HomeMy WebLinkAboutResolution - 4207 - Grant Application - Robert Wood Johnson Foundation - Increasing Immunizations - 07_22_1993Resolution No. 4207
July 22, 1993
Item # 18
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a grant
application and associated documents for the "All Kids Count" program of
the Robert Wood Johnson Foundation, attached herewith, which shall be
spread upon the minutes of the Council and as spread upon the minutes of
this Council shall constitute and be a part of this Resolution as if fully
copied herein in detail.
Passed by the City Council this 22nd
ATTEST:
Betty son, City -cretary
APPROVED AS TO CONTENT:
Uoug-Gooman,, Public
Adminisfr-Vnr
APPROVED AS TO FORM:
0
ive irs
Assistant City Attorney
DGV:de/AGENDA-D1/JHNSNFND.res
July 13, 1993
day of July , 1993.
DVLANGSTON,-MAYOR
Randy Neugebauer, Mayor Pro-Tem
THE
KOBERTWMD
JOHNSON
FOUNDATION
Request for Project Support
and
Conditions of Grant
Route i and College Road East
P.O. Box 2316
Princeton, NJ 08543-2316
(609) 452-8701
Title of Project:
The Texas Panhandle and South Plains All Kids Count Program
Purpose of Project: To implement a plan which will link the communities of this 38,000
square mile region to a computerized immunization network in an effort to lower the
incidence of vaccine -preventable disease and to raise the immunization rate of preschoolers
Applicant Institution (name, address, and telephone number): Check to be Made Payable to:
City of Lubbock Health Department
City of Lubbock
P.O. Box 2548
Lubbock, Texas 79408
Institutional Financial Officer (full name, title, address,
telephone number, and fax number):
Amount of Support Requested (total project period):
$506,975
Period for Which Support is Requested (total project period):
From 11101 / 9 3 Through 10131 / 9 7
Month Day Year Month Day Year
'Project Director (full name, title, address, telephone number,
and fax number):
Richard Kolas
Project Director
(806) 767-2942
(806) 762-5506 Fax
P.O. Box 2548
Lubbock, Texas 79408
(NOTE: Signature required on page 4)
Robert Massengale
Assistant City Manager/Financial Services
City of Lubbock
1625 13th Street
Lubbock, TX
(806) 767-2015
Applicant Institutional Approval (fun name, tale, and address of
official authorized to sign for institution):
David R. Langston, Mayor
City of Lubbock
1625 13th St. Lubbock, Texas
(806) 767-2009
(NOTE: Signature required on page
Applicant's tax-exempt status:
Before the Foundation can take final action on your proposal, we need evidence that your institution is currently either a
tax-exempt entity as described in Section 501(c)(3) of the Internal Revenue Code and not a private foundation as described
in Section 509(a), or an organization described in Section 170(c)(1) or Section 511(a)(2)(B).
These requirements will be satisfied by your providing the following:
If your institution is a tax-exempt organization as described in Section 501(c)(3) of the Intemal Revenue Code and
not a private foundation as described in Section 509(a), (1) a copy of the letter your institution received from the Internal
Revenue Service stating that your institution is exempt from taxation as described in Section 501(c)(3); (ii) a copy of
the letter your institution received from the Internal Revenue Service stating that your institution is not a private
foundation as described in Section 509(a); and (iii) a copy of Form 4653 or Form 1023 and other data, if any, your
institution has filed with or received from the Internal Revenue Service concerning your tax status.
If your institution is an organization described in Section 170(c)(1) or Section 511(a)(2)(B), (i) a copy of the
correspondence, if any, from the Internal Revenue Service stating that fact; or (ii) a copy of the legislation establishing
your organization.
These documents must be accompanied by a letter signed by a responsible officer of your institution certifying that the copies
so provided are true and correct copies of the originals on file with your institution and that they remain in full force and effect.
If your institution is not recognized as a tax-exempt entity, briefly describe its organization.
Any questions you may have about your tax-exempt status should be directed to the Office of the Vice President, General
Counsel and Secretary (609-243-5908).
'The project director is the individual directly responsible for developing the proposed activity, as implementation, and day -today direct supervision of the project should
funds be made available.
RWJF (05/93)
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CONDITIONS OF GRANT
Following are the conditions applying to grants made by The Robert Wood Johnson Foundation. You should
read these conditions carefully prior to signing this form. Your signature on this form constitutes your
acceptance in full of all conditions contained herein. To induce the Foundation to make the grant requested
hereby, the grantee accepts and agrees to comply with the following conditions in the event that such grant is
awarded.
1. PURPOSE AND ADMINISTRATION. The grant shall be used exclusively for the purposes specified in the
grantee's proposal, dated , the Request for Project Support Form on page 1 hereof,
and related documents, all as approved by the Foundation. In the event that the funds are not used for these
purposes within the time specified in the grantee's proposal or within any approved extension of said time
period, the funds shall be returned to the Foundation.
The grantee will directly administer the project or program being supported by the grant and agrees that
no grant funds shall be disbursed to any organization or entity, whether or not formed by the grantee, other
than as specifically set forth in the grant proposal referred to above.
Except as may otherwise be provided in Section 12 hereof, all copyright interests in materials produced as
a result of this grant are owned by the grantee. The grantee hereby grants to the Foundation a royalty -free,
nonexclusive, perpetual, and irrevocable license to reproduce, publish, copy, after, or otherwise use and
to authorize others to use any such materials for Foundation purposes.
2. USE OF GRANT -FUNDS.
A. No part of the grant shall 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].
B. No part of the grant shall be used to attempt to influence the outcome of any specific public
election or to carry on, directly or indirectly, any voter registration drive [within the meaning of
Section 4945(d)(2) of the Internal Revenue Code].
C. The grantee shall not use any part of the grant funds to provide a grant to an individual for travel, study,
or similar purpose except under procedures which have been approved in advance by the Secretary
of the Treasury or his delegate under Section 4945(g) of the Internal Revenue Code and without prior
written approval of The Robert Wood Johnson Foundation. Payments of salaries, other compensation,
or expense reimbursement to employees of the grantee within the scope of their employment do not
constitute "grants" for these purposes and are not subject to these restrictions.
D. No part of the grant shall be used for a grant to another organization without prior written approval of
The Robert Wood Johnson Foundation.
E. No part of the grant shall be used for other than religious, charitable, scientific , literary, or educational'
purposes or the prevention of cruelty to children or animals [within the meaning of Section 170(c)(2)(B)
of the Internal Revenue Code].
3. BUDGET. Expenditures of the grant funds must adhere to the specific line items in the grantee's approved
grant budget. Transfers among line items (increases and decreases) are restricted to one thousand dollars
($1,000) or ten percent (10%) of the approved line item amount, whichever is greater. If a transfer in excess
of this restricted level becomes necessary, the grantee shall promptly request authorization from the
Foundation by letter, giving full details. Such transfers may not be made without prior written approval by
the Foundation.
4. ACCOUNTING AND AUDIT. A systematic accounting record shall be kept by the grantee of the receipt and
disbursement of funds and expenditures incurred under the terms of the grant, and the substantiating
documents such as bills, invoices, cancelled checks, receipts, etc., shall be retained in the grantee's files
for a period of not less than four (4) years after expiration of the grant period. The grantee agrees to
promptly furnish the Foundation with copies of such documents upon the Foundation's request.
The grantee agrees to make its books and records available to the Foundation at reasonable times.
The Foundation, at its expense, may audit or have audited the books and records of the grantee insofar
as they relate to the disposition of the funds granted by the Foundation, and the grantee shall provide all
necessary assistance in connection therewith.
5. REPORTS. Narrative and financial reports shall be furnished by the grantee to the Foundation for each
budget period of the grant and upon expiration or termination of the grant. Such reports shall be fumished
to the Foundation within a reasonable period of time after the close of the period for which such reports
are made. The narrative report shall include a report on the progress made by the grantee towards
achieving the grant purposes and any problems or obstacles encountered in the effort to achieve the grant
purposes.
-3-
The financial report should show actual expenditures reported as of the date of the report against the
approved line item budget.
The Foundation may, at its expense, monitor and conduct an evaluation of operations under the grant,
which may include visits by representatives of the Foundation to observe the grantee's program procedures
and operations and to discuss the program with the grantee's personnel.
6. FOUNDATION USE OF DATA AND PUBLIC USE DATA TAPES. The grantee hereby grants to the
Foundation a nonexclusive, irrevocable, perpetual, royalty -free license to use and to license others to use
any and all data collected in connection with the grant in any and all forms in which said data are fixed,
as set forth in Section 1 hereof. If the box below is checked, the grantee shall, at no additional cost to the
Foundation, cause public use data tape(s) to be constructed (with appropriate adjustments to assure
individual privacy) in accordance with the specifications of the Inter -University Consortium for Political and
Social Research, University of Michigan, including the full tape documentation outlined in the Consortium's
current data preparation manual. Unless the Foundation shall otherwise specify, such public use data
tape(s) shall include all data files used to conduct the analysis under the grant. One computer -readable
copy of such public use data tape(s) and the tape documentation shall be transmitted to the Consortium
upon closure of the grant.
❑ Public use data tape(s) and full documentation required.
7. PUBLIC REPORTING. The Foundation will report this grant, if made, in its next Annual Report. The
Foundation does not usually issue press releases on individual grants; however, should it elect to do so,
it would be discussed with the grantee in advance of dissemination. The grantee may issue its own press
announcement, but shall seek approval of the announcement from the Foundation before distribution. In
addition, the grantee will be asked to review and approve a Program Summary briefly describing the
grantee's activity which will be used by the Foundation to respond to inquiries and for other public
information purposes.
The grantee shall send to the Foundation copies of all papers, manuscripts, and other information materials
which it produces that are related to the project supported by the Foundation.
In all public statements concerning the Foundation - press releases, annual reports, or other
announcements - grantees are specifically requested to refer to the Foundation by its full name: The
Robert Wood Johnson Foundation.
8. GRANTEE TAX STATUS. The grantee represents that it is currently either a tax-exempt entity as described
in Section 501(c)(3) of the Internal Revenue Code and not a private foundation as described in
Section 509(a), or an organization described in Section 170(c)(1) or Section 511(a)(2)(B). The grantee shall
immediately give written notice to the Foundation if the grantee ceases to be exempt from federal income
taxation under Section 501(c)(3) or its status as not a private foundation under Section 509(a) is materially
changed, or its status as a Section 170(c)(1) or Section 511(a)(2)(8) organization is materially changed.
The grantee agrees to apply the proceeds of the grant solely to exempt purposes specified in
Section 170(c)(2)(13) of the Internal Revenue Code.
It is expressly agreed that any change in the grantee's tax status or any use by the grantee of the grant
proceeds for any purpose other than those specified in Section 170(c)(2)(13) of the Internal Revenue Code
will terminate the obligation of the Foundation to make further payments under the grant.
9. CERTIFICATION REQUIRED WHEN GRANT MAY BE USED FOR RESEARCH INVOLVING HUMAN
SUBJECTS. If the grant is to be used in whole or in part for research involving human subjects, the grantee
hereby certifies that an institutional review board, which applies the ethical standards and the criteria for
approval of grants set forth in Department of Health and Human Services policy for the protection of human
research subjects (45 CFR part 46, as amended from time to time), has determined that the human subjects
involved in this grant will not experience risk over and above that involved in the normal process of care
and are likely to benefit from the proposed research program.
10. GRANT REVERSION AND TERMINATION. If the grant is intended to support a specific project or to
provide support for a specific period of time, any portion of the grant unexpended at the completion of the
project or at the end of the time period and any authorized extension thereof shall be returned to the
Foundation within fifteen (15) days.
The Foundation, at its sole option, may terminate the grant at any time if (i) the grantee ceases to be exempt
from federal income taxation under Section 501(c)(3) of the Internal Revenue Code; (ii) the grantee's status
as not a private foundation under Section 509(a) or its status as a Section 170(c)(1) or Section 511(a)(2)(B)
organization is materially aftered; or (iii) in the Foundation's judgment, the grantee becomes unable to carry
out the purposes of the grant, ceases to be an appropriate means of accomplishing the purposes of the
grant, or fails to comply with any of the conditions hereof.
If the grant is terminated prior to the scheduled completion date, the grantee shall, upon request by the
Foundation, provide to the Foundation a full accounting of the receipt and disbursement of funds and
-4-
expenditures incurred under the grant as of the effective date of termination. The grantee shall repay within
thirty (30) days after written request by the Foundation all grant funds unexpended as of the effective date
of termination and all grant funds expensed for purposes or items allocable to the period of time subsequent
to the effective date of termination.
11. LIMITATION; CHANGES. It is expressly understood that the Foundation by making this grant has no
obligation to provide other or additional support to the grantee for purposes of this project or any other
purposes. Any changes, additions, or deletions to the conditions of the grant must be made in writing only
and must be jointly approved by the Foundation and the grantee.
12. SPECIAL CONDITIONS. The grantee accepts and agrees to comply with the following Special Conditions
(if no Special Conditions are imposed, so state):
The foregoing conditions are hereby accepted and agreed to as of the date indicated.
Date: July 22, 1993 Grantee Institution:
Date: 0'711_ 51-15 3
By
(Signatur�of thorize�Offici�al)��
Randy Neugebauer for DAVID R. LANGSTON
Mayor Pro-Tenle: Mayor
By:
(Signature of Project Director)
THE
ROBEKTWCOD
JOHNSON
FOUNDATION
Request for Project Support
and
Conditions of Grant
Route f and College Road East
P.O. Box 2316
Princeton, NJ 08543-23 t 6
(609) 452-8701
Title of Project:
The Texas Panhandle and South Plains All Kids Count Program
Purpose of Project: To implement a plan which will link the communities of this 38,000
square mile region to a computerized immunization network in an effort to lower the
incidence of vaccine -preventable disease and to raise the immunization rate of preschoo
Applicant Institution (name, address, and telephone number): Check to be Made Payable to:
City of Lubbock Health Department City of Lubbock
P.O. Box 2548
Lubbock, Texas 79408
Institutional Financial Officer (null name, title, address,
telephone number, and fax number):
Amount of Support Requested potal project period):
$506,975
Period for Which Support is Requested (totai proieot period):
From 11/01/93 - Ttwough to/311g7
Month Dar Year Month Day Year
'Project Director MA Tama, till., address. telephone number,
and fax number):
Richard Kolas
Project Director
(806) 767-2942
(806) 762-55.06 Fax
P.O. Box 2548
Lubbock, Texas 79408
(NOTE: Signature required on page 4)
Robert Massengale
Assistant City Manager/Financial Services
City of Lubbock
1625 13th Street
Lubbock, TX
(806) 767-2015
Applicant Institutional Approval (bur name. oaa, and address of
official authorized to sign for IrmUtWon):
David R. Langston, Mayor
City of Lubbock -
1625 13th- St., : Lubbock, Texas
(8D6) 767-2009
(NOTE: Signatuwe required on page 4)
Applicant's tax-exempt status:
Before the Foundation can take final action on your proposal, we need evidence that your institution is currently either a
tax-exempt entity as destaned in Section 501(c)(3) of the Internal Revenue Code and not a private foundation as described
in Section 509(a), or an organization described in Section 170(c)(1) or Section 511(a)(2)(B).
These requirements will be satisfied by your providing the following:
If your institution is a tax-exempt organization as described in Season 501(c)(3) of the Internal Revenue Code and
not a private foundation as described in Section 509(a), (ij a copy of the letter your institution received from the Iritemal
Revenue Service stating that your insfrlution is exempt from taxation as described in Section 501(c)(3); (in a copy of
the letter your institution received from the Intemal Revenue Service stating that your institution is not a private
foundation as described in Section 509(a); and (iiij a copy of Form 4653 or Form 1023 and other data, if any, your
institution has filed with or received from the Intemal'Revenue Service concerning your tax status.
If your institution is an organization described in Section 170(c)(1) or Section 511(a)(2)(B), (Q a copy of the
correspondence, if any, from the Internal Revenue Service stating that fact; or (ii) a copy of the legislation establishing
your organization.
These documents must be accompanied by a letter signed by a responsible officer of your institution certifying that the copies
so provided are true and correct copies of the originals on file with your Institution and that they remain In full force and effect.
If your institution is not recognized as a tax-exempt entity, briefly describe its organization.
Any questions you may have about your tax-exempt status should be directed to the Office of the Vice President, General
Counsel and Secretary (609-243-5908).
*The project' director Is the 4dlvldual directly reepormble for developing the proposed activity. As lmplemerdatlom and day -loch y direct aupervislon of the project aruorrld
funds be made avaltable.
RWJF (05MM
-2—
CONDITIONS OF GRANT
Following are the conditions applying to grants made by The Robert Wood Johnson Foundation. You should
read. these conditions carefully prior to signing tttis form. Your signature on this form constitutes your
acceptance in full of all conditions contained herein. To Induce the Foundation to make the grant requested
hereby, the grantee accepts and agrees to compty with the following conditions In the event that such grant Is
awarded.
1. PURPOSE AND ADMINISTRATION. The grant shall be used exclusively for the purposes specified In the
grantee's proposal, dated , the Request for Project Support Form on page 1 hereof,
and related documents, all as approved by the Foundation. In the event that the funds are not used for these
purposes within the time specked in the grantee's proposal or within any approved extension of said time
period, the funds shag be returned to the Foundation.
The grantee will directly administer the project or program being supported by the grant and agrees that
no grant funds shall be disbursed to any organization or entity, whether or not formed by the grantee, other
than as specifically set forth in the grant proposal referred to above.
Except as may otherwise be provided in Section 12 hereof, all copyright interests in materials produced as
a result of this grant are owned by the grantee. The grantee hereby grants to the Foundation a royalty -free,
nonexclusive, perpetual, and Irrevocable license to reproduce, publish, copy, alter, or otherwise use and
-to authorize others to use any such materials for Fpundation purposes.
2 USE OF GRANT -FUNDS.
A. No part of the grant shag be used to carry on propaganda or otherwise attempt to influence legislation
[within the meaning of Section 4945(d)(1) of the internal Revenue Coft
B. No part of the grant shaft be used to attempt to influence the outcome of any specific public
election or to cant' on, directly or indirectly, any voter registration drive [within the meaning of
Section 4945(dX2) of the Internal Revenue Code].
C. The grantee shah not use any part of the grant funds to provide a grant to an individual for travel, study.
or similar purpose Except under procedures which have been approved in advance by the Secretary
of the Treasury or his delegate under Section 4945(g) of the Infernal Revenue Code and without prior
written approval of The Robert Wood Johnson Foundation. Payments of salaries, other compensation,
or expense reimbursement to employees of the grantee within the scope of their employment do not
constitute 'grants' for these -purposes and are not subject to these restrictions.
D. No part of the grant shall be used for a grant to another organization without prior written approval of
The Robert Wood Johnson Foundation.
E. No part of the grant shall be used for other than religious, charitable, scientific , literary, or educational*
purposes or the prevention of cruelty to children or animals [within the meaning of Section 170(c)(2)(B)
of the Internal Revenue Code].
3. BUDGET. Expenditures of the grant funds must adhere to the specific line items in the grantee's approved
grant budget. Transfers among tine items (increases and decreases) are restricted to one thousand dollars
($1,000) or ten percent (10%) of the approved fine hem amount, whichever is greater. If a transfer in excess
of this restricted level becomes necessary, the grantee shall promptly request authorization from the
Foundation by letter, giving fug details. Such transfers may not be made without prior written approval by
the Foundation..
4. ACCOUNTING AND AUDIT. A systematic accounting record shall be kept by the grantee of the receipt and
disbursement of funds and expenditures incurred under the terms of the grant, and the substantiating
documents such as bills, invoices, cancelled checks, receipts, etc., shall be retained in the grantee's files
for a period of not less than four (4) years after expiration of the grant period. The grantee agrees to
promptly furnish the Foundation with copies of such documents upon the Foundation's request.
The grantee agrees to make Its books and records available to the Foundation at reasonable times.
The Foundation, at Is expense, may audit or have audited the books and records of the grantee insofar
as they relate to the disposition of the funds granted by the Foundation, and the grantee shag provide all
necessary assistance in connection therewith.
S. REPORTS. Narrative and fnancW reports shall be furnished by the grantee to thb Foundation for each
budget period of the grant and upon expiration or termination of the grant. Such reports shag be furnished
to the Foundation within a reasonable period of time after the close of the period for which such reports
are made. The narrative report shall Include a report on the progress made by the grantee towards
achieving the grant purposes and any problems or obstacles encountered in the effort to achieve the grant
purposes.
The financial report should show actual expenditures reported as of the date of the report against the
approved line Item budget.
The Foundation may, at its expense, monitor and conduct an evaluation of operations under the grant,
which may Include visits by representatives of fhe Foundation to observe the grantee's program procedures
and operations and to discuss the program with the graMee's personnel.
6. FOUNDATION USE OF DATA AND PUBLIC USE DATA TAPES. The grantee hereby grants to the
Foundation a nonexclusive, Irrevocable, perpetual, royalty -free license to use and to license others to use
any and all data collected in connection with the grant in any and all forms in which said data are fixed,
as set forth in Section 1 hereof. If the box below is checked, the grantee shall, at no additional cost to the
Foundation, cause public use data tape(s) to be constructed (with appropriate adjustments to assure
Individual privacy) In accordance with the specifications of the inter -University Consortium for Political and
Social Research, University of Michigan, including the full tape documentation outlined In the Consortium's
current data preparation manual. Unless the Foundation shall otherwise specify, such public use data
tape(s) shall Include all data files used to conduct the analysis under the grant. One computer -readable
copy of such public use data tape(s) and the tape documentation shall be transmitted to the Consortium
upon closure of the grant.
- Public use data tape(s) and full documentation required.
7. PUBLIC REPORTING. The Foundation will report this grant, if made, in its next Annual Report. The
Foundation does not usually issue. press releases on Individual grants; however, should it elect to do so,
II would be discussed with the grantee in advance of dissemination. The grantee may issue its own press
announcement, but shall seek approval of the announcement from the Foundation before distribution. In
addition, the grantee will be asked to review and approve a Program Summary briefly describing the
grantee's activity which will be used by the Foundation to respond to inquiries and for other public
information purposes.
The grantee shall send to the Foundation copies of all papers, manuscripts, and other information materials
which it produces that are related to the project supported by the Foundation.
In all public statements conceming the Foundation - press releases, annual reports, or other
-announcements - grantees are specifically requested to refer to .the Foundation by its full name: The
Robert Wood Johnson Foundation.
& - GRANTEE TAX STATUS. The grantee represents that it is currently either a tax-exempt entity as described
in Section 501(c)(3) of the Intemal Revenue Code and not a- private foundation as described in
Section 509(a), or an organization described in Section 170(c)(t) or Section 511(a)(2)(B). The grantee.shall
immediately give written notice to the Foundation if the grantee ceases to be exempt from federal income
taxation under Section 501(c)(3) or its status as not a private foundation under Section 509(a) is materially
changed, or its status as a Section 170(c)(1) or Section 511(a)(2)(B) organization is materially chariged.
The grantee agrees to apply the proceeds of the grant solely to exempt purposes specified in
Section 170(c)(2)(B) of the Intemal Revenue Code.
- h is expressly agreed that any change in the grantee's tax status or any use by the grantee of the grant
proceeds for any purpose other than those specked in Section 170(c)(2)(B) of the Intemal Revenue Code
will terminate the obligation.of the Foundation to make further payments under the grant.
9. CERTIFICATION REQUIRED WHEN GRANT MAY BE'USED FOR RESEARCH INVOLVING HUMAN
-SUBJECTS. If the grant is to be used in whole or in part for research irnroWg human subjects, the grantee
hereby certifies that an institutional review board, which applies the ethical standards and the crderta for
approval of grants set forth in Department of Heatth and Human Services pofiq for the protection of human
research subjects (45 CFR part 46, as amended from time to time), has determined that the human subjects
involved in this grant will not experience risk over and above that involved in the normal process of care
and are likely to benefit from the proposed research program.
10. GRANT REVERSION AND TERMINATION. If the grant is intended to support a specific project or to
provide support for a specific period of time, any portion of the grant unexpended at the completion of the
project or at the end of the time period and any authorized extension thereof shall be retumed to the
Foundation within fifteen (15) days.
The Foundation, at Its sole option, may terminate the grant at any time ii h) the grantee ceases to be exempt
from federal income taxation under Section 501(c)(3) of the Intemal Revenue Code; (ii) the grantee's status
as not a private foundation under Section 509(a) or its status as a Section 170(c)(1) or Section 511(a)(2)(B)
organization is materially altered; or (III) in the Foundation's Judgment, the grantee becomes unable to carry
out the purposes of the grant, ceases to be an appropriate means of accomplishing the purposes of the
grant, or fails to comply with any of the conditions hereof.
If the grant is terminated prior to the scheduled completion date, the grantee shall, upon request by the
Foundation, provide to the Foundation a full accounting of the receipt and disbursement of funds and
-4-
expenditures incurred under the grant as of the effective date of termination. The grantee shall repay within
thirty (30) days after written request by the Foundation all grant funds unexpended as of the effective date
of termination and all grant funds expensed for purposes or Items allocable to the period of time subsequent
to the effective date of termination.
11. LIMITATION; CHANGES. It Is expressly understood that the Foundation by making this grant has no
obligation to provide other or additional support to the grantee for purposes of this project or any other
purposes. Any changes, additions, or deletions to the conditions of the grant must be made in writing only
and must be jointly approved by the Foundation and the grantee.
12. SPECIAL CONDITIONS. The grantee accepts and agrees to comply with the following Special Conditions
Of no Special Conditions are Imposed, so state):
The foregoing conditions are hereby accepted and agreed to as of the date indicated.
Date: July 22, 1993 Grantee Institution:
By: 11 ���
(Signature o uthorized OffimQ
Randy Neugebauer for DAVID R. LANGSTON
Mayor Pro-TemTitle: Mayor
111
)Date: 9 3 By: _ t
(Signature of Project Director)
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
SUBMITTED TO:
THE ROBERT WOOD JOHNSON FOUNDATION
NATIONAL PROGRAM OFFICE
THE TASK FORCE FOR CHILD SURVIVAL AND DEVELOPMENT
ONE COPENHILL
ATLANTA, GEORGIA 30307
SUBMITTED BY:
CITY OF LUBBOCK HEALTH DEPARTMENT
P.O. BOX 2548
LUBBOCK, TEXAS 79408
ADMINISTRATOR: R. DOUG GOODMAN
(806) 767-2900
PROJECT DIRECTOR: RICHARD KOLAS
(806) 767-2942
DATE OF PROPOSAL: JULY 30, 1993
REQUESTED FUNDING: $506,975
IQM
SIGNATURE:
Randy Neu auer, yor ro-
DAVID R. LANGSTON, Mayor
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
SUBMITTED TO:
THE ROBERT WOOD JOHNSON FOUNDATION
NATIONAL PROGRAM OFFICE
THE TASK FORCE FOR CHILD SURVIVAL AND DEVELOPMENT
ONE COPENHILL
ATLANTA, GEORGIA 30307
SUBMITTED BY:
CITY OF LUBBOCK HEALTH DEPARTMENT
P.O. BOX 2548
LUBBOCK, TEXAS 79408
ADMINISTRATOR: R. DOUG GOODMAN
(806) 767-2900
PROJECT DIRECTOR: RICHARD KOLAS
(806) 767-2942
DATE OF PROPOSAL: JULY 30, 1993
REQUESTED FUNDING: $506,975
SIGNATURE:
Randy Neugebauer, Mayor DAVID . LANGSTON
Pro-Tem
for
Resolution No. 4207
July 22, 1993
Item # 18
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
TABLE OF CONTENTS
Acknowledgement.........................................Pg. i
Executive Summary.......................................Pg. 1
Project Narrative.......................................Pg. 2 - 29
Goals and Objectives....................................Pg. 25
Work Activity Plan Timeline.............................Pg. 26 - 27
Work Activity Plan......................................Pg. 28 - 29
Budget and Budget Justification .........................Budget 1 - 31
Immunization Survey Results .............................Al
Questionnaires..........................................A2 - A4
Letters of Support......................................B1 - B8
Certification of Public Status ..........................C1 - C9
We gratefully
acknowledge the
assistance and
expertise of all the
following task force
members:
laronda Albert
Jacinto Alderete
Janie Ammons, School
Nurse
Daphne Ashburn
Karen Baer, RN
Nolan Saggett
Linda Kay Baker
Renee Ball
Judy Barrett
Lupo Benavides
Linda Benge
Amparo Berena
Claudia Blackburn,
Administrator
Mary Blanch
Jim Bone, CEO
Louise Boothe
Amber Boswell
Barbara Bouton, RN
Jim D. Brown, County
Judge
Lisa Buck
Mary Jane Burrus
Danny Buyers
Diana Cabezulo
Kathy Caldwell
Patsy Camunes
Roberta Cantrell
Sally Carmen
Bob Carson
Billie Caviel
Angie Cervantes
Joan Chapman
Barbara Cheyne, School
Nurse
James Childers, M.S.
Chuck Clark
David D. Clark
Gardner CoUint
Dorothy Conlon
Vickey Cooper
Phil Cotham, Principal
Ronald Crown
Maria Cruz
Rose Marie Davis, RN
Lynda Day
Jerry DeSha, Program
Manager
Dean Decker, County
Judge
Linda Dodson, RN
Barbara Dorman, RN
Esther Dorman,RN
Donna Dunigan
Ruth Elliott, RN
Kay Ewing, RN
Paulette Foster, School
Nurse
Debra Frankhouser
Barbara Freid
Brenda Frttch
Denice Gabor, School
Nurse
Janie Gerow
Chris Gikas, Mayor
Diane Gillit, Associate
Director of Health Services
Nathan Goldstein III, MD
Doug Goodman, Health
Director
Arlene Guccione, Director
of Preventive Medicine
Deborah Guinn, RN
RoH Habersang, MD
E. Oren Hamilton,
Superintendent
Patty Hamm
Frays Hammons, RN
Kaia Hawley
Herbert Hawley, County
Commissioner
Kahtleen Hennessey, Ph.D
Stephen Henry
Patty Hensley
Ray Hightower
Bobble Hid
Madle Holland, RN
Jeanne Howard
Geneva Hunter,
Administrator
Nila Hunter, School Nurse
Ken Jackson, PAC
Diane Johnson, RN
Vicki Johnson, RN.,
M.S.N.
Rise Jones
Billie Jordan, RN
Millie Kantner
Michael J. Keller,
Administrator
Grace Killough, RN
Carol King, Director
Francis Kirby
Kelvin Knsuf
Joan Knox, School Nurse
Retta Knox, School Nurse
Carol Lantz, RN
LuLu Lehman
Adele Lopez
Edna Lumas
Dana Madison
Sharon Mallory, RN
Wallace Marsh, M.D.
Mary Martinez, School
Nurse
Dens Matthews
Erueda Mays
Joan McClellan, RN
Mary Ann Mehta, RN
Frances Miller, School
Nurse
Luella Miller
Roma Miller, RN
Lavada Mills, School Nurse
James Keith Morgan, M.D.
Nina Morris, County
Commissioner
Alice Morton
Marcia Muir
Judy Mullins, LVN
Marie Mullins
Elaine Muntle
Galissa Murry
Pat Murry
Ken Oiler
Maria Ortega, School
Nurse
Cara Phelan
Margie Pinkerton, RN
Alma Ptttenger
Dale Pittman
Tracy Pool
Janet Porterfield
Charlene Poteat
Suzanne Presson
John Ouimby, Coordinator
of Special Services
Floria Ramirez
Jill Rasberry
Ruby Biggins, LVN
Lori Riveria
Marjorie Robinson
Shirley Roggow
June Rudd
Mary Salsa, School Nurse
Antonio Santiago, M.D.
Audrey Sanzoters
Yvonne Schue
Bob Shaffer
Gwyn Shannon, RN
Martta A. Sheehan, M.D.
Polly Simpson, County
Judge
Peggy Skinner, Ph.D
Rebecca Smallwood, RN
Frances T. Smith,
Administrator
Glands Smith
Pam Smith
Sandra Stabeno, School
Nurse
Nancy Stone
Debbie Sullivan, School
Nurse
Deborah Summers
Windy Swarb
Karen Tate
Tins Thomas
Bid Thomas
Liz Tipps, RN
Jane Tustin, RN, MSN.,
CSN.
Gloria Valdez, RN., BSN
Kaye Vidalia, School
Nurse
Mary Von Winkle
Juanita Veasage
Sharon Wadley, RN
Diane Wallace
Lois Walton
David Weil, Assistant V.P.
Judy Whelsenant
Doug Whipkey
D.L. Wilson, Program
Manager
Karen Workman
Virginia Yarbrough
Staff:
Audre Bed
Corbin Pemberton
Vicente Ramirez
Danish Wilson
1
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
EXECUTIVE SUMMARY
Lead Agency: City of Lubbock Health Department
P.O. Box 2548
Lubbock, Texas 79408
(806) 767-2900
Administrator: R. Doug Goodman
Project Director: Richard Kolas
Area to be Served: Region 2 of the Texas Department of Health (the
Panhandle and South Plains of Texas)
AMOUNTS ARE COMULATIVE FOR ALL FOUR YEARS
Amount Requested from the Robert Wood Johnson Foundation ...... $506,975
In -kind Provided by City of Lubbock
(10% of 2 city employees' salary and fringe): .................................. 34,575
Texas Department of Health and other foundations: ........................ 649,518
TotalIn -Kind Support .................................................................. 684,093
Total Amount Needed for Project: ........................................... $ 1,068
Subcontractor: Texas Department of Health, Region 2
Canyon, Texas
An estimated 30,000 children in the Texas Panhandle and South Plains are not up-to-date
on their immunizations. Should a disease such as measles, Haemophilus influenza type b, or
any of the other seven vaccine -preventable disease gain a foothold in this region, the
disease could spread rapidly through the infant and toddler population.
Thus, the Texas Panhandle and South Plains All Klds Count Program will electronically link
over 100 public and private healthcare providers who administer vaccines in this 41 county
area. This computer system will monitor the immunization status of children ages two and
under in an effort to lower the rate of vaccine -preventable disease and increase the
immunization rate.
A combination high-tech low -tech plan was developed to accommodate the needs of all
providers and other users of the system. Healthcare providers will be provided with
computer hardware and/or software with the capacity to electronically transfer data to and
from a central database. The immunization software and the network is generic and user
friendly to meet the needs of all 219 communities in the region.
Another method of transferring data will entail exchanging diskettes via courier, mail or
other means. The provider will have the option of which method to use. This method will
also be in place as a back-up. The central database will be located at the Texas Department
of Health, Region 2 office in Lubbock.
Interested public and not -for -profit providers will be linked to the system during the first two
years. Private providers will be connected the third and fourth years.
11. OVERVIEW OF THE STUDY
Pgrgose
Over 58,200 children age 4 and under live in a 38,000 square mile area (Table 1) which
is relatively underserved by physicians, nurses and other health care professionals. Due to
the lack of health care services in many areas and the low immunization rates in the region,
the Texas Panhandle and South Plains All Kids Count staff, the Texas Department of Health,
and the 14 task forces conducted four studies to determine:
1. Regional immunization rates
2. The availability of healthcare services
3. Accessibility to healthcare services
4. The technical aspects of a database network.
The fundamental reason for conducting these studies was to determine the state of
health care services available to children and gauge the necessity and feasibility of a
computerized system to monitor children's immunizations.
The immunization survey verified statistically what was believed to be an unusually low
rate. Using this rate as a basis for future studies, we will be able to gauge more accurately
the success of the combined immunization promotion efforts.
An assessment of needs and a provider survey were conducted in order to determine the
existing gaps in children's health care services. The expansiveness of this rural area, is a
contributing factor to this regions low immunization rate.
A comprehensive study to develop a computerized database network to monitor and
track childhood immunizations concluded that a technically feasible, cost effective system
could be developed and implemented within a reasonably short time frame. This network
would link participating private and public healthcare providers who provide immunizations
within this region.
Task Force
The 176 members on the 14 task forces, representing 153 agencies and organizations,
were instrumental in the planning process. The task forces were formed to give input
relative to the needs and to service availability in communities throughout the region. These
members also assisted in the distribution and collection of needs assessment and provider
2
TABLE 1
SERVICE AREA AND POPULATION
REGION 2
Pop.
Pop.
COUNTY
Population
< age 5
COUNTY
Population
< age 5
Armstrong
2,021
124
Bailey
7,064
564
Briscoe
1,971
129
Carson
6,576
466
Castro
9,070
863
Childress
5,953
340
Cochran
4,377
367
Collingsworth
3,573
235
Crosby
7,304
586
Dallam
5,461
458
Deaf Smith
19,153
1,831
Dickens
2,571
139
Donley
3,696
182
Floyd
8,497
742
Garza
5,143
404
Gray
23,967
1,612
Hale
34,671
3,139
Hall
3,905
226
Hansford
5,848
450
Hartley
3,634
234
Hemphill
3,720
277
Hockley
24,199
2,067
Hutchinson
25,689
1,843
King
354
24
Lamb
15,072
1,121
Lipscomb
3,143
218
Lubbock
222,636
16,938
Lynn
6,758
556
Moore
17,865
1,689
Motley
1,532
84
Ochiltree
9,128
757
Oldham
2,278
136
Parmer
9,863
897
Potter
97,874
8,742
Randall
89,673
6,566
Roberts
1,025
70
Sherman
2,858
215
Swisher
8,133
676
Terry
13,218
1,136
Wheeler
5,879
350
Yoakum
8,786
758
Source; U.S. Bureau of Census,1990.
questionnaires. They served to increase awareness in their respective communities and to
gain the interest and support of the public and private health care providers. Though the
majority of the task force members were health care professionals, many were
representatives of municipal and county governments, state agencies and educational
institutions. Without their interest, information, advice and leg work, our objectives could
not have been achieved.
Immunization Survey
The Texas Department of Health, Region 2, Communicable Disease Division, conducted
a retrospective immunization survey in public schools throughout the Texas Panhandle and
South Plains (Appendix A-1). Reviewing the immunization documents of kindergartners,
investigators were able to determine the rate of immunizations for each age appropriate
series. The fourth series is recommended by TDH at 15 months, while some private
physicians administer this series at 18 months. So, the investigators focused on those
children age 19 months and found the rate to be as low as 4% in some areas and as high as
54% in another area. The average rate for two year olds is 38%. Nevertheless, all rates
were low. The purpose of this study, though retrospective in nature, is to give us an idea of
the overall rate of immunizations in the region and to prepare a proper course of action
(Table 2).
Needs Assessment
The purpose of the needs assessment was to gauge the actual or perceived services
available throughout the region, and more importantly, on a county by county basis. This
information was also used to target the population needing immunizations. The actual
services available were determined from questioning the respondents as to where children
received immunizations and medical care. The respondents perception of available services
is equally important. If people are unaware of services, then as far as they are concerned,
those services do not exist. The needs assessment questionnaire was given to parents of
young children at a variety of public and private institutions (Appendix A-2 and A-3).
Daycare facilities, public schools, churches, clinics and homeless shelters were among
those targeted in all 41 counties. The return rate for these instruments was in excess of
3
TABLE 2
IMMUNIZATION RATES FOR SELECTED COUNTIES
Pop.
% delinquent
# children
% delinquent
# children
COUNTY
< age 5
at 19 months
at risk
at 24 months
at risk
Bailey
564
64.0%
361
44.0%
248
Castro
863
80.0%
690
72.0%
621
Crosby
586
80.0%
469
64.0%
375
Deaf Smith
1,831
88.0%
1,611
72.0%
1,318
Floyd
742
84.0%
623
76.0%
564
Gray
1,612
76.0%
1,225
64.0%
1,032
Hale
3,139
88.0%
2,762
82.0%
2,574
Hansford
450
80.0%
360
64.0%
288
Hockley
2,067
76.0%
1,571
32.0%
661
Hutchinson
1,843
74.0%
1,364
62.0%
1,143
Lipscomb
218
96.0%
209
80.0%
174
Lubbock
16,938
68.0%
11,518
55.2%
9,350
Moore
1,689
88.0%
1,486
72.0%
1,216
Ochiftree
757
80.0%
606
60.0%
454
Parmer
897
78.6%
705
57.1 %
512
Potter/Randall
15,308
70.3%
10,762
59.4%
9,093
Swisher
676
96.0%
649
76.0%
514
Terry
1,136
45.5%
517
45.5%
517
Sources: U.S. Bureau of Census, 1990.
TDH Region 2 Immunization Survey, 1993.
68%. One important aspect derived from this study is that 66% of all respondents go to a
public health clinic for immunizations.
Providers Survey
Questionnaires were distributed to over one thousand health care providers, both public
and private, within Region 2 to determine who provided health care services for children,
whether immunizations were administered and where these providers were located. This
survey was also interested in the amounts charged to patients for vaccinations and the
types of payment accepted for services. Also evaluated was the interest of providers in
administering immunizations if vaccine supplies were made available at no charge. The
providers were also asked if they would be interested in being linked to a network to track
and monitor children's shot records (Appendix A-4).
The Network
The planning process was multi -phasic, concentrating on the following factors:
1. Networking
2. Assessing Needs
3. Assessing available services
4. Education
The technical aspect of the network planning and design was contracted to Kathleen
Hennessey, Ph.D., Director of the Institute for Studies of Organizational Automation, Texas
Tech University. Dr. Hennessey and her team, after a six-month study of the constraints,
alternative and technical possibilities involved, designed a system which will accomplish five
major tasks:
1. Provide health care workers with information about children under
age 2 who are to be immunized.
2. Acquire and disseminate information about each injection given.
3. Index immunization records.
4. Provide current information to designated health care professionals
with adequate safeguards to ensure protection of privacy and
confidentiality.
4
5. Accommodate varied environments.
In addition, the system has to be able to link to information systems being developed in
other areas of Texas, state-wide facilities, and national initiatives --none of which have been
finalized. Of particular importance are:
1. ICES, a database program purchased by the Texas Department
of Health which includes an immunization record management
facility.
2. The Center for Disease Control's draft proposal for
immunization record interchange protocol issued in January 1993.
3. Current manual recording of immunizations by means of the Texas
immunization record card.
The design team determined that an inexpensive information system could be developed
and implemented quickly. The system could be fairly easily integrated with and/or
transitioned to other systems by following the CDC protocols.
ADVISORY COMMITTEE
Two advisory committees were formed to provide the best representation possible for
this region. One committee represented 21 counties in the Panhandle, the other, 20
counties in the South Plains. These committees are composed of representatives from the
seven task forces in each area. These individuals, representing the public and private
sectors, health care and government, are experienced in the areas of planning and
budgeting. These committees brought together all of the challenges, problems, suggestions
and ideas from their respective areas. They then analyzed and synthesized into solutions all
of the information at their disposal.
III. DESCRIPTION OF SERVICE AREA
The South Plains and Panhandle region of Texas covers a land area of approximately
38,000 square miles, which is 5,000 square miles more than that contained in the combined
states of New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. This
vast region is predominantly grassland prairies and rangelands. The major industries of this
region are ranching, farming, oil and natural gas exploration. This area of Texas is one of
the largest cotton producers in the United States.
5
The Panhandle and South Plains region is an area of small communities which rely on
each other for survival. There is a large amount of travel from one community to the next.
People shop in one town, meet in another, attend church in another, recreate in another,
visit friends and family in still other towns. Most people in this region are quite used to
driving 100 miles for a Saturday visit or shopping trip. During the fall football seasons, fans
follow their high school teams all over the region to attend the games. Migrant farmworkers
are a traditional part of life in the farming and ranching communities. Many people follow
the crops, spending a few weeks in one location then moving on to another. This accepted
mobility of the people in the region effects both the immunization rates of local areas as well
as the spread of vaccine -preventable disease.
The population of this large region is three quarters of a million people, only 4% of the
entire population of Texas (Table 3). There are only two cities in the region which have
populations close to 200,000, Lubbock and Amarillo. The majority of the region is
composed of small towns and rural communities which are located 20 to 50 miles from one
another. The average poverty rate of the region is high, 26%. Ten of the twenty poorest
counties in Texas are located in this 41 county region. Twenty-two percent of the region is
Hispanic, while 5% is African American, and 71 % is Anglo. In Lubbock, as in the remainder
of the region, the fastest growing segment of the population is the Hispanic population.
According to the Comprehensive Housing Affordability Strategy (CHAS) recently submitted
by the City of Lubbock, the annual population growth for the City of Lubbock is .5%. The
annual population growth for the Hispanic population in Lubbock is 3.5%, while that for the
African American community is 1.2%.
This large, poor, rural area is relatively underserved by physicians, nurses, and other
health professionals. Four of the forty-one counties have no patient care physicians located
within the county. Thirteen counties have no Texas Department of Health licensed hospital,
while 13 additional counties have only one hospital with 50 or less licensed beds. Four
counties have had one or more hospitals closed in the last decade. The majority of the
hospitals in the region are small (less than 50 beds) and have a low occupancy rate (average
41 %). The major hospitals in Lubbock and Amarillo have been instrumental in keeping
several small hospitals open by "adopting" the hospitals, helping both financially and with
6
TABLE 3
REGION STATISTICS
TOTAL POPULATION, REGION 2
TOTAL POPULATION, < AGE 5, REGION 2
TOTAL SQUARE MILES, REGION 2
TOTAL POPULATION OF TEXAS
PERCENTAGE OF POPULATION OF TEXAS IN REGION 2
734,138
58,211
38,000
16,986,510
4%
TOTAL NUMBER OF VACCINE -PREVENTABLE DISEASE IN REGION 2 IN 1992 119
PERCENTAGE OF PRESCHOOL CHILDREN NOT FULLY IMMUNIZED AT AGE 2 61%
TOTAL NUMBER OF CHILDREN AT RISK AT AGE 2
30,654
TOTAL NUMBER OF CHILDREN AT RISK AT AGE 19 MONTHS 37,488
staffing. It is the cooperation among the medical entities in the Panhandle and South Plains
which assures the best possible medical coverage for the most people.
With large areas of Region 2 designated as physician manpower shortage areas (Table 4)
much of the work involved with preventive medicine, including the administration of
vaccines, falls on the shoulders of the Texas Department of Health Region 2 clinics. These
clinics and their satellite clinics, primarily staffed by the nurses acting under standing orders,
are located in 28 of the 41 counties (Table 5). A large number of these clinics are only
open a few days each week or each month; this creates a barrier to service for the rural
patient with inadequate transportation.
Case of Vaccine -Preventable Disease
The incidence of vaccine -preventable diseases in this region has been high during the
past several years, especially in proportion to our population. In 1989, 11 % of all the
measles cases in Texas were reported in our region (335 out of 3313), which consists of
only 4% of the population of Texas. The region has experienced an outbreak of vaccine -
preventable diseases in 1992 with 109 mumps cases, 2 measles, 7 pertussis and 1
Haemophilus influenza type b. Lubbock experienced 16 of the 109 cases of mumps. When
compared to the population the rate of infection for mumps is 7.1 per 100,000. The State
rate is 2.2. Three of the seven cases of pertussis were reported in Lubbock, the rate of
infection here is 1.3, compared to the state rate of 0.9 per 100,000. As of April 1993
there have been 5 confirmed cases of mumps.
IV. SURVEY RESULTS
Immunizations
The Texas Department of Health recently completed a retrospective survey of
immunization rates within Public Health Region 2. The study focused on the immunization
records of kindergarten students from 35 schools. The investigators noted the age at which
each series of vaccine was to have been administered. According to the findings, this
region's immunization rate, for infants to 19 months old, is 25%, the lowest in Texas.
Some areas within this region are as low as 4%, while the highest rate is 54%. Lubbock's
rate is 32%, while that of Amarillo is slightly lower at 30%. The average rate for two year
7
PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE
AREA DESIGNATIONS
FOR TEXAS DEPARTNiENT OF HEALTH REGION 2 -- SEPTEMBER 1991
Entire County
Subcounty:Portion of Geographic Area
`.-. Subcounty:Population Group
Texas Dept. of Criminal Justice Unit
Combination of Subcounty (both geographic
area and population group) and Facility
• Amarillo
,► Lubbock
Reproduced from map prepared by Texas Department of Health, Health Professions Resource Center,
Bureau of State Health Data and Policy Analysis
Source:Bureau of Health Care Delivery and Assistance, U.S. Department of Health and Human Services
Office of Strategic Planning and Program
t. Texas Tech University Health Sciences Center
Texas Department of Health - Region 2
Table 5
0 PHR 2 Office/Clinic Site
E] Satellite Clinic
olds in the entire region is 38% (Appendix 1). This study shows that the problem touches
all areas of the region, regardless of geographic dispersion, income or ethnicity.
Needs Assessment
Out of 5000 needs assessments distributed, approximately 3500 surveys were returned.
Because the response was so large, we believe these results are representative of the entire
region. Thirty percent stated that there is no doctor's office in their community, 37%
reported having no clinic, and 28.5 stated there is not a hospital in their area (Table 6).
Over eighty-five percent of those surveyed replied that they took at least one of their
children to a doctor's office or clinic in 1992 (Table 7). These same respondents listed up
to five responses as to the nature of those visits. The three most frequent responses were
immunizations (75%), injury (30.6%), and checkup/physical (30.1 %) respectively (see table
8).
The needs assessment also shows that 65.5% of the respondents take their children
to public health clinics for immunizations, while only 25.2% visit private practitioners for the
service (Table 9). Of those visiting public clinics, 47% reported earning less than $15,000
annually (Table 10). Almost half of public clinic patrons are Hispanic, while 39% are Anglo.
African -Americans comprise 7% of those utilizing the services of public clinics (Table 11).
Respondents were also asked to list their perceived barriers to service. Cost is the most
frequent response in both rural and metropolitan areas. Lack of transportation is frequently
cited as a barrier in Amarillo and Lubbock. Convenience and location are the most frequent
responses in the outlying areas.
A major concern were the responses regarding insurance coverage of the
respondents children. One-third of those who responded indicated their children were not
covered by any type of insurance. Twenty-six percent said their children were covered by
medicaid (Table 12).
Providers Survey
To ensure that the results of this study were not skewed, surveys were distributed
to every healthcare provider in Public Health Region 2. Over 1000 surveys were distributed,
and 366 were returned. Of those responding, 60% stated that they provide healthcare
services for children. The number that administer immunizations is much lower at thirty-
8
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REGION 2
HOSPITAL CLINIC SOC.SERV.ASST.
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REGION 2
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REGION 2
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NEED ASSESSMENT SURVEY-1 993
Region 2
GROUP INDIGENT CARE HMO OTHER
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nine percent. The number of immunization providers in rural areas is sixty-eight, thirty-two
of which are public entities. In the metropolitan areas, the number of immunization
providers is sixty-three, only eleven of which are public clinics.
According to the returned surveys, there is great variance in the number of
immunizations administered monthly between private pediatricians, family and general
practitioners on the one hand and public providers on the other. Depending on the time of
year, public clinics may out -pace their private counterparts by a five -to -one ratio. Another
variance is that many private providers charge in excess of six times the amount collected
by public clinics.
For those providing children's health services other than immunizations, the cost to
supply vaccine is cited most frequently (32%) as a reason for the exclusion of the service.
Twenty-eight percent state that inadequate staffing or not being set up for the service
prevents them from offering vaccinations. One in four claim that immunizations are not
related to their field of speciality. Only sixteen percent say liability issues prevent their
offering the service (Table 13). Twenty-six providers are interested in offering the service if
the vaccine is supplied free of charge.
Of those providers offering immunizations, more than eighty-five percent are willing
to be linked into our tracking system. Another seventeen, who are interested in
administering the service once free vaccine becomes available September 1, 1993, are
willing to be linked as well. Others interested in linking into the tracking system include
numerous schools.
V. SERVICE AVAILABILITY
To gauge the gaps and barriers that perpetuate low immunization rates, we are
relying on the knowledge of the healthcare professionals that constitute our advisory
committees as well as information from our needs assessment. Both the advisory
committee and the survey verified previous beliefs concerning the availability of services.
Because the region is so vast, gaps in the system exist such as several counties
lacking healthcare facilities. Seven counties are served only by TDH satellite clinics. These
clinics, which are held once a week or sometimes only once a month, are often located in
church basements or barns. Many times there is no electricity available which can limit
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REGION 2
LIABILITY LACK OF STAFFING
REASONS IMMUNIZATIONS NOT GIVEN
evening clinics during autumn and winter. Time constraints, location and frequency of
services are among the barriers that prevent the satellite clinics from fully serving the
intended population.
Other gaps exist primarily in the larger cities. While healthcare services are more
readily available here, the number of family practitioners and pediatricians that provide
immunizations is surprisingly low. Both the high cost of purchasing vaccine and the liability
issues involved with administering the service are cited as reasons why so few providers
give immunizations. Because of this, many parents must take their children to one location
to receive primary care and to another for vaccinations.
City dwellers, who do not share the same mentality that their rural counterparts do,
are discouraged by the prospect of driving ten to fifteen miles across town to receive
healthcare. According to the needs assessment, those respondents living in the larger
cities mentioned that transportation and location were primary barriers. There is also a
stigma attached to public clinics in the larger cities. When offered rain checks for free
immunizations at the Lubbock Health Department, residents of Southwest Lubbock refused.
One reason frequently offered was that the health department was too far away. Another
reason was that the residents thought that the health department was too dirty, and only for
those that are poor.
Another service gap is that few clinics are located in low-income neighborhoods.
Because many living in poverty lack adequate transportation, this problem requires serious
attention. According to the needs assessment, ten percent claimed that transportation is a
barrier (Table 14). Lack of adequate transportation affects those living in the rural areas
because of the great distances between clinics and the people. In Amarillo the problem is
fueled by the health department's unwillingness to advertise the fact that they have free bus
passes available to low-income individuals. Once in the hand of those in need, these
vouchers reduce transportation barriers. Presently, those that would benefit from the
service must rely on word of mouth for the information.
Another barrier, cost for immunization services, is common to rural as well as
metropolitan areas. Fifty-six percent cited cost as a barrier to service (Table 14). The
price for immunizations varies within the region. Some public clinics charge on a sliding
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REGION 2
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scale, based on income, while others charge a fixed rate. However, public clinics are
required to display a sign stating that no one will be refused service because of inability to
pay. Private physicians charge large amounts to make up for their investment in the
vaccine.
Convenience is claimed to be a barrier by fifteen percent of the respondents (Table
14). The South Plains Public Health District, which serves five counties in this region,
requires that all customers have appointments. This prevents any long waiting time, but no
walk-ins are accepted. On the other hand, city health departments such as Lubbock's and
Amarillo's are strictly walk-in clinics. The drawback is that customers wait for long periods
of time during July and August. All TDH clinics have a combination of appointments and
walk-in acceptance, thus offering the advantages of both modus operandi.
Because of the mobility of the population in this region, another barrier exists. The
families of migrant workers move so frequently that personal belongings, especially
immunization records, are often misplaced. When migrant parents can neither produce a
shot record nor remember the last clinic at which their children received immunizations, the
entire series of vaccinations are started anew. This not only wastes vaccine, it also
discourages the parents. These parents begin to see the whole process as a waste of time
and money.
Another barrier exists that affects the utilization of services. Cultural beliefs
preclude many Hispanic and Native -American parents from vaccinating their children. The
belief that vaccine will harm, rather than protect, their children is a dangerous one,
especially since the migrant population is predominantly Hispanic.
VI. SOLUTIONS
Attempts have been made to reduce the gaps and barriers that perpetuate the low
immunization rates. First, several innovative clinics have been held within the region with
varying degrees of success. In March, the LHD held a clinic at the South Plains Mall to
coincide with a community sponsored health fair. In a nine hour period spanning Friday
evening and Saturday afternoon, 270 vaccinations were administered free of charge.
Because of the large turnout, LHD is administering four similar clinics to be held on
weekends at this mall. This clinic reduced the barriers of cost, convenience, and location.
11
In mid -May, an all day clinic was held in the town of Silverton, population 918, with just
over 100 shots given. A fee, based on income, was charged for the service, however, no
one was turned down. The success of these clinics is due to long term planning, effective
publicity campaigns and non-traditional scheduling that allows parents to attend at their
convenience. These three criteria can be applied to similar clinics throughout the region to
reduce the gaps and barriers that continue to keep immunization rates low.
The Amarillo Bi-City-County Health Department held a free immunization clinic on a
Saturday afternoon at Wal-Mart. Thirty-six vaccinations were given during a four hour
period. The cooperation of Wal-Mart will help increase immunization rates. With each
repeat clinic, utilization will increase as families begin to make plans to have their children
immunized there.
The City of Lubbock also installed a clinic at the Greenfair Manor, the local housing
authority, in an attempt to reach a largely underserved population. The Greenfair clinic,
which provides free services, including vaccinations, to low-income families, is open every
Tuesday afternoon from 1:00 - 4:00 p.m. Barriers such as cost and location are eliminated.
Elementary schools in the region have also served as clinic sites. Four campuses in
Lubbock, chosen for their socioeconomic population, were each staffed by two LHD nurses.
Immunizations were administered from 4:00-6:30 p.m. Forty-two children received
vaccinations and sixty-three doses were administered.
The elementary school in Kress (Swisher County) and those in Plainview (Hale
County) provide immunizations on a regular basis. In both cases, those children that are
behind schedule are taken out of the classroom, vaccinated by the school nurse, and are
then returned. The advantages are that convenience, cost, and location are reduced as
barriers. The Plainview elementary schools also hold immunization clinics to correspond
with pre -kindergarten registration because the delinquency rate for children at five years of
age in this city 60%. Free vaccine is provided by the Plainview Health Department and
school nurses staff the clinic. Immunization records are started for those children lacking
one.
The above examples reflect a shifting service paradigm. Local officials are becoming
increasingly aware that the future of public health will require mobility of services. There
litl
are two reasons for this shift. First, the indigent lack transportation, requiring services to be
taken directly to them. The second reason is that the middle and upper class tend to be
consumer oriented, therefore, services need to be combined and located in various
neighborhoods, so that healthcare is more convenient for them. Mobility of services will
certainly increase accessibility to healthcare.
The March of Dimes organization has offered a different perspective dealing with
transportation problems. A pilot project, called the Mom Mobile, was recently introduced in
Amarillo. The goal is to provide low-income women with transportation to their pre -natal
care. The project is designed to service mothers up to one year after giving birth. This
should certainly assist in confronting low immunization rates. The success of this project
will determine whether or not other cities in the area implement similar ones.
Another feasible solution, sharing and coordinating resources between public and
private entities in the outlying areas, presents an efficient and cost effective means of
reducing a barrier that perpetuates low immunization rates. Rural clinics are notoriously
understaffed, while at the same time, rural hospitals have only a 41 % occupancy rate.
According to several hospital administrators in rural areas, agreements can be made to share
nursing staff with public clinics. In addition to nurses, paramedics, who are already
qualified to give injections, could be educated about immunizations though in-service
training. Rural hospitals, utililizing their own nursing staff and space, can also hold evening
clinics with the vaccine coming from the public clinics.
A fourth solution will reduce two barriers. As of September 1, TDH will supply
private physicians with free vaccine. This will save parents large amounts of money,
therefore reducing the barrier of high costs for service. Also, more opportunities to
immunize will become available, as well as providing more children with a medical 'home'.
According to our survey, twenty-six providers are willing to begin administering the service
when free vaccine becomes available.
Another solution is providing education to the public at large. Public health facilities
should advertise their services. However, those advocating this means of education also
realize that this can be counterproductive. If there is a large response, clinics that are
13
already understaffed will be over -run, thus perpetuating the belief that one must wait for
large periods of time before receiving services at public clinics.
Public service announcements, posters, and involving the media are traditional
avenues for education. Members of the advisory committee suggested that panels of
discussion could be an effective means of reaching certain populations. The involvement of
community leaders is paramount to the success of this type of education. Whatever avenue
is to be utilized, it is crucial to present the information in as many languages as possible,
especially in the larger population centers.
The Junior League of Lubbock, Inc., is reviewing a grant application which will
support the All Kids Count Program and the health department. The application is
requesting $13,000 to fund an education and public awareness campaign, as well as partial
funding of additional immunization clinics in Lubbock County. If approved the funding
would span a three year period, June 1994 - May 1997.
VII. THE NETWORK
INFORMATION SYSTEM DESIGN FOR ALL KIDS COUNT
AN AFFORDABLE IMMUNIZATION TRACKING SYSTEM FOR NORTHWEST TEXAS
A major part of the All Kids Count planning grant activity to be carried out in 1993 is the
design of a tracking system for immunizations of all Northwest Texas children under two
years of age. The system design, developed by AKC Consultant Kathleen Hennessey, Ph.D.,
is the result of a six-month study of the constraints, alternatives and technical possibilities
involved in such a system by a team of the Institute's systems analysts/designers and
programmers.
The system design has to deal with five major tasks:
1. Provide health care workers with access to reliable information regarding
approximately 30,000 children under age 2 who are to be immunized. Case workers
and clinic staff assured the team that a high number of patients would arrive for
immunization without anything to identify themselves or indicate their immunization
status.
14
2. Acquire and disseminate information about every injection given each of 58,000
pre-school children residing in the area under the jurisdiction of Texas Department of
Health Region 2.
3. Index immunization records so that patients can be contacted in the case of vaccine
recall.
4. Provide current information to designated health care professionals about location
and caretakers of the approximately 30,000 children whose immunizations are not
up to date, with adequate safeguards to ensure protection of privacy and
confidentiality of personal information.
5. Accommodate varied environments in which means of access to information
services is constrained by available resources, specifically:
a. Large existing data network facilities linked to teaching hospitals in Amarillo and
to some extent, Lubbock --in which the emphasis is on patient billing. In
Amarillo much of the software is designed and developed in-house, while in
Lubbock it is mainly purchased in object code form from out-of-state vendors.
b. Desktop PCs running on varied operating systems such as, MS-DOS WINDOWS
and UNIX, running dedicated vendor - proprietary patient billing systems in
doctor's offices and clinics. Typical cost is $10,000 - $50,000.
c. Desktop PCs, some on local area networks within public health clinics, with
external connections by dial -up telephone or network links in some cases;
d. Small clinics with access to electricity and intermittent use of dial -up telephone;
e. Weekly or less frequent clinics with no guaranteed access to electricity or
telephone, held in places such as barns and church basements.
In addition, the system has to be able to link to information systems being developed in
other areas of Texas, state-wide facilities, and national initiatives --none of which have been
finalized. Of particular importance are:
1. ICES, a database program purchased by the Texas Department of Health which
includes an immunization record management facility.
2. The Center for Disease Control's draft proposal for immunization record
interchange protocol issued in January 1993.
15
3. The SmartCard proposal for maintaining patient records.
4. Use of barcoded coupons issued to mothers soon after the
patient's birth.
5. Current manual recording of immunizations by means to the
Texas immunization record card.
Various descriptions of ICES have been provided to the system design team, the most
consistent of which are the following-
1 - The program is written in FoxBase, a proprietary facility using dBase data
formats and facilities.
2. The program uses the ARCNET network architecture.
3. The program provides access to immunization records by means of a multi -level
menu; the user must know in advance what single key is to be used for
retrieval.
4. The program has not been used for large databases.
5. Source code will not be made available to local data processing facilities for
amendment and adaptation to local requirements.
It is the conclusion of the design team that the ICES program will not be able to meet the
immunization tracking information system requirements described above, for the following
reasons:
1. The relational database architecture on which the program is based cannot deal
efficiently with non -unique key retrievals that are not predefined. This type of
general inquiry facility is essential because many caregivers are unable to
provide any single identifier when the child is presented for immunization. ICES'
menu -based single -key inquiry facility does not deal adequately with the
frequent situation in which the caregiver brings no relevant identification
materials with the child.
2. The dBase architecture is designed for small databases, normally under 10,000
records. Above that number, the systems retrieval time is excessive, normally 5
to 15 minutes per record. Furthermore, network performance of dBase facilities
is not known to be reliable with multiple concurrent enquiries on multiple keys.
16
3. ICES and its FoxBase architecture does not provide links with other data
systems, which is essential for the interchange of information about patients
and immunizations among existing and forthcoming facilities as well as
developments in other areas of Texas and the nation. The ICES system does
not provide access according to the CDC interchange protocol, which outlines
an information interchange architecture that can accommodate the large
number of heterogeneous systems handling immunization records. The CDC
protocol specifies record interchange formats and protocols in detail,
following the general approach of international Open Systems Interchange
standards, and is likely to be widely adopted.
4. Systems developed for the dBase architecture cannot be transferred easily to
larger or different environments such as a VAX, RX6000, AS400 or
mainframe; they have to be completely re -written and the database
re- organized. Another problem with relational databases as well as traditional
programming languages such as COBOL and C, is that when an additional field
must be added to a relation or some other field has to be used as a key, the
entire database must be reorganized. This hampers ongoing development and
requires allocation of a large amount of technical time for maintenance.
Using other facilities for the immunization database will not pose a serious problem when
and if ICES becomes available. Most database facilities, spreadsheets and CASE tools are
capable of providing dBase format data as output. The proposed immunization program will
be capable of communicating with most database programs used by other agencies.
The team also concluded that dedicated high-speed data network facilities would not be
suitable because of the low volume of inquiries and transactions involved at any one site --a
maximum of 50 per day, often fewer than 10. Use of 800 dial -up facilities for on-line
database access would involve excessive cost, estimated at $60,000 per year to deal with
an estimated volume of 120,000 immunization events involving an estimated 60,000 5-
minute non -local calls per year at $0.20 per minute. Calls would be made by over 200
providers, many of whom operate outside the Lubbock and Amarillo local dialing areas.
17
Furthermore, a substantial portion of the public health immunization effort takes place in
locations without assured access to a telephone or even electricity.
Smartcard proposals were not found to be feasible because of the dispersed nature of
providers' immunization clinics, the low volume of immunizations per provider, and the high
cost of smartcard reading/recording equipment. Protection against unauthorized access to
patient records cannot be assured. At least half the patients presented for immunization in
public health clinics lack adequate identification or immunization status documents.
Although the use of coupons was initially seen as an effective solution to the problem of
patient identification and repeated vaccinations due to lack of information in remote areas,
further analysis of the costs for materials and processing of coupons led the design team to
reject it as a possible solution. Serious problems were identified with handling coupons
onto which bar-coded self-adhesive labels to identify provider and vaccine would be
attached, because either large volumes of labels would have to be preprinted and distributed
or label makers and labels would have to be supplied to every provider. Labels would have
to be stored with boxes of vaccine bottles and vials that are kept under refrigeration, where
the adhesive would deteriorate quickly. Other coupon - and label -based scenarios that were
investigated gave rise to similar concerns, as well as the general problem that the majority
of patients do not bring adequate documentation with them to the clinic.
The design team determined that, because of the 60-day cycle of the immunization
process, an inexpensive information system could be developed and implemented quickly.
The system could be fairly easily integrated with and/or transitioned to other systems by
following the CDC protocols. Providers, health care workers and community outreach
workers would be offered the following five modes by which to obtain and submit
information for the proposed information system:
1. Monthly electronic data transfer of immunization activity records, via dial -up or
leased line, for a provider with data communication/data network facilities. The
provider's system would transmit its current month transaction records and
receive a copy of all immunization transaction records transmitted the previous
month by all providers in the region.
18
2. Monthly submission of immunization transaction records on floppy disk by mail,
courier service, or outreach worker from providers with desktop and laptop
computers. Before the end of the current month, each provider would receive a
diskette containing a copy of all immunization transaction records submitted the
previous month by all providers in the region.
3. Ad hoc dial -up to a voice response facility that would give infrequent providers
access to patient immunization records and allow providers to enter details of
immunizations they had given.
4. Dial -up by providers, school nurses, and patients to an operator who would
answer inquiries about immunization status of patients. The operator would also
add new immunization transaction records to the current month's central
transaction file based on telephone calls from authorized providers.
5. Monthly activity and delinquency reports and ad hoc vaccine recall reports will be
prepared centrally. Access to private information about caretakers and patients
will be provided only to authorized professionals by password.
A single central master database will be maintained on two 486 tower computers (one
for normal operations and one for development, maintenance and backup) each with six
megabytes of memory, a 200 megabyte of hard disk unit, four modems, object -oriented
mainframe -compatible database and network access software. Upon registration each
provider will be supplied with a free database program and a current copy of the master
database.
At the end of each month, all providers' immunization transaction records, new patient
records and address changes, as well as newborn wellness check and infant death records
for that month will be batch processed to produce a single database update file. In return
for monthly submission of immunization transactions, the provider will receive a copy of all
the previous month's changes to the database for the previous month, which the free
database program will automatically incorporate into the provider's copy of the database.
Because the update file will be provided in the CDC interchange format, providers with
their own systems can use the file to update their own databases. At specific points in the
database program are software 'ports' through which the provider's own software may
19
interact with the database program. Upon provider request, the database system source
code will be made available and the provider will be assisted to obtain a database
developer's kit. Providers who wish to incorporate their immunization records into their
existing billing information systems will be provided with a set of pseudo -CPT codes
and advised to treat Texas Department of Health as a payer; the CDC record formats would
be specified just as for electronic submission to any other payer with its own unique format.
Monthly transmission of immunization records to TDH could then follow the provider's
standard billing procedures.
Monthly delinquency reports, reminder notices to the expected 1,500 delinquent clients,
regional immunization status reports and vaccine distribution lists will be produced on the
central computer system, both electronically and on paper as required. When reminder
notices are returned in the mail, staff at the TDH office will indicate 'wrong address" for the
client's record; when the monthly database update file is sent to providers the client's
record will be flagged so that when the client subsequently is presented to any participating
provider in Region 2, the provider will request and enter the current address so that it can
be transmitted with the immunization transactions at the end of the month and the master
database record can be brought up to date.
The free database program will maintain a vaccine inventory for each provider and will
automatically copy onto each immunization record the manufacturer and lot number of each
vaccine administered.
Some providers already have their own information handling facilities, operating in well-
equipped clinics, with easy access to computer terminals and networked desktop
computers. They are able to incorporate immunization record keeping into their own
systems and usually have adequate technical support. They are not expected to require
equipment, technical support or other assistance from the All Kids Count program. On the
other hand, many rural health clinics are severely under-resourced and have no means to
obtain information handling facilities or technical assistance. As the main focus of the
program, they will receive laptop computers, the free database program, and extensive
technical support to get started using the equipment and help with the record submission
and updating procedures.
20
IMPLEMENTATION
General
The purpose of the implementation phase is to link all health care providers who
provide immunizations to a network to monitor and follow up preschooler immunization
status. Computer hardware will be provided to those public and/or not -for -profit clinics
which demonstrate a need for the equipment. Modems, communications software or the
immunization program will be provided to those clinics which will use their own system.
Private, for profit providers will only be furnished the immunization computer program and,
if needed the communications software.
Installation, training, and technical support will be provided by two full-time
computer technicians proposed to be on staff. One technician will be based in Lubbock and
the other in the Amarillo area. A minimum of one lap top computer will be held in reserve in
each area (Panhandle and South Plains) as a back-up in the event of hardware failure which
the technician can't repair on site.
1st Year
The first year of the implementation plan will be used to install the two 486
computers, modems, 1-800-telephone lines, software and voice response systems at the
Texas Department of Health, Region 2 office in Lubbock. This will be the central location
for the collection and dissemination of all immunization records within the region. The TDH
equipment is expected to be operational within 60 days of receiving the computer hardware.
Upon completion of the installation information from the newborn screening records
will be loaded into the TDH system to begin the tracking process from birth. The screening
information will cover all births in the region and will be cross referenced with death
records. Since many hospitals have begun providing the Hepatitis B vaccine at birth, follow-
up reminders will begin immediately.
The first clinics to have equipment and/or software and communications packages
installed will be those with the largest case load, primarily those in Lubbock, Amarillo and
Plainview. The population served by the clinics in these communities is 60% of the total
census of the region. These clinics will be equipped to electronically transfer and receive
data from the Region 2 office.
21
Installation in the clinics will begin soon after the hardware arrives and the software
is loaded and tested. Although the clinics will not be linked until TDH is operational, the
time will be used to train immunization personnel to use the equipment. The clinic
employees would also begin entering data into the system.
The Texas Department of Health will simultaneously provide compatible equipment
and software to its 20 clinics in Region 2. After the installation is complete at TDH and in
Lubbock, Amarillo and Plainview other clinics in Lubbock, Randall, Potter and Hate counties
will be added to the system. The total number of clinics/sites linked to the system the first
year will be 40.
The initial phase of the installation process is being focused around the major
population centers so that any problems which may arise can be corrected quickly. It's our
desire to ensure the integrity of the system before installing the equipment in the distant
rural clinics.
2nd Year
The second year will see the system expanding to all other public and not for -profit
clinics in the rural areas. These clinics serve the other 37 counties of the Panhandle and
South Plains. Thirty additional clinics will be added.
To better utilize time, the installation will be grouped into the current task force
geographical division. One task force area will be completed before moving to another.
Two of the task force areas would have been completed the first year. The remaining
twelve would be accomplished at approximately one month intervals. This allows for
training, installation, trouble shooting, and problem solving.
As in the first year, training on the system will be provided prior to being connected
to the system. Data entry will be done by immunization personnel.
The AKC computer technicians will provide ongoing technical support.
3rd Year
All other private providers who provide immunizations and who wish to be linked
will be provided the necessary software. These providers (physicians, hospitals, etc.) must
provide their own hardware. Training on the use of the software and connecting to the TDH
system will be provided. Technical support will be provided only when software problems
22
exist. Technical support will continue for all systems and training as needed on any
upgraded version of the immunization software.
4th Year
The final year of the implementation project will be used to link any additional
providers to the system. Software and training will be provided, as well as support for the
software. All responsibility for training maintenance, upgrading and expansion of the
system will be transferred to TDH.
The process to link the immunization program with other systems will begin this
year. The immunization tracking system will be linked into the WIC computer network.
Since the Texas Department of Health is responsible for administering WIC in majority of
communities in the region, this could be accomplished through administrative action.
The immunization tracking system will also be linked to the Texas Education
Agency's statewide network. All schools are tied to the system. This would allow school
nurses access to student's immunization records. These nurses would have only visual
access to particular information. They would not have the capability to make changes to
the record, unless they actually provide immunizations and are given additional clearance.
BROADER APPLICATIONS
The proposed immunization program is written in a database language which permits
fields to be added, deleted, or changed without the complicated process which is required
for such program languages as COBOL. This program is so generic and user friendly as to
allow clinic personnel to add to the program to meet the needs of their community.
PROGRAM ADMINISTRATION
The project director will continue to administer the implementation phase. He will
supervise one secretary, two computer technicians, and one outreach worker.
The Project Director, secretary, one computer technician, and the outreach worker
will be based in Lubbock. The second computer technician will be based in Canyon. This
technician will be supervised locally by Jerry DeSha of TDH, Region 2.
One area of concern is that equipment distributed to clinic be used for its intended
purpose. The staff will ensure this through formal agreements and visual checks.
23
Throughout the four year implementation phase, the staff will continue to encourage
private providers to participate in this program.
EVALUATION
There will two fundamental types of evaluations which will occur over the four year
implementation phase.
1. A systems evaluation
2. A program evaluation
SYSTEMS EVALUATION
A systems evaluation will be conducted by the computer consultant after each phase
of installation to ensure all hardware and software are functioning properly. An annual
evaluation will also be conducted by the consultant and project director.
PROGRAM EVALUATION
The project director will conduct an annual evaluation to determine the success of
the tracking system. This will be accomplished by following randomly selected records of
children ages birth through two. This will be a continuous study beginning immediately
after the first phase of installation.
The staff will look to see if reminder notices are actually being sent, if the
immunizations are received on schedule and if not what follow-up is being done to get the
child into the clinic or physician.
A real time immunization survey will be conducted by the project staff and the 14
task forces. This will determine the current rate and give us a base with which to compare
future rates. This survey will be done annually.
24
VIII. GOALS AND OBJECTIVES
A. To install a region -wide network of computers, linked via telephone, to enable
healthcare providers who administer vaccines access to a system developed for
sharing information, coordinating services, and planning strategies to meet common
needs.
B. To develop and conduct an annual real-time survey in the Texas Department of
Health Region 2 which will determine the immunization rate of preschool children in
the region.
C. To implement a comprehensive plan for the Texas Department of Health Region 2
which will result in an increase in the rate of immunization of preschool children and
in a decrease of vaccine -preventable diseases.
D. To expand the program by informing new providers of immunizations of the benefits
of being linked to this system.
E. To investigate and develop a plan expanding the scope of this program, beyond that
of immunizations, to facilitate the distribution of primary health care to young
children in the region.
25
THE TEXAS PANHNADLE AND SOUTH PLAINS ALL RIDS COUNT PROJECT
WORK ACTIVITY PLAN
1993/1994
Activity No De Ja Fe Ha Ap Na Ju Ju Au Se Oc
A. Installation Network
1. Purchasing Process x x x
2. Installation of hardware
a. Lubbock x x
b. Amarillo x x
c. Plainview x x
3. Training x x x x
4. Data Entry x x x x x x x x x x
B. Follow-up
1. Develop method/procedure
to monitor records x x x x x
2. Monitor records x x x x x x x
3. Develop
Immunization survey x x x
4. Conduct
Immunization survey x x x x x x x x x
5. Evaluate survey x x x x
6. Contact new
providers x x x x x
7. Advisory/Task force
meeting x x x x
S. Evaluation -by
agency participants x x
1994/1995
Activity No De Ja Fe Ma Ap Ma Ju Ju Au Se Oc
A. Installation Network
1. Purchasing Process x x
2. Installation of system x x x_ x x x x x x x x x
3. Training x x x x x x
B. Follow-up
1. Monitor records x x x x x x
2. Immunization Survey x x x x x x x x x x x x
3. Evaluate Survey x
4. Contact new
providers x x
5. Advisory/Task force
meeting x x x x
6. Evaluation by
agency participants x x
26
Activity
A. Installation Network
1. Purchasing Process
2. Installation of system
3. Training
B. Follow-up
1. Monitor records
2. Immunization Survey
3. Evaluate Survey
4. Contact new
providers
5. Advisory/Task force
meeting
6. Evaluation by
agency participants
1995/1996
No De Ja Fe Ma Ap Ma Ju Ju Au Se Oc
x x x x x x
x x x x x
x x x x x x x x x x x
x
1996/1997
Activity No De Ja Fe Ma Ap Ma Ju Ju Au Se Oc
A. Installation Network
1. Purchasing Process x x
2. Installation of system x x x x x x
3. Training x x x x x x
B. Follow-up
I. Monitor records x x x x x x
2. Immunization Survey g x x x x x x x x x x x
3. Evaluate Survey x
4. Contact new
providers x x
5. Advisory/Task force
meeting x x x x
6. Evaluation by
agency participants x x
7. Transition to TDH x x x
27
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
WORK ACTIVITY PLAN 1993 - 1994
A:1-2. Purchase and install hardware and software in Lubbock,
Amarillo and Plainview at approximately 40 sites. (Project
Director and Computer Technician)
A:3. Train immunization personnel on the use of hardware and
software. Provide instructions on accessing the network.
(Computer Technician and Outreach Worker)
A:4. Provide data entry services for clinics to enter immunization
records into system. (Project Director)
B:1-2. Develop methods and procedures to monitor randomly selected
records entering the system, then monitor those records to
determine the effectiveness of the immunization network.
(Project Director and Outreach Worker)
B:3-5. Develop and conduct a real-time immunization survey to
determine the current immunization rate. Evaluate the survey
as it relates to this project. (Project Director, Outreach
Worker and Task Forces)
B:6. Contact new providers of vaccine to determine their interest in
connecting to the network. (Outreach Worker)
B:7. Conduct advisory and task force meetings at regular intervals
to provide them with new information and to receive needed
feedback. (Outreach Worker)
B:8 Evaluate the network in terms of hardware and software
dependability; technical support; accuracy of data; timely
retrieval of data; reminder and following of clients.
(Project Director and Advisory Committee)
WORK ACTIVITY PLAN 1994 - 1995
A:1-2. Purchase equipment and install hardware and software in all
remaining public and not for profit clinics in the region.
(Project Director and Computer Technician)
A:3. Train immunization personnel on the use of hardware and
software. Provide instructions on accessing the network.
(Computer Technician and Outreach Worker)
B:1. Monitor records to determine the effectiveness of the
immunization network. (Project Director and Outreach Worker)
B:2-3. Conduct a real-time immunization survey to determine the
current immunization rate. Evaluate the survey as is relates
to this project. (Project Director, Outreach Worker and Task
Forces)
B:4. Contact new providers of vaccine to determine their interest in
connecting to the network. (Outreach Worker)
B:5. Conduct advisory and task force meetings at regular intervals
to provide them with new information and to receive needed
feedback. (Outreach Worker)
B:6. Evaluate the network in terms of hardware and software
dependability, technical support; accuracy of data; timely
retrieval of data; reminder and following of clients.
(Project Director and Advisory Committee)
28
WORK ACTIVITY PLAN 1995 - 1996
A:1-2 Purchase equipment and install and software in private
for -profit clinics. (Project Director and Computer Technician)
A:3. Train immunization personnel on the use of hardware and
software. Provide instructions on accessing the network.
(Computer Technician and Outreach Worker)
B:1. Monitor records to determine the effectiveness of the
immunization network. (Project Director and Outreach Worker)
B:2-3. Conduct a real-time immunization survey to determine the
current immunization rate. Evaluate the survey as is relates
to this project. (Project Director, Outreach Worker and Task
Forces)
B:4. Contact new providers of vaccine to determine their interest in
connecting to the network. (Outreach Worker)
B:5. Conduct advisory and task force meetings at regular intervals
to provide them with new information and to receive needed
feedback. (Outreach Worker)
B:6. Evaluate the network in terms of hardware and software
dependability, technical support; accuracy of data; timely
retrieval of data; reminder and following of clients.
(Project Director and Advisory Committee)
WORK ACTIVITY PLAN 1996 - 1997
A:1-2. Purchase equipment and install hardware and software in all
remaining clinics in the region. (Project Director and
Computer Technician)
A:3. Train immunization personnel on the use of hardware and
software. Provide instructions on accessing the network.
(Computer Technician and Outreach Worker)
B:1. Monitor records to determine the effectiveness of the
immunization network. (Project Director and Outreach worker)
B:2-3. Conduct a real-time immunization survey to determine the
current immunization rate. Evaluate the survey as is relates
to this project. (Project Director, Outreach Worker and Task
Forces)
B:4. Contact new providers of vaccine to determine their interest in
connecting to the network. (Outreach Worker)
B:S. Conduct advisory and task force meetings at regular intervals
to provide them with new information and to receive needed
feedback. (Outreach Worker)
B:6. Evaluate the network in terms of hardware and software
dependability, technical support; accuracy of data; timely
retrieval of data; reminder and following of clients.
(Project Director and Advisory Committee)
B:7. Transfer records and responsibility for the maintenance
and expansion of the network to the Texas Department of Health.
(Project Director)
29
BUDGET
AND
BUDGET JUSTIFICATION
TI IE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
THE ROBERT WOOD JOHNSON FOUNDATION
LINE ITEM BUDGET
Grant Period: (from 11/01/93 to 10/31/97)
Budget Period: (from 11/01/93 to 10/31/97)
CUMULATIVE BUDGET
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position
Base Salary
% Time
Pers. Health Svcs. Coord.
$44,000
10%
$17,600
$0
$17,600
Administrative Technician
$21,000
10%
$8,400
$0
$8,400
Project Director
$26,283
100%
$117,542
$85,042
$32,500
Outreach Specialist
$21,632
100%
$97,228
$33,314
$63,914
Computer Technician
$25,875
100%
$115,715
$53,820
$61,895
ADP Programmer
$28,668
100%
$114,672
$0
$114,672
Secretary
$15,146
100%
$67,737
$67,737
$0
Clerical Support (hourly)
var.
var.
$21,635
$10,400
$11,235
Total Salaries
$560,529
$250,313
$310,216
Fringe Benefits
$118,557
$52,781
$65,776
II. OFFICE OPERATIONS
Supplies
$5,200
$5,200
SO
Printing
$10,850
$10,850
$0
Duplicating
$10,850
$10,850
$0
Telephone
$14,740
$14,740
$0
Postage
$5,600
$5,600
$0
III. PROJECT STAFF TRAVEL
$34,895
$34,895
SO
Sub -Total
$761,221
$385,229
$375,992
IV. INDIRECTCOSTS
$68,510
$34,671
$33,839
V. COMPUTER EQUIPMENT
$171,000
$21,000
$150,000
VI. CONSULTANT HONORARIA
$30,000
$30,000
$0
VII. SUBCONTRACTS
$160„137
$36,075
$124,262
TOTAL
$1,191,068
$506,975
$694,093
1
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH
REGION 2 (PANHANDLE OFFICE)
Grant Period: (from 11/01/93 to 10131/97)
Budget Period: (from IMI/93 to 10/31/97)
CUMULATIVE BUDGET
I. PERSONNEL
Position Base Salary % Time
Immunization Program Manager $30,500 10%
Computer Technician $25,875 100%
Total Salaries
Fringe Benefits
II. OFFICE OPERATIONS
Supplies
Duplicating
Telephone
Postage
III. PROJECT STAFF TRAVEL
Sub -Total
IV. INDIRECT COSTS
V. COMPUTER EQUIPMENT
TOTAL
RWJF
OTHER
TOTAL
SUPPORT
SUPPORT
$9,150
$0
$9,150
$83,722
$12,938
$70,784
$92,872
$12,938
$79,934
$18,574
$2,588
$15,987
$1,200
$0
$1,200
$1,800
so
$1,800
$5,400
s0
$5,400
$2,800
$0
$2,800
$16,195
$16,195
s0
$138,841
$31,721
$107,121
$12,496
$2,855
$9,641
$9,000
$160,137
$1,500 $7,500
$36,075 $124,262
2
THE ROBERT WOOD JOHNSON FOUNDATION
LINE ITEM BUDGET
Grant Period: (from 11/01/93 to 10/31/94)
Budget Period: (from 11/01/93 to 10/31/94)
PROJECT YEAR 1
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position
Base Salary
% T-une
Pers. Health Svcs. Coord.
$44,000
10%
$4,400
$0
$4,400
Administrative Technician
$21,000
10%
$2,100
$0
$2,100
Project Director
$26,283
100%
$26,283
$26,283
$0
Outreach Specialist
$21,632
100%
$21,632
$21,632
$0
Computer Technician
$25,875
100%
$25,875
$25,875
$0
ADP Programmer
$28,668
100%
$28,668
$0
$28,668
Secretary
$15,146
100%
$15,146
$15,146
$0
Clerical Support (hourly)
var.
var.
$14,145
$10,400
$3,745
Total Salaries
$138,249
$99,336
$38,913
Fringe Benefits
$27,303
$19,566
$7,737
II. OFFICE OPERATIONS
Supplies
$1,200
$1,2W
$0
Printing
$2,500
$2,500
SO
Duplicating
$2,500
$2,500
$0
Telephone
$3,400
$3,400
$0
Postage
$1,400
$1,400
$0
III. PROJECT STAFF TRAVEL
$9,820
$9,820
$0
Sub -Total
$186,372
$139,722
$46,650
IV. INDIRECT COSTS
$16,773
$12,575
$4,198
V. COMPUTER EQUIPMENT
$122,000
$19,500
$102,500
VI. CONSULTANT HONORARIA
$12,000
$12,000
$0
VII. SUBCONTRACT'S
SO
$0
$0
TOTAL
$337,145
$183,797
$153,348
M
BUDGET NARRATIVE - YEAR 1
Other Support:
The funding in this column will be provided by the City of Lubbock
Health Department, Texas Department of Health and grants. The Lubbock
Health Department funding will consist of personnel time and equipment
(computers and office furniture). Other support listed will be provided
by the Texas Department of Health, Region 2 in the form of in -kind
personnel time and equipment. Other support may include funding and in -
kind support from the Junior League and the Lubbock Area Foundation.
I. Personnel:
NOTE: Annual salary increases reflect the maximum allowable performance
based increases under current city policies.
The Personal Health Services Coordinator will supervise the project
director, will ensure that the project is complying with all City of
Lubbock policies and procedures, and will offer her expertise to ensure
the success of the project.
The Administrative Technican will be responsible for managing the
budget, providing back-up for all financial expenditures, producing the
required financial reports, and operating the grant following all City
of Lubbock financial policies and procedures.
The Project Director will be accountable for planning, organizing, and
directing the implementation and operations of the project. The Project
Director will supervise one full time computer technician, one full time
outreach worker and the secretary. The Project Director will coordinate
the activities with the staff, the consultant and the volunteers from
the local level. The Project Director will meet with the regional
advisory committees comprised of individuals from the local task forces.
The Project Director will act as staff liaison to the regional task
force as the plans are implemented on a regional and local basis.
One Computer Technician will be on staff. The technician will install
and maintain the computer equipment, correct any software problems,
train immunization personnel on the use of the equipment and software
and work closely with Texas Department of Health technicians to maintain
the integrety of the immunization database network.
Two ADP Programmers will be responsible for installation and maintenance
of the equipment and software installed at the Texas Department of
Health Region 2 office and its 20 clinics. These are TDH employees
working 50% of their time on the tracking system.
The outreach Worker will work out of Lubbock and cover the entire
region. He will coordinate with the immunization providers in the
region, hold periodic local task force meetings, conduct local real-time
immunization surveys, follow randomly selected immunization records
through the system and facilitate the dialogue between the different
agencies and individuals in the region participating in the project.
n
The Secretary will be responsible for clerical and data processing
tasks. She will coordinate the schedules of the staff, be a consistent
presence in the Lubbock office to answer inquiries, and type, duplicate
and distribute surveys, reports, brochures, etc.
Clerical Support - Temporary part-time workers to enter data at clinics
throughout the region. These workers, needed to enter active
immunization records and assist in entering new client data, will be
hired as needed in each community to bring the data entry up to date.
2080 hrs. X $5 per hour - 10,400.
Volunteer data entry personnel will work approximately 624 hours per
year for the first three years of the program in Lubbock County with an
in -kind contribution of $3120.
We are requesting a full time equivalent for One Computer Technician,
the Secretary position and Outreach Worker. This project will cover a
large amount of territory. It is our belief that there needs to be a
person in the office during work hours who can answer questions and
problem -solve, while ensuring continuity to the project. This person
would be the Secretary.
The Outreach Worker, Computer Technician and the Project Director will,
by definition, need to be in the field much of the time. We believe
that the Computer Technician and an Outreach Worker will be able to
accomplish the assigned tasks working full time.
Fringe Benefits:
The fringe benefits provided by the City of Lubbock Health Department
and TDH include Federal Withholding Tax, FICA, Workman's Compensation,
life insurance, health insurance, dental insurance, and retirement for
full-time equivalent staff members. The fringe rate varies.
Pers. Health Services Coordinator
Administrative Technician
Project Director
Outreach Worker
Computer Technician
ADP Programmer
Secretary
TOTAL FRINGES:
$968 (In -Rind)
$462 (In -Rind)
$5,782
$4,759
$5,693
$6,307 (In -Rind)
$3,332
$27,303
5
II. Office Operations:
Supplies: The requested supply budget is $1,200 for the implementation
grant. This money will be used for general office supplies for four
full time equivalent staff positions. The needed supplies include tape
and tape dispensers, stationary, paper clips, pens, pencils, rolodex
cards, staplers, calendars, notepads, typewriter ribbons, computer
paper, diskettes, and ribbons for printers.
Printing: The requested printing budget is $2,500 for the first
implementation year. These funds will cover the cost of business cards,
educational material, and instructions manuals for the use of the
computers and software.
Duplicating: The requested duplicating budget is $2,500. This will
include the cost of duplicating surveys and other related needs. The
cost includes copy paper, toner, and dispersant for the copier.
Telephone: The requested telephone budget is $3,400. We are
anticipating numerous telephones calls between the Lubbock staff,
participating agencies, and to volunteers around the region. Based on
previous phone bills for various telephone calls to other cities in the
region, we are estimating a monthly phone bill of $280.
Postage: The requested postage budget is $1,400. This money will be
used to provide postage between the staff in Lubbock, participating
agencies and individual volunteers, as well as postage to the Robert
Wood Johnson Foundation.
III. Project Staff Travel:
I
Local Travel: The requested budget for local travel is $6,860. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker and the project director may
need to spend the night on the road when contacting some of the local
communities. We included hotel and a per diem in the local travel
budget to cover this necessity. The local travel breakdown for the
Lubbock staff is as follows:
Mileage ($.275 per mile X 1500 miles per month) _ $4950
Hotel ($55 per night for 12 nights) _ $ 660
Per Diem ($25 per day for 50 days) _ $ 1250
TOTAL $6,860
6
Non -local Travel: The requested budget for non -local travel is $2,960.
This includes money for two people to attend one national meeting
sponsored by the Robert Wood Johnson Foundation for two nights and two
days. It also includes two trips for one person in Texas, but outside
the region, to observe and assess other immunization programs. These
trips will be one night trips.
The non -local travel breakdown is as follows:
National Trip
($1,140 X 2)
$
2,280
In -State Air Fare
($240 X 2) _
$
480
In -State Hotel
($75 X 2) _
$
150
Per Diem
($25 X 2) _
$
50
TOTAL
$
2,960
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Computer Equipment:
The requested budget amount for this category is $19,500. This money
will be used to purchase 10 laptops with internal modems. 10 portable
printers.
10 computers X $1000 = $10,000
10 portable printers X $350 - $3,500
10 external modems X 100 = $1,000
$5000 is requested for computer supplies, such as diskettes, computer
paper/cards, ribbons, etc.
In -kind contributions for Texas Department of Health include 26 laptop
computers, 4 modems, database program license for 100 terminals, 2 voice
response systems, Novell Network Access Server, 4 - 800 telephone lines.
TDH Total in -kind contribution = $92,500
Junior League funding 2 Laptops at $2500 = $5,000
Lubbock Area Foundation funding 2 Laptops at $2500 = $5,000
VI. Consultant Honoraria:
The requested budget amount for this category is $12,000. Dr. Kathleen
Hennessey of Texas Tech University will provide expertise in the field
of database networks. The $12,000 estimate is based on forty (40)
days/year at $300 per day. There will be no travel expense as she is
based in Lubbock.
7
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
THE ROBERT WOOD JOHNSON FOUNDATION
LINE ITEM BUDGET
Grant Period: (from 11/01/94 to 10%l1/95)
Budget Period: (from 11/'01/94 to 10/31/95)
PROJECT YEAR 2
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position
Base Salary
% Time
Pers. Health Svcs. Coord.
$44,000
10%
$4,400
$0
$4,400
Administrative Technician
$21,000
10%
$2,100
$0
$2,100
Project Director
$28,386
100%
$28,386
$28,386
$0
Outreach Specialist
$23,363
100%
$23,364
$11,682
$11,682
Computer Technician
$27,945
100%
$27,945
$27,945
$0
ADP Programmer
$28,668
100%
$28,668
$0
$28,668
Secretary
$16,358
100%
$16,358
$16,358
$0
Clerical Support (hourly)
var.
var.
$3,745
$0
$3,745
Total Salaries
$134,966
$84,371
$50,595
Fringe Benefits
$28,869
$18,562
$10,307
II. OFFICE OPERATIONS
Supplies
$1,300
$1,300
$0
Printing
$2,750
$2,750
$0
Duplicating
$2,750
$2,750
SO
Telephone
$3,740
$3,740
$0
Postage
$1,400
$1,400
$0
III. PROJECT STAFF TRAVEL
$10,645
$10,645
$0
Sub -Total
$186,420
$125,518
$60,902
IV. INDIRECTCOSTS
$16,778
$11,297
$5,481
V. COMPUTER EQUIPMENT
$16,500
$1,500
$15,000
VI. CONSULTANT HONORARIA
$9,000
$9,000
$0
VIL SUBCONTRACTS
$54,136
$26,800
$27,336
TOTAL
$282,833
$174,114
$108,719
BUDGET NARRATIVE - YEAR 2
Other Support:
The funding in this column will be provided by the City of Lubbock
Health Department, Texas Department of Health and grants. This support
will primarily be in -kind funding consisting of personnel time and
equipment (computers and office furniture). Other support listed in the
Subcontract will be provided by the Texas Department of Health, Region 2
in the form of in -kind personnel time and equipment. Other support may
include funding and in -kind support from the Junior League and the
Lubbock Area Foundation.
I. Personnel:
The Personal Health Services Coordinator will supervise the project
director, will ensure that the project is complying with all City of
Lubbock policies and procedures, and will offer her expertise to ensure
the success of the project.
The Administrative Technican will be responsible for managing the
budget, providing back-up for all financial expenditures, producing the
required financial reports, and operating the grant following all City
of Lubbock financial policies and procedures.
The Project Director will be accountable for planning, organizing, and
directing the implementation and operations of the project. The Project
Director will supervise two full time computer technicians, one full
time outreach worker and the secretary. The Project Director will
coordinate the activities with the staff, the consultant and the
volunteers from the local level. The Project Director will meet with the
regional advisory committees comprised of individuals from the local
task forces. The Project Director will act as staff liaison to the
regional task force as the plans are implemented on a regional and
local basis.
Two Computer Technicians will be on staff. One will be assigned to the
Panhandle and one to the South Plains. The technicians will install and
maintain the computer equipment, correct any software problems, train
immunization personnel on the use of the equipment and software and work
closely with Texas Department of Health technicians to maintain the
integrety of the immunization database network. One of these employee's
salary will receive one half of their support from RWJF, with the
remainder from TDH.
Two ADP Programmers will be responsible for installation and maintenance
of the equipment and software installed at the Texas Department of
Health Region 2 office and its 20 clinics. These are TDH employees
working 50% of their time on the tracking system.
9
The Outreach Worker will work out of Lubbock and cover the entire
region. He will coordinate with the immunization providers in the
region, hold periodic local task force meetings, conduct local real-time
immunization surveys, follow randomly selected immunization records
through the system and facilitate the dialogue between the different
agencies and individuals in the region participating in the project.
One half of his salary will be provided by RWJF, with the remainder from
TDH.
The Secretary will be responsible for clerical and data processing
tasks. She will coordinate the schedules of the staff, be a consistent
presence in the Lubbock office to answer inquiries, and type, duplicate
and distribute surveys, reports, brochures, etc.
Volunteer data entry personnel will work approximately 624 hours per
year for the first three years of the program in Lubbock County with and
in -kind contribution of $3120.
We are requesting a full time equivalent for two Computer Technicians,
the Secretary position and Outreach Worker. This project will cover a
large amount of territory. It is our belief that there needs to be a
person in the office during work hours who can answer questions and
problem -solve, while ensuring continuity to the project. This person
would be the Secretary.
The Outreach Worker, Computer Technicians and the Project Director will,
by definition, need to be in the field much of the time. We believe
that two Computer Technicians and an Outreach Worker will be able to
accomplish the assigned tasks working full time.
Fringe Benefits:
The fringe benefits provided by the City of Lubbock Health Department
and TDH include Federal Withholding Tax, FICA, Workman's Compensation,
life insurance, health insurance, dental insurance, and retirement for
full-time equivalent staff members. The fringe rate varies.
Pero. Health Services Coordinator $968 (In -Rind)
Administrative Technician $462 (In -Rind)
Project Director $6245
Outreach Worker $5140
Computer Technicians $6148
ADP Programmers $6307 (In -Rind)
Secretary $3599
TOTAL FRINGES: $28,869
10
II. Office Operations:
Supplies: The requested supply budget is $1,300 for the implementation
grant. This money will be used for general office supplies for four
full time equivalent staff positions. The needed supplies include tape
and tape dispensers, stationary, paper clips, pens, pencils, rolodex
cards, staplers, calendars, notepads, typewriter ribbons, computer
paper, diskettes, and ribbons for printers.
Printing: The requested printing budget is $2,750 for the first
implementation year. These funds will cover the cost of business cards,
educational material, and instructions manuals for the use of the
computers and software.
Duplicating: The requested duplicating budget is $2,750. This will
include the cost of duplicating surveys and other related needs. The
cost includes copy paper, toner, and dispersant for the copier.
Telephone: The requested telephone budget is $3,740. We are
anticipating numerous telephones calls between the Lubbock staff and the
Canyon staff, participating agencies, as well as to volunteers around
the region. Based on previous phone bills for various telephone calls
to other cities in the region, we are estimating a monthly phone bill of
$310.
Postage: The requested postage budget is $1,400. This money will be
used to provide postage between the staff in Lubbock and Canyon and
between Lubbock, participating agencies and individual volunteers, as
well as postage to the Robert Wood Johnson Foundation.
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $7,685. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker and the project director may
need to spend the night on the road when contacting some of the local
communities. We included hotel and a per diem in the local travel
budget to cover this necessity. The local travel breakdown for the
Lubbock staff is as follows:
Mileage ($.275 per mile X 1750 miles
Hotel ($55 per night for 12 nights)
Per Diem ($25 per day for 50 days)
TOTAL
per month) _ $ 5775
$ 660
$ 1250
$7, 685
11
Non -local Travel: The requested budget for non -local travel is $2,960.
This includes money for two people to attend one national meeting
sponsored by the Robert Wood Johnson Foundation for two nights and two
days. It also includes two trips for one person in Texas, but outside
the region, to observe and assess other immunization programs. These
trips will be one night trips.
The non -local travel breakdown is as follows:
National Trip
($1,140 X 2) _
$
2,280
In -State Air Fare
($240 X 2) _
$
480
In -State Hotel
($75 X 2) _
$
150
Per Diem
($25 X 2) _
$
50
TOTAL
$
2,960
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Computer Equipment:
The requested budget amount for this category is $1,500. This money
will be used to purchase 5 external modems.
5 external modems X $100 = $500
$1,000 is requested for computer supplies, such as diskettes, computer
paper/cards, ribbons, etc. The request from the Texas Department of
Health includes 5 laptop computers at $2500 each and $2500 for computer
supplies.
TDH Total in -kind contribution = $15,000
VI. Consultant Honoraria:
The requested budget amount for this category is $9,000. Dr. Kathleen
Hennessey of Texas Tech University will provide expertise in the field
of database networking. The $9,000 estimate is based on thirty (30)
days/year at $300 per day. There will be no travel expense as she is
based in Lubbock.
VII. Subcontracts:
See separate narrative.
12
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH
REGION 2 (PANHANDLE OFFICE)
Grant Period: (from IMI/94 to 10/31/95)
Budget Period: (from 1W1/94 to 10/31/95)
PROJECT YEAR 2
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position Base Salary % Time
Immunization Program Manager $30,500 10%
$3,050
$0
$3,050
Computer Technician $25,876 100%
$25,876
$12,938
$12,938
Total Salaries
$28,926
$12,938
$15,988
Fringe Benefits
$5,785
$2,598
$3,198
II. OFFICE OPERATIONS
Supplies
S400
$0
$400
Duplicating
$600
SO
$600
Telephone
$1,800
$0
$1,800
Postage
$800
$0
$800
III. PROJECT STAFF TRAVEL
$7,685
$7,685
SO
Sub —Total
$45,996
$23,211
$22,786
IV. INDIRECT COSTS
$4,140
$2,089
$2,051
V. COMPUTER EQUIPMENT
$4,000
$1,500
$2,500
TOTAL
$54,136
$26,800
$27,336
13
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH, REGION 2
BUDGET NARRATIVE - YEAR 2
Introduction:
The subcontract with the Canyon office of Texas Department of Health,
Region 2 grant proposes to implement a better way of tracking
immunizations. It would be very difficult for a computer technician
based in Lubbock to effectively cover the entire Panhandle. Some of the
towns in the Panhandle are more than a six (6) hour drive from Lubbock.
The distance would require the worker to spend more time driving than
meeting and working with people. One FTE in Canyon would cut most of
the traveling time in half, at least. We believe this would provide
greater cost effectiveness for the grant dollar. We have therefore
developed a proposal which subcontracts the Panhandle Computer
Technician to the Texas Department of Health.
Other Support:
The funding in this column will be provided by the Department of Health
in the form of in -kind personnel time and equipment (computers and
office furniture and offices expenses).
I. Personnel:
The Immunization Program Manager will supervise the computer technician
assigned to the Panhandle of Texas, will ensure that the project is
complying with all state policies and procedures, and will offer his
expertise to ensure the success of the project.
The Computer Technician will work in Canyon and the surrounding counties
of the Panhandle of Texas, installing and maintaining computer hardware
and software, and training immunization personnel on the use of the
system. The Panhandle of Texas is a larger geographical area than the
South Plains of Texas, although the population is roughly equivalent.
This larger geographical area will necessitate that this worker will be
traveling more and spending the night on the road more often than the
technicians covering the South Plains. We believe that the technician
will be able to accomplish the assigned tasks working 100% of the time.
Fringe Benefits:
The fringe benefits would be provided as in -kind by the State of Texas.
II. Office Operations:
Provided by Texas Department of Health In -kind $3,600.
14
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $7,685. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker may need to spend the night on
the road when contacting some of the local communities. We included
hotel and a per diem in the local travel budget to cover this necessity.
The local travel breakdown for the Canyon staff is as follows:
Mileage
($.275 per mile X 1750 miles per month)
$
5,775
Hotel
($55 per night for 12 nights) _
$
660
Per Diem
($25 per day for 50 days) _
$
1,250
TOTAL
$
7,685
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Equipment:
The requested budget amount for this category is $1,500. This money
will be used to purchase 5 external modems, and supplies such as
diskettes, computer paper/cards, ribbons, etc.
5 modems X $100 = $500
Supplies = $1000
15
THE TEXAS PANHANDLE AND SOUTH PLAINS ALL KIDS COUNT PROGRAM
TIIE ROBERT WOOD JOHNSON FOUNDATION
LINE ITEM BUDGET
Grant Period: (from 11/01/95 to 10%31/96)
Budget Period: (from 11/01/95 to 10%31/96)
PROJECT YEAR 3
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position
Base Salary
% Tune
Pers. Health Svcs. Coord.
$44,000
10%
$4,400
$0
$4,400
Administrative Technician
$21,000
10%
$2,100
$0
$2,100
Project Director
$30,373
100%
$30,373
$30,373
$0
Outreach Specialist
$25,232
100%
$25,232
$0
$25,232
Computer Technician
$29,901
100%
$29,901
$0
$29,901
ADP Programmer
$28,668
100%
$28,668
$0
$28,668
Secretary
$17,503
100%
$17,503
$17,503
$0
Clerical Support (hourly)
var.
var.
$3,745
$0
$3,745
Total Salaries
$141,922
$47,876
$94,046
Fringe Benefits
$30,399
$10,533
$19,866
II. OFFICE OPERATIONS
Supplies
$1,350
$1,350
$0
Printing
$2,800
$2,800
$0
Duplicating
$2,800
$2,800
$0
Telephone
$3,800
$3,800
$0
Postage
$1,400
$1,400
$0
III. PROJECT STAFF TRAVEL
$7,215
$7,215
$0
Sub -Total
$191,686
$77,774
$113,912
IV.INDIRECTCOSTS
$17,252
$7,000
$10,252
V. COMPUTER EQUIPMENT
$15,000
$0
$15,000
VI. CONSULTANT HONORARIA
$4,500
$4,500
$0
VII. SUBCONTRACTS
$51,821
$4,638
$47,183
TOTAL
$280,259
$93,911
$186,348
16
BUDGET NARRATIVE - YEAR 3
Other Support:
The funding in this column will be provided by the City of Lubbock
Health Department, Texas Department of Health and grants. This support
will primarily be in -kind funding consisting of personnel salary time
and equipment (computers and office furniture). Other support listed in
the Subcontract will be provided by the Texas Department of Health,
Region 2 in the form of in -kind personnel time and equipment. Other
support may include funding and in -kind support from the Junior League
and the Lubbock Area Foundation.
I. Personnel:
The Personal Health Services Coordinator will supervise the project
director, will ensure that the project is complying with all City of
Lubbock policies and procedures, and will offer her expertise to ensure
the success of the project.
The Administrative Technican will be responsible for managing the
budget, providing back-up for all financial expenditures, producing the
required financial reports, and operating the grant following all City
of Lubbock financial policies and procedures.
The Project Director will be accountable for planning, organizing, and
directing the implementation and operations of the project. The Project
Director will supervise two full time computer technicians, one full
time outreach worker and the secretary. The Project Director will
coordinate the activities with the staff, the consultant and the
volunteers from the local level. The Project Director will meet with the
regional advisory committees comprised of individuals from the local
task forces. The Project Director will act as staff liaison to the
regional task force as the plans are implemented on a regional and
local basis.
Two Computer Technicians will be on staff. One will be assigned to the
Panhandle and one to the South Plains. The technicians will install and
maintain the computer equipment, correct any software problems, train
immunization personnel on the use of the equipment and software and work
closely with Texas Department of Health technicians to maintain the
integrety of the immunization database network. Both of these
employee's salary will be funded by TDH.
Two ADP Programmers will be responsible for installation and maintenance
of the equipment and software installed at the Texas Department of
Health Region 2 office and its 20 clinics. These are TDH employees
working 50% of their time on the tracking system.
17
The Outreach Worker will work out of Lubbock and cover the entire
region. He will coordinate with the immunization providers in the
region, hold periodic local task force meetings, conduct local real-time
immunization surveys, follow randomly selected immunization records
through the system and facilitate the dialogue between the different
agencies and individuals in the region participating in the project.
His salary will be provided by TDH.
The Secretary will be responsible for clerical and data processing
tasks. She will coordinate the schedules of the staff, be a consistent
presence in the Lubbock office to answer inquiries, and type, duplicate
and distribute surveys, reports, brochures, etc.
Volunteer data entry personnel will work approximately 624 hours per
year for the first three years of the program in Lubbock County with and
in -kind contribution of $3120.
We are requesting a full time equivalent for two Computer Technicians,
the Secretary position and Outreach Worker. This project will cover a
large amount of territory. It is our belief that there needs to be a
person in the office during work hours who can answer questions and
problem -solve, while ensuring continuity to the project. This person
would be the Secretary.
The Outreach Worker, Computer Technicians and the Project Director will,
by definition, need to be in the field much of the time. We believe
that two Computer Technicians and an Outreach Worker will be able to
accomplish the assigned tasks working full time.
Fringe Benefits:
The fringe benefits provided by the City of Lubbock Health Department
and TDH include Federal Withholding Tax, FICA, Workman's Compensation,
life insurance, health insurance, dental insurance, and retirement for
full-time equivalent staff members. The fringe rate varies.
Pero. Health Services Coordinator $968 (In -Rind)
Administrative Technician $462 (In -Rind)
Project Director $6682
Outreach Worker $5551
Computer Technicians $6578
ADP Programmers $6307 (In -Rind)
Secretary $3851
TOTAL FRINGES: $30,399
18
II. Office Operations:
Supplies: The requested supply budget is $1,350 for the implementation
grant. This money will be used for general office supplies for four
full time equivalent staff positions. The needed supplies include tape
and tape dispensers, stationary, paper clips, pens, pencils, rolodex
cards, staplers, calendars, notepads, typewriter ribbons, computer
paper, diskettes, and ribbons for printers.
Printing: The requested printing budget is $2,800 for the first
implementation year. These funds will cover the cost of business cards,
educational material, and instructions manuals for the use of the
computers and software.
Duplicating: The requested duplicating budget is $2,800. This will
include the cost of duplicating surveys and other related needs. The
cost includes copy paper, toner, and dispersant for the copier.
Telephone: The requested telephone budget is $3,800. We are
anticipating numerous telephones calls between the Lubbock staff and the
Canyon staff, participating agencies, as well as to volunteers around
the region. Based on previous phone bills for various telephone calls
to other cities in the region, we are estimating a monthly phone bill of
$316.
Postage: The requested postage budget is $1,400. This money will be
used to provide postage between the staff in Lubbock and Canyon and
between Lubbock, participating agencies and individual volunteers, as
well as postage to the Robert Wood Johnson Foundation.
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $4,255. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker and the project director may
need to spend the night on the road when contacting some of the local
communities. We included hotel and a per diem in the local travel
budget to cover this necessity. The local travel breakdown for the
Lubbock staff is as follows:
Mileage ($.275 per mile X 1000 miles per month) _ $ 3300
Hotel ($55 per night for 6 nights) _ $ 330
Per Diem ($25 per day for 25 days) _ $ 625
TOTAL $4,255
19
Non -local Travels The requested budget for non -local travel is $2,960.
This includes money for two people to attend one national meeting
sponsored by the Robert Wood Johnson Foundation for two nights and two
days. It also includes two trips for one person in Texas, but outside
the region, to observe and assess other immunization programs. These
trips will be one night trips.
The non -local travel breakdown is as follows:
National Trip
($1,140 X 2) _
$
2,280
In -State Air Fare
($240 X 2) _
$
480
In -State Hotel
($75 X 2) _
$
150
Per Diem
($25 X 2) _
$
50
TOTAL
$
2,960
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Computer Equipment:
In -kind contributions for Texas Department of Health include 5 laptop
computers with external modems and computer supplies.
TDH Total in -kind contribution = $15,000
VI. Consultant Honoraria:
The requested budget amount for this category is $4,500. Dr. Kathleen
Hennessey of Texas Tech University will provide expertise in the field
of database networks. The $4,500 estimate is based on fifteen (15)
days/year at $300 per day. There will be no travel expense as she is
based in Lubbock.
VII. Subcontracts:
See separate narrative.
20
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH
REGION 2 (PANHANDLE OFFICE)
Grant Period: (from 111005 to 10/31/'96)
Budget Period: (from 11/01/95 to 10/31/96)
PROJECT YEAR 3
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position Base Salary % Tune
Immunization Program Manager $30,500 10%
$3,050
$0
$3,050
Computer Technician $27,945 100%
$27,945
$0
$27,945
Total Salaries
$30,995
$0
$30,995
Fringe Benefits
$6,199
$0
$6,199
II. OFFICE OPERATIONS
Supplies
$400
$0
$400
Duplicating
$600
SO
M
Telephone
$1,800
$0
$1,800
Postage
$1,000
SO
$1,000
III. PROJECT STAFF TRAVEL
$4,255
$4,255
$0
Sub —Total
$45,249
$4,255
W,994
IV. INDIRECT COSTS
$4,072
$383
$3,689
V. COMPUTER EQUIPMENT
$2,500
SO
$2,500
TOTAL
$51,821
$4,638
$47,183
21
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH, REGION 2
BUDGET NARRATIVE - YEAR 3
Introduction:
The subcontract with the Canyon office of Texas Department of Health,
Region 2 grant proposes to implement a better way of tracking
immunizations. It would be very difficult for a computer technician
based in Lubbock to effectively cover the entire Panhandle. Some of the
towns in the Panhandle are -more than a six (6) hour drive from Lubbock.
The distance would require the worker to spend more time driving than
meeting and working with people. One FTE in Canyon would cut most of
the traveling time in half, at least. We believe this would provide
greater cost effectiveness for the grant dollar. We have therefore
developed a proposal which subcontracts the Panhandle Computer
Technician to the Texas Department of Health.
Other Support:
The funding in this column will be provided by the Department of Health
in the form of in -kind personnel time and equipment (computers and
office furniture and offices expenses).
I. Personnel:
The Immunization Program Manager will supervise the computer technician
assigned to the Panhandle of Texas, will ensure that the project is
complying with all state policies and procedures, and will offer his
expertise to ensure the success of the project.
The Computer Technician will work in Canyon and the surrounding counties
of the Panhandle of Texas, installing and maintaining computer hardware
and software, and training immunization personnel on the use of the
system. The Panhandle of Texas is a larger geographical area than the
South Plains of Texas, although the population is roughly equivalent.
This larger geographical area will necessitate that this worker will be
traveling more and spending the night on the road more often than the
technicians covering the South Plains. We believe that the technician
will be able to accomplish the assigned tasks working 100% of the time.
This technician's salary will be funded by TDH.
Fringe Benefits:
The fringe benefits would be provided as in -kind by the State of Texas.
II. Office Operations:
Provided by Texas Department of Health In -kind $3,800.
22
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $4,255, We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker may need to spend the night on
the road when contacting some of the local communities. We included
hotel and a per diem in the local travel budget to cover this necessity.
The local travel breakdown for the Canyon staff is as follows:
Mileage
($.275 per mile X 1000 miles per month) _
$
3,300
Hotel
($55 per night for 6 nights) _
$
330
Per Diem
($25 per day for 25 days) =
$
625
TOTAL
$
4,255
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Equipment:
In -Rind funding of $2,500 for the purchase of supplies, such as
diskettes, computer paper/cards, ribbons, etc.
23
THE ROBERT WOOD JOHNSON FOUNDATION
LINE ITEM BUDGET
Grant Period: (from 11/01/96 to 10%31/97)
Budget Period: (from 11/01/96 to 10/31/97)
PROJECT YEAR 4
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position
Base Salary
%Time
Pers. Health Svcs. Coord.
$44,000
10%
$4,400
$0
$4,400
Administrative Technician
$21,000
10%
$2,100
$0
$2,100
Project Director
$32,500
100%
$32,500
$0
$32,500
Outreach Specialist (S.Plains)
$27,000
100%
$27,000
$0
$27,000
Computer Technician
$31,994
100%
$31,994
$0
$31,994
ADP Programmer
$28,668
100%
$28,668
$0
$28,668
Secretary
$18,730
100%
$18,730
$18,730
$0
Total Salaries
$145,192
$18,730
$126,662
Fringe Benefits
$31,986
$4,121
$27,866
II. OFFICE OPERATIONS
Supplies
$1,350
$1,350
$0
Printing
$2,800
$2,800
$0
Duplicating
$2,800
$2,800
$0
Telephone
$3,800
$3,800
$0
Postage
$1,400
$1,400
$0
III. PROJECT STAFF TRAVEL
$7,215
$7,215
$0
Sub -Total
$196,743
542,216
$154,528
IV. INDIRECT COSTS
$17,707
$3,799
$13,907
V. COMPUTER EQUIPMENT
$17,500
$0
$17,500
VI. CONSULTANT HONORARIA
$4,500
54,500
$0
VII. SUBCONTRACTS
$54,380
54,638
$49,742
TOTAL
$290,830
$55,153
$235,677
24
BUDGET NARRATIVE - YEAR 4
Other Support:
The funding in this column will be provided by the City of Lubbock
Health Department, Texas Department of Health and grants. This support
will primarily be in -kind funding consisting of personnel salary time
and equipment (computers and office furniture). Other support listed in
the Subcontract will be provided by the Texas Department of Health,
Region 2 in the form of in -kind personnel time and equipment. Other
support may include funding and in -kind support from the Junior League
and the Lubbock Area Foundation.
I. Personnel:
The Personal Health Services Coordinator will supervise the project
director, will ensure that the project is complying with all City of
Lubbock policies and procedures, and will offer her expertise to ensure
the success of the project.
The Administrative Technican will be responsible for managing the
budget, providing back-up for all financial expenditures, producing the
required financial reports, and operating the grant following all City
of Lubbock financial policies and procedures.
The Project Director will be accountable for planning, organizing, and
directing the implementation and operations of the project. The Project
Director will supervise two full time computer technicians, one full
time outreach worker and the secretary. The Project Director will
coordinate the activities with the staff, the consultant and the
volunteers from the local level. The Project Director will meet with the
regional advisory committees comprised of individuals from the local
task forces. The Project Director will act as staff liaison to the
regional task force as the plans are implemented on a regional and
local basis. His salary will be requested from TDH grants.
Two Computer Technicians will be on staff. One will be assigned to the
Panhandle and one to the South Plains. The technicians will install and
maintain the computer equipment, correct any software problems, train
immunization personnel on the use of the equipment and software and work
closely with Texas Department of Health technicians to maintain the
integrety of the immunization database network. Both of these
employee's salary will be funded by TDH.
Two ADP Programmers will be responsible for installation and maintenance
of the equipment and software installed at the Texas Department of
Health Region 2 office and its 20 clinics. These are TDH employees
working 50% of their time on the tracking system.
25
The Outreach Worker will work out of Lubbock and cover the entire
region. He will coordinate with the immunization providers in the
region, hold periodic local task force meetings, conduct local real-time
immunization surveys, follow randomly selected immunization records
through the system and facilitate the dialogue between the different
agencies and individuals in the region participating in the project.
His salary will be provided by TDH.
The Secretary will be responsible for clerical and data processing
tasks. She will coordinate the schedules of the staff, be a consistent
presence in the Lubbock office to answer inquiries, and type, duplicate
and distribute surveys, reports, brochures, etc.
We are requesting a full time equivalent for two Computer Technicians,
the Secretary position and Outreach Worker. This project will cover a
large amount of territory. It is our belief that there needs to be a
person in the office during work hours who can answer questions and
problem -solve, while ensuring continuity to the project. This person
would be the Secretary.
The Outreach Worker, Computer Technicians and the Project Director will,
by definition, need to be in the field much of the time. We believe
that two Computer Technicians and an Outreach Worker will be able to
accomplish the assigned tasks working full time.
Fringe Benefits:
The fringe benefits provided by the City of Lubbock Health Department
and TDH include Federal Withholding Tax, FICA, Workman's Compensation,
life insurance, health insurance, dental insurance, and retirement for
full-time equivalent staff members. The fringe rate varies.
Pero. Health Services Coordinator $968 (In -Rind)
Administrative Technician $462 (In -Rind)
Project Director $7150 (In -Rind)
Outreach Worker $5940 (In -Rind)
Computer Technicians $7039 (In -Rind)
ADP Programmers $6307 (In -Rind)
Secretary $4121
TOTAL FRINGES: $31,987
26
II. Office Operations:
Supplies: The requested supply budget is $1,350 for the implementation
grant. This money will be used for general office supplies for four
full time equivalent staff positions. The needed supplies include tape
and tape dispensers, stationary, paper clips, pens, pencils, rolodex
cards, staplers, calendars, notepads, typewriter ribbons, computer
paper, diskettes, and ribbons for printers.
Printing: The requested printing budget is $2,800 for the first
implementation year. These funds will cover the cost of business cards,
educational material, and instructions manuals for the use of the
computers and software.
Duplicating: The requested duplicating budget is $2,800. This will
include the cost of duplicating surveys and other related needs. The
cost includes copy paper, toner, and dispersant for the copier.
Telephone: The requested telephone budget is $3,800. We are
anticipating numerous telephones calls between the Lubbock staff and the
Canyon staff, participating agencies, as well as to volunteers around
the region. Based on previous phone bills for various telephone calls
to other cities in the region, we are estimating a monthly phone bill of
$316.
Postage: The requested postage budget is $1,400. This money will be
used to provide postage between the staff in Lubbock and Canyon and
between Lubbock, participating agencies and individual volunteers, as
well as postage to the Robert Wood Johnson Foundation.
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $4,255. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker and the project director may
need to spend the night on the road when contacting some of the local
communities. We included hotel and a per diem in the local travel
budget to cover this necessity. The local travel breakdown for the
Lubbock staff is as follows:
Mileage ($.275 per mile X 1000 miles per month) _ $ 3300
Hotel ($55 per night for 6 nights) _ $ 330
Per Diem ($25 per day for 25 days) _ $ 625
TOTAL $4,255
27
Non -local Travel: The requested budget for non -local travel is $2,960.
This includes money for two people to attend one national meeting
sponsored by the Robert Wood Johnson Foundation for two nights and two
days. It also includes two trips for one person in Texas, but outside
the region, to observe and assess other immunization programs. These
trips will be one night trips.
The non -local travel breakdown is as follows:
National Trip
($1,140 X 2) _
$
2,280
In -State Air Fare
($240 X 2) _
$
480
In -State Hotel
($75 X 2) _
$
150
Per Diem
($25 X 2) _
$
50
TOTAL
$
2,960
IV. Indirect Costs:
9% times amount requested in items I through III.
V. Computer Equipment:
In -kind contributions for Texas Department of Health include 5 laptop
computers with external modems and computer supplies.
TDH Total in -kind contribution = $17,500
VI. Consultant Honoraria:
The requested budget amount for this category is $4,500. Dr. Kathleen
Hennessey of Texas Tech University will provide expertise in the field
of database networks. The $4,500 estimate is based on fifteen (15)
days/year at $300 per day. There will be no travel expense as she is
based in Lubbock.
VII. Subcontracts:
See separate narrative.
28
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH
REGION 2 (PANHANDLE OFI ICE)
Grant Period: (from 11/01/96 to 10/31/97)
Budget Period: (from 11/01/96 to 10%31/97)
PROJECT YEAR 4
RWJF
OTHER
I. PERSONNEL
TOTAL
SUPPORT
SUPPORT
Position Base Salary % Time
Immunization Program Manager $30,500 10%
$3,050
$0
$3,050
Computer Technician $29,901 100%
$29,901
$0
$29,901
Total Salaries
$32,951
$0
$32,951
Fringe Benefits
$6,590
$0
$6,590
II. OFFICE OPERATIONS
Supplies
$400
$0
$400
Duplicating
$600
$0
$600
Telephone
$1,800
$0
$1,800
Postage
$1,000
$0
$1,000
III. PROJECT STAFF TRAVEL
$4,255
$4,255
$0
Sub —Total
$47,596
$4,255
$43,341
IV. INDIRECTCOSTS
$4,284
$383
$3,901
V. COMPUTER EQUIPMENT
$2,500
$0
$2,500
TOTAL
$54,380
$4,638
$49,742
29
SUBCONTRACT WITH TEXAS DEPARTMENT OF HEALTH, REGION 2
BUDGET NARRATIVE - YEAR 4
Introduction:
The subcontract with the Canyon office of Texas Department of Health,
Region 2 grant proposes to implement a better way of tracking
immunizations. It would be very difficult for a computer technician
based in Lubbock to effectively cover the entire Panhandle. Some of the
towns in the Panhandle are more than a six (6) hour drive from Lubbock.
The distance would require the worker to spend more time driving than
meeting and working with people. One FTE in Canyon would cut most of
the traveling time in half, at least. We believe this would provide
greater cost effectiveness for the grant dollar. We have therefore
developed a proposal which subcontracts the Panhandle Computer
Technician to the Texas Department of Health.
Other Support:
The funding in this column will be provided by the Department of Health
in the form of in -kind personnel time and equipment (computers and
office furniture and offices expenses).
I. Personnel:
The Immunization Program Manager will supervise the computer technician
assigned to the Panhandle of Texas, will ensure that the project is
complying with all state policies and procedures, and will offer his
expertise to ensure the success of the project.
The Computer Technician will work in Canyon and the surrounding counties
of the Panhandle of Texas, installing and maintaining computer hardware
and software, and training immunization personnel on the use of the
system. The Panhandle of Texas is a larger geographical area than the
South Plains of Texas, although the population is roughly equivalent.
This larger geographical area will necessitate that this worker will be
traveling more and spending the night on the road more often than the
technicians covering the South Plains. We believe that the technician
will be able to accomplish the assigned tasks working 100% of the time.
This technician's salary will be funded by TDH.
Fringe Benefits:
The fringe benefits would be provided as in -kind by the State of Texas.
II. Office Operations:
Provided by Texas Department of Health In -kind $3,800.
30
III. Project Staff Travel:
Local Travel: The requested budget for local travel is $4,255. We are
defining local travel as any travel within the region which is
cooperating in the planning project. This region covers approximately
38,000 square miles. The outreach worker may need to spend the night on
the road when contacting some of the local communities. We included
hotel and a per diem in the local travel budget to cover this necessity.
The local travel breakdown for the Canyon staff is as follows:
Mileage ($.275 per mile X 1000 miles per month) _ $ 3,300
Hotel ($55 per night for 6 nights) s $ 330
Per Diem ($25 per day for 25 days) _ $ 625
TOTAL $ 4,255
IV. Indirect Costs:
98 times amount requested in items I through III.
V. Equipment:
In -Rind funding of $2,500 for the purchase of supplies, such as
diskettes, computer paper/cards, ribbons, etc.
31
APPENDICES
STATISTICAL REPORT FOR THE REGION 2 SCHOOL DISTRICT
BASED UPON 35 SCHOOLS
I TOTAL ENROLLMENT: 0 TOTAL RECORDS REVIEWED IN GRADE K : 850
GRADE K : 2341 RECORDS LACKING AN IMMUNIZATION HISTORY: 0
IMMUNIZATION STATUS
AT 3 MONTHS:
DTP 1:
POLIO 1:
DTP 1 OR POLIO 1:
DTP1 AND POLIO 1:
AT 7 MONTHS:
DTP 3:
POLIO 2:
DTP 1 OR POLIO 1:
DTP3 AND POLIO 2:
AT 12 MONTHS:
DTP 3:
POLIO 2:
DTP 1 OR POLIO 1:
DTP 1 AND POLIO 1:
DTP 3 AND POLIO 2:
AT 19 MONTHS:
DTP 4:
POLIO 3:
MMR 1:
DTP 1 OR POLIO 1:
DTP 3 AND POLIO 3 AND MMR 1:
DTP 4 AND POLIO 3 AND MMR 1:
AT 24 MONTHS:
DTP 4:
DTP 3:
POLIO 3:
MMR 1:
DTP 1 OR POLIO 1:
DTP 3 AND POLIO 3 AND MMR 1:
DTP 4 AND POLIO 3 AND MMR 1:
AT 36 MONTHS:
DTP 4 AND POLIO 3 AND MMR 1:
AT 48 MONTHS:
DTP 4 AND POLIO 3 AND MMR 1:
AT 60 MONTHS:
DTP 4 AND POLIO 3 AND MMR 1:
DTP 3 AND POLIO 3 AND MMR 1:
AT 72 MONTHS:
DTP 3 AND POLIO 3 AND MMR 1:
DTP 4 AND POLIO 3 AND MMR 1:
GRADE K
NO. t
501 58.9
499 58.7
501 58.9
499 58.7
95% CONFIDENCE
INTERVALS
54.0 63.9
53.8 63.6
54.0 63.9
53.8 63.6
253
29.8
25.2
34.3
504
59.3
53.7
64.9
672
79.1
74.8
83.3
253
29.8
25.2
34.3
471
55.4
50.5
60.3
632
74.4
68.9
79.9
744
87.5
84.7
90.4
737
86.7
83.3
90.2
471
55.4
50.5
60.3
242
28.5
23.6
33.4
550
64.7
59.4
70.0
476
56.0
52.0
60.0
790
92.9
90.8
95.1
396
46.6
41.7
51.4
213
25.1
21.2
28.9
366
43.1
38.0
48.1
626
73.6
68.0
79.3
600
70.6
65.2
76.0
602
70.8
67.3
74.4
803
94.5
92.7
96.3
504
59.3
54.1
64.5
329
38.7
34.2
43.2
477
56.1
51.0
61.2
541
63.6
58.5
68.8
672
79.1
73.9
84.2
769
90.5
86.8
94.1
822
96.7
94.4
99.0
744
87.5
82.5
92.5
DATE RUN: 04/30/93 TIME RUN: 14:56:45 Page 1
A-1
The Texas Panhandle and South Plains All Kids Count Program
Needs Assessment Survey
This survey is designed to determine the needs of children's health care in your community. This
document should be completed only by parents with young children.
PLEASE DO NOT WRITE YOUR NAME ON THIS QUESTIONNAIRE
City County
The ZIP CODE of your residence
1. How many children do you have?
2. What are their ages (please list):
3. What are their sexes (please provide a number):
_ Male — Female
4. Where do you take your child(ren) for their immunizations? (Name the clinic or doctor AND
the city).
5. Have any of your children been to a doctor or clinic in the past year? — Yes —No
In what city was the doctor or clinic located?:
6. What was the reason for the visit to the doctor or clinic? (please check all that apply)
_ Checkup/Physical Exam — Immunizations
Illness _ Injury
Other: Did not visit a doctor
7. Have any of your children ever been hospitalized?
_ Yes _ No
8. If yes, what was the name of the hospital and in what city was the hospital located?
9. Can you go to a hospital or doctor's office whenever you need treatment?
_ Yes (If yes, go to Question 11) _ No
10. If you checked 'NO' on N9, why? (check all that apply)
_ Costs _ Location
Convenience _ Inadequate Care
— Lack of Transportation + Other (please describe):
11. Please check the type of medical insurance that your child(ren) is currently covered under.
No Medical Insurance Private -individual policy
Private -group policy Private -Health Maintenance Organization
Medicaid CHAMPUS
Indigent/Charity patient care Other
A-2
12. Please check those services which are available in your community
_Doctor's Office _Clinic
_Hospital _Home health care
_Household help _Social Services Assistance
13. Please check whether you are satisfied with the following:
Availability of timely medical appointments: , Yes _ No
Availability of hospital services: — Yes _ No
Availability of financial assistance to help with medical care: _ Yes _ No
Degree of concern of health care providers: , Yes No
The following questions are for statistical purposes only. Please check the answer that applies to you.
1. Age: 2. Sex: Male Female
3. Ethnicity: , Black _ White, non -hispanic Hispanic, non -white
Asian Other
4. Now much education do you have?
None _ 1 to 8 Years
_ 9 to 11 Years _ High school graduate/GED
_ Some college — College graduate _ _ Post graduate
5. Please indicate with whom you share your housing (check all that apply):
No one —Spouse/partner _Friends
_Relatives _Children Other (please describe) _
6. Are you (the parent or guardian) currently employed?
Yes No
7. What is your annual household income (please choose only one):
_Less than 15,000 _15,000 to 20,999
21,000 to 25,999 _26,000 to 39,999
40,000 or more
Thank you for your cooperation In completing this survey.
TEXAS PANHANDLE Y LA PLAN/CIES DEL SUR CON EL PRO GRAMA
TODOS LOS NINOS CUENTAN
Estudio de Reconocimiento de Necesidades
Este estudio as disensdo pars determiner las necesidedes del cuidado de Is selud de los ninos an su comunidad.
Este documento debe ser completsdo solo por padres con rhos pequenos.
POR FAVOR NO ESCRIBA SU NOMBRE EN ESTA ENCUESTA
Ciudad Condado
El CODIGO POSTAL de su residencia
1. lCuantos ni6os tiene7
2. lLas edades son (por favor enliste)1
3. lLos sexos son (por favor provee un n6mero)7
_ Hombre _ Muier
4. IDonde Ileva a su nino por sus vacunas7
(Nombre la clfnica o doctor y la Ciudad)
5. lAIguno de sus niPios ha visto a un doctor o clfnica en
el pasdo ano7 _Si _No
En que ciudad estaba el No
o clfnica localizados7
6. lPorque fue al doctor o clinical (por favor marque todo
que aplica)
— Comprobaci6n/Examen Fisico T Vacunas
_ Enfermedad _ Heridas
no visit6 un doctor Otro
7. ZAlgunos de sus nir)os han sido hospitalizados7
Sf No
8. lSi marca sf, cual es el nombre de la clfnica y en qu6
ciudad esta localizada7
9. lPuede it a una clfnica o oficina de doctor cuando
necesite tratamientol
_ Sf (Si marca sf, siga con la Pregunta 11) _ No
10. Si marco 'NO' en #9, 1porqu67 (Marque todo que aplica)
_ Gastos _ Localizacion
_ Conveniencia — Cuidado Inadequado
Falta de Transportaci6n _ Otro (por favor
describa)
A-3
1 1. Por favor marque el tipo de seguro m6dico que cubre a
su(s) nino(s) al presente
Sin Seguro M6dico _ p6liza privada
_ del Grupo privad
_ Organizaci6n del Mantenimiento de la Salud privada
_ Medicaid _ CHAMPUS
Lugares/indigente/de caridad ,Otro
12. Por favor marque los servicios que estan disponible
en su comunidad
_Oficina de Doctor _ Clinica
_Hospital _Casa afliccion de la salud
_Ayuda de casa _Asistencia de Servicios Sociales
13. Por favor marque si es sastifecho con to siguiente:
Disponible de citas medicas:
_ Sf _ No
Disponible de servicios hospitales:
Si No
Disponible de asistencia financiera que ayuda con el
cuidado medico:
Si No
Grado de preocupacion de proveedores del cuidado de la
salud
Si No
Las siguientes preguntas son solamente para estadisticos. Por favor marque la respuesta a to que le
aplique.
1. Edad: ` 2. Sexo: u Hombre _ Mujer
3. Raza: _ Negro _ Blanco , Hispano _
Asiatico Otro
4. 1Cuanta educaci6n tiene?
— Ninguno _ 1 a 8 Anos _9 a 11 Anos
graduado de la escuela secundaria/GED
Algun universidad _ graduado de la Universidad
_ graduado del Poste
5. Por favor indique con quien comparte su casa (marque
todo que aplica)
_ Solo _ Esposo/Esposa _ Ninos _Parientes
Otro (Por favor describa)
6. (Este (el padre o guardian) corrientemente empleado?
Si No
7. jOue es su engreso anual? (por favor escoga uno)
_ Menos que 15,000 _15,000 a 20,999
21,000 a 25,999 26,000 a 39,999
40,000 o mis
Muchas gracias por su cooperacion an completer este estudio.
Texas Panhandle and the South Plains A# Kids Count Program
Health and Medical Services
Providers Questionnaire
This questionnaire is about the services that your agency or business provides and your current
capabilities and future needs for automating immunization assessment. Also, the information will be
used to develop a directory of primary care services available to children. If you have questions
regarding the survey, please call Richard Kolas with the Lubbock Health Department at (806) 767-
2942.
Please provide your name, the name of your agency or organization and its address in the spaces
provided below.
Name of Agency:
Your Name:
Your Title:
Mailing Address:
City: Zip Code:
Telephone: ( 1
If different from the above, who should we contact if any further information is needed about your
agency or organization:
Person who should be contacted:
Title:
Telephone: ( 1
................................................ 4 0 * 9 0 * ... !
1. Do you provide children health services?
Yes _ No
2. Do you provide childhood immunizations?
Yes — No
If you answer "NO" to BOTH questions, STOPI You have completed this survey. Thank you
for your cooperation.
If you answered "YES" only to question #1, skip to question #8.
If you answered 'YES' to question x2, please continue with question M3.
OVER
A-4
3. What are the costs for a child to receive immunizations?
DTP, OPV, HibCV
DTP, HibCV
DTP, OPV, HibCV, MMR
DTP, OPV, MMR
TD
Hepatitis B
Do you charge for an office visit when a child receives only an immunization?
Yes r No
If yes, how much?
4. Approximately how many patients receive immunizations within a month at your organization?
5. Approximately how many doses are given in a month?
6. If you do not provide immunizations for children, why not?
_ Expense
Liability
— Inadequate staffing
Other
7. If a patient is not able to pay for immunizations are they referred to another agency?
Yes — No
8. If vaccine were supplied at no cost to providers would you or your agency consider providing
the service?
Yes _ No
9. If the vaccine was provided at no cost, would you provide the immunizations for a fee
not to exceed $10?
Yes No
10. Which of the following best describes your agency or organization's legal status?
Federal
State
— County
City
Private Non-profit
Private For -profit
Religious Affiliation
Other, please specify
11. What type of payments are accepted?
(Check all that apply.)
_ Medicaid
_ Medicare
Insurance
+_ Cash/check only
Credit Cards
Other, please specify
12. If the patient is not able to pay at the time the services are needed, are the services still
rendered?
_ Yes No
13. Do you provide any educational services (i.e. videos, instructional programs, media material) to
inform the general public about children health care? (Do not count in-service programs for
employees.)
Yes ! No
14. Would you be willing to be linked to a computerized network to track children's immunizations?
Yes _ No
Thank you for your cooperation In completing this survey.
LETTERS OF SUPPORT
March of Dimes
Birth Defects Foundation
Northwest Texas Chapter
2345-50th Street #109
Lubbock, Texas 79412
(806) 797-6771
June 22, 1993
RECEIVED
1281993
LuSfl()C,Fi Gty HEALTH DEp►
"h of
Imes
I Menling
Biith0efects
11�—
Healthier
Babies
Robert Wood Johnson Foundation
The Task Force for Child Survival and Development
One Copenhill
Atlanta, Georgia 30307
Dear Sirs,
The Northwest Texas Chapter of the March of Dimes gladly
endorses and recommends support for the All Kids Count
project, developed by the Lubbock Health Department. The
mission of the March of Dimes is healthy babies and the
prevention of birth defects.
Education and loving concern are the tools used by the March
of Dimes in our struggle to complete this mission. The
educating process, designed to promote prenatal and newborn
care, must be extended to early childhood. Our healthy
babies will become our healthy preschoolers only if
consistent efforts to educate parents and the children
themselves are maintained. Proper immunization and
immunization records are imperative to that end.
Education, the process of teaching and learning should be
unending. A program of such a noble nature, the All Kids
Count project, must be provided the financing to be brought
into infancy, and strongly supported thereafter in its
growth and maturation. The Northwest Texas Chapter of the
March of Dimes will proudly support this birth.
Yours in healthier babies,
Kim King
Chapter Director
Research - Education - Medical Care - The Salk Institute
University Medical Center
July 1, 1993
Richard Kolas
All Kids Count
1902 Texas Ave.
Lubbock, TX 79408
Dear Mr. Kolas,
This letter is to express University Medical Center's full
support for your work toward a region -wide immunization tracking
system. The need for such a system is evident when considering
the poor rate of immunization of children in the South Plains
region. The increased coordination between service agencies that
will result from this project will greatly improve the rate of
immunization of preschool children and reduce the prevalence of
vaccine -preventable diseases in our region.
University Medical Center is a supportive partner in the "All
Kids County" endeavor. Please let me know how UMC may be of
assistance toward the development and implementation of this
timely program.
S41y yours,
Gafford
V'ce President V
cc: James Courtney, President & CEO
602 Indiana Avenue PO Box 5980
1 111,11-A 'r_ (I , 11 C(Wfl V(V i 7 ) 1 1 1
J CL
IN r
ST. MARY OF THE PLAINS HOSPITAL
A Sisters of St Joseph of Orange Corporation
July 6, 1993
To: Robert Wood Johnson Foundation
Recognizing the health risks inherent to any population
where immunizations are not conducted regularly, St. Mary
Hospital proudly supports the Lubbock Health Department
in its child immunization efforts.
In no situation is the phrase, "an ounce of prevention is
worth a pound of cure" more appropriate than with the
immunization of our children.
The health care environment of the future will dictate
that we place even greater emphasis on wellness and
prevention, and St. Mary Hospital heartily endorses this
endeavor.
Sincerely,
C-
Charley Trimble
President & CEO
RECEIVED
junior league of Lubbock
June 24, 1993
Nancy Haney, Health Programs Supervisor
City of Lubbock Health Department
P. O. Box 2548
Lubbock, Texas 79408
Dear Project Applicant:
i,1 2 9 1993
LUBBOCK C'TY HEALTH DEPT.
The Junior League of Lubbock acknowledges the receipt of your
project proposal for the 1994-95 funding year. We have received
numerous requests for funding under the Health and Wellness Impact
Area. Nineteen different proposals totalling over $700,000.00 have
been delivered to our office. The Research and Development
Committee will begin reviewing these proposals during the next few
weeks, with more formal investigation scheduled for the early fall.
We look forward to working with you during the next few months and
appreciate your efforts in the area of Health and Wellness. If you
have any questions or concerns, please do not hesitate to contact
me.
Sincerely,
Lori Scott
Research and Development Chairman
"The Association of Junior Leagues International, Inc . reaches out to women of all races.
religions and national origins who demonstrate an interest in and commitment to voluntarism."
1901-B 50th Street Lubbock, Texas 79412
10,
06vut4 ]Jhtins ]Juhlir Aealt4 District
P.O. BOX 112 :-: 919 EAST MAIN
MORRIS S. KNOX. M.D.
�9rehinfieia, Texagi 79316
Director
DAWSON COUNTY
HOCKLEY COUNTY
GAINES COUNTY YOAKUM COUNTY
TERRY COUNTY
LAMESA, TEXAS 79331
LEVELLAND, TEXAS 79336
SEMINOLE. TEXAS 79360 DENVER CITY, TEXAS 79323
BROWNFIELD. TEXAS 79318
P.O BOX 1291-1510 N. BRYAN
P.O. BOX 610 - 609 AVE. D
P.O. BOX 1713 - 704 HOBBS HWY. P.O. BOX 315 - 412 N. AVE. F
P.O. BOX 112 - 919 EAST MAN
PHONE 872-5863
PHONE 894-4045
PHONE 758.2212 PHONE 592-2706
PHONE 637.2164
Barbara Bouton, R.N.
Director of Nurses
South Plains Public Health District
919 E. Main
Brownfield, Texas 79316
June 30, 1993
LETTER OF SUPPORT:
South Plains Public Health District supports the Immunization Task
Force in its efforts to bring computerized immunization records to
this area.
South Plains Public Health District operates 5 Health Departments in
5 counties, providing immunization clinics in 7 cities.
Given the tremendous numbers of children this project would impact,
and consequently reduce the incidence of disease in our community, and
given the increasing numbers of providers giving immunizations, it
will become vital that computerized immunization records be kept and
be readily available. This will be invaluable in assuring that chil-
dren not only receive adequate immunizations, but also that they will
not inadvertantly be over immunized due to parents accessing muliple
providers.
South Plains Public Health District will continue to participate in and
provide Richard Kolas and the Task Force with all the support and
assistance he requests.
If you require any further assistance or information, please do not
hesitate to contact me at South Plains Public Health District
central office in Brownfield. Telephone 806-637-2164.
Sincerely,
Barbara Bouton, R.N.
Director of Nurses
South Plains Public Health District
Teare Memorial Clinic j
Bob Shaffer
P. 0. Box 410
Booker, Texas 79005
June 30, 1993
Richard Kolas
Lubbock Health Department
P.O. Box 2548
Lubbock,TX 79408-9961
Dear Richard,
I would like to express my support of the Texas
Panhandle and South Plains All Kids Count Program. I
have a small clinic in Lipscomb County. It's the only
medical clinic in the county. We have parents bringing
their children in all the time and when we ask them about
their children's immunization they can't remember. Some
of them even have trouble finding their cards. So I can
see the advantages of having good records and being able
to get a history on what vaccinations each of the
children ha
ve received.
I have been involved with the needs assessment surveys
and meeting with the representative from All Kids Count.
I believe it to be a good and worthy project and I would
support it whole heartedly.
Sincerely yours,
-/� :1�
Bob Shaff�,RNMN,FNP
jlb
y: Ploinview-Hole Counfy Heolfh I)isfricf
t
Mary D. Bublis, M.D. Affiliated with Texas State Department of Health Area Code =6
t• Director ;Ji`r Tenth t Ash Streets Tek — &rs 1738 d'0"e 2911359
PLAINVIEW, 1 E%AS 79073
July 7, 1993
Richard Kolas
All Kids Count
Box 2548
Lubbock, Texas 79408
Dear Mr. Kolas:
The Plainview -Hale County Health Department whole-
heartedly supports the ALL KIDS COUNT Immunization
initiative.
/—a
Johnstro
Administrator
Plainview -Hale County Health District
CERTIFICATION
OF
PUBLIC STATUS
Canadian Area Family YMCA
P.O. Box 1106
Canadian, Texas 79014
Tel.8061323-5254
7; 1 2)! 93
Richard Kolas
Lubbock Health Crept.
P.O, Cox 2546
Lubbock., Tex. 79406-9961
Dear Mr. Kolas,
The need for the Panhandle All Yids Count Program to continue is rriost
important to Our rural area. As a member of the Panhandle Task Force
Cornrrlittee, I feel that after reviewing the bleed: Assessment Survey that
was taken in Our communities-, that there is a great creed for continuous
education for promotinq timely immunization for children in this area.
The computer networking that has been proposed would greatly improve
and provide more efficient service to our population plus provide the
healthcare workers with more information and better recordkeeping
instruments.
The All Yids Count Program should be extended and further developed. If
the Canadian 'riICA can be of help to the program do not hesitate to call on
us.
Sincerp.lq,
�C
Giliss:a 1-1i_rrray
ExPCUtive Director
DATE: 11 July 1993
FROM: Alma Pittenger RN, BSN
Field Office Coordinator
Texas Department of Health
Hereford, Texas 79045
TO: Richard Kolas
Lubbock Health Department
P.O. Box 2548
Lubbock, Texas 79408-9961
I would like to take this opportunity to thank you for your efforts,
through the "Kids Count" initiative, to increase the number of
children in our area who are immunized and to provide a method by
which these children can be tracked. Those of us involved with
the immunizations programs in this area are well aware that there
is a need for improvement in both these areas.
I have enjoyed working with Audra Bell on this project and I look
forward to the time we can actually get all the children on network.
Thank you again for your efforts in this project.
cc:
Phyllis McLemore MSN, BSN
Director of Nursing Services
D. L. Wilson
Immunizations Services
LuLu Lehmann RN, BSN
Area Coordinator
PART
CHARTER*
Chapter One
[BASIC CHARTERt)
Art.
I.
In General, If 1-4
Art.
II.
General Powers, Of 1-25
Art.
II -A.
Street Improvements, 44 1-2
Art.
III.
Judicial, §§ 1-10
Art.
IV.
Initiative; Referendum; Recall, if 1, 2
Art.
V.
Taxation Generally, I1 1-4
Art.
VI.
Occupation Taxes; Licenses, It 1-7
Art.
VII.
Finance Generally, if 1-9
Art.
VIII.
Bonds, If 1-5
Art.
IX.
Council; Elections; Administration, if 1-31
Art.
X.
City Manager, §1 1-7
Art.
XI.
Legal Status, if 1-6
ARTICLE I. [IN GENERAL]
Sec. 1. Corpora',e name.
The City of Lubbock, Lubbock County, Texas, as the boundaries and limits of said City are
herein established, or may hereafter be established, shall be a body politic, incorporated uneer
and known by the name and style of the "City of Lubbock," with such powers, rights and duties as
hereinafter provided.
"Editor's note —Ord. No. 4247, § 1 ordered a special election on December 27, 1917, to
approve Charter amendments. Amendment No. 7 was adopted and reads as follows: "All sections
of the Charter of the City of Lubbock which refer or have reference to and now read 'City
Commission,' 'Commission,' 'Commissioner,' 'Commissioners,' be amended to hereafter read
'City Council,' 'Council,' 'Councilman,' and 'Councilmen,' respectively. The term 'Councilmen'
and'Councilman'shall include females, who shall be known as'Councilwomen' or'Councilwom-
an.' "The changes necessitated by said amendment have been made. References in the Charter to
the "corporation court" and the "recorder" should be read "municipal court" and "judge" respec-
tively, pursuant to VTCS Art. 1194 et seq., and particularly Art. 1200gg. Catchlines for sections in
the Charter have been placed on one line for purposes of clarity, consistency with the Code of
Ordinances and space saving. Also, for the same purposes, a dash 1-1 in a Charter catchline has
been changed to a semicolon 1 J.
tEditor's note —Ord. No. 9175, adopted Feb. 25, 1988, called a special charter amend-
ment election, held May 7, 1988. The electorate approved propositions 1-3, 5, 6, 8-11, as
reflected in the Resolution and Order passed by council on May 26, 1988. Such amendments
are included herein, indicated by a history note to the date of election following each affected
paragraph, and the Charter Comparative 'fable on page 101 lists the disposition of such
amendatory material.
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Ch. 1, Art. 1, § 2 LUBBOCK CODE
Sec. 2. Boundaries.
The boundaries and limits of said corporation shall be as follows: Beginning at the northeast
corner of Survey No. 1, Block "0," which is also the southeast corner of Survey No. 79, Block "A;"
Thence north 165 feet along the east line of said Survey No. 79; Thence west on a line parallel
with, and 165 feet north of the south line of said Survey No. 79, a distance of 2129.25 feet to the
east line of the Sanders Addition to the City of Lubbock; Thence north along the east line of said
Sanders Addition a distance of 1037 feet to the northeast corner of the said Sanders Addition;
Thence west along the north line of the Sanders Addition and Acuff Heights Addition to the City
of Lubbock, a distance of 1639.75 feet to the northwest corner of said Acuff Heights Addition,
which point is in the east line of the Wm. Tubbs Addition to the City of Lubbock; Thence north
along the east line of the said Wm. Tubbs Addition, a distance of 1438 feet to the northeast corner
of said Wm. Tubbs Addition; which point is in the north line of Survey No. 79, Block "A;" Thence
west along the north line of said Survey No. 79, and the center line of Survey 19, Block "A," a
distance of 6791 feet to the west line of said Survey No. 19; Thence south along the west lines of
said Survey No. 19, Survey No. 2, Block "0;" and Survey No. 9, Block "B," a distance of 9297 feet
to the southwest corner of Block 100 in McCrummen's 2nd Addition to the City of Lubbock,
Thence east following the south lines of Blocks 100 and 95, and the center line of 5th Street in said
McCrummen's Addition, a distance of 5280 feet to the east lines of said Survey No. 9, Block "B,"
which is also the line of Survey No. 7, Block "B;" Thence south along the west line of said Survey
No. 7, a distance of 1263 feet to the center line of said Survey No. 7; Thence east along the center
line of said Survey No. 7, and the center line of Survey No. 5, Block "O," a distance of 65M feet;
Thence north on a line parallel with and 1200 feet east of the west line of said Survey No. 5, Block
"0," and the west line of Survey No. 3, Block "0," a distance of 3696 feet to a point due east of the
northeast corner of Block 4 in Wheelock's 1st Addition to the City of Lubbock; Thence west 375
feet to the northeast corner of said Block 4 in Wheelock's 1st Addition; Thence north along the
east line of said Wheelock's Addition a distance of 3606 feet to the northeast corner of Block 18 in
the said Wheelock's Addition; Thence west along the north lin,- of said Block 18 in the said
Wheelock's Addition a distance of 825 feet to the northwest corner of said Block 18, which point is
in the west line of Survey 3, Block "0," and the east line of Survey 1, Block "0;" Thence north
along the east line of said Survey No. 1, Block 44
0," a distance of 470 feet to the place of beginning.
Sec. 3. Extension of boundaries.
The limits of said Corporation may be hereafter extended by adding additional territory to
the same in the manner provided in the Municipal Annexation Act (Vernon's Ann. Civ. St. Art.
970a (.
Editor's note --The following ordinances which changed the city boundary are on rile in the
office of the city secretary -treasurer.
Ord. No. Date Ord. No. Date
2533 9-11-58 6517 12-14-72
2535 9-11-58 6596 4-26-73
2536 9-11-58 6631 5-10-73
2544 9-11-58 7310 9- 9-76
2545 9-11-58 7340 10-14-76
6201 10-28-71 7361 11-18-76
Supp.No 15
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CHARTER Ch. 1, Art. II, 4 1
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7504 8-11-77 7903 8-23-79
'- 7557 12- 8-77 7991 2-14-80
7747 10-12-78 8025 4-10-80
7900 8-23-79 8074 8-14-80
- Amendment note —The above section 3 was amended by the electors at a special election
held January 24, 1967 (effective February 9, 1967) to read as set out above. Prior to amendment
said section provided for the extension of the corporation limits whenever the majority of the
qualified electors of the territory to be added indicated a desire to be included within the limits of
the corporation in the manner provided in Article 781, Chapter 1, Title 22 of the Revised Civil
Statutes of the state.
r See.3A. [Repealed.]
Editor's note —Section 3A, providing for alteration and extension of the boundary limits by
the City Council, was repealed by the electors at a special election held January 24,1967.
Sec. 4. Platting of property.
Should any property lying within or adjacent to the city limits, as established by this
Charter, be hereafter platted into blocks and lots, the owners of said property shall plat and
1 lay the same off to conform to the streets and alleys abutting on same, and shall file with the
-� City of Lubbock a correct map thereof, and such act or acts performed by said owner or owners
of such land is and shall be considered the vote of such owner or owners to place such lands
^j within the city limits of said City of Lubbock, under this Charter and all its requirements;
provided, that in no case shall the City of Lubbock be required to pay for any of said streets or
alleys, at whatever date opened, but when opened by reason of the platting of said property, at
whatever date platted, they shall become, by such act, the property of the City of Lubbock, for
use as a public highway. (As amended May 7, 1988)
ARTICLE II. [GENERAL POWERS]
Sec. 1. Corporate powers generally.
The City of Lubbock, made a body politic and corporate by the legal adoption of this Charter,
shall have perpetual succession, may use a common seal, may sue and be sued, may contract and
be contracted with, plead and be impleaded in all courts and places and in all matters whatever;
�may take, hold and purchase lands and any character of lands, within or without the city limits as
may be needed for the corporate purposes of said city and may sell any real estate or personal
property owned by it; perform and render all public services and when deemed expedient, may
condemn property for corporate use, and hold, manage and control the same, and shall be subject
to all the duties and obligations now pertaining to or incumbent upon said city as a corporation,
not in conflict with the provisions of this Charter, and shall enjoy all the rights, immunities,
l powers, privileges and franchises now possessed by said City and herein conferred and granted.
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Ch, 1, Art, V, S I LUBBOCK CODE
ARTICLE V. [TAXATION GENERALLY*]
Sec. 1. Levies, etc.; when taxes to be levied; amount.
It shall be the duty of the governing authorities at the first regular meeting in March of each
and every year to levy such ad valorem and occupation taxes as may be necessary to cover the
expenses of the City government for the current year; provided, however, that failure to levy such
taxes at such meeting shall not prevent the same being levied at any subsequent meeting of said
authorities; and, provided, further, that if the governing authorities shall fail or neglect to pass a
tax ordinance for any one year, levying the taxes for that year, that the tax ordinance last passed
will be considered in force, and the failure to pass such ordinance shall in nowise invalidate the
collection of the tax.
Sec. 2. City may foreclose lien against any taxpayer.
The tax levied by the governing authorities is hereby declared to be a lien, charge and
encumbrance upon the property on which the tax is due, not only as against any resident of this
State, but entitled to enforce and foreclose in any court having jurisdiction of the same, and the
lien, charge and encumbrance on the property in favor of the City for the amount of taxes due on
such property is such as to give the State courts jurisdiction to enforce and foreclose said lien on
the property on which the tax is due, not only as against any resident of this State, but against any
persons who are nonresidents of this State, or whose residence is unknown, and against the
unknown heirs of any person who owns the property on which the tax is due.
Sec. 3. All property not specially exempted subject to taxation.
All property, real, personal or mixed, except as may be hereinafter expressly exempted, is
subject to taxation, and the same shall be rendered and listed in the manner prescribed by the
general laws in regard to general State taxation, when applicable. The definition of property and
terms, as defined by the general laws under the head: "Taxation" and what is subject to taxation.
as prescrib- i, by the general laws of the State, shall apply to the taxation of this City. All taxes
shall be payable at the office of the Assessor and Collector, and no demand by him shall be
necessary or requisite to enforce the collection thereof by any proceedings herein prescribed, nor
for any taxes due before the adoption of this Charter.
State law reference --Definitions relating to property texes, VTCA Tax Code 11.04.
Sec. 4. Remedies to collect taxes.
The City of Lubbock shall have all other remedies for the levy and collection of city taxes as
are given by the Constitution and Statute of Texas to State and County for the levy and collection
of state and county taxes. (As amended April 1, 1930)
State law reference —Tax collections and remedies, VTCA Tax Code, Title 1, Ch. 31 et
seq.
*State law reference —Property Tax Code, VTCA Tax Code § 1.01 et seq.
Supp No IS
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iCHARTER I Ch. 1, Art. IX, 122
Sec. 18. Publication of ordinances.
All ordinances carrying a penalty shall be published once a week for two consecutive weeks in
some newspaper regularly published in the City of Lubbock, and no such ordinance shall become
effective until ten (10) days after the date of its last publication, provided that emergency
measures shall take effect according to their terms.
ISec. 18. Recording of ordinances.
Every ordinance, or resolution, upon its becoming effective, shall be recorded in a perma-
nently bound book kept for that purpose and shall be authenticated by the signature of the Mayor
or presiding member of the Council, and the person exercising the duties of City Secretary.
ISea 20. Investigations by Council.
The Council may investigate the financial transactions of any officer or department of the
City government and the acts and conduct of any official or employee. In conducting such
investigation, the Council may compel the attendance of witnesses, the production of books and
papers, and other evidence, and for that purpose may issue subpoenas or attachments on which
shall be signed by the Mayor —if the Mayor should be under investigation, then by the Mayor Pro
Tem--or in the absence of both the Mayor and Mayor Pro Tem, then by the Councilman next in
order according to his numerical standing, and which may be executed and served by any officer
authorized by law to serve subpoenas or other process, or any peace officer of the City. If any
witness shall refuse to appear or to testify to any facts within his knowledge, or to produce any
papers or books in his possession or under his control, relating to the matter under investigation
before the Council, the Council shall have the power to cause the witness to be punished as for
contempt, not to exceed a fine of One Hundred Dollars ($100.00) and three days confinement in
the City prison. No witness shall be excused from testifying, touching his knowledge of the matter
under investigation in any such inquiry, but such testimony shall not be used against him in any
criminal prosecution except for perjury committed upon such inquiry.
Sec. 21. Contracts for services.
No contract shall ever be made which binds the City to pay for personal services to be
rendered for any stated period of time, but all officers and employees of the City, other than the
Mayor and Councilmen, shall be appointed and shall be subject to peremptory discharge as in this
Charter provided.
Sec. 22. Creation and consolidation of departments.
The City Council shall create and consolidate such appointive offices as [and J may divide the
administration of the City affairs into such departments, as it may deem advisable, and may
discontinue any such appointive officers or departments at its discretion, except the office of City
Manager. (As amended Nov. 7, 1961)
Annotation —The commission, under this section, having the power to consolidate the
offices of secretary and collector and to assign the duties to one person, and having, by long course
of dealing, recognized the authority of the accused to act as collector, was not, precluded from
Supp. No. 15
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CHARTER Ch. 1, Art. XI, 14
Sec. 6. Governing body's relations with city manager.
The governing body and each of its members shall hold the City Manager responsible for the
proper administration of all affairs of the City, but neither the governing body nor any board or
commission created by it, nor any members thereof, shall dictate the appointment of any person
to or his removal from office or employment within the City, or in any manner interfere in the
appointment of officers and employees in the departments of the administrative service vested in
the City Manager by this Charter. Except for the purpose of inquiry, the governing body and its
members shall deal with the administrative service solely through the City Manager, and neither
the governing body nor any member thereof shall give orders to any subordinate of the City
Manager either publicly or privately.
Sec. 7. Nepotism; city manager.
No person related within the second degree by affinity or within the third degree by consan-
guinity, to the City Manager, shall be appointed to any official position, clerkship or service of the
City.
ARTICLE XI. [LEGAL STATUS]
Sec. 1. Construction; home rule provision.
All powers vested in cities of exceeding One Thousand (1,000) population by the provisions of
Title 22, or other provisions of the Revised Statutes are hereby retained and are cumulative of the
powers vested by this Charter in the City of Lubbock, and the enumeration of the powers made in
this Charter shall never be construed to preclude by implication or otherwise, the City from
exercising all the powers incident to the enjoyment of local self-government and from doing any
and all things not inhibited by the Constitution and laws of the State of Texas.
Sec. 2. Ratification of ordinances.
All ordinances and resolutions in force at the time of the taking effect of this Charter, not
inconsistent with its provisions, shall continue in force until amended or repealed.
Sec. 3. Amendments to Charter.
This Charter, after adoption, may be amended in accordance with provisions of an Act of the
Thirty-third Legislature of the State of Texas, entitled, "An Act Authorizing Cities Having More
Than 5000 Inhabitants, by a Majority Vote of the Qualified Voters of Said City, at an Election
Held for That Purpose, to Adopt and Amend Their Charter, etc." [VTCS Art. 1165 et seq.]
approved April 7th, 1913, and any acts amendatory thereof.
Sec. 4. Savings clause.
Should any provision or portion of this Charter be declared unconstitutional by the Courts of
this State, the remainder thereof shall be unimpaired by such holding and shall be in full force
and effect until amended or repealed, as herein provided.
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Ch. 1, Art. XI, ¢ b LUBBOCK CODE
Sec. 6. Past elections.
If this Charter shall fail of adoption at which the Charter is submitted as herein provided,
this shall be regarded as a rejection of the Charter; or if a majority of the votes cast at such election
are in favor of the Charter it will then be the duty of the qualified electors of the City of Lubbock
to vote for and elect a Mayor, Councilman No. 1, Councilman No. 2, Councilman No. 3, and
Councilman No. 4, as provided for by this Charter, at the regular municipal election to be held in
the City of Lubbock on the first Tuesday of April, 1918, and on said day every two years
thereafter.
Sec. 6. Designation of governing body.
Upon their qualification, such Mayor and Council shall be and constitute the governing body
and authority of the City of Lubbock and shall thereafter administer its affairs agreeable to the
provisions of this Charter, provided, that the present officers at the regular municipal election
held on the first Tuesday in April, 1917, may, if they so desire, hold and retain their respective
offices and enjoy the emoluments thereof as now provided, until the expiration of said terms of
office in April, A.D. 1919, subject, however, - to all of the provisions of this Charter and all
ordinances and resolutions hereafter passed and adopted under its provisions.
(The next page is 891
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CHARTER
Chapter Two
[REFERENDUM; RECORD]
Art. I. In General, 44 1-4
ARTICLE I. [IN GENERAL]
Sec. 1. Vote on proposed Charter, Charter committee instructions.
Ch. 2, Art. I, 14
This Charter shall be submitted to the qualified voters of the City of Lubbock for adoption or
rejection on the 27th day of December,1917.
Sec. 2. Form of ballot;1917 election.
It is hereby prescribed that the form of ballot for use in such election shall be as follows, to
wit: FOR THE ADOPTION OF THE CHARTER: AGAINST THE ADOPTION OF THE
CHARTER.
Sec. 3. Election;1917.
The present City Council shall call such election, and same shall be conducted, and the
returns made and result declared as provided by the laws of the State of Texas governing
municipal elections, and in case a majority of the votes cast at such election shall be in favor of the
Charter, then an official order shall be entered upon the records of said City by the City Council of
Lubbock, declaring the same adopted, in case said Charter shall receive a majority in favor of the
adoption thereof at such election.
Sec. 4. Record of Charter.
The City Secretary shall record, at length, upon the records of the City, in a separate
permanently bound book to be kept in his office for such purpose, this Charter if adopted at such
election, and such Secretary shall furnish to the Mayor a copy of such Charter as adopted,
authenticated by his signature and the seal of the City, which copy of the Charter shall be
forwarded by the Mayor of the City of Lubbock to the Secretary of State, and shall show the
approval of such Charter by a majority vote of the qualified voters of the City of Lubbock.
By Charter Commission, duly elected:
Geo. C. Wolffarth, Chairman
Roscoe Wilson
Percy Spencer
H. A. Davidson
W. F. Schenck
R. K. Henderson
C. E. Parks
J. H. Moore
W. S. Posey
J. 0. Jones
Jas. L. Dow
J. D. Lindley
E. B. Green
E. L. Klett
M. T. Jacobs, Acting Secretary
89