HomeMy WebLinkAbout2017-516-E Health - Minority Diabetes Prevention Program (MDPP) - MOU DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
IVIDPP ADM ....NISI...R "".... V - _ _ _ �, ....I....
This Agreement, made and entered into this 8th day of September, 2017, ("Effective Date") by and between
Orange County, North Carolina,a political subdivision of the State of North Carolina, by and through its
Orange County Health Department("Orange County"), party of the first part; and Alamance County,a
political subdivision of the State of North Carolina, by and through its Alamance County Health Department
("Alamance County"), party of the second part.
1. PURPOSE
The Division of Public Health allocated Minority Diabetes Prevention Program (MDPP)funding to Region V for
the purpose of establishing an evidenced-based diabetes prevention program targeting minority populations
within the nine(9)county region.
The goal of the MDPP funding is to 1)to implement a prediabetes and diabetes prevention awareness and
marketing campaign in minority communities,2)to provide community screening for prediabetes and
referrals to diabetes prevention lifestyle classes and diabetes self-management programs, and 3)to offer CDC
Lifestyle classes"Prevent T2"and its Spanish-language equivalent to minority communities.
The purpose of this Agreement is for the parties to develop and maintain a relationship that will allow each
party to engage in the Minority Diabetes Prevention Program (MDPP)funding.The parties hereby agree to
jointly enter into this Agreement for the administrative coordination and financial support for the
implementation of MDPP. Alamance County through its Health Department shall act as an Administrator and
will serve as a MDPP participant and fiscal agent, respectively,for Region 5 County Health Departments
(Rockingham, Randolph, Caswell, Person, Orange, Durham,Guilford and Chatham counties) in regards to
MDPP.
2. SERVICES
The services to be provided will begin July 1, 2017 and continue until June 30, 2018.
All services will be provided in a professional, competent and workmanlike manner.
Alamance County, is responsible for the following:
1. Serve as the fiduciary agent for MDPP Region V funding including budgeting funds and working with
local health directors to establish allocations to local health departments and/or community
organizations
2. Submit plans, reports,and budget to the NC Division of Public Health contact
3. Identify an internal lead to oversee the Agreement Addenda
4. Contract for a Regional Coordinator to implement the deliverables as detailed in the Agreement
Addenda
5. Lead the regional collaborative via the Regional Coordinator and internal lead
6. Execute all other major duties as defined by the lead agency in the attached Agreement Addenda
(Appendix A)
DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
Orange County shall:
1. Designate a County contact to serve as liaison for the MDPP program.This liaison will serve on the
regional collaborative.
2. Submit a budget for allocated MDPP funds in accordance with acceptable expenditures as defined in
the Agreement Addenda Section VI: Funding Guidelines or Restrictions
3. Identify staff and/or community Administrator(s)to be trained as coach(es).
a. Newly trained staff shall submit a copy of documentation that training has been completed
to the Regional Coordinator.
b. Newly identified coaches shall participate in weekly coaching calls with the Regional
Coordinator.
4. Participate in a minimum of 50%of the regional collaborative meetings.
5. Work with regional coordinator to coordinate at least one community screening events.
6. Implement and provide lifestyle coaching classes for referred individuals.
a. Coaches shall fulfill the requirements as outlined in the MDPP Agreement Addenda Section:
III,subsection section 3 subpart(b) located in Appendix A of this agreement.
b. Class shall be implemented and conducted with fidelity including but not limited to accurate
monitoring of participants.
c. Participating counties shall be placed on a Plan for Improvement if identified as not
complying with the fidelity of the model as determined by the Regional Coordinator, Lead
Health Director and/or Division of Public Health Program Coordinator.The plan will include
strategies for success and expected outcomes for improvement period. Failure to comply
with fidelity or plan for improvement may result in the loss of funds.
3. BUDGET - Region 5 will receive $230,105 through the MDPP funding beginning July 1, 2017
and ending June 30, 2018. Funds are recurring annually, dependent on the availability of
funding. Funds will be distributed within Region 5 according the agreement addenda
attached as Appendix A. Orange County will receive $10,175 to implement the MDPP
program in the community.
Partnering County shall prepare an allocation expenditure budget by August 30, 2017. Upon
receipt of proposed budget and subsequent approval of proposed budget, Alamance County
will release funds to the Participating County for use. Acceptable expenditures for the
allocation to the Participating County must meet the requirements set out by the
Agreement Addenda in Section VI and may include:
- Salary and fringe benefits for staff
- Program supplies (including books, manuals, food, etc.)
- Participant incentives
- Equipment
- Training
- Travel for staff
DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
- Media and Communications (including flyers, brochures, etc.)
Orange County is responsible for the purchase of all items included in the submitted
budget.
Orange County shall follow and abide by fiscal accounting policies and maintain records of
expenditures in the event of an audit. Any changes to the budget once approved shall
require notification to the Alamance County Health Department liaison and an amended
budget to reflect changes.
4. SPACE/LOCATION—Alamance County Health Department will provide space for the lead
agency liaison and appropriate space for regional coordinator, as needed. Each local agency
is responsible for providing or coordinating space, as needed,to identified life style coaches
in their counties.
5. ASSURANCE—All parties listed herein agree to follow all federal, state and local
employment law to assure the appropriate treatment of staff hired through this Contract.
6. TERM AND TERMINATION — This Contract may continue annually, contingent on the
availability of funding. Contracts will be reviewed and signed each year of funding. Should
funds or other financial support for this program become unavailable, any party may cancel
their involvement in this Contract arrangement with a thirty (30) day written notice to each
party's identified representative as listed in this document. Also, any party may terminate
their participation in this Contract for any reason and without penalty upon thirty (30) days
written notice to all other parties.
7. AMENDMENT-The terms of this Contract may only be modified or amended with a written
Contract Amendment executed by the parties.
8. NOTICES — Written notices are required to be mailed to all parties by being sent to the
attention of the contact persons listed herein:
Participating County Health Department
Attn: Renee Kemske
300 W. Tryon Street
Hillsborough,NC 27278
Phone: 919-245-2380
rkemske @orangecountync.gov
DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
ALAMANCE COUNTY HEALTH DEPARTMENT
Attention: Stacie Saunders
319 N Graham Hopedale Rd.
Suite B
Burlington, NC 27217
Phone: 336.513.5514
Email: Stacie.Saunders @alamance-nc.com
9. INDEPENDENT CONTRACTOR—The parties shall operate as independent contractors for all
purposes. Without waiving sovereign immunity,the parties agree to each be solely
responsible for their own acts or omissions in the performance of each of their individual
duties hereunder, and shall be financially and legally responsible for all damages
proximately caused by their individual acts or omissions.
10. WAIVER - No party's failure to insist on enforcement of any rights under this Contract at any
time or for any period of time shall be deemed waiver of those rights. The waiver by any
party to this Contract of a breach of any provision hereof shall not operate or be construed
as a waiver of any subsequent breach.
11. HEADINGS-The headings set forth in this Contract are for convenience only and shall not in
any way affect the substance of any provisions contained in this Contract.
12. SEVERABILITY -The provisions of this Contract are independent of and separable from each
other, and no provision shall be affected or rendered invalid or unenforceable by virtue of
the fact that for any reason any other provision or other provisions may be invalid or
unenforceable in whole or in part.
13. GOVERNING LAW AND VENUE—This Contract shall be governed by the laws of the State of
North Carolina. Venue shall be proper and shall lie exclusively in the Superior Court of
Alamance County North Carolina. Alamance County shall at all times remain in compliance
with all local, state, and federal laws, rules, and regulations including but not limited to all
state and federal anti-discrimination laws, policies, rules, and regulations and the Orange
DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is
incorporated herein by reference and may be viewed at
tirr i r,l 1 i r c r,1Jl I is .r, rir I .;Ital,l'i ,)I c i i 1 Ili it Ir,l iAr l i l 1't l . Any
violation of this requirement is a breach of this Agreement and Orange County may
immediately terminate this Agreement without further obligation on part of Orange
County. This paragraph is not intended to limit the definition of breach to discrimination. By
executing this Agreement, Alamance County affirms that Alamance County is and shall
remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By
executing this Agreement, Alamance County certifies that Alamance County has not been
identified, and has not utilized, the services of any agent or subcontractor, on this list
created by the State Treasurer pursuant to G.S. 147-86.58.
14. ENTIRE CONTRACT AND SIGNATURES - This Contract, including Exhibits and/or
Attachments, if any, sets forth the entire agreement between the parties with respect to
the subject matter hereof. All prior conversations or agreements, whether written or oral
among the parties hereto or their representatives are merged within and
extinguished. Except as provided herein, no modification hereof shall be binding upon the
parties unless the same is in writing and signed by all. All electronic signatures affixed
hereto evidence the consent of the parties to utilize electronic signatures and the intent to
the parties to comply with Article 11A and Article 40 of the North Carolina General Statutes
Chapter 66.
IN WITNESS WHEREOF, the parties have set their hands and seals as of the day and year written
above.
o!'.3 ,, hQUNTY HEALTH DEPARTMENT
Vorogui Citu.n.fi
Dorothy Cilenti, Interim Health Director
ALAMANCE COUNTY HEALTH DEPT.
r®octuSigrnet9,,blr
tmt, mu
FA770,,v,4„,„,),,
Stacie Saunders, MPH, Health Director
DocuSign Envelope|D:._ _ _ _ . _^..^.... o.^`..~.^
FY 17'1Q for A|amanceCounty
" of Division �u � ���� Health
Agreement Addendum
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Page 1 of 12
North Carolina Office of
Alamance County Health Department/ ---_-- — Minority Health and Health Disparities
Local Health Department Legal Name
DPH Section/Branch Name
Lisa Hodges,919-707-5041.
473 Minority Diabetes Prevention Program liuu.bodQex��dhhnoo.gov
Activity y�uom6eraod Description 0P��Program Contact --
(name.phone number,and email)
06/01/2017 B1/2018
, Service Period -----'---- -- - ---- ------- - ---
0PH Program Si nmtnro Date
(only required for uum@ubad�agreement addendum)
) U7/01/20/7-Oh/3O/2010
Payment Period
Original Agreement Addendum
L Agreement Addendum Revision #
I.
Background:
Prediabetes is a condition where people have higher than normal blood glucose levels(mg/di), but their
mg/d1 is not yet high enough to be diagnosed as diabetes. Nationally, an estimated 86 million American
adults have prediabetes,but only about 11%of them know it. African Americans,American Indians,
Alaska Natives,Asians, Hispanics,Native}(mwuiiunx°and other Pacific Islanders are o1biohu,risk than
000-E{iuyunicwhites for developing type 2diuh�eu(CDC. Diabetes Bopmd%Ol4). lu%01-'the
prevalence uCpradimhwtmaiol4o�b Carolina rvouemtino�odtohn about 9Y�. [o that' same year,9.5%of
respondents iou Behavioral Risk Factor Surveillance System survey indicated that they had been told 6v
u doctor or other beubbprofessional that they had pr*diuheteuorbordedinm diabetes. 0fthose
'
m:upundautm. 3l.]Y6 were racial and ethnic minorities(African Americans: 13.0%; Hispanic/Latinos:
5.1Y6| American Indians: 6.8%;and other racial and et nic minorities:6.4%). (North Carolina State
Center for Health Statistics, BRFSS 2014).
Without intervention,each year,about 11%of those with prediabetes will progress h)typo2diub*tex.
Early detection and treatment of prediabetes can help to sl w the projected increase in type 2 diabetes
prevalence.
In 2016,the North Carolina General Assembly made funding available to the Division of Public Health
(]PT{) for the Office of Minority Health and Health Disparities(NC OMHHD)to establish and
administer,in consultation with the Chronic Disease and Injury Section, an evidenced-based diabetes
pmavuwtiouprogrum1ucQobngA8icau'Azooziouon'8ixpnnio/Lu1inoxundAruohcooludiaom(8B |O3U.
20 15-241, Section 12E.3). The goal of the Minority Diabetes Prevention Program (MDPP) is to provide
'~-
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�*��'�
HhokbD��mr3i8nxmr (mobkmink) --- Date
-- /
Local Health Department to complete: I,HD program contact name:
(If follow-up information is needed by DPH) Phone number with area code: 336 .
Signature on this page signifies you have read and accepted all pages of this document, Revised lune 2016
DocuSign Envelope ID:A824226C-8DDB-4DD9-83EC-DD32AAD99084
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these three components: 1)a prediabetes and diabetes prevention awareness and marketing campaign in
minority communities,2)community screenings for prediabetes and referrals to Diabetes Prevention
Program Lifestyle classes and diabetes self-management programs and 3)offering the CDC's Lifestyle
Classes"Prevent T2"and"Prevenga el T2"to minority communities across North Carolina.
Diabetes prevention programs are designed to empower people with prediabetes to take charge of their
health and well-being. These year-long,evidenced-based programs can help people who have
prediabetes or who are at high risk for type 2 diabetes make realistic and achievable lifestyle changes
which can cut their risk of developing type 2 diabetes by up to 58%percent.(CDC,"Preventing Type 2
Diabetes")People who are enrolled in the 12-month MDPP Lifestyle Class series will learn to
incorporate healthier eating and moderate physical activity, as well as problem-solving, stress reduction
and coping skills into their daily lives.The 12-month MDPP Lifestyle Class series are held with a
trained lifestyle coach over a 12-month period. There are 16 classes held on a weekly basis during the
first six months,after that,six or more follow-up classes are held during the last six months.
H. Purpose:
This Agreement Addendum enables the Local Health Department to utilize the MI)PP Regional
Collaborative that it created in the previous fiscal year to(I)complete the last six months of the DPP
Lifestyle classes with previously enrolled participants and(2)engage,screen and deliver the Minority
Diabetes Prevention Program that includes the CDC curricula"Prevent T2" and"Prevenga el T2"to a
new cohort of minority communities within its region.The Local Health Department and its partners
may engage, screen and enroll non-Hispanic whites in the MDPP,provided that no less than 6 0 of
.-
program participants are members of racial/ethnic minority groups. 4•
The Local I-Iealth Department shall serve as the Regional Collaborative's fiduciary lead agency and shall
encourage entities such as other local health departments,community-based organizations(CROs),
faith-based organizations(FBOs), local Community Care of North Carolina(CCNC)networks,
Federally Qualified Health Centers(FQHC), Rural Health Centers,farmworker programs, Indian Health
Services, and hospitals to join its Regional Collaborative in order to better engage with minority
communities through meeting the Minority Diabetes Prevention Program's screening,education and
outreach goals.
HI. Scope of Work and Deliverables:
The Local Health Department, in conjunction with its Regional Collaborative,shall:
1. Submit a plan that demonstrates partnership with existing health access infrastructure(e.g.,C130,
FBO, CCNC networks,hospitals,FQHC,Rural Health Centers,Farmworker programs,and Indian
Health Services) to the DPH Program Contact by 4:00 pm on July 14,2017.The plan shall identify
community partners who will assist the lead agency with the continuation of the MDPP to plan and
provide early detection,outreach,screening, follow-up and referral services for MDPP eligible
minority populations.
2. Submit Memoranda of Agreement(MOAs)to partner with CBOs,FBOs,hospitals,and CCNC
networks (including Health Net providers),or other health care provider organizations that offer
primary care services(e.g., FQh1C, rural health centers, Indian health centers, Health Net providers,
free clinics, private providers).These partnership agreements shall include roles delineation,scopes
of work,and allotted resources, so that each partnership will deliver a Diabetes Prevention Program
(DPP)curricula: PreventT2 or Prevenga el T2. The executed MOAs shall be submitted to the DPI-1.
Contract Administrator by 4:00 pm on August 11,2017,
Revised Jule 2016
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3. Provide the following staff for the MDPP: one Regional MDPP Coordinator and a minimum of
two Lifestyle Coaches.
a. A minimum of one full-time(1.0 FTE)Regional MDPP Coordinator to serve the entire
collaborative area.The Regional MDPP Coordinator shall:
1. Complete the two-day Diabetes Prevention Program Lifestyle Coach training by
August 15,2017 for all new staff.To facilitate this required training,a local certified
DPP Master Trainer or a Master Trainer from one of the following Lifestyle Coach
and Master Training organizations may be utilized:
a. American Association of Diabetes Educators, Diabetes Prevention Program
b. Black Women's Health Imperative
c. Center for Excellence in Aging&Community Wellness/Quality and
Technical Assistance Center(QTAC)
d. Diabetes Training and Technical Assistance Center,The Emory Centers for
Training and Technical Assistance at Emory University
e. Magnolia Medical Foundation
f. Solera Health Inc
g. University of Pittsburgh Diabetes Prevention Support Center,Department of
Epidemiology at the Graduate School of Public Health
h. Virginia Center for Diabetes Prevention& Education
i. Any CDC approved vendor in-person training.
2. Submit documentation that shows that he or she has completed the aforementioned
in-person training or an equivalent on-line training within the previous 12 months to
the DPH Program Contact by August 15,2017. MDPP staff trained prior to August
15,2017 may complete the CDC-approved on-line refresher course. MDPP staff
hired after August 15,2017 must complete an in-person training provided by a CDC-
approved vendor.
3. Ensure that all MDPP staff have been trained to provide the National DPP curricula
(Prevent T2 and the Spanish version Prevenga el T2) and submit documentation to
the DPH Program Contact by August 15,2017.
4. Implement the lifestyle program, supervise daily operations related to the lifestyle
program,provide support and guidance to lifestyle coaches, and ensure that the
program achieves quality performance outcomes. The lifestyle program must include:
a. The use of a CDC-approved curriculum(i.e.,Prevent T2 or Prevenga el T2)
with lessons, handouts,and other resources
b. A lifestyle coach,specially trained to lead the program and facilitate
discussions and help make the program fun and engaging
c. A support group for MDPP participants where they can share ideas,celebrate
successes,and work to overcome obstacles.
Refer to the CDC website for more information about the lifestyle program at
http://www.cdc.gov/diabetes/prevention/lifestyle-program/experience/index.html.
5. May serve alongside the three required Lifestyle Coaches as a fourth Lifestyle Coach,
for which the role is described in Section III,Paragraph 4.b below.
Revised June 2016
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6. Ensure that participant and program data is entered into the MDPP database on a
weekly basis and that monthly reports are submitted to the DPH Program Contact by
the 15th day of the following month.
7. Submit monthly progress reports to the NC OMHHD by the 15th day of the following
month.
8. Participate in all mandatory NC OMHHD training classes and monthly MDPP
lifestyle coach calls organized by the NC OMHHD and the Community and Clinical
Connections for Prevention and Health Branch(CCCPH)in the Chronic Disease and
Injury Section.
b. A minimum of two part-time MDPP Lifestyle Coaches to serve the entire collaborative area.
Each Lifestyle Coach shall:
L Complete the two-day Diabetes Prevention Program Lifestyle Coach training by
August 15,2017 for new hires.To facilitate this required training,a local certified
DPP Master Trainer or a Master Trainer from one of the following Lifestyle Coach
and Master Training organizations may be utilized:
a. American Association of Diabetes Educators, Diabetes Prevention Program
b. Black Women's Health Imperative
c. Center for Excellence in Aging& Community Wellness/Quality and
Technical Assistance Center(QTAC)
d. Diabetes Training and Technical Assistance Center,The Emory Centers for
Training and Technical Assistance at Emory University
e. Magnolia Medical Foundation
f. Solera Health Inc
g. University of Pittsburgh Diabetes Prevention Support Center,Department of
Epidemiology at the Graduate School of Public Health
h. Virginia Center for Diabetes Prevention& Education
i. Any CDC approved vendor in-person training.
2. Submit documentation that shows that he or she has completed the aforementioned
in-person training or an equivalent on-line training within the previous 12 months to
the DPH Program Contact by August 15,2017. MDPP staff trained prior to August
15,2017 may complete the CDC approved on-line refresher course.MDPP staff hired
after August 15,2017 must complete an in-person training provided by a CDC-
approved vendor.
3. Conduct a maximum of two MDPP 12-month Lifestyle Class series which are to
begin during this Agreement Addendum's Service Period.
4. Conduct the remaining classes for the MDPP 12-month Lifestyle Class series which
began during the FY16-17 Agreement Addendum.
5. Newly hired MDPP Lifestyle Coaches must complete the MDPP Lifestyle Coach
Demographic Questionnaire provided by DPH.
6. Administer the MDDP Pre-and Post-Knowledge and Behavioral Health
Questionnaires provided by DPH to all MDPP participants, enter the questionnaire
data into the MDPP database,scan and send a copy of the completed MDPP
Revised June 2016
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participant questionnaires to DPH. Enter MDPP participant and program data into the
MDPP database on a weekly basis.
7. Deliver the MDPP program in a way that increases the capacity of MDPP participants
to make and sustain positive lifestyle changes.This includes understanding and being
sensitive to issues and challenges for individuals trying to make and sustain
significant lifestyle changes.
8. Provide support and guidance to MDPP participants in the lifestyle program and
implement standard curriculum designed for the lifestyle program by the CDC.
9. Make and document a minimum of four good faith attempts to follow-up with MDPP
participants who miss a weekly session during the first six months of the program or
who miss a monthly session during the last six months of the program.Each
participant follow-up should include two telephone calls and a written letter or email,
and may include a home visit.
10. Maintain an outreach log to track correspondence with MDPP participants.
11. Participate in all mandatory NC OMHHD training sessions and monthly MDPP
lifestyle coach calls organized by the NC OMHHD and the CCCPH in the Chronic
Disease and Injury Section.
4. Conduct a targeted marketing and awareness campaign utilizing existing DPH DPP and CDC
materials in minority communities using 10-15%of the budget.Marketing is to include one or more
of the following:
a. Billboards and bulletins in minority neighborhoods
b. Running advertisements in English and Spanish on English and Spanish-language radio
stations that rank highly in the target minority communities
c. Direct mail, social media,PSAs, TV ads and other approval media outlets
d. Recruitment at community events
e. Recruitment at clinical offices(such as flyers and posters)
f. Healthcare provider information about prediabetes
g. Worksite education and outreach.
5. Screen for prediabetes a minimum of 225 people,ages 18 years and older.The Local Health
Department may screen more than the minimum number for prediabetes, if screening is being used
as one of several strategies to identify, refer and enroll people in MDPP 12-month Lifestyle Classes
series. One of these screening methods is to be used:
a. A CDC prediabetes paper screening which requires a score of nine and above to indicate the
presence of prediabetes.The CDC prediabetes paper screening can be found at
http://www.cdc.gov/diabetes/prevention/pdf/pred iabetestest.pdf
b. A prediabetes paper screening from the American Diabetes Association(ADA)which
requires a score of four and above to indicate the presence of prediabetes. The ADA
prediabetes paper screening can be found at http://maindiabetes.org/dorg/PDFs/risk-test-
paper-version.pdf
c. Plasma glucose measured 2 hours after a 75 gm glucose load,with a result of 140 to 199
mg/dl
Revised June 2016
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d. A fasting blood glucose score of 100 to 125mg/dI,
e. An Ale test resulting in a level of 5.7-6.4 percent,or
f. Clinically diagnosed gestational diabetes mellitus during a previous pregnancy(may be self-
reported)
From the population screened for prediabetes,refer 100%of eligible people to the MDPP
and refer 100%of persons whose screening numbers indicate diabetes into diabetes self-
management education programs. Document all referrals and include the number of referrals
made in the performance reports
6. Enroll a minimum of 75 people total into the Minority Diabetes Prevention Program 12-month
Lifestyle Class series which are to begin during this Agreement Addendum's Service Period and
ensure that no less than 75%of the MDPP participants are members of racial/ethnic minority groups.
The CDC requires that all Lifestyle Class participants be 18 years of age or older and have a body
mass index(BMI)of 2224 kg/m(>22 kg/m, if Asian).In addition,a minimum of 50%of a program's
participants must have had a recent(within the past year)blood test(may be self-reported),a
medical claim code indicating they have prediabetes,or a history of gestational diabetes mellitus
(GDM),according to one of the following specifications):
a. Plasma glucose measured 2 hours after a 75 gm glucose load,with a result of 140 to 199
mg/dl
b. A fasting blood glucose score of 100 to 125mg/d1,
c. An Ale test resulting in a level of 5.7-6.4 percent,or
d. Clinically diagnosed gestational diabetes mellitus during a previous pregnancy(may be self-
reported)
A maximum of 50%of a program's participants may be considered eligible without a blood test or
history of GDM only if they screen positive for prediabetes based on the CDC Prediabetes Screening
Test or screen positive for diabetes on the hard copy or electronic version of the American Diabetes
Association Type 2 Diabetes Risk Test or on a claims-based risk test.The"CDC Diabetes
Prevention Recognition Program Standards and Operating Procedures" document can be found at
http://www.cdc.gov/diabetes/prevention/pdf/dprp-standards.pdf. A description of the curriculum,
handouts and requirements can be found at http://www.cdc.gov/diabetes/prevention/lifestyle-
program/curriculum.html.
7. Charge all MDPP participants a one-time fee of$25 unless a scholarship is provided. Scholarships,
in the form of a fee waiver,must be offered to any MDPP participant who finds the participation fee
to be a barrier. Scholarships should be offered on a sliding scale in the amounts of$10,$15 or$20,
depending on need. Lead agencies and their partners can provide scholarships to class participants.
All MDPP participants receiving scholarships are responsible to pay the remaining balance (i.e., if
the participants receive a$20 scholarship,he or she shall pay the remaining$5 balance)of the one-
time fee. Organizations not affiliated with the Lead agency and their partners can provide a
sponsorship voucher in the amount of$25 to cover the one-time class fee. Sponsored MDPP
participants must complete the Readiness to Change Questionnaire,administered by staff of the non-
affiliated organization, and have a score that reflects readiness to change.DPH will provide the
Readiness to Change Questionnaire.
Revised June 2016
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8, Distribute the following supplies to MDPP staff: Food models, blood pressure cuffs,digital scales.
9. Complete all activities for the MDPP 12'moot Lifestyle Class series which began during the
FYI 6-17 Agreement Addendum's Service Period.
10. Conduct a minimum of Ov*ail;
—v —`' MDPP 12-month Lifestyle Classes series in
multiple counties throughout the Local Health Department's��u�ax�ominio��|�5O
����u��. T� Li��|on��m� �held atuminimum of two counties within the
Local Health Department's region.The Local Health Department and its collaborative.partners may
deliver additiona classes (i.e.,more than the minimum requirement each month)for
participants needing additional support.
All new MDPP 12-month lifestyle Class series shall start between June 1 and September 15,2017,
and shall be conducted in accordance with the CDC recommendations, guidelines,standards,and
operating procedures, as described in the"CDC Diabetes Prevention Recognition Program Standards
and Operating Procedures"document, which can be found at
h(tp://w*v.ode,gov/diuh vonikxn/pdfldnrp'siundon]s'pdC
a. The first six months of each series must include l6 weekly MD}r Lifestyle Classes.
b. The last six months of each series must include a minimum of six follow-up t6DPPl.ih:utyle
Classes.
ii. Maintain the following retention rates,Out of the MDPP 12-month Lifestyle Class series:
a. During the firs six months of the program:
I. 50%of MDPP participants complete four MDPP Lifestyle Classes
2. 33%of MDPP participants complete eight MI)PP Lifestyle Classes
3. 25%of MDPP participants complete nine or more MDPP Lifestyle Classes
b. During the last six months of the program:
l. 50%of MDPP participants complete three of the monthly MDPP Lifestyle Classes
2. 33%of MDPP participants complete six of the monthly MDPP Lifestyle Classes
12. Track participant and program data, including program outcom s,in the Wake Fores School of
Medicine Minority DPP du1uuuhuohptiou service database("MDPP database").
13. Maintain a subscri tion to the Wake Forest School of Medicine Minority DPP data subscription
service y'K�DpPda¢abuy�'`)f�rtbuaoticr�u�u\ y�ur
` database") .
14. Collect and report aggregate data from all Regional Collaborative partners on the outcomes and
effectiveness of the MI)PP to DPI-i.
15. Adhere to all documents,reporting and evaluation requirements and timelines as designated by
DPH, CDC, and the Wake Forest University School of Medicine.
16. Provide items and services that address barriers to partici tiug in the MDPP Lifestyle classes,
including:
a. Transportation, bus passes and gas cards
b. Facility rentals
c. Child care, and
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d. Healthy snacks for classes and meetings. (Utilize the"Eat Smart North Carolina: Guidelines
for Healthy Foods and Beverages at Meetings, Gatherings and Events"for suggestions on food
and drinks to serve at meetings. The guide can be found at
http://w•ww.eatsmartmovemorenc.com/l IealthyMeetingGuide/I Ica lthyMeetingGuide.html.)
17. Administer an incentive program for MDPP participants according to the plan listed below to
ensure successful completion of the 12-month Lifestyle class series. Incentives should consist of the
following items:
Number of Classes Corresponding Lesson Participant Incentive
Completed
2 Get Active to Prevent T2 Calorie King books
3 Track Your Activity Pedometers
4 Eat Well to Prevent T2 Portion plates
6 Get More Active T-shirt
8 Shop and Cook to Prevent T2 Digital food scale
10 Find Time for Fitness Fitness trackers
16 Stay Motivated to Prevent T2 Gym Membership or Subscription Service
18 Take a Fitness Break Gym Membership or Subscription Service
and a digital bathroom scale
20 Stay Active Away from Home Gym Membership or Subscription Service
and a$25 Grocery Store gift card
24 Get Enough Sleep Gym Membership or Subscription Service
and a George Foreman grill
18. Organize and co-host at least one community forum ("Community Conversation")with DPH
MDPP staff. During these Community Conversations,representatives from the Regional
Collaborative,the NC OMHHD,and CCCPH will meet with community members for a discussion
on prediabetes, its impact on the community's health and how we can all work together improve
health outcomes and reduce the disparities.
IV. Performance Measures/Reporting Requirements:
The Local Health Department shall:
1. Participate in:
a. Program skill building meetings and webinars as required by DPH. The skill building
meetings and webinars must be attended by the MDPP Regional Coordinator and Lifestyle
Coaches.
b. Monthly reporting and technical assistance calls regarding challenges in achieving
performance and strategies for overcoming the barriers.
e. All evaluation and program activities as required by the NC OMHHD, CCCPH,DPH, CDC
and the Wake Forest School of Medicine.
d. Mandatory meetings and training sessions sponsored by the NC OMHHD, including but not
limited to:
1. An Introduction to Culturally and Linguistically Appropriate Services(CLAS)
2. Effective Community Engagement Strategies
All LHD and MDPP staff who participate in MDPP meetings,training sessions and webinars must
complete the event sign-in sheet to receive credit for attendance.
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2. Submit performance reports that include the information listed in the Tables 1 to 5 below:
Table 1:Screenings and Referral Measures Minimum Reporting
Standard Frequency
1. Total number of people screened for prediabetes via community I 1-.A enthly,Interim,
and clinical methods in FY 17 and and Final
2. Percent of eligible people referred to MDPP 12-month Lifestyle 100% Monthly
Class series
3. Percent of eligible people —_._._._._ _
gi l
. _ _ .� _,--
_... p p e referred to DSME program 100% Monthly
4. Percent minority MDPP participants in community and clinical ?75% Monthly
screening events
Table 2:MDPP Program Measures Minimum Reporting
Standard Frequency
1. Number of MDPP 12-month Lifestyle Class series offered across Monthly
_.._.. region 7 :._ l
2. Number of people enrolled in MDPP 12-month Lifestyle Class 5 onthly
es
seri I'''
3. Number and percentage of MDPP participants who attend?.4 ?50 Monthly
MDPP Lifestyle Classes in the first 6 months of the 12-month
Lifestyle Class series
4. Number and percentage of MDPP participants who attend?13 >33% Monthly
MDPP Lifestyle Classes in the first 6 months of the 12-month
Lifestyle Class series
5. Number and percentage of MDPP participants who attend y9 . 25%
MDPP Lifestyle Classes in the first 6 months of the 12-month
Lifestyle Class series
6. Number and percentage of MDPP participants who attend 16 Monthly
MDPP Lifestyle Classes in the first 6 months of the 12-month
Lifestyle Class series
7. Number and percentage of MDPP participants who attend?4 ?50%
MDPP Lifestyle Classes in the last 6 months of the 12-month Monthly
Lifestyle Class series
8. Number and percentage of MDPP participants who attend 8 33%
MDPP Lifestyle Classes in the last 6 months of the 12 month Monthly
Lifestyle Class series
9. Number and percentage of minority participants in MDPP ?75% Monthly
Lifestyle Classes
1.0. Number and types of incentives distributed , Monthly,Interim
I and Final
11. Number and percentage of MDPP participants who attend a Interim and Final
minimum of 4 MDPP Lifestyle Classes and lose>5%of their
baseline body weight
12. Percentage of MDPP participants who report a change in i Quarterly,
knowledge Interim,and Final
13, Percentage of MDPP participants who report a change in Quarterly,
behavior Interim,and Final 1
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Table 3:Outreach Measures Minimum Reporting
Standard Frequency
1. Number of people who participate in community screening Monthly
events
2. Number of people who submitted clinical screenings results Monthly
3. Number of follow-up phone calls to non-compliant MDPP >_2 Monthly
enrollees
4. Number of follow-up emails to non-compliant MDPP enrollees >_1 Monthly
5. Number of home visits to non-compliant MDPP enrollees Monthly
(optional)
Table 4:Meeting and Training Measures Minimum Reporting
Standard Frequency
1. Attendance and participation in mandatory monthly meetings 100% Monthly
2. Attendance in NC OMHHD trainings 100% Interim and Final
Table 5:Targeted Marketing&Awareness Campaign Measures Minimum Reporting
Standard Frequency
1. Number of billboards or bulletins flights in minority communities >_1 Monthly, Interim,
(English and Spanish) and Final
2. Number of MDPP focused radio ads and PSAs ran during Fy 16 ?10 Monthly,Interim,
and Final
3. Number of MDPP focused newspaper ads and impressions >_1 Monthly,Interim,
(English and Spanish) and Final
4. Number of direct mailers distributed (English and Spanish) Interim and Final
5. Estimated number of people reached through the targeted Interim and Final
marketing and awareness campaign
3. Demonstrate that progress toward project objectives is being made and tracked by submitting a
monthly performance report to the NC OMHHD.
4. Submit an interim report by December 29,2017 and a final report by June 30,2018 to the DPH
Program Contact.A template will be provided by the NC OMHHD. These reports shall include:
a. Experience with implementing the evidence-based program
b. Strategies
c. Number of people served
d. Services provided
e. Outreach outcomes, and
f. Other demographic information.
V. Performance Monitoring and Quality Assurance:
The NC OMHHD and CCCPH will monitor the Local Health Department by conducting site visits and
audits (minimum of one per year)and reviewing the required reports to determine if program
deliverables are being met.The Local Health Department will be visited at least once during the service
period of this Agreement Addendum and there will be routine correspondence between the Regional
MDPP Coordinators and the DPH MDPP Program Consultants.If deliverables are not being met,the
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NC OMHHD will request a written response from the Local Health Department that documents the
barriers that are preventing the Local Health Department from meeting the deliverables.
If the Local Health Department is deemed out of compliance,the NC OMHHD and CCCPH staff shall
provide technical assistance and funds may be withheld until the Local Health Department is back in
compliance with deliverables. If technical assistance does not prove beneficial,the Agreement
Addendum may then be terminated. Funds will be re-allocated if milestones included in implementation
plan are not achieved in a reasonable timeframe.
VI. Funding Guidelines or Restrictions:
1. Requirements for pass-through entities: In compliance with 2 CFR§200.331—Requirements for
pass-through entities,the Division provides Federal Award Reporting Supplements to the Local
Health Department receiving federally funded Agreement Addenda.
a. Definition: A Supplement discloses the required elements of a single federal award.
Supplements address elements of federal funding sources only;state funding elements will
not be included in the Supplement. Agreement Addenda(AAs)funded by more than one
federal award will receive a disclosure Supplement for each federal award.
b. Frequency: Supplements will be generated as the Division receives information for federal
grants. Supplements will be issued to the Local Health Department throughout the state fiscal
year. For federally funded AAs, Supplements will accompany the original AA. If AAs are
revised and if the revision affects federal funds,the AA Revisions will include Supplements.
Supplements can also be sent to the Local Health Department even if no change is needed to
the AA. In those instances,the Supplements will be sent to provide newly received federal
grant information for funds already allocated in the existing AA.
2. Funds may be used for:
a. Salaries and fringe benefits
b. Materials and supplies needed to implement the proposed interventions including,but not
limited to,printing costs, blood pressure cuffs,food models, and digital scales
c. Travel,using current state rates.
d. Indirect costs,not to exceed 10%
e. Targeted marketing in minority communities utilizing existing DPH DPP and CDC materials
that raise awareness of prediabetes and advertise the MDPP (10-15%of the total award)to
include:
1. Billboard and bulletins in minority neighborhoods
2. Advertisements in English and Spanish on English and Spanish-language radio
stations that rank highly in the target minority communities
3. Direct mail, social media,PSAs,TV ads and other approval media outlets
4. Recruitment at community events
5. Recruitment at clinical offices(flyers,posters)
6. Healthcare provider information about prediabetes
7. Worksite education and outreach.
f. MDPP Participant incentives to include: Calorie King books,portion plates, digital food
scale,digital bathroom scale,pedometers,fitness trackers,gym memberships or subscription
services, George Foreman grills, and T-shirts. All MDPP incentives(valued at more than
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$10)must be logged within 24 hours of purchase and maintained in locked storage. Each
MDPP incentive recipient must sign and date the MDPP log when they receive the incentive
valued at more than$10.This shall be evidenced by the MDPP incentive log reviewed during
every site visit.
g. Items to address barriers to DPP participation to include:
I. Gas cards from gas stations and travel vouchers if used to address transportation
barriers for MDPP participants to attend focus groups and DPPs. Gas cards must be
from gas stations and not department or grocery stores that offer gas. Gas cards must
be tracked by card number(serial number),recipient, and signature from recipient
acknowledging receipt.
2. Healthy snacks served during Lifestyle classes
3. Facility rental to hold Lifestyle classes
4. Childcare during Lifestyle class
h. Lifestyle Coach Training sessions
i. Wake Forest School of Medicine data subscription service
j. Funds may not be used for:
1. Lobbying activities
2. Cash incentives
3. Gift cards except as noted above in Section VI.,Paragraph 2.g.1 above.
Revised June 2016
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PFH-Aid-To-Counties For Fiscal Year: 17/18 Budgetary Estimate Number:0
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29 Davidson 0 0 0
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33 Edgecombe 0' 0 0
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36 Franklin 0 0 0
36 Gaston 0 0 0
38 Graham 0 0 6
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42 Halifax 0 0 0
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44 Haywood 0' 0 0
45 Henderson 0 0 0
46 Hertford 0 0 0
47 Hoke .0 0 0
48 Hyde 0 0 0
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