0093

COUNTY OF SANTA CRUZ

HEALTH SERVICES AGENCYP.O. BOX 962,108O EMELINE AVENUE

SANTA CRUZ, CA 95061(408) 454-4066 FAX: (408) 454-4770

TDD: (408) 454-4123

AGENDA: May 9,200O

BOARD OF SUPERVISORSCounty of Santa Cruz701 Ocean StreetSanta Cruz, CA 95061

Re: APPROVAL OF 2000-2001 DENTAL DISEASE PREVENTION PROGRAM FUNDINGAPPLICATION

Dear Board Members:

The Health Services Agency is requesting approval of the attached 2000/01 renewal fundingapplication in the amount of $22,973 for the Dental Disease Prevention Program. Also attachedis a State-required resolution approving the application and authorizing the Health ServicesAgency Administrator to sign the related State revenue agreement when received.

Each year, the Health Services Agency receives State funding for various school-based dentaldisease prevention activities called the “Happy Tooth” program. This program providessupervised brushing and flossing in the classroom, instructional visits by a trained dental healthinstructor, educational materials and supplies, and teacher training workshops for participatingschools.

The program is designed to reach 5,105 pre-school and elementary school children in high needareas in the County and to stimulate the development of community resources to respond to theneed for preventive oral health services for children. The State funds support a part-timebilingual Health Program Specialist to coordinate the program and to conduct class visits.Supplies and materials are underwritten by the County.

It is therefore RECOMMENDED that your Board:

1. Adopt the attached resolution approving the $22,973 funding application for the2000-01 Dental Disease Prevention Program and authorizing the Health ServicesAgency Administrator to sign the related State revenue agreement when received,and

24

2.0094

Direct the Clerk of the Board to return one certified copy of the resolution to theHealth Services Agency to forward to the State.

Sincerely,

tSusan A. MaurielloCounty Administrative Officer

cc: County Administrative OfflceAuditor-ControllerCounty CounselHSA Administration

24

Rama’Khalsa, Ph.D.,HSA Administrator

BEFORE THE BOARD OF SUPERVISORS 0095OF THE COUNTY OF SANTA CRUZ. STATE OF CALIFORNIA

Resolution No.

On the motion of Supervisorduly seconded by Supervisorthe following resolution is adopted:

RESOLUTION APPROVING FUNDING APPLICATION FOR THE DENTAL DISEASE PREVENTIONPROGRAM AND AUTHORIZING SIGNATURE OF THE RELATED STATE STANDARD AGREEMENT

WHEREAS, the State Department of Health Services has solicited funding applications for the 2000-01Dental Disease Prevention Program; and

WHEREAS, the funding application requires a Resolution from the Local Governing Body authorizing theapplication submission and further authorizing the local Agency Administrator to sign the resultant StateStandard Agreement and any amendments thereto related to minor program changes; and

WHEREAS, the Health Services Agency has prepared a funding application for the 2000-01 DentalDisease Prevention Program in the amount of $22, 973.

NOW, THEREFORE, BE IT RESOLVED that the Santa Cruz County Board of Supervisors herebyapproves the 2000-01 funding application for the Dental Disease Prevention Program in the amount of$22,973 for the period July 1, 2000 - June 30, 2001 and authorizes the Health Services AgencyAdministrator to sign the related State Standard Agreement and any amendments thereto related to minorprogram changes.

PASSED AND ADOPTED by the Board of Supervisors of the County of Santa Cruz, State of California,this of day , 2000, by the following vote (requires four-fifths approval).

AYES: SupervisorsNOES: SupervisorsABSENT: Supervisors

Chair of said Board

ATTEST:Clerk of Said Board

APPROVED AS TO FORM:

lLL& p&-J-/Assistahtmnty Counsel

Distribution:

County Administrative OfficeAuditor-ControllerCounty CounselHSA Administration

24

0096

Attachment2

APPLICATION COVER SHEETFY 2000-2001-/

1. Contact Person for this Annlication and Mailing Address

Legal Name of Agency Santa Cruz County Health Fed Tti I.D.# gs-6ooos34Services Agency

TitleofProject 'Happy Tooth Program' ~

Mailing Address P.O. Box 962

City Santa Cruz ZIP 95061 County Santa Cruz

Contact Person’s Name Yolanda Chavez Phone (831) 454-4312

Project Coordinator’s Narne Celia Barry Phone (831 454-4318

Mailing Address P.O. BOX 962 Santa Cruz CA 9506

2. Proposed Funding Amount $ 2 2,9 7 3.

3. Proposed Number of children to be served:

PRE-K K 1 2 3 4 5 6 UNGR TOTAL.

1,446 1,116 848 652 448 393 102 56 44 5,105

4. The undersigned hereby aff&ts that the stateme‘nts contained in this application packageare true and complete to the best of the applicant’s knowledge, and accepts as a conditionof any resulting contract the obligation to comply with applicable state requirements,policies, standards, and regulations. The undersigned recognizes that this is a publicdocument and open to public inspection. ’

Signature

TypeNameand Title Celia Barry, Senior Health Ebntnr

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.

0097

Attachment 4Page 1

APPLICANT INFORMATION SHEET

PLEASE COMPLETE THIS FORM CAREFULLY

1. Agency Information:

Legal Name of Applicant Organization Santa Cruz County Health Services Agency

Title of Project Happy Tooth Program.

Mailing Address P.O. Box 962

City Santa Cruz ZIP 95061

Federal Tax ID # 95-6000534

County (where agency headquarters is located) Santa Cri37

Telephone Number (831) 454-4312 FAXNumber m 454-5048

2. Project Coordinator (This person is responsible for all of the day-to-day ‘activities ofproject implementation. This person will be the contact person for the Office of OralHealth staff, will receive all programmatic, budgetary and accounting mail for theproject, and will be responsible for the proper dissemination of project information):

Name Celia Barry

Address P.O.. Box 962

City Santa Cruz ' ZIP 95061.

Telephone Number ( 454-43 18 FAX Number csu) 454-5048

In the event that the Project Coordinator is not yet appointed, identify a contact person forthe Office of Oral Health to send pertinent contract and program materials in the interim.

Name

Address

City

Telephone Number (

ZIP

FAX Number (

24

0098Attachment 4

Page 2

28

3. Financial Officer (This person has signature authority for invoices):

NameDavid McCollum; Chief of Fiscal Services

AddressP.O. Box 962

City Santa Cruz ZIP 95061

Telephone Number && 454-4329 -- FAX Number (83f) 454-4488

4. Agency Offkial (This person has official signature authority to enter into an agreementfor the agency):

NameRama Khalsa, Administrator

AddressP.O. Box 962

City S a n t a Cruz ZIP 95061

Telephone Number (831) 454-4015 FAX Number m 454-4476

5. All payments for invoices are automatically,sent to the address of the Agency Official. Ifthe address of the Agency Official is not the address you wish payments mailed to, pleaseindicate the correct contact person and address below. The Office of Oral Health staffwill notify the DHS Accounting Section when special handling is required for youragency.

NameDavid McCollum

Address P.O. Box 962

City Santa Cruz ' ZIP 9 5 0 6 1

Telephone Number ( FAX Number (

above is true and correct:

33-

0099

Attachment5 *

AFFlRMAm ACTION INFORMATTON SHEET AND INSTRUCTIONS

Complete Affirmative Action Information Sheet, HAS 1090, that follows this instructionsheet. The form is essqntial for statistical information and grant processing. The form isself-explanatory except for section, “Statistical Information.” Min0rit-y Busmess,Enterprise and Woman Business Enterprise definitions and information is alsoshould you wish to apply for certification with CalTrans, Office of Civil Rights.

provided

The stat&al information needed in Affirmative Action Sheet, HAS 109O,‘(ethnic andgender) e the majority ethr;ic and gender composition of your “governing body.” Thegoverning body is either the Advisory Board, Board of Directors, etc. For example, ifyou have a seven member board and four of the members are Black Americans and fourof the members are male, then you would circle: I- Black American/Male.. If you havea seven member board and, four of the members are Bl,ack Americans and four of themembers are female, then you would circle: A- Black Americans/Female. .

M.NORITY BUSINESS ENTERPRISE AND W0ti~ BUSINESS ENTERPRISEDEFINITIONS:

.A. Minoritv Business Enterrx-ise fMGE) MBE is defined in the Public Grant Code10470(e) as follows:

MBE’is a small business owned and controlled by one or more minorities orwomen. Owned and controlled means that:

1.

2.

at least 51 percent of the small business concern is owned by one or moreminorities or women or, in the case of a publicly owned business, at least51 percent of the stock of which is owned by one or more minorities orwomen; andwhose management and daily business operations are controlled by oneor more such individuals.

B. Women Business Entercx-ise IWBEk WBE is defined in the public Grant Code10470(f):

WBE is a sqall business, owned and controlled by one or more women. Ownedand controlled means that:

1. at least 51 percent of the small business concern is owned by one or more. women;and

2. whose management and daily business operations are controlled by oneor more women who own it.

For additional information on MBE and WBE, please contact: CalTrans, Office of CiRights, P.O. Box 94378HG 44, Sacramento, CA 94274, (916) 4452276.

w----m

AFFEMATIVE ACITON XNFORMATION SHEET

Attachrmit 5 .

1. For statistical purposes, please complete the following information to the questions below. 0 1 0 0

2 llis information is for statistical use only. It is considered confidential and does not constitnte a basis for award or rejection of acontract, work order, service authorization, or purchase order with the Department.

VENDOR/CONLRACTOR INFORhL4’TION

Name of FirmSanta Cruz County Health Services Agency

-,Nameof Printipal (if othertbanan*Izalfirm)

DCSVendor N u m b e rN/A

N/ATitle

BusinessAd& =Y

P.O. Box 962 S a n t a Cruz C A 95061Type of Ownerskip (Use 2 digits, ie, 01,02,10,11, et&

01 - Individrral 02 - Partnership 03 -For Profit Corp. 04 - Not-for&it Corp. OS - For Profit Hospital/Skilled Nnming Facility 06- Not-for-profit Hospital/Sk&d Nu&ng Facility 07 - Incorporated Association 08 - CoBege/Universiry (including both publicand Private) including University Hospitals 09 - COIXI~~ Government only 10 - Other CaBfor& governmental entity, exceptCO~U&S and No. 11 below, (City, Sclud DistkcL Water District, Joint Powers, et@ 11 - California State Agencyi+dktg Federal Govemrnent, another State. any entity not identified in 1 through 11.

I2 - Other entity,

Indicate Ownership digit(s) here: I2 -otheT entitu: public

Type of Business

Public Health DepartmentContractors License N/A if any:

Statist@ Information

Ethnic Codes:Male Female Maie

Black Americans 1 A Amexican In&an/AIaskt NativesAsian-Pacific Americans 2 BHispanic Americans 4 ZZZQllS

i iiI

Pacific Islanders 6 F” Caucasian/White Americans 65 E

Enter Ethic@ of Vendor /Contractor from above List ECa&ian/Female

Has Vendor/Contractor appiied to and been approved by the 0Yes 9 No Jf

‘ce of SmalI and Minority Business, Department of General servicesasa small business? (See reverse side).Lf yes, enter the date of the letter O%fB sent to the Vendor/Contractor approving the smaB business status:

Has Vendor/Contractor applied to and been approved by the ft;of CivilBusiness Enterprise or a Disadvantaged Business Enterprise? NoIf yes, enter CalTmns seven-digit certificate number given to Vendor/Contractor.Enter certificate expiration date:

is vendor/Contractor a “woman-Owned Enterprise? YES 0 Nay .

DHS Information. Date Receivedz

DHSProgmm Name:

By:

incMssAIog ‘_. . . . . . . . . . . .

INFORh4AllON F’RAcncEs ACT STATEMENT

This infcmnation is requested by the State of California, Department of Health Setices for ~ratistical ptqoses only.form is voluntary and there are no consequent for not providing the informatior~

Completion of theInformation will be provided to Contract Manager

and possibly other public agencies. For more information or access to your records, contact the section CbM, Contmct Management-oh~artment of Health Services, 744 P Street, Sacramento. CA 95314. Telephone (916) 322-6122HAS 1090 (2/&3).

0101

Attachment 6

ABSTRACT OF PROPOSAL

1. Legal Name of Applicant Organization: Santa Cruz Counts Health Serivces

2. Project Title: “Happv Tooth” Dental Disease Prevention Prbqram

3. Project Coordinator: Celia Ban-v. MPH

4. Provide a brief program description. include a summary of the essential contents of theproposal. . .

The “Happy Tooth” Dental Disease Prevention Program (DDPP) is a voluntaryschool-based program focusing on, but not limited to, the City of Watsonvillewhere dental disease prevention and education needs are the greatest. TheDDPP has been a popular prevention program for children in Santa Cruz Countysince 1980, and continues to be well-received by the community. The programprovides a comprehensive dental and nutritional education program for at least5,105 preschool through sixth grade students, consisting of two instructionalpresentations, daily fluoride tablets, and brushing and flossing. Each childreceives two toothbrushes over the course of the school year.

, A bilingual educator performs program activities. Volunteer school nursesprovide an annual dental screening/educational visit for children in the program.Teachers in all participating classrooms receive an in-service to prepare them forthe program. Update trainings are provided yearly for participating “HappyTooth” teachers. The program coordinator assists with planning, evaluation,supervision of staff, report writing and general coordination of the program.

24

0102

TABLE OF’ CONTENTS

,problem Statement/Nee& &sessment ------------ -______---___________ - ___________ 1

Proposed Schools for Project Implementation -------------------------------------3

Scope of Work -------------------------------------- -__________________________________ 7

Evaluation plan --- _______________- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 .

Budget

A. DDPP line Item Budget --- --____ -- -________________________________ 19

‘B. Budget Summary ------------ ________________________________________ 20

Agency Description and Capability

A. Organization Charts -------- _____ - ________________________________ T- 2 1

B.

C.

Board of Supervisors Resolution SupportingApplication Submission ________________________________________---- 23

Statement of Compliance ________________________________________--- 24

D.

E.

Drug-Free Workplace Cefiification ______ i ________ --------- _______ 25

Resumes for Key Agency and Project Personnel --------------- 26

F. Job Descriptions for All Project Staff ---------------------------- 28

List of Dental Health Advisory Committee Members ___________________________ 32

Letter of Support ----------------------------------------------------------------------- 33

Fluoride Supplement ------------------------------------------------------------------ 34

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0103

PROBLEM STATEMENT / NEEDS ASSESSMENT

TARGET POPULATION ,

I 999-00 elementary enrollment data for the County of Santa Cruz, are as follows:

Kindergarten 3,051First 3,099Second 3,249Third 3,278Fourth 3,259Fifth 3,020Sixth 3,115Other 128

Total number enrolled in elementary school is 22,599. Approximately 44% of these childrenparticipate in the Free School Lunch Program.

Most recent figures indicate that there are now 47% “Latino” students in Santa Cruz County and46% of Santa Cruz County’s students are classified as “Anglo”. Other ethnic groups comprise atotal of 7% of students in Santa Cruz County (African-American and Asian/Other).

It is estimated that approximately 690 children and youth in Santa Cruz County are homeless(Santa Cruz County Office of Education). Countywide, 10.7% of residents live below the povertyline. The majority of those living in poverty are children. In Watsonville, 1 out of 4 children live inpoverty (Community Action Board of Santa Cruz). The Happy Tooth program concentratesservices at Watsonville area schools because of this significant levefof poverty.

AVAILABLE ORAL HEALTH SERVICES

Most dentists in Santa Cruz County serve children. However, most dentists do not accept Medi-Cal. DentiCal referrals are commonly made to out-of-county dentists.

Cabrillo College Dental Hygiene Program offers cleanings to children two days per semester for afee of $25 per child and the clinic takes Medi-Cal. Sealants are provided at $5.00 per tooth. Inemergency cases only, x-rays are taken for $15.00 - $25.00. Clinics for children participating inMigrant Education Programs are held twice a year at $25.00 per child. This is an increase of 52%over the last two years.

Dientes Community Dental Clinic, Inc. has one - two dentists working five days a week. DientesClinic has a school based sealant program at five Pajaro Valley Elementary Schools and one HighSchool. Children receive screenings and referrals to local dentists as needed. At least 150children from each school have been provided with sealants, fluoride treatments, prophys and/orfillings. Approximately 70 children have been referred to private dentists in the area for urgentcare.

124

0104

The Santa Cruz County Happy Tooth Dental Disease Prevention Program serves over 5,000students each year with comprehensive dental health education. Each year, students areprovided with two toothbrushes, floss and flossmen, and if they have parental permission, daily

fluoride tablets. The students receive instruction in brushing, flossing, fluoride, nutrition anddental safety. Examples of students the bilingual health educator has seen include: fifth and sixthgraders who have never flossed before, second graders who have never used a toothbrush,students who share one toothbrush will all family members and parents who are grateful that theirchildren receive fluoride supplements in school because they could not afford them otherwise.

GAPS IN EXISTING ORAL HEALTH RESOURCES

Dental treatment resources for low-income children continue to be inadequate. Dentists arereluctant to take Medi-Cal and Dientes Community Dental Clinic provides treatment on a limitedbasis. The only other option available for dental treatment is referrals to dentists who will provideservices free of charge. Community efforts continue to attempt to address the need for moreaffordable dental treatment.

Comprehensive dental health education is provided by the County’s Happy Tooth Program to over5,000 students each year. The number of free school lunch stu.dents in Santa Cruz Countycontinues to rise, indicating a need to serve a greater number of students with dental healtheducation.

Overall the need for dental services for low-income children in Santa Cruz County has outpacedthe emergence of new resources.

BARRIERS

‘The changing ethnic composition of Santa Cruz County students provides challenges inimplementing a comprehensive dental health program. Among the children served are recentimmigrants, mostly from Spanish-speaking countries. Many of their parents have never usedtoothbrushes and have never received dental care. The Happy Tooth Program’s educator isbilingual English/Spanish and bicultural and is sensitive to the problems of newly immigratedstudents and their families. The Happy Tooth Program’s curriculum includes dental healthinformation given to the students intended for their families to reinforce what the students arelearning.

24

Another barrier to addressing the dental health education needs of Santa Cruz County children isthe lack of funds needed to provide the Happy Tooth Program to all schools which have a highpercentage of free school lunch students.

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0 1 1 7

EVALUATION PLAN

COMPONENT I. FLUORIDE SUPPLEMENTS

Objective 1.1: By 10/16/00, all children in grades K - 6’h targeted by the program and whohave parental permission will receive a daily fluoride supplement a classminimum of 30 weeks.

Who: Targeted children in grades K - 6” with parental permission

How Many: All targeted children

Intervention: Daily fluoride supplements

Instrument: Daily fluoride use records, teacher evaluations

Method: Count the total number of targeted children in grades K - 6’h grade with parentalpermission who are participating in the fluoride supplement program byOctober 16,200O.

Objective 1.2: By 10/16/00, a11 children in preschool targeted by the program and whohave parental permission will receive a daily fluoride supplement a classminimum of 30 weeks.

Who: Targeted children in preschool with parental permission

How Many: All targeted children

Intervention: Daily fluoride supplements

Instrument: Daily fluoride use records, teacher evaluations

Method: Count the total number of targeted children in preschool with parentalpermission who are participating in the fluoride supplement program byOctober 16,200O.

COMPONENT II. Plaque Control

Objective 2.1: By 10/16/00, all children in grades K - 61h targeted by the program willreceive instruction and guided practice in toothbrushing for 25 daysfollowed by daily home brushing or daily classroom brushing.

who:

How Many:

Intervention:

Targeted children in grades K - 6*

All targeted children

Instruction and practice in toothbrushing for 25 days followed by daily homebrushing or daily classroom brushing

Instrument: School visit records, teacher evaluations, home brushing contracts

Method: ’ Calculate total number of children in grades K - 6’h grade by the projectreceiving instruction and guided practice in toothbrushing for 25 days followedby daily home brushing or daily classroom brushing by June 30,200l

0118

Objective 2.2: By 10/16/00, all children in preschool targeted by the program will receiveinstruction and guided practice followed by daily classroom brushing.

who: Targeted children in preschool

How Many: All targeted children .

Intervention: Instruction and practice in toothbrushing followed by daily classroom brushing

Instrument: School visit records, teacher evaluations, home brushing contracts

Method: Calculate total number of children in preschool targeted by the project receivinginstruction and guided practice in toothbrushing followed by daily classroombrushing by June 30,200l

COMPONENT III: Oral Health Education

Objective 3.1: By 10/16/00, all participating K - 6’h grade students will receive a series oftwo instructional visits on oral health, each lasting approximately 30minutes, using appropriate scope and sequence principles. The followingsubject areas will be included: causes, processes and effects of oral disease;.plaque control; nutrition; use of preventive dental agents, includingfluorides and sealants; the need for regular dental care and preparationfor visiting the dentist; and dental injury prevention.

who: All participating K - 61h grade students

How Many: All targeted children

Intervention: Classroom instructional visits on oral health

24

Instrument: School visit records, teacher evaluations, home brushing contracts dailyfluoride supplements

16

0119Method: Calculate total number of children in grades K - 61h targeted by the project

receiving two instruction visits on oral health by June 30,200l

Objective 3.2: By 10/16/00, all participating preschool students will receive a skies of twoinstructional visits on oral health, each lasting approximately 36 minutes,using appropriate scope and sequence principles. The following subjectareas will be included: causes, processes and effects of oral disease; plaquecontrol; nutrition; use bf preventive dental agents, including fluorides andsealants; the need for regular dental care and preparation for visiting thedentist; and dental injury prevention.

who: . All participating preschool students

How Many: All targeted children

Intervention: Classroom instructional visits on oral health

Instrument:. School visit records, teacher evaluations, home brushing contracts

Method: Calculate total number of children in preschool targeted by the project receivingtwo instruction visits on oral health by June 30, 2001

Objective 3.3: By June 30,2001, all participating preschools will be offered dental healtheducation for parents which could include baby bottle tooth decay, causes,processes and effects of oral diseases, plaque control, nutrition; use ofpreventive dental agents, including fluorides and sealants; the need forregular dental care and preparation for visiting the dentist; and dentalinjury prevention.

Who: All participating preschools

How Many: All participating preschools

Intervention: Presentation for parents

Instrument: Sign-in sheets, copies of letters offering presentation, agendas and minutes

Method: Calculate total number of parents attending presentation

COMPONENT IV: Sealant Advisory Committee

Objective 4.1 By June 30,2QOl the Sealant Advisory Committee will hold at least twopublic meetings; which will include representative from at least education,the dental professions and parent groups; will assist in developing andreviewing the local project application; and will provide input on the needfor and adequacy of local preventative oral health services for children.

0120Intervention:

Instrument:

Method:

Objective

WhOi

How Many:

Intervention:

Instrument:

Method:

Hold meetings

Meeting agendas, meetings minutes, roster of advisory committee members.

Assure advisory committee held at lease two meetings; included representativesfrom education, the dental professions and parent groups, assisted in developingand reviewed the local project application: and provided input on the need forand adequacy of local preventative oral health services for children.

Evaluation Objective

By June 30,200l ten classrooms of 3fd grade students targeted by the projectand receiving dental health education will demonstrate scores in knowledge andattitudes toward dental health that average at least 15% higher on post-testscores than on pre-test scores (before and after intervention).

Third grade students

Ten classrooms targeted by the project.

Classroom instructional visits on oral health.

Pre-test and post-test on dental health knowledge and attitudes before and afterintervention.

Calculate percentage difference between pre-test and post-test.

2418

(I.1 2 1

Attachment9

BUDGETDDPP Line Item Budget

Contractor: Santa Cruz County Health Services Agency

1. Personal Services (includeFunding

position & rate x time calculations)Health Program Specialist

Periods

Proposed State

$ Amount

$17,997

2. Fringe Benefits (State share not to exceed 30%) 4,976

SUBTOTAL PERSONAL SERVICES

3. INDIRECT COSTS (@ of Personal Services)(a of Contractual Services)

4. General Expense

5. Expendable Supplies

6. Print&z & Duplicating.

7. Communications & Postage

8. Travel. Per Diem & Training

9. Contractual Services

10. Educational Materials

11. Rent & Utilities

12. Other (Specifv)

SUBTOTAL OPERATING EXPENSES (4-12)

TOTAL $22,973 ‘,

LOP’C& $ PEP’0 1 $ ELG’ZZ $ lVlO1

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sw9n ‘8 wtl 3i

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0

NnJ

0123

SANTA CRUZ COUNTY HEALTH SERVICES AGENCYRENTAL. DISEASE PREVENTION PROGRAM

-5 AdministratorRama Khalsa, MPH, PHD

Health OfficerDavid McNutt, MD

Chief of Public HealthElizabeth McCarty, RN, MS

Senior Public Health Program ManagerPatricia Ellerby, MPH, MPA

Dental Health Advisory Committee

0124 ’

SANTA CRUZ COUNTY HEALTH SERVICES AGENCYDENTAL DISEASE PREVENTION PROGRAM

Project CoordinatorCelia Barry

Project EducatorYolanda Chavez

22

srA7EoP~

NONDlSCRlMIHATIONCOM~llANCESTATEMENTsm. 1s fulaf. 2.m)

Attachment 12

0125.

COUPANYNAU

Santa C&z County Health Services Agency

me company’named above (keinafier referred to as “prospective contractor”) hereby certifies, unlessspecifically exempted, compliance with Government Code Section 12990 (a-f) and Cafifomia Code ofRe,@ations, IMe 2, D&ion 4, Chapter 5 in matters relating to reporting requirements tid thedevelopme= kplementation andmaintenande of aNondis&ninationProgram.~Prospective contiactoragrees not to UntawfulIy di&minate, harass or allow harasiment against any employee or applicant foremployment because of sex, rack, color, ancestry, religious creed, national origin, physical disabili~(iicludi.n~HIv and AIDS), m&al disability, medical condition (cancer),and denial of f&y care leave.

age (over 40), mariral status,

CERTIFICATION

I, the o#icid named below, hereby swear that I am duly authorized to legally bind the pmspectivecontractor to the above descn*bed cenificarion. I am fullr aware that this cer@ication, executed on thedate t&d in the courg below, is made underpenalry ofperjzuy under the laws of the State of Cd~omia.

OiFtcaLSNME

Sandra HaugenDAiE fEW

April 17, 2000IDQaJEo~mEcmNvoFSanta 'Cruz

PFcs?ECm cwR*cToRs LEW BUSINESS NAME.

Santa Cruz County Dental Disease Prevention Program

.

.

se

24

24

Attachment 13

DRUG-FREE WORKPLACE CERTIFICATION .0126

Santa Cruz County Health Services Agency

The contractor or grant recipient named above hereby certifies compliance with Government Code Section8355 in marters relating to providing a drug-free workplace. The above named contractor will:

1.

2.

3.

Publish a statement notifying employees that unlawN manufacture, distribution. dispensation,possession, or use of a controlled substance is prohibited and specifying actions to be taken againstemployees for violations, as required by Government Code Section 8355(a).

Establish a Drug-Free Awareness Ro,,g as required b) Government Code Section 8355(b), toinform employees about all of the followiug:

a. The dangers of drug abuse in the workplace;

b. the person’s or organization’s policy of maintaining a drug-&e workplace;

c. any available counsehng, rehabilitation and employee assistance pro,-, and;

d. penalties that may be imposed upon employees for drug abuse violations.

Provide as required by Government Code Section 8355(c) that every employee who works on theproposed contract or grant:

a. WiJl receive a copy of the company’s drug-free policy statement, and;

b. will aagree to abide by the terms of the company’s statement as a condition of employment on thecontract or grant.

CERTIFICATION

I, the official named below, hereby swear that I am duly authorized Ieoallv to bind the contractor or mtrecipient to the above described certification. I am fully aware that & cekfication, executed on the%&and in the county below, is made under penalty of perjury under the laws of the State of Californiia.

OFFIW'S NAMESandra'Haugen

94-6000534

25

24

Celia Barry

123 Cayuga Street .’0127

Santa Cm, CA 95062(408) 423-9020

EDUCATION:

Master of Public Health; San Jose State U,piversity 8189-.

Bachelor of Arts; In Political Science, University of California, Davis 6/80

PROFESSIONAL EXPERlENCE:

Senior Health Educator,Health Services Agency, Santa Crux, CA8i93 to present

._ .

Program Skills

Responsible for planning, developing, impIementing and evaluating a variety of health education programsincluding tobacco prevention, injury prevention, and dental disease prevention; provides health educationconsultation and develops cooperative relationships with a wide variety of individuals, groups, representativeswithin Agency and community; establishes and maintains coalitions; writes press releases and conducts pressevents; collects and analyzes data to identify health needs.

Managem’en f Skills

. Responsible for writing grants and reports; analyzes and prepares contracts; manages budgets and invoicingfor five health education programs with an annual budget of $340,000; interprets and applies legislativeregulations, administrative policies and procedures; supervises a staff of five full-time employees; selects,trains and evaluates staff.

:Health Educator,Health Services Agency, Santa Cruz, CA9189 to 8193

Responsible for planning, implementing and evaluating health education programs including tobaccoeducation., injury prevention, Child Health and Disability Prevention, emergency medical services, andenvironmental health.

PIkESENTATIONS:

1995 California Traffic Safety Summit, San Diego1994 California TrafEc Safety Summit, Lake Tahoe1992 Traf?ic Safety Cities Conference, Aptos

A W A R D S :

1995 National Highway Traflk Safety Administrator’s Program of Excellence1995 California O&e of Traffic Safety award recipient

PUBLICATIONS:

Co-Editor for “The Bicycle Zone” curriculum guide, 1994

26

Jt4.

YOLABDA D. CHAVEZ714 fiir Avenue, Santa Cruz, C-4 95060(408) 4250672 (home) - (408) 45-Ul41 (work)

. .

RECEhT EXPERIENCE: 0128

Health Program SpecialistSanta Cw County-Health Services Agency, Santa Cruz, CA2189 to present

Responsible for developing and facilitating dental and presentations for the elementary schools in SantaCmz County; evaluate and develop educational material for the schools and different commm&y cl&its; maintain resource library; co11ect and evaluate statistical data; assist in the research and preparationof reports; evaluate the effectiveness of program information and methods.

ResponsibIe for facilitating a comprehensive child passenger safety curriculum being used at Santa CmCounty Headstart and Migrant Headstart Prgrams.

.Presently implementing the cur-ricuium at State Preschools in Santa Crux Counry.

Dental Health EducatorDientes’ Community Dental Clinic, Inc.April 1, 1993

Developed curriculum for DIEWS Health Education Component.

Responsible for conducting Health Education sessions for families with information on baby bottle toothdecay, nutrition and dental health, and brushing instruction.

Cleik IISanta Cruz County Health Services Agency, Santa Crux, C44/86-X9

Responsible for typing form letters and reports in finished form; typed drafts of reports and othermaterial from rough copy or machine transcription; proofread finished copy and made correction;operated standard office equipment such as photocopy machine, adding machine and word processor;assisted the public by referring them to the appropriate personnel or location.

Bank TellerPacific Western Bank, Santa Cruz, CA10183 to 4/86 ’

Responsible for various transactions, deposits, withdrawals, cashiers checks and bonds. Back-up forbookkeeping; balance checkbooks and open new accounts.

:

EDUC4TJOru’:

l CabrilIo Colle,oe - 1988 - General Educationl San Jose State

i

24 ;

. ,. .

27

0129

SANTA CRUZ COUNTY SEPTEMBER 1989

SENIOR HEALTH EDUCATOR

jXFINITION ‘:.

Under direction, to plan, develop, supervise, evaluate and monitor a specific healtheducation program(s) for the Health Services Agency; and to do other work as re-quired.

DISTINGUISHING CHARACTERISTICSc

.._ .,.- -..._ .This class is distinguished from the Health Educator class in that the incumbent isresponsible for the preparation, administration and evaluation of a specific publichealth education program(s), grant contracts and budgets. In addition the incumbentsupervises staff assigned to a specific program(s),

The class is distinguished from the Health Education Program Manager in that thelatter manages the County-wide public health education program while this positionis responsible for the preparation, administration and evaluation of the publichealth education efforts of a specific program(s).

TYPICAL TASKS

Plans, implements and evaluates a specific public health education program(s); as-sesses and identifies community needs for educational services in a specific programarea(s); plans, organizes, designs, .develops, evaluates public health educationactivities; carries out or directs others to carry out public health education ac-tivities including educational presentations and workshops; assists in the develop-ment and adaptation of data collection instruments and designs for assessment andevaluation activities; develops educational literature, flyers and provides informa-tion to the community; selects, trains, directs, evaluates and h&dles disciplinaryproblems of subordinate staff; seeks funding sources for specific public healtheducation program(s); prepares grant proposals; develops memoranda of understandin;and budgets; negotiates and monitors contracts with the State and other subcontrac-tors.; develops and maintains liaison with interfacing State and County-departments,community organizations and the media;health

serves as the community leader of public

education efforts for a specific program(s); inputs, accesses and analyzes datausing a computer.

EMPLOYMENT STAEjDARDS

Knowledges:

Thorough knowledge of the principles of public health educationincluding program planning and evaluation;

Thorough knowledge of public health education methods and

0130

SANTA CRUZ COUNTY SEPTEMBER 19 87

HEALTH PROGRAM SPECIALIST

JIEFINITION

Under general supervision, to develop, coordinate,‘implement and evaluate publichealth information and related education programs; and to do other work as required.

PISTINGUISHING CHARACTERISTICS

This class is responsible for planning, facilitating and disseminating health infor-mation and related programs to the community and community organizations. Positionsin this class are distinguished from the higher level class of Health Educator inthat Health Program Specialist positions do not perform consultative and technicaleducational services in major health program areas.

TYPICAL TASKS

Develops and facilitates the presentation of a wide variety of health informationprograms to community groups and.organiz&ions; plans and implements outreach activ-ities by evaluating and developing.educatiorial health information programs, meetingsand speakers bureau; maintains liaison between the Health Services Agency-and otherprivate or public agencies, professional groups and health care providers to presenthealth information programs to the community and community organizations; maintainsresource directories; writes letters, newsletters,’ agendas, bulletins and brochures;organizes and coordinates volunteer assistance, meeting facilities and programevents; collects and evaluates statistical data; assists in the research and prepa-ration of reports, grant proposals and budgets; evaluates the effectiveness of pro-gram information and methods; and may supervise volunteers, clerical or other staff.

EMPLOYMENT STANDARDS

K n o w l e d g e s :

1

1

Working knowledge of the. methods and materials of healthinformation and education;

Working knowledge of the functions and objectives ofpublic and private agencies and institutions thatprovide community health information and educationalactivities, programs and services; and

Some -knowledge of the theories and techniques of teachingand learning for groups such as youth, elderly,physical or mental handicapped, or the economically orsocially disadvantaged.

_’

2430

DENTAL HEALTH ADVISORY 0131COMMITTEE MEMBERS

Cathleen FilpatrickPVUSD Nurse294 Green Valley RoadWatsonville, CA 95076

Shahe MountafianPVUSD NurseOhlone Elementary School21 Bay Farms RoadWatsonville, CA 95076,

Lau r i e Hes te rSanta Cruz Head Start408 E. Lake AvenueWatsonville, CA 95076

Elaine GluntWelfare Parents Support GroupVolunteer Coordinator506 Broadway StreetSanta Cruz, CA 95062

Jay BalzerDientes Community Dental Clinic930 Mission StreetSanta Cruz, CA 95060

Celia BarryHealth Services AgencySenior Health EducatorP.O. Box 962Santa Cruz, CA 95060

Yolanda ChavezHealth Services AgencyHealth Program SpecialistP.O. Box 962Santa Cruz, CA 95060

Maria Carmen HemandezHealthy Start Program0hlon.e Elementary School21 Bay Farms RoadWatsonville, CA 95076

Doris DownsHealthy Start ProgramSalsipuedes Elementary School115 Casserly RoadWatsonville, CA 95076

Roy JimenezGrowth & Opportunity Child CareProgram40 Brennan StreetWatsonville, CA 95076

Jeff RichmanPVUSD NurseFreedom Elementary School25 Holly RoadWatsonville, CA 95019

0132

County of Santa CruzHEALTH SERVICES AGENCY

POST OFFICE BOX 962,107O EMELINE AVENUE SANTA CRUZ, CA 9566%0962

(831) 454-4141 FAX: (831) 454-5048 TDD: (831) 454-4123

Health Education Programs

April 17,200O

L a u r i e S t a s z a kOffice of Dental Health ServicesContinental Plaza/MS 253P.O. Box 942732Sacramento, CA 94234-7320

Dear Ms. Staszak,

I have reviewed the 2000-01 Santa Cruz County Health Services Agency’s Happy Tooth Dental Disease PreventionProgram proposal.

I support the program’s goals: providing fluoride supplements to preschool through sixth grade students with parentalpermission, conducting lessons in toothbrushing and providing toothbrushes, presenting oral health sessions onnutrition, fluoride, dental care, and other dental issues, and advocating for community oral health needs.

I strongly support the Happy Tooth Program and urge you to continue funding this valuable community program.

Sincerely,

8

.

-Q /4!4c+-49Laurie HesterSanta Cruz Head StartActing Chairperson, Dental Health Advisory Board

2433

0133

County of Santa Cruz .-

HEALTH SERVICES AGENCY

POST OFFICE BOX 962,107O EMELINE AVENUE SANTA CRUZ, CA 95061-0962

(831) 454-4141 FAX: (831) 454-5048 TDD: (831) 454-4123

Community Health and Prevention Programs

I

Exhibit AState of California

Department of Health ServicesOffice of Dental Health ServicesSample Blanket Prescription

Q Daily Fluoride Tablet

Sample RX:

R,:‘.

For all nre K children in the C o u n t y o f S a n t a Cruz(grade level) (jurisdiction: county, school district)

who have parental consent.(program name)

0 . 5 5 rn? sodium, fluoride tablets(dosage: 0.55 mg, 1.1 mg or 2.2 sodium fluoride)*

Sig: One (1) tablet per day, to be chewed in the mouth for 30 seconds, swished between theteeth for 30 seconds, then swallowed. Nothing by mouth, including water, for 30 minutes

Michele V i o l i c h , M . D . (831)454-4066

Name (Print plainly) Phone

1080 Emeline AvenueAddress -

AoW619License Number

Santa Cruz, CA 95060City, State, Zip

Copies: Original prescription should be kept on permanent file by the program coordinator and a copy sentto the Office of Dental Health Services with the initial or renewal program application.

Renewals: A new blanket prescription should be written each school year by the advisory dentist, the localhealth officer, or other qualified dentist or physician.

l In calculating the supplemental fluoride dosage, both the child’s age and the fluoride concentration in alJmajor sources of drinking water (e.g., home and school) need to be considered, since fluoride contentand water supplier can vary greatly within a region. Refer to Daily Fluoride Tablet Program Guidelinesfor appropriate dosage to prescribe. 2.2 mg sodium fluoride contains 1 mg fluoride, 1.1 mg sodiumfluoride contains 0.5 mg fluoride and 0.55 contains 0.25 mg fluoride.

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County of Santa CruzHEALTH SERVICES AGENCY

POST OFFICE BOX 962,107O EMELINE AVENUE SANTA CRUZ, CA 95061-0962

(831) 454-4141 FAX: (831) 454-5048 TDD: (831) 454-4123

Community Health and Prevention Programs

.,Exhibit A

State of CaliforniaDepartment of Health Services

Office of Dental Health ServicesSample;Blanket Prescription

[B1 Daily Fluoride Tablet

Sample R,: F o r a l l k - 6 children in the County of Santa Cruz(grade level) (jurisdiction: county, school district)Haonv T o o t h Prosam who have parental consent.

(program name)R,: s o d i u m f l u o r i d e t a b l e t s1.1 rag:

(dosage: 0.55 mg, 1.1 mg or 2.2 sodium fluoride)*

Sig: One (1) tablet per day, to be chewed in the mouth for 30 seconds, swished between theteeth for 30 seconds, then swallowed. Nothing by mouth, including water, for 30 minutesollowing treatment.

/4pziid.4, I.

J.0.I

Signature -4gg--

Michele V i o l i c h , M . D . (831)454-4066

Name (Print plainly) Phone

1080 Emel ine Avenue

Address License Number

S a n t a C r u z , C A 9 5 0 6 0

City, State, Zip

Copies: Original prescription should be kept on permanent file by the program coordinator and a copy sentto the Office of Dental Health Services with the initial or renewal program application.

Renewals: A new blanket prescription should be written each school year by the advisory dentist, the localhealth officer, or other qualified dentist or physician,

l In calculating the supplemental fluoride dosage, both the child’s age and the fluoride concentration in &lmajor sources of drinking water (e.g., home and school) need to be considered, since fluoride contentand water supplier can vary greatly within a region. Refer to Daily Fluoride Tablet Program Guidelinesfor appropriate dosage to prescribe. 2.2 mg sodium fluoride contains 1 mg fluoride, 1.1 mg sodiumfluoride contains 0.5 mg fluoride and 0.55 contains 0.25 mg fluoride.

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