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Children and Youth <br />Ornce. Seczion, or Branch <br />Conrractor <br />S <br />N.C. Department of Environment. Health, and Natural Resources Page of <br />Division of General Semces <br />FY <br />CONTRACT ADDENDUM <br />Conrract Dumber <br />Child z:ea'_:h <br />Acnviry <br />Child Service Coordination <br />1. An estimated of eligible children birth through age 5 will receive <br />child service coordination through _he local health department. <br />2. An estimated % of enrolled children receiving child service <br />coordination from the health department will have assured parental involvement <br />through signed parent agreements, release of information forms, and signed <br />child service coordination plans in the child's record. <br />3. An estimated % of enrolled children receiving child service <br />coordination from the health department will have a child service coordination <br />plan based on family needs assessment, child needs assessment and assessment <br />of parent -child interaction. <br />4. An estimated % of enrolled children receiving child service <br />coordination from the health department will have documentation of <br />communications to and -from referral sources and other providers. <br />5. An estimated % of enrolled children receiving child service <br />coordination from the health department will receive follow up, which includes <br />follow up of missed appointments, summary information sent to relevant <br />persons, and monitoring of treatment and referral recommendations. <br />6. An estimated of children receiving child service coordination `__... <br />the health department will have program identification and status report ;o =s <br />conmleted and suamitted at appropriate times. <br />7. An estimated of enrolled children receiving child service <br />coordination From the health department will receive intermediate assessme °_= <br />at appropriate times. <br />B. The health depa= t-went will maintain agreements with _ aaencies enroi_er <br />as child service coordination providers for - children in the county. <br />9. The health deaar =Te ^.t will enter data from other agencies•that provide <br />service coordina_ion _o children wit: in t_he _.,_..ty. <br />Lis': Ch-J I:2 Service ...,.._ac_ person: <br />Name Phone <br />Reviewed by <br />D£HNR 3300 (Revised 2/90) <br />-- - C_4 _ rp_..._,,. i io;� initials Dale <br />