AMD GRANT AGRMT RE HOME VISITATION NFP 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: Tracy Sloat
Members tracysloat@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 South Regional
Clarence H. Carter Partnership Council. The award period for your grant, FTF-RC014-13-0371-02-Y3, is July
Director DES 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
Sam Leyvas Resources 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
FTF-RC014-13-0371-02-Y3
of Phoenix, Arizona 85012
Phoenix South
Home Visitation 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 $579,599.00
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)
Maricopa County Department of Public Health (MCDPH) proposes to continue implementation
of Nurse-Family Partnership (NFP) with fidelity to the model in the following South Phoenix
Region zip codes: 85009, 85031, 85033, 85035, 85037, 85040, 85041, 85042, and 85339.
Capacity and support for the NFP program is greatly enhanced by being housed in Maricopa
County Department of Public Health. The Office of Family Health (OFH) administration has
played a critical role in the success of the program by facilitating an organizational environment
that supports NFP implementation within the agency. MCDPH OFH embraces the program
theories of human ecology, self-efficacy and attachment as well as the mission of this evidence-
based program, and demonstrates this by promoting the benefits of the program to the wider
community. The OFH Nurse Manager, Tracy Sloat as well as the Community Health Action
Administrator, Toby Urvater have attended NFP NSO Administrator Orientation provided in
Denver, demonstrating a true commitment to the NFP model.
Outreach and recruitment of eligible women to the program is primarily implemented by the
Community Outreach Specialist. The Community Outreach Specialist participates in numerous
community coalitions working to build and sustain a network of community service providers
who identify eligible women and refer into the NFP program early in pregnancy. MCDPH
participates in the South Phoenix home visiting alliance, Parents, Partners Plus, Healthy
Mother's Healthy Babies, Isaac Coalition meeting, Healthy Start coalition as well as other
maternal- child work groups in the community. The outreach specialist visits WIC clinics
regularly, the MIHS Women's clinic, and partners with South Phoenix Healthy Start to teach the
Phoenix Union High School Pregnant & Parenting class. To ensure comprehensive, responsive,
and timely services for women and their children, MCDPH NIP will continue to coordinate
outreach, recruitment, referral and enrollment activities with Southwest Human Development
(SWHD). Recruitment will be targeted to first-time mothers who are income eligible for Women,
Infants, and Children (WIC), teens, Latina and African American women and other recognized
factors that increase the risk of an unhealthy outcome for pregnancy and childhood.
A team of 4 Nurse Home Visitors (NHV's) will partner with 95 at-risk, first-time mothers and
their infants residing in the region, providing 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. By helping to break the cycle of poverty, we propose to play a role in helping to
improve the lives of South Phoenix Regions most vulnerable members, building a stronger early
1

childhood development community, and leaving a positive impact on this and future
generations.
Since FY 2013 MCDPH has augmented the NFP model with support of an Infant Mental Health
Consultant. Nicole Valdez, MSW, LCSW, IMH-E Ill provides support and training to NFP staff on
infant and family development observations and strategies required when responding to
families with multiple risks, identification of disorders in infancy and strategies for referral and
intervention. She attends the twice monthly case conferences and participates periodically in
reflective supervision with nurse supervisor and nurse home visitor. The IMH Consultant
provides reflective supervision for the nurse supervisor and when indicated, the IMH Consultant
accompanies the NHV on home visits for high-risk parent child dyads.
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.
As reported in Quarter 4 FY 13, the social worker resigned in April of 2013 requiring recruitment
of a new staff person. Prior to filing the position we reflected on the job functions of the Social
Worker over the previous two years. It was determined the majority of her time was spent in
the job function of outreach and recruitment as well as health education at sites likely to refer
pregnant women.
A new position was created for a Health Educator/Community Outreach Specialist to replace the
Social Work position which did include a job function of community outreach. The job
description was submitted with the FY13 Quarter 4 Narrative Data Report. Lisa Norman was
hired in June of 2013 and has excelled at partnering with Parent Partners Plus, coordinating
outreach with Southwest Human Development, and partnering with South Phoenix Healthy
Start to teach the Pregnant & Parenting Teen classes for the Phoenix Union High School District.
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.
Together with the National Service Office, MCDPH NFP monitors quality at every phase of the
program by focusing on client interactions, program implementation and outcome achievement.
The Efforts to Outcomes (ETC) system is a core tool in NFP's integrated Quality Framework. Data
is collected on every home visit by the NHV and then input in to ETO by the data staff. The data
are used to create the quality performance reports that can be accessed at any time through the
NFP Reporting Portal by the Nurse Supervisor as well as to complete the monthly and quarterly
FTF reports.
Data on performance measures unique to FTF are entered to the MCDPH secure database. FTF
performance measure data common with NFP's are entered to the ETO system. Data required
for monthly and quarterly FTF reports are compiled from these two systems by the Nurse
Supervisor and submitted to PGMS. ETO reports are run by the nurse supervisor for team
outcomes. The information gathered on the data collection forms by NHV's and NS serve
2

several purposes: to support clinical practice; to provide documentation of services received by
clients enrolled in program; to assist administrators and program staff in tracking families'
progress in attaining program goals; to measure program effectiveness; to monitor program
performance; to assist supervisors in providing feedback to individual nurse home visitors on
strengths and areas for improvement in implementing the program model; and to assist
administrators and program staff in planning quality improvements to enhance program
implementation and outcomes attained locally.
One example of the use of data to improve practice in the past year included developing a new
tracking tool. In September of 2013 reports indicated a low percentage of referrals made by
nurse home visitors were ever followed up on by the client. A meeting was held where nurses
discussed the identified issue and the current process of documenting this information on home
visits. It was determined that there was no current procedure for tracking the outcomes of
referrals other than the nurse home visitor remembering to ask the client at subsequent visits. A
few nurses had developed their own system of tracking referrals and shared their process with
the team. Based on recommendations from the staff the nurse supervisor drafted a tracking tool
and a procedure. Several draft updates were made based on feedback from staff after using in
the field. The tool has now been used one month and we will be studying future reports to
determine if the tracking tool results in increased follow up secondary to increased reporting.
3

4
Documentation Quarterly Partnership Outcome Reports supervision, team reports. Report Report supervision, log ETO
& To & System and ETO Linkage To" conference Professional
Monthly Family Efforts Collection reflective conference log Service "Referrals reflective
Support 1)FTF Reports 2)Nurse (NFP) Data Management ETO) Weekly case meeting ETO FTF Weekly and case reports Internal Development
(
Will
Task Be Completed/Timel me
Date Ongoing Ongoing Ongoing Ongoing
Plan Person Responsible Supervisor: Tiemeier Supervisor Family Manager: Sloat Supervisor Home Supervisor Mental Valdez
2015 of Consultant:
Nurse Denise Nurse Office Health Tracy Nurse Nurse Visitor Nurse Infant Health Nicole
Implementation
Specialist, (NHV's) (NS), service clients recruited into NFP & conferences each community at risk: for moms which &
Program Task Outreach Visitors Supervisor community potential to, the pregnancy. administrative using in 1:1 service on needs, needed. identification to mental services Interventions relationship knowledge support
with so that referred into early in supervision practice case meetings. based identified available as mothers/dyads access health NF-IV system
Community Nurse Home Nurse network providers be enrolled program provides clinical reflective supervision, team provides coordination client's referring to services, Identify Prevention/early Improve health/infant mental dyads: support p-c Increase early childhood
and can and NS and NHV and skills/
and of
B Activities outreach development Agency in and services Coordination Health
sources NHV's NFP Mental
Attachment Community continued referral Implementing supports implementing sustaining Service Infant Augmentation

5
Office for The on outcome & in Visit by
data the to program. focused program reports Home signed visit. on performance Standard
Service monitor fidelity phase are and monthly FTF home gathered ETO reports.
every the efforts interactions, completes Form, each health for
National MCDPH and at throughout implementation achievement. Completed Quarterly NHV Encounter at is Data maternal measures Quarterly
NFP & quality model quality client PGMS 1) parent 2) and
Ongoing Ongoing
Supervisor Supervisor Home
Nurse Visitor
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& reflective on data continuous MCDPH into first every them challenges apportioning domains.
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of practice deliver improve parent health
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6
Quarterly
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FTF Reports
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in risk well- therapeutic focused to that of every 2 months,
parent pregnancy, reducing healthy ongoing change her own and each community 21 years.
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works a by health engages the promote provides based identified available visits for 6 toddler child
recognizing and exercise, management, care, promoting and and and to as until until
NHV supporting factors prenatal diet, woman NHV nurse-client abilities protect health child. NHV coordination parent's referring services, Home postpartum weeks monthly
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7
child measures
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is
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2) for
to wants to the ability respond promote her family promoting promotes and obtain each community
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2) to to 3) and 4) and 5)

8
on use for
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government standard
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NHV visits for and

Line Item Budget
Attachment C Budget period: July 1, 2014 — June 30, 2015
Bildget CotegOrY Line Item Description eititeSteill:fgOls„. TatalCast
PERSONNEL SERVICES Personnel Services Sub Total $344,659.00
Salaries Nurse Supervisor, Denise Tiemeier 41,357.00
Nurse Home Visitor, Sharon Gongora 77,791.00
Nurse Home Visitor, Elizabeth Nobles 77,791.00
Nurse Home Visitor, Helen-Haggerty-Harper 76,047.00
Nurse Home Visitor @ 60% 46,675.00
Data Entry, Norha Medina 13,732.00
Community Outreach/Educator, Lisa Norman 11,266.00
:tryiPLOYE:g...01.Agt4gxemse.:$ Employee Related Expenses Serb Total $1 14011.00
Fringe Benefits or Other ERE Fixed Costs $8,904 per FTE 43,630.00
Variable 19.26% of total salaries, see budget 66,38100
narrative
PROFESSIONAL AND OUTSIDE SERVICES Professional & Outside Services Sub Total $29,859.00
Contracted Services NSO, Core Education 4,549.00
Program Support Fee 7,046.00
Nurse Consultation 4,224.00
Infant Mental Health Cons. ultant, Nicole 14,040.00
Valdez
TRAVEL Travel Sub Total $20,590.00
In-State Travel 8,455.00
Out of State Travel 2,135.00
AID To ORGANIZATIONS OR INDiVIDUALS Aid to Organizations or Individuals Sub Total
Sub grants or Subcontracts to
organizations/agencies/entities
OTHER pPgprOapRosai Other Operath,g Expenses Sub Torts $31,189.00:::
• Telephones/Communications Services $60 mo/5 phones/12 months 3,600.00
• Internet Access
• General Office Supplies $30015.5.FTE/12 months 1,470.00
• Food Meetings/Graduation 1,100,00
• Rent/Occupancy
• Evaluation (non-contracted & non-
personnel expenses)
• Utilities
• Furniture
• Postage
• Software (including IT supplies)
• Dues/Subscriptions
• Advertising $65/95 families/12 months 6175.00
• Printing/Copying
• Equipment Maintenance $500/5 FTE/12 months 2,500.00
• Professional Development/Staff Training
• Conference Workshops/ Training Fees for
Staff
• insurance
• Program Materials 16,944.00
• Program Supplies
• Scholarships
• Program Incentives
NOM-CAPITAL EQuiPmrivr Aii;Cap#41.SOitaiii1
Equipment .',44..999 or res5 in vohje
Subtotal Direct Program Cots:
Mdirect/Admin Costs 10%
Authorized Signature Date 1267/y
d‘,

Attachment C (Continued)
ATTACHMENT C: BUDGET NARRATIVE
Personnel Services:
In order to create a budget within the allowed amount of $ 579,837, it is necessary to decrease a Nurse
Home Visitor FTE to 60%. The resulting target number of families served will remain 95. It should be
noted that at any point in time, nurse caseloads will not exceed 25 clients per FTE to maintain model
fidelity. The salary rate for each position was determined according to MCDPH market range levels.
Nurse salaries are determined based on years of nursing experience. Cost elements to implement SPNFP
with fidelity to the model, were obtained directly from NFP NSO. Costs were adjusted for local salary
ranges, the required state mileage rate and current training and material costs.
Nurse Supervisor: Denise Tiemeier
The nurse supervisor will ensure effective program management and provide clinical supervision of the
MCDPH nurse home visitors and data entry staff. The nurse manager will help build community
partnerships and ensure that nurse home visitors are clinically competent and able to implement the
NFP program. With an hourly rate of $39.62 x 2088 annual hours, 50% of which will be charged to this
grant for the 12-month grant cycle, or $41,357,00
Nurse Home Visitors (NHV)
The NHVs will provide home-based preventive intervention with young families. The NHVs will assess
status, teach, make referrals and nurture the development of young parents across several domains of
functioning, by developing a therapeutic relationship.
Elizabeth Nobles: With an hourly rate of $37.25 x 2088 annual hours, 100% of which will be charged to
this grant for the 12-month grant cycle, or $77,791.00
Sharon Gongora: With an hourly rate of $37.25 x 2088 annual hours, 100% of which will be charged to
this grant for the 12-month grant cycle, or $77,791.00
Helen Haggerty-Harper: With an hourly rate of $36.42 x 2088 annual hours, 100% of which will be
charged to this grant for the 12-month grant cycle, or $76,047.00
TBD: With an hourly rate of $37.25 x 1253 annual hours, 100% of which will be charged to this grant for
the 12-month grant cycle, or $46,675.00
Data Entry/Admin Assistant: Norha Medina
The data entry staff will support the nurse home visitors and nursing supervisor by providing efficient,
accurate, thorough entry of program and home visit data into the national web-based Efforts To
Outcome (ETO) as well as organizing and storing NFP materials and client files. With an hourly rate of
$13.15 x 2088 annual hours, 50% of which will be charged to this grant for the 12-month grant cycle, or
$13,732.00.
Outreach/Educator Specialist: Lisa Norman
The Outreach/Educator Specialist will support the program and the staff by utilizing expertise to provide
referral sources and assistance to families needing resources for education, legal, child support, housing,
food and career issues. Services will include health education in Phoenix Union High School Pregnant &
Parenting classes, coordination of client socializations and graduations, participation in the bi-weekly
NFP team meeting and the bi-weekly case conference, outreach and collaboration with other agencies
serving pregnant women and young mothers in South Phoenix Region. With an hourly rate of 17.99 x

2088 annual hours, 30% of which will be charged to this grant for the 12-month grant cycle, or
$11,266.00.
Total Personnel Services= $344,659.00
Employee Related Expenses:
Fringe Benefits are calculated @ $8,904.00 per FTE for medical and dental coverage $43,630.00
Variable of 19.26% of total salaries for Medicare, social security, unemployment, worker's
compensation, long term disability, life insurance, and Arizona State Retirement System.
$66,381.00
Total Employee Related Expenses =$/10,011.00
Professional and Outside Services: Nurse-Family Partnership National Service Office
Initial Education Session Tuition
Implementation of the NFP model requires completion of Units One, Two & Three training from the
National Service Office. MCDPH is currently fully staffed however, in the event of a vacancy the cost of
training one nurse includes:
NHV Initial Education Tuition + Education Materials = $4,549.00
Program Support Fee Contributes to covering costs associated with the following:
o Data system (ETO) operation and use, and Program Quality. Reporting- NFP routinely provides
reports to agencies through (ETO) and through email delivery of two standard reports. The
reports in ETO are generated by the user, using information provided in the ETO Reports
Manual. Quarterly, two reports are sent to all agencies, supervisors and states with contracts
via email. The Quarterly report includes cumulative, state and national information about NFP
processes and outcomes, the NFP MlECHV Benchmark report provides information related to
the federal requirements for the Maternal, Infant and Early Childhood Home Visitation
Program. NFP can generate special reports to meet individual needs of an agency. These
customized reports are charged based on the programming effort and the frequency of
delivery. Each report request is evaluated individually, and a cost estimate is provided.
o Ongoing Nurse-Family Partnership nurse home visitor, supervisor, and administrator education;
resource library; conference calls; web forums; Nurse-Family Partnership Community resources;
and maintenance of Visit-to-Visit Guidelines and supporting materials. The mix of these ongoing
education components varies from year to year based on what issues arise and what additional
education is needed.
o Marketing and Communications consultation and support, including marketing and community
outreach materials (brochures, posters, Client Referral Kits (with wallet cards, counter display,
posters and other program information); health fair bags, and nurse recruitment packets. The
agency, however, is responsible for printing, stamping or affixing labels with their local contact
information to the majority of these materials. Client Referral Kits are customized/printed at no
additional charge to the agency. Also provided are the NFP marketing and communications
resources and guidance and a copy of the NFP Public Awareness Video, as well as updates and
regular monthly communications from the NFP National Service Office.
o Policy and Government Affairs, including advocacy and educational work at federal and state
levels.
The fee is due annually on the implementation agreement anniversary=$7,046.00

Nurse Consultation: Contributes to covering costs associated with a Nurse-Family Partnership Nurse
Consultant providing the following support to supervisors:
o Helping the supervisor develop an annual plan for quality implementation with fidelity to the
model.
o Monitoring reports based on the supervisor and her/his team's activity and performance and
providing support with quality improvement initiatives.
o Structured, routine support for the supervisor in operations and clinical issues.
o Periodic visits to the supervisor and NEP team.
o Clinical and supervisory coaching and consultation with the supervisor.
The fee is due annually on the implementation agreement anniversary. = $ 4,224.00
Infant Toddler Mental Health Consultant-Nicole Valdez, LCSW, IMH-E (III) e
Secondary to the decrease in salary from cutting a Nurse FTE to .6 some additional hours are going to
the Infant Mental Health Consultant. The ITMH Consultant provides support and training to NFP home
visitors and to high risk families. She staffs twice monthly case conferences, co-facilitates reflective
supervision once per month with each NHV and accompanies NHV on home visits for high-risk parent
child dyads. With an hourly salary of $90 hour, at 3 hours per week, of which 52 weeks will be charged
to this grant for the 12 month grant cycle, or $14,040.00
Total Professional and Outside Services=$29,859.00
Travel
In State Mileage
This line item covers the nurse home visitors', social worker' and nurse supervisors' travel related to
client visits and community outreach. The cost was calculated as:
20 trips per 95 families/yr x 10 miles/trip @.445 per mile= $8455.00
Out of State Travel
Annual Education Symposium, a three to four day in-person session held annually. The cost to agencies
includes travel to the symposium location, some meals and hotel. There will be no tuition or registration
fee to attend this session. All nurse supervisors are required to attend the annual education symposium
after completing their first year as an NIP nurse supervisor. .
Air Travel $350.00
Meals 4 days x $44.00 $176.00
Hotel 3 nights x $ 127.00 $381.00
Ground travel $75.00
Total $982.00
Because implementation of the NEP model is dependent on specially trained staff, the budget includes
the cost of travel to training for one nurse. The cost includes estimated travel, meals and hotel.
Air Travel $350.00
Meals 5 days x $ 44.00 $220.00
Hotel 4 nights x $ 127.00 $508.00
Ground travel $ 75.00
Total $1153.00
Total Travel = $10,590.00

Other Operating Expenses
Telephone/Communication Services:
Includes phones, adaptors, and chargers. Cell phones are an essential element of home visiting program
to ensure the safety of the nurse home visitor. $60.00/per nurse home visitor and nurse supervisor (5) x
12 month of grant cycle =$3600.00
Office Supplies:
Essential supplies such as materials for organizing and storing files, as well as client file folders, paper,
pens: $300 per 4.9 FTE for the 12 month grant cycle. =$1,470.00
Food:
Community Advisory Board Meetings are held quarterly to promote a community support system for
the program and to promote program quality and sustainability. All NFP teams in Maricopa County
participate in the CAB and will rotate the cost. Light refreshments and the cost for plates, napkins etc. 1
meetings x $100 = $100.00
Graduation ceremonies will be held twice per year for mothers, children and their immediate family. All
NFP teams in Maricopa County participate in 2 events per year. MCDPH will host one event. Every effort
will be made to secure facilities at no cost, a cake reception and snack will be provided with beverage
and paper products=$ 500.00
Group Education & Support - a lunch is provided at the group education and support groups. MCDPH
will host 1 event @ $500 per event, 12 month grant cycle=$500.00
Total Food = $1,100.00
Printing/Copying:
Cost of printing handouts and program facilitators for clients.
95 families x $ 65 = $6,175.00
Professional Development:
Additional specialized professional development that individuals or the teams may identify as needs. For
example, it may include opportunities to learn more about community health, and /or maternal and
child health or certifications in breastfeeding consultation or childbirth education. $500 per 5 FTE for the
12 month grant cycle=$2500.00
Program Materials
Client Materials
o Support materials for families and for nurse home visitors to assist in the work they are doing
with families beyond NFP and PIPE handouts. It is important nurses demonstrate how to nurture
a relationship by acknowledging births, birthdays, successes, NFP graduation, etc. with cards,
photos. Etc.
o Use of program materials to assist in removing barriers, improve health education, and reward
healthy behavior including -completion of home visits, prenatal care, post-partum care and well
child care, up-to-date immunizations. Our program strategy is to pair an appropriate item with a
home visit theme such as:
o To demonstrate and support coping with fussy babies, crying and soothing we give a swaddling
blankets with "The Happiest Baby on the Block" pre- natal education visit.
o Safe Sleep Sacks: Since 2005, the American Academy of Pediatrics has suggested the use of a
wearable blanket to replace loose blankets in the crib that can cover a baby's face and interfere
with breathing. Halo Sleep Sack company offers discounted rates for health educators. Sleep
sacks are given on the first home visit after birth.

o The Low Literacy "What To Do When Your Child is Sick" book is given when on the visit the nurse
provides when your baby is sick education and is supplemented with a thermometer.
o A tummy time mat is provided with the floor time education and PIPE activity while
developmental milestones and anticipatory guidance are shared by the nurse.
o A sippy cup is provided at the infant's six month visit to reinforce healthy oral health behaviors,
o On a separate visit that focuses on oral health care, a developmentally appropriate dental brush
for baby and floss and tooth brush for Mom and Dad are provided.
o At one and two years of age a developmental toy is provided for birthdays to acknowledge the
significance of these life events.
o Items like those from select Brain Boxes, that match with corresponding themes in NFP
facilitators provide reinforcement and an opportunity for practice after the visit, such as a
puppet to reinforce language development, a knobby ball for sensory stimulation a small photo
book for sense of family and infant visual stimulation.
o Craft activities with Moms on visits focused on self-worth, setting goals and affirmation results
in keepsakes that serve as reminders for change.
o Photos and photo books are a favorite for families to record the milestones of an infant's
development as well as facilitate attachment.
o A home safety assessment is done with the family and needs are identified. Items such as socket
plugs, bath water thermometers, door knob guards, night lights, cabinet locks, toilet lid locks,
and furniture straps are available to choose.
o A graduation certificate and gift are given to women who have made the over two year
commitment to be the best parent they can be and have completed the NFP program.
$105/95 families/12 month grant cycle = $ 9,975.00
Medical Supplies:
Items needed for home visiting nursing activities such as growth charts, disposable measuring tapes,
scale cloths, hand sanitizer, gloves, surfaces wipes, thermometer covers, nursing bags. $200 per (4)
nurse home visitor per 12 month of grant cycle =$800.00
Emergency Transportation Assistance:
Transportation is often a barrier in accessing unexpected health care needs, getting prescriptions filled,
getting to medical visits not covered by Medicaid transportation; and for one client, getting to the
hospital to deliver her baby. Bus/Rail passes and emergency cab vouchers are used to meet this need
when all other possibilities have been exhausted.
$5/95 family per12 month grant cycle=$475.00
Safe Sleep Cribs:
Replace unsafe sleeping environments as need is identified for enrolled families.
20 cribs @ $150.00/ea. = $3000.00
Group Education & Support:
Quarterly group education and support groups for NFP pregnant women and young parents to
coordinate support with education events in order to build sense of community and decrease sense of
isolation. These groups will be coordinated with the other NFP contractor for South Phoenix with the
plan for each program to sponsor 1 event. Supplies for activities, costs of paper products, raffle items, or
props to accompany educational topic.
$200 per event x 1 per 12 month grant cycle=$200.00
Early Literacy:
7 board books/ 95 family/12 month grant cycle @ 3.75 per book = $2,494.00

Total Program Materials$16,944.00
Total Other Operating Expenses= $31,789.00
Non-Capital Equipment
$0.00
Subtotal Direct Program Costs: $526,908.00
Option B: Federally Approved Indirect Costs: $52,691.00
MCDPH has an established federally approved indirect cost rate for Federal awards of 15%. MCDPH is
requesting an allocation for indirect cost of 10%, $52,691.00, as allowed by First Things First.
TOTAL $579,599.00
147°'
V/297/i
Authorized Signature Date
Job Title Drpe.

Attachment D
KEY PERSONNEL
STAFF MEMBER 1 BACKGROUND AND EXPERTISE OF PERSONNEL
Name: Denise Tierneier, BSN, MCDPH Nursing Supervisor for NIP since 2009 and Nursing
RN Title: Nurse Supervisor, FTE Supervisor for the Newborn Intensive Care Program since 2007.
on this project: 0.5 Prior nursing experience includes 28 years in maternal child
health including NICU, Pediatric Home Health, Pediatric Case
Management, Head Start / Early Head Start Health Services and
as a Liaison for United Healthcare/APIPA Medicaid plan and CRS.
Name: Elizabeth Nobles, BSN, MCDPH NFP NHV since September 2009 Community Health Nurse
RN Title: Nurse Home Visitor for the Newborn Intensive Care Program for over two years.
FTE on this project: 1.0 Nursing experience for 27 years in neonatal, pediatric and
international nursing in Bolivia as well as a Case Manager in the
Women and Infant Services and NICU at Banner Thunderbird for
seven years. Beth is fluent bilingual English/Spanish.
Name: Sharon Gongora, BS, RN MCDPH NFP NHV since September 2009.Community Health
Title: Nurse Home Visitor Nurse for the Newborn Intensive Care Program for eight years.
FTE on this project: 1.0 Nursing experience for over 28 years including Pediatric ICU at St.
Joseph's Hospital for 17 years. Sharon also has a degree in
English/Spanish and is fluent bilingual Spanish.
Name: Helen Haggerty-Harper, MCDPH NFP NHV since September 2010. Nursing experience
BSN, RN includes over 20 years as a school nurse for Madison and Phoenix
Title: Nurse Home Visitor Elementary School Districts as well as home visiting with MCDPH
FTE on this project: 1.0 and a hospital nurse in Arizona and California.
Name: Kelly Hanson MCDPH NHV since June 2013. Nursing experience includes
Title: Nurse Home Visitor teaching prenatal care classes, postpartum patient care, case
FIE on this project: 1.0 management and patient representative at MIHS. Kelly is fluent
bilingual Spanish.
Name: Norha Medina MCDPH NFP Data Entry Clerk since August 2011. Payroll
Title: Data Entry Clerk Specialist, MCDPH Human Resources 2006-2011. Front Office
FTE on this project: .5 Assistant, Polycraft Industries 2003-2006. Attended Glendale
Community College and Adelphi Business College.
Name: Lisa Norman Outreach Specialist/Health Educator with MCDPH NFP since July
Title: Community 2013. Over 5 years of experience including a supervisory position
Outreach/Health Educator as Associate Director of Injury Prevention at Friendly House,
FTE on this project: .3 Injury Prevention Program Coordinator; Family Specialist with Aid
to Adoption of Special Kids. BA Psychology, ASU, National Child
Passenger Safety Technician, CPR & FA Instructor. Fluent bilingual
Spanish.
Name: Nicole Valdez NFP ITMH Consultant since August 2012. A Licensed Clinical Social
Title: Infant Mental Health Worker, Nicole has worked across Arizona's urban and rural areas
Consultant with low socio-economic and high risk young children, families
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FTE on this project: .05 and colleagues in home, clinical and medical settings. In 2008
Nicole was among the first professionals to become endorsed at
Level Three as an Infant Mental Health Specialist through the
Infant Toddler Mental Health Coalition of Arizona. Nicole is
conversationally fluent in Spanish.
*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
(Federal, State, local, other) Received From Amount match on
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
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Attachment F
First Things First Standard Agency Information Collection Form
A. Agency Information:
Program Name (if applicable) Maricopa County Department of Public Health: Office of Family Health Services — FTF Program
Agency Maricooa County through its Department of Public Health Contact Person Denise Tiemeier
Address 4041N Central Avenue, Suite 1400 Position Nursing Supervisor
Address Email
City, State, Zip Phoenix, Arizona 85012 Phone 602-506-6782 Ext
County Maricopa Fax
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 EN? __X _Y N
If not, please go to http://www.goo,az.aov/Vendar/account setup horne.asp,
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.Wwww.azredistrictina.ora 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 Y N
Contact information for firm conducting agency audit:
Audit firm: State of Arizona Office of the Auditor General
Address: 2910 N 446 Street, Suite 410, Phoenix, Arizona 85018
Phone: 602-553-0333
B. Proposed Program Information/Description:
Amount requested: $611,966.05
Service area of proposed program: All zip codes in the FTF South Phoenix Region
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Target population of proposed program: Low income, first time pregnant women and their children up to age 2
Lead Strategy — Home Visitation
Provide a contracted number for the following service unit for FY 15:
Number of families served: 95
Number of children receiving screening: 35
Number of developmental screenings conducted: 70
Number of hearing screenings conducted: NA
Number of vision screenings conducted: NA
Important Items to NOTE:
• 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 PGIVIS 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.
Program Description: South Phoenix Nurse Family Partnership is an evidence based, nurse home
visiting program that improves the health, well-being, and self-sufficiency of low- income, first-time
parents and their children. A registered nurse is paired with a woman early in her pregnancy .From
pregnancy through the child's second birthday, the nurse makes home visits and works with her client to
achieve three goals:
Improve pregnancy outcomes by helping women engage in good preventive health practices, including
obtaining thorough prenatal care from their healthcare providers, improving their diet, and reducing
their use of cigarettes, alcohol, and illegal substances.
Improve child health and development by helping parents provide responsible and competent care for
their children.
Improve the economic self-sufficiency of the family by helping parents develop a vision for their own
future, plan future pregnancies, continue their education, and find work.
Eligibility includes: low income, first time mother less than 28 weeks pregnant, living in the following zip
codes: 85009,85031,85033,85035,85037,85040,85041,85042,85043,85339.
To make a referral call 602-224-1740, For more information call Denise Tiemeier RN, 602-506-6782
http://www.maricopa.gov/Public_Flealth/Community/Programs/NFP/Default.aspx
Contact Information:
For each contract in the Partner and Grants Management System (PGMS), there are four contact slots available
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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: Tracy Sloat
Position: Nursing Manager
Address: 4041N Central Avenue, Suite 700
City, State, Zip: Phoenix, Arizona 85012
Email: TracySioat@mailmaricopa.gov
Phone: 602-506-0610 Ext. Fax: 602-506-6896
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: Denise Tiemeier
Position: Nursing Supervisor
Address: 4041 N Central Avenue, Suite 700
City, State, Zip: Phoenix, Arizona 85012
Email: DeniseTiemeler@mail.maricopa.goy
Phone: 602-506-6782 Ext. Fax:
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: John Schulz
Position: Accountant
Address: 4041 N Central Avenue, Suite, 700
City, State, Zip: Phoenix, Arizona 85012
Email: JohnSchulz@mail.maricopa.gov
Phone: 602-506-6788 Ext. Fax:
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: Denise Tiemeier
Position: Nursing Supervisor
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Address: 4041 N Central Avenue, Suite 700
City, State, Zip: Phoenix, Arizona 85012
Email: DeniseTiemeier@mail.maricoria.gov
Phone: 602-506-032 Ext. Fax:
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:
O Accessing/Navigating PGMS Contact(s):
O Narrative/Data Report Entry Contact(s):
O Reimbursements/Budget Modifications Contact(s):
O Other: Contact(s):
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