HomeMy WebLinkAboutResolution - 5865 - Grant Application - TDOH HIV Division - Health Department Funding - 05_28_1998Resolution No. 5865
Item No. 17
May 28, 1998
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, by and
between the City of Lubbock and the Texas Department of Health HIV Division, and
related documents. Said contract is attached hereto and incorporated in this resolution as
if fully set forth herein and shall be included in the minutes of the City Council.
Passed by the City Council this 28th day of May 1998.
R
ATTEST:..
Kaythilparnell
City SeVretary
APPROVED AS TO CONTENT:
Doug Go
Director o Health and Community Services
APPROVED AS TO FORM:
A /- X'-
William de Haas
Municipal Contracts Attorney
CcdocsGrant Application to the Texas Department of Health HIV Division.Res
May 28, 1998
I
Resolution No.
Item No. 17
May 28, 1998
Texas Department of Health
Face Page - Application for Financial Assistance
1. APPLICANT INFORMATION
Ia. Legal Name: -
City of Lubbock Health Department
1b. Address (include Street & Mailing Addresses, City, County, State and Zip Code):
1902 Texas Avenue
P.O. Box 2548
CuubboLk, TX 79408
Lubbock Comity
lc. PAYEE Name and Mailing Address (if different from Applicant):
Id. Employer Identification No. or State of Texas Comptroller Vendor Identification No. (14 digit):
75-6000590-6
le. Applicant's Legal Authority to Contract: City of Lubbock - Health Department
2. TYPE OF ENTITY (enter appropriate letter in box): ® If response is F. or G., is entity a HUB? Yes/No
A. City E. Nonprofit Organization I. Other (specify)
B. County F. Individual
C. Other Political Subdivision G. For Profit Organization
D. State Agency H. State Controlled Institution of Higher Learning
3. TYPE OF APPLICATION (check one:) New Continuation X
4. PROPOSED PROJECT PERIOD: StartDate 01 /01 /99 End Date 12/31 /01
S. COUNTIES AFFECTED BY PROJECT: Lubbock
6. PUBLIC HEALTH REGION: 1
7. AMOUNT OF FUNDING REQUEST: $49,663.74
S. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION ARE TRUE AND CORRECT.
THE DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT, AND THE
APPLICANT WILL COMPLY WITH THE ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
8a. Typed Name & Title of Authorized Reprasentative
8b. Telephone Number
806 ) 775-2010
Mayor
8c. Signature ofAu lorized p n ive
8d. Date
oS zg IgB
Kay Darnell
Ci VI
cretary
a�ura:.4
Director`s!'' Health and Community Svcs.
APP AS TO FOFM:
illiam de Haas
Knicipal Contracts Attorney
TEXAS DEPARTMENT OF HEALTH
APPLICATION CHECKLIST
Legal Name of Applicant City of Lubbock Health Department
INSTRUCTIONS: This Checklist must be completed and submitted with the original application. It is provided
to ensure that the application is complete, proper signatures are included, and the required assurances,
certifications and attachments have been submitted. Application is typed (computer or typewriter), single-spaced
on 8 %" x 11" white paper and does not exceed page limits where specified. Confidential information is clearly
marked in the application and reasons the information should be confidential are stated.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K
L.
M.
N.
O.
P.
H
� • • �11JI
Included N/A
Face Page is completed, and proper signature and date are included
X
Application Checklist is completed and attached to original application
X
Contact Person Information
X
Administrative Information (with supplemental documentation)
X
Applicant Background is included
X
Applicant HIV Prevention -Related Experience is included
X
Capacity of Organization is included
X
Assessment Narrative is included
X
Goals are included
X
Peformance Measures are included
_X
Work Plan is included
X
Evaluation Plan is included
X
Collaboration with Other Agencies is included
X
Referral Plan is included
X
Quality Assurance Plan is included
X
Financial Information
1. Funding Information Form is completed and letters of good
X
standing and financial statements are attached if required
2. Budget:
• Budget Summary Form (for use with cost reimbursement) is complete
� CX
and attached.
• Budget Category Detail Forms (for use with cost reimbursement) are included
X
• Copy of most recently approved indirect cost agreement is attached
if applicable
Other Required Forms and Documentation are attached and signed
1. Justification for Request for Equipment Purchases Form - if applicable
x
(no signature required)
2. Target Population Chart Form (no signature required)
_ X
3. HIV Contractor Assurances
X
4. Assurance of Compliance with Requirements for Contents, etc.
X
S. Historically Underutilized Businesses [HUBS]
X
6. TDH Assurances
�!
7. TDH Certifications
X
8. Disclosure of Lobbying Activities
X _
9. Nonprofit Board Member and Executive Officers Assurances Form
X
10. Certification Regarding License, Certificate or Permit
X
Contact Person Information
Legal Name of Applicant: City of Lubbock Health Department
The purpose of this form is to provide information to TDii about the appropriate contact person in the applicant's
organization. Please type in complete information about each person authorized to perform the following responsibilities.
If any of the following information changes during the term of the contract, please notify the Vendor Coordinator, Grants
Management Division, TDH.
Name of
Applicant's Authorized Representative: Windy Sitton
Title: Mayor
Address: 1625 13th Street . Lubbock, TX 79401
E-Mail Address: wsittcn@hiail.ci.lubbock.tx
Telephone Number. (806) 775-2010
Fax Number: (806) 775-2051
Named
Project Coordinator: 'bry Strange
Title: RN, Public Health Manager
Address: 1902 Texas Avenue Lubbock, TX 79405
E-Mail Address: mstrarZe@,nail . ci .lubbock. tx
Telephone Number: (806) 775-2899
Fax Number: (806) 775-3209
Name of contact person
regarding this application: TIIJ Foskey
Title: HIV Counselor
Address: 1902 Texas Avenue Lubbock, TX 79405
E-Mail Address: tfoskey&ail.ci.lubbock.tx
Telephone Number. (806) 775-2953
Fax Number: (8TD) 775-3209
Name of Financial Officer. Anna MOsqueda
Tide: Director of Financial Services
Address: 1625 13th Street Lubbock, TX 79401
ES Mail Address: aWSC1Ueda@roai1.ci.1ubbock.tx
Telephone Number: (8W) 775 2002
Fax Number:
Name of person responsible for Project
Quality Assurance (if applicable): Beckie BraWley
Title: Prevention Manager
Address: 1 qO2 Texas Avenix, Liftorko TX 794M
%r-Mail Address: bbrawlie@mail.ci.lubbock.tx
Telephone Number: (806) 775-�939
Fax Number: (806) 775-3209
ADMINISTRATIVE INFORMATION
Legal Name of Applicant: City of Lubbock Health Department
INSTRUCTIONS: Answer each question or provide the required information for each statement below.
The form must be signed by an authorized representative of the applicant. If responses require additional
pages, identify the supporting pages/documentation with the applicable question or statement number and
place the pages behind this form.
Identifying Information
1. The applicant must attach the following information:
If a Governmental Entity
• Names (last, fast, middle) and addresses for the officiat who are authorized
to enter into a contract on behalf of the applicant.
If a Nonprofit or For profit Corporation
• Full names (last, first, middle), addresses, telephone numbers, titles and
occupations of members of the Board of Directors or any other principal
officers. Indicate what offices are held by members (e.g. chairperson,
president, vice-president, treasurer, etc).
• Full names (last, first, middle) and addresses for each partner, officer, and
director as well as the full names and addresses for each person who owns five
percent (5%) or more of the stock if applicant is a for profit corporation.
2. Is applicant a private, nonprofit organization?
o YES e3 NO
If YES, applicant must include evidence of its nonprofit status with the application. Any
one of the following is acceptable evidence and should be attached following this form.
Check the appropriate box for the attached evidence or complete the "Previously Filed"
section, whichever is applicable.
❑ (a) A reference to the organization's listing in the Internal Revenue
Service's (IRS) most recent list of tax-exempt organizations
described in section 501(c)(3) of the IRS Code.
❑ (b) A copy of a currently valid Internal Revenue Service Tax exemption
certificate.
❑ (c) A statement from a State taxing body, State Attorney General, or
other appropriate State official certifying that the applicant
organization has a nonprofit status and that none of the net earnings
accrue to any private shareholders or individuals.
❑ (d) A certified copy of the organization's certificate of incorporation or
similar document if it clearly establishes the nonprofit status of the
organization.
❑ (e) Any of the above proof for a State or national parent organization,
and a statement signed by the parent organization that the applicant
organization is a local nonprofit affiliate.
If an applicant has evidence of current nonprofit status on file with a program of TDH, it
will not be necessary to file similar papers again, but the TDH program name and date of
filing must be indicated.
Previously Filed with: (TDH Program) On
(Date)
3. Is applicant a for -profit entity?
o YES a NO
If YES, applicant must complete the Texas Department of Health Child Support Affidavit
(Affidavit is contained in SECTIONlx BLANK FORMS AND INSTRUCTIONS). The
Texas Family Code, §231.006 places certain restrictions on child support obligers.
(Contracts with governmental entities or nonprofit corporations are not subject to
§231.006.) The affidavit requires the applicant to certify that any individual or sole
proprietor, partner, shareholder, or owner with an ownership interest of at least 25 percent
is not 30 days or more delinquent in providing child support under a court order or written
repayment agreement under the Texas Family Code, §231.006. A false statement regarding
child support will be treated as a material breach of the contract and may be grounds for
termination.
Conflict Of Interest and Contract History
The applicant must disclose any existing or potential conflicts of interest relative to the performance
of the requirements of this RFP. Examples of potential conflicts may include an existing business or
personal relationship between the applicant, its principal, or any affiliate or subcontractor, with
TDH, the participating agencies, or any other entity or person involved in any way in any project that
is the subject of this RFP. Simflarly, any personal or business relationship between the applicant,
the principals, or any affiliate or subcontractor, with any employee of TDH, a participating agency,
or their respective suppliers, must be disclosed. Any such relationship that might be perceived or
represented as a conflict must be disclosed. Failure to disclose any such relationship may be cause
for contract termination or diqualification of the proposal. If, following a review of this
information, it is determined by TDH that a conflict of interest exists, the applicant may be
disqualified from further consideration for the award of a contract.
FA
applicant was in breach. TDH will evaluate the facts and may, at its sole discretion, reject
the proposal on the grounds of the applicant's or any member of applicant's executive
management, project management, board members or principal officers past performance
(Attach no more than one additional page.)
10. Within the past. five years, has the applicant or any member of the applicant's executive
management, project management, board members or principal officers been debarred,
suspended, or otherwise excluded from or deemed ineligible for participation in Federal
assistance programs or affiliated with an organization which has been debarred, suspended,
or otherwise excluded from or deemed ineligible for participation in Federal assistance
programs?
o YES 2r NO
If YES, and applicant is currently debarred, suspended, excluded, or ineligible, applicant
may not apply for funding. If applicant has been debarred, suspended, excluded, or
ineligible, over the past five years but is now eligible, please explain. (Attach no more than
one additional page.)
11. Does the applicant or any member of applicant's executive management, project
management, board members or principal officers owe funds to TDH or ever defaulted on
an agreed repayment schedule with any funding organization?
o YES V NO
If YES, please explain. (Attach no more than one additional page.)
Additional Information
12. Applicants must be able to demonstrate fiscal solvency. Applicants shall submit a copy of the
organization's most recent audited balance sheet and statement of income and expenses. If
the applicant does not have an audited balance sheet and statement of income and expenses,
the applicant must attach the most recent unaudited balance sheet and statement of income
and expenses, and explain why audited documents are not available (AMich no more than one
additional page). The TDH will evaluate the financial statements and may, at its sole
discretion, reject the proposal on the grounds of the applicant's financial capability.
Are required financial statements attached?
M' YES o NO
13. Does the applicant have personnel policies approved by the governing body which address
essential issues of personnel management?
P' YES o NO
14. Does the applicant contract with or employ the services of a CPA, accountant, bookkeeping
service or trained financial manager other than the Executive Director?
M� YES o NO
4
Explain:
15. �� applicant is a nonprofit entity, respond to the following: Not Applicable ( Local Health
a) Applicant has active, involved board as demonstrated by bylaws, regular meetings with
sufficent attendance, minutes, and clear definition of role?
❑ YES a NO
b) Board membership includes diverse community representation?
❑ YES ❑ NO
c) Board membership includes diverse skills?
❑ YES a NO
d) Applicant maintains Directors and Officers insurance?
❑ YES a NO
e) Applicant has a Board policy and procedures manual?
❑ YES a NO
f) Applicant provides orientation and training on board member responsibilities to new
members?
❑ YES a NO
g) What date did the applicant's Board of Directors adopt the current operating budget of the
agency?
h) Applicant must attach a copy of the Board minutes for the meeting in which the operating
budget was adopted. Are the minutes attached?
❑ YES a NO
Signature of Authorized Official
Title Mana�:ng Director of
Health and Camnmity Services
Typed Name of Authorised Representative Date
Ta & Foskey
-A
y. Darnell
City retary
APPROVED AS TO CONTF3V'I': APPROVED AS TO FOFM:
Doug i liar de Haas
Directo f Health and Camuiity Svc. W�ciayl Contracts
APPLICANT BACKGROUND
The City of Lubbock Health Department has been in existence for 70 years, having
been established in 1918. The City of Lubbock has contracted with the Texas
Department of Health for the last ten years to provide HIV education, prevention
counseling, risk reduction, testing, post test counseling and partner elicitation.
Appropriate referrals are made for the early intervention clinic, located at the South
Plains AIDS Resource Center (SPARC), substance abuse treatment and counseling,
prenatal care, STD screening and treatment, family planning, TB testing, etc.
The City of Lubbock Health Department has affiliations with: the City of Lubbock and
the Board of Health is affiliated with the National Association of Local Boards of Health.
The City of Lubbock Health Department has as its mission statement:
The City of Lubbock is committed to the efficient delivery of quality products and
Services to its citizens. We, the employees, fulfill the mission through personal and
organizational comitment to the following values:
Accountability, accepting responsibility as stewards of public resources and
investing pride in our work;
Initiative, taking positive action to accomplish our mission;
Respecting our differences, treating each other with understanding and dignity;
Development, enhancing our skills and increasing our knowledge to achieve our
personal best;
Innovation, searching for new and creative ways of doing business;
Communication, each employee openly sharing and receiving information;
Leadership at all levels, challenging the process, inspiring the vision, and
modeling the way;
Teamwork, approaching decision -making and problem solving by involving all
employees, focusing on people first, then processes;
Continuous improvement as a way of life.
We believe that our commitment is the foundation of all our endeavors to make
our community a better place now and for future generations.
Accomplishments in the previous years have included the forming of an Early
Intervention Clinic for those persons diagnosed HIV positive. This clinic provides
physician care as well as case management for those persons unable to afford care at
a private physician's office. The clinic is called La Clinica Du Buena Saladud (The
Clinic of Good Health). The clinic is now operated from the South Plains AIDS
Resource Center. The City of Lubbock Health Department also was awarded a grant to
provide HIV/AIDS Surveillance for the Lubbock Health region to assist in the reporting
of both HIV and AIDS infections more accurately and in a more timely manner.
The Health Department's commitment to the prevention of HIV began officially with the
on -set of the disease. Education efforts began early on, as the experts began to
understand the reasons for the spread of HIV. As soon as testing became available,
the Health Department began to provide testing through the STD clinic. We were one
of the original HIV Counseling and testing sites funded by the Texas Department of
Health. We have maintained that funding and remained a testing site from that time
forward. With an ever -changing face of the epidemic, we have remained on the cuting
edge, changing our services to meet the changing needs of the at -risk populations. Our
goal is to continue to lead the Lubbock community in recognizing at -risk behaviors and
in creating prevention measures to address these behaviors. In 1997, Ms. Foskey and
the other trained staff members have provided HIV Counseling and Testing to 2586
individuals, twenty of whom tested positive. 95.24% of all individuals tested in this
program in 1997 have returned for post-test counseling, while 95% of all individuals
testing positive received post-test counseling and a referral for case management
services. We believe that, if continued funding is supplied, we will be able to maintain
these high percentages, if not improve them, over the next two years.
APPLICANT HIV PREVENTION -RELATED EXPERIENCE
The City of Lubbock Health Department has operated with one full-time staff member
for the ten years that the City of Lubbock Health Department has had a contract with
the Texas Department of Health. Ms. Tammy Foskey is the HIV Counselor currently
employed by the City of Lubbock Health Department and was hired in September of
1990. She received her Masters of Art degree in Clinical Counseling in 1990. Her
responsibilities include providing HIV Prevention Counseling and Partner Elicitation,
HIV testing, providing referrals and follow-up counseling to those individuals testing
seropositive, assisting at -risk individuals in developing personalized risk reduction
plans, maintaining statistical data used to forumulate monthly and quarterly reports, and
assisting in the submission of annual applications for continued funding. Ms. Foskey's
position is fully funded by the Texas Department of Health grant and is is 100%
dedicated to PCPE activities. She has provided prevention counseling and testing to
15,498 persons since her employment. Prevention counseling was provided to 2586
persons in 1997.
She has worked with numerous agencies to provide collaborative activities, those
agencies receiving HERR contracts to provide education, as well as others who receive
funding from other sources to provide HIV education. She has developed cooperative
agreements to provide testing at numerous facilities including a Baptist church on the
east -side of Lubbock, Texas Tech University Student Health, Captain Hollywood (the
gay club), Inside/Out and the Lubbock County Jail.
The HIV Counselor has availed herself of numerous opportunities to further her skills
and knowledge. She has attended the Annual Texas Department of Health HIV/STD
Conference for eight years. She has attended the Prevention Counseling course
offered by the Texas Department of Health. The Cultural Competency Training course
and TB Course offered and required by the Texas Department of Health for contractors
have also been attended by the HIV Counselor. She has attended numerous
teleconferences that have enhanced her current knowledge of various sexually
transmitted infections as well as HIV.
The HIV Counselor has also provided HIV education to numerous persons through
presentations at various public high schools and junior highs, Texas Tech University,
drug treatment facilities, correctional facilities, home health agencies, and others as
specially requested and as her schedule allows. She has a very thorough knowledge of
other sexually transmitted infections and presents information about these and the
correlation between HIV and other STDs when applicable.
The Project Director for the program is currently the Prevention Manager, Beckie
Brawley. She is an RN and has managed the HIV Prevention counseling grant for the
past three years. She has worked for the City of Lubbock Health Department for nine
years in areas of STD, Prenatal and Family Planning, and Immunizations. She assisted
with HIV/AIDS Surveillance when there was no paid position. The previous manager
retired in 1995. She encourages the HIV Counselor to obtain further education by
providing opportunities and time away from the job. She supports the HIV Counselor
by providing assistance in the development of other testing sites, grant writing
assistance, and seeks input in the development of objectives and goals. She provides
written evaluations on a quarterly basis. Mary Strange, RN is the Director of Nursing
and provides assistance and support to all programs of the Health Department. She
has worked for the Health Department for 18 years. She has held the positions of
Clinical Supervisor, Personal Health Section Coordinator, and beginning in 1995, of
Department Head. Ms. Strange has supervised all the HIV projects conducted by the
Health Department since their inception. Included in her responsibilities are: managing
budgets, supervising personnel, submitting regular reports, and submitting proposals for
continued funding. Ms. Strange has a BS in Nursing and has participated in HIV
Counselor Training Courses in 1988 from TDH and in 1986 and 1989, from the Fifth
Army.
The City of Lubbock Health Department has been the recipient of a contract with the
Texas Department of Health for ten years. The City of Lubbock has an excellent
reputation for providing quality care for those seeking services for HIV testing, STD
screening and immunizations. The City of Lubbock Health Department has worked with
numerous agenices, private and public, to provide preventive health care for its citizens.
The City of Lubbock recognizes their role in the health of the citizens and its mission
statement reflects their role in preventing infection through education and testing. The
City of Lubbock Health Department was also recognized for its excellence and received
a grant to provide HIV/AIDS Surveillance for the Lubbock Health Service Delivery Area.
This position has been held by Gabriel Cruz for the past two years. The City of
Lubbock Health Department also employs a Disease Investigator Specialist that assists
in the role of Partner notification for those persons tested positive for HIV.
The continuity of care is very important to many clients of the City of Lubbock Health
Department. The HIV Counselor has provided stability to this position and has earned
the trust and respect of many clients that may have sought HIV prevention counseling
and testing over the previous years. She has also earned the respect of other
collegues through her willingness to work with various populations and in a variety of
settings.
CAPACITY OF THE ORGANIZATION
The City of Lubbock Health Department is one part of a much larger organization that
has at its request support and assistance from many other departments including
Budget and Research, Legal, Information Services, Accounting and other services as
needed. Organizational charts are attached for the City of Lubbock and for the
Department of Health. (See Apppendix A-B) All policies are those of the City of
Lubbock and the Texas Department of Health. The City of Lubbock Health Department
was audited in December of 1997 for the HIV Prevention Counseling program and was
found to be in compliance with all policies that were requested by the Texas
Department of Health.
Support systems are in place to provide us with training for a number of areas including:
CPR and First Aid training, telephone training, customer service, cultural sensitivity and
a large number of computer programming classes to provide employees with the skills
to perform their job to the highest degree possible. Technical assistance is provided
through the Information Services department and Human Resource department for
enhanced computer programs and Internet access. Information that is important to
provide support to the HIV Prevention program as well as to the clientele served by the
program is made available through funding to various journals, periodicals and other
HIV/AIDS related materials. Information through the CDC Daily Summary reports are
also received through the Internet and are forwarded to appropriate personnel. The
Accounting, Financial and Budget and Research divisions of the City of Lubbock
provide the financial assistance and support necessary for monitoring of the program
and its funds. Quarterly and annual financial reports are completed by the Support
services staff of the City of Lubbock Health Department in coordination with the
Accounting Department of the City of Lubbock. Audits are completed on a regular
basis by the Texas Department of Health and the Accounting Department of the City of
Lubbock. Administrative systems are in place, as seen through the attached
organizational charts. The Administration of the programs are overseen by qualified
staff and the administration is available to provide assistance and support as needed.
The Board of Health is an advisory board to the City Council and are charged with
making recommendations to the City Council regarding policy making and service
delivery. They are able to hold public hearings when deemed necessary. The Board of
Health is composed of seven members of the community of Lubbock. They meet on a
monthly basis. They are appointed to the Board of Health by the City Council. They
serve a three-year commitment to the Board of Health.
Resources beyond the scope of the grant are available to the organization as a whole.
ASSESSMENT NARRATIVE
The City of Lubbock Health Department has been involved with providing public
health and assessing the community's needs for additional services, services
that can be providing by a private entitity, and those which the Health
Department can provide in a more proficient way.
There have been several agencies and groups that have conducted health
assessments in the past few years. Among these agencies are: the United
Way, Saint Mary of the Plains, the South Plains AIDS Resource Center (SPARC)
and the City of Lubbock Health Department through Neighborhood Associations
in the following areas: Arnett -Benson, Cherry Point, Jackson and West Overton.
The community that will be encompassed by this grant application includes the
city of Lubbock. It is an suburban area of approximately 194,000 persons in the
Panhandle of Texas. There are numerous smaller communities that surround
Lubbock and there is a migration of persons from those smaller communities that
travel to Lubbock to receive a variety of services including HIV prevention testing
and counseling. The fear of confidentiality being violated is an important issue
for many of these clients.
Ethnicity, gender and age demographic data for Region 1 (Lubbock and Amarillo
being the two major urban areas) estimate that in 1995 there were:
Males: 297,803 total above the age of 13
White 209,140
African American 15,893
Hispanic 67,460
Other 5,310
Females: 311,128 total above the age of 13
White 227,661
African American 14,893
Hispanic 64,264
Other 4,310
The socio-economic indicators include an Unemployment rate of 4.5% for the
Region compared to 6.0% for the state of Texas. The total Medicaid
Expenditures for the region were $294,034,950 in 1995. Percentage of
adolescent mothers (<18) was 8.9% for the region compared to 6.9% for the
state. Those mothers receiving late or no prenatal care was numbered at 3,214
or 27.9% for the region compared to 22.7% for the state.
Other communicable diseases and the rates for the region and state include:
per 100,000
Tuberculosis 6.5 region
12.7 statewide
Primary and secondary
syphilis
8.3 statewide
Gonorrhea 172.3 region
165.0 statewide
Chlamydia 375.4 region
238.9 statewide
AIDS 8.4 region
25.1 statewide
Mortality rates include:
per 100,000
Deaths from all causes
526.1
region 526.0 statewide
Cardiovascular disease
193.8
189.1
Heart disease
152.3
146.7
Stroke
29.9
31.5
All cancer
123.5
130.0
Lung cancer
38.1
39.0
Female breast cancer
19.2
20.4
Chronic obstructive Pulmonary
Disease
28.9
22.3
Diabetes
14.2
18.0
Infant deaths
7.8
6.5
Fetal deaths
7.4
6.3
Unintentional Injury accidents
34.4
31.3
Motor Vehicle Injury
21.9
17.5
Work -related injury
3.3
2.2
Homicide
7.7
9.9
Suicide
16.6
11.5
The geographic service area that this grant application is targeting is the city of
Lubbock. There are several target populations within this area that the grant will
work more closely with including:
M/MS: majority between the ages of 18-30 targeted at the gay club, majority are
of hispanic or African American ethnicity
F/MS: Numerous target areas including: correctional facilities, drug treatment
facilities, Texas Tech University, Inside/Out and Mt. Gilead outreach programs,
and the majority of those persons seeking testing at the City of Lubbock Health
Department site. The majority of those in correctional facilities are of hispanic or
African American ethnicity and are in the age range of 20-35. The ethnicity of
those in drug treatment facilities is inclusive of all ethnic groups found in the city
of Lubbock (Hispanic, White and African American). The age range is 22-35 in
the majority of cases. Texas Tech University targets all students but those
seeking prevention counseling and testing are predominantly white and the age
range is 18-24. Inside/Out and Mt. Gilead target those in areas with higher
poverty rates and single-family households, there is also a higher incidence of
drug use and abuse and crime. The ethnicity of this target population is
predominantly hispanic and African American and the age range is 25-45. The
majority of those testing at the City of Lubbock Health Department are white and
the majority range in age from 15-35.
IDU: The majority of those seeking prevention counseling and testing from this
specific target population will seek testing through the correctional facilities, drug
treatment programs and Inside/Out and Mt. Gilead. Those populations have
been previous described in the F/MS target population.
Many of those seeking HIV prevention counseling at the various sites are without
health insurance, take the bus to the testing site, live in areas where there are
higher rates of crime and drug use, and are of a members of a minority group.
Gaps to receiving the services include: lack of understanding on how to care for
themselves, lack of resources and lack of knowledge in accessing healthcare.
Low income males ages 19-60 are also at a greater loss due to the lack of
Medicaid eligibility.
GOALS
The goals of the City of Lubbock Health Department in meeting the needs of the
community at risk for HIV infection include the following targeted subpopulations as
identified by the Planning Coalition for Region 1.
*The M/MS subpopulation includes all ages and ethnic groups who are at a high -risk
for HIV infection through unprotected and and/or oral sex. This population includes:
substance abusers, adolescents, both identifying and non -identifying gay males, sex
partners of those who are HIV+, those who trade sex or drugs for money and those with
other STDs.
The goal of the City of Lubbock Health Department is to provide prevention counseling
and testing to 200 of those who who are members of this subpopulation. This will be
achieved through collaboration with other service providers including the South Plains
AIDS Resource Center, Managed Care, Lubbock MHMR, Central Lubbock Church of
Christ Inside/Out program, Mt. Gilead Baptist Church, the Lubbock County Jail and the
Lubbock County Community Correctional Facility, Texas Tech University and Captain
Hollywood (the gay club), as well as the City of Lubbock Health Department testing site.
These systems are already in place and have been for a number of years with the HIV
Prevention program of the City of Lubbock Health Department. The HIV Counselor has
been working with various other agencies to provide testing for the above
subpopulation and is well accepted and respected by her peers and clientele as well as
those overseeing and managing the other programs at various agencies.
*The F/MS subpopulation includes all males and females of all ages and ethnic groups
who are at highest risk for HIV infection and reinfection due to unprotected oral, anal
and vaginal sex. This subpopulation includes: adolescents, those who trade sex for
money and/or drugs, women who give birth, and those who use non -injecting
substances such as crack -cocaine, marijuana, alcohol, inhalants and any other
recreational drug.
The goal of the City of Lubbock Health Department is to provide prevention counseling
and testing to 1000 of those who are members of this subpopulation. This will be
achieved through the above mentioned collaborations and agencies that serve the
F/MS subpopulation. Specific details regarding the collaborative agencies and the
workplan to achieve this goal can be found in future sections.
*The IDU subpopulation includes IDUs of all ages, ethnic groups and genter who are
at highest risk for HIV infection and reinfection due to unprotected oral, anal and/or
vaginal sex as well as sharing needles and the works used in injecting drug use. The
act of sharing a needle and the "works" is the main behavior that brings these
individuals together regardless of their race or gender.
The goal of the City of Lubbock Health Department is to provide prevention counseling
and testing to 250 of those who are members of this subpopulation. This will be
achieved through collaborative activities with Inside/Out, Lubbock MHMR, the Lubbock
County Jail, Lubbock County Community Correctional Facility, Captain Hollywood, Mt.
Gilead and Managed Care as well as the City of Lubbock Health Department STD/HIV
Testing site. Specific detailed workplans to achieve this goal can be found in future
sections of the grant application.
The goal of the City of Lubbock Health Department is two -fold: To prevent future
infections with HIV among the citizens and to assist in the early intervention of those
who are infected with HIV. The City of Lubbock has the resources and experience to
achieve these goals and will work diligently to achieve them.
PERFORMANCE MEASURE REQUIREMENTS
OBJECTIVE 1: By the end of the 12-month contract period, the City of Lubbock Health
Department will provide 2000 HIV prevention contacts to the targeted subpopulations
outlined in the appropriate Regional Action Plan.
OBJECTIVE 2: During the project year, the City of Lubbock Health Department will
provide posttest prevention counseling to at least 75% of the individuals who test for
HIV infection.
OBJECTIVE 3: During the project year, 95% of the individuals testing HIV positive
through the City of Lubbock Health Department will receive posttest prevention
counseling.
OBJECTIVE 4: During the project year, the City of Lubbock Health Department will
successfully link at least 95% of the individuals testing HIV positive to case
manangement for early intervention.
OBJECTIVE 5: During the project year, the City of Lubbock Health Department will
elicit at least one sex and/or needles sharing partner, for health department referral,
from 80% of those HIV -positive individuals receiving posttest prevention counseling.
WORK PLAN
BDTP: M/MS
This group includes all Men who have sex with Men of all ages and ethnic groups who
are at highest risk for HIV infection and re -infection due to unprotected anal and/or oral
sex. This subpopulation includes substance abusers, adolescents, both identifying and
non -identifying gay males, sex partners of HIV+ men, those that have sex for drugs or
money and those with other STDs.
Prevention counseling and testing are offered at a number of locations including: the
City of Lubbock Health Department site, Texas Tech University, Captain Hollywood (the
gay club), through collaboration with Inside/Out and outreach in high -risk
neighborhoods, on -site testing at Mt. Gilead Baptist Church located in another high -risk
neighborhood, and at correctional facilities including the Lubbock County Jail and the
Lubbock County Community Correctional Facility.
Proposed HIV prevention interventions to be used to target this subpopulation include:
Individual level of intervention: counseling and testing, condom distribution,
demonstration of condom usage when applicable, safer sex behavior negotiation skills,
and referral for on -going counseling to appropriate agencies when needed.
LOCATION OF INTERVENTION:
CITY OF LUBBOCK HEALTH DEPARTMENT: Prevention counseling site within the
STD clinic. Prevention counselor available Monday through Friday for several hours a
day dependent on other sites and hours at those sites. Appointments are made for
clients so that they can be served as quickly as is possible. The STD Clinic is open late
on Thursday evenings and the HIV Counselor is available on Thursday evenings until
7pm to allow for those who work during the day to have an available time without
having to miss any time from work. The HIV Counselor will also adjust her schedule as
needed to work with a client to arrange an appropriate time for him/her. The HIV
Counselor is available most weeks on Mondays from 8-12 and 2-4:30, Tuesday from 8-
10:30 and 1:30-4:30, Wednesday from 8-10:30, Thursday from 10:30-12 and 2-7 and
Friday from 8-12. A total of 25 hours are available at the City of Lubbock Health
Department testing site most weeks.
INSIDEIOUT: Collaboration with the Central Lubbock Church of Christ Inside/Out
program has been in existence for two years. On -site prevention counseling and
testing is available during the lunch hour Monday through Friday when the facility is
serving a hot lunch to the homeless and others in the area in need of services offered
by the Church such as the food pantry and clothes closet. A support group for those in
recovery or seeking recovery from an addiction is held Monday through Friday from
12:30-1:30 following lunch. The HIV Counselor has been available from 12-1:30 on
Monday, Tuesday and Thursday and from 12-12:30 on Friday. This schedule will
continue to be offered through the next project year. The HIV Counselor is also
available to work with the Outreach workers during the year, and especially during the
summer months, to provide on -site prevention counseling and testing at apartment
complexes, parks, homes, etc. The HIV Counselor works with the outreach workers to
collaborate activities in areas where persons at high -risk for HIV infection congregate.
The HIV Counselor is available on Friday afternoons from 1-5pm and as needed during
the week.
MT. GILEAD BAPTIST CHURCH: A recent collaboration with the City of Lubbock
Health Department. Prevention counseling and testing for HIV are being offered at Mt.
Gilead Baptist Church on Tuesday and Wednesday from 10:30-12:30 and from 6-7pm
on Thursday evenings. Lunch will be served to those in need within the community and
the opportunity for education regarding HIV and testing for the infection will be made
available to those being served by the Church and those in the neighborhood.
Thursday evenings will offer support group meetings for those who are in recovery from
substance abuse and/or are required to attend a support meeting as a part of his/her
parole or probation. Prevention counseling and testing will be offered prior to the
support group meetings for those interested.
LUBBOCK COUNTY COMMUNITY CORRECTIONAL FACILITY: Prevention
counseling, education about HIV and testing are available on a monthly basis at the
facility. Collaboration with Inside/Out to provide on -site education regarding safer sex
behavior and negotiation skills for the inmates of the facility has been in existence for
more than two years. Voluntary testing for HIV is offered following the education. The
counselors and nurse employed by the facility also are encouraged to call if there
should be an inmate needing additional counseling, etc. Prevention counseling and
testing are offered the first Monday of the month from 9:30-12noon.
LUBBOCK COUNTY JAIL: Prevention counseling, education and testing are available
at the Jail for inmates seeking trustee status (working within/outside the facility).
Collaboration with Lubbock MHMR has made it possible to provide this service. Testing
is offered once a week, usually Monday morning, to those who are seeking trustee
status. All other inmates desiring testing for HIV are asked to request this service
through the Infirmary and arrangements are made to provide prevention counseling and
testing with the City of Lubbock Health Department.
TEXAS TECH UNIVERSITY: Prevention counseling and testing is offered through the
City of Lubbock Health Department in collaboration with Texas Tech University Student
Health Services. Testing has been available through this collaboration for ten years.
Appointments are available Wednesday from 1-4 and Friday from 9-11 and 1-4 during
the Fall and Spring semesters and on Wednesday from 1-4 and Friday from 9-11 during
the Summer sessions.
CAPTAIN HOLLYWOOD: Prevention counseling and testing are offered by the City of
Lubbock Health Department at the gay club once a month from 10pm-2am on a
Friday/Saturday evening. This has been offered for two years and has been a
successful intervention location.
HOME TESTING: Testing has been offered by the HIV Counselor to provide a more
comfortable environment for the client by testing at the client's home/other location that
is more appropriate. These arrangements are made between the client and the HIV
Counselor and a location and time that is best for the client is set.
The HIV Counselor is responsible for carrying out the above interventions at the
sites/locations as mentioned. She does have the assistance of the HIV Surveillance
Specialist and the DIS as needed to assist in providing the services to the clientele.
Texas Tech University also has two staff members that provide Prevention counseling
and testing to students on Friday mornings. All Prevention counseling and testing
opportunities include safer sex behavior negotiation skills and condom distribution as a
part of the prevention counseling. Referrals for on -going counseling when necessary
are made by the HIV Counselor to the most appropriate agency including, but not
limited to: SPARC, Managed Care, Catholic Family Services Counseling Center, Texas
Tech University Counseling Center, Lubbock MHMR and other counselors privately
employed.
Rapport has been established with the above mentioned agencies for a number of
years. Respect and trust of the individuals involved with the agencies, or inmates of the
above agencies has been gained through on -going involvement with the agencies and
maintanance of confidentiality always being on primary importance. Other members of
the subpopulation have encouraged friends to seek out the assistance of the HIV
Counselor when the need for prevention counseling and testing have been expressed.
Collaboration with other agencies with members of their staff have also allowed rapport
to be developed within this subpopulation.
The possible obstacles and barriers to reaching this target population may be lack of
trust due to past experience with other agencies, etc., not being ready to accept
information or lifestyle change, presence of alcohol and/or other substances that would
inhibit client from seeking or receiving information.
There are several members on staff that speak Spanish and can be called on when
necessary to translate and/or provide the prevention counseling and testing in the
Spanish language. Translators for the hearing impaired can be arranged when
needed.
BDTP: F/MS
This group includes all males and females of all ages and ethnic groups who are at
highest risk for HIV infection and reinfection due to unprotected oral, anal and vaginal
sex. This subpopulation includes adolescents, those who trade sex for money and/or
drugs, females who give birth, and those who use non -injecting substances such as
crack -cocaine, marijuana, alcohol, inhalants andn any other recreational drug.
Prevention interventions that will be offered include:
Individual level: STD screening and education, safer sex behavior negotiation skills,
condom distribution and demonstration and other safer sex messages, counseling and
testing, and referrals for on -going intensive counseling.
Group level: HIV Prevention education, safer sex behavior negotiation skills, condom
distribution and demonstration and other safer sex messages, counseling and testing
LOCATION OF INTERVENTION:
CITY OF LUBBOCK HEALTH DEPARTMENT:. As mentioned above, the HIV
Counselor is on -site to provide the above interventions, including referral to the STD
Clinic, when necessary. She is available Monday through Friday and late on Thursday
evenings.
INSIDE/OUT: Collaboration with the Central Lubbock Church of Christ has been in
existence for two years and on -site prevention counseling and testing are available
during the lunch hours Monday, Tuesday, Thursday and Friday. Support group for
those seeking recovery/in recovery from an addiction is offered Monday through Friday
from 12:3-1:30 following lunch. Collaboration to provide the above interventions with
the outreach workers in areas of high -risk individuals is provided during the summer
months on Friday afternoons and as needed at other times of the year. This prevention
counseling and testing may take place in apartment complexes, parks, street corners,
homes, and other areas that may have persons at high risk for HIV infection
congregating.
MT. GILEAD BAPTIST CHURCH: A recent collaboration serving a high -risk
community with large numbers of persons involved with drugs and/or gangs.
Homelessness and poverty are in much higher prevalence than other communities.
Prevention counseling and testing as well as the above listed individual interventions
will be offered on Tuesday and Wednesday from 10:30-12:30 and on Thursday from 6-
7pm. A hot lunch and availability of a clothes closet are also available at Mt. Gilead.
Support group meetings for those recovering from an addiction(s) as well as those
required to attend a support group as a stipulation of parole/probation will be held on
Thursday evenings from 7-8pm.
TEXAS TECH UNIVERSITY: Collaboration with Texas Tech University Student Health
Services has been in existence for ten years. Prevention counseling and testing as well
as the above mentioned individual interventions will continue to be offered to students
by appointment on Wednesday from 1-4 and on Fridays from 9-11 and 1-4.
LUBBOCK COUNTY JAIL: Collaboration with Lubbock MHMR to provide prevention
counseling and testing to those inmates seeking trustee status (work within the
jail/outside the jail) has been in place for two years.
Inmates seeking prevention counseling and testing without trustee status are offered
the opportunity to test for HIV by completing a request to the Infirmary. Arrangements
are made with the Health Department to provide this service. Condoms are not
provided due to jail regulations.
LUBBOCK COUNTY COMMUNITY CORRECTIONAL FACILITY: Collaboration with
the facility and Inside/Out to provide monthly prevention counseling, HIV Prevention
education, Safer Sex Behavior Negotiation Skills, Condom Demonstration and STD
Education for inmates of the facility has existed for two years. The first Monday of the
month is the arranged time to provide these interventions but arrangements have been
made between the counselors and nurse of the facility when necessary to provide
prevention counseling and testing for a specific inmate at a time other than the above.
Condoms are made available through the nurse when the inmate is leaving on pass for
the weekend.
BILLY MEEKS DRUG TREATMENT FACILITY: Collaboration with Lubbock MHMR to
provide prevention counseling, HIV Prevention education, Safer Sex Behavior
Negotiation Skills, and condom demonstration and availability has been offered
quarterly for two years. The program includes in -patient treatment program for 28 days
and then an out -patient program that may last for 6 months or longer. Testing is
provided quarterly on -site at the designated meeting time of 6:30-8:30pm. Lubbock
MHMR provides the HIV Prevention education, Safer Sex Behavior Negotiation skills,
and condom availability and demonstration in a group level and the HIV Counselor
provides client -centered prevention counseling and testing. Many of those in
attendance are court -ordered to attend as a stipulation of his/her probation or parole.
THE RANCH: Collaboration with Lubbock MHMR to provide prevention counseling,
HIV Prevention education, Safer Sex Behavior Negotiation Skills, and condom
demonstration and availability has been offered the last year as needed and requested
by the staff. The Ranch is an adolescent treatment facility/halfway house for
adolescent males transitioning from the Lubbock County Youth Center back to their
homes or a long-term facility. The adolescents usually have been sexually active, many
have had involvement with drugs of various forms and many have gang involvement.
The group level intervention is offered by Lubbock MHMR to provide prevention
education, condom demonstration and safer sex behavior negotiation skills. The City of
Lubbock Health Department provides the HIV Counselor to provide prevention
counseling and testing. The various interventions are offered on a weekday afternoon
when the residents have finished school, generally 4:00-5:30pm on a Monday or
Tuesday. Testing is totally optional. Condoms distributed are kept by the staff until the
resident leaves the facility and then they are given to the client.
Rapport as indicated above in the M/MS BDTP group has been established in many of
the locations for several years. Trust and respect of the persons involved in the
intervention(s) is critical to the acceptance of the information given and the behavior
change(s) that may result. The HIV Counselor has a long-term relationship with many
of the persons involved due to her holding the position for eight years. Confidentiality is
critical to the establishment of trust and Ms. Foskey has understood the importance of
this and has worked to make all clients feel comfortable and confident in her abilities.
The collaborating agencies have depended on Ms. Foskey to help complement their
programs and have been critical to her rapport and acceptance of clientele.
The possible obstacles and barriers that may exist in reaching this target population are
substance use/abuse and lack of desire/resources to obtain help. There are many
persons that are awaiting detox treatment and long-term treatment for substance abuse
but there are limited beds available in the area. The HIV Counselor works to provide
assistance and referral to agencies that can access the system easier to obtain the
most prompt attention for her client. Managed Care and Lubbock MHMR provide
assistance for those desiring treatment, and Inside/Out and Mt. Gilead provide support
group meetings that can offer out -patient assistance. Others are not ready to seek
treatment and may need other alternatives. Other barriers and obstacles may be time
and location of interventions, although arrangements can be made if needed. The
primary barrier and obstacle is helping persons to assess his/her risk and/or that of
partners. Many persons do not want to admit his/her possible risk and deny the
existence of a risk and need for information.
As stated before, there are several staff members that speak Spanish that are available
to translate and/or provide prevention counseling, testing and other interventions as
needed. For those who are hearing impaired, TTUHSC Communication Disorders
Clinic provides translators who can sign.
Referrals for substance abuse treatment will be made to Lubbock MHMR, Managed
Care and/or in coordination with the Inside/Out program and Mt. Gilead support groups.
Individuals in need of on -going, intensive counseling will be referred to, but not limited
to: Rape Crisis Center, Texas Tech University Counseling Center, Inside/Out, Catholic
Family Services Counseling Center, Managed Care and other counselors in private
practice.
BDTP: IDU
This group includes IDUs of all ages, ethnic groups and gender who are at highest risk
for HIV infection and reinfection due to unprotected oral, anal, and/or vaginal sex as
well as sharing needles. The act of sharing a needle is the main behavior that brings
these individuals together regardless of their race or gender.
Prevention interventions to be used with this target population include:
Individual level of intervention: safer sex and needle use behavior negotiation skills,
condom distribution and demonstration with safer sex messages, and referrals for
intensive, on -going behavioral counseling as well as prevention counseling and testing
Group level of intervention: safer sex and needle use behavior negotiation skills,
condom distribution and demonstration with safer sex messages
LOCATION OF INTERVENTION:
CITY OF LUBBOCK HEALTH DEPARTMENT: Prevention counseling site within the
STD Clinic. Prevention counselor available Monday through Friday for several hours a
day dependent on other sites and hours at those sites. Appointments are made of
clients so that they can be served as quickly as possible. The STD Clinic is open late
on Thursday evenings for those clientele with time conflicts due to work, etc. The HIV
Counselor will also adjust her schedule to assist a client in providing an appropriate
time for him/her. A total of 25 hours are available most weeks at this location.
INSIDE/OUT: Collaboration with the Central Lubbock Church of Christ Inside/Out
program has been in existence for two years. On -site prevention counseling and
testing is available during the lunch hour Monday through Friday when the facility is
serving a hot lunch to the homeless and others in the area in need of services offered
by the Church such as the food pantry and clothes closet. A support group for those in
recovery or seeking recovery from an addiction is held Monday through Friday from
12:30-1:30 following lunch. The HIV Counselor has been available from 12-1:30 on
Monday, Tuesday and Thursday and from 12-12:30 on Friday. This schedule is
anticipated to continue during the next project year. The HIV Counselor is also
available to work with the Outreach workers during the year, and especially during the
summer months to provide on -site prevention counseling and testing at apartment
complexes, parks, homes, etc. The HIV Counselor works with the Outreach workers to
complement their activities and provides prevention counseling and testing in areas
where persons at high -risk for HIV infection congregate. The HIV Counselor is
available on Friday afternoons from 1-5pm and as needed during the week.
MT. GILEAD BAPTIST CHURCH: A recent collaboration with the City of Lubbock
Health Department. Prevention counseling and testing for HIV are being offered at Mt.
Gilead on Tuesday and Wednesday from 10:30-12:30 and from 6-7pm on Thursday
evenings. Lunch will be served to those in need within the community and the
opportunity for education regarding HIV and testing for the infection will be made
available to those being served by the Church and those in the neighborhood.
Thursday evenings will offer support group meetings for those who are in recovery from
substance abuse and/or are required to attend a support meeting as part of his/her
parole or probation. Prevention counseling and testing will be offered prior to the
support group meetings for those interested.
LUBBOCK COUNTY COMMUNITY CORRECTIONAL FACILITY: Prevention
counseling, education about HIV and testing are available on a monthly basis at the
facility. Collaboration with Inside/Out to provide on -site education regarding safer sex
behavior and negotiation skills for the inmates of the facility has been in existence for
more than two years. Voluntary testing for HIV is offered following the education. The
counselors and nurse employed by the facility are also encouraged to call the HIV
Counselor if there should be an inmate with additional needs for counseling, etc.
Prevention counseling and testing are offered on the first Monday of the month from
9:30-12noon. This facility is a two-year program and all inmates are males serving time
for a drug -related offense.
LUBBOCK COUNTY JAIL: Prevention counseling, education and testing are available
for inmates seeking trustee status (working within/outside the facility). Collaboration
with Lubbock MHMR has made it possible to provide this service. Testing is offered
once a week, usually Monday morning, to those who are seeking trustee status. All
other inmates desiring testing for HIV are asked to request this service through the
Infirmary and arrangements are made to provide prevention counseling and testing with
the City of Lubbock Health Department.
THE RANCH: Collaboration with Lubbock MHMR to provide prevention counseling,
HIV Prevention education, Safer Sex Behavior Negotiation Skills, and condom
demonstration and availability has been offered the last year as needed and requested
by the clients and staff. The Ranch is an adolescent treatment facility/halfway house
for adolescent males transitioning from the Lubbock County Youth Center to their
homes or a long-term facility. Many of the adolescents have been sexually active,
many have had involvementn with drugs of various forms and many have gang
involvement. The group level intervention is offered by Lubbock MHMR to provide
prevention education, condom demonstration, and safer sex behavior negotiation skills.
The City of Lubbock Health Department provides the HIV Counselor to complement the
education and offer prevention counseling and testing. The various interventions are
offered on a weekday afternoon when the residents have completed school for the day,
generally 4:00-5:30pm on a Monday or Tuesday afternoon. Testing is voluntary.
Condoms distributed are kept by the staff until the resident leaves the facility and then
they are given to the client.
BILLY MEEKS DRUG TREATMENT FACILITY: Collaboration with Lubbock MHMR to
provide prevention counseling, HIV Prevention education, Safer Sex Behavior
Negotiation Skills, and condom demonstration and availabilty has been offered
quarterly for two years. The program includes in -patient treatment program for 28 days
and then an out -patient program that may last for six months or longer. Testing is
provided quarterly on -site at the designated meeting time of 6:30-8:30pm. Lubbock
MHMR provides the HIV Prevention education, Safer Sex Behavioral Negotiation skills,
and condom availability and demonstration on a group level and the HIV Counselor
provides client -centered prevention counseling and testing. Many of those in
attendance are court -ordered to attend as a stipulation of his/her probation or parole.
HOME TESTING: Testing has been offered by the HIV Counselor to provide a more
comfortable environment for the client by testing at the client's home/other location that
is decided upon. These arrangements are made between the client and the HIV
Counselor and a location and time is arranged that is best for the client. Prevention
counseling and testing, as well as the above mentioned interventions are always
incorporated into the time spent with the client.
Rapport has been established with the above mentioned agencies for a number of
years. Respect and trust of the individuals involved with the agencies, or inmates of the
above agencies has been gained through on -going involvementn with the agencies.
Maintenace of confidentiality always being of primary importance, has enhanced this
trust. Other members of the subpopulation have encouraged friends to seek out the
assistance of the HIV Counselor when the need for prevention counseling and testing
have been expressed. Collaboration with other agencies and members of their staff
have also enhanced the development of rapport within this subpopulation.
The possible obstacles and barriers to reaching this target population may be lack of
trust due to past experience with other agencies, etc., not being ready to accept
information or lifestyle change, presence of drugs, alcohol, etc., and lack of resources
for in -patient treatment for substance use.
There are several members on staff that speak Spanish and can be called on when
necessary to translate and/or provide the prevention counseling and testing in the
Spanish language. Translators for the hearing impaired can be arranged through
when needed.
Desired outcomes of workplans include:
Determination of individual's HIV status in order to inititate early intervention and
treatment
Encouragement of safer sex practices to reduce HIV infection or re -infection
To encourage and support a commitment to healthy behaviors
EVALUATION PLAN
Those persons seeking prevention counseling and testing have a CDC produced form
that is completed by the HIV Counselor. These forms are used to develop the monthly
and quarterly reports that are submitted to the Program manager, Prevention Manager,
and the TDH. The HIV Counselor works in collaboration with a number of agencies that
are able to identify and target the priority subpopulations.
As discussed in detail in the Workplan, there are a number of prevention counseling
and testing locations that are available to those within the priority subpopulations. The
City of Lubbock Health Department is a location that has been in place for ten years
and is on the bus route and is accessible to the majority of those seeking HIV testing.
The two churches that collaborate with the City of Lubbock Health Department are in
locations with higher prevalences of poverty, homelessness, drug related problems, etc.
These two churches, Central Lubbock Church of Christ and Mt. Gilead Baptist Church,
have members of the community that are involved in helping to identify those persons
at increased risk for HIV infection and have a strong desire to assist those members of
their communities. Texas Tech University is a site that has been in place for ten years
and meets the target populations of M/MS and F/MS in large numbers. Due to the age
of the majority of the students and the presence of alcohol and other drugs on a college
campus, this subpopulation is very readily identifiable and accessible. The Texas Tech
University Student Health staff is also helpful in encouraging students to seek
prevention counseling and testing for HIV especially those being seen for STDs and
with abnormal pap smears. Texas Tech University also has a program called Impact
Tech that presents on HIV and STDs to various campus organizations and classes and
encourages students to seek prevention counseling and testing if he/she feels he/she
may have put himself/herself at risk.
The various correctional facilities, Lubbock County Jail and the Lubbock County
Community Correctional Facility, have members of the subpopulations in larger
percentages than within the larger community. The HIV Counselor, in coordination with
the collaborating agencies, works to assist in the development of a plan to prevent or
reduce his/her risk while in the facility as well as when they are released. The HIV
Counselor uses a self -identified risk form to collect some data and to use as a tool to
provide client -centered prevention counseling for inmates so that the process can move
more quickly. The drug treatment facilities, The Ranch and Billy Meeks Treatement
Facility, also use a self -identified risk form for data collection and as a tool to provide
prevention counseling for clientele in a timely manner.
This information is compiled by the HIV Counselor on a monthly basis and then is used
to compile quarterly reports. The primary risk of the client, as determined by the HIV
Counselor and the client, are documented as is the age, race and sex of the client. The
scan-tron forms developed by CDC are used as another tool to gather information. This
information is gathered at the end of the day and are put onto forms that will be used to
complete the monthly report.
The HIV Counselor is also responsible for completing a Partner Elicitation form for TDH
on those persons testing positive for HIV. Those partners elicited for partner
notification are then forwarded to the DIS or to the TDH.
The reports are read and feedback is given by the managers, TDH staff and/or the
regional coodinator. If a specific subpopulation is not meeting the desired performance
objectives, then a plan is developed to increase the time spent in that target area and
other areas have time decreased.
The HIV Counselor has the experience developing activities, gathering the data
necessary and developing thorough and detailed monthly and quarterly reports to show
her work. She maintains a daily calendar that documents where the activity is occurring
and how many persons received the information, sought testing, etc.
Barriers and problems are not anticipated due to the experience of the HIV Counselor.
The only barriers and problems that may be anticipated may occur if additional
information that has not been requested in the past should be desired and then the
development of ways to collect that data will need to be considered. The various
agencies within Region 1 have always been helpful in the development of other ideas
and ways to perform the activities with minimal interference to the programs and the
clientele served. The agencies within Region 1 have regular meetings to address
issues related to our programs and the clientele and work together to help each other
with problems and barriers.
COLLABORATION WITH OTHER AGENCIES
Collaboration is a critical component of providing any HIV related service or activity.
There is no one agency that can provide for all the needs of the community and serve
the clientele in a thorough and responsible manner. The needs of those in need of
prevention counseling and testing may be very different from those who are infected.
Region 1 is very fortunate to have the collaboration of many agencies to provide for a
variety of needs regarding HIV and other factors that may place on at a higher -risk for
HIV prevention activities.
Collaboration activities with various agencies are detailed below:
SOUTH PLAINS AIDS RESOURCE CENTER (SPARC): The City of Lubbock Health
Department collaborates with SPARC to provide HIV prevention counseling and testing
at the gay club, Captain Hollywood and at other sites within the City of Lubbock. The
City of Lubbock Health Department was involved with the 24-hour Testing Marathon
held at SPARC in October of 1997. The City of Lubbock Health Department refers all
persons testing positive for HIV to SPARC for case management, enrollment in the
Early Intervention clinic, and other client needs. The City of Lubbock; Health
Department and many other agencies in Lubbock serve on the World AIDS Day
Planning Committee and the HIV Consortium. SPARC makes referrals to the City of
Lubbock Health Department when needed for the STD Clinic and Immunization Clinic.
The HIV Counselor and the staff of SPARC have a good working relationship and call
on each other to provide assistance, education, etc to clientele as needed.
INSIDE/OUT: The City of Lubbock Health Department collaborates with the Inside/Out
program to provide prevention counseling and testing to clientele of the agency and to
assist the Outreach workers in providing a resource for prevention counseling and
testing for those members of the community they are targeting. The City of Lubbock
Health Department makes referrals to the Inside/Out program for food, clothing and
support group (drug treatment) needs.
MANAGED CARE: The City of Lubbock Health Department collaborates with
Managed Care to provide a resource for clientele in need of in -patient and/or out-
patient substance abuse treatment. Managed Care receives funding to provide case
management for those HIV -positive individuals with substance abuse issues. Managed
Care refers to the City of Lubbock Health Department for STD testing and treatment
and for Immunizations.
MT. GILEAD BAPTIST CHURCH: Collaboration between the Church and the City of
Lubbock Health Department is fairly recent. The City of Lubbock Health Department
provides the HIV Counselor on -site for prevention counseling and testing three days a
week. The HIV Counselor also makes referrals to the Church for support group
meetings for those in recovery or seeking recovery from an addiction. Referrals are
also made to Mt. Gilead for clothing needs of clientele.
LUBBOCK COUNTY COMMUNITY CORRECTIONAL FACILITY (LCCCF):
Collaboration between the City of Lubock Health Department, Inside/Out and this
facility have been in place for two years. LCCCF provides a time each month to allow
the City of Lubbock Health Department and Inside/Out to meet with the inmates to
provide HIV prevention education, counseling and testing. The City of Lubbock
provides a resource for the inmates and staff of LCCCF to obtain additional services,
education, case management, etc for those inmates that are HIV -positive. Referrals
are made to the City of Lubbock Health Department for STD testing and treatment and
collaborative activities have included on -site immunizations for the inmates.
LUBBOCK COUNTY JAIL: The collaborative activities to provide HIV prevention
education, counseling and testing have been in existence for two years. Lubbock
MHMR provides collaborative assistance in providing HIV prevention education. The
City of Lubbock assists in referrals for those inmates that are HIV -positive for case
management, early intervention, etc. The Lubbock County Jail makes referrals to the
City of Lubbock Health Department for STD testing and treatment.
TEXAS TECH UNIVERSITY: Collaborative activities to provide on -site prevention
counseling and testing for students on a voluntary basis has been in place for ten
years. Texas Tech University Student Health Services provides a room for
confidential/anonymous counseling and testing and the City of Lubbock Health
Department provides the HIV Counselor. Texas Tech University advertises this service
and promotes it with the various activities of its students and organizations, especially
the student group, Impact Tech, that works to educate students on a variety of heath
issues. Referrals are made to the Health Department for STD testing and treatment
and Immunizations if the student has not paid his/her health fee and/or is uncomfortable
seeking testing and treatment at Student Health.
CAPTAIN HOLLYWOOD: Collaboration with Captain Hollywood, the gay club, has
existed for almost two years. Captain Hollywood provides access to a private room for
prevention counseling and testing on -site. The City of Lubbock Health Department
provides the HIV Counselor once a month during operating hours to be available for
clientele of the club. The City of Lubbock Health Deparment also assists in providing
condoms for clientele of the club.
LUBBOCK MHMR: Collaboration with Lubbock MHMR has existed for two years to
complement their program by offering the availability of the HIV Counselor to provide
HIV prevention counseling and testing at sites where their staff was providing HIV
Prevention education, skills building, etc. These sites include, but are not limited to:
The Ranch, Billy Meeks Treatment Facility, the Lubock County Jail, Methodist School of
Nursing, South Plains College, the Jail Training Center, and on -site at the City of
Lubbock Health Department. Referrals are made to the City of Lubbock Health
Department STD Clinic and Immunization Clinic for clients of Lubbock MHMR and
others as referred by the Outreach staff. The City of Lubbock Health Department
makes referrals to Lubbock MHMR for substance abuse treatment and the Methadone
Clinic.
OTHER COLLABORATIVE AGENCIES:
There are many other agencies that provide collaborative activities and are used for
resources throughout the year. The City of Lubbock Health Department employs a
Disease Intervention Specialist that assists with Partner Notification. The Texas
Department of Health provides other staff to assist with Partner Notification outside of
the Lubbock area and provides resources for clinical services in areas outside of the
Lubbock region. The three local hospitals provide assistance in providing health
services outside the scope of the Health Department as does the Community Health
Centers of Lubbock and various satellite clinics operated by the larger hospitals. The
Rape Crisis Center is a valuable resource for those who are victims of a sexual assault.
The Lubbock Council on Drug and Alcohol Abuse provide assistance in substance
abuse and recovery. The City of Lubbock has a bi-monthly meeting organized by the
City of Lubbock Surveillance Department that brings together health care providers
throughout the area to address health care concerns and needs of our community. The
Board of Health provides assistance as needed in addressing the health needs of the
citizens of Lubbock. The Surveillance Department of the City of Lubbock Health
Department addresses the morbidity/mortality rates of various infections, viruses,
bacterias, etc within the community and seeks to educate and prevent further
infections. The City of Lubbock Health Education department provides education to the
citizens of Lubbock on a variety of health related areas, including HIV, STD, andTB.
The TDH Regional Office serves as a referral agency for those with reactive skin tests
for TB and/or active TB. Various agencies exist also to assist with Prescription
assistance, Housing needs, Utility payments, and food and clothing needs. There are
also numerous agencies that provide on -going intensive counseling for individual, family
and substance abuse needs. Training opportunities are varied and are offered through
a variety of agencies including the various hospitals, teleconferences at TDH-Region 1,
SPARC, etc.
Collaborative activities are documented and are reported in the quarterly report
submitted to theTexas Department of Health. Referrals to various agencies are also
documented and included in the quarterly report. The Referral Plan will be expanded
upon in the next section.
REFERRAL PLAN
Referrals for on -going intensive counseling, case management, early intervention,
substance abuse treatment, sexual assault counseling, TB testing and referrals and
STD testing and treatment as well as prenatal and family planning are common in
providing prevention counseling.
Referrals are made to the City of Lubbock Health Department STD for those desiring or
having a need for further testing and treatment of other sexually transmitted diseases.
The STD Clinic provides testing and medication based on CDC Guidelines. The STD
Clinic also employs physicians to staff the clinic several days a week.
The City of Lubbock Immunization Clinic is referred to when a client should be in need
of an immunization and/or a TB skin test. If the client should have a reactive skin test
for TB, he/she is referred to the Texas Department of Health, Region 1 for further
testing, chest x-rays, etc.
Referrals are made to SPARC for early intervention for those persons testing HIV+ and
Managed Care is also able to provide early intervention services to those persons with
a substance abuse history and a reactive HIV test.
Treatment for those with a substance abuse history are referred to Managed Care,
Lubbock MHMR, Inside/Out, Lubbock Council on Alcohol and Drug Abuse, and Mt.
Gilead.
Prenatal care and family planning referrals are made to the TTUHSC Ob/Gyn Clinic or
Presbyterian Women's Clinic located within the Community Health Centers of Lubbock.
A client reporting some form of sexual assault is referred to the Lubbock Rape Crisis
Center for further counseling and/or pursuit of legal rights and procedures.
Other counseling, individual, marital and/or family therapy are commonly referred to
Catholic Family Services Counseling Center, Texas Tech University Counseling Center,
or other private practitioners in the area, as well as ministers of churches.
Clientele that are in need of further mental health needs, including assessment for
suicidal/homicidal ideation, are referred to Lubbock MHMR for evaluation. .
Clothing and/or food needs as well as housing,utility and medication assistance are
made to several churches, including Mt. Gilead and the Central Lubbock Church of
Christ, the Salvation Army, Catholic Family Services, Lutheran Services, and the South
Plains Food Bank. The Womens Protective Services and West Texas Legal are also
referral agencies when applicable.
Documentation of referral is completed by the HIV Counselor and is maintained until the
client has made contact with that agency. The HIV Counselor tries to make the
appointment by phone when the client is in the office. The HIV Counselor writes the
name, location, phone number and contact person that he/she will be speaking with as
well as the time and date of the appointment. When applicable, the person from the
agency being referred to may meet the client at the HIV Counselor's office within the
hour. The HIV Counselor is responsible for assuring that the contact was made and the
appointment kept and is available to provide assistance to the referral agency as
needed and able. Confidentiality is assured to the client.
The HIV Counselor is familiar with the resources of the community and has worked with
members of the above agencies to help meet the needs of her clients.
See referral form below:
CITY OF LUBBOCK HEALTH DEPARTMENT
NAME OF PERSON REFERRED:
DATE OF REFERRAL:
REFERRAL TO: (NAME OF AGENCY)
(ADDRESS)
(CONTACT PERSON)
(PHONE NUMBER)
DATE AND TIME OF APPOINTMENT:
REFERRAL FOR: (CIRCLE ALL THAT APPLY)
EARLY INTERVENTION PRENATAL CARE
FAMILY PLANNING COUNSELING TB TEST
STD TESTING IMMUNIZATION _
SUBSTANCE ABUSE TREATMENT ASSISTANCE WITH:
CLOTHING FOOD HOUSING UTILITY
MEDICATION OTHER:
CONTACT MADE: YES NO
ACTION TAKEN (IF APPLICABLE):
COUNSELOR'S NAME:
DATE:
ADDITIONAL CLIENT INFORMATION IN CASE CONTACT IS NOT MADE:
ADDRESS:
PHONE NUMBER:
EMERGENCY PHONE NUMBER:
QUALITY ASSURANCE PLAN
The City of Lubbock Health Department performs annual reviews of staff for
salary increases. The supervisors also perform mid -year reviews so that staff
can be aware of any areas of deficiencies and in what areas the staff is
proficient. The employee can work to correct them before the annual review and
can address other objectives as well as areas of training that he/she feels could
assist with his/her job performance. These reviews are conducted by the
employee's immediate supervisor with approval of the Department Head.
The HIV Counselor is reviewed once a quarter as requested by the Texas
Department of Health. The immediate supervisor or another HIV trained
counselor sits in on one to two sessions to evaluate the HIV Counselor and to
address areas that could be improved upon in further sessions. Once a year,
the Regional coordinator and/or the Texas Department of Health liason will
review the program and will evaluate the HIV Counselor. The Texas Department
of Health will also assure at this time that there are procedures and protocols in
place and that these are acceptable for the program.
Staff development day is held the last Tuesday of every month. This is a time to
meet educational needs and there have been several months that offers
opportunities for the nursing staff to obtain CEUs. Many of the workshops
offering CEUs are also made available to outside agencies so that their nursing
staff can take advantage of training opportunites closer to home and at a fairly
low cost for the CEUs. Some of the areas addressed in the past have included:
HIV update, STDs and Sexuality, CPR, Pharmacy Update, Severe Weather,
Violence in the Workplace, Cultural Competency training, etc. This day is also
set aside to work on educating staff on other areas that are required of all city
employees, for example: MSDS training,
In the past the City of Lubbock Health Department has been recognized and has
been accredited by the National League of Nurses (NLN). Standards and
protocols were met and continue to be important and in place for the health and
safety of clients and staff. Client satisfaction surveys are done twice a year, for a
week each time. These are used to address particular issues that clients have
seen as excellent and those where recommendations made for improvement.
Changes that will improve client satisfaction with services at the City of Lubbock
Health Department are taken under consideration when designing programs.
There is a policy to address grievances by clientele and staff. These policies are
available to any client that requests a copy or has a grievance that he/she would
like to have addressed. The policy has been approved by the Texas Department
of Health. There was a form that was implemented to address any grievances
that were received on the phone as well. This was implemented when the
Family Planning and Maternity clinics were closed due to need to privatize and
lower costs for the City of Lubbock. The form addressed the client's complaint
and the client was contacted by a supervisor for follow-up when needed.
Every effort is made to incorporate suggestions by clientele and staff to better
serve the citizens of Lubbock. The City of Lubbock Health Department seeks to
have staff that is qualified and exemplary in his/her job and seeks to offer
additional training to compliment his/her training. Quality of service is key to the
many programs that the City of Lubbock Health Department offers and the long-
term service of the Health Department is a direct result of the cooperation and
coordination of services between the clientele and staff.
BUDGET SUMMARY
Legal Name of Applicant: City of Lubbock Health Department
Cost Categories
TDH Funds
Requested
(1)
Direct Federal
Funds
(2)
Other State Agency
Funds
(3)
Local Funding
Sources
(4)
Other Funds
(5)
Total
(6)
A. Personnel
$ 32 339.00
S
S
$
$
$
B. Fringe Benefits
S 11,323.50
S
S
S
S
S
C. Travel
S 1,330.00
$
S
S
$
$
D. Equipment
$
S
S
$
S
S
E. Supplies
$ 721.24
$
S
$
$
S
F. Contractual
$
$
$
S
S
$
G. Construction
N/A
$
S
S
S
$
1.Other
S 750.O�
$
$
S
S
S
1. Total Direct Costs
$ 46 463.74
$
$
$
S
$
J. Indirect Costs
$ 3,200.00
$
$
$
S
$
K. Total (Sum of I and J)
S 49,663.74
$
S
$
$
$
L. Program Income
--Projected Earnings
— Carry Forward
$ 900.00
$
$
$
S
S
S
$
$
S
$
$
M. Match
--In-Kind
--Other Match
$
$
$
$
$
$
$
$
3
$
S
$
Indirect costs are based on (mark the statement which Is accurate):
❑ The applicant's most recently approved indirect cost rate (%). A copy is attached behind the OTHER Budget Category Detail Form.
❑ The applicant's most recently approved indirect cost rate (%} which is on file with TDH's Fiscal Division.
0 Uniform Grants and Contract Management Standards.
FINANCIAL AUDITED STATEMENT
The most recent audited statement for 1996-97 is incomplete at this time. The
Accounting Department of the City of Lubbock is currently auditing all City of Lubbock
budgets and programs and this will be complete by July 31, 1998. A copy will be
forwarded to the Texas Department of Health upon completion.
PERSONNEL Budget Category Detail Form
LEGAL NAME OF APPLICANT: City of Lubbock Health Der)artment
unehnnal Title +Code '/e Certi#iention/ otal Annual $alaty Requested Vacant Justititin
E=ExistingP Proposed Time. License W01red. Shcaiy foT Protect Y/1�I .
HIV Counselor (E) 100 $32 339.00 $32.33 .00 N
FRINGE BENEFITS: Itemize the elements of fringe benefits in this space. Attach an SALARY TOTAL $
additional sheet of paper if more space is required. 11 32 33 .00
FICA $2,473.00 Health Insurance $3,456.00 Fringe Benefits Rate 33 q
Pension $4,514.00 Life Insurance $32.50
Long Term Disability $122.00 Stability $450.00
Dental Insurance $276.00 $
FRINGE BENEFITS TOTAL 11 323.50
NOT APPLICABLE
FUNDING INFORMATION FORM
Legal Name of Applicant: City of Lubbock Health Department
Funding From Other State of Texas Agencies (Do not include TDH funding )
State of Texas Agency & Program
Name
Name of Contact Person at State
Agency
Telephone No.
Period Funds Available
Total Amount of Funding
S
TOTAL STATE AGENCY FUNDING
$
A letter of good standing from each state agency providing funds to applicant (other than TDH) must be attached behind this form. If applicant is a State Agency or a State of Texas
Institution of Higher Education, letters of good standing are not required.
Applicant's fiscal year ending month is:
Applicant must enter the total projected amount of federal expenditures for applicant's current fiscal year. Projected amount should include funding for all activities including
"pass through" funds from all state agencies. Do not include funds being requested in this application; however, any other TDH funds that have been awarded to the applicant that
are pass -through federal funds should be included in the projection. $
Applicant must enter the total projected amount of state expenditures for applicant's current fiscal year. Projected amount should include finding for all activities including TDH
funds except finds being requested in this application. $
OTHER Budget Category Detail Form
LEGAL NAME OF APPLICANT: City of Lubbock Health Department
Amount requested in budget for other: S 750.00
TRAVEL Budget Category Detail Form
LEGAL NAME OF APPLICANT: City of Lubbock Health Department
Local Travel Costs (Travel and Per Diem)
I
".".
M
6;
M-4 0 i ..
..J.
.....i... or 11.
(..,..ft......c...l....d.
bgrsem
b..f
D
.....i...... ....
.. IN
. . .
J W. al ...
....... ...
....
.... ......-.
I ......
.......
c
..
......W .. ..... ...................
... ..h ...... ........... ....
...r....
6h................................. ..................-...........-.........-..........—.... .- . .... .........
...
..',
..,..Miles
.. .. . .
.
......
.....
. ......
.
-,........'.............. ...... ..
............
..
...
.
....
.
U
...............
...................
......................
...6................
....... .. —� . : -............... .....
.. ....... .. ....... - . . ..... . . .. ...
I$ .325/mile
........
2,400
780-00
780.00
HIV Counselor, travel to various sites to provide HIV
prevention counseling
Costs
WT U
.7
b
c-
whom TD U finds
$te;_ 6100 tw .....
............ ......... ..
... . .... . ......
........ -
. ...
C
. ... .. ... .. . ...
M/Sm &rug
Lubbock
I
1
I
150.00
100.00
I
30.00
I
75-00
I
1 11
Conference
TOTAL IS 150,00 1 $ 100-00 1$ 30.00 1 $ 75-00
NOTE: All contracts with the Texas Department of Health require that a written travel policy be maintained by the contracting entity. Attach a copy of the travel policy as an appendix
to the proposal. If a written travel policy is not in place, TDH's travel policy will be used.
NOT APPLICABLE
EQUIPMENT Budget Category Detail Form
LEGAL NAME OF APPLICANT: City Of Lubbock Health Deparbrnent
Amount requested in budget for equipment: $
Itemize, describe and justify the list below. Attach complete specifications or a copy of the purchase order. Equipment is defined by TDH as non -expendable personal property
with a unit cost of more than $1,000.00 and a useful life of more than one year, with the following exceptions: fax machines, stereo systems, cameras, video recorders/players,
microcomputers, printers, software, medical and laboratory equipment which cost over $500. Medical and laboratory equipment in this classification are defined as microscopes,
oscilloscopes, centrifuges, balances, and incubators. Medical and laboratory equipment not included in these five categories are not considered a capital asset unless the unit value
NCT APPLICABIE
CONTRACTUAL Budget Category Detail Form
LEGAL NAME OF APPLICANT: City of Lubbock Health Department
Amount requested in budget for contractual: $ . List only subcontracts for health or health -related services provided directly to applicant's clients by a third
party. If subcontractor(s) is not yet identified, describe the service to be subcontracted and show subcontractor as 'To be named." Justification for subcontract that delegate a substantial
NOT APPLICABLE
J ub"n 11:&nuiN r uK KEQuEb-i- vuK r: wrmEm- ruKC:m"us
Instructions: Use one Justification form for each item listed on the Equipment List.
Contractor Name: I
Scope of Work: I
Contract Number:
Contract Term: I
Description of Equipment Requested (attach additional sheets if necessary and copies of
specifications and/or other pertinent documentation):
I ALL APPLICANTS MUST COMPLETE THIS SECTION: I
11. Does the cost include shipping and handling?
12. Does the cost include a warranty?
13. Does the cost include a maintenance agreement?
14. Does the cost include training in the use of the equipment?
15. If the equipment is a lease -to -purchase agreement, is a copy of the agreement attached?
1
6. Why is the equipment needed? What is the purpose of the equipment? Who will benefit
and how? Who will use the equipment? Where will it be located?
7. Why is this equipment more appropriate than other alternatives considered or a less
expensive piece of equipment?
18. If the equipment has "special' or 'optional' features, explain why they are necessary.
19. If the equipment is being leased with no option to buy, explain the benefit(s).
10. If lease -purchase costs are spread across several funding sources, other than TDH, who
are the other funding sources and what is their percent of funding?
11. Do the item(s) fit the current TDH definition of equipment?
2. Are any of the item(s) "exception" items as listed in the equipment definition?
13. Is the equipment reflected in the correct budget category?
4. Is the equipment specifically allowed or disallowed by the TDH RFP/RFA?
5. Is the equipment appropriate to the contract attachment's scope of work?
If the equipment is of a technical nature, describe the process and the knowledgeable
resources used to determine appropriateness of equipment request.
HIV PREVENTION OBJECTIVE 1: TARGET POPULATION CHART
REGION ' -
By the end of the 12-month contract period, the City of Lubbock Health Department (title of agency) will provide 1450 (total
number of) HIV prevention contacts to the targeted subpopulations described in the appropriate Regional Action Plan, as outlined below:
Distution-and Training -
-----
�■
-�Condcm-
�Safer Sex tiating Skills
M
CoLmselinz md Testinz,
Qaa!Owus Distri* iti*t mi, "Wi die
Safer Sex Neg:)tiating -%dlls
Safer Sex tiating Sdlls
ME'
ON>,
lil-zl i
HIV PREVENTION OBJECTIVE 1: TARGET POPULATION CHART
REGION 1
By the end of the 12-month contract period, the City of Lubbock Health Departnent (title of agency) will provide 1450 (total
number of) HIV prevention contacts to the targeted subpopulations described in the appropriate Regional Action Plan, as outlined below:
----------------
TracLe Sex for Mmey
-_
•: a .- •• ._.• - .-
'ZO-MI'M MN mottAW-i 'No -M.7- t M.
Gondcm-Distributicnmd Training
�0
S
ri
H.
, I
IM
HIV PREVENTION OBJECTIVE 1: TARGET POPULATION CHART
REGION 1
By the end of the 12-month contract period, the City of Lubbock Health Department (title of agency) will provide 145o (total
number of.) HIV prevention contacts to the targeted subpopulations described in the appropriate Regional Action Plan, as outlined below:
---------------------
Mgt.)
gas
milmis
WIS
Ccndcm Distribution and Training
�,i-
-- ------------------IM--.-r
i�?
,,,.
�-M11011b
11,1
7,
-m
,
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pE=I
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----------
'110
Texas Department of Health
Bureau of HIV & STD Prevention
1 HIV Contractor Assurances
2
3 1. ADVOCATE AND PROMOTE
4 The applicant agency assures that it does not advocate or promote conduct that violates state law, in
5 compliance with the HIV Services Act, Texas Health and Safety Code, Section 85.011, as follows:
6 "Grants may not be awarded to an entity or community organization that advocates or
7 promotes conduct that violates state law. This subsection does not prohibit the award
8 of a grant to an entity or community organization that provides accurate information
9 about ways to reduce the risk of exposure to or transmission of HIV."
10 2. CONFIDENTIALITY
11 The applicant agency and its employees or subcontractors, if applicable, provide assurance to the Texas
12 Department of Health.that confidentiality of all records shall be maintained. No information obtained
13 in connection with the examination, care, or provision of programs or services to any person with HIV
14 shall be disclosed without the individual's consent, except as may be required by law, such as for the
15 reporting of communicable diseases. information may be disclosed in statistical or other summary
16 form, but only if the identity of the individuals diagnosed or provided care is riot disclosed.
17 We are aware that the Health and Safety Code, §81.103, provides for both civil and criminal penalties
18 against anyone who violates the confidentiality of persons protected under the law. Furthermore, all
19 employees and volunteers who provide direct client care services or handle direct care records wherein
20 they may be informed of a client's HIV status or any other information related to the client's care, are
21 required to sign a statement of confidentiality assuring compliance with the lave. An entity that does
22 not adopt a confidentiality policy as required by law is not eligible to receive state funds until the policy
23 is developed and implemented.
24
3. CONFLICT OF INTEREST
25 The applicant agency and its employees or subcontractors, if applicable, provide assurance to the Texas
26 Department of Health that no person who is an employee, agent, consultant, officer, board member,
27 or elected or appointed official of this agency, and, therefore, in a position to obtain a financial interest
28 or benefit from an activity, or an interest in any contract, subcontract, or agreement with respect
29 thereto, or the proceeds thereunder, either for himself or herself or for those with whom he or she has
30 family or business ties, during his or her tenure or for one year thereafter shall participate in the
HIV/STD Form No. 500.001 -1-
Contractor Assurances
1 decision making process or use inside information with regard to such activity. Furthermore, this
2 agency will adopt procedural rules which require the affected person to withdraw from his or her
3 functions and responsibilities or the decision -making process with respect to the specific assisted
4 activity from which they would derive benefit.
5 4. TUBERCULOSIS COLLABORATION
6 The applicant agency assures the TDH that it maintains collaborative efforts with local Tuberculosis
7 (TB) Control programs in order to insure that HIV and TB treatment and prevention services are
8 provided to persons at risk of HIV and TB.
9 5. DRUG -FREE WORKPLACE REQUIREMENTS
10 The undersigned (authorized official signing for the applicant organization) certifies that it will provide
11 a drug -free workplace in accordance with 45 CFR Part 76 by:
12 (a) Publishing a statement notifying employees that the unlawful manufacture, distribution,
13 dispensing, possession or use of a controlled substance is prohibited in the grantee's
14 workplace and specifying the actions that will be taken against employees for violation of such
15 prohibition;
16 (b) Establishing a drug -free awareness program to inform employees about-
17 (1) The dangers of drug abuse in the workplace;
18 (2) The grantee's policy of maintaining a drug -free workplace;
19 (3) Any available drug counseling, rehabilitation, and employee assistance
20 programs; and
21 (4) The penalties that may be imposed upon employees for drug abuse violations
22 occurring in the workplace;
23 (c) Making it a requirement that each employee to be engaged in the performance of the grant
24 be given a copy of the statement required by paragraph (a) above;
25 (d) Notifying the employee in the statement required by paragraph (a), above, that, as a
26 condition of employment under the grant, the employee will-
27 (1) Abide by the terms of the statement; and
28 (2) Notify the employer of any criminal drug statute conviction for a violation
29 occurring in the workplace no later that five days after such conviction;
30 (e) Notifying the agency within ten days after receiving notice under subparagraph (d)(2), ft;A
31 from an employee or otherwise receiving actual notice of such conviction;
32 (f) Taking one of the following actions, within 30 days of receiving notice under
33 subparagraph (d)(2), above, with respect to any employee who is so convicted-
34 (1) Taking appropriate personnel aciion against such an employee, up to and including
35 termination; or
36 (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or
37 rehabilitation program approved for such purposes by a Federal, State, or local
38 health, law enforcement, or other appropriate agency;
HIV/STD Form No. 500.001 -2-
Contractor Assurances
1 (g) Making a good faith effort to continue to maintain a drug free workplace through
2 implementation of paragraphs (a), (b), (c), (d), (e), and (f), above.
3 6. POLICIES OF THE BUREAU OF HIV & STD PREVENTION
4 The applicant agency assures the TDH that it will abide by all policies of the Bureau of HIV and STD
S Prevention which apply to the programs being provided. A list of policies applicable to 1H HIV and
6 STD contractors is provided on the attached page..Please review the list and designate which ones you
7 do not have. Return this sheet with your application. Copies will be forwarded to you with this
8 request.
9
10
11
v •A 7 . APPROVED AS TO CCNTEIVT:
yt Il
City tart' Direc f Health and Comrnmity Svc.
APPROVED AS M FORM:
Williern de Haas
Knicipal Contracts Attorney
HIV/STD Form No. 500.001 -3-
Texas Department of Health
Bureau of HIV & STD Prevention
I. ASSURANCE OF COMPLIANCE WITH REQUIREMENTS FOR CONTENTS OF
2 AIDS -RELATED WRITTEN MATERIALS, PICTORIALS, AUDIOVISUALS,
3 QUESTIONNAIRES, SURVEY INSTRUMENTS, AND
a EDUCATIONAL SESSIONS, AND ITS PREFACE
S The applicant agency certifies that its Project Director and Authorized Business Official:
6 have received a copy of the Requirements for Contents of AIDS -Related Written Materials, Pictorials,
7 Audiovisuals, Questionnaires, Survey Instruments, and Educational Sessions in Centers for Disease
s Control Assistance Programs, dated June, 1992, and its Preface;
9 have read them;
10 accept them;
11 agree to comply with all particulars and specifications set forth; and
12 agree that all specified materials shall be submitted to the local program materials review panel and
13 subject to the CDC Basic Principles set forth.
14 Following are the names, occupations, affiliations and addresses of the proposed panel members: (use
15 attachment page if needed.) One member must be an employee of the local health department.
16
17
19
19
Name Occupation Affiliation and Address
Kelly Northcott Health Educator City of Lubbock Health Dept.
Corey Turner Prevention Educator SPARC
Shirley Johnson Outreach Worker Inside Out
Jim Bell Prcgrm ManaMr Managed Care
Sylvia Perez Case Manager SPARC
,City of Lubbock
Applicant Ag c3
Signature of A,
rri
oslze1gb
Date
APPROVED AS TO FUN:
w 1 u..r finl D� th}fl�
mu�fl4Age. Co��4�7s �77ai9iUEi
Applicant Name:
NOT APPLICABLE Application/RFP Deadline:
TDH RFP Name:
TEXAS DEPARTMENT OF HEALTH
TDHHuB GOOD FAITH EFFORT PROGRAM(GFEP)/CLIENT SERVICES FORM
7EW DEPARDaM OF HEAUN
In accordance with Texas Government Code Title 10, Subtitle D, Chapter 2161 and Title 1 Texas Administrative Code (TAC) § 111.11 through § 111.24,
state agencies are required to make a good faith effort to assist historically underutilized businesses (HUBs) in receiving contract awards issued by the
state. The goal of this program is to promote full and equal business opportunities for all businesses in contracting with the state. See back of form for
HUB definition.
The Texas Department of Health (TDH) is very committed to the HUB program and shall make a good faith effort to utilize HUBS in contracts for
commodities and service purchases. TDH will achieve annual program goals by contracting directly with HUBS or indirectly through subcontracting
opportunities. A subcontractor is an entity that enters into a contract with a contractor (vendor) to provide the goods or services for which the contractor
is responsible under the terms of its contract with TDH.
It is the intent of TDH that all TDH contractors make a good faith effort to subcontract with HUBS during the performance of their contract; however,
any business that enters into a Client Services contract with TDH for 5100,000 or more shall be required to make a good faith effort to award
subcontracts to HUBS to meet the goal of 18.10%. Any combination of the following subcontracting areas may be used to satisfy this goal:
• Commodity purchases (e.g. medical supplies, office supplies, laboratory supplies)
• Professional Services (e.g. physicians, nursing, laboratory services, pharmacy)
• Other Services (e.g. legal services, consulting, maintenance/repair services, computer services)
This Good Faith Effort Program goal does not prevent any business group from participating in contracting opportunities with the State
of Texas. Further assistance and/or copies of the applicable sections of 1 TAC can be obtained by contacting the TDH HUB Program at
(512) 458-7111, extension 3760 or 1-800-243-7487.
INSTRUCTIONS:
Applications for contract funds totaling less than $100,000 - Applicants are encouraged to voluntarily comply with the HUB Good
Faith Effort Program, complete and return this HUB Good Faith Effort Program/Client Services Form with the application, and if a
contract is awarded, to submit Quarterly Reports regarding HUB subcontracting activity. However, for applications less than S 100,000,
completion of this form and Quarterly Reports are not mandatory.
Applications for contract funds totaling 5100.000 or more - Applicants are required to: comply with the HUB Good Faith Effort
requirements, complete and return this HUB Good Faith Effort Program/Client Services form along with a supplemental letter as explained
below (0) with the application or no later than 7 working days following the submission of the original application, and if a contract is
awarded, to submit appropriate Quarterly Reports regarding HUB subcontracting activity. For applications totaling $100,000 or more,
compliance with these requirements is a condition of awarding a contract.
Are you certified as a Texas Historically Underutilized Business (HUB)? Yes No
If "Yes" -What percentage of the contract work will be completed by your employees?
If an award is issued, do you plan to utilize a HUB Subcontractor or Supplier for all or any portion of the contract?
Yes No If "Yes" -What percentage of the total dollar amount of the award will be or is estimated to be
subcontracted?
3. Attach supplemental documentation based on your answer to question N2 as follows: If "Yes"- List specific subcontracting or
supply areas that compose the percentage amount listed; if "No"- Provide written explanation.
Quarterly Reports (Due December, March, June and September): If TDH determines you have complied with the good faith effort
requirements and awards you a contract, you will be required to submit one of the following quarterly reports if you provide any HUB
subcontracting opportunities:
► Non -HUB Vendors: Progress Assessment Report by Non -Historically Underutilized Businesses of Work Sub -Contracted (NON -HUB -PAR).
► HUB Vendors: Progress Assessment Report by Historically Underutilized Business of Work Sub -Contracted (HUB -PAR -A).
Applicant Representative Signature:
NOTE: A list of all General Service Commission certified HUBS may be electronically accessed through the Internet. Using a Web
Browser (like Netscape, Mosaic, etc.), connect to http://www.gsc.state.tx.us (this is the GSC home page).
A HUB is defined in the Texas Government Code §2161.001(2), VTCA, as:
A. a corporation formed for the purpose of making a profit in which 51 percent or more of all classes of the
shares of stock or other equitable securities are owned by one or more socially disadvantaged persons who
have a proportionate interest and actively participate in the corporation's control, operation, and
management;
B. a sole proprietorship created for the purpose of making a profit that is completely owned, operated, and
controlled by a socially disadvantaged person;
C. a partnership formed for the purpose of making a profit in which 51 percent or more of the assets and interest
in the partnership are owned by one or more socially disadvantaged persons who have a proportionate
interest and actively participate in the partnership's control, operation, and management;
D. a joint venture in which each entity in the venture is a historically underutilized business; or
E. a supplier contract between a historically underutilized business and a prime contractor under which the
historically underutilized business is directly involved in the manufacture or distribution of the goods or
otherwise warehouses and ships the goods.
"Socially disadvantaged person" is defined in Texas Government Code §2161.001(3) as "... a person who is socially
disadvantaged because of the person's identification as a member of a certain group, including Black Americans,
Hispanic Americans, women, Asian Pacific Americans and Native Americans, and who has suffered the effects of
discriminatory practices or other similar insidious circumstances over which the person has no control."
A HUB is defined in the General Appropriations Act, 75th Legislature, Regular Session, ARTICLE M General
Provisions, Section 124, Contracting with Historically Underutilized Businesses, Subsection 3, in the same manner
except that "socially disadvantaged person" is replaced with the tern "economically disadvantaged person." The
term "economically disadvantaged person" is defined in the General Appropriations Act as " ... a person who is
economically disadvantaged because of the person's identification as a member of certain groups, including Black
Americans, Hispanic Americans, women, Asian Americans and Native Americans, and who has suffered the effects
of discriminatory practices or other similar insidious circumstances over which the person has no control"
NC1T APPLICABLE
K*2 Contractor:
TDH Grant/Contract Name:
TDHPROGRESS ASSESSMENT REPORT BY
TEYAS=AATACM 0F HEALTH
NON -HISTORICALLY UNDERUTILIZED BUSINESS
OF WORK SUB -CONTRACTED (NON -HUB -PAR)
Contractor Name:
Vendor Identification Number(VID#):
Mailing Address:
Total Contract Amount: S
Total Amount Paid to HUB Subcontractor(s): S
To be reported quarterly by the following dates:
�Qutlr€er
Mgl�tbs 11ocluded
A a.d
First
Sept, Oct., Nov.
December 5th
Second
Dec., Jan., Feb.
March 5th
Third
March, April, May
June 5th
Fourth
June, July, Aug.
September 5th
Signature
Title
Date
Telephone #
Return to:
Texas Department of Health
Attn: TDH HUB Coordinator
Bureau of Support Services
1100 West 49th Street, G-103
Austin, TX 78756
Attach a narrative report describing your good faith efforts during the reporting period.
_ Contractor:
NOT APPLICABLE TDH Grant/Contract Name:
TDHI
PROGRESS ASSESSMENT REPORT By
HISTORICALLY UNDERUTILIZED BUSINESS
,1®ces��r�uwr� OF WORK SUB -CONTRACTED (HUB -PAR)
Contractor Name:
Vendor Identification Number(VID#):
Mailing Address:
Total Contract Amount: S Total Amount Paid to HUB Subcontractor(s): S
% of Contract performed by Contractor's employees for reporting period:
.
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ED
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To be reported quarterly by the following dates:
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First
Sept., Oct., Nov.
December 5th
Second
Dec., Jan., Feb.
March 5th
Third
March, April, May
June 5th
Fourth
June, July, Aug.
September 5th
Signature
Title
Date
Telephone 4
Return to:
Texas Department of Health
Attn: TDH HUB Coordinator
Bureau of Support Services
1100 West 49th Street, G-103
Austin, TX 78756
Attach a narrative report describing your good faith efforts during the reporting period.
TEXAS DEPARTMENT OF HEALTH
ASSURANCES
Note: Some of these assurances may not be applicable to your project. If you have questions, contact
the awarding program within TDH. Further, the applicant may need to certify to additional
assurances pursuant to specific state/federal awarding agencies' regulations. If such is the
case, you will be notified or an appendix will be added to this package or included in the
resulting contract.
As the duly authorized representative of the applicant. I certify that the applicant:
1. Has the legal authority to apply for state/federal assistance, and the institutional, managerial and
financial capability (including funds sufficient to pay the non-state/federal share of project costs) to
ensure proper planning, management and completion of the project described in this application;
2. Has a financial system that demonstrates accounting, budgetary and internal controls; cash
management; reporting capability; cost allowability determination; and source documentation;
3. And parent, affiliate, or subsidiary organization, if such a relationship exists, will give TDH, the
Comptroller General of the United States, and if appropriate, the federal government, through any
authorized representative, access to and the right to examine all records, books, papers, or documents
related to the award; and will establish a proper accounting system in accordance with generally
accepted accounting standards or agency directives;
4. Will establish safeguards to prohibit employees from using their positions for a purpose that
constitutes or presents the appearance of personal or organizational conflict of interest, or personal
gam;
5. Will honor for 90 days after the application due date the technical and business terms contained in
the application;
6. Will initiate the work after receipt of a fully executed contract and will complete it within the
contract period;
7. Will comply with the requirements of the Immigration Reform and Control Act of 1986, 8 USC
§ § 1324a, et seq., as amended, regarding employment verification and retention of verification forms
for any individual(s) hired on or after November 6, 1986, who will perform any labor or services
proposed in this application;
8. Agrees to comply with the following to the extent such provisions are applicable:
A. Title VI of the Civil Rights Act of 1964,42 USC §§2000d, et seq.;
B. Section 504 of the Rehabilitation Act of 1973, 29 USC §794(a);
C. The Americans with Disabilities Act of 1990, 42 USC §§12101, et seq.; and
D. All amendments to each and all requirements imposed by the regulations issued pursuant to
these acts, especially 45 CFR Part 80 (relating to race, color and national origin), 45 CFR Part
84 (relating to handicap), 45 CFR Part 86 (relating to sex), and 45 CFR Part 91(relating to age).
9. Will comply with the Uniform Grant and Contract Management Act (UGCMA), Texas Government
Code, Chapter 783, VTCA, and the Uniform Grant and Contract Management Standards (UGCMS),
as amended by revised federal circulars and incorporated in UGCMS by the Governor's Budget and
Planning Office, which apply as terms and conditions of any resulting contract. If a conflict arises
between the provisions of a resulting contract, and the provisions of UGCMA and UGCMS, the
provisions of UGCMA and UGCMS will prevail unless expressly stated otherwise. A copy of the
UGCMS manual and its references are available upon request;
10. Will remain current in its payment of franchise tax or is exempt from payment of franchise taxes,
if applicable;
11. Will comply with the non-discriminatory requirements of Texas Labor Code, Chapter 21, VTCA
which requires that certain employers not discriminate on the basis of race, color, disability, religion,
sex, national origin, or age;
12. Will comply with environmental standards which may be prescribed pursuant to the following:
A. Institution of environmental quality control measures under the National.Environmental Policy
Act of 1969, 42 USC Chapter 783, 4321-4332 and Executive Order.(EO) 11514 "Protection
and Enhancement of Environmental Quality;"
B. Notification of violating facilities pursuant to EO 11738 "Providing for Administration of the
Clean Air Act and the Federal Water Pollution Contract Act with Respect to Federal Contracts,
Grants or Loans;"
C. Conformity of federal actions to state clean air implementation plans under the Clean Air Act
of 1955, as amended, 42 USC §§7401- 7642;
D. Protection of underground sources of drinking water under the Safe Drinking Water Act of
1974, as amended, 21 USC §349, 42 USC §§300f-300j;
13. Will comply with the Pro -Children Act of 1994, 20 USC §§6081-6084, regarding the provision of
a smoke -free workplace and promoting the non-use of all tobacco products;
14. Will comply, if applicable, with National Research Service Award Act of 1971, 42 USC §289L-1
and 20 USC §§2080-6081, regarding the protection of human subjects involved in research,
development, and related activities supported by this award of assistance;
15. Will comply, if applicable, with the Clinical Laboratory Improvement Amendments of 1988 (CLIA),
42 USC §263 a, which establish federal requirements for the regulation and certification of clinical
laboratories;
16. Will comply, if applicable, with the Occupational Safety and Health Administration Regulations on
Bloodborne Pathogens, 56 Fed. Reg. 64175 (1991), 29 CFR §1919.030, which set safety standards
for those workers and facilities who may handle bloodborne pathogens;
17. Will bear, if a private nonprofit organization or a for profit organization, along with its governing
board, full responsibility for the integrity of the fiscal and programmatic management of the
organization which includes accountability for all funds and materials received, compliance with
applicable fedeml/state rules, policies, procedures, laws and regulation.,, and correction of fiscal and
program deficiencies identified through self -evaluation or future statelfederal monitoring processes.
Ignorance of requirements contained or referenced herein or in the resultant contract shall not
constitute a defense or basis for waiving or appealing such provisions or requirements. Further, the
governing board shall ensure separation of powers, duties, and functions of board members and
organization staff;
18. Will cause to be performed the required financial and compliance audits in accordance with the
Single Audit Act of 1984, 31 USC §§7501-7507, and any revisions thereto;
19. Will supplement the project/activity with funds made available through a contract award as a result
of this RFP and will not supplant funds; .
20. Affirms that it has not given, nor intends to give, at any time hereafter any economic opportunity,
future employment, gift, loan, gratuity, special discount, trip, favor, or service to a public servant
or any employee or representative of same, in connection with this procurement;
21. Will not, if a for profit organization, charge a fee for profit. A profit or fee is considered to be an
amount in excess of actual allowable, allocable, and reasonable direct and indirect costs which are
incurred in conducting an assistance project;
22. Will comply with all applicable requirements of all other statelfederal laws, executive orders,
regulations, and policies governing this program;
The above certifications and assurances are made as a required element of the proposal to which they
are attached, understanding that the truthfulness of the facts affirmed here and the continuing
compliance with these requirements are conditions precedent to the award or continuation of the
related contract(s):
Signature of Authorized Certifying Official
Legal Name of Applicant
Ci ty of
ATTEST:
VY
`Kaythie Darnel
` ,City Secretary
I; 1
Title
Date
OS 17.
Health and C==ity Svcs.
APPROVED AS TO FUN:
h4�" //"
illiam de Haas
M,micipal Contracts Attorney
TEXAS DEPARTMENT OF HEALTH
CERTIFICATIONS
1. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION
The undersigned (authorized official signing for the applicant organization) certifies to the best of his or her
knowledge and belief, that the applicant, defined as the primary participant in accordance with 45 CFR Part
76, and his/her principals:
(a) are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily
excluded from covered transactions by any federal department or agency;
(b) have not within a 3-year period preceding this proposal been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a
public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen
property;
(c) are not presently indicted or otherwise criminally or civilly charged by a governmental entity (federal,
state, or local) with commission of any of the offenses enumerated in paragraph (b) of this
certification; and
(d) have not within a 3-year period preceding this application/proposal had one or more public
transactions (federal, state, or local) terminated for cause or default.
Should the applicant not be able to provide this certification, an explanation should be placed after this form
in the application response.
The applicant agrees by submitting this proposal that he/she will include, without modification, the clause
titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion -Lower Tier
Covered Transaction' (Appendix B to 45 CFR Part 76) in all lower tier covered transactions (i.e.,
transactions with subgrantees and/or contractors) and in all solicitations for lower tier covered transactions.
2. CERTIFICATION REGARDING LOBBYING
Title 31, USC §1352, entitled "Limitation on use of appropriated funds to influence certain federal
contracting and financial transactions," generally prohibits recipients of federal grants and cooperative
agreements from using federal (appropriated) funds for lobbying the executive or legislative branches of the
federal government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also
requires that each person who requests or receives a federal grant or cooperative agreement must disclose
lobbying undertaken with non-federal (non -appropriated) funds. These requirements apply to grants and
cooperative agreements EXCEEDING $100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the applicant organization) certifies, to the best of his or her
knowledge and belief, that:
(a) No federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to
any person for influencing or attempting to influence an officer or employee of any agency, a member
of Congress, an officer or employee of Congress, or an employee of a Member of Congress in
connection with the awarding of any federal contract, the making of any federal grant, the making of
any federal loan, the entering into of any cooperative agreement, and the extension, continuation,
renewal, amendment, or modification of any federal contract, grant, loan, or cooperative agreement.
(b) If any funds other than federally -appropriated funds have been paid or will be paid to any person for
influencing or attempting to influence an officer or employee of any agent, a member of Congress, an
officer or employee of Congress, or an employee of a member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit
Standard Form-LLL, "Disclosure of Lobbying Activities," (SF-LLL) in accordance with its
instructions. SF-LLL and continuation sheet are included at the end of this application form.
(c) The undersigned shall require that the language of this certification be included in the award
documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants,
loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made
or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed
by USC § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less
than $10,000 and not more than $100,000 for each such failure."
3. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA)
The undersigned (authorized official signing for the applicant organization) certifies, to the best of his or her
knowledge and belief, that the statements herein are true, accurate, and complete, and agrees to comply with
the TDH terms and conditions if an award is issued as a result of this application. Willful provision of false
information is a criminal offense (Title 18, USC §1001). Any person making any false, fictitious, or
fraudulent statement may, in addition to other remedies available to the Government, be subject to civil
penalties under the Program Fraud Civil Remedies Act of 1986 (45 CFR Part 79).
q:.-.• ar Or s
ME
APPR(NID AS TO FORM:
'ie!�, //,,
M i am de Haas
M-inic;ipal Contracts Attorney
Signature of Au orize erti ng fficial
Title
Mayor
Applicant Organtion
Date
City of Lubbock Health Department
OSIZB `q 8
NOT APPLICABLE
DISCLOSURE OF LOBBYING ACTIVITIES .
Complete this form to disclose lobbying activities pursuant to 31 USC 1352
(See reverse for public burden disclosure.) Approved by OMB
0348-0046
1. Type of Federal Action:
2. Status of Federal Action
3. Report Type:
o a. contract
o a. bid/offer/application
o a. initial filing
b. grant
b. initial award
b. material change
c. cooperative agreement
c. post -award
d. loan
For Material Change Only:
e. loan guarantee
Year Quarter
f. loan insurance
Date of last report
4.Name and Address of Reporting Entity:
5. If Reporting Entity in No. 4 is Subawardee, Enter Name and
o Prime o Subawardee
Address of Prime:
Tier , if known:
Congressional District, if known:
Congressional District, if known:
6. Federal Department/Agency:
7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
4. Award Amount, if known:
10. a. Name and Address of Lobbying Entity
b. Individuals Performing Services (including address if different
(If individual, last name, first name, W:
from No. 10a) (last name, first name, MI):
(Attach Continuation
Sheets(s) SF-LLL-A, if necessary)
11. Amount of Payment (cheek all that apply):
13. Type of Payment (check all that apply):
$ o actual o planned
o a. retainer
a b. one-time fee
t] c. commission
12. Form of Payment (Check all that apply):
o d. contingent fee
o a. cash
o e. deferred
a b. in -kind; specify: nature
o f. other, specify:
value
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or
Member(s) contacted, for Payment indicated in item 11.
(Attach Continuation Sheets(s) SF-LLL-A, if necessary)
15. Continuation Sheet(s) SF-LLL-A attached: o Yes t3 No
16. Information requested through this form is authorized by
Title 31 USC Section 1352. This disclosure of lobbying
Signature
activities is a material representation of fact upon which
reliance was placed by the tier above when this transaction was
Print Name:
made or entered into. This disclosure is required pursuant to
31 USC 1352. This information will be reported to the
Title:
Congress semi-annually and will be available for public
inspection. Any person who fails to file the required disclosure
Legal Name of Applicant:
shall be subject to a civil penalty of not less than $10,000 and
not more than $100,000 for each such failure.
Telephone No: Date:
Federal Use Only:
Authorized for Local Reproduction
Standard Form - LLL
NOT APPLICABLE
NONPROFIT BOARD MEMBERS AND EXECUTIVE OFFICERS
ASSURANCES FORM
(Name & Address O, rOrganization)
The persons signing on behalf of the above -named organization certify that they are duly authorized to sign this Assurances Form
on behalf of the organization.
1) The undersigned acknowledge that an annual budget has been approved for each contract with TDH.
2) The Board of Directors convenes on a regularly -scheduled basis (no less than quarterly) to discuss the operations of the
organization.
3) Actual income and expenses are being compared with the approved budget, variances are noted, and corrective action taken
as needed (with board approval).
4) Timely and accurate financial statements are presented by the designated financial officer on a regular basis to the board.
5) Any required financial reports and forms, whether federal or state, are being filed on a current and timely basis.
6) Adequate internal controls are in place to ensure fiscal integrity and accountability and to safeguard assets.
7) The Treasurer of the Board has been fully informed of his or her responsibilities as Treasurer.
8) The Board has Audit and/or Finance Committees that convene regularly and communicate effectively with the Board
Treasurer and other board members in understanding and responding to financial developments.
9) The organization observes generally accepted accounting principles when preparing financial statements, and fund
accounting practices are observed to ensure integrity among specific contracts or grants.
10) This form will be discussed in detail at the next official board meeting and that discussion and
a copy of this form will be included in the minutes of the meeting. A copy of the minutes will be forwarded to the Texas
Department of Health's Grants Management Division no later than 45 days after the meeting in which the form was
discussed.
Chairman of the Board Signature Date
President/Executive Director Signature Date
Certificate Regarding License, Certificate, or Permit
Article IX, Section 163 of the General Appropriations Act, 75th Legislature prohibits an agency which receives an appropriation
under either Article II or V of the General Appropriations Act from awarding a contract with the owner, operator, or administrator
of a facility which has had a license, certificate, or permit revoked by another Article II or V agency.
For purpose of this requirement, Article II agencies are:
• Texas Department of Aging
• Texas Commission on Alcohol and Drug Abuse
• Texas Commission for the Blind
• Texas Cancer Council
• Children's Trust Fund of Texas Council
• Texas Commission for the Deaf and Hard of
Hearing
• Interagency Council on Early Childhood
Intervention
For the purpose of this requirement, Article V agencies are:
• Adjutant General's Office
• Texas Alcoholic Beverage Commission
• Texas National Guard Armory Board
• Texas Department of Criminal Justice
• Texas Criminal Justice Policy Council
• Texas Commission on Fire Protection
• Texas Commission on Jail Standards
• Texas Juvenile Probation Commission
• Texas Health & Human Services Commission
• Texas Department of Human Services
• Texas Department of Mental Health & Mental
Retardation
• Texas Department of Protective and
Regulatory Services
• Texas Rehabilitation Commission
• Texas Department of Health
• Texas Commission on Law Enforcement
Officers Standards & Education
• Texas Polygraph Examiners Board
• Board of Private Investigators and Private
Security Agencies
• Texas Department of Public Safety
• Texas Council on Sex Offender Treatment
• Texas Youth Commission
Certification
In accordance with Section 163 of Article IX of the General Appropriations Act, 75th Legislature the undersigned
certifies that no owner, operator, or administrator of the facility or entity applying for this contract has had a license,
certi te, or permit rev ed by any of the Texas state agencies listed above.
osjz8 j9S
Signature Date
Doug Goodman Dir. of Health & Carm. Svcs.
Printed Name Title or Position with Contactor
Legal Name of Applicant: Cit, of Lubbock Health Dtpartment
City of Lubbock Health Department
Mary Strange
Public Health Manager
Judy Henderson
Grants Manager (State Paid)
Surveillance (8)
Tigi Ward, Supervising Health Nurse
Judy Bolin, Public Health Nurse
Pat MacLeod, Public Health Nurse
Cynthia Howle, Public Health Nurse
Eric Benson, Disease Intervention Spec.
Manuel G. Cruz, AIDS/HIV Surv. Spec.
Estela Salazar, Data Entry Operator
Danielle Palmer, Int. Clerk Typist
Revised V7/99
Education (6)
Vacant, Health Ed. Coordinator
Kelly Chase, Health Educator
Kelly Northcott. Health Educator
Mary Croyle, Health Educator
Carol Cozby, LVN
Rhetta Bennett, Int. Clerk Typist
Laboratory (7)
Tommy Camden, Lab Svcs. Coor.
Kevin McClaran, Public Hlth. Microbiologist II
Lydia Palmer, Public Hlth. Microbiologist I
David Pauik, Public Hlth. Microbiologist I
Vilke Scott, Public Hlth. Microbiologist I
Kim Swacina, Medical Technologist I
Priscilla Renteria, Secretary
Prevention (10)
Beckie Brawley, Supervising Health Nurse
Ruth Ramirez, Public Health Nurse
Ronda Cartwright, Public Health Nurse
Jessie Abeila, Public Health Nurse
Diane Foard, LVN
Leveme Taylor, LVN (State Paid)
Tammy Foskey, HIV Counselor
Vacant, Secretary
Isabell Chavez, Sr. Clerk Typist
Priscilla Ortiz, Health Aide III
Dept. Support (6)
Eva Smith, Sr. Bookkeeper
Isabel Olivarez, Sr. Cashier
Brenda Martinez, Sr. Deputy Registrar
Tracie Luera, int. Clerk Typist
Vacant, Clerk Typist
Cynthia Ramos, Cashier
Organization Chart
City of Lubbock
MUNICIPAL COUR
JAN MATTHEWS
2462
SERVICES
ANNA MOSW
2002
BUDGETS
RESEARCH
LESLIE COX 29M
FLEET SERVICES
WOODY WIWON
2ti5
FINANCE
SETSYBUCY 21e1
ACCOUNTING
JIMMY ROORNKW-Z
2190
IMATERIALS MGT
VICTOR KILMAN
21e5
1 Revhed 3/20RB
COURT AD".
TOM TROMBIEY
2480
i
CITY ATTORNEY
ANMA BUROVS3
2211
1ST. ASST. ATTY.
DON VANDIVER
2212
CITIZENS
MAYOR: WINDY SITTON 2009
DISTRICT 1: VICTOR HERNANDEZ 2027
DISTRICT 2: T.J. PATTERSON 2007
DISTRICT 3: DAVID NELSON 2011
CITIZEN
CRY
DISTRICT I: MAX INCE 2005
BOARDS 8
AIL
DISTRICT 5 RANDY NEUGE13AUER 2023
COMMISSIONS
DISTRICT 6: TY COOKE 2031
CRY MANAGER
AUINT
CRY ARY
ASSISTANT TO CITY MANAGER
BOB CASS
MENDELL SCHELIN 2230
KAYTHRIE DARAR NELL
RON LEYMS 3373
2001
2025
L EGISLATWE
MTERNS
ASST. CRY MGRS.
DEBRA B. FORTS (1ST)
AVIATION
MARK EARLE 3126
2015
LMICROFILM.
CORPORATE COMMUNICATIONS ICATgNS
RICHARD BURDWE
2014 BUSINESS LIAISON
TONY PRRN'ETT 2280
KEVIN WALKER 2M
�COUNCIL AOMIN.
CONTRACT ADMINISTRATION
PUSUC TION
YMLLIAM &HAAS 3219
INFORMATION TECHNOLOGY
BHARLETICHOWN " 23"
ENVIRONMENTAL COMPLIANCE
tRADIO SHOP
DAN DENNISON 2960
TEIPCOMIMU"ICATIO"
HEALTH & COMM.
STRATEGIC
CIVIC SERVICES
POLICE
FIRE
TRANSPORTATION
ELECTRIC UTIL-
SERVICES
PLANNING NG
SERVICES
DOUG GOODMAN
JIM BERTRAM
TOMMY GONZA
KEN WALKER
STEW HAILEY
MLDRED COX
PALL THOMPSON
2900 ,
2013
2015
2750
2630
2330
2500
HEALTWLAR
COMPREHENSIVE
CIVIC CENTERS
STREETS
ADK40MLES
SERVICES
PLANNING
VICIO KEY 2275
DON JENNNGS
DERRELL OLNER
MARY STRANGE 20"
RANOYHEIISON 2f93
2000
2502
LIBRARIES
CLAUDIA
FOX 2"1
ANIMAL SERVICES
EMERGENCY
JETF RPtEL 2M
STREET DRAINAGE
PROOMTION
NANCYHICKMAN
MANAGEMENT
ADMINISTRATION
SUPPORT SERVICES
LARRY HERTEL
JAYTVADSWORTH
2055
KEN OLSON 3032
PARKS!
DALE 110LTON 7751
TWA DUNCAN 2E31
2329
3535
RECREATION
E/MRONMENTAL
NEIGHBORHOOD
RUSTY BLACK
PATROL
OPERATIONS
TRAFFIC
P4104GOCOLLECTION
INSPECTION
SERVICES
2071
GEORGE EWNO
RHEA COOPER
JERE HART 2130
RICK SMITH 767-2503
ROB ALLMON 2110
CLOETTA SHOTTS
27"
2933
3092
CULTURAL ARTS
TRANSIT
DISTRIBUTION
SLOG. INSPECTION
SERVICES
INVESTIGATIONS
PREVENTION
-JOIN NILSON 797-
WAYNE WKS 2552
MAX GARZA 2050
FACILITIES
COOK Omems
CLALRIE JOKES 2749
MILE KEW 26"
23@0
MANAGEMENT
767.3115
COMMUNITY OEV.
GARY SMITH 3075
EOUIPMENT
SOLO WASTE
AND HOUSING
MAINTENANCE
24"
NANCY HANEY 2300
MIKE HENRICKS
2537
TRAINING
LF MS TREADWELL
20"
INTERIM
+CONTRACT
RESOURCES
TERRY
MARY ANDREWS
ELLERBROOK
I
2315
2585
ASST DIRECTOR
ENGINEERING
SCOTT SNIDER
2*12
2312
TREATMENT
RISK MGT I SAFETY
SR110E RLALACK 26t3
LEMA HUTCHESON
2777
RECLAMATION
SCOTT CONNERY 3227
RECRUMNG
ANTHONY JOKES
LAND APPLICATION
ml
JOHN 111NDMAN 7e1-3157
BENEFITS
WWATER COLLECT I
LOU MOORE 2317
CUSTOMER SERVICE
ROOM ROBINSON
ORO OFVELOPMENT
2004
SANDY
FORTENBeRRY
PIPELINE MANTEN
2315
RUDY AO ILAR 25"
COMPENSATION
LAKE ALAN HENRY
STEW SYNCK 2313
BANE LOCKNANE 2602
ENNRON PROGRAMS
SWRRY STEPHENS
29e9
I..
r
GRANT PROPOSAL EVALUATION FORM
Page 1
1. Is this grant: New Continuing XX
Number of
Years 10
2. Is a match required? Yes No XX
If yes: Percentage Amount
Is it: In -kind OR Cash
Source
3. Are there any indirect costs, i.e. building use, computer time, administrative _
supervision, associated with the grant? Yes XX No
If yes, please list the estimated
costs. Building Use, Computer Time,
Administrative Time = $3200
4. If there are indirect costs, are they reimbursed by the grant?
Yes XX No
Percentage_10%
5. Are audit costs reimbursed? Yes No XX
Percentage
6. What are the audit requirements for this grant? Texas Department of Health's Grants Management
Division performs on -site reviews of grantees and provides technical assistance on fiscal matters. The on -
site review consists of a review of internal controls, verification that reported expenses are properly
supported, and evaluation of compliance with contract terms and government regulations.
7. Can this grant be renewed?
If yes, how many times?
What are the terms of renewal?
Yes XX No
As long as funds are made available from
the State and the Federal Government.
See Above
8. Does the grant require the City to gradually assume the cost of the program?
Yes
If yes, what is the timetable?
No XX
40
GRANT PROPOSAL EVALUATION FORM
Page 2
9. Please address whether other agencies are currently administering similar programs and whether any
other agencies are available to administer this program. SPARC receives this grant to provide testing
and counseling to at -risk populations outside of Lubbock County. This program is offered by other
agencies: however, there are limited agencies which provide education, testing, prevention counseling
and risk reduction at an affordable rate to the citizens of Lubbock. The City of Lubbock Health
Department not only focuses on homosexuals but also heterosexuals, teens, college students, incarcerated
persons (teens and adults), gangs and high -risk females through outreach activities.
10. For the "Current Year". Please identify how expenditures are to be made in the following categories and
how the program will be funded. If the grant is for an on -going program, pleases project revenue and
expenditures for future years. If the grant is for one year, show any on -going costs to the City, such as
the cost of maintenance on equipment purchased by the grant.
CURRENT FUTURE YEARS
YEAR
1999 19 19 19 19
EXPENDITURES
Personnel
$43,662
Full Time Salary
$32,339
TMRS
$ 4,514
Social Security
$ 2,473
Health
$ 3,456
Life
$ 32.50
Dental
$ 276
Long -Term Disability
$ 122
Stability
$ 450
Supplies
$ 721.24
Maintenance
$ 0
Other(travel, educ. supplies
and indirect costs)
$ 3,950
Indirect Costs
$ 3,200
Capital
TOTAL EXPENDITURES
$49,663.74
Federal Grant 0
State Grant $49,663.74
Local Match 0
Other 0
TOTAL REVENUE $49,663.74
11. Pleases list the number and title (s) of personnel funded by this grant: 1 HIV Counselor
12. Please list any new positions to be added:
None
41
GRANT PROPOSAL EVALUATION FORM
Page 3
13. Please list any capital items to be purchased: None
14. Please discuss how this program will impact current employee allocation and utilization and whether it
will have a long-term financial or manpower impact. Attach additional pages if needed.
As this program has been in existence for 10 years, the impact will come if it is not funded. If that is the
case, one staff person will lose her job and 4 others will have to add HIV testing and counseling to their
other responsibilities in the STD Clinic. Due to the down -sizing of the Health Department persons at risk
for HIV would not be given adequate risk reduction and prevention counseling to encourage behavior
change to reduce or eliminate their risk. HIV infection rates would continue to climb and tax dollars
would increase due to the cost to treat HIV- infected individuals. Prevention of HIV infection is the goal
of the Health Department and the money received from the Texas Department of Health will serve to
increase awareness of HIV and protection from HIV for persons at risk.
15. In narrative form, pleases provide a brief description of the program, including the need which will be
addressed, the goals and objectives of the program, the target population to be served, and any other
significant aspects of the application. Attach additional pages if needed.
This proposal to provide prevention counseling and partner elicitation will be client -centered, focused on
producing behavioral changes, prevention -oriented, and directed toward the target groups determined by
the Regional HIV Coalition including Men who have Sex with other Men (Subcategories: adolescent,
college -aged, of color, anglo, and HIV+); Intravenous Drug User's (Subcategories: homeless, sex
workers, and incarcerated) and people who have Unprotected Heterosexual Sex (Subcategories: HIV+,
migrants, gang members, and sexual partners of IDU and/or MSM). The City of Lubbock Health
Department's STD Clinic will continue to be used as an HIV testing site. Other testing sites include
Texas Tech University, Lubbock County Jail, Lubbock County Youth Center, Lubbock County
Community Correctional Facility, the gay club, and Managed Care drug treatment facilities All clients
tested will receive pre -test counseling. Post-test counseling will be provided to 75% of those tested as the
goal of the Texas Department of Health; however, the City of Lubbock HIV Counselor has been
consistent in providing post-test counseling to 85-95% of those persons who are teged. 95% of those
testing seropositive will receive post-test counseling, referrals to case management and early intervention
services, and follow-up appointments. Partner elicitation will produce at least one partner for a
minimum of 80% of those testing seropositive.
Collaboration. activities include assisting Catholic Family Services with Prevention Counseling and
Partner Elicitation (PCPE) activities as they provide education to migrants, adolescents, and female
partners of IDU's and MSM's; assisting Inside/Out with PCPE activities as they provide education to
gang members, IDU's, homeless and MSM's of color; and assisting Lubbock Mental Health/Mental
Retardation as they provide education to those in treatment for drug/alcohol abuse, sex workers, as well
as the IDU who is homeless/incarcerated and those involved with gangs. Testing referrals and/or on -site
counseling and testing following HIV education presentations will be offered to the target audiences of
these groups when requested.
Prevention of HIV infection is the main focus of all PCPE activities and testing is one realm of
prevention. Referrals for those testing seropositive will be coordinated through the South Plains AIDS
Resource Center (SPARC). Forming a support group for those who are high -risk seronegatives is a goal
for the coming year. Referrals for drug treatment will continue to be made to Lubbock MHIVIR and to the
AA/NA groups in the Lubbock and surrounding areas when applicable.
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