MARICOPACOUNTYDPH_ NFP_INCENTIVEFUNDSUSTAINABILITYAWARDLTR_DRAFT.PDF
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July 17, 2023 Bonnie Drenth Maricopa County Department of Public Health 4041 N Central Ave Suite 700 Phoenix, AZ 85012 Dear Ms. Drenth: Nurse-Family Partnership, a Colorado nonprofit corporation (“NFP”), is pleased to make an investment not to exceed $273,569 from the Nurse-Family Partnership Incentive Fund in Maricopa County Department of Public Health (“Agency” or “you”) to support sustainability of the Nurse-Family Partnership® Program (the “Program”). The NFP Incentive Fund offers short-term sustainability funding to existing NFP organizations looking to continue to serve families. We are investing in you so vulnerable moms will continue to receive the care and support they need to have healthy pregnancies and achieve better lives for themselves and their families. After careful consideration, we have approved your request for Sustainability Incentive Funds to MCDPH NFP families within the current service area over the next 12 months while longer-term sustainable funding is secured. NFP is prepared to support you during the term of this investment with a restricted grant (the “Investment”) as described below and by providing other services and support as described in the [Implementation Support Services Agreement, dated November 1, 2018 as amended] (the “Implementation Agreement”). This letter of agreement, including all exhibits, which are attached and incorporated by this reference (the “Agreement”), is effective as of July 1, 2023, through December 31, 2023, and sets forth the terms and conditions of the Investment. The parties agree that the Investment is expressly contingent on Agency satisfying the terms of this Agreement, including meeting the milestones set forth in Exhibit A (the “Milestones”). NFP has the right to adjust or withhold payments as it deems appropriate based on vacancy savings resulting from Agency hiring later than dates projected in the Milestones. The parties further agree that the Investment is intended to support Agency’s efforts to implement the Program while Agency secures and gains access to sustainable Program funding. Agency agrees to notify NFP as soon as Program funding is secured from another source. What NFP Will Do: 1. Invest in Agency. NFP will invest up to $273,569 in Agency. NFP will make payments in accordance with monthly invoices from the Agency as outlined in the payment schedule and Milestones reporting. 2 2. Collaborative Success Plan. To support Agency’s ongoing successful implementation, NFP will periodically assess the extent to which Agency is implementing the Program with Fidelity to the Model. NFP’s Nurse Consultant and Agency will co-create a Collaborative Success Plan (the “CSP”) to identity goals and specific action steps, including due dates for completing action steps. The CSP will be in place as long as Agency is implementing the Program. The CSP is assessed and updated as circumstances require to identify opportunities for growth and provide a framework for action. 3. Supervisor and Nurse Home Visitor Hiring Support. Should Agency experience challenges after 30 days of posting position, such as not finding enough candidates, not being able to source candidates expediently, not being able to meet market salary, or not being able to find bilingual or nurses who can work flexible hours, Agency shall notify NFP and NFP will work directly with Agency to explore and execute solutions to hiring. 4. Sustainability Resources. NFP will provide tools and support Agency in its efforts to become sustainable, including providing a Sustainability Planning Template and advising Agency on how to complete it. 5. Tools and Support for Outreach, Referral Generation, Referral Conversion to Enrollment and Client Retention. NFP will consult on generating, converting and retaining referrals, including specialized training, marketing, developing and executing an outreach plan at the request of the Agency, should Agency need it to meet their milestones. 6. Notify Agency If Payments Will Not Be Made. NFP will notify Agency in writing, at least 15 days before the scheduled payment date, if any payment from NFP will not be made as scheduled because Agency has not fulfilled its obligations or met the Milestones. The notification will detail where Agency is not making satisfactory progress. NFP will meet with Agency to attempt to resolve the issues detailed in the notification. 7. Manage Information and Expectations. NFP will work with Agency on its preparation of its bi-annual progress reports and provide quarterly data reports to Agency. The payment amounts and reporting schedules may be changed by NFP under certain circumstances, such as identification of risks that need additional attention or material changes in circumstances that may affect the successful completion of Milestones. To minimize the impact on Agency, any such modifications will be discussed in advance with Agency. If Agency believes that its performance will be materially affected by any such material changes, events or issues, Agency shall promptly provide a written report to NFP. Such a report must describe the relevant events or situation and Agency’s proposed action plan. Any material change in Agency’s plans must be approved by NFP. 8. Retain Right to Revise Terms or Declare Investment Terminated. If there is a material change in the administration of Agency or the other funding supporting Program delivery or if NFP believes Agency is incapable of satisfactorily completing the work of the investment or meeting the Milestones, or if Agency has breached any material term, representation or warranty set forth in this Agreement, or if circumstances regarding NFP’s available funding significantly change, or if any other reason in NFP’s discretion warrants it, NFP may, at its sole discretion, declare the investment terminated, or unilaterally revise the terms and 3 conditions of, the investment. NFP will meet with Agency to attempt to resolve the issues before making such a declaration. What Agency Will Do: 1. Implement the Program with Fidelity to the Model. Agency shall implement the Program in accordance with the terms of the Implementation Agreement, as amended from time to time, adhering to the Model Elements, including, but not limited to, Model Element 12, which states that a “full time Nurse Home Visitor carries a caseload of 25 or more active Clients.” Agency shall provide NFP with at least three (3) months’ advance written notice of any circumstances that suggest Agency may not meet the fidelity standards. 2. Sustain your NFP Program as Proposed in your Incentive Fund Application. Agency shall carryout sustainability of NFP services as described in its Incentive Fund application, which was submitted to and approved by NFP. Agency shall submit a written request to NFP for approval if they would like to change anything that was specified in the Incentive Fund application, such as geographic service area or staffing. 3. Sustainable Funding; Use of Investment. Agency shall report ongoing efforts to secure sustainable funding from other sources. Agency shall notify NFP immediately upon securing sustainable funding and shall access the Investment funds last when other funds are available. Agency shall discontinue invoicing NFP once sustainable new funds are received. 4. Milestones. Agency will meet the Milestones outlined in Exhibit A. Agency shall notify NFP as soon as possible after becoming aware that Agency may not meet the Milestones. 5. Collaborative Success Plan. Agency will fully cooperate with the CSP process and use it to drive program improvement, program fidelity and goals. 6. Supervisor and Nurse Home Visitor Hiring Support. Agency shall post all open NHV and Supervisor positions on NFP’s national careers website within two (2) weeks of opening the job requisition. Agency shall make best efforts to find bilingual nurses, as appropriate for the population served. 7. Tools and Support for Outreach, Referral Generation, Referral Conversion to Enrollment and Client Retention. If Agency has Outreach FTEs, the FTEs must be trained, by NFP, in NFP outreach and sales strategies to increase referrals. Agency shall ensure NFP has access to its referral information, by either providing NFP with an electronic file at least quarterly or by using an NFP-hosted system for entering, tracking and reporting referral information. 8. Notify NFP of Key Personnel Changes. Agency will notify NFP immediately of any changes in key personnel in the leadership team or in Nurses hired as part of this expansion. 9. Comply with Reporting and Meeting Requirements. Agency will comply with the reporting requirements detailed in Exhibit B. On a regular basis, NSO may meet with Agency to review progress against both the end of investment results and the Milestones specified Exhibit A. 4 10. Representations and Warranties. Agency represents and warrants to NFP that: (1) it is qualified to receive charitable contributions and has the full power and authority to make and enter into this Agreement; and (2) Agency’s entering into and performing its obligations under this Agreement do not violate any applicable law or any agreement with or right of any person. 11. Responding to Clients; Enrolling the Highest-Risk Clients. Agency shall respond within two (2) business days of receiving referrals. Agency shall make best efforts to enroll the highest risk clients. High-risk clients exhibit at least one of the following characteristics: • Serious mental health issues • Substance abuse issues • Intimate partners violence • Developmental/intellectual disability • Pregnancy complications/chronic illness • <19 and not in school • Excessive economic hardship • Homeless/residential instability • >19 and <12th grade education Agency shall demonstrate best efforts to enroll high risk clients by conducting outreach directed at any of the following: • Substance abuse treatment centers, • Teen-serving organizations • Incarceration or juvenile detention centers • Homeless and teen pregnancy centers • Schools • Social services offices • Entitlement services offices • Women’s shelters • Foster care systems • Women outside of the traditional social services network. 12. Ensure That All External Communications About the Investment Meet NFP’s Guidelines. All internal and external communication about the investment will be identified as “with support from the Nurse-Family Partnership Incentive Fund”. Agency shall be open and available to do presentations, information calls and other types of communication (in person or online) to inform stakeholders, funders, peer agencies and others about NFP’s Incentive Fund. Agency will use NFP brand guidelines (logo, the right naming conventions, etc.) in all NFP business. 13. Use of Funds. Agency shall use the investment for the purposes and in the manner provided in this Agreement. No portion of the investment may be expended for any purpose other than as provided in this Agreement without the prior written approval of NFP. No portion of the investment may be used to carry on propaganda or otherwise attempt to influence legislation within the meaning of Section 4945(d)(1) of the Internal Revenue Code of 1986, as amended, and the Treasury regulations thereunder (the “Code”), or to influence the outcome of any public election or to carry on a voter registration drive within the meaning of Section 4945(d)(2) of the Code. 5 14. Future Funding. Agency acknowledges that NFP and its representatives have made no actual or implied promise of funding except for the amount specified by this Agreement. If the investment is terminated or if any of the grant funds are returned, Agency acknowledges that NFP will have no further obligation to Agency relating to this investment upon such return or termination. Payment and Milestones. NFP will make payments not to exceed $273,569 over the term of the Investment and in alignment with the budget in Exhibit C, provided Agency has satisfied all conditions in the Agreement and does not have other available funds for Program implementation: These payments will be made following receipt of an invoice and brief report each month and/or until all funds are expended: Report and Invoice Date – Sent to NSO – No Later Than: Invoice Payment Date – Sent to MCDPH NFP – No Later Than 08/31/23 for July Expenses 9/29/2023 09/29/23 for August Expenses 10/31/2023 10/31/23 for September Expenses 11/30/2023 11/30/23 for October Expenses 12/29/2023 12/29/23 for November Expenses 1/31/2024 1/31/24 for December Expenses 2/29/2024 Nurse-Family Partnership looks forward to working with you to reach more families and improve the lives of more moms and babies. Thank you for the opportunity to work with you. Sincerely, Date: Chief Executive Officer Accepted: Agency Taxpayer I.D. # By: ________________________________ Date: ______________________________ Name, Title FOR AND ON BEHALF OF MARICOPA COUNTY By:____________________________________________ Chairman, Board of Supervisors Date ATTEST ______________________________________________ Clerk of the Board Date APPROVED AS TO FORM ______________________________________________ Attorney for Maricopa County Date 6 EXHIBIT A – MCDPH, AZ NFP Sustainability MILESTONES 1. Service Capacity and Families Served A. Staffing. Agency shall maintain the 2 FTE NHVs, 0.5 Supervisor, 0.5 Outreach, and 0.25 administrative assistant being funded throughout the duration of this award. B. Capacity / Caseload. MCDPH NFP shall reach through ramp-up and maintain enrollment of 50 families. Agency’s NHVs from all teams shall make best efforts through ramp-up to reach and maintain full caseloads of 25 families. Measured monthly. Projected Caseload 07/31/2023 08/31/2023 09/30/2023 10/31/2023 11/30/2023 12/31/2023 MCDPH NFP 50+ 50+ 50+ 50+ 50+ 50+ C. Referrals. Agency shall maintain an average response time of no more than two business days, from receiving a referral to following-up with the referral by engaging with the potential client directly or documenting attempts to do so. 3. Sustainability A. Convene at least four CAB meetings per grant year; B. Provide update monthly on progress towards sustainability progress and long-term sustainability of current budget. C. Complete the long-term sustainability planning tool by October 2, 2023 of the Investment. 4. Continuous Quality Improvement and Innovations A. Agency shall have in place a robust CQI process and a team that will continuously assess potential barriers to quality implementation. The Collaborative Success Plan (CSP) is a tool to support these efforts. 1. During the investment period, Agency shall work on a minimum of one (1) formal QI project on client recruitment, nurse recruitment, client retention, or nurse retention in alignment with CSP; note: if other funders require a QI project you can use that QI project for this milestone as well. EXHIBIT B – REPORTING AND MONITORING 7 Reporting. During the Investment Term, Agency shall report to NFP the following Milestones (template will be emailed to Agency): ▪ Service Capacity and Families Served o Staffing o Caseload o Referral process ▪ Sustainability ▪ Continuous Quality Improvement work. Timing of Reports. Agency shall report on their progress against Milestones monthly, alongside the monthly invoice, using a template to be provided prior to first invoice (from Exhibit A). EXHIBIT C – Sustainability Budget – MCDPH NFP 8 9