Illinois Department of Human Services



Illinois Department of Human ServicesHealthy Families IllinoisProgram PlanFY 2017AGENCY NAMEAgency Name: Click here to enter text.Address: Click here to enter text.City: Click here to enter text.State: Click here to enter text.ZIP: Click here to enter text.Phone: Click here to enter text.Fax: Click here to enter text.Email: Click here to enter text.ADMINISTRATIVE CONTACTAdministrative Contact: Click here to enter text.Address: Click here to enter text.City: Click here to enter text.State: Click here to enter text.ZIP: Click here to enter text.Phone: Click here to enter text.Fax: Click here to enter text.Email: Click here to enter text.Fiscal CONTACTFiscal Contact: Click here to enter text.Address: Click here to enter text.City: Click here to enter text.State: Click here to enter text.ZIP: Click here to enter text.Phone: Click here to enter text.Fax: Click here to enter text.Email: Click here to enter text.Program CONTACTProgram Contract: Click here to enter text.Address: Click here to enter text.City: Click here to enter text.State: Click here to enter text.ZIP: Click here to enter text.Phone: Click here to enter text.Fax: Click here to enter text.Email: Click here to enter text.Healthy Families America Accreditation/AffiliationDate Last Accredited: Click here to enter text.Date Of FY16 Site Visit: Click here to enter text.Additional Comments:Click here to enter text.Target Population(Include factors such as age, Medicaid eligibility, geographical boundaries and parenting status, e.g. first time or all parents)Click here to enter text.Geographic Area Served(Indicate any changes from FY16)(Chicago-include ZIP codes)Click here to enter munity PartnersCommunity Partners who will identify and refer families meeting the definition of the target population. Indicate if this is a change from Fiscal Year 2016.Click here to enter text.Recent Statistical Data Regarding the Target Population(e.g., how many families meet all of the descriptors of the target population-for example how many 1st time births to mothers receiving Medicaid)Click here to enter text.Ethnic/Racial Demographics of Community ServedClick here to enter text.Ethnic/racial and age distribution(current HFI caseload)Click here to enter text.OTHerHFI policy/procedure Manual reviewed for accuracy.Date: Click here to enter text.Acceptance rate for the 1st - 3rd quarters during FY16?Rate: Click here to enter text.Changes in curricula implemented during FY16Changes: Click here to enter text.Parental Support activities, other than home visits provided by HFI staff (e.g. Parent Support groups)Click here to enter text.Program Enhancements (e.g. Doula, Infant Mental Health)Click here to enter text.HFI Program Staff – Provide the Name, % of time with HFI and %of time spent in each activity.For your agency Full time (FTE) is considered Click here to enter text. hours per week.HFI Staff Name%FTE*%SUP%Outreach Worker%FSWTrainedFAWFSWClick here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text.Click here to enter text. ................
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