91-1844 � �' ` Council r ile # 9/��
���1�VAL ' 2 �`'
\�,�� Green Sheet # 6375
RESOLClT14N -
CITY F SAINT PAUL, 111�INNESOTA
. J
Present�d By
Referred Committee: Date
SAINT PAUL BOARD OF HSALTH
WHEREAS, the City of St. Paul throu�h its Division of Public Health
is required bp 3tatute to prepare a biennial Maternal and Infant
Health Grant to receive State fundin�; and
WH�BTsAS, the Board of Health will be required to approve up coning
contracts between the Department of Health and the City of St. Paul
Division of Public Health;
THEREFORB, BE IT RESOLVTD, that the City Council sitting as the
Board of Health does accept and approve the 1992-1993 Maternal and
Child Health Grant for St. Paul.
Yeas _ Navs Absent Requested by Department of:
�swi t z �
- � Communi Services
acca ee
ettman
►�n e r �'�
s son � By.
�
Adopted by Council: Date QCT � � �9�� Form Approved by C'ty A torney
Adoption Cer 'fied by Counc'1 S �cretary � ` C/� ���
' , By' , t
_,; ,�
By� Approved by Mayor for Submission to
Approved by ay r: Date 0�T 1 5 1991 Council '
� -- - " ����fi'�
gy� �.c��'t�'v ` gy; �1t'1✓
PUBUSHED OCT 19'91
_ - -.� _ - j q`f-/�y�
,
DEPARTM[NT/OFFICEICOUNCIL DATE INITIATED �
c.s./Public Health 9/10/91 GREEN SH�ET No. 6 3 7 5
OONTACt PERSON 8 PHONE IN DATE II�NTIAUDATE
�C DEPAHTMENT DIRECTOR I CITY COUNpI i
Diane Holmgren 292-7712 �� qTy qnpp�y � �cm aEaK ` -
MUST BE ON COUNqL AOENDA BY(DATE) ROUTIf�K� BUDOET DIRECTOR i �FIN:d�MOT.SERYIGES DIR.
Scheduled for October l, 1991 Nu►va+coR�ssisr
TOTAL#�OF SKiNATURE PAQES � (C.LIP ALL LOCATIONS FOR SIQiNATUR�
ACT10N REWESTED:
i
City signatures on a Resolution for Board of Health approvallof various grants to the
Minnesota Department of Health by the St. Pau1 Division of P�jblic Health.
I
RECOMMENDnTiON8:�Pw�UU a►�1�(� COUNqL CONMAITTEEI�SEARCN REPOAT
_PUINNINO COMAM8810N _qNIL�RVI�GOMMISSION ANALY8T � PFIONE NO. V�D
_pB OOMMITTEE _ �
_STAFF _ COMMENTS: ���°� �, ,f.�' ' � �
—a����,� _ �
k��. SEP j 1 1991
?' CITY
��wH�,������ ATT�
�r�n�nru�PROe�.issue,o�oaru�xTV�wiw.wn.�.wnM►,wh.►e.wry�:
;
The City of St. Paul, Division of Public Health requests Board of Health approval of grant
proposals to the Minnesota Departmen� of Health for funding i�cluding:
- Maternal and Child Health for 1992-1993 ($1,645,862)
- WIC (Women, Infants and Children) Supplemental Food Progra� for 10/1/92-9/30/93 ($2,325,00 ) "
- Refugee Health (Monitoring Program) for 10/1/92-9/30/93 ($4i9,270)
�
ADVANTA(iE8 IF APPR01/ED:
li
The City, Division of Public Health will receive approximately� $4,Q20,132 to support these
programs and activities. �
'�, RECEIVED
j SEP 2 61991
018ADVANTAOES IF APPROVED:
NONE
f RECEOVED
' SfP 2 0 1991
� MAYOR'S OFFICf
DI8ADVANTHOEB IF NOT APPROVED:
The City of St. Paul, Division of Public Health may not recei��e full funding for these
activities
CQU;�ci� Rese�r��= ����s�� �
S P 2 3 1991
TOTAL AMOUNT OF TRANSACTION = 4 s�2�,132 c08T/F�VENUE S1�iET�(CMICLE ONE) YEE NO
0
�Np��� State of Minnesota ����RVario s
FlNANpAL INFORMATION:(EXPWI� I n
�
�I dW
,
� �
� � NOTE: COAAPLETE DIRECTIONS ARE IMCLUDED IN THE CiREEN�IEET INSTRUCTIONAL � ��'�
MANUAL AVAIIABLE IN THE PURCHA8INO OFFICE(PFIONE NO.298-4225).
ROUTIN(i ORDER:
Below are prefened routinga for the fNro most frequent typea of documerNs:
CONTRACTS (aseum�s authorized COUNqL RESOLUTION (Amsnd, Bd�s./
budgei sxists) Accept. a►ants)
t. Outside Apsncy 1. DepartmeM Director
2. Initiating DspartmsM 2. Budgst Dinctor
3. City Attomsy 3. City Attomey
4. Mayor 4. Mayor/Assiatant
5. Finar�cs&Nl�mt Svcs. Dir�ctor 5. qty Council
6. Flnancs AccourMing 8. Chisf Aocountant, Fln&Mgmt Svice.
ADMINISTRATIVE ORDER (�, COUNqL RESOLUTION (��)�N� -
1. Activity Manaper 1. Initiating Depertment Diredor
2. Dep�Rrtant AxouMaM 2. qty Attomay
3. Department Diroctor 8. MayoNAsNstar�t
4. Budpst arector 4. City CoUncil
5: City derk
6. Chief Accountant, Fln d�Mgmt 3�n:s.
ADMINI3TRATIVE ORDER3 (all ahers)
1. InRiatlny Department
2. City Attornsy
3. MayoNAsaistant
4. dty(�erk
TOTAL NUMBER OF SIONATURE PACiES .
Ind�ate the#of p�pes on wh�h Mgnstursa sre required and paperc�fP
each of these� ..
ACTION REQUESTED
Dssc�ibs whet ths project/roqusst seeks to accomplfsh fn sither chronolopi-
cal order or o►dsr of importanc�,wMdanrsr Is mat appropriate for the
issus. Do not writte complste ssMenc�ss. Begin each Rsm in�rour Ust with
a verb.
RECOMMENDATIONS
Complete H the iseue in qusNion hes been pre,erKed bsbre any body,Publ�
or p�ivats.
SUPPORTS WHICH OOUNqI OBJECTIVE4
Indicats which Council ob�sctive(s)YW�ProlwtJrequ�t s�ports bY Iistlng
the key word(s)(HOU81NCi, RECREATION,NEIOHBORHOODS, ECOMOMIC DEVELOPMENT,
BUDCiET, 3EWER SEPARATION).(SEE COMPLETE LI3T iN IN3TRUCTIONAL MANUAL.)
COUNCIL COMMITTEFJRESEARCH REPORT-OPTIONAL A3 RE�UESTED BY COUNGL
INITIATINC3 PROBLEM,133UE,OPPORTUNITY
Explain the eltuation or oonditlo�thd c�ted a need for your project
or request.
�°
ADVANTA(3ES IF APPROVED
Indicate whethsr this is simply�n annual bud�et procedure requfred by law/
chaRer or whethsr there ars�ciflc wa in which the dry of Selnt Paul
and its dtfzsns wlll bsneflt trom thls pro�laCtlon.
DISADVANTAaE31F APPROVED
Whet nsgative sffscts or major chen�ea to�cisting or past processes migM
thfs P�ol�re4�P�uce if it is pes�ed(�.g..traflic delays. no�se�
tax increaees a eseessmenb)?To Whom?Whsn?For how bng?
DISADVANTAf1ES IF NOT APPROVED
What will be the ns�ative c�nesqusncss if ths promiaed action ia not
approved?InabNity to dslfwr ssrvk:s?Continued high trafNc, noiae,—
axident rate7 Loss of rovsnus�
FINANpAL IMPACT
Afthougt►you must teibr ths infonnation you provide here to the fssue you
are addnesinq, in general you must anawar two qusations: How much is it
pofng to c�st?Who fa goinp to p�y?
��,_,��
;.�
ErsES t�.n
'F CITY OF SAINT PAUL
��`"� r�'" OFFICE OF THE CITY COUNCIL
�
PAULA MACCABEE sus,aN ooE
Councilmember Legislative Aide
, Members:
• Paula Maccabee, Chair
Bob Long
Janice Rettman
Date: October 9, 1991
COMMITTEE REPORT
HUMAN SERVICES, REGULATED INDUSTRIES AND RULES AND POLICY COMMITTEE
1. Approval of the minutes of the Human Services, Regulated Industries, and
Rules & Policy Committee for: August 14, 1991; August 28, 1991; and
September 11, 1991.
COMMITTEE APPROVED, 3-0
2. Resolutions referred from the Board of �lealth (Referred 10-1-91) :
A. Resolution 91-1842 - approving Refugee Health Grant for F.Y. 1992 -
F.Y. 1993.
COMMITTEE RECOMMENDED APPROVAL, 3-0
B. Resolution 91-1843 - approving 1992-1995 St. Paul-Ramsey County
Community Health Services Plan,a nd the 1992-1993 Indian Health Grant
for St. Paul and Suburban Ramsey County.
COMMITTEE RECOMMENDED APPROVAL AS AMENDED, 3-0
C. Resolution 91-1844 - approving 1992-1993 Maternal C�hild Health Plan
for St. Paul .
COMMITTEE RECOMMENDED APPROVAL, 3-0
_ D. Resolution 91-1845 - approving F.Y. 1992 - F.Y. 1993 Application for
Administration of Local W. I.C. (Women, Infants and Children) Project.
COMMITTEE RECOMMENDED APPROVAL, 3-0
3. Ordinance - amending Chapter 318 of the Legislative Code relating to
Mechanical Amusement Devices (Last in Committee 9-25-91) .
THIS ISSUE WAS LAID OVER TO THE OCTOBER 23, 1991, HUMAN SERVICES, REGULATED
INDUSTRIES, AND RULES AND POLICY COMMITTEE MEETING
CITY HALL ' SEVENTH FLOOR SAINT PAUL, MINNESOTA 55102 612/298-5378
B�46
Printed on Recycled Paper
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� MATERNAL AND CHILD HEALTH SPECIAL PROJECTS GRANT
t FOR ,
, IMPROVED PREGNANCY OUTCOMES
AND
ADOLESCENT HEALTH
� 1992-1993
�
� � � �
' Submitted by:
THE ST. PAUL DIVISION OF PUBLIC HEALTH
555 Cedar Street
� St. Paul, MN 55101
� Amount Requested:
Total funds for two year period: $1,645,862
� Request for year 1: $822,931
Request for year 2: $822,931
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' . Paul MCH S ecial Pro'ects Grant 1992-1993
St p �
� Table of Contents
' NIINNESOTA DEPARTMENT OF HEALTH FORMS
FaceSheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
� Project Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Worker's Compensation Evidence of Compliance 5
MCHSP Summary Types of Services Provided By Operating Agencies & Funding
� Allocation By Legislative Priority : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 7
Assurances and Agreements 9
Certification Concerning Use of MCH Special Project Grant Funds to Provide
� and/or Arrange Sterilizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
APPLICATION NARRATIVE
� Community Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Improved Pregnancy Outcomes
� Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Program Response to Minnesota MCH Priorities 24
Inventory of Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
� Goals of the Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Objectives of the Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Target Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
� Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Subgrantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Health Start, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
rModel Cities Health Center, Inc. . . . . . . . . . . . . . . . . . . . . . . . 45
Face to Face Health and Counseling Services, Inc. . . . . . . . . . . 51
North End Medical Center . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
� St. Paul-Ramsey Medical Center/Ramsey Clinic . . . . . . . . . . . 63
Monitoring/Evaluation of Subgrantees . . . . . . . . . . . . . . . . . . . . . . . 68
� Program Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Adolescent Health Program
Problem Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
' Goal . . . . . . . . - ' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Target Population 69
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
� Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Training/F.xperience 71
Linkages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
� Reunbursement and Fees : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 72
Budget Just�cation 72
Monitoring/Evaluation of Subgrantee . . . . . . . . . . . . . . . . . . . . . . . . 72
' Program Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
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� BUDGET AND FINAL EXPENDITURE FORMS
� 1992 BudgetForm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
1993 BudgetForm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Budget Detail of Local Match . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
� Budget Justification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
1992 Special Project Breakdown Budget/Final Expenditure Report by
Legislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
� 1993 Special Project Breakdown Budget/Final Expenditure Report by
Legislative Priority . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
rAPPENDICES
� Appendix A - Community Resources • .
Improved Pregnancy Outcomes Al
Family Planrung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AS
Childhood Injury Reduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A10
� Children with Handicaps and Chronic Illness . . . . . . . . . . . . . . . . . . . . . . . A14
Appendix B - Solicitation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B1
� Appendix C - MCH Monitoring Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C1
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� MINNESOTA DEPARTMENT OF HF�ALTH
Faa Sbeet
� Grant Application For
� (1) Maternal and Child Health S�p,sial Pr�Tectc
Name of Grant
� 2 APPLICANi'AGENCY
Legal Name Address Phoae (iaclude area cade)
City of St. Paul, 555 Cedar Street
Division of Public Healt St. Paul, MN 55101 (612)292-7712
' 3 DIRECTOR OF APPLICANT AGENCY
Name/T",tle Address Pbone (iaclude area code)
� Katherine Cairns 555 Cedar Street
Public Health Svcs. St. Paul, MN 55101 (612)292-7712
4 FISCAL MANAGEMENT OFFICER OF APPL.ICANT AGENCY
� Name/Tide Address Pbone(iaclude uea code)
Katherine Cairns 555 Cedar Street
Public Health Svc. Mgr. St. Paul, MN 55101. (612)292-7712
� OPERATING AGENCY if differeat from number 2
Name�tle Address Phone(include area code)
� NOT APPLICABLE
6 CONTAGT PEdtSON FOR OPERATII�IG AGENCY if different from number 3
� Name/Tide Address Phoae(iaclude area code)
� CON'TACT PERSON FOR FURTHER IIVFORMATION ON APPLICATION if differeat from aumber 6
Name�de Address Phone(iaclude area code)
� Diane Holmgren 555 Cedar Street
dm'n. M r. St. Paul MN 55101 612 292-7712
(8) COPIES OF THIS APPLICATION HAVE BEEN SENT TO THE FOLLOWII�IG REVIEW AGENCIES:
� AGFNCY TYPE AGENCY NAME(S) Metro olitan Council Date seat
Re�onal Development
Commission(s) 230 E. Sth `Street, St. Paul, MN 55101
� Commuaity Health Board(s) N/A '
—N/A if the Board is
� the Applicaat—
� (9) I certify that the iaformation coataiaed berein is we aad accurate to the best of my owledge aad that I submit this
application on behalf of tbe applicant ageary.
. .
Si�ahue of Direcior of Applicaat Agenry:
� Tide: Public Health Services ManaQer Date:C��I
� HE-0127402(3/1S/91)
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�i MINNF'SOTA DEPARTMENT OF HFALTH
PROJECT INFORM.4TION
� (1) Maternal and Child Health Svecial Projects
(Name of Graat)
� (2) PROJECT INFORMATTON .
APPLICANT AGENCY
City of St. Paul, Division of Public Health
� BEGINNING DATE END DATE PROJECT FUNDS REQUESTED
January 1, 1992 December 31, 1993 Y��1 Y0�2
$ 822,931 $ 822,931
� SERVICE AREA(Ciry,County,or Couatiu) LOCAL MATCH PROVIDED
Cit� of St. Paul Yearl y��2
� 1,192,962 1,192,962
MN TAX I.D.#
� 802-5095
FED.I.D. # (if applicable)
� 41-6005521
� (3) NON-PROFIT S'i'ATU • ,
SOLC3 copy attached: Yes Not Applicable X
s
� (4) �VIDENCE OF WORKERS' COMPF�rSaTTnN IN m n1�iCE
'��0� Y__ No__ Not Applicable�_
(� A�FIRM.4'I'fVE ACITON•
1 The agency has a certificate fsom the Commissioner of Human Ris�hts, pursuant to Minnesota Statutes,
s�on �.o�:
� Attacaed: Yes_ No X _ .
Not Applicable berause: a._TotaI contract is SSp,ppp or less
b•__ABancy bas 2D or fewer CuII-cime employees
� �-_�_Units of local government
d.__indiaa reservations
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� EVIDENCE OF COHPLIANCE
State law forbids the Commissioner of Health from entering into
� any contract until the Commissioner receives acceptable evidence
of compliance with workers' compensation insurance coverage
requirements from the contractor. The exception. to this
requirement is a self-employed contractor who has no e�ployees.
� An employee, as defined by Minn. Stat. 176. 011, subd. 9 , is any
person who perfor,ns services for another for hire, including
ninors and family members.
� If you do not fall within the exception and you wish to enter
into a contract with the Comnissioner of Health, you can furnish
� acceptable evidence of compliance with workers' compensation
coverage in any one of the following four ways:
I. Attach a certificate of insurance (supplied by you workers'
� ccmpensation carrier) to this Exhibit; or
II. If you are self-insured, attached a written order from the
� Minnescta Commissioner of Commerce allowing you to self- �
insure to this Exhibit; or
� III. If you are self-insured and you are a state agency or a
municipal subdivision of the state, pursuant to Minn.
Stat. 176 . 181, subd. 2 , and are not required to obtain a
written order from the Commissioner of Commerce, circle this
entire item and sign and date the form below in the space
provided; or .
� IV. Fill in the information for each item below and sign in the
space provided:
� A. Name of Contractor's insurance carrier:
� B. Address of Contractor's insurance carrier:
� C. Contractor's insurance policy number:
� D. I affina that all the employees of
(Contractor's Name)
are covered by the workers'
� compensation insurance policy listed ove. .
.
� . Siqned by:
Titl e: pLhl;c Healrh Services ManaQer
Date: ����(
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�
� ASSURANCES AND AGREEMENTS
� BY SIGNATQRE, THE AIITHORIZED OFFZCZAL AGREES AND A88IIRE8 THAT:
� 1. Services will be provided in accordance with applicable State
and federal laws, rules and procedures.
� 2 . The agency will comply with State and federal requirements
relatinq to privacy of client information.
� 3 . 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 employees) and any
subcontractors with 15 or more employees will have on file and
available for submission to MDH upon request a written non
� discrimination policy containing at least the following:
"All programs, services, and benefits which are administered,
� authorized, and provided shall be operated in accordance with
the non discriminatory requirements pursuant to Title VI of the
Civil Rights Act of 1964, Section 504 of the Rehabilitation Act
of 1973 , as amended, the Age Discrimination Act of 1975, and
� the non discriminatory requirements of the MCH Hlock Grant.
No person or persons shall on the ground of race, color,
� national origin, handicap, age, sex, or religion, be excluded
from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under any program service
� or benefit advocated, authorized, or provided by this
Department. "
5. The agency (if it has 15 or more employees) and any
� subcontractors with 15 or more emp2oyees will disseminate
information to beneficiaries and the general public that
services are provided in a non discriminatory manner in
I compliance with civil rights statutes and requlations. This
may be accomplished by:
� A. zncluding a handout containing civil rights policies in any
brochures, pamphlets, or other communications designed to
acquaint potential beneficiaries and the public with
programs; and/or
� B. Notifying referral sources in routine letters by including
_ prepared handouts which state that services and benefits
� must be provided in a non discriminatory manner.
Copies of each document disseminated and a description of
1
� �
�
how these documents have been disseminated will be provided �
to the Minnesota Department of Health (MDH) upor. request.
6. No residency requirements for services other than State �
residence, will be imposed.
7. Services shall not be denied based on inability to pay. �
8. Arrangements shall be made for communications to take place in
a language understood by the maternal and child health service �
recipient.
9. All written materials developed to determine client eliqibility
and to describe services provided under this grant will be �
understandable to a person who reads at a seventh grade level
using the Flesch Analysis Readability Scale as required in
Minnesota Statute 144. 054 (see Appendix 16, Plain Language in �
Written Materials, Minnesota Statute, Section 144. 054) .
10. The agency will provide services in keeping with program
quidelines of the Minnesota Department of Health and quidelines �
of accepted professional groups such as the American Academy of
Pediatrics, American College of Obstetricians and
Gynecologists, and American Public Health Association. �
11. Upon request, one copy of any subcontract executed as part of
the project will be provided to the Minnesota Department of �
Health.
12. The agency will report accomplishments of the project to the
Minnesota Department of Health. Such reports will be submitted �
no later than 90 days after the completion of the calendar
year. Upon request, the aqency will provide additional
information needed by the Department for evaluation of the �
project's objectives and methods and compliance with any
special conditions (see Appendix 14, Program Reporting
Requirements for Maternal and Child Health Special Projects) . �
13 . Grant funds shall not be used for inpatient services except
for hiqh-risk pregnant women and infants.
14. Cash payments shall not be made to intended recipients of �
health services. �
15. Grant funds shall not be used for purchase or improvement of �
land or facilities.
16. Grant funds shall not be used for purchase of equipment costing �
more than $5, 000. 00 per unit and with a useful life exceeding
one (1) year.
17. Grant funds shall not be used for reimbursement for travel and �
i
�� 1
�
� subsistence expenses incurred outside the State unless it has
received prior written approval from the Minnesota Department
of Health for such out-of-state travel.
� 18. When applicable, the agency shall provide nonpartisan voter
registration services and assistance using forms provided by
� the State to employees of the agency and the public as required
by Minnesota Statutes,. 1987 Supplement, Section 201. 162 (see
Appendix 11, Requirements for Voter Registration) .
� 19. When issuing statements, press releases, requests for
proposals, bid solicitations, and other documents describing
projects and programs funded in whole or in part with federal
� money, all grantees receiving federal funds shall clearly state
(a) the percentage of the total cost of the program or project
which will be financed with federal money, and (b) the dollar
� amount of federal funds for the project or program.
20. The agency will not use grant funds to pay for any item or
service (other than an emergency item or service) furnished by
� an individual or entity convicted of a criminal offense under
the Medicare or any State health care program (i.e. , Medicaid,
Maternal and Child Health, or Social Services Block Grant
� programs) .
21. Materials developed by Maternal and Child Health Special
� Project qrant and matching funds will be part of the public
domain and will be accessible to the public as financially
reasonable. Materials developed by the Maternal and Child
Health Special Project grant and matching funds may be
� reproduced and distributed by the Project to other agencies
and providers for a profit so long as the revenues from such
sale are credited to the Special Project budget for expenditure
� by the Special Project.
22. The agency will comply with all standards relating to fiscal
� accountability that apply to the Minnesota Department of
Health, specifically:
A. Budget revisions with justification will be submitted to
� I�IDH for prior approval whenever:
(1) chanqes are made in the objectives to be met in the
� Maternal and Child Health Special Project, or
(2) the cumulative amount of funds transferred 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 $2 , 500.00, whichever is greater.
� B. An expenditure report will be completed and filed with the
Minnesota Department of Iiealth no later than 45 days
�
� 11
�
following the end of each calendar year quarter. Final �
expenditure reports are due 90 days after the end of the
calendar year.
C. Grant funds are used as payment for services only after �
third-party payments, such as from the Medical
Assistance/Medicaid (Title XIX SSA) , Children's Health Plan, �
and Prenatal Care Initiative reimbursement proqrams of the
Minnesota Department of Fiuman Services and private insurance
are utilized. �
D. Project financial management systems will provide for:
(1) Accurate, current, and complete disclosure of the �
financial status of the project.
(2) Records which identify adequately the source and �
application of funds for Maternal and Child Health
Special Project activities. These records are to
contain information pertaining to project awards and �
authorizations, obligations, unobligated balances,
liabilities (encumbrances) , outlays, and income.
(3) Effective control over the accountability for all �
funds, property and other assets. Projects are to
adequately safeguard such assets and assure that they
are used solely for authorized purposes. �
(4) Comparison of actual obligations with budget amounts
for each activity. �
(5) Accounting records which are supported by source
documentation.
(6) Audits which will be made by or at the direction of �
� the Minnesota Department of Health (see Appendix 18 ,
State Audits) . �
SIGNATURE OF CHAIR OR VICE-CHAIR
OF THE COIrIlKUNITY HEALTIi BOARD OR �
AN AGENT APPOINTED BY RESOLUTION ' •
OF TIiE COIrIlrIUNITY HEALTH BOARD:
TITLE: Public Health Services Manager �
DATE: � �� (
,
�
�
12 �
�
�
CERTIFICATION CONCERNING USE OF MCH SPEClAL PROJECT
, GRANT FUNDS TO PROVIDE AND/OR ARRANGE STERIUZATIONS
� CHECK ONLY ONE BOX:
tMCH Special Project grant funds will not be used during CY 1992-93 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 be
"arranging" a sterilization.
No
� sterilization
provided
�
� MCH Special Project grant funds will be used to provide and/or arrange
sterilizations during CY 1992-93. Agencies which use MCH Special Project
grant funds to pay for a procedure or related purpose, such as provision of
transportation or detailed counseling, must adhere to specfic federal service
� and reporting requirements described elsewhere in this document.
Yes
� steriliiation
provided
� I certi that to the best f m n
fy o yk owiedge the above �nformat�on �s correct, and that �f th�s
status changes, formal noti�ication in this regard will be sent to the Section Chief, MCH
� Technical Services, Minnesota Department of Health, Minneapolis.
/ Signature of Director • .
of Applicant Agency: .
� Tltl@: Public Health Services Manager
Date: �- 3� I
� �
�
�
� 13
�
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�
instructions for Com� pleting �
Certification Concerning Use of MCH Special Pro'ect
Grant Funds To Provid-e And/or Arrange Steriliza�ions
All federal Public Health Service su orted ro rams, includin the Maternal and Child �
Heaith Services Block grant programPwhich use federal funds to provide and/or arrange
for steriiization are required to follow federal procedures and to provide written �
documentation in this regard on a quarterly basis.
MCH Speciai Projects (MCHSP) may obtain an exemption from this reporting requirement
by signing a certification that their agency is not using MCHSP funds to provide and/or �
arrange steriiizations. (If a client is merely provided information and referred, this is not
reported.) Reporting is required if MCHSP funds are used in some form of participation �
(paying for the procedure, providing transportation, making an appointment with another
heaith provider, or detailed counseling beyond simple provision information).
All Community Health Boards are accordingly required to complete the Certification. For �
agencies which do not provide sterilizations, no further action will be needed during CY
1992-93. The agencies which indicate they do provide sterilizations must adhere to
specfic federal service and reporting requirements described elsewhere in this document. �
'
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14 �
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� APPLICATION NARRATIVE
�
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ST. PAUL MATERNAL AND CHILD HEALTH GRANT PROPOSAL
, 1992 - 1993
� COMMiJNITY ASSESSMENT
� An assessment of St. Paul - Ramsey County community health needs and resources was
conducted as part of the preparation in developing the St. Paul - Ramsey County
Community Health Services Plan for 1992-1995. Staff from the St. Paul Division of
� Public Health, and the Ramsey County Public Health Department were instrumental in
collecting data and information depicting various health status and indicators from
various community sources. This assessment process included reviewing numerous
� reports and data to determine what the highest priority problems are in our community.
A list of the various data sources reviewed as well as a more complete detail of the
community assessment and problem prioritization process can be located in the 1992 -
� 1995 St. Paul - Ramsey County Community Health Services Plan.
As a result of this assessment, the St. Paul Division of Public Health has ident�ed
� improving pregnancy outcomes as a maternal and child health service priority for St.
Paul. While technology has improved to allow care and treatment of some high risk
births, it is much more e�cient, 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 Ramsey County
have poorer birth outcomes and may benefit from increased levels of targeted outreach
� and service. These health planning areas, all within the City of St. Paul, include:
Thomas-Dale, Summit-Dale, Downtown St. Paul, Riverview, Dayton's Bluff, Mount Airy
and Rice Street.
� d ition to focus bein laced on im roved re an outcomes, the Adolescent
In a d g P P P Sn �Y
Health Program, utilizing school based clinics operated by Health Start, Inc. and
, previously funded by the pre-block grant program, will continue to be supported through
MCH funding. Adolescent health continues to be a concern within the community, and
the need remains for accessible, efficient and effective service to this potentially high risk
� and often forgotten population. In fact, a number of issues related to adolescent health
are included in the St. Paul - Ramsey County Community Health Services Plan as
� priority health problems.
Through the community assessment completed as part of the CHS planning process, it
� was identified that there are appropriate resources within the community to meet the
needs in the areas of family planning, handicapped/chronically ill children and childhood
injury control. Based on this assessment, no funding is requested for these areas through
� the Matemal and Child Health Special Project Grant. However, these areas will
continue to be monitored by the Division of Public Health to ensure that resources exist
to handle the various health problems and issues in each area.
� 'I'he provision of services addressing improved pregnancy outcomes will be subcontracted
to various community-based providers who were identified through a process of request
�
15
�
r r osals. The St. Paul Division of Public Health has chosen to subcontract for �
fo p op
these services in an effort to utilize established 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. It is 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.
�
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16 �
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� IMPROVED PREGNANCY OUTCOMES
� PROI3LEN1 STATCMENT
� Poor pregnancy outcomes have been identified through a community assessment as high
p r i o r i t y p u blic health problems in St. Paul by the St. Paul-Ramsey County Community
Health Services Advisory Committee and staff from the St. Paul Division of Public .
� Healtli. The problems which were identifiecl inclucle:
•high infant mortality rate
� �hi h prevalence of premature births
8
� •increasing and/or high incidence of low birthweight births,
particularly among adolescent and minoriry women.
' For each of these indices, the City of St. Paul has higher rates 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 Street have
� been targeted as the specific geo�raphic areas to be served in response to especially high
rates of poor pregnancy outcomes.
� RESIDENT INFANT MORTALITY RATES, 1980-1988
MINNESOTA AND SELECTED RAMSEY COUNTY AREAS
� Health Pianning Areas
Thomss-Dale ��'2
� Downtown �s'�
� Summit-Dal• ���+
Riv�rvl�w t2.a
� D�ytons Bluft t 2.e
Wlount Alry ��•�
� CITY OF SAINT PAUL ��•4
RAMSEY COUNTY �•� I
� � i.2
STATE OF MINNESOTA
1 RAMSEY SUBURBS �•�
Rie• St�•�c •.s
� 0.o s.o t o.o t S.o 20.0
I�tent Deaths per 1000 Live Births Sr Pi1�D1�10NOF��"�"�rM
.� �.,....�.�.......
� �. ...,.�
17
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� � � w �
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� PREMATURE LIVE BIRTHS I N 1988
by Area of Residence in Ramsey County
� HPA or other residence
1 Downtown 10.0%
Mt. Alry 8.896
� Thomas-Dale 7.8%
Daytons Bluff 7.6%
, City of St. Paul 6.996
� Summit-Dale 6.79G
Suburban RC 6.4%
� Ramsey County 6.196
� Rice Strsst 4.6%
Rivervlsw 4.496
� 0.096 2.4°X. 4.896 7.2% �.6% 12.0%
� Percent under 3T weeks gestation
� SAM/T PAUL DfVISIQN OF PUBUC HEALTH
iOt/WCE: Mrr�ref�GnM br MwMh St�eua
L9: Aupwr taaf
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� 19
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LOW BIRTHWEIGHT LIVE BIRTHS BY RACE �
St. Paui Residents, 1986 and 1988 average
�
Black �9•8°� �
Asian 12,40� �
�
Native Am. �1•2°k
�
ALL RACES 9.1°�6 �
�
White 6.9°�6
�
0.0°k 5.0°�6 10.0°�6 15.0% 20.0°k 25.0%
PERCENT UNDER 2500 GRAMS �
ST.PAUL DNISION OF PUBLIC HEALTH �
iOURCE: hine�a��CMbr br HwMh Sutis6n
LB: Aupust toD� �
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i
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, LOW BIRTH WEIGHT LIVE BIRTHS, 1980-1988
Residents of Minnesota and selected areas compared
� AREA /960•68 1l68 1�67 1986 19t5 1l8� 1l63 1982 1991 1�80
� SELECTED AREAS of MINNESOTA
STATE
ll�• SI►tA�. Tol�l l027Tt !l.7r3 l6.1EB l6.7A8 67.112 l6.715 lS,SSO 68.312 l9.6S2 67.&13
d600 pre�BW.......... �0.034 7.337 �239 �?B9 �.278 �.260 l.27B �.�57 �.370 7A60
Pwcrnl LBW..._._.. SO% 5.0% 6.0% 501� IJ% 4.9X 6A% I.Y% 0.2% 6.1X
� RAMSEY CO
u•. s�nn., TM�1 rl.00e ��re �.a�s s�oa �.s+z aaea �.�w �.aee �.aes �.szs
<2500 pnr BW.......... �.131 M7 4M �O(1 112 117 � M6 670 4B0
P�ranllBW......_.. 6.711 6.IK SaY. !.0% SA1L 6A1� S.0% 6.!% 6.1% 6�%
ST PAUL
I u.• sinn., Te�.i .ss,o s.,ze �.o+z s.oer a,ax ao�. 4.as� s.oa2 s.�a� �.eo2
�2soo om.ew.......... x.e.e 328 31e n� xx+ zae a�2 3oi aeo 3,�
P«o.m�ew.......... sax. s.�x a4x a.a,c s.sx s.ex e.�x a.ox �.2x e.ex
RC SUBURBS
Llve Blnn�. Tot�l 26.798 3.150 2.999 3.1�5 3,100 3.OSS 2.756 2.93� 2.8�1 2,82a
� c2S00 prtn BW.......... 1ZB3 119 t2B 163 12D /tS t50 144 tat 164
PvosnllBW..._..... t.B% 3.91< <.31L 6.2'K 12% 1.7X S.SK �.9% SO% S.BK
HENN CO
Uw Bfr1M. Totd 137,861 16.'.i� 15.910 18Al2 15,906 15.159 /4.81� 11.900 14,875 U.061
<2500 prrs BW.......... 7.872 Y18 007 W6 !75 8r0 p3 d1p SSt !t6
� Pwasn�LBW.......... 5.7X b.7% 6.7X S4x. S.S% S.6% 5.7% b.M 5.816 59%
MPLS
�w. sirin., Toui ee.� e,�e, eau e.ss. as+s s.2�o a��. e�eo es2s s.w+
c2600 pma BW.......... 4,01! � �Yt 61Y 490 �OY �7 �02 MB �92
P�ran+t LBW..._._.. 7.1X 7.!% 7.M 7.0% 6.B% 63X RSx 6.1% 7.2'K 6.9%
� Hc sueuRSs
u.. si��n.. Tm.i eo.oso �o.,,� a.a�c o..�e 4.zo� a.eeo e,soo e.s,� e..so a�2o
�zsoo p�.ew.......... a.ese a�o �iF aze a2s a� u5 a�� �a+ �z3
ParosM LBW......_.. I.B% 4.1% 1.4% �.SX 4.8% SA% SIX 5.2% t.BX S2%
� RICE STREET SELECTED HPAs ot RAMSEY COUNTY
Llv• lI�1��, Tet�l 7700 3B6 3e6 3oB �8/ 37S 964 �70 979 310
c2fi00 prrs BW.......... ?2! iB � 9 21 21 27 � 36 20
P�rwM LBW..._..... b.8% 4.9% 6.0% 6.B% 6.S% 6.lX 7AK 7.�'K Y.S% YAX
THOMAS•DAIE
� L�ve sntn.. Te1.� z4a2 3oe 300 290 27/ 259 233 2n 282 2u
�ssoo o�,.ew.......... z�� ae a� a z� ao r� z+ a� �e
Mrasnt LBW..._..... l.7X 9.1% Y.7x l!x 7.7% 7,% 99X !3% 0.2x 7Ax
MT. AIRY
� Ltv Birth�. Tot�l /176 137 112 135 141 117 132 13S 130 1W
�2500 pms BW.......... 8� 9 S Y 10 1� 11 Y u 7
P�rosnt LBW..._._.. 7.�% R!X 4.'J% d.7% !.9% �.BX !3'K 6.7X 1Q9% 6.7X
CAYTONS BIUFF
LI�• Olrl��, Tot�l 1678 �OB b2S 61S S18 521 323 649 613 S10
� c2'i00 prr�BW.......... �6 �Y ,0 M 33 36 �4 38 96 47
P«o�n1lBW..._._.. 7.!% 7.!% 7.!% �.SX 6.9% 6.4ri RSx 6.0% 1Q7X 92%
SUMMIT•�ALE
ur• sinn.. Toui �� s�� ea2 eQO sxi ew eo� su sr� +ss
�noo o�.ew.......... aos ee � � �e � n as u +s
P«am�ew..._._.. a9+c ta7x a4x �.vx 7.tx 72x 7�x 7.ox �.a�+c Y3+r.
1 oowNTOwN
u�. sinn., Teui ��s ao a a �z �s �e a a �o
�noo oT.ew.......... w � o � o � s � z o
P«am�ew..._._.. ».�x sox �a.ex �o.ox o.ox. a.�x z�.ex �aox n.2+� o.ox
' RwEaviEw
liv /Ir1M. Tol�l T�t! 715 �11 �10 �1l �01 �06 ]� �26 �t2
s2S00 pms BW.......... 187 ?2 � 17 1B 1A ?2 /S Z� 14
Prc�nllBW..._._.. 6.9X 7.0% l4X 5.'.Nt 5.71� 5�% 721L 4.77L 7.iX 43X
� ST.PAUL DIVISION OF PUBUC NEALTH
SOURCE: �qnnNOf�GnNr la FN�ArA Sutkrlca
LB: .luly /99 t
�
� 21
�
One factor contributin to oor re nancy outcomes including high infant mortality, �
B P P g
premature birth, and low birthweight births, is late or no entry into prenatal care. Again,
the targeted Health Planning Areas within the City of St. Paul have a much higher �
percentage of women who begin prenatal care late (third trimester) or who received
none at all than suburban Ramsey County and the State overall.
�
,
�
LATEORABSENTPRENATALCARE, 198
8 �
by Area of Residence in Ramsey County �
HPA or other residence
Mt. Airy 16.8°ti i
Downtown �5•0°'� ,
Thomas-Dals �4•6°�6
Rics Strsst �2•3� �
Summit-Dale �2•0�
Da tons Blutf 8.9% �
Y
City of St. Paul 7,5°�6 �
Rlverview 6.096
Ramse Count 5.696 �
Y Y
Suburban RC 2.5�6 �
0.0% 4.OX 8.0'�6 12.0`b 16.096 20.0°k
Percent 3rd Trimester or None �
SAIM PAUL DIV�SION OF PUBL�C HEALTH �
aOUwCE: MnnMOb C«�r.b,►h.nn Snn:.a
L!: Auyw�ICOf �
�
22 �
�
�
RAMSEY COUNTY RESIDENT LIVE BIRTHS
� BY RACE, 1988
Total Low BW Motb�r Lat�a no
� RACE Ilv� (Und�r t��n- pnn�tal
OlrtAs �b00pms) aO�r wn
-Nrrnber-
� TOTAL 8.276 445 731 608
Whlt• 6,569 306 421 192
dlaek 6�0 7� 1� �
Asian 849 5t 131 776
� Indian t 77 11 21 17
Oth�r 111 4 10 15
-Pcree�t ojGrs birrAs-
� TOTAL 100.0% 5.4% 0.896 7.3%
Whlt� 100.0% 4.79L 6.196 2�'iG
Blaek 100.OX 11.3% 23.tX, 32.5%
' Aslan t00.OX &t% 15.4�6 Z0.7�6
Indlan 100.0% 9.496 17.996 14.596
Oth�r 100.0°i6 3.696 9.0% 13.5%
,
CARE BEGAN IN 3rd TRIMESTER OR NOT AT ALL
� Ramsey County residents, by race, 1988
RACE
,,,'r'.;c.':.:'.'' ' �4;''x,:F�,�:;y�'a<�;\};i".i;;s;,:;:...�.�i;<::
� Black �; . :�:� «.<:�.��.:,.. .:•...,,•:,.•;;:<:;��:.::r;.
c.c::.�:; c;�,�:;,�:`<:#f:;:'.�"'.'.::>.�:'��g�,a�t�.{c?�>-�;•rs:.:;:>;ry::;::::32.5%
...:�:�• 1.,.,.. k::...::
'`:�"�}T:�fia�:�t�i:�t:3:'�v`i:vc:y,coLw:
� .............................:..................ti..."'.............�............. .........................
},*.,7Fep+r4,:�y"'r�:k?:�. t:w;:;r,..�>:::
::y�<+,:•t;.;<2;.y�:•.yt•�+,.�3`"�'�'k.M1'..%?tt'�f•`v':•V?;``:•:•;.
Afian `�,., �:.W..::�:. ,t:�;,20.
•;. :r:�:�:,:�
..............................:.............................:............................•-:-.....
� ...--�..................
Indian • .��.� '
..............:.............................i..............................:......
� ..................
Whit� Y<a�2ex
, ,..
o.ox �o.ox zo.ox ao.ox �o.ox
� PERCENT LATE ON NO PRENATAL CARE
� SAINT PAUL D/VISION OF PUBLIC HEALTH
SOUFiCE: Alinnaoh CNwr!or FN�Mr Saristcs
LB: JWy 7YD1
�
, 23
�
�
C�rrent maternal and child health activities funded through the Maternal and Child
Health Special Projects Grant are monitored quarterly, and more thoroughly evaluated �
on an annual basis. A report assessing the activities of the current project in 1990 was
completed for the Minnesota Department of Health with additional copies available
upon request. Since cunent comprehensive data on St. Paul health indicators is not �
readily available, it is difficult to fully assess the impact of present programs at this time.
However, based on the data received from the programs, the following summary
information from 1990 programs receiving MCH funding to improve pregnancy outcomes �
is available: ,
• 1,319 clients were seen for prenatal services �
• 45% of the clients seen received prenatal care in the first trimester of
pregnancy
• 8 fetal deaths were identified �
• 0 neonatal deaths ocrurred
• 9.4% of births were below 2500 grams
From this assessment, it is clear that continuing efforts need to be made to help ensure �
early and continuous prenatal care, especially among some minority populations.
i
PROGRAM RESPONSE TO MINNESOTA MCH PRIORITIES
P 1 Division of Public Health's Im roved Pre nan Outcome Pro am �
The St. au p g Cy �
responds to the goals and priorities for services identi�ied by the MCH Advisory Task
Force in the 1990 update of the Health Plan for the Mothers and Children of Minnesota. �
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 the �
Division of Public Health has identified priorities consistent with the following MCH
Task Force priorities:
•a reduction in the percentage of low birthweight births �
•an increase in the percentage of women receiving prenatal care in the first
trimester �
•an increase in the number of women at high risk for poor pregnancy
outcomes reached early in pregnancy.
These priorities will be addressed through the objectives and methods identi�ed by the ,
community agencies approved for funding by the MCH Special Project Funds Proposal
Review Committee. The agencies recommended to receive funding are: Face to Face ,
Health and Counseli.ng Service, Inc., Ramsey Foundation, on behalf of St. Paul Ramsey
Medical Center and Ramsey Clinic's Certified Nurse Midwife Program, North End
Medical Center, and Model Cities Health Center. ,
The programs of these agencies provide a variety of inethods which are targeted to
increase the percentage of women receiving prenatal care in the first trimester, ensure ,
continuous prenatal care, education and case management, reduce infant mortality, and
decrease low birthweight births.
,
24
�
� INVENTORY OF SERVICES
� From the inventory which was completed, it has been identified that there are currently
14 agencies providing prenatal care in St. Paul; 13 of these accept Medical Assistance
and/or base their client fees on a sliding fee schedule. An inventory of agencies
� providing prenatal care, including the target population served and the services provided,
is included in Appendix A.
' Additionally, there are many physicians in private practice providing prenatal care, labor
and delivery, and postpartum care services. From data received from the Department of
Human Services, as of February 1991, 51 private physicians using a St. Paul billing
� address had billed Medical Assistance for reimbursement for ob/gyn services. Although
the majority of private physicians in St. Paul identify themselves as accepting Medical
Assistance, there is a widespread perception in the community that many are limiting the
� number of MA patients they will accept or are not accepting any new MA patients.
An inventory of family planning providers and referral agencies, service providers for
� handicapped/chronically ill children, and service providers for child injury control can be
found in Appendix A and is also included in the 1992-1995 St. Paul-Ramsey County
Community Health Services Plan.
i
1
�
t
�
�
1
1
1
1
� zs
�
�
GOALS OF THE PROJECT
The overall goal of the projects which will be supported through the Maternal and Child �
Health Special Projects grant is:
To im rove re an outcomes of hi h risk, low income women residing in St. �
P P � �Y g
Paul.
,
OBJECTIVES OF TI� PROJECT
' ctives have been established for the Im roved Pre an Outcome �
A number of ob�e P � �Y
project including: �
• To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 7.5% in 1988 (MN rate is 4.1%) to 4.5% in
1995 with a special emphasis on pregnant white teens and all pregnant African �
American, Native American and Asian women.
• To make progress toward the goal of reducing the overall St. Paul infant �
mortality rate from 10.3/1000 in 1988 to 9.5 by 1995 with a special emphasis on
African American women. ,
• To make progress toward the goal of reducing the rate of St. Paul low
birthweight infants from 6.4% (1988) to 4.0% by 1995 with a special emphasis on �
African American, Native American and Asian women.
• To conduct outreach efforts to pregnant teenagers to increase the rate of first ,
trimester prenatal care from 31.5% (1986) to 50% in St. Paul pregnant women
under age 20 by 1993, with a special emphasis on outreach to minority teens.
• To monitor the St. Paul rates for pregnancy outcome indicators through 1993. ■
TARGET POPULATION �
The clients targeted by programs funded by the St. Paul Division of Public Health are ,
low income (less than 200% of poverty) St. Paul women at high risk for poor pregnancy
outcomes, as de�ned by legislative parameters. 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 entry into prenatal care.
ntee selected as well as the ob'ectives �
The target population specific to each subgra , ) ,
methods, training/experience of staff, linkages, reimbursement and fees and budgets will
be described separately for each subgrantee. �
26 ,
�
( SOLICITATION PROCESS
� To determine the agencies with whom a subcontract would be established, a solicitation
process was conducted beginning in June of 1991. 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 St. Paul Pioneer Press.
Six proposals for programs to improve pregnancy outcomes were received by the
� deadline. The proposals were reviewed by 3 representatives of the St. Paul - Ramsey
County Community Health Services Advisory Committee, one representative from the
Children's Defense Fund and one representative from the St. Paul Division of Public
' Health.
An evaluation form similar to the Minnesota Department of Health evaluation form was
� used to evaluate the proposals which were received. The review committee felt that it
was important to fund as many projects as possible, and would rather provide partial
funding for many projects, than full funding for fewer projects. Additionally, the review
� committee was mindful of the target areas of service and chose to fund a combination of
projects which would ensure that some services were provided in each of the target
health planning areas with as little duplication as possible.
� he RFP a summa list of the ro osals received, and the evaluation tool
The details of t , ry p p
' used are described in Appendix 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
following pages. Each project has speci�c target populations, objectives (which mclude
� projected service levels), and methods, but all projects are working toward the same goal
of improving pregnancy outcomes for residents of St. Paul. Copies of the full proposals
submitted by each of the grantees are available from the St. Paul Division of Public
� Health upon request.
The following table indicates the projects which are proposed for funding and for which
' a complete program description follows.
'
'
�
, 2�
�
ArF.NCIES PROPOS�D FOR FUNDING jSUB�RA_NTS ,
AmoLnt Reauested Amount Awarcled �
Agency Total: yr. l: yr.2: Total: yr. l: yr. 2: ,
H e a 1 t h 656,862 328,431 328,431 656,862 328,431 328,431
Start '
(IPO)
�
M o d e 1 99,043 49,422 44,621 50,000 25,000 25,0(� �
Cities
Face to 59,648 28,510 31,138 53,624 27,812 25,812
�
Face �
N o r t h 18,538 7,514 11,204 17,000 7,500 9,500 ,
End
�
Ramsey 37,082 18,541 18,541 19,000 9,500 9,500 �
H e a 1 t h 800,000 400,U00 400,000 800,000 400,000 400,000 �
Start
(Adol . ,
Health)
Health Start receives non-competitive funding as a pre-block grant provider to provide both ,
improved pregnancy outcome services through outreach and prenatal care, and adolescent
health services through school based clinics. ,
Model Cities is receiving funding pnmanly for outreach and transportation.
Face to Face is receiving funding to continue their outreach/case management program. t
North End is receiving funding the fust year primarily for a health educator and a patient ,
representative to conduct outreach, and for a health educator and a bilingual worker the
second year.
Ramsey Foundation is receiving funding for a bilingual (Hmong) worker. '
��
�
� Subgrantee A - Health Start, Inc.
' Health Start, Inc., as a Pre-Block grant provider of services, continues to receive
Maternal and Child Health Special Project Grant funding for services to improve
pregnancy outcomes.
� T�et Population - Persons who are at high risk for both obstetrical and pediatric
complications who would, without accessible and high quality services, continue to
� experience the multiple problems associated with high risk pregnancies. Client
representation is comprised primarily of St. Paul women.
' Obiectives - To unprove pregnancy outcomes, Health Start has developed the following
objectives:
, 1. To provide comprehensive multidisciplinary prenatal care to 600 high risk adult and
adolescent women during 1992 and 1993.
' 2. 40% of women who deliver through Health Start in 1992 and 1993 will initiate
prenatal care in the first trimester of pregnancy, and 85% of women will initiate care by
� the end of the second trimester or pregnancy.
3. Prenatal education group classes will be provided to 300 prenatal clients during 1992
' and 1993.
4. By December 31, 1993, low birthweight and prematurity rates in the target population
' will be reduced to 9.5%.
�ethods - A number of inethods will be undertaken to assure that the goals and
� objectives for this project will be accomplished, including:
• A full range of comprehensive interdisciplinary prenatal services will be
� provided to clients in clinics located at St. paul Ramsey Medical Center, the
Public Health Center and Family Tree. This will ensure accessibility and
acceptablilty for clients seeking prenatal care.
, • Prenatal and postpartum care will follow the comprehensive Health Start
model, using the established protocols and methods that have proven effective
' with high-risk clients since 1967.
• All clients will be assessed for high-risk conditions using the Edwards Risk
' Scoring System at the initial visit and 36 weeks. Appropriate preventive
management will be provided for all clients.
� • All clients will receive a lifestyle assessment conducted by a Health Start
h e al t h e ducator which focuses on lifes t yle behaviors such as smokin g, alcohol, and
chemical used which place women at risk for poor birth outcomes.
� r V inf i n sin the Health Start
• CLents will also be assessed for nsk fo HI ect o u g
� 29
�
�
AIDS Risk Assessment Tool and individualized prevention education will be
provided. HIV testing will be provided on site as needed. ,
• All clients will receive a nutrition assessment conducted by a Health Start
nutritionist. Clients will be certified for WIC at the clin.ic visit. Clients with ,
specific nutrition concerns, i.e. diabetes management, anemia, weight control, etc.
will receive ongoing nutrition education and counseling throughout their prenatal
care. '
• Ail clients will receive a psycho-social assessment conducted by a Health Start
perinatal social worker. Ongoing support, counseling and referrals will be �
provided as needed.
• All clients delivering through Health Start will receive family planning services ,
for 12 months after the baby's birth.
� Outreach services will be provided for pregnant women �
• Health Start staff will network with and refer clients to other agencies,
resources and services in the community (Ramsey County Public Health nurses, '
Community Human Services, WIC, emergency shelter, etc.) as needed.
� Clients in need of specialized medical services such as cardiology, endocrinology ,
and genetic counseling will be referred to St. Paul Ramsey Medical Center.
• Clients will receive individualized prenatal education in clinic and will be r
invited to attend the weekly Health Start prenatal classes at St. Paul Ramsey
Medical Center. �
• Prenatal and postpartum clients who fail appointments will be followed-up by
telephone and mail to help ensure that they receive needed health care services. �
• Language interpreters and interpreters for the deaf will be available in chruc
and by phone during non-clinic hours as needed. ,
• Although most clients will find the clinic sites easily accessible, Health Start
will provide bus tokens or cab cards when needed. �
15raininEf E�cperience - Documentation of the uaining and e�cperience of staff follows.
�jp�gg,� - As identified in the Methods section, Health Start currently has linkages �
established with many providers, and has systems in place to make client referrals
between agencies. Follow-up of referrals is completed. '
�3.eimbLrsement and Fees - Matemal and Child Health funding allows Health Start to
provide prenatal care for clients who have no tturd party source of payment, although �
most Health Start clients are eligible for medical assistance. Clients are assisted in
applying for Medical Assistance when they are eligible and not yet enrolled. Health
30 ,
,
� Start also has worked with the Prenatal Care Initiative Program, and will bill third
parties for services whenever possible.
' Bud�et iustification - Health Start will receive $728,431 in 1992 and $728,432 in 1993 to
support their proposed program to improve pregnancy outcomes. These funds will be
' used primarily for outreach, education and prenatal care activities. The total budget and
justi5cation for the project follows.
'
�
'
�
�
' �
�
�
,
�
'
'
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, 31
Health Start, Inc. '
�
Training/Eaperlence of Staff ,
Health Start has provided maternal and child health services in St. Paul
since 1967. All Health Start staff are professional health care personnel
with special expertise in maternal and child health. The majority have had ,
more than five years experience. All staf�' are evaluated at least once a year.
, Staff are supervised by the executive director, medical director, associate
medical director, nursing supervisor, social work supervisor, nutrition �
supervisor or health educat�on supervisor. Donna Zimmerman is the
executive director of Health Start and is responsible for the overall
management and direction of the pro,�ect, as well as external relations and �
long-range planning. Dr. Laura Edwards is the medical director and is on
the staf�' of the Department of Obstetrics and Gynecology at St. Paul-Ramsey
Medical Center. She has been director of the MCH program for 17 years ,
and is responsible for all Ob/Gyn medical aspects of the project. Dr. Chris
Reif, a member of the Family Practice Department at St. Paul-Ramsey
Medical Center, is the associate medical director, responsible for medical ,
direction in the school-based clinic program.
Because of their expertlse witti maternal, child and adolescent issues, many �
staff of Health Start are in demand as speakers locally and nationally.
Staff continue to update their knowledge and skills by attending relevant '
workshops and conferences.
�
�
,
�
�
. ,
,
�
32 • '
Health Start, Inc.
#� � R
' BIOGRAPHICAL SKETCH
�,R TMc fo��or�na ��o�u►T i ort FOR GW IQY STAFr I�Qr71�R. a�a��t ra r 1 T?I T1it rROGRAM D 1 RSCTOR.
t COf�f�1 NtJAT 1 ON PAC�E,'.� AHO FOLLO� TFt SAbQ QiKRAL FO�tAT �'OR EACH PERSON.
NAhQ T 1 TLt 0 l R'7f�AT[ �Mo�ow r,r*
�.ONEY•, Janyth K . Maternity Clinic Nurse 2-2-47
ED�CAT��'1 ��SQ i!/ ■1 TM �IICCAL�JARlA t OR OTMtR 1 N 1 T f AL rROFtlf 1 ONAI. tDYCAT 1 ON AND 1 NCLNOi
�OfTDOGTORAL TRAININ0.3
f NljT i M 1 ON /1f� LOCAT 1 ON D�6Rtt YEAR 00(�EItlRD F i ELD OR 9TtlDY
�niversity of Minnesota Prac. 1966 Practical Nursing
School of Nursing Nursing
�etropolitan Community Nursing 1974 Associate of Arts
ollege Registered Nursing
lanned Parenthood of Minnesota OB/GYN 1984 Nurse Practitioner
� - Family
Planning
Nursing
, Pract-
itioner
Fi�SEARa� At�/OR PRORES31 ONAL E��SR 1 QVC= CONCLYD 1 NO I�1 TN rRt!!NT rOS 1 T 1 ON. L 1 fT 1 N CMRONOLOa 1 GAL
' 011D[R P11tV 1 ON� tlArLOYMtNT �]Ctl111 tNC! AND FIONORi.
INCLVDt rR[ltNT M�M�tRSMI� ON ANY COMMITTtlS.
�966 to 197u - University of Minnesota Hospital - Licensed Practical
, Nurse . Newborn and Pediatric Intensive Care and also
worked on a surgical station .
'�973 to 1974 - Metroploitan Community College - Nursing Class President .
1974 - Volunteer work with Neighborhood involvement Project
and Minneapolis Chapter Red Cross .
'1974 - University of Minnesota Hospital , Staff Nurse-Pediatrics .
1974 to �975 - American Red Cross , st. Paul Chapter , Staff Nurse -
Bloodmobile Team .
�1976 to 1977 - St. Paul Ramsey Medical C•�nter, Staff Nurse-Newborn
Intensive Care.
,1977 to present - St. Paul Ramsey Medical center, Maternal and Infant Care
Pro,ject.
1978 to �983 - Member Minnesota Council for Unmarried Parents .
'1978 to 1980 - Board Member MCUP of Minnesota
�PROE'ESSIONAL MEMBERSHIPS
Member of the Nurses Association of the American College of Obstetrics and
� Gynecologists .
' . 3
3
�� �— _ APP C.��� -
Health Start, Inc.
BIOGRAPHICAL SKETCH .
.c
TMsc ►o��o�i r�a 1 N/OfiMAT I ON r01t tAQ� IQY sTMr btEAmElt. ee c t rri�ra •�TM TMs �ROCn�w O 1 RE CT'OR. '
St COKt t P0.1AT 1 ON rAGE! AJ� FOLLOf M S/Y�Q G�J'tRAl. /OR�4AT f'Olt EAO�1 PERSON.
� T 1 TL� 01 RT��11Tt ��ro.ow v.rw,
SHINN � Wendy yedical Assistant 5-29-52
XJCATION C�tOIN •1TN �ACCALNARiA�[ OII OTMtII 1M1TfAL rllprtlslOMAI. lDYCATIOM Al�IO iNCLYOt
►OiTDOCTORAL T11A i N 1 NO.
���nrr�oH �ro �ouT i oN occ�ra� �wie ca�crn�so r i c� or snio�r
Sawyer School of Business •
Minneapolis , MN CMA tg79 Medical Assistant '
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SE,AA�O� A!�/OR PROFESS 1 O[�tAL E7�'ER 1 ETKt CONtt,ND i Na �1 TM tR!ltliT rOf i T t OM. L 1 sT 1 N GMRONOLOO i CAL
OROtR rRtV 1 OU! <I�IrLOYMtNT iXt[1�1[NCt AND MONORf.
INCLUDt rlliitNT Mai�tR:NI� OM ANr GO�WITT[i!.
1 ? to resent - St . P=_::1 Maternal and Infant Care Pro,�ect - St . Paul ,
9 9 P
Ra:nsey '•:edical Center .
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I BIOGRAPHICAL SKE?CH , 9i—���`��
: T�� POLLOr 1 HO 1 t�OF�IAT 1 ON FOR GW I�Y STAf I 6�ER. �G t[�QH 1 NG f 1 TH THE PROGitAM O 1 ft�CTOR.
�COK�f MJAT i ON PAG�S At'�D FOLLO'r M .+l�l� G�rT'Q:RAL FOAbtAT FOR E�1Q�i PERSON.
TITLi 8lRTf�AT! �r�o.�wY.rw,
�:AivSOh , PaTRICI;+ Dietitian 1/ 14/51
ED�JGAT ION C�t0 t N R 1 T/1 �J►CCA{.UARCAjs OII OTf1�11 /N 17 t AL rROFtlf 1 ONAL [OYCAT ION /1ND t MCLtJD�
rOiTDOCTORAL TMININO. �
�r�st��vr�oH �ro �ouT�oM oec�s �r�►a cororEr� �t Et� or sTwir
�niversity o: :?innesota 1972 College of Liberzl
►•finneapolis , :iinnesota �rts
�niversity of 'rlinnesot2 B.S. 1974 D�etetics
t. �aul , ;;innesota
St. ?aul Ramsey i�ledical Center � �• 1975 Dietetic Internship
�niversity of IoWa C.E.U. 1978 Intensive Ceurse on
?edistric ?Jutrition
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�FaRp� /►P�/OR PROFESStCNAL ��R1QVC= COlIC�VOINO *1TN PRtfENT ►Of1T1OM• L1fT 1N GMRONOLOaiCAL
OI�D[R IRtV 1 OU! QI*LOYf�1l1R <�tR 1<NCt AIfD F10N01tf.
1 MCL1JDt rpS3ENT MOit�LRSl1 I� ON AKr COiW(TTit!.
- `:I� Dietitian, St . ?aul ?a�sey :'ediczl Center - t976 to ?resent
� Clinical Dietitian, International Diabetes Center� St Paul Associate -
J�ne-August t987 �
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�v?`;, APPLICANT ,\ �E,'t
Health Start, Inc.
BIOGRAPHICAL SKETCH . ,
it � ro«o���c ��o�u►r�ar Fort ua� �mr sT�v� �eR. eEC�cw t r�a ■i TM ha paocww o�a�croR.
JSi COKT 1 t�JAT i ON PACE'.i AAO FOLLOr Tt� SAhR G�TER/1L FOi�tAT !'OR EAO�i P£RSON.
�� T 1 TLi s 1 RT}�Jl?� �Mo.ow r,�rw
YANG . fa Her Healtn Interpreter 10- 1�:-�2
EOUCATICN ��tdlN fITM �ACGLttARtATs OR OTNtQ INITIAL rRO/tfiIONAL iOYCATION ANO tNGLVDt
rOiTDOCTORAI. TRAtNINO. �
1 NST 1 M 1 ON APD' LOGT 1 ON DEGAE� YLAR COP�ERflaD F 1[LD OF S7'�Y
Preser.:iy attending school '
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�£SEArtQi AND/OR PROFESSIONAL ��RIENCE COMGLVDINa ■ITM rRC�tTIT ►OlITIOft• LIlT l�i GMRONOLOOICAL
OROCR rR[V 1 OU! 6M►LOYMl�NT CIC1�tR 1[NC< A�ID NONORi.
INGLtJOC PRCfENT MpMSCRSMI� ON ANY GOMMtTT[[:. ,
1980 - �resent - St. Paul Maternal and Infant Care Pro�ect , St . P�ul
Ramsey Medical Center .
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1 Subgrantee B - Model Cities Health Center, Inc.
' �et PoQulation - African American and Hmong teens and women in the Summit-Dale
and Thomas-Dale neighborhoods.
' O�j�ctives - Model Cities has a number of objectives in their proposed program related
to case finding and outreach, clinical intervention, and reducing barriers which prevent
access to care. Objectives related to each of these areas include the following:
� 1. To identi and link with at least five community organizations including City of St.
�
Paul Public Housing for intensive case-finding and community outreach education to
, increase early and continuous prenatal care by December 31, 1993.
2. To provide comprehensive prenatal care to at least SOO lugh risk women by December
' 31, 1993.
3. To increase the numbers of women receiving early prenatal care by 50% by offering
' outreach to women in public housing, churches and community centers by December 31,
1993.
� 4. To increase substance independence for pregnant and postpartum women by offering
case management, counseling, treatment and support with Chemical Health Educator
' and Case Management Coordinator to 100% of chemically dependent women using
Model Cities prenatal/postpartum services by December 31, 1993.
' S. To reduce access barriers to prenatal and postpartum care by offering van
transportation to 100% of pregnant women and their children needing roundtrip
transportation from their home to the health center by December 31, 1993.
� 6.To reduce delays in prenatal care by scheduling immediate return visits for pregnancy
confirmation for 100% of confirmed pregnancy tests by December 31, 1993.
� �� - To achieve the objectives mentioned above, Model Cities Health Center will
be undertaking a number of activities including:
� • A Hmong and African American outreach worker will perform outreach and
collaborate with other agencies such as public housing, churches and community
� groups.
• One-to-one and group prenatal education will be provided on proper nutrition,
� exercise, and prenatal care.
• Case management and tracking of women will be performed to help ensure
, prenatal appointments are kept to reduce infant mortality and low birthweights.
• Transportation will be provided to women as necessary to help ensure that
, prenatal appointments are kept.
� 45
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� ' e wi h 1 r 11 a ro riate chemical de enden treatment centers are '
Lmkag s t cu tu a y pp p p cy
establish which provided treatment and ancillary services to pregnant women. '
� Coordinating enhanced sernces with routine primary health care, including
coordination and collaboration with Ramsey Public Health Nursing, Family
Services of Greater St. Paul, and a number of other agencies identified under the ,
Linkages section.
• Provide monthly prenatal group with activities emphasizing the important role �
of nutrition, cooking, exercise, and self-esteem to increase prenatal care through
duration of pregnancy to ensure normal birth weights (2500 grams and over).
'
• Provide one-to-one prenatal education for all prenatals on proper nutrition and
prenatal care to ensure normal birth wight infants. '
Model Cities will provide a Hmong and African American outreach worker as it is felt
that a outreach workers who are of the same race and culture as the individuals whom '
tlus project is trying to meet would be most effective. These individuals will go to where
the people are located to perform outreach. �
Provisions for tracking patients to ensure that services are provided to these individuals
will be performed, as well as referrals and follow-up to other appropriate services and '
providers as identified to be needed on a case by case basis.
�5raini e�erience - Documentation of the training and experience of staff follows. '
Linl� - Model Cities intends to provide linkages to various services and agencies for
medical and ancillary services. Some linkages will be made for clients within the Model �
Cities Health Center system, and also to the Model Cities Family Development Center.
Other agencies which are mentioned as linkages with which services will be coordinated
include: Family Services of Greater St. Paul, Turning Point Chemical Dependency �
Treatment Center, Institute on Black Chemical Abuse of Minnesota, Minnesota
Department of Human Services and St. Paul Ramsey Medical Center. '
Reimburc�ment and Fees - Model Cities reimbursement and clinical fee system bills
Children's Health Plan, Medical Assistance, Ramsey Care and private insurance for the �
clinical costs of health care. Uninsured patients can apply for sliding fee, tliscounted
from 20% to 80%.
Budget Tustification - Model Cities Health Center will receive �25,000 each year in 1992 ,
and in 1993 to support their proposed program to improve pregnancy outcomes. 1'hese
funds will be used primarily for outreach and transportation activities. The total budget �
and justification for the project follows.
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� , � Model Cities Health Center, Inc.
A-3 BIOGRAPHICAL SKETCHES OF KEY PERSONNEL
� Patriciv Franz,ANP�Perirroto!Nurse/Perinata!Educator
Ms. Franz received her undergraduate education at the college of St Catherine.Department of Nursing and St.
� Mary's Medical Hospital in Minneapolis,Minnesota,where she earned her Baccalaureat� in 1957. She also
aaended Metrogolitan State Universiry where she received a bachelors degree in Human Service with
concentradons in Business and Management(1986). Ms. Franz has worked as a registered nurse sincc graduadng
in 1957. Her work experience includes Intensive Coronary Care nursing for seven years.evening superv�sor for
� a 325 bed hospital for 3 years. and endocrinology for 4 years. Her responsibilities as Director includcd
budgeting,financial rracldng. supervising head nurses,and worldng on the development of policies and
procedures for recruiting registered nurses. Ms. Franz collaboraud on a cardiac rehabilitation book for pauents
� that won a national award. she also coordinated a cardiac services study to determine cost containment. In 1986,
Ms. Franz received certification as an Adult Nurse Pracdtioner and Gerontological Nurse Practitioner from che
College of St Catherine.
� Barbara Leone,M.D.,Fomily Pracrice Physicion
Dr. Leone received her undergiaduate education at the University of Minnesota(1972)where she graduated in che
� honors program,receiving a baccalaureate degree in Anthropology. Her undergzaduate medical training was at
Harvard Medical School where she received her M.D. in 1983. Dr. Leone completed her medical residencv in
family pracdce at Bethesda Lutheran Medical Center,an affiliate o f the Universiry o f Minnesota in 1 9 8 6. Since
� then, Dr. L.eone has worked at Model Cities Hcalth Center,emphasiring matemal and child health and was
� inswmental in implementing the Perinatal Delivery System. In April. 1988,Dr. Leone presented a research paper
on "Ethnic Differences in Perinatal Morbidiry and Prenatal Risk"to the Minnesota Academy of Family Physicians.
Dr. I.eone is a member of the American Academy of Family Physicians,where she serves on the Minority Affairs
� Commitue; the Minnesota Medical Associadon,and the Ramsey Counry Medical Sociery. Dr. Leone is also an
active communiry member and serves on the Board of Directors of the Summit-University Chapter of the
American Cancer Socity. She also is a Junior Church Teacher at the River of Life Chrisrian Center in St Paul.
� Carol Hargate,Certified Pediatric Nurse Practitioner
� Carol Hargate rcceived her Master in Public Health and Podiatric Nuise Associate Certificate from the Universiry
of Minncsota in 1981, wher�she also worked in the Nconatal Intensive Care Unit. Btfore joining Model Cities in
1988,'she was an instructor at Gustavus Adolphus Collcge with a Child Health focus. She was also the
coordinator of the Maternal Child Health Expoctant Family Home Visit Program. She specializes in children with
� developmental dclays and/or learning disabilities.and worked in collaboradon with the Anoka/Hennepin School
District in various pre-school screening programs as a provider consultant Ms. Hargate was�rained on the
Brazelton Neonatal Developmental Assessmcnt in 1990 to m�asure delays affecting infants with prcnatal substance
� exposure.
� Deborah Mielke,M.D.,Family Practice Physiciai
� Dr. Mielke graduated from the University of Minnesota Medical School in 1983. She completed her Family
Medicine residency at Saint Paul/Ramsey Medical Center in 1986. Dr. Miellce precepts and assists with resident
curriculum issues,quality improvement and practice management at the Family Physician's Health Center,in
� addition to seeing prenatal patients at Model Cities Health Center. She has special inurests in the areas of prenatal
care for the economically disadvantaged,care for the mentally disabled,and practice management
� Deniee Leverea,Chemical Health Edueator
Ms. Leverett began her counseling and intervenrion work at Model Cities in 1991 where she provides education,
counseling,and support to pregnant women with chemical addictions. Ms. Leverett is completing a Bachelor of
� Science degroe at Metrapolitan State Universiry,Minneapolis. She has also facilitated adolescent sexual
responsibiliry and interracial identiry groups, and providul assessments,counseling,and intervenaon to clients
with chemical dependency and domesnc abuse concems.
�
� 47
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Model Cities Health Center, Inc. �
- � A-4 JOB DESCRIPTIONS
W RKER �
� POSITION TITLE: OUTREACH O
� JOB RESPONSIBILTTIES: '
- Under the supervision of the Program Manager,conducts ouveach and case-findu�g in the Afncan Amencan
community of Saint Paul to find pregnant uens and underserved females who have no prenatal carc and necd �
� medical care,education.or have social support needs.
DUTIES AND RESPONSIBILITIES:
� - Links with centers throughout the Saint Paul communiry to find pregnant women and tcens without clinical �
' services and cnroll them in Model Cides Health Center prenatal pmgram.
� - Coordinates transportation,airangments for medical appointments,enrollment in nutrition education, �
- parenting,chemical health.or women support groups for pregnant women in the community needing health
center services.
� - Serves as a health center link to public housing projxts to provide outreach for underserved single heads of �
household in need of prenatal care.
� - Serves as a vita; link between African American organizadons and services to provide efEeetive case- �
management an�i linkage betwcen those organizations and Model Ciaes Health Center.
- Maintains a record log of all outreach initiatives and provides follow-up with public housing staff when �'
� needed for effxtive collaboration.
� - Atunds all staff in-service trainings,case management meetings, and prenatal staff development sessions. �
- Coordinates enrollment in health education with the Nutritionist,Chemical Health Educator,Women's
� Group Coordinator. and Perinatal Educator. �
' JOB QUALIFICATIONS:
� Completion of a high school education GED. Previous coursework or training in human service delivery desired,, �
but noc mandatory. Prior experience in human service or communiry outrca�ch prefemed. Ability to work with
persons of various cultural,ethnic.and economic backgrounds is essential.
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� 48 �
Piodel Cities Health Center, Inc.
POSITION TITLE: OUTREACN WORKER
JOB RESPONSIBILTTIES:
Under the supervision of the Program Manager.conducts outreach and case-finding in the Hmong and SouchEast
Asian communiry of Saint Paul to find pregnant teens and underserved females who have no prenatal care and
neod medical care,education,or have social support needs.
DUTIES AND RESPONSIBILITIES:
- Links with Hmong and SouthEast Asian organizadons tivoughout the Saint Paul communiry to find pregnant
� women and teens without clinical services and enroll them in Model Citics Health Center prenatal pro�arrL
- Coordinates vansportation,an�angments for mcdical appointments,enrollment in nutrition education,
parenting,chemical health.or women support groups for pregnant women in the Hmong and SouthEasc
Asian communiry needing health center services.
- Serves as a health center link to Hmong public housing projects to provide ouveach for underserved women
in need of prenatal care.
- Maintains a record log of all ouu�each initiatives and pmvides follow-up wich public housing staff when
needed for effecdve collaboraaon.
- Attends all staff in-service vainings, case management meetings,and prenatal staff developmcnt sessions.
- Coordinaus enrollment in health educadon with the Nutridonist,Chemical Health Educator, Women's
Group Coordinator, and Perinatal Educator.
- Serves as a link between the Hmong and SouthEast Asian community and the health center in communicating
unmet cultural/ethnic needs to the health center staff.
-Works closely with 2 FI'E Hmong Inurpretors to provide effective case-management and linlcage between
the Hmong and SouthEast Asian padents and the prenatal program.
JOB QUALIFICATIONS: .
Compledon of a high school education GED. Prcvious coursework or training in human service delivery desired,
but not mandatory. Prior experience in human scrvice or communiry outreach preferred. Knowledge of the Saint
Paul HmonglSouthEast Asian community prefemable. Abiliry to work wich persons of various cultural,ethnic,
and economic backgrounds is essential.
� 49
Model Cities Health Center, Inc. �
� PROGRAM BUDGET, 1992-1993
The 2-yeaz project budget totals$113,589,$99,043 of which is being requested in MCH funding and the �
remaining 514,546 to be covered by Model Cities H�alth Center. Not included in these calculations are those
salary/fringe expenses associated with in-kind services will be provided by Model Cities Health Center and Model
Cities Family Development Center staff as well as the WIGNutritiotist and Human Services Case Worker. �
� A. LINE 1TEM DETAIL: YEAR I YEAR II
O/her Total O�her To�al ,
� Personnel S�urt�t� �il.�l C.�s1 S�s M.�l ` C°st
Outteach Interpretor(Hmong, .50 FTE) --- 9,256 9,256 -- 9,534 9,534 �
� Outreach Interprotor(African ___ 9,256 9,256 ___ 9,534 9,534
American, .50 F1'E))
Family Practice Physician (2.0 FTE) In-kind 5,200 5,200 --- 5,200 5,200
Adult Nurse Practiti��ner (1.0 FI'E) In-kind --- --- In-kind --- -~ �
� Podiatric Nurse Practitioner(1.0 FTE) In-kind __= N_ In-kind ___ _N
Case Managemcnt Coordinator(1.0 FI'E) In-kind In-kind
Nutritionist In-kind •-- --- In-kind --- -° �
MCFD Social Worker(2.0 FTE) In-kind -•- --- In-kind --- ---
Chemical Health Educator In-kind --- --- In-kind --- ---
Ramsey MA Enrollment Worker In-kind --- --- In-kind --- --- ,
Van driver 3,500 3,500 7,000 3,500 3,500 7,000
Subtotal: 3,500 27,217 30,717 3,500 27,768 31,268
Fringe Benefits/FICA:
(22percent) 770 5,988 6,758 770 6,109 6,879
Supplies: �
Clinical
Modical 100 1,000 1,100 1,800 100 1,900
Pharmacy 100 1,000 1,100 100 1,300 1,400 �
Laboratory 100 1,000 1,100 100 1,100 1,200
Office 50 800 850 50 1,000 1,050
Rccords/Tracking 100 900 1,000 100 1,000 1,100 �
Subtotal: 450 4,700 5,150 2,150 4,500 6,650
Other Operating Expenses: �
Patient Transporcation: 200 1,700 1,900 200 1,900 2,100
PatientEducation 100 500 600 100 500 600
Printing 100 500 600 100 500 600 �
Data Processing 500 2,000 2,500 100 1,500 1,600
Subtotal: 900 4,700 5,600 500 4,400 4,900
Total Direct Costs: 55,620 42,605 48,225 6,920 42,777 49,697 �
Indirect Costs @ 16 percent 899 6,817 7,716 1,107 6,844 7,951 �
Total PrQject Costs $6,519' 49,422 55,941 8,027• 49,621 57,648
�
* Dallar amount of other sources (i.e. in-Idnd contributions)dces not include actual salary dollar amounts of
pmviders and additional staff. This amount exceods the 25 percent in-kind contribution guidelines of the grant �.
proposal.
50
�
�
� Sub antee C - Face to Face Health and Counselin Services, Inc.
�' g
� Z'a�t Pouulation - Adolescents and young women primarily from the Dayton's Bluff
area, and some women from the Summit-University, Thomas-Dale and Riverview areas.
� Ovjectives - Face to Face has seven objectives for their project:
1. To provide 70 adolescents and young women with holistic and comprehensive prenatal
� care services which are accessible, acceptable and meaningful, and which are integrated
and coordinated with other community services and clients' individual life situations each
' year in 1992 and 1993.
2. To provide special outreach to pregnant adolescents who are minority and/or live in
� Dayton's Bluff, and enroll at least 20 teens who are minority and 8-10 young women who
are minority.
3. To enroll 70% of the 50 clients under age 21 during their first trimester of pregnancy.
�:
4. To provide special outreach and support services to "high risk" clients as measwed by
� (1) risk scores of 10 or higher, or (2) by living situation.
5. To effect positive birth outcomes in all clients, as measured by low birthweight rates
� of less that 4 percent for all age and racial groups served in each year of the project.
6. To ensure that 90% of the 70 clients enrolled each year in prenatal care attend and
� participate in at lease seven of a series of ten prenatal education classes.
7. To ensure that all women delivering through the project are linked with ongoing
� primary care for their infants, and social services for at least one year postpartum.
Methods - A core method for reaching the goal of healthy babies for high risk youth is
r� comprehensive and sensitive prenatal care services. The nurse practitioner works with
an on-staff nurse midwife to provide nursing care services. Individual chemical health
education is also provided.
� ' ' n an outreach worker "continuous counselor" works with other a encies to
Addit�o ally, / g
identify adolescents who may be pregnancy early in their pregnancies, and helps organize
� and advocate for services for individuals.
� Other key activities include:
• Outreach worker providing ongoing case management and crisis intervention
� services for clients.
• Free pregnancy testing and counseling, and follow-up to assure prenatal care is
� obtained.
• Prenatal care will be provided, and access to contract medical staff will be
� 51
�
available during all non-clinic hours.
�
• Outreach worker will be available by beeper to assure access to staff, and will ,,
attend the births of clients who are without a support person.
• Face to Face will continue to work closely with multiple agencies (see Linkages) �
and staff, including social workers, youth workers, and medical staffs.
• Face to Face will provide transportation or financial assistance for . �
transportation for all clients who need help in getting to medical visits or classes.
• Each client will be assessed for risk, and a care plan meeting each client's �
sperific needs will be developed.
• Chemical health education will be provided to all clients, and support groups �
will be available to clients, and encouraged for those with potential or current
chemical use. �
�raining f�erience - Documentation of the training and experience of staff follows.
Lj,�ggg The linkages that Face to Face staff have made over the past year have �
become one of the strengths of the prenatal outreach project. Face to Face works with a
number of agencies including: Turning Point, Guadalupe Area Project, The Loft/Jimmy �
Lee Center, Agape School, Minnesota Adolescent Youth Program, Dayton's Bluff
Recreation Center, Health Start, Ramsey County Nursing, the St. Paul Division of Public
Health and many more. These linkages have provided mechanisms for education, and �
outreach and referral activities.
Reimbursement and Fees Medical Assistance is the primary source of reimbursement for �
prenatal care services provided at Face to Face. Only clients who are age 20 and over
and who are above 100% of poverty will be charged fees, and then on a sliding fee scale
of 10% to 100% of charges. �
Budggt Tusti�cation - Face to Face will receive $27,812 in 1992 and $25, 812 in 1993 to
support their proposed program to improve pregnancy outcomes. These funds will be ;�
used primarily for outreach and case management activities. The total budget and
justi�cation for the project follows. �
. �
�
�
52 �
�
• � Face to Face Health And Counseling Services, Inc.
�
TRAINING AND EXPERIENCE OF KEY STAFF
� . The outreach worker 1s Cara Carlson. who came to Fate to Face in June of 1990.
,, She has a Dachelor ot Arts tn Soc1a1 Work trom the Cotlege ot St. Catherine� and
�� experience as a group tacilltator and case manager at the St. Pau1 YWCA betore
� coming to Face to Face.
The nurse practltloner 1s Sue Garber. who has been wlth face to Face stnce June
� of 1989. She had been Otrecto� ot Nealth Services at Carlton College and St.
Mary's Coltege before �otning the Face to Face team. She is a graduate of the
Nurse f'ractlttoner Program at Brlgham Young Universlty. has a BSN from Wlnona
� State Unlversity and 1s a Certitted Adult Nurse Practltioner.
Debra Reinisch ,joined Face to Face on July lst of this year after recelving her
M.S. 1n the Nurse-Mldwitery program at the Universlty of Minnesota. She has been
� a staff nurse in Labor and Deltvery with NealthEast. and a charge nurse in a
private care center.
'� L1sa Eicher has been at Face to Face for almost tour years. She has an M.S.W�
degree from the University ot Iowa� and has worked since 1980 1n crlsis
counseiing� as a psychiat�lc soctal worker� and as a counselo�/therapist
almost entlrely wlth adotescents.
� The physician for the program ts currently Or. Carolyn Borow, who is a Family
Practltloner 1n prlvate practice. She has had extenslve perinatal and cortmunity
� clinic experience.
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� 53
Face to Face Health And Counseling Services, Inc. �
�
�
BUDGET - YEAR ONE - 1992
MCH OSAP MED. OTHER TOTAL - �
REQ. ASST. FUNDS
b IN -KIND ,
' �
PERSONNEL
1.0 Outreach Worker �
@ �21,500 15,125 6,375 21,500
0.25 Nurse Practitioner �
@ 34,000 6,765 1,735 8,500
0.25 Nurse Midwife �
@ 39,OQC� 6,109 3,641 9,750
0.15 Counselor -�
@ 27,000 2,782 1,268 4��� �
0.25 Medical Asst.
@ 15,600 3,120 780 3,900 �
0.20 Receptionist
@13,520 2,704 2,704
0.20 Clinic Director �
@28,100 2,837 2,783 5,620
0.10 WIC Nutritionist �
@28,000 2,800 2,800
6 474 11 643 2 800 58 824 ,
TOTAL PERSONNEL 17,907 2 , , . .
FRINGE @ 14.5X 2,597 3,839 1,688 406 8,530 �
CONTRACT MD @ _
�140/CLINIC FOR �
50 CLINICS 5,200 1,800 7,000
CHRYSALIS CONTRACT 8,000 8•� �
SUPPLY/LAB FOR 100
CLIENTS @ �100 PER
CLIENT 3,000 4,000 7,000 �
BEEPER @ �250/YEAR 250 2�
MILEAGE FOR OUTREACH �
WORKER @ 1,000 MILES 1,250 1.250
54 �
� Face to Face Health and Counseling Services, Inc.
�
�
TRANSPORTATION FOR
� CLIENTS 2,000 2,000
, OFFICE SUPPLIES FOR ,
OUTREACH WORKER 200 200
� ULTRASOUNDS/DIABETES
CLINIC 10,000 10,000
�
TOTAL DIRECT COSTS 24,204 46,513 29,131 3,206 103,054
� FACILTIES/INSURANCE
MANAGEMENT AND
� GENERAL ,@ 21y. OF
SALARIES/FRINGE
AND SUPPLIES 4,306 6,996 5,089 16,391
� GRAND TOTAL 28 510 53 509 29 131 8,295 119,445
� � �
� ---------------------------------------------------------------------------------
------------------------------=--------------------------------------------------
� --------------------------------------------------------------------------------
BUDGET - YEAR TWO - 1993
� MCH OSAP MED. OTHER TOTAL
REQ. ASST. & IN
KIND
� �
PERSONNEL @ 5�G INCREASE 21,067 12,767 12,225 15,706 61,765
� � reduction in OSAP
match for Outeach Worker
FRINGE @ 14.5X 3,055 1,851 1,773 2,277 8,956
� CONTRACT M� 2,650 4,550 7,200
� CONTRACT WITH CHRYSALIS 4,000 4,000
SUPPLIES 3,100 4,100 7,200
� BEEPER @ 260 260 260
MILEAGE 1,200 50 1,250
iCLIENT TRANSPORTATION 2,000 2.�
, 55
Face to Face Health And Counseling Services, Inc. �
�
�
OFFICE SUPPLIES FOR
OUTREAI:H 200 200 �
, ULTRASOUNDS/DIABETES
CLINIC 12,000 12,000
------------------------------------------------------------------------------ �
TOTAL DIRECT 27,782 24,368 34,698 17,983 104,831
INDIRECT 3,356 3,714 6,711 3,362 17,143 �
GRANO TOTAL 31,138 28,082 41,409 21,345 �
$ 121,974
�
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56 '
�
� - North End Medical Center
Subgrantee D
iTarget Po�ulation - Minority women in the Rice Street and Mt. Airy health planning
areas. Special efforts will be made to reach single women under the age of 30.
� Objectives - North End Medical Center has two primary objectives for the project to
improve pregnancy outcomes:
� 1. Develop an outreach program in the North End/Mt. Airy areas to increase awareness
of the importance of early and on-going prenatal care and availability of services.
� 2. Increase by 25% the number of minority women served who are at risk for late entry
to prenatal care or poor birth outcome because of income status, lifestyle or age by
� December 31, 1993.
Methods - In order to achieve the abovementioned objectives, some of the methods
� which will be undertaken include:
• By 4-30-92 develop written materials that are culturally, age and educationally
� appropriate describing the importance of prenatal care and agencies able to meet
prenatal needs.
� • By 5-30-92 meet with area service providers to increase awareness and
communication and to develop a process for patient access to prenatal care.
� • By 12-31-93 conduct 16 information sessions in the community to communicate
the importance and availability of prenatal services. Written materials will be
distributed to a minimum of 2,000 people.
� • - 2 conduct trainin sessions on culturall sensitive renatal care for
By 4-30 9 g Y P
Native American, Southeast Asian and African American women.
� n uct four ou health education sessions to women who are at-
• By 12-31-93 co d gr p
risk and contemplating pregnancy to stress the importance of early prenatal care.
�
• By 12-31-93 work individually with 75 pregnant women and help them access
prenatal care at North End Medical Center or another provider during the lst
� trimester.
� • By 12-31-93 have identi5ed, coordinated care, and delivered babies to 50
minority women considered at-risk.
� For several years, North End Medical Center has had a Patient Representative staff
person who coordinates care within the clinic and referrals needed outside of the clinic.
Since this has proven to be effective, this established referral process and dorumentation
� procedure will be used for this project also.
'l�aining/ExQerience - Documentation of the training and experience of staff follows.
�
57
�
�
I,j�gg� - North End Medical Center works cooperatively with many area agencies to
ensure the needs of patients are being met. Some of the primary agencies with whom �
North End interacts include: Capitol Community Services, Ramsey County Public
Health Nursing, Ramsey Action Programs, public housing authority/social workers, Lao
Community Service, and other community clinics. �
$eimbursement and Fees - Eligibility to Medical Assistance and other programs is
determined for all prenatal patients. A sliding fee scale is available for those individuals �
who do not quality for public programs.
Budget Tustification - North End will receive $7,500 in 1992 and $9,500 in 1993 to �
support their proposed program to improve pregnancy outcomes. These funds will be
used primarily for outreach, education and case management activities. The total budget �
and justification for the project follows.
��
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58 �
.
� orth End Medica Ceilter A NON-PROFIT COMMUNITY CLINIC
�]35 MAN1TUl3/1 AVCNUE • S'f. ['AUI., MINNESOrI'A 55117 • Medical Services
(612)489-8U21 • Mental Health Services
• I atient Education Program
POSITION: Health Educator
RESPONSIBLE TO: Director
SUPERVISION: None
ROLE: To provide health education information and
support to clinic patients, individuals and groups in
the North End community
� EDUCATION: BA Degree in Health Education or closely
. related field
� QUALIFICATIONS: Interest in public health issues; experience desired
� Strong written and verbal communication skills
� Ability and some demonstrated experience in
, working with individuals and groups
� Ability to effectively work with a variety of
� patient lifestyles and life-circumstances
RESPONSIBILITIES: Establish a rapport on a one-to-one basis with
any individual seeking information on health issues
� Responsible for developing and maintaining
i
education resource files and "education corner"
� Develop working relationships with area agencies
to promote North End Medical Center health education services
Make appropriate referrals to outside resources to
meet the needs of patients
�.
Maintain patient records and log book
� Conduct individual and group sessions on health
� topics of interest to tarqeted populations
� Prepare health education/information articles for
newsletter and neighborhood newspaper
� Develop health education programs in response to '
patient/clinic needs
� Other duties as requested by Director
�
� �,0 6/91
Ifranrh L�natiun: ?��N1 Kirr �Ii��et • I.itlle Cana�la, �4innesnta 55113
�
.
North End Medical Center A NC)N-I'ROfIT COMhtUNl7'Y �t.INIC
135 1�1AN17�1)IiA AVGNUL • S'1'. I'nUl,, MINN[:SOTA 55117 • Medical Services
(612) 489-81121 • Mental Health Services
• Patient Education Program �
POSITION: Patient Representative �
RESPONSIBLE T0: Director
SALARY RANGE: �
SUPERVISION: Works under the supervision of Director; no
supervision of others. �
ROLE: The role of the Patient Representative is to serve
as an advocate for North End Medical Center patients,
and as a liaison to community agencies to promote �
clinic services.
EDUCATION: Must have graduated from an accrediated nursing or
social work program; or have background and exper-
ience in advocacy/�ommunity relations . A background
in public health issues is preferred.
QUALIFICATIONS: A working knowledge of community/public health �
services
Knowledge of community resources in the Metro area; �
and ability to coordinate information and referral
requests
Ability to work with a variety of health care and �
community professionals and patient circumstances
RESPONSIBILITIES: Provide referral and resource information to provide
and clients �
Provide all necessary referral material/patient infor-
mation to resources when a referral is made �
Act as the liaison with insurance carriers for auth-
orizations for special services and referrals �
Responsible for documentation as required
Meet with community agencies to promote clinic servi e
� and identify new areas of service development �
Responsible for maintaining an accurate referral log
Work with providers in case management of patients �
• Coordinate prenatal programming with providers and
3rd party payors �
Act as a advocate for clinic patients and document a 1
activities in medical records
Triaging phone calls and advise patients according to
medical protocol �
Other tasks as required by supervisor
G(� Rev: 6/°
.• � � --'- �--- �nn�� u:.... c....V.Y� 1 :��1., r'.......J. \�:..........�� SG111
i
.
� North End Medica Center A NON-PROFIT COMMUNI"JY CLINIC
l35 MANITOBA AVENUE • ST. PAUL, MINNESOTA 55117 • Medical Services
(612)489-8021 • Mental Health Services
� • Patient Education Program
� POSITION: Bilinqual Medical Assistant
RESPONSIBLE T0: Lab Supervisor
SALARY RANGE:
� SUPERVISION: Works under the supervision of Lab Supervisor
ROLE: The role of the Bilingual Medical Assistant is to
facilitate the health care delivery to SE Asian patients by
� assisting providrs, performing medical support and advocacy
services
� EDUCATION: Graduate of a Medical Assistant program;
MA Certification preferred
QUALIFICATIONS: Fluent in English and Hmong languages
� Knowledqe and experience with lab equipment; health
care delivery; and ability to work with a variety of providers
� and patient cultures/lifestyles
RESPONSIBILITIES: Prepare patients and examination areas for clinic visits
� Assist in taking patient histories and performing
routine screenings/lab testing
� Perform electrocardiograms, give injections, veni-
punctures and take vital signs
� Assist in providing education to patients
Serve as an interpreter during medical appointments
� Translate health information to SE Asian patients and
develop written materials as necessary
� Assist with appointment scheduling and patient
reqistration
� � Act as advocate for SE Asians seeking service at NEMC
Act as liason with area aqencies and service providers
to promote clinic services available to SE Asian population
� Provide outreach services to Mt. Airy residents to
promote clinic services and provide health care information
� Coordinate case management and referrals of SE Asian
patients with Patient Representative
� Other duties as requested by supervisor
,� 61 6/91
��1'111�'�1 � �1,'.rlh�il. ^�1111) �'I�•�• �iIP�'�'� • � 1����' �'�lll.li�,l n�111111�ti��) i �i�� ��
North End Medical Center �
BUDGET: �
Year I Personnel: � �
Health Educator . 20fte @ $11. 50/hr
salary and benefits $4 ,784
Patient Representative . 10 fte @ $10/hr �
salary and benefits 2,080
�
Training: �
Cultural sensitivity training 500
Printing: �
Written materials 2 ,000 pieces 150
TOTAL $7 , 514 �
(25$ match in Year I is from Bilingual Worker -
expected to be involved with this project for � �
8 hours a week = $4 , 680)
Year II Personnel: �
Health Educator .20fte @ $12/hr
salary and benefits $4 , 992
Patient Representative . lOfte @ $11/hr 2, 288 �
Bilingual Worker . 20fte @ $9/hr 3,744
TOTAL �11,024 �
(25$ match in Year II is from �
additional printing $400; phone $450
staff travel ;250; other personnel time
;2, 500; office space $2, 000� physician' s �
participation in case managment $1 , 600;
and program promotion ;250 - $7 ,450)
Units of Service: 50 prenatal patients/deliveries - �
2,000 individuals reached in outreach activities
' 16 agency sessions
0 health babies to high-risk women �
Cost per unit of delivering 5 y
through this project is ;220. 48 per women �
�
�
62 �,
��
� n r m e linic
Subgrantee E - St. Paul-Ramsey Medical Ce te /Ra s y C
� T�get Po lation - High risk and low income Southeast Asian women living in St. Paul
� Obiectives - This project is directed at providing culturally sensitive care under a
program wluch combines home visits and clinic visits under the direction of Certified
Nurse Midwives. The pnncipal ob�eMive �s to reduce the late (thud trimester or none)
prenatal care in Southeast Asian women. As such, there are two primary objectives:
�
1. To increase the number of Southeast Asian women who seek early prenatal care by
� December 31, 1993.
2. To provide culturally appropriate staff and environment to Southeast Asian women
� receiving prenatal care through December 31, 1993.
Methods - The methods which will be supporting the objectives include:
� • A Certified Nurse Midwife (CNM) will hold a prenatal clinic within the
International clinic one day/week.
� • Satellite clinics will be continued in Mt. Airy and McDonough projects and two
other clinics will be established.
� � A Hmong bilingual worker will be hired to assist in the clinics, combining
interpreting and care provision.
� • Public Health Nurses PHN and Nursin Assistants NA) will identify and refer
� ) g �
women as soon as pregnancy is identi�ed.
� • All care 'vers will be women.
�
� • Pregnant women will interact with only two primary care givers.
� • Fewer laboratory tests and invasive procedwes will be done.
- • Monthly meeting and case conferences will be held between CNM, PHN and
� consultants.
14�aini g�xue� - Documentation of the training and experience of staff follows.
� � - The principal linkage for this project involved the Ramsey Clinic Certified
Nurse Midwives and the Ramsey County Public Health Nurses.
� Reimbursement and Fees - Reimbursement for services provided will be sought from
available resources including Medical Assistance and Ramsey Care.
� BudEet Tustification - Ramsey Foundation will receive $9,500 in 1992 and $9,500 in 1993
to support their proposed program to improve pregnancy outcomes. These funds will be
� 63
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�
used for a bilingual worker to support outreach, education and prenatal care activities.
The total budget and justification for the project follows. �
�
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64 �
I .
Ramsey Foundation
�
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� PROFESSIONAL VITAE
Helen B. Bruce, R.N.
, R.G.N. , S.C.M. . M.T.D. (U.K.)
�
Present Address: 5314 Hiawatha Lane. Minneapolls. Mn 55417
�
Registration: United Kingdom with The Central Council for Nurses, Midwives.
� and Health Visitors as a Registered Nurse and Certified. Midwife, Personal
Identiflcatlon Number 604 0026.5. Minnesota Registered Nurse Number 472-08-2453.
� Training and Educational Preparation:
1 . Student Nurse Training: Peel Hospital , Galashiels. Scotland
2. Pupil Midwife: Elsie Inglis Maternity Hospital , Edinburgh, Scotland
� 3. Midaife Tutor Student: High Combe Teacher Training College, Kingston Upon
Thames, Surrey, England
4. Recertification Student: Frontier School of Midwifery and Family Nursing,
Hyden, Kentucky
� Professional Experience:
1 . General Theatre Complex: Peel Hospital , Galashiels. Scotland 1963-1965
� Position: Staff Nurse and Sister
2. The Simpson Memorial Maternity Pavilion: Edinburgh. Scotland 1966-1969
Position: Staff and Sister Midwife
� 3. Kur�i Holy Family Hospital : Patna, Bihar, India 1969-1973
4. The Labour Ward: The Simpson Memorial Maternity Pavilion: Edinburgh.
Scotland 1973-1975 and 1976-1979
5. The Queen Mothers Hospital : Yorkhill . Glasgox, Scotland. 1979-1986
� 6. Perinatal Unit: Abbott-Northwestern Hospital , Chicago Avenue, Minneapolis
Mn, 1987-present
�
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� 65
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Ramsey Foundation
�
ROBERTA RAE POIRER �
MS, RN, BSN, CNM. RNA
� Present Address: 2300 Duncan Road. Bloomer. Wi
�
/ Registration: Mlnnesota Nursing Number NB-00173-01 . Wisconsln Nursing
Number 60239. ACNM Nursing Number 03277/4676. �
Training and Educational Preparation: �
t . Certified Nurse Midwife: tCNM)Medical University of South Charleston,
Charleston. South Carolina
2. Nursing Leadership: (MS)Univeristy of Minnesota, Minneapolis. Mn
3. Nursing: (BSN)University of Wisconsin, Eau Claire, Wi �
4. Nurse Training: Presbyterian Hospital , Chicago, I1
Professional Experience: �
1 . Director-Nurse Midwife Service. Ramsey Clinic Associates, St. Paul . Mn
3-88 to Present
2. Private Practice-Blue Diamond Family Practice Clinic. Bloomer� Wi �
9-86 to 3-88
3. Developing Private Practice-3-86 to 9-86
4. Staff CNM-Nurse Midwife Service-St. Paul Ramsey Medical Center. St. Paul
Mn 6-85 to 3-86 �
5. Fellowship Nurse-Midwife-Birth Center, Holy Family Services, Weslaco. Tx,
2-85 to 6-85
6. Faculty-Associate Degree Nursing-Proqram Instructor-Eau Claire, WI �
10-82 to 12-83
7. Staff RN-Nursing Pool-Professional Nursing Service. Metiarie. LA
9-81 to 3-82
8. Lecturer-Maternal/Child Health-University of Wisconsin, Eau Claire, Wi �
9-81 to 3-82
�
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66 �
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Ramsey Foundation
� ET
BUDG
� . �� SiT_d.C.� To t a 1
� Pro�ect Dlrector — (Roberta Poirier)
Certified Nurse Midwife E�
, Director CNM Services at RC
� Salary — 0.1 FTE f 2.125 s2,125
Fringe benefits @ 25X 531 531
� Certified Nurse Midwife (Helen Bruce)
Salary — 1 .0 FTE �29.017 ; 9,673 =38.690
Fringe benefits l25X 7.255 2,418 9.673
� Hmon nursin assistant (to be hired)
9 9
Salary — 0.5 FTE = 4,680 4,680 9.360
� Fringe benefits � 25X 1 .170 1 �170 2,340
� Secretary/Data entry (to be hired)
Salary — 0.25 FTE S 5.000 5,000
Fringe beneflts @ 25X 1 ,250 1 �250
� Consultant fees for PHN
S50/month 600 600
�
Supplies 300 300
� TOTAL — 1992 s51 ,328 518,541 �69,869
TOTAL — 1993 �1 .328 S18•541 569.8�
� TOTAL FOR TWO YEARS , 102,656 537,082 5139,738
�
Amount requested - s18,541/year for two years • =37,082.
�
�
�
� �
� 67 '
,
�
MONITORING/EVALUATION OF SUBGRANTEES
�
To ensure that every effort is made to achieve the proposed goals and objectives, the
subgrantees efforts and performance will be monitored on a regular basis throughout the �
contract period.
Contracts will be written between the St. Paul Division of Public Health and the �
subgrantees indicating specific performance objectives and outcome indicators. The
contracts will outline the subgrantees duties, reporting requirements, the monitoring
expected/performed by the Division, and evaluation indicators. An example of an �
monitoring/evaluation tool to be used for on-site evaluation visits is included in
Appendix C.
Subgrantees will also be required to provide a semiannual performance report 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 virtually every aspect �
of their programs are reviewed.
�
PROGRAM EVALUATION
a will be sou ht from various sources, both nationall and locally, including the �
Dat g Y
Minnesota Department of Health, to monitor pregnancy outcome trends. This data will
be used to analyze the impact that the project has had on the goals and objectives of the �
project throughout the two year period. Since most of the overall objective for this
project extend beyond the two year cycle of this grant, and summary data is frequently
available on a two year delayed basis, progress toward the objectives will be measured. �
In addition, data will be collected from each subgrantee to identify: �
• age of clients
• race and ethnicity of clients �
• residence of clients
• time of entry into prenatal care
• number of individual health education/counseling visits �
• number of group education/counseling sessions held, and number of persons
served
• number of fetal deaths �
• number.of neonatal deaths
• number of infants with birth weights less than 2500 grams
The evaluation results will be used to identify whether or not current programs are �
appropriately impacting the efforts to improve 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.
68 �
� ��- ����
� 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.
� PrQblem Statement - Adolescents have a wide variety of needs specific to their age
group. While they are still in the process of development, many adolescents exhibit
health problems that are closely associated with social factors including poor decision-
� making and conflict-resolution skills, low self-esteem, isolation and alienation from
others, and lack of basic knowledge about their own health.
� Because of this, adolescents require services tailored to meet their specific needs. The
services must be accessible, acceptable and available in order to be effective. For these
reasons, Health Start provided comprehensive adolescent health services within the
� school setting at five public high schools in St. Paul: Harding, Como Park, Central,
Johnson and Humboldt Junior/Senior High.
� Health Start is also actively studying the feasibility of opening a school-based clinic at
the Highland Secondary Complex, the sixth mainstream high school in St. Paul. The
need for services at Highland Park is documented by the students and demographic data
� about them. A significant number of the students come from low income families.
Based on family income in 1989-90, 52% of the students qualified for free or reduced
price lunch, the second highest percentage among the six lugh schools. 48% of the
! students are members of minority groups, comparable to Central and Humboldt High
Schools.
� Discussion and planning is currently underway to allow for the school-based clinic at
Highland, with a possible operational date in 1992 if suf�cient funding is available. If
� tlus occurs, projections in Health Start's clients during this proposal period would be
altered at a later date.
� During the 1990-91 school year, students again demonstrated their need for clin.ic
services by using current services extensively. A total of 2,512 students made 11,974
visits, generating 23,811 encounters with staff.
� For many students, the Health Start school-based clinics are their only source of health
care. For many others, these clinics are an important link that enables them to obtain
� access to other existing community health care resources.
� - The goal of the Adolescent Health Program is to promote a positive health status
� and reduce the incidence of unplanned pregnancy, nutrition problems, depression,
chemical abuse and family and relationship problems among adolescents in St. Paul by
providing comprehensive health care services at five sites within the city.
� T�et Po u1R ation - 1'he clients targeted to be served by the Health Start Adolescent
Health Program are adolescents living in the City of St. Paul.
�
� 69
�
'v v n tablished for the Adolescent Health �
Ob�ectives - The follovv�ng ob�ecti e ha e bee es
Program in order to achieve the goal: �
1. A total of 5,000�uruor and senior high students will make visits to the school-based
clin.ics during 1992 and 1993. �
2. Physical examinations, health assessment and screenmg and reproductive health
services will be provided in 15,000 visits in 1992 and 1993. �
3. The incidence of prematurity and low birthweight of infants born to adolescents
followed through the high school clinics will be reduced to 9.5% by December 31, 1993. �
4. The number of males using family planning services in the five high school clinics will
be increased by 5% by December 31, 1993. �
5. Psychosocial evaluation and diagnostic assessments and on-going counseling will be
provided for 21,800 adolescents at risk for depression, chemical misuse, pregnancy,
relationship problems, school problems and/or physical, sexual or emotional abuse in �
1992 and 1993.
6. Decision maldng counseling and family planning services will be provided for 1000 �
adolescents in 1992 and 1993.
7. Nutrition education and counseling will be provided for 1200 adolescents in 1992 and �
1993.
Methods - Man methods have been identified to achieve the above Adolescent Health �
Y
Program Objectives including the following:
� Com rehensive services that are accessible and acce table to hi school a e �
p P Sb S
adolescents will be provided in clinics physically located within the school building
of five St. Paul schools: Johnson, Harding, Central and Como Park High School �
and Humboldt Junior/Senior High School.
• Clinics will be open daily during school hours, and for at least on half hour �
before school open and one half hour after school closes.
• Interdisciplinary health care services will be provided to adolescents enrolled in �
the high schools. These services are offered to address the diverse health needs
of students. �
• Students registering for clinic services will be asked to complete a history form
that details medical and family history, behaviors and feelings. This form will �
provide staff with background data necessary for providing good care and for
triaging clients to appropriate staff.
• Physical examinations, health screening and assessment, diagnosis and treatment �
of acute and minor illness, and simple laboratory tests will be provided on site by
70 �
�
� a pediatric nurse associate, family physician and/or pediatrician.
' • Nutrition education and counseling, including identification and counseling of
students with weight control issues, eating disorders, athletic and general nutrition
needs will be provided by a Health Start nutritionist.
� • Psychosocial assessment and ongoing counseling about relationship and family
issues, physical, sexual and emotional abuse issues, pregnancy, chemical use,
� depression, eating disorders, school problems, and financial and housing problems
will be provided by the clinic social worker.
� • Decision-making counseling and family planning education and counseling will
be provided to adolescents requesting these services by a Health Start health
� educator.
• Reproductive health services of family planning counseling, examination, and
prescriptions, testing and treatment of sexually transmitted diseases and pregnancy
', testing and counseling will be provided in clin.ic by the nurse practitioner.
� Prenatal care will be provided in each clinic by an obstetrician, certified nurse
� midwife, or family physician for those students choosing to deliver through the
Health Start program.
� • Health Start staff will provide risk assessment and prevention education for all
STDs, including AIDS.
� • Extensive health education activities such as prenatal and parenting classes,
weight control classes, and human sexuality programs will be offered in order to
� maximize the understanding and practice of positive health behaviors.
� Individual and group education will be provided in clinic and in selected
� classrooms by all members of the interdisciplinary team.
� Education programs for groups of adolescents with special needs will be
� developed and implemented as needed, (i.e. learning disabled, English as a
second language, adjudicated youth).
� � Clients will be refened to other sources of care as needed in order to ensure
continuity of care for adolescents and to maintain coordination and integration
with other existing health, social service and educational programs for adolescents.
� - Documentation of the training and experience of staff follows.
, j�j� - Clients will be referred to other sources of care as needed in order to ensure
continuity of care for adolescents and to maintain coordination and integration with
other existing health and social service and educational programs for adolescents.
�
� 71
�
- Matemal and Child Health fundin allows Health Start to �
Reim g
provide comprehensive health care services to adolescents who have no third party
source of payment. Clients are assisted in applying for Medical Assistance and the S
Children's Health Plan when they are eligible and not yet enrolled. Health Start also
has worked with the Prenatal Care Initiative Program, and will bill third parties for
services whenever possible. ,
Budget Tustification - Health Start, Inc. will receive $400,000 each year in 1992 and 1993 �
to support the Adolescent Health Program through school based clinics. The total
budget and justification for the budget follows.
Monitorin�,/�valuation of Subgrantee - To enswe that every effort is made to achieve `
the proposed goals and objectives, Health Start's efforts and performance will be
monitored on a regular basis throughout the contract period. �
A contract will be written between the St. Paul Division of Public Health and Health
Start indicating specific performance objectives and outcome indicators. The contract �
will outline Health Start's duties, reporting requirements, the monitoring
expected/performed by the Division, and evaluation indicators.
Health Start will also be required to provide a semiannual performance report evaluating �
their own program, and assessing progress toward goals and objectives. Both subjective
and objective tools will be used-�y-Health Start to ensure that virtually every aspect of �
their program is reviewed.
PrQgram Evaluation �
Data will be sought from various sources, both nationally and locally, including the
Minnesota Department of Health, to monitor adolescent health trends. This data will be �
used to analyze current adolescent health needs and problems, and the impact that the
program has had on the goals and objectives of the project throughout the two year
period. Since summary data is frequently available on a two yeaz delayed basis, progress �
toward the objectives will be measured as data becomes available.
In addition, data will be collected from Health Start to identify: �
• number of clients served �
• age of clients
• race and ethnicity of chents
• number of physical exams and health assessments performed �
• number of group education/counseling sessions held, and number of persons
served
• number of psychosocial evaluations/diagnostic assessments performed '
• number of counseling visits
• number of males seeking family planning service for contraception counseling
�
72 �
�
il The evaluation results will be used to identify whether or not current programs are
appropriately impacting the efforts to improve adolescent health. Based on this
� evaluation, services and programs may need to be modi�ied or reforused to maximize the
likelihood that the objectives and goals are met.
�
�
�
�
�
�
�
�
�
�`
�
�
�
�
�
� 73
Health Start, Inc. �
�
1Y�II�/EZpCtICIICC Of StSff �
Health Start has provided maternal and child health services in St. Paul
since 1967. All Health Start staff are professional health care personnel
wtth special expertise in maternal and child health. The majority have had ,
more than Sve years experience. All sta�'are evaluated at least once a year.
� Staff are supervised by the executive director, medical director, associate
medical director, nursing supervisor, social work supervisor, nutrit�on �
supervisor or health education supervisor. Donna Zimmerman is the
executive director of Health Start and is responsible for the overall
management and direction of the project, as well as external relations and i
long-range planning. Dr. Laura Edwards is the medical director and is on
the sta�of the Department of Obstetrics and Gynecology at St. Paul-Ramsey
Medical Center. She has been director of the MCH program for 17 years ,
and is responsible for all Ob/Gyn medical aspects of the pro,�ect. Dr. Chris
Reif, a member of the Family Practice Department at St. Paul-Ramsey
Medical Center, is the associate medical director, responsible for medical �
direction in the school-based clinic program.
Because of their expertise witti maternal, child and adolescent issues, many
staff of Health Start are in demand as speakers locally and nat�onally. �
Staff continue to update their knowledge and skills by attending relevant , �
workshops and conferences.
�
�
_ _ _ �
�
�
. �
. �
�
74 • �
� Health Start, Inc.
CURRICULUM VITAE
,
NAME TITLE
�lCaren Grumstrup Nurse Practitioner/Clinic Coordinator
t
DUCATION (INSTITUTION AND LOCATION) DEGREE/YEAR CONFERRED FIELD OF STUDY
lanned Parenthood of Minnesota Certificate/1990 OBJGYN NP
�Alletropolitan State University B.A.N./1985 Nursing
�Anoka-Ramsey Community College A.D./1972 Nursing/R.N.
!�
ROFESSIONAL EXPERIENCE (COMMENCING WITH PRESENT POSITION)
�10/90 - present Health Start, Inc., 640 Jackson Street, St. Paul, Minnesota.
Nurse Practitioner and Central High School Clinic team leader.
'�6/90 - 10/90 Group Health, Inc., 2829 University Avenue, S.E., Minneapolis,
Minnesota. OB/GYN primary provider of gynecological services.
�8/84 - 6/89 Goodhue-Wabasha Public Health Services, 419 Bush Street,
Redwing, Minnesota 55066. Fami�y Planning, Adolescent
Health Educator and AIDS Education Coordinator. Managed the
� HIV/AIDS Education Program for Goodhue and Wabasha Counties.
�1979 - 1984 St. John's/Interstate Medical Center, Highway 61 . Redwing,
Minnesota 55066. Developed and taught classes for expectant
� parents.
1�974 to 1978 Hennepin County Medical Center, 701 Park Avenue, M�nneapolis,
� • Minnesota 55415. Supervisor, nursing staff and Manager of
Patients Needs, Emergency Services.
�PROFESSIONAL AFFILIATIONS
Minnesota Public Health/American Public Health Association
�NAACOG
Sicus
, PUBLICATIONS, PAPERS� PRESENTATIONS� PROFESSIONAL AWARDS
�
� Date: 7/91
75
Health Start, Inc. �
CURRICULUM VITAE
NAME TITLE t
Mary Jo Mleziva, L.I.C.S.W. Clinical Social Worker
�
EDUCATION (INSTITUTION AND LOCATION) DEGREE/YEAR CONFERRED FIELD OF STUDY
University of Utah M.S.W./1975 Social Work
Salt Lake City, Utah �
College of St. Scholastica B.A./1965 Social Work �
Duluth, Minnesota
PROFESSIONAL EXPERIENCE (COMMENCING WITH PRESENT POSITION) �
1984 - present Health Start, Inc. (formerly St. Paul MIC Project), St. Paul,
Minnesota, Clinical Social Worker, School-Based Clinic Coordinator,
Humboldt High School ,
1976 - 1980 Grant County Department of Social Services, Lancaster, Wisconsin, ,
Supervisor Adult and Family Services
1975 - 1976 Salt Lake City Division of Family Services, Salt Lake City, Utah, ��
Certified Social Worker for unmarried parents
1971 - 1973 Salt Lake City Division of Family Services, Salt Lake City, Utah, �
Social Worker for unmarried parents
1969 - 1971 Dakota County Welfare Dept., South St. Paul, Minnesota, Social �
Worker for child welfare
1967 - 1969 Catholic Welfare Services, Minneapolis, Minnesota, social worker �
for unmarried parents and adoptions
1965 - 1967 Stearns County Welfare, St. Cloud, Minnesota, Social Worker for �
Child Welfare
PROFE I NA F I �
SS O L A FIL ATIONS
- Minnesota Association of Social Workers
- Member of Task Force on Foster Care developing criteria for selection and training r
of foster parents
- President of Associated Students of Social Work �
- Member of the Faculty Executive Council, University of Utah
- Student representative of Faculty Councit, University of Utah
- Vice President of Union, Dakota County Welfare Agency Professional and Non- �
professional Employees
�tJBLICATIONS� PAPERS, PRESENTATIONS, PROFESSIONAL AWARDS �
- Developed flier for conference use explaining services to the single adolescent
parent
76 '
BIOGRAPHICAL SKETCH .
vs TMc Fo��on�ra ��oFau►r�oH rae uo+ �a�r srru►� �acR• �G l(�!i N6 •1 TH 7f1E PflOGRAM D 1 REGTOR.
t CO�fT 1 N�JAT 1 ON rA� MO FOLLO�/ T1; SIM� GiJ�RAL F01irtAT FOR Gal P[RSON.
� • TITL� sIRTFDAT! �MO.owr.rw;
S.�A«SOI� , PaTRICI�+ Dietitian 1/ 14/51
71 ON (�t01 N w 1 TN �I1CCJ1Lt1A1�tA�t 011 OT11ilt 1 N t T 1 AL rROr!!f I ONAL l�YCAT 1 ON AND t NCLYDt
rOiTDOCTORAL TRAININO.
1 NST 1 M I ON MO L06A?1 ON DEGTiEt YSAR CO[�E!!�D F 1 tLD OR STLIGY
University o: ::innesota 1972 College of Liberal
?•1in�e2polis , :;innesota �rts
� University of 'r3innesot2 B.S. 1974 D�etetics
St. 'aul , ?;innesota
St. ?aul ita�sey i�ledical Center �• �• 1975 t�ietetic Internship
� University of Iowa C.E.U. 1978 Intensive Ceurse on
?edistric ;lutrition
�
gF�Rp♦ /�tm/OR pROFE551 ONAL D�ER�ENCS CONCLUD i NO w 1 TM rRtl�'fT !'Of 1 T 1 OM• L 1 t1 (N GMRONOI.OQ 1 CA L
011DtR rRlV 1 OUS Oi►LOYfA�lIT [XttR 1�NCt AND NONORf.
1 NCLtJOi ►RiftltT MO�t<tRSM 1� ON AlfY CO�OI t TTttf.
� `:I� Dietit�an, St. ?aul ?amsey :4ed�czl Center - 1976 to ?resent
- � nical Dietitian International Diabetes Center St Paul Associate -
June-August 1987 � � �
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BUDGET DETAIL OF LOCAL MATCH
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�22� 1�23
, 1. Local Tax Levy Funds
� • MCH Prenatal Care at Community $136,497 $136,497
Clinics
� • Day Care 46,282 46,282
• Infant Mortality 150,355 150,355
,
� Subtotal: Local Tax 333,134 333,134
� 2. Other Local Funds Including
CHS Allocation
, • Famil Plannin $149,400 $149,400
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' • Immunizations 104,525 104,525
• Lead Screening ' 188,889 188,889
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• Nutrition 188,883 188,883
, • Health Education 173,657 173,657
, • Well Cluld 54,474 54,474
, Subtotal: Other Local Funding 859,828 859,828
�
' TOTAL LOCAL MATCH $1,192,962 $1,192,962
' �
, 91
�
' �
BUDGET JUSTIFICATION
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 outcome and adolescent health programs, a portion of the Maternal and Child
Health Special Projects Grant is budgeted to remain at the St. Paul Division of Public �
Health for Administrative Costs.
1222 122� �
Sala F, ringe: ,
17% Diane Holmgren, Health Admin. $11,308 $11,308
Manager at $66,517 �
10% Kathy Mohrland, Accounting 6,249 6,249
Tech IV at $62,492 �
9% Diane Kraft, Clerk-Tygist II 2,257 2,257
at $25,082 '
Salary/Fringe Subtotal: $19,814 $19,814 ,
Indirect ost for Administration; ,
City of St. Paul - 24.6% of $4,874 $4,8'�4
Salary/Fringe �
TOTAi AI>MINISTRATIVE COST: $24,688 $24,688 '
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, APPENDICES
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, APPENDIX A - COMMUNITY RESOURCES
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� APPENDIX B - SOLICITATION PROCESS FOR SUBGRANTS
�
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' Solicitation Pmcess for Subgrants
Notification of the availabihty of funding was provided to qualified programs in the
' area through a direct mailing of a Request for Proposals (RFP) to 30 agencies and a public
notice placed in the St. Paul Pioneer Press on June 27, 1991. An open meeting was held
on July 2, 1991 at the Division of Public Health in order to answer any questions about the
� RFP or subgrant application process. The process for selection of priority program
components and the process for selecting the requests (evaluation criteria) included in the
grant application are explained in the following RFP. The public notice, a l�st of agencies
� receiving the direct mailing, and a list of the 6 agencies requesting subgrants are also
included in this appendix.
� NOTICE OF AVAILABILITY OF MATERNAL & CHILD HEALTH (MCH) FUNDS
AND REQUEST FOR PROPOSALS (RFP)
/ ISSITED JUNE 24, 1991
SAINT PAUL DIVISION OF PUBLIC HEALTH
� SiJMMARY .
The Saint Paul Division of Public Health invites community health service providers and
� related organizations to submit proposals to conduct maternal and child health projects for:
♦ improving pregnancy outcomes through outreach, referral and/or the direct
iprovision of prenatal care for low income/high risk individuals in targeted
neighborhoods during the period of January 1, 1992 - December 31, 1993.
` The City of Saint Paul through its Public Health Division will receive $139,624 in State
Matemal & Child Health Special Project funds over this two-year period to support selected
proposals addressing improved pregnancy outcomes. Proposals are due at the Saint Paul
, Division of Public Health by 4:00 p.m. July 19, 1991.
� An MCH ad hoc task force of the Community Health Services Advisory Committee and
representatives from additional appropriate agencies and organizations will review the
proposals and make recommendations to the Board of Health for approval. Proposals
� approved by the St. Paul Board of Health will be included in the St. Paul Maternal & Child
Health Special Project Application to the MN Department of Health.
Organizations interested in applying for these competitive grant funds must show evidence
� of 501 (c) 3 status, or be local government agencies. Applicants must also meet the
eligibility requirements and proposal guidelines outlined in the following instructions, and
be in compliance with attached assurances and agreements.
� � ,
�
� B1
'
MCH SPECIAL PROJECT FUNDS FOR ST. PAUL �
According to State law, MCH Special Project funds may be used to address any or all of �
the following statewide program priorities: improved pregnancy outcomes, family planning,
handicapped or chronically ill children, and childhood injury control. Based on an
assessment of community needs, the St. Paul Division of Public Health is choosing to focus �
the available funds on projects for improving pregnancy outcomes. The Division will
allocate up to $69,812 each year for this purpose, targeted but�ot limited to residents in any
or all of the following areas: Thomas-Dale, Summit-Dale, Downtown St. Paul, Riverview, �
Dayton's Bluff, Mount Airy and Rice Street. Outreach, referral and direct services may be
provided in a variety of settings. �
All applicants must demonstrate m-kind contributions equal to 25% of the grant request.
Proposals must comply with the legislative definitions of eligible services and the St. Paul �
MCH services priorities.
Applicants may request funds for up to two years or less during the period of 1/1/92- ,
12/31/93. Proposals may be for one-time only projects or may be projects that would
require some source of continuation funds. However, MCH funds from St. Paul cannot be
guaranteed beyond 12/31/93 and should not be relied on for continuation of the project �
beyond 12/31/93. The amount and the conditions for the availability of MCH funds for
1993-95 will be determined in 1993.
St. Paul MCH Priorities �
Improved Pregnancy Outcomes �
♦ To make progress toward the goal of reducing the overall rate of late (3rd
trimester or none) prenatal care from 7.5% in 1988 (MN rate is 4.1%) to 4.5% in �
1995 with a special emphasis on pregnant white teens and all pregnant African
American, Native American and Asian women.
♦ To make ro ress toward the goal of reducing St. Paul infant mortality from ,
P S
10.3/1000 (1988 data) to 9.5 by 1995 with a special emphasis on African American
women. ,
♦ To make progress toward the goal of reducing the rate of St. Paul low birthweight
infants from 6.4 (1988) to 4.0% by 1995 with a special emphasis on African �
American, Native American and Asian women.
♦ To conduct outreach efforts to pregnant teenagers to increase the rate of first �
trimester prenatal care from 31.5% (1986) to 50% in St. Paul pregnant women
under age 20 by 1993 with a special emphasis on outreach to minority teens.
♦ To monitor the St. Paul rates for pregnancy outcome mdicators through
1993. �
�
B2 ,
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� PROPOSAL FORMAT
� The proposal should consist of a narrative description limited to ten pages which describes
the project in the following format:
, 1. Project Title
� 2. Name & Address of Applicant
3. Contact Person - Name and Phone Number
� 4. Amount Requested and Project Period
s 5. Project Abstract (1 page)
�
6. Project Narrative
, a. Tar�et PoRulation -describe the target population relative to age, income and risk
factors, and include an estimate of the number of individuals to be served.
� b. Obj�ctives - specific statements of what is to be accomplished during the project
period;objectives should be time-specific,realistic,and stated in measurable terms.
� c. Methods - describe the specific activities by which objectives will be achieved;
include how and why activities were selected, and how procedures for referral and
� follow-up will be incorporated into services provided.
d. Evaluation - describe the methodologies to be used to analyze the impact of the
� project.
e. Training,[�erience of Key Staff - summarize; one page - resume may be
, attached.
f. L,��� - describe the linkages with other relevant maternal and child health
, service providers in the project service area. Include a procedure for written
referrals for service needs not addressed by project.
� g. Reimbursements and Fees - describe plans for use of reimbursements from the
Department of Human Services (Medical Assistance, Children's Health Plan). If
� fees are to be charged to clients, please describe the sliding fee schedule to be
used.
� 7. Budget - Include a detailed project budget itemizing personnel and other costs or a cost
per unit of service provided.
� The total units of service to be provided during the project period must also be stated.
' B3 �
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PROPOSED DEADLINE - REVIEW PROCESS
Eight copies of the proposal should be submitted by 4:00 p.m., July 19, 1991 to Diane ,
Holmgren, St. Paul Division of Public Health, 555 Cedar Street, St. Paul, MN 55101.
Questions about this announcement may be directed to Diane Holmgren, 292-7712. �
An MCH ad hoc task force of the Community Health Services Advisory Committee and
additional appropriate agencies will review proposals and make recommendations to the full �
Advisory Committee. 'The CHS Advisory Committee will review these recommendations
and advise the St. Paul Board of Health about proposals recommended for funding.
Proposals approved by the St. Paul Board of Health will be incorporated into the City's �
MCH Special Project Application to be sent to the Minnesota Department of Health.
The MCH planning timetable is as follows: � �
10/1/90 - 4/30/91 Analyze MCH data for St. Paul to determine
priorities in relationship to State and '
local priorities
3/6/91 Review and input of local priorities by �
CHS Subcommittee and publ�c
6/24/91 Mail RFP �
7/2/91 Open meeting at Public Health Center from
10:00 - 11:00 a.m. to answer questions �
related to the RFP
7/19/91 Proposals due �
7/22/91 - 8/2/91 Review and selection of proposals by MCH �
Review Conunittee
8/7/91 CHS Advisory Committee review of MCH Plan �
8/8/91 St. Paul Board of Health action
9/16/91 MCH Plan sent to the State �
Upon approval by the Minnesota Department of Health (MDH), the St. Paul Division of �
Public Health staff will develop city contracts with the approved applicant agencies for the
project services. Approved projects will be required to submit monthly or quarterly reports
(as specified in the contract) and eupenditure reports to obtain reimbursement. A copy of �
the reports required by the MDH aze enclosed in the RFP. Actual reporting requirements
may vary. If desired, monthly payments based upon expenditures or units of services
provided may be negotiated. '
B4 ,
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, �FFIDAVIT OF i'ZJI3LiCATYON
�
STATi: OF 14f[Ni\E�OTA
' COUNTY OF' RA11iSEY
, ROSEhiARY J I'RANK ,being
� i°�710E Of�E duly sworn on oath, eays: thut ho is� and durin� �
�vA�ue�urv oF all timos hercin stated has been, Clerk of
�' FUNDS FOR
�"'ME�;N`sER°�c�F'sLO Nortbwest Publications, Inc., publisher of the
The MMneso�• Deosr�msnt
� a a�a��� �.•�,.o. s»v.as. new�apaper known se the Saint Paul Pioneer
i���bN �o S�. P�u� Inroupn
=n� M�lern�l •ne Cn�ia pI'@B!i� a newepaper of general circulation within
•ItN Fqmul� BbCk Orant
r cNerWSr r�era �v��•,vs,. the City of St.Paul and the County of Ramsey.
fundt msr Dt used 10
CDnducl orokcts/w Improv-
��0 orto���cr ou�comes
� Mroupn pulreac�, rHerral �
.�e�a ��.a�.K�ao„�:��o, That the Notice hereto attacbed was cut from the
p�natsi ure
aiwa uoon sn stsesxm�nt oi colwnne of said newepaper and was printed and
�nlernsl �nC Cn1�E Heelth
cH> �«o:��St.Pe�l, i�o published tlierein on the following dates:
ltr is Inleres�ed In su0con-
t��c11n0 wlth outside sven- �
� C1lt 10 DtOVId! p1lflaf711
nea��n un ano o��treecn 91
s�rr�ces ro� n�on rlsk ane 2,7th JUNE
IOw Income wpmin. ��
O►O�nItNlO�t InleflSleO In �
p�ovltlin0 tMi� lervic�t wlll ��ny �r
D! �fkld 10 tllvNOD a oro- �
pOSal f011Owlnp MlnnflOts �
� WDerlme�f O/Hlsllh af wlll
lrL.St. P�ul OlvlilOn o1 PvDllt �/
dn �f ,
H�elln OulASl�nes. Int�reslcd J
aoenlrstlons sMU10 con�sct
Dlant Mo�mpren,SI.Peul DI-
v!s�on p1 Publlc Nesil�, SSS
�w°�:Ss"s o; iivi ii;���"io: dn,' t►r , 19
� tlrsn� o��de�lnas ProDOtels —
�re dw to tM�OOV!etlOreas � ' �9
ev�90 P.m.on Julv 19. 1991. ��`' ��'
�.n oo«+meeihrp ww oe neia �
af��e St. P�ul P�IC HaaUh
C�fer on Julv Z rom 10.00- .
1f�00a.m.10�nswer ouestlont
rN�tM to tM Rwuesl lor �
Pr000se�s<RFP). �n� n� 1
, Tlie RFP tor IIMV U�nds wes
�h9 ms�kd w OlstrlDulcd �o
27 wp�nlretlons/ Inelvidunls ]
rvNO sr• Int�r�sfsd In pup Hc (IAy' Of � 1�
Mitm Iasuea o► wno orovtoe .
11Mternsl sM Chlld Heann
Servkes to Nph rlsk�nE bw ' 1�
� i�„»wo��. da�� of
.71�e Community Mesttn Serv-
ites Advlsory Comml�tea
ldenilnM�ot Us memeers to
Nrve on �n �d twc MCH
tOmmittee lo r�vfew tM Gro-
� ppy�li�RO fMkf�lCOTTlf1-
. •QlNOOS fa tun01n0. AAEt- n
, lionei �C Aoe commluee
/1'1fTblff WNI CpfT1�tfOT eP�
oroais�e soencks �nE w-
Wnitetionf.
P'anee�Prns Jun 47 no 15S
Subscribed and sworn to before me this
� 27th �ny ��. JUNE 19 91
,
/ � � .
l i�� / � " Z`_ '
� _ � �
�\ Nocrry rubl�c
\
� Washi.ngton County, b'Iinnesotu
My commission cxpires October A , 19 93
� h��t.1.R�ltl`I,�+.��ne.�a�4n!:qAt�qep.NwOO�.`(
R �
f .. .�` �Y.A'� �1 RS:C.111�', P
` rI–'�7ft �:i�iLF'� �`tiRi If. :��': :f , .fA �
�. ? �;..�`'••, �:��:�.�.'. :;tp,�C�,i•r:,ti� ..
� a;�1 t,.����;r.•,t� •r fxpiits Gcl t19. t9�iZ r
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.... .!!. . .......... . . . ..':'....7✓X:':V7?t
�
r��m�u�e� B5
AGENCIES RECEIVING COPIES OF MATERNAL AND CHILD HEALTH R.F.P. 1
ST PAUL YOMAN'S CLINIC YOUTH SERVICE BUREAU AGAPE �
1690 UNIVERSITY AVENUE 1619 DAYTON AVENUE 1290 ARCADE STREET
ST PAUL MN 55104 ST PAUL MN 55104 ST PAUL MN 55106
�
LUTHERAN SOC SERV OF MN ARLINGTON HOUSE . MARY SONNEN
1201 PAYNE AVENUE 704 E. LARPENTEUR AVE DIV OF PUBLIC HEALTH �
ST PAUL MN 55101 ST PAUL MN 55117 FAMILY PLANNING PROGRAM
CATHOLIC CHAR OF ST PAUL ST PAUL PUBLIC SCHOOLS BETHESDA FAM PRACTICE CLINIC�
215 OLD 6TH STREET 360 COLBORNED STREET 590 PARK ST STE 310
ST PAUL MN 55102 ST PAUL MN 55102 ST PAUL MN 55103 �
BOOTH BROWN HOUSE SETON CENTER UNITED HOSP-MOD CLINIC
1471 COMO AVENUE
436 MAIN STREET 333 NORTH SMITH STREET �
ST PAUL MN 55108 ST PAUL MN 55102 ST PAUL MN 55102
�
THE LOFT TEEN CENTER FAMILY PHY HEALTH CENTER THE MARKETPLACE �
1063 IGLEHART AVENUE 579 WELLS STREET 2900 RICE STREET
ST PAUL MN 55104 ST PAUL MN 55101 LITTLE CANADA MN 55113
�
ANN RICKETTS PEG LABORE TOM YARDIC
FACE TO FACE CLINIC FAMILY TREE CLINIC i1EST SIDE HEALTH CENTER ,
642 E 7TH STREET 1619 DAYTON AVENUE 153 CONCORD STREET
ST PAUL MN 55106 ST PAUL MN 55102 ST PAUL MN 55107
V RLY HAWKINS CHILDREN'S HOME SOCIETY �
MARCHETA MADDEN BE E
HELPING HAND HLTH CENTER MODEL CITIES HLTH CENTER OF MINNESOTA
545 w 7TH STREET 430 NORTH DALE STREET 2230 COMO AVENUE �
ST PAUL MN 55106 ST PAUL MN 55103 ST PAUL MN 55108
COMMONHEALTH CLINIC ST PAUL RAMSEY OB/GYN NANCY BRIGGS t
13961 NORTH 60TH STREET CLINIC NORTH END HEALTH CENTER
STZLL{iATER MN 55082 640 JACRSON STREET 135 MANITOBA STREET '
ST PAUL MN 55101 ST PAUL MN 55117
PLANNED PARENTHOOD PLANNED PARENTHOOD ST PAUL RAMSEY �
OF MINNESOTA OF MINNESOTA PEDIATRIC CLINIC
1965 FORD PARRWAY 1700 RICE STREET 640 JACKSON STREET
ST PAUL l�i 55116 ST PAUL MN 55113 ST PAUL MN 55101 �
HEALTH START CERTIFIED NURSE MIDVIVES JEANNE RANCONE '
640 JACKSON STREET RAMSEY FOUNDATION FAMILIES IN CRISIS
ST PAUL MN 55101 640 JACKSON STREET DIVISION OF PUBLIC HEALTH
ST PAUL MN 55101
B6 �
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� Agencies Submittiug Proposals for Subgrants
' The followin communi a encies submitted ro osals to the St. Paul Division of Public
g tY g P P
Health by the deadline:
�
1. Face to Face Health and Counseling Center, Inc.
� 642 E. 7th Street
St. Paul, MN 55106
, 2. Health Start
640 Jackson Street
� St. Paul, MN 55101
3. Model Cities Health Center
� 430 North Dale Street
St. Paul, MN 55103
� 4. North End Medical Center
135 Manitoba Street
St. Paul, MN 55117
� 5. Certified Nurse Midwives
Ramsey Foundation
, 640 Jackson Street
St. Paul, MN 55101
� 6. Families in Crisis Program
St. Paul Division of Public Health
555 Cedar Street
� St. Paul, MN 55101 .
'
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, B�
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REQUESTS FOR MCH SPECIAL PROJECT FUNDS (IPO)
Total $ available each year: $69,812 � ,
Agency: North End Medical Center
Amount requested: �18,538 Y 1: �7,514 Y2: S 11,204 �
Target population: nunority women and women under age 30
; Rice St., Mt. Airy, Thomas-Dale
n t ident' women �
Proposal: Program to support an outreach compone t o ify
postponing or neglecting early prenatal care and working with �
them to remove barriers and access care earlier; primarily
through written materials, information sessions, cultural
sensitivity training, group health education, and working �
individually with pregnant women to access and coordinate
prenatal care
�
Agency: Ramsey Foundation (Certifed Nurse Midwives)
Amount requested: 537,082 Y1: not provided Y2: not provided �
Target population: Southeast Asian families
Proposal: Maintain and expand existing program to reduce late prenatal �
care in SE Asian women; primarily through home and clinic
visits by a culturally appropriate staff, referrals, in-service
education �
Agency: Health Start �
Amount requested: $55,042 Y1: $30,177 Y2: $24,865
Target population: Mt. Airy, Dayton's Bluff, Rice St.
Pro osal: Establish a new prenatal clinic;provide outreach,prenatal care, ,
P
follow-up and referral, transportation if needed, education,
interpretive services available ,
Agency: Face to Face �
Amount requested: �59,648 Y1: �28,510 Y2: 531,138
Target population: adolescents
Dayton's Bluff, Downtown, Riverview ,
Proposal: Continue outreach/case management program; �
provide outreach, pregnancy testing, transportation, child care,
education and counseling, prenatal care, risk assessment
'
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Agency: Model Cities
Amount requested: �99,043 Y1: �49,422 Y2: $44,621 �
' Target populatioa: African American and Hmong teens and women
Summit-Dale, 'I'homas-Dale
� Proposal: Provide social support and clinical services to
' pregnant women;primarily through case management,individua.l
� & group support,parenting education,outreach, transportation,
� prenatal care, emergency assistance
� Agency: St. Paul Division of Public Health
Amount requested: �139,624 Y1: 569,812 Y2: �69,812
� Target population: pregnant women attending Frogtown Loaves &
Fishes (Thomas-Dale)
Proposal: An interdisciplinary team to meet each pregnant woman
� attending Loaves & Fishes, and provide outreach and case
management through pregnancy and following delivery;activities
� to include pregnancy testing, referrals, risk assessment, home
visits and transportation
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AGENCY N7�iME �
l�CH COHPETITIVB GRaNT I
REVIBA CRITERIa
' YES NO COMMENT
I. I�iPPLIGTI ON
A. Aqency ia eliqible to receive funds
B. All paqes are numbered �
C. Received by deadline
POOR SriTIS EXCEL
D. Is in accordance �ith City MCH
priorities 1 2 3 4 5
E. Proposes services tarqeted to low-income �
hiqh risk individuals in tarqeted areas . 1 2 3 4 5
F. Is clearly Written and the format
far.ilitates review. 1 2 3 4 5
II . TARGET POPULATION
A. Is described including the number �
of individuals to be served,
racinl/ethnic distribution and
eligibility criteria 1 2 3 4 5
B. The applicant can demonstrate past
successful experience workinq with '
tarqet populations 1 2 3 4 5
III. OBJECTIVES �
A. Described 1 2 3 4 5
8. Relbted to priorities 1 2 3 4 5
C. Realistic 1 2 3 4 5
D. Time Specific 1 2 3 4 5
E. Measurable 1 2 3 4 5
F. Identify client's or community' s needs, 1 2 3 4 5 �
not the applicant's
IV. METHODS
A. Described 1 2 3 4 5
,
B10
, � . _ ' - :
' B. Relate to objective 1 2 3 4 5
, C. Include procedure for referral and �
fo11oW-up 1 2 3 4 5
D. Describe hov aervices will be accessible
' to tarqet population 1 2 3 4 5
� E. Are consistent vith accepted public
� health practice 1 2 3 4 5
' F. Emphasize services not research 1 2 3 4 5
� G. Likely to achieve objectives 1 2 3 4 5
V. EV]lLU7�►TION
� �i. 1�11 activities Mhich Marrant evaluation
are identified 1 2 3 4 5
B. Methods for collectinq the data are
' described and are feasible 1 2 3 4 5
C. Gives evidence that evaluation results
, Will be used for proqram manaqement �
decisions 1 2 3 4 5
D. Collects data which relate to the
� objectives 1 2 3 4 5
E. Methods for analyzing data are 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, traininq
and qualifications for staff directly
; involved in the project is included 1 2 3 4 5
_ . 8. Staff patterns appear to be sufficient _
to handle the project aorkload 1 2 3 4 5
� VII. LINRAGES
' A. Linkages and referral arranqements are
described 1 2 3 4 5
B. Description of current or anticipated
� cooperative aqreements to minia►ize
potential for duplication 1 2 3 4 5
C. Pa.ans for or descriptions of onqoinq
� collaborative activities With providers
aur.h as participation on task forces,
committees, etc. 1 2 3 4 5
, D. �pplicant can aho� e�cperience in
auccessful follow-up on referrals 1 2 3 4 5
, B11
_ � ' ,
E. Evidence of stronq referral arranqements
for prenatal care and faiaily planninq 1 2 3 4 5
VIII . BUDGET
A. Budget items are justified in terms of
project activities 1 2 3 4 5
B. Complete 1 2 3 4 5
C. Provides a rationale for formula/process
for calculation of items 1 2 3 4 5
D. Amount of fundinq requested is
appropriate for the level of service and
objectives identified 1 2 3 4 5
YES NO COMMENTS j
E. Agency has demonstrated in kind
contributions of at least 25$ of the
grant request.
F. Are mathematically correct
G. Indicates plans to obtain and use DHS ;
reiunbursements (Medical Assistance,
Children' s Health Plans)
H. Indicates sliding fee schedule to be �
used if fees are to be charged to
clients.
* ADDITIONAL COMMENTS:
�
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� APPENDIX C - MCH MONITORING TOOL
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i
1
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