HomeMy WebLinkAbout1988-03-14 88-143 ORDER88-143
Introduced by Councilor Shubert March 14, 1988
CITY OF BANGOR
(TITL&) Mrb¢r, Author ng.,_gity,Ma ager to.e ecute a Grant Agreement
with Maine Dept. of Human Services - Public Health Nursing Program
By the GUY Cement of the city ofBmmyor.
ORDERED,
TUT the City Manager, on behalf of the City of Bangor, is
hereby authorized and directed to execute a Grant Agreement with the
Maine Department Of Human Services, a copy of which is on file in the
Office of the City Clerk, and to take all other necessary action,
including execution of documents and contracts, for the purposes of
providing services.under the Public Health Nursing Program.
in city council march 14,1988
Paste
ctty cler
88-143
ORDER
reg %9R 10 M00
Title,
CITY OF BANGOR
Authdrizing City Manager to EXswte a .� tliY CLERK
civet ngreerent with vaine dept. a
................ 4.....................
human services Public health nursing Program
%Ail<ro ced a H e
CoweSlman
Page 1 of
STATE OF NAME
STANDARD AGROD3ENT
THIS AGREEMENT, made this tet day of lily , 19 aR , is by and
between the State of Maine, Human Services , hereinafter called
"Department," and Bandar Da,nrtmnt of Honlib And WP1F111 hereinafter
called "Contractor.'•
The principal office of the Contractor is located at (street, city,
state, zip): 103 Texas Avenue
Bangor, Maine 04401
The Employer Identification Number of the Cuntractor is
9150010
IRS or Social Security Number
WITNESSETH, that far end in te,mtderation of in, p.m.nto and apreenenta nSr'llartaC nentlma. to bo near
and performed by Ne department, too CanCxtor hereby agmx 11th the Oapaetvant to finish all ciol"']ed
personnel. faeitltLa, mabnais and aenlne and in ,="ratio, vjah tie congruent, to perfarn toe
study or peojerta defended In Rider A. The follad,g riders are her un incorporated into this agrement by
refero ce.
Rider A - Specifications of Work to be Performed
Section A - Identification/Compliance Requirements
Section 0 - Narrative
Section C - Budget
Rider B - Payment and other Provisions
IN WIMSS "REOF,the maroons and We contactor, of tree, repreeentativee duly aub,prima, hall
tattooed Nag gremnnt in 4 (Noeber) origuuls as of m day am year first Ware arittn.
APPROVE) AS TO FDRN:
Date: 49_
eyt
Attorney General
DEPARTMENT: -
Department of Hunan Services
Department Name
By:
AUUoiSignature
Rudollphh Naples, Deputy commissioner
tbud
yped ame and at e
STATE CONTROLLER CONTRACTOR
IQ�� e`�iI� • CES
yped Nave and it e
Page _ of
State of Maine
Department of Human Services
Bureau of Health
Division of Maternal and Mild Health
At a duly authorized! Teting of the Board of Directors
ofcity held an 'arch lr. lgaa
Hama o Drgandzatlon
it was voted that (a):
tle
of this organization, Be authorized to execute contracts/grants in the home of
and an behalf of said organization: and that (B):
Nre e
of this
organization,
be authorized to submit vouchers agaireat this contract/
grant.
yvl
wj.. TT)
Marshall ENWT
Council � it e
(BMD 411) Revised t/9a Board of Directors
STATE OF MAINE
Standard Agreement Summary Page
Department of Human Se[ / Bureau Or Division of Maternal and Child Health
Name of Community Agezy, Bsnoor
Department Project Nene/No.
Maternal and
Child Health
2.
of Health and welfare
3.
4.
Agency fiscal Year July 1, 1988 to June 30,198
Address 103 Texas Avenue
Employer In B
0160020
_
Benner Main n44n1
Agreement Dates
from July 1:
1988
7.
_
to June 30.
1959
Ayprop/ Account No.
amount
Enaobrance
8's
1.
1316 1700
6401 866.472.00
2.
3.
4.
5.
_
6.
_
7.
_
Type
of Community Agency
Typo of Agreement
(complete appropriate
statement
1. An individual
doing business as
_ New
x Renewal
2. A partnership
Amendment
%
3. A corporation
of the State of Meine
_ Supplement
_
a, other:
NAVE
Of LEAD AGENCY:
p�,,rtmeno of Human Services
STUMEO m AAi(6S5ExT
PIM A
A£CIFIGTICIR OF MR. TO IS FfT6pMID
YCTIMI A deoulremn s
cwyuanre a.dii, ni 6ts amen W,ern t6a Ile of tn.m moils are.
Papi_If
I. Sac, al 5ecurl ty Oct, Sect Ion 503, 504. 506 (43 Y.S.C. 703. )w, 705. )M):
3. adreeu of Ibelta. Olvision of Wternel Intl Chill eaIM PoIIcy Nenual (Wrcn. 1586).
5nurce of 'ands:
1. General Fund - Title V Black Match
n� hal t
RIM A
sena e - %.ail"
B. pm-rrsn miatirxs and S ataclies
1. pari (s):
The Bangor Public Health nursing Divisim of toe Bangor Dapartrent of Health a welfare
is ci¢rently mlgsised of 1 x sing Director w a1w Oaxxies an P caseload, 2 MH
staff nurses and 1 geriatric staff nurse.
Tlie goals of the tMFI pstion of our agency is to, provide quality comanzdty rn:rsing
intervention to the pota:t�ly at risk population, as wa11 as to tole families al-
ready identified at risk. This is ammplished tturngh bare visiting nursing services
to prenatal and postnatal. women of all aces, ne.&oms and high-risk infants, youeg
£asiliss with social psoblalla ioterteriog with tlndr p 1-1>eing, handicapped children
and parents experiencing SUddea L:famt Death Syndrome. BCMol casing to private schools
a i immmimtim clinics alw premie his goal Of nursing care through health pramtim
and health eduratim.
a) aramti:g aortic a ly and physically healthier families, who are already in
at risk situations, by'regN frequent nurshg hcae visits to assess family
reeds and adoration thus snperiencirg the family's utilizatim of awrupriate
omnunity wrvices. -
bl ➢xzeasing the n s of prenatal nursing tole visits to all woven referred
inpreparatim for a positive hixt expetie attacommt and
sense of respmslbility to a wrval birth c. eight healthy infant.
c) armoting i d pe tan skills tlm h a r__._ ad hOre Pale ti.
prcgxan
presental by the nurse in ccm labor with the ragular health pro-
motional Mme visit iretead Of txyirg this at -risk population already lacking
eotivation will seek it for theneelves. Tris will enhnnce mnwiolent
:rethads of p cant=g thus reducing child abuse.
d) aeducix tie number of children who are victims Of child abuse and r deet
through nursing sq;ott to ton families, healtheducation and appropriate
accessible services for the family.
e) adducing ton names of teenage pregnancies by frequent regular tune visits
Offerinq health education, anmm-agog self-estces enhancirn their
amnptame
of the mespomsibiiity of their life-style and that of their intants
toward malistic productive 901
f) arrooti stringer, less stressful uot�baby relationships by resspc ding
to the hospital disdm mfaa s Of suspzcted at -risk families with
maeim turre visits as sour as possible, to enable p rents to ask questims,
lmm proper infant rare, discuss safety issues and allows nurse to assess
reed for m going Ise visits.
srwoam awenart w _a_
a. Program miec*ives an.d Strategies
1. ,.__. Is): Cum -It.
gl Inaaeasvq the numher of children identified at an earlier age with develop-
semtal delaysby making available nursing time for an -going regular Imre
visits and enacvmagirg early intervention while prrbess sn m e easily
he amnaged.
h) emoting the respwsib ty of curs w seeking entry into the prenatal
health care system at the first trimester level. the utilizatimh
of the Prenatal Gre Program, as aell as other ceynvit modes and encnhsaging ..
regular home easing visits for mmitortng and health eduotdw during prenatal
l od thus entasur=9 d s of healthier moths aml i ants at birch.
i) Prmotmg families to be resp e.nte for their can health mre needs, as aell
as axial 1fBm assistance i£ needed in helping to reduce family stress lead-
ing to irrespceieibility and violence.
J) Promotng healthier life-style behaviors regarding substance abuse, ®raking,
nutrition, prevention of it ss, regular health ore, day ore choices,
educatimn cppatimities through health education and active armmmicetion on
a regular basis between nurse and family.
k) Prmoting healthier school age children in the 500 students enrolled in
the 5 private sdaols do Winch am nurses are screwing for prcuess and
nekirg apP•z =te referrals. ctr& m6ng to ®hasize to the sctml pommel
the needs for health eduotim as part of the oarfarh
1) Pmvidug cppmtodty for all chilAsi in greater Panngcr area to bene
cpth ly inwmized Haoogh the 2 mthly i ization clinics the nurses
Wau!uct.
M) _ ]L¢ea ri the among service prordders to enhance the efforts
toward the well-heing of a-famiiy ard awiding duplication of services.
n) Providing the WEE p pulat= Hie host onnrant updated iiiEoxmstion and nutsfug
skills to their family ca l though on-going =sing education.
MI.E OF � pr • Bangor Public Heal to fi5mning
DEPM'I me OF HR 4 SFAYICES
DIWSIw OF n4 mMU. Atd1 adLD fffALTH G D ' Jul 1 1988 rn imc �0, 1989
0. frogm Objectives and Sintevies
Z. Objectives:
The 3 Mat nurses continue to state realistic objectives in accordance with the available
ursing hpuss. Bangor has a high density of low inrnne, socially and educationally
limited families who,bsoause of their low self-estesmare not easily receptive to change.
Onfortoately, this Population a ibits very inadequate parenting skills which is the
bacldnne of their children's destiny. 'fie emphasis in all of our objectives originates
with the parenting na aviors of cur adult PCH population aM its affect on their children
they are rearing now and tssa r . Parenting education is ti.n¢ oonsming and cost
effectively onald he betT_r in a gram@ setting. we knw from enperiece the motivation
in attending parenting classes is very lnor. T problems still exist in spite of many
trained parent educators. The focus now is to try a new approach, taking perantirg
e tion into the tans where tine setting is more W Ive to learning and the nurse/
client relationship is non -threatening.
The following objectives are stated with the parentinq issue applicable to mast of than
in fostering iroraaaol family responsibility affecting tlamaelves a� their oammmity:
a) The Epp nurses will continue using 80% musing time for the purpose of
Inn visits for health eolr tion and health'prarotinn to the at -risk
population which nun r 1400 individuals per year. The ransinnar of tin¢
will be spent on clinics, school nursing in-service education and reaxd
keeping.
b) The PCH nurses will oxo time to maintain a caseload of 75 pregnant and
parenting teenagers.
c) Trere will be a 10% i razse in educated pre of and parenting teens
in th PCH =sea caseload.
d) 'fie P verses will continue to identify and apprr iately help plan care
for these children with induced developmental delays by coolHinating with the
local precool project and participating on early childhood teams once a
week.
e) 'Deere will be a reduction of the length of tine a family retains under
ohildrenta protective services when the vM nurses are involved with than
sansfami.lias. These 45 families represent 7% of the total number of opal
cases in Bangor, but the ! nurses providing than with 158 of nursing
time sport.
f) 'fie immunization cliwc will contims to maintain fully immunize! status
of 100% of the hi ldren in the clinic system with an anticipated caseload
of 400.
g) Injury control will be taught at 80% of all the hoc visits to the 1900.
Clients served.
M. OF M Froeram: Bar Public Health Nursing
DFPABTPf OF M I SMVIC6
DIVISION OF NATkANAl AM CMU IffA G Da ' JUY 1 1899 to June 30, 1989
B. PMram Objectives ami Stratesies
2. Objectiees:
h) M n1i mases will attempt to enroll 1008 of all maternity clients into
preatal came during the first trimester. M current caseload is 180.
i) Muse will be a 18 d%xasse in family violence due to substance abuse,
unemployment, poverty, poor parenting, loo self-esteem in the existing
caseload. The asrxnt caseload of potential family violence families
is 500.
j) Me t nurses will continue to provide age appropriate primary health
s l bused services to 500 children, grades K Uumagh 12, in select
Bangor schools.
k) M F nurses will continue to maintain .staff developmamt time at 0.028
time of aaJ ly workload.
1) Me M numses wlll continue to follow-up on 1008 of post-ie�xVam and
nedmom nursing referrals.
SI OF MAIMo..g• Bangor Public Daslth Nursiml
DeF 71 R:t OF H 1 SFdViCEB
DmslQ OF WllFRtNi AtUI Cf61D MEV.SM Grant Dates: July 1, 1899 to Jm 30, 1989
B. Ia tam Obiectives sad Svrateaies
Z. Objectives:
fi) Tne Ib3
nurses will attaQt to enroll 1008 of all maternity clients into
prenatal osre da the first trimester. 9 cunsant caselcad is 100.
i) 'Mere will be a 18 decresse in family viola due to substance abuse,
unaaplg t, poverty, poor parenting, low self-estean in the e<istiM
caseload. ' current caselasd of potential family violate families
is 500.
j) 'Me M asses will continue to ptovide'age appropriate prinary Imlth
schcvl based services to 500 children, grades K through 12, in select
Bangw schools.
k) 16e M% n=aes will cmtiwe to maintain staff develo t time at 0.028
time of xeeitly workload.
17 1fie M^H nurses will continue to follow-up m 1008 0£ post -Fart and
naSvm m¢sing rc£errels.
SLUE OF 441INE
Pro¢
x
Fubl' dt�wg
DVARA N1' OF F1ANi SFRYICES
Help text find stgl'Drt-family, friends.
g.
HF
DIVISION OF M4YkANPb PND 61IL0 M
Grant Daces:
lulu 1. 1988 to Mm.
30 1989
B. Proarm Obiectives and Strategies
3. Strategy Statement-.
f.
Help text find stgl'Drt-family, friends.
g.
Fatcoosage her calling nurse with giestims.
h.
Stress necessity to keep cl tors appointments.
i.
Schedule Irne visit at least monthly early in prannancy and every 2-3 reeks
last trimester.
j.
Introduce birth control optima before delivery.
k.
mtrcduce Nome Parent Program.
6)
Continue
the 2 nvtthly nsmmiantim clinics in Bangor to upd d Objective F.
a
Children test have physician's onfar for immmmipatim of tuts vaccine
Preventable childfsood diseases.
b.
d ar.
rs not restricto Bangor but serves brearea.
Clinicted
$2.00dcnatim suggested per child if Passible.
aA
.
Permanent records kept at clinic.
7)
Wntinue
with Its® visits t0 teen parents and their infants as stated in Objective B.
a.
Same Protocol as with older parentixg wen in $4.
b.
Discuss birth conssrl and enwiu'agieg her to make realistic ChOicas.
c.
Discuss advantages of , ying subse3umt pregnancies, invOurage 6 week
check-up.
d.
Discuss ednsational opportunities. -
.
Concentrate'tM fore m Parent Program and enmt¢age her to Participate.
£.
Assess for realistic living conditions and teenager's abilities to provide
for infant.
g.
Frequent some visits every 2-3 reeks first 3 myths, if FOSS ble, by nurse.
8)
Continue
with health lxrnntiss+1 visits in families with suspected or identified
child
abuse ani n gleet as strtad in Objective E.
a.
Visit sent y or more often if in crisis:
b.
lntrodexs Hare Forest PYp]ram or refer to Parattiry Class if available.
Assess for abusive behavior ants observe child closely.
d.
Assess for devaloptental delays in child.
e.
Help family find remurces to alleviate household stress, that is, day care.
f.
Eneoucage family to cell nurse betxsm visits or if problems.
g.
[sip family planand follow through with health care of children.
h.
Assess entire family for timet needs.
9)
Onstintre with school nursing in 5 private sctaols as a means to Objective J.
a.
Check for cmpleted ivmrmiratims and refer.
b.
Oneck new egloyees for IB tests and dowhen necessary.
c.
Vision screening in designated grades.
d.
Hearing screening in desirynatad gr' des.
a.
Spinal s¢eenvg in designated grades.
f.
Refer for follow-up as necessary to parents choice of doctors.
g.
Follerup on compliance.
h..
Interact with parents and styrol personnel on behalf of students r rding
xtvironmmental check, health education classes needed.
SU= OF MAINE proa[aa' Bangor Public Health Nursing
OEPAE'R@R OF dgOdPN SERVICE+
DIVISION OF HGTEitWL =WMID iffAI.TH Gran[ Oates: July 1, 1988 to Jvne 30, 1989
B. P[ Objectives and S[ratagies
3. Strategy Staremsnt:
10) continue a carritvent to health pranation of the aamnmity regarding canm�nicable
disease control, child abuse prevention, injury control, tsaage pregnancy, etc.,
as a result of Objective K.
a) Arrange for ArBS training regarding sitaatims; with children and families.
b) Presentatian to doctors in obstetrics and pediatrics regarding referral
systen and how they can use systau.
C) Media arsoinhcaoants relardvng clinics, special health interests, safety
tips regarding children,
ll) Wntinue to pmviae for the Handicapped children's Prgr in Bangor, as part
of task of Objective B.
a) Hare visits to determine eligibility after receiving initlsl referral.
b) Refer to Prtscncol PtOject for coordinating services, if a pcesrinoler.
C) Assess for needs of entire family, as 11 as child.
d) navelodmental a sessrents using nurses' screening tools.
a) Arranging with family clinic and physician apdninla 1hs.
12) Continue to netxork with otter service providers on behalf of the Mad clients
being seined by several providers toward Objective K.
a) Nurses serve as active mardsars of organiutians fonsed to benefit Children,
that is, mild Care Advisory CtVWittee, S Tame, Tem Coalition, atc.
Evaluation Plan
A. In evaluating the effectiveness of the CHN intervention in Bangor,
the objectives must be analysed at the end of quarterly and year end
periods. Weekly worksheets are kept by each nurse who compiles data
about her caseload. By monthly agency reports, we know at a glance how
many referrals r ved, what age bracket, what type of case and nursing
offered. Data will continue being collected this way.
B. The implementation of the Home Parent Program and it's effectiveness
will be measured at the 6 month mark and again at 1 year to determine:
1. --the number of teens or other single parents who participated;
2. --how many completed the entire program, if dropped out, when?
rea
3.--Aresany of these women referred to children's Protective Care
during this time;
4. --what did the client like or dislike regarding the program;
5. --did child remain healthy and free of accidental injury during
this time.
C. At the year-end it will be recorded on each teen served if she
received education toward high school, college or employment. Percentages
will be figured accordingly.
D. By 1990, the percentage of Headstart children identified with speech and
Language delays should be reduced by 108. These figures will be obtained
in cooperation with Headstart.
E. The length of time a family remains under Children's Protective Service= -
for child abuse and/or neglect will decrease as the MCH nurse also works
with family toward appropriate parenting. This data is reviewed with the
Department of Human Services twice yearly and accessible to community
health nursing services.
F. According to data gathered by the Immunisation Project, the immunisation.
status of the greater Bangor area should reach 988 by 1990.
G. .The number of preschoolers in our caseload involved in accidents
and injuries requiring medical attention will be declining a stated i
nursing records by 1990. This data is collected through periodic record
reviews.
H. By 1990, the number of home visits to each prenatal will average 10
or pro -rated as to when they enter the nursing
ing system. This will be
monitored through chart audit and periodic record review.
I. A decrease in family violence may be difficult to measure but the
factors contributing to this my be evaluated as clients enter into
treatment, or gain employment or receive parenting education. This data
would be gathered from nursing reports and F.S.I.D. system.
S. The school health record will be used to collect data not in school
reports. The year-end school reports submitted to the state reflect
the entire school health outcome.
K. Measurement of nursing contributions to Early Intervention activity
will be done through Child Find count.
STN4]40 AGRE EIn "_ Of _
BANGOR PUBLIC HEALTH NURSING
7/1/88 6/30/84
Outcome Measures
The outcome measures for serving the Bangor MCH population are as
follows:
1. The percent of live births to teenagers will be no higher than
1984-86 state average of 46.8.
2. The percent of pregnant women of all ages getting first trimester
prenatal care will average 738, which corresponds with the 1984-86
state average with special emphasis on the pregnant teen.
3. 508 of our MCH caseload will receive the Home Parenting Program
as an alternate to parenting class.
4. At the age of 1 -year, the immunization status of 958 of children
will be up-to-date as per the American Academy of Pediatrics.
5. Upon identification, 958 of children with developmental delays
will receive assessment and treatment as facilitated by the
MCH nurse.
6. 85% of the children identified for suspected abuse and neglect
will have not been victims after MCH intervention in the home.
7. 908 of children will not be subject toenvironmentally induced
developmental delays once identified and referred to this agency.
8. 908 parenting teens will not have a subsequent pregnancy within
one year of postpartum period.
9. 959 of the pregnant teens referred to, our agency will have healthy
outcomes for both mother and baby including normal birth weight.
10. 1008 of families will receive accident, prevention education
integrated with health promotion with a positive 708 outcome
during the preschool years up to age S.
L1. 908 of infants 0-12 will be between the 5th and 95th percentile
for weight and height growth record.
smaNst 4waD9R e^P _ m _
BANGOR PUBLIC HEALTH NURSING
MCH GRANT 7/1/88-6/30/89
Needs Assessment
The City of Bangor,with a population of 32,500, represents 258 0£ the total
population in Penobscot County. The area is 34 sq. miles. There are several
factors affecting the lifestyles of people living in the urban setting versus
the rural areas of the county. Therefore, it is incorrect to assume that 258
of the county's population also have 258 of the county's problems.
These variable factors affecting the needs of our NCH population are.
1. There a areas in the city with a high density of low-income
-am-.iese One such area houses 493 families.
2. According to the Housing Authority, 908 of the subsidized households
have single parents.'
3. According to the recent HUD grant, it was estimated that 806-908
of the low-income families are affected by drug and alcohol abuse.
4. According to the Maine Employment Security Commission, the current
unemployment rate in Bangor is 5.08, compared to 5.58 in the state.
These figures do no count the people who are not currently registered
or who are not drawing unemployment. Most of the families with whom
we are serving would,therefore,not be counted.
S. Bangor's General Assistance Program helps 300 households per month.
608 of these households have children. As a result, $39,000 per month
is distributed to families to meet the basic needs of food and shelter.
6. The child abuse statistics in Bangor are suggestive of the special
needs families residing here.
According to the Department of Human Services Child Protective Unit:
Penobscot County 7/1/84 - 12/31/86 Bangor
470 cases assigned to workers 264 cases assigned
416 cases screened out 301 cases screened out
7/1/87 - 12/31/87
366 assigned to worker 322 assigned
553 screened out 401.screened out
This pattern of increase emphasizes the fact that the percentage of
troubled families living in Bangor needs to be address separately from
the rural county needs.
7. The number of live births per 1000 teenagers in Penobscot County
(45.4) is rising to nearly the state level (46.8) according to Maine
Vital Statistics 1984-1986, which is reflective in the 998 increase
n prenatal and parenting teen referrals we receive. Because the city
s a "hub' attracting teens, the number of referrals is probably greater
than in other parts of the county.
F 1uu
M_ of
B. In 1986, 668 0£ the teens becoming pregnant in the state delivered
live births. 0£ these, 908 occurred in unwed mothers. The combination
of being a single parent and a teenager is one of the biggest risk
factors for the beginning roots of dysfunctional families. During that
time, Penobscot County was 98 greater than the state statistics. Bangor,
therefore, probably averaged 10-158.
9. In 1986, the percentage of pregnant teens statewide receiving medical
are in the first trimester of pregnancy ranges from 40-608. In women
over 20, 769-858 seek care. In view of this fact, Penobscot County sees
the largest number of low birth weight babies born to the 16 -year-old
mother. We now know that the trend in teenage pregnancies is that the
15 and 16 year olds have an
increased pregnancy rate while the 18 and
19 year olds are in decline.
10. The live birth rate of infants under 2500 Ems. for Penobscot County
shows a slightly higher rate that the state average, but not surprising
because of the location o£ Eastern Maine Medical Center being in Bangor
serving the outlying areas. This medical center is the major facility
for all the outlying areas and I am uncertain how these statistics are
calculated.
Thanks to the support of the MCH grant monies that the services provided to
our MCH population are well received and the referral rate for our at -most -
risk population, the pregnant teens,is being recognized by all care pro-
viders. The basic fact is that the more time invested in a family by the
MCR nurse, the more positive the outcome.
Page _ of _
PROCROM PROXCTIM
ul M iServed
(0-2)
Infants
(3I
rnildr
(12-24)
raensaoia
aj.
>25
Women
>25
0
Total
Unduplicated cant
564
896
Walkin
lin
29A
43
2411
6SP
Iq
Age(s)served by
Servica(s)
Rare vis
Imagunizat
s -
= Clinic
Home Vj
school
sits
aursing
Hare V]
3its
(2) Income requirement (if applicable, attach sliding-fee-scffie used to determine fee Charged
to clients): I Nae
(3) State any eligibility requirements not described above (e.g., health conakitions,
referral): Or Passing agency is reapansible to all Border residents foreinitial
assesssents - clean referred to other camomity resources or initiatad Nto Part MY
caseload, according to prinrity level.
(6)
The geographic area
to be served by this
program is (state, county(ies), portion
of
counties): City of
Bangor only. ewxpt
for Immunization Clinic which serves
(5) Budget distribution (based an total staff):
% of time spent in direct service 70
. of tis spent in ieMireet service '(e.g., travel, meetings, conferences) 10
S of time spent N management/a6rinistxatian 20
(6) If applicable, list clients served by priority (e.g., 1. high risk infants, 2. pregnant
teens, 3. high risk pregnant adults):
High risk rents
High risk pregnant adults
Pregnant teens
At risk fmnilies with pzexlvolers
HIDER a Page � of
SECTION C
SAM OF MW NE Program:
DEPPR'PEC OF HEWN SERVICES -
DIVISICN OF W TH4YAL AND CHILI HEALTH Great Dates: 7/1/88-6/30/89
I::..�+:E�LEOiTnal6i;Id.I!
1. State/Federal Fwdinq Sources
{rent Tear
Fr000sed Tear
a. Divisi¢n¢F PSI
63,915
66,472 I
�facaTf lll¢ Sources
I
a. TONI/HLY
37,599
37,266
o.
¢vavrrw,...e
J. ou[ses
a.
o.
IC.I
I
I J. Program Incom I
a. Clien[ Fees
400
qpp
CQiL4U {atrw e[vlces I
c.
$. t { KWe
C.
(BHDCH-003)
Revised 5/85
Page _ of
I
STATF OF :RINE Agency Ness:
08
DFFPR 5D1N F M4TfANAL gIM MIDDM
tam Title: - ngor RPAI�h 9 17.1f, t
MILD fffi1I.Tli
4�1fY1JTlYi,la.Ma-
TOTAL - Paz Reports to Division
Income
E: Dose
0a lance
104,138
Ralatrc<
35.8
N/A
37 6
0
I
I
I
I
TOtd 5
30
0[a1 A-u5tmen25
'm'rel fVCadPIF FOO lbST BRPRING (A mines 3)
1Y1S1' SiNRING
Fadi Sauces
o a
Income std et
35.8
ora
Avail. Ivcome
vaa a
Itaome
Drax
Ralatrc<
35.8
37 66 -
37 6
0
Qb] G AM
City of Bangor
Cli cat Fees
TOtd 5
30
9 -013
Revised 5/85
Page _ of _
STATE OF -3. Pto° m'
DEPMDfiR T OF NRN1Y SERVICES
MD Cf¢tD HVA1.TM Grant Dates: -
OIYISIdi OF ANTFN4PL
1.
Salaries 6 wa
es2.
Frin a Benefits1.
jo
consultant Fees4.
Ptoviders FeesTotal
PersoE
6.
Purchases
7.
Rental
8. Total Equi nt jxpensas
Si
9A8
9. Total Subcontract Expenses
S
lo.
O cuv eme
2,258
11.
Depreciation
12.
Utilities
13.-
Heat
14.
MeintetuKe
15.
Televhnne
688
16,
Materials 6 5 lies
1,114
17.
tabora[o
18.
Travel
1]5
19.
Imuiame
20.
Pana e
21.
al
AMinizm[iv< IMiiKt)
80,3]4
22.
Other (Attach Detail)
]44
35. To eal All Other mea
15.355
Lima 6
24. TOTAL E%Pf M
'104 138
STATE OF PAIRS PROGRAM% MCH
OEPLETNBNI OF HUMAN SERVICES BUDGET JUSTIFICATION
DIV19100 OF MTEENAL ANG CHILD HARDER PERSONNEL EXPENSES GRANT GRIM 7/1/08-6110/84
(1)
No. O!
Personnel
1 1
Position or Title
131
Rale
(4)Nov[ly Total Xeekly
Weekly salary
Noute
Nofte[
Weeks
Total
celery Po[
Grant
Period
Il
Time
Been! an
la P[oq.
thin
'Total
PRale[
[period nt
period
1
Director Pub. Nlth.
NO
542
20 20
22,561
37 5 328.45_
19,680
Public He
--
_—..__
t
PRIME BENEFITS
EUIPtRRY
T e
of Sane tl!
\ Pe Fill
BX
en
P[a
sed Year
4
Total Salary
65.255
—
Total Fringe
_P �
I ICA 2
P11
Total Number Gf3.
Total Rale[ enRA
F
Totales
\
Reneekee
In
RRBCR-ops l/R: h
Page __ of
VA= OF M Pro MCH
OEPBKDR OF HM WI SFAnffS
DInHI0.4 OF t TENN. MID CMR MM Gnn Osies �/1 /88-6/3x/89 _
80.5M OF DL IB=%G SHPEFD DDiECI EXPENSES
OCcuoan.
F P00 :C.
0 FOO
feei�-
1DTAL £%Pfi6E5
OCH
E.
PR0G80.M E%P.
1.
Personnel Expense
S133,048
S
82,817
FTEZ.
one
.95 PTE.00
fib
PTE4.
3
4.
ARA
5.
6.
Ti
8.
7a4
p
1V1AL
166 006
E
104
138
ALIX'Ai1➢N Oe ewe'
D N 0i
WE tm.05
FTEZ.
one
.95 PTE.00
PTE4.
ff=�
5.00 FTE
STAk)Af9 pgiEpFM
RIM 8
MXEN! AND 0mgmR mmisIQIE
i. WRPPCT MOM.
Pogo _ o/
Total .amount $66,472.00
lateral Schedule
Four (4)
quarterly
payments
- $16.6113.00
each
2.IINWIM NO M1ME111S. Payment shell be shady by the apartment vltnrn Is ban a/K, """Pt of an
approved r emi¢b Inwicu wdaHteo by thu mntracbr made his usual bl II ly forms or [bslresa
3. BENEFITS AND CQUCTIM. If the Contractor Ie an Individual, the contracts understands and
Independent MnM1actor for hasFederal or State I yr II be
d
abductehby the Department, and for whot ad retirement benefits, s,rvlwr sandlotxn n, group
I to nod
yaand eek Iucw, and similar benefits available to State employees ail I
The xtrw benefitseContract« further understands that annual Information returns as -,,k od by try
internal Ramada aide or State o/ Male, Income man lav If I has filed by the State Controller vote
the monomer Pawnor Servrw and the rah of halm Su:eed of Tavatlon. co od Of .horn vH on
furnished to the contractor for his makes, Tax racoon.
4. INEMORDExm flPPRI The parses afford agree that the Contractor, and any agents ate awl
Of the Conmeeror. In the performance Of tors agreement, shall act In an lMyend:nt nPaofty and
net as officers or employees or agents of me State.
s. WIIRMm .IW Ix Is1MiCP. Flo morins, progress reports, darrasponMnce and related ambassadors
free the Contracfor shall be directed h:
Bel: Meredith Tipton, B.S.N.. M.P.H.
Director, women and Children's
Title: Preventive Services Program
Mdrems:_ Diyision of Maternal and Child Health
brute Here StnHnn #11
meta Maine /Mil
,he Is designated as the contract Mmr ni stento' on behalf of fW apartment for thra contract.
6. MARTENT'S MRSERIRIVC. The contract Me in l crystal- shall as the EsparlmanYs r,pumantatl ee
l-rng the period of this agreareM. he has authority to stop the work If scary to ensure rfa
proppear e,fachution.a a ,Tory f e Copan n payments udder Mea met are due
the h ro be half. alb shall make decisions an al cialms of the antraeto9.a sa�J.cl to the and
appro�lnof the reed of the aparreent.
7. CxeW S a THE WORK. The aparinent may Order changes In the dump, the agreement $um Ming
adjusted accordingly. All such orders and adjustments shell be rn writing. Clalma by the
Contractor for ahem cost must be made in rating and signed by the O ntcacf Mri,istranor before
emea Ing the work Involved,
STATE OF KM Prat C
DWATMT W fma SERVICER
DIVISION OF MATHLWL AND WILD HELLTR Grant Dates: 7/l/88-6/30/89
OM DIRECT. EIIPEISE JUSTIFICATION ota uw
Line Ives No Description f I - Usis Us'of Exee Item Eameme
22 Other 744
1. Special Personnel
--Typewriter Repair Contract
--Deaf Interpreter
2. Education and Membership goo
Line Iter Nuaber M t Agree WiZA Line 1tcm On rum,
ffOW-0%
Revised 5/85