CONTRACT RE HRPP NICP PART 2 WITH ADHS.PDF

MARICOPA COUNTY DEPARTMENT OF PUBLIC HEALTH
HIGH RISK PERINATAL PROGRAM/NEWBORN INTENSIVE CARE PROGRAM
(HRPP/NICP) COMMUNITY NURSING
SOLICITATION NO: ADHS14-00003830
2.1 TABLE OF CONTENTS
SECTION Pages
2.2 Executive Summary 1-2
2.3 Method of Approach (Methodology) 1-27 (below)
2.3.1 Written Narrative
2.3.1.1 Method of Approach to Perform Tasks 1-14
2.3.1.2 Projected Number of Clients Able to Serve 14-16
2.3.1.3 Scope of Training 16
2.3.1.4 Plans as Detailed in Scope of Work, Requirements 16-26
2.3.1.5 Description of Similar Projects 26-27
2.4 Experience and Expertise 1-7 (below)
2.4.1 Description of Experience and Expertise 1-4
2.4.2 Key Personnel 4-5
2.4.3 Technical Qualifications: Project Manager 5-7
2.4.4 References (ATTACHMENT B) 7
APPENDIX A — Zip Code List March 2014
APPENDIX B — NCP Service Area Map by Visit Utilization 1
APPENDIX C — Resume and Job Descriptions 1-22
Maricopa County Department of Public, Table of Contents, ADHS14 -00003830, Page 1

EXECUTIVE SUMMARY
The commitment to caring for the children of the community is part of the
Maricopa County Department of Public Health (MCDPH) mission to protect and
promote the health and well-being of Maricopa County residents and visitors. The
MCDPH Newborn Intensive Care Program (NICP), through the Office of Family
Health, supports that mission through providing a quality program with
comprehensive services aimed at improving the health, wellness and life
outcomes of high-risk infants. Since 1988, the MCDPH NICP program has
partnered with Arizona Department of Health Services (ADHS) to reduce the
morbidity and mortality of Arizona's most vulnerable infants with the home
visitation community health nursing (CHN) services. With over 50 years of
combined NICP experience, the MCDPH NICP nurses provide highly specialized
health and developmental follow-up nursing services to medically fragile infants
and their families in their home.
A primary goal of MCDPH NICP is to identify infants and children who have an
increased risk for developmental delays and refer them to early intervention
services while providing the family with education and support. This is done
using a holistic, family-centered, culturally sensitive, interdisciplinary model of
care that focuses on the needs and goals of the family in order to achieve
successful outcomes. A case management method of approach is used in order
to building successful relationships with the families and other multidisciplinary
providers involved in the care of the client. New referrals are assigned to a
community health nurse (CHN) who initiates first contact within one week
according to ADHS requirements. The CHN goal is to complete the first home
visit with the family within two weeks of receiving the client referral. The
assigned case CHN is responsible for the development and implementation of
the HRPP/NICP family plan, which is based on the identified needs, family
concerns and mutually agreed upon goals. The CHN is the resource person,
advocate, and facilitator for other community services in order to achieve the
outcomes mutually agreed upon by the CHN and family.
At the home visit, CHNs provide care for both the infant/child and the mother. It
is also an opportunity to identify any other children or family members that may
benefit from receiving early intervention services through the enrollment in
OCSCHN services. CHNs complete a basic wellness assessment of the mother
and educate them regarding the value of caring for themselves and the
importance of interconception care for their future pregnancies and children.
Mothers are screened for a postpartum mood disorder using the Edinburgh
Postnatal Depression Scale screening tool and provided information, resources
and referrals to support them. MCDPH has historically been a promoter of
statewide initiatives to provide folic acid to women of childbearing age, including
the provision of packets from Power Me A2Z that include information, resources
and samples of folic acid.
Maricopa County Department of Public Health, Executive Summary, ADHS14-00003830 Page 1

Early intervention activities and promotion of infant/child's health and wellness
are key components of the home visit. Multiple assessments are done during the
home visit in order to have a holistic approach to services that support best
outcomes for the infant/child and family. This includes a physical, psychosocial,
environmental and developmental assessments. At age appropriate intervals,
the CHN provides a developmental screening of the infant/child using the Ages
and Stages 3 Questionnaire. A plan for interventions is developed with the family
based on the results of the screening. Referrals are made to Arizona Early
Intervention Program (AzEIP) with the parent's permission, activities to promote
growth and development are taught, resources and information are provided.
The MCDPH CHN staff partner with community resources to collaborate, reduce
duplication of services and support coordination care for the infant/child. The
home visiting nurse teaches the family how to help their infant/child so that the
outcomes of interventions are sustainable.
The foundations for becoming an evidenced-based program have been laid over
the past three years at MCDPH. With the support of the MCDPH Office of
Performance Improvement, an analysis was completed and recommendations
made to define and improve processes so that outcomes could be measured.
These recommendations are in progress of being implemented. Internal policies
•have been revised to support best practices in measuring outcomes. The CHN
orientation and continuing education programs have been improved to
incorporate evidenced based and promising practice standards. The home visit
components have been defined for measuring purposes. This approach allows
for individualized, family-centered care while ensuring that standards are met.
In order to achieve this, technology has been integrated into the home visit.
Families are provided with a variety of media based on their learning needs.
Over the past two years, MCDPH has committed resources to improving the
quality of the NICP program by providing in kind support for the development and
implementation of a web-based, secured, electronic medical record (EMR) for the
program. This EMR when fully implemented will improve efficiency for the nurses
by reducing the amount of time spent on patient documentation. An important
function of the EMR is that it provides a method of gathering, collecting, and
reporting data on quality indicators that relate to care that is being provided. The
efficacy of interventions such as safe to sleep education and the infant's reported
sleep position can be measured. This and other important interventions lay the
foundations for building an evidenced based program.
MCDPH is firmly committed to the mission of the NICP program. MCDPH has
ability and willingness to provide services to any infant/child enrolled in the
program within Maricopa County with the provision of funding resources.
Maricopa County Department of Public Health, Executive Summary, ADHS14-00003830 Page 2

2.3 METHOD OF APPROACH
2.3.1.1 The method of approach that will be used to provide the services to
perform the Tasks as described in the Scope of Work and Special Terms and
Conditions.
The method of approach for the OFH HRPP/NICP is to provide a home based
visitation program to promote optimal health and development of the infant and family
by strengthening family resilience within the defined Scope of Work; this includes the
physical, developmental, psychosocial and environmental assessment of the
discharged infant, a postpartum wellness and interconception health assessment of
the mother, and the ability to provide follow-up for the Newborn Screening Program
as needed.
Task: 3.1.1 Provide a home based visitation program, which shall include a CHN and
may include early interventionist and/or a social worker for children enrolled in the
NICP or other children with special health care needs including credentials of staff
providing services.
Services for this home based visitation program begin when the referral is received
from the hospital or other referral source. Each client is assigned to a Community
Health Nurse based on the client's geographic region, special needs, cultural needs,
language and continuity of care requests when the family has or had other children
enrolled in the program. Specialized CHNs deliver individualized, family-centered,
culturally competent care to the client and family at each visit. It is essential to have
skilled nurse home visitors who are proficient in building trust and rapport with
families despite the relative limited interaction and scope of this program.
Assessments are completed by the CHN at each visit, including but not limited to a
physical assessment, general health and wellness assessment of both infant and
mother, psychosocial and home safety assessments. Based on the information
obtained during the assessments, in collaboration with the family's self- identified
strengths and needs, the experienced CHN is able to assist the family in obtaining
the necessary community services in order to optimize health, development and
family resilience. The methodology and approach utilized by the CHN is determined
based on the family's learning needs and readiness. The client and family continue
to receive services based on the family's need, risk level and receptivity. Once
services are no longer indicated, the CHN closes the case in accordance with the
ADHS CHN Policy and Procedure Manual.
All NICP home visiting staff have bachelor's degrees and are licensed Registered
Nurses in the state of Arizona. MCDPH utilizes the American Nurses Association's
Public Health Nursing: Scope and Standards of Practice as the framework for CHN
practice. Public health nursing is the practice of promoting and protecting the health
of populations using knowledge from nursing, social, and public health sciences —
this practice is exemplified throughout the NICP Community Health Nursing services.
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 1

Task 3.1.2 Identify and enroll infants, toddlers and children meeting the requirements
for OCSHCN.
Since 2009, MCDPH NICP has provided OCSHCN home visitation services to 170
children. Referrals from hospitals for infants with special needs that do not meet the
criteria of a NICU/SCN stay are readily accepted. In addition, the CHN has a unique
advantage as a home visitor to work with families to identify other children that may
benefit from early intervention services, such as the sibling of an infant enrolled in
NICP; as these additional children are identified, the CHN facilitates enrollment in the
OCSHCN program.
The primary goals for home visitation services for children enrolled under OCSHCN
are to assess, screen and identify any concerns related to the child's growth and
development and provide education, resource and referral to the appropriate
agencies. The guidelines required in the ADHS CHN Policy and Procedure Manual
provide the outline for the home visitation and case management services provided
by the CHN staff. Children enrolled under OCSHCN are transitioned to the
appropriate community resources for follow-up with any early intervention, health or
medical needs; they can receive home visitation services for up to six months or
longer with approval of ADHS.
Task 3.1.3 Provide a program that at a minim recruits, hires, trains and supervises
community health nurses (CM}, early interventionists and social workers and
maintains credentials of staff providing services as required by ADHS CHN Policy and
Procedure Manual.
Program hiring and personnel management is completed within policy and
procedures as defined by MCDPH Human Resources. Newly hired staff complete
the Maricopa County new employee orientation in addition to public health and
program specific trainings, including but not limited to Public Health 101, OSHA
safety, driving safety and program expectations. MCDPH provides in kind
management and administrative support to ensure that all N1CP staff, at the
completion of orientation, are able to provide care within the contractual guidelines
following the ADHS CHN Policy and Procedure Manual. The Program Manager
monitors and supervises staff following the MCDPH performance management policy
and procedures.
MCDPH NICP is currently staffed with 3.8 FTE CHNs, 1 'as needed' CHN available
from another OFH program, and 1 FTE Project Nurse Manager who supervises the
NICP staff as well as provides direct services as needed. All N1CP home visiting staff
have bachelor's degrees, are licensed in Arizona as Registered Nurses, have
experience in pediatrics and/or neonatal care and maintain Basic Life Support for
Healthcare Providers Certification. Each nurse has completed the required
orientation and training per the ADHS CHN Policy and Procedure Manual and are
fully competent on the expectations of contract compliance with the HRPP/NICP
program. Two nurses are IBCLC certified to provide advanced lactation counseling
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services to any of the enrolled clients in the MCDPH service area. In addition,
bilingual services are provided by three of the CHNs on the team.
The Program Manager is responsible to ensure that all CHN staff have current
Arizona licensure through the Arizona State Board of Nursing, Basic Life Support for
Healthcare Providers Certification and all credential requirements listed in the ADHS
CHN Policy and Procedure Manual.
Task 3.1.4 Provide a program that ensures the first home visit shall be done by a
CHN and subsequent visits shall be made by appropriate professionals. All visits with
children having on-going medical problems shall be done by a CHN.
Each client is assigned to a CHN case manager who is then responsible to provide
all of the NICP services to the child and family, including the initial home visit. If the
assigned CHN is not available to complete the initial visit within the expected two
week time frame, the Program Manager or another designated CHN provides
coverage for the first visit. At the initial visit, the CHN develops the HRPP/NICP plan
of care together with the family based on the assessment and the family's goals and
needs. The schedule for subsequent visits is determined by the client/family goals
and needs and also based on available staffing. While creating a team-based
approach with other professionals, such as social work or early interventionists,
within the MCDPH program would be ideal, the disproportionately high number of
initial visits required based on the number of new referrals received compared to the
ability to provide multiple follow up visits, all of our FTE's are designated as CHNs in
order to best meet the needs of the program.
Task 3.1.5 Complete a physical, developmental, psychosocial and environmental
assessment of the enrolled infant including evidence based education, family support
and early intervention along with referral services to community resources as needed
(ADHS CHN Policy and Procedure Manual).
A holistic approach to assessment allows the CHN to be effective in helping the
family to meet their goals and promote the overall health and wellness of both the
child and the family. The CHNs are required to complete a physical assessment at
each regular visit. A complete head-to-toe assessment is done at the initial visit as
appropriate utilizing the physical assessment standards in Wono's Essentials of
Pediatric Nursino, 9e, 2012, On subsequent visits, the physical exam components
will be at the discretion of the nurse based on the infant/child's age, history, parent
concerns, client presentation at the visit and assessed needs. In addition to the
physical assessment, the CHNs utilize assessment components that are a part of the
BABIEs assessment training by Dr. Joy Brown. The CHN assesses for organized
and disorganized behaviors along with caregiver contributions and integrates this into
the overall assessment which contributes to a more comprehensive developmental
assessment.
A developmental screening is completed at each visit based as on the age of the
child utilizing the Ages and Stages 3 (ASQ-3) Questionnaire. Nurses have specific
training and competency based education to provide developmental screening
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services and to provide educational interventions based on the child's assessed
needs. The CHNs have extensive training and experience to provide early
intervention anticipatory guidance support during the home visit. In addition to
developmental screening and referral to early intervention, the CHN educates and
demonstrates developmental activities that will promote the infant and child's healthy
growth and development; such as tummy time, range of motion and looking at a
picture book to promote early literacy. This is a critical component of the visit due to
the fact that many infants have delays in receiving early intervention services or may
not meet the qualifications for eligibility. Teaching the family to support the infant's
developmental needs promotes their overall brain development and long term
outcomes. The tools for early intervention support are from evidenced based
resources such as Pathways.org and The Harvard Center for the Developing Child.
Parents are provided with options for learning including giving them electronic files or
links for videos on activities such as tummy time.
A psychosocial assessment is completed at each visit so that the nurse can identify
any critical needs or family concerns, provide the related resources and make
appropriate referrals. An example of this is identifying that the mother lost her job
and is without her insurance coverage. The CHN would provide resources and
support to help the mother obtain coverage through the healthcare.gov enrollment
website. In addition, at the initial visit, the infant's Adverse Childhood Event (ACE)
score is assessed and documented by the CHN. ACE scores have been proven to
have a direct correlation on long-term outcomes for chronic disease, mental health
and at risk behaviors. Supporting the family with tools and resources to build
resiliency is a standard intervention for all infants with ACE scores of 4 or more. As
collecting ACE scores is a relatively new practice, the implications of this information
will be reviewed over time in order to provide interventions that will optimize the long
term health and developmental outcomes of the infant. A follow-up risk assessment
is done at each regular visit and recorded in the Community Nursing Neonatal and
Pediatric Assessment Form electronic medical record. There is also an informal
learning assessment that is done with the family or caregivers.
An environmental assessment is completed at each regular visit and interventions
are planned together with the family. For example, families are assisted with
resources and provided advocacy with landlords when needed for unresolved issues
such as poorly maintained apartments with safety hazards or pestilence. Families
with smokers in the home are given information on the Ashline smoking cessation
program.
Evidenced based family education is provided at each regular visit. In general,
education done in the visit is based off of determined needs. The education and
tools used by the MCDPH NICP CHNs are based off of evidenced based and
promising practices. The American Academy of Pediatric: Pediatric Clinical Practice
Guidelines and Policies, 13th edition, is a reference guide used by the nurses and is
available to them electronically on their laptops. Tools or resources must be from
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evidenced bases sources that have been approved by the Program Manager and in
accordance with the ADHS CHN Policy and Procedure Manual.
In order to reduce costs and be eco-friendly, MCDPH NICP has made a concerted
effort to reduce the costs of printed resources for families by providing families with
the options of electronic resources. Families are provided with multimedia options for
learning including print, videos, websites and electronic copies of documents
depending on the family's needs and requests. Families are also taught how to seek
out information on their own using an approved list of websites related to child health,
wellness, growth and development. Electronic resources can be sent through text
message or email links depending on the family's preference. Printed materials are
available if it better suits the family's learning needs or if electronic communication is
not available. A 70% budget cut on printed materials was accomplished in 2013
while maintaining excellence in education.
Family support is provided by the CHN based on the needs and goals identified on
the HRPP/NICP Family Plan. In addition to the home visit, CHNs provide family
support through case management services. The CHN is an advocate and a
facilitator to connect the child and family to necessary resources and community
services. They support families in identifying barriers to meeting their goals and then
support them on developing a plan to remediate barriers whenever possible. An
example of this is when the CHN supports the family in establishing a medical
home/primary care physician. If a parent discloses that the baby hasn't been to the
pediatrician since discharged from the hospital, the CHN assists the family to
understand the importance of ongoing medical and wellness care and helps the
family identify and overcome barriers in getting to the pediatrician. Families are
connected to community resources that will help them meet their goal of getting the
child to the doctor.
Referrals are made based on the assessments and screening needs identified.
Infants arid children with suspicious screening results are referred to Arizona Early
Intervention Program (AzEIP). AzEIP is also a conduit for referrals to the Division of
Developmental Disabilities (DDD). MCDPH CHNs obtain the consent of the family
and enter the referrals on the AzEIP online referral website. When available, the
CHNs will also provide documentation of qualifying diagnoses for both AzEIP and
DDD. The CHN staff have developed relationships with the state AzEIP program and
with the contracted agencies to ensure that the referral process is effective and
timely. When possible, the CHNs will attend the initial planning visit with the AzEl P
contracted coordinator to support the process and the family.
Task 3.1.6 Provide postpartum wellness screening, interconception assessment,
support and education to the mother as outlined in the Policy and Procedure Manual.
An integral part of the home visit is supporting the health and wellness of the mother.
The home visit provides a supportive and caring environment to address sensitive
subjects such as family planning and postpartum mood disorders. Screening is
done using the appropriate screening tools as well as through a basic maternal
pregnancy history intake. At the initial visit and as indicated on subsequent visits, the
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CHN uses the Edinburgh Postnatal Depression Scale to screen for a post-partum
mood disorder; referrals are provided for scores of 10 or higher or if otherwise
indicated, and then documented on the visit form. The goal for interconception care
is to provide the mother with resources and support to improve the birth outcomes for
any future pregnancies. Each CHN is required to have training and ongoing
education in interconception health and wellness. Education is provided to the
mother of the infant on ways to improve the health of future pregnancies including but
not limited to reproductive awareness, environmental toxins and teratogens, nutrition
and folic acid, genetics counseling, substance use including tobacco and alcohol;
medical conditions and medications; infectious diseases and vaccination; and
psychosocial conditions. While supplies last, MCDPH CHNs will provide each mom
with the Power Me A2Z folic acid information and supplement packets.
Task 3.1.7 Contact the enrolled family within one week of receiving the NICP
Enrollment and Discharge Forms
In accordance with the ADHS CHN Policy and Procedure Manual, the client's
family/guardian is contacted within one week of receiving the client referral.
MCDPH's compliance rate in 2013 was 95% for this indicator. The Program
Manager provides support to the CHN staff as needed to achieve the five day contact
requirement when there is a high volume of referrals and/or for coverage related to
staff absences.
Electronic communication systems are in place to promote timely, efficient and
effective communications. When the referral is received by MCDPH, the client data is
entered into the MCDPH NICP electronic database by the administrative assistant,
and the referral is electronically scanned and sent to the CHN in a HIPAA compliant
protected email; this allows the field based CHN to receive the referral and contact
the family within the set time parameter. On this initial contact, the CHN reviews the
general program information and schedules the initial within 14 days when possible.
This first call is an opportunity to begin building the relationship with the family.
CHNs have been provided with smart phones to support improved, effective
communications with families by offering multiple means of communication such as
phone, text and email. It is the experience across MCDPH family service programs
that clients who have grown up with cell phones are more likely to respond to texts
than phone calls. Families are offered the contact option of choice for future program
communications.
Task 3.1.8 Visit the enrolled infant/family within two weeks of receipt of the N1CP
Enrollment and Discharge Forms
During the initial contact phone call, the CHN requests to schedule the initial visit with
the family within the first two weeks after receiving the client referral. The CHN
explains the benefits of a visit close to hospital discharge in order to facilitate a
smooth transition from hospital to home. Although this is the consistent practice at
MCDPH, compliance in meeting the ADHS indicator of two weeks is challenging due
to families requesting a later date for personal reasons and also due to families
cancelling the initial visit requiring rescheduling. MCDPH recently added a data
collection indicator as part of a quality improvement process to better understand and
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address the causes that delay the initial visit beyond two weeks of referral receipt; as
of January 2014, data is being collected to better determine interventions to improve
the compliance with this indicator.
Task 3.1.9 Visit enrolled infants a minimum of four times within a year from the date
of discharge and/or prioritize visitation to ensure the infants are seen as appropriate
according to their risk as required by the ADHS CHN Policy and Procedure Manual.
The goal of this program is to provide at least four visits/client per year. The number
of visits completed per client is dependent on two major factors; the number of new
referrals received per FTE, and the acuity of the referred clients as determined by the
risk tool. Due to the high number of new referrals received by MCDPH per FTE,
CHN resources are prioritized to allow for initial visits to be provided within the ,
required two week window. Based on current referral levels, this averages seven (7)
initial visits each week per CHN, approximately half of the CHN visit capacity each
week.
The Program Manager is responsible to oversee client assignments. Utilizing the
Medical Risk Criteria Form as written in the ADHS CHN ADHS Policy and Procedure
Manual, each referral is assessed for risk level according to the information provided
and documentation received from the referring hospital. When a CHN is unable to
contact the client/family after two attempts, a letter is sent to the address provided on
the referral as an additional attempt to contact. High-risk drop in visits may be done,
per nurse discretion, if the CHN is unable to reach a client/family that has been
identified as high-risk based on the above criteria.
In order to improve productivity due to cancellations and no-show visits so that the
program can better meet the goal of four visits per client per year, each CHN is
required to maintain a list of clients who are willing and able to schedule visits on
short notice; should the CHN have a last minute cancellation, she can quickly offer
the time slot to another family.
Task 3.1.10 Coordinate service area with other contracted CHN agencies when
providing services in the same metropolitan area.
MCDPH NICP actively participates in collaborations, communication and
partnerships with other CHN agencies within Maricopa County and across the state;
communication and partnerships between agencies is critical in maintaining quality
and excellence as a standard of care for the program. Currently, discharge planning
meetings for all Level II EQ and Level III hospitals are divided amongst the four
contracted CHN agencies in Maricopa County. Transition of patients from hospital to
home is coordinated by the assigned CHN regardless of the client's geographic
location. The CHNs receive a transition report during hospital rounds that is
subsequently communicated via written communication and/or by a verbal report as
indicated by the need to the appropriate contracted agency. Clients who move out of
the service area are transitioned with a written and/or verbal report to the new CHN
agency in order to provide continuity of care.
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The MCDPH NICP Program Manager partners with managers from other contracted
agencies to share educational materials and opportunities so that all CHNs may
benefit. In 2012 and 2013, joint training meetings were organized, presented and
opened to all CHN contracted agencies in Maricopa County.
Task 3.1.11 Coordinate with other providers and make referrals to appropriate
services within the community and prevent duplication of services.
All efforts are made to collaborate and coordinate services with the family and other
community providers to assure continuity of care and avoid duplication of services.
Each nurse collaborates with the family to implement an HRPP/NICP Family Service
Plan that identifies the desired outcomes of the family. This process helps the nurse
and family identify the necessary resources and referrals. Children with special
health care needs often have multiple service providers involved in their care.
Through the family service plan process, the CHN helps the family identify the
purpose and priority of the services they are receiving, in addition to identifying the
correct level of service that will best meet the family needs, for example social
services verses medical and health based services. The CHN participates in AzEl P
or DOD family Initial Planning Process whenever possible to help assess and
facilitate the child's eligibility for early intervention. If a referral is received from the
hospital and the child has a family service plan through AzEIP already in place, the
nurse will conduct an initial visit in order to ensure the maternal assessment
components are addressed and any medical, care coordination needs of the infant
have been met. Infants with special medical needs receiving early intervention
services through AzEIP or DOD may be continued to be followed by the CHN as
needed. Otherwise, the case will be closed in accordance with the ADHS CHN
Policy and Procedure Manual.
Task 3.1.12 Assist the ADHS Newborn Screening Program in locating families and
facilitating the collection and submission of another newborn screening test for
infants with a previously abnormal test result as outlined in the ADHS CHN Policy and
Procedure Manual.
While the demand for this service is relatively small, there is level of proficiency
required in order to provide this service when needed. Over the years, MCDPH
NICP and the ADHS Newborn Screening program have developed a collaborative
relationship to best meet the needs of the program. Upon receipt of a NBS referral,
MCDPH CHNs assist ADHS in locating the family, provide information and education
to the family, coordinate care with the primary care physicians and, when necessary,
obtain and submit a lab specimen. MCDPH is fortunate to call upon a CHN from the
Lead Hazard Control Program who is crossed trained in phlebotomy, as the NICP
nurses do not provide this skill with enough frequency to achieve proficiency.
Each referral is unique and dependent on the specific screening result requested and
the circumstances of the child and family. In order to support the service requested,
CHNs invest time to learn the current information related to the indicated condition.
Educational materials obtained from the ADHS Newborn Screening Program are
reviewed with the families. NBS referrals are often related to families with high
social risk factors and provide opportunity for the CHN to assess for other needs,
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especially related to the health and safety of the newborn. Nurses are often able to
provide multiple community referrals, interconception care education and assess for
OCSCHN eligibility of any children within the home.
Task 3.1.13 Assure professional competency with high -risk infants and toddlers.
Professional competency of staff is ensured through several methods. All registered
nurses are bachelors prepared with pediatric and/or NICU experience. Staff must
complete a competency based education plan that is individualized based on the
nurse's specific learning needs. In addition, continuing education topics that support
quality, evidenced-based care are presented at bimonthly staff meetings, The
Program Manager supervises and supports care services through weekly case
conferences with CHN staff and by conducting staff meetings where staff present
case scenarios for group discussion. The Program Manager completed the BABIES
Learning Collaborative in 2013-2014. All staff have completed the BABIES training
course. Two of the staff are IBCLC certified and complete the required trainings to
maintain their certifications. Supervision is done through case conference on a
weekly basis with the nurse and program manager. Supervisory visits are done
regularly based on the experience and proficiency level of the CHN. In addition, joint
visits are done to support staff with new or complex situations that require additional
expertise. For example, if a CHN has not had a child on a home ventilator who is
needing support for tummy time, the Program Manager will attend the visit to mentor
and provide assistance to the nurse.
MCDPH NICP seeks to expand the quality of services provided in this next fiscal year
by integrating an Infant Toddler Mental Health Specialist (ITMHS) as a part of a
multidisciplinary team. The IMHS would provide consultation services to the CHN
staff at both a monthly staff case conference and at home visits on a limited basis for
a total of six (6) hours per month. This would also have the sustainable outcome of
providing the CHN staff with professional development in managing infants who have
high adverse childhood event (ACE) scores and are in need of infant mental health
interventions. This model has been utilized by the Nurse-Family Partnership
Program with great benefit to the clients served. Although funding resources are
limited to provide infant mental health services at the level needed to all children, this
consultative program will allow infant mental health services to be provided to a
greater population in need.
Task 3.1.14 Provide orientation for new staff, continuing education and ongoing
supervision of staff for this program
A comprehensive orientation program is in place for all newly hired CHNs, including a
system wide MCDPH new employee orientation and an NICP department level
orientation. At the MCDPH level, new hire staff are provided with important trainings
related to safety, customer service and other topics that support compliance with the
mission and vision of Maricopa County and the Department of Public Health.
The MCDPH NICP staff orientation plan was revised in 2012 to be a competency
based training program with three components: 1) didactic education and training
provided by the Program Manager, 2) self-learning modules and required reading
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 9

and, 3) a competency based, precepted clinical field experience. The requirements
provided in the ADHS CHN Policy and Procedure Manual are incorporated along with
additional requirements required by the MCDPH NICP program. Nurses are asked to
assess and identify their own learning needs and a plan is developed to address
them with the Program Manager. Nurses must successfully complete orientation and
demonstrate competency with all components before they can practice independently
with home visits and case management.
Nurses are expected to maintain proficiency on current evidenced based practices
related to their nursing practice and are provided support and resources to
accomplish this by the Program Manager. A newly hired CHN must complete joint
home visits with the Program Manager and with an assigned, experienced CHN
preceptor until competency has been demonstrated. Supervisory home visits are
done yearly at minimum depending on the needs and experience level of the staff.
When a new CHN is assigned an unfamiliar, complex case, the Program Manager is
available to provide a joint visit for mentoring and staff development. All CHN staff
have been provided with smart phones that have the ability to provide Facetime,text
and phone support as needed in the field.
Ongoing supervision of staff is provided using several approaches. The Program
Manager is available to support staff with any questions, concerns or with mentoring
as needed. The Program Manager and CHN have a weekly case conference
meeting or discussion that may be done in person or on the phone. The purpose of
this to provide support and mentoring to the CHN, ensure quality services are being
delivered as care is provided and to provide supervision while staff are working in a
remote location. There are also bimonthly staff meetings where staff are asked to
bring case scenarios for review. Mentoring and supervision is provided as cases are
reviewed. MCDPH has an employee performance appraisal system in place that
requires annual evaluations of all staff members. The Program Manager is
responsible for evaluating staff and facilitating a staff development plan.
Staff are provided five training days/year in order to attend conferences and training
such as the HRPP Annual Meeting and the Strong Families Home Visitation
Conference; the fee schedule for Training Days reflect the cost of registration,
mileage and nominal staffing time reimbursement.
Task 3.1.16 Ensure that all newly licensed nurses shadow an experience licensed
nurse for a home visit until they are qualified to complete a visit on their own.
It is the experience of MCDPH that this specific Task applies to all nurses new to
community health nursing and developmental follow-up of high risk newborns, not
just those who are newly licensed. The skill set required of an NICP CHN is unique
and advanced, the NICP CHN is an independent field practitioner expected to
provide a broad yet advanced level of expertise depending on what situation is
presented within the home at any given time. While a nursing background in
maternal child health certainly provides a foundation for services, it is the experience
of providing family-centered, competent services to medically fragile infants and their
families in the home that builds this unique skill set.
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Therefore, all newly hired CHNs are required to demonstrate competency in the
required home visit components to either the Program Manager or an experienced
preceptor prior to functioning independently in the field. An example is the CHN must
correctly administer an ASQ-3 developmental screening under the guidance of a
preceptor prior to screening independently. The extent of the precepted orientation is
individualized to the learning needs of the CHN based on the experience and initial
assessed competency levels. Fortunately, MCDPH NICP has 3 CHN preceptors,
each with 10 or more years of experience practicing as an NICP nurse home visitor.
Even after the CHN has demonstrated competency and is independently providing
care in the field, situations arise in which a shadow visit with a more experienced
CHN or the Program Manager is recommended. For example, a newly hired nurse
may not have experienced a very complex medical child where the family is
homeless. The new nurse can request that the Program Manager also attend the
visit to provide mentoring. After each precepted visit, there is a case conference with
the preceptor/mentor and the CHN to discuss the case, assessment,
recommendations and general plan for interventions. This ongoing level of support
has contributed to a highly developed, trained team.
Task 3.1.16 Continuous quality improvement process (CQI) for community nursing
services based on specific indicators, one of which is to be determined by ADHS.
MCDPH is actively committed to improving the quality of services delivered in order
to improve the long-term health and developmental outcomes of the NICP population.
As of April 2014, MCDPH is providing an in-kind investment to convert the current
NICP database from Microsoft ACCESS to SQL Server; this conversion is long
overdue and will allow for improved data collection, evaluation efforts and reporting
capabilities. With full implementation of this system, quality indicators for most visit
components will be monitored and evaluated. For example, this system will allow for
the Program Manager to determine if clients have a medical home/primary care
physician identified and yet are still using the emergency department in lieu of their
doctor, as reported by the family to the nurse. This kind of information will help to
identify key areas for client interventions and program improvements.
While the Program Manager is responsible to oversee the CQI activities, all staff are
involved in the CQI process. MCDPH's electronic documentation system
incorporates both the Community Health Nursing Services Form and an expanded
version of the Community Nursing Neonatal and Pediatric Assessment Form. Nurses
document visit assessments and interventions directly into the electronic record. In
order to obtain good and meaningful data, measures have been implemented to
control for variables. This includes training the CHN staff in the expectations related
to each indicator, establishing a standard for education for families as it relates to the
quality indicator and documenting assessments and interventions on the electronic
medical record. Data is reported as required by the ADHS CHN Policy and
Procedure Manual including the number of clients who received first contact within
five days, the number of clients who received a visit within fourteen days, and the
number of suspicious developmental screenings that were referred for early
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intervention services. This is reported to ADHS in the quarterly report, annual report
or as requested by the Program Unit Manager.
Some key data components currently being tracked in the database are:
• Number of clients receiving education on safe to sleep practices
• Sleep position of infants reported or observed at the visit
• Safe to sleep crib environment reported or observed at the visit
• Number of clients receiving breastfeeding education
• Number of clients that are reported as breastfeeding at the visit (complete or
partial feeds)
• Number of clients receiving tummy time education
• The amount of tummy time the infant receives daily as reported at the visit
• Number of client family members referred to Ashline smoking cessation
program
• Number of clients with complete immunizations per report at the visit
• Number of clients receiving education on the importance of a medical home
• Number of clients with a medical home
• Number of times a client used the ER in lieu of a medical home
• Insurance status of the client and mother
• Number of clients/families on WIC
Quality improvement discussions are a standing agenda topic at monthly staff
meetings. Staff are presented with current data and asked to participate in
strategizing improvement activities. In addition to the above, staff may recommend a
specific target for improvement. For example, in the past year staff identified multiple
infants who were eligible for Synagis but not receiving it. A quality improvement
process was put in place to address this concern. Training was received by Los
Nirios, the community provider for Synagis. This training was also extended to other
contracted CHN providers. A process was put in place based on input from Los
Nitios. Referring hospitals were educated on the need to provide information on the
date of the Synagis dose. CHNs supported families as they transitioned from the
hospital to the primary care physician, ensuring they kept track of the timing of the
next dose of Synagis in order to facilitate the referral to Los Nilios. This
multidisciplinary CQI project was successful in helping enrolled infants obtain their
Synagis in the required timeframe for efficacy to help prevent infection from the RSV
virus. These types of grass roots quality improvement activities are what make a
program effective.
As part of the Maricopa Family Support Alliance, MCDPH Office of Family Health is
adopting the Standards of Quality for Family Strengthening and Support as the
framework for ongoing quality improvement. These 17 standards were developed by
the California Network of Family Strengthening Networks and adopted by the
National Network of Family Strengthening; they are based on The Principles of
Family Support Practice (Family Support, America) and The Protective Factors
Framework (Center for the Study of Social Policy, 2005) and provide a continuous
quality improvement process for program implementation in five areas: Family
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Centeredness, Family Strengthening, Embracing Diversity, Community Building, and
Evaluation. The Standards can be reviewed at: http://www.cnfsn.org/. The MCDPH
N1CP program manager and staff will begin the process of implementing the
Standards by completing a programmatic self-assessment starting in May 2014. The
NICP program manager will be maintaining documentation not only of the actual Q1
projects, but also of the process in order to publish and disseminate the information.
Task 3.1.17 Designate a CHN to attend the weekly Discharge Planning meetings at
Level ll Enhanced Qualification and Level III Newborn Intensive Care Units as
appropriate
MCDPH CHN staff provide N1CP representation at four hospitals: Banner Samaritan
Medical Center, Scottsdale Shea Medical Center, Thunderbird Medical Center and
Arrowhead Hospital; staff attend weekly discharge meetings to support the transition
of all enrolled infants and to provide pre-discharge visits to families as scheduled by
the hospital NICP liaison. All enrolled NICP infants are provided with transition care
support regardless of their geographic home location. The CHNs provide pertinent
information from discharge rounds to the assigned nurse in written note form. In
complex cases, the CHN will provide a phone report to the designated contracted
CHN agency in order to communicate any specific needs and concerns that have
been identified for the infant during discharge rounds.
MCDPH partners with the assigned hospitals to meet the goal of helping families to
learn a consistent message for the best care of their baby. The MCDPH Program
Manager has been an active participant in the Smooth Way Home Task force that
supports transition from hospital to home and facilitates early enrollment of at risk
infants into early intervention services. The CHN staff have been instrumental in
bringing Smoothe Way Home into the assigned hospitals which were not a part of the
original pilot. Arrowhead Hospital is a Level II Enhanced Qualification hospital which
did not meet the volume for an AzEIP representative at discharge rounds. However,
the MCDPH CHN worked together with the HRPP/NICP hospital liaison at Arrowhead
Hospital to successfully establish processes with similar outcome of having the
infants eligible for AzE1P services prior to discharge.
Another project that MCDPH CHN staff committed to in 2013 was to improve safe to
sleep practices in the home. In order to accomplish this, it was necessary to work
together with hospitals to examine the safe to sleep policies that were being modeled
in the hospital setting. Parents often mirror the sleep practices that they observe in
the hospital with their babies. Hospital liaisons were provided education on current
safe to sleep practice guidelines and given copies of the American Academy of
Pediatrics (AAP) Technical Report : SIDS and Other Sleep-Related Infant Deaths:
Expansion of Recommendations for a Safe Infant Sleeping Environment, September
2011. CHNs encouraged the hospital HRPP liaisons to champion the use of AAP
guidelines for safe sleep in their hospital policies. Through ongoing partnerships, the
CHNs and hospitals work together to improve the care of these vulnerable infants.
Task 3.1.18 Within one week of discharge, send a letter to families when a newborn
infant may be enrolled in the program by the family, but has been determined to be
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low-versus high-risk and does not require an initial visit. The family may request a
follow-up visit.
Newly referred clients who are screened as low-risk based on the Medical Risk
Criteria Form will be sent a low risk letter within one week of discharge, assuming the
referral is received by MCDPH in a timely manner. The letter provided to the family
will indicate that the infant has been enrolled in the program, has been identified at a
lower risk for developmental delays and will give the family the option of requesting a
home follow-up visit. In addition to the low-risk letter, a developmental guidance
brochure is included with the letters. If the family requests a visit, one will be
provided at the earliest possible date. Although the infant may be low-risk, often
times this is an opportunity to address maternal health and interconception care
needs with the mother. The goal is to either close the case due to low-risk or
transition the infant to other needed services determined at the visit. MCDPH will
submit a log of low-risk letters to ADHS in order to obtain reimbursement for this
service; the reimbursement rate reflects nursing time needed to review and identify
risk level, administrative staffing time to generate and mail the letter, and the cost of
supplies, including the developmental guidance brochure and postage.
2.3.1.2 A detailed description of the projected number of clients the Offeror
is able to serve and the areas of the State in which the Offeror intends to
provide service.
MCDPH NICP is able to provide services to clients anywhere within Maricopa County
as funding allows. The MCDPH NICP currently assigned zip codes are essentially
the north half of Maricopa County and are equal to approximately 3,400 square miles
of coverage. In FY2013, MCDPH had 4.3 FTE CHNs, received 1,224 new referrals,
910 (74%) of which received an initial visit. A total of 2,397 home visits were
provided; direct services were provided to 1,204 clients creating the average of 2
visits/client. Due to administrative adjustments by MCDPH, the NICP CHN capacity
was decreased to 3.8 FTE's in FY2014 due to a nominal performance pay increase
implemented in July 2013 for all staff and a nursing salary market adjustment in
January 2014 which affected one staff salary. These two adjustments required the
program to discontinue the 0.5 FTE temporary position; to supplement productivity,
the Program Manager provides home visits as needed, in addition to a cross trained
CHN from the Lead Hazard Control Program who provides NICP services as needed
based on demand and funding availability.
It is difficult to calculate the number of clients our program is able to service as
historically, MCDPH NICP has been required to accept all referrals for the assigned
zip codes, regardless of staffing levels. As a result, the CHN caseload service
intensity has fluctuated in order to accommodate the increased demand for initial
visits resulting in fewer follow-up visits; this inability to cap new referrals received per
FTE does not allow the program to maintain a degree of service intensity for each
client— such as 4 visits/year/client. Under the current model, we will serve all of the
referrals that are distributed within our assigned zip codes; the intensity of the
service we provide will be dependent on the number of new referrals received
related to the funded staffing level.
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We are able to calculate the number of visits each CHN can realistically complete
each year. This program has many years invested in developing quality community
health nursing services and has shown a commitment to retaining a dedicated,
competent nursing staff; it is essential to the long-term quality of this program to
maintain standards of visit quality within realistic productivity expectations. In order
to maintain program quality,1 FTE CHN is realistically expected to perform at
the level of 585 visits/year; this is based on 14 visit slots per week and accounting
for: 1 no show or last minute cancellation per week, 21 vacation days, 5 sick
time/family leave days, 12 paid holidays, 5 days of education and training (such as
the HRPP Business Meeting, Strong Families Conference, etc). Of note, the Nurse-
Family Partnership model is based on a target of 12 visits per week for a caseload of
25 families; the 14 visits slots/week expectation is aggressive in light of the number of
clients the MCDPH NICP CHN is currently managing, an average of 120 clients at
any given time with approximately seven (7) new clients each week.
While the goal is 585 visits/year per FTE, some CHNs are able to exceed this based
on geographical location, such as higher socioeconomic areas where families are in
situations that allow them to prioritize attendance at their NICP visit, or higher density
zip codes with less travel time, while another CHN who works in higher
socioeconomic risk zip code areas may struggle to achieve this goal due to excessive
no shows, last minute cancellations, and increased time needed to provide case
management services for these more vulnerable families; also, if the CHN is covering
Wickenburg and Aguila, productivity is largely and negatively affected by excessive
travel time. Despite the fluctuation in service delivery based on external factors, the
average CHN productivity per week is calculated at: home visit - 13 hours; travel —
15 hours; discharge planning — 1 hour; staff meeting/case conference with supervisor
— 1 hour; documentation — 3,5 hours; case management/scheduling — 6.5 hours;
Total 40 hours/week.
Within the current parameter of assigned zip codes, funding and staffing level of 3.8
CHN FTEs , MCDPH NICP is able to provide an average of 2 visits/client based on
the approximate number of 100 new referrals currently received each month. In
order to increase service intensity to provide 4 visits/year, under these current
parameters, 5.5 FTE's are needed.
The Fee Schedule submitted with this proposal reflects some increase in cost per
service; this increase is necessary to ensure that the program is able to bill down the
awarded amount each year in order to cover the cost of the program. It cost
approximately $120,000/CHN FTE per year to cover salary, benefits, mileage
reimbursement, cell phone for safety, and indirect costs, and approximately
$30,000/0.6 FTE administrative assistant salary, benefits and indirect. Ideally, the
fee schedule should be designed so that the program can bill down the full award
within a ten to eleven month timeframe. This builds in a safety net or buffer to
accommodate for staffing issues that occur as a normal part of maintaining a
workforce, such as a staff member who needs surgery or has an extended illness, or
a staff member needing to take family medical leave. It is important to note that once
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 15

the yearly award is billed down, services continue to be provided until the end of the
contract.
It is also important to note the economy of scale principle when implementing NICP;
service efficiency and productivity are enhanced (cost per unit goes down) when
administrative overhead is maximized. MCDPH currently provides approximately
$150,000/year of In-kind administrative and supervisory staff plus additional in-kind
costs in enhanced database capabilities, all of which are required in order to
implement the program even at a minimum level; however, these services are
currently not being maximized by the level of utilization at 3.8 FTE CHNs. MCDPH
can immediately accommodate an additional 4.2 CHN FTEs (for a total of 8 CHNs),
within the in-kind costs that are already being provided. Even if this means an
increased service area with increased referrals, flexibility and resiliency of the
program will be increased by having more staff members providing services.
2.3.1.3 Details related to the scope of any training sessions to be provided
including, but not limited to, length of time, materials, equipment and optimal
number of attendees per training session;
Ongoing training is an important part of maintaining a skilled, developed workforce.
MCDPH provides in kind training and education support through both the MCDPH
human resource department, education department and the Program Manager.
Regular trainings are done at staff meetings by the Program Manager and the topics
are driven by the identified staff needs and also based on quality improvement
needs. The length of time is dependent on the training and is incorporated to the
time of the staff meeting itself. Trainings are also done with staff at the OFH Quarterly
Staff Meetings.
The topics of trainings vary and are focused on provided a foundational level of
education to meet the goals of the program. For example, during RSV season, a
training was developed on RSV and its application as a home visitor. This training
session was shared with other Maricopa County contracted CHN providers. The
equipment used for training includes laptops, projectors and related equipment
provided in kind by MCDPH.
The MCDPH CHNs attend the HRPP/N1CP Statewide Conference and Strong
Families Conference. Staff are also encouraged to attend other trainings provided in
the community in order to continue professional development such as the training on
Infant Mental Health and Prevent Child Abuse Arizona's Conference. In addition, two
of the CHNs are IBCLC certified and are attending the IBCLC conference in 2014.
The Program Manager participates in the Arizona Perinatal Trust Conference which
allow for opportunities for both professional development and networking.
2.3.1.4 All plans as detailed in the Scope of Work, Requirements Section
Requirement 4.1 Employ Arizona Licensed Registered Nurses with Basic Life
Support Certification, experienced in pediatrics and/or NICU and a Bachelor of
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Science Degree. Social workers shall be a licensed Master Social Worker and/or hold
a Master of Social Work degree.
MCDPH currently employs 5 registered nurses as CHNS and one Program Manager
RN licensed in the state of Arizona. All the nurses are bachelors prepared and have
current certification in Basic Life Support. MCDPH has a human resource division
that supports timely recruitment and hiring of additional registered nurses to support
program expansion as needed.
Requirement 4.2 Provide the required documentation of the home visitation to
ADHS which consists of orientation log, completed CHN Follow-up visit forms,
monthly invoices, logs of clients seen and quarterly reports:
The Program Manager is responsible to submit all required documentation to ADHS
in accordance with the ADHS CHN Policy and Procedure Manual. The monthly
invoices and logs are generated from the MCDPH NICP database and have been
created to in accordance with ADHS requirements. These monthly invoices and logs
are submitted according to the contractual agreement to ADHS by the 30 th of each
month. Quarterly reports are submit according to the required schedule. The
quarterly reports provide a statistical and historical overview.
Requirement 4.3 Maintain all necessary permits and licenses, when applicable, and
be licensed to provide service in Arizona;
Any required licenses and certifications are obtained by MCDPH administration and
maintained on record in the employee files. The Program Manager verifies nursing
licensure at http://www.azbn.govionlineverification.aspx. Required documents are
available to the ADHS Program Unit Manager upon request.
Requirement 4,4 Provide and update as requested by ADHS the following plans to
provide service:
Requirement 4.4.1 Recruitment, hiring, training, supervision and ongoing
professional competency of CHNs, early interventionists and social workers that have
contact with infants, toddlers and families.
Policies and procedures are in place at MCDPH to provide the framework,
requirements and processes for recruitment, hiring, training, supervising and
providing ongoing professional development of the CHNs.
MCDPH has human resource systems in place to provide efficient and timely
recruitment and hiring of staff. All MCDPH are provided with a MCDPH system wide
orientation program and a NICP department level orientation program. Refer to
section 3.1.15 and 3.1.14 for further discussion.
Requirement 4.4.2 Map and/or list of zip codes of areas to be served, including
but not limited to, the project number of clients to be served.
Currently, MCDPH NICP provides service coverage for zip codes over approximately
3,400 square miles. MCDPH is able to provide coverage for NICP services
anywhere within the Maricopa County borders according to the agreed upon zip code
assignment. See Map and Zip Code Attachments.
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In FY2013, MCDPH had 4.3 FTE CHNs, received 1,224 new referrals, 910 (74%) of
which received an initial visit; a total of 2,397 home visits were provided. Direct
services were provided to a total of 1,204 clients, averaging 2 visits/client. Under the
current model, we will serve all of the referrals that are distributed within our
assigned zip codes; the intensity of the service we provide (number of
visits/client) will be dependent on the number of new referrals received related
to the funded staffing level. Using FY13 numbers and our current staffing of 3.8
FTE CHNs, each CHN will maintain a schedule that can serve seven initial visit slots
per week; allowing for seven follow-up slots per week. Due to circumstances outside
of the CNN's control, including client no-shows and last minute cancellations, the
expectation is to complete at least 13 visits a week. CHN staff are taught methods to
improve efficiency including maintaining a list of clients that are willing to schedule on
short notice should a cancellation occur. A very specific time analysis has been
completed in order to be time and cost efficient in staffing and visit expectations; this
has been used in quality improvement projects to increase efficiency.
Requirement 4.4.3 Family contact within one week of receipt of NICP Enrollment and
Discharge Forms
A quality indicator for the MCDPH NICP program is to have first contact with the
family within one week of receiving the referral. In 2013, the compliance rate was
95%. Quality indicators are reviewed at staff meetings quarterly. Interventions for
improvement are discussed, planned, implemented and evaluated for efficacy.
Requirement 4.4.4 Home visits, including but not limited to, first home visit within
two weeks of receipt of the NICP Enrollment and Discharge Forms
During the initial contact phone call, the CHN requests to schedule the initial visit with
the family within the first two weeks after receiving the client referral. The CHN
explains the benefits of a visit close to hospital discharge in order to facilitate a
smooth transition from hospital to home. Although this is the consistent practice at
MCDPH, compliance in meeting the ADHS indicator of two weeks is challenging due
to families requesting a later date for personal reasons and also due to families
cancelling the initial visit requiring rescheduling. MCDPH recently added a data
collection indicator as part of a quality improvement process to better understand and
address the causes that delay the initial visit beyond two weeks of referral receipt; as
of January 2014, data is being collected to better determine interventions to improve
the compliance with this indicator.
Requirement 4.4.5 Identification and enrollment of children with special health
care needs.
Since 2009, MCDPH NICP has provided OCSHCN home visitation services to 170
children. Referrals from hospitals for infants with special needs that do not meet the
criteria of a NICU/SCN stay are readily accepted. In addition, the CHN has a unique
advantage as a home visitor to work with families to identify other children that may
benefit from early intervention services, such as the sibling of an infant enrolled in
NICP; as these additional children are identified, the CHN facilitates enrollment in the
OCSHCN program.
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The primary goals for home visitation services for children enrolled under OCSHCN
are to assess, screen and identify any concerns related to the child's growth and
development and provide education, resource and referral to the appropriate
agencies. The guidelines required in the ADHS CHN Policy and Procedure Manual
provide the outline for the home visitation and case management services provided
by the CHN staff. Children enrolled under OCSHCN are transitioned to the
appropriate community resources for follow-up with any early intervention, health or
medical needs; they can receive home visitation services for up to six months or
longer with approval of ADHS.
Requirement 4.4.6 Assessments including but not limited to physical,
developmental, psychosocial and environmental assessments for enrolled infant
including evidence based education, family support and early intervention along with
referral services to community resources as needed
A holistic approach to assessment allows the CHN to be effective in helping the
family to meet their goals and promote the overall health and wellness of both the
child and the family. The CHNs are required to complete a physical assessment at
each regular visit. A complete head-to-toe assessment is done at the initial visit as
appropriate utilizing the physical assessment standards in Wong's Essentials of
Pediatric Nursing, 9e, 2012. On subsequent visits, the physical exam components
will be at the discretion of the nurse based on the infant/child's age, history, parent
concerns, client presentation at the visit and assessed needs. In addition to the
physical assessment, the CHNs utilize assessment components that are a part of the
BABIEs assessment training by Dr. Joy Brown. The CHN assesses for organized
and disorganized behaviors along with caregiver contributions and integrates this into
the overall assessment which contributes to a more comprehensive developmental
assessment.
A developmental screening is completed at each visit based as on the age of the
child utilizing the Ages and Stages 3 (ASQ-3) Questionnaire. Nurses have specific
training and competency based education to provide developmental screening
services and to provide educational interventions based on the child's assessed
needs. The CHNs have extensive training and experience to provide early
intervention anticipatory guidance support during the home visit. In addition to
developmental screening and referral to early intervention, the CHN educates and
demonstrates developmental activities that will promote the infant and child's healthy
growth and development; such as tummy time, range of motion and looking at a
picture book to promote early literacy. This is a critical component of the visit due to
the fact that many infants have delays in receiving early intervention services or may
not meet the qualifications for eligibility. Teaching the family to support the infant's
developmental needs promotes their overall brain development and long term
outcomes. The tools for early intervention support are from evidenced based
resources such as Pathways.org and The Harvard Center for the Developing Child.
Parents are provided with options for learning including giving them electronic files or
links for videos on activities such as tummy time.
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A psychosocial assessment is completed at each visit so that the nurse can identify
any critical needs or family concerns, provide the related resources and make
appropriate referrals. An example of this is identifying that the mother lost her job
and is without her insurance coverage. The CHN would provide resources and
support to help the mother obtain coverage through the healthcare.gov enrollment
website. In addition, at the initial visit, the infant's Adverse Childhood Event (ACE)
score is assessed and documented by the CHN. ACE scores have been proven to
have a direct correlation on long-term outcomes for chronic disease, mental health
and at risk behaviors. Supporting the family with tools and resources to build
resiliency is a standard intervention for all infants with ACE scores of 4 or more. As
collecting ACE scores is a relatively new practice, the implications of this information
will be reviewed over time in order to provide interventions that will optimize the long
term health and developmental outcomes of the infant. A follow-up risk assessment
is done at each regular visit and recorded in the Community Nursing Neonatal and
Pediatric Assessment Form electronic medical record. There is also an informal
learning assessment that is done with the family or caregivers.
An environmental assessment is completed at each regular visit and interventions
are planned together with the family. For example, families are assisted with
resources and provided advocacy with landlords when needed for unresolved issues
such as poorly maintained apartments with safety hazards or pestilence. Families
with smokers in the home are given information on the Ashline smoking cessation
program.
Evidenced based family education is provided at each regular visit. In general,
education done in the visit is based off of determined needs. The education and
tools used by the MCDPH NICP CHNs are based off of evidenced based and
promising practices. The American Academy of Pediatric: Pediatric Clinical Practice
Guidelines and Policies, 13 th edition, is a reference guide used by the nurses and is
available to them electronically on their laptops. Tools or resources must be from
evidenced bases sources that have been approved by the Program Manager and in
accordance with the ADHS CHN Policy and Procedure Manual.
In order to reduce costs and be eco-friendly, MCDPH NICP has made a concerted
effort to reduce the costs of printed resources for families by providing families with
the options of electronic resources. Families are provided with multimedia options for
learning including print, videos, websites and electronic copies of documents
depending on the family's needs and requests. Families are also taught how to seek
out information on their own using an approved list of websites related to child health,
wellness, growth and development. Electronic resources can be sent through text
message or email links depending on the family's preference. Printed materials are
available if it better suits the family's learning needs or if electronic communication is
not available. A 70% budget cut on printed materials was accomplished in 2013
while maintaining excellence in education.
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Family support is provided by the CHN based on the needs and goals identified on
the HRPP/NICP Family Plan. In addition to the home visit, CHNs provide family
support through case management services. The CHN is an advocate and a
facilitator to connect the child and family to necessary resources and community
services. They support families in identifying barriers to meeting their goals and then
support them on developing a plan to remediate barriers whenever possible. An
example of this is when the CHN supports the family in establishing a medical
home/primary care physician. If a parent discloses that the baby hasn't been to the
pediatrician since discharged from the hospital, the CHN assists the family to
understand the importance of ongoing medical and wellness care and helps the
family identify and overcome barriers in getting to the pediatrician. Families are
connected to community resources that will help them meet their goal of getting the
child to the doctor.
Referrals are made based on the assessments and screening needs identified.
Infants and children with suspicious screening results are referred to Arizona Early
Intervention Program (AzEIP). AzEIP is also a conduit for referrals to the Division of
Developmental Disabilities (DDD). MCDPH CHNs obtain the consent of the family
and enter the referrals on the AzEl P online referral website. When available, the
CHNs will also provide documentation of qualifying diagnoses for both AzEIP and
DOD. The CHN staff have developed relationships with the state AzEIP program and
with the contracted agencies to ensure that the referral process is effective and
timely. When possible, the CHNs will attend the initial planning visit with the AzEIP
contracted coordinator to support the process and the family.
Requirement 4.4.7 Complete postpartum wellness assessment of the mother,
including at a minimum interconception support and education
An integral part of the home visit is supporting the health and wellness of the mother.
The home visit provides a supportive and caring environment to address sensitive
subjects such as family planning and postpartum mood disorders. Screening is
done using the appropriate screening tools as well as through a basic maternal
pregnancy history intake. At the initial visit and as indicated on subsequent visits, the
CHN uses the Edinburgh Postnatal Depression Scale to screen for a post-partum
mood disorder; referrals are provided for scores of 10 or higher or if otherwise
indicated, and then documented on the visit form. The goal for interconception care
is to provide the mother with resources and support to improve the birth outcomes for
any future pregnancies. Each CHN is required to have training and ongoing
education in interconception health and wellness. Education is provided to the
mother of the infant on ways to improve the health of future pregnancies including but
not limited to reproductive awareness, environmental toxins and teratogens, nutrition
and folic acid, genetics counseling, substance use including tobacco and alcohol;
medical conditions and medications; infectious diseases and vaccination; and
psychosocial conditions. While supplies last, MCDPH CHNs will provide each mom
with the Power Me A2Z folic acid information and supplement packets.
Requirement 4.4.8 Coordination with other CHN agencies providing services within
the same metropolitan or local area,
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MCDPH NICP actively participates in collaborations, communication and
partnerships with other CHN agencies within Maricopa County and across the state;
communication and partnerships between agencies is critical in maintaining quality
and excellence as a standard of care for the program. Currently, discharge planning
meetings for all Level II EQ and Level III hospitals are divided amongst the four
contracted CHN agencies in Maricopa County. Transition of patients from hospital to
home is coordinated by the assigned CHN regardless of the client's geographic
location. The CHNs receive a transition report during hospital rounds that is
subsequently communicated via written communication and/or by a verbal report as
indicated by the need to the appropriate contracted agency. Clients who move out of
the service area are transitioned with a written and/or verbal report to the new CHN
agency in order to provide continuity of care.
The MCDPH NICP Program Manager partners with managers from other contracted
agencies to share educational materials and opportunities so that all CHNs may
benefit. In 2012 and 2013, joint training meetings were organized, presented and
opened to all CHN contracted agencies in Maricopa County.
Requirement 4.4.9 Orientation, continuing education and supervision of staff,
A comprehensive orientation program is in place for all newly hired CHNs, including a
system wide MCDPH new employee orientation and an NICP department level
orientation. At the MCDPH level, new hire staff are provided with important trainings
related to safety, customer service and other topics that support compliance with the
mission and vision of Maricopa County and the Department of Public Health.
The MCDPH NICP staff orientation plan was revised in 2012 to be a competency
based training program with three components: 1)didactic education and training
provided by the Program Manager, 2) self-learning modules and required reading
and, 3) a competency based, precepted clinical field experience. The requirements
provided in the ADHS CHN Policy and Procedure Manual are incorporated along with
additional requirements required by the MCDPH NICP program. Nurses are asked to
assess and identify their own learning needs and a plan is developed to address
them with the Program Manager. Nurses must successfully complete orientation and
demonstrate competency with all components before they can practice independently
with home visits and case management.
Nurses are expected to maintain proficiency on current evidenced based practices
related to their nursing practice and are provided support and resources to
accomplish this by the Program Manager. A newly hired CHN must complete joint
home visits with the Program Manager and with an assigned, experienced CHN
preceptor until competency has been demonstrated. Supervisory home visits are
done yearly at minimum depending on the needs and experience level of the staff.
When a new CHN is assigned an unfamiliar, complex case, the Program Manager is
available to provide a joint visit for mentoring and staff development. All CHN staff
have been provided with smart phones that have the ability to provide Facetinne, text
and phone support as needed in the field.
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 22

Ongoing supervision of staff is provided using several approaches. The Program
Manager is available to support staff with any questions, concerns or with mentoring
as needed. The Program Manager and CHN have a weekly case conference
meeting or discussion that may be done in person or on the phone. The purpose of
this to provide support and mentoring to the CHN, ensure quality services are being
delivered as care is provided and to provide supervision while staff are working in a
remote location. There are also bimonthly staff meetings where staff are asked to
bring case scenarios for review. Mentoring and supervision is provided as cases are
reviewed. MCDPH has an employee performance appraisal system in place that
requires annual evaluations of all staff members. The Program Manager is
responsible for evaluating staff and facilitating a staff development plan.
Requirement 4.4.10 Location of families and facilitating collection and submission of
additional newborn screening tests for infants with a previously abnormal test result.
While the demand for this service is relatively small, there is level of proficiency
required in order to provide this service when needed. Over the years, MCDPH
NICP and the ADHS Newborn Screening program have developed a collaborative
relationship to best meet the needs of the program. Upon receipt of a NBS referral,
MCDPH CHNs assist ADHS in locating the family, provide information and education
to the family, coordinate care with the primary care physicians and, when necessary,
obtain and submit a lab specimen. MCDPH is fortunate to call upon a CHN from the
Lead Hazard Control Program who is crossed trained in phlebotomy, as the N1CP
nurses do not provide this skill with enough frequency to achieve proficiency.
Each referral is unique and dependent on the specific screening result requested and
the circumstances of the child and family. In order to support the service requested,
CHNs invest time to learn the current information related to the indicated condition.
Educational materials obtained from the ADHS Newborn Screening Program are
reviewed with the families. NBS referrals are often related to families with high
social risk factors and provide opportunity for the CHN to assess for other needs,
especially related to the health and safety of the newborn. Nurses are often able to
provide multiple community referrals, interconception care education and assess for
OCSCHN eligibility of any children within the home
Requirement 4.4.11 Provision of continuous quality improvement
MCDPH is actively committed to improving the quality of services delivered in order
to improve the long-term health and developmental outcomes of the N1CP population.
As of April 2014, MCDPH is providing an in-kind investment to convert the current
NICP database from Microsoft ACCESS to SQL Server; this conversion is long
overdue and will allow for improved data collection, evaluation efforts and reporting
capabilities. With full implementation of this system, quality indicators for most visit
components will be monitored and evaluated. For example, this system will allow for
the Program Manager to determine if clients have a medical home/primary care
physician identified and yet are still using the emergency department in lieu of their
doctor, as reported by the family to the nurse. This kind of information will help to
identify key areas for client interventions and program improvements.
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 23

While the Program Manager is responsible to oversee the CQI activities, all staff are
involved in the CQI process. MCDPH's electronic documentation system
incorporates both the Community Health Nursing Services Form and an expanded
version of the Community Nursing Neonatal and Pediatric Assessment Form. Nurses
document visit assessments and interventions directly into the electronic record. In
order to obtain good and meaningful data, measures have been implemented to
control for variables. This includes training the CHN staff in the expectations related
to each indicator, establishing a standard for education for families as it relates to the
quality indicator and documenting assessments and interventions on the electronic
medical record. Data is reported as required by the ADHS CHN Policy and
Procedure Manual including the number of clients who received first contact within
five days, the number of clients who received a visit within fourteen days, and the
number of suspicious developmental screenings that were referred for early
intervention services. This is reported to ADHS in the quarterly report, annual report
or as requested by the Program Unit Manager.
Some key data components currently being tracked are:
• Number of clients receiving education on safe to sleep practices
• Sleep position of infants reported or observed at the visit
• Safe to sleep crib environment reported or observed at the visit
• Number of clients receiving breastfeeding education
• Number of clients that are reported as breastfeeding at the visit (complete or
partial feeds)
• Number of clients receiving tummy time education
• The amount of tummy time the infant receives daily as reported at the visit
• Number of client family members referred to Ashline smoking cessation
program
• Number of clients with complete immunizations per report at the visit
• Number of clients receiving education on the importance of a medical home
• Number of clients with a medical home
• Number of times a client used the ER in lieu of a medical home
• Insurance status of the client and mother
• Number of clients/families on WIC
Quality improvement discussions are a standing agenda topic at monthly staff
meetings. Staff are presented with current data and asked to participate in
strategizing improvement activities. In addition to the above, staff may recommend a
specific target for improvement. For example, in the past year staff identified multiple
infants who were eligible for Synagis but not receiving it. A quality improvement
process was put in place to address this concern. Training was received by Los
Nirlos, the community provider for Synagis. This training was also extended to other
contracted CHN providers. A process was put in place based on input from Los
Nitlos. Referring hospitals were educated on the need to provide information on the
date of the Synagis dose. CHNs supported families as they transitioned from the
hospital to the primary care physician, ensuring they kept track of the timing of the
next dose of Synagis in order to facilitate the referral to Los Nielos. This
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 24

multidisciplinary CQI project was successful in helping enrolled infants obtain their
Synagis in the required timeframe for efficacy to help prevent infection from the RSV
virus. These types of grass roots quality improvement activities are what make a
program effective.
As part of the Maricopa Family Support Alliance, MCDPH Office of Family Health is
adopting the Standards of Quality for Family Strengthening and Support as the
framework for ongoing quality improvement. These 17 standards were developed by
the California Network of Family Strengthening Networks and adopted by the
National Network of Family Strengthening; they are based on The Principles of
Family Support Practice (Family Support, America) and The Protective Factors
Framework (Center for the Study of Social Policy, 2005) and provide a continuous
quality improvement process for program implementation in five areas: Family
Centeredness, Family Strengthening, Embracing Diversity, Community Building, and
Evaluation. The Standards can be reviewed at: http://www.cnfsn.org/. The MCDPH
NICP program manager and staff will begin the process of implementing the
Standards by completing a programmatic self-assessment starting in May 2014. The
NICP program manager will be maintaining documentation not only of the actual QI
projects, but also of the process in order to publish and disseminate the information.
Requirement 4.4.12 Attendance at weekly Discharge Planning meeting at Level II
Enhanced Qualification and Level III Newborn Intensive Care Units as requested.
MCDPH CHN staff provide NICP representation at four hospitals: Banner Samaritan
Medical Center, Scottsdale Shea Medical Center, Thunderbird Medical Center and
Arrowhead Hospital; staff attend weekly discharge meetings to support the transition
of all enrolled infants and to provide pre-discharge visits to families as scheduled by
the hospital NICP liaison. All enrolled NICP infants are provided with transition care
support regardless of their geographic home location. The CHNs provide pertinent
information from discharge rounds to the assigned nurse in written note form. In
complex cases, the CHN will provide a phone report to the designated contracted
CHN agency in order to communicate any specific needs and concerns that have
been identified for the infant during discharge rounds.
MCDPH partners with the assigned hospitals to meet the goal of helping families to
learn a consistent message for the best care of their baby. The MCDPH Program
Manager has been an active participant in the Smooth Way Home Task force that
supports transition from hospital to home and facilitates early enrollment of at risk
infants into early intervention services. The CHN staff have been instrumental in
bringing Smoothe Way Home into the assigned hospitals which were not a part of the
original pilot. Arrowhead Hospital is a Level II Enhanced Qualification hospital which
did not meet the volume for an AzEIP representative at discharge rounds. However,
the MCDPH CHN worked together with the HRPP/NICP hospital liaison at Arrowhead
Hospital to successfully establish processes with similar outcome of having the
infants eligible for AzEIP services prior to discharge.
Another project that MCDPH CHN staff committed to in 2013 was to improve safe to
sleep practices in the home. In order to accomplish this, it was necessary to work
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 25

together with hospitals to examine the safe to sleep policies that were being modeled
in the hospital setting. Parents often mirror the sleep practices that they observe in
the hospital with their babies. Hospital liaisons were provided education on current
safe to sleep practice guidelines and given copies of the American Academy of
Pediatrics (AAP) Technical Report : SIDS and Other Sleep-Related Infant Deaths:
Expansion of Recommendations for a Safe Infant Sleeping Environment, September
2011. CHNs encouraged the hospital HRPP liaisons to champion the use of AAP
guidelines for safe sleep in their hospital policies. Through ongoing partnerships, the
CHNs and hospitals work together to improve the care of these vulnerable infants.
Requirement 4.6 All services for this Contract shall be performed in accordance with
the Community Nursing Services Policy and Procedure Manual.
The ADHS CHN Policy and Procedure Manual is the foundation for all policies and
procedures for provision of services at MCDPH. All services delivered are in
accordance with the expectations provided in the manual.
Staff are given electronic and paper access to the manual. They are provided
training on the manual during orientation and ongoing education through quality
improvement discussions at staff meetings. Any updates to the manual are provided
to staff through education from the Program Manager.
2.3.1.5 Submit three examples of prior projects similar to those as described in
this solicitation including but not limited to, a description of the work
performed, the method used to complete the project, recommendations made
to the client's process and project outcome. The ADHS may not be used as the
only example of prior projects; other examples of similar projects shall be
included. Provide the name of the organization, contact person, title,
telephone number, fax number, address and the email address for each
example as a reference.
Nurse Family Partnership (NFP) - First Things First grantor
Contact Information: Jonathon Gonzales, MPA , Regional Director
Telephone: 602-771-5045 Email: icionzalesazftf.qov
Address: 4000 N. Central Ave #800 Phoenix AZ 85012
MCDPH OFH provides the Nurse-Family Partnership (NFP) with fidelity to the model
in all zip codes of the South Phoenix Region (SPR). A team of 4 Nurse Home Visitors
(NHV's) partner with 95 at-risk, first-time mothers and their infants residing in the
region, to provide the education, support and care they need to have a healthy
pregnancy, provide responsible and competent care for their children, and become
more economically self-sufficient. From pregnancy until the child turns two years of
age, NHV's provide home visits, forming a much-needed, trusting relationship with
these first-time moms, instilling confidence and empowering them to achieve a better
life for their children — and themselves. NFP's outcomes include long-term family
improvements in health, education, and economic self-sufficiency. By helping to
break the cycle of poverty, this program plays a role in helping to improve the lives of
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 26

these most vulnerable members, building a stronger early childhood development
community, and leaving a positive impact on this and future generations.
South Phoenix Healthy Start (SPHS) — HRSA grantor
Contact Information: Juliann DeStefano, RN, MPH HRSA Senior Program Analyst
Telephone: 301-443-0883 Address: 5600 Fishers Lane Rockville, MD 20857
Fax: 301-594-0186 Email: IDeStefano(@hrsa.gov
For the past twelve years, the MCDPH OFH South Phoenix Healthy Start (SPHS)
project has provided key leadership and programmatic roles in strengthening families
within the urban communities of South Phoenix and Maryvale. This Healthy Start
model utilizes a team-based approach of a community health worker, social worker
and registered nurse in service implementation. Services are centered on the
provision of targeted individual and community based outreach, recruitment and
access linking to medical homes for preconception, prenatal, inter-conception and
infant/toddler health care; in addition to home based case management, risk
screening, health and parenting education services for targeted women, their
partners, infants and families. This program provides direct services to
approximately 400 clients per year.
Lead Hazard Control Program - City of Phoenix grantor
Contact: Laura C. Smith
Telephone: 602-534-2528 Email: laura.smithRphoenixsiov
Address: 200 W. Washington St. Phoenix, Az 85003
The MCDPH Lead Hazard Control Program (LHCP) is a subcontract of the HUD/City
of Phoenix Lead Poisoning Prevention and Control Program that provides community
health nursing home visitation services. A primary goal of the program is to screen,
identify and refer children under six who are at risk for lead poisoning. The program
seeks to raise awareness and educate families through both home visitation
education and community based training. While in the home, the CHN obtains blood
samples for lead screenings that are processed with a contracted laboratory.
Families are provided education on lead poisoning awareness and prevention.
Interconception care is provided at each visit with a mother of child bearing age with
special attention to lead poisoning prevention and folic acid benefits.
The LHCP nurse is also specially trained in child growth and development. During
the visit, the nurse LHCP nurse is able to provide developmental screenings for
children that are at risk due to lead exposure. Children who have suspicious
screenings are referred for early intervention and may be enrolled with funding
through the Office of Children with Special Health Care Needs (OCSHCN). Parents
are educated with strategies to encourage their child's development
Methods used to complete the project include the provision of home visitation
services with community health nurses who are specially trained in lead poisoning
prevention, Healthy Homes, and infant/child growth and development.
Maricopa County Department of Public Health, Method of Approach, ADHS14-00003830 Page 27

2.4 EXPERIENCE AND EXPERTISE
2.4.1 A description of Offeror's experience and expertise regarding the services
offered including, but not limited to, company history, location, number of years
in business, types of services provided, number of current full and part-time
employees, and number of current clients. Offeror shall provide a statement of
mission, vision and guiding principles for the provision of services in the
Solicitation;
Maricopa County is the nation's fourth most populous county with an estimated 3.8
million people and is home to 60% of the state's residents and the city of Phoenix,
now the nation's fifth largest city. Spread out over 9,200 square miles, the county is a
mix of urban and rural areas and includes the whole or parts of five Indian Reservations.
One of the fastest growing areas of the country during the 1990s and early 2000s,
Maricopa County is the state's major center of political and economic activity. MCDPH
is the public health agency of Maricopa County government. Its mission is to protect and
promote the health and well-being of Maricopa County residents and visitors. MCDPH
is organized into offices that are housed in five Divisions: Community Health Action,
Community Transformation, Disease Control, Clinical Services and Administration.
Additionally, the Office of Community Engagement, Office of Performance
Improvement, and Public Health Policy Consultant report independently to the director.
MCDPH provides an extensive array of clinical and community health services. Major
programs include maternal and child health home visiting and community education,
parenting education, childhood immunizations, HIV/AIDS counseling and education,
STD prevention and treatment, oral health, tobacco use prevention, health promotion
and education, WIC and other nutrition and education services, and health care for the
homeless. The department has 600 employees and a current annual budget of
$59.8 million.
MCDPH is actively engaged in building the capacity and infrastructure needed to
sustain long-term community partner relationships in order to build and
strengthen the capacity of the public health system to prevent chronic disease
and promote wellness. The Maricopa County 2012-2017 Community Health
Improvement Plan (CHIP) is a community-wide action plan structured to utilize evidence
based-strategies and policy, systems and environmental approaches to impact health
priorities. Community members identified Diabetes, Access to Care, Cardiovascular
Disease, Lung Cancer and Obesity as top public health priorities. The CHIP addresses
these chronic disease issues in places where people spend significant amounts of time
and includes four sectors: Healthcare, Community, Worksites, and Education. The
CHIP is anchored on the premise that all sectors must work collaboratively to address
health priorities by focusing on interventions that can help manage chronic diseases
and access to care by addressing health risk factors and determinants such as tobacco
use, physical activity, nutrition, and linkages to care in a coordinated and focused way.
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 1

The CHIP Workplan is a dynamic document that captures contributions from both
MCDPH and community partners and will become the strategic blueprint for how public
health and community partners will work collectively in making Maricopa County a
healthier place to live and work. Work is formulated into objectives and classified in the
CHIP Workplan document under appropriate categories and strategies. Each objective
has performance measures and indicators of progress that are collected, updated and
communicated to stakeholders quarterly, both to monitor progress toward identified
goals, and to establish new goals and priorities as necessary.
The Health Improvement Partnership of Mar/cope County (HIPMC) is a collaborative
effort between Maricopa County Department of Public Health and more than 55 public
and private organizations addressing the priority health areas identified in the 2012-
2017 Community Health Improvement Plan. The HIPMC brings together partner
agencies and collaborative groups passionate about promoting health and wellness
within their respective communities and provides stable infrastructure to share ideas
and resources, identify gaps and barriers to existing services and engage in thoughtful
planning to achieve a shared vision. HIPMC meetings and communications provide
forums for information and data sharing, collaborative workgroup initiatives, networking
and shared reporting.
Task forces representing four different sectors of the community—Where We Live
(Community), Where We Learn (Education), Where We Work (Worksites), and Where
We Receive Care (Healthcare)—have been formed to develop plans with emphasis on
utilizing evidence based-strategies and policy, systems, and environmental approaches
to impact health priorities. These taskforces, referred to as "clouds" have been
established within MCDPH to increase collaboration between various health department
programs, work synergistically to address shared concerns, coordinate partnerships and
community outreach and facilitate timely communication in a very large organization.
HRPP/NICP is represented at the Healthcare Cloud on a monthly basis in order to
communicate program needs and provide input regarding program expertise in
this area; most recently HRPP/NICP has increased collaboration with community
hospitals to encourage and facilitate implementation of NICU safe sleep policies in order
to improve support to families through the transition of implementing safe sleep practice
in their home. Another example of program expertise shared is the importance of
medical homes in general, but specifically for the population of children with special
health care needs, promoting a community approach to supporting and implementing
medical homes for this population.
In 2013, MCDPH implemented an online performance management system called the
"MCDPH Dashboard." This custom built database brings operational plans to life, offers
a way to get all staff involved in strategic planning and organizational success as well as
supports community partnerships and collaborative efforts. MCDPH Programs and
certain partner agencies, coalitions or collaborative groups each identify measureable
objectives and activities needed to achieve these objectives. These activities and
objectives are then organized into broader goals and services. Dashboard information
is updated on a monthly basis by program staff and is visible to MCDPH staff across the
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 2

department providing a simple and clear snapshot that displays the organization's
performance at a given point in time. Customized reports on progress of selected
objectives are also shared with community partners and collaborative groups as
appropriate. HRPP/NICP is an active user of this new tool, working to incorporate
evidenced-based practice data into a format that is easily disseminated to the
community — showing the difference NICP makes in the lives of the most
vulnerable within our community.
The MCDPH Dashboard also serves as a partner tracking tool. Collaborating partners
are linked to specific MCDPH program objectives highlighting existing partnerships and
identifying opportunities for coordinating partnerships across public health programs.
Customized reports can also be generated by Dashboard users to identify which
MCDPH programs, community partners and/or collaborative groups are working in a
specific area. (e.g. all objectives impacting obesity, all objectives targeting children age
0-5 or all school-based objectives).
HRPP/NICP is affiliated under the Office of Family Health which is part of the
Community Health Action Division; this division also includes the Offices of Health
Promotion and Education, Oral Health and WIC. The OFH currently provides four
grant-funded, maternal child health home visitation programs that include: Healthy Start,
Nurse-Family Partnership, Lead Hazard Control Program, and the HRPP/NICP
Community Health Nursing program. The OFH has a strong history of contract
performance and experience, including current contracts with federal, state, local and
private grantors with a current annual budget of $3.9 million and 43 staff members.
Each of the OFH programs work under the guiding principle of promoting optimal
health and development by strengthening family resilience through the promotion
of quality services. This guiding principle is based on the following premises:
services are family/client centric, culturally competent, and developmentally appropriate;
in order to obtain positive outcomes for the infant/child, it is critical to provide care and
support for the mother and family as a whole; that a strong, trusting and caring
relationship between the nurse and family is key to successful outcomes; and quality
services begin with establishing a highly trained, competent team of nurses dedicated to
the mission, vision and goals of the program.
Newborn Intensive Care Program (NICP) Community Health Nursing
Since 1988, The Arizona Department of Health Services and MCDPH's Office of Family
Health have partnered together to provide NICP follow-up services. Despite an
increasingly high volume of workload and demand for services, the MCDPH NICP
program consistently strives to provide excellent community health nursing services to
the enrolled population. Each family interaction is a unit of quality service based on the
HRPP/NICP Scope of Work to provide physical, developmental, psychosocial and
environmental assessments of the infant as well as postpartum wellness and
interconception health assessments of the mother. The program successfully utilizes
Office for Children with Special Health Care Needs funds to extend services to other
siblings in the home who exhibit a developmental concern, as well as successfully
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 3

providing follow-up for the Newborn Screening Program, including phlebotomy services
in the home as a last resort for obtaining an additional screening.
In addition to meeting the Scope of Work, this program is visionary in establishing a
foundation for an evidenced-based program including:
• Ensuring MCDPH operational policies and procedures for home visitation
services are based on current evidenced-based and promising practices.
• A competency based education and training program for all staff.
• An established clinical library of tools and materials that support teaching
evidenced-based and promising practice.
• The active development of a documentation system that allows for the input and
collecting of statistical data to support the practices of the community health
nurses at the home visit. This system is expected to be fully implemented in
June 2014.
This program contributes to nursing work force development through its preceptorship
programs with Arizona State University and Grand Canyon University. Nursing
students are provided an opportunity to work with both the NICP Program Manager
and CHNs with an emphasis on the overall importance of home visiting services and
early intervention.
MCDPH provides community based education in health and wellness practices as
requested. For example, in-services on Pertussis and Respiratory Syntitial Virus were
organized through our program and offered to all CHN contracting agencies in
Maricopa County. Training was also done at the Healthy Start Consortium for home
visitors. The experienced staff at MCDPH is committed to promoting the health and
wellness of the community through education in various forums.
2.4.2 Resumes or curriculum vitae for key personnel, as defined in the Special
Terms and Conditions, responsible for delivery of service. Provide resumes for
existing staff that will be part of the project and job descriptions for positions to
be filled. Describe staff accountabilities and expertise. List how much time each
person each person will spend on the project. Resumes shall include name, title,
key responsibilities and previous experiences that are relative to that field.
Include all professional licensure, certifications, experience, educational history,
professional awards and publications; and
Key Personnel. See Attachment for Resumes and Job Descriptions
Tracy Sloat, RN, MN Administrator, Office of Family Health 0.25 FTE In-kind
Mary Anthony, RN, BSN Project Nurse Manager 1.0 FTE In-kind
Elizabeth Harroun, Data Analyst 0.25 FTE In-kind
Alice Brumniett, RN, BSN, CHN Variable, as needed
Jeanne Kayser, RN, BSN, CHN 0.8 FTE
Lacey Kohr, RN, BSN, CHN 1.0 FTE
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 4

Barbara Small, RN, BSN, CHN 1.0 FTE
Jackie Stout, RN, BS, CHN 1.0 FTE
Deanna Reid, Admin and Data Entry 0.6 FTE
Infant Toddler Mental Health Specialist: Job description
Staff Accountability and Expertise
An enduring strength of the MCDPH NICP Program is the highly skilled and
experienced nursing staff; this group of dedicated nurses have over 54 years of
combined experience working as NICP Community Health Nurses, this includes four
nurses who each have 10 or more years working for this program - clearly
demonstrating their commitment to the NICP families.
There are currently 3 full-time CHNs, one 0.8 full-time, 1 full-time project manager who
provides direct supervision for the CHN's and admin staff, in addition to providing home
visits to support productivity as needed. One CHN is cross-trained from the Lead
Hazard Control Program who supports the program as needed and as funds are
available. This CHN also provides Newborn Screening Follow-up visits for
phlebotomy as needed. All staff are direct employees of MCDPH; there are currently
no contracted employees.
Support services for the program include a part-time administrative assistant who
provides support for the daily operations including facilitating referral distribution and
tracking and data entry. The OFH Data Management Analyst, provided in-kind to the
program, is responsible for the database design and on-going management.
The CHNs are Bachelor's prepared and licensed registered nurses by the Arizona
State Board of Nursing; they maintain a current Life Support CPR for Heathcare
Professionals Certification. In addition, each CHN has completed an extensive
competency-based orientation training that meets and exceeds the ADHS CHN Policy
and Procedure manual requirements. All CHNs have completed the BABIES and
ASQ-3 training for developmental assessment.
Two CHNs are International Board Certified Lactation Consultants, providing advanced
breast-feeding support to their own clients and consultation to families of their CHN
peers as needed. Three of the CHNs are bilingual and provide services in both English
and Spanish.
2.4.3 Technical Qualifications: Offerors shall identify a Project Manager who
shall be the primary contact person for the ADHS Program Unit Manager in
discussing work that needs to be completed. Offerors shall provide a detailed
description of the Project Manager's functions and how they will accomplish the
minimum tasks listed herein:
2.4.3.1. The Project Manager and primary contact person for the ADHS Program Unit
Manager is Mary Anthony, RN, BSN. The nurse manager is available by mobile phone
602-350-5119 or by email at marvanthonvmail.maricopa.qov.
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 5

2.4.32. The nurse manager attends meetings with ADHS and other agencies,
participates in community networking, advocacy functions, resource
development and contract coordination. In addition to operational support, the nurse
manager also provides representation and support at various committees and task
forces to promote and improve care for children in Arizona. The project manager
provides support for HRPP/NICP planning and implementing conferences and
educational sessions as requested by the ADHS Program Unit Manager. Currently, the
MCDPH Program Manager provides representation at the statewide Safe to Sleep
Coalition, Smoothe Way Home Task Force and the Adverse Childhood Events Task
Force.
2.4.3.3. The Project Manager is responsible for ensuring that all components
required in the ADHS CHN Policy and Procedure Manual are operationalized in
the program and services. The manager oversees, plans, directs and evaluates the
MCDPH NICP services and daily operations. This includes the development and
implementation of program goals and strategic plans, quality improvement processes,
operational policies and procedures, and maintaining contract compliance. In addition,
the nurse manager supervises and supports all staff in the provision of client services.
This includes the development of staff job descriptions and expectations, hiring, training,
development, monitoring performance and providing ongoing evaluations. Updates to
the ADHS CHN Policy and Procedure Manual are incorporated into MCDPH operational
policies and procedures. All CHNs are provided training on any updates to ADHS policy
and procedures including a plan to operationalize.
2.4.3.4. Contract compliance is to be maintained at all times as a priority; the
nurse manager is responsible for resolving problems related to implementation of
services. Proactively, all MCDPH staff are provided with expectations and training on
customer service and contract compliance upon hire. The nurse manager ensures that
staff are in compliance with the accepted standards of practice and risk management
guidelines and have the education and tools needed to do so. This is done through
ongoing supervision, trainings, staff meetings and other methods of communication and
support.
Building a trusting, caring relationship between the client and nurse is an important
component of promoting positive outcomes. Quality customer service and client
satisfaction is emphasized as a priority with staff, who are trained to use the L.E.A.F
Plus One method for resolving complaints brought by clients. This is an acronym for
Listen, Empathize, Apologize, Fix It (this is defined by the issue) and go above and
beyond when possible. The LEAF method aims to develop and foster positive
relationships so that home visitation services are effective. Should a complaint, concern
or deviation from accepted practice occur, the nurse manager and associated staff
member develop an action plan to address the issue and implement process
improvements towards resolution.
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 6

2.4.3.5. The alternate contact is Tracy Sloat, RN, MN, OFH Administrator. Tracy has
previous experience working as the MCDPH NICP Project Manager and is well versed
in the operations and management of the program. Tracy Sloat can be contacted at
mobile 602-506- 0610 or by email at tracysloatmail.maricopa.dov.
2.4.3.6. The nurse manager with support from the OFH Administrator is
responsible to ensure that all duties and responsibilities under the Contract are
fulfilled. MCDPH administration and the nurse manager have maintained open
communication channels with ADHS regarding historic and current systematic
difficulties in meeting program requirements as written in the Policy and Procedures.
For example, the number of new referrals received each month, per FTE, exceeds the
number each nurse can possibly provide services to at the rate of four visits per year.
All requested information for the ADHS Program Manager is completed by the nurse
manager, including the monthly contractor's expenditure report and data for statistical
reports. Reports are available in both electronic and paper format.
2.4.4 Provide three (3) references including past similar contracts that support
your company's abilities to provide the proposed services. Use the format on
Attachment B to include the Contract Title, a description of the services
performed, Contract Term/Dates of Work, Reference Company, the Telephone
Number, the Contact Person related to the referenced Contract, and the Address.
ADHS personnel shall not be provided as a reference. Attachment B.
Maricopa County Department of Public Health, Experience and Expertise, ADHS14-00003830 Page 7

Division for Planning and Operations
Office of Procurement
1740 West Adams Street, Room 303 JANICE K. BREWER, GOVERNOR
Phoenix, Arizona 85007-2670 WILL. HUMBLE, DIRECTOR
(602) 542-1040
(602) 542-1741 Fax
June 5, 2014
Maricopa County Department of Public Health
Attn: Ms, Toby Urvater
4041 N. Central Avenue, Suite 700
Phoenix, AZ 85012
RE: RFP No. ADHS14-00003830, HRPP/N1CP Community Health Nursing Services
Dear Ms, Urvater,
Pursuant to Arizona Procurement Rules, A. R. S. 41-2534, Competitive Sealed Proposals, R2-7-C315,
Final Proposal Revision, the Arizona Department of Health Services (ADHS) hereby requests additional
information for the referenced Request for Proposal (RFP) from your firm. This represents an
opportunity to amend your proposal. ADHS is not asking for a new proposal in its entirety.
The Proposal submitted by Maricopa County Department of Public Health (MCDPH) has been
evaluated and MCDPH has an opportunity to improve its offers by providing as much detail as possible
in the areas listed below:
1. Method of Approach (Methodology):
• Provide detail how "In addition, at the initial visit, the infant's Adverse Childhood
Event (ACE) score is assessed and documented by the CHN" will be executed.
▪ MCDPH shall provide projected number of clients able to serve.
• Demonstrate how MCDPH will provide four (4) visits and/or prioritize the visits for the
infant according to the Scope of Work Section 31,9 of the RFP.
2. Cost/Pricing:
• Provide MCDPH's best and final pricing in ProeureAZ using the Items Tab,
• Provide an attachment for the projected number of visits for each of the line items,
MCDPH's response to this request supersedes any previous information, If MCDPH does not submit a
written notice of withdrawal Or a written final proposal revision by the date and time stated below,
MCDPH's immediate previous written proposal will be accepted as its final proposal revision.
Your Final Proposal Revision must be received in ProcureAZ, no later than 3:00 P.M. on Monday. June
1
Health and Wellness for all Arizonans

9, 2014. Log into ProcureAZ and re-open your Quote to provide additional information or edit,.
If you have any questions, please contact me at (602) 542-1011e
Tracey Thonati
Senior Procurement SiTidalist
2
Health and Wellness lot all Arizonans

Line Item Attachment for Projected Visits
Number of Visits Cost/Visit Yearly Total
Regular 2075 $ 205.00 $ 425,375.00
Out of Town 30 $ 215.00 $ 6,450.00
Out of County 0 $ 215.00
Interim 120 $ 170,00 $ 20,400.00
shadow 25 $ 100.00 2,500,00
Family 15 $ 205.00 $ 3,075.00
Staffing 35 $ 170.00 $ 5,950.00
Visit Subtotal* 2300
Training - local 12 $ 205.00 2,460.00
Training - non local 2 $ 205.00 $ 410.00
NBS 1 $ 205.00 $ 205,00
LRL 100 $ 20.00 $ 2,000.00
468,825,00
*See note on Narrative Clarification

MCDPH Clarifications RE: RFP No. ADHS14-00003830, HRPP/NICP Community Health Nursing Services
• Method of Approach
• Documentation of the ACE score: Assessing ACE scores and then determining how to
use the information is a relatively new concept within our field of practice; therefore,
we approach the use of ACE scoring cautiously, but feel there is sufficient evidence to
support the integration into our practice. At this time, on the initial visit the CNN
determines the infant's ACE score based on what the family discloses during the visit
(social/emotional assessment) and the family history received from the hospital report.
This is then documented in the nursing assessment and entered into our database. At
this time, we plan to track ACE scores by zip code to help identify one component of
case load acuity when distributing referrals amongst staff.
• Projected Number of Clients able to serve: Based on level funding, MCDPH is able to
provide 4.3 CNN FTE's (3.8 funded from ADHS, 0.5 in-kind from MCDPH Supervisor
support) for 2,500 visits per year. Based on 2013 numbers, we received 1,174 new
referrals of which 910 (83%) agreed to and received at least an initial visit. So, with level
funding and based on our current zip code allocation, we can serve 1,200 new clients
per year and will prioritize follow-up visits according to the policy and procedure.
• Provide 4 visits and /or prioritize the visits for the infant according to the Scope of
Work Section 3.1.9: While ideally all families will receive 4 visits/year, the current
number of new referrals per CNN FTE does not allow for this. The inability to cap the
number of new referrals per nurse (ie: maintaining a maximum case load number) does
not allow us to manage the intensity of their services (ie: all families receive 4
visits/year) such as with other home visits programs. Therefore, we must prioritize
based on risk level and the family's desire for visits. Prioritizing visits for follow-up is
based on the infants identified risk factor as determined by utilizing the Medical Risk
Criteria Form as written in Chapter 4.4 of the ADHS CNN Policy and Procedure; each
referral is assessed for risk level according to the information provided in the hospital
discharge summary. At the initial home visit, the CNN will conduct a complete
assessment of the child and complete the Community Nursing Neonatal and Pediatric
Assessment Form. Infants with major risk factors from the Medical Risk Criteria Form
will remain high risk. Infants with two (or more) areas of concern in two (or more
categories) from the CHN Assessment form will also be considered high risk. Infants
with one area of concern in two categories on the CHN Assessment Form will be
considered Moderate Risk; infants with one area of concern from one category will be
considered low risk. The nurse will schedule follow-up visits with the family at
incremental levels, with the goal of providing at least four visits/year for high and
moderate risk infants and at least two visits (initial and 1 follow-up at 4 or 6 months) for
the low risk infant so that at least one developmental screening is done. Subsequent
visits may be scheduled until both the nurse and family feel they are no longer needed.

In addition to this system, MCDPH families are instructed at each visit that they have the
ability to contact their CHN at any time they have a health or developmental concern.
2. Cost/Pricing: See Fee Scale Tab and Attachment: The proposed fee schedule is created
based on the ability to bill down our yearly contract award with the 3.8 FTE )s that are
directly funding through this grant, which is approximately 2,300 visits. MCDPH is providing
0.5 FTE in kind that will assist in billing down the contract in a more expedient manner and
which also allows us to increase our total number of visits to the goal of 2,500. This fee
scale is designed to ensure we can cover the cost of this program. Even if the total contract
award is billed down before the end of the FY, we do not stop services; we continue to see
clients and do not expect reimbursement if there is none.

Division for Planning and Operations
Office of Procurement
1740 West Adams Street, Room 303 JANICE K. BREWER, GOVERNOR
Phoenix, Arizona 55007-2670 WILL HUMBLE, DIRECTOR
(602) 542-1040
(602) 542-1741 Fax
June 3, 2014
Maricopa County Department of Public Health
Attn: Ms, Toby Urvater
4041 N. Central Avenue, Suite 700
Phoenix, AZ 85012
RE: RFP No. ADHS14-00003830, HRPP/NICP Community Health Nursing Services
Dear Ms. Urvater:
Pursuant to R2-7-C314, Section B, the Arizona Department of Health Services (ADHS) hereby requests
negotiations for the referenced Request for Proposal (RFP) from Maricopa County Department of Public
Health.
The proposal is being evaluated and negotiations are required, A conference call is scheduled for
Wednesday, June 4, 2014, at 9:00 a.m. local Arizona Time, to discuss the points listed below.. This
letter is being provided as a tool to allow you to prepare for this can. This conference will be limited
only to the items listed.
A.. Method and Approach
1. Demonstrate how "In addition, at the initial visit, the infant's Adverse Childhood Event
(ACE) score is assessed and documented by the CT-IN" will be executed.
2. Offeror shall provide projected number of clients able to serve.
3„ Demonstrate how Offeror will provide four (4) visits and/or prioritize the visits for the
infant according to the Scope of Work Section 3.1.9 of the REP
B.. Cost:
1. Best and Final Offer
ProcureAZ Pricing
If you have any questions, please contact me at (602) 542-1011.
Sr. Procurement Specialist
Health and 'Wellness for all Atizonarks

ProcureAZ Page 1 of 2
Seller Setter Administrator
MOP Code Browse I My Account I Customer Service I About June 4, 2014 9:5443 AM MST p 0 #
Home POs Bids I Contracts Quotes Frances Delgado
Quote 000027020 - Maricopa County Public Health
General items Questions Subcontractors Notes Terms & Conditions Attachments(12) Summary to Bid Back
General Notes
Sort by Column: I Print Sequence,w r: Sort Descending N
Item Print Questions Description
* Sequence Exist
Quantity UOM Unit Discount Tax Freight Extended No No
Cost Rate Amount Bid Charge
1 1.0 No Regular Home Visit
1.0 Vat $205.00 0.0% $0.00 $205.00
Alternate
Description:
2 2.0 No Out of Town Home Visits (All class of visit) Thirty (30) or more miles from start point of
home/office
1.0 Vst $226.00 0.0% $0.00 $225.00 FE Ei
Alternate
Description:
3 3.0 No Out of County Home Visits (All class of visits)
1.0 Vst $225.00 0.0% $0.00 $225.00
Alternate
Description:
4.0 No interim Local Home Visits
1.0 Vst $170.00 0,0% $0.00 $170.00 in
Alternate
Description:
5 5,0 No Shadowing Local Home Visits
1.0 Vat $100.00 0,0% $0,00 $100.00 in
Alternate
Description;
8.0 No Family Local Home Visits
1.0 Vet $205.00 0,0% $0.00 $205,00
Alternate
Description:
hftps://proeure.az.gov/bso/quotes/vendor/vquotelternGeneral.sdo?quoteId=000027020 6/4/2014

ProcureAZ Page 2 of 2
7 7.0 No Multi-DiscIplinary Staffing Local Horne Visits
1.0 Vat $170.00 0.0% $0.00 $170,00 ra
• Alternate
Description:
8 8.0 No NICP /Other Sponsored Training - Local Per Person / Per Day
1.0 DAY $410.00 0.0% $0.00 $410.00
• Alternate
Description:
9 9.0 No NICP / Other Sponsored Training - Non-Locai . Per Person / Per Day
1.0 DAY $450.00 0.0% $0.00 $460.00
Alternate
Description:
10.0 No Newborn Screening Follow-up Visit
1,0 Val $226,00 0.0% $0.00 $225,00
Alternate
Description:
No Low Risk Letter - Price Wieder
1.0 EA $20,00 0.0% $0.00 $20.00 IN FA
Alternate
Description:
Quote Response Total $2406.00
Discount only quotes Indicate discount airiount off of list catalog prical
Copyright 2014 Periscope Holdings, Inc. - All Rights Reserved. instance-3
https://procure ,az.gov/bso/quotes/vendor/vquoteiteraGeneraLsdo?quoteId=000027020 6/4/2014