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Home My WebLink About1997 Health- Consolidated Contract Amendment 2 between The State of NC as Represented by the State Health Director AMENDMENT NUMBER 2 to CONSOLIDATED CONTRACT between THE STATE and THE Orange COUNTY/DISTRICT HEALTH DEPARTMENT This contract covering the period from July 1. 1997 to _June 30. 1998 (Month)(Day)(Year) (Month)(Day)(Year) is hereby amended to add the following activities: ACTIVITIES: Home Visiting Project All provisions and clauses set forth in the Contract are hereby incorporated in this Amendment and constitute the terms and conditions applicable for the above activities involving State funding. CONTRACTOR SIGNATURES 0 Health DirectorV 6atW Finance Officer Date h i atq County/commissioners Date NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES H. David Bruton, MD, Secretary By Department Head's Signature LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health,and Natural Resources Revision Number-- Division of General Services Sfl, q g Division of Maternal and Child Health ————P.O. Number 7 / 97 6 / 98 9 8 5 3 4 0 0 0 6 8 Effective Date Termination Date Contract Number Contractor. Orange County Health Department Activity. Home Visiting Project Project Director. Rosemary L. Summers, MPH, DrPH Total Budget:$ 105,000.00 Interim Health Director ITEM DESCRIPTION CLASSIFICATION ITEM AIMOUNT E STATE EXPENDITURES: X Salaries & Fringe Benefits SA/FR 1000 22,757.00 Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 48,782.00 E General Contracted or N Purchased Services GENERAL 6100 School Health SCH HLTH 6200 D Clinician CLN 6863 I T Laboratory LAB 6862 Pharmacy Services RX SERV 6865 U Transfer TXDC 6864 R Subtotal State Expend. $ 105,000.00 E LOCAL EXPENDITURES: LOCAL EX? 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 105,000.00 LOCAL FUNDS: R Appropriation APPROP 101 E TXTX TXIX 102 C Other Receipts OTHR REC 103 E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I P 2B01-536961-1531-5340-0098 105,000.00 T S Subtotal Smte/Federal/Scecial S 105,000.00 TOTAL RECEIPTS—equal to Total E:cpenditures $ 105,000.00 ��/y► c�.co 3 /0 � Local Authc&&ed Official Signature bate Hod Division/Section Signature Date trance Officer Signature Date Fiscal Management Signature Date DEHNR 2948(Rr.;sed 2/93) LOCAL HEALTH DEPARTMENT BUDGET N.C.Department of Environment, Health,and Natural Resources Revision Number-- Division of General Services SFy 98 Division of Maternal and Child Health ----- P.O. Number 7 / 97 6 / 98 9 8 5 3 4 0 0 0 6 8 Effective Date Termination Date Contract Number Contractor. Orange County Health Department Activity: Home Visiting Project Project Director. Rosemary L. Summers, MPH, DrPH Total Budget:$ 105,000.00 Interim Health Director ITEM DESCRIPTION CLASSIFICATION ITEM AMOUNT E STATE EXPENDITURES: Salaries & Fringe Benefits SA/FR 1000 22,757.00 X Operating Expenses OP EXP 2000 P Purchase of Equipment EQUIP 5000 48,782.00 E General Contracted or N Purchased Services GENERAL 6100 School Health SCH HLTH 6200 D Clinician CLN 6863 I ,r Laboratory LAB 6862 Pharmacy Services RX SERV 6865 U Transfer TXIX 6864 R Subtotal State Expend. $ 105,000-00 E LOCAL EXPENDITURES: LOCAL EXP 9000 S TOTAL EXPENDITURES—equal to Total Receipts $ 105 000.00 LOCAL FUNDS: R Appropriation APPROP 101 E TXIX TXIX 102 C Other Receipts OTHR REC 103 E Subtotal Local Funds $ STATE/FEDERAL/SPECIAL FUNDS: I .P 2B01-536961-1531-5340-0098 105,000.00 T S Subtotal State/Federal/Special $ 105,000.00 TOTAL RECEIPTS —equal to Total Expenditures $ 105,000.00 &Lm�� 5//0/0 Ly- Local AudVaed Official Signature Date f 4Head Division/Section Signature Date F' ante Officer Signature Date cm Fiscal Management Signature Date DELM 2948(Revised 2/93) N.C.Department of Health and Htunaa Services Page_I FY 199&99 CONTRACT ADDENDUM OranCR County 9853400068 Office,Section,or Branch Contract Number t?range GouM Heath Deria� .Home Visiting Project Contractor Activity SCOPE OY SERVICES Under this contract the following services will be provided by the Contractor. 1. The Contractor will assure that the Home Visiting Demonstration Project provides inteusive.home visiting services to families who are identified as needing this level of service. Intensive home visiting includes the following: • Caseloads of no more than 25 families Use of universal screening or self-referral forms • Voluntary participation by families • Minimum of weekly visits for a specified period,followed by less frequent visits based on family's and worker's assessment of family's needs • Use of curriculum or protocol which guides work with families • Ability to work with family from prenatal period or birth of child until child is at least three years old • Initial and ongoing staff training 2. 'The Cont,raetot agrees to assume responsibility for the immediate direction and programmatic supervision of the activities supported through the contract. 3. Project staff will be hired by April 30, 1998. 4. Project staff will receive orientation and initial training for home visitors by May 15, 1998_ 5. Use of the North Carolina Family Resource and Referral Checklist and the Family Interest Form will be implemented by the Contractor. The Contractor will educate other community service providers about these tools and will encourage their use in multiple sites in the community. 6. The Contractor will=participate in a multi-agency advisory group to guide Project development and implementation and to assure the integration of the Project services into the community's existing continuum of services for pregnant women,young children and their families. This group must include consumers. 7. A home visiting.curriculum/protocol for guiding work with families will be developed/initiatied by April ^0, 1998. .8. The Contractor agrees to collect project data,provide reports as requested by DHHS and participate in all evaluation activities required by the state and its evaluation contractor. RrAcwcd by Initials Oats OHMS 3300 1.C.Department of Health and Human Services•... ;page 2 of '1, YY 1998-99 CONTRACT ADDEYi DLTYI Ora—no COUM - 9853400068 Office,Section,or Branch Contract Number Orangg C.oM Real&D=artment Horne Visitng Project Contractor Activity 9. A central portal of intake and-referral to receive universal screening and self-referral forms will be developed by April 1, 1998. 10. A Home Visiting Callabortion Team consisting-of representatives from primary•service agencies will be established by March 31, 1998,and will meet monthly. 11. An ad hoc committee will be formed by March 311998,to determine how the NC FamilyResource and Referral Checklist will be used and to develop a system for deteanining risk status. 12. Approximately 75;families will receive the universal.support screening component and 10-to 20 families will be enrolled in Focus on Families by June 30, 1998. Jnivals Dati: DM 3300 Capital Outlay Detail OCBO 92 Department Health Division Intensive Home Visiting New or Department Del2artment Account Code Replacement Priori Description/Justification Request 7401 New 3 laptops @$3,525 $10,575 New 9 computers @$1,750 $15,750 New 1 color printer @$3,400 $3,400 New 1 copier @$2,113 $2,113 New 1 colordesk jet printer @$400 $ New 1 fax @$700 $700 New 1 jet direct card @$250 $250 Shipping&Handling $925 TOTAL $34,113 Operating Detail (no more than 2% increase) OCBO 1 9A Department Health Division Personal Intensive Home Visiting 11642 Account Code Description/Justification Department Request 1001 TRAVEL $500 1002 PERSONAL MILEAGE 368 miles @$.315/miles for inter/intra County Travel $116 1011 TRAINING $13,792 Training in Intensive Home Care and Computer Training Courses 1101 TELEPHONE $480 Phones with voice mail @$35/month x 4($280) Pagers @$5/month x 4($40) Long distance charges ($160) 1201 POSTAGE $200 Stamps for program related client and community agency mailings;state courier charges ($200) 1701 DUPLICATING $540 Copying of client education materials,agency forms,program protocols and curriculum($540) 1801 PRINTING $1,000 Printing of program promotional items and brochures,staff business cards ($1,000) 1901 ADVERTISING $500 Newspaper advertisement promoting Home Visiting Program($500) :.' 2101 DEPARTMENTAL SUPPLIES $3>000 ($120) Baby scales (2)-($800) Blood pressure cuff systems (2)-$300 Client incentives (including car seats,developmental toys) ($1200) Dever kits(2)-($140) Hear kits (2)- ($120) Tote bags (3)-($75) Stethescopes (2)-($40) Measurement mats (2)-($120) CPR masks (2)-($40) DSM IV-($45) Capital Outlay Detail OaO 12 Department Health Division Intensive Home Visiting New or Department Department Account Code Replacement Priori Description/Justification Request 7405 New 7 Module Unit(comer unit,hutch,2 workstations,2 file units) $9,674 New 7 chaos $2,079 New 2 tables (computer and fax) $260 New 7 Four Drawer File Cabinets $987 7 bookcases $1,015 7 stableable Guest chair with black Synthetic Arms $518 1 Storage Cabinet $136 TOTAL $14,669 r' Operating Detail (no more than 2% increase) OaO 11A Department Health Division Personal Intensive Home Visiting 11642 Account Code Description/justification Department Request 2102 OFFICE SUPPLIES $4,500 Routine office supplies needed for program implementation($4,500) 2105 EDUCATIONAL SUPPLIES $2,000 Parent Education reference books/materials/videos ($900) Child Development reference books/materials/videos($900) _ Program brochures ($200) 2201 PROFESSIONAL CONTRACT SERVICES $6,833 UNC Hospitals Contract($2,833) Computer Technical Support($2,500) Volunteer Support($500) Collaboration Team($1,000) TOTAL $33,461