GRANT RENWL AMD RE ORAL HEALTH PNPS WITH FTF.PDF

4000 North Central Avenue, Suite 800
Phoenix, Arizona 85012
Phone: 602-771-5100
Fax: 602-274-7040
www.azftf.gov
Chair
Steven W. Lynn DATE: June 11, 2014
Vice Chair TO: Maricopa County Department of Public Health
Dr. Pamela Powell
ATTENTION: Kirsten Roling
Members KirstenRoling@mail.maricopa.gov
Nadine Mathis Basha
Gayle Burns FROM: Renae Rosales
Janice Decker
Hon. Cecil Patterson RE: Grant Renewal Information
Vivian Saunders
Ruth Solomon
________________________________________________________
Ex-Officio Members
Congratulations on the renewal of your grant from the Phoenix North,Phoenix South
Clarence H. Carter Regional Partnership Council. The award period for your grant, GRA-RC013-14-0627-01-
Director DES Y2, is July 1, 2014 through June 30, 2015.
Will Humble Follow Up Action Necessary
Director ADHS Please print two copies of the attached Grant Renewal Amendment form, obtain original
signatures by your designated signatory, and mail both originals back to my attention.
First Things First will countersign and return one original for your records.
John Huppenthal
Superintendent ADE For your FY15 grant, the reimbursement requests, data and narrative reports, and
general grant management documentation will continue to be submitted through the
Chief Executive Officer Partner and Grant Management System (PGMS). Please reference the Grantee Resources
Sam Leyvas Folder in PGMS for the most current versions of the budget modification request and
staff change notification forms.
Your current grant ends June 30, 2014 and the current terms require final data and
narrative reports be submitted on or before July 21, 2014 and your final request for
reimbursement must be submitted no later than August 15, 2014 (45 days from the
grant end date.) Unexpended funds from 2014 do not carry over to the 2015 fiscal year.
If you have any questions, please contact either of us, Renae Rosales, rrosales@azftf.gov,
or Kathy Rice, krice@azftf.gov, 602-771-5096. We look forward to working with you
again this year.

Early Childhood Health and
Grant Renewal Amendment Development Board (First
Things First)
Page
2015 Grant Award 4000 North Central
1 Avenue, Suite 800
GRA-RC013-14-0627-01-Y2
of Phoenix, Arizona 85012
Phoenix North,Phoenix South
Oral Health 1 (602) 771-5000
(602) 265-0009 fax
CONTRACTOR:
Maricopa County Department of Public Health
4041 N. Central Ave., Ste. 1400
Phoenix, Arizona 85012
PURPOSE OF AMENDMENT:
1. Pursuant to Special Terms and Conditions, “Contract Renewal”, of the above referenced Grant
Agreement/Contract Award, the State of Arizona hereby exercises its sole option to renew the Grant
Agreement/Contract Award number referenced above. The renewal start date is July 1, 2014 and end
date is June 30, 2015.
2. Total award amount for the contract period is $400,000.00
3. The Grantee is responsible for all updated Standards of Practice located for reference in the First
Things First Grant Management System known as PGMS under Grantee Resources.
4. All other terms and conditions remain unchanged.
Contractor hereby acknowledges receipt and understanding The above referenced amendment is hereby executed
of the contract amendment. effective July 1, 2014 once signed and dated below:
Signature _______________________________________________
Josh Allen
Name CFO/COO
Title _______________________________________________
Date
Date

Attachment A
Program Implementation Questions
1. Provide a brief narrative description of your current approved program and your plan for
continuation in SFY15, including context for the activities listed in the Program
Implementation Plan. (Attachment B)
First Teeth First is currently provides oral screenings, fluoride varnish and education to
children through the age of five years old at Maricopa County Women, Infant and
Children (WIC) clinics, Maricopa County immunization clinic, childcare centers and
preschools throughout the Central Phoenix Region. The program provides a basic oral
screening to the child and provides one on one education to parents at the time of
service. Children are given a toothbrush kit once services are completed to promote
healthy brushing habits in the future. The parent is encouraged to return with the child
to our site every 6 months to obtain services and continue to promote healthy habits.
First Teeth First also provides basic oral screenings and education to pregnant women at
our permanent location sites. Education is provided to pregnant women on the
importance of their oral health during the pregnancy and informed on the value of
maintaining regular dental visits during their pregnancy for the outcome of a healthy
baby. Referrals are made to low cost/reduced fee clinics when an urgent dental need is
determined by our registered dental hygienist for a child or pregnant woman we have
screened.
2. If applicable, explain any proposed modifications for SFY15, including the change(s) to be
made, how they were determined to be necessary, and how they will contribute to the
success of your program. Please note that program modifications cannot deviate from the
original scope of work or applicable standards of practice.
In the interest of program sustainability and improvement, we are changing the staffing model
for contract staff. First Teeth First will be transitioning from independent contract staff and
hiring individuals as Maricopa County temporary status employees.
3. Describe how the program data will be utilized to improve program implementation. Include
assurances that data collection and submission will be timely and ongoing.
A relational database management system (RDBMS) is utilized by sites to identify if a child has
been screened in our program within the last 6 months. Our site assistants input data on a daily
basis to provide a real-time date record of service. Our program utilizes childcare and preschool
location data to continue administration of oral health screenings and fluoride varnish services
at locations in the Central Phoenix region. The database allows our program access to real-time
numbers that we report to First Things First on a quarterly basis.

2
treatment treatment treatment
Documentation
forms, Database forms, Database forms, Database
Support Consent records, Consent records, Consent records,
Be
Task Will Completed/Time] i e
Date Ongoing Ongoing Ongoing
Plan and and
Responsible Coordinator, Coordinator,
Implementation 2015 personnel assistants personnel assistants. Educator/Outreach
Person Program dental site Program dental site Health Specialist
Program to the our on one while screened in the one while
staff to never have oral and through one services. and to services on services. child's
Task WIC services have that received parents WIC staff have varnished one parents parent events
the the and screenings varnish Provide to receiving the continued we Continue to receiving one during
with provide clients that received previously fluoride program. education is with Immunization provide children fluoride education is Sites -One on education services. -Community
Work health child Work to and past. child WIC
fluoride in WIC Immunization education clinics, and
B Activities health and children the health WIC locations
Attachment oral to and oral at
Provide screenings varnish clinics clinic, Provide parents community events.
to

3
treatment treatment treatment subcontractor
forms, Database forms, Database forms, Database from monthly
Consent records, Consent records, Consent records, Report received Database Database
Year to Things
Ongoing Ongoing Ongoing School Quarterly First First Ongoing
Coordinator Assistant Program Program hygienists), coordinator Coordinator Coordinator, assistant coordinator, assistant
Health Educator/Outreach Specialist Program Program Health Educator/Outreach Specialist Coordinator Assistant Subcontractors (dental Program Subcontractor, Program Program program Program program
Things with and every women
with First Childcare region. centers provide location pregnant and sites. to analysis and of clinic
contact/visit/schedule First in the childcare to at the screenings at Services input and analysis
Collaborate First to Quality Centers Track preschools services six months WIC Sites -Provide oral education Provide community Data Data interpretation findings
fluoride in and region, to location'
Oral health and children Centers in the Phoenix education the women oral and education Reporting
to Care in
Provide screenings varnish Child preschools Central providing children Pregnant screenings Program

Attachment C
Line item Budget
Budget period: July 1, 2014 —June 30,2015
qudget,Categor Line Item DescriP ion .!*IPIMeted finds Iota' cct,
PERSONNEL ER VICES Persorinel Services Sub Total $23C906
Salaries Program Coordinator .25 Fit $10,205
Accounting Specialist .25 FTE $8,154
Outreach Specialist 2 FTE $71,702
Registered Dental Hygienists —3,432 $92,664
hours
Site Assistants— 3,432 hours $51,480
3% Salaries Increase Permanent
Personnel $2,702
EMPLOYEE RELATED EXPENSES::- . Employee Related Expenses Sub Total
Fringe Benefits or Other ERE Fixed Benefits $8,904 for 2.5 FTE I $22,260
Variable Benefits 19.26% Permanent
Personnel $17,866
Variable Benefits 19.26% Temporary
Personnel $27,762
PROFESSIONAt:Apip:OUTSIOE:SERWEES :;!:,: Professional & Outside Services Sub
Total
Con 1rvLrd Services Consulting Dentist $2,500
Dentist/Dental Professional S15.600
Travel Sub Total
In-State Travel Mileage: $935
Out of State Travel -Program Coordinator $2,670
- 2 Outreach Specialist $3,605
$400
Airfare-1 FTE $600 $1,740
Hotel $240
Per diem $100
Home & conference airport shuttles $400
Conference Registration
:41P:TO . OROOlitAtIONS OR votviwo Aid to Organizations or individuals Sub Tote
Subgrants or Subcontracts to N/A N/A I N/A
organizations/agencies/entities
OTHER OPERATING EXPENSES Other operating Expenses Sub Total. $35,397
• Telephones/Communications Services Monthly charges for 2 smart phones I- $2,400
$100/month for 12 months
• General Office Supplies $100/month for 12 months $1,200
• Rent/Occupancy 7 WIC clinic days/weeks $20/day $7,280
12 months.
• Printing/Copying $100/month for 12 months $1,200
• Professional Development/Staff Training 2 people @ $250 $500
Ssao
• Conference Workshops/ Training Fees for WR Dental Conference
Staff 3@$140 +1 @$300
• Program Supplies $2.00/bag (toothbrushes, stickers, ed $9,798
materials) for approx. 4,899 kids
$2.00/visit (fluoride varnish, gloves, $9,798
etc.) for 4,899 children
4

Toothbrushes for pregnant woman $1,575
1,050 x $1.50
brochures, pamphlets, cups for kids, $1,066
misc. incentives
Authorized signature Date
5

Attachment C (Continued)
Budget Narrative
Personnel Services-Permanent:
The Program Coordinator will be responsible for managing all aspects of the contractors (dental
hygienists, and site assistants), recruiting, hiring, and scheduling. In addition, the Program Coordinator
will be responsible for oversight of all ordering and assist the Outreach Specialist with program
oversight. This position will supervise the Administrative Assistant (funded in other FTF oral health
programs). The 12-month salary @ $19.55 per hour for this position is $10,205.
The Accounting Specialist is responsible for tracking the budget, submitting reimbursement requests
and other financial related activities. At $15.62 per hour, the 12-month salary for this .25 FTE position is
$8,154.
The Outreach Specialist/Health Educator will promote the program in the communities and identify
partners drawing large numbers of families, children five years of age and under, and pregnant women
where preventive oral health services will be offered. The 12-month salary @ $17.17 per hour for two
specialists in this position is $71,702.
Personnel Services- Temporary:
Registered Dental Hygienists (RDHs)
Dental hygienists are hired by Maricopa County as temporary personnel to provide one on one
education, standardized oral screenings, and fluoride varnish applications.
Dental hygienists in the Central Regions are estimated to spend a total 3,432 hours; at an estimated
$27/hour the total is $92,664 for the twelve-month period.
Site Assistants
Site assistants are hired by Maricopa County as temporary personnel to provide translation for dental
hygienists who are not bilingual, and to assist the dental hygienist on-site with patient flow, forms, and
data entry. They are scheduled at the same time as the dental hygienists, for the same number of
hours/days described above for the dental hygienists (the difference being the site assistant's salary, at
an estimated $15/hour). Sites assistants in the Central Regions are estimated to spend a total 3,432
hours; at an estimated $15/hour the total is $51,480 for the twelve-month period.
Employee Related Expenses:
Fringe Benefits for permanent personnel are calculated at $8,904 per FTE (2.5 FTE) for a total of
$22,260 (fixed rate) for medical and dental coverage. Variable benefits are calculated at 19.26% of
salaries for Medicare, social security, unemployment, workers' compensation, long term disability, life
insurance, and the Arizona State Retirement System. Total variable benefit cost is $17,866 for twelve
months. The total cost of fixed and variable benefits is $40,126.
6

Fringe Benefits for temporary personnel only include the variable benefits and are calculated at 19.26%
of salaries for Medicare, social security, unemployment, workers' compensation, long term disability, life
insurance, and the Arizona State Retirement System. Total variable benefit cost for temporary personnel
is $27,762 for twelve months.
Professional and Outside Services:
Contracted Services
Consulting Dentist
A Dentist will be contracted to provide standing orders and clinical consultations across the Central
Region at sites this expense totals $2,500 for twelve months.
Dentist/Dental Professional
A Dentist/Dental Professional will be contracted to provide outreach to other dentists to increase
awareness of the necessity to provide services to young children and ultimately increase access to
pediatric providers across the Central Region at sites. The dentist/Dental Professional will spend 4 hours
a week at $75/hr. for 52 weeks with the Central clinics this expense totals $15,600 for twelve months.
Travel:
In-State Travel
Travel is necessary between sites for training, events, program monitoring, and meeting attendance
(e.g., First Things First State and Regional meetings). Travel for the twelve-month period for the program
coordinator and two outreach specialists are estimated at 8,100 miles. At $.445/mile, mileage for in-
state travel totals $3,605.
Out-of-state Travel
Attendance for one staff person to attend the annual National Oral Health Conference is estimated to
cost $400 in registration fees, $400 in airfare, $600 for a conference hotel ($150/night x 4 nights), $240
per diem ($60/day x 4 days), and $100 in airport shuttles ($50 RT in Phoenix for 1 person and $50 RI in
the host city), for an estimated total of $1,740. Depending on the location all costs will stay with the
federally allotted guidelines.
Aid to Organizations or Individuals: N/A
Other Operating Expenses:
Telephone communications services
Monthly charges for two smart phones is $200 ($100 each), or $2,400 for the twelve-month period.
General Office Supplies
7

Office supplies are estimated at $100 per month, for twelve months for all three regions, totaling
$1,200.
Rent/occupancy
Space in two WIC Centers will cost $20 per day, for a total of 7 clinic days per week, for 52 weeks per
year up to $7,280.
Printing/Copying
Printing and copying of forms is estimated at $100 per month, for twelve months totaling $1,200.
Professional Development/Staff Training
Staff training for 2 staff is estimated at $250 each, for a total of $500 for the twelve-month period.
Conference Workshops/ Training Fees for Staff
The annual Western Regional Dental Conference registration will cost a total of approximately $580 for
three people (the program coordinator and two outreach specialists).
Program Supplies-gift dental bags
The gift bags (e.g., toothbrush, stickers, toothpaste, etc.) are estimated at $2 per bag. It is estimated
that we will need approximately 4,899 bags or $9,798 for the twelve-month period.
Program Supplies-clinical
Each visit requires approximately $2 in clinical supplies (fluoride varnish, gloves, gauze, etc.) 4,899 visits
total $9,798 in clinical supplies for the twelve-month period.
Program supplies-toothbrushes for pregnant women
We expect to use approximately 1,050 adult toothbrushes across all sites. At $1.50 each, this totals
$1,575 for the twelve-month period.
Program supplies-educational materials
Pamphlets/brochures will include; the First Teeth First program brochures, brochures for pregnant
women, kids zero to two years and age two to five years. Incentives such as, toothbrush kits, infant
toothbrushes, floss, toothpaste, other educational materials for a total of $1,066.
Non-Capital Equipment:
N/A
Administrative/Indirect Costs:
The indirect rate is calculated based on actual costs from a prior fiscal year, and is updated annually.
The indirect amount is determined monthly by applying the percentage rated to actual expenditures
8

for the prior month. The current federally approved indirect rate is 15%. Indirect costs @ 10% of the
agreement expenses will be $36,364.
El Option B - Federally Approved Indirect Costs: If your organization has a federally approved
indirect cost rate agreement in place, grantees may include an allocation for indirect costs for up
to 10% of the direct costs. Applicants must provide a copy of their federally approved indirect
cost rate aareement(Attachment G)
Authorized signature Date Li /3hq
9

Attachment D
Key Personnel
STAFF MEMBER BAcgoft.oti:NO.;AND p.cpERTI$g OF PERSONNEL
Name: Kimberly Richards The Program Coordinator has daily oversight of overall program implementation,
Title: Program Coordinator management and reporting. This position completes reports, tracks performance
FTE on this project: .25 FTE measures, and supervises the program staff. A resume has been previously
submitted.
Name: Camelia Williams The Accounting Specialist is responsible for tracking the budget, submitting
Title: Accounting Specialist reimbursement requests and other financial related activities. A resume has
FTE on this project: .25 FTE previously been submitted.
Name: Tirsia Lopez The Outreach Specialist/Health Educator will promote the program in the
Title: Outreach Specialist communities and identify partners drawing large numbers of families, children five
FTE on this project: 1.0 FTE years of age and under, and pregnant women where preventive oral health
services will be offered. A resume has been previously submitted.
Name: Anwar Jamal Robinson The Outreach Specialist/Health Educator will promote the program in the
Title: Outreach Specialist communities and identify partners drawing large numbers of families, children five
FTE on this project: 1.0 FTE years of age and under, and pregnant women where preventive oral health
services will be offered. A resume has been previously submitted.
Name:
Title:
FTE on this project:
Name:
Title:
FTE on this project:
*In addition, please attach a resume (for current personnel) or a job description (for positions to be
hired) for the key personnel involved in the project and listed above. If awarded and there is a change
in staff or a vacant position filled, a Staff Change Notification form and resume must be uploaded via
the Communication Log in PGMS within 14 days of hire.
KEY PERSONNEL INCLUDE ANYONE WHO WILL BE PAID FROM THE GRANT
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Attachment E
DISCLOSURE OF OTHER FUNDING SOURCES
Please list all other funding that your organization currently receives from State or Public Agencies,
Federal Agencies, Non-Profit Organizations, or any other source providing funding for the funded
program*. Statute ARS 8-1183 provides for a prohibition on supplanting of state funds by First Things
First expenditures, meaning that no First Things First monies expended are to be used to take the place
of any existing state or federal funding for early childhood development and health programs.
Use a continuation sheet if necessary. The following form may be reproduced with word processing
software or another form may be created that contains all the information requested.
Type of Funding If used for
Received From Amount match on
(Federal, State, local, other)
this grant
N/A
TOTAL: 0.00
*Should include only those funds that will support the program detailed the awarded First Things First grant award
11

Attachment F
First Things First Standard Agency Information Collection Form
A. Agency Information:
Program Name (if applicable) Maricopa County Department of Public Health
Agency Maricopa County through its Department of Public Health Contact Person Emily Lehr
Address 1645 E. Roosevelt Position Office of Oral Health Supervisor
Address Email EmilyLehr@mail.maricopa.gov
City, State, Zip Phoenix, Az 85006 Phone (6021506-6890 Ext
County Maricopa Fax (602) 506-3081
Employer Identification Number: 86-6000472
Agency Classification: State Agency X County Government Local Government Schools
Tribal Faith Based Non Profit Private Organization Other
Have you previously conducted business with First Things First using this EIN? X
If not, please go to htto://www.qao.az.clov/Vendor/account setup home.aso,
download the State of Arizona Substitute W-9 Form, and submit with your application
Congressional district (federal) in which agency provides most services: District # 4
Legislative district (state) in which agency provides most services: District # 15
Go to http://www.azredistrictino.orq and click on Final Maps to identify your
Congressional and legislative district
Approximate federal funding (from a federal source) to be received in current fiscal year? $ 28.696,233
Agency's fiscal year-end date: June 30, 2014
Agency's accounting method: Cash X Accrual
Does your organization undergo an annual independent audit in accordance with OMB Circular A-133? _X . V
Contact information for firm conducting agency audit:
Audit firm: State of Arizona, Office of the Auditor General
Address: 2910 N 44th Street, Suite 410, Phoenix, AZ 85018
Phone: 602-553-0333
B. Proposed Program Information/Description:
Amount requested: $400,000
Service area of proposed program: Central Phoenix First Things First Region-Oral Health
12

Target population of proposed program: Pregnant women, Children birth through fives years of age and their parents
Lead Strategy — Oral Health
Provide a contracted number for the following service unit for FY 15: Pregnant women, Children birth through fives years of age
and their parents
Number of children receiving oral health screenings: 5020
Number of fluoride varnishes applied: 4800
Number of participating adults: 40 (group setting) 3500 (one on one setting)
Number of participating professionals: 15
Number of prenatal women receiving oral health screenings: 220
Important Items to NOTE:
(E. If you are providing a different contracted service number than what was contracted for in FY 14, provide a
brief description explaining the change.
• If you are not providing services for a particular service unit within a strategy with more than one service unit,
please indicate "NA."
• A complete listing of First Things First Target Service Unit descriptions can be found in PGMS under the
Grantee Resources folder.
Please provide a brief description (250 words or less) of the proposed program. This description will be used by First Things
First for all public information regarding the grant.
First Teeth First will provide oral health screenings, fluoride varnish and education to children through
the age of five years at Maricopa County Women, Infant and Children (WIC) clinics, childcare centers and
preschools in the Central Phoenix region. This program provides a basic oral health screening to the
child and provides one on one education to parents at the time of service. Children receive a toothbrush
kit once services are completed to promote healthy brushing habits to the child. The parent is
encouraged to bring the child back to the site every six months to receive services again and continue to
promote healthy habits. In addition, we will provide basic oral screenings and education to pregnant
women.
Contact Information:
For each contract in the Partner and Grants Management System (PGMS), there are four contact slots available
that provide a varying degree of access. The four slots are the Main Contact (all access), the Program Contact
(access to narrative and data reports), the Evaluation Contact (access to only data reports) and the Finance
Contact (budget and reimbursements.) The same person may be assigned to more than one slot.
Main Contact: This person has overall responsibility for ensuring the program is successfully implemented and will
have access to all financial, programmatic, and data reports in PGMS,
Main Contact: Emily Lehr, R.D.H.
Position: Office of Oral Health Supervisor
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Address: 1645 E. Roosevelt
City, State, Zip: Phoenix, AZ 85006
Email: Emilylehr@mail.mancopa.gov
Phone: (602) 506-6890 Ext. Fax: (602) 506-3081
Program Contact: This person has responsibility for the regular program operations. They will be able to access
program narrative and data reports in PGMS.
Program Contact: Kimberly Richards
Position: First Teeth First Program Coordinator
Address: 1645 E. Roosevelt, 2rd Floor
City, State, Zip: Phoenix, AZ 85006
Email: KimberlyRichards@mall.maricopa.gov
Phone: (602) 372-4650 Ext. Fax: (602) 506-3081
Financial Contact: This person has the responsibility for financial accounting and reporting including submitting
reimbursement request through PGMS. They will be able to access financial information in PGMS.
Financial Contact: Camelia Williams
Position: Accounting Specialist
Address: 4014 N Central Ave, Suite 700
City, State, Zip: Phoenix, AZ 85012
Email: CamellaW1 lams@mail.maricopa.gov
Phone: 602-372-8405 Ext. Fax: 602-506-6896
Evaluation Contact: This contact person has responsibility for the program's evaluation and data collection
activities. They will be able to access the data reports in PGMS.
Evaluation Contact: Kimberly Richards
Position: First Teeth First Program Coordinator
Address: 1645 E Roosevelt, f d Floor
City, State, Zip: Phoenix, AZ 85006
Email: KimberlyRichards@mail.maricopa.gov
Phone: (602) 372-4650 Ext. Fax: (602) 506-3081
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PGMS Training
If any of the contacts are new or in need of technical assistance with PGMS, please indicate the type of training
and which contact:
X Accessing/Navigating PGMS Contact(s): Emily Lehr
O Narrative/Data Report Entry Contact(s):
O Reimbursements/Budget Modifications Contact(s):
O Other: Contact(s):
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