MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) TABLE OF CONTENTS

Transcription

1 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) TABLE OF CONTENTS PROPOSAL NARRATIVE Page 1 A. Background Information Page 1 A- 1. Community description, geographic characteristics, and demographics Page 1 A- 2. Mendocino County chronic disease burden Page 2 A- 3. Priority population Page 3 B. Approach Page 4 B- 1. Problem statement Page 4 B- 2. Purpose Page 4 B- 3. Outcomes Page 5 B- 4. Strategies and activities Page 5 B- 5. Strategies specific to the priority population Page 8 C. Applicant Evaluation and Performance Measurement Plan Page 9 C- 1. Evaluation support and Coalition engagement Page 9 C- 2. Evaluation capacity Page 9 C- 3. Evaluation and performance measurement plans Page 9 C- 4. Use of evaluation findings for continuous improvement Page 11 C- 5. Contribution of evaluation to evidence base Page 12 C- 6. Communication and dissemination of evaluation findings Page 12 D. Organizational Capacity of Applicant to Implement the Approach Page 12 D- 1. Applicant capacity Page 12 D- 2. Coalition capacity Page 15 E. Work Plan Page 18 BUDGET NARRATIVE Page 26 Budget Justification Narrative Page 26 Documentation of Indirect Cost Rate Page 45 ATTACHMENTS Page 46 Attachment A. Evidence of Organizational Capacity Page 46 Attachment B. Memorandum of Agreement and Letters of Commitment Page 99 Attachment C. Letters of Support Page 107 Attachment D. Assurances and Certifications Page 113 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP

2 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) A. BACKGROUND PROJECT NARRATIVE Table 1. Acronyms used in the proposal ACHIEVE Action Communities for Health, Innovation, and Environmental Change AO Annual Objective CBO Community- Based Organization CDSMP Chronic Disease Self- Management Program CHOICE Creating Healthy Opportunities in Child Care Environments FPC Mendocino County Food Policy Council FTE Full- Time Equivalent HHSA Mendocino County Health and Human Services Agency MUH Multi- Unit Housing NCO North Coast Opportunities PICH CDC Partnerships to Improve Community Health Program PPO Project Period Objective PSE Policy, Systems, and Environmental SHS Second- Hand Smoke TA Technical Assistance A- 1. Community description, geographic characteristics, and demographics Mendocino County (pop. 87,192) is located on the Pacific coast in rural Northern California, 120 miles north of San Francisco. The county is predominantly white/non- Hispanic, with significant numbers of American Indians (7%) and Latinos (23%). In 2014, 40% of county students were Hispanic, demonstrating the county s changing demographics. Although Californians are younger than the national average, 15.4% of county residents are age 65 or older, compared with a statewide rate of 11.4%. The California Department of Finance has projected that this age group will increase markedly over the next two decades by 2030, the number of seniors will reach 46,580, a full quarter of the population. 1 (Note: Please see list of citations in Attachment A, page 98.) The high school graduation rate is 80%. Economically, 20% of county residents live below the federal poverty level, 31% of children live in families below the poverty level, and more than half of local children (55.5%) live in low- income families with incomes at or below 200% of the federal poverty level. 2 Disparities can be seen in the number of American Indians (37.5%) and Hispanics (28.5%) that live in poverty. 3 The county s median household income ( ) is $43,721 (71% of the state median). The county s four incorporated cities (Ukiah, Fort Bragg, Point Arena, and Willits) have median household incomes ranging from half to two- thirds of the statewide median, as shown in Table 2. Countywide, 68% of students participate in free and reduced price school meal programs. According to the California Health Interview Survey (2012), one- third (35%) of low- income adults experience food insecurity, compared with 42% statewide. At 3,500 square miles, Mendocino County covers an area the size of Delaware and Rhode Island combined, with a population density (22.7 persons/square mile) closer to that of Nevada. Four small cities and numerous small unincorporated communities are scattered throughout the CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 1

3 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) county s rugged terrain, separated by winding mountain roads. Because of this configuration and a history of car- oriented planning, Walk Score rates the county as car- dependent. Walkability scores for cities within the county range from highs of 97 and 91 in Fort Bragg and Ukiah, respectively, to 77 in Willits and 55 in Point Arena.4 On the positive side, healthy eating, physical activity, and local food production have become key aspects of the community zeitgeist and will contribute to achieving the vision of the ACHIEVE (Action Communities for Health, Innovation, and Environmental Change) Coalition. Table 2. Demographic and socioeconomic indicators5 MENDOCINO CALIFORNIA COUNTY Population 7, ,871 4,845 87, million Poverty Level ( ) 19.9% 33% 22% 31% 19.4% 15.3% Median Household Income $36,389 $26,710 $44,958 $34,504 $43,721 $61,400 Ethnicity: Hispanic/NAI 32%/2% 43%/<1% 28%/5% 21%/5% 24%/7% 38%/1% A- 2. Mendocino County chronic disease burden Chronic diseases account for the four leading causes of death in Mendocino County with cancer (including lung cancer) and heart disease causing over 50% of all deaths, followed by stroke and chronic lower respiratory diseases. The Robert Wood Johnson Foundation s County Health Rankings rate Mendocino County worse than 44 of California s 58 counties in health behaviors that are risk factors for chronic diseases, including tobacco use, and worse than all but 8 in length of life. Mortality rates and rankings are shown below: INDICATOR INCORPORATED CITIES FORT BRAGG PT. ARENA UKIAH WILLITS Table 3. Age- adjusted mortality rates6 (rates are per 100,000; rankings reference California s 58 counties, with worse rates shown by higher ranking numbers) MENDOCINO COUNTY CALIFORNIA % CHANGE RANK Deaths from all causes % Cancer % Lung % Diabetes % Heart disease % Cerebrovascular disease % Chronic lower respiratory disease % In 2006, overweight, obesity, and physical inactivity cost Mendocino County an estimated $47 million due to direct health care costs, worker s compensation, absenteeism, and presentee- ism (not being productive at work).7 Other indicators: MORTALITY RATES 18.6% of adults and teens are current smokers, compared with 13% for California as a whole. A 2014 survey found that 60% of tenants live in buildings without rules to limit smoking, and 30% have experienced second- hand smoke (SHS) drifting into their home. Nearly two- thirds (64%) of respondents favored rules prohibiting smoking in common areas, and 58% favored prohibition inside apartments. Furthermore, 98% agreed that SHS is harmful if inhaled.8 In spite of this community support, however, the American Lung CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 2

4 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Association s State of Tobacco Control 2012 study gave Mendocino County jurisdictions grades of D and F on most tobacco control indicators, including smoke- free outdoor air and smoke- free housing. 9 These data highlight the need to regulate secondhand smoke. 58% of adults were overweight or obese in 2012, 10 and fewer than half (47.8%) of the county s 5 th graders are at a healthy weight. 11 According to the 2012 California Health Interview Survey, the county s diabetes rate is 5.6%, up by 27% from the 2005 rate of 4.3%. Mendocino County s Retail Food Environment Index is 2.0, indicating that there are twice as many convenience stores and fast food restaurants as grocery stores and produce stands/farmer s markets in Mendocino County. 12 Local farmers markets are utilized primarily by shoppers of a narrow demographic; many people perceive farmers markets as an expensive source of specialty produce, rather than as an affordable and accessible place to do their weekly grocery shopping. Research shows that ease of access and affordability are primary drivers of healthy food choices, making it vital to increase perceptions of both the accessibility and the affordability of fresh local produce and farmers markets % of adults have been diagnosed with heart disease (compared with 4.6% statewide), and the rate of high blood pressure prevalence stands at 27.9 (23.4 statewide). 19% of adults report no leisure- time physical activity, compared with 18% statewide, and 45% lack adequate access to locations for physical activity, compared with 9% statewide. 14 A- 3. Priority population Mendocino County has nine federally- recognized Native American Rancherias, the fourth most of any county in the country, and Native American Indians account for approximately 7% of county residents. Sadly, the historical mistreatment of American Indians did not omit Mendocino County and has left a legacy of economic and health challenges that continue to emerge in health disparities. For example, the per capita income of American Indians is $12,150 per year, barely half of the county average of $23,179. Similarly, 37.5% of American Indians and 48.3% of American Indian children live below the federal poverty level, compared with 19.4% countywide. 15 People with low incomes suffer disproportionately high rates of obesity and chronic diseases; nationally, American Indians have a life expectancy that is 5.2 years lower than the overall population. 16 In Mendocino County, three clinics provide Indian Health Service- funded health care to local residents: Consolidated Tribal Health Project (CTHP, a Coalition partner), Round Valley Indian Health Center, and an outreach clinic operated by Sonoma County Indian Health Project. The county s Native American population will be the priority population for the proposed project. Native Americans live in all county census tracts, 17 not only on the federally- designated Rancherias. The selection of this population is based on the following local health indicators: 83% of adults seen by Consolidated Tribal Health Project are obese or overweight. 18 Fewer than half (47.6%) of American Indian 5 th graders are at a healthy weight. 19 According to data reported by Consolidated Tribal Health Project and the Round Valley Indian Health Center in 2008, 29% of patients had a primary diagnosis of diabetes. 20 Nationwide, Native Americans are 2.6 times more likely to have diabetes. 21 In Round Valley, Native American students account for 66% of student enrollment, and 96% of students participate in the free and reduced price meal program. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 3

5 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) The 2012 California Health Interview Survey found that as many as 74% of American Indians were current smokers. B. APPROACH The Coalition s approach is based on the project Logic Model, shown in Section C- 3 below. B- 1. Problem statement As described in Section A, Mendocino County presents its residents with both opportunities and challenges. Strong local collaboration at the organizational level and a growing interest in healthy lifestyles among county residents form a strong foundation for addressing problems through the CDC Partnerships to Improve Community Health (PICH) Program: Tobacco Use and Exposure. 18.6% of adults and teens are current smokers; 60% of tenants live in buildings without rules to limit smoking; and 30% have experienced second- hand smoke drifting into their unit. The American Lung Association s State of Tobacco Control 2012 study gives Mendocino County jurisdictions grades of D and F on most tobacco control indicators, including smoke- free outdoor air and smoke- free housing. Poor Nutrition. 25% of adults are obese, 22 and fewer than half (47.8%) of the county s 5 th graders are at a healthy weight. 23 Physical Inactivity. 19% of adults report no leisure- time physical activity and 45% lack adequate access to locations for physical activity (compared with 9% statewide), because of street design that fosters automobile traffic at the expense of cyclists and pedestrians. Chronic Disease. Chronic diseases account for the four leading causes of death in Mendocino County, and County Health Rankings place Mendocino County worse than 43 of California s 58 counties in health behaviors that are risk factors for chronic disease. Coalition Capacity Development. To maintain the ACHIEVE Coalition s capacity to carry out activities, strategies, performance measurement, and evaluation requires increased assessment capacity and stronger community linkages. B- 2. Purpose Mendocino County s ACHIEVE Coalition seeks to make the healthy choice the easy choice by partnering in innovative ways to create healthful spaces that provide every resident with a fair and equitable chance to experience healthy living, learning, working, and playing. Based on needs prioritized through the county s 2013 Community Health Assessment (see Attachment A) and described in Section A, the Coalition will focus evidence- based efforts on all four risk factors by: Working closely with the county s five jurisdictions (county government and four incorporated cities) to promote implementation of ordinances or policies for complete streets, bicycle and pedestrian plans, smoke- free multi- unit housing and outdoor recreation areas, and zoning that increases access to fresh fruits and vegetables through community gardens, urban farmstands, and similar activities; Working with local jurisdictions, organizations, and child care providers to develop, adopt, and implement healthy food, beverage, and activity policies; Working with local American Indian tribes to plan and implement wellness programs; and Expanding access to Chronic Disease Self- Management Program (CDSMP) workshops, and partnering with providers to develop a system that will increase referrals to the workshops. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 4

6 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) B- 3. Outcomes The Coalition s anticipated short- term outcomes will build the county s capacity to achieve CDC s long- term objectives for the PICH Initiative, which are: To reduce rates of death and disability due to tobacco use by 5%. To reduced prevalence of obesity by 3%. To reduce rates of death and disability due to diabetes, heart disease, and stroke by 3%. Table 4. Short- term outcomes (Awardee Reach), by outcome and strategy RISK FACTOR AND STRATEGY YEAR 1 REACH YEAR 1 SETTINGS YEAR 3 CUMULATIVE REACH YEAR 3 CUMULATIVE SETTINGS 1. Increased access to smoke- free environments Smoke- free MUH ordinances 3, ,000 4 Outdoor tobacco use policies 2, Increased access to healthy food and beverages Healthy beverage and food policies 6,000 5 Policies to increase the price of sugar- 6,000 5 sweetened beverages 10% local food procurement policies 2, , Farmers market vouchers and coupons 2, ,500 7 Zoning that increases access to fresh produce through community gardens and farmstands ,800 4 Child care nutrition and activity , Increased access to physical activity options Complete streets policies 12, ,000 3 Bicycle and pedestrian plans 2, Increased access to physical activity options for priority population: Native Americans Tribal wellness programs 1, , Increased opportunities for chronic disease prevention CDSMP workshops and referral system , Increased Coalition capacity Building capacity for community assessment, community linkages, and sustainability (75% x total pop. of 88,000 = 66,000) TOTAL 22, , B- 4. Strategies and activities Through the ACHIEVE Coalition, the Mendocino County Health and Human Services Agency (HHSA), will use evidence- based policy, systems, and environmental (PSE) change strategies to reduce and prevent chronic conditions. The Coalition will address all four of the CDC PICH risk factors, using population- based approaches, as well as implementing strategies to increase Coalition capacity. The proposed strategies build on local momentum to enhance, expand, and strengthen current efforts and will reach at least 75% of the county population, as shown in Table 4 above. In the following narrative, strategies are organized by risk factor; further details CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 5

7 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) are provided in the attached Work Plan, which constitutes pages of the 25 pages allowed for the project narrative. The evidence base for each strategy is described in the Work Plans. B- 4a. Project Period Objective (PPO) 1.0: Increased access to smoke- free environments To increase access to smoke- free environments, the Coalition will focus in Year 1 on increasing the number of people who have access to smoke- free environments in multi- unit housing (MUH) in the City of Ukiah, as outlined in the Work Plan for Annual Objective (AO) 1.1. After reviewing data and meeting with city representatives to determine their level of readiness and providing education regarding the health benefits of smoke- free housing, the Project Coordinator will set up a schedule with the City of Ukiah for the provision of technical assistance (TA) in the development and drafting of a municipal ordinance requiring smoke- free housing policies for rental units. The Project Coordinator will also work with Healthy Mendocino ( to implement an information campaign to educate the community about the rationale and value of smoke- free MUH. Healthy Mendocino was initiated in 2011 by the HHSA Advisory Board. Under their leadership, a coalition of 20 funding partners came together to create and fund Healthy Mendocino, which debuted in January 2013 as a data- based effort to connect people and information for better community health. The Healthy Mendocino website is developed and maintained by the Healthy Communities Institute in Berkeley, California, under the guidance of a local steering committee. During Years 2 and 3, the Coalition will continue to work towards smoke- free housing in other jurisdictions and will also work to increase the number of people that have access to smoke- free environments in parks and other outdoor recreation areas by providing county and city jurisdictions with TA in the development of policies for smoke- free public parks and sports fields, and education regarding the health benefits of such policies. B- 4b. PPO 2.0: Increased access to environments with healthy food and beverage options To increase access to environments that have healthy food and beverage options, in Year 1 the Coalition will carry out the activities listed below and detailed in Work Plan AO 2.1 and 2.2. North Coast Opportunities (NCO), a Coalition member, will be subcontracted to carry out these strategies. NCO is the Community Action Agency for Mendocino County and has played a leading role in numerous efforts to increase healthy local food production and food security. AO 2.1: Eat 10% Local Campaign. The Nutrition Coordinator will work with Healthy Mendocino to plan and conduct a community- wide media and promotion campaign focused on policies that increase access to, purchasing of, and consumption of fresh local fruits and vegetables. Through the message, fruits and vegetables from local sources lead to better health, the campaign will focus on education and promotion that results in the adoption of institutional policies for 10% local procurement and individual commitments to purchase 10% of fruits and vegetables locally. The campaign will also link local farms and community- supported agriculture programs with food banks and other safety net providers. As part of this campaign, the project will work to develop systems that increase the purchasing power of low- income residents, such as promoting farmers market purchases by strengthening linkages between farms and food banks and other safety net providers; distributing farmers market coupons to people with chronic diseases, through their health care providers and CDSMP workshops; and systematizing the distribution of CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 6

8 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) farmers market matching vouchers for food stamp customers. NCO will also educate policymakers, to facilitate adoption of zoning policies and regulations that are aligned among all county jurisdictions to increase access to fresh fruits and vegetables through community gardens and urban farmstands, and promote the new policies to encourage public participation. AO 2.2: CHOICE Model for Child Care Providers. NCO will use the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) Model to help child care providers develop healthy food policies. Using CHOICE, NCO will provide training to 90 child care providers to enable them to: assess their nutrition programs; develop nutrition policies; share policies with parents; and implement policies in their child care programs. During Years 2 and 3, NCO will continue the activities described above and expand an additional strategy to increase access to environments with healthy food and beverages. Working through subcontracts with community- based organizations (CBOs), the project will recruit and train youth groups to promote and advocate for healthy food and beverage policies. The youth will research data in their own communities, develop presentations, identify organizations, safety net providers, faith- based groups, and other entities who have not yet implemented healthy beverage and/or food policies, and bring their presentations to the boards or other decision- making bodies of these groups. In addition, youth will advocate for policies that increase the prices charged by the organizations for sugar- sweetened beverages. Also during Year 2, project staff will begin advocating within HHSA for adoption of healthy vending machine standards. B- 4c. PPO 3.0: Increased access to physical activity options To increase access to opportunities for physical activity, the Coalition will focus in Year 1 on increasing the number of jurisdictions that have adopted complete streets policies, as outlined in the Work Plan for AO 3.1. After reviewing data and meeting with city representatives to determine their level of readiness and providing education regarding the health benefits of complete streets policies, the Project Coordinator will set up a schedule with the City of Ukiah for the development and adoption of a complete streets policy, and will also work with Healthy Mendocino to design and implement an information campaign to educate the community about the rationale and value of complete streets. In addition, through a subcontract with Walk and Bike Mendocino, the project will develop and disseminate a countywide walking and biking resource guide that will be published in print and online. During Years 2 and 3, the Coalition will continue the efforts described above and will also work to increase the number of jurisdictions that have active bicycle and pedestrian plans by providing county and city jurisdictions with TA in the development of the plans, including identifying unsafe crossings and other hazards, signage, and timelines, as well as education regarding the health benefits of bicycle and pedestrian plans. B- 4d. PPO 4.0: Increased access to physical activity options for priority population See Section B- 5. B- 4e. PPO 5.0: Increased opportunities for chronic disease prevention During Year 1, the Coalition will work to expand the existing CDSMP, as outlined in the Work Plan for AO 5.1. Ten Lay Leaders will work in pairs to deliver four workshop series of six weekly sessions during the year, for a total of 20 workshop series reaching at least 200 people. HHSA CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 7

9 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) will also coordinate with local health care providers to develop and implement a referral system that increases the number of chronic disease patients referred to the workshops. During Years 2 and 3, the Coalition will continue to coordinate CDSMP workshops and also work with partners to develop a mutual support and training forum for Lay Leaders and other Patient Navigators working with health care systems and providers throughout the county. B- 4f. PPO 6.0: Increased Coalition capacity Infrastructural improvements are outlined in AO : Organization Capacity/Staffing. HHSA will train two new Lay Leaders to expand the capacity of the CDSMP to reach high- risk groups, including Native American communities. 6.2: Coalition. The Coalition will develop stronger connections with the HHSA Advisory Board, whose mission is to advise the HHSA Director and the Board of Supervisors in order to: promote health and wellness; promote individual and community responsibility for health; reduce environmental health hazards; facilitate coordination and integration of community services; and educate the community on current and emerging health and social services issues. To build closer ties with the HHSA Advisory Board, the Coalition will designate a member to attend Advisory Board meetings and report on Coalition activities. The Advisory Board and the Coalition will also develop shared sub- committees, and each will include the other s activities as standing agenda items during their regular meetings. 6.3: Performance Measurement/Evaluation. Healthy Mendocino will conduct a review of all of the data and assessment needs of local agencies and organizations, and work with them to develop a consolidated assessment process that will reduce duplication of effort and ensure that accurate and standardized data is available for all assessments. 6.4: Communications and Dissemination. Plans for communicating the health benefits of project activities and measuring project performance are described in Section C- 3 below and will be fully detailed in the communications plan submitted within 60 days of award. 6.5: Fiscal Management. HHSA prioritizes prevention, including PSE change strategies, and the Coalition will make sustainability funding a standing agenda item. HHSA has achieved an impressive record of grant- seeking success, using a systematic process to identify grant opportunities and leverage partnerships to maximize resources. However, sustainability plans extend beyond grantseeking to include advocacy, capacity building, and community education, and HHSA will submit a detailed sustainability by the end of Year 2. B- 5. Strategies specific to the priority population This component will be carried out by a tribal health clinic or other tribal entity (selection will be made upon receipt of the grant). During Year 1, the Coalition will work with this partner provide training and TA to build tribal capacity to plan, develop, implement, and strengthen physical activity and wellness programs for their members, in their facilities, and on their rancherias, including the design and development of senior walking programs, outreach to help people incorporate physical activity into their daily activities, and walkability and bikeability audits on tribal lands. These activities are outlined in PPO 4.0/AO 4.1. This partner will also provide technical assistance to the Coalition to ensure that project activities and materials are culturally sensitive and address the cultural needs of Native American Indians. During Years 2 and 3, the Coalition will continue these efforts, seeking to reach more people. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 8

10 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) C. APPLICANT EVALUATION AND PERFORMANCE MEASUREMENT PLAN C- 1. Evaluation support and Coalition engagement As described in the Budget Narrative attachment, HHSA has allocated 10.45% of the proposed $1,690,871 budget to evaluation activities, including an evaluator at 20% FTE and a Data Analyst at 50% FTE. ACHIEVE will be fully engaged in all evaluation work. Using an empowerment model, the Evaluator will work collaboratively with staff, Coalition members, and partners to develop and implement a comprehensive evaluation that assesses activities prioritized by Coalition members, tracks outcomes, and ensures that necessary data are collected efficiently and consistently. Upon start up, the Evaluator will train Coalition members and partners on data collection and reporting procedures. The Evaluator and/or the Data Analyst will participate in all Coalition meetings to present and discuss evaluation options and findings at least quarterly, determine the most appropriate ways to track project indicators and assess progress, present preliminary and final data, and lead discussion of course corrections based on collected data. C- 2. Evaluation capacity HHSA and its partners are willing and able to collect data for local evaluation, as well as data required for CDC reporting. HHSA has an impressive level of in- house evaluation expertise, including three staff trained in health impact assessment methodology. As shown in Table 6 in Section D- 1 and in the resumes that are included in Attachment A, the Evaluator holds an MPH degree and has extensive evaluation and statistical analysis experience. All HHSA prevention programs include process and outcome evaluation components, and HHSA has developed the capacity to analyze population- level health data and measure health impact, focusing on populations suffering health inequities. HHSA is an experienced and successful grant seeker, and has proven its capacity to comply with the evaluation and reporting requirements of numerous federal and state grants. Through Healthy Mendocino, the Coalition will have access to a valuable resource in terms of data tracking, consolidation, analysis, and reporting. Coalition members also have experience with impact evaluation and reporting, making them a strong addition to the project evaluation team. C- 3. Evaluation and performance measurement plans C- 3a. Evaluation plan narrative The evaluation builds on the project Logic Model (Figure 1) and will play a critical role in assessing whether the Coalition is accomplishing what it set out to do and how its work might be improved. The Evaluator will develop a formal evaluation plan that will include both formative and summative evaluation components, with the goals of: 1) documenting implementation; 2) identifying areas in need of improvement; 3) providing formative guidance; 4) assessing progress; 5) supporting sustainability; and 6) mobilizing community support. The evaluation will inform program development (process evaluation) and measure program effects (outcome evaluation). Through partnership with Healthy Mendocino, the Coalition will develop and maintain a web- based tracking system/initiative center to monitor project outcome indicators. The Evaluator will be responsible for analysis and interpretation of evaluation data. Quantitative data will be analyzed using the STATA Data Analysis and Statistical Software and qualitative data managed and analyzed using Atlas- ti software. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 9

11 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Inputs! Strategies/Activities! ACHIEVE' TA'to'jurisdictions'in'development'and' multi-sectoral' implementation'of'smoke-free'muh' ordinances'and'smoke-free'outdoor' community' coalition' recreation'areas' Education'of'key'stakeholders'and'public' Community' Health'Needs' Assessment' Community' Health'Action' Plan' regarding'health'benefits'' Community-wide'campaign'to'increase' purchase'and'consumption'of'fresh'local' fruits'and'vegetables,'including'distribution' of'farmers'market'vouchers'and'coupons' TA'to'jurisdictions'in'development'and' implementation'of'zoning'policies'that' increase'access'to'fresh'produce'' Existing' TA'to'jurisdictions'in'development'and' infrastructure' implementation'of'complete'streets' policies'and'bicycle'and'pedestrian'plans' Existing'data' Education'of'key'stakeholders'and'public' sources' regarding'health'benefits'' Development'of'biking'and'walking'guide' Qualified'staff' Build'capacity'to'develop'systems'for' CDC'TA' planning'and'implementing'fitness'and' wellness'programs'for'tribal'communities'' CDC'funding' ' Expand'number'of'CDSMP'workshops'held' Referral'system'to'increase'Network'for' Lay'Leaders'and'Navigators' ' Train'additional'Lay'Leaders'' Develop'consolidated'needs'assessment' process'and'template' Shared'subcommittees'' Implement'sustainability'plan' Implement'communications'plan' ' Figure 1. Year 1 evaluation logic model Short"Term% Outcomes! Increased' access'to' smoke-free' environments' Increased' access'to' environments' with'healthy' food'or' beverage' options' Increased' access'to' physical' activity' opportunities' Increased' access'to' physical' activity' opportunities' Increased' opportunities' for'chronic' disease' prevention' Increased' Coalition' capacity' Evaluation* Strategy(and( Data$Source! Text'of'local' ordinances' Population' counts' Media'log' Local'policy' texts' Text'of'local' ordinances' Population' counts' Wellness' programs'in' operation' Referral'count' Workshop' attendance' Consolidated' assessment' procedure' Coalition' survey'! Targets! Evaluation*Measures! Y1! Y2! Y3! #'jurisdictions'that' adopt'smoke-free' ordinances'for'muh' #'people'with' increased'access' #'MUH'units'' #'institutions'that' adopt'10%'local' policy'for'procuring' fresh'produce'' #'people'with' increased'access' Media'activities'' #'jurisdictions'that' adopt'complete' streets'policies'' #'people'with' increased'access'' #'individuals'trained' Written'wellness' programs' #'participants' #'people'referred'to' CMSDP'workshops' #'CDSMP'workshops' held' #'infrastructure' improvements'' #'people'actively' involved'in'coalition' Consolidated' assessment'process' 1' ' ' 3,250' ' 5' ' ' ' 6,300' 1' ' ' 12,000' ' 1' ' ' 5,000' 5' ' ' ' 13,000' 1' ' ' 4,000' 2' ' ' 7,500' 5' ' ' ' 13,000' 1' ' ' 6,750' Cumm.% Total! 4!!! 15,750! 15!!!! 32,300! 3!!! 22,750! 1,000' 1,000' 1,000' 3,000! 200' ' ' 20' 3' ' ' 50' 700' ' ' 20' 1' ' ' 50' 700' ' ' 20' ---' ' ' 50' 1,600!!! 60! 4!!! 50! Note that the following evaluation plan includes only the evaluation questions and strategies selected by the Coalition for evaluation during Year 1. C- 3b. Evaluation questions To assess implementation, the evaluation will seek answers to the following questions: Fidelity. With what degree of fidelity was the project implemented? What types of deviation occurred, and what effect did deviations have? Context. What program/contextual factors were associated with outcomes? Barriers. What barriers were encountered and how were they addressed? The following questions address the project s short- term impact on the four PICH risk factors: Tobacco. How many jurisdictions, representing how many MUH apartments and how many residents, adopted smoke- free housing ordinances? Nutrition. How successful were project efforts to increase the number of organizations and/or institutions that implement policies to procure 10% of fresh produce locally? Physical activity. How many jurisdictions, representing how many residents, adopted complete streets policies? Physical activity among priority population. To what extent was the project able to increase physical activity opportunities among members of the priority population? CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 10

12 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Chronic disease. How effective was the referral system in increasing the number of referrals to CDSMP workshops? Infrastructure. How effective, and how well- documented, were efforts to create a process and template for a consolidated community assessment process? C- 3c. Evaluation data collection plan Data collection and measurement activities and time schedules will comply with CDC reporting requirements, including electronic submission of quarterly data; semi- annual submission of performance measure data, with success stories; and annual submission of performance reports and media activity reports. Table 5. Year 1 evaluation and data collection plan OUTCOME INDICATOR DATA SOURCE ANALYSIS Tobacco # jurisdictions adopting ordinances # MUH units covered # people with increased access Nutrition # organizations adopting policies # people with increased access Physical Activity # jurisdictions adopting policies # people with increased Physical Activity for Priority Population access Partner identified # people with increased access Chronic Disease Institutionalization of referral system # people referred Infrastructure Completion of consolidated assessment process Minutes Text of ordinances Minutes Text of policies Minutes Text of policies Text of policies Signed agreements # partners Healthy Mendocino website # users Coalition survey C- 4. Use of evaluation findings for continuous improvement Numerical count Content analysis Documentation of process Numerical count Content analysis Documentation of process Numerical count Content analysis Documentation of process Numerical count Documentation of process Numerical count Content analysis Documentation of process Numerical count Documentation of process Member satisfaction The Evaluator will present findings to the Coalition at least quarterly to ensure that lessons learned will be put to use immediately for program improvement, and will also prepare extracts using evaluation data for presentation to other local groups and for news articles in local media. As lead agency, HHSA will be responsible for conducting annual Coalition and other surveys to assess the quality of the program from all points of view. Analysis of these surveys will be used to develop recommendations for midcourse corrections. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 11

13 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) C- 5. Contribution of evaluation to evidence base HHSA has selected strategies that have a strong evidence base and will share findings and best practices that confirm existing research, including strategies that led to success in achieving short- term outcomes, with fellow grantees and CDC. HHSA will also ensure that data are collected in compliance with CDC guidance to facilitate aggregation of data among grantees. The Coalition s process of developing a consolidated community assessment process that meets the requirements of a range of agencies and CBOs will be well- documented to facilitate replication by other communities. C- 6. Communication and dissemination of evaluation findings Coalition partners will share responsibility for dissemination of evaluation findings with the Evaluator and Data Analyst. Locally, evaluation reports will be distributed to HHSA Departments and Advisory Boards and through the Healthy Mendocino initiative center and local news media. Healthy Mendocino will track and report utilization of project data through Google Analytics. As specific findings are developed, they will be summarized in formats suitable for target audiences (e.g., brochures, PSAs, PowerPoint presentations, social media postings, and feature news articles) to increase community knowledge and capacity while building support for sustaining the project. Evaluation findings will also be reported to CDC and at relevant conferences. Finally, the Coalition will work with CDC to develop a final dissemination document covering the entire grant period. D. ORGANIZATIONAL CAPACITY OF APPLICANT TO IMPLEMENT THE APPROACH D- 1. Applicant capacity D- 1a. History of Coalition membership and experience The Mendocino County Health and Human Services Agency (HHSA), the applicant, has extensive experience in chronic disease prevention and control and, in May 2011, led county partners in establishing the ACHIEVE (Action Communities for Health, Innovation, and Environmental Change) Coalition. The Coalition s experience is summarized in Section D- 2b below and documented in Attachment A. HHSA s commitment to sustainable solutions has been demonstrated through several collaborative health assessment and evaluation efforts, including the Public Health Institute Partnership for the Public s Health Initiative and the National Association of County and City Health Officials (NACCHO) Mobilizing for Action through Planning and Partnerships. HHSA s experience with population- level strategies to address chronic disease risk factors also includes holding two Chronic Disease summits that used the Performance Partnership Model to bring together parties concerned about chronic disease rates in Mendocino County. The first summit, which was held in June 2009 and attended by participants from health care, nonprofit, education, government, and tribal agencies across the county, reviewed local data and determined to focus joint and individual efforts on reducing the county s smoking rate to 10%. The second summit, held in January 2011, included participants from hospitals, community centers, the American Lung Association, a retiree association, CDSMP leaders, a Latino Family Center, and the California Arthritis Partnership, in addition to attendees from the first summit. After reviewing local data, the participants determined to focus on the goal of reducing the percentage of county residents diagnosed with heart disease from 8.7% to 7.5%. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 12

14 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Since establishing ACHIEVE, partners have carried out the following environmental efforts: Chronic Disease. Trained 30 Lay Leaders to deliver CDSMP workshops, using Stanford University s evidence- based curriculum to teach self- management strategies. Workshops have been funded by the California Heart Disease and Stroke Prevention Program, the Diabetes Prevention Program of the California Department of Public Health, and the CDC Community Transformation Grant. Two of the Lay Leaders have also been trained in the Spanish version of the program. Lay Leaders have delivered 26 workshop series, reaching 270 people with chronic diseases over the past 4 years. Tobacco. HHSA implements the county s Tobacco Control Program, which enacts policy changes to reduce access to tobacco products, and has successfully advocated with owners of 400 units of MUH to voluntarily adopt smoke- free housing policies. Nutrition. Through the Community Transformation Grant Program, HHSA subcontracted with local schools and CBOs to train 55 youth to be advocates for healthy changes in their own communities. As a result, more than 25 entities have adopted healthy beverage policies. HHSA also co- founded the Mendocino County Food Policy Council and participated in the creation of its Food Action Plan, which outlines steps to reduce chronic illnesses such as heart disease and diabetes. Finally, HHSA has administered Supplemental Nutrition Assistance Education Program grants funded by USDA since 2002, providing nutrition education, physical activity promotion, and PSE change strategies to help shape environments that lead to healthy behaviors. Physical Activity. HHSA has worked with schools and school districts to develop and adopt safe routes to school policies and activities, working with trained youth groups. Through the ACHIEVE Coalition and the activities listed above, HHSA has proven its commitment and capacity to implement the PICH Project. HHSA has collaborated extensively with diverse community groups, schools, nonprofits, tribes, and other partners and employs 475 people. HHSA manages an annual budget of $104.5 million, using Generally Accepted Accounting Principles to accurately reflect fiscal transactions and provide accounting data so that cost effectiveness can be determined separately and checks and balances maintained. The proposed PICH Project will be carried out under the direction of the Project Director (25% FTE). Responsibilities and qualifications for key staff positions are provided below. Table 6. Staffing structure (See resumes in Attachment A) POSITION RESPONSIBILITIES QUALIFICATIONS HHSA C. Schenck (70% FTE, of Responsible for overall direction and which 10% is match) guidance, monitoring subcontracts, and Project Director and ensuring submission of fiscal and Chronic Disease program reports, as well as chronic Coordinator disease strategies. Ms. Schenck has worked with HHSA since 2002, and has coordinated HHSA s Community Transformation Grant since CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 13

15 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) POSITION RESPONSIBILITIES QUALIFICATIONS J. Stull- Otto (100% FTE) Project Coordinator To Be Hired (TBH: 20% FTE, match) PSE Change Coordinator S. Kinney (20% FTE) Project Evaluator Healthy Mendocino M. Rich Data Analyst (50% FTE) and Communications Coordinator (40% FTE) North Coast Opportunities J. Dalton (90% FTE) Nutrition Outreach Coordinator TBH (50% FTE) CHOICE Coordinator To Be Determined (Tribal Entity) TBH (100% FTE) Wellness Coordinator Responsible for day- to- day coordination of Coalition, budget management, and required reports. This position will also implement tobacco and physical activity strategies. Responsible for working with local jurisdictions and all project staff to promote PSE change through best practice strategies and models. The Evaluator will work with CDC staff to design a comprehensive evaluation plan, and will coordinate and implement evaluation strategies. Work with Evaluator to develop a project initiative center in Healthy Mendocino data center to track project outcomes, and coordinate with partners to plan, develop, and disseminate outreach and educational materials. Responsible for 10% campaign and providing TA to local jurisdictions regarding implementation of zoning policies and processes to increase access to fresh fruits and vegetables. Work with Rural Communities Child Care to conduct outreach to child care providers, train them in use of the CHOICE model for developing healthy food policies, and monitor and support implementation of policies. Work to increase tribal capacity to plan and implement physical activity and fitness programs and conduct walkability/bikeability audits. Provide TA to ensure that activities address cultural needs of Native American Indians. Ms. Stull- Otto has 6 years of experience with planning and public health, holds a BS in Environmental Studies and Planning, and has been with HHSA since This position requires experience with policy development and local government; BA is preferred. Ms. Kinney holds an MPH degree, has extensive evaluation experience, and is HHSA s Senior Analyst. Ms. Rich is an experienced data analyst and manager, with 6 years experience with communications efforts, including media relations, and marketing. Ms. Dalton is an experienced communications and marketing consultant and led a recent USDA Farmers Market Promotion grant. This position requires experience working with child care providers, familiarity with child care regulations, and ability to provide instruction. BA is preferred. This position requires experience working with local tribes and cultures and experience and knowledge related to physical activity and wellness. BA is preferred. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 14

16 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) D- 1b. Support for evaluation and communication activities Evaluation. HHSA is committed to evaluation, and has dedicated a total of $176,679 (10.45%) of the proposed budget to evaluation activities, as shown in the Budget Narrative attachment. As described in Section C- 2, the Evaluator (20% FTE) will work closely with Healthy Mendocino s Data Analyst (50% FTE) to develop the evaluation plan, design data collection strategies and instruments, and ensure a regular reporting schedule for sharing project accomplishments and outcomes with Coalition members and the broader community. HHSA experience with evaluation and research includes two publications: A Health Impact Assessment of the Harms of High Alcohol Outlet Density in Mendocino County (2013) and a Retail Food Landscape Study (2010). The former study mapped alcohol outlets to demonstrate the effects of high alcohol outlet density on health outcomes, while the latter mapped the retail food environment to reveal the over- saturation of fast food/convenience stores in low- income and Latino neighborhoods. HHSA s Tobacco Control Program has used GIS mapping strategies to locate tobacco retailers throughout the county, and uses the Communities of Excellence process to conduct a tobacco needs assessment every three years. Communication and dissemination. HHSA is also committed to a strong communication effort and has allocated $175,544 (10.38%) for communication and dissemination strategies, including a Communications Coordinator (40% FTE) who will use program data to develop and distribute reports and educational materials to promote the project and its accomplishments. Since 1995, HHSA has produced a biennial Community Health Status Report that tracks population health indicators and is broadly disseminated throughout the county. In 2010, the Report added indicators reflecting socio- economic and environmental determinants of health, including original analyses of life expectancy by race and ethnicity. HHSA has also contributed to health language that has been incorporated in the Mendocino County General Plan, including policies to increase access to healthy foods and everyday physical activity, and to reduce health disparities. Through a Sustainable Communities Planning Grant and Incentive Program Award from the California Strategic Growth Council, HHSA supported the cities of Ukiah and Fort Bragg in incorporating health and sustainability criteria into their land use plans. D- 2. Coalition capacity D- 2a. Documentation of Coalition eligibility The Mendocino County ACHIEVE Coalition was established in May 2011 when HHSA was awarded a three- year grant from the National Association of Chronic Disease Directors. The Coalition s mission is: to work collaboratively for policies and environmental changes to empower all people within our community to lead healthier lives. The Coalition s efforts have focused on improving the nutrition, physical activity, and tobacco environments and reducing chronic disease. In December 2013, the Coalition completed a comprehensive Community Health Needs Assessment using the CDC Community Health Assessment and Group Evaluation (CHANGE) Tool; results of the assessment were used to inform the content of this proposal. Coalition members include all of the six required sectors (community/local government, community- based organizations, health care, faith- based, schools, and work sites). Approximately 62% of the proposed budget has been allocated to subcontracts with community partners. Please see Attachment A for documentation of eligibility for PICH funding, CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 15

17 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) including meeting minutes and membership roster, and Attachment B and C for documentation of the commitment and support of Coalition and other partners. Responsibilities of partners in the PICH project are outlined below. Table 7. Project partners and their roles Partners Sector Responsibilities HHSA Local Health Department Coordinate and administer grant. Lead tobacco, physical activity, chronic disease, and infrastructure/capacity building components. Lead evaluation efforts. HHSA Advisory Board Multiple Strengthen links with ACHIEVE through consolidated assessment, and joint subcommittees. NCO CBO Lead nutrition component. Healthy Mendocino To Be Determined Food Policy Council Walk and Bike Mendocino CBO Tribal Entity CBO CBO Lead community assessment process. Develop initiative center to track outcome data. Community education and outreach. Work with tribes to train and provide support for implementation of wellness programs. Provide TA to ensure cultural competency of activities. Assist with activities that address Food Action Plan goals. Provide input on policies that increase access to healthy foods and educate the community on benefits. Develop countywide walking and biking resource guide. Conduct outreach and promotion for implementation of physical activity policies. D- 2b. Documentation of Coalition experience addressing risk factors for chronic disease Since its creation in 2011, the ACHIEVE Coalition has completed a comprehensive community health assessment, used the results to identify and prioritize target issues, and developed and carried out a number of PSE strategies, as detailed below: The Coalition s Community Health Assessment provided data for community members who successfully advocated for a Ukiah Downtown Zoning Code that prohibited new tobacco shops and new fast food chain businesses while allowing community gardens and farmers markets to be established more easily in more places. The Coalition educated policy- making bodies on the need for smoke- free places and reduction of youth access to tobacco products, resulting in smoke- free recreation areas in Fort Bragg and Ukiah, and the adoption of tobacco retail license ordinances in Fort Bragg, Ukiah, Willits, and Mendocino County all but 1 of the county s five jurisdictions. In 2010, HHSA and numerous community partners established the Food Policy Council to coordinate activities to reduce hunger, increase health, and expand local fruit and vegetable production. The FPC has completed a countywide Community Food System Assessment (2012), a Food Action Plan (2014), and prioritization of the local food CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 16

18 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) component contained in the Vision Mendocino Blueprint, covering Community Gardens Use- by- Right Zoning, California s Cottage Food Act (AB 1616), and urban farming. Through programs funded by the CDC Community Transformation Grant and the California Obesity Prevention Program, the Coalition has supported the work of youth groups, who advocate for healthy policies including smoke- free apartments, school wellness policy implementation, organizational and city healthy snack and beverage standards, and infrastructure changes to make it easier to walk or bicycle to school. The Coalition has worked with local farmers markets and community supported agriculture (CSA) farms to accept CalFresh (food stamp) electronic benefit transfer (EBT) payments to increase access to healthy foods among low income residents. The Coalition has worked with local school districts to develop policies that increase the variety and number of fresh fruits and vegetables served in student meals, eliminate candy and unhealthy bake sale items from fundraising strategies, reduce access to sugar- sweetened beverages, and increase availability of free, safe drinking water. With Coalition support, the county s largest health care system instituted a healthy food environment policy to address nutritional labeling, pricing strategies to incentivize consumption of healthier foods, and prohibition of advertisement of unhealthy foods. The City of Fort Bragg adopted a Healthy Eating, Active Living resolution that encourages employees to walk or bike to work, requires food items in city- owned vending machines and food served at city events to meet nutritional guidelines, and requires city planners and other staff to foster built environment designs that encourage walking and biking. D- 2c. History of Coalition compliance with federal reporting requirements Led by HHSA, the Coalition has successfully implemented numerous large federal, state, and foundation grants, and has complied with all grant and fiscal reporting requirements by submitting all required information and reports with accuracy and on time. HHSA has the capacity, the infrastructure, and the commitment to comply with all reporting and implementation requirements of the CDC PICH Program. D- 2d. Coalition experience with conducting mass communication and evaluation efforts The Coalition has prepared numerous press releases on topics specific to the work of the Coalition, and its efforts to improve health have been featured in articles in the San Francisco Chronicle and the Santa Rosa Press Democrat. Two research reports, The Retail Food Landscape in Mendocino County (2010) and Alcohol Outlets and Our Community (2013), were both disseminated nationwide and presented at a national webinar of ACHIEVE grantees. For its work on these studies, HHSA was nominated for a SAMHSA Service to Science Award. In evaluating the efforts undertaken by the Coalition through the Community Transformation Grant and other programs, the Coalition has documented its successes and achievements and shared them with the community through local radio and news outlets. HHSA s presentations on its youth advocacy work for healthier beverage policies earned the organization a Transformational Game Changer Award from California Convergence, a network of individuals and organizations that promotes PSE change to reduce and prevent chronic diseases. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP NARRATIVE PAGE 17

19 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) E. WORK PLAN/COMMUNITY ACTION PLAN Risk Factor TOBACCO- AND SMOKE- FREE ENVIRONMENTS Objective ID 1.0 Measurement Direction Unit What Will Be Measured Baseline Target Data Source Increase Number People impacted by tobacco control ordinances ,750 Ordinance text City Council minutes Timeframe Start: September 29, 2014 End: September 29, 2017 PPO Increase the # of people with increased access to tobacco- free environments from 400 to 15,750 by September PPO Description To date, no local jurisdictions have adopted smoke- free multi- unit housing (MUH) ordinances. However, there is a clear need to regulate secondhand smoke (SHS): 18.6% of adults and teens are current smokers, compared with 13% for California as a whole. The county s age- adjusted lung cancer death rate is 42.2/100,000, 21% higher than the statewide rate of 34.8/100,000. ANNUAL OBJECTIVE 1.1. Increase the number of Mendocino County jurisdictions that adopt and implement smoke- free MUH ordinances. Measurement Direction Unit What Will Be Measured Baseline Target Data Source Increase Number Jurisdictions with smoke- free MUH ordinances 0 1 Jurisdiction records Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Community Strategy Work with Ukiah City to develop a smoke- free MUH ordinance and provide education and TA for its adoption and implementation. Justify the selection Approximately 13,000 county residents live in MUH, placing them at higher risk for SHS exposure; 60% of tenants live in buildings without of this strategy rules to limit smoking; and 30% have experienced SHS. Nearly two- thirds (64%) favor rules prohibiting smoking in common areas of MUH, and 58% favor prohibition inside apartment units. Over the past three years, ACHIEVE has worked with owners of 400 apartment units to help them develop smoke- free policies, on a voluntary basis. This strategy moves further toward smoke- free housing by working with local jurisdictions for the adoption of smoke- free MUH ordinances. The Community Preventive Services Task Force recommends smoke- free policies to reduce SHS exposure and tobacco use on the basis of strong evidence of effectiveness in: reducing SHS exposure, reducing the prevalence of tobacco use, increasing the number of tobacco users who quit, and reducing tobacco- related morbidity and mortality. Estimated # 1 jurisdiction Estimated number of people reached 3,250 people Pop. Focus General Population Obj. Description Providing support, education, and TA to jurisdictions will build their capacity to adopt and implement smoke- free MUH ordinances. ACTIVITIES ID Milestone Title Milestone Description Start End Lead Staff Key Partners Output/Measure Coalition building Determine jurisdiction readiness and prioritize efforts 10/01/14 12/31/14 Proj. Coord. HHSA Local Governments Comm. survey Information and Develop draft ordinances and meet with jurisdiction 12/01/14 03/31/15 Proj. Coord. HHSA Meeting minutes education officials to educate and inform Local Governments Draft ordinances Implementation Provide TA and information to support development 04/01/15 09/29/15 Proj. Coord. HHSA Meetings held and adoption of ordinances Local Governments Community mobilization Implement campaign to educate community about rationale and value of smoke- free MUH 04/01/15 09/29/15 Proj. Coord. HHSA Healthy Mendo. # news articles, PSAs, etc. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 18

20 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Risk Factor ENVIRONMENTS WITH HEALTHY FOOD OR BEVERAGE OPTIONS Objective ID 2.0 Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number People impacted by policies and ordinances 3,000 32,300 Meeting minutes Policy/ordinance texts Timeframe Start: September 30, 2014 End: September 29, 2017 PPO Increase # of people with increased access to environments with healthy food or beverages from 3,000 to 32,300 by Sep PPO Description In Mendocino County, 25% of adults are obese, and fewer than half (47.8%) of the county s 5th graders are at a healthy weight. Furthermore, Mendocino County s Retail Food Environment Index is 2.0, indicating that there are twice as many convenience stores and fast food restaurants as grocery stores and produce stands/farmer s markets in the county. Promoting 10% procurement policies and consumption will increase the number of environments with access to fresh fruits and vegetables. ANNUAL OBJECTIVE 2.1. Increase the number of institutions that adopt 10% local food policies. Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number Institutions that adopt 10% local food policies 0 5 Organizational policies Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Community Institution/Organization Strategy Develop and implement a campaign promoting purchase and consumption of local fruits and vegetables. Justify the selection Over the past decade, community awareness of the health benefits of buying and eating local food has increased, but the habit of buying of this strategy and eating local foods remains confined primarily to a narrow demographic. Many people perceive fresh local fruits and vegetables as out of their price range, and farmers markets as an expensive source of specialty produce rather than as an affordable place to do their weekly grocery shopping. Through a subcontract with NCO, the Coalition will build on past and current work to promote systems that increase the number and variety of people and institutions with access to fresh produce, and the number consuming fresh local fruits and vegetables. The approach is recommended by the CDC Guide to Strategies to Increase the Consumption of Fruits and Vegetables, which includes such specific strategies as expanding farmers markets, promoting home and community gardens, and expanding farm- to- institution programs. In Recommended Strategies and Measurement to Reduce Obesity in the US (2009), the CDC recommends: increasing availability of healthier food and beverage choices; improving availability of mechanisms for purchasing foods from farms; restricting availability of less healthy foods and beverages in public service venues; and zoning for mixed- use development. Estimated # 5 Estimated number of people reached 5,800 Pop. Focus General Population Obj. Description Developing systems that prioritize purchasing local fruits and vegetables, and providing TA for their implementation, will raise community awareness and increase access to fresh produce for the general public. ACTIVITIES ID Milestone Title Milestone Description Start End Lead Staff Key Partners Output/Measure Planning Develop campaign plan and market test proposed messages and materials 10/01/14 12/31/14 Nutrition Coordinator NCO Healthy Mendo. Materials developed Community mobilization Provide TA in the development and promotion of zoning policies to increase access to fresh produce 11/01/14 08/31/15 Nutrition Coordinator NCO Local Jurisdictions Policies adopted Promotion CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 19

21 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Information and education Community mobilization Implement media campaign through print, radio, local 01/01/15 08/31/15 Nutrition TV, and social media, as well as printed materials Coordinator Promote farmers market purchases through 01/01/15 09/29/15 Nutrition distribution of food stamp match vouchers and Coordinator farmers market coupons (through health care providers and CDSMP workshops) Work with youth groups to promote healthy food and 02/01/15 06/30/15 Nutrition beverage policies among local CBOs Coordinator NCO Healthy Mendo. NCO, HHSA Farmers Market Association Number of PSAs, ads, articles, etc. Vouchers and coupons distributed Information and education NCO CBOs Policies adopted ANNUAL OBJECTIVE 2.2. Increase the number of child care facilities that adopt and implement healthy food policies. Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number Child care facilities with healthy food policies 0 30 Provider policies Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Community Institution/Organization Strategy Train and support child care providers in developing and adopting healthy food policies. Justify the selection The Coalition will work with Rural Communities Child Care to (RCCC) identify child care providers who are currently participating in the of this strategy Childcare Food Program to increase the number of children with access to healthy food. The Coalition will use the Creating Healthy Opportunities in Child Care Environments (CHOICE) model to work with child care providers to develop and implement healthy food policies. CHOICE provides a self- assessment framework and a guide for setting goals, monitoring progress and individualizing written policies that provide an educational resource for staff and parents, and clear and consistent guidelines that can help solve and/or avoid problems. Written policies express the child care provider s commitment to nutrition, and they stimulate discussion of best practices with parents. CHOICE materials provide step- by- step directions, worksheets with sample policies, and an easy- to- follow process. CHOICE is available in both English and Spanish and is a best practice model released in 2011 by the Contra Costa Child Care Council to improve nutrition and physical activity for children in family child care. Estimated # 30 Estimated number of people reached 500 Pop. Focus General Population Obj. Description Direct guidance and support to child care providers will increase the number of facilities that adopt and implement healthy food policies. ACTIVITIES ID Milestone Title Milestone Description Start End Lead Staff Key Partners Output/Measure Planning Identify and make contact with child care providers 10/01/14 12/31/14 CHOICE NCO, RCCC # contacted Coordinator Information and Make training and monitoring visits to providers 11/01/14 09/29/15 CHOICE NCO, RCCC # trained education Coordinator Community mobilization Conduct outreach and education to raise awareness of child care providers with healthy food policies 01/01/15 09/29/15 CHOICE Coordinator NCO, RCCC Outreach efforts Performance measurement Follow- up with providers to ensure full implementation of policies 04/01/15 09/29/15 CHOICE Coordinator NCO, RCCC # adopting policies CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 20

22 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Risk Factor PHYSICAL ACTIVITY OPPORTUNITIES Objective ID 3.0 Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number People impacted 0 22,750 CHIS Local survey Timeframe Start: September 30, 2014 End: September 29, 2017 PPO Increase the number of people with increased access to physical activity opportunities from 0 to 22,750 by September PPO Description Among local adults, 25% are obese, and fewer than half (47.8%) of 5th graders are at a healthy weight. These data highlight the need to promote increased physical activity through complete streets policies and bike and pedestrian plans. ANNUAL OBJECTIVE 3.1. Increase the number of Mendocino County jurisdictions that adopt and implement complete streets policies. Measurement Direction Unit What Will Be Measured Baseline Target Data Source Increase Number Jurisdictions adopting complete streets policies 0 1 Local Jurisdictions Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Community Strategy Work with the City of Ukiah to develop and adopt a complete streets policy. Justify the selection 19% of local adults report no leisure- time physical activity, and 45% of the population lacks adequate access to locations for physical of this strategy activity, compared with 9% statewide, because of the area s autocentric street design and lack of recreational facilities. Complete streets are designed and operated to enable safe access for all users, including pedestrians, bicyclists, motorists, and transit riders of all ages and abilities, and make it easy to cross streets, walk to shops, and bicycle to work. By adopting a complete streets policy, communities direct their transportation planners and engineers to routinely design and operate the entire right of way to enable safe access for all users. The CDC Community Preventive Services Task Force recommends design and land use policies and practices that support physical activity in urban areas based on sufficient evidence of effectiveness in facilitating an increase in physical activity ( policy/communitypolicies.html). Estimated # 1 Estimated number of people reached 12,000 Pop. Focus General Population Obj. Description Providing support, education, and TA to jurisdictions will build their capacity to adopt and implement complete streets policies. ACTIVITIES ID Milestone Title Milestone Description Start End Lead Staff Key Partners Output/Measure Coalition building Determine jurisdiction readiness 12/01/14 01/31/15 Physical Activity HHSA Meetings held Coordinator Implementation Develop draft ordinances and meet with jurisdictions to educate and inform 02/01/15 06/30/15 Physical Activity Coordinator HHSA Walk and Bike Mendocino Draft texts Meetings held Information and education Community mobilization Develop and disseminate countywide walking and biking resource Design and implement campaign to educate community about value of complete streets 01/01/15 09/29/15 Physical Activity Coordinator 04/01/15 09/29/15 Physical Activity Coordinator Walk and Bike Mendocino HHSA Healthy Mendo. Printed guide Online guide Outreach efforts CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 21

23 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Risk Factor PHYSICAL ACTIVITY OPPORTUNITIES: PRIORITY POPULATION Objective ID 4.0 Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number People impacted 0 3,000 Wellness Programs Timeframe Start: September 30, 2014 End: September 29, 2017 PPO Increase number of people with increased access to physical activity through wellness programs from 0 to 3,000 by September PPO Description Mendocino County has nine federally- recognized Native American Rancherias, and Native Americans account for 7% of county residents. The per capita income of American Indians is $12,150 per year, barely half of the county average of $23,179. Similarly, 37.5% of American Indians, and 48.3% of American Indian children live below the federal poverty level, compared with 19.4% countywide. People with low incomes suffer disproportionately high rates of chronic diseases, and life expectance for local Native Americans averages 2 years below that of the general population. ANNUAL OBJECTIVE 4.1. Increase the number of tribal entities that develop, adopt, and implement comprehensive wellness programs. Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number Tribes that adopt wellness programs 0 3 Wellness Programs Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Other: Tribal Governments Strategy Provide training and TA to tribal entity to increase the number of people with access to opportunities for physical activity. Justify the selection of this strategy Selection of the priority population is based on the high rates of obesity (83% of adults obese or overweight) and high rates of diabetes. Among patients served by local Indian Health Centers, 29% have a primary diagnosis of diabetes, compared with 5.8% in the general population. Nationwide, Native Americans are 2.6 times more likely to have diabetes. HHSA will provide support and TA to help tribal entities plan, develop, implement, and promote wellness programs, using such tools as the Native American Fitness Council s Group Fitness Instructor Certification program, which uses evidence- based exercise techniques that are specific to Native Americans in content and teaching style. Estimated # 1 Estimated number of people reached 1,000 Pop. Focus Priority Population: American Indian Obj. Description Increasing the capacity of tribal entities to plan, implement and promote comprehensive wellness programs will result in increased opportunities for physical activity for community members. ACTIVITIES ID Milestone Title Milestone Description Start End Lead Staff Key Partners Output/Measure Community connections Contact tribal governments to inform them about available training and technical assistance. 10/01/14 12/30/14 Wellness Coordinator To Be Determined # tribes contacted Training Schedule and conduct training. 12/01/14 01/31/15 Wellness Coordinator To Be Determined # training participants Technical Provide tribes with support and TA in developing and 02/01/15 06/30/15 Wellness To Be # tribes assisted assistance implementing wellness programs. Coordinator Determined Communication Provide tribes with support and TA in promoting and 07/01/15 09/29/15 Wellness To Be # programs and dissemination strengthening wellness programs. Coordinator Determined implemented CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 22

24 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Risk Factor OPPORTUNITIES FOR PREVENTION OF CHRONIC DISEASES Objective ID 5.0 Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number People impacted 500 1,600 Health care providers Timeframe Start: September 30, 2014 End: September 29, 2017 PPO Increase the number of people with increased access to chronic disease prevention opportunities from 500 to 1,600 by Sep PPO Description Chronic diseases account for the 4 leading causes of death in the county, and County Health Rankings rate the county worse than 43 of California s 58 counties in health behaviors that are risk factors for chronic diseases. ANNUAL OBJECTIVE 5.1. Increase the number of chronic disease workshop series conducted in communities throughout the county. Measurement Direction of Change Unit What Will Be Measured Baseline Target Data Source Increase Number Workshop series conducted Lay Leader Reports Timeframe Start: September 30, 2014 End: September 29, 2015 Setting/Sector Health Care Strategy Work with health care providers to develop referral system and provide CMSDP workshops for people with chronic diseases. Justify the selection of this strategy CDSMP is delivered through a series of 6 weekly workshop sessions in community settings for people with a variety of chronic health problems. Workshops are facilitated by trained Lay Leaders and cover: techniques to deal with frustration, pain and isolation; exercise; medications; communicating effectively; nutrition; decision making; and evaluating new treatments. Classes are interactive, and mutual support builds participant confidence in their ability to manage their health. CDSMP has been evaluated through numerous studies; a 2013 study showed significant reductions in ER visits (5%) at both the 6- month and 12- month assessments as well as hospitalizations (3%) at 6 months. Estimated # 20 workshop series Estimated number of people reached 200 Pop. Focus General Population Obj. Description Developing a referral system and protocols in collaboration with health care providers and increasing the number and frequency of CDSMP workshops will increase access to chronic disease prevention opportunities throughout the county. ACTIVITIES ID Title Description Start End Lead Staff Key Partners Output/Measure Information and Schedule and conduct workshop series. 12/01/14 09/29/15 Lay Leaders HHSA # workshop series education Performance measurement Collect pre/post surveys from participants. 12/01/14 09/29/15 Lay Leaders HHSA # surveys collected Communication and dissemination Disseminate information on achievements. 01/01/15 09/29/15 Evaluator Healthy Mendo. Knowledge gained Community connections Develop referral system and protocols. 03/01/15 09/29/15 Chronic Disease Coordinator Providers # referrals CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 23

25 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Risk Factor INFRASTRUCTURE DEVELOPMENT Objective ID 6.0 Measurement Increase number of infrastructure components that are strengthened from 0 to 4, documented by meeting minutes. PPO Beginning September 30, 2014, build capacity to carry out activities, strategies, performance measurement, and evaluation by strengthening infrastructure systems, procedures, and protocols from 0 components to 4 components by September PPO Description Coalition members will strengthen connections with the HHSA Advisory Board, raise community awareness, seek sustaining funding, and work to develop a consolidated needs assessment process that meets the needs of a range of local organizations and agencies. ANNUAL OBJECTIVE 6.1. CAPACITY/STAFFING: Increase ACHIEVE capacity to deliver chronic disease prevention by training additional Lay Leaders. Measurement Beginning Sep. 30, 2014, increase number of trained Lay Leaders from 8 to 10 by Sep. 29, 2015, documented with training certificates. Setting/Sector Healthcare Population Focus Work Site Estimated # 2 Lay Leaders # people reached 40 people Strategy The CMSDP is well established but lacks the capacity to reach all communities in the county. Justification CMSDP follows the evidence- based curriculum developed at Stanford University. Obj. Description Having more trained Lay Leaders will increase the reach of the program in terms of number of communities and number of participants. ID Title Milestone Description Start End Lead Staff Key Partners Output/Measure Train 2 additional Lay Leaders complete training 01/01/15 03/31/15 Chronic Dis. Health care providers # trained Coordinator Certify 2 additional Lay Leaders demonstrate learning 01/01/15 03/31/15 Chronic Dis. Coordinator Health care providers Post- training assessments Monitor Monitor workshop delivery to ensure quality 04/01/15 09/29/15 Chronic Dis. Coordinator Health care providers Participant satisfaction Support Provide support as needed to increase skills 04/01/15 09/29/15 Chronic Dis. Coordinator Health care providers # TA sessions ANNUAL OBJECTIVE 6.2. COALITION: Increase ACHIEVE capacity by strengthening linkages with HHSA Advisory Board to improve assessment processes. Measurement Beginning Sep. 30, 2014, increase number of joint subcommittees from 0 to 2 by September 29, 2015, documented in Coalition minutes. Setting/Sector Community Population Focus General Population Estimated # 2 subcomm s # people reached 50 people Strategy Work with members to strengthen Coalition capacity in the areas of community connections, community assessment, and sustainability. Justification The ACHIEVE Coalition and the HHSA Advisory Board have similar missions and shared priorities. Obj. Description Creating joint subcommittees will increase effectiveness of PSE efforts. ID Title Milestone Description Start End Lead Staff Key Partners Output/Measure Assess Assess needs and priorities for shared 09/30/14 10/31/14 Project Dir. HHSA Advisory Board Needs identified subcommittees Link Establish shared subcommittees 11/01/14 11/30/14 Project Dir. HHSA Advisory Board # subcommittees Measure Conduct Coalition survey 07/01/15 08/31/15 Project Dir. HHSA Advisory Board % members satisfied Report Share survey results with Coalition members 09/01/15 09/29/15 Project Dir. HHSA Advisory Board Meeting minutes CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 24

26 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ANNUAL OBJECTIVE 6.3. PERFORMANCE MEASUREMENT: Increase ACHIEVE effectiveness by developing consolidated community assessment process. Measurement Beginning September 30, 2014, develop consolidated community assessment process and template by September 29, Setting/Sector Comm. Institution Pop. Focus General Population Estimated # 1 process # people reached 10,000 people Strategy Work with Healthy Mendocino to assess needs of agencies and CBOs, and develop process for consolidated assessment process. Justification Healthy Mendocino has the capacity to collect and consolidate much of the data that is required by individual agencies and CBOs. Obj. Description Having a consolidated assessment process will reduce duplication of effort while ensuring consistent, current, and accurate data. ID Title Milestone Description Start End Lead Staff Key Partners Output/Measure Assess Assess data needs and priorities of agencies and CBOs 09/30/14 03/31/15 Data Analyst Healthy Mendocino Needs known Develop Develop assessment template and process 04/01/15 06/30/15 Data Analyst Healthy Mendocino Process in place Develop Develop initiative center for assessment 04/30/15 06/30/15 Data Analyst Healthy Mendocino Center on line Pilot Pilot assessment with at least one agency 07/01/15 09/29/15 Data Analyst Healthy Mendocino 1 assessment ANNUAL OBJECTIVE 6.4. COMMUNICATION/DISSEMINATION: Share progress and achievements with key stakeholders and broader community. Measurement Beginning September 30, 2014, develop and implement strong communications plan by September 29, Setting/Sector Comm. Institution Pop. Focus General Population Estimated # 1 plan # people reached 10,000 people Strategy Work with Healthy Mendocino to develop and implement communication plan, materials, and content. Justification Healthy Mendocino has the capacity to compile data and outcomes and develop targeted information for a variety of audiences. Obj. Description Communicating Coalition progress in appropriate language and format will raise awareness of the need for supportive environments. ID Title Milestone Description Start End Lead Staff Key Partners Output/Measure Plan Develop communications plan 11/01/14 01/31/15 Comm. Coord Healthy Mendocino Plan developed Share Develop and disseminate messages and materials 02/01/15 09/29/15 Comm. Coord Healthy Mendocino Info. shared Develop Use outcome data to inform messages and materials 02/01/15 09/29/15 Comm. Coord Healthy Mendocino Using data Survey Survey community to strengthen materials 09/01/15 09/29/15 Comm. Coord Healthy Mendocino Survey conducted ANNUAL OBJECTIVE 6.5. FISCAL MANAGEMENT: Ensure Coalition s fiscal health and sustainability. Measurement Beginning September 30, 2014, develop and implement strong sustainability plan by September 29, Setting/Sector Community Pop. Focus General Population Estimated # 1 plan # people reached 50 Strategy Work with Coalition members to develop and implement sustainability plan. Justification Coalition members have the skills and knowledge to generate sustainability funding through future grants and leveraging of funds. Obj. Description Having a strong sustainability plan will prepare the Coalition for continuing its work beyond the grant. ID Title Milestone Description Start End Lead Staff Key Partners Output/Measure Plan Develop sustainability plan and monitor funding opportunities 11/01/14 01/31/15 Project Mgr. All Coalition members Plan developed Implement Support funding applications with project data 02/01/15 09/29/15 Project Mgr. Healthy Mendocino Data used Apply Submit grant applications 02/01/15 09/29/15 Project Mgr. All Coalition members Grants submitted Educate Use data to seek support from local entities 02/01/15 09/29/15 Project Mgr. Healthy Mendocino Local support generated CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 25

27 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) BUDGET NARRATIVE The Mendocino County Health and Human Services Agency (HHSA) is requesting a three- year grant of $1,690,871 for the ACHIEVE Coalition. Grant funds will be matched with a total of $358,450 in contributions, equal to 21.20% (15.80% in Year 1, 21.20% in Year 2, and 26.38% in Year 3). Please note that computer rounding may cause one- dollar differences. YEAR ONE A total of $552,380 is requested for Year 1, with $87,259 (15.8%) contributed as match. A. SALARIES AND WAGES FEDERAL REQUEST: $97,994 Position Title and Name Annual Salary Time Months Request C. Schenck, Project Director $60,100 25% 12 $15,025 J. Stull- Otto, Project Coordinator $57, % 12 $57,000 C. Schenck, Chronic Disease Coordinator $60,100 25% 12 $15,025 S. Miller, Project Assistant $32,200 5% 12 $1,610 S. Kinney, Evaluator $46,670 20% 12 $9,334 Project Director (25% FTE) will be responsible for overall project direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. Project Coordinator (100% FTE) will be responsible for day- to- day coordination of ACHIEVE development and management, budget management, and preparation of required reports. This position will also have direct responsibility for Year 1 implementation of strategies and activities related to the tobacco and physical activity components. Chronic Disease Coordinator (25% FTE) will have direct responsibility for Year 1 implementation of strategies and activities related to the chronic disease component. Project Assistant (5% FTE) will support the Project Director and Project Coordinators with logistics and communications. Evaluator (20% FTE) will coordinate the project evaluation in partnership with the Healthy Mendocino subcontract and will be responsible for developing the evaluation design and preparing evaluation reports. MATCHING CONTRIBUTIONS: $24,510 Position Title and Name Annual Salary Time Months Request To Be Hired (TBH), Prevention and Planning Unit $71,000 10% 12 $7,100 Manager C. Schenck, Project Director $60,100 10% 12 $6,010 TBH, PSE Coordinator $57,000 20% 12 $11,400 Manager, Prevention and Planning Unit (10% FTE) will supervise staff and provide high level direction and guidance, as well as serving as the primary liaison with project partners. Project Director (10% FTE, with an additional 25% grant- funded) will be responsible for overall direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 26

28 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) PSE Coordinator (20% FTE) will be responsible for guiding staff in implementing best practice PSE strategies. B. FRINGE BENEFITS FEDERAL REQUEST: $55,612 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. MATCHING CONTRIBUTIONS: $13,909 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. C. CONSULTANT COSTS FEDERAL REQUEST: $0 MATCHING CONTRIBUTIONS: $30,000 Name and Affiliation of Consultant Number Rate Request Chronic Disease Prevention Educator $50/hour $10,000 Lay Leaders for Chronic Disease workshops 10 4 workshop series per $500 per series $20,000 Chronic Disease Prevention Educator will develop a system for delivery of disease- specific chronic disease prevention and management education in the community. Lay Leaders will be trained and contracted to deliver CDSMP sessions using the evidence- based Stanford curriculum to teach self- management strategies. D. EQUIPMENT NONE E. SUPPLIES FEDERAL REQUEST: $600 Item Requested Type Number Unit Cost Request General office supplies Pens, pencils, paper, toner, ink 12 months $50 per month $600 Office Supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). MATCHING CONTRIBUTIONS: NONE F. TRAVEL FEDERAL REQUEST: $5,474 Purpose of Travel Number of People Local travel, countywide Varies Mileage Item Computation Cost 300 miles per $0.56 mile $2,016 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 27

29 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Purpose of Travel Grantee Training in Atlanta, Georgia Number of People Item Computation Cost 2 Airfare $600/person 1,200 Hotel 3 nights x $ Mileage 260 miles x $0.56/mile 146 Airport shuttle 2 trips x $30/trip 120 Per diem 4 days x $ Parking 4 days x $20/day 80 $3,458 Local travel. Project travel will be reimbursed at the standard 2014 IRS rate of $0.56/mile. The budget includes funding for reimbursement of 300 miles/month of local travel for outreach and promotion, meeting with Coalition partners, and meeting with local jurisdictions. Grantee training. Two people will travel to Atlanta, Georgia for required training and grantee conference. Costs are based on federal travel allowances for MATCHING CONTRIBUTIONS: NONE G. OTHER COSTS FEDERAL REQUEST: $16,200 Item Number Calculation Request Insurance 12 months $280/month $3,360 Lay Leader training 2 Lay Leaders $3,000/person $6,000 Communications 12 months $70/month $840 Advertising and promotion 12 months $200/month $2,400 Video editing 60 hours $50/hour $3,000 Printing and copying 12 months $50/month $600 Insurance. Costs are estimated at an average of $280/month for facility liability insurance. Lay Leader training. HHSA will send two additional Lay Leaders to CMSDP training, for delivering the CMSDP workshops, at a cost of $3,000/person. Communications. Communications costs of $70/month include internet and phone service for the Project Coordinator. Advertising and promotion. The Project Coordinator will work with project partners to coordinate outreach and promotion efforts and materials. HHSA has budgeted $200/month for outreach and promotion during Year 1. Video editing services will be use to edit videos filmed by youth groups for advocacy efforts. Photocopying and Printing costs include printing flyers, brochures, business cards, and other project materials and are budgeted at $50/month MATCHING CONTRIBUTIONS: NONE CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 28

30 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) H. CONTRACTS FEDERAL REQUEST: $341,094 Name of Subcontractor Months Amount North Coast Opportunities 12 $172,236 Healthy Mendocino 12 $73,840 To Be Determined (Tribal Entity) 12 $82,518 Walk and Bike Mendocino 12 $12,500 For all of the contracted activities, HHSA will use the agency s established procurement protocols; it is anticipated that most subcontracts will be sole source because these are the only organizations capable of providing the proposed services. All contractors will participate in grant coordination meetings and submit quarterly fiscal and program reports to HHSA. NORTH COAST OPPORTUNITIES (NCO): $172,236 HHSA will contract NCO to carry out the project strategies and activities associated with the nutrition component. Nutrition Outreach Coordinator: 90% FTE at annual salary of $52,000, plus 30% fringe benefits = $60,840. The Nutrition Outreach Coordinator will be responsible for the media and promotion campaign, as well as providing technical assistance to local jurisdictions regarding implementation of zoning policies and regulations that are aligned across local city and county jurisdictions to increase access to fresh fruits and vegetables through such strategies as community gardens and urban farmstands. Child Care Nutrition Coordinator: 50% FTE at annual salary of $52,000, plus 30% fringe = $33,800. The Child Care Nutrition Coordinator will work with Rural Communities Child Care to conduct outreach to child care providers, train them in use of the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) model for developing and implementing healthy food policies, and monitor and support their implementation of the policies. Local travel to child care providers, meetings, farmers markets, local jurisdictions, etc.: 400 miles/month x 12 months x $0.56/mile = $2,688. Youth groups: NCO will train and work with youth groups to conduct outreach, promotion, and advocacy leading to healthy food and beverage policies at local organizations, safety net providers, faith- based groups, and other entities: 3 youth groups x $9,000/group = $27,000. Office supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). Media and promotion campaign = $15,000 for advertising, development of marketing materials, graphic design, etc. NCO will develop and implement a community- wide media and promotion campaign focused on institutional policies and individual action in support of the message, fruits and vegetables from local sources lead to better health, including linking local farms and community supported agriculture programs (CSAs) with food banks and other safety net providers. Farmers market coupons, to increase access to fresh local produce: 500 coupons x $10/coupon = $5,000. NCO will strengthen systems to increase the number of people with access to healthier diets through community awareness raising and distribution of CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 29

31 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) farmers market coupons to high- risk populations by health care providers and in chronic disease self- management workshops. Farmers market match vouchers for people making farmers market purchases with food stamps (called CalFresh in California), to increase their access to fresh local produce: 500 vouchers x $15/voucher = $7,500. Training materials, small kitchen appliances, and cooking demonstrations for child care providers: $205/child care provider x 30 providers = $6,150. Using the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) Model, NCO will provide training to 30 child care providers to enable them to: assess their nutrition programs; develop nutrition policies; share policies with parents; and implement policies in their child care programs. Printing and copying: $75/month x 12 months = $900. Indirect is calculated at NCO s negotiated rate of 8% of direct costs: 8% x $159,478 = $12,758. HEALTHY MENDOCINO: $73,840 HHSA will contract with Healthy Mendocino to contribute to both program evaluation and communications. Data Analyst: Work with program evaluator to develop a project initiative center in the Healthy Mendocino online data resource ( that will track project deliverables and outcomes: 50% FTE at annual salary of $52,000, plus 30% fringe benefits = $33,800. Communications Coordinator: Work with program partners to plan, develop, and disseminate outreach and educational materials that incorporate data drawn from project activities: 40% FTE at annual salary of $52,000, plus 30% fringe benefits = $27,040. Database hosting and management: approximately $667/month x 12 months = $8,000. Printing and copying outreach materials: $5,000. To Be Determined: $82,518 HHSA will contract with a tribal entity to carry out activities focused on the Priority Population of Native American Indians. (This partner will be selected upon receipt of the grant.) Through this contract, a full- time staff member will work with tribal jurisdictions to increase their capacity to plan, develop, implement, and strengthen physical activity and wellness programs for their members, in their facilities, and on their rancherias. The subcontractor will be provided with technical assistance to help them conduct walkability and bikeability audits of their communities, to further encourage physical activity, and will also ensure that project activities address the cultural needs of Native American Indians. Wellness Coordinator: 100% $52,000, plus 30% fringe benefits = $67,600. Local travel: 300 miles/month x 12 months x $0.56/mile = $2,016. Training supplies: $150/month x 12 months = $1,800. Outreach and promotion: $300/month x 12 months = $3,600. Indirect at 10% of direct costs: 10% x $75,016 = $7,502. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 30

32 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) WALK AND BIKE MENDOCINO: $12,500 HHSA will contract with Walk and Bike Mendocino to research, prepare, print, and disseminate, in print and online, a detailed resource guide for cyclists and walkers, including maps of facilities, etc. Walk and Bike Mendocino will also participate in outreach and promotion to encourage greater physical activity in the community. Research and develop countywide walking and biking resource guide: $200 hours x $25/hour = $5,000. Print 250 copies of resource guide: $10/copy x 250 copies = $2,500. Conduct outreach and promotional activities: $200 hours x $25/hour = $5,000. MATCHING CONTRIBUTIONS: $9,984 Name of Subcontractor Months Amount North Coast Opportunities 12 $5,184 Healthy Mendocino 12 $4,800 North Coast Opportunities will contribute building occupancy costs (lease, office equipment rental, communications, maintenance, etc.) for the two staff members working on project activities ($400/month x 12 months, plus 8% indirect = $5,184). Healthy Mendocino will contribute $4,800 ($400/month) toward the cost of hosting and maintaining the Healthy Mendocino website. I. DIRECT COSTS Year 1 direct costs total $516,973 in the budget request and $78,403 in match. J. INDIRECT COSTS FEDERAL REQUEST: $35,406 Description Computation Cost 23.05% x $153,606 $35, % of personnel costs (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. MATCHING CONTRIBUTIONS: $8,856 Description Computation Cost 23.05% of personnel costs 23.05% x $38,419 $8,856 (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 31

33 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) SUMMARY OF EVALUATION COSTS: $56,431 (10.22% of Year 1 budget) Organization Description Calculation Amount HHSA Project Evaluator 20% FTE x $46,670 $9,334 HHSA Project Evaluator Fringe 56.75% $5,297 Healthy Mendocino Data Analyst 50% FTE x $52,000 $26,000 Healthy Mendocino Data Analyst Fringe 30% $7,800 Healthy Mendocino Database Management Approximately $667/month $8,000 SUMMARY OF COMMUNICATION AND DISSEMINATION COSTS: $60,540 (10.96%) Organization Description Calculation Amount Healthy Mendocino Communications 40% FTE x $52,000 $20,800 Coordinator Healthy Mendocino Communications Fringe 30% $6,240 Coordinator HHSA Promotion and $200/month $2,400 advertising Healthy Mendocino Dissemination costs Printing, advertising, etc. $5,000 Walk and Bike Mendocino Resource Guide Development: $5,000 $7,500 Printing: $2,500 To Be Determined (Tribal Outreach and promotion $300/month $3,600 Entity) NCO Media and promotion campaign Advertising, graphic design, printing, etc. $15,000 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 32

34 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) YEAR TWO A total of $562,423 is requested for Year 2, with $119,219 (21.2%) contributed as match. A. SALARIES AND WAGES FEDERAL REQUEST: $101,311 Position Title and Name Annual Salary Time Months Request C. Schenck, Project Director $60,100 25% 12 $15,025 J. Stull- Otto, Project Coordinator $59, % 12 $59,850 C. Schenck, Chronic Disease Coordinator $60,100 25% 12 $15,025 S. Miller, Project Assistant $32,200 5% 12 $1,610 S. Kinney, Evaluator $49,004 20% 12 $9,801 Project Director (25% FTE) will be responsible for overall project direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. Project Coordinator (100% FTE) will be responsible for day- to- day coordination of ACHIEVE development and management, budget management, and preparation of required reports. This position will also have direct responsibility for Year 2 implementation of strategies and activities related to the tobacco and physical activity components. This position includes an annual increase of 5%. Chronic Disease Coordinator (25% FTE) will have direct responsibility for Year 2 implementation of strategies and activities related to the chronic disease component. Project Assistant (5% FTE) will support the Project Director and Project Coordinators with logistics and communications. Evaluator (20% FTE) will coordinate the project evaluation in partnership with the Healthy Mendocino subcontract and will be responsible for developing the evaluation design and preparing evaluation reports. This position includes an annual increase of 5%. MATCHING CONTRIBUTIONS: $37,405 Position Title and Name Annual Salary Time Months Request To Be Hired (TBH), Prevention and Planning Unit $74,550 10% 12 $7,455 Manager C. Schenck, Project Director $60,100 10% 12 $6,010 TBH, PSE Coordinator $59,850 40% 12 $23,940 Manager, Prevention and Planning Unit (10% FTE) will supervise project staff and provide high level direction and guidance to the project, as well as serving as the primary liaison with project partners. This position includes an annual increase of 5%. Project Director (10% FTE, with an additional 25% grant- funded) will be responsible for overall project direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. PSE Coordinator (40% FTE) will be responsible for guiding staff in implementing best practice PSE strategies. This position includes an annual increase of 5%. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 33

35 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) B. FRINGE BENEFITS FEDERAL REQUEST: $57,494 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. MATCHING CONTRIBUTIONS: $21,227 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. C. CONSULTANT COSTS FEDERAL REQUEST: $0 MATCHING CONTRIBUTIONS: $30,000 Name and Affiliation of Consultant Number Rate Request Chronic Disease Prevention Educator $50/hour $10,000 Lay Leaders for Chronic Disease workshops 10 4 workshop series per $500 per series $20,000 Chronic Disease Prevention Educator will develop a system for delivery of disease- specific chronic disease prevention and management education in the community. Lay Leaders will be trained and contracted to deliver CDSMP sessions using the evidence- based Stanford curriculum to teach self- management strategies. D. EQUIPMENT NONE E. SUPPLIES FEDERAL REQUEST: $600 Item Requested Type Number Unit Cost Request General office supplies Pens, pencils, paper, toner, ink 12 months $50 per month $600 Office Supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). MATCHING CONTRIBUTIONS: NONE F. TRAVEL FEDERAL REQUEST: $2,016 Purpose of Travel Number of People Local travel, countywide Varies Mileage Item Computation Cost 300 miles per $0.56 mile $2,016 Local travel. Project travel will be reimbursed at the standard 2014 IRS rate of $0.56/mile. The budget includes funding for reimbursement of 300 miles/month of local travel for outreach and promotion, meeting with Coalition partners, and meeting with local jurisdictions. MATCHING CONTRIBUTIONS: NONE CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 34

36 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) G. OTHER COSTS FEDERAL REQUEST: $18,934 Item Number Calculation Request Insurance 12 months $280/month $3,360 Lay Leader training 2 Lay Leaders $3,000/person $6,000 Communications 12 months $70/month $840 Advertising and promotion 12 months $400/month $4,800 Video editing 60 hours $50/hour $3,000 Printing and copying 12 months Approximately $78/month $934 Insurance. Costs are estimated at an average of $280/month for facility liability insurance. Lay Leader training. HHSA will train two additional Lay Leaders to deliver the CMSDP workshops, at a cost of $3,000/person. Communications. Communications costs of $70/month include internet and phone service for the Project Coordinator. Advertising and promotion. The Project Coordinator will work with project partners to coordinate outreach and promotion efforts and materials. HHSA has budgeted $400/month for outreach and promotion during Year 2. Video editing services will be use to edit videos filmed by youth groups for advocacy efforts. Photocopying and Printing costs include printing flyers, brochures, business cards, and other project materials and are budgeted at approximately $78/month. MATCHING CONTRIBUTIONS: NONE H. CONTRACTS FEDERAL REQUEST: $345,464 Name of Subcontractor Months Amount North Coast Opportunities 12 $177,347 Healthy Mendocino 12 $76,882 To Be Determined (Tribal Entity) 12 $86,236 Walk and Bike Mendocino 12 $5,000 For all of the contracted activities, HHSA will use the agency s established procurement protocols; it is anticipated that most subcontracts will be sole source because these are the only organizations capable of providing the proposed services. All contractors will participate in grant coordination meetings and submit annual fiscal and program reports to HHSA. NORTH COAST OPPORTUNITIES (NCO): $177,347 HHSA will contract NCO to carry out the project strategies and activities associated with the nutrition component. Nutrition Outreach Coordinator: 90% FTE at annual salary of $54,600, plus 30% fringe benefits = $63,882. The Nutrition Outreach Coordinator will be responsible for the media and promotion campaign, as well as providing technical assistance to local jurisdictions regarding implementation of zoning policies and regulations that are aligned across local city and county jurisdictions to increase access to fresh fruits and vegetables through such strategies as community gardens and urban farmstands. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 35

37 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Child Care Nutrition Coordinator: 50% FTE at annual salary of $54,600, plus 30% fringe = $35,490. The Child Care Nutrition Coordinator will work with Rural Communities Child Care to conduct outreach to child care providers, train them in use of the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) model for developing and implementing healthy food policies, and monitor and support their implementation of the policies. Local travel to child care providers, meetings, farmers markets, local jurisdictions, etc.: 400 miles/month x 12 months x $0.56/mile = $2,688. Youth groups: NCO will train and work with youth groups to conduct outreach, promotion, and advocacy leading to healthy food and beverage policies at local organizations, safety net providers, faith- based groups, and other entities: 3 youth groups x $9,000/group = $27,000. Office supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). Media and promotion campaign = $15,000 for advertising, development of marketing materials, graphic design, etc. NCO will develop and implement a community- wide media and promotion campaign focused on institutional policies and individual action in support of the message, fruits and vegetables from local sources lead to better health, including linking local farms and CSAs with food banks and other safety net providers. Farmers market coupons, to increase access to fresh local produce: 500 coupons x $10/coupon = $5,000. NCO will strengthen systems to increase the number of people with access to healthier diets through community awareness raising and distribution of farmers market coupons to high- risk populations by health care providers and in chronic disease self- management workshops. Farmers market match vouchers for people making farmers market purchases with food stamps (called CalFresh in California), to increase their access to fresh local produce: 500 vouchers x $15/voucher = $7,500. Training materials, small kitchen appliances, and cooking demonstrations for child care providers: $205/child care provider x 30 providers = $6,150. Using the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) Model, NCO will provide training to 30 child care providers to enable them to: assess their nutrition programs; develop nutrition policies; share policies with parents; and implement policies in their child care programs. Printing and copying: $75/month x 12 months = $900. Indirect is calculated at NCO s negotiated rate of 8% of direct costs: 8% x $164,210 = $13,137. HEALTHY MENDOCINO: $76,882 HHSA will contract with Healthy Mendocino to contribute to both program evaluation and communications. Data Analyst: Work with program evaluator to develop a project initiative center in the Healthy Mendocino online data resource ( that will track CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 36

38 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) project deliverables and outcomes: 50% FTE at annual salary of $54,600, plus 30% fringe benefits = $35,490. Communications Coordinator: Work with program partners to plan, develop, and disseminate outreach and educational materials that incorporate data drawn from project activities: 40% FTE at annual salary of $54,600, plus 30% fringe benefits = $28,392. Database hosting and management: approximately $667/month x 12 months = $8,000. Printing and copying outreach materials: $5,000. To Be Determined: $86,236 HHSA will contract with a tribal entity to carry out activities focused on the Priority Population of Native American Indians. (This partner will be selected upon receipt of the grant.) Through this contract, a full- time staff member will work with tribal jurisdictions to increase their capacity to plan, develop, implement, and strengthen physical activity and wellness programs for their members, in their facilities, and on their rancherias. The subcontractor will be provided with technical assistance to help them conduct walkability and bikeability audits of their communities, to further encourage physical activity, and will also ensure that project activities address the cultural needs of Native American Indians. Wellness Coordinator: 100% $54,600, plus 30% fringe benefits = $70,980. Local travel: 300 miles/month x 12 months x $0.56/mile = $2,016. Training supplies: $150/month x 12 months = $1,800. Outreach and promotion: $300/month x 12 months = $3,600. Indirect at 10% of direct costs: 10% x $78,396 = $7,840. WALK AND BIKE MENDOCINO: $5,000 HHSA will participate in outreach and promotion to encourage greater physical activity in the community. Conduct outreach and promotional activities: $200 hours x $25/hour = $5,000. MATCHING CONTRIBUTIONS: $17,072 Name of Subcontractor Months Amount North Coast Opportunities 12 $9,072 Healthy Mendocino 12 $8,000 North Coast Opportunities will contribute building occupancy costs (lease, office equipment rental, communications, maintenance, etc.) for the two staff members working on project activities ($400/month x 12 months). NCO will also contribute $3,600 for 240 food stamp match vouchers. Direct contributions total $8400, plus 8% indirect = $9,072. Healthy Mendocino will contribute $8,000 ($~667/month) toward the cost of hosting and maintaining the Healthy Mendocino website. I. DIRECT COSTS Year 2 direct costs total $525,819 in the budget request and $105,704 in match. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 37

39 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) J. INDIRECT COSTS FEDERAL REQUEST: $36,604 Description Computation Cost 23.05% x $158,805 $36, % of personnel costs (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. MATCHING CONTRIBUTIONS: $13,515 Description Computation Cost 23.05% of personnel costs 23.05% x $58,632 $13,515 (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. SUMMARY OF EVALUATION COSTS: $58,853 (10.46% of Year 2 budget) Organization Description Calculation Amount HHSA Project Evaluator 20% FTE x $49,004 $9,801 HHSA Project Evaluator Fringe 56.75% $5,562 Healthy Mendocino Data Analyst 50% FTE x $54,600 $27,300 Healthy Mendocino Data Analyst Fringe 30% $8,190 Healthy Mendocino Database Management Approximately $667/month $8,000 SUMMARY OF COMMUNICATION AND DISSEMNATION COSTS: $56,792 (10.1%) Organization Description Calculation Amount Healthy Mendocino Communications 40% FTE x $54,600 $21,840 Coordinator Healthy Mendocino Communications Fringe 30% $6,552 Coordinator HHSA Promotion and $400/month $4,800 advertising Healthy Mendocino Dissemination costs Printing, advertising, etc. $5,000 To Be Determined (Tribal Outreach and promotion $300/month $3,600 Entity) NCO Media and promotion campaign Advertising, graphic design, printing, etc. $15,000 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 38

40 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) YEAR THREE A total of $576,068 is requested for Year 3, with $151,972 (26.38%) contributed as match. A. SALARIES AND WAGES FEDERAL REQUEST: $101,801 Position Title and Name Annual Salary Time Months Request C. Schenck, Project Director $60,100 25% 12 $15,025 J. Stull- Otto, Project Coordinator $59, % 12 $59,850 C. Schenck, Chronic Disease Coordinator $60,100 25% 12 $15,025 S. Miller, Project Assistant $32,200 5% 12 $1,610 S. Kinney, Evaluator $51,454 20% 12 $10,291 Project Director (25% FTE) will be responsible for overall project direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. Project Coordinator (100% FTE) will be responsible for day- to- day coordination of ACHIEVE development and management, budget management, and preparation of required reports. This position will also have direct responsibility for Year 3 implementation of strategies and activities related to the tobacco and physical activity components. Chronic Disease Coordinator (25% FTE) will have direct responsibility for Year 3 implementation of strategies and activities related to the chronic disease component. Project Assistant (5% FTE) will support the Project Director and Project Coordinators with logistics and communications. Evaluator (20% FTE) will coordinate the project evaluation in partnership with the Healthy Mendocino subcontract and will be responsible for developing the evaluation design and preparing evaluation reports. This position includes an annual increase of 5%. MATCHING CONTRIBUTIONS: $45,259 Position Title and Name Annual Salary Time Months Request To Be Hired (TBH), Prevention and Planning Unit $78,278 10% 12 $7,828 Manager C. Schenck, Project Director $60,100 10% 12 $6,010 TBH, PSE Coordinator $62,843 50% 12 $31,421 Manager, Prevention and Planning Unit (10% FTE) will supervise project staff and provide high level direction and guidance to the project, as well as serving as the primary liaison with project partners. This position includes an annual increase of 5%. Project Director (10% FTE, with an additional 25% grant- funded) will be responsible for overall project direction and guidance, including implementation of infrastructure component and ensuring compliance with fiscal and program reporting and coordination of evaluation activities. PSE Coordinator (50% FTE) will be responsible for guiding staff in implementing best practice PSE strategies. This position includes an annual increase of 5%. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 39

41 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) B. FRINGE BENEFITS FEDERAL REQUEST: $57,772 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. MATCHING CONTRIBUTIONS: $25,684 Fringe Benefits are calculated at HHSA s average rate of 56.75% and include retirement, FICA- A and B, unemployment, workers compensation, and health insurance. C. CONSULTANT COSTS FEDERAL REQUEST: $0 MATCHING CONTRIBUTIONS: $30,000 Name and Affiliation of Consultant Number Rate Request Chronic Disease Prevention Educator $50/hour $10,000 Lay Leaders for Chronic Disease workshops 10 4 workshop series per $500 per series $20,000 Chronic Disease Prevention Educator will develop a system for delivery of disease- specific chronic disease prevention and management education in the community. Lay Leaders will be trained and contracted to deliver CDSMP sessions using the evidence- based Stanford curriculum to teach self- management strategies. D. EQUIPMENT NONE E. SUPPLIES FEDERAL REQUEST: $600 Item Requested Type Number Unit Cost Request General office supplies Pens, pencils, paper, toner, ink 12 months $50 per month $600 Office Supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). MATCHING CONTRIBUTIONS: NONE F. TRAVEL FEDERAL REQUEST: $2,016 Purpose of Travel Number of People Local travel, countywide Varies Mileage Item Computation Cost 300 miles per $0.56 mile $2,016 Local travel. Project travel will be reimbursed at the standard 2014 IRS rate of $0.56/mile. The budget includes funding for reimbursement of 300 miles/month of local travel for outreach and promotion, meeting with Coalition partners, and meeting with local jurisdictions. MATCHING CONTRIBUTIONS: NONE CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 40

42 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) G. OTHER COSTS FEDERAL REQUEST: $19,169 Item Number Calculation Request Insurance 12 months $280/month $3,360 Lay Leader training 2 Lay Leaders $3,000/person $6,000 Communications 12 months $70/month $840 Advertising and promotion 12 months $400/month $4,800 Video editing 60 hours $50/hour $3,000 Printing and copying 12 months Approximately $97/month $1,169 Insurance. Costs are estimated at an average of $280/month for facility liability insurance. Lay Leader training. HHSA will train two additional Lay Leaders to deliver the CMSDP workshops, at a cost of $3,000/person. Communications. Communications costs of $70/month include internet and phone service for the Project Coordinator. Advertising and promotion. The Project Coordinator will work with project partners to coordinate outreach and promotion efforts and materials. HHSA has budgeted $400/month for outreach and promotion during Year 3. Video editing services will be use to edit videos filmed by youth groups for advocacy efforts. Photocopying and Printing costs include printing flyers, brochures, business cards, and other project materials and are budgeted at approximately $97/month. MATCHING CONTRIBUTIONS: NONE H. CONTRACTS FEDERAL REQUEST: $357,928 Name of Subcontractor Months Amount North Coast Opportunities 12 $182,713 Healthy Mendocino 12 $80,076 To Be Determined (Tribal Entity) 12 $90,140 Walk and Bike Mendocino 12 $5,000 For all of the contracted activities, HHSA will use the agency s established procurement protocols; it is anticipated that most subcontracts will be sole source because these are the only organizations capable of providing the proposed services. All contractors will participate in grant coordination meetings and submit annual fiscal and program reports to HHSA. NORTH COAST OPPORTUNITIES (NCO): $182,713 HHSA will contract NCO to carry out the project strategies and activities associated with the nutrition component. Nutrition Outreach Coordinator: 90% FTE at annual salary of $57,330, plus 30% fringe benefits = $67,076. The Nutrition Outreach Coordinator will be responsible for the media and promotion campaign, as well as providing technical assistance to local jurisdictions regarding implementation of zoning policies and regulations that are aligned across local city and county jurisdictions to increase access to fresh fruits and vegetables through such strategies as community gardens and urban farmstands. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 41

43 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Child Care Nutrition Coordinator: 50% FTE at annual salary of $57,330, plus 30% fringe = $37,265. The Child Care Nutrition Coordinator will work with Rural Communities Child Care to conduct outreach to child care providers, train them in use of the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) model for developing and implementing healthy food policies, and monitor and support their implementation of the policies. Local travel to child care providers, meetings, farmers markets, local jurisdictions, etc.: 400 miles/month x 12 months x $0.56/mile = $2,688. Youth groups: NCO will train and work with youth groups to conduct outreach, promotion, and advocacy leading to healthy food and beverage policies at local organizations, safety net providers, faith- based groups, and other entities: 3 youth groups x $9,000/group = $27,000. Office supplies are calculated at $50/month ($600/year) and include standard supplies and materials (e.g., paper, pens, printer toner, clips, and staples). Media and promotion campaign = $15,000 for advertising, development of marketing materials, graphic design, etc. NCO will develop and implement a community- wide media and promotion campaign focused on institutional policies and individual action in support of the message, fruits and vegetables from local sources lead to better health, including linking local farms and CSAs with food banks and other safety net providers. Farmers market coupons, to increase access to fresh local produce: 500 coupons x $10/coupon = $5,000. NCO will strengthen systems to increase the number of people with access to healthier diets through community awareness raising and distribution of farmers market coupons to high- risk populations by health care providers and in chronic disease self- management workshops. Farmers market match vouchers for people making farmers market purchases with food stamps (called CalFresh in California), to increase their access to fresh local produce: 500 vouchers x $15/voucher = $7,500. Training materials, small kitchen appliances, and cooking demonstrations for child care providers: $205/child care provider x 30 providers = $6,150. Using the evidence- based CHOICE (Creating Healthy Opportunities in Child Care Environments) Model, NCO will provide training to 30 child care providers to enable them to: assess their nutrition programs; develop nutrition policies; share policies with parents; and implement policies in their child care programs. Printing and copying: $75/month x 12 months = $900. Indirect is calculated at NCO s negotiated rate of 8% of direct costs: 8% x $169,179 = $13,534. HEALTHY MENDOCINO: $80,076 HHSA will contract with Healthy Mendocino to contribute to both program evaluation and communications. Data Analyst: Work with program evaluator to develop a project initiative center in the Healthy Mendocino online data resource ( that will track CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 42

44 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) project deliverables and outcomes: 50% FTE at annual salary of $57,330, plus 30% fringe benefits = $37,265. Communications Coordinator: Work with program partners to plan, develop, and disseminate outreach and educational materials that incorporate data drawn from project activities: 40% FTE at annual salary of $57,330, plus 30% fringe benefits = $29,812. Database hosting and management: approximately $667/month x 12 months = $8,000. Printing and copying outreach materials: $5,000. To Be Determined: $90,140 HHSA will contract with a tribal entity to carry out activities focused on the Priority Population of Native American Indians. (This partner will be selected upon receipt of the grant.) Through this contract, a full- time staff member will work with tribal jurisdictions to increase their capacity to plan, develop, implement, and strengthen physical activity and wellness programs for their members, in their facilities, and on their rancherias. The subcontractor will be provided with technical assistance to help them conduct walkability and bikeability audits of their communities, to further encourage physical activity, and will also ensure that project activities address the cultural needs of Native American Indians. Wellness Coordinator: 100% $57,330, plus 30% fringe benefits = $74,529. Local travel: 300 miles/month x 12 months x $0.56/mile = $2,016. Training supplies: $150/month x 12 months = $1,800. Outreach and promotion: $300/month x 12 months = $3,600. Indirect at 10% of direct costs: 10% x $81,945 = $8,195. WALK AND BIKE MENDOCINO: $5,000 HHSA will participate in outreach and promotion to encourage greater physical activity in the community. Conduct outreach and promotional activities: $200 hours x $25/hour = $5,000. MATCHING CONTRIBUTIONS: $34,676 Name of Subcontractor Months Amount North Coast Opportunities 12 $26,676 Healthy Mendocino 12 $8,000 NCO will contribute: Child Care Nutrition Coordinator: 25% FTE at annual salary of $52,000, plus 30% fringe = $16,900. Building occupancy costs (lease, office equipment rental, communications, maintenance, etc.) for the two staff members working on project activities ($400/month x 12 months). NCO will also contribute $3,000 for 200 food stamp match vouchers. Indirect 8% = $13,534. Healthy Mendocino will contribute $8,000 ($~667/month) toward the cost of hosting and maintaining the Healthy Mendocino website. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 43

45 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) I. DIRECT COSTS Year 3 direct costs total $539,286 in the budget request and $135,619 in match. J. INDIRECT COSTS FEDERAL REQUEST: $36,781 Description Computation Cost 23.05% x $159,573 $36, % of personnel costs (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. MATCHING CONTRIBUTIONS: $16,352 Description Computation Cost 23.05% of personnel costs 23.05% x $70,943 $16,352 (salaries + fringe) Indirect costs are calculated at HHSA s negotiated rate of 23.05% of personnel costs (salary plus fringe). See documentation in Indirect Cost Rate attachment. SUMMARY OF EVALUATION COSTS: $61,395 (10.66% of Year 3 budget) Organization Description Calculation Amount HHSA Project Evaluator 20% FTE x $51,454 $10,291 HHSA Project Evaluator Fringe 56.75% $5,840 Healthy Mendocino Data Analyst 50% FTE x $57,330 $28,665 Healthy Mendocino Data Analyst Fringe 30% 8,600 Healthy Mendocino Database Management Approximately $667/month $8,000 SUMMARY OF COMMUNICATION AND DISSEMNATION COSTS: $58,212 (10.1%) Organization Description Calculation Amount Healthy Mendocino Communications 40% FTE x $57,330 $22,932 Coordinator Healthy Mendocino Communications Fringe 30% $6,880 Coordinator HHSA Promotion and $400/month $4,800 advertising Healthy Mendocino Dissemination costs Printing, advertising, etc. $5,000 To Be Determined (Tribal Outreach and promotion $300/month $3,600 Entity) NCO Media and promotion campaign Advertising, graphic design, printing, etc. $15,000 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP PAGE 44

46 MEREDITH J. FORD Auditor-Controller LLOYD B. WEER Assistant Auditor-Controller COUNTY OF MENDOCINO AUDITOR-CONTROLLER 501 LOW GAP RD., RM UKIAH. CALIFORNIA PH: (707)-4&304-38& FAX: (707) January 22, 2014 Dianne Laster Drug and Alcohol Programs County of Mendocino Re: 2013/14 Overhead rates for AODP (BU 4012) Dear Dianne: Stated as a percentage of regular full time salaries, the overhead rates for the Drug & Alcohol budget unit are as follows: Retirement Retirement Cost of Living FICA FICA-B (Medicare) Health Insurance Unemployment Insurance Workers Comp Insurance Total Fringe Benefits 24.36% 11.16% 5.59% 1.30% 21.49% 0.00% 3.98% 67.88% Services and Supplies (exci862189) 36.39% A-87 Indirect Costs 11.82% The Fringe Benefit and Services and Supplies percentages are based on the 2013/14 budget, while the A-87 Indirect Costs percentage is based on actual 2011/12 expenditures. All were applied to the budgeted 2013/14 regular full time salaries for the Drug & Alcohol budget unit. Please call me if you need any further information. ours,.~ r uditor-controller

47 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ATTACHMENT A. EVIDENCE OF ORGANIZATIONAL CAPACITY ACHIEVE Member Roster Page 47 ACHIEVE Meeting Minutes Page 48 HHSA Organizational Chart Page 52 Key Staff Resumes Page 53 ACHIEVE Community Action Plan Page 62 ACHIEVE CHANGE Tool Community Assessment Page 64 Publication: The Retail Food Landscape in Mendocino County Page 74 Publication: Alcohol Outlets and Our Community Page 86 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 46

48 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ACHIEVE Coalition Member Roster Action Communities for Health, Innovation & EnVironmental ChangE January 2014 Name Organization Community Sector Carol Mordhorst Mordhorst Services Work Site Anne Molgaard First Five Mendocino Community Organization Patty Bruder North Coast Opportunities, Inc. Community Organization Neil Davis Walk and Bike Mendocino Community Organization Petra Schulte Fort Bragg Unified School District Education/School Bessie Glossenger Mendocino County Office of Education Education/School Terry d Selkie Ukiah Unified School District Education/Schools Michelle Rich Healthy Mendocino Community Organization Tanya Wyldflower Jen Dalton Chaplain, Mendocino Coast District Hospital Mendocino County Food Policy Council Faith-based Community Donna Schuler Mendocino Coast District Hospital Health Care Colleen Schenck Mendocino County Health and Human Services Agency Community Terri Persons Mendocino Council of Governments Community Dan Gjerde Alicia Meier Mendocino County Board of Supervisors Mendocino County Department of Transportation Community Community Michele Curley Consolidated Tribal Health Project Healthcare (focus on Native American Indian population) Thomas Oliver Northern Circle Housing Authority Community/Tribal Housing CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 47

49 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ACHIEVE (Action Communities for Health, Innovation & Environmental Change) Meeting Minutes May 4, 2011, 10:00 am 12:00 pm CR#375 Facilitators: Linda Helland, Terry Nieves, Mary Williamson Minutes & Refreshments: Suzy Miller Present: (see sign in sheet) Katie Marsolan, Terry Nieves, Pat Sanborn, Dan Gjerde, Roni McDermott, Donna Schuler, Mary Williamson, Linda Helland, Suzy Miller, Carol Mordhorst, Armand Brint, Pat Meek, Allyne Brown, Liz Elmore. Karen Black and Lauren Sinnott joined by phone. * Pat Meek - introduction to members; description of ACHIEVE (3 years / $64k total); Mendocino County was one of 194 organizations to apply for the 2011 ACHIEVE grant; 40 were selected, and as a result you are here to work together to reduce youth access to tobacco and secondhand smoke exposure, improve nutrition and increase physical activity in Mendocino County. Chronic diseases and conditions, such as heart disease, stroke, diabetes, cancer, obesity, and arthritis, are pervasive health problems in the United States, affecting almost half of the population and accounting for 7 of the 10 leading causes of death nationally; yet only 4% of US health expenditures are spent on prevention. The preventable risk factors of tobacco use and exposure, insufficient physical activity, and poor nutrition are major causes of these chronic diseases. The smoking rate in Mendocino is significantly higher than in California as a whole. 65% of Mendocino County adults are overweight or obese. If current trends continue, 1 in 3 kids born since the year 2000 will develop diabetes in their lifetimes, and this will contribute to their living shorter lives than their parents generation, for the first time in modern history. 1. Introductions: Name, organization and role, what is your 30-second vision of a healthy community; what does it look like? ; participants introduced themselves and their agencies; all members gave their vision of a healthy community ; 2. Overview and background of ACHIEVE; goals of ACHIEVE; sectors addressed; process and timeline Linda provided a power point presentation for the members; detailed description of the ACHIEVE grant goals / objectives; CHART completes Assessments of Community Policies and Environments in 5 sectors: community at large; school; work site; health care and community institution/organization; assessments will culminate in CHART development of a Community Action Plan (CAP) and selection of a few policy/systems/environmental change strategies; timeline is to complete 1 assessment in each sector by June, meet monthly through Sept 30, complete at least 3 assessments in each of the 5 sectors by August, develop the CAP in August and Sept, then continue to meet bi-monthly or quarterly through Feb 2013, implementing the CAP and reassign the community policy environment once; (see powerpoint slides) 3. What are policy, systems and environmental changes, some examples, and why are they the focus of ACHIEVE? (See slides) Reducing & Preventing Chronic Disease: CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 48

50 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) What Works? Primary prevention, or preventing health problems before they occur, is fundamental to public health successes. If there s anything that we ve learned from the last 150 years of public health history, it s that it required changing policies, systems and environments to double life expectancy in this country. For example, life expectancy almost doubled from 39 years in 1850 to 78 in 2004 due largely to environmental improvements brought about by requirements to construct sanitary water and sewage systems, the implementation of effective garbage removal, child labor laws, and the 8 hour work day, all brought about by policy changes, in addition to declining family size, improvements in housing, nutrition, the filling and draining of swamps to reduce malaria, and public health campaigns and regulations to control milk-borne diseases. Treatment of infection played little if any part in the reduction of mortality, as treatment was generally ineffective until the introduction of early antibiotics in As public health researcher Richard Doll concluded in the American Journal of Public Health: The principal roles in reduction of mortality must be attributed to the improved environment (defined as the conditions under which people lived). Today, lived experience suggests this and the research affirms it. For this initiative, we are focusing on Changing the Context to make individual default decisions healthy or making the healthy choice the easy choice. Decades of research have demonstrated that these interventions reach more people at once and are more long lasting. They are the policy, systems and environmental changes we re discussing. For example, many more people are influenced to quit smoking when the price of tobacco rises (an economic policy) than can be reached with one-on-one tobacco cessation services (an individual educational intervention). While policy changes can take a long time to enact, they are often more cost effective long term, because they don t require ongoing program expenses they way individual education programs do. Also, many policies - like requiring sidewalks or playgrounds to be built when a new development goes in - are implemented and enforced by the planning officials in the course of their regular jobs, and do not require new programs or staff to be implemented. 4. Role of the CHART, expectations of CHART members, why create a new group? Mary described the requirements of the ACHIEVE grant re: a broad participation form the community and why that is important representation from diverse; reviewed the expectations of CHART members: Attend orientation meeting (today) and regular team meetings; Promote ACHIEVE and related activities; Bring your organization s assets, expertise and strengths to help collectively improve health and well-being of community; and Assist with completion of CHANGE (community assessment tool) and development of CAP. 5. Introduction to the CHANGE assessment tool (see booklet and CD tool); Mary introduced the CHANGE assessment tool; if you missed this meeting and have not listened to the CHANGE tool webinar, we recommend it: 1 Meckel, Richard A Save the Babies: American Public Health Reform and the Prevention of Infant Mortality. Preston, Samuel, and Michael Haines Fatal Years: Child Mortality in Late Nineteenth-Century America. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 49

51 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) At least two methods (interview, observation, photovoice, walkability audit, focus group, survey, etc. see p. 14 in CHANGE book) need to be used for each site assessment; need to assess one site in each of the 5 sectors by mid-june. 6. Discuss/select initial sites to assess Terry reviewed the potential sites for assessment and members brainstormed other possibilities (see attached for what was selected for the first assessments); Community at Large : -City of Fort Bragg -Multi-unit housing complexes Ukiah area regarding smoke free housing policies - Laytonville? - Pt. Arena? Community Institution / Organization: - Laytonville Healthy Start (Jayma Shields / Carol M.)? - Northern Circle Indian Housing ( Emily James)? - NCO (Patty B. / Miles Gordon / Denise Gorney)? - Boys & Girls Club (Liz) - Safe Passage (Laura W.)? School: - Ukiah USD - Oak Manor; - Willits USD - Brookside School; - Mendocino USD; - -Fort Bragg USD Work Site: - Schats? - Safeway? - UVMC? - NCO? Health Care: - ARCH (Kathy Frey at least one clinic-willits?); - UVMC / RHC (Allyne)? - Partnership Health Plan? - Consolidated Tribal Health (Freddie Rundlet)? - Mendocino Coast District Hospital (Roni / Donna); - Howard Hospital (Kevin E / Kristin Meadows / Carlton Jacobson)? Linda to ask about interest at sites with? 7. Volunteer to assess a site participants decided who will assess which sites for the first round, by the first week in June: Community at Large: City of Fort Bragg Dan, Jaimi, Mary Schools: Willits Brookside School Pat & Terry Ukiah Oak Manor Terry & Linda CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 50

52 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) Worksite: County of Mendocino Linda, Mary Health Care: Mendocino Coast District Hospital Roni, Donna Community Institution/Organization: Boys & Girls Club Liz, Terry, Linda 8. What key sectors are not yet represented on the CHART? MWOW; ARCH; Laytonville Healthy Start; FIRST 5; Aging (senior centers, AAA etc); Redwood Children s Services (The Arbor); Plowshares (Judy Judd); Pinoleville Tribe (G Provencher); Linda to outreach to them to join CHART; if other CHART members speak to these folks, please invite them to participate as well! 9. Discuss next steps and follow-up from coordinators all members will receive meeting minutes; contact from staff by June 2011; staff will contact potential partners who have not been contacted yet for involvement in the project; the first set of assessments need to be complete by early June. 10. Set next meeting date for June June 29 th, 10 noon, Public Health Building, 1120 South Dora St., Ukiah, Conference Room #1 (first door on the left after coming in the main entrance). CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 51

53 Public Health Nursing Services/Prevention & Planning Health and Human Services Agency Stacey Cryer (X) Director Public Health Tom Pinizzotto (X) HHSA Assistant Director Health Services Public Health Director Craig McMillan Interim Public Health Officer Public Health Nursing Services (1) Sharon Convery (C) Deputy Director Senior Program Manager (2) Linda Helland (C) Senior Program Manager Samantha Kinney (C) SR Public Health Analyst Senior Program Manager Vacant (C) Senior Program Manager Senior Program Manager (1) Senior Program Manager (1) Laura Warren (C) Senior Program Manager Peter Schlichting Senior Program Manager PAPU Community Health (5) Colleen Schenk (C) Program Administrator Meredyth Reinhard (C) SR Program Specialist Jessica Stull-Otto (C) SR Program Specialist Judy Judd (C) SR Program Specialist Heather Criss (C) SR Program Sepcialist EH PAPU - AOD (7) Tina Tyler-O Shea (C) Program Administrator Colleen Gorman (C) SR Program Specialist Annie Robinson (C) SR Program Specialist Sarah Barrington (C) Program Specialist II FB Katherine Fengler (C) Program Specialist II Suzy Miller (C) Staff Assistant III (.9) Jean Cunnington (C) Program Specialist II EH Child Health & Disability (3) Carol Kelsey (C) Program Administrator BL Dolores Barajas (C) Staff Assistant II BL Maribel Craig (C) Staff Asst II BL California Children Services (5) Susan Baldridge (C) Senior PH Nurse Anna Anttila (C) Senior PH Nurse Angie Contreras (C) SR Health Program EW BL Maria Manzo (C) SR Health Program EW BL Michelle Ebel-Vega (C) Health Program EW BL Emergency Preparedness (4) Valerie Cannon (C) Program Administrator Guadalupe Chavez (C) SR Program Specialist BL Christy Carlton (C) Staff Assistant II Tamara Bray-Chairez (C) Staff Assistant II EH Field Nursing (5) Melissa Wuoltee (C) Senior PHN Lilia Arredondo (C) CH Services Spec II BL - Willits Gabriela Burleson (C) CH Services Specialist II BL Lucila Martinez (C) CH Services Spec II BL - FB Sheri Santee (C) PH Lab Technician Communicable Disease / Immunizations (3) Erika Nosera (C) Supervising PHN Karen Broderick (C) LVN Maria Pulido (C) Health Program Tech BL Senior Program Manager EH (1) Linda Nagel Sr. Prog Manager EH WIC Unit 1 (7) Patricia Longstreth (C) Nutritionist (.65) Honisuki Cano (C) Health Program EW BL Gloria Fausto (C) Health Program EW BL Azalia Garduno (C) Health Program EW BL (.9) Maria Ruiz (C) Health Program EW BL Elizabeth Valentine (C) Health Program EW BL Fabiola Ruiz (C) Staff Asst II BL WIC Unit 2 (6) Terese O Connell Nutritionist (.8) Maria Hurtado (C) Health Program EW BL FB Sofia Vargas (C) Community Health Worker II BL (.5) Teresa Rodriguez (C) Health Program EW Nicole Pogrund (C) Program Specialist II (.5) BL Alicia Soria (C) Comm Health Worker II BL (.5) FB Black = HHSA Budget Unit 5020 Green = Social Services Budget Unit 5010 Blue = Mental Health Budget Units 4050 & 4051 Red = Public Health Budget Units Purple = Contract Employees Providing Mandated Services BL = Bilingual EH = Extra Help C = Civil Services Employee M = Merit Employee X = Exempt Employee Employees on leave for more than three months are italicized Permanent staff this page = 47 Extra help staff this page = 4 Revised 6/23/14 Effective through 6/23/14 according to Staffing Announcement updates. PH Page 2

54 RESUME COLLEEN SCHENCK 3400 Clark Rd. Philo, CA (707) ACADEMIC PREPARATION: Northern Illinois University, DeKalb, Illinois, MFA 1983 Northern Illinois University, DeKalb, Illinois, MA 1979 Rosary College, River Forest, Illinois, Bachelor of Art, 1971, Secondary Teaching Credential in Art PROFESSIONAL EXPERIENCE: Nov present Jan, 2002 Nov Jan Mendocino County Health and Humans Services Agency, Public Health, Prevention and Planning Unit, Program Administrator, Ukiah, CA Responsibilities include to develop goals and objectives, to develop and monitor budget and act as spokesperson for the project; responsible for coordination of the day to day implementation of project activities: responsible for coordination with other CA4Health staff for implementation of activities and facilitation of meetings, planning trainings, progress reporting, recruiting and maintaining community partners and subawardees, contract development and monitoring, and is the responsible position for ensuring necessary reports/documentation are submitted to funder. Mendocino County Health and Humans Services Agency, Public Health Branch, Prevention and Planning Unit, Senior Program Specialist, Ukiah & Boonville, CA Responsible for coordination, implementation and evaluation of WAVE Grant, including supervision of two county employees, contract writing and monitoring. Coordination, implementation and evaluation for Drug Suppression, Drug Free Communities, TUPE, School Community Violence Prevention and STOP Act Grants received by Anderson Valley Unified School District. Arts Council of Mendocino County. Executive Director, Boonville, CA Responsible for start up of organization to promote the arts in Mendocino County. Duties included working with Board of Directors to plan and implement fundraising and major donor plan, development of strategic plan, Implement art programming including contracting with artists, county-wide aart events, outreach to communities, artists and educators. Creation of communications plan, newsletter and website. Feb Anderson Valley Unified School District, Boonville, CA, Substitute Teacher, k - 12 April Feb Mendocino Art Center, Mendocino, CA, Fine Arts Coordinator & Education Director Responsible for day to day management of education program. Responsible for coordination and supervision of seven departments and their coordinators for the planning and implementation of art education programming, budgets,

55 publication of class schedule, contracting with visiting artists, summer activities for visiting students and the artist in residency program Richmond Art Center, Richmond, CA, Education Program Director Responsible for the planning, coordination, and supervision of on-site art education program for adults and children and outreach programs in schools and community sites for children and youth. This included, hiring, training and supervision of artist/instructors; supervision of on-site support staff for management and maintenance of studio facilities and programming; budget planning and implementation; liaison with school personnel, community organizations, city departments and California Art Council; assisted with grant writing and fund-raising activities; worked with publicist to produce class schedule, advertising and marketing of programs; responsible for writing of California Arts Council Artists In Schools Residency Program grant for which RAC received top rating for 9 out of 10 years in which I was responsible for this program, organized and conducted California Art Council Artist In Residence Contractors Conference for 4 years when hosted by RAC California College of Arts and Crafts, Oakland, CA, Visiting Lecturer, Metal Arts Department, Fall Semester. Taught third year Advanced Metal Arts and 1/3 of Color on Metal specialty course Grand Canyon University, Phoenix, AZ, Assistant Professor of Art, , curriculum development and teaching of five classes per semester, Art Department Coordinator, , Responsible for budget development and implementation, supervision of studio facilities and gallery, hiring and supervision of art faculty of five, planning and scheduling of classes and degree program, recruitment and retention of students, student advisement, various committee assignments, Saturday Children s Art Program Gallery Director, , responsible for research, planning and hanging of exhibitions. Artist in Residence, , responsible for teaching and curriculum development for 5 classes per semester. Student Teacher Supervisor, 1989, supervise and evaluate art student teachers in schools York Community High School, Elmhurst, IL, Art Instructor: responsible for curriculum design and instruction of grades 9 12 in Color Design, Art I & II, Jewelry, Printmaking and Drawing. Wrote and received Illinois Art Council Grant for Artist in Residence. OTHER EDUCATIONAL EXPERIENCES: Media Advocacy, HHSA Public Health, Ukiah, CA 2012 Non-Profit April 2012 Cultural Competency Marijuana and Youth 2012 Responsible Beverage Service Training, Philo, CA 2011 CADCA Mid-Year Institute, July 2011 Advocacy Montana Most of Us Summer Institute for Social Norms, July 2010 Youth Development Seminar, Community Network for Youth Development, San Francisco, CA Pilot Professional Exchange Program, sponsored by the East Bay Center for the Performing Arts, Richmond, CA

56 Jessica Snow Stull-Otto PO Box 401 Covelo, CA Work Experience Over 6 years of experience in community planning and public health, working for the County of Mendocino, holding positions in both the Planning and Building Department, working on General Plan development, and the Public Health Department, focusing on Safe Routes to Schools, Active Transportation, and Planning for Sustainable Communities. Mendocino County Public Health Prevention & Planning Unit July Present Positions Held: Senior Program Specialist Mendocino County, Planning & Building Services March 2008 July 2012 Positions Held: Planning Technician, Planner I Projects & Achievements Provided Safe Routes to School program and policy development direction and technical assistance to 11 schools throughout Mendocino County. Worked with schools and community organizations to organize walk and bike to school day events, evaluate and communicate infrastructure and public safety needs, review and propose updates to school policy language, and develop and support ongoing walking groups and bike-safety education pilot programs. Acted as a liaison between schools, public safety, and transportation agencies. Brought Safe Routes to School and Active Transportation needs and perspectives into 5 committees, including public safety, traffic engineering, and school district wellness policy committees, and 8 planning processes including the Round Valley Bicycle and Pedestrian Infrastructure Plan, City of Ukiah Climate Action Plan, Mendocino County General Plan, and Mixed Use Development Ordinance. Participated in Technical Advisory Groups for Mendocino County Safe Routes to School Plan and the Round Valley Bike & Pedestrian Plan. Assisted with grant writing and program development for 3 grant applications, including an Office of Traffic Safety Grant, with bike/pedestrian focus, and two Active Transportation Program Grant applications, including Safe Routes to School programs to serve 5 communities within Mendocino County. Conducted surveys and demographics research and analysis to guide program and policy development for Safe Routes to Schools projects and development of community plans. Skills & Capabilities Experience developing work plans, coordinating projects with multiple community partners and agencies, and reporting on achievements to funders. Experience and comfort with presenting at public meetings such as to Planning Commissions, City Council, Board of Supervisors, and Mendocino Council of Governments. Well versed in community and transportation planning processes and strategies to increase traffic safety through design, education, and enforcement, including Safe

57 Routes to School programs, general plans, complete Streets ordinances and sustainable planning principles. Networking skills; comfortable talking with anyone and well connected with several Safe Routes to School program leads throughout California through CA4Health grant work. Collaboration skills: experienced at working as a part of a team in developing ideas, strategizing, planning action, and implementing. This includes having excellent listening skills and the ability to incorporate many ideas and viewpoints into a synergistic process and outcome. Organizational Skills: good with managing multifaceted projects, and collaborating with a broad range of community partners. Creative and capable of adapting to changing circumstances while keeping the longterm goals in mind. Self motivated and passionately dedicated to promoting active transportation, adept working both independently or as part of a collaborative team. Computer skills including Word, Excel, Powerpoint, and ArcGIS. Writing skills including research and progress reports, newsletters, policy documents. Experience serving low-income communities and communities with diverse cultural backgrounds. Able to work from home and to travel for meetings, conferences, and to provide technical assistance to communities as needed. Education & Training BS, Environmental Studies & Planning, Magna cum laude, Sonoma State University, 2008 Mendocino Council of Governments best practices tour Safe Routes to Schools and active transportation conferences Form Based Code development workshop References: Linda Helland Manager of Public Health Prevention & Planning Unit (707) hellandl@co.mendocino.ca.us Colleen Schenck Senior Program Manager, Public Health, and my current Supervisor (707) schenckc@co.mendocino.ca.us Dan Gjerde Mendocino County District Supervisor and MCOG Board Chair (707) gjerded@co.mendocino.ca.us Patrick Ford - Former Planning Colleague (917) patrickjford1974@yahoo.com

58 1718 Lockwood Drive Ukiah, California, Citizenship: U.S.A Cultural/ Ethnic Diverse Populations Interview / Assessments / Capabilities Short-Term Targeted Interventions Federal / State Regulations Compliance Environmental Health Inspections FORMAL TRAINING: Samantha Leigh Kinney Samkinney87@gmail.com kinneys@co.mendocino.ca.us Security Clearance: Level II CORE COMPETENCY AREAS Infectious Disease Analyst Data Compliance / Organize / Maintain Publication Proposals Program Eligibility / Confidentiality Evaluation Strategies EDUCATION & CREDENTIALS EAST CAROLINA UNIVERSITY, Greenville, North Carolina Master of Public Health (July 2013) 3.56 GPA Ethnic and Rural Health Disparities Certificate (2013) 4.00 GPA Interpersonal Relationship Skills Statistical Software Systems Management Scheduling / Support Public Health Educator Survey Construction EAST CAROLINA UNIVERSITY, Greenville, North Carolina Bachelor of Science, Environmental Health (2010) 3.0 GPA ADDITIONAL ACTIVITIES: Committees: GLAM Youth Project, Public Health Organization, North Carolina Public Health Association Certified in: First-Aid, CPR, Human Research Curriculum Volunteer: GLAM Youth Project, Relay for Life, Special Population Prom, Eco-Pirates Community Service: Mendocino County GLAM Youth Project, Mendocino County Pride March Coalition, Professional Research: Thesis Perception of HIV Home Test Kits Among Seasonal Migrant Farmworkers in NC. Professor Advisor, Dr. Cary Lea. Developed an exploratory study to examine factors that may predict HIV home test kit usage, if available, with the intent to accept the kits in Latino seasonal migrant farmworker population in Eastern North Carolina. Study includes HIV knowledge, sexual behavior, beliefs, and practice of condom use and how all factors impacts the farmworkers and influences their intention to use HIV home test kits. Professional Presentations: An Investigation Project: An Epidemiological Study Through Beach Environmental Assessment. Presented at Naval Hospital Camp Lejeune, Department of Preventive Medicine, July 2013 Perception of HIV Home Test Kits Among Seasonal Migrant Farmworkers in N.C. Presented at Brody School of Medicine Panelist, July 2013 Computer Skills: STATA, EPI INFO, CBINFO, JMP Pro10, Snagit, Quatrics, Taskstream, SPSS, Microsoft Movie Maker, Python, SEER Stat Relevant Applied Coursework: Public Health Practice, Global Public Health, Biostatistics, Introduction to Epidemiology, Behavioral Science and Health Education, Epidemiology of Cancer, Health Informatics, Food Sanitation, Industrial Hygiene, Physical Safety, Interdisciplinary Rural Health, Fundamental of Environmental Health, Ethnic Health and Health Disparities, Epidemiology of Infectious Disease CAREER ADVANCEMENT MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY, 1120 South Dora Street, Ukiah, California, Public Health Prevention and Planning Unit- Senior Public Health Analyst (March 2014-Present) Supports data collection and analysis needs of various Public Health programs such as Maternal, Child and Adolescent Health, Alcohol and Other Drug Programs, Tobacco Control Program, Sustainable Communities, and Supplemental Nutrition Assistance Program Education Analyzes, interprets and evaluates health data using bio-statistical principals to track trends in health indicators in the county; produces reports and summaries including tables and graphs for various Public Health programs and collaborative partners. Provides information to county and outside agencies and individuals who seek health data about the community; gathers and reviews current statistical literature and data reports; defines populations of interest to develop health studies for specific groups in the county Evaluates the effectiveness of intervention program/strategies using appropriate program evaluation methods and determines health status outcomes in order to ensure that established program standards and goals are met Designs and analyzes surveys and develops data collection instruments; creates statistical and technical summary reports based on these surveys for others Represent Mendocino County on the California Performance Improvement Management Network for the accreditation committee. NAVAL HOSPITAL CAMP LEJEUNE, 100 Brewster Blvd, Jacksonville, North Carolina, Preventive Medicine Department Environmental & Public Health Consultant/Intern (May 2013-July 2013)! Created and implemented a recreational water quality program at Camp Lejeune with assistance of the Environmental Health Naval personnel. Conducted an exploratory investigation on recreational water quality, created and implemented a recreational water quality program at the Naval Hospital Camp Lejeune. Conducted data collection and surveillance through laboratory testing and statistical analysis. Conducted an epidemiological surveillance project of sexually transmitted diseases reported on Camp Lejeune, North Carolina. The focus of the program was to determine historical trends and season peaks of commonly reported sexually transmitted diseases. Statistical analysis was

59 conducted using JMP PRO 10 to determine incident rates and relative risk ratios. Results from the analyses were used to create an educational flyer which was disbursed throughout the base as a health intervention program. Accomplishments: Publication of analysis and recreational water quality program in The Globe, Marine Corp Newspaper, Marine Corp Community Service website, and Scuttlebutt Newsletter located online and Naval Hospital Camp Lejeune and potentially reaching all Onslow County. Implemented training materials for Onslow's Beach lifeguards and recreational management team. Constructed an educational powerpoint presentation which was distributed throughout Camp Lejeune through TV advertisements and billboards. EAST CAROLINA UNIVERSITY, Speight 102, Greenville, North Carolina, College of Education Data Analyst/Graduate Assistant (January 2012-June 2013)! Closely collaborated with various faculty members and the dean on assessment strategies and publications. Executed and monitored the teacher candidates performances by providing basic data analyses assistance through JMP Pro 9 statistical software, constructed geographic data evaluation of candidates employment, created proposals for publication and other resources as needed in addition to creating surveys, data entry and instruction manuals. FURNITURE FAIR, 4930 Arendell Street, Morehead City, North Carolina, Office Manager ( )! Provided human resource management and supervision of employees, in addition enhanced analytical and problem solving skills. Maintained, organized, and reviewed customer documentation for financial standing. Reviewed and supervised import and export merchandise from point of purchase. Supervised and trained office staff, maintained company computer database, and controlled daily activities of accounting procedures. COASTAL COALITION FOR SUBSTANCE ABUSE PREVENTION, New Bern, North Carolina, Substance Abuse Prevention Member (August 2011-October 2011)! Provided assistance in substances abuse research analyses in alcohol accessibility for adolescents. Conducted, and maintained alcohol purchase surveys for CCSAP through visiting over 150+ convenient stores in Carteret, Craven, and Onslow counties, attempted to purchase alcohol without the use of proper ID within August 2011 and October EAST CAROLINA UNIVERSITY, Carol Belk Building, Greenville, North Carolina, Environmental Health Researcher (March 2010-July2010)! Involved in two research projects: Analyzed aflatoxins in animal feed, corn, and corn dust samples and mycotoxins included aflatoxin B1 in cultural spices and herbal formulations from Eastern North Carolina.! Analytical techniques used: Extracted samples using liquid phase extraction (SPE) and liquid-liquid extractions. Screened analysis using Enzyme Immunoassay (ELISA) and thin layer chromatography (TLC). Qualitative and quantitative analysis using liquid chromatography and mass spectrometry (LC/MS). Constructed a chemical inventory list for lab experiments, assisted in preparing laboratory manual and standard operating procedures, and maintained laboratory safety standards. Provided assistance with setting up chemical lab experiments and organized lab station for lab experiments. UNITED STATES PUBLIC HEALTH SERVICE, Indian Health Service, 1395 Greg Street # 101, Sparks, Nevada, JRCOSTEP Internship (August December 2009) Served as an Environmental Health and Safety Officer for the Reno District Health Office that provides essential public health and healthcare services to underserved and disadvantaged populations in an effort to prevent and control injuries and the spread of diseases. Provided comprehensive environmental health services for 21 tribes/colonies spread throughout Nevada, California, and Utah whose service population is 17,000 Native Americans. Assisted the assurance of environmental safety by conducting and supporting inspections of kitchens, daycares, headstarts, latchkeys, women shelters and community buildings to eliminate diseases, health disparities, and injuries. Provided detailed public health information to local residents on food handling safety and blood borne pathogen. Developed, and organized rabies clinics vaccinations for 17 tribes/colonies. Constructed and developed a resource manual for Tribal Health Centers who expressed an interest in pursuing Accreditation Association for Ambulatory Health Centers. CARTERET COUNTY HEALTH DEPARTMENT, 3820 Suite A Bridge Street, Morehead City, North Carolina,, Environmental Health Intern (May 2008-August 2008) Provided assistance with inspections of restaurants, food stands, nursing homes, and pools in 5 towns located in Carteret County. Conducted indoor air quality investigation and soil sampling throughout new developments, collected water samples with the Western Marina Center for enterococcus and other contamination to prevent public exposure to health risk. Professional References Available Upon Request

60 Michelle L. Rich PO Box 667 Ukiah, CA WORK EXPERIENCE Data and Research VISTA: FIRST5 Mendocino 2013-Present Ukiah, California Performed local website maintenance and development, including writing and editing new content for HealthyMendocino.org Gave presentations and trainings on how to use Healthy Mendocino and resources Wrote weekly column in Ukiah Daily Journal Participated in collaborative groups and initiatives Demonstration Coordinator: Davis Food Co-op Davis, California Managed volunteers; planned and implemented in-store demonstrations Development Team Coordinator: Oregon Coast Community Action Coos Bay, Oregon Coordinated communications efforts, including annual reports, press releases, grant reports, and other marketing documents Researched and wrote grants, bringing in more than $1.9 million Coordinated $10 million community facilities project Assisted CEO with strategic development planning and budgeting; supervised employees Facilitated meetings; planned and executed events Acquisitions Manager: Inkwater Press Portland, Oregon Reviewed manuscripts for potential liability and suitability for publication Scheduled meetings with authors; tracked publication through design phase Documented submissions and author services procedures English Graduate Student Organization Coordinator: PSU English Department Portland, Oregon Planned and implemented professional development workshops and student events Recruited and coordinated student volunteers to support events and activities Small Group Leader, Mentor, and Intern: Chi Alpha Western Washington University Bellingham, Washington Assisted with event planning, fundraising, and administration Led small groups; recruited and trained volunteer student leaders EDUCATION Master of Arts: English, Portland State University Portland, Oregon Bachelor of Arts: Linguistics, Western Washington University Bellingham, Washington TRAINING AND CERTIFICATION Grant Writing: The Grantsmanship Center Chico, California Group Facilitation: Facilitating in Chaotic Times Ukiah, California Resource Specialist Training: Alliance for Information and Referral Systems web-based Community Development Block Grant Administration Certification: Business Oregon Infrastructure Finance Authority Salem, Oregon Women s Alpine Backpacking Leadership Course: Outward Bound Montana Permaculture Certification: Oregon State University Corvallis, Oregon

61 Jen$Dalton$ 809$West$Clay,$Ukiah,$CA$95482$ $415<412<8784$ Education* B.A.* *1993* *INDIANA*UNIVERISTY;BLOOMINGTON* Double$Major:$English$Literature$and$World$History$ Double$Minor:$Journalism$and$Italian$$ Related$coursework:$Journalism,$Political$Science,$Psychology,$Communications$ Skills*&*Abilities* LEADERSHIP*&*MANAGEMENT* Design$and$present$facilitated$meetings$and$agendas$for$program$staff$and$major$events$ Plan,$coordinate$and$implement$program$services$and$manage$junior$staff$ COMMUNICATION*&*MARKETING* Demonstrated$success$in$creating$and$executing$marketing$and$communication$plans$for$programs,$projects$and$ products$ Design$and$lead$marketing,$media$training,$and$personal$development$courses$ WRITING*&*EDITING* Published$writer$ Over$20$years$in$print$and$web$including$magazine,$books,$grants,$brands,$blogs$and$website$development$ COMMUNITY*OUTREACH* Dynamic$and$networked$advocate$with$demonstrated$success$in$engaging$individuals$and$groups$on$shared$goals$ Change$agent$with$strong$ability$to$create$and$inspire$calls$for$positive$action$ TEACHING*AND*CURRICULUM*DEVELOPMENT* Design$curriculum$for$national$organizations$and$community$classes$ Teach$culinary$and$food$system$coursework$ EVENT*COORDINATION* Lead$teams$to$create$events$that$have$experiential$and$educational$impact$$ Over$5$years$experience$producing$events$for$trade,$media$and$the$general$public$ Experience* WELLNESS*COORDINATOR* *NORTH*COAST*OPPORTUNITIES *JANUARY*2014;PRESENT* Develop$and$coordinate$wellness$initiatives$and$programs$for$a$non<profit$of$200$employees$ Research$and$write$wellness$materials$including$monthly$newsletter$ Create$workshops$and$presentation$and$deliver$to$staff$and$community$members$

62 $ COORDINATOR* *MENDOCINO*COUNTY*FOOD*POLICY*COUNCIL* *NOVEMBER*2013;PRESENT* Manage$the$promotion$of$the$Mendocino$County$Food$Action$Plan$ Meet$with$public$officials$and$select$community$members$to$solicit$endorsements$ Research$and$write$grants$with$a$fundraising$team$ Organize$and$coordinate$monthly$Food$Policy$Council$meetings$ Distribute$minutes$and$other$news$via$community$and$member$ s$ Update$the$website$ COMMUNICATIONS*&*COMMUNITY*STRATEGIST *KITCHEN*TABLE*CONSULTING *2008;PRESENT* Develop$and$implement$strategic$marketing$and$business$plans$ Provide$resource$and$network$strategies$for$people,$organizations$and$projects$ Create$campaign$content$for$web,$print$and$social$media$ Write$grants$ Develop$curriculum$and$teach$coursework$related$to$cooking$and$food$systems$ Teach$cooking$classes$ MARKETING*MANAGER *MENDOCINO*WINEGRAPE*&*WINE*COMMISSION *DECEMBER*2010* *JUNE*2012* CULINARY*EDUCATOR *MENDOCINO*COMMUNITY*COLLEGE *DECEMBER*2010;MAY*2011* CO;FOUNDER *KITCHEN*TABLE*TALKS *2009;PRESENT* LOCAL*EATS*EDITOR *CIVIL*EATS *2009;2014* PROGRAM*DIRECTOR *SLOW*FOOD*NATION *MAY*2008;OCTOBER*2008* SENIOR*COPYWRITER *EVB *2005;2006* SENIOR*COPYWRITER *TRIBAL*DDB*WORLDWIDE*COMMUNICATIONS *2004;2005* MARKETING*CONSULTANT *JEN*DALTON*COMMUNICATIONS *2003;2006* BRAND*VOICE *COCKTAILS*BY*JENN *2003;2006* CAMPAIGN*&*COMMUNICATIONS*CONSULTANT *STEARNS*CONSULTING *1998;2004* PRODUCTION*EDITOR *WELDON*OWEN*PUBLISHING *1996;1998* ASSOCIATE*&*MANAGING*EDITOR *VEGGIE*LIFE*MAGAZING *1994;1996* Additional*Training*&*Education* FACILITATION*SKILLS*FOR*CHAOTIC*TIMES* *SYNETICS *OCTOBER*2013;APRIL*2014* PROJECT*MANAGEMENT,*LEADERSHIP**&*COMMUNICATIONS *LANDMARK*EDUCATION *1998;2001* CULINARY*SKILLS *TANTE*MARIE*COOKING*SCHOOL *1997;1998* $ Page$2$

63 ACHIEVE, CA4Health, Tobacco Control Program Community Action Plan VISION: The vision of Mendocino County ACHIEVE is healthy people in healthy communities. MISSION: Mendocino County ACHIEVE works collaboratively for policies and environmental changes to empower all people within our community to lead healthier lives. Goal 1: Increase the percent of Mendocino County residents engaging in moderate to vigorous physical activity. Objective 1.1: By February 2014, the City of Ukiah will adopt a Complete Streets policy to assure that streets meet the needs of all users regardless of age, ability, or mode of travel. Objective 1.2: By September 29, 2014, 4 schools adopt school level Safe Routes To Schools policy Objective 1.3: By September 29, 2014, 1 school district will adopt district level Safe Routes To Schools policy (e.g. District Wellness Policy). Objective 1.4: By September 30, 2014, The Walk and Pedal in Fine Fettle Project will improve traffic safety by focusing on preventing collisions that impact pedestrians and cyclists in Willits and Ukiah. Goal 2: Reduce the percent of Mendocino County residents who smoke and increase the number of residents who are protected from second-hand smoke. Objective 2.1: By February 2014, a 100% Smoke-free Mental Health Facility will be adopted and implemented by the Mendocino County Board of Supervisors that applies to 100% of outdoor areas with the exception of designated smoking areas. Objective 2.2: By September 29, 2014, a total 35% of multi-family rental housing in the City of Ukiah and surrounding urban areas will adopt voluntary smoke-free housing policies. Objective 2.3: By September 29, 2014, at least one Multiple-family rental housing property management agency in the city of Willits will adopt smoke-free housing policy. Objective 2.4: By September 29, 2014, at least one Multiple-family rental housing property management agency in the city of Fort Bragg will adopt smoke-free housing policy Objective 2.5: By June 30, 2014, at least five providers in Mendocino County that serve mental health clients and substance use clients will adopt a smoke-free workplace policy that applies to 100% of outdoor areas around the providers owned and leased buildings. Updated 11/22/13

64 ACHIEVE, CA4Health, Tobacco Control Program Community Action Plan Objective 2.6: By June 30, 2014, the City of Fort Bragg will implement its tobacco retail licensing policy by earmarking a portion of its license fee for enforcement activities, establishing a licensing program, and carrying out Youth Tobacco Purchase Surveys (YTPS) at least once yearly.. Goal 3: Increase access to healthy foods and beverages for all Mendocino County residents. Objective 3.1: By February 2014, Potter Valley and Willits Unified School Districts will fully implement the components of their Wellness Policies calling for alternatives to unhealthy foods used as fundraisers, rewards, and in school celebrations. Objective 3.2: By February 2014, the County of Mendocino will adopt a policy to require at least 50% of the food and beverage options in all county vending machines to meet specified nutrition standards. Objective 3.3: By September 29, 2014, decrease access to sugary beverages from 0 to 3 schools districts (Fort Bragg Unified School District, Anderson Valley Unified School District and Laytonville Unified School District that adopt the PHI beverage standards for schools. Objective 3.4: By September 29, 2014, increase access to water from 0 to 9 schools that install a hydration station and adopt language that commits to increasing access to and promotion of water through district-wide policy e.g., Local School Wellness Policy). Objective 3.5: By September 29, 2014, decrease access to sugary beverages and increase access to healthier beverages (e.g., water, non-fat and 1% unflavored milk) from 6 to 14 community organizations that adopt the PHI beverage standards. Objective 3.6: By September 29, 2014, decrease access to sugary beverages and increase access to healthier beverages (e.g., water, non-fat and 1% unflavored milk) from 1 to 2 governmental departments that adopt the PHI beverage standards for vending. Goal 4: Increase the number of Mendocino County residents with high blood pressure and/or high cholesterol who have access Chronic Disease Management services by September 2016.! Objective 4.1: By September 29, 2016 Mendocino County will increase the number of physician teams engaging RURAL Community Health Workers who link with community-based resources from 0 to 10.! Objective 4.2: By September 29, 2016, Mendocino County will increase the number of healthcare providers supporting a comprehensive approach to developing Community Health Workers by implementing a workforce development strategy from 0 to 3. Updated 11/22/13

65 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Community-At-Large Sector Summary COMMUNITY NAME: City of Fort Bragg (CAL1) Note: Community information should be provided at red tab above. Red tabs below indicate requested descriptive information for module % differences. Physical Activity Nutrition Tobacco Chronic Disease Management Leadership Demographic Information Community Density - Population Community Density - Sq Miles Community Setting Median Household Income % No High School Diploma % Poverty % Unemployed Module % Module % Difference Yr1. - Difference across Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period P E P E P E P E P E 78.26% 67.16% 90.00% 77.61% % 82.35% % 57.14% 69.84% 63.49% % 63.49% % 43.64% 46.00% 46.00% % 46.00% % 31.11% 33.33% 31.11% % 93.33% % 52.73% 82.00% 64.00% % 68.00% Rural $31,411 19% 22% 12.50% Rural $31,411 19% 26% 11% Rural $33, % 21% 7.90% Mendocino County Health and Human Services Agency Page

66 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Community-At-Large Sector Summary COMMUNITY NAME: City of Ukiah (CAL2) Note: Community information should be provided at red tab above. Red tabs below indicate requested descriptive information for module % differences. Physical Activity Nutrition Tobacco Chronic Disease Management Leadership Demographic Information Community Density - Population Community Density - Sq Miles Community Setting Median Household Income % No High School Diploma % Poverty % Unemployed Module % Module % Difference Yr1. - Difference across Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period P E P E P E P E P E 64.29% 72.86% % 61.43% % 54.55% % 68.89% % 80.00% Rural $39,159 12% 20% 12.50% Mendocino County Health and Human Services Agency Page

67 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Community-At-Large Sector Summary COMMUNITY NAME: City of Willits (CAL3) Note: Community information should be provided at red tab above. Red tabs below indicate requested descriptive information for module % differences. Physical Activity Nutrition Tobacco Chronic Disease Management Leadership Demographic Information Community Density - Population Community Density - Sq Miles Community Setting Median Household Income % No High School Diploma % Poverty % Unemployed Module % Module % Difference Yr1. - Difference across Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013 Project Period P E P E P E P E P E 52.24% 55.22% 52.24% 56.72% % 50.00% 27.42% 50.00% % 38.00% 38.00% 38.00% % 64.44% 28.89% 64.44% % 54.55% 61.82% 54.55% Rural $39,747 25% 20% 12.50% Rural $39,747 25% 20% 12% Mendocino County Health and Human Services Agency Page

68 COMMUNITY NAME: 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Work Site Sector Summary Mendocino County ACHIEVE Note: Red tabs below indicate requested descriptive information for sites and module % differences. Sites: Module % Module % Module % Module % Difference Difference Yr1. - Difference across Difference Yr1. - across Project Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Period P E P E P E P E P E P E P E P E P E P E Physical Activity 33.33% 46.67% 33.33% 46.67% % 46.67% Nutrition 21.33% 54.67% 24.00% 58.67% % 60.00% Tobacco 48.00% 70.00% 58.00% 78.00% % 90.00% Chronic Disease Management 67.27% 63.64% 67.27% 65.45% % 44.00% Leadership 75.38% 92.31% 75.38% 92.31% % 60.00% Demographic Information County of Mendocino (W1) NCIHA (W2) # of employees Sector Type Profit Type Type of Worksite Public Not for Profit Public Not for Profit Government Government Private Not for Profit Tribal Mendocino County Health and Human Services Agency Page

69 2013 ACHIEVE Program Community Health Assessment and Group Evaluation School Sector Summary COMMUNITY NAME: Mendocino County ACHIEVE Note: Red tabs below indicate requested descriptive information for sites and module % differences. Sites: Brookside Elementary School, Willits USD (S1) Oak Manor Elementary, Ukiah USD (S2) Physical Activity 68.00% 76.00% 72.00% 72.00% % 72.00% 72.00% 76.00% Nutrition 56.00% 96.00% 64.00% 90.00% % 92.00% 74.00% 96.00% Tobacco 20.00% 20.00% 20.00% 20.00% % 0.00% 0.00% 0.00% Chronic Disease Management 40.00% 95.00% 36.00% 84.00% % 63.33% 40.00% 66.67% Leadership 42.27% 52.73% 54.55% 50.91% % 60.00% 52.73% 66.27% After-school 60.00% 66.67% 63.33% 70.00% % 93.33% 70.00% 93.33% Demographic Information # Students Served School Level School Grades Type of School School Setting % Free/Reduced Price Lunch Median Household Income Module % Module % Module % Module % Difference Yr1. - Difference across Difference Yr1. - Difference across Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period P E P E P E P E P E P E P E P E P E P E Elementary K -2 Public Rural Elementary K-2 Public Rural $39,747 $ 39, Elementary K-6 Public Rural 94 $39,159 $ 468 Elementary K-6 Public Rural 94 39,159 Mendocino County Health and Human Services Agency Page

70 COMMUNITY NAME: Mendocino County ACHIEVE Sites: Fort Bragg High School (S3) Module % Module % Difference Yr1. - Difference across Yr. 1 (2011) Yr. 2 (2012) Yr2. Yr. 3 (2013) Project Period P E P E P E P E P E Physical Activity % % % % Nutrition % 96.00% % 96.00% Tobacco 0.00% 0.00% % % Chronic Disease Management 90.00% 86.67% 90.00% 86.67% Leadership 92.73% 90.91% 92.73% 90.91% After-school % % % % # Students Served School Level School Grades Type of School School Setting % Free/Reduced Price Lunch Median Household Income High School High School 12-Sep 12-Sep Public Public Rural Rural $31,411 $ 31,411 Mendocino County Health and Human Services Agency Page

71 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Health Care Sector Summary COMMUNITY NAME: Mendocino County ACHIEVE Note: Red tabs below indicate requested descriptive information for sites and module % differences. Sites Ukiah Valley Medical Center (Hospital Only) (H1) Mendocino Coast District Hospital (H2) Yr. 1 (2011) Yr. 2 (2012) Module % Difference Yr.1 - Yr.2 Yr. 3 (2013) Module % Difference across Project Period Yr. 1 (2011) Yr. 2 (2012) Module % Difference Yr.1 - Yr.2 Yr. 3 (2013) P E P E P E P E P E P E P E P E P E Physical Activity 60.00% 60.00% % 33.33% 40.00% 53.33% % 53.33% Nutrition 55.71% 74.29% % 92.06% 72.55% 72.55% % 60.78% Tobacco 74.00% 72.00% % 72.00% 82.00% 82.00% % 82.00% Chronic Disease Management 74.00% 64.00% % 62.50% 72.50% 77.50% % 75.00% Leadership 67.86% 89.66% % 53.33% 66.67% 70.00% % 69.49% Demographic Information # Staff Sector Type Profit Type Type of Healthcare Organization # Patients Private Not for Profit Hospital Public Not for Profit Hospital 1, Public Not for Profit Hospital 1, Public Not for Profit Hospital 1,462 Mendocino County Health and Human Services Agency Page

72 COMMUNITY NAME: Mendocino County ACHIEVE Consolidated Tribal Health Project Incorporated (H3) Module % Module % Difference across Difference Yr.1 - Module % Difference Project Period Yr. 1 (2011) Yr. 2 (2012) Yr.2 Yr. 3 (2013) across Project Period P E P E P E P E P E P E Physical Activity % 80.00% 80.00% 80.00% Nutrition % 71.43% 52.08% 71.43% Tobacco % 72.00% 64.00% 72.00% Chronic Disease Management % 70.00% 67.50% 70.00% Leadership % 65.12% 43.90% 67.44% # Staff Sector Type Profit Type Type of Healthcare Organization # Patients Public Public Not for Profit Not for Profit Clinic Clinic Mendocino County Health and Human Services Agency Page

73 2013 ACHIEVE Program Community Health Assessment and Group Evaluation Community Institution/Organization Sector Summary COMMUNITY NAME: Mendocino County ACHIEVE Note: Red tabs below indicate requested descriptive information for sites and module % differences. Sites Boys & Girls Club Ukiah (CIO1) Laytonville Healthy Start (CIO2) Physical Activity 40.00% 80.00% 40.00% 80.00% % 83.33% 51.67% 83.33% % 83.33% Nutrition 21.43% 62.71% 21.43% 62.71% % 89.09% 21.57% 90.91% % 90.91% Tobacco 60.00% 92.50% 60.00% 92.50% % 67.50% 30.00% 67.50% % 67.50% Chronic Disease Management 30.00% 42.50% 30.00% 42.50% % 27.50% 25.00% 27.50% % 27.50% Leadership 48.00% 66.00% 48.00% 66.00% % 48.00% 44.00% 48.00% % 58.00% Demographic Information # Individuals Served Target Population Grades Served (if children/youth) Community Setting Median Household Income Institution Type Sector Type Profit Type Module % Module % Difference Module % Module % Difference Yr. across Project Difference Yr. 1 Difference across Yr. 1 (2011) Yr. 2 (2012) 1 - Yr.2 Yr. 3 (2013) Period Yr. 1 (2011) Yr. 2 (2012) - Yr.2 Yr. 3 (2013) Project Period P E P E P E P E P E P E P E P E P E P E 73/day 73/day Children <18 K - 12 Rural $39,159 Boys/Girls Club Private Not for Profit Children <18 K - 12 Rural $39,159 Boys/Girls Club Private Not for Profit All P - 12 Rural $28,021 Park/FRC Public Not for Profit All P-12 Rural $28,021 Park/FRC Public Not fo Profit 1170 All P-12 Rural $28,021 Park/FRC Public Not fo Profit Mendocino County Health and Human Services Agency Page

74 North Coast Opportunities (CIO3) Module % Module % Difference Yr. Difference across Yr. 1 (2011) Yr. 2 (2012) 1 - Yr.2 Yr. 3 (2013) Project Period P E P E P E P E P E 49.18% 62.90% 52.46% 64.52% % 64.52% % 77.27% 55.77% 72.22% % 72.22% % 97.50% 95.00% 97.50% % 97.50% % 50.00% 40.00% 50.00% % 50.00% % 46.00% 48.89% 48.89% % 48.89% All P-12 All P-12 All P-12 Rural Rural Rural $41,867 $ 41, $ 41, Community Action Community Action Community Action Ag Private Private Private Not for Profit Not for Profit Not for Profit Mendocino County Health and Human Services Agency Page

75 The Retail Food Landscape in Mendocino County RESEARCH BRIEF, DECEMBER 2010 By the Prevention and Planning Unit, Community Health Services of the Mendocino County Health & Human Services Agency Summary: Unhealthy diets are associated with overweight, obesity, and a host of chronic diseases. Whether people eat healthy foods is a result of many different factors. One factor receiving increasing attention concerns the kind of foods that are available in a neighborhood. Research suggests that people living in neighborhoods with more fast food restaurants and convenience stores, and fewer grocery stores or produce vendors have higher rates of obesity and diabetes. 1 Community Health Services of the Mendocino County Health and Human Services Agency found that there are two fast food restaurants or convenience stores for every one grocery store or produce vendor in the county as a whole while Fort Bragg has 2.1, Ukiah has 4.3 and Willits has 5.2. Not everyone has equal access to sources of healthier foods. Many communities across the nation are making changes to improve access to healthy foods, so that the healthy choice becomes easier to make. A ccording to the California Health Interview Survey (CHIS) 2007, 59% of Mendocino County adults and teens are overweight or obese. Overweight and obesity can lead to health problems including heart disease, stroke, high blood pressure, bone problems, depression, diabetes and some cancers. The costs of obesity and overweight in Mendocino County were approximately $ 23.7 million in 2006 due to direct health care costs, worker's compensation, absenteeism and presenteeism (not being productive at work). 2 To halt rising rates of chronic diseases linked to unhealthy diet, the Surgeon General, doctors and nutrition experts recommend that Americans eat more fresh fruits, vegetables and whole grains, and less added sugars, fats, and fewer processed foods. However, many residents do not have ready access to these recommended foods, but instead are surrounded by fast food restaurants and convenience stores. Studies increasingly show that individuals diets are strongly affected by what foods are available in their neighborhoods. The 2010 Dietary Guidelines for Americans concluded that: Moderately strong evidence now indicates that the food environment is associated with dietary intake, especially less consumption of vegetables and fruits and higher body weight. The presence of supermarkets in local neighborhoods and other sources of vegetables and fruits are associated with lower body mass index [weight], especially for low-income Americans, while lack of supermarkets and long distances to supermarkets are associated with higher body mass index. Finally, limited but consistent evidence suggests that increased geographic density of fast food restaurants and convenience stores is also related to increased body mass index. 3 The collection of neighborhood retail businesses where food may be purchased is called the retail food environment. One measure developed to describe the relative abundance of different types of retail food outlets in a given area is the Retail Food Environment Index (RFEI). The RFEI is calculated by dividing the total number of fast-food restaurants and convenience stores by the total number of grocery stores and produce vendors (including farmers markets) within a given area. The higher the RFEI, the greater the number of fast food restaurants and convenience stores compared to supermarkets and farmers markets. The Prevention and Planning Unit and the Environmental Health Division of Community Health Services collaborated to calculate the RFEI for Mendocino County as a whole and for the largest cities within the county. The RFEI data shown were compiled from January through April 2009.

76 The Retail Food Landscape in Mendocino County Below is a map of Mendocino County with Retail Food Establishments noted by colored symbols. RFEIs are calculated for the county as a whole and for selected cities and towns. The Mendocino County RFEI is 2.0, indicating that there are twice as many convenience stores and fast food restaurants as grocery stores and farmer s markets. Mendocino County Retail Food Environment RFEI = Retail Food Environment Index (# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets) Piercy County RFEI* = 2.0 HWY 1 Legget RFEI = 0.3 US 101 Covelo RFEI = 0.3 HWY 162 Westport Laytonville RFEI = 2.5 HWY 1 Cleone Fort Bragg Mendocino Little River Albion Elk RFEI = 2.1 HWY 20 RFEI = 1.0 Comptche Navarro US 101 HWY 20 HWY 1 HWY 128 Willits RFEI = 5.2 Calpella Potter Valley Redwood Valley Ukiah RFEI = 4.3 Talmage RFEI = 1.5 Manchester Point Arena RFEI = 3.0 Philo HWY 253 Boonville RFEI = 0.4 US 101 Yorkville HWY 175 Hopland RFEI = 5.0 HWY 1 Anchor Bay Gualala RFEI = N 6 Miles Grocery Stores Farmers Markets Fast Food Restaurants Convenience Stores Sources: Poverty Level: Census 2000; Food Establishments data: Mendocino Environmental Health 2

77 HWY 1 Research Brief, December 2010 Below are maps of the 3 largest cities in Mendocino County highlighting the details of the retail food establishments. US 101 Ukiah RFEI = 4.3 Talmage Willits and Ukiah have high RFEIs while Fort Bragg's RFEI is close to the County RFEI. Ukiah has a population of over 15,000 and is the county seat with a surrounding area that includes several small towns with over 20,000 additional residents. People come to Ukiah to do business with the courts, government, and others, to shop at large and small stores and to eat out. The density of convenience stores and fast food restaurants is highest along State Street and US 101. Hopland, south of Ukiah on U.S. Hwy 101, has a high RFEI of 5.0, but only 6 retail food establishments, the majority of which are convenience stores. RFEI = 5.2 HWY 20 US 101 Willits Willits is a small town with a large surrounding rural area of more than 13,000 residents. The highest density of fast food restaurants and convenience stores is concentrated along US 101, also known as Main Street. This high density gives Willits the distinction of having the highest RFEI in the county. RFEI = 2.1 Fort Bragg Fort Bragg is the largest city on the north coast. The Fort Bragg area has a total population of about 12,000. The highest density of fast food restaurants and convenience stores is concentrated along Highway 1 which runs through the middle of the shopping district. HWY 20 3

78 The Retail Food Landscape in Mendocino County How Does the Retail Food Environment Affect Health? Grocery Stores and Produce Vendors People who have grocery stores near their homes tend to eat more fruits and vegetables, 5,6 and are less likely to be obese or have diabetes. 7,8 There is a connection between the availability of healthful products in stores and the reported healthfulness of individuals diets. 9 Residents with no supermarkets near their homes are 25%-46% less likely to consume a healthy diet than residents with nearby access to supermarkets. 10 Local food environments influence the choices made by children, families and community members. Institute of Medicine, Fast Food Fast food makes up an increasing share of many families food intake. On a typical day, 30% of children eat fast food at least once. 11 Many fast food restaurants have expanded their menus to include options such as salads and fruit. However, a study in the American Journal of Clinical Nutrition found that only 3% of kids meals at major fast food companies met the nutrition standards of the National School Lunch Program. 12 Multiple studies have found that fast foods tend to be high in fat content and energy dense (meaning many calories per weight of the food). 13,14,15 Eating fast food is associated with consuming more calories, 16 more sweetened beverages, 17 and higher rates of diabetes. 18 Strong and consistent evidence indicates that children and adults who eat fast food are at increased risk of weight gain, overweight, and obesity, according to the Dietary Guidelines for Americans. 3 There is evidence to suggest that residents who live close to fast food restaurants and farther from grocery stores have higher rates of premature death due to diabetes, cancer and cardiovascular disease, 19 and conversely that residents with limited access to fast food have healthier diets and lower levels of obesity. 5 Convenience Stores A study of mostly low-income children outside corner convenience stores found that the items the children most frequently purchased were high-calorie, low-nutrition foods such as chips, candy and sweetened beverages. 20 A four-state study found that the presence of convenience stores is associated with a higher prevalence of obesity and overweight. 21 For children and adolescents, living in a neighborhood with higher convenience store density is associated with being more overweight. 22 Unequal Access to Grocery Stores and Produce Vendors The Institute of Medicine has found that nationwide, the availability of fast food and energy-dense foods is greater in lower-income and minority neighborhoods, and that residents in lower-income, minority and rural neighborhoods are more likely to be overweight or obese. 23 A study in Health Affairs found that the quality of the fresh produce in low-income neighborhood stores was significantly worse than in high-income neighborhoods, and that there were fewer healthier foods such as low-fat dairy, lean meats or whole grains in low-income versus highincome stores. 24 Lower-income and minority neighborhoods and communities suffer disproportionately high rates of preventable, diet-related diseases, including obesity, and inequalities in access to affordable, healthy and nutritious food contribute to those disparities. Ford and Dzewaltowski, 2008; Morland and Evenson, 2009, in Institute of Medicine, Definitions Grocery stores are defined as any full-line self-service grocery store that sells fresh fruits and vegetables as well as prepackaged goods. Produce vendors include produce stands and farmers markets (both certified and non-certified). Fast food restaurants are restaurants offering quick or counter service, meal service (versus snacks, desserts and coffee only) and prices usually less than $ 7 per meal. Restaurants with more than five locations with the same name are included. Convenience stores are businesses that sell a wide array of consumable and prepackaged products. A gasoline or other fuel station may be included. 4

79 Research Brief, December 2010 Analysis of Mendocino County s food environment reveals a statistically significant correlation between the percentage of the population below the poverty level and the RFEI in the county s census block groups (r s =.386, p=.026, n=33). This means that, in general, there is a tendency for there to be more fast food and convenience stores in lower-income neighborhoods, and fewer grocery stores and farmers markets. This may result in diets higher in fats and sugars, and lower in fresh fruits and vegetables among low-income populations in Mendocino County. Mendocino County Retail Food Environment Related To Percent Population Below Poverty Level Piercy County RFEI* = 2.0 HWY 1 Legget RFEI = 0.3 US 101 HWY 162 Covelo RFEI = 0.3 Westport HWY 1 Laytonville RFEI = 2.5 US 101 Cleone Fort Bragg RFEI = 2.1 Willits RFEI = 5.2 Mendocino Little River Albion Elk Manchester Point Arena RFEI = 1.0 HWY 1 HWY 1 HWY 20 Comptche RFEI = 3.0 Navarro HWY 128 Philo Calpella RFEI = 4.3 HWY 253 Redwood Valley RFEI = 1.5 HWY 20 Ukiah Potter Valley Talmage US 101 Boonville RFEI = 0.4 Hopland Yorkville RFEI = 5.0 HWY 175 % Population Below Poverty Level by Census Block Group Anchor Bay Gualala RFEI = N 6 Miles 0% 8% 8% 16% 16% 25% 25% 36% RFEI = Retail Food Environment Index (# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets) Note: Towns with RFEI=0.0 are not noted on the map. RFEIs are for cities, not census block groups Sources: Poverty Level: Census 2000; Food Establishments data: Mendocino Environmental Health 5

80 The Retail Food Landscape in Mendocino County In Mendocino County there is a statistically significant correlation between the percentage of Latino residents and the number of fast food and convenience stores in the county s census block groups (r s =.319, p=.004, n=78). 25 This means that, in general, there is a tendency for there to be a high number of fast food and convenience stores in areas with a high percentage of Latino residents. This may contribute to diets higher in fats and sugars, and lower in fresh fruits and vegetables among this population. Mendocino County Fast Food & Convenience Stores Related To Percent Hispanic Population Piercy HWY 1 Legget US 101 Covelo HWY 162 Westport HWY 1 5 Laytonville HWY 1 21 Anchor Bay Gualala Total Fast Food Restaurants = 69 Total Convenience Stores = 61 % Hispanic Population Level by Census Block Group 0% 7% 7% 14% 14% 25% 25% 53% Cleone Fort Bragg Mendocino Little River Albion Elk Manchester Point Arena 5 HWY 1 HWY 20 HWY 1 # Comptche 7 Navarro HWY 128 Philo US 101 Willits 26 Calpella 19 HWY 253 Boonville 4 Number of Fast Food Restaurants and Convenience Stores Redwood Valley Ukiah 25 Talmage US 101 Yorkville Potter Valley HWY 20 Hopland 6 N RFEI = Retail Food Environment Index (# Convenience Stores + # Fast Food Restaurants) / (# Grocery Stores + # Farmers Markets) Note: Towns with RFEI=0.0 are not noted on the map. RFEIs are for cities, not census block groups Sources: Hispanic Population: Census 2000; Food Establishments data: Mendocino Environmental Health 6

81 Research Brief, December 2010 Steps Communities Can Take to Improve Availability of Healthy Foods Individuals can make better nutritional choices when healthy foods are affordable and within easy reach. Policymakers and municipalities have a key role to play in creating environments that make the healthy choice the easy choice. The failure of individual-based nutrition and physical activity efforts can be explained, in part, because the environments where they have been implemented are not conducive to healthful choices. Booth et al., 2001, in Institute of Medicine, Healthy Corner Store Programs provide loans, grants or technical assistance to convenience stores and corner stores to purchase refrigeration equipment for fresh produce, or increase display or shelf space. Healthy Corner Store programs can also offer assistance in marketing of healthy foods. See Municipalities can allow farmers markets, community gardens and produce stands by right or on an expedited basis in appropriate land use zones, so that it is easier to create these facilities. New York City s Green Cart Program gives expedited permits to mobile or street vendors to sell fruits and vegetables, and allows extra permits in areas where the residents eat few fruits and veggies, according to population surveys. See _carts.shtml Many municipalities throughout the US limit the number, location or density of fast food outlets or drivethrus. Concord, MA prohibits fast food and drive-thrus. Carlsbad, CA, Weymouth, MA, Westerly, Bainbridge Island, WA and Newport, RI prohibit drive-thru restaurants. Davis, CA, Arcata, CA, Bainbridge Island, WA, Elmsford, NY & Warner, NH, regulate fast food outlet density, number and location. Detroit, MI requires at least 500 feet between fast food and schools. Arden Hills, MN requires at least 400 feet between fast food and schools, parks, churches and residential property. 26 In 2008 Los Angeles enacted a one-year moratorium on new fast food restaurants and drive-thrus in 32 square miles of area, based on health concerns due to over-concentration of fast food outlets in low-income neighborhoods. 27 While that moratorium has expired, it marks the first prohibition on fast food enacted due to health concerns. Los Angeles has proposed an ordinance limiting new convenience stores within ½ mile of each other unless they carry a certain amount of fruits and vegetables. 28 A 2010 White House Task Force on Child Obesity report recommended that 29 The federal and state governments analyze the effect of state and local sales taxes on less healthy, energy-dense foods. Local governments create incentives to attract supermarkets and grocery stores to underserved neighborhoods and improve transportation routes to healthy food retailers. Communities provide fruits and vegetables in a variety of settings and encourage the establishment and use of direct to-consumer outlets such as farmers markets and community supported agriculture programs. 7

82 The Retail Food Landscape in Mendocino County The state of California requires chain restaurants with 20 or more outlets to list calorie counts on fast food menu boards. Table-service chains must list calories, saturated fat, trans fat, sodium, and carbohydrate content next to each menu choice. 30 Non-chain restaurants could voluntarily provide nutrition information in menus and on menu boards, or could be required to do so by local policy. Healthy Food Financing Initiatives have been proposed at the state and federal level to help grocers and farmers' markets open new locations in poor neighborhoods and help existing corner stores expand to stock more fresh produce. Similar programs have been implemented in other states such as Pennsylvania. 31 Municipalities could provide discounted bus passes for those who receive food stamps to ensure that they have access to the healthiest food available. Municipalities could make transportation options, such as bus routes, more available for people in areas without grocery stores or with high RFEIs. Individual behavior change can only occur in a supportive environment with accessible and affordable healthy food choices... Former Surgeon General David Satcher, 2001 A Neighborhood Market Provides Healthy Food to Local Residents Westside Renaissance Market Holly and Scott Cratty bought the last mom and pop neighborhood store in Ukiah in They had no previous retail experience, but much passion about promoting the bounty of locally sourced food organic produce and meats, handmade jams and honey, breads, pastries and pie, herbs and spices, wine, olive oil, cheeses, fresh flowers and more! Their great pride is their produce from Mendocino Organics seasonal, biodynamically produced, health-giving and delicious. Neighborhood markets have become one of the missing links in the food system, says Scott, referring to the glut of convenience stores selling quick-fix foods with little nutritional value, and few distribution sites for small farmers to sell their fresh fare locally. The Westside Renaissance Market fosters a slowing down process in a rushed world - fresh food, local art, and community. 8

83 Research Brief, December 2010 Methods This research brief draws on a previous study by the California Center for Public Health Advocacy entitled Searching for Healthy Food: The Food Landscape in California Cities and Counties. 32 That study determined the RFEIs for California cities and counties with more than 250,000 residents. Mendocino County with a population of about 90,000 was not included. This brief differs from the statewide study in that the Mendocino County RFEI includes convenience stores at gasoline stations and many markets that would not have met the $ 1 million per year sales volume used to define grocery stores in the statewide study. These businesses were included because of anecdotal evidence that significant portions of daily calories are purchased at gas station convenience stores in rural areas. Therefore, it is not possible to compare Mendocino County with the results in the statewide study. This research and report were made possible by a grant from The California Endowment, as well as support from Community Health Services of the Mendocino County Health & Human Services Agency, and technical assistance from the California Center for Rural Policy. Special thanks go to Jessica Van Arsdale and Melissa Jones of California Center for Rural Policy at Humboldt State University for peer review. The report can be downloaded from 9

84 The Retail Food Landscape in Mendocino County Endnotes 1 California Center for Public Health Advocacy, PolicyLink, UCLA Center for Health Policy Research. Designed for Disease: The Link Between Local Food Environments and Obesity and Diabetes. April California Center for Public Health Advocacy. The Economic Costs of Overweight, Obesity and Physical Inactivity Among California Adults July Dietary Guidelines Advisory Committee. Report of the Dietary Guidelines Advisory Committee on the Dietary Guidelines for Americans, Appendix E-1 - Major Conclusions. Washington DC: US Department of Agriculture Available at Accessed October 18, Institute of Medicine. Local Government Actions to Prevent Childhood Obesity. Washington, D.C.: National Academies Press Morland K, Wing S, Diez Roux A. The contextual effect of the local food environment on residents diets: the atherosclerosis risk in communities study. American Journal of Public Health. 2002; 92: Larson N, Story M, Nelson M. Neighborhood environments: disparities in access to healthy foods in the US. American Journal of Preventive Medicine. 2009; 36(1): Auchincloss AH, Diez Rouz AV, Brown DG, Erdmann CA, Bertoni AG. Neighborhood resources for physical activity and health foods and their association with insulin resistance. Epidemiology. 2008; 19(1): Morland K, Diez Roux AV, Wing S. Supermarkets, other food stores, and obesity: the atherosclerosis risk in communities study. Am J Prev Med. 2006; 30(4): Cheadle A, Psaty B, Curry S, Wagner E, Diehr P, Koepsell T, Kristal A. Community-level comparisons between the grocery store environment and individual dietary practices. Prev Med. 1991; 20: Moore LV, Diez Rouz AV, Nettleton JA, Jacobs DR. Associations of the local food environment with diet quality a comparison of assessments based on surveys and geographic information systems : the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2008; 167(8): Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast food consumption on energy intake and diet quality among children in a national household survey. Pediatrics. January 2004; 113(1): O Donnell SI, Hoerr SL, Mendoza JA, Goh ET. Nutrient quality of fast food kids meals. American Journal of Clinical Nutrition. 2008; 88(5): Prentice AM, Jebb SA. Fast foods, energy density and obesity: a possible mechanistic link. Obesity Reviews. 2003; 4(4): Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA, Ludwig DS. Effects of fast-food consumption on energy intake and diet quality among children in a national household survey. Pediatrics. 2004; 113(1): French SA, Story M, Jeffery RW. Environmental influences on eating and physical behavior. Annual Review of Public Health. 2001;22: Satia JA, Galanko JA, Siega-Riz AM. Eating at fast food restaurants is associated with dietary intake, demographic, psychological and behavioral factors among African Americans in North Carolina. Public Health Nutr. 2004;7(8): Taveras EM, Berkey CA, Rifas-Shiman SL, et al. Association of consumption of fried food away from home with body mass index and diet quality in older children and adolescents. Pediatrics. 2005; 116(4):e Jeffery RW, Baxter J, McGuire M, Linde J. Are fast food restaurants an environmental risk factor for obesity? Int J Behav Nutr Phys Act. 2006; 3(2):doi: / Gallagher M. Examining the impact of food desserts on public health in Chicago Available at: Bank_FoodDesert_ExecSummary.pdf/view Accessed December 3, Borradaile KE, Sherman S, Vander Veur SS, et al. Snacking in children: the role of urban corner stores. Pediatrics. 2009;124(5):

85 Research Brief, December Morland K, Wing S, Diez Roux AV, Poole G. Neighborhood characteristics associated with the location of food stores and food service places. Am J Prev Med. 2002; 22: Grafova IB. Overweight children: assessing the contribution of the built environment. Prev Med. 2008; doi: /j.ypmed The Food Trust Pennsylvania Fresh Food Financing Initiative. Available at: Accessed August 31, California Center for Public Health Advocacy. Searching for Healthy Food: The Food Landscape in California Cities and Counties. January Baker at al., 2006, Larson et al., 2009, Black and Macinko 2008; Story et al., 2008 as cited in Institute of Medicine. Local Government Actions to Prevent Childhood Obesity. Washington, D.C.: National Academies Press Andreyeva T, Blumenthal DM, Schwartz MB, Long MW, Brownell KD. Availability and prices of foods across stores and neighborhoods. Health Affairs. 2008: 27(5): The correlation between the percentage of Latino residents and RFEI was not statistically significant, likely due to the fact that RFEI cannot be calculated for census block groups that only have fast food and convenience stores. 26 Mair JS, Pierce MW, Teret SP. The Use of Zoning to Restrict Fast Food Outlets: A Potential Strategy to Combat Obesity. October Strategic Alliance. Los Angeles fast food moratorium. Enact Local Policy Database Available at: il.php?s_search=los+angeles&policyid=293. Accessed December 7, Hirsch J. War on obesity has new target: studies focusing on convenience stores bring calls to limit the density of such small markets in South L.A. Los Angeles Times. October 12, 2009:B White House Task Force on Childhood Obesity. Solving the problem of childhood obesity within a generation Available at Obesity_May2010_FullReport.pdf. Accessed May 14, California Center for Public Health Advocacy. Resources: menu labeling. Available at: ling.html. Accessed December 7,

86 Mendocino County Health & Human Services Agency

87 Alcohol Outlets and Our Community A Health Impact Assessment of the Harms of High Alcohol Outlet Density in Mendocino County, California January 2013

88 From May 2010 through August 2010 Mendocino County Public Health Services Prevention and Planning Unit conducted a health impact assessment of the effects of alcohol outlet density on the health of the community. This report summarizes the activities and findings of this health impact assessment (HIA). HIA is a means of assessing the health impacts of policies, plans and projects in diverse sectors using quantitative, qualitative and participatory techniques. HIA helps decision makers make choices about alternatives and improvements to prevent disease or injury and to actively promote health. SUMMARY The number of alcohol outlets per community (outlet density) is an indicator of readily available alcohol to the public and an indicator of overall alcohol consumption. While local governments may be inclined to grant approval to alcohol license applicants in attempts to bolster local business and the economy, a high density of outlets corresponds with a proportional increase in alcohol related violence, underage drinking, unprotected sex and driving after drinking. There are many steps communities can take to reduce the harm associated with high alcohol outlet density. Success stories from other communities can help lead the way to implement tools and policies at the local level. Published Literature on Effects of Alcohol Outlet Density Communities of color and individuals in lower income brackets are more likely to be surrounded by alcohol outlets. These are the communities at highest risk for crime and alcohol abuse. i Controlling for race and ethnicity, young people in zip codes with high numbers of alcohol outlets were still significantly more likely to access alcohol. Every additional outlet within a half mile of their residences corresponded with increased binge drinking among adolescents and driving after drinking. xi All outlet types displayed a consistent positive association with violence. vi,viii In a study of various California counties, a 10% increase in numbers of liquor stores and bars correlated with 1.67% and 2.06% increases in violence rates. Every six outlets accounted for one additional assault that resulted in at least one overnight hospital stay. Researchers estimated that, on average, eliminating one bar per zip code in California would reduce the number of assaults requiring overnight hospitalization by 290 per year in the state. iv Alcohol outlet density was strongly associated with reduced indicators of social capital such as community participation and safety. ix 2

89 Positive associations have been found between outlet density and sexually transmitted infections, liver problems, and experienced violence. Even when controlling for individual alcohol consumption, there was still a correlation with sexually transmitted infections and violence. x This means that the harms of alcohol outlet density happen even to people that do not drink. The most frequently reported consequences of high outlet density are alcohol-related collisions. According to a study of 72 cities in California, for every one percent increase in outlet density there was a.54% increase in alcohol-related crashes. Thus, if a city of 50,000 had 100 alcohol outlets, the residents would experience 2.7 additional crashes for each new bar or liquor store. vii State Limits on Alcohol Outlet Densities Because of these multitudes of harms associated with high alcohol outlet densities, the California Department of Alcoholic Beverage Control (ABC) Act has set guidelines for maximum acceptable levels of outlets in communities. The ABC Act Chapter 5, Article 2, sections specify that the on-sale general ratio should not exceed one alcohol outlet for every 2,000 county residents. On-sale outlets are where the alcohol is consumed on the premises, such as night clubs, restaurants and bars. The off-sale ratio is limited to one alcohol license for every 2,500 inhabitants. Off-sale outlets are where the alcohol is taken off-site for consumption, such as liquor stores, convenience stores, grocery stores and gas stations. ABC standards, there would only be 35 off-sale outlets in the county. ABC has placed Mendocino County on its moratorium list for off-sale beer and wine licenses due to the degree to which the current number of licenses exceed one for each 2,500 inhabitants. Alcohol Outlets and Crime in Ukiah An examination of crime statistics from the California Department of Justice and the California Alcohol Beverage Control revealed that Mendocino County has a higher assault rate than the state for the years and more than twice the state s alcohol outlet density. Prompted by this data, the Prevention and Planning Unit conducted an assessment with youth of all off-sale alcohol outlets in three incorporated Mendocino County cities: Ukiah, Willits and Fort Bragg. The outlets were mapped, and arrest data for being drunk in public for the year 2009 were also plotted on the maps. On page 4 is a map of Ukiah with a population of 16,000. The map displays data for 2009 arrests for being drunk in public and locations of off- and on-sale alcohol outlets. Census tracts that exceed these limits are considered to have an undue concentration of outlets, and ABC is required to refuse all alcohol license applicants in those tracts unless special approval by local governing bodies is supplied. The number of outlets in Mendocino County per capita is over twice that of the State. Mendocino County has 48 outlets per 10,000 residents versus 21 outlets per 10,000 residents in California as a whole. There are 168 off-sale alcohol outles in Mendocino County. To conform to the 3

90 Ukiah Alcohol Off-sale and On-sale Outlets Arrests for Drunk in Public in arrests at hospital emergency room 15 arrests at convenience store There were 374 arrests for Drunk in Public in Ukiah. Some addresses were outside the downtown area of Ukiah and do not show on this map. 15 arrests at Walmart parking lot Arrests for Drunk in Public On-sale Alcohol Outlets Off-sale Alcohol Outlets Schools Sources ARREST DATA: City of Ukiah OUTLET DATA: California Department of Alcoholic Beverage Control The blue triangles represent arrests for being drunk in public in Ukiah. Some addresses are outside central Ukiah and do not show up on this map. Drunk in public arrests were of individuals on foot and the blue triangles indicate where they were arrested. There are large clusters of arrests around areas with a high density of alcohol outlets, most of which are along the main artery in Ukiah (State Street). The 35 arrests at Ukiah Valley Medical Center hospital emergency room were due to the arresting officers transporting their arrestees to the emergency room for needed care and then arresting them at the hospital (see map above). 4 Alcohol Outlets and Our Community

91 Alcohol Outlet Density in Mendocino County, Other Counties and the State of California Comparing Mendocino to the six similarly-sized counties in California of mostly rural demographics without major urban areas and to the state reveals that Mendocino County has the highest alcohol outlet density among these counties at 4.8 off-sale alcohol outlets per 2,500 people compared to the State at Off-sale Alcohol Outlet Density for Selected California Counties vs State Outlets per 2,500 Population Calaveras 3.0 Humboldt 3.6 Lake 4.8 Mendocino 2.3 Nevada Tehama Tuolumne 1.9 California Comparison Counties / State Source: California Alcohol Beverage Control Department (ABC) Crime in Mendocino County and California Compared to California, Mendocino County has had alarmingly higher rates of aggravated assault. In 2009 and 2010 the Mendocino County rate of aggravated assault was nearly twice the State rate as can be seen in the graph below. Aggravated Assault Arrest Rates Aggravated Assault Rate per 10,000 Population California Mendocino Source: California Department of Justice 5

92 The Relationship between Off-sale Alcohol Outlet Density and Crime The 20 California counties with populations less than 135,000 and greater than 10,000 were compared with Mendocino County, examining the relationship between offsale alcohol outlet density and crime, focusing on rates of underage drinking arrests and driving under the influence (DUI) arrests. The 20 counties are: Amador, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Inyo, Lake, Lassen, Mariposa, Mendocino, Nevada, Plumas, San Benito, Siskiyou, Sutter, Tehama, Trinity, Tuolumne and Yuba. Below is a scatter plot of the 20 counties comparing rates of off-sale alcohol outlets (on the bottom) with rates of underage drinking arrests (on the left). Underage drinking arrests include juvenile arrests for DUI, public drunkenness, and violation of liquor laws. Mendocino County is denoted by the triangle. Using linear regression analysis on this data and applying the resulting equation, a practical finding is that each additional off-sale alcohol outlet is associated with almost 3 more arrests for underage drinking. The number of outlets accounted for 20% of the variation in underage drinking arrests. Scatter plots can be used to display these relationships. They use horizontal and vertical axes to plot data points to show how much one variable is affected by another. The relationship between two variables is called their correlation. Underage Drinking Arrest Rate vs. Off-sale Alcohol Outlets Rate in 20 California Counties in 2010 Underage Drinking Arrests per 10,000 Population y x R 2 = Off-sale Alcohol outlets per 10,000 Population 6

93 Below-right is a scatter plot of the 20 counties comparing rates of off-sale alcohol outlets (on the bottom) with rates of DUI arrests (on the left). Mendocino County is denoted by the triangle. Using linear regression analysis on this data and applying the resulting equation, a practical finding is that each additional off-sale alcohol outlet is associated with almost 7 more DUI arrests. The number of outlets accounted for 47% of the variation in DUI arrests. Source: California Department of Alcohol Beverage Control; California Department of Justice, Crime Data Driving Under the Influence vs. Off-sale Alcohol Outlets Rate in 20 California Counties in 2010 DUI Arrests per 10,000 Population y x R 2 = Off-sale Alcohol outlets per 10,000 Population 7

94 8 Youth Focus Groups In June, 2010, two focus groups were conducted with year olds, in the City of Ukiah. The setting was a casual, round robin that elicited discussion on alcohol availability to youth, usage and recommendations to limit youth access to alcohol. Both groups noted the following: Hard liquor was much preferred, primarily as a means to get drunk fast. The main goal of drinking was intoxication so the youth engaged in binge drinking, consuming more than 3 drinks per drinking occasion. Parents were considered very influential in determining drinking habits for their children, primarily through education and attitude towards alcohol. Common methods of acquiring alcohol were through an of-age friend or sibling, or alternatively, asking a stranger to buy it for them. Stealing from larger stores was also fairly common. People living in low-income apartments and young children were considered most susceptible to the harms of alcohol outlets and their effects such as alcohol abuse. Alcohol outlets were seen to increase drinking, thus leading to increased sexual violence and unprotected sex among youth. To limit the harms of alcohol outlets and drinking, the youths suggested moving alcohol away from other popular items such as candy, soda and cigarettes, more security through locking alcohol away or keeping it behind the counter, better education regarding legal or criminal consequences of both underage drinking and serving alcohol to a minor, possibly requiring placards at counters of all alcohol outlets with information on laws and consequences, and limiting alcohol outlets near schools and parks. Statewide Tools to Limit Alcohol Outlets In 1994 the California Legislature passed the Caldera Bill to give more local control over alcohol licenses. Under the Caldera Bill, if an alcohol license application either: a) is in an area that is already oversaturated (>1 per 2500 residents for off-sale beer and wine licenses); or b) in an area that has high crime (exceeds the city s or county s average by 20%), then ABC must deny the license application unless there is sufficient demonstration of Public Convenience or Necessity, primarily determined by local governing bodies, often law enforcement. Under this criterion, if a local authority does not indicate a need, the ABC is required to deny the alcohol license. v All of Mendocino County is oversaturated with off-sale alcohol licenses, resulting in a moratorium on new licenses unless an applicant receives a letter of Public Convenience or Necessity from the local jurisdiction. Before writing a letter of Public Convenience or Necessity to allow the new alcohol license, local officials are presumed to weigh benefits versus risks of a new outlet. The letter of Public Convenience or Necessity is a statement indicating that the public will benefit in some manner or receive a hitherto unavailable product or service after the license is granted. However, busy government officials do not always take the time to weigh risks and benefits before agreeing to write a letter of Public Convenience or Necessity for the applicant to receive an alcohol license. In Mendocino County, there are few known cases in which a law enforcement agency refused to provide the applicant with a letter of Public Convenience or Necessity. Local governing bodies wanting local control over alcohol licensing can provide their own regulations and ordinances in addition to ABC s guidelines. Such ordinances can set standards for when a license will not be granted, establish criteria for writing letters of Public Convenience or Necessity, set conditions for granting Conditional Use Permits, or provide performance standards to address nuisances associated with existing outlets. Local Land Use Tools to Limit Alcohol Outlets Local governments have fairly broad authority under their police powers to regulate alcohol sales establishments, provided a) the regulations don t violate Constitutional rights; b) that a nexus is demonstrated between the proscribed beverages (such as high-strength malt liquors) and elevated public health and safety problems in the surrounding area; and c) the zoning ordinance permits retail alcohol outlets in some areas of the jurisdiction (that is, a city cannot vote itself dry).

95 Guidelines for Writing Letters of Public Convenience or Necessity to Grant a New Alcohol License ii Mandatory guidelines are criteria adopted by ordinance under which no finding of Public Convenience or Necessity will be made. The local government can decide that no new licenses will be allowed in certain areas. Examples of mandatory guidelines include: Restricting liquor store proximity (e.g. not less that 1,000 feet between outlets) Prohibiting outlets within a certain distance to sensitive community areas such as churches, schools, hospitals, youth centers, etc. Enforcing a maximum allowable density of alcohol outlets per capita Moratorium in blocks/districts that have high rates of crime compared to other areas in the county/city If the local government is not willing to enact mandatory guidelines, then discretionary guidelines can be adopted, which guide the decision of whether or not to grant a letter of Public Convenience or Necessity to allow a new alcohol license. Discretionary guidelines involve a risk-benefit analysis by the local decision making body and the burden of proof falls to the applicant to provide a reasonable case for allowing another alcohol outlet by demonstrating how their products are different than other nearby alcohol retailers, providing supporting crime data in surrounding areas, or other evidence of benefit. Considerations a local government can adopt to consider when deciding on a new alcohol outlet may include: Percentage of youth in the surrounding area Alcohol retail hours Proportion of profits from alcohol sales (i.e. a corner store that sells primarily alcohol shall be scrutinized differently from a large grocery store) Duplication of services Staff under 21 years of age working in liquor stores Homelessness and alcoholism increase Conditional Use Permits (CUPs) are land use zoning classifications adopted by local governments that allow restrictions or conditions to be placed upon approval of a new alcohol license. The operating conditions can limit outlet location, sale hours, types of alcohol sold, etc. for the purposes of minimizing the harmful effects of alcohol outlets on the community. iii Examples of conditions that can be placed on alcohol outlets include: The sales of beer or malt beverages in quantities of quarts, 22 oz., 32 oz., 40 oz., or similar size containers is prohibited. No beer or malt beverages shall be sold, regardless of container size, in quantities of less than six. No happy hour type of reduced price alcoholic beverage promotion shall be allowed The possession of alcoholic beverages in open containers and the consumption of alcoholic beverages is prohibited on or around these premises The gross sales of alcoholic beverages shall not exceed the gross sales of any other item during the same period There are virtually unlimited conditions that can be applied by the local jurisdiction regarding location or density of outlets, types of outlets, security, lighting, music or noise restrictions, signage, hours, storage, parking, litter, etc. Conditions can also require that servers complete responsible beverage training so that they don t serve to minors or intoxicated customers. Conditional use permits can be revoked with due process if the establishment does not comply with the conditions imposed. Ratio of alcohol related crime to other crimes in the neighborhood (number of arrests for being drunk in public, underage drinking, DUIs compared to the number of other crimes in the area) 9

96 Public Nuisance Ordinances (Deemed Approved Ordinances) The following is from the Community Anti-Drug Coalitions of America (CADCA) and the Center on Alcohol Marketing and Youth (CAMY) at Johns Hopkins Bloomberg School of Public Health: Communities often have concerns about the nuisance problems created by existing on- and off-premise alcohol outlets. Public Nuisance Ordinances (referred to here as Deemed Approved Ordinances or DAOs) are another tool used by many local governments to limit the risks associated with alcohol outlet density by imposing conditions of operation on existing alcohol retail outlets (those not subject to CUP requirements). DAOs change the legal status of existing alcohol outlets, granting them Deemed Approved status, permitting them to operate as usual, under specific performance standards. The standards focus on preventing and abating public nuisances (e.g., loitering, increased police calls, noise, graffiti, drug sales, etc.), adhering to state or local laws, and avoiding any adverse effects to the health and safety of those residing and working in the surrounding area. Violations of the ordinance are handled at the city or county level. Law enforcement and administrative costs associated with the DAO are sometimes funded by an annual fee collected from alcohol outlet businesses. The use of CUPs and DAOs to regulate alcohol outlet density and other operational characteristics is growing nationally. Examples of model CUP and DAO policies are provided at Potential to Reduce Harms in Mendocino County Currently, there are 168 off-sale outlets or one off-sale alcohol outlet for every 532 residents. To conform to the ABC standards, Mendocino would have only 35 outlets, rather than 168; 133 of the current 168 off-sale outlets in Mendocino County would have to close. In 2010 there were 793 DUI arrests in Mendocino County. From the trends derived from data from the 20 similarly-sized California counties, presented on page 7, it can be seen that every off-sale outlet per 10,000 residents was associated with almost 7 DUI arrests per 10,000 residents. These data suggest that decreasing the number of off-sale outlets will correspond with significant decreases in DUIs. In 2010 there were 46 arrests for underage drinking in Mendocino County. The analysis of these data found that every off-sale outlet per 10,000 residents was associated with almost 3 arrests for underage drinking per 10,000 underage residents (see p.6). These data suggest that decreasing the number of off-sale outlets will correspond with significant decreases in arrests for underage drinking. Conclusions and Next Steps This health impact assessment confirmed that there are harms associated with high alcohol outlet density in Mendocino County and revealed the potential to reduce harm, crime and injury by utilizing the land use and regulatory tools at hand to limit alcohol outlet density and associated nuisances. A presentation of preliminary results of this study along with advocacy by community members resulted in the City of Ukiah s Planning Commission deciding to prohibit new off-sale alcohol outlets in the downtown area. In September 2012 the Ukiah City Council upheld the prohibition of new off-sale alcohol outlets in its adoption of the Downtown Zoning Code as an amendment to the city code. A presentation of these findings was made to the chiefs of police of all incorporated cities and the county sheriff, with a request that they consider denying requests for letters of Public Convenience or Necessity for new alcohol outlets, or at least establish criteria for consideration of letters of Public Convenience or Necessity. Updated presentations of these findings are planned for all incorporated cities planning commissions or city councils in This Health Impact Assessment report was originally funded in 2010 through The Local Public Health and The Built Environment (LPHBE) Network, a joint project of The California Active Communities Unit and the Safe and Active Communities Branch within the California Department of Public Health. This project and report were supported by the Preventive Health and Health Services Block Grant. Its contents are solely the responsibility of the grantee and do not necessarily represent the official views of Center for Disease Control and Prevention. 10

97 The authors wish to thank Jessica Van Arsdale, M.D., MPH at the California Center for Rural Policy of Humboldt State University for peer review and technical assistance. For more information, contact: Meredyth Reinhard HHSA, Public Health, Prevention and Planning Unit References: i Alaniz ML. Alcohol availability and targeted advertising in racial/ethnic minority communities. Alcohol Health and Research World. 1998; 22(4): ii Colman V, Sparks M. Public Convenience or Necessity: A Guide for Local Government and Interested Citizens. Community Prevention Initiative Available at www. ca-cpi.org/publications/cars_pcorn.pdf iii Community Anti-Drug Coalitions of America (CAD- CA), Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health. Strategizer 55. Regulating alcohol outlet density: An action guide iv Gruenewald PJ, Remer L. Changes in outlet densities affect violence rates. Alcohol Clin Exp Res. 2006; 30(7): vi Livingston M. A longitudinal analysis of alcohol outlet density and assault. Alcoholism, clinical and experimental research. 2008; 32(6): vii Scribner RA, MacKinnon DP, Dwyer JH. Alcohol outlet density and motor vehicle crashes in Los Angeles County cities. J Stud Alcohol. 1994; 55(4): viii Scribner RA, MacKinnon DP, Dwyer JH. The risk of assaultive violence and alcohol availability in Los Angeles County. American Journal of Public Health. 1995; 85(3): ix Theall KP, Scribner R, Cohen D. et al. Social Capital and Neighborhood Alcohol Environment. Health & Place. 2009; 15(1): x Theall KP, Scribner R, Cohen D, et al. The neighborhood alcohol environment and alcohol-related morbidity. Alcohol and Alcoholism. 2009; 44(5): xi Truong KD, Sturm R. Alcohol environments and disparities in exposure associated with adolescent drinking in California. American Journal of Public Health. 2009; 99(2): v Institute for Public Strategies. Public Convenience or Necessity: The power of local municipalities to control alcohol outlet density. June

98 Alcohol Outlets and Our Community: A Health Impact Assessment of the Harms of High Alcohol Outlet Density in Mendocino County, California January 2013

99 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ATTACHMENT B. MEMORANDUM OF AGREEMENT AND LETTERS OF COMMITMENT ACHIEVE Memorandum of Agreement Page 100 HHSA Advisory Board Page 104 Mendocino County Food Policy Council Page 105 Mendocino County Farmers Market Association Page 106 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 99

100 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) MEMORANDUM OF AGREEMENT Mendocino County Health and Human Services Agency (HHSA) and ACHIEVE Coalition I. PURPOSE OF MEMORANDUM OF AGREEMENT (MOA) This MOA confirms the intent of partners to work in collaboration to improve the health of Mendocino County residents and communities by carrying out the activities described in HHSA s proposal to the CDC Partnerships to Improve Community Health (PICH) Program. II. GENERAL ASSURANCES. All partners agree to: A. Participate in monthly and other scheduled planning and coordination meetings. B. Collect and submit timely and accurate data and reports as required by funders and for program accountability. C. Actively seek continuation funding and leverage supplemental resources. D. Publicize project achievements to recruit political, civic, and community support. Specific commitments of HHSA and ACHIEVE members are itemized below. III. HEALTH AND HUMAN SERVICES AGENCY (HHSA) A. Serve as grantee and lead agency. B. Provide overall grant coordination and monitoring. C. Develop and monitor subcontracts. D. Participate in CDC-led phone calls, trainings, and coordination activities. E. Coordinate data collection, evaluation, and reporting activities. F. Strengthen linkage and coordination between HHSA Advisory Board and ACHIEVE through cross-membership, regular agenda items, and joint subcommittees. G. Tobacco Use and Exposure Risk Factor: 1. Provide technical assistance (TA) in development and implementation of municipal ordinances requiring smoke-free housing policies for rental units in city jurisdictions, and provide education regarding the health benefits of such policies. 2. Provide TA in development and implementation of policies for smoke-free public parks and sports fields in city jurisdictions, and provide education regarding the health benefits of such policies. H. Poor Nutrition Risk Factor: 1. Advocate for adoption of healthy vending machine standards within HHSA. I. Physical Inactivity Risk Factor: 1. Provide TA in development and implementation of complete streets policies in city jurisdictions, and provide education regarding the health benefits of such policies. 2. Provide TA in development and implementation of bike and pedestrian plans in city and county jurisdictions, and provide education regarding the health benefits of such policies. J. Lack of Access to Chronic Disease Prevention, Risk Reduction, and Management Opportunities Risk Factor: 1. Expand Chronic Disease Self-Management Program by increasing the number of workshop series held to 20 series annually. 2. Develop and implement referral system to institutionalize and increase the number of referrals to Chronic Disease Self-Management workshops. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 100

101 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) IV. 3. Develop mutual support and training forum for Lay Leaders and Patient Navigators working with health care providers throughout the county. HEALTHY MENDOCINO A. Coordinate with HHSA Evaluator to develop and implement evaluation. B. Develop and maintain tracking system/initiative center to track project outcome indicators. C. At least quarterly, generate summative outcome reports for Coalition meetings. D. Track and report utilization of project data through Google Analytics. E. Use project data to develop, disseminate, and publish news articles, PSAs, social media postings, and other outreach, promotion, and advertising messages. F. Work with partners to design and implement consolidated needs assessment, to meet the requirements of multiple organizations. G. Work with Project Director to plan, develop, print, and disseminate report on accomplishments and outcomes at the end of the three-year project. V. HHSA ADVISORY BOARD A. Include ACHIEVE as a standing agenda item for all HHSA Advisory Board meetings. B. Invite an ACHIEVE Coalition member to participate in HHSA Advisory Board meetings and report to the Advisory Board on ACHIEVE activities and progress. C. Work with ACHIEVE to develop joint subcommittees. D. Provide technical assistance and support, on request. E. Participate in outreach and promotion to increase community awareness. F. Participate in the Coalition s review process for development of annual Work Plans for the Partnerships to Improve Community Health grant. VI. VII. MENDOCINO COUNTY FOOD POLICY COUNCIL (FPC) A. Work with ACHIEVE members and HHSA staff to ensure that food-related topics and strategies are aligned with the FPC s Food Action Plan goals and objectives. B. Provide input on policies that increase access to healthy foods and educate community, cities, and the county on the benefits of such policies. NORTH COAST OPPORTUNITIES (NCO) A. Poor Nutrition Risk Factor: 1. Develop and implement a community-wide media and promotion campaign focused on increasing access to, purchasing of, and consumption of fresh local fruits and vegetables. Through the message, fruits and vegetables from local sources lead to better health, the campaign will focus on education and promotion that results in the adoption of institutional policies for 10% local procurement and individual commitments to purchase 10% of their fruits and vegetables locally. The campaign will also link local farms and community-supported agriculture programs with food banks and other safety net providers. 2. Promote farmers market purchases through community awareness raising and distribution of farmers market match vouchers (for customers making purchases with CalFresh/food stamps) and farmers market coupons (distributed to high-risk populations attending Chronic Disease Self-Management workshops and by health care providers). 3. Provide TA regarding development and implementation of zoning policies and practices that are aligned across local city and county jurisdictions to increase access to fresh fruits and vegetables by simplifying processes for establishing community gardens and farmstands. 4. Using the CHOICE (Creating Healthy Opportunities in Child Care Environments) Model, provide training to 90 child care providers to enable them to: assess their CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 101

102 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) VIII. nutrition programs; develop nutrition policies; share policies with parents; and implement policies in their child care programs. 5. Subcontract with community-based organizations to coordinate youth advocacy groups that work with local organizations to adopt healthy beverage and healthy food policies. B. Physical Inactivity Risk Factor: 1. Using the CHOICE Model, provide training to 90 child care providers to enable them to: assess their activity programs; develop physical activity policies; share policies with parents; and implement policies. WALK AND BIKE MENDOCINO A. Research, develop, publish, and disseminate countywide walking and biking resource guide. B. Conduct outreach and promotion for adoption of physical activity policies. CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 102

103 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) x. TERM OF MEMORANDUM OF AGREEMENT. A. This agreement shall be in effect throughout the grant period and may be renegotiated by any participating party upon 30-day notice. Stacey Cryer Director Healthy Mendocino HHSA Advisory Board Michelle Rich Data I Susan Baird Kanaan Stp.p.rir,a Committee Chair i ~~~~;c:oast[5istiicttid~o~n~n~a~sfcc~hwuiiele;;:r ~~!!...~ri7:t'lf~~r1 Well ness Coordinator Terri Persons Associate Planner Dan Gjerde County Office Circle Housing Ukiah Unified School District Alicia Meier Project Manager Bessie Glossenger Coordinator After School Carol Mordhorst Consultant Thomas Oliver Terry d'selkie Garden and Nutrition Education CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page

104 tlecuthy PeopLe", tlecuthy C~'-"'4' MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY :J{eaftliy CPeopfe, J[eaftliy Communities ADVISORY BOARD July 14, 2014 Stacey Cryer, Director Mendocino County Health and Human Services Agency 1120 South Dora Street Ukiah, CA LETTER OF COMMITMENT The Mendocino County Health and Human Services Agency (HHSA) Advisory Board was formed in September 15, 2009, as part of the integration of departments creating the Mendocino County Health and Human Services Agency and continuing the work of the earlier Mendocino County Public Health Advisory Board Appointed by the Mendocino County Board of Supervisors, the Advisory Board's mission is to advise the Director of the Health and Human Services Agency and the Board of Supervisors in order to: Promote health and wellness; Promote individual & community responsibility for health; Reduce environmental health hazards; Facilitate coordination and integration of community services; Support and empower people to live healthy, safe and sustainable lives; and Educate the community on current and emerging health and social services issues. Since the establishment of the ACHIEVE Coalition in 2011, members of the HHSA Advisory Board have fully supported your work; and we look forward to working even more closely with you throughout the implementation of your proposed CDC Partnerships to Improve Community Health grant. Because we believe in your project, and your target risk factors and strategies are in full alignment with our Advisory Board goals, we will make the following contributions: Include ACHIEVE updates as a standing agenda item for all HHSA Advisory Board meetings. Invite an ACHIEVE representative to attend all HHSA Advisory Board meetings to keep the Board informed about ACHIEVE activities and progress. Work with ACHIEVE to develop and participate in joint subcommittees. Provide technical assistance and support, on request Participate in outreach and promotion to increase community awareness. Participate in the ACHIEVE Coalition's annual review process for development of annual Work Plans. The HHSAAdvisory Board is very pleased to support the ACHIEVE Coalition and the strategies it has proposed as part of the CDC Partnerships to Improve Community Health grant, and we look forward to working closely with you to make our community the healthiest place to live in the country. Sin/;1l~ 6;~ 1U-----" s1:t.:~aird Kanaan Chair

105 MENDOCINO COUNTY FOOD POLICY COUNCIL 413 North State Street Ukiah, CA July H Stacey Cryer, Director Mendocino County Health and Uuman Services Agency 1120 South Dora Street Ukiah, CA RE: ACHIEVE Coalition Application for CDC Partnerships to Improve Community Health Program LETTER OF COMMMITMENT I am writing to express my support for the Mendocino County Health and Human Service Agency's (HH SA) application to the CDC Partnerships to Improve Community Health Program. Through the ACHIEVE Coalition, which will implement the strategies and activities included in the proposal. the HHSA will reach multiple community sectors in order to have the greatest possible impact on com munity health. As Coordinatorofthe Mendocino County Food Policy Council. I am especially pleased to see that theac HI EVE proposal has a sttong emphasis on food-related issues, including aligning with many objectives articulated in our recently published Food Action Plan. For example: AC HI EVE's ~Eat 10% Locar campaign aligns with our Objectives 4.1: Develop programs that facilitate and support local food purchasing, and 4.5: Revise institutional purchasing policies to incorporate geographical preference. ACHIEVE's plans to advocate for zoning policies to simplify processes for individuals to raise backyard animals and establish community gardens and farmstands renect our Objective 5.8: Establish and maintain policies and ordinances that create access and support for urban food production. ACHIEVE's plans to promote farmers market purchases through community awareness raising and distribution of farmers market match vouchers (for customers making purchases with food stamps) and farmers market coupons is aligned with our Objective 7.2: Provide financial assistance so all community members can purchase more local foods from farmers markets and other local outlets. The Food Policy Council Is very pleased to be part of your project and will contribute by revlewingyour strategies to ensure they are aligned with the FPC's Food Action Plan goals and objectives into the future, and by supporting your outreach and promotion efforts. Your proposal is very timely, and we are excited about working with you to Improve the health of our community. Sincerely, Jen 0 on, Coordinator

106 7/15/ Vichy Hills Drive, Ukiah, CA Phone: (707) Stacey Cryer, Director Mendocino County Health and Human Services Agency 1120 South Dora Street Ukiah, CA RE: ACHIEVE Coalition Application for CDC Partnerships to Improve Community Health Program LETTER OF COMMMITMENT I am writing to express my support for the Mendocino County Health and Human Service Agency s (HHSA) application to the CDC Partnerships to Improve Community Health Program. Through the ACHIEVE Coalition, which will implement the strategies and activities included in the proposal, the HHSA will reach multiple community sectors in order to have the greatest possible impact on community health. As General Manager, Mendocino County Farmers' Market Association (MCFARM), an organization with 37 years experience running farmers markets in our community, I am especially pleased to see that the ACHIEVE proposal has a strong emphasis on food-related issues and incorporates our insights about some of the key areas in which our markets and our community can best benefit from additional support. In particular, ACHIEVE s plans to promote farmers market purchases through community awareness raising and distribution of farmers market match vouchers (for customers making purchases with food stamps) and farmers market coupons is aligned with and reflects our experience with the many positive benefits that accrue when a Food Stamp/EBT matching program is sustained consistently for a long period of time and the community of potential program beneficiaries comes to learn of and participate in the program as has started to happen at the Ukiah farmers market. HHSA's proposal will help fully engage the Ukiah community in this vital program and will also help roll it out to the other farmers market communities in Mendocino County. To help ensure that the project is successful, MCFARM will work to maintain EBT and market match programs in its Mendocino County certified farmers markets. The Ukiah market will also provide technical assistance to other markets joining the matching program and will share our written promotional materials, program management forms, and other documentation regarding program processes and protocols. We are looking forward to working closely with ACHIEVE and fully support your proposal. Successful implementation of this project will strengthen local families, local farmers, and improve the health of our community. Thanks for your attention. Sincerely, Scott Cratty General Manager, Mendocino County Farmers' Market Association Market Manager, Ukiah Certified Farmers' Market!!!

107 MENDOCINO COUNTY HEALTH AND HUMAN SERVICES AGENCY (HHSA) ATTACHMENT C. LETTERS OF SUPPORT Cancer Resource Center of Mendocino County Page 108 Round Valley Indian Health Center Page 109 Ukiah Valley Medical Center Page 110 Visit Mendocino Page 111 Congressman Jared Huffman Page 112 CDC PARTNERSHIPS TO IMPROVE COMMUNITY HEALTH (PICH): CDC-RFA-DP Page 107

108 CANCER RESOURCE CENTERS of MENDOCINO COUNTY COAST: CALPELLA ST. PO BOX 50 MENDOCINO, CA INLAND: 590 S. DORA ST. UKIAH, CA Stacey'Cryer,'Director' Mendocino'County'Health'and'Human'Services'Agency' 1120'South'Dora'Street' Ukiah,'CA'''95482' ' RE: ACHIEVE Coalition Application for CDC Partnerships to Improve Community Health Program LETTER OF SUPPORT I am writing this letter in strong support of the Mendocino County ACHIEVE Coalition. As the founder and Executive Director of the Cancer Resource Centers of Mendocino County, I am committed to strengthening our community s chronic disease prevention efforts, and this is ACHIEVE s focus. For example, over the past several years ACHIEVE has trained lay leaders to deliver Stanford University s evidence-based Healthier Living with a Chronic Disease workshops to people throughout Mendocino County who are living with chronic disease diagnoses. We also strongly support the work that ACHIEVE has done to promote policies that encourage healthier diets and increased physical activity, because we know that nutrition and exercise are linked to many chronic diseases, including cancer. The CDC s support for the continuation and expansion of ACHIEVE activities is essential. With three additional years of funding, ACHIEVE will continue and expand its work in a number of ways, including advocating for municipal smoke-free rental housing ordinances; outdoor tobacco use policies in parks and sports fields; complete streets policies; and bike and pedestrian plans. In addition to its policy development and advocacy work, ACHIEVE will implement a community-wide media campaign to encourage businesses, institutions, and individuals to purchase at least 10% of their food from local farmers. The Cancer Resource Centers of Mendocino stands ready to support the work of the ACHIEVE Coalition through shared data, participation on appropriate subcommittees, and promotion and dissemination of ACHIEVE outreach materials and messages. I will follow your project with interest and stand ready to provide any possible assistance as you move forward. Sincerely, Sara O Donnell Executive Director

109 ROUND VALLEY INDIAN HEALTH CENTER Post Office Box 247. Covelo, California Fax, Medical Pharmacy Dental Outreach Stacey Cryer, Director Mendocino County Health and Human Services Agency 1120 South Dora Street Ukiah, CA Fax, Yuki Trails Fax Administration RE: ACHIEVE Coalition Application for CDC Partnerships to Improve Community Health Program Please accept this letter to demonstrate my support for the ACHIEVE Coalition and the work it is proposing in the application to the CDC Partnerships to Improve Community Health Program that is being submitted by the Mendocino County Health and Human Services Agency. As a health care provider, we recognize the vital importance of policy-level efforts that are focused on improving community health. As you know, Covelo/ Round Valley is a tiny community located a two-hour drive from Ukiah in the rural northeast corner of Mendocino County. Our valley is home to about 4,500 residents, half of whom are tribal members living on the second largest reservation in the state. Round Valley Indian Tribes provides the only formalized local government, and Round Valley Indian Health Center is the only health care provider in the community. With our community members in mind, we applaud your plans to include a focus on the health needs and concerns of Native American in your project. The ACHIEVE Coalition has been instrumental in our community's recent efforts to facilitate walking and biking in our community, and we are pleased to see that you plan to continue this focus through the proposed grant. In the course of our work, we unfortunately have ample opportunity to witness the harm that our patients experience as a result of tobacco exposure, physical inactivity, and poor nutrition. The chronic diseases associated with these risk factors leave patients with knowledge deficits that can only be addressed by teaching them self-management skills. We applaud ACHIEVE's proposal to expand and extend this work to reach more people with more intensive education. We also strongly supportthe work that ACHIEVE has done to promote policies that encourage healthier diets and increased physical activity, because we know that nutrition and exercise are linked to many chronic diseases. These activities are strongly linked and consistent with our own Fit Kid/Fit Teen program. Round Valley Indian Health Center is strongly committed to improving the health of our community, and your project builds on and is well-aligned with existing efforts in our community. I fully support your proposal, and look forward to working with you to provide the very best quality of life for our patients in Round Valley. es Russ, Executive Director ound Valley Indian Health Center

110 Ukiah Valley Medical Center _Adventist Health July 11, 2014 Stacey Cryer, Director Mendocino County Health and Human Services Agency 1120 South Dora Street Ukiah, CA 9S482.. RE: Letter of Support for ACHIEVE Coalition's Application Dear Ms. Cryer, I am writing to express support for the Mendocino County Health and Human Services Agency's application for CDC funding through the Portnerships to Improve Community Heolth program. As Mendocino County's largest health care system, we have developed a strong relationship and appreciation for the work of the ACHIEVE Coalition, which will be responsible for implementing the activities described in the proposal. The ACHIEVE Coalition was instrumental in supporting our successful efforts to institute a healthy food environment policy that addresses nutritional labeling, adjusts pricing strategies to incentivize consumption of healthier items, and prohibits advertisement of unhealthy foods. We believe that healthcare settings are unique and powerful vehicles to encourage staff, patients, and community members to adopt healthy lifestyle behaviors. By eliminating or reducing barriers to healthy foods, we know we can positively impact nutrition patterns. In the course of our work, we unfortunately have ample opportunity to witness the harm that our patients experience as a result of tobacco exposure, physical inactivity, and poor nutrition. The chronic diseases associated with these risk factors leave patients with knowledge deficits that can only be addressed by teaching them self-management skills. Over the past several years ACHIEVE has trained lay leaders to deliver Stanford University's evidence-based Healthier Living with 0 Chronic Diseose workshops to people throughout Mendocino County who are living with chronic disease diagnoses. We applaud ACHIEVE's proposal to expand and extend this program to reach more people with more intensive education. UVMC is strongly committed to doing our part to improve the health of our community, and the proposed project builds on and is well-aligned with existing efforts in our community. Sincerely, ;;l-- Brandon Parker Chief Financial Officer 275 Hospital Drive I Ukiah, CA I wwwuvmeorg

111 July 14, 2014 Stacey Cryer, Director Mendocino County Health and Human Services Agency 1120 South Dora Street Ukiah, CA Subject: ACHIEVE Coalition Application for CDC Partnerships to Improve Community Health Program LETTER OF SUPPORT We are writing to express our support for the Mendocino County Health and Human Service Agency's (HHSA) application to the CDC Partnerships to Improve Community Health Program. Through the ACHIEVE Coalition, which will implement the strategies and activities included in the proposal, the HHSA will reach multiple community sectors in order to have the greatest possible impact on community health. Visit Mendocino County is concerned about health not only because we, too, are members of the community. We are also concerned about community health because we know that a healthy community is attractive to the visitors who support our local economy. Visit Mendocino County is dedicated to the growth of the travel and tourism industry throughout Mendocino County. We market the county's travel opportunities, businesses, events and specials throughout United States and world with a variety of programs and partnerships, and promoting Mendocino County as a place where people live and thrive is essential to the success of our work. We are very pleased to support your project and will contribute by including information about work and your achievements, as appropriate, in our promotional materials, and by providing any relevant data that you may request from us Your proposal is very timely, and we are excited about working with you to improve the health of our community. Sincerely, Scott Schneider President and Chief Executive Officer SS/sjp 345 north lranklin street. lort bragg. co ph Ix /5 ISITMENDO(INO.(O

112 JARED HUFFMAN 2ND OoST~IC't, c.u'00i"'" COMMITIEEON NATURAL RESOURCES COMMlffiE ON THE BUDGET C!Congre~~ of tbe miniteb ~tate~ J!.jouse of l\eprrsentntibes ~"sbil1gtol1. lll(( WASHINGTON OFFICE 1630 lomgwollttl HooJ5f. O... CI 8""'D"'0 WASHIHGT()N, OC ~, ( FAX: (202) July Dr. Ursula Bauer PhD, MPH Director, National Center fo r Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention 4770 Buford Highway, NE MS F-Sl Atlanta, GA Dear Dr. Bauer: I am writing this letter in support of the Mendocino County ACHlEVE Coalition's application for $1.3 million for the Center for Disease Control's (COC) Partnerships to Improve Community Health Program. Since 2011, the ACHI EVE Coalition has urged Mendoc ino County communities to adopt healthier policies, systems, and environmental change. ACHIEVE's accomplishments are numerous and include: adoption of healthy beverage and healthy food environment policies by a number of community-based organizations; improvements in the nutritional content of school meals; changes in school based nutrition policies related to fundraisillg and event promotion such as el imination of candy sales; instituting electronic screen limit policies to increase physical activity; development and distribution of local walking maps; and adoption of a tobacco retailer licensing ordinance and a Healthy Eating, Active Living (HEAL) policy in one jurisdiction. With three additional years of funding. ACHIEVE has plans to advocate for municipal smoke free rental housing ordinances, outdoor tobacco use policies in parks and sports fields, compl ete streets policies, and bike and pedestrian plans. ACHlEVE also intends to implement a community wide media campaign to encourage businesses, institutions, and individuals to purchase at least 10% of their food from local fanners, and ACHIEVE will also be working with local child care providers to help them develop and implement policies that promote healthy eating and physical activity. The ACHIEVE Coalition plans are vital to strengthening the capacity of Mendocino County residents to improve the collective health of their community's residents, and I hope that you will give this request Sig your full consideration. II ~ ~ (AAED /Irr{~ ~ember of Congress SAN RAFAEL 999 F,n.. AVONUI!. SUm> 290 S~.. II...:!., CA P >ton~ ~!I657 F"",141512!.8-991] PETALUMA 206 G S1 ~ iet. 13 P... UMJ.. CA PHONE' (707) FAA; (41 5) 2!; UKIAH 559 l ow G.~ ROAD UK... CA 9S<I82 PttONI! & FAA; 1707) FORT BRAGG 430 N0I01" FUN <UN STMOT PO. 80~2208 Fooo. 8ft.t.CC. CA PItC>NE' ( F... ~, (707) EUREKA 317 T... t> S1~U1. SI)ffE 1 EUA "",- CA P>>QN" F... ~: 170,,

113 OMB Number: Expiration Date: 06/30/2014 ASSURANCES - NON-CONSTRUCTION PROGRAMS Public reporting burden for this collection of information is estimated to average 15 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project ( ), Washington, DC PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET. SEND IT TO THE ADDRESS PROVIDED BY THE SPONSORING AGENCY. NOTE: Certain of these assurances may not be applicable to your project or program. If you have questions, please contact Ihe awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified. As the duly authorized representative of the applicant, I certify that the applicant: 1. Has the legal authority to apply for Federal assistance and the institutional, managerial and financial capability (including funds sufficient to pay the non-federal share of project cost) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States and, if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standards or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C ) relating to prescribed standards for merit systems for programs funded under one of the 19 statutes or regulations specified in Appendix A of OPM's Standards for a Merit System of Personnel Administration (5 C.F.R 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L ) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C , and ), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. 794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U. S.C ), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L ), as amended, relating to nondiscrimination on the basis of drug abuse, (I) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L ), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. 290 dd-3 and 290 ee- 3), as amended, relating to confidentiality of alcchol and drug abuse patient reccrds; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, Ul the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already ccmplied, with the requirements of Titles II and III of the Uniform Relocalion Assistance and Real Property Acquisition Policies Act of 1970 (P.L ) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally-assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply, as applicable, with provisions of the Hatch Act (5 U.S.C and ) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. Previous Edition Usable o Authorized for Local Reproduction Standard Fonn 4248 (Rev. 7-97) Prescribed by OM8 Circular A 102

114 9 Will comply, as applicable, with the provisions of the Davls Bacon Act (40 U.SC. 276a to 276a-7), the Copeland Act (40 U.S.C. 276c and 18 U.S.C. 874), and the Contract Work Hours and Safety Standards Act (40 U.S.C ), regarding labor standards for federally-assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L ) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L ) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetlands pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Coastal Zone Management Act of 1972 (16 U.S.C et seq.); (I) conformity of Federal actions to State (Clean Air) Implementation Plans under Section 176(c) of the Clean Air Act of 1955, as amended (42 U.S.C et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended (P.L ); and, (h) protection of endangered species under the Endangered Species Act of 1973, as amended (P.L ). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. 470), EO (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. 469a-1 et seq.). 14. Will comply with P.L regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L , as amended, 7 U.S.C et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 USC et seq.) which prohibits the use of lead-based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act Amendments of 1996 and OMB Circular No. A-133, "Audits of States, Local Governments, and Non-Profit Organizations. " 18 Will comply with all applicable requirements of all other Federal laws, executive orders, regulations, and policies governing this program 19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TYPA) of 2000, as amended (22 USC. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award. SIGNATURE OF IoUTHORIZED ~TIFYING OFFICIAL A,. ) ~... "7' ~ " APPLICANT ORGANIZATION Mendocino County Health and Human Services Agency TITLE IDirector DATE SUBMITTED I 7ZllZ14 Standard Form 4248 (Rev. 7 97) Back I I

115 CERTIFICATIONS 1. Certification Regarding Debarment and Suspension The undersigned (authorized official signing for the applicant organization) certifies, to the best of his or her knowledge and belief, that the applicant, defined as the primary participant in accordance with 45 CFR Part 76, and its principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency. (b) Have not, within a 3-year period preceding this proposal, been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property. (c) Are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (b) of this certification. (d) Have not, within a 3-year period preceding this application/proposal, had one or more public transactions (Federal, State, or local) terminated for cause or default. Should the applicant not be able to provide this certification, an explanation as to why should be placed after the assurances page in the application package. The applicant agrees by submitting this proposal that it will include, without modification, the clause titled "Certification Regarding Debarment, Suspension, Ineligibility, and Voluntary Exclusion - Lower Tier Covered Transactions" in all lower tier covered transactions (i.e., transactions with sub-grantees and/or contractors) and in all solicitations for lower tier covered transactions in accordance with 45 CFR Part Certification Regarding Drug-Free Workplace Requirements The undersigned (authorized official signing for the applicant organization) certifies that the applicant will, or will continue to, provide a drug-free work-place in accordance with 45 CFR Part 76 by: (a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition. Page 1 of 4

116 (b) Establishing an ongoing drug-free awareness program to inform employees about (1) The dangers of drug abuse in the workplace. (2) The grantee's policy of maintaining a drug-free workplace. (3) Any available drug counseling, rehabilitation, and employee assistance programs. (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. (c) Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a) above. (d) Notifying the employee in the statement required by paragraph (a), above, that as a condition of employment under the grant, the employee will - (1) Abide by the terms of the statement. (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction. (e) Notifying the agency in writing within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant. (f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d)(2), with respect to any employee who is so convicted- (I) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended. (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency. (g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (1). For purposes of paragraph (e) regarding agency notification of criminal drug convictions, the DHHS has designated the following central point for receipt of such notices: Office of Grants and Acquisition Management Office of Grants Management Office of the Assistant Secretary for Management and Budget Department of Health and Human Services 200 Independence Avenue, S.W., Room Washington, D.C Page 2 of 4

117 3. Certification Regarding Lobbying Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions," generally prohibits recipients of Federal grants and cooperative agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non-federal (non-appropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING $100,000 in total costs (45 CFR Part 93). The undersigned (authorized official signing for the applicant organization) certifies, to the best of his or her knowledge and belief, that: (a) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (b) If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. (c) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly. This certification is a material representation offact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 4. Certification Regarding Program Fraud Civil Remedies Act (PFCRA) The undersigned (authorized official signing for the applicant organization) certifies that the statements herein are true, complete, and accurate to the best of his or her knowledge, and Page 3 of 4