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HomeMy WebLinkAboutResolution - 5244 - Grant Application - TDH, HIV Division - HIV Counseling & Testing - 08/22/1996RESOLUTION N0.524, August 22, 1996 Item 415 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, attached herewith, by and between the City of Lubbock and the Texas Department of Health, HIV Division for HIV counseling and testing, and any associated documents, which Application shall be spread upon the minutes of the Council and as spread upon the minutes of this Council shall constitute and be a part of this Resolution as if fully copied herein in detail. Passed by the City Council this2.2 nd day of . August , 1996. DAVID R. LANGS-ff CV, MAYOR ATTEST: ArnWillard, Interim City Secretary APPROVED AS TO CONTENT: 1--�) �" 9'&� Doug Goo n, Director of Health and Communtffy Services APPROVED AS TO FORM: Dbilald G. Vandiver, First Ass City Attorney DGV:da/ccdocs/app-hiv.res August 12, 1996 RESOLUTION NQ 5244 August 22, 1996 APPLICATION FOR WNDING Item 415 TEXAS DEPARTMENT OF HEALTH HIV/STD HEALTH RESOURCES DIVISION DATE RECEIVED BY STATE rs..r,,¢.yy}:i •r.r r. y. ..,.;; .. ,.; .. . r ....; ,}� ;#�{..;•�tfi.},.,,.. v,}`.. ..,kg7e.�j i.. :... w [.4:4:•}.. .. .. .. k; .g.......... .�',i•'fi.�Ziiv. n . r.A:. :.•.•... r.'.... ... r...332•�5`.+• :..H.•r. .+:�.. 1�.:+.�;IPS�?:;i�..��'.!n'. N. �.���'c-..',._:?-��•�''i`'•{�e�Pc�,'...•-.•,.�::..i'. 1) LEGAL NAME: City of Lubbock Health 6) ADDRESS: (Sheet Addy ..,PA.B=Nmnbmcity,c=dy.st tk Department 1Od Zip Code) 2) PAYEE NAME: City of Lubbock 1902 Texas Avenue P.O. Box 2548 3) PROJECT DIRECTOR AND PHONE NOS: Lubbock TX 79408 Mary Strange Lubbock County a) office No: (806) 767-2939 7) PAYEE ADDRESS: (u t>. b) FAX No: (806) 762-5506 N/A 4) CONTACT PERSON* AND PHONE NO: Tammy Foskey 806 767-2953 FINANCIAL OFFICER AND PHONE NO: 8) TAX I.D. NUMBER: Debra Forte' 1 7 5 6 0 0 0 5 9 0 6 806 767-2015 9) TYPE OF APPLICANT: (enter appropriate letter:) A a) City Health Depar nerd t) Private Non -Profit Organization b) County Health Department g) Higher Education c) District Health Department h) Indian Tribe d) Community -Based Organization i) Minority Organization . e H Other 10) TYPE OF APPLICATION ❑ NEW ® CONTINUATION . 11) DESCRIPTIVE TITLE OF PROJECT: 12) REQUESTED FUNDING: a) Total Charges $40,333.00 HIV PREVENTION COUNSELING AND b) Indirect Cost 1600.00 PARTNER ELICITATION c) Total Funding Requested $41,933.00 13) START DATE END DATE 16) LIST ALL COUNTIES TO BE SERVED: 01/01/97 12/31/98 LUBBOCK 14) EXECUTIVE DIRECTOR OF AGENCY: Doug Goodman 15) a) NAME OF AUTHORUMD REPRESENTATIVE: David R. Langston b) TITLE: Mayor ��LEPHNO: 806 767-2900- d) sI AUTH RES EN IVE 7) DATE SIGNED: 8 22/96 Ta- v Lan ston;.Ma r A Name of Applicant: City of Lubbock Health Department Fringe Benefits $ 8,660.00 Mailing Address: 1902 Texas Avenue (P.O. Box 2548), Lubbock, Texas 79408 Equipment Contact Person: Tammy Foskey $ 50.00 Contractual Telephone Number: (806) 767-2953 FAX Number: (806) 762-5506 Public Health Region: 1 HSDA: - Lubbock State Senatorial District: 28 State Representative District: 82-83 List All Counties Served: Lubbock Congressional District: 84-83 Total Estimated Number to be Served: Total 1600 By Sex: Males 800 Females 800 By Age: Adults over 20 1000 Adolescents 13-20 600 Children under 13 By Race: White (Non -Hispanic) 400 Black (Non -Hispanic) 500 Hispanic 600 Asian/Pacific Islander 100 Unknown Project Summary: (Narrative overview afthe goal(sN objectivm and activities.) 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 MSM's (adolescent, college -aged, of color, anglo, and HIV+); IDU's (homeless, sex workers, and incarcerated) and UHS's (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, and the gay club. All clients tested will receive pre-test counseling. Post-test counseling will be provided to 75% of those tested. 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 PCPE activities as they provide education to migrants, adolescents, and female partners of IDU's and MSM's and assisting Inside/Out with PCPE activities as they provide education to gang members, IDU's, homeless and MSM's of color. 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 NIfMt and to the AA/NA groups in the Lubbock and surrounding areas when applicable. Budget Summary: Personnel $ 29,868.00 Fringe Benefits $ 8,660.00 Travel $ 1,200.00 Equipment $ 0.00 Supplies $ 50.00 Contractual $ 0.00 Other S 555.00 Total Direct Costs 40.333.00 Indirect Costs (UGCMS) $ 1,600.00 Total Requested S 41,933.00 2 PCPE APPLICATION CHECKLIST NAME OF APPLICANT: City of Lubbock Health Department Instrudions: Send all items below with the 1997 application. PREFATORY DOCUMENTS XX Application for Funding Form XX Abstract XX Application Checklist XX Table of Contents . PROJECT NARRATIVE XX Capacity of the Organization XX Collaboration with Other Agencies XX Referral Plan XX Workplan. XX Quality Assurance Plan XX Target Group Chart for Objective l XX other -Required Objectives XX Evaluation Plan BUDGET INFORMATION XX Key Personnel Form XX Multiple Funding Sources Form XX Categorical Budget ASSURANCES XX Contractor Assurances 1-10 XX Physician Supervision ADM mTRATIVE HISTORY CERTIFICATION XX Administrative History Certification Form NA Evidence of non-profit status NA Latest Financial Statement NA Balance Sheet NA Letters of Good Standing NA Other Documentation Requested OTHER REQUIRED DOCUMENTATION XX Board of Directors List NA HUB Good Faith Effort Form NA Newspaper advertisement of subcontracting opportunity APPENDICES Indirect cost rate agreement, if applicable Other documentation you deem necessary TABLE OF CONTENTS Page No. L Application for Funding Form 1 11 Abstract 2 IIL Application Checklist 3 IV. Table of Contents 4 V. Capacity of the Organization 5-7 VL Collaboration with Other Agencies 7-9 VIL Referral Plan 10-11 VIIL Workplan 11-16 IX. Quality Assurance Plan 16-17 X. Target Group Chart for Objective 1 20-21 XL Other Required Objectives 17-24 XM Evaluation Plan 17-24 XHL Key Personnel Form 25 XIV. Multiple Funding Sources Form 26 XV. Categorical Budget 27 XVL Contractor Assurances Advocate and Promote 28 Confidentiality 28 Conflict of Interest 28 Workplace Guidelines 29 Debarment and Supervision 29 Lobbying 29-30 Program Fraud Civ Remedies Act 30 Environmental Tobacco Smoke 30-31 Good Standing 31 Assurance of Compliance with Requirements 32 Physician Supervision 33 XVIL Administrative History Certification Form 34-37 XVIII. Board of Directors List 33 XIX. Appendices A. SPARC letter of collaboration 39 B. Inside/Out letter of collaboration 40 C. Catholic Family Services letter of collaboration 41 D. Lubbock MH11IR letter of collaboration 42 E. Texas Tech University letter of collaboration 43 F. Captain Hollywood letter of collaboration 44 G. Lubbock County Youth Center letter of collaboration 45 H. Lubbock County Community Correctional Facility letter of collaboration 46 L Lubbock County Jail letter of collaboration 47 J Lubbock A J newspaper article 48 K. City of Lubbock "City Profile" article 49 L. TDH newletter article 50 M. Referral form 51 N. Core Site.Review from TDH 52-66 O. Pregnancy Referral Protocol 67 P. Physician List for Pregnancy referrals 68 Q. Protocol for HIV+ Referrals 69 R. Partner Elicitation/Prenatal Referral (TDH) form 70 S. HIV Risk Assessment 71 T. SPARC letter of referral 72 U. Inside/Out letter of referral 73 V. Catholic Family Services letter of referral 74 W. Lubbock MHMR letter of referral 75 X. Collaborafive/Referral agreements from the City Health Department 76-83 4 CAPACITY OF THE ORGANIZATION The City of Lubbock has provided HIV testing and counseling to at -risk individuals for the past seven years. The HIV Counseling and Testing Program has been funded in its entirety through grants from the Texas Department of Health. The City of Lubbock Health Department also receives grant monies from the Texas Department of Health to conduct HIV surveillance. We are the designated reporting agency for the Lubbock Health Service Delivery Area. This long-standing commitment to the prevention of HIV and AIDS began in the Health Department's Sexually Transmitted Disease Clinic. In the ensuing years, our HIV program has grown to include testing and counseling, prevention education, and an Early Intervention Clinic. The City Health Department also provides an Immunization Clinic which tracks the immunization status of the clients enrolled in the HIV Early Intervention Clinic. The Project Director for the City of Lubbock Health Department's HIV Testing and Counseling Program is Mary Strange, R.N. Ms. Strange has worked at the Health Department for the last 16 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 B.S. in Nursing and has participated in HIV Counselor Training Courses in 1988, from TDH, and in 1986 and 1989, from the Fifth Army. Ms. Tammy Foskey is the HIV Counselor at the City Health Department. She has been serving in this capacity. since 1990. Ms. Foskey received a Master's Degree in Counseling in 1989, which provided her with the basic skills necessary to be successful as our HIV Counselor. 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 to develop personalized risk reduction plans, maintaining statistical data used to formulate monthly and quarterly reports, and assisting in the submission of annual applications for continued funding. Ms. Foskey's position is fully funded by the TDH grant and is 100% dedicated to PCPE activities. Ms. Foskey has attended the client -centered, required PCPE training from the Texas Department of Health. She was trained to draw blood by the Nursing staff at the Health Department after she joined the staff six years ago. Although Ms Foskey is not a member of one of the target groups, she is considered by members of the group to be a peer. Her six years as the HIV Counselor has provided stability to the program, allowing members of the target groups the opportunity to develop trusting relationships with Ms. Foskey and the Health Department staff. Ms Foskey has attended cultural sensitivity training provided by the City of Lubbock and the state Health department at their annual conference. She has spent time with members of the target groups learning about their differing cultures. She has learned where they hang-out, what their main concerns are, and how to provide culturally appropriate prevention messages. 5 --# Ms. Foskey conducts outreach activities with adolescents who self -identify as MSM, gang members, and/or incarcerated IDU's at the Lubbock County Youth Center. She provides out reach activities to homeless IDU's, incarcerated IDU's, and IDU's who are sex workers at the Lubbock County Community Correctional Facility, in conjunction with Inside/Out HERR activities, and at the Lubbock County Jail. She reaches out to MSM college students, as well as, UHS female partners of MSM/IDU at Texas Tech University's Student Health Clinic. Ms. Foskey provides PCPE activities for at -risk students requesting testing, students referred by the physicians in the Student Health Clinic, and students referred by Tech's HIV -education program. Collaboration with Inside/Out has also opened on-site locations for testing of IDU's in their recovery programs. On-site counseling and testing at the City's STD clinic also allows Ms. Foskey to provide counseling and testing to members of every target group identified in the action plan for TDH Region 1. The City Health Department has four PCPE trained staff members, including clinicians and one disease intervention specialist. These trained staff members are available to provide PCPE activities for targeted individuals requesting HIV testing on-site during the times when Ms. Foskey is providing services off-site.. As of July 1, 1996, HIV testing is being routinely included in the STD clinical exam. Those individuals who fall into one of the targeted risk groups, who are undecided about testing, and/or who refuse the HIV test are routinely referred to the HIV Counselor in order to provide more personalized prevention messages and to further reassure the client of confidentiality or anonymity.. The City of Lubbock Health Department is accessible by Citibus. The building is located on a major North/South route as well as a major East/West bus route. This allows access for people from all over the City. Our HIV program receives administrative support from various city departments, due to the fact that it is a project of the Health Department. The $1600 requested in indirect costs does very little to defray the actual cost for the administrative services received by the project. The PCPE Project receives support from Budget and Research, Purchasing, Accounting, Personnel, Fleet Services, Communication, Information Services, City Management, Building Maintenance, and many other departments. The support services received include proper financial management assistance, internal audits, purchasing of all supplies, assistance in maintaining proper personnel records and training, adequate telephones and FAX machines, up-to-date information services systems, proper supervision and management systems, and so -on. The ability to draw upon the City organization for all of these supportive features allows the HIV Counselor the opportunity to focus on providing PCPE activities to members of all the target populations. 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 reason 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- [ -1 changing face of the epidemic, we have remained on the cutting 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 the first six months of 1996, Ms. Foskey and the other trained staff members have provided HIV Counseling and Testing to over 1300 individuals, 5 of whom tested positive. 83.8% of all individuals tested in this program this year have returned for post-test counseling, while 100% of all individuals testing positive have 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. COLLABORATION WITH OTHER AGENCIES The City of Lubbock Health Department has many long-term, collaborative relationships with other health and human services providers within the City of Lubbock. Currently we are providing counseling and testing for the clients of the following agencies: Texas Tech University Student Health Catholic Family Services Lubbock County Jail Inside/Out Lubbock County Community Correctional Facility Lubbock County Youth Center Lubbock Health Department STD Clinic A local gay club The City's HIV Counselor works closely with Catholic Family Services Minority HIV educator and Inside/Out's HERR HIV educator, providing testing and referral services following their education presentations when requested. Inside/Out provides HIV education to inmates at the Lubbock County Community Correctional Facility once each month. The City's HIV Counselor attends these monthly presentations and offers inmates the chance for testing after each presentation, thus tying the state's HERR. money with the PCPE money. We also work with Inside/Out, testing their clients in various neighborhood settings each Friday afternoon. Since Inside/Out targets non -identifying MSM's, IDU's and gang members in certain minority neighborhoods, this provides the City staff with an entry into these communities that might not otherwise be receptive to a representative of the local government. Inside/Out's HERR grant provides them with funds to educate high-risk individuals on a daily basis, providing them with HIV prevention and risk reduction messages. The HIV Counselor work closely with Inside/Out to ensure that her messages coincide and support the messages given by Inside/Out. Ms. Foskey goes to Inside/Out's local office at noon each Monday through Friday in order to provide their clients with a daily opportunity for testing and counseling. The City's collaboration with Inside/Out is 7 relatively new and has provided a wonderful opportunity to leverage both agency's grants, providing more services for very little increase in costs. The Counseling and Testing Services provided to Catholic Family Services in conjunction with their HIV education grant is provided on a more random basis. CFS targets predominantly Hispanic individuals who are also members of the migrant community and/or self -identified gang members. They spend many hours in one-on-one education efforts. When a client requests testing CFS arranges for a counseling and testing appointment with Ms. Foskey in a setting that is convenient for the client. Many times that setting is the City Health Department. The CFS educator often accompanies the client to the testing appointment in order to provide translation services to the client, if needed. Ms Foskey and Ms. Reyes of CFS have a good working relationship which enables the counseling and testing session to proceed naturally, even when Ms. Reyes is translating for Ms. Foskey. They function well as a team, thus helping the clients to feel comfortable with the process. The South Plains AIDS Resource Center, better known as SPARC provides HIV education services through their HERR grant to members of the gay community in Lubbock and the surrounding counties. They also target sex workers and non -identifying males having sex with other males. They provide education services to the area WIC clinics located outside the Lubbock City limits, to residents of the Lubbock Housing Authority and to patients at Lubbock's Charter Plains Hospital. The SPARC educators will refer individuals to the City Health Department for testing and counseling, if one of their volunteers cannot be present at the presentation to provide testing and counseling on-site. SPARC and the City Health Department have worked in conjunction with each other for the past five years. We have both provided staff for the HIV Early Intervention Clinic. SPARC receives the HIV Services grant for Lubbock County and maintains a case management program with some of those dollars. We refer individuals who are seropositive for HIV to SPARC to receive case management and for enrollment in an appropriate support group. The City of Lubbock's grant writer has assisted SPARC with preparing applications for new and continuing grant funding. SPARC is applying for PCPE funding this year. They are planning to hire a staff person to conduct counseling and testing in areas of Lubbock County that are outside the Lubbock City limits and in the other counties in the Lubbock HSDA. This is a gap in services that is sorely needed and we wholeheartedly support their application. We will continue to provide PCPE services in the City of Lubbock to our clientele. The addition of another HIV Counselor in this large 15 County area will enable all the residents of the HSDA the opportunity for testing and counseling closer to their homes and yet it will not increase duplication of services. It will allow for a more structured means of providing back-up services when one person is ill or on vacation. Lubbock's Regional Mental Health Mental Retardation (MHMR) Agency will continue to educate and provide HIV Counseling and Testing for their clients. The NUBM staff, which is funded by grants from both TDH and the Texas Council on Alcohol and Drug Abuse, provides street outreach services to IDU's, Sex Workers, and individuals who. reside on the streets. They provide prevention messages and enroll individuals in treatment programs. The MHN% staff has been very successful in working with a highly specialized target 8 group. They provide education to clients wherever they can be found; on the street, in jails, in treatment facilities, in halfway houses, etc. The city staff has worked cooperatively with NJFIlVIR staff for the past seven years. We often refer clients we see in the STD clinic to MHMR and they refer clients to us. They provide the testing for the vast majority of their clients, since they are always ready to test someone on the spot,. no matter where the person is staying. When they locate someone who is HIV positive, they refer the client to the HIV Early Intervention Clinic located in the Health Department. Their program and ours have proved to be a nice match in the past. MHMR staff are able to provide intense one-on-one education, counseling, and testing to individuals who are wary of any governmental officials. We can follow-up with STD exams and/or HIV testing and counseling if the clients request it. We do not believe that there has been.a duplication of effort. With almost 200,000 residents in Lubbock, having two HIV Counselors who both target IDU's has not proven to be overkill. We do not go out on the streets to target the IDU's. We work with the IDU's who seek testing at the STD clinic and who are clients of Inside/Out. We work cooperatively with Lubbock County, providing testing and counseling services to each of their correctional facilities, Lubbock County Jail, Lubbock County Youth Center, and Lubbock County Community Correctional. Facility. They allows us access to the inmate population to provide testing. and counseling when requested by the inmate. We work closely with the state regional. office which is located in Lubbock. The Regional Health Director also serves as the Local Health Authority. The cooperation between the local health department and the state regional office has been superior in all areas of public health; from mosquito control and environmental health issues to animal control to TB control programs, immunizations, and HIV prevention. Ms. Foskey and Billie Ray, the Regional HIV Coordinator, maintain a good working relationship, contacting one another when either has a question or concern regarding our program. For f uuther information regarding collaboration, please see our letters of Agreement which can be found in Appendix A-41. In Appendix L -L, we have included some newspaper articles regarding our PCPE program which highlights our success and our efforts to collaborate with the other agencies in town which provide similar services. N REFERRAL PLAN All clients testing seropositive are referred to agencies for the following services:. STD Screening and Treatment Tuberculosis Testing and Treatment Substance Abuse Counseling and Treatment Family Planning Services Prenatal Services including treatment to reduce maternal transmission of HIV Prevention Case Management Early Intervention Medical Services Immunization Review and Update Seropositive clients are referred to other agencies for the following services, if needed: Support Group Family Support Group Food Assistance Housing Assistance Transportation High -Risk Seronegative Clients are either referred or scheduled for a follow-up visit to maintain ongoing HIV prevention counseling. A list of referral agencies is maintained and updated by the City of Lubbock HIV Counselor. The list includes names, addresses, and phone numbers of the agencies. The referral agencies include: The City of Lubbock Health Department for: STD Testing and Treatment, TB Testing and Treatment, Early Intervention Medical Services, Immunization Review and Update, The Community Health Center of Lubbock for: Family Planning Services, Prenatal Services, Housing Assistance, and Transportation Services South Plains AIDS Resource Center (SPARC) for: Prevention Case Management, Support Groups, Family Support Groups, Ongoing HIV Prevention Counseling, Food Assistance, Housing Assistance, and Transportation Services Lubbock MHMR for: Substance Abuse Counseling and Treatment, Ongoing HIV Prevention Counseling, Support Groups 10 Inside/Out for: Ongoing HIV Prevention Counseling, Substance Abuse Counseling and Treatment Narcotics Anonymous and Alcohol Anonymous for: Ongoing HIV Prevention Counseling, Substance Abuse Counseling and Treatment Clients are given addresses and phone numbers for the agency referred to. If possible the HIV Counselor makes the original appointment for the client. The date and time of the appointment is given to the client. The HIV Counselor tries. to schedule the appointment between the date of the current appointment and the date of the follow-up post-test counseling session for the client. This way the Counselor can learn from the client if they kept the appointment and the conclusions of the appointment. If the appointment was not kept, the, HIV Counselor will attempt to determine why it was not kept and take appropriate action (schedule another appointment, schedule with a different agency, or schedule another post-test counseling session.) If the referral is for a service provided at the Health Department, the HIV Counselor will attempt to refer the client to the appropriate staff member at that point in time. She will then personally escort the client to the staff person and make the appropriate introductions. If the client must come back at another time, Ms. Foskey will meet the client in. her office and then introduce them to the appropriate staff person. All personnel working with any Health Department patient are required to sign a statement of confidentiality. All referrals require the use of the HIV Positive Referral Tracking Form.. A copy of the tracking form can be found in Appendix M. The form includes the client's name and/or CDC number and where the client was referred. There is a place for the referral conclusion and the date the conclusion was verified. This form is maintained in the client's record. The HIV Counselor tracks the referral until appropriate action has been taken and verified. A copy of the latest Core Site Review conducted by TDH in April 1996, is included in Appendix N. This review verifies the existence and use of a referral and tracking protocol. The protocols for referral and tracking, for both seropositive clients and for prenatal clients are included in Appendix M.O-R. WORKPLAN The City Health Department Prevention Counseling/Partner Elicitation Activities will focus on the target populations identified by the 1996 Region 1 Action Plan as determined by the Region 1 HIV Planning Coalition and the Texas Department of Health. Specifically these targeted groups are: men who have sex with men (MSM) who are adolescents, college - aged, men of color and anglo men; injecting drug users (IDI) who are incarcerated, sex workers, and/or homeless; and people who have or have had unprotected heterosexual sex 11 (CTHS) and who are migrants, gang members and/or female partners of injecting drug users and/or female partners of men who have sex with men. The City has targeted all these groups during past years. During the first six months of 1996, the City's HIV Counselor has served: 5 MSM - Adolescent 20 MSM - College -Aged 32 MSM - Of Color 36 MSM - Anglo 3 IDU - Homeless 9 IDU -Sex Worker 51 IDU - Incarcerated 1 UHS - Migrant 1 UHS - Gang Member 66 UHS - Female Partner of IDU and MSM 1088 - Other 1312 - TOTAL From October 1994 through October 1995, the City of Lubbock provided counseling and testing for 1,941 individuals. Of those tested, 1,628 returned for post-test counseling for a return rate of 84%. The return rate is very important as it is.an indication of the ability of the HN Counselor to "connect" with the individuals she is testing. The clients report that they find the testing experience comfortable, non judgmental, and respectful. These attributes appear to be the reason so many individuals return for their test results. These attributes also make it possible for the HN Counselor to overcome many perceived barriers to service. These perceived barriers to service include: 1) the lack of a peer providing the testing and counseling; 2) the location of the primary testing site in a local government building; 3) number of people sitting in the STD waiting room, and 4) the need to make an appointment for testing and counseling, if one wants to be seen quickly. All of these perceived barriers to service have been overcome by time. When the Health Department started conducting an HIV testing and counseling program, many clients asked to be tested anonymously and/or off-site. As time has passed and no-one has been identified by Health Department staff as HIV positive or as having been tested, the confidence level of potential clients has increased. The high-risk populations have developed. a sense of trust in the Health Department staff primarily due to a word-of-mouth publicity campaign. As individuals come in to be tested and are treated- with respect and nonjudgmentally, they relate their experience to'their peers. Presently, we are finding that we are testing some individuals who could choose to be tested by peers, but they prefer our system, our location, and our reputation for maintaining confidentiality. To increase the number of individuals we are reaching in each specific target group we have spent the last year adding locations for off-site testing. The Health Department staff plans to continue to reach out to individuals in their communities rather than waiting for them to come to us. The HN Counselor will continue working with various agencies in the 12 Lubbock area to collaborate in providing testing after HIV educational presentations. Those agencies include Inside/Out, Texas Tech University, Catholic Family Services, and SPARC. The HN Counselor will also provide testing to the incarcerated female trustees at the Lubbock County Jail and will provide testing at the Lubbock County Youth Center. Testing will continue to be offered on-site at the Health Department and off-site at Texas Tech University's Student Health. The HIV Counselor will continue to work with the management of the adult theaters/bookstore and gay club to provide preventive materials, testing on-site and/or referral for testing to the City of Lubbock Health Department. The HIV Counselor will spend a minimum of 10 hours per week providing testing and counseling to at -risk clients in their own communities, where at -risk behavior occurs, and/or where the targeted groups congregate. Table 1 identifies each target group, where testing and counseling will be offered, when it will be offered, which agency, if any, will participate in the effort, and the HIV Counselor involved in the out -mach effort. Rapport willbe established with different groups in different ways. With many groups, such as the men at the gay club, the students at Texas Tech, and the inmates at the Lubbock County Youth Center and the Lubbock County Jail, the testing and counseling activities will be a continuation of activities that have been ongoing for several years. With these groups the continued presence of the HIV Counselor on a regular basis is sufficient to maintain rapport. Ms. Foskey is accepted as a member or as a support person for members of their group. She is able to walk into their environment and start up conversations with ease. In these groups she uses personalized risk reduction messages to encourage testing and counseling. With other groups, such as the Inside/Out neighborhoods and migrant farmworkers, Ms. Foskey collaborates her efforts with those of the HIV educators. The educators spend time with these individuals on a daily basis establishing rapport and providing ane -on -one education to the at -risk population. Ms. Foskey's regular visits then allow the educators to offer on-site testing. Since they vouch for her reliability, she is able to provide counseling and testing to another target group. Possible barriers that Ms. Foskey might encounter while providing PCPE activities include lack of transportation, language barriers, lack of childcare, privacy, and hours of operation. Staff have planned and worked hard to try to find ways to overcome these barriers. Transportation should not be a problem, since Ms. Foskey is spending more time doing off- site testing and counseling. She will meet the individual requesting testing and counseling in whatever location that is accessible to them, including their own homes. Ms. Foskey is not fluent in Spanish although she understands it somewhat. She collaborates with Catholic Family Services to provide some help with translation, as well as other Health Department staff when testing in the STD clinic. She has worked with these translators enough to develop a smooth counseling session in spite of the translation time lag. 13 ?1, a rA '000 0 0 �a Wcn g "a 8 �$ a HAI P� 0�S az o x ac OO N 00 N N O o s °QCJaG ° In Qdx I g F ° cn 0Q °0°fig U �° o . a o 0 0 0 a a H .o ON T paq U HWA a 0 On 0 0.- 0 0 On On, 0 U O w O w O w O w O w O w O w OR O w O w O w z >4 d �" ;Z4 o w �5'a5o - dNg c WOW �z w d a 0 z A 0 d �,a0 o z aw.w O O O� Rwdew O z ^" a x o �n � O x DO N H H H 00 N Oo ti zO O `i O ow p 150 O 91 �+p WZ O OORO0 9 0 � 00 , -# - Lack of childcare is really more of a perceived barrier than a real barrier to testing and counseling. For clients requesting testing .and counseling at the Health Department, there is always another staff member available to tend the children while their caregiver is being counseled. Since Ms. Foskey will schedule her off-site appointments at any time to be convenient to the client, she will work with them to find a time when the caregiver has someone else to watch the children or she will bring along a nursing student or another staff member to watch the children. Privacy is not an issue for those receiving services at the Health Department. Clients are only identified by number, not name. They have a separate waiting room from the main room at the Health Department, with a private entrance. Ms. Foskey has a private office for counseling and testing. Off-site Ms. Foskey insists on privacy for the PCPE sessions. If a private place cannot be arranged, she will schedule the client for a visit in another location which she and the client arrange. Ms Foskey works 8 until 5 Monday,Tuesday, Wednesday and Friday and 10:45-7:15 on Thursdays. If those hours are not convenient for the target group, she has permission to shift her hours to suit the needs of the target group. This is evident in her late night/early morning testing hours at the gay club. More details regarding specific activities as they relate to the objectives are found with each individual objective. QUALITY ASSURANCE PLAN In order to maintain the highest Ievel of service available to their patients, the City of Lubbock Health Department has a client -centered quality assurance program. This program applies to all projects operating within the Health Department including the HIV Prevention Counseling/Partner Elicitation Program. The Quality Assurance Program involves maintaining a long-range plan, writing program objectives for each project on an annual basis, and participating in regular evaluations. TDH monitors the Health Department, both for financial responsibility and programmatic responsibility. The Community Health Accreditation Program (CHAP) , a subsidiary of the National League for Nursing has conducted an annual evaluation of the Nursing Program for the past three years. During the last unannounced evaluation, the Health Department passed without any recommendations for change. Programs and policies are developed with the patient as top priority. Standards for Care, such as those developed by the Centers for Disease Control (CDC) and the American Nurses' Association (ANA) are a critical component of these policies. Client care is evaluated formally through the use of Case Conferences, Medical Records Audits, and 0 16 Client Satisfaction Surveys. The Client Grievance Policy is explained to each new patient, providing a method for the consumers to express their specific complaints with the services provided. A section of the Quality Assurance Program addresses the need to ensure the quality of the staff at the Health Department. The quality assurance program covers the application process, the interview process, staff orientation, annual performance evaluations, and the provision of continuing education to the staff. Annual*performance evaluations are required by the personnel policy guidebook for the City of Lubbock. The evaluations are tied to merit pay increases. Forms are developed by the City's Human Resources office and all supervisors- are required to attend training. The staff development policy includes the recognition that. it is important to have employees who maintain a high degree of knowledge in the field of public. health, clinical proficiency, and continuing education credits to maintain professional certification. To this end, three avenues for obtaining continuing education are provided by the department. These avenues are monthly in-service programs, specific workshops and conferences, and unspecified funding for individuals, subject to case-by-case approval. REQUIRED OBJECTIVES, ACTIVITY MEASURES, AND EVALUATION PLANS PROCESS OBJECTIVE I: By December 31, 1997, the City of Lubbock PCPE program will provide HIV prevention counseling, according to TDH guidelines, to 1600 persons as outlined in the Target Group Chart. (See Table 2 for Target Group Chart) ACTIVITY MEASURES: A Maintain current STD site for counseling and testing. 1. Document HIV risk assessment in STD chart. (Appendix 5) 2. PCPE trained nursing staff will be available to do on-site counseling and testing for high-risk individuals when the HIV Counselor is unavailable. 3. Maintain availability of HIV pamphlets in the STD clinic lobby area. B. Maintain testing site at Texas Tech University (on-site) eight hours a week. (MSM, IDU, female partners of MSM and/or IDU) (Appendix E) C. Collaborate with Inside/Out (HERR) to provide testing for individuals (IDU, MSM, MSM of color, MSM adolescents, gang members) off-site. Referrals will also be made to the City of Lubbock Health Department when needed. (Appendix B) D. Collaborate with Catholic Family Services (HERR) to provide testing for individuals (migrants, homeless, IDU, MSM adolescents, female partners of MSM and/or IDU) upon request. (Appendix 17 E. Continue to work with the management of adult theaters/bookstores to provide prevention materials and on-site testing. (MSM, MSM of color) F. Continue to work with the management of a local gay club to provide on-site testing and referrals for testing to the City of Lubbock Health Department. (MSM, MSM of color) (Appendix E) G. Continue to provide on-site testing for female trustees at the Lubbock County Jail. (IDU, sex workers, sexual partners of MSM and/or IDU). (Appendix Ia H. Continue to provide on-site testing to incarcerated individuals at the Lubbock County Youth Center and the Lubbock County Community Correctional Facility. (IDU, gang members and high-risk females) (Appendix F_Ga . EVALUATION OF OBJECTIVE: Monthly and quarterly reports will indicate the number of individuals receiving prevention counseling and those individuals being tested for HIV. Number of individuals within specific target groups receiving pretest counseling and testing will be documented on monthly and quarterly reports. Counselor will use the state forms to collect data and to report data. EVALUATION FORMULA: # prevention counseled and # testing PROCESS OBJECTIVE II: During the project year, the City of Lubbock Health Department PCPE program will provide posttest counseling to a minimum of 75% of the individuals who test for HIV infection. ACTIVITY MEASURES: A Due to confidentiality laws, emphasis is placed on the importance of returning for results in person. B. Maintain adequate and varied hours for scheduling appointments for results. C. Posttest counseling is documented. EVALUATION OF OBJECTIVE: Monthly and quarterly reports will indicate the percentages of individuals returning for test results. Counselor will use the state forms to collect data and to report data. EVALUATION FORMULA: # receiving posttest counseling/# HIV tested x 100 PROCESS OBJECTIVE III: During the project year, 95% of the individuals testing HIV positive through the City of Lubbock Health Department PCPE program will receive posttest prevention counseling. ACTIVITY MEASURES: 18 A. Emphasize the need to obtain test results in person. B. If confidential testing is selected, obtain locating information to assist in notification of individual should he/she test seropositive for an HIV infection. C. Emphasize the confidentiality of results and importance of knowing serostatus to make important life and health decisions. 19 N 0 td d ti . w n s � 0 L cr r cr �o �d . n b b 0 b c r•► 0 �s OQ� !y ua 0 00 c5o rn 0 CA CA C.- c� c c c c C c CDrAW y 't ly tU O o � a c c c � b r� = �a - a y 0 �s to c �••�+ N o �-+ 0 N 0 o0 0 00 0 00 o c E ■. O C o �C o� rL 0� a o (� R v� 52. C%. o r- " (n �'c o OECD ,-� " v,� n • Z . 0 CA Chlp �• Q �, n o C H yw h n V con 0 Ul �.. td d ti . w n s � 0 L cr r cr �o �d . n b b 0 b c r•► 0 �s OQ� !y ua 0 00 c5o rn 0 N i rte. a o � Q Q O Q �Ai Lo O O GI EVALUATION OF OBJECTIVE: Monthly and quarterly reports will indicate the number of individuals testing seropositive and the number returning for test results that are seropositive. Counselor will use the state forms to collect data and to report data. EVALUATION FORMULA: # receiving seropositive results/# testing seropositive PROCESS OBJECTIVE IV: During the project year, the City of Lubbock Health Department-PCPE program will successfully link at least 95% of the individuals testing HIV positive to case management for early intervention. ACTIVITY MEASURES: A. A packet of information will be reviewed with the Counselor and given to each person. B. An appointment will be made at the early intervention clinic located at the City of Lubbock Health Department. C. A list of private physicians will also be available for those who are desiring more confidentiality and anonymity. D. A follow-up appointment will be scheduled to assess individual's needs and implementation of further referrals. E. Referral will be made to the South Plains AIDS Resource Center for social and support services. F. Referral to the Immunization clinic for immunization update and TB testing. EVALUATION OF OBJECTIVE: A tracking system was developed to provide agencies a method that is consistent in making appropriate referrals for early intervention medical services, and social and support services. (Appendix __) Monthly and quarterly reports will document progress towards this objective. Counselor will use the state forms to collect data and to report data. EVALUATION FORMULA: # referred for early intervention/# seropositives x 100 PROCESS OBJECTIVE V: During the project year, the City of Lubbock Health Department PCPE program will elicit at least one sex and/or needle sharing partner, for health department referral, from 80% of those HIV-positive individuals receiving posttest prevention counseling. ACTIVITY MEASURES: A. Introduce partner elicitation during pretest counseling session. B. At the time of seropositive posttest counseling session, address the issue of the importance of notification of partners. If unable to elicit partners at the time, arrange for a follow-up appointment to discuss this and any other issues. C. Work with DIS (Disease Intervention Specialist) to arrange follow-up field visit if necessary. 22 D. All trained HIV Counselors will be trained in Partner Elicitation course offered by TDH. E. The Wellness Coordinator at the Early. Intervention clinic will also work to elicit names and re-emphasize the importance of partner notification during the counseling session. EVALUATION OBJECTIVE: Monthly and quarterly reports will be the tools for evaluation. The form developed by TDH will be submitted by the HIV Counselor immediately following a seropositive posttest counseling session. EVALUATION FORMULA: # seropositive clients requesting assistance/ # seropositive clients x 100 PROCESS OBJECTIVE VI: During the project year, 100% of women testing HIV positive who. are identified as pregnant will be referred for prenatal care. ACTIVITY MEASURES: A. Emphasize the importance of returning for test results for the health of the mother and child. B. Obtain locating information, if needed, on all pregnant women testing through the City of Lubbock Health Department for notification of seropositive results. C. Physician referrals will be made for women testing seropositive and follow-up will be made by the HIV Counselor to assure that the prenatal appointment(s) is kept. D. Materials documenting the evidence of AZT in the prevention of HIV in infants will be made available. Breast feeding and plans for delivery (vaginal or C-section) will also be discussed and information made available. E. Partner Elicitation/Prenatal Referral Report Form will be submitted to TDH within 2 working days of the seropositive posttest counseling session. EVALUATION OF OBJECTIVE: Monthly and quarterly reports will document the progress. Counselor will use the state forms to collect data and to report data EVALUATION FORMULA: # seropositive pregnant women referred for prenatal care/ # seropositive pregnant women 23 PROCESS OBJECTIVE VII: During the project year, the HIV Counselor will collaborate with other agencies serving high-risk seronegatives to form a support group(s) to address risk reduction issues in an effort to remain HIV negative. ACTIVITY MEASURES: A. Work with SPARC, Lubbock-NMM t, Catholic Family Services, Inside/Out, and the management of the adult theaters/bookstores and gay club to determine the needs of the community that remains at high-risk for HIV. B. Work with Texas Tech University students as volunteers for organizing the format and publicity of the support group(s). C. Gather material from other programs in the state that have seronegative support groups to be used in forming one in the Lubbock area: EVALUATION OBJECTIVE: Monthly and quarterly reports will document the progress. Reports will include minutes of meetings with attendees listed and copies of materials gathered from across the state. PROCESS OBJECTIVE VIII: During the project year, the HIV counselor will work to establish relationships with the Neighborhood Associations of the City of Lubbock and the Health Education section of the City of Lubbock Health Department provide HIV Education and testing in high-risk neighborhoods (IDU, gang, high-risk females). ACTIVITY MEASURES: A. Work with the Health Education section of the City of Lubbock Health Department and the Neighborhood Associations of the City of Lubbock to determine how the HIV counselor can assist in providing HIV education and prevention counseling and testing to those persons at risk for HIV. B. Organize place and time to be available in specific neighborhoods on a monthly basis to maintain visibility within the high-risk populations. EVALUATION OF OBJECTIVE: Monthly and quarterly reports will document the progress. Reports will include agency representatives and others who have assisted in the planning and implementation of this objective. 24 C�Jf W-- t H y o1z 0 O ;;' O C FF G � SID '00 CC F C 0P0Po O O � Q• Fr 00 PCO 00 O�0 O C A C CL 4 0 4 e� rCi. N 69 O O wo 0 0 •c Q� � C eb 46 o O -ti 60 0 o 0 o o�arnB Is Is M c N y m h .00 °Oi o 00to M t y` o 0 c K 6 h �o iA m46's oo 461% QAC s i �p w C� oww w LA LAo00 LA N ON oo b n o p OocOOo o a 0 Q10 ol .o�otrJ� o O •• z� ° p 0 0 0 0 0 0 O •`•y p p 0 0 0 0 0 0 0 0 0 0 0 0 O 0 1 �I 0 0 0 0 0 0 0 O A w C> p o Co a 0 6 0 0 0 0 0 0 0 O O 0 0 0 0 0 0 0 O !D 0 0 0 0 0 0 0 O p O O O O O a O 0 0 0 0 0 0 0 O •• a cr' 0 000000 0 "` 0 0 0 0 0 0 0 0 � �p yesON y � owtA0O w LA •.r oo ON ON � O w o opo 0 0 0 0 0 0 0 0 4 C HIV PREVENTION COUNSELING AND PARTNER ELICITATION BUDGET JUSTIFICATION A PERSONNEL $29,868.00. HIV Counselor (Tammy Foskey) 100% FTE for PCPE Activities 2489 /month X 12 months = $29,868.00 This position will continue to provide counseling, testing, referral, and partner elicitation in Lubbock County for STD clients, female trustees, women who are partners of men who have sex with men or use injecting drugs, gang members, men who have sex with men, injecting drug users, and others seeking testing for HIV at the City of Lubbock Health Department B. FRINGE (29%) $8,660.00 FICA: rate x salary $2,218.00 Insurance: cost per month x FTE's $6,442.00 (Health ins: 2,613 Life ins. 33 Dental ins. 209 Retirement 3,587 Total Fringe Rate 29% C. TRAVEL $1,200.00 Expenses for HIV Counselor to attend one state conference. Airfare $100.00 Hotel @ $55 x 4 days $220.00 Meals @ $25 x 4 days $100.00 Car Allowance ($.30/mi. x 2600 mi/yr) $780.00 D. SUPPLIES $50.00 Funds are requested for the purpose of general office supplies. E. OTHER $555.00 Educational Supplies $500.00 Conference Registration $55.00 F. TOTAL DIRECT COSTS. $40,333.00 G.. TOTAL INDIRECT COSTS (UGCMS) . $1,600.00 H. TOTAL BUDGET $41,933.00 27 Texas Department of Health Bureau of HIV & STD Prevention I Contractor Assurances 2 June 12, 1996 .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 entityor 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 not disclosed. 17 We are aware that the Health and Safety Code, §81.103, provides for both civil and criminal penalties is 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 law. An entity that does 22 not adopt a confidentiality policy as required by law is not eligible to receive state fiends 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 as 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 31 decision making process or use inside information with regard to such activity. Furthermore, this 32 agency will adopt procedural rules which require the affected person to withdraw from his or her 33 functions and responsibilities or the decision making process with respect to the specific assisted 34 activity from which they would derive benefit. 28 HIV/STD Form No. 500.001 -1- -0 Contractor Assurances - _.„ 1 4. HN/AIDS MODEL WORKPLACE GUIDELINES FOR PROVIDERS OF DIRECT 2 CARE, SERVICES, OR PROGRAMS 3 The applicant agency assures that its Project Director and Authorized Business Official have: 4 A. received a copy of the HIV/AIDS Model Workplace Guidelines, Providers of Direct Care, s Services, or Programs, Amended Final Rules, Texas Board of Health, January 27, 1990; 6 B. have read them; 7 C. agree to adopt and implement workplace policies on HN/AIDS to include at a minimum: s 1) the provision of education for employees and clients concerning HIV, its related 9 conditions, and AIDS; 10 2) confidentiality of AIDS and HIV-related and all other medical information for 11 employees, clients, inmates, patients, and residents served by the applicant agency; 12 and 13 3) an anti -discrimination policy assuring all privileges and opportunities for any employee 14 or client with a communicable disease, unless based on accurate scientific information. 15 5., DEBARMENT AND SUSPENSION 16 The undersigned (authorized official signing for the applicant organization) assures to the best of his 17 or her knowledge and belief, that the applicant, defined as the primary participant in accordance with 1s 45 CFR Part 76, and its principals: 19 A. are not presently debarred, suspended, proposed for debarment, declared ineligible, or 20 voluntarily excluded from covered transactions by any Federal Department or Agency; 21 B. have not within a 3 -year period preceding this proposal been convicted of or had a civil 22 judgment rendered against them for commission of fraud or a criminal offense in connection 23 with obtaining, attempting to obtain, or performing a public (Federal, State, or local) 24 transaction or contract under a public transaction; violation of Federal or State antitrust statutes 25 or commission of embezzlement, then, forgery, bribery, falsification or destruction of records, 26 making false statements, or receiving stolen property; 27 C. are not presently indicted or otherwise criminally or civilly charged by a governmental entity 28 (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (b) 29 of this certification; and 30 D. have not within a 3 -year period preceding this application/proposal had one or more public 31 transactions (Federal, State, or local) terminated for cause or default. 32 Should the applicant not be able to provide this certification, an explanation as to why should be placed 33 after the assurances page in the application package. 34 The applicant agrees by submitting this proposal that it will include, without modification, the clause 35 titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion -Lower 36 Tier Covered Transaction" (Appendix B to 45 CFR Part 76) in all lower tier covered transactions (i.e., 37 transactions with . subgrantees and/or contractors) and in all solicitations for lower tier covered 38 transactions. 39 6. LOBBYING 40 Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to 41 influence certain Federal contracting and financial transactions," generally prohibits recipients of 42 Federal grants. and cooperative agreements from using Federal (appropriated) funds for lobbying the 43 Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant 44 or cooperative agreement. Section 1352 also requires that each person who requests or receives a 2° HIV/STD Form No. 500.001 -2- Contractor Assurances -'-'" 1 Federal grant or cooperative agreement must disclose ' lobbying undertaken with non -Federal (non - 2 appropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING 3 $100,000 in total costs (45 CFR Part 93). 4 The undersigned (authorized official signing for the applicant organization) certifies, to'the best of his 5 or her knowledge and belief, that: 6 A. No Federal appropriated funds have been paid or will be paid, by or on behalf of the 7 undersigned, to any person for influencing or attempting to influence an officer or employee s of any agency, a Member of Congress, an officer or employee of Congress, or an employee 9 of a Member of Congress in connection with the awarding of any Federal contract, the making 10 of 'any Federal grant, the making of any Federal loan, .the entering into of any cooperative 11 agreement, and the extension, continuation, renewal, amendment, or modification of any 12 Federal contract, grant, loan, or cooperative agreement. 13 B. If any funds other than Federally appropriated funds have been paid or will be paid to any 14 person for influencing or attempting to influence an officer or employee of any agent, a 15 Member of Congress, an officer or employee of Congress, or an employee of a Member of _16 Congress in connection with this Federal contract, grant, loan, or cooperative agreement, _the 17 undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying 18 Activities," in accordance with its instructions. (If needed, Standard Form -LLL, "Disclosure 19 of Lobbying Activities," its instructions, and continuation sheet are included in the Appendices 20 of this application form.) 21 C. The undersigned shall require that the language of this certification be included in the award 22 documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under 23 grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose 24 accordingly. 25 This certification is a material representation of fact upon which reliance was placed when this 26 transaction was made or entered into. Submission of this certification is a prerequisite for making or 27 entering into this transaction imposed by Section 1352, U.S. Code. Any person who fails to file the 28 required certification shall be subject to a civil penalty of not less than $10,000 and not more than 29 $100,000 for each such failure." 30 7. PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA) 31 The undersigned (authorized official signing for the applicant organization) certifies, to the best of his 32 or her knowledge and belief, that the statements herein are true, accurate, and complete, and agrees 33 to comply with the TDH terms and conditions if an award is issued as a result of this application. 34 Willful provision of false information is a criminal offense (Title 18, U.S. Code, Section 1001). Any 35 person making any false, fictitious, or fraudulent statement may, in addition to other remedies available 36 to the Gover anent, be subject to civil penalties under the Program Fraud Civil Remedies Act of 1986 37 (45 CFR Part 79). 38 8. ENVIRONMENTAL TOBACCO SMOKE 39 Public Law 103-227, also known as the Pro -Children Act of 1994, requires that smoking not be 40permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used 41 routinely or regularly for -the provision of health, day care, early childhood development services, 42 education or library services to children under the age of 18, if the services are funded by Federal 43 programs either directly or through State or local governments, by Federal grant, contract, loan, or 44 loan guarantee. The law also applies to children's services that are provided in indoor facilities that 45 are constructed, operated, or maintained with such Federal funks. The law does not apply to children's 30 HIV/STD Form No. 500.001 -3- I services provided in .private residences; portions of facilities used for inpatient drug or alcohol 2 treatment; service providers whose sole source of applicable funds is Medicare or Medicaid; or 3 facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law may a result in the imposition of a civil monetary penalty of $1,000 for each violation and/or the imposition s of an administrative compliance order on the responsible entity. 6 The contractor assures that the submitting organization will comply with the requirements of the Act 7 and will not allow smoldng within portion of any indoor facility used for the provision of services for 8 children as defined by the Act. 9 The submitting organization further agrees that it will require that the langulge of this certification be 10 included *in any subawards which contain provisions for children's services and that all subrecipients 11 shall certify accordingly. 12 9. GOOD STANDING 13 Applicant agency certifies that it is in good standing with any state/Federal agency that it has a 14 - contracting relationship with and has not had a contract terminated within the last 12 months for 15 deficiencies in contract performance. 16 Applicant certifies that it is, at the time of this application and throughout the application cycle, in good 17 standing with the Texas Department of Health CMH) in regard to current and past TDH contracts. is Applicant certifies that it has not defaulted on an agreed repayment schedule for amounts owed to the 19 TDH. If funds owed to the TDH have not been repaid, the applicant understands it is ineligible to 20 apply for funds from the TDH until the amounts owed are paid in full. By signing this form, appricentigrantee agrees to abide by the requirements of the assurances stated herein. L11'hbock Tjealtbe e t of MIMS May id L on Name 7( 1 e OT p anal • • Date 8/22/96 gna e o izea Kreser ive vd R. La ton, Mayor 31 HIV/STD Form No. 500.001 -4- Texas Department of Health Bureau of HIV & STD Prevention 1 ASSURANCE OF COMPLIANCE WITH REQUIREMENTS FOR CONTENTS OF 2 AIDS -RELATED WRITTEN MATERIALS, PICTORIALS, AUDIOVISUALS, 3 QUESTIONNAIRES, SURVEY INSTRUMENTS, AND 4 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 8 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 is attachment page if needed.) One member must be an employee of the local health department. 16 Name Occupation Affiliation and Address 17 is 19 -M Liz Inskip-Paulk HPpii-h peilnatnr City of Lubbock HaaIth nepartmer 1902 Tei;as Ave. Lubbock, TX Soila Reyes HIV Educator Catholic Family Service 102 Ave.J, Lubbock, TX Leonard Jarman Mi ni si-.p r/qA rnnnan+1 nPPni-ra1 T iihAnr-Ir r1111rrrh of Christ Inside Out, 1409 23rd, Lubbock, Ben Morales Manager Crystal Cinema 1408 N. Ave Y, Lubbock, TX Dan "rowp1 l NTVFrl�tr-atnr�4P� LR(�gR oC 5513 Brownfield Hwy., Lubbock, i 32 August 22, 1996 x Date Texas Department of Health Bureau of HIV & STD Prevention I ASSURANCE OF COMPLIANCE WITH THE 2 TEXAS HEALTH AND SAFETY CODE 3 SUBCHAPTER D. TESTING PROGRAMS AND COUNSELING a SEC. 85.085 PHYSICIAN SUPERVISION OF MEDICAL CARE s By Signing and submitting this form, the applicant agency certifies that its project staff and 6 volunteers are worldng under the standing delegation order. of a licensed practicing physician 7 when providing HIV counseling and testing services as required in part by the Texas Health s and Safety Code, Sec. 85.085. 9 Citv of Lubbock Health Denartment to wlicant Akepncy i David IfA Langston, mayty 13 dot 2), -OA 14 Signature of Licensed Physician is w7(v�;z, LT- �Ynro? 16 License Number 33 Augu.st 22, 1996 Date Date ADMINISTRATIVE HISTORY CERTIFICATION Name of Applicant crrY of u�oc'x Answer each of the questions and address each of the statements below and attach all documentation requested. Identify any attached documentation with the applicable question or statement number in the right hand comer. 1. 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. Similarly, any personal or business relationship between the applicant, the principals, or any affiliate or subcontract, _ 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 disqualification of the proposal. If, following a review of this information, it is determined by TDH that a conflict of interest exists, the offeror may be disqualified from further consideration for the award of a contract Does applicant have any existing or potential conflict of interest relative to the performance of the requirements of this RFP? o YES El NO If YES, detail any such relationship(s) that might be perceived or represented as a conflict. (Attach no more than one additional page.) 2. Have any of the applicant's principal officers been employed by the State of Texas in the past 24 months? a YES 0 NO If YES, indicate her/his name, Social Security number, job title, agency employed by and separation date in this space below 3. Has the applicant, or any of its principal officers, contracted with TDH during the past 24 months? h YES .a NO Administrative History Certification 1 34 -M . If YES, indicate the contract number(s) and/or any other information available to identify the contract. Indicate if the contract(s) is or was on probation, on vendor hold, restricted, or otherwise subject to any type of sanction. (Attach no more than one additional page.) Contract Nur er 756005905-97 4. Is the applicant, or any of its principal officers, delinquent on any State, Federal or other debt? o YES z NO If YES, please explain.(Attach no more than one additional page.) 5. Has a State or Federal agency terminated a contract with the applicant within the past two years for .default or for deficiencies in performance of the contract?. o YES -b NO If YES, entity may not apply for these funds. 6. Has a State or Federal agency terminated a contract with the applicant in the last five years for default or for deficiencies in performance of the contract? o YES ® NO If YES, please give details of each event. (Attach no more than one additional page.) 7. Has the applicant, or any of its principal officers, been debarred, suspended, or otherwise excluded from or deemed ineligible for participation in Federal assistance programs within the past five years ? o YES P- NO If YES, and applicant is currently debarred, suspended, excluded, or ineligible, it may not apply for funding. If applicant has been debarred, suspended, excluded, or deemed ineligible, over the past five years but is now eligible, please explain. (Attach no more than one additional page.) 8. Does the applicant owe funds to TDH or has it ever defaulted on an agreed repayment schedule? o YES LM NO If YES, please explain. (Attach no more than one additional page.) Administrative History Certification 2 35 - 9. Is the applicant a private, non-profit organization? D YES D NO NOT APPLICABLE M -e City of Lubbock is a not for profit goverTr ent organization. If NO, entity may not apply for these funds. If YES, applicant must include evidence of non-profit status. The following two documents are presented as evidence of non-profit status and are attached to this form: (Circle the two included.) (a) A copy of a currently valid Internal Revenue Service Tax exemption certificate. (b) A statement from a State taxing body, State Attorney General, or other appropriate State official certifying that the applicant organization has a non-profit status and that none of the net earnings accrue to any private shareholders or individuals. (c) A certified copy of the organization's certificate of incorporation or similar document if it clearly establishes the non-profit status of the organization. - - (d) 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 non-profit affiliate. 10. Board Information (a) Applicant has active, involved board as demonstrated. by bylaws, regular meetings with sufficient attendance, minutes, and clear definition of role? D YES D NO Wr APPLIMLE (b) Board demonstrates similar diversity of communities represented? D YES D NO NOT epucABLE (b) Board demonstrates diversity in skills available? D YES D NO NOT APPLSCABLE (c) Applicant maintains Directors & Officers insurance? D YES D NO NOT APPL ULE (d) Applicant has a Board policy and procedures manual? D YES D NO Wr APPLICABLE (e) Applicant provices orientation and training on board member responsibilities to new members? D YES D NO NOT APPLICABLE 11. Non-profit applicants must be able to demonstrate fiscal solvency. A copy of applicant's latest financial statement and a balance sheet are attached to this form: D YES O NO NOT APPLICABLE (Attach no more than two additional pages.) 12. , Does applicant have personnel policies approved by the governing body which address Administrative History Certification 3 36 essential issues of personnel management? m YES o NO 13. Applicant must submit letters of good standing from current grantor agencies. A letter should be attached for each source of funding shown on the Other Funding Sources Form. Letters of good standing are attached to this form: a YES u NO NOT APPLICOLE 14. Applicant had a fiscal audit conducted within the past year? - 0 YES o NO If NO, what is the date of last fiscal audit? 15. Applicant contracts with or employs the services of a CPA, accountant, bookkeeping service or trained financial manager other than the Executive Director. -i YES o NO Please explain: The City of Lubbock employs Certified Public kocmtants in the Accounting Department and contracts with an outside Certified Public Accountant firm for an-iial audits. 16. Is the applicant a governmental agency? ra YES o NO If YES, cite here the authority to contract: The City of Lubbock City Council and Mayor. I CERT "T THE`AJ)VE ESW43RA14TION IS TRUE AND CORRECT: •I / P"t'"'kn,0007d August 22, 1996 Official &avid Rj\LangstDAte Administrative History Certification 4 37 I:�•'1 1 --II BOARD MEMBER COMPANY BUSINESS ADDRESS BUSINESS PHONE Josie Alvarado Essential Home Health 1313 Broadway Annex' 747-4229 Care Plaza Lub TX 79401 Barry Bartee Dentist in Private 3234 64th Street 792-2311. Practice L TX 79413 Richard 011er Offer Engineering P.O. Box 53423 799-0075 Lubbock,TX 79453 Gary Schwede Acres North Veterinary 5201 13th Street 793-2863 Hospital Lubbock TX 79416 Jane Tustin L.I.S.D. 1628 19th Street 766-1972 Lubbock, TX 79401 Kelly Waggoner Norwest Bank P.O. Box 1241 798-8844 Lubbock, TX 79408 38 r 4pe ft" M imam .- _..° August 77- 1996 _ � r - Ms.rTanuny Foske- Lubbock City Health Department 1902 Texas Avenue ' P.O. Box 2548 Lubbock, Texas 29408-9961 Dear Ms. Foske: I am writing to follow-up on our earlier conversations regarding establishing collaboration between the City of, Lubbock Health Department• and the South Plains AIDS Resource Center (SPARC). It is "my ^understanding this is for a. grant request that you "are submitting to"theyTexas Department of -Health for `HNprevention counselin and testing. _SPARC fully endorses. this _< collaboration and we are eager to begin the`work South Plains AIDS Resource Center will collaborate in the following activities-:' 1. Offer --HIV prevention education when appropriate and requested by. the, City 'Health -Department. 2: Provide an HIV counselor_ to assist with counseling and testing after group presentations within the City of Lubbock when requested by the Health'Depart ment. - 3._ Share our resources (e.g.. video tapes, ,reading materials, etc) when appropriate - 4. Provide and share, when appropriate, information regarding resources available through our organization to individuals who are found to be HIV+. - 5. Provide client services to individuals that are found -to be HN seropositive and referred to SPARC by the City Health Department. - 6. Assist in the planning and implementation ofMV/AIDS activities planned for World AIDS Day and HIV Awareness Week. - I anticipate that this collaboration will bring the following advantages to the communities that we service: - _ A. We will be"able to reach a larger segment of the Lubbock community since City of Lubbock Health department provides services to a broad spectrum of the community. - .2. Individuals whom SPARC personnel educate' about the HIVinfection-and methods of preventing will have "on-site"'testing available to them immediately after receiving education, a time they are most likely to be interested in being tested. - 39 P.O. Box 6949 • Lubbock, Texas 79493 • (806) 796-7068 (800) 62757079 • FAX 796-0920 Appendix A - 3. Avoidance of duplication of services and materials by our organizations. - 4. Provide an additional mechanism for SPARC to reach the high risk populations with education and services. Thank you for this opportunity to collaborate. We look forward to working with your agency on this project. Sincerely, ' ��t-�►-- /1 • I�G %%�4. how Kathryn K. McMahon, Ph.D. Executive Director Mloutl 1409 23rd Street • Lubbock, Texas 79405 (806) 744-8633 ♦ FAX (806) 744-8667 August 8, 1996 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 Appendix B I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health department is'submitting to the Texas Department of Health, requesting funds to provide HIV Prevention Counseling and Partner Elicitation services in the city of Lubbock. The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. Offer the services of our Community Outreach Specialists to provide HIV Prevention Education in the communities of Central and East Lubbock. 2. Offer the services of our Community Outreach Specialists to accompany HIV Counselor in high-risk environments (street corners, alleys, parks, apartment complexes, bars, etc.) for point of contact HIV education and testing. 3. Offer the services of our facility to provide daily opportunities for on-site HIV Counseling and Testing during the lunch hour. 4. Offer the services of our Community Outreach Specialists to provide HIV Prevention Education at the Lubbock County Community Correctional Facility prior to on-site testing by the HIV Counselor. 5. Offer the services of our Food Pantry and Clothes Closet for Homeless/Indigent among the at -risk target population contacted by the HIV Counselor 6. Share our resources (Video Tapes, monitor, materials, etc.) when appropriate to assist the HIV Counselor in providing Counseling and Partner Elicitation and Testing. 7. Offer the bulletin board and agency newsletter to provide additional HIV Prevention Education to our clientele and the services offered by the City of Lubbock Health Department. Outcomes of these activities: -Our clients will become better informed about HIV/AIDS -Clientele served will have a testing opportunity available that is more accessible to them. -Clientele of the Central Lubbock Church of Christ Inside Out Program will have knowledge of another agency in town and the services offered by the City of Lubbock Health Department. There is an ongoing need for HIV Prevention Counseling and Partner Elicitation for IDUs, High Risk females, MSM of Color, and Gang members. Please accept this letter of collaboration in a spi ' of support for this important agency, the City of Lubbock Health Department. S• Gere , I L " Executive Director, fj ide Out Program 40 "Real Change Takes Place From The Inside Out" " Flores Marftza +bm Offer space for HIV testing and counseling � 1a when appropriate. William (Wall» Wein v� lrt,a LM Include HIV testing -at CFS presentations, Stalls L VWO when appropriate. Marviano Morales Sister Mary Kathleen Small Ed""naTheny - Refer and encourage our clients to utilize the services of City of Lubbock Health Department which include: TB screening, STD screening, immunizations and HIV Early Intervention clinic. - Share our resources (video tapes, TV, VCR, materials, etc.) with the City of Lubbock Health Department, when appropriate. 2. Outcomes of these activities: - Our clients will have better opportunities to be tested for HIV if testing is carried out "in house". • Persons that might not be reached by the City of Lubbock Health Department will be reached as a result of the City of Lubbock Health Department staff sharing part of a MEMBER CFS agenda._ 41 Catholic Charities Y USA102 Avenue J, Lubbock, Texas 79401 (806) 765-8475 Fax(806)765-8630-55 August 8, 1996 SWW of'b0d` P&ido Rodriguez TO WHOM IT MAY CONCERN: Executive Ste May. `i►cSW I am writing this letter of collaboration in relation to the grant request that the City of BOARD OF DIRECTORS Lubbock Health Department is submitting to the President Texas Department of Health, requesting funds RkftWYbarra to provide HIV\AIDS services. Catholic Family Vice -President o Service, Inc. will collaborate with the Arlene Brooks Treasurer following services: . Lewis Eggenberger a Olivae ht 1. Activities: " Flores Marftza +bm Offer space for HIV testing and counseling � 1a when appropriate. William (Wall» Wein v� lrt,a LM Include HIV testing -at CFS presentations, Stalls L VWO when appropriate. Marviano Morales Sister Mary Kathleen Small Ed""naTheny - Refer and encourage our clients to utilize the services of City of Lubbock Health Department which include: TB screening, STD screening, immunizations and HIV Early Intervention clinic. - Share our resources (video tapes, TV, VCR, materials, etc.) with the City of Lubbock Health Department, when appropriate. 2. Outcomes of these activities: - Our clients will have better opportunities to be tested for HIV if testing is carried out "in house". • Persons that might not be reached by the City of Lubbock Health Department will be reached as a result of the City of Lubbock Health Department staff sharing part of a MEMBER CFS agenda._ 41 Catholic Charities Y USA102 Avenue J, Lubbock, Texas 79401 (806) 765-8475 Fax(806)765-8630-55 Appendix C --' - avoid duplication of spanish materials that Catholic Family Service has already developed\purchased and City.of Lubbock Health Department can use. Please accept this Letter of Collaboration in a spirit of support for this important City of Lubbock Health Department request to your organization. Sincerely,. OStephtn Hay Executive Director 41-A aN4HN4R Lubbock Regional Mental Health Mental Retardation Center Texas Department of Health HIV/STD Health Resources Division Austin, Texas 78756 To Whom It May Concern: August 12,1996 Lubbock Regional Mental Health and Mental Retardation is entering into this Referral Agreement with the City of Lubbock which indicates the referrals that we will reciprocate for the following: 1. Referrals for TB screening to City of Lubbock Health Department 2. Referrals for STD screening to City of Lubbock Health Department 3. Referrals for immunizations to City of Lubbock Health Department 4. Referrals for HIV prevention counseling and testing when appropriate (when personnel is unavailable and/or when needed after a small group presentations) to Lubbock MHMR. 5. City of Lubbock will refer clients who are needing alcohol and/or drug treatment to Lubbock MHMR. 6. City of Lubbock will make referrals to Lubbock MHMR for HIV education seminars that meet the target populations as requests are received. 7. City of Lubbock will refer clients seeking additional education on Bleach and Water cleansing to prevent HIV risk, and other blood-borne among IDUs to Lubbock MHMR. 8. Lubbock MHMR will refer partner elicitation services to the Disease Intervention Specialist at the City of Lubbock Health Department. We will agree to discuss any other referral needs that should develop in the contract years so that the needs of the community can be met. Sincerely, 4Na a of Repr senta ve (��- Lubbock Regional MHMR 42 aiw /4 j ?!L e Name o Repre entative City of Lubbock Health Department P.O. Box 2828 • 1602 10th Street • Lubbock. Texas 79408-2828 806/766-0310 All I:Clual Opportunity Employer Serving Cochran. Croshy, Hockley. Lubbock. Lynn Counties Appendix E y a TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER Student Health Services Thompson Hall Lubbock, Texas 79430 (806) 743-2860 Texas Department of Health HIV/STD Health Resources Division August 7, 1996 Austin, TX 78756 To Whom It May Concern: I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health Department is submitting to the Texas Department of Health, requesting funds to provide HIV prevention counseling and testing to the MSM (college -aged) and high-risk females. The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. Provide clerical assistance to make the appointments for HIV testing. 2. Provide office space in an area that is not highly visible or trafficked. This office area allows privacy, anonymity and confidentiality to those students who are interested in prevention counseling and testing. 3. Make referrals to the testing services provided on campus when involved in an HIV education program on campus. 4. Publicize the testing services offered in the University Daily, in the residence halls and within Student Health Services so that students are aware of the services. 5. Provide an additional trained HIV counselor to provide HIV testing one morning a week to meet the demand of testing requested. Outcomes of these activities: - Students will become better informed about HIV/AIDS. - Students will have a testing opportunity that is more accessible to them. - Students will have the opportunity to organize a risk -reduction plan for themselves, with the assistance of the HIV counselor. There is an ongoing need for HIV/AIDS education for college -aged MSM, high-risk females and other students that are at risk due to the increase in sexual experimentation and alcohol/drug use on college campuses. Please accept this Letter of Collaboration in a spirit of support for the City of Lubbock Health Department. Sincerely, Nam f Agency Representative 43 An EEO /Affirmative Action Institution __M - Captain Hollywood PO Box 6455 Main and X Lubbock, TX 79493 Texas Department of Health HIV/STD Health Resources Division August 6, 1996 Austin, TX 78756 To Whom It May Concern: I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health Department is submitting to the Texas Department of Health, requesting funds to provide HIV prevention counseling and testing to MSM (college -aged, of color and anglo). The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. To provide an area where prevention counseling and testing can occur on a monthly basis. 2. To promote the availability of testing on-site. 3. To make appropriate referrals for testing and/or prevention counseling when needed to the City of Lubbock Health Department. 4. To post information concerning HIV prevention, transmission, etc. provided by the City of Lubbock Health Department. 5. To make condoms provided by the City of Lubbock Health Department available to the clientele of the establishment. Outcomes of these activities: - Clientele will become better informed about HIWAIDS. - Clientele will have a testing opportunity that is more accessible to them. - Clientele will have a means of protecting themselves against HIV transmission. There is an ongoing need for HIV/AIDS education for the gay community. Please accept this Letter of Collaboration in a spirit of support for the City of Lubbock Health Department. Sincerely, 7-4 Name of Ag ncy iWresentative 44 LUBBOCK COUN'T'Y YOUTH CENTER 2025 North Akron Avenue Lubbock, Texas 79415 (806) 765-2500 Fax (806) 765-2560 August 9, 1996 Texas Department of Health HIV/STD Health Resources Division Austin, Ti 78756 To Whom It May Concern: ndix G - I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health Department is submitting to the Texas Department of Health, requesting funds to provide HIV/AIDS prevention counseling and testing to gang members, high risk females, MSM (adolescent) and IDU (incarcerated). The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. To provide an area where HIV prevention counseling and testing can occur on a monthly basis. 2. To promote the availability of testing on-site for those youth at risk for HIV infection. 3. To make information regarding HIV transmission, prevention, etc. from the City of Lubbock Health Department available to the incarcerated youth. Outcomes of these activities: -Inmates will be better informed about HIV/AIDS. -Inmates will have the opportunity to organize an HIV risk -reduction plan for themselves, with the assistance of the HIV counselor. -Inmates will have a testing opportunity that is more accessible to them. There is an ongoing need for HIV/AIDS education for our high-risk youth, specifically those with gang involvement. Please accept this Letter of Collaboration in a spirit of support for the City of Lubbock Health Department. Sincerely, it Name of Agency Representative 45 JOEL. TFtEvwo MANDY AsHLOCK CHIEF PROBATION OFFICER ASSISTANT CHIEF Pnaknm OFFICER TE Appendix H - LUBBOCK COUNTY COMMUNITY CORRECTIONS FACILITY STEVE RAMPY 3501 NORTH HOLLY AVENUE DIRECTOR LUBBOCK, TEXAS 79403 JIM HENDERSON �ocacov' 806 7615-3395 ASSISTANT DIRECTOR August 7, 1996 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 To Whom It May Concern: , I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health Department is submitting to the Texas Department Of Health, requesting funds to provide HIV prevention counseling and testing to IDU (incarcerated) and other men who have placed themselves at risk sexually due to their involvement with drugs (MSM, heterosexual). The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. To provide an area where HIV prevention counseling and testing can occur on a monthly basis. 2. To promote the availability of testing on-site. 3. To make information concerning HIV prevention, transmission, etc. from the City of Lubbock Health Department available to the inmates. Outcomes of these activities: -Inmates will become better informed about HIV/AIDS. -Inmates will have the opportunity to organize an HIV risk -reduction plan for themselves, with the assistance of the HIV Counselor. -Inmates will have a testing opportunity that is more accessible to them. There is an ongoing need for HIV/AIDS education in the inmate populations, specifically those with drug-related offenses. Please accept this Letter of Collaboration in a spirit of support for the City of Lubbock Health Department. S/ince /e,am Py... Chief Adult Corrections Officer Ev D. L. "SONNY" KEESEE SHERIFF EARL BARTLEY CHIEF DEPUTY DON ADDINGTON JAIL ADMINISTRATOR SHERIFF'S OFFICE L. m o l COUNTY LUBBOCK, TEXAS August 12, 1996 Texas Department of Health HIV/STD Health Resources Divsion Austin, Tx. 7876 To Whom It May Concern '-A - APRXIIMFFICE BOX 10536 TELEPHONE 767-1400 LUBBOCK, TEXAS 79408 FAX#: (806) 767-1453 I am writing this letter of collaboration in relation to the grant request that the City of Lubbock Health Department is submitting to the Texas Department of Health; requesting funds to provide HIV/AIDS prevention counseling and testing to IDU (sex workers and incarcerated) and high- risk women seeking trustee status at the Lubbock County Jail. The collaborating activities that we are willing to offer toward the success of the City of Lubbock Health Department program are as follows: 1. To provide an area where HIV prevention counseling can occur on a weekly basis, or as needed. 2. To make information regarding HIV transmission and prevention available. 3. To provide a private setting, when needed, for post-test seropositive counseling session and partner elicitation. Outcomes of these activities: -Female inmates will be better informed about HIV/AIDS. -Inmates will have the opportunity to organize an HIV risk -reduction plan for themselves, with the assistance of the HIV counselor. -Inmates will have a testing opportunity that is more accessible to them. There is an on-going need for HIV/AIDS education for the high-risk women, sex workers, and IDU populations. Please accept this Letter of Collaboration in a spirit of support for the City of Lubbock Health Department. Sincerely O /'4 . Name of Age y Reltiresentative Sir? Pain-, r"efte'r snapQ , HIV counseIor iot By GINA HOWARD AvalancheJouraal Tammy Cook-Foskey has made a noble attempt at turning her drab clinic office into something a little more homey. Framed pictures of her young• nieces. and nephews decorate a small bookcase. A light blue- Tamp sits next to her wedding photo, and posters cover much of the wall - space in her small ofli m at the : City . Health Department. Cook-Foskey is the person in Lubbock County who, -for the past 5v2 years, has summoned feelings of either rrlrtf or dread in the people she visits with; She it the city's HIV counselor, and in 1995 she was responsible for telling almost 1;800 people whether they were HIV-positive. Her bright smile and warm voice belie the tough, emotional job -the has to .do. The good news, is that of those 1,800 peo- ple, only five tested positive for the virus that causes AIDS. Still;, letting someone know he is positive is a big responsibility. "Those are never the easy days in my life," she said. But her job also can be rewarding. "I try to deal with the reality of HIV," Cook-Foskey said. "It's no longer a death sentence. They are now living 16 years really healthy, but they need to know" how to live with HIV. The number -if people coming into the clinic for testing is up this year, she said. Last year, the clinic averaged about 150 tests a month. This year, it is closer to 230. Since 1985, 440 people in Lubbock have tested positive for HN. Almost 200 con- tracted AIDS. And, of those, 116 1,nve died. - - If a person wants to get Lusted but can't come into the clinic — or is afraid to = then Cook-Foskey doesn't mind making a house call. Some people worry about who they might run into at the clinic on the corner of Texna Avenue and 19th Street, she said. "I will meet them wherr-pr they feel comfortable — at home, in a parking lot, even once in the Dillard's ladies' depart- ment," she said. Doug Goodman, the -city's director of health and community . services, said Cook-Foskey is tailormade for her job. "I can't think of anyone better for doing the kind of work she is doing," he said. "She is able to work with people from dif- ferent lifestyles and make them feel com- fortable and at ease." Making clients feel comfortable — through little things such as giving her of - Mt PnotdRobert I ft( Tammy Cook-Foskey has worker as an HIV counselor for the City Health Department for more thar five years.. -. flee a warm touch — is an important part of ensuring they come back for their re- sults. That'4 ^ne of the reasons Cook -Fos - key draws blood herself. It means one les: person for the client to hnr- fa talk to which can be important. e "Especially when they are worries about who they arP going to know (at the clinic). We try to involve as few people a: possible," she said. Just .last week, Cook-Foskey hit the streets of East Lubbock with a local church group, walking around looking fol people wanting to be tested "We testes seven in one hour." The 32 -year-old counselor grew up it Maine and earned her master's degree it counseling from Eastern New Mexico Uni- versity .in Portales. She was working in Plainview when the job in Lubbock opened. Each day, she makes the one-hour drive from her home in Olton to Lubbock.. She doesn't have r choice becauso her husband, Mike, L Olton's mayor. It. doesn't matter where the counseling and testing takes place, she said. "Many people don't get tested because they don't want to lose their family and friends," Cook-Foskey said. `They fear that no one is going to want to be arounc them anymoix ." For more information about AIDS m HIV, or for a confidential tPAt, call Cook Foskey at 767-2953 or call (800) 299 AMR May 3, 1996 Appendix K Pao 3 TAMMY FOSKEY H1V Counselor Has Good News for Most By Adam Richardson, TTU Intern HIV, the virus that causes AIDS, is a serious problem in the United States, and Lubbock is not immune to the disease. Tammy Foskey is the Health Department's HIV Counselor, a post she has held for five and half years. "Some of the positive aspects of my job are that I get to meet many different types of people, and most of the time I get to give them good news. I try to be as friendly as I can when they are in my office in. hopes that they will come back for their test results." she said. The good news is that of the 1,780 people Tammy tested last year for HIV, only five tested positive. Because of her friendly manner, she has the highest return rate in the state of people who come in for a test and then come back for the results. Since 1985. Lubbock has reported 489 people affected by the AIDS virus. which is relatively low compared to the fact that one in every 250 Texans is HIV positive. In addition to testing, Tammy also helps educate the community about the dangers and risks involved with the virus. "Most of the young people that I counsel don't know the dangers associated with HIV," Tammy said. "They are never taught what is safe behavior and what is unsafe." "Kids are not getting HIV information and sex education from the right people", she says. "Parents must get involved." According to Tammy, most of the people affected with AIDS in Lubbock range in age from 22 to 45. About 30-40% of those con- tracted the disease from using contaminated drug needles. For more information about AIDS. or for a confidential test. call Tammy at ext. 2953. Or call 1 -800 -299 -AIDS for additional information. . 49 Classified OD: Notices his sedlon ae tm to CttY.� Deadline Is 9:00 pm. Friday prior to payday. pkass Isdt to 23 words. !ring your ads to Public latormatioo, Room 102, City Nall, or call Nary Gonzales, ext. 2293. We wig not accept advertising related to for-prott businesses such as Amway. Nary Kay, etc. SILVER-PLATED FLUTE FOR SALE: Great for beginner, $500. Call 792-8421 after 4:30. 513 NORDIC TRAK PRO SKI machine for sale: Sells new for $600, asking $300. Call 792-8421 after 4:30. 513 OAK CREEK LAKE 3 bedroom, 2 bath mobile home for sale. Sits under metal cover, 2 bams plus boat ramp. $65,000. Call John at 765-5273. 414 BASS BOAT FOR SALE: Side- winder, 35 horsepower, call Robert after 5 p.m. 762-1984. 414 New &&(B These nine new employees went through Orientation on April 30. Irene Brooks & Stacy Rolen Communication Services Edward Broussard Library Richard Casner City Attorney Mildred Cox Transportation Johnny Garcia Parks and Rec Adrienne Long Human Resources Florence Searcy City Secretary Jean Webb Aviation TDH News'' Cominued from page 5 community health clinics and family practice physician residency programs in Corpus Christi, El Paso, La Marque, Laredo, Fort Worth, San Antonio, San Marcos, Gonzales, Denton, Tyler, Austin, Amarillo and San Angelo. Program staff includes director Rick Danko, nurse consultant Crystal Wilkinson and health educator Barry Sharp who provide materials, training and technical assistance to funded sites. The three-year-old program is a U.S. Department of Health and Human Services -funded project. Phil Huang, M.D., heads the Bureau of Chronic Disease Prevention and Control. HIV counselor sets records How do you persuade people who choose HIV testing to return for post- test counseling? Ask City of Lubbock Health Department's Tammy Cook- Foskey. She blasts the standard 70 percent return tate with a whopping 80 to 95 percent return rate for post-test counseling. In January, March, May, June and November 1995, Cook-Foskey tested an average of 142 clients a month and about 127 clients a month returned for HIV post-test counseling. Cook-Foskey's supervisor credits her attitude. "Tammy's attitude is always upbeat and positive, which is crucial when you see people on a daily basis who live a. life of high-risk behavior. Tammy goes out of her way to make everyone feel they.are the most important person of the day. She takes time to listen to what the client is %a%m; and allows clients all the time the% need to ventilate fears or con - Appendix L May 1996 TDH Pulse Monitor l c LL Lubbock Health Department HIV counselor Tann, Cook-Foskey gets an 80 to 95 percent return rate from her clients for post-test HIV counseling. About 70 percent is typical. terns," says Prevention Manager Beckie Brawley. Cook-Foskey has worked as an HIV counselor with the Lubbock Health Department for nearly six years. Clients appreciate her attitude, her interest in their problems and her willingness to test at times convenient for them. Cook-Foskey demonstrates every day that quality service and attention to customer needs yields I utstanding results, says Brawley. March of Dimes Birth Defects Foundation funds health record Thanks to the generosity of the March ofDimes Birth Defects Founda- tion. Texas parents now have a 50 L= • tai lith i i>fai convenient way to keep track of their children's immunizations and other medical and family records. The 16 - page "My Child's Health Record" was underwritten with a $50,000 grant from the March of Dimes Birth Defects Foundation. Besides immuni- zation records, the passport -size booklet has pages devoted to family history, important baby milestones, medical history and baby's photo and thumbprint. Communications and Special Health Initiatives director Lynn Denton and Commissioner David Smith, M.D., traveled to Corpus Christi and Houston in March and to Midland, Amarillo, San Antonio and Lubbock in April to publicize "My Child's Health Record." Dallas and Longview trips are planned for May to promote the message that if parents of every child born in the next four years use the booklet, immunization rates for 2 year olds could improve as much as 25 percent. Alice White and Jay Fowler of the Communications and Special Health Initiatives Division accompa- nied Denton and Smith to Midland and Amarillo, and Kathy Clement of the Bureau of Women and Children went to Corpus Christi. Gale Morrow and Bob Crider of the Immunization Division and Lupe Manduiano Garcia of the Communications and Special Health Initiatives Division will go to San Antonio and Lubbock to help educate health care professionals and parents. The child health record has been a project of the Immunization Division. EPSDT Program and Shots Across Texas. One million copies of the booklet. in English and Spanish. will CITY OF LUBBOCK HEALTH DEPARTMENT REFERRAL CLIENT NAME/NUMBER(CHART/CDC): REFERRAL TO: DATE AND TEVIE LA CLINICA: SPARC: LUBBOCKMHMR: INSMEAOUT: PRESBYTERIAN WOMENS CLINIC: IMMUNIZATION CLINIC: TB TESTING: STD CLINIC: MINA: PRIVATE PHYSIMN: COUNSELOR: OTHER: TEST SITE LOCATIONAND CODE#: COUNSELOR AND CODE#: DATE: 51 Appendix M David R. Smith, M.D. Commissioner Carol S. Daniels Deputy Commissioner for Programs Roy Hogan Deputy Commissioner for Administration July 16, 1996 may: Texas Department of Health Bureau of HN & STD Prevention 1100 West 49th Street Austin, Texas 78756-9987 (512) 490-2505 Fax N (512) 490-2544 Mr. Doug Goodman, Director Lubbock Health Department 1902 Texas Avenue Lubbock, Texas '79405 Re: TDH Document #750005906-97-011 Dear Mr. Goodman: JUS 29 1996 CITy N��1 r ' rl JEPT Appendix P1 -M „ HIV/STD Epidemiology Division (512) 490-2545 - Fax (512) 490-2536 HIV/STD Health Resources Division (512) 490-2515 - Fax (512) 490-2538 Pharmacy Division (512) 458-7500 - Fax (512) 458-7489 Thank you and your staff for the assistance provided to the Texas Department of Health, Field Operations Branch during the Counseling, Testing, Referral and Partner Elicitation (CTRPE) site visit on April 22 and 23, 1996. Enclosed is a copy of the official site visit report. Ms. Billie Ray, Regional HN Coordinator, and. Mr. Cedric Mitchell, Field Operations Consultant will be available to work with you and your staff to accomplish any recommendations made during the review. If you have any questions or concerns, don't hesitate to contact Ms. Ray, at (806) 744-3577 or Mr. Mitchell at (512) 490-2520. Thank you again for the assistance of the staff at thP� phandla 111.,mWwed-n making this a productive visit.%�-- W e C1,; d, 1>e -r- Gsrr-j n-1 r.n Please submit a response to this site visit report within the next 45 days detailing corrective action to meet the recommendations. Mail your response to Ms. Ray at 1109 Kemper, Lubbock, Texas 79403, with a copy to Mr. Mitchell at the HN/STD Health Resources Division, Texas Department of Health, 1100 W. 49th, Austin, Texas 78756. Sincerely, J Zumbrun, anager Field Operations Branch HN/STD Health Resources Divisions Enclosure cc: Ms. Billie Ray, HN Coordinator, PHRI Contract File 52 An Equal Employment Opportunity Employer Appendix N 0 on 9 :D' W b z� 0JQ CD o Aa a . � W �. rD a NOD 'S rA b• O � X>1 XX o 0 Appendix N W b z� C a� E . o U z 'Q 'z 0 z cis«S a, R+ p N •� ob " ,� :ago; 'd a •..,cc 43 .o a a� •i. .; U •a o 8a oIZ342 it a cc I `C p =p 4; w p4 o �, .' 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M U� U ¢� E a� �'N °H' P u d� G7 E-4.5 Z H a2 w 3 t!: 157 d 'z O z b a 58 --M . U . \p r --* Appendix N TEXAS DEPARTMENT OF HEALTH BUREAU OF HIV AND STD PREVENTION CTRPE PROGRAM REVIEW DATE OF REVIEW: April, 22 1996 CONTRACTOR: City Of Lubbock Health Department LOCATION: Lubbock, Texas COUNTIES SERVED: Lubbock PERIOD OF CONTRACT: 01/01/96 - 12/31/96 CONTRACT NUMBER: 756000590697-01 CTRPE CONTRACTOR SINCE: Fall 1988 AGENCY DIRECTOR: Mr. Doug Goodman REGIONAL HIV COORDINATOR: Ms. Billie Ray REVIEWER(S): Mr. Cedric L. Mitchell III A. ADMINISTRATIVE 1. HIV COUNSELING AND TESTING REPORT FORMS (SCANNABLE FORMS) ARE UTILIZED ACCORDING TO TDH GUIDELINES AND INSTRUCTIONS. FORMS ARE ACCURATELY COMPLETED AND SUBMITTED AS SOON AS THE CLIENT IS POSTTEST COUNSELED OR THIRTY (30) DAYS FROM THE DATE OF PRETEST COUNSELING IF THE CLIENT HAS NOT RETURNED FOR POSTTEST COUNSELING. Yes X No Comments: Contractor has utilized scanable forms in an appropriate manner. Forms are accurately completed and up to date. 59 Appendix N Recommendations: 2. THE AGENCY HAS A POLICY OF COMPLIANCE WITH THE REQUIREMENTS FOR CONTENTS OF AIDS -RELATED WRITTEN MATERIALS (STATE CONTRACTS ONLY). Yes No Comments: Non- Applicable- Agency has a federal contractual agreement with TDH. Recommendations: 3. THE AGENCY HAS A POLICY COMPARABLE TO THE TDH HIV MODEL WORKPLACE GUIDELINES.. Yes_X_ No Comments: Agency has adopted the TDH HIV model workplace guidelines. Recommendations: B. PERSONNEL AND STAFFING 1. THE AGENCY MONITORS COUNSELOR PERFORMANCE AT LEAST MONTHLY FOR MONTHS 1-6 OF EMPLOYMENT, BI -MONTHLY FOR MONTHS 7-12, AND QUARTERLY THEREAFTER. COUNSELOR EVALUATIONS ARE KEPT ON FILE AND AVAILABLE FOR TDH REVIEW. NECESSARY CHANGES ARE MADE BY THE HIV PROGRAM TO CORRECT ANY WEAKNESS/DEFICIENCIES IDENTIFIED. Yes No X Continents: Presently there are no current counselor performance evaluations on file that are current. Recommendations: Quarterly reviews have been completed by the immediate supervisor. However MEG Appendix N there were no reviews on'file within the past 90 days. It is recommended that a performance review be completed on the. HIV Counselor and kept on file. There will be a records check to follow-up on this action item. 2. HIV PRETEST AND POSTTEST COUNSELING IS CONDUCTED BY STAFF WHO HAVE SUCCESSFULLY COMPLETED CTRPE TRAINING AND REQUIRED UPDATES FROM A COURSE APPROVED BY THE TDH. Yes . X No Comments: Tammy Foskey ( HIV/STD Counselor) has completed the 1 and 2 day updates for CTRPE training. The counselor has also completed the new POPE course, March 28, 1996. Recommendations: 3. SCANNABLE FORMS OR OTHER HIV RISK ASSESSMENT TOOLS ARE NOT USED TO DRIVE HIV COUNSELING SESSIONS. Yes X No Comments: Scannable forms are not used to drive HIV counseling sessions. Recommendations: C. PLANNING AND EVALUATION 1. QUARTERLY. SUMMARY REPORTS ARE SUBMITTED BY THE PROGRAM IN ACCORDANCE WITH CONTRACTUAL AGREEMENTS. Yes X No 61 Appendix N Comments: Quarterly reports are received within the guidelines of the RFP. Recommendations: 2. CTRPE SERVICES ARE PROVIDED TO THE TARGET POPULATIONS STATED IN THE PROGRAM'S CONTRACT AND OBJECTIVES. Yes X No Comments:. During the site evaluation several counseling sessions were observed separately by Billie Ray and Cedric Mitchell. The individuals interviewed were all IDU's, only one target population stated in the programs contract and objectives. Recommendations: It is recommended that future counseling sessions be observed by the TDH in non-traditional settings. This will be coordinated through the region by the Regional Coordinators office. This will eliminate any conflicts in scheduling and offer any needed assistance by the agency being evaluated. 3. A MINIMUM OVERALL POSTTEST COUNSELING RETURN RATE OF 75 PERCENT AND A MINIMUM SEROPOSITIVE RETURN RATE OF 85 PERCENT ARE MAINTAINED BY THE PROGRAM. Yes X No Comments: Posttest counseling return rate is 86% for 1995 and 91% for 1996 based upon information taken from the scannable forms. The seropositive return rate - 80% for 1995 and 1996 100%. Recommendations: 4. ALL SEROPOSITIVE AND PARTNER ELICITATION/NOTIFICATION ACTMTIES ARE PERFORMED IN ACCORDANCE WITH THE TDH "HIV SEROPOSITIVE AND PARTNER NOTIFICATION GUIDELINES." CONTRACTORS SHOULD BE ABLE TO REPORT THE NUMBER 62 Appendix N OF PARTNER/SEROPOSITIVE NOTIFICATION REQUESTS REFERRED TO THE HEALTH DEPARTMENT. Yes X No Comments: 1 st Qtr positives - 3 Referral to the Health Dept. - 3 Recommendations: D. CLIENT SERVICES AND REFERRALS 1. HIV COUNSELING AND TESTING SERVICES, INCLUDING OFF-SITE TESTING, ARE OFFERED AT LOCATIONS THAT ARE CONVENIENT FOR THE MAJORITY OF THE TARGET POPULATIONS. Yes X No Comments: The counselor provides off-site counseling and testing to a diverse group of agencies within the Lubbock area. A list of these agencies are listed in section (F) of the quarterly report. Those agencies include PASO, Amar-i-luo Area Health nistrint Projea A W-A.of Oth .*e s 1,-N 5: d e, /C% -t-4 Tf- c,- P% L4 t') i v ars Ycl .-�!� C'tr� rem'' �,�,1 jh �:c� v��-cl'1 fy C.c..TY► r1't ul"1 i Fy G��r c G is i Recommendations: Fc� cr 4' I �' h+ . C c� 1-�►'� I-1 c� ��► ►fv � c-:c� L u l� c/�.- t=.�"-�1 i �x.J 2. CTRPE SERVICES ARE REGULARLY PUBLICIZED/PROMOTED SO THAT POTENTIAL CLIENTS WILL KNOW WHERE AND WHEN SERVICES ARE AVAILABLE. Yes X No Comments: CTRPE services are publicized through a network of collaborative agencies to include health care providers, community based organizations, bars, etc. Recommendations: 63 Appendix N -_. 3. WAITING AREAS HAVE POSTERS, PAMPHLETS AND AUDIOVISUALS THAT PROVIDE CLIENTS WITH INFORMATION REGARDING HIV/AIDS, STDs, AND OTHER DISEASES FOR WHICH THEY MAY BE AT RISK. THE EDUCATIONAL MATERIAL PROVIDED IS CULTURALLY SENSITIVE AND EASILY UNDERSTOOD. Yes X No Comments: Recommendations: 4. CLIENTS HAVE THE OPTION OF TESTING ANONYMOUSLY OR CONFIDENTIALLY. IDENTIFYING/LOCATING INFORMATION IS OBTAINED FROM CLIENTS WHO TEST CONFIDENTIALLY. Yes X No Comments: The clients choice of testing is repeated to each client in the counseling session. This assures the client that every possible action is taken to insure their confidentiality is maintained. Recommendations: 5. Client confidentiality is ensured during the registration process and the counseling session. Yes X No Comments: A numerical system is used for client identification. All counseling sessions are conducted in private offices. Recommendations: 6. CLIENT TESTING RECORDS ARE MAINTAINED IN A LOCKED FILING CABINET WITH ACCESS LIMITED ONLY TO APPROPRIATE COUNSELING STAFF. THESE RECORDS AND FILES, Appendix N - . WHETHER CONFIDENTIAL AND/OR ANONYMOUS ARE MAINTAINED AND RELEASED TO CLIENTS IN A MANNER THAT IS CONSISTENT WITH REGULATIONS SPECIFIED IN THE TDH "111V SEROLOGIC TESTING AND DOCUMENTATION GUIDELINES." Yes X No Comments: Locked filing cabinets for clients files are located in the counselor's office with accesibility only to the immediate supervisor and the manager of the program. Recommendations: HIV COUNSELING 1. EVERY CLIENT IS PROVIDED CULTURALLY SENSITIVE AND EFFECTIVE MV PRETEST AND POSTTEST COUNSELING BASED ON THE TDH APPROVED MODEL. Yes X No Comments: Recommendations: 2. CONDOMS PROVIDED BY THE TDH ARE GIVEN FREE OF CHARGE (SIX PER CLIENT) ALONG WITH SAFER SEX EDUCATIONAL INFORMATION/MESSAGES. Yes X No Comments: Recommendations: REFERRALS 65 Appendix N 1. THE CT"E PROGRAM SUCCESSFULLY COLLABORATES WITH HIV/AIDS, STD, AND OTHER RELATED PROGRAMS IN THE COMMUNITY (E.G. MWAIDS SERVICE PROVIDERS, HEALTH DEPARTMENTS, CBO'S, EDUCATIONAL PROVIDERS, ETC.). Yes . X No Comments: Recommendations: 2 THE PROGRAM MAINTAINS DOCUMENTATION REGARDING THEIR SEROPOSITIVE CLIENTS WHO ARE SUCCESSFULLY LINKED TO EARLY INTERVENTION SERVICES. A SYSTEM IS IN PLACE FOR REFERRAL OF HIGH RISK SERONEGATIVE CLIENTS TO OTHER SERVICES AS NEEDED (E.G. STD, TB, SUBSTANCE ABUSE TREATMENT, ETC.. Comments: Appendix B Counselor uses newly revised forms for this information. Recommendations: filename: g:ltoo11o1slctrptoo1.wpd Rev. 2/5/9 .: Yes X No Appendix 0 PREGNANCYPROTOCOL PREGNANCY TESTING IS AVAILABLE MONDAY, WEDNESDAY AND FRIDAY AT THE CITY OF LUBBOCK HEALTH DEPARTMENT. IF THE CLIENT IS PREGNANT: REFERRALS ARE MADE TO AREA PHYSICIANS (SEE APPENDIX ) FOR PRENATAL CARE. APPOINTMENT IS MADE FOR THE CLIENT BEFORE THEY LEAVE, IF THE PHYSICIAN'S OFFICE IS OPEN. THE SURVEILLANCE DEPARTMENT HAS A SPECIFIC NURSE ASSIGNED TO FOLLOW-UP ON THE CLIENTS WITH POSITIVE PREGNANCY TEST RESULTS. HER RESPONSIBILITIES INCLUDE: ASSURING THAT THE CLIENT KEPT HER APPOINTMENT WITH THE PHYSICIAN, ANSWERING ANY ADDITIONAL QUESTIONS THAT THE CLIENTS SHOULD HAVE, REINFORCING THE IMPORTANCE OF PRENATAL CARE IF THE CLIENT SHOULD NOT HAVE KEPT HER APPOINTMENT. PHYSICIANS ARE PERFORMING HIV TESTING AT THE FIRST PRENATAL VISIT. IF A WOMAN IS HIV+ AND IS IDENTIFIED BY HER PHYSICIAN AT HER PRENATAL VISIT, THE PHYSICIAN WILL PROVIDE THE NEEDED CARE OR MAKE A REFERRAL TO A PHYSICIAN /CLINIC THAT WILL PROVIDE THE PRENATAL CARE. IF A WOMAN IS IDENTIFIED AS HIV+ AT THE CITY OF LUBBOCK HEALTH DEPARTMENT AND IS PREGNANT: -REFERRAL IS MADE TO THE TTUHSC OB/GYN CLINIC AND FOLLOW-UP IS COMPLETED BY THE HIV COUNSELOR OR -REFERRAL TO HER PRIVATE PHYSICIAN, IF DESIRED, AND FOLLOW-UP IS COMPLETED BY THE HIV COUNSELOR -INFORMATION REGARDING AZT THERAPY TO PREVENT HIV TRANSMISSION TO THE FETUS AND BREASTFEEDING ARE GIVEN TO THE CLIENT -FURTHER REFERRALS ARE MADE AS NEEDED AND DESIRED BY THE CLIENT 67 FAMILY PRACTICE PRENATAL CLIIJIC TEXAS OTT HEALTH SCIENCES CENTER PRESBYTERIAN PRENATAL CLINIC 3RD �� 4TH II+IDIANA CLINIC ' 1318 BROADWAY Appendix P -- , 765-2611 743-2343 PARKWAY CLINIC 406 MARTIN LUTHER KING BLVD 767-9744 DR MIRO 2424 SOTH ST,STE 301 795-3299 DR •SCOTT 2424 50TH ST, STE 200 792-7115 DR BOTROS 6630 QUAKER, STE 207 793-2971 HEALTH PLUS 7601 QUAKER 79424 793-5444 MINOR EMERGENCY CENTER SM & IINIVERSM 79413 797-4357 CATHOLIC FAMILY SERVICES 123 N. AVE N. 765-8425 EXPRESS CARE 5705 SLIDE RD. 79414 795-5844 PRIMARY MEDICAL CLINIC 5130 82ND 79424 794-9378 FREEDOM SQUARE CLINIC 130150TH ST. 762-3597 ST MARY FAMILY HEALTH CARE CENTER 6502 SLIDE RD 79424 796-4400 68 DR VARMA 2424 50TH ST, STE 302 791-5537 DR PATEL' 3106 50TH ST. Y97-2835 DR MCMIIZdAN 6630 QUAKER, SM 207 797-2794 METHODIST CIELDREN 3801 19TH & MEMPMS, STE 111 79410 785-5437 TEXAS TECH HSC FEDI amm 36014TH 743-2330 CHATMAN CONDAUNTTY HEALTH CLINIC 230 S. CEDAR 79404 749-0024 9 TO 9 MEDICAL CLINIC 4410 50TH 79414 793-8555 ST. MARY FAMILY HEALTH CARE CENTER 405 SLIDE RD 79416 796-4410 ST. MARY FAMILY HEALTH CARE CENTER 36201-27 796-4450 Appendix % ffiV SEROPOSITIVE REFERRAL PROTOCOL FOR CLIENTS THAT TEST HIV SEROPOSITIVE (REACTIVE EIAx 2 AND REACTIVE WESTERN BLOT) THE FOLLOWING REFERRALS ARE MADE: - REFERRAL TO SPARC FOR CASE MANAGEMENT, EARLY INTERVENTION CLINIC APPOINTMENT, SUPPORT GROUP, FOOD PANTRY, UTILITY/HOUSING ASSISTANCE, MEDICATION ASSISTANCE, CARE CENTER ACTIVITIES, ETC. - REFERRALS TO PRIVATE PHYSICIANS IF DESIRED - REFERRALS TO LUBBOCK IVIS MR, NA/AA AS NEEDED FOR DRUG AND/OR ALCOHOL TREATMENT AND SUPPORT - REFERRALS FOR TB SKIN TESTING - REFERRALS FOR HVIMUNIZATIONS - REFERRALS TO PRIVATE COUNSELOR IF DESIRED - IF THE WOMAN IS PREGNANT, REFERRAL IS MADE TO THE TTUHSC OB/GYN CLINIC FOR PRENATAL CARE - REFERRAL FOR BIRTH CONTROL, PAP SMEAR, ETC. IF NEEDED OTHER INFORMATION GIVEN: NUTRITION INFORMATION PARTNER ELICITATION (INVOLVEMENT OF DIS WHEN NECESSARY) -TELLING YOUR PARENTS -LEGAL RESOURCES -ADDITIONAL INFORMATION (POSITIVELY AWARE, POZ, LIFETIMES II, ETC.) REFERRALS ARE MADE AND APPOINTMENTS ARE MADE AS NEEDED FOR THE CLIENT BEFORE HE/SHE LEAVES THE OFFICE. AN ADDITIONAL APPOINTMENT IS MADE FOR NO LATER THAN ONE WEEK LATER TO ADDRESS ANY FURTHER QUESTIONS, NEEDS, ETC. AND TO FOLLOW UP ON REFERRALS THAT WERE MADE. .• TEXAS DEPARTMENT OF HEALTH Appendix R PARTNER ELICITATION / PRENATAL REFERRAL REPORT FORM SECTION 1: 1. NAME OF ORGANIZATION: 2. CTS ORGANIZATION NUMBER: 3. DATE OF POSTTEST COUNSELING: 4. POSTTEST COUNSELOR IDENTIFICATION NUMBER: SECTION 2: 5. CLIENT'S SCANNABLE FORM (CDC) NUMBER: 6. SEX: MALE FEMALE UNKNOWN * (IF CLIENT IS FEMALE, SEE SECTION 4) SECTION 3: 7. NUMBER OF PARTNERS ELICITED TO BE NOTIFIED BY A LOCAL OR STATE STD PROGRAM: TOTAL 8. NUMBER OF PARTNERS TO BE NOTIFIED BY THE INDEX CLIENT: TOTAL SECTION 4: 9. THIS WOMAN IS PREGNANT? YES NO 10. IF PREGNANT, WAS REFERRED FOR PRE -NATAL CARE? YES NO. SECTION 5: This form must be completed after each positive posttest counseling session and submitted on a weekly basis to: Texas Department of Health HIV/STD Health Resources Division 1100 West 49th Street Austin, TX 78756-3149 Attn: Partner Elicitation 70 Appendix S S.T.D./HIV HIGH RISK QUESTIONNAIRE This is a questionnaire to find out if you may need HIV testing as part of your Sexually Transmitted Disease screening. Your answers will be reviewed by the clinician in the clinic and kept confidential. Please read and answer each question to the best of your knowledge. Circle "Y" for YES; Circle "NA for NO Y N Have you ever been the victim of a sexual assault or of sexual abuse? Y N Are you employed in a setting with a risk to HIV exposure? Y N Have you ever had sex with someone who is HIV positive? Y N Have you received a blood transfusion or tattoo prior to 1985? Y. N Have you ever been diagnosed with a sexually transmitted disease such as gonorrhea, chlamydia, genital warts, syphilis, herpes, etc. Y N Have you ever used IV drugs? Y N Have you ever traded sex for drugs and/or money? Y N Have you ever had sex while under the influence of drugs and/or alcohol? Y N Have you ever had sex with someone who uses IV drugs? Y N Have you ever had sex with a male who had sex with a male? Y N Do you travel and do seasonal work? Y N Are you or have you ever been homeless? When do you use condoms? Always _Occasionally _Never Y N Do you know how to put on a condom correctly? What risks do you have that are not stated on this questionnaire? Please list: When is the last time you had an HIV test? Date? Y N Would you like to have an HIV test as part of your STD exam today? 71 - - _ . - t _ =.•�" ice« para :�,''..p,ss w+�;F:� ate.,;» • Y ta 'August -7, 1996 _ 3 , f i ■ i ° i ,Ms. Tammy Foskey 1902 Texas Ave. ` P.Q. Box 2548 __. Lubbock, Texas 79408-9961 f rt RE: REFERRAL AGREEMENT Dear Ms. "Foskey South Plains AIDS Resource e - 1 - South Center SPARC) is entering "into this Referral Agreement-�- with the Lubbock City. Health Department. The agreement indicates the referrals that we will accept from the'City Health Department�include (( �• 1. Referrals for HIV -prevention education when -appropriate,, .,,`�� l :-- .'r` -.� • i s' .' ..e /"'. Tr ~' �.,.-; �-,. , tib_ 2. "Referrals for -IHV prevention counseling and testing to individuals at high'risk when ' �. appropriate (when City Health Department personnel is 6i avai'lable or when an individual from outside the city limits ofLubboek contacts your organization and it is more.appropriate-for SPARC to provide the service) _- -. 3". -Referrals to HIV+/PWAs for client services provided by SPARC including case management, _. ^HIV early intervention health care, housing/utihties assistance, medication" assistance,,support ., groups, food pantry, care center activities, etc. - SPARC will refer individuals from within Lubbock f 'r IIV preyentian counseling and/or ` - testing when appropriate. SPARC will refer individuals for TB and STD screening and for immunizations to the City Health Department when, appropriate We will be happy to discuss any other, referral needs that should develop during the -' contract year. This referral collaboration will ensure that;community needs >pe met: ` Sincerely, r o;,`V2,;i�� oe Kathryn K. McMahon, Ph.D. Executive Director 72 - - P.O. Box 6949 • Lubbock, Texas 79493 • (806) 796-7068 (800) 627-7079 • FAX 796-0920 IM11cout 1409 23rd Street ♦ Lubbock, Texas 79405 (806) 744-8633 ♦ FAX (806) 744-8667. Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 August 8, 1996 To Whom it May Concern: Appendix U , The Central Lubbock Church of Christ Inside/Out program is entering into this referral agreement with the City of Lubbock Health Department which indicates the referrals that we will accept from the City of Lubbock Health Department. 1. Referrals for HIV Prevention Education 2. Referrals for Substance Abuse/Addiction Counseling 3. Referrals for Peer Support Groups 4. Referrals for Food Pantry 5. Referrals for Clothing Assistance We will also refer clients to the City of Lubbock Health Department for services when appropriate. Sincerely, Central Lubbock Church of Christ Inside Out Program Name of Organization 73 B( . e9a-X4�� Executive Directo "Real Change Takes Place From The Inside Out" Diocese of Lubbock Bishop of Lubbock PLiccido Rodriguez Executive Director Stephen Hay, ACSW BOARD OF DIRECTORS President Vice -President Arlene Brooks Treasurer Lewis Eggenberger Secretary Alicia Oliva Knight Kathy Flores Maritza Gamboa Joe Garcia Joe Hart William (Wally) Klein Stephen T. Krier Velma Lara Stella Lovato Marciano Morales Sister Mary Kathleen Small Edwina Thierry MEMBER 6. Catholic Charities. USA ca". yai�-A . &Wim, TW's REFERRAL AGREEMENT August S, 1996 TO WHOM IT MAY CONCERN: Appendix V Catholic Family Service, Inc. is entering into this Referral Agreement with the City of Lubbock Health Department. This agreement indicates the referrals that we will accept from the City of Lubbock Health Department: 1. referrals for HIV\AIDS education to UHS migrants, gang and at -risk youth and high risk women. 2. referrals for presentations in Spanish, when appropriate. 3. referrals for medications to the Catholic Family Service Emergency Assistance Program, when appropriate. 4. referrals to other Catholic Family Service Programs (Immigration\Naturalization, Family Counseling, At -Risk Youth Counseling, Thrift Store, etc.) when appropriate. Sincerely, (Dte'- ph n Hay Catholic Family -Service, Inc. 74 102 Avenue J, Lubbock, Texas 79401 (806) 765-8475 Fax (806) 765-8630-55 96. Appendix X Health Department City of Lubbock 1902 Texas Avenue P.O. Boz 2548 Lubbock. Texas 79408-9961 Texas Department of Health H1V/STD Health Resources Division Austin, TX 78756 August 7, 1996 To Whom It May Concern: The City of Lubbock Health Department is entering into this Referral Agreement with the Central Lubbock Church of Christ Inside/Out program which indicates the referrals that we will accept from the Inside/Out program. 1. Referrals for TB screening 2. Referrals for HIV Prevention Counseling and testing 3. Referrals for STD screening 4. Referrals for immunizations 5. Referrals for the HIV Early Intervention clinic We will also refer clients to the Inside/Out program for services when appropriate. Sincerely, City of Lubbock Health Department Name of Organization 76 ,o .�� X - NameV *rcsentaUve I � t City of Lubbock 1902 Texas Avenue P.O. Box 2548 Lubbock, Texas 79408-9961 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 August 7, 1996 To Whom It May Concern: Appendix X Health Department The City of Lubbock Health Department is entering into this Referral Agreement with the Catholic Family Services, Inc. (CFS) HIV/AIDS Education Prevention Program which indicates the referrals that we will accept from the CFS HIV/AIDS Education Program: 1. Referrals for TB screening 2. Referrals for HIV Prevention Counseling and testing 3. Referrals for STD screening 4. Referrals for immunizations 5. Referrals for the HIV Early Intervention clinic We will also refer clients to the CFS HIWAIDS Education Project for services when appropriate. Sincerely, City of Lubbock Health Department 'q _ Name of Organization NameVP4brtsentifive 77 y7 r Appendix X Health Department City of Lubbock 1902 Texas Avenue P.O. Boz 2548 Lubbock, Texas 79408-9961 Texas Department of Health HIV/STD Health Resources Division August 7, 1996 Austin, TX 78756 To Whom It May Concern: I am writing this letter of collaboration in relation to the grant request that Catholic Family Service, Inc. is submitting to the Texas Department of Health, requesting funis to provide HIV/AIDS prevention education services to UHS Migrant Farmworkers, UHS Gang members and UHS High Risk Females. The collaborating activities and outcomes that we are willing to offer toward the success of the Catholic Family Service Program are as follows: Offer space for group and/or one to one presentations on HIWAIDS. - Encourage our clients to cooperate with HIWAIDS educator for one-to-one sessions, group sessions, etc. - Share our resources (video tapes, materials, TV, VCR, etc.) when appropriate, to assist the HIV/AIDS educator in providing educational services to our clients. 2. Offer our bulletin board in the STD Clinical area lobby to provide additional education to our clientele on the services offered by CFS and/or HIV -specific material that is relevant to the clientele served. 3. Offer the services of our HIV Counselor to provide on-site testing in Lubbock county, when needed and/or to provide a location to make referrals to when providing HIV Education in Lubbock county. Outcomes of these activities: - Our clients will become better informed about HIV/AIDS. - Clients will benefit from the use of up-to-date information via video tapes which are presented in a medium that many people like, that is, watching a video on TV. The discussion following the video will help to clear up any additional questions that might arise after viewing the video. - Clientele of the City of Lubbock Health Department will have knowledge of another agency in town and the services offered by Catholic Family Services. There is an ongoing need for HIV/AIDS education for migrants, gang members and high risk women. Please accept this Letter of Collaboration in a spirit of support for this important Catholic Family Service, Inc. Sincerely, Name of Ag6ncy Representative 78 Appendix X --W - Health Department City of Lubbock 1902 Texas Avenue P.O. Box 2549 Lubbock. Texas 7940e-9961 Texas Department of Health HIV/STD Health Resources Division August 7, 1996 Austin, TX 78756 I am writing this letter of collaboration in relation to the grant request that the Central Lubbock Church of Christ Inside/Out program is submitting to the Texas Department of Health, requesting funds to provide HN/AIDS prevention education services to MSM of color, UHS gang members, UHS High Risk females, and IDU (incarcerated, sex workers and homeless). The collaborating activities that we are willing to offer toward the success of the Inside/Out program are as follows: 1. Offer the services of our Hi V counselor to provide on-site testing at Inside/Out through the lunch hour Monday through Friday. 2. Offer the services of our HN counselor to provide on-site testing when the HIVeducators are providing outreach activities in the community of Lubbock. ' 3. Offer the services of our HN counselor to provide on-site testing at the Lubbock. County Community Correctional Facility after the HIVeducator has given a small group presentation to the inmates of the facility. 4. Share our resources (video tapes, materials, etc.) when appropriate to assist the HIVeducator in providing HIVprevention. 5. Offer the bulletin board in the STD Clinic lobby to provide additional education to our clientele on the services offered by Inside/Out and/or HIV -specific material that is relevant to the clientele served. Outcomes of these activities: - Our clients will become better informed about HN/AIDS. - Clientele served will have a testing opportunity available that is more accessible to them. - Clientele of the City of Lubbock Health Department will have knowledge of another agency in town and the services offered by the Central Lubbock Church of Christ Inside/Out program. There is an ongoing need for HN/AIDS education for IDUs, High Risk females and MSM of color and gang members. Please accept this Letter of Collaboration in a spirit of support for this important agency, Inside/Out. Sincerely, R'lifFill, 'i fly"VotIgmi 79 City of Lubbock 1902 Texas Avenue P.O. Boz 2546 Lubbock, Texas 7940e-9961 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 To Whom It May Concern: August 7, 1996 Appendix X Health Department I am writing this letter of collaboration in relation to the grant request that the South Plains AIDS Resource Center is submitting to the Texas Department of Health, requesting funds for HIV Prevention Education and Testing for MSM (adolescent, of color, college -aged and anglo), for those men who are non -identifying MSM, and those who are seeking sex for money. The collaborating activities and outcomes that we are willing to offer toward the success of SPARCs programs are as follows: 1. Provide an HIV counselor to assist with testing needs after a small group presentation within the City of Lubbock. 2. Share our resources (video tapes, materials, etc.) when appropriate to assist the HIV educator in providing I V prevention. 3. Offer the bulletin board in the STD Clinic lobby to provide additional education to our clientele on the services offered by SPARC and/or HIV -specific material that is relevant to the clientele served. 4. Assist in the organization of a support group for high-risk seronegative persons (MSM) 5. Assist in the planning and implementation of HIWAIDS activities planned for World AIDS Day (December 1) and HIV Awareness Week (October). 6. Provide an HIV counselor, as needed, to assist with Testing Marathons. Outcomes: - Community will see that cooperation exists between agencies in the City of Lubbock in providing HIV education and prevention counseling and testing. - Clientele of the City of Lubbock Health Department will have knowledge of another agency in town and the services offered by SPARC. - HIV counseling will able to be offered to additional persons due to the number of available counselors. - High risk seronegative MSM will. have additional support to maintain their negative status. - Increased visibility in the community when specific HIV/AIDS activities are planned. There is an ongoing need for HIV/AIDS education and testing for MSM and sex workers, especially in the surrounding counties that make up the 15 county Health District. Please accept this Letter of Collaboration in a spirit of support for this important agency, SPARC. Sincerely, Name of Agericy Representative City of Lubbock 1902 Texas Avenue P.O. Box 2546 Lubbock, Texas 7940e-9961 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 To Whom It May Concern: August 7, 1996 Appendix X Health Department The City of Lubbock Health Department is entering into this Referral Agreement with the South Plains AIDS Resource Center (SPARC) which indicates the referrals that we will accept from SPARC: 1. Referrals for TB screening 2. Referrals for STD screening 3. Referrals for HIV prevention counseling and testing when appropriate (when personnel is unavailable and/or when a Lubbock agency is requesting testing in coordination with a small group presentation given by the HIV Educator of SPARC) 4. Referrals for immunizations The City of Lubbock Health Department will refer HIV seropositive clients to SPARC for case management, appointments for the Early Intervention clinic, support groups, medication and assistance with SSI, Disability, Medicaid and Medicare forms. The City of Lubbock Health Department will make referrals to SPARC for HIV Education seminars that meet the target populations as requests are received. The City of Lubbock Health Department will refer persons outside of Lubbock county requesting education seminars and/or HIV prevention counseling to SPARC when appropriate. The City of Lubbock Health Department will also refer persons seeking additional information on HIV/AIDS research trials, etc. to SPARC if funding is received from the National Library of Medicine to organize a computer link to the latest HIV/AIDS related material. We will agree to discuss any other referral needs that should develop in the contract. year so that the needs of the community can be met. Sincerely, City of Lubbock Health Department Name of Organization Name of Represenfive 81 Appendix X M / Health / Department City of Lubbock 1902 Texas Avenue P.O. Boz 2548 Lubbock. Texas 79408-9961 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 To Whom It May Concern: The City of Lubbock Health Department is entering into this Referral Agreement with Lubbock Mental Health and Mental Retardation (IV MR) which indicates the referrals that we will accept from MHMIL 1. Referrals for TB screening 2. Referrals for STD screening 3. Referrals for immunizations 4. Referrals for HIV prevention counseling and testing when appropriate (when personnel is unavailable and/or when needed after a small group presentation) • The City of Lubbock Health Department will refer clients who are needing alcohol and/or drug treatment to Lubbock WIME . • The City of Lubbock Health Department will make referrals to Lubbock MHIAR for HIV education seminars that meet the target populations as requests are received. • The City of Lubbock Health Department will refer clients seeking additional education on Bleach and Water cleansing to prevent HIV risk, and other blood-borne infections among IDUs. We will agree to discuss any other referral needs that should develop in the contract year so that the needs of the community can be met. Sincerely, City of Lubbock Health Department Name of Organization 82 Name of R6preseniatrve City of Lubbock 1902 Texas Avenue P.O. Boz 2546 Lubbock. Texas 79406-9961 Texas Department of Health HIV/STD Health Resources Division Austin, TX 78756 To Whom It May Concern: August 9, 1996 Appendix X Health Department I am writing this letter of collaboration in relation to the grant request that Lubbock A*DvM is submitting to the Texas Department of Health, requesting funds for IRV Prevention counseling and testing for IDU (incarcerated, sex workers, homeless) and others at high risk for IRV due to their alcohol and/or drug use. The collaborating activities and outcomes that we are willing to offer toward the success of Lubbock hO VIR's programs are as follows: Share our resources (video tapes, materials, etc.) when appropriate to assist with HIV education and prevention counseling. 2. Accept referrals for prevention counseling and testing when appropriate. Offer the bulletin board in the STD Clinic lobby to provide additional education to our clientele on the services offered by Lubbock 11MM'and/or HIV -specific material that is relevant to the clientele served. Outcomes: -Community will see that cooperation exists between agencies in the City of Lubbock in providing HIV education and prevention counseling and testing. -Clientele of the City of Lubbock Health Department will have knowledge of another agency in town and the services offered by Lubbock W&R -Clients will be better informed about HIV/AIDS and the relationship between drug use and HIV. There is an ongoing need for HN/AIDS education and testing for IDUs, especially those who are incarcerated and are sex workers. Please accept this Letter of Collaboration in a spirit of support for this important agency, Lubbock MEML Sincerely, Name of Age cy Representative 83 GRANT PROPOSAL EVALUATION FORM Page 1 1. Is this grant: New Continuing XX Number of Years 7 2. Is a match required? Yes Nc 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 = $1,600 4. If there are indirect costs, are they reimbursed by the grant? Yes XX No PercentageL 4% 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 erantees and provides technical assistance on fiscal matters The on- site review consists of a review of internal controls verification that re orted eKpenses mTjgpprly imported. and evaluation of compliance with contract terms and government mgplatio4s. 7. Can this grant be renewed? Yes XX No If yes, how many times? As long as funds are made available from the State and the Federal Government What are the terms of renewal? See Above 8. Does the grant require the City to gradually assume the cost of the program? Yes No XX Ifyes, what is the timetable? iih GRANT PROPOSAL EVALUATION FORM Page 2 Please address whether other agencies are currently administering similar programs and whether any other agencies are available to administer this program. UHMR provides one-on-one street outreach counseling and testing for HIV to their clients SPARC is appl .nng for 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 anaffordable rate to the citizens of Lubbock. The Ci of Lubbock Health Department not Q& 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. Capital TOTAL EXPENDITURES $41,933 I;i�1/�`tTj�� Federal Grant 0 State Grant $41,933 Local Match 0 Other 0 TOTAL REVENUE $41,933 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: 40 None CURRENT FUTURE YEARS YEAR 1997 19 19 19 19 EXPENDITURES Personnel $38,528 Full Time Salary $29,868 TMRS $ 3,587 Social Security $ 2,218 Health $ 2,613 Life $ 33 Dental $ 209 Supplies $ 50 Maintenance $ 0 Other(travel, educ. supplies and indirect costs) $ 3,355 Capital TOTAL EXPENDITURES $41,933 I;i�1/�`tTj�� Federal Grant 0 State Grant $41,933 Local Match 0 Other 0 TOTAL REVENUE $41,933 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: 40 None 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 7 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, and the gay club. 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 tested. 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 and assisting Inside/Out with PCPE activities as they provide education to gang members, IDU's, homeless and MSM's of color. 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 MH11It and to the AA/NA groups in the Lubbock and surrounding areas when applicable. 41 IRWAIDS REPORTED 1993-1996 1993: AIDS 250 HIV 366 1994: AIDS 278 HIV 394 1995: AIDS 297 HIV 428 1996: AIDS 308 HIV 442 r -+ -qvzO�D�`�D -n` O q 0-0,mDG)�� L�rn� 0- n vv �uVuU v � V vv M N 0 CO -4 iC71Owcn - to 0 0 M -+ 0) CO V O v co _ CC' O V N.NaM CJtO�OD V W C) CS O) V C i N .P c0 i co CA r 0 i ...1 N i i �► i i �► i i ...1 co PN AODNVcOOo V c0�lY V 0 -+ i (O W -+ N N O co r vZjv SG N -A. O co 46 ,A CO C - -4 A Rom co co 4 0 A. CA co 0 O 0 0 -4 N 0 44- .p r i- i i i i i i. i i J co 0 00M-4"00 41.0 t O N W co WWO"OOWOO OV 0 n N -P CO co .NP. CA -N+ co O O-&cntn0 W O O C0<--l"UU0r<z�NMwz MMOmc'�m r-oMc wa)M9-N-1 =D �; gym i co CO ,� i i i .f i i J i ...► i CJt N W NNN.PcoOONiwN CO V i- CJ7Cl1A(DC)co � i V OVOW0VCO�V VOCOVW CO -4W 0CW W V P AiNNCJ1 0 Co u+ Co � :V Co b o V C C) 0) 00000o000OCOCO V -+i Cn ii i i isiii CO -+ N A CO A 00 W CO 4, P W -► CO N N --L P -L CO co CO O CO co 0) iLn i 0o V CO 4 00 00 CO CO CO V CO CO CO COO 9) ODNNNOOOCACoOtn"CA i b) Co :p. Co N -+ 'Co C0 Vf V W o' W NO V O- L" CO? Wim o o o el o o o elS-R o i CO CO (i N N V OCONO W Co CO -* ;a -I (A A O i c0 00 co 0o CO CO 00 O CO 000-��aoQO XXXXXWWOCA) wto O o Oo 0 0 o Co 42 GRANT PROPOSAL EVALUATION FORM Page 1 1. Is this grant: New Continuing XX Number of Years 7 2. Is a match required? Yes No XX If Yes: Percentage Amount Is it: In-kind OR Cash Source Are there any indirect costs, i.e. building use, computer time, administrative supervision, associated with the grant? Yes XX No Myes, please list the estimated costs. Building Use, Computer Time. Administrative Time = $1600 4. If there are indirect costs, are they reimbursed by the grant? Yes XX Percentage 40/6 5. Are audit costs reimbursed? Yes Percentage No No XX 6. What are the audit requirements for this grant? Texas Department of Health's Grants Management Division performs on-site reviews of Wntees and provides technical assistance on fiscal matters. The on- site review consists of a review of internal controls verification that reported expenses areproper1v supported and evaluation of ggWhance with contract terms and government regulations. 7. Can this grant be renewed? Yes XX No If yes, how many times? As lona as funds are made available from the State and the Federal Government. What are the terms of renewal? See Above 8. Does the grant require the City to gradually assume the cost of the program? Hyes, what is the timetable? Yes No XX 39 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. WMt provides one-on-one street outreach, counseling and testing for HIV to their clients SPARC is applving for thisar�nt 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 g& 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. H 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. Capital TOTAL EXPENDITURES $41,933 REVENUE Federal Grant 0 State Grant $41,933 Local Match 0 Other 0 TOTAL REVENUE $41,933 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: r1�� None CURRENT FUTURE YEARS YEAR 1997 19 19 19 19 EXPENDITURES Personnel $38,528 Full Time Salary $29,868 TMRS $ 3,587 Social Security $ 2,218 Health $ 2,613 Life $ 33 Dental $ 209 Supplies $ 50 Maintenance $ 0 Other(travel, educ. supplies and indirect costs) $ 3,355 Capital TOTAL EXPENDITURES $41,933 REVENUE Federal Grant 0 State Grant $41,933 Local Match 0 Other 0 TOTAL REVENUE $41,933 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: r1�� None 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 7 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 MV+); 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 HN testing site. Other testing sites include Texas Tech University, Lubbock County Jail, Lubbock County Youth Center, Lubbock County Community Correctional Facility, and the gay club. All clients tested will receive pre-test counseling. Posttest 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 tested. 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 800% 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 and assisting Inside/Out with PCPE activities as they provide education to gang members, IDU's, homeless and MSM's of color. 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 WNR and to the AA/NA groups in the Lubbock and surrounding areas when applicable. 41 HIV/AIDS REPORTED 1993-1996 1993: AIDS 250 HN 366 1994: AIDS 278 HN 394 1995: AIDS 297 HN 428 1996: AIDS 308 HN 442 pnccv mO O mmc mc-i'n,+�rm�c _ r O --q c r n p�p c ti- z� z ��/ � V i M N i i i i i 3 i i i i (D N O Oo O O j O—L Wi 4 CO O O V O •- sc W + h)K) + N N+ N i O V—►(A+-L ppA00 V W O CnCA VO+VNACD+CON r CD O i i N i pig i+ i+ i i i V (J�A�—A►+�ACD W �NNcOo i + i i i i i i i i i i (gy(pp V 0 � CA co (D CD -4 (A CCn & p i c71 cn cn m -4 0) CD CD A 07 N cp c0 CD W c0 + O O W Qs CD A CO V 0 r` A ACD CD+AN+ CD CO + CA M O W O C) —IOzON>C-C_ - �� o mmo-+c'�m r-o;oc a) C13 m z M -c i i A CCA ACn0 C►toa)to�A i cp to V OfDpf4CDV A�NNCVl�A CC' VtotT1W WV �o cog(*coiO3mom0j i NAAOW 0 AW -�C4 0 C1r i - W CD CO w co a CA i pppp O OVDNNN0 ulccoo �cn- Ln p� _ _ �.p ww o W LL �NcooA W -4A~ co ocOi gi i i i N o Np i o V NCJ1 A co i co WOD�p W mMMW Co co -400)0) m mmmmm' i ' o,.j:a' 42