HomeMy WebLinkAboutIGA - OHSU - CaCoon Program�0TES �,
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Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of September 10, 2008
DATE: August 28, 2008
FROM: Dan Peddycord, Health 322-7426
TITLE OF AGENDA ITEM:
Consideration of Board signature of document # 2008-502 - the Agreement between Oregon Hearth
& Science University (OHSU) and the Deschutes County Board of County Commissioners for the
2008 — 2009 CaCoon (Care Coordinator) Program.
PUBLIC HEARING ON THIS DATE? No
BACKGROUND AND POLICY IMPLICATIONS:
The goals of the CaCoon (Care Coordination) Program are to identify children and youth, (birth to
age 21), with special health needs; assure access to care, and assist families with information and
skills needed to become as independent as possible in caring for their child(ren).
The role of the Public Health Nurse (PHN) serving children in the CaCoon (Care Coordination)
Program is to:
- Conduct accurate assessments of child health, family strengths and needs in order to help
families identify concerns, priorities and available resources;
- Help families learn about and access comprehensive services locally;
- Coordinate health care and other services for their child(ren) with special needs;
- Collect and submit data according to CaCoon program guidelines.
This Agreement helps fund our CaCoon (Care Coordination) nurse, Debbie Fields (Public Health
Nurse).
Total: $8,350.25 each quarter for a total of: $33,401/ year.
FISCAL IMPLICATIONS:
This amount of $8,350.25 each quarter for a total of $33,401 per year is represented in the
08 — 09 budget.
RECOMMENDATION & ACTION REQUESTED:
Review and approval of the Agreement between Oregon Health & Science University and the
Deschutes County Board of County Commissioners for the 2008 — 2009 CaCoon (Care Coordinator)
Program.
ATTENDANCE: Kate Moore
DISTRIBUTION OF DOCUMENTS:
Brittany Kirkendall, OHSU, Mail Code: CDRC 707 SW Gaines St., Portland, OR 97207, 503
494-2708; and Jill Fox, Health Department, 2577 NE Courtney Dr., Bend, OR 97701.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Please complete all sections above the Official Review line.
Date: August Department:
Contact Person:
Dan Peddycord
Contractor/Supplier/Consultant Name:
HEALTH
Phone #:
322-7426
OHSU (Oregon Health & Sciences
University), Portland, Oregon, Brittany Kirkendall, 503-494-2708
Goods and/or Services:
Consideration of Board signature of document # 2008-502 - the Agreement between
Oregon Health & Science University (OHSU) and the Deschutes County Board of
County Commissioners for the 2008 — 2009 CaCoon (Care Coordinator) Program.
Background & History:
The goals of the CaCoon (Care Coordination) Program are to identify children and
youth, (birth to age 21), with special health needs; assure access to care, and assist
families with information and skills needed to become as independent as possible in
caring for their child(ren).
The role of the Public Health Nurse (PHN) serving children in the CaCoon (Care
Coordination) Program is to:
- Conduct accurate assessments of child health, family strengths and needs in
order to help families identify concerns, priorities and available resources;
Help families learn about and access comprehensive services locally;
Coordinate health care and other services for their child(ren) with special needs;
Collect and submit data according to CaCoon program guidelines.
This Agreement helps fund our CaCoon (Care Coordination) nurse, Debbie Fields
(Public Health Nurse).
Agreement Starting Date:
October 1, 2008
Ending Date:
September 30, 2009
Annual Value or Total Payment: $8,350.25 each quarter for a total of: $33,401/ year
❑ Insurance Certificate Received check box) N/A
Insurance Expiration Date:
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
X Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? X Yes ❑ No
If No, has budget amendment been submitted? ❑ Yes ❑ No
8/28/2008
Departmental Contact:
Title:
Program Manager
Kate Moore
Phone #:
322-7422
Department Director Approval:r P Z? -of
Signature Date
Distribution of Document:
Brittany Kirkendall, OHSU, Mail Code: CDRC 707 SW Gaines St., Portland, OR
97207, 503-494-2708; and Jill Fox, Health Department, 2577 NE Courtney Dr., Bend,
OR 97701.
Official Review:
County Signature Required (check one): ❑ BOCC ❑ Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
Document Number
f
)
8/28/2008
OREGON
HEALTH
&SCIENCE
UNIVERSITY
Child Development
and Rehabilitation
Center
Oregon Center for
Children and Youth with
Special Health Needs
(OCCYSHN)
Mail code CDRC
707 SW Gaines St
P.O. Box 574
Portland, OR 97207-0574
tel 503 494-8303
toll free 1-877-307-7070
fax 503 494-2755
www.occvshn.oro
August 19, 2008
Dear Contract Administrator,
Enclosed is the CaCoon contract for the fiscal year October 1, 2008 through
September 30, 2009 (FY09). We will continue with the financial reporting
requirement started last year. The details are referenced in the agreement
under item #5 - Financial Reporting Requirement. This annual report is to
be submitted on organizational letterhead and should include the information
listed on the example template — Attachment E. We would expect to see
consistency between your reported expenses and the budget allocations bui if
you have any discrepancies, please include an explanation on your report.
Although this contract is for the upcoming CCN year, the financial report
should reflect spending during the fiscal year of October 1, 2007 — Septem ber
30, 2008 (FY08). Your report is due no later than November 15, 2008. Please
note that rates have not changed so you can use the figures on Attachment E
when reporting your FY08 expenses. We will process our contract payments
for the first quarter of FY09 as you prepare your report for last year. Future
quarterly payments will be on hold pending receipt of the financial
report.
For questions related to the financial reporting requirements, please contact
Brittany Kirkendall at (503) 494-2708. Questions pertaining to CCN or the
OCCYSHN program standards can be directed to your OCCYSHN
Community Consultant.
Please obtain the appropriate signature on page 5 of the agreement and return
all paperwork attention:
Brittany Kirkendall
CDRC Business Office
PO Box 574
Portland, OR 97207
For your convenience, a pre -addressed envelope has been provided. Please
note, one original copy of the agreement should be retained for your records.
"r)c) aff-t
Marilyn Hartzell, M.Ed.
Director Director
Oregon Center for Children and Youth with Special Health Needs
Phone: (503) 494-6961
e-mail: hartzelt@ohsu.edu
Subaward No. 4 B04MC06604-01-044 B04MC06604-01-04
CFDA No. 93.994
OREGON HEALTH & SCIENCE UNIVERSITY
This Agreement is by and between the Oregon Health & Science University at 3181 SW Sam
Jackson Park Road, Portland, Oregon (hereinafter referred to as the UNIVERSITY) and
DESCHUTES COUNTY BOARD OF COMMISSIONERS (hereinafter referred to as
SUBAWARDEE)
Witnesseth:
Whereas, UNIVERSITY has been awarded DHHS, Health Resources and Services
Administration (HRSA), grant number prime contract 107743, through the State of Oregon, for
support of the project entitled "Maternal and Child Health Services Block Grant".
Whereas, the SUBAWARDEE has proposed to receive a fixed funding amount to support the
completion of a specific Scope of Work, as detailed in the grant application referenced above;
Whereas, the UNIVERSITY and SUBAWARDEE are subject to the terms and conditions of the
State of Oregon contract number 107743 and the Maternal and Child Health Service Block
Grants to the States Terms and Conditions in Attachment C.
Now therefore, the parties agree to the following conditions:
1. Scope of Work
SUBAWARDEE shall utilize the funds to complete the CaCoon Program Goals as identified in
Attachments A and D, and in Attachment B as applicable. SUBAWARDEE shall meet the
Minimum Standards of Program performance as identified in Attachment D. The conditions of
Attachment E, Eligibility Criteria shall also be met by the SUBAWARDEE when admitting
clients into the Project. All attachments referenced are hereby made a part of this Agreement.
2. Period of Performance
The period of performance of this Agreement shall be October 1, 2008 through September 30,
2009.
3. Personnel
Marilyn Sue Hartzell, M.Ed., shall be responsible for the conduct of all activities under this
project for UNIVERSITY. Debbie Fields shall be responsible for the conduct of all activities
under this project for SUBAWARDEE. SUBAWARDEE shall notify UNIVERSITY and
OCCYSHN in writing in advance of any change in Personnel. Notification shall be given to the
contact as listed in Article 16, Notices.
4. Compensation and Payment
UNIVERSITY will issue payment to SUBAWARDEE in the amount of $8,350.25 quart rly.
Payment shall be based upon the reasonable, allowable and allocable costs incurred in
providing services described in Attachments A, B and D. UNIVERSITY will reserve the right to
verify data submission and withhold payment if requirements, per the attachments, and the
reporting requirement described in Article 5 is not met.
CaCoon
Subaward No. 4 B04MC06604-01-044 B04MC06604-01-04
CFDA No. 93.994
Quarterly payment may be increased or decreased at the discretion of the UNIVERSITY,
dependent on levels of funding provided the State of Oregon and the Maternal and Child
Health Service Block Grants to the States.
Quarterly payment adjustments will be implemented by way of an amendment executed by
both parties.
Prior to submission of the final payment, SUBAWARDEE agrees to provide UNIVERSITY with
a copy of SUBAWARDEE's most current audit report. Failure to submit the report in a timely
manner will result in a delay of final payment.
The SUBAWARDEE agrees to maintain financial records, in accordance with generally
accepted accounting practices and OMB policies and regulations, which clearly identify and
describe the nature and type of all costs of the project and establish the SUBAWARDEE's right
to reimbursement. All costs will be subject to audit by the UNIVERSITY's Financial Officer or
the Secretary of State Division of Audits and the cognizant Federal Audit Agency.
From time to time, UNIVERSITY will conduct desk audits. SUBAVVA DEE agrees to comply
with requests for information in a timely manner when selected for
5. Financial Reporting Requirement
SUBAWARDEE shall submit a financial report for the project year, October 1, 2007
through September 30, 2008, and annually thereafter, no later than November 15 each
year. This reporting requirement shall be made a part of all future agreements for future
project years. Failure to submit the report in a timely manner will result in the
withholding of the second quarterly payment until SUBAWARDEE complies. Report
shall be in the format provided in Attachment E.
6. Independent Contractor
The SUBAWARDEE is an independent contractor. No provision of this Agreement shall be
deemed to constitute the SUBAWARDEE or any agent or employee of the SUBAWARDEE as
an agent or employee of the UNIVERSITY. The SUBAWARDEE agrees that it has entered
into this Agreement and will discharge its obligations, duties, and undertakings and the work
pursuant thereto whether requiring professional judgment or otherwise as an independent
SUBAWARDEE and without liability on the part of the UNIVERSITY.
7. Indemnity
OHSU and SUBAWARDEE each shall be responsible, to the other, to the extent permitted by
the Oregon Constitution (including but not limited to Article XI, Section 7 thereof), subject to the
limitations of the Oregon Tort Claims Act (ORS 30.260-30.300), only for the acts, omissions, or
negligence of its officers, employees or agents. Either party may, at its election and expense,
assume its own defense and settlement of any claim, action or suit if it determines that the
other party is prohibited from defending it, or is not adequately defending its interests, or that
an important government principle is at issue and the party desires to assume its own defer se.
CaCoon
Subaward No. 4 B04MC06604-01-044 B04MC06604-01-04
CFDA No. 93.994
8. Attribution
Neither party may produce any book, article or paper based upon or arising from the activities
conducted under this Agreement without 1) providing a copy of the book, article or paper to the
other party and 2) attributing, in the book, article or paper, the contributions of the other party
to the activities conducted under this Agreement or obtaining written permission from the other
party to forego such attribution.
9. Publications
Any research reports and publications relating to the work under this Agreement shall bear
proper acknowledgment of the support provided by grant # 4 B04MC06604-01-04 in
accordance with Sponsor requirements.
10. Use of Name
Neither party shall use the name of the other party or that party's employees, agents or
assigns in any form of advertisement or publicity without first obtaining the other party's written
approval for such use.
11. Ownership of Deliverables
SUBAWARDEE and UNIVERSITY shall jointly own all materials produced or required to be
delivered under this Agreement. UNIVERSITY and SUBAWARDEE hereby grant to the
Federal Government Funding Source an irrevocable, non-exclusive, perpetual, royalty -free
license to use, reproduce, prepare derivative works based upon, distribute copies of, perform,
and display the materials produced, and to authorize others to do the same.
12. Modifications
The parties agree that the terms and provisions of this Agreement shall be modified in writing
and executed by the parties hereto, to reflect any additional requirements or changes
mandated by the Sponsor.
13. Termination
This Agreement may be terminated by either party upon thirty (30) days notice. This
termination must be in writing and delivered by certified mail or in person. Any such termination
of this Agreement shall be without prejudice to any obligations or liabilities of either party
already accrued prior to such termination.
14. Notices
All notices required to be given under this Agreement shall be in writing and sent to the party
as indicated below:
TO UNIVERSITY
Shellye Dant, Grants & Contracts Administrator
Oregon Health & Science University
3181 SW Sam Jackson Park Road, L106
Portland, Oregon 97239
TO SUBAWARDEE
CaCoon
Subaward No. 4 B04MC06604-01-044 B04MC06604-01-04
CFDA No. 93.994
Deschutes County Board of Commissioners
Debbie Fields
2577 NE Courtney St.
Bend, OR 97701
16. Certifications
By signing this Agreement, the authorized official of the SUBAWARDEE certifies compliance
with the following rules and regulations.
A. Discrimination/Affirmative Action: The SUBAWARDEE will not discriminate against any
employee or applicant for employment because of race, color, religion, sex, marital status,
handicap or national origin. SUBAWARDEE certifies compliance with:
Title VI and VII of the Civil Rights Act of 1964, as amended, 42 U.S.C. 2000d et seq.
and
Executive Order 11246
Section 504 of the Rehabilitation Act of 1973, as amended: 29 U.S.C. 794
Title IX of the Education Amendments of 1972, as amended: 20 U.S.C. 1681 et seq.
Age Discrimination Act of 1975, as amended: 42 U.S.C. 6101 et seq.
The Americans with Disabilities Act of 1990
Non -Discrimination Action: 41 CFR Part 60
Affirmative Action Compliance: 41 CRF Part 60-1 and 60-2
B. Lobbying: No Federal appropriated funds have been paid or will be paid, by or on behalf
of the SUBAWAREE, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress, or an
employee of a Member of Congress in connection with the awarding of any Federal contract,
the making of any Federal grant, the making of a Federal loan, the entering into of any
cooperating agreement, and the extension, continuation, renewal, amendment, or modification
of any Federal contract, grant, loan, or cooperative agreement.
If any funds other than Federal appropriated funds have been paid or will be paid to any
person for influencing or intending to influence an officer or employee of any agency, a
Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the
SUBAWARDEE shall complete and submit Standard Form -LLL, "Disclosure Form to Report
Lobbying," to the UNIVERSITY.
C. Debarment, Suspension: SLIBAWARDEE certifies that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from participation in this transaction by any Federal department or agency (45 CFR
Part 76).
D. Drug Free Workplace: SUBAWARDEE certifies compliance with the requirements of the
Drug Free Workplace Act of 1988.
E. Pro -Children Act of 1994: SUBAWARDEE certifies compliance with the requirements of
PL 103-227, Title X, Part C Environmental Tobacco Smoke.
CaCoon
Subaward No. 4 B04MC06604-01-044 B04MC06604-01-04
CFDA No. 93.994
F. Clean Air Act of 1970: In compliance with 42 USC 7401 et seq., SUBAWARDEE certifies
that it is not listed on the Environmental Protection Agency List of Violating Facilities. In
addition, SUBAWARDEE will immediately notify UNIVERSITY of the receipt of any
communication from the Environmental Protection Agency indicating that any facility that
SUBAWARDEE proposes to use for the performance of this Agreement is under consideration
to be listed on the EPA List of Violating Facilities.
G. Medicare and Medicaid Anti -Kickback: SUBAWARDEE certifies compliance with 42
USC 1320a -7b (b).
THIS AGREEMENT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN UNIVERSITY
AND SUBAWARDEE. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS
OF THIS AGREEMENT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED
BY A DULY AUTHORIZED REPRESENTATIVE OF BOTH ORGANIZATIONS.
Approved and Agreed:
OREGON HEALTH & SCIENCE UNIVERSITY SUBAWARDEE
By:
Date:
�1
Jesse N II
Manage , Research Grants & Contracts
/0044.1.)-1
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Y\ (QL r, Sc� \t& k11
Q1�.blesa„
Date: 112..ty v�
DATED this Day of 2008.
BOARD OF COUNTY COMMISSIONERS
OF DESCHUTES COUNTY, OREGON
DENNIS R. LUKE, Chair
TAMMY (BANEY) MELTON, Vice Chaii
MICHAEL M. DALY, Commissioner
ATTEST:
Recording Secretary
CaCoon
ATTACHMENT' A
OREGON CARE COORDINATION PROGRAM - CaCoon
Role of Public Health Nurse CaCoon Coordinator (Applicable to all Subcontractors)
1. Be available as a resource to other health, education and community service providers regarding
children with special health needs. (e.g.; providing information on specific disabilities or services
such as SSI, OSCSHN funding, etc.)
2. Assure that CaCoon is represented on the county Local Interagency Coordinating Council
(LICC) that addresses services for CYSHN, or Early Childhood Committee in counties that have
combined those early childhood planning groups.
3. As the Oregon Center for Children and Youth with Special Health Needs explores additional
services at the local and regional level for children with special health needs, the CaCoon
Coordinator may be asked to participate in program planning and coordination of these services
for the children residing in their county. (e.g.; Community Connections Network, grant projects,
State planning, etc.)
4. Receive and disseminate all communication from Oregon Center for Children and Youth with
Special Health Needs (OCCYSHN)
5. Attend Inservice Training or designate a replacement
Role of Public Health Nurse Serving Children with Special Health Needs (Applicable to all
Subcontractors)
The goals of the CaCoon Program are to identify children and youth, birth to 21, with special health
needs (CYSHN); assure access to care, and assist families with information and skills needed to
become as independent as possible in caring for their child(ren). The role of the Public Health Nurse
serving children in the CaCoon Program is to:
Conduct accurate assessments of child health and family strengths and needs in order to help
families identify concerns, priorities and available resources
- Learn about and access comprehensive services locally
- Coordinate health care and other services for their child(ren) with special needs.
- Collect and submit data according to CaCoon program guidelines.
It is the responsibility of the CaCoon Nurse Coordinator, and each nurse providing CaCoon service, to
assure that program standards are met for each family served.
Individual and Family Interventions
The following are examples of typical interventions PHNs provide:
1. In collaboration with the family, develop a health plan and determine steps to accomplish family
priorities and obtain needed services. Evaluate and revise the plan as needed and document in the
child/family health record.
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July, 2007
2. Ensure each child has a primary care provider for routine health care and referral for
comprehensive assessment and specialty care when needed.
3. Assist family to secure funding for health care, if necessary.
4. Inform families about available community and specialty resources for health, education, and
family support.
5. Assist families to understand application forms, releases of information and other health care and
service agency processes, as necessary.
6. Assist families to problem solve barriers to health care and specialty services.
7. Provide information and anticipatory guidance related to families around:
a. Health issues related to their child's disability, as well as health promotion activities for
their child's age
b. The effects of their child's disability or chronic condition on their growth and/or
developmental course.
c. Promoting their child's self-management skills at each developmental stage.
d. Disability related laws and rights in health, education and services
8. Assist the family in the coordination of and communication with multiple health providers and
community services when necessary.
9. Monitor child and family progress, and review, evaluate and modify the mutually- decided -upon
care plan.
10. Advocate for the child and family with providers and agencies.
Community Level Activities
1. Assist in community processes to identify needs and resources for children with special needs
and participate in developing services to address gaps or deficient services. (e.g.; respite care and
child care, access to public buildings, etc.)
2. Participate in state and local county efforts to leverage additional funds to provide service to this
population. (e.g., Targeted Case Management (TCM) and Medicaid Administrative Match)
3. Submit appropriate data and reports as specified by the program. (See Standard #5)
Multidiscipline Team Process/Interventions
Some communities have a formal multidiscipline process in which providers and family come together
to plan for services or care of a child with complex needs who may not be succeeding in the
community. (Community Connections Network, Service Coordination Teams, etc.) Depending on the
role of the Team, the nurse may participate as one of the team of providers for a specific child, or to
represent a health perspective when evaluating child needs and planning interventions.
The Nurse role on the multidiscipline team may include:
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o Participate on the multidiscipline team as appropriate.
o Be a resource to the team about specialty and community services.
o Provide care coordination and follow up of team recommendations when appropriate.
o Communicate/collaborate with other providers involved in the plan for the child/family.
CaCoon Promatora Program as applicable:
1. Perform Cacoon Nurse Coordinator responsibilities as outlined in the CaCoon Promatora
Guidelines. (See Attachment B)
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ATTACHMENT B
CaCoon (Care Coordination) Promatora Guidelines
CaCoon Nurse Coordinator General Responsibilities:
The CaCoon Nurse Coordinator will provide direction to the CaCoon Health Promotora (where
applicable) and oversight of the day-to-day activities of the Health Promotora. The CaCoon Nurse
Coordinator is responsible for orientation to the CaCoon program and to state and community services for
children with special health needs. The CaCoon Nurse Coordinator is also responsible for implementing
a home visit protocol and assuring that the program standards are met.
CaCoon IIealth Promotora General Responsibilities applicable to:
Hood River County Board of Commissioners: .35 FTE
Jackson County: .50 FTE
Malheur County Board of Commissioners: .35 FTE
Marion County: .60 FTE
The CaCoon Health Promotora will work under the direction of the CaCoon Nurse Coordinator to
provide services to the target population (Attachment D) from the Hispanic community in the county. The
Health Promotora complements the CaCoon program and enhances the capacity of the CaCoon Nurse
Coordinator. The Health Promotora is not intended to provide health services but to promote health
behaviors and help families access and coordinate health and related services.
Duties of the Health Promotora include:
• Participates as a member of the health team
• Conducts outreach activities to identify families
• Visits families in their homes
• Assists the CaCoon Nurse Coordinator to identify individual and family needs
• Monitors, evaluates, and modifies care coordination plan with the family and under the direction
of the CaCoon Nurse Coordinator
• Links families with appropriate services
• Assists families to arrange for supports to access health and related services, e.g., transportation
and interpretation services
• Advocates for the child's and family's needs
• Coordinates services to prevent duplication, promote continuity of care
• Acts as a liaison and source of information between the family and service providers by
translating and interpreting if necessary, to ensure access of care
• Collaborates with other community agencies and service providers
• Participates in CaCoon program training and technical assistance
• Assists in the development of education materials
• Participates on community coalitions, committees and other appropriate groups
• Collects data and reports activity
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ATTACHMENT B
Protocol for the CaCoon Nurse Coordinator and Health Promotora
1. The CaCoon Nurse Coordinator makes the initial home visit on all new referrals
2. The CaCoon Nurse Coordinator makes a joint visit with the Health Promotora.
3. A care plan is developed by the CaCoon Nurse Coordinator, Health Promotora and the family
a. Level of service is determined
b. Involvement/role of the Health Promotora is defined including frequency of visits
4. The Health Promotora carries out the activities of the care plan that are not within the exclusive
domain of nursing practice, in which case, nursing delegation would need to occur.
5. The CaCoon Nurse Coordinator consults with the Health Promotora on a weekly basis, or more often
if health or other issues develop
a. The meeting should include chart reviews and review of plan and intervention performed by the
health promatora.
b. Additional training needs can be identified and plan developed for meeting them.
6. The CaCoon Nurse Coordinator or another PHN should be available by phone at all times for
consultation
7. A joint home visit with the CaCoon Nurse Coordinator and Health Promotora is completed at least
quarterly for evaluation and reassessment of the plan
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Attachment C
Use of Allotment Funds [Section 504]
The SUBAWARDEE may use funds paid to it for the provision of health services
and related activities (including planning, administration, education, and
evaluation) consistent with its application. It may also purchase technical
assistance if the assistance is required in implementing programs funded by Title
V.
Funds may be used to purchase technical assistance from public or private
entities if required to develop, implement, or administer the MCH Block Grant
Funds may be used for salaries and other related expenses of National Health
Services Corps personnel assigned to the State
Funds may not be used for cash payments to intended recipients of health
services or for purchase of land, buildings, or major medical equipment.
Other restrictions apply.
Funds may not be used to make cash payments to intended recipients of
services.
Funds may not be provided for research or training to any entity other than a
public or non-profit private entity.
Funds may not be used for inpatient services, other than for children with special
health care needs or high-risk pregnant women and infants or other inpatient
services approved by the Associate Administrator for Maternal and Child Health.
Infants are defined as persons less than one year of age.
Funds may not be used to make payments for any item or service) other than an
emergency item or service) furnished by an individual or entity excluded under
Titles V, XVIII (Medicare), XIX (Medicaid), or XX (Social Services Block Grant) f
the Social Security Act.
MCH Block Grant funds may not be transferred to other block grant programs.
ATTACHMENT D
NO CaCoon
OREGON CARE COORDINATION PROGRAM
Minimum Standards of Program Performance
1. Children referred to the CaCoon Program will receive an initial contact within ten (10) days.
The local health department will establish and maintain a triage system that acknowledges
the most vulnerable children with special health needs. Priority will be given to families
with:
a. a newborn with a disability
b. a newly diagnosed infant/child with a disability
c. children with increased nutrition risk (e.g., children with congenital cardiac defects, cleft
lip and palate, and cystic fibrosis)
d. families having difficulty accessing or coordinating their child's care and services
2. The CaCoon Nurse/Coordinator for will meet the minimum caseload expectation of twenty-
five (25) visits per month for a 1.0 FTE. For counties funded less than 1.0 FTE, the visits
would be proportionate to the percent of one FTE. This standard assumes a mixed Tier I -III
level caseload as defined in the CaCoon Program Manual. Please refer to Attachment F,
Data Summary.
3.
4. Families considered part of the CaCoon Nurse Coordinator's active caseload will receive no
fewer than one contact every three months.
5. The CaCoon Nurse Coordinator will assure that children and their families receive the
following minimum assessments:
a. family assessment
b. developmental assessment (use of developmental tool for this population would be
selective and for the purose ofmonitoring, teaching or documenting progress)
c. child health assessment, to include monitoring of vision and hearing (includes follow-up
of hearing results from the newborn screening including hearing and vision screening
d. nutrition assessment — using CYSHN screening tool or equivalent
6. The CaCoon Nurse Coordinator (or designee) will assure that completed data collection
forms for each month will be submitted by the 5th day of the following month.
7. The CaCoon Nurse Coordinator will assure that CaCoon is represented at the county Local
Interagency Coordinating Council (LICC) or planning group that assumes the mandate of
LICC.
8. The Nursing Supervisor will name a designated CaCoon Nurse Coordinator to oversee
program standards. New CaCoon Nurse Coordinators will attend the Program Orientation.
The designated CaCoon Nurse Coordinator will attend one (1) statewide training sponsored
by Oregon Center for Children and Youth with Special Health Needs (OCCYSHN) and at
least one networking opportunity (i.e., regional meetings, web casts, listserv.) Nurses, other
C:\Documents and Settings\kirkenda\Desktop\2009 CaCoon Subs\Attachment D Minimum Standards.6.07_msh edits.doc August 9, 2006
ATTACHMENT D
than the designated Coordinator, who provide services to this population, would benefit form
attending the program orientation.
C`.\Documents and Settings\kirkenda\Desktop\2009 CaCoon Subs\Attachment D Minimum Standards.6.07_msh edits.doc August 9, 2006
ORGANIZATION LETTERHEAD
To: OHSU
Child Development and Rehabilitation Center
PO Box 574
Portland, OR 97207
Attn: Brittany Kirkendall
ATTACHMENT E
Date :
Award Period: 10/01/07-09/30/08
Re: SubAward # 4B04MC06604-01-044 CFDA No. 93. 994 Award Amount: $0.00
Period reported:
CaCoon Coordinator
Promotora
Admin Support
Approved
Budget
$30,364.55
N/A
$3,036.45
Total $33,401.00
Actual Expenditure
Amount
I certify that all expenditures reported and payments received are for appropriate purposes and in accordance with the application
award documentation.
Signature of
Organization Financial Officer
<Print Name>
<Print Title of Individual signing for organization>
ATTACHMENT F
CaCoon FY 2009 Subaward
Data Summary
Subaward Name
Subaward Type
Deschutes County Board of Commissioners
Coordinator
FTE Summar
Y
Coordinator
.40
TOTAL FTE
.40
Financial Summary
Annual Amounts
Coordinator
$33,401.00
Total Quarterly Payment Amount
$8,350.25
Total Annual Subaward Amount
$33,401.00