ANNEX 2
FY 2014 PUBLIC HEALTH MASTER AGREEMENT ANNEX
Program Description and Reporting Requirements
PROGRAM NAME: IMPACT- Implementing More Positive Alternative Choices for Teens
PROGRAM CODE: 086
FUNDING SOURCE: TANF
PURPOSE:
To assist at- risk adolescents 17 and under in Ware County make positive lifestyle choices through education, leadership opportunities and clinical reproductive health services.
FUNDING REQUIREMENTS:
Restrictions
- Funds must be used to enhance comprehensive teen community prevention programs, outreach and district level coordinated services.
- Funds shall not be used to supplant local funds.
- Program must assure compliance with federal and state regulatory requirements.
- The program must have prior approval from the state office for equipment purchases. Must complete and submit Equipment form 5111 to the state office. Personnel paid from this program must not bill Medicaid services.
- Program funds not utilized by the end of the fiscal year shall be returned to the state office.
- Indirect costs shall not be charged to this program unless a cost allocation plan has been approved by the office of Financial Services.
Deliverables
Primary
Clinical Reproductive Health Services for Adolescents/ Positive Alternative Choices for Teens
- Adhere to all Program Guidelines for Project Grants for Family Planning Services most recent edition.
- Conduct Well Child Examination - Health Check (EPSDT) and Comprehensive Health Assessment
- Provide youth engagement opportunities that teach life skills, provide opportunities to practice those skills, and leadership opportunities.
- Implementation and successful completion of three obesity and two tobacco use prevention education programs for 20 or more youth, using state approved curriculum. Priority given to youths enrolled in Department of Health and Human Services (DHHS) funded out -of-school
programs, independent living programs (ILP), and local public health programs.
- Provide education and technical assistance to youth, their families, and community -based organizations. (This information, advocacy and skill-building opportunity efforts should increase awareness, capacity and support for adolescent health issues and youth development).
- Participate as needed and as appropriate in the Title V 5-year needs assessment and other planning processes.
- Participate in meetings as requested by the program.
- Complete Needs assessment for training, technical assistance, services and resources.
PERFORMANCE MEASURES:
Objective: Increase the number of unduplicated teen users in family planning services by 5%,
(from 232 adolescents (17 years of age and under)to 244 adolescents by June 2015).
Objective: Reduce the percentage of birth rate (per 1,000 live births) for adolescents.
(From 17.6% / 1000 to 15%/ 1000 by June 2015.)
Birth Data/ OASIS 2011 Georgia 7.4% 2011
Objective: Reduce the percentage of repeat births among adolescents age 17 years of age and under. (From 19.9% In 2009 to 12% or less by June 2015)
Birth Data / Oasis Georgia 9.0% 2011
ALLOCATION METHOD:
Funds are allocated to the Ware County Board of Health for the benefit of the counties in District 9-2.
REFERENCES:
· Program Guidelines For Project Grants for Family Planning Services
http://www.hhs.gov/opa/pdfs/2001-ofp-guidelines.pdf
· CMS-Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Early-Periodic-Screening-Diagnosis-and-Treatment.html
· http://oasis.state.ga.us
REPORTING REQUIREMENTS:
- Submit Annual Work Plan Proposal by August 1, 2013
- Submit line item budget (Form 5410) to Family Planning Program state office by August 15th.
- Submit electronically programmatic reports to the state office quarterly:
October 15th, January 15th, April 15th, July 15th Reports to include, and not limited to,
o Service delivery and activities targeted to adolescents and their families.
o Educational activities, including parental involvement, leadership development, abstinence education, utilization of risk reduction strategies, and best practices for prevention of pregnancy and STI’s.
o Quarterly expenditure report Form # 5410.
o Quarterly IMPACT Clinic report.
PROGRAMMATIC CONTACTS:
PROGRAMMATIC/STATISTICAL REPORTS ARE TO BE TRANSMITTED ELECTRONICALLY DIRECTLY TO:
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ANNEX 2
Diane Kelly RN (Lead)
Family Planning Nurse Consultant
Office of Family and Community Health
2 Peachtree St. N.W. Suite 11-482
Atlanta, GA 30303-3142
404-657-3153 (Phone)
404-478-4333 (Fax)
Wanda Prince RN, MSN/MHA,
Director Family Planning Program
Office of Family and Community Health
2 Peachtree St. N.W. Suite 11-482
Atlanta, GA 30303-3142
404-657-3149 (Phone)
404-478-4341 (Fax)
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