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HomeMy WebLinkAboutMINUTES - 06201995 - D.1 5....L To: BOARD OF SUPERVISORS F&HS-01 Contra ,,E..• : ., �...aF FAMILY AND HUMAN SERVICES COMMITTEE /fir FROM: Costa o.. _ `� County DATE: June 12, 1995 ''T SUBJECT: STATUS REPORT ON SERVICE INTEGRATION, THE POLICY ACADEMY, FAMILY MAINTENANCE ORGANIZATION AND CHILDREN AND FAMILY SERVICES BUDGET SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS: 1. ACCEPT the following reports: ✓ A report dated June 6, 1995 from Bill Weidinger on the status of Service Integration. ✓ A report dated June 7, 1995 from Mary Foran on the status of the Family Maintenance Organization. ✓ A report dated June 6, 1995 from Mark Finucane on the status of locating a health clinic at each school site in the County. ✓ The Children and Family Services Budget for the 1995-96 fiscal year, which we understand has been supplied under separate cover to each Board member. 2. EXPRESS the Board's appreciation to the staff from the County Administrator's office who were responsible for producing the Children and Family Services Budget for the 1995-96 fiscal year under less than ideal circumstances and under a substantial time pressure. 3. REQUEST the County Administrator to include in the Children and Family Services Budget the next time it is produced "goals" to accompany the outcomes which were included this time. 4. REQUEST the Health Services Director to explore funding options for health clinics at school sites and other cooperative programs with schools and report any progress back to the Family and Human Services Committee when he makes his next report to the Committee on these subjects. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARDCOM TTEE APPROVE OTHER SIGNATURESMARK DQ I ACTION OF BOARD ON A ROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS / I HEREBY CERTIFY THAT THIS IS A TRUE v UNANIMOUS(ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. �-a ATTESTED 0 • / ,5- Contact: PHIL ATCHELOR,CLERK OF THE BOARD OF cc: See Page 3 SUPERVISORS AND COUNTY ADMINISTRATOR BY DEPUTY 1 F&HS-01 5.' AUTHORIZE the members of the Family and Human Services Committee to sign a letter to those agencies with which the County contracts for human services emphasizing the importance of the County's receiving complete and accurate data on the services which are being provided through contract with the County so the Board of Supervisors has the information necessary to assure itself that the County is receiving the services for which it is paying, to be able to monitor the provision of those services and to undertake all necessary audits of those services. 6. REQUEST the County Administrator, Health Services Director, Acting Social Services Director, County Probation Officer and Community Services Director to report to the Family and Human Services Committee in September with reports on the status of Service Integration, the Policy Academy and Family Maintenance Organization, as well as each of the assignments made above. BACKGROUND: On April 25, 1995, the Board of Supervisors approved a number of recommendations from our Committee to follow-up on the issues of Service Integration, the Policy Academy, Family Maintenance Organization and the preparation of a Children and Family Services Budget for the 1995-96 fiscal year. On June 12, 1995, our Committee met at the North Richmond Service Integration site with staff from the County Administrator's Office, the Health Services Department, the Policy Academy and representatives from the schools. We received and reviewed the three attached reports and also received the Children and Family Services Budget for the 1995-96 fiscal year. Bill Weidinger presented his report on the status of the service integration sites. We are pleased with the progress which is being made with service integration and would just like to be kept advised of the status of the two sites and the related issues. In the absence of Mary Foran, Janine Smith summarized Ms. Foran's report on the Family Maintenance Organization. We are also pleased with the progress which is being made in this area and would simply encourage staff to continue to develop this concept and keep us advised of the status of the Family Maintenance Organization. Bev Jacobs from Public Health summarized Mark Finucane's report on health clinics in schools. We are very encouraged with the progress which is being made in the West Contra Costa Unified School District and with the exploratory talks which are underway in the Mt. Diablo Unified School District to establish a health clinic at one or another of the high school campuses. In some cases funding for these sites can be obtained by making the site a Medi-Cal eligible billing site. We are very excited at these developments and would like to see further progress in the coming months. Sara Hoffman from the County Administrator's Office presented the Children and Family Services Budget for the 1995-96 fiscal year and noted the status of work to assemble information on all services which are funded through contract agencies. We are very pleased with the initial Children and Family Services Budget effort. We would like to see some measurable goals added to the Budget the next time it is revised. We are also concerned that the private non-profit agencies with which the County contracts for services understand the vital importance of providing the County with all of the data we require in order to adequately monitor and audit what the County is receiving for the money we are providing these agencies. As a result, our Committee would like to support the efforts of the County Administrator's Office and Departments by writing to these agencies, lending importance to the need to provide the County with the data which has been requested. Initial responses from some of these agencies indicates some confusion regarding what was requested and some difficulty in providing data which will be comparable among all agencies. Finally, we would like to have additional status reports back from the County Administrator and Departments on these subjects in September so we can continue to assess progress in these vital areas. 2 F&HS-01 cc: County Administrator Health Services Director Public Health Director Mental Health Director Substance Abuse Program Director Acting Social Service Director County Probation Officer Community Services Director Sara Hoffman, Senior Deputy County Administrator Mary Foran, Director, Office for Service Integration, HSD Bill Weidinger, Coordinator, Service Integration Teams 3 Board of Supervisors County Administrator Contra Jim Rogers Costa fist District County Administration Building Jeff smith 651 Pine Street,filth FloorCounty o�nti 2nd District Martinez,California 94553-1229 Y (510)646-40$0 Gayle Bishop 3rd District FAX: (510)646-409$ SE L Mark DeSaulnier Phil Batchelor 4th District County Administrator f Tom Tortakson o 'S 5th District tpsr'� COU N June 5, 1995 TO; Supervisor Mark DeSaulnier Supervisor Jeff Smith Family and Human services Committee FROM; Bill Weidinger Program Coordinator Services Integration Team SUBJRCT: Progress Report on Service Integration Since the April 4, 1995 report, progress has been made in the following areas: Client Enrollment and Servings The Bay Paint and North Richmond teams are serving approximately 1400 families. The number of families sewed will remain at this level until the AB 1741 waivers are obtained and then the number of families served may eventually grow to 2800. our families are receiving services and benefits from the following programs: AFDC; Medi-Cal; Food Stamps; Juvenile Probation; Public Health Nursing; Child Welfare; GAIN; Mental Health and Alcohol/Drug Recovery. At the North Richmond site the Grandparent Group continues to grow and staff has made contact with the Senior Center in Richmond to share resources. Two members from the St. Vincent de Paul Society will be at our site for three days a week serving residents of North Richmond in a Job Training program. The team is looking forward to this working relationship. A benefit is that many of the persons seeking work, who are not currently eligible for the GAIN program, will be able to benefit from the program that St. 'Vincent's is operating. The North Richmond team also wrote supporting letters for two proposals: 1) Healthy Start Planning Grant for Peres School and a 2) Housing Authority proposal that will provide subsidized apartments with space for GAIN services and computer training. Last week Peres School was notified that their Planning Grant was funded and we will be meeting with this collaborative to share our experiences. The Housing Authority will be notified in late July regarding their proposal. The Ambrose Team continues their active involvement in the community_ Team members have helped with the Hay Point Clean-Up, sponsored by the Contra Costa County Conservation Corps; The Cinco de Mayo Celebration at Ambrose Park; The Teen Dance sponsored by the Ambrose Teen Council and staffed a SIT booth at the Pittsburg Community Relations Day. Team members are working with other agencies. in preparing for the Soul Food Festival and are volunteering their time in some of the summer youth activity programs. Meetings with the schools in Bay Point has increased the frequency and depth of communication and credit to the Healthy Start personnel needs to be given. Several of our case conferences have involved both the SIT and school personnel. Staffing Issues The staffing of the North Richmond team has experienced some difficult issues. The half time Recovery Counselor has been needed at his home department due to several vacancies that occurred there. The process for replacing him has begun and we hope to have this position filled shortly. The original Deputy Probation Officer accepted a permanent position elsewhere in her Department a month ago. The SIT position for Probation will be filled with a temporary DPO after the budget process plays out. The Child welfare position in North Richmond was filled at the beginning of June. The Social Services Department is making this position one that will be characterized with early intervention and prevention activities. The Probation position at the Ambrose site was made into a permanent position. However the person currently in this position is concerned that he.may be "bumped" out of this position if layoffs were to occur in his Department. Training Two all-day training sessions were held with both teams on May 24 and 31, 1995 . These sessions were a follow up to our large meeting on March 20, 1995 and addressed the issues of team building and case management. The case management training was particularly beneficial to staff and a further training on this issue is in the planning stages for possibly dune or early July. Additionally, if funding is permitted by the Departments, the teams will be attending the Second Annual Family Based Conference in Sacramento on June 19 and 20, 1995. This conference focuses on the family based approach to problem solving. The proposal to the Cowell Foundation for designing a comprehensive training program has been delayed by a month. The draft plan is very close to completion and will be circulated to the teams, the Services Integration Management Team(SIMT) , and the employee organizations for their input before the plan is finalized and submitted to the Cowell Foundation. Management Information System Several members of the SIT have been working diligently with members of the County's Data Processing Department for the past several months to design a MIS that will enable the teams to collect data, 'track progress and prepare needed reports(among many other things) . This work has led to the development of a prototype system. The issue now is securing funding to complete this MIS system. The estimate for the needed hardware and software, along with Data Processing staff time is close to $110, 000 .00. Meetings will be held with the fiscal staff from each of the Departments to determine a share of cost. Then the Social Services Department will submit an "Advance Planning Document" to the State Department of Social Services to seek reimbursement for a percentage of these costs. Employee Organizations On April 24, 1995 the employee organizations and management personnel met to discuss a number of issues that the SIT program has raised. we met again on June 5, 1995 and have scheduled another meeting for June 25, 1995 . 1741 Status The County Administrator's Office is in the process of speaking with various legislators to inform them of our county's plans for implementing AB 1741. Enlisting the legislators' support in helping us move our AB 1741 agenda with the State is important to the success of our efforts. Additionally the five AB 1741 counties have met twice since the last report to strategize how we can work together, share information and resources to further all our plans to implement A$ 1741 in our counties. In the May meeting of the SIMT, a "Proposal for a Financing Structure to Increase the Efficiency and Effectiveness of Service Delivery to Children and Families in Contra Costa County" was shared with the STMT. This proposal was the Master' s Thesis prepared by a graduate student who has been working closely with the SIT and the County Administrator's Office. This proposal suggests various strategies that may augment funding for the SIT. The SIMT will be discussing these strategies in detail at the June meeting. Our thanks to this graduate student. Additional Notable Items Mr. Batchelor and several Department Directors met with both teams in April. These meetings were truly appreciated by staff. SE_ L Health Services Department OFFICE OF THE DIRECTOR Office for Service Integration 597 Center Avenue, Suite 365 Martinez, CA 94553 .; _ j40 (510) 313-6254 ,.�� (510) 313-6708 - Fax ST'4_COUn To: Supervisor Mark DeSaulnier Supervisor Jeff Smith Family and Human Services Committee From: Mary Foran �ol--(%� f Director, Office for rvice Integration Date: June 7, 1995 Subject: PROGRESS REPORT ON PLANNING THE FAMILY MAINTENANCE ORGANIZATION When we last met with you in April, the FMO planning staff had identified close to final outcomes for the FMO and the criteria which would be used to develop options for the FMO framework of programs and services. Since that time, we'have made significant progress in defining what we believe to be the key functions, or building blocks, which will make up the initial pilot phase of the FMO. Proposed Framework for Further Development: The framework for the FMO incorporates the outcomes, priorities and parameters identified thus far, and is based on the following guiding premises: 1. Healthy relationships among all family members and the ability to cope with the stressors of daily living are fundamental to the health and well-being of all families. If any family member suffers from substance abuse, mental illness or is the perpetrator or victim of violence, is it probable that the entire family will be affected. 2. Health problems that occur during gestation and in the first years of a child's life can limit potential and future options. If a child is not healthy or not well cared for, he or she will have difficulty learning. If the child is unable to learn, as adult he or she will face immense obstacles in securing employment and housing and in being able to raise a healthy family of his or her own. A-3o6 Contra Costa County Progress Report on Planning the Family Maintenance Organization Page 2 June 7, 1995 3. The health system has limited opportunity to interact with adolescents as they tend to seek care only when there is a problem. School-based programs have much more opportunities to interact with teens on a regular basis. Any programs designed to address the issues of teens should be developed in conjunction with the schools, parents and teens themselves. Based on the above, and on all of the information compiled to date, we propose to examine how the following functions and services can form the first phase of the FMO: Infrastructure• ♦ Information and Referral: Staff and families alike need access to readily available, accurate information if they are to effect positive changes. The Help Desk, currently in testing and development through the Office for Service Integration, is a first step at making information available. Though the Help Desk is currently available only to staff on a phone-in basis, the FMO staff recommends that for the initial phase of the FMO that access be extended to all HSD staff and FMO enrollees by phone. On-line access for staff is recommended for future phases. ♦ Staff Development: Staff training and awareness is needed in the areas of cultural competency, access issues (barriers), brief intervention, strengths- based family assessment and screening for potential problems. ♦ Child Friendly Environments: Families with children need to feel welcome in our health care settings. Currently, Merrithew Memorial Hospital and Health Centers is purchasing equipment and supplies with funds donated by the Sega Foundation and the Forty Niners Foundation to set up child play areas in each of the ambulatory care health centers. For the FMO, we recommend that these areas be supervised, ideally by volunteers, so that parents can feel comfortable leaving their children on- site while they are seeking care for themselves, or other children or taking advantage of any of the FMO education and support programs. ♦ Transportation: Currently, assistance is made available to families through taxis and bus vouchers and the vans operating between the Health Centers and Merrithew Memorial Hospital. We recommend that these services be continued and expanded if necessary so that no family will go without 2 Progress Report on Planning the Family Maintenance Organization Page 3 June 7, 1995 needed care, or take an unnecessary ambulance trip, because of lack of transportation. Information on transportation access will be made available through Help Desk. Services: ♦ Health Promotion/Education: Health promotion and education can and should be provided in variety of ways and settings. Information should be culturally appropriate, supportive, build upon family strengths rather than highlighting weaknesses, and should be available to families within their own communities. FMO staff recommends expanding the education and health promotion capacities to promote appropriate utilization of resources, as well. Current services should be re-oriented to a family approach, and personalized, home-based approaches should be used whenever possible and appropriate. Below are the key methods we propose using to fulfill this function. ♦ Classes on psycho/social issues, which offer instrumental support (including skills building), on a wide range of family health issues. Class topics could range from parenting, temperament assessment, and disease management to fitness, nutrition and communication skills. ♦ Support groups on a variety of topics and issues (transitional support) for psycho/social and medical issues. Families will be connected to programs existing elsewhere, then additional capacity will be created as warranted, in both clinic and community-based settings. ♦ Outreach will be conducted to encourage families to enroll in a regular source of well-managed health care, to promote more appropriate utilization and to provide education and capacity building within the communities. ♦ Community Resource Development: FMO staff recommends as a start connecting people to existing community building resources. 3 Progress Report on Planning the Family Maintenance Organization Page 4 June 7, 1995 ♦ Warm Line: Phone-in "Warm Line" available to do brief assessment of problems, very brief counseling and connecting families to the most appropriate resources for their needs.. ♦ Child Health Screening/Child Development: Increase attention paid during child wellness visits to developmental issues. Include temperament assessment with follow-up education as the "hook." ♦ Intake, Assessment and Connection for Problem Situations: Ability to do immediate assessment as part of medical encounter. ♦ Intervention: Explore creation of an "Intervention Team" for family problems which would be cross trained in Domestic Violence; Alcohol, Tobacco and other Drugs; Child Abuse and Neglect; and Mental Health issues. ♦ Family Resource Center: Staffed library with educational materials, class sign ups, intake function and Help Desk in FMO suite of offices. Next Steps: In addition to presenting the preceding framework to the Family and Human Services Committee for review, we are presenting it for wide review within the Health Services Department, as well as to our Family, Program and Policy Advisors and Policy Academy members. It will undergo further refinement until we agree on the key elements for initial implementation. Then, the FMO staff will address the many implementation questions such as selection of a geographic site for the pilot; determination of which families to enroll; which HSD programs to build upon; how to sequence initiation of components; how the pilot will be funded and staffed, and how the success of the program will be evaluated. We hope this information gives you a sense of the complexity of the issues we are addressing and the progress we have made thus far. We look forward to hearing your reactions on June 12. Attachment: A. Proposed Final Outcomes MF:hf a7/FHSRFT,jur0une 7,1995 4 Attachment A FAMILY MAINTENANCE ORGANIZATION PROPOSED FINAL OUTCOMES Many health and human services change efforts are currently using outcome-based planning to measure the effectiveness of programs and financial investments. Outcomes describe the desired impact of services and/or systems. They are the results toward which prevention, early intervention and intervention activities are directed. Developing outcomes is not a new technique, but is re-emerging as a trend in planning health and human services. Outcomes are: ■ precise statements of specific results sought for children and families; ■ expressed as a condition, competency, or characteristic, of a family or child that is measurable in some relatively simple and direct fashion, or for which a reasonable proxy can be identified. FMO planning staff surveyed outcomes and indicators being used by other organizations and change efforts, including Healthy Families 2000, the Service Integration Teams, The State of Oregon Benchmarks and many others. From these, the staff developed a set of draft outcomes and indicators and then convened interdisciplinary work groups, comprised of County Health Services, Social Services, Housing and Probation Department staff, to review and refine the outcomes and identify indicators which could be used to measure whether the outcomes are attained. After reviewing the baseline data gathered to assess the magnitude of health and social issues on Contra Costa's families, the FMO planning staff refined and re-organized the outcomes into categories by age and related issues in recognition that different outcomes are needed and appropriate for the different stages of development. The outcomes, by group, and the health issues they attempt to address, are listed on the pages which follow. FAMILY COPING AND RESILIENCY 1. Healthy Family Relationships Background: The familial relationship is a dominant force contributing to the health status of both adults and children. Healthy relationships between all family members and the ability to cope with the stressors of daily living are fundamental to the health and well- being of all families. We recognize that parents, caregivers and children each can benefit from information, skills and support that will strengthen their ability to communicate effectively and support each other through life. Issues Addressed: Family functioning in areas related to the relationships between parent and child and between parents (or the parents and their partners). Outcome: ♦ Families are able to avoid the escalation of life challenges into more serious/additional problems through: • Identifying their needs 0 Connecting with available culturally appropriate resources • Creating & sustaining supportive community networks 2. Substance Abuse 3. Mental Health and Illness 4. Violence, Abuse and Neglect Background: The outcomes described below were developed to address issues which typically have an adverse effect on family functioning. They impact the not only the individual, but if not addressed, issues can escalate to the point where they affect the entire family and perhaps even the community. In addition, issues which affect family relationships often contribute to inappropriate use of medical resources. Issue Addressed: Mental health/illness/distress, domestic violence/partner abuse, Child abuse and neglect, Homicide and injury, substance abuse, smoking cessation. Outcomes: ♦ Persons with Substance abuse problems acknowledge these problems, seek appropriate help and make progress towards recovery. ♦ Families with a substance abusing member recognize the negative effects on the rest of the family, learn about options available to them and take action to strengthen themselves and the family. ♦ Families who are experiencing stress due to a family member with mental illness will know about resource options and strategies available to them and take action to strengthen themselves and the family. ♦ Individuals or families experiencing emotional distress or difficulty with the stresses of daily living will seek support in developing more successful coping strategies. ♦ Family members who are abusing or neglecting their partners or children, either verbally, sexually, emotionally or physically, acknowledge the problems, stop the behavior and develop new emotional management or parenting skills. 2 ♦ Adult family members who are being abused by their partners acknowledge the problem as abuse, take appropriate action to provide safety for themselves and their children and seek support. ♦ Children feel safe and supported and have a competent, caring adult in their lives. INFANCY AND EARLY CHILDHOOD 5. Healthy Infants (Prenatal - Age 2) 6. School Readiness (Ages 2 - 5) 7. School Success (Ages 5-11) Background: Health problems that occur during gestation and in the first years of a child's life can limit potential and future options. When a child is not healthy or well-cared for, and if the family does not possess adequate skills or support to encourage the child, the child may have difficulty learning and reaching full potential. Issues Addressed: Low birth weight, infant mortality, childhood injury (unintentional), asthma, anemia (malnutrition), dental decay/disease, child abuse and neglect, child development and developmental delays. Outcomes: ♦ Babies are born healthy and continue to grow and develop. ♦ Children are supported, encouraged and integrated into the educational system at a level appropriate to their physical, mental and emotional development. ♦ Children have the support and resources necessary to value and obtain a good education appropriate to their learning capacity. ADOLESCENT HEALTH AND BEHAVIOR 8. Responsible Adolescents (Ages 12-22) Background: Adolescents face many obstacles and pressures that directly affect their health and well-being. The health care system has limited opportunity to interact with adolescents as they tend to seek care only when there is a defined health problem. School-based and community-based programs have much more opportunities to interact with teens on a regular basis and thus are essential building blocks for designing interventions for teens. 3 Issues Addressed: Smoking initiation/cessation,substance abuse, mental health (suicide, depression),the"changing body" (puberty,hygiene),eating disorders,violence/homicide, chronic disease (promotion of good health and fitness habits), intentional and unintentional injury, teen births, STDs/AIDS/HIV Outcome: ♦ Adolescents consider options for their future and exercise responsible behavior and decision making. ADULT HEALTH 9. Chronic Disease Background: Many of the chronic health conditions affecting adults are preventable or at least manageable through effective education and support that encourages prevention and self-management of diseases. Additionally, successful self-management of chronic conditions may be more successful if efforts can be extended to the entire family so they can support behavior changes in the affected individual. Issues Addressed: Chronic disease, general health and fitness (good habits) Outcome: ♦ Families achieve and maintain optimal physical and oral health by: • Seeking and maintaining appropriate care • Recognizing their role and responsibility for self-care in the areas of chronic disease prevention, tooth decay and gum disease prevention, and communicable disease transmission. J S:FMOdisk#3:outcomes.Ist 4 Contra Costa County The Board of Supervisors HEALTH SERVICES DEPARTMENT OFFICE OF THE DIRECTOR Jim Rogers, 1st District Mark Finucane, Director Jeff Smith,2nd District aE-_S •.o� Gayle Bishop,3rd District -- =4,; 20 Allen Street Mark DeSaulnier,4th Districtof _ : • - Martinez, California 94553-3191 Tom Torlakson,5th District (510)370-5003 ,a County Administrator ��;¢.-_='`__ 4° FAX(510)370-5098 Phil Batchelor coSrA'cooy GPti County Administrator To: Supervisor Mark DeSaulnier Supervisor JefES 'th Family and HServices Committee A41/1 From: Mark Finucane Health Services Director Date: June 6, 1995 Subject: HEALTH CLINICS AT SCHOOL SITES This report is in response to the report from the Family and Human Services Committee of April 25, 1995, adopting as a Board of Supervisor's policy a goal of locating a health clinic at each school site in the county. The Health Services Department, Public Health Division currently operates a clinic at Richmond High School five half days a week. The services at the clinic include sports physicals, CHDP screening, hearing and vision testing, family planning examinations, sexual transmitted disease services and immunizations at no cost to students. It operates during the school year, Monday through Friday from 8 a.m. to noon. Students are referred to the Richmond Health Clinic or other appropriate facilities for illness care and contraception. The program was developed as part of Richmond High School's "Cities in Schools" initiative. The Public Health Division is also working with the Mt. Diablo Unified School District to develop appropriate school based health services for the Bay Point attendance area. Based on needs identified by parents and school personnel, we are developing a plan which will include such activities as child health/CHDP screening, sports physicals, immunizations, and health education on a range of child health issues. As our experience of developing these programs deepens we will be talking with other schools, particularly those developing Healthy Start programs. In pursuing the policy goal of bringing care and services to children at school, we are finding that each school Merrithew Memorial Hospital S Clinics Public Health • Mental Health • Substance Abuse Environmental Health Contra Costa Health Plan Emergency Medical Services • Home Health Agency Geriatrics A-345 (12/94) Supervisor Mark DeSaulnier Supervisor Jeff Smith Family and Human Services Committee June 6, 1995 Page 2 has different needs and priorities for health assistance. As we develop these plans with school personnel, we are examining together the range of health needs, as well as the available resources, in order to implement programs tailored to each school site. Please let me know if you would like any other information about these efforts. mpf:hf a7:hltdn.rep