LETTER OF AGREEMENT RE PREV SVCS WITH ST LUKES HLTH INT.PDF

November 6, 2015
Mark Gallegos
Community Health Development Supervisor
Maricopa County Department of Public Health
Office of Tobacco and Chronic Disease Prevention
Dear Mr. Gallegos:
St. Luke’s Health Initiatives (SLHI) is pleased to offer this Letter of Agreement between SLHI and Maricopa
County Department of Public Health (Contractor) in partnership with the Arizona Living Well Institute to form
the Healthy Living Collaborative of Maricopa County to prevent and decrease the incidence of hypertension
and cardiovascular disease, related to SLHI Priority Four. This letter is intended to accept the Healthy Living
Collaborative of Maricopa County proposal and accompanying budget dated October 28, 2015.
PAYMENT AMOUNT AND SCHEDULE
SLHI agrees to reimburse Contractor $70,000 in accordance with the proposed budget. Within five days
after the end of each month, we request that the contractor submit an invoice to Melanie.Mitros@slhi.org.
While most payments are processed within 5 business days, SLHI reserves a 15 business days processing
time-line.
TERMINATION
SLHI reserves the right to terminate the contract at any time, without penalty or recourse, by giving written
notice to Contractor at least fourteen (14) days prior to the effective date of such termination. The Contractor
shall be entitled to receive just and equitable compensation for that work completed prior to the effective date
of termination.
ACCEPTANCE OF TERMS AND CONDITIONS
If you have questions about the scope of work, or terms of payment, please let me know. Otherwise, please
indicate your acceptance by signing and returning the enclosed copy of this letter as well as the W-9 Form.
Accepted:
Sincerely,
Melanie Mitros, PhD Date Steve Chucri Date
Director Strategic Community Partnerships Chairman, Maricopa County
St Luke's Health Initiatives Board of Supervisors
S:\COMMUNITY CAPACITY\MEDICAL ASSISTANCE\FY 2016 MAP GRANTS\Heart-Lung\MCDPH Agreement
Letter.2015-2016.docx

C-86-16 ATTACHED TO AND A PART OF
Letter of Agreement
St. Luke’s Health Initiatives
Hypertension and Cardiovascular Program
IN WITNESS WHEREOF, the parties agree to enter into this Contract:
FOR AND ON BEHALF OF
MARICOPA COUNTY
By
Chairman, Board of Supervisors
Date
ATTEST:
Clerk of the Board
Date
APPROVED AS TO FORM:
Attorney for Maricopa County
Date

Administrative Offices
4041 N Central Ave, #1400 • Phoenix, Arizona 85012
Phone: (602) 506-6900 • Fax: (602) 506-6885
October 28, 2015
Melanie Mitros, PhD
Director, Strategic Community Partnerships
St. Luke's Health Initiatives
2929 N. Central Ave, Suite 1550
Phoenix, AZ 85012
Dear Dr. Mitros,
Maricopa County Department of Public Health (MCDPH) and the Arizona Living Well Institute
(AZLWI) are coming together and forming the Healthy Living Collaborative of Maricopa County. We are
seeking the support of St. Luke’s Health Initiative by requesting $70,000 for this initiative; of which a
total of $35,500.00 would be allotted to AZLWI and $34,500.00 would be allotted to MCDPH.
Through this collaboration we plan to help prevent and decrease the incidence of hypertension and
cardiovascular disease by employing Community Health Workers to conduct biometric screening events,
refer participants to health resources, conduct chronic disease self-management workshops, and support
the adoption of smoke-free policies. Our intent is to reach faith-based organizations and HUD properties
throughout Maricopa County. By leveraging our resources we will empower our partners to create and
sustain a culture of wellness at their sites.
Our community partners include Creciendo Undios/Growing Together, Valle del Sol, and the Arizona
Smoke-Free Living coalition. This collaboration is currently being funded by the Arizona Department of
Health Services and with your support we can grow and sustain our efforts creating a collective impact in
Arizona communities.
The primary contact for this proposal is Mark Gallegos for Maricopa County Department of Public
Health. He can be reached at (623) 755-7627, MarkGallegos@mail.maricopa.gov or at the mailing
address listed above.
Sincerely,
Mark Gallegos
Community Health Development Supervisor
Maricopa County Department of Public Health
623.755.7627

Healthy Living Collaborative of
Maricopa County
From cancer and stroke to diabetes and Alzheimer’s, seven out of the 10 leading causes
of death in Arizona are attributed to a chronic disease. Regardless of race/ethnic group, arthritis
is the number one cause of disability, with one in four adults receiving a diagnosis from a
provider. The Chronic Disease Self-management Program (CDSMP) is a key way to help
Arizonans lead longer, healthier lives, but many do not know it’s an option and are not referred
by a healthcare provider. The Healthy Living Collaborative of Maricopa County will help bridge
that gap by empowering faith-based organizations, behavioral health facilities, and low-income
housing properties to create a culture of wellness for those they serve.
Organization
Our mission at Maricopa County Department of Public Health (MCDPH) is to protect
and promote the health and well-being of all of our residents and visitors. This means providing
protection from the health threats such as food-borne illnesses, natural and man-made disasters,
toxic exposures, and preventable injury. Public Health also works to prevent chronic diseases,
such as heart disease, cancer, and diabetes by addressing their risk factors: poor nutrition,
inadequate physical activity, and tobacco use. We are increasingly moving towards policy,
systems and environmental approaches to improving the health of our community.
Proposed Innovation and Expected Outcomes
The Healthy Living Collaborative of Maricopa County will bring together MCDPH and
the Arizona Living Well Institute (AZLWI) to create a collaborative health partnership with the
intent of reaching faith-based organizations, behavioral health facilities, and US Department of
Healthy Living Collaborative of Maricopa County 1

Housing and Urban Development (HUD) properties including those serving senior and disabled
populations. This three-year project will expand on existing partnerships to prevent and reduce
the incidents of hypertension/cardiovascular disease by employing Community Health Workers
(CHWs) to conduct biometric screening events, referring participants to health resources,
training CHWs as lay-leaders to conduct chronic disease self-management workshops, and
supporting the adoption of smoke-free policies.
The Collaborative will leverage existing resources from MCDPH and AZLWI and
empower these partner sites to improve the health-related outcomes of their population bases and
implement policy and environmental changes.
Alignment with SLHI goals
The Collaborative is well aligned with SLHI’s goals, priorities and values.
To increase community capacity to identify and to collectively address the issues that affects
the health and resiliency of Arizona communities.
By providing community outreach and partnership development activities, this
collaborative will increase the capacity of communities to independently administer self-
management workshops while identifying those within the community that may be at risk of
chronic disease through biometric screening events.
Increasing the capacity of communities to become healthier by developing a sustainable lay-
led, CHW workforce model to promote health and bridge the health literacy gap, which is a
priority of the Collaborative.
To effectively address the conditions (social determinants of health) that enable
Arizonans to be healthy and resilient.
Healthy Living Collaborative of Maricopa County 2

Many challenges exist in disparate communities of Maricopa County. This collaborative
will work to develop social support networks while decreasing the social exclusion of some
populations within the county.
To redefine health and to effectively utilize communication tools and strategies to impact
systems and polices “where health happens” – where we live, learn, work and play, and to
improve Arizonans access to high quality and cost effective care.
The Community Referral Network (CRN) will provide an access to resources that is as
easy as a mouse click. This will enable referrals to be actioned and feedback provided in an
unprecedented manner, which will increase the ability of community member’s to access health-
related resource in a timely manner.
Community Partners
Valle del Sol and Creciendo Unidos/Growing Together (CU) will serve as coordinating
agencies to develop and maintain partnerships with behavioral health facilities and faith-based
organizations respectively.
Arizona Smoke-Free Living (ASFL) coalition will provide technical assistance to HUD
multi-unit housing properties wanting to implement smoke-free policy. The coalition has helped
more than 100 properties go smoke-free since 2012.
Arizona Living Well Institute (AZLWI) will assist with training for the CHW
workforce and coordinating self-management workshops. AZLWI has been training lay-leaders
in Stanford University’s evidence-based programs since 2010. The series of workshops are
designed to increase the self-efficacy of participants to manage their chronic disease or diabetes.
Healthy Living Collaborative of Maricopa County 3

Feasibility of Strategy/Methodology to Achieve Results
The Healthy Living Collaborative of Maricopa County grew out of MCDPH’s Million
Hearts initiative, which was piloted from July 2014 to June 2015. The pilot program began with
biometric screening events in targeted communities. Participants who were identified as having a
chronic disease such as diabetes, hypertension or high cholesterol were referred to CDSMP
workshops facilitated by the AZLWI as well as other appropriate services. The pilot exceeded all
expectations for referral and workshop completion rates:
 82% of participants were referred to a self-management workshop
 59% of participants self-reported at least one chronic condition
 54% of participants were pre/hypertensive
 31% of participants were pre/diabetic
 18% of participants were uninsured
 48% of participants self-reported not seeing a primary care provider in the past six months
This program also served as an important link to community organizations and HUD
properties. By leveraging these relationships, MCDPH was able to tie in another model
initiative–smoke-free multi-unit housing policy work and assist these properties in achieving
HUD’s recommendation to provide smoke-free environments for residents.
The proposed Healthy Living Collaborative of Maricopa County expands on what was
learned during the past year and furthers the potential impact by focusing on building a culture of
wellness within faith-based organizations and at HUD properties.
Audiences
HUD sites have been encouraging property managers to adopt smoke-free policies.
MCDPH and the ASFL coalition are already helping interested properties go smoke-free.
Through the Collaborative we will be able to offer additional resources to support the culture of
Healthy Living Collaborative of Maricopa County 4

wellness at these and other properties thereby reaching low-income, senior, disabled and mental
health communities.
Churches, synagogues and other faith-based organizations are in a unique position to
encourage and support their members in choosing a healthy lifestyle. Partnerships in this
community will allow MCDPH to reach residents who may lack access to health care or have
low health literacy, through trusted leaders in their communities.
Behavioral health facilities can use a Peer Support Specialist to model recovery and
provide support, encouragement and hope to others on their journey. Employees in this position
can facilitate group discussions, provide independent skills training, help a person learn to
navigate the behavioral health system, assist an individual in learning to self-advocate and to step
back into community life. The Collaborative will provide lay-leader training to these employees
so they can provide self-management workshops and be reimbursed for these services.
Project overview
Step 1: The assessment process will be guided by the Center for Disease Control and
Prevention’s Community Health Assessment and Group Evaluation (CHANGE) Tool. Through
this assessment process, we will assist the partner site with identifying opportunities to improve
the health of its members in the areas of physical activity, nutrition, tobacco use, chronic disease
management and leadership development to support these initiatives.
Step 2: A charter or personalized action plan will be used to plan around the key areas identified
as potential collaboration opportunities.
Step 3: Based on the opportunities identified, free resources will be provided to partner sites in
the following areas:
 Smoke-free policy
 Biometric screening
Healthy Living Collaborative of Maricopa County 5

 Diabetes self-management program (DSMP) or CDSMP workshops
 Tobacco education and cessation
 Health fair and education resources
 Additional areas that can be addressed by other partners of MCDPH
Step 4: Support continues throughout the process along with customized resources to assist sites
with meeting their needs, overcoming hurdles and growing a lasting culture of wellness.
Objectives
Objective 1: By Jun. 30, 2018, train 30 lay-leaders of CDSMP and DSMP workshops.
Objective 2: By Jun. 30, 2018, hold 20 biometric screening events at partner sites.
Objective 3: By Jun. 30, 2018, facilitate 30 CDSMP or DSMP workshops for at least 250
participants completing the series.
Objective 4: By Jun. 30, 2018, provide technical assistance for smoke-free policy adoption to 30
HUD properties.
Work Plan Activities
 Develop partnerships two reach the three key audiences by conducting an assessment and
plan to increase the capacity of partners to deliver self-management workshops (Year 1).
 Create a charter or action plan with at least 12 partners (Year 1), 12 partners (Year 2), and six
partners (Year 3).
 Train lay-leaders and conduct CDSMP workshops (Years 1-3).
 Create environmental change by providing smoke-free policy technical assistance to at least
10 properties per year (Years 1-3).
 Attain referrals by conducting at least seven biometric screening events per year (Years 1-3).
Healthy Living Collaborative of Maricopa County 6

 Implement the Community Referral Network as a referral action vehicle with 10 partners per
year (Years 2-3).
Potential Sources of Revenue for Implementation and
Sustainability
The components of the Collaborative have been supported with federal and state funding
through the Arizona Department of Health Services for the past six years, and funding is
expected to continue.
AZLWI’s new Community Referral Network will allow healthcare providers to make
web-based patient referrals directly to agencies providing self-management workshops. Fees
paid by member agencies will help sustain the system. The key to CDSMP sustainability is
building the capacity of communities to embed CDSMP structures into existing statewide
systems that provide community-based care, social services, and supports to adults to help them
maintain their health and independence in the community.
By training staff and/or volunteers in all sectors to deliver self-management workshops
we are building the capacity of these organizations to deliver services to their communities and
creating sustainability for them to continue to deliver these services after funding period.
The behavioral health system utilizes a combination of staff and Peer Support Specialists
to facilitate self-management workshops as a component of the Behavioral Health Prevention
Education Services, which is reimbursable at a rate of $7.96 - $14.50 per participant per 15
minute unit which equates to $ 79.60 - $145 per participant per session reimbursement.
Evaluation
AZLWI plans to subcontract with Saguaro Evaluation Group LLC, an evaluation
consulting agency, as a provider of analysis and evaluation of this collaboration. The contractor
Healthy Living Collaborative of Maricopa County 7

will furnish developmental evaluation services designed to help facilitate and document the civic
engagement processes and individual to community/environmental level impacts of the
collaboration work.
Quantitative and qualitative data will be collected throughout the project to include
process evaluations annually to assess the impact, benefits, and potential improvements of
Collaborative. Participant outcomes to be assessed include biometrics collected at biometric
screening events and community engagement by workshop completion rates. Workforce
development will be assessed by number of leaders trained in each sector and the number of
workshops provided.
Fidelity coaching sessions occur annually with all facilitators and will move to bi-annual
to ensure oversight of Collaborative providers. Fidelity coaches are experienced facilitators who
are trained and certified by AZLWI to ensure that the curriculum and process developed by
Stanford University is maintained to maximize participant outcome and reduce unnecessary
health care services and cost. The fidelity in process in Arizona has been modeled after National
Study demonstration states, replicated in other states, and has been in place for four years.
Conclusion
AZLWI and MCDPH are committed to embedding and sustaining a culture of wellness
amongst faith-based organizations, housing and urban development sites, and behavioral health
agencies over the next three years. We plan to accomplish this through strategic planning and
coordination of policy change, health education and screening, and delivery of self-management
workshops. Increasing the workforce capacity of each sector by training individuals already
embedded into their system to continue to offer services.
Healthy Living Collaborative of Maricopa County 8

Budget Narrative – Per Year
(Start Date: 23 November, 2015 - End Date: 30 June, 2018)
Personnel Unit Cost # of Units Total Cost
Personnel (*) $18.37 550 hours $10,000.00
Administration Cost (*) $125.00 12 months $ 1,500.00
Evaluation Unit Cost # of Units Total Cost
Evaluation (*) $ 5,000.00
Biometric Screening Events Unit Cost # of Units Total Cost
CHW Labor (*) $ 200.00 20 events $ 4,000.00
RN Labor (*) $ 150.00 20 events $ 3,000.00
LDX Cassettes (+) $ 354.00 20 events $ 7,080.00
Medical Supplies (+) $ 3,920.00
Self-Management Workshops Unit Cost # of Units Total Cost
Lay Leader Training (+) $ 150.00 30 trainees $ 4,500.00
CHW Workshop Stipends (*) $ 400.00 30 workshops $12,000.00
Workshop Books (+) $ 300.00 30 workshops $ 9,000.00
Participant Toolkits (+) $ 176.43 30 workshops $5,292.75
Other:
Indirect Costs (+) $4707.25 1 $4707.25
Total $ 70,000.00
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Healthy Living Collaborative of Maricopa County Budget Narrative

(*) Represents funds coming from AZLWI and (+) represents funds coming from MCDPH. Total of
$35,500.00 to AZLWI and $34,500.00 to MCDPH.
 Personnel: Cost will be used to cover AZLWI staff time to coordinate English and Spanish
workshops, report data collection to MCDPH, and assist with biometric screening events.
 Administration: Cost will cover time for management of project delivery and coordination.
 Evaluation: Cost will be used to support Saguaro Evaluation Group’s analysis and evaluation of this
collaboration.
 Biometric Screening Events
o CHW Labor: Cost will cover time of two Community Health Workers delivering education
at biometric screening events. [$25 per hour x 5 hours per event x 2 CHWs = $250]
o RN Labor: Cost will cover time of a registered nurse collecting biometrics and overseeing
education at biometric screening events. [$35 per hour x 5 hours per event = $175]
o LDX Cassettes: Cost will cover machine used to test blood. [$118.00 per box (10 units) x 3
per event = $354.00]
o Medical Supplies: Cost will cover expendable medical supplies needed to draw blood.
 Self-Management Workshops
o Lay Leader Training: Costs will cover fee to AZLWI for lay-leaders to attend four-day
training including all training materials.
o CHW Workshop Stipends: Cost will cover time of CHWs delivering and traveling to six-
week self-management workshops. [$200 per workshop series x 2 CHWs = $400]
o Workshop Books: Cost will cover books so each participant will receive a Living a Healthy
Life with Chronic Conditions book for free at the workshops. [$15 per book x 20 participants
per workshop = $300]
o Participant Toolkits: Cost will cover self-management tools provided to participants who
complete the workshop series. Toolkits include blood pressure cuffs or glucose monitors, pill
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Healthy Living Collaborative of Maricopa County Budget Narrative

sorters, pedometers, tracking cards and other items. [$14.60 per toolkit x 20 participants per
workshop x 50% completion rate = $146.43]
o Indirect costs: Department's Combined Indirect County-Wide Rate is 15.800%.
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Healthy Living Collaborative of Maricopa County Budget Narrative

10/14/2015
Melanie Mitros, PhD
Director, Strategic Community Partnerships
St. Luke's Health Initiatives
2929 N. Central Ave, Suite 1550
Phoenix, AZ 85012
Dear Dr. Mitros,
Valle del Sol strongly supports Maricopa County Department of Public Health’s application for the Healthy
Living Collaborative of Maricopa County with the Arizona Living Well Institute. We value Maricopa
County Department of Public Health’s efforts to create a culture of wellness amongst organizations
throughout the county.
Valle del Sol recognizes the need to educate and support our patients and community with care coordination
and health education. Valle del Sol’s Community Health Workers are trusted members of the community
and strive to provide best practices.
We recognize the value of the Chronic Disease Self-Management workshops and support the delivery of the
workshops to our clients. However, due to budget cuts we have faced barriers sustaining the workshops at
our clinics. We are eager to bring back this offering with training and resources from the Collaborative.
The support of this grant will help provide the foundation needed to sustain these workshops through the
peer-support reimbursement model in the behavioral health field.
Please feel free to contact if you have any questions.
Sincerely,
Stephanie Martinez
Community Health Worker Supervisor
3807 N. 7th St. 1209 S. 1st Ave. 502 N. 27th Ave. 8410 W. Thomas Rd., Ste. 116
Phoenix, AZ 85014 Phoenix, AZ 85003 Phoenix, AZ 85009 Phoenix, AZ 85037
509 S. Rockford Dr. 4135 S. Power Rd. #108 10320 W. McDowell Rd., Ste. G-
Tempe, AZ 85281 Mesa, AZ 85212 7024 12
Avondale, AZ 85392
PLEASE CONSIDER VALLE DEL SOL IN YOUR ESTATE PLANNING
602.258.6797 | www.valledelsol.com

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October 14, 2015
Melanie Mitros, PhD
Director, Strategic Community Partnerships
St. Luke's Health Initiatives
2929 N. Central Ave, Suite 1550
Phoenix, AZ 85012
Dear Dr. Mitros,
Saguaro Evaluation Group (SEG) strongly supports Maricopa County Department of Public
Health’s application for the Healthy Living Collaborative of Maricopa County with the Arizona
Living Well Institute. We value Maricopa County Department of Public Health’s efforts to
create a culture of wellness amongst organizations throughout the county.
SEG is a local company that provides research, evaluation and professional training services to
government and non-profit organizations. We have worked with the Arizona Living Well
Institute with the Americorps’ groups, and with St Luke’s Health Initiatives in a contract that
focused on Community Health Workers in Arizona. We have also collaborated with Maricopa
County Department of Public Health in various initiatives and with numerous non-profit
organizations. SEG has been a supporter of Community Health Workers (CHW) and the
Stamford Chronic Disease Self-Management program for several years now and we know that
CHWs work in our hard-to-reach underserved communities is invaluable.
We recognize the value of the Chronic Disease Self-Management workshops and support the
delivery of the workshops in Arizona communities. We will be happy to provide the expertise
and tools needed to evaluate this collaboration and the impact it is making in our communities.
Please feel free to contact if you have any questions.
Sincerely,
Monica Parsai, Ph.D.
Chief Executive Officer
Saguaro Evaluation Group
mparsai@saguaroevaluation.com
480-621-6895
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