Running head: HEALTHY PREGNANCY FOR WOMEN WITH GDM 1

Grant Proposal: Healthy Pregnancy for Women with

Gestational Diabetes Mellitus Program

Jerry Aneke, BS MPH (c)

Shikha Kakkar, BDS, MHA, MPH (c)

Maria Lira, BS MPH (c)

Alejandra Sanchez, BS MPH (c)

Health Science 609: Grant Writing

California State University, San Bernardino

Spring 2019
HEALTHY PREGNANCY FOR WOMEN WITH GDM 2

April 9, 2019

U.S. Department of Agriculture

1400 Independence Ave., S.W.
Washington, DC 20250

Letter of Intent
Attn: U.S Department of Agriculture Food and Nutrition Service (USDA)
Re: Healthy Pregnancy for Women with Gestational Diabetes Program
Dear: U.S. Department of Agriculture Food and Nutrition Service (USDA)

The San Bernardino County Department of Public Health Nutrition Program would like to
express its interest in the forthcoming allocations from the United States Department Agriculture
Food and Nutrition Service (USDA) for the Healthy Pregnancy for Women with Diabetes
Program by providing nutritional and healthy lifestyle education during pregnancy within the
WIC program. This letter is to inform of our intention to submit the 3 Year Program on Healthy
Pregnancy for Women with Diabetes to the Food Nutrition Service Agency (FNS).

The San Bernardino County Department of Public Health Nutrition Program along with the
Women, Infants, and Children program has more than 35 years in providing services to the
residents of San Bernardino County. Currently the San Bernardino County Department of Public
Health Nutrition Program administers state funded programs such as Women, Infants, and
Children, and Cal Fresh which provide gateway services for nutritional and healthier lifestyle
education.

As you are aware, the Center for Disease Control and Prevention has identified an increase in
pregnant women that have or develop diabetes during pregnancy. As a non-for-profit
organization we recognized our responsibility in maintaining and improving the health of
pregnant women with gestational diabetes in San Bernardino County.

The San Bernardino County Department of Public Health Nutrition Program will be responsible
for administering the day-to-day fiscal and administrative oversight and accountability of the
U.S. Department of Agriculture Food and Nutrition Service, Healthy Pregnancy for Women with
Diabetes Program. It is understood that the first year of funding is reported anywhere from
$29,600 - $160,000 with an on-going annual funding of $54,000. Upon submission, a California
Department of Health Services Request for Plans and Budgets form will provide detailed
information for review and evaluation by the first date of submission acceptance, April 22, 2019,
or within the noted time frame for submission.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 3

We are currently interested in providing these Healthy Pregnancy for Women with Diabetes
Program services and would like to be kept notified of any modifications or updates related to
this funding opportunity.

Respectfully,
Amelyn Olson
Chief of Community and Family Health
San Bernardino County Department of Public Health Nutrition Program
HEALTHY PREGNANCY FOR WOMEN WITH GDM 4

Table of Contents:
Abstract .......................................................................................................................................... 5
Specific Aims ................................................................................................................................. 6
Needs /Problem .......................................................................................................................... 6
Literature Review....................................................................................................................... 7
Working Hypothesis .................................................................................................................... 8
General program Plan .................................................................................................................. 8
Proposed Interventions/Goals and Expected Outcomes ........................................................... 9
Aim 1 ......................................................................................................................................... 9
Aim 2 ......................................................................................................................................... 9
Target Population ........................................................................Error! Bookmark not defined.
Geographic Region .................................................................Error! Bookmark not defined.1
Race/Ethnicity .........................................................................Error! Bookmark not defined.1
Socioeconomic Status .............................................................................................................. 12
Education ..................................................................................Error! Bookmark not defined.
Approaches and Methods ..........................................................Error! Bookmark not defined.2
Project Goal ............................................................................Error! Bookmark not defined.2
Objectives ................................................................................................................................ 13
Activities .................................................................................................................................. 14
Timeline ................................................................................................................................... 15
Program Evaluation Plan ..........................................................Error! Bookmark not defined.5
Agency Capacity.........................................................................Error! Bookmark not defined.8
Project Management ....................................................................Error! Bookmark not defined.
1. Positions Needed/Recruitment/Training/Retention ............................................................ 19
2. General Program Management Structure and Approaches ................. Error! Bookmark not
defined.20
3. Job Description/Minimum Qualifications.........................20Error! Bookmark not defined.
Budget .......................................................................................Error! Bookmark not defined.5
Budget Justification .................................................................Error! Bookmark not defined.7
Community Support ................................................................Error! Bookmark not defined.30
References .................................................................................Error! Bookmark not defined.31
Appendix ...................................................................................................................................... 34
A. Sign in Sheet Template ....................................................Error! Bookmark not defined.
B. Letter of Support............................................................................................................. 35
HEALTHY PREGNANCY FOR WOMEN WITH GDM 5

Abstract:

San Bernardino County is home to approximately 2.16 million people. From 2016 to

2017, the population of San Bernardino County increased from 2.14 million people to 2.16

million people. According to the California Department of Public Health, in the county of San

Bernardino, 8.0 per 1,000 female ages 15-44 years of age have Gestational Diabetes Mellitus

(GDM) during their pregnancy. A total of $159,000 is asked from the United States Department

Agriculture Food and Nutrition Service (USDA) to implement the Healthy Pregnancy for

Women with Gestational Diabetes Mellitus Program. All allocated funding would serve the San

Bernardino County female population between 18-44 years of age who are pregnant and have or

are at risk of GDM. For the purpose of this grant proposal by providing education and resources

to low-income pregnant women in the County of San Bernardino the number of women who

have or are at risk of Gestational Diabetes Mellitus will decrease and allow them to have a

healthier pregnancy and prevent further complications throughout their pregnancy or future

development of Type II Diabetes. All implementation and evaluation of this program will be

conducted internally. Once completion of the program, the analyzation of the results and

reporting will be made available to the stakeholders of this program if necessary.

HEALTHY PREGNANCY FOR WOMEN WITH GDM 6

Specific Aims:

Needs /Problem:

San Bernardino County is home to 2.16 million people, between the years 2016 to 2017

the population of San Bernardino County increased from 2.14 million people to 2.16 million

people. San Bernardino County covers 20, 053 square miles making it the largest continuous

county in the United States. The burden of disease for diabetes in the County of San Bernardino

costs $700 million dollars in medical costs each year (San Bernardino County, 2016). According

to the California Department of Public Health, in the county of San Bernardino 8.0 per 1,000

females ages 15-44 years of age have Gestational Diabetes Mellitus (GDM) during their

pregnancy. The Maternal Child and Adolescent Health Community Profile for the year of 2017-

2018 reveals that, 52.7% of births in the County of San Bernardino are covered by Medi-Cal and

24.7% of females aged 18-64 do not have health insurance. The inability for females of

childbearing age to properly access medical attention throughout their pregnancy possibly related

to economic instability, or access to health insurance leads to the purpose for the Healthy

Pregnancy for Women with Gestational Diabetes Program services with the collaboration of

Women, Infants, and Children Program.

The needs of the community are outlined as follows:

1. Raise awareness among low-income pregnant women in San Bernardino County who

currently have or are at risk of developing Gestational Diabetes Mellitus.

2. Reduce gestational diabetes mellitus GDM among San Bernardino County women (18-

44 years of age).
HEALTHY PREGNANCY FOR WOMEN WITH GDM 7

Literature Review:

Literature review was conducted, and Gestational Diabetes Mellitus is the most common

metabolic and endocrine perinatal complication and it is a growing public health problem

worldwide. In the next 30 years, a significant increase in the number of diabetic patients

worldwide up to 366 million is expected, therefore preventive measures must be planned and

implemented to prevent this global public health problem the prevalence of GDM varies from 1-

14% during pregnancy, which depends on the region and nature of the population, different

methods of data collection, the non-accidental choice of mothers and the diagnostic criteria used

(Dolatkhah et al., 2018). GDM is associated with a wide range of adverse health consequences

for women and their infants in both in the short- and long-term range (Comersall et al., 2017).

GDM is increasing in prevalence coincidently with the dramatic increase in the prevalence of

overweight and obesity in women of childbearing age. In most countries a selective screening is

carried out using parameters such as previous GDM testing, testing of measurement for the size

of the baby, diabetes of any kind in first degree relatives, pre-pregnancy adiposities, belonging to

a particular ethnic group associated with a high prevalence of GDM, glycosuria, and high

maternal age (Kampmann et al., 2015). By using selective screening there is a risk of missing

GDM cases hence the clear necessity for an intervention initiative with more focus on this

population is necessary.

Policy implementations are also a supportive factor that can help address the need for

initiative interventions to help reduce complications and or deaths for pregnant mothers. The

Association of Maternal and Child Health Programs is already working to increase collaborative

efforts to help our target population of pregnant women and prevent the most critical situation

for a mother in which would be a fatality. AMCHP invites policymakers, partners, and the public
HEALTHY PREGNANCY FOR WOMEN WITH GDM 8

to a joint commitment to lift the health of mothers in a way that prioritizes and respects the

transformative experience of pregnancy, childbirth, and parenthood. This challenge is too great

for any one group or sector and will require the collective contribution of us all to create change

(AMCHP, 2019). Efforts are being conducted, our program would be a direct support for this

community of pregnant women who are at risk of GDM.

Working Hypothesis:

By providing education and resources to low-income pregnant women in the County of

San Bernardino the number of women who have or are at risk of Gestational Diabetes Mellitus

will decrease and allow them to have a healthier pregnancy and prevent further complications

throughout their pregnancy or future development of Type II Diabetes.

General Program Plan:

The program is mainly based on a preventive intervention which includes general

awareness about gestational diabetes and education to low-income women about healthy diet and

lifestyle. The program is divided into three phases: pre-intervention, intervention, and post-

intervention. In pre-intervention, we will conduct an analysis of the baseline county data for

assessing the number of women who are pregnant in the county, breastfeeding, postpartum, who

are having gestational diabetes and living under the 185 percentiles below the poverty line.

Thereafter, a pre-survey questionnaire will be used to evaluate the knowledge level of the

women enrolled in the program. Furthermore, with the help of our technical expert team, we will

reevaluate the already developed curriculum of the educational program to make any necessary

changes prior to implementation. In intervention phases, we will work on strengthening capacity

building and outreach of health care though our staff. The trained outreach health care staff will

further approach the target population at various locations throughout the county for education
HEALTHY PREGNANCY FOR WOMEN WITH GDM 9

for the participants about the early screening of diabetes, treatment, healthy nutrition, lifestyle

and behavioral change for a safe and healthy pregnancy. Enrollment of the participants will be

done at Women, Infant, and Children sites. Information about the program can also be provided

through community health fairs or events to increase the knowledge about this program for the

community. After enrollment and participation in the program, the curriculum will be

implemented with the participants and will then evaluated. In the post-intervention phase, we

will distribute the post-survey questionnaire to the participants either by mail or in-person and

analyze data to understand if the program has met its goals and objectives.

Proposed Interventions/Goals and Expected Outcomes:

Aim 1:

To increase awareness of women who are at risk of Gestational Diabetes Mellitus and

decrease the rates of women at risk within the San Bernardino County, the promotion of the

Healthy Pregnancy for Women with Gestational Diabetes Program will be conducted through the

Women, Infant, and Child Program locations. Promotions through paper and electronic formats

will help increase awareness for women within this specific population. The expected outcome

would be of women who have or are at risk of GDM to enroll in the Healthy Pregnancy for

Women Program during the remainder of their pregnancy. This would be measurable after

further examination of pre-surveys administered throughout the duration of the program and

post-surveys administered after completion of the program.

Aim 2:

To educate program participants in healthier food choices as well as to how to properly

check their blood glucose if needed. The expected outcomes would be of the participants to

increase their knowledge in healthier food choices to reduce their risk of developing GDM. The
HEALTHY PREGNANCY FOR WOMEN WITH GDM 10

expected outcome for participants with GDM would be to increase their knowledge in healthier

food choices as well as how to properly check their blood glucose levels to ensure that they keep

themselves and their baby safe from the effects of GDM and further developing Type II

Diabetes. This would be measurable by having patients bring in a log of their blood glucose

results and analyzing the blood glucose values to determine if participants are having normal

ranges of blood glucose as they go through this program and in their pregnancy. To further

measure the patients understanding of healthier food choices participants will be required to keep

a food log, participation of local WIC office Registered Dietitians will be incorporated to help

participants understand the relationship between the foods previously consumed and their blood

glucose values.

Target Population:

The target population for the Healthy Pregnancy for Women with Gestational Diabetes

Program are low-income female’s ages 18-44 years participating in Women, Children’s, and

Infants Program living in the County of San Bernardino. The estimated population size for the

County of San Bernardino is 2.16 million people (datausa.io).

Geographic Region:

San Bernardino County is located in the southern portion of the U.S. state of California

and located within the Inland Empire area. According to the U.S Census Bureau, the county has

a total area of 20,105 square miles (52,070 km2), of which 20,057 square miles (51,950 km2) is

land and 48 square miles (120 km2) (0.2%) is water. There are 24 cities and town in the county.

It is the largest county by area in California and in United State. Out of 58 counties, it is the 5th

most populated county in the state of California.

HEALTHY PREGNANCY FOR WOMEN WITH GDM 11

Race/Ethnicity:

The racial demographics for the county of San Bernardino as of 2017 are: 1.15 million

Hispanic or Latino residents (53.4%), 614,000 Caucasian (28.4%), 167,000 African American

(7.75%), 152,000 Asian (7.06%), 54,000 two or more races (2.5%), 8,003 American Indian &

Alaska Native (0.372%), 6,027 Native Hawaiian & other Pacific Islander (0.291%), and 3,055

Some other race (0.165%). The county of San Bernardino has the highest percentage of

Hispanics when compared to other races (usadata.io).

*Data retrieved from DATA USA and Census Bureau 2017

Socioeconomic Status:

Data USA reports the median household income for the County of San Bernardino as of

2017 as $60,420 and a poverty rate of 18.2%. An increase of 7.25% for the median household

income was noted from 2016 to 2017.

HEALTHY PREGNANCY FOR WOMEN WITH GDM 12

*Data retrieved from DATA USA and Census Bureau 2017

Education:

The US Census Bureau 2013-2017 reported high school graduate percentages for 25+

years to be 79.2% in San Bernardino County. It is also reported that college graduate rates for

25+ years in 2013-2017 to be 19.8%.

Approaches and Methods:

Project Goal:

There are two project goals which San Bernardino County Department of Public Health

Nutrition Program would like to accomplish. First, is to raise awareness among low-income

pregnant women in San Bernardino County who have or are at risk of developing gestational

diabetes mellitus. Women between the ages of 18-44 are considered of childbearing age and are

at a higher risk for Gestational Diabetes Mellitus (GDM) due to their environmental factors,

economic status and lifestyle behavior. According to the San Bernardino County Maternal, Child

and Adolescent Health Community Profile 2017-2018, in San Bernardino County, 40.4% of

women aged 18-64 in San Bernardino County were living in poverty, which is defined living
HEALTHY PREGNANCY FOR WOMEN WITH GDM 13

under the 200% Federal Poverty Level, 8 out of every 1,000 females aged 15-44 had Gestational

Diabetes Mellitus.

The second project goal is to educate the above-mentioned target population about better

choices for a healthier diet and lifestyle to prevent and control GDM. The education would entail

healthier food choices as well as how to test for blood glucose levels. GDM usually emerges

week 24 through week 28 of the pregnancy. Evidence suggested that GDM increases maternal

complications and increases health risks for the fetus. The issue is low-income pregnant women

usually lack knowledge and access to health care for the information on preventative measures

which are inclusive of starting or continuing a healthier diet and lifestyle. The first step in

treating gestational diabetes would be to modify the participant’s diet, followed by lifestyle

changes, which would then allow for a normalized blood glucose level for the expectant mother.

In conclusion the goal of our project is to provide support to inform and raise awareness for the

target population on the dietary patterns, nutritious diets, balanced meals, and physical exercise

to prevent GDM.

Objectives:

The objective of our project is to each year reduce Gestational Diabetes Mellitus among

San Bernardino County women (18-44 years of age) by providing nutritional and healthy

lifestyle education through the 3 year program starting in 2019 and ending in 2021 by 45%. Each

fiscal year San Bernardino County Department of Public Health Nutrition Program will achieve

the project objective by implementing the above-mentioned project objective in the county by

collaborating with the Women, Infant, and Children Program to provide education and reducing

GDM among this population by 15% per year. .

HEALTHY PREGNANCY FOR WOMEN WITH GDM 14

Activities:

San Bernardino County Department of Public Health Nutrition Program will achieve its

goals and objectives through a set of program activities. First, we will work on the baseline

County data to collect information about the women in San Bernardino County currently with

GDM or who are at risk of GDM. The obtained data will be further analyzed by the

epidemiologist for the goal to reach as many women within this specific population. Women

who qualify for this program based on the above mentioned, would then be enrolled in the

Healthy Pregnancy for Women with GDM Program. WIC program is a program under the San

Bernardino County Department of Public Health which currently provides many services

including nutrition for expectant mothers, as well as women and their infants. In collaboration

with WIC prior to the implementation of the Healthy Pregnancy Program, we will coordinate a

dates and schedule all required dates for the implementation of this program to ensure location

availability at the WIC locations throughout the county.

All staff must attend a mandatory Diabetes training through the American Association of

Diabetes prior to any education provided. Once the training is completed, the program

coordinator along with the health education assistant, and health services assistant will create the

educational presentation, any informational information in either electronic or paper format; and

the pre and post surveys for evaluation of the education presented. The educational material

includes units on a dietary pattern, nutritious diets, balanced meals, physical exercise, the effect

of diabetes on the baby, and measures to prevent gestational diabetes. Next activities will include

implementation of the education through videos or PowerPoint presentations already created for

the enrolled participants. The pre-survey will be collected by the staff presenting prior to any

education and a post surveys will be collected at the end of the last class attended by each
HEALTHY PREGNANCY FOR WOMEN WITH GDM 15

participant. The implementation of this program will be conducted through three consecutive

years to an approximation of 45% of gestational diabetes mellitus pregnant women.

Timeline:

Healthy Pregnancy for Women with Gestational Diabetes Program timespan for this

project is three years. Within three years, the department of public health will provide this

educational intervention to 30-40% of women with GDM in the county. The details for the

program timeline are displayed below:

Program Evaluation Plan:

The evaluation plan for San Bernardino County Department of Public Health Nutrition

program, will be applied at every step of the process. Program epidemiologist, health education

Assistant, and health service assistant will evaluate the program indicator on a quarterly basis,

for measuring the effectiveness of the program. Reports will be collected on processes, outcomes

and overall impact of the program. Some program indicators will be measured through statistical

analysis while other will be measured through survey questionnaires. Reporting can be provided
HEALTHY PREGNANCY FOR WOMEN WITH GDM 16

to stakeholders if necessary with the inclusion to the Centers for Disease Control and Prevention

(CDC), Food and Nutrition Service (FNS), and National Institute of Health (NIH). This part of

the evaluation process reporting is of high importance as it will help in recognizing the program's

strengths as well as areas of improvements.

In efforts to help address questions or comments that may arise during the interactions of

the participants with the program staff members it will be advised during weekly group

meetings. This would ensure that throughout the programs duration questions, concerns, or areas

in which the program can be improved can be done so. Discussing this and finding the proper

approach to topics discussed in these meetings would further allow for further program

improvement and efficiency.

To measure the participation adherence to the program, the number of the participant’s

enrollment at the beginning of program and at the end of the program will be measured. The

signing sheets will be used as the measurement tool (See appendix A). The health education

assistant will be responsible person for collecting the aforesaid data and the program

epidemiologist will be further responsible for analyzing the data. The information collected will

help us to measure the participation adherence.

The awareness, knowledge and behavior of the participants would be measured by pre-

survey and post survey questionnaire. The health educator assistant along with the health

services assistant will be responsible for the developments of a survey, and will receive approval

through the program coordinator prior to the use of this tool. Surveys will be disseminated before

and after educational interventions at different Women, Infant, and Children Program locations

in San Bernardino County. The pre-post surveys will have knowledge-based questions derived

from the materials being provided and open-ended questions for quality assurance. This part of
HEALTHY PREGNANCY FOR WOMEN WITH GDM 17

our program evaluation will assist in identifying if our interventions have increased knowledge

of the participants on Gestational Diabetes, healthier diets and lifestyle changes. This is a very

important tool to analyze the effectiveness of the program intervention as well as to identify if

there are areas that require improvement. As previously mentioned, the health education assistant

will be responsible person for collecting the aforesaid data and Program epidemiologist will be

further responsible for analyzing the data.

Year 2019- 2020

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Pre survey collection Pre survey collection Pre survey collection Pre survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge knowledge knowledge knowledge

Post survey collection Post survey collection Post survey collection Post survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge gain knowledge gain knowledge gain knowledge gain

Collection of sign in Collection of sign in Collection of sign in Collection of sign in

sheets to evaluate sheets to evaluate sheets to evaluate sheets to evaluate
enrollment enrollment enrollment enrollment

Year 2020- 2021

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Pre survey collection Pre survey collection Pre survey collection Pre survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge knowledge knowledge knowledge

Post survey collection Post survey collection Post survey collection Post survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge gain knowledge gain knowledge gain knowledge gain
HEALTHY PREGNANCY FOR WOMEN WITH GDM 18

Collection of sign in Collection of sign in Collection of sign in Collection of sign in

sheets to evaluate sheets to evaluate sheets to evaluate sheets to evaluate
enrollment enrollment enrollment enrollment

Year 2021-2022

Quarter 1 Quarter 2 Quarter 3 Quarter 4

Pre survey collection Pre survey collection Pre survey collection Pre survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge knowledge knowledge knowledge

Post survey collection Post survey collection Post survey collection Post survey collection
for evaluating for evaluating for evaluating for evaluating
participants participants participants participants
knowledge gain knowledge gain knowledge gain knowledge gain

Collection of sign in Collection of sign in Collection of sign in Collection of sign in

sheets to evaluate sheets to evaluate sheets to evaluate sheets to evaluate
enrollment enrollment enrollment enrollment

Table shows evaluation plan and tools to measure the program evaluation indicators.

Agency Capacity:

The Healthy Pregnancy for Women with Diabetes Program was established in 1984. Its

mission is to increase awareness of gestational diabetes among low-income women in San

Bernardino County and to prevent or manage gestational diabetes in low-income women in San

Bernardino County through education about healthier diet and lifestyle choices. The

administrative office is in San Bernardino, California. This agency provides a range of health

education services and resources to the San Bernardino County. This agency consists of a 7-

member staff that manages an annual budget of $54,000. The staff includes 1 Program

Coordinator, 1 Health Education Assistant, 2 Health Services Assistants, 1 Administrative

Services Assistant, 1 Office Assistant, and 1 Epidemiologist Analyst. This agency works closely

with other community partners, such as Women, Infants, and Children (WIC) and Cal Fresh.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 19

The program coordinator works with staff members, budgets, and procedures to ensure the

implementation and success of programs. The health education assistant helps in the planning,

development, implementation, and evaluation of health education programs. The health services

assistants help in observing, monitoring and communication with the target population and

providing support to health education assistant. In addition, the program coordinator along with

the health education assistant and health services assistant keep track of the connection with key

stakeholders such as the funding agency, the target population, and the WIC locations. The

Administrative Services Assistant prepares documents and reports and compiles records. The

Office Assistant supports the general administrative functions including greeting, referring, and

assisting of visitors or future participants as well as scheduling and organizing meetings,

answering phones and queries. The Epidemiologist Analyst collects all surveys from the health

education assistant, inputs data onto electronic database and analyzes program data. Reporting of

this data is used for program grant reporting and provision for stakeholders most importantly to

the funders of this grant.

Project Management:

1. Positions Needed/Recruitment/Training/Retention

The positions needed are as follows: Program director, Health Education Assistant,

Health Services Assistant, Administrative Services Assistant, Office Assistant, and

Epidemiologist Analyst. The full time equivalent (FTE) for all these position for the program is

41.5 % (FTE’s) and one part-time equivalent at 4.2% (PT). Recruitment of Staff will be done by

conducting a search through LinkedIn or Idealist. Prior Staff training will already have been

done with the County of San Bernardino Public Health Department but will add through 2

workshops the necessary goals and objectives of this proposed program and any other rules that
HEALTHY PREGNANCY FOR WOMEN WITH GDM 20

may apply. The scope of work necessary for this program is broken down per position in the

below job descriptions. All goals and objectives must be meet on a quarterly basis and evaluated.

If there is a goal and or objective that is no longer relevant or does not provide a positive

outcome for this specific population or program, it will be reevaluated and decided whether kept

or no longer necessary.

2. General Program Management Structure and Approaches

The Program Coordinator will supervise the components of the program. Together in

collaboration with all members assigned for this program will work to achieve the program

objectives and goals. Every week all team members will check-in to review program and staff

member’s tasks. Monthly meetings will be held with all staff to collaborate and check on the

progression of the program.

3. Job Description/Minimum Qualifications

1) Program Coordinator:

a) Basic responsibilities: Work with the health educators, evaluation designer and

community outreach coordinator for in depth program meetings to assess the process, and

progress of the program. Plan, develop and implement the cultivating Healthy

Communities grant program.

b) Minimum Qualifications: At least 5 years of experience in the Public Health or

related field. Education and/or experience equivalent to a bachelor’s degree in health

science or related field. Preferred Master’s Degree in Public Health, Health Science or

related field. Willing to consider years of experience in substitution for the master’s
HEALTHY PREGNANCY FOR WOMEN WITH GDM 21

degree. Knowledge of nutritional health program supervision and implementation at the

state or national level.

2) Health Education Assistant:

a) Basic Responsibilities: Research literature for current statistics, create

PowerPoints, collaborate with partners, and educate the community.

b) Minimum Qualifications: Graduation from a recognized college with a

Bachelor’s degree in Public Health, Health Sciences or Services, Health or Community

Health Education, or related health field. 2-3-year experience which involved assisting and

participating in a health education program which may be substituted for up to two years

of the required education on a year for year basis. This experience must have included

responsibility for the preparation of health education materials and preparing and

delivering talks on health and nutrition topics and community health services.

3) Health Services Assistant:

a) Basic Responsibilities: Work in conjunction with the Health Education Assistant

to collaborate on planning events, preparing reports for stakeholders, and presenting.

b) Minimum Qualifications: Graduation from a recognized college with a

Bachelor’s degree in Public Health, Health Sciences or Services, Health or Community

Health Education, or related health field. 1-2-year experience which involved assisting and

participating in a health education program which may be substituted for up to two years

of the required education on a year for year basis. This experience must have included

responsibility for the preparation of health education materials and preparing and

delivering talks on health and nutrition topics and community health services.

4) Administrative Services Assistant:

HEALTHY PREGNANCY FOR WOMEN WITH GDM 22

a) Basic Responsibilities: Will work in conjunction with the other members to

revolve around managing and distributing information within an office. This generally

includes answering phones, taking memos and maintaining files. Administrative

assistants will also be in charge of sending and receiving correspondence, as well as

greeting clients and customers in conjunction with the office assistant. Will also prepare

documents and reports, maintain records, and manage budget.

b) Minimum Qualifications: Equivalent to graduation from an accredited four-

year college or university (180 quarter units or 120-semester units) with major

coursework in business or public administration, or a field related to the work.

(Additional professional or paraprofessional administrative experience may be substituted

for the education on a year-for-year basis.) Equivalent to one year of full-time

professional-level experience in planning and conducting administrative, operational and

organizational studies and providing varied administrative support.

5) Office Assistant:

a) Basic Responsibilities: Will work in conjunction with the other members to

revolve around managing and distributing information within an office. Handle

organizational and clerical support tasks. This may include organizing files, scheduling

appointments, writing copy, proofreading, receiving guests and more.

b) Minimum Qualifications: High School diploma or equivalent years of

experience within job description requirements. Under supervision, to perform a variety

of moderately difficult clerical work, and to do other work as required.

6) Epidemiologist Analyst:
HEALTHY PREGNANCY FOR WOMEN WITH GDM 23

a) Basic Responsibilities: Assists in the planning, design, and implementation of

health-related surveillance systems or epidemiologic studies, including outbreak

investigation and analysis of epidemiology surveys.

b) Minimum Qualifications: Bachelor's Degree from an accredited college or

university with major coursework in Business, Public Administration, or a related field.

Five (5) years of experience in a relevant field, including but not limited to management,

analysis, or policy development. Master's degree in Public Health, Epidemiology,

Biostatistics or related field preferred.

Position Activity Participant

Program Coordinator ● Plan and organize the Nancy Bell

program
● Lead staff members
● Oversee budgets

Health Education Assistant ● Engage stakeholders Adam Jones

that are necessary for
the program
● Assist in the planning,
development,
implementation, and
evaluation of health
education programs

Health Services Assistant ● Engage with the target Kelly Williams

population
● Support the Health
Education Assistant

Administrative Services ● Prepare documents Leslie Smith

Assistant and reports
● Maintain records
● Manage budget

Office Assistant ● Greet and attend to Joe Pierce

visitors
HEALTHY PREGNANCY FOR WOMEN WITH GDM 24

● Schedule and organize

meetings
● Answer phones and
queries

Epidemiologist Analyst ● Collect and analyze Bill Sanchez

data from the program
● Provide conclusions
drawn from the data to
the program
coordinator for annual
grant funding
reporting
HEALTHY PREGNANCY FOR WOMEN WITH GDM 25

Budget:

ORGANIZATION BUDGET FOR YEARS 1-3

ORGANIZATION INCOME FISCAL YEARS:______2019-2022_____

Source Amount
Support
Government grants $54,000
Foundations $0
Corporations $0
United Way or other federated $0
campaigns
Individual contributions $0
Fundraising events and products $0
Membership income $0
In-kind support $1,000
Investment income $55,000

Revenue $0
Government contracts $0
Earned income $0
Other (specify) $0

Revenue Income $0

Total Income $54,000

ORGANIZATION EXPENSES YEARS:_____2019-2022_____

Item Amount
Salaries, wages and benefits $42,000
Insurance and/or other taxes $5,000
Consultants and professional fees $0
Travel $4,000
Equipment $1,000
Supplies $500
Printing and copying $1,100
Telephone and fax $300
Postage and delivery $100
Rent and utilities $0
In-kind expenses $0
Depreciation $0
HEALTHY PREGNANCY FOR WOMEN WITH GDM 26

Other (food for trainings) $1,000

Total Expense $54,000

Difference (Income less Expense) $0

PROGRAM/PROJECT EXPENSES
Item Amount %
FT/PT
Salaries and wages (break down by individual
position and indicate full- or part-time $
Program Coordinator- Full Time $10,500 8.3% FT
Health Education Assistant-Full Time $7,500 8.3% FT
Health Services Assistant-Full Time $6,000 8.3% FT
Administrative Services Assistant-Full Time $8,000 8.3% FT
Office Assistant-Full Time $6,000 8.3% FT
Epidemiologist Analyst-Part Time $4,000 4.2% PT
SUBTOTAL $42,000
Insurance, benefits and other related taxes $5,000
Consultants and professional fees $0
Travel $4,000
Equipment $1,000
Supplies $500
Printing and copying $1,100
Telephone and fax $300
Postage and delivery $100
Rent and utilities $0
In-kind expenses $0
Depreciation $0
Other (specify) $1,000

Total Expense $55,000

Difference (Income less Expense) $0
HEALTHY PREGNANCY FOR WOMEN WITH GDM 27

Budget Justification:
Category

1. Salaries
A. Program Coordinator (PC) PHA Request
$10,500 (per year)
Description - The PC scope of work is to plan the program, organize the program, and lead
staff members. The program coordinator will also oversee budgets and procedures to ensure
the implementation and success of the program throughout the three year time period of
funding.
B. Health Education Assistant (HEA) PHA Request
$7,500 (per year)
Description - The HEA will assist in the planning, development, implementation, and
evaluation of health education programs. Responsible for engaging all necessary stakeholders
in accordance to this program.
C. Health Services Assistant PHA Request
$6,000 (per year)
Description - This position will act as the health services assistant and will carry out the
following functions: Observing, monitoring and communication with the target population and
providing support to health education assistant.
D. Administrative Services Assistant (HAS) PHA Request
$8,000 (per year)
Description - ASA will act as the administrative services assistant and will carry out the
following functions: Preparing documents, reports, budget management, and compiling
records as necessary.
E. Office Assistant PHA Request
$6,000 (per year)
Description – OA will act as the office assistant and will carry out the following functions:
Supports the general administrative functions including greeting/referring/assisting visitors
scheduling and organizing meetings, answering phones and queries.
F. Epidemiologist Analyst PHA Request
$4,000 (per year)
Description - This position will act as the epidemiologist analyst and will carry out the
following functions: Input and analysis of program.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 28

2. Fringe Benefits PHA Request

$5000 (per year)
Description - Fringe benefits are calculated at 8.3% for full time and 4.2% for part time of
salaries. Fridge benefits were calculated to reflect calculated by adding together the annual cost
of all benefits and payroll taxes that will be paid, and dividing by the annual wages paid.
Benefits include medical, disability, and paid time off.

3. (a) Travel – Local Private Vehicle PHA Request

$4000 (per year)

Description - The estimated cost for reimbursement to staff for use of private vehicles while
conducting any project activities through the use of county vehicles or personal vehicles.
Reimbursement rate is calculated as .54 cents per mile in accordance with IRS Travel
Reimbursement rates.
(b) Travel – Transportation, Airfare PHA Request
$0
Description – Not applicable
(c) Travel – Per Diem/Subsistence PHA Request
$0
Description – Not applicable.

4. Consumable Supplies and Materials

A. General Office Supplies PHA Request
$1,000 (per year)
Description – Cost of general office supplies including: paper, pens, writing tablets, envelopes
and office materials.
B. Archival Materials PHA Request
$500 (per year)
Description - Archival materials will include the following records in both electronic and
hard copy: sign in sheets, all evaluation materials, informational brochures, and marketing
materials.
C. Miscellaneous PHA Request
$0
Description - No miscellaneous items were estimated for extra expenses.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 29

5. Services PHA Request

$1,400 (total cost per year)
A. Communications PHA Request
$300 (per year)
Description – Costs includes landline telephone service and email.
B. Printing Services PHA Request
$1,100 (per year)
Description – Cost for printing and reproduction services includes printing of archival
documents, educational materials, brochures, forms, announcements and other mail outs.
C. Postage PHA Request
$100 (per year)
Description – Estimated cost is of $100 if need arises for any information to be mailed out to
participants.
D. Facilities Cost PHA Request
$0
Description – Not applicable.
E. Staff Training PHA Request
$600 (per year)
Description – Certification for educators through the American Association of Diabetes.

6. Other Costs PHA Request

$1000 (per year)

Description – Costs would include healthy food and or snacks for participants during
educational classes.
A. Equipment PHA Request
$1000 (per year)
Description – Cost for equipment is of $1000 per year, for necessary repairs on computers
and printers for project support. This also includes cost of shredders, copiers, and laminators.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 30

Community Support:

Community participation is a definite key factor in the implementation and maintenance, and

continuation of the Healthy Pregnancy for Women with Gestational Diabetes Mellitus. To define

who are key stakeholders within the San Bernardino County community it is important to

distinguish those who will in any way or form will be affected through this program. As

previously mentioned in this grant proposal, the population within this county continues to grow

and therefore to have a population with the healthiest lifestyle starts in the womb, those children

born from the mothers who will participate in the program are key stakeholders to ensure the

future of the San Bernardino County. The low income has affected not only the mothers with or

at risk of GDM but also those who work for this population. Therefore some of the most

important stakeholders are: cities in which the program will be implemented, funding agency for

this program, the agency implementing and evaluating it, the participants and their family

members or future family members (See appendix B).

HEALTHY PREGNANCY FOR WOMEN WITH GDM 31

References:

Boyle, Patrick. “AMCHP Calls for National Commitment to Reduce ‘Glaring Racial Inequity’ in

Maternal Mortality.” Association of Maternal and Child Health Programs, 2019.

Retrieved May 29, 2019 from

http://www.amchp.org/AboutAMCHP/NewsRoom/Documents/CDC%20Vital%20Signs

%20MM%20Data%205-19.pdf

Bureau, U. C. (2017). American Community Survey 5-Year Estimates 2013-2017. Retrieved

April 25, 2019 from

https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=CF

CH, L. (2005, November 28). The postpartum metabolic outcome of women with previous

gestational diabetes mellitus. Chang Gung Med J, 11, 794-800. Retrieved April 25, 2019

from https://www.ncbi.nlm.nih.gov/pubmed/16422186

County, S. B. (2017). Maternal Child and Adolescent Health Community Profile 2017-18.

Department of Public Health. Retrieved April 27, 2019 from

https://www.cdph.ca.gov/Programs/CFH/DMCAH/LocalMCAH/CDPH%20Document%

20Library/Community-Profile-SanBernardino.pdf

Dolatkhah, N. (2018, June). Nutrition Therapy in Managing Pregnant Women With Gestational

Diabetes Mellitus: A Literature Review. J Family Reprod Health, 12(2, 57–72. Retrieved

April 29, 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6391302/

Gestational diabetes | March of Dimes. (2019, April). From March of Dimes:

https://www.marchofdimes.org/complications/gestational-diabetes.aspx

Gomersall, J. C. (2017, November 13). Combined diet and exercise interventions for preventing

gestational diabetes mellitus. Cochrane Database Syst Rev. doi:

HEALTHY PREGNANCY FOR WOMEN WITH GDM 32

10.1002/14651858.CD010443.pub3

Herrick, C. J. (2019, Feb 4). Postpartum diabetes screening among low income women with

gestational diabetes in Missouri 2010–2015. BMC Public Health, 19.

doi:10.1186/s12889-019-6475-0

Horvath, K. (2010, April 1). Effects of treatment in women with gestational diabetes mellitus:

systematic review and meta-analysis. BMJ. doi:doi: https://doi.org/10.1136/bmj.c1395

Kampmann, U. (2015, July 25). Gestational diabetes: A clinical update. World J Diabetes, 6(8),

1065–1072. doi:10.4239/wjd.v6.i8.1065

Ramos, James. “Community Indicators Report 2016.” Community Indicators Report, San

Bernardino Board of Supervisors, 2016,

cms.sbcounty.gov/Portals/21/Resources%20Documents/SB_2016_REPORT.ONLINE%2

0bookmarked.pdf?ver=2017-05-11-102049-407.

Services, C. D. (2000). Burden of Diabetes in California Counties. California Department of

Health Services. Retrieved April 26, 2019 from

http://sandiegohealth.org/disease/diabetes/stat-burdenofdiabetesca1.pdf

Shepherd, E. (2017, Nov 13). Combined diet and exercise interventions for preventing

gestational diabetes mellitus. Cochrane Database Syst Rev. doi:10.1002/14651858

Team, Executive. “Executive Team.” Executive Team | Department of Public Health, 2017,

wp.sbcounty.gov/dph/about/executive-team/.

Tieu, J. (2017, January 3). Dietary advice interventions in pregnancy for preventing gestational

diabetes mellitus. Cochrane Database Syst Rev. doi:10.1002/14651858

HEALTHY PREGNANCY FOR WOMEN WITH GDM 33

U.S. Census Bureau. “U.S. Census Bureau QuickFacts: San Bernardino County, California.”

Census Bureau QuickFacts,

www.census.gov/quickfacts/fact/table/sanbernardinocountycalifornia/EDU685217#EDU685217.
HEALTHY PREGNANCY FOR WOMEN WITH GDM 34

Appendix:

A. Sign in Sheet Template

HEALTHY PREGNANCY FOR WOMEN WITH GDM 35

B. Letter of Support

To whom it may concern,

The city of San Bernardino is proud to support the “Healthy Pregnancy for Women with

Gestational Diabetes Mellitus Program” As a community it is our responsibility to empower and

aid in educate our citizens to enrich their lives and support program as such to do so. We fully

support this initiative to have healthier mothers and newborns.

The “Healthy Pregnancy for Women with GDM” is welcomed and supported to participate in

city health fairs and or events in hopes of the following:

 Educate our community about this program and its benefits

 Enroll participants to the program

 Provide educational materials for this target population

As previously mentioned we will do our best efforts in support of this program to better

and enrich our community.

Sincerely,

Richard Carey Davis

City of San Bernardino Mayor