CTR055429 A3 FOR SIGNATURE MARICOPA.PDF

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
1 
 
Healthy People Healthy Communities 
 
It is mutually agreed that the Intergovernmental Agreement referenced is amended as follows: 
 
1. Pursuant to Terms and Conditions, Provision Six (6) Contract Changes, Section 6.1 Amendments, Purchase Orders and 
Change Orders, the following changes are made under this Amendment Three (3): 
 
1.1. The Scope of Work is revised and replaced; 
 
1.2. The Price Sheet is revised and replaced; and 
 
1.3. Exhibit A, C, and D are revised and replaced. 
 
ALL CHANGES ARE REFLECTED IN RED 
 
All other provisions of this agreement remain unchanged. 
 
 
 
Contractor Name: Maricopa County 
 
Authorized Signature 
4041 N. Central Avenue #1400 
 
 
Address:  
 
Print Name 
Phoenix 
AZ 
85012 
 
 
City 
State 
Zip 
 
Title 
 
Pursuant to A.R.S. § 11-952, the undersigned public agency attorney has 
determined that this Intergovernmental Agreement is in proper form and is 
within the powers and authority granted under the laws of Arizona 
This Intergovernmental Agreement Amendment shall be 
effective the date indicated.  The Public Agency is hereby 
cautioned not to commence any billable work or provide 
any material, service or construction under this IGA until 
the IGA has been executed by an authorized ADHS 
signatory.  
 
State of Arizona 
Signature 
Date 
 
Signed this                         day of                              
20              . 
 
 
Print Name 
 
Procurement Officer 
 
 
Contract No.: CTR055429, which is an Agreement between public agencies, 
has been reviewed pursuant to A.R.S. § 11-952 by the undersigned Assistant 
Attorney, who has determined that it is in proper form and is within the powers 
and authority granted under the laws of the State of Arizona.  
 
 
 
Signature 
Date 
 
Assistant Attorney General 
Print Name

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
2 
 
SCOPE OF WORK 
 
1. 
Background 
 
1.1. The vision of the Arizona Department of Health Services (ADHS) is “Health and Wellness for all Arizonans.” 
In December of 2013, ADHS completed a State Health Assessment (SHA). The SHA utilized Community 
Health Assessments conducted by local county health departments to assess the needs and capacity of 
public health in Arizona. This work resulted in the identification of fifteen (15) leading public health issues 
affecting the health of our communities. With stakeholder input, the Arizona State Health Improvement Plan 
(AzHIP) created a roadmap to improve the health of Arizonans over the next five (5) years through the 
development of partnerships and resources to work collectively on shared health improvement goals and 
strategies. This is how the original Healthy People Healthy Communities Intergovernmental Agreement 
(HPHC IGA) was born. 
 
1.2. These goals and strategies were accomplished through a collaborative approach that engages local, state 
and national partners to improve the health and well-being of Arizonans. Collectively, evidence-based 
preventative health strategies were implemented, designed to impact health through health policy, system 
and environmental change initiatives, health promotion and education for individuals and communities, and 
enhancement of the public health infrastructure. 
 
1.3. Implementation of the original IGA was completed in three (3) phases that occurred in the first year of the 
IGA to accommodate funding cycles. Phase I included Tobacco, Chronic Disease, and the Health in Arizona 
Policy Initiative (HAPI), and began in July 2015. Phase II included the Public Health and Health Services 
Block Grant/Accreditation and began in October 2015. Phase III included Teen Pregnancy Prevention, Family 
Planning, and Maternal and Child Health, and began in January 2016. All three (3) phases were operational 
and fully implemented in years two (2) through five (5) with annual start dates of July 1st. 
 
1.4. In July 2020, the original HPHC IGA was split apart and two (2) separate IGAs were formed; a fixed price 
contract and a cost-based reimbursement contract. The programs to be included in this fixed price contract 
are: Tobacco Cessation and Prevention, Teen Pregnancy Prevention and its Youth Mental Health First Aid 
Initiative, Health in Arizona Policy Initiative (HAPI), Public Health Improvement, Healthy Arizona Worksite, 
and the Suicide Mortality Review Programs. 
 
1.5. The Suicide Mortality Review Program is administered by ADHS, who will develop a suicide mortalities data 
collection system, encourage and assist in the development of local suicide mortality review teams, and 
provide training and technical assistance to those teams.  
 
1.6. Beginning in July 2022, the Public Health Improvement Program, which is funded by the Preventive Health 
and Health Services Block Grant, will move from the HPHC IGA to the Maternal and Child Health (MCH) 
Healthy Arizona Families (HAF) IGA. 
 
1.7. Beginning in July 2022, the Healthy Arizona Worksite Program (HAWP), statewide worksite wellness 
initiatives will transition back to ADHS from the Maricopa County Department of Public Health. Maricopa 
County specific Worksite Wellness activities will be moved to the HAPI scope of work/action plan. 
 
2. 
Purpose  
 
The purpose of this IGA is to leverage multiple public health funding sources to support implementation of health 
priorities identified in the AzHIP (2021- 2026) and the County Health Improvement Plans (CHIP). This IGA is 
intended to provide flexibility to the County Health Departments to best meet the needs of their local communities 
through high impact strategies that realize the agreed upon outcomes. The IGA provides a pathway to improved 
coordination of multiple prevention programs and the Suicide Mortality Review Program, while streamlining the 
administrative functions for the programs that were previously administered separately.

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
3 
 
3. 
Objective 
 
The County Contractor will implement evidence-based strategies at the local community level that: 
 
3.1 
Promote and implement healthy communities’ interventions that target policy, system and environmental 
approaches that will shape the communities in which we live, learn, work, and play; and 
 
3.2 
Promote and implement healthy people interventions that target individual behavior and support making 
healthy choices. 
 
4. 
Scope of Service 
 
This IGA offers a variety of evidence-based strategies designed to impact policy, system, and environmental 
change at the community, organizational, individual, and policy levels in order to promote county-wide health 
changes so that public health impact will be maximized. Contingent upon available funding, Counties are expected 
to implement at multiple levels, in accordance with local community needs, and should emphasize complementary 
policy, environmental, programmatic, and infrastructure activities that integrate and build on each other to optimize 
the health improvements of the community.  
 
Counties must select from a menu of evidence-based strategies, found in Exhibits A-E that influence individual 
behaviors, policy, organizational practices, systems, and environments though the following specific program 
areas: 
 
4.1 
Exhibit A – Tobacco; 
 
4.2 
Exhibit B – Health in Arizona Policy Initiative (HAPI); 
 
4.3 
Exhibit C – Teen Pregnancy Prevention and Youth Mental Health First Aid Initiative; 
 
4.4 
Exhibit D – Suicide Mortality Review; and 
 
4.5 
Exhibit E – Supporting Documentation. 
 
5. 
Evaluation: 
 
Performance measures and evaluations allow the counties and ADHS to collaboratively track progress, process 
indicators, outcomes measures, and impacts. As part of the local evaluation plan, the counties will be responsible 
for measuring the short term, and intermediate outcomes. Monitoring progress on short-term outcomes provides an 
opportunity for the Local Health Departments to adjust strategies to ensure increased long-term impact. ADHS in 
coordination with the Counties will be responsible for measuring the long-term and impact outcomes. Process 
indicators, outcomes measures, and impacts must clearly relate to the selected strategies and activities identified 
within each County’s Annual Action Plan. 
 
6. 
Approvals:  
 
6.1. The quarterly reports, yearly action plans, yearly budget templates, and supporting documentation shall be 
approved by ADHS; 
 
6.2. Once the Action Plan has been approved, any changes to the approved activities, or strategies must be 
approved again, by ADHS prior to implementation; 
 
6.3. Capital Equipment (Single item purchase of $5,000 or more) purchased for the program: A written request 
shall be submitted to ADHS for review and approval prior to any purchase on a case-by-case basis. The 
written request shall include details of how the proposed purchase supports current approved scope of work

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
4 
 
and annual action plan. Ownership will be retained by the Contractor for continued use in the objectives of 
the Action Plan; 
 
6.4. All marketing materials (the use of ADHS logo, brochures, posters, public service announcements, paid 
media, videos, etc.) which have been developed, written, published, or recorded by the Counties and paid for 
with funds from this award must be first approved by ADHS prior to the dissemination of such materials or 
airing or use of such announcements; 
 
6.5. All County local emerging issues and related supporting documentation must be approved by ADHS prior to 
implementation. The approval process document will be provided to all Counties and must be followed in 
order for the proposed local emerging issue to be worked on; 
 
6.6. Contractors will be required to attend ADHS Suicide Mortality Review quarterly training and technical 
sessions, submit quarterly Suicide data using the ADHS Data Collection Tool and the ADHS report template 
to the Suicide Mortality Review Program Manager prior to payment; 
 
6.7. The quarterly Contractor’s Expenditure Report (CER/Invoice) and any supporting documentation, when 
submitted, shall be approved by ADHS prior to payment; and 
 
6.8. All evaluation components that involve human subjects.  
 
7. 
Tasks 
 
The County Contractor shall for the overall IGA: 
 
7.1 
Develop and implement a 3-year Action Plan and a Budget Plan within the first forty-five (45) days of each 
budget period; 
 
7.2 
Participate in all calls (monthly, bi-monthly, quarterly), technical assistance calls and/or webinars, meetings 
and trainings; 
 
7.3 
Implement the approved strategies;  
 
7.4 
Participate in the development of a shared comprehensive evaluation plan and report out on any performance 
measures related to the implementation of their activities (process and/or intermediate), or as defined by the 
funding sources; and 
 
7.5 
Provide supporting documentation that supports the completion of the defined deliverables within the 
approved annual action plan to the ADHS IGA Program Administrator. Examples of acceptable supporting 
documentation can be found in Exhibit E. Further guidance will be provided by specific ADHS Program 
Managers, as needed.  
 
 
ADHS shall for the overall IGA: 
 
7.6 
Review, provide feedback, and approve the Annual Action Plan(s), Annual Budgets, and Supporting 
Documentation within thirty (30) days of submission; 
 
7.7 
Provide evidence-based strategies and supporting resources; 
 
7.8 
Provide a Quarterly Reporting Template; 
 
7.9 
Provide the Annual Action Plan Template; 
 
7.10 Provide a Budget Plan and CER Template;

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
5 
 
 
7.11 Collaborate and work with the County to develop a comprehensive Logic Model Template; 
 
7.12 Host TPP Youth Mental Health First Aid Certification Training annually, if needed; 
 
7.13 Provide Outcome Measures and examples of process, or intermediate performance measures, as needed; 
 
7.14 Provide a Financial Guidance Document (if applicable); 
 
7.15 Provide feedback, technical assistance, and training to support the approved Annual Action Plan(s), Annual 
Budget, Quarterly Reporting, and Supporting Documentation; 
 
7.16 Provide access to virtual technical assistance and guidance from ADHS staff, local Health Department 
peers/mentors, and subject matter experts related to the strategy for which the County has received funding; 
and 
 
7.17 Coordinate and conduct Contractor site visits. Note: If not yearly, at least every two (2) years a site visit will 
be conducted. 
 
8. Requirements 
 
The County Contractor shall meet the requirements listed below: 
 
8.1 
All revisions to the Annual Action Plan strategies, goals, objectives, and timelines will require joint review and 
approval from ADHS staff; 
 
8.2 
All staffing and programmatic changes will be reported to the specific ADHS Program Manager and the ADHS 
IGA Program Administrator within fifteen (15) days. Once someone is hired for a job vacancy, an email 
containing the new hire’s full name, contact information, start date, areas of the IGA that she/he will work in, 
and a resume will be submitted to the specific ADHS Program Administrator and the ADHS IGA Program 
Manager within fifteen (15) days; 
 
8.3 
All requests for a single item of capital equipment at or above the purchase price of five thousand dollars 
($5,000.00) will be requested in writing and submitted to the specific ADHS Program Administrator and the 
ADHS IGA Program Manager for approval; 
 
8.4 
Food and/or beverages served at events/meetings are not to be paid for with State funds per the State of 
Arizona 
Accounting 
Manual 
(SAAM) 
policy, 
found 
here: 
https://gao.az.gov/sites/default/files/8010%20Food%20and%20Beverages%20at%20State-
sponsored%20Events%20181113.pdf. 
 
8.5 
Comply with all State reporting requirements; 
 
8.6 
At least one Program Manager, or coordinator from each HPHC IGA program must be in attendance of the 
Annual HPHC IGA Summit; 
 
8.7 
Funds cannot be used for any lobbying activities, including the preparation, distribution, or use of any kit, 
pamphlet, booklet, publication, electronic communication, radio, television, or video presentation designed to 
support or defeat any proposed or pending regulation, administrative action, or order issued by the executive 
branch of any State or local government; 
 
9. 
Deliverables and Delivery Schedule 
 
The County Contractor shall submit the deliverables listed below to the ADHS IGA Program Administrator:

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
6 
 
9.1 
Contractor Expenditure Report (CER) to ADHS, due thirty (30) days after each quarter end (Q1: July – 
September; Q2: October – December; Q3: January – March; and Q4: April – June); Supporting 
Documentation is to also be submitted. Counties will select from a menu of acceptable forms of Supporting 
Documentation found in Exhibit E; 
 
9.2 
A written Quarterly Report, due thirty (30) days after each quarter end (Q1: July – September; Q2: October – 
December; Q3: January – March; and Q4: April – June); 
 
9.3 
A final CER invoice not later than forty-five (45) days following the end of each Agreement year; 
 
9.4 
Provide the name, email address and phone numbers of all program staff funded under this Agreement within 
thirty (30) days of hire; 
 
9.5 
Notify ADHS IGA Program Manager of any change in program staff under this Agreement within fifteen (15) 
days of the change. If there is a new employee, include the new hire’s work contact information (i.e. email 
and phone number), and resume within the fifteen (15) days window period; 
 
9.6 
Collaborate and participate with ADHS on the development of a logic model; 
 
9.7 
Submit an Annual Action Plan by August 15th; 
 
9.8 
Submit an Annual Budget Plan by August 15th; 
 
9.9 
Submit an Annual Report forty-five (45) days following the end of each Agreement year; 
 
9.10 Submit a written request to use the ADHS Logo in any print, web documents, publications and video 
recordings prior to use;  
 
9.11 Submit a written request for the development of brochures, posters, public service announcements, paid 
media, videos, sponsorships, etc., to be paid for with funds from this Agreement prior to development. 
 
10. 
Notices, Correspondence, and Reports 
 
10.1 
Notices, correspondence, reports and invoices/CERs from the County contractor to ADHS shall be sent to: 
 
For Overall Fixed Price IGA: 
 
Healthy People Healthy Communities (HPHC) IGA Program Administrator 
Bureau of Chronic Disease and Health Promotions 
Arizona Department of Health Services 
150 N. 18th Avenue, Suite 310 
Phoenix, AZ 85007 
Office: 602-364-3603| Email: Constance.Washington@azdhs.gov  
 
10.2 
Notices, correspondence, and reports (and payments if sent to same address) from ADHS to the contractor 
shall be sent to: 
 
Maricopa County 
Attn: Theresa Poindexter 
PUBLIC HEALTH PURCHASING AND CONTRACTS 
Grants/Contracts Administrator 
4041 N. Central Ave Ste 1400 
Phoenix, AZ 85012 
O:   602-372-4163

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
7 
 
Annual Price Sheet 
 
Healthy People Healthy Communities  
 
July 1 – June 30 
 
ACTION PLAN 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
NUMBER 
OF UNITS 
UNIT RATE 
TOTAL 
Upon approval of the following Action 
Plans: 
Tobacco Prop 200 = $102,822.00 
Chronic Disease Prop 303 = $183,052.00 
WIC Lottery = $7,700.00 
Teen Pregnancy = $45,967.00 
EA 
1 
$399,541.00 
$339,541.00 
 
TOBACCO PROGRAM 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
NUMBER 
OF UNITS 
UNIT RATE 
TOTAL 
Upon completion of tasks for each specific 
service strategy after approval of quarterly 
reports. See SOW for Specific Service 
Strategies (i.e. Prevention, Cessation, 
Secondhand Smoke, Enforcement) 
QTR 
4 
$488,404.00 
$1,953,616.00 
 
HEALTH IN ARIZONA POLICY INITIATIVE PROGRAM 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
NUMBER 
OF UNITS 
UNIT RATE 
TOTAL 
Upon completion of tasks for each 
specific service strategy after approval of 
quarterly reports. See SOW for Specific 
Service Strategies (i.e. Alzheimer’s, 
Chronic Pulmonary Disease, 
Hypertension, Self-Management, 
Procurement, Healthy Community Design, 
School Health, Worksite Wellness, and 
Clinical Care) 
Funding Per Quarter includes:  
Chronic Disease Prop 303 = $347,504.00 
WIC Lottery = $32,300.00 
 
QTR 
4 
$94,951.00 
$379,804.00 
 
TEEN PREGNANCY PREVENTION PROGRAM 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
NUMBER 
OF UNITS 
UNIT RATE 
TOTAL 
Upon completion of tasks for each 
specific service strategy after approval of 
quarterly reports. See SOW for Specific 
Service Strategies 
QTR 
4 
$45,967.00 
$183,868.00

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
Amendment No: 3 
Procurement Officer: 
Anthony Beckum 
 
8 
 
 
TEEN PREGNANCY PREVENTION PROGRAM – YOUTH MENTAL HEALTH FIRST AID INITIATIVE 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
MAX # OF 
UNITS PER 
YR 
UNIT RATE 
TOTAL 
Upon completion of tasks for each. See 
SOW for Specific Service Strategies 
Training 
6 
$1,000.00 
$6,000.00 
 
SUICIDE MORTALITY REVIEW PROGRAM 
ITEM/SERVICE DESCRIPTION 
UNIT OF 
MEASURE 
NUMBER OF 
UNITS 
UNIT RATE 
TOTAL 
Upon completion of tasks for each specific 
service strategy after approval of quarterly 
reports. See SOW for Specific Service 
Strategies  
QTR 
4 
$50,000.00 
$200,000.00 
 
TOTAL 
ITEM/SERVICE DESCRIPTION 
TOTAL 
ANNUAL TOTAL 
$3,062,829.00

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 1 of 18 
 
Exhibit A 
 
EVIDENCE-BASED STRATEGIES FOR TOBACCO 
 
The Office of Tobacco Prevention and Cessation (“Office of Tobacco”) within the Bureau of Chronic Disease and Health 
Promotion (“BCDHP”) at Arizona Department of Health Services (ADHS) has historically supported evidence-based 
programs and system level changes that assist smokers in disparate or high-risk populations with tobacco prevention 
and cessation services. In Arizona, there are populations that are disproportionately impacted by tobacco use. Currently, 
priority populations identified by the Office of Tobacco are:  1) youth, 2) the justice-involved, and 3) those enrolled in 
the Arizona Healthcare Cost Containment System (AHCCCS). 
 
County health department partners are required to identify three (3) populations that are disproportionately impacted 
by tobacco use in their communities, which may include the three populations identified above or with other populations 
which may be identified based on county-level data. Counties will provide the selected population groups with targeted 
evidence-based programs and activities for two components: 1) Tobacco Prevention and 2) Tobacco Cessation. In 
addition, counties will participate in three ADHS-led work groups that will explore innovative approaches to tobacco 
programming that address 1) Youth; 2) Secondhand Smoke (SHS); and 3) Emerging Issues. Counties will also engage 
in in-person and virtual meetings as identified by ADHS. 
 
The strategies within the Healthy People Healthy Communities (HPHC) Intergovernmental Agreement (IGA) are 
population-based approaches that will require collaboration and support from key community partners, as well as 
promote health system level changes within healthcare systems and employers. These tobacco prevention and 
cessation strategies align with the U.S. Surgeon General’s Report on Smoking Cessation 2020, the Centers for Disease 
Control (CDC) National Comprehensive Tobacco Control Program (NTCP), and Arizona Health Improvement Plan 
(AzHIP) 2021-2025. 
 
The Tobacco component of the HPHC IGA is funded by Proposition 200, which states that tobacco tax dollars under 
the Health Education Account (HEA) requires monies be spent on “programs for the prevention and reduction of tobacco 
use.” Arizona Revised Statute (A.R.S. § 36-772) authorizes four types of expenditures by the HEA: contracts with county 
health departments and other local partners, administrative expenses, advertising, and evaluation of programs. 
Spending these monies for lobbying for political campaigns is expressly prohibited. 
 
The County Contractor must select one (1) or more strategies from this strategic area. 
 
This Exhibit defines the Program Strategy/s within each Strategic Area: 
 
1. Strategic Area: Tobacco 
 
1.1 
Reduce tobacco-related disparities among target populations. Counties will select populations based on local 
available data, including tobacco prevalence rates (BRFSS, AYS, YRBSS), CHIP, and CHA data, to inform 
programming; 
 
1.1.1 
Prevent the initiation of tobacco use (including emerging products and e-cigarettes) among youth and 
young adults (required), 
 
1.1.1.1 
Maintain current peer-to-peer youth programming to empower youth leadership and 
engagement via the Students Taking a New Direction (STAND), the statewide anti-tobacco 
youth coalition; 
 
1.1.1.2 
Support the ADHS-selected contractor with recruiting youth participants for statewide 
Enforcement efforts; and

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 2 of 18 
 
1.1.1.3 
Facilitate and conduct in their county the AGO Arizona Retailer Tobacco Training Program 
with retailers and clerks that have been cited for selling tobacco to underage youth 
 
1.1.1.4 
Collaborate with schools in their counties by: 
 
1.1.1.4.1 
Offering the American Lung Association’s INDEPTH: An Alternative to Teen 
Nicotine Suspension or Citation, a train the trainer model, and 
 
1.1.1.4.2 
Establishing a Task Force with school districts, school administrators, or 
superintendents to identify current needs in youth prevention. Task Force 
efforts must include the development of a work plan, evaluation plan, and 
identified evidence-based strategies. 
 
1.2 
Implement evidence-based, culturally appropriate community interventions to promote quitting 
among adults and youth, via health systems changes incorporating Arizona Smokers’ Helpline 
(ASHLine) cessation services into providers protocols/work flow, and promoting services offered 
through Arizona Smokers’ Helpline (ASHLine). 
 
1.2.1 
Counties will identify and eliminate tobacco-related disparities among two additional population 
groups: 
 
1.2.1.1 
Individuals involved or at-risk for involvement with the criminal justice system, including 
jails, prisons, probation, parole, or specialty court; 
 
1.2.1.2 
People of low socioeconomic status; 
 
1.2.1.3 
Individuals with behavioral health conditions (including mental health conditions and 
substance use disorders); and/or 
 
1.2.1.4 
Other priority populations not listed and pre-approved by ADHS. Counties will submit a 
proposal to ADHS that will include surveillance and evaluation data to justify the 
population selection, 
 
1.2.2 
Engage communities, partners, and community-based organizations to strengthen capacity. 
Counties will identify and select community partners that may include: 
 
1.2.2.1 
Employers; and 
 
1.2.2.2 
Healthcare systems, including: 
 
1.2.2.2.1  
Federally Qualified Community Health Centers (FQHCs) or FQHC Look-
Alikes; 
 
1.2.2.2.2 
Hospitals; 
 
1.2.2.2.3 
Community clinics; 
 
1.2.2.2.4 
Private practices; 
 
1.2.2.2.5 
Behavioral Health Clinics; and/or 
 
1.2.2.2.6 
Substance Abuse Centers

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 3 of 18 
 
1.3 
Participate in at least one ADHS-led Tobacco Work Group that addresses one of the following priority 
issues: 
 
1.3.1 
Youth, 
 
1.3.2 
Secondhand Smoke, and 
 
1.3.3 
Emerging Issues; 
 
1.4 
Participate in required ADHS Office of Tobacco update conference calls, virtual meetings, and in-
person meetings, including (but not limited to): 
 
1.4.1 
1:1 Calls, 
 
1.4.2 
Group monthly conference calls, 
 
1.4.3 
Annual HPHC IGA Summit, and 
 
1.4.4 
In-person semi-annual statewide partner meetings, to occur: 
 
1.4.4.1 
Spring (March/April); and 
 
1.4.4.2 
Fall (September/October); 
 
1.4.5 
Tobacco Office Hours/Coffee Talks, as scheduled and needed, and 
 
1.4.6 
Call with contracted technical assistance providers regarding initiatives. Example: Youth TA 
Provider (TBD), TA-Community of Practice for Justice Involved, and ASHLine contracted provider. 
 
1.5 
Obtain ADHS approval on all county-level tobacco marketing or communications initiatives. 
 
1.5.1 
All marketing materials (the use of the ADHS logo, brochures, posters, public service 
announcements, paid media, videos, etc.) which have been developed, written, published, or 
recorded by the Grantee and paid for with funds from this grant award must be first approved by 
ADHS prior to the dissemination of such materials or airing or use of such announcements. 
 
1.5.1.1 
Submit request for fund utilization for marketing & media through the ASHLine Asset 
Portal and the documents contained within the portal for approval by ADHS Office of 
Tobacco. (ASHLine.org). 
 
1.6 
Obtain ADHS approval to attend conferences whether they are in-state or out-of-state. Contractors 
shall follow the following guidelines; 
 
1.6.1 
Travel is limited to two (2) Tobacco program staff persons, 
 
1.6.2 
A completed HPHC IGA Tobacco Program: Conference Attendance/Travel Request Form must be 
submitted to the HPHC IGA Program Administrator and the HPHC IGA Tobacco Program Manager 
90 days prior to conference/travel, to allow for review and approval, 
 
1.6.3 
Contractors are required to follow guidance and rates established by the ADOA-GAO SAAM, and

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 4 of 18 
 
1.6.4 
Notify and obtain approval from ADHS/Office of Tobacco proposed prior to entering into contracts 
for professional  or outside services, memorandum of understanding (MOU) in reference to work  
               related to Tobacco Strategies.

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 5 of 18 
 
 
Exhibit C 
 
EVIDENCE-BASED STRATEGIES FOR TEEN PREGNANCY PREVENTION 
 
The Teen Pregnancy Program offers strategic approaches to improve the health and social well-being of youth through 
the reduction of teen pregnancies and sexually transmitted infections/diseases, and the awareness of healthy 
relationships and life skills, including financial literacy and educational and career success.  The program provides youth 
with knowledge and skills that can be applied throughout their lives. Program models are evidence-based, age 
appropriate, medically accurate, and culturally relevant and incorporate a positive youth development approach. 
 
The teen pregnancy prevention programs also offer a Parent/Youth Communication Education component which can 
give parents the tools to actively engage in meaningful communication with their teens on a variety of topics including 
sexual health issues. Parents, grandparents and guardians of a teen are welcome and encouraged to participate in 
these educational sessions.  
 
Proposition 203, The Healthy Arizona Initiative, was passed by Arizona voters in November 1995, authorizing the use 
of lottery funds when available to be utilized for teen pregnancy prevention programs.  The funds from the lottery 
became available in July 2005.  The Arizona Department of Health Services (ADHS), Bureau of Women’s and Children’s 
Health (BWCH), Teen Pregnancy Prevention Program, is charged with the implementation of these funds.   
 
Proposition 207, The Smart and Safe Act, was passed by Arizona voters in November 2020, authorizing the legal use 
of recreational marijuana. The funds from this act will be available on July 1, 2021. The Arizona Department of Health 
Services (ADHS), Bureau of Women’s and Children’s Health (BWCH), is charged with the implementation of a portion 
of these funds. 
 
The County Contractor must select one (1) or more strategies from this strategic area. 
 
This Exhibit defines the Program Strategy/s within each Strategic Area: 
 
3. Strategic Area: Teen Pregnancy Prevention 
 
3.1 
Implement with fidelity, abstinence plus evidence-based program models, through curriculum delivery to 
youth ages eleven to nineteen (11-19) and implement core curricula that are on the ADHS TPP approved 
curriculum list incorporating a positive youth development approach. 
 
3.1.1 
Program models shall be evidence-based, culturally relevant, medically accurate, and age 
appropriate. Programs for youth shall be inclusive of at least three (3) of five (5) Adulthood 
Preparation Subjects -Healthy Relationships, Healthy Life Skills, Adolescent Development, 
Educational/Career Success, and/or Financial Literacy. Optionally, to parents/caregivers of youth 
eleven to nineteen (11-19) years of age, 
 
3.1.2 
Program management, services, requirements, deliverables, etc. shall be in accordance with the 
TPP Policy and Procedures Manual, and 
 
3.1.3 
Program tasks include but are not limited to: 
 
3.1.3.1  
Delivery of curriculum in a variety of settings – in school, after school, community-based, 
juvenile detention/probation, foster care group homes, etc.; 
 
3.1.3.2  
Educating youth on both abstinence and contraception for the prevention of teen 
pregnancy and sexually transmitted diseases/infections;

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 6 of 18 
 
3.1.3.3  
Obtaining active parental consent forms for youth participation in programming and 
evaluation; 
 
3.1.3.4  
Maintaining up-to-date attendance records; 
 
3.1.3.5  
Administering pre and post surveys to youth, and submitting completed surveys to ASU 
SIRC; 
 
3.1.3.6  
Ensuring the number of youths proposed is served and that eighty percent (80%) of youth 
participating in the curriculum complete at least seventy-five (75%) of curriculum dosage; 
 
3.1.3.7  
Completion of fidelity monitoring logs following each session delivered; 
 
3.1.3.8  
Submitting monthly unduplicated counts of youth served; 
 
3.1.3.9  
Submitting annual Forms A-D of reporting total unduplicated count of youth served, 
program hours received, and type of programs received; 
 
3.1.3.10 Attending meetings and/or calls, i.e., semi-annual contractor meetings, mid-year budget 
review and youth served calls, Wyman Teen Outreach Program® review calls (if 
applicable), summer professional development, etc.; and/or 
 
3.1.3.11 Navigating the TPP SharePoint for entry of reporting data, program announcements, 
discussion boards, and obtaining program forms. 
 
4. Strategic Area: Teen Pregnancy Prevention Youth Mental Health First Aid Initiative 
 
4.1 
Certify staff in TPP Youth Mental Health First Aid Training with prior approval from ADHS; 
 
4.1.1 
Complete the National Council for Behavioral Health (NCBH) “Coordinator Access” form to grant 
ADHS staff viewer rights to pre and post training survey data from organizations trained: 
 
4.1.1.1 
Participate in technical assistance meetings and/or phone calls to be hosted by ADHS. 
 
4.2 
Certified trainer must deliver at minimum three (3) trainings per year to maintain active certification in 
YMHFA; 
 
4.3 
Trainers may co-facilitate and each facilitator can count co-facilitations towards their required three (3) 
training(s) per year, for certification purposes; 
 
4.4 
Co-facilitated training(s) will only count as one training for payment of stipends; 
 
4.5 
Training events must follow the training outline identified by the National Council of Behavioral Health 
(NCBH) Youth Mental Health First Aid; 
 
4.6 
During the pandemic, if in-person training is prohibited, training to youth serving organizations can be 
conducted virtually;  
 
4.7 
Once pandemic restrictions are lifted and in-person training and travel are allowed, training to youth serving 
organizations shall be conducted in one (1) of two (2) options: In-person or blended learning; 
 
4.8 
Each training shall consist of no less than five (5) participants and no more than thirty (30) and include 
participant training materials; and

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 7 of 18 
 
 
4.9 
Course materials must be ordered for all training participants as this is a required component. 
 
4.10 
For the TPP Youth Mental Health First Aid Training, programs will submit the following with their quarterly 
CERs: 
 
4.10.1 Participant sign-in sheet (if in person) that includes organization’s name, date, and name of the 
educator, or 
 
4.10.2 “Chat Box” sign-in sheet (if virtual) that includes the organization's name, date, and name of the 
educator. 
 
Please note: Stipends can only be billed for training(s) conducted during the quarter.

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 8 of 18 
 
Exhibit D 
 
EVIDENCE-BASED STRATEGIES FOR SUICIDE MORTALITY REVIEW 
 
Suicide is preventable. In Arizona, both the number and rate of suicides continues to rise. Arizona’s rate of suicide per 
100,000 people was 24% higher than that of the United States in 2017. In 2018, suicide ranked 8th among the leading 
causes of death but contributed substantially to premature mortality. Pursuant to A.R.S. § 36-199 and § 36-199.01, 
ADHS is establishing a Suicide Mortality Review Program in the Arizona Department of Health Services (ADHS). The 
program will conduct an annual analysis on the incidences and causes of suicides in the state during the preceding 
fiscal year. This analysis will help to inform what changes are needed to decrease the incidence of preventable suicides, 
and as appropriate, take steps to implement these changes. ADHS will fund, encourage and assist in the development 
of local county health department Suicide Mortality Review Teams in their local jurisdiction and to develop suicide 
prevention recommendations for their communities.  
 
On March 3, 2020 Governor Doug Ducey joined mental health advocates, legislators and family members affected by 
suicide to sign Senate Bill 1523, also known as Jake's Law. The bill is named in honor of Jake Machovsky, an Arizona 
teen who lost his life to suicide in 2016 after battling mental health issues. The law requires insurance companies to 
cover mental health treatment and creates the Children's Behavioral Health Services Fund and provides $8 million for 
behavioral health services for children who are uninsured or underinsured. The law prohibits insurance companies from 
denying coverage for services that are covered by the plan simply because they are delivered in an educational setting. 
This law also establishes a mental health parity advisory committee to ensure that all parties including families, 
providers, advocacy organizations, and insurers have a voice at the table, creates a suicide mortality review team to 
review deaths by suicide and provide policymakers with improved data and recommendations, and helps increase 
follow-up services for patients at risk for suicide.  
 
Proposition 207, The Smart and Safe Act, was passed by Arizona voters in November 2020, authorizing the legal use 
of recreational marijuana. The funds from this act will be available on July 1, 2021. ADHS, through the Bureau of Chronic 
Disease and Health Promotion, is charged with the implementation of a portion of these funds. The five (5) year IGA 
action plan(s) and activity/activities developed by the local health department will address the following: 
 
1) A.R.S. § 36-199 and § 36-199.01: Suicide Mortality. 
 
This Exhibit defines the Program Strategy/s within each Strategic Area: 
 
6. Strategic Area: Suicide Mortality Review 
 
6.1 
Promote and implement healthy communities' interventions that target policy, system and environmental 
approaches that will shape the communities in which we live, learn, work, and play; 
 
6.2 
Attend ADHS training and technical assistance sessions on standards and protocols for local suicide 
mortality review teams, this includes the onboarding of new program staff; 
 
6.3 
Bring together local community agencies in a formal process to systematically share information on suicide 
events for persons over the age of eighteen (18) years old, identify risk factors in those deaths, and provide 
prevention recommendations. Program tasks include but are not limited to: 
 
6.3.1 
The County Contractor shall for the Suicide Mortality Review Program: 
 
6.3.1.1 
Attend scheduled training sessions with ADHS on Suicide Mortality Review Policies 
and Procedures;

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 9 of 18 
 
6.3.1.2 
With guidance from ADHS Suicide Mortality Program Manager, establish a local 
Suicide Mortality Review team roster and submit to ADHS for review, including times 
when team member(s) vacate or are new to the local Suicide Mortality Review Team; 
 
6.3.1.3 
Provide orientation to all members and consultants which include, at a minimum, the 
following topics: 
 
6.3.1.3.1 Instruction regarding confidentiality, 
 
6.3.1.3.2 Overview of Senate Bill that establishes the local Suicide Mortality Review 
team;  
 
6.3.1.3.3 Use of the data forms, 
 
6.3.1.3.4 Public access to team information, 
 
6.3.1.3.5 Responsibilities and limitations of team membership; Process and goals of 
fatality review, 
 
6.3.1.3.6 The promotion of culturally diverse and competent approaches in case 
reviews, using Suicide Mortality Review materials provided by the State 
Team, 
 
6.3.1.3.7 The promotion of culturally diverse and competent approaches in case 
reviews, and 
 
6.3.1.3.8 Review materials provided by the State Team, 
 
6.3.1.4 
Establish procedures for accessing the following records related to the circumstances 
surrounding suicide:  
 
6.3.1.4.1 Death Certificates, 
 
6.3.1.4.2 Birth Certificates, 
 
6.3.1.4.3 Law enforcement Reports, 
 
6.3.1.4.4 Medical Examiner's Reports, 
 
6.3.1.4.5 Medical Records, 
 
6.3.1.4.6 Child Protective Services' Reports, and 
 
6.3.1.4.7 Other Records, as needed, 
 
6.3.1.5 
Establish procedures to track fatalities requiring review by the Local Team and 
completion of Reviews;

INTERGOVERNMENTAL AGREEMENT (IGA) 
 
Amendment  
 
ARIZONA DEPARTMENT OF 
HEALTH SERVICES 
150 18th Ave Suite 530 
Phoenix, Arizona 85007 
 
Contract No.: CTR055429 
IGA Amendment No:  3 
Procurement Officer 
Anthony Beckum 
 
Page 10 of 18 
 
 
6.3.1.6 
Prepare quarterly and/ or annual reports and data for the ADHS Suicide Mortality 
Review Program, cases reviewed, and obstacles to completion of reviews; 
 
6.3.1.7 
Convene team meetings, at a frequency sufficient to review all fatalities within the 
identified scope of work. If the State Suicide Mortality Review Team will be reviewing 
records for your jurisdiction, you shall send a representative when the review is 
conducted; 
 
6.3.1.8 
Enter data for each case reviewed using ADHS Suicide Mortality Review Data 
Collection Tool to include demographic and prevention recommendation data. Data for 
cases shall be entered by an employee of the County Contractor following completion 
of each case review meeting and shall be submitted to the Suicide Mortality Review 
Program Manager on a quarterly basis; and 
 
6.3.1.9 
Conduct an annual analysis on the incidences and causes of suicides in the local 
community during the preceding fiscal year. 
 
6.3.2 
For the Suicide Mortality Review Program, ADHS will: 
 
6.3.2.1 
Establish a State Suicide Mortality Review Team; 
 
6.3.2.2 
Provide a Policies and Procedure Manual, and update as necessary; 
 
6.3.2.3 
Develop standards and protocols for local suicide mortality review teams and provide 
training and technical assistance to these teams; 
 
6.3.2.4 
Provide a Quarterly and/ or Annual Reporting Template; 
 
6.3.2.5 
Provide a Suicide Mortality Data Collection Tool; 
 
6.3.2.6 
Provide supporting documentation requirements for quarterly payment; 
 
6.3.2.7 
Provide Quarterly Meetings for contractors to:  
 
6.3.2.7.1 Provide training and technical assistance on the suicide mortality review 
process; and 
 
6.3.2.7.2 Provide access to technical assistance and guidance from ADHS staff, 
Local Health Department peers/mentors and subject matter experts related 
to the strategy for which the County has received funding.