HomeMy WebLinkAboutMINUTES - 06151993 - 1.46 1 _46 r�
TO: BOARD OF SUPERVISORS
FROM: Mark Finucane, Health Sh
Services Director Ulf ,C Contra
By: Elizabeth A. Spooner, Contracts Administrator WSL�
DATE: June 3, 1993 10 County
SUBJECT: Approve submission of Funding Application #29-208-44 to the State Department
of Health Services for the Immunization Assistance Program
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
I. RECOMMENDED ACTION:
Approve and authorize submission of Funding Application #29-208-44 to the State
Department of Health Services in the amount of $204,663, for the period July 1,
1993 through June 30, 1994, for continuation of the Immunization Assistance
Program.
II. FINANCIAL IMPACT:
Approval of this application will result in $204,663 of State funding for the
Immunization Assistance Program during FY 1993-94. No County match is required.
III. REASONS FOR RECOMMENDATIONS/BACKGROUND:
On August 11, 1992, the Board approved Standard Agreement #29-208-42 (as amended
by Standard Agreement Amendment #29-208-43) , with the State Department of Health
Services to provide funds for County's long-standing Immunization Assistance
Program, for the period July 1, 1992 through June 30, 1993. This program,
operated by the Public Health Division of the Health Services Department, makes
immunizations available to all persons in need of these services in order to
prevent the occurrence and transmission of childhood diseases.
Approval of Funding Application #29-208-44 will provide State funding for
continuation of the program during FY 1993-94. The program will continue to
monitor the compliance of preschools, elementary schools, and secondary schools,
in order to meet State-mandated immunization requirements through inservice
programs and limited technical assistance. Program staff will continue to
maintain an adverse reaction monitoring system and outbreak control team. This
application must be approved in order for the County to continue to receive free
vaccine from the State.
In order to meet the deadline for submission, a draft copy of the application has
been forwarded to the State, but subject to Board approval. After Board approval,
seven certified copies of the Board Order should be returned to the Contracts and
Grants Unit for submission to the State Department of Health Services.
CONTINUED ON ATTACHMENT: YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATORRECOMME -
ATI NOF BOARD C MMITTEE
APPROVE OTHER
SIGNATURE(S)
ACTION OF BOARD ON APPROVED AS RECOMMENDED OTHER
VOTE OF SUPERVISORS
_4L�_ UNANIMOUS (ABSENT ) 1 HEREBY CERTIFY THAT THIS IS A TRUE
AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN
ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD
Contact: Wendel Brunner, M.D. (313-6712) OF SUPERVISORS ON THE DATE SHOWN.
JUN 15 1993
CC: Health Services (Contract) ATTESTED
Auditor-Controller (Claims) Phil Batchelor, Clerk of the Board of
State Deptartment of Health Services
Supenl*rs 0d GoullV Administramr
M3e2/7-83 BY DEPUTY
1 -46 EXHIBIT A
- TERMS
SECTION I. TERMS AND CONDITIONS
The Contractor must agree to the following inclusive objectives and conduct the following activities. Please
note that many of these Terms and Conditions are also objectives and activities required by the Federal
Government and are conditions for funding of the California Immunization Program and/or statutory
requirements of State and local health departments. The level of subvention contract funding to be awarded
is not represented as sufficient for support of all the required activities; a significant amount of local support
and funding is expected. Subvention contract funds must not be used to supplant (i.e., replace) local funds
currently being expended for routine immunization services and activities. Subvention funds can only be
used for the activities outlined in the budget justification.
A. Objectives:
1.) Raise to (or maintain) immunization levels of 98% or greater for each of the legally required
immunizations among all kindergarten entrants and incoming transfer students to schools within the
Contractor's jurisdiction.
2.) Raise age-appropriate immunization levels to 95% or greater among infants and preschool-age
children residing within the Contractor's jurisdiction.
3.) During the twelve-month (12) period of this agreement, the number of fourth doses of DTP
administered in public clinics to children before their second birthday will increase by ten
percentage (10%) points compared to the number administered to children of the identical age
during the preceding twelve-month (12) period.
4.) Through prevention, surveillance and outbreak control, reduce, and if possible eliminate, illness,
disability and death due to vaccine preventable diseases such as polio, diphtheria, tetanus,
pertussis, measles, rubella, mumps, hepatitis B, and Haemophilus Influenzae Type b within the
Contractor's jurisdiction.
B. Specific Pediatric Activities:
1.) Immunization Clinic Services
a.) Augment staffing in existing regularly scheduled public immunization clinics and/or expand
clinics in more locations on more days with longer hours which are reasonably accessible to
parents of children who reside within the Contractor's jurisdiction.
b.) Clinic policies must allow for the immunization of all susceptible infants, children, adolescents
and adults who visit within the scheduled hours of operation regardless of their city, county or
state of residence.
c.) Public immunization clinic policies and practices must be in general accordance with the
current recommendations approved by the U.S. Public Health Service and endorsed by the
American Academy of Pediatrics (AAP) as specified in the 'Standards for Pediatric
Immunization Practices. (Note: ' The ,Standards represent the consensus of the National
Vaccine Advisory Committee (NVAC) and of a broad group of medical and public health experts
about what constitute the most desirable immunization practices. The Standards are expected
to be useful as a means of assisting providers to identify needed changes,to obtain resources
if necessary, and to actually implement the desirable immunization practices.) Accordingly,
appropriate in-service training shall be instituted to assure compliance with the Standards.
d.) Each patient (or patient's parents) receiving"pediatric"immunizations through the Contractor's
public clinics must be provided a new or updated California Immunization Record (CIR). The
month, day and year of each immunization must be recorded on the CIR.
EXHIBIT A(Pediatric-IAP Continued)
FY 1993-94 Page 2
e.) Assure that the importance of completing the recommended schedule of immunizations is
discussed with all patients (or parents of patients) receiving immunizations at the public clinics.
f.) Assure that the date the next vaccine dose(s) are due is given in writing to the patient or
parent. The appropriate space on the CIR may be used for this purpose.
g.) Within the health jurisdiction, the Contractor will strive to implement and maintain public
immunization clinic reminder/recall systems among all medical providers, who receive state-
supplied vaccines,to improve age-appropriate immunizations of preschool-age children.
h.) In accordance with current Immunization Branch guidelines, which were furnished to the
contractor by the State,the Contractor must participate in the national Vaccine Adverse Events
Reporting System (VAERS)for adverse events following immunization.
2.) Immunization Assessment Levels
a.) In accordance with the guidelines and timetables provided by the Immunization Branch, the
Contractor must coordinate the assessment of the immunization levels of child care centers,
Head Start Centers, and kindergarten entrants.
b.) Through coordination with Immunization Branch Representatives, county health authorities
and local child care center and school authorities, the Contractor must make efforts to ensure
that all (100%) child care centers, Head Start centers and schools fully enforce existing
regulations pertaining to the immunization of children admitted to such institutions.
c.) Annually,within the health jurisdiction,the Contractor shall select at least a 20%representative
random sample of public clinics who receive state-supplied vaccine. Of the public clinics
selected, the Contractor shall conduct immunization record audits of children (24 months -35
months old) who are served by the clinics. The sampling technique and immunization clinic
record methodology must be compatible with the methodology of the Immunization Branch
(formerly Immunization Unit) of the California Department of Health Services. The record audit
specifications (with additional detailed guidelines), if requested, will be provided to the
Contractor by the CDHS Immunization Branch.
3.) Immunization of Infants and Preschool Children
In addition to the above stated activities,the Contractor agrees to the following activities intended to
assure the age-appropriate immunization of infants and preschoolers who reside within the
Contractor's jurisdiction.
a.) Make efforts to ensure that the immunization status of infants and children receiving services
through programs such as CHDP, MCH, AFDC, and WIC is assessed and that a system is
established to ensure age-appropriate immunization.
b.) Promote immunization information and education of parents with newborn children through all
hospitals with maternity services within the Contractor's jurisdiction.
4.) Vaccine Preventable Disease Surveillance and Outbreak Control
a.) Establish and maintain an effective system for identification and reporting of suspect, probable
and confirmed cases of vaccine preventable diseases. Sources of surveillance information
should include practicing physicians, outpatient clinics, hospitals, schools, child care centers
and Head Start centers. Active surveillance is only required during outbreaks of measles.
b.) Investigation and Control of Measles
1.) Investigation of.all reported suspect, probable and confirmed cases of measles must be
EXHIBIT A(Pediatric-IAP Continued)
FY 1993-94 Page 3
initiated within one working day of receipt of a report by the Contractor.
2.) Outbreak control procedures in accordance with the guidelines of the Immunization
Branch must be initiated by the Contractor within two working days of determination of a
probable or confirmed measles case.
C. Requlred Reports
1.) Reports of Local Program Progress and Activities
In accordance with the guidelines and format provided by the Immunization Branch, the Contractor
shall submit, through his/her Immunization Branch District Field Representative. to
the Branch identified in paragraph 6 of Section I in this Exhibit, by the 15th of the month following
the end of each quarter, a written quarterly report of progress and activlties. In addition to the written
report the Contractor and Project Liaison,or his designee, may meet and discuss the above matters
in person.
2.) Upon completion of the investigation of each probable or confirmed measles case, a completed
investigation form must be submitted to the Immunization Branch.
3.) Contractor agrees that itemized personnel positions listed in said Exhibit B shall not be subject to
Contractor's personnel policy decisions to refrain from filling vacant positions. The total amount of
the contract will be indicated as either some part, or all, of the total operations budget. If the total
amount of the contract is less than the total operations budget, the Contractor will be responsible
for providing the difference between the total amount of the contract and the total operations
budget. Further, all invoices to the State which request reimbursements for positions included in
Exhibit "B" must include the name and Social Security number of the persons that have performed
in these positions.
4.) The Contractor shall provide for any personnel or operating expenses that are'necessary to meet
the provisions included herein but are not provided for in the Budget included as Exhibit "B".
5.) The Contractor shall submit through his/her Immunization Branch District Field
Redresentative.to the Branch identified in paragraph 6 of Section I in this Exhibit, on or before
the 3rd of the month following the report month, a written Monthly Vaccine Usage Report in the form
prescribed by the State Department of Health Services, Immunization Branch.
6.) All reports, other than those required to be directed to the District Field Representatives, invoices,
and other written communications are to be addressed and delivered to the State Department of
Health Services, Immunization Branch, 2151 Berkeley Way, Berkeley, California 94704.
7.) The State reserves the right to use and reproduce all reports and data produced and delivered
pursuant to this Contract and reserves the right to authorize others to use or reproduce such
materials, provided that the confidentiality of patient information and records are protected pursuant
to Caldomia State laws and regulations.
8.) This Contract may be terminated by either party upon 30 days' written notice to the other party.
Further, this Contract may be terminated or suspended upon written notification by the State at any
time for failure on the part of the Contractor to comply with any of the provisions contained herein.
9.) In consideration of the above services, performed in a manner acceptable to the State, the State
shall reimburse the Contractor quarterly, in arrears, upon submission of a quarterly invoice by
Contractor on Contractor's letterhead, in quadruplicate stating the time period covered, stating the
contract number, for actual expenditures in accordance with the budget (attached hereto and
shown as Exhibit "B"), to: Department of Health Services, Immunization Branch, 2151 Berkeley
Way, Room 712, Berkeley, CA 94704. The Contractor may make changes in any individual line item
in the budget, provided that such changes in the sum total does not exceed $10,000 that the
EXHIBIT A(Pediatric-IAP Continued)
FY 1993-94 Page 4
Contractor submit an explanation of the need for such excess with the claim for reimbursement and
to specifically identify the line Rem(s) to be reduced in order to increase the excess items) and
provided further that the State reserves the right to deny any such claim for any excess
reimbursement on any item. It is further understood that in no event shall the maximum amount
payable under this agreement exceed the maximum amount specified in paragraph of the Standard
Agreement.
10.) It is agreed by the Contractor that in the event that a significant portion of the Contract objectives for
the initial four months of the Contract are not met by that time; and in the event that the State
determines from quarterly invoices, performance reports, and other sources of information that the
Contractor will not perform the total quantity of services contracted for; and that therefore, the total
budget allocation will not be depleted; the State and/or Contractor may make an equitable
adjustment in the original Contract budget and Contract objectives in order to decrease the total
quantity of services and commensurate Contract amount. Any adjustment shall be by amendment
only and duly executed by both parties and approved by the Department of General Services (if
applicable).
SECTION 11. TERMS AND CONDITIONS FOR RECEIPT OF VACCINE PURCHASED
WITH STATE OF CALIFORNIA OR FEDERAL FUNDS
The local health department receiving vaccine purchased with State of Caldomia/Federal funds, herein
called State purchased vaccines, agrees to the following terms and conditions.
1.) Prior to receipt of an immunization,all patients(or their parents or legal guardians) must be:
a.) provided a copy of the current "Important Information" statement and/or "Vaccine
Information Pamphlet"for each vaccine dose to be administered (in the case of hepatitis B
vaccine given to newborn infants this can be provided to the mother during prenatal care or
within 12 hours after delivery);
b.) provided a reasonable opportunity to read the "Important Information" statement(s) and/or
"Vaccine Information Pamphlets)";
c.) provided an opportunity to ask questions and have questions answered concerning the
benefits and risks of each immunization;
d.) specifically asked N they understand the information provided to them and if they have any
questions;
e.) given a telephone number to call should the patient become ill and have to visit a physician,
clinic or hospital within the 28 days following the immunization;
f.) provided the authorized appropriate translations of the "Important Information" statements
and/or "Vaccine Information Pamphlets" if English is not their first language and their
language is one for which the State has made translations available.
The Immunization Branch will supply to all local health departments camera-ready copies of the
current "Important Information" statements and a supply of the "Vaccine Information Pamphlets" in
English and Spanish. In addition, should a sufficient need exist, the Immunization Branch will
arrange for authorized translations and provide camera-ready copies of the "Important Information"
statements and a supply of"Vaccine Information Pamphlets"in other languages.
2.) If a signature card or clinic log is used in lieu of the bottom portion of the "Important Information"
statement and/or"Vaccine Information Pamphlet", the patient (or parent or legal guardian) must
read the following statement which is required to appear at the top of the signature record card or
EXHIBIT A(Pediatric-IAP Continued)
FY 1993-94 Page 5
log sheet and then sign for each antigen administered:
"I have been given a copy,and have read, or have had explained to me the
information contained in the Vaccine Information Pamphlet(s) or the appropriate
Important Information Statement(s) about the disease(s) and vaccines(s) indicated
below. I have had a chance to ask questions which were answered to my satisfaction.
I believe I understand the benefits and the risks of vaccine(s) and request that the
vaccine(s) indicated below be given to me or to the person named below for whom I
am authorized to make this request."
The record card or log sheet must include as a minimum the following information:
a.) patient name
b.) address
c.) date of birth
d.) age at time of immunization
e.) type of vaccine(s) given
f.) clinic identification
g.) date of immunization
h.) site of immunization
i.) name and title of person administering the vaccine (e.g., S. Smith, R.N.)
j.) vaccine manufacturer
k.) vaccine lot number
I.) signature of patient or parent/guardian authorizing immunization
m.) date of signature
n.) date(s) printed on the "Important Information"statement(s) and/or"Vaccine
Information Pamphlets"provided to the patient or parent/guardian
NO ALTERATION, VARIATIONS OR ADDITIONS TO THE IMPORTANT
INFORMATION STATEMENTS, VACCINE INFORMATION PAMPHLETS, OR
VACCINE AGREEMENT MAY BE MADE WITHOUT THE PRIOR WRITTEN
APPROVAL OF THE CHIEF OF THE IMMUNIZATION BRANCH OF THE
CALIFORNIA DEPARTMENT OF HEALTH SERVICES.
3.) The agreement/signature portion of the "Important Information" statement and/or "Vaccine
Information Pamphlet" or the authorized signature record card or authorized clinic log sheets
must be stored by the local health department in a retrievable file for a minimum of 10 years
following the end of the calendar year in which the statement/pamphlet was signed. In addition,
if a notice of a claim or lawsuit has been made, the record must be retained until after a final
disposition has been made.
4.) In the case of a school-based program, or other programs where the "Important Information"
statement(s) and/or "Vaccine Information Pamphlet(s)"are to be read and signed in advance of
the immunization by the patient or parent/guardian or other authorized person who will not be
present at the site where the immunizations are to be given, procedures shall be established and
made known for answering questions by telephone.
5.) Outside non-profit providers of immunization services must sign the State provided "Outside
Provider Agreement for Receipt of State-Supplied Vaccines" terms prepared by the State
Immunization Branch before they may receive State purchased vaccine. Medical providers of
immunization services who sign the agreement must agree to use the "Important Information"
statements and/or"Vaccine Information Pamphlets"and must be provided as many copies of the
statements/pamphlets as vaccine doses distributed, or at least one camera-ready copy of each
vaccine statement. The "Outside Provider Agreement..." and the use of the "Important
Information" statements and/or "Vaccine Information Pamphlets" are required in clinic settings
even if the clinics are supervised by a physician in attendance. The "Outside Provider
EXHIBIT A(Pediatric-IAP Continued)
FY 1993-94 Page 6
Agreement..." shall be signed annually by non-health department medical providers and
retained by the local health department for a minimum of ten years following the last calendar year
in which the State Immunization Branch purchased vaccine was provided.
6.) Local health departments receiving State-supplied vaccines are required to provide State-
supplied vaccines to Community Health Centers (e.g., Federal and/or State-Funded Community
Health Centers, including Migrant, Rural and Indian Health Centers, etc.) if state vaccine funding
resources are sufficient and if the Community Health Centers maintain compliance with the terms
and conditions listed in the State provided "Outside Provider Agreement for Receipt of State-
Supplied Vaccines".
7.) No charge may be made to the patient, parent, guardian or third party payer for the cost of State
purchased vaccine provided to local health departments by the Immunization Branch. In
addition, outside, non-profit providers of immunization services receiving State purchased
vaccine may not charge patients or parents for the cost of vaccine. Charges made by local health
departments for the direct costs incurred for administration or injection of the vaccine are
discouraged but are not specifically prohibited. Should the health department or outside
medical provider receiving state vaccine establish an administration fee for an injection of
vaccine, information, e.g., sign/poster, IDEM be prominently displayed which indicates that no
one receiving an immunization in a public clinic may be denied vaccine provided through public
funds for failure to pay the administration fee or failure to make a donation to the provider.
8.) Local health departments and other private and public providers utilizing State purchased
vaccine and/or hepatitis B immune globulin (HBIG) must report quarterly the vaccine and HBIG
doses administered, by vaccine type and age group of patient, and dose in series (for multiple-
dose vaccines) in a format provided by the Immunization Branch. Reports should be submitted
to the Immunization Branch by the third day of the following month.
9.) Each quarter, the local health department must report a current vaccine inventory including all
sites within the county or local jurisdiction. The Immunization Branch will supply the reporting
forms. All local health departments are to notify their Immunization Branch Field
Representative of any vaccine which is unlikely to be used not later than three months prior to
its date of expiration.
10.) The local health department agrees to ensure that the storage and handling of State purchased
vaccine within its facilities is in accordance with the manufacturers' specifications. The local
health department also agrees to inform other providers who receive Immunization Branch
purchased vaccine of the manufacturers'specifications for vaccine storage and handling.
State of California•Health and Welfare Agency Department of Health Services
immunization Branch
Exhibit B
Budget
Application For Immunization Project Subvention Funds
Contra Costa County Health Services 2. Director of Project:
Applicant's Name Name -Dottie Lanp-thorn
Public H,=,q1fh/TmrninJmeati nye I-I-Qif-
Organizational Unit Title Immunization Program Coordinator
597 Center Ave. #200A De.gree
Street address - P. O. Box B.S.N./P.H.N.
Martinez, Ca 94553
City County Zip Code
3. Budget Period: 4. Type of Application:
From: 7-1-93 TO: 6-30-94 ❑ New [3Renewal El Continuation
❑ Supplement Q Revision
5. Amount Requested: 6. Financial Management Official:
Name Alan Abreu
$ 204.663 Public Health
Title Finance Manager
Address 20 Allen Street
Martinez, CA 94553
Phone --510-370-5025
DHS 8312 (9/92)
DHS 8312 (9/92) EXHIBIT B
BUDGET
PAGE 1 OF 4
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant : Contra Costa Count
Budget Period From: 7/1/93 to 6/30/94
DETAILED LINE ITEM BUDGET FOR THIS PROJECT
%of time and/or Monthly salary range Dollars required
1. Personal Services hours on 12I41ect and/or hourly rate from California
S S
Immunization Coordinator 100 386-5331 31,986 (l)
Registered Nurse 100 9-4962 59,544 .. .
Registered Nurse 20 9-4962 11,909
Communicable Disease 50 925-2340 14,100
Technician
Clerk Experienced Level 100 849-2248 13,398 (l)
Clerk Experienced Level 25 1849-2248 6,699
State lunds cover approximatel 50% of Immunization
Coordinator and 50% f the Clerk personnel aenses.
Total Salaries& Wages $137,636
Staff Benefits 30 %/%
TOTAL PERSONAL SERVICES
DHS 8312(9/92) EXHIBIT B
BUDGET
PAGE 2 OF 4
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant
Budget Period From: to
DETAILED LINE ITEM BUDGET FOR THIS PROJECT
Required from
11. Operating Expenses California
A. Supplies
1) Office Mailing, stationary supplies $1000
2) Clinic Syringes, alcohol, needle disposal boxes, etc. $1500
B. Health Education Materials
Printing and reproduction $3000
C. Laboratory Screening (Hepatitis B only)
D.Travel
1) In-State 1500 miles @ $0.28 per mile $ 420
2) Out-of-State National Conference $1200
E. Equipment
Computer hardware and software $3617
F.Subcontracts
(description(s)on Exhibit B Budget,Subcontract page(s)
$15,000
TOTAL OPERATING EXPENSES $ $25,737
TOTAL BUDGET = (I Personal Services + II. Operatina Ex e� $ $204,663
DHS 8312(9/92) EXHIBIT B
BUDGET
PAGE 3 OF 4
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant : Contra Costa County
Budget Period From: to
F.Subcontracts
(List the name of the contractor or consultant and the time period of the contract,
Also,Indicate the hourty/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Neighborhood House of North Richmond
Address: 305 Chesley Ave.
City, State,&Zip Code: Richmond, Ca. 94801
Telephone#: •510-215-4770 "
Dollar Amount
I.Personal Services Rate of Required from
(List cositfons) Time Period Reimbursement Califomia
Community Outreach 7/1/93-6/30/9 $10 per hour $7500
Worker for a total of
750 hours
Personal Services Subtotal $ 7500
Il. Operating Expenses
Supplies
Health Education Materials
Travel (in-state)
Equipment
Operating Expenses Subtotal $
F.Subcontracts Total = (I. Personal Services +11. Operating Expenses) $
(Include amount on Operating Expenses, Exhibit B, Budget,page 2)
Note:
A written Justification of the above Contractor service(s)and-expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
DHS 8312(9/92) EXHIBIT B
BUDGET
PAGE 4 OF 4
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION FUNDS
Applicant : Contra Costa County
Budget Period From: 7/1/93 to 6/30/94
F.Subcontracts
(List the name of the contractor or consultant and the time period of the contras.
Also,Indicate the hourty/weekly/monthly rate of reimbursement and total contract amount)
Name of Subcontractor: Pittsburg Preschool Coordinating Council
Address: 1760 Chester Drive
City, State, &Zip Code: Pittsburg, Ca. 94565
Telephone# 510-439-29061
Dollar Amount
I. Personal Services Rate of Required from
(List cositions) Time Period Reimbursement California
Community Outreach 7/1/93-6/30/94 $10/hr. for a $7500
Worker total of 750 houis
Personal Services Subtotal r$--7500
ll. Operating Expenses
Supplies
Health Education Materials
Travel (in-state)
Equipment
Operating Expenses Subtotal $
F.Subcontracts Total = (I. Personal Services +11.Operating Expenses) $ 00 75
(Include amount on Operating Expenses, Exhibit B, Budget,page 2)
Note:
A written justification of the above Contractor service(s)and expected completed
work product(s) must be included in Exhibit C Budget Justification of this agreement.
(DHS 8312(9/92) - Exhibit C
Project Summary and
Budget Justification
Page 1 of 3
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
SHORT SUMMARY OF PROJECT (Not to exceed 200 words)
The purpose of the Immunization Program is to prevent the occurrence and transmission of vaccine
preventable diseases through immunizations, surveillance and outbreak control. The program will provide
immunization services, promote immunization awareness, encourage families to keep permanent
immunization records, and assure that schools maintain a-permanent record keeping system. Program
activities will be coordinated with local school officials and community agencies.
These activities will be carried out in an attempt to: (1) raise immunization levels above 98% for all school
age children and 95% for all infants and preschool children and (2) increase the number of 4th doses of
DTP administered in public health clinics to children 15 months to 2 years by 10% over the prior fiscal year.
Surveillance and outbreak control measures are incorporated into the program which include measles,
pertussis, rubella, Hepatitis'B,Haemophilus Influenzae Type b and other vaccine preventable disease.
Priority will be given to the: 1) annual kindergarten and preschool immunization assessments and selective
review audits, 2) distribution of immunization materials to all public and private schools and preschools with
inservice/consultation visits maintained, 3) expanded outreach efforts to infants and toddlers 4) on-site clinics
at WIC, State Preschool and Headstart sites, 4) toddler immunization campaign, 5) measles elimination
program, 6) provision of regularly scheduled public immunization clinics with special clinics as needed, ') a
reminder/recall system for children who attend the monthly immunization clinics, WIC, and State
Preschool/Headstart on site clinics 8) outbreak control measures to contain/stop vaccine preventable disease.
9) increased provider outreach efforts to adopt the "The No Barriers to Immunization Policy'to reduce
missed opportunities with programs for continuing education units for professionals.
A computerized immunization system with a 386 PC and Green Lira software is updated monthly to
maintain: 1) permanent retrievable record keeping system for persons given immunizations in the
immunization-only clinics and special outreach clinics 2) vaccine usage and inventory activities, and 3)-
communi- cations to schools, health care providers, hospitals, and community organizations. Other software
programs will be investigated this year in an effort to establish a computerized immunization link to public
and private immunization providers.
Name of Project Director Name and Address of Applicant Including
Organizational Unit Responsible for
Project Activity
Dottie Langthorn
Immunization Program
597 Center Ave.. #200A
Martinez, CA 94553
(DHS 8312(9/92)
Exhibit C
Project Summary and
Budget Justification
Page 2 of
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
BUDGET JUSTIFICATION
(Please provide written justifications for all positions and operating expenses requested on Exhibit B Budget pages 1 &2.
h additional space is required,attach additional pages.)
I. PERSONNEL SERVICES:
Immunization Coordinator
Coordinates activities to meet program goals: conducts immunization assessments and
provides consultation and technical assistance to school and child care facilities to raise
and/or maintain immunization levels of at least 98% in school age children and 95% in
infants and preschool children, participates in newborn and toddler outreach efforts,
provides immunization information to the medical and lay communities, coordinates
programs for continuing education for professionals, works to reduce/eliminate vaccine
preventable disease (ie., measles, mumps, rubella, pertussis, hemophilus influenza type b),
provides the operational link between schools and preschools and the State IAP office,
supervises the computerized record keeping system, manages vaccine and vaccine
accountability,
Registered Nurse
WIC clinics operate throughout the county 15-29 times a month. There are an average of
22000-5000 children seen in each area of the county per month. The nurse will provide
immunizations, information on immunizations and health referrals for other needed medical
care. The nurse will also staff the special clinics in targeted areas, assist with health
education information development and assist with evaluation of Day Home assessments.
Clerk-Experienced Level
Provides clerical support to accomplish the goals and objectives of the program. The
activities include: typing and filing reports and letters, xeroxing, preparing kindergarten and
preschool registration packets, filling orders, tabulating audit results, mailing materials to
schools, child care facilities, family day homes and health care providers, maintaining the
computerized retrievable immunization record system and manual reminder system, and
providing clerical support to clinic and the Immunization Program Coordinator.
Communicable Disease Technician
Will provide door to door outreach and information giving. Will give information classes in
clinics and to community groups in appropriate languages. Will work with migrant workers
to determine needed times for clinics and best access.
Project Summary and
Budget Justification
Page 3 of 3
APPLICATION FOR IMMUNIZATION PROJECT SUBVENTION
H. OPERATIONAL EXPENSES
A. Supplies
1. Office - Pens, paper, envelopes, postage for mass mailings and
reminder/recall postcards, phone for computer fax/modem.
2. Clinic - syringes, alcohol, drapes, cotton, bandaids, needle disposal-boxes.
B. Health Education Materials .
Printing reminder/recall postcards to remind parents when their child's next
immunization is due; developing, printing and/or ordering of culturally sensitive
brochures, fliers, posters, videos.
C. Travel
1. Out-of-State: National Immunization Conference
Air fare, room and meals for 5 days.
2. In-State: Local program related activities.
D. Equipment
Computer software and associated hardware to establish a computer network
system with multi-provider access and reminder/recall.
F. Subcontract Services
Will provide community door-to-door outreach workers in high risk neighborhoods
with poor immunization compliance.
III. TOTAL BUDGET- $204,663