 1 2 3 4 5
D. Collects data which relate to the objecfives 1 2 3 4 5
E. Methods for analyzing data aze described 1 2 3 4 5
F. Is objective as well as subjective 1 2 3 4 5
VI. TRAINING/EXPERIENCE
A. Indication of work experience, training and
qualifications for staff d'uecfly 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 refemal arrangements wiih other
community service providers ue described
and relate to goals, objecrives and methods 1 2 3 4 5
' ��- [Oq.�
,.�
' POOR SATIS EXCEL
B. Description of current or anricipated
cooperative agreements to m;n;m;�P potential
for duplication 1 2 3 4 5
C. Plans for or descriptious of ongoing
collaborative acriviries with providers such as
participation on task forces, committees, etc. 1 2 3 4 5
D. Applicant can show experience in successful
follow-up on refeaals 1 2 3 4 5
VIII. BUDGET
A. Budget items are justified in terms of project '
activifies 1 2 3 4 5
B. Complete 1 2 3 4 5
C. Provides a rationale for farmula/process for
calculation of items 1 2 3 4 5
D. Amount of funding requested is appropriate
for the levei of service and objectives
identified 1 2 3 4 5
YES NO COMMENTS
E. Agency has demonsuated in ldnd contributions
of at least 25 % of the grant request
F. Are mathematically correct
G. Indicates pians to obiain and use DHS
reimbursements (Medical Assistance,
Children's Health Pian)
H. Indicates sliding fee schedule to be used if
fees are to be charged to clients.
* ADDTITONAL CONII�IENTS/RECONIMENDATIONS:
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,
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MATERNAL AND CHILD HEALTH FORMULA SPEC{AL PROJECTS - 1998-1999
CITY OF SAINTPAUL
AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Model Cities Health Center, Inc. - Improved Pregnancy Outcome Program
The goal of this project is to improve birth outcomes among the target area population
by focusing on eariy entrance into coordinated, case-managed clinical services which
offer preventive education. The fundamental goals of this Pregnancy Outcome
Program are to improve birth outcomes and neonatal development, to increase
- accessibility to early prenatal care of underserved high risk African Americans and
Hmong females of chiidbearing ages and to reduce the over-all rate of late (3rd
trimester or none) prenatal care.
Total -$60,132 Year 1- 530,066 Year 2- 530,066
Face To Face Health and Counseling Service - Prenatal Access Project
Face To Face Health and Counseling Service is proposing to continue its program
aimed at reaching high risk, pregnant adolescents with comprehensive first trimester
prenatal care services, which have resulted in a higher rate of healthy birth outcomes.
Face To Face has historicaily 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. This project utilizes outreach efforts and
case management to encourage and support pregnant adolescents to access prenatal
care so as to increase their chances of having a successfuf pregnancy.
Total - 577.054 Year 1- 538,527 Year 2- 538,527
West Side Community Health Clinic - Improving Pregnancy Outcomes for High Risk
Hispanics and Asians in Saint Paul
The goal of this project is to reduce low birth weight and infant mortality rates in the
Saint Paul Hispanic and Southeast Asian populations by providing outreach, tracking
all positive pregnancy tests, performing prenatal risk assessments and coordinating
prenatal care. This project will be supplemented by existing West Side Community
Clinic staff and services. The clinic offers comprehensive health care services on a
sliding fee scale. This project will give Hispanic and Southeast Asian families greater
access to a full array of services including well child care, immunizations, family ,
planning, parenting, and STD services as well as linkages by referral to over fourteen
other community agencies.
Total - 526,980 Year 1- 513,490 Year 2- 513,490
�.� - (��
Health Start, Inc. - Improved Pregnancy Outcome
Health Start, Inc., as a Pre-Block grant provider of services, continues to receive
Maternal and Child Health Special Project Grant funding for services to improve
pregnancy outcomes. Health Start, Inc. is an organization specializing in maternal,
infant and adolescent health care services to high risk populations. Its goal is to
improve the health status of women, children and youth who are at risk for disease
or disability due to economic, social or medical conditions, and to reduce morbidity
and mortality in this populations. "
Health Start proposes to continue to serve the needs of low income and adolescent
pregnant and postpartum women. Health Start will provide multidisciplinary,
comprehensive prenatal care at hospital and school based out-patient clinics. Prenatal
care offered to students in the high schools facilitates early entry into prenatal care.
This component of the Health Start program addresses the City of Saint Paul's
Maternal and Child Health priority of improved pregnancy outcomes, emphasizing
adolescents and adult women of color.
Total - 5393,902 Year 1-$196,951 Year 2- S196,951
Health Start, ►nc. - Adolescent Health Program
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 Saint Paul
by providing comprehensive health care services at seven high school sites and two
alternative school sites within the City.
Total - 51,010,070 Year 1- 5505,035 Year 2- 5505,035
AGBNCY
Modei
Cities
Face to
Face
West Side
Health
Start
(IPO)
Health
Start
(Adol)
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AGENCIES PROPOSED FOR FUNDING/SUBGRANTS
Amount Requested Amount Awarded
Total: Yr. 1: Yr.2: Total: Yr. 1: Yr.2:
62,430 31,215
80,000 40,000
28,000 14,000
31,215 60,132 30,066
40,000 77,054 38,527
14,000 26,980 13,490
30,066
38,527
13,490
409,042 204,521 204,521 393,902 196,951 196,951
1,047,820 523,910 523,910 1,010,070 505,035 505,035
Model Cities is requesting funding primarily for case-managed clinical services whichoffer
outreach, educationand transportation.
Face To Face is requesting funding to continue their outreach efforts and case management.
West Side is requesdng funding prunarily for outreach, education and tracking.
Health Start receives non-competitive funding as a pre-block grant provider to provide both
improved pregnancy outcome services through ouueach and prenatai care, and adolescent
health services through school based clinics.