HomeMy WebLinkAbout020711_ca08~K,,,, ~ Consent Agenda
~~~~__ ~` JEFFERSON COUNTY PUBLIC HEALTH
°. `"~ ~ 615 Sheridan Street • Port Townsend • Washington • 98368
www.jeffersoncountypublichealth.org
l~~ --~,
Decemiber^I~9,~~0~ ~ V ~ ~~. f
i
JEFFERSON COUNTY ~~~ ~ ~~~~ `~~"'
BOARD OF COUNTY COMMISSIONERS ~,.-..~-.-_ -
JEr~ ~~;~;~ ~~uHn
AGENDA REQUEST
a~
TO: Board of County Commissioners JAN p 3 201
Philip Morley, County Administrator
_.
<„ },
FROM: Jean Baldwin, Director ~ ~" ;
~: ~ _ . ,,
DATE: ~~--~ ~--U ~, ~Y `? , ~o i i
SUB7ECT: Agenda Item -Agency. Agreement -Early Family Support Services
(EFSS) # 1063-93584, Amendment # 1 with the Department of Social
and Health Services; December 1, 2010 -June 30, 2011; Decreased
$2,428.79 total compensation $36,203.21
STATEMENT OF ISSUE:
Jefferson County Public Health is requesting Board approval of the Agency Agreement -Early Family
Support Services (EFSS) #1063-93584, Amendment #1 with the Department of Social and Health Services;
December 1, 2010 -June 30, 2011; Decreased $2,428.79 total compensation $36,203.21
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This amendment represents across the board state budget reductions at 6.287%.
JCPH will continue to provide prevention and education services for families that have been screened by
CPS and determined to be at risk for child abuse and neglect. Services are provided by a Public Health
Nurse during a home health visit.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This amendment represents across the board state budget reductions at 6.287%. This will cause minimal
service level decreases over the next seven months.
RECOMMENDATION:
JCPH management request approval of the Agency Agreement -Early FamilySupport Services (EFSS)
#1063-93584, Amendment #1 with the Department of Social and Health Services; December 1, 2010 -
June 30, 2011; Decreased $2,428.79 total compensation $36,203.21
~~~
Mo le ounty Admini rator Date
DEOVELOPIMENTAL DISC ABILITIES PUBLIC HEALTH ENVIRONWATERLQUA ITY
MAIN: (360) 385-9400 1~LWAYS WORKltdG F®K A SdsFEK ANA MAIN: (360) 385-9444
FAX: (360) 385-9401 HEALTHIER C®IIANIUNITY FAX: (360) 379-4487
DSHS CONTRACT NUMBER:
~~~~ CONTRACT AMENDMENT lass-93584
Washin fon Sfafe
() ,
DEPARTMENT OF
S
[$
9
for
7~
/
`
I
SoclALfrHEALTH
SERVICES Amendment No. 1063-93584-01
Earl Famil Su ort Services -EFSS
This Contract Amendment is between the State of Washington Department of Program Contract Number
Social and Health Services (DSHS) and the Contractor identified below. 0613-
Contractor Gontract Number
CONTRACTOR NAME CONTRACTOR doing business as (DBA)
Jefferson County
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
IDENTIFIER (UBq
615 Sheridan St
161-001-169 1223
Port Townsend, WA 98368-
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Julia Danskin 360 385-9420 Ext: 360 385-9401 ~danskin co.~efferson.wa.us
DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE
Division of Children and Family 2046CS-63
Services
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Ann Polanca 6840 Capital Blvd Bldg 3
Contracts Manager P.O. Box 45714
OI m ia, WA 98504-
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
360 725-6760 Ext: 360 725-6769 ann300 dshs.wa. ov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
NO
AMENDMENT START DATE CONTRACT END DATE
12/01/2010 06130/201.1
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$3$,632.00 $-2,428.79 $36,203.21
REASON FOR AMENDMENT',.
CHANGE OR CORRECT: End Date and/or Maximum Amount.
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference:
^ Exhibits s eci :Exhibit C-1 -Bud et
This Contract Amendment, including aIf Exhibits and other documents incorporated- by reference, contains all of the terms
and conditions agreed upon by the parties as changes to the original Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this .Contract Amendment shall be deemed to exist or
bind. the parties. All other terms and conditions of the original Contract. remain in full force and effect. The parties signing
below warrantthat they have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS Amendment (11-18-10)
~, ~~ ~~
Page 1
It
;gin Co. Prosecutor's {
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1. Purpose. The purpose of this Amendment is to reduce the maximum consideration payable under the
Contract in order to implement budget reductions pursuant to Executive Order 10-04 issued by the
Governor requiring across-the-board reductions of 6.287% in spending authority for all agencies with
General Fund-State (GF-S) appropriations.
2. Effective Date of Amendment. This Amendment shall be effective as of the start date indicated on
page 1 under "Amendment Start Date."
The Special Terms and Conditions are amended as follows:
3. Section 5. Budget Exhibit is amended as follows:
If payment for services is based on actual costs or equal monthly payments and the Contractor's
budget for providing services under this contract is attached as an exhibit to the original Contract, it is
prorated accordingly to reflect the above stated Vendor Rate Decrease of 6.287%.
Contractors who require revisions to specific individual line items, may submit a revised Budget for
consideration to the DSHS contact stated on page 1 of this Amendment. If approved by DSHS, .the
revised Budget will be signed and dated by both parties and incorporated into this Contract by an
additional Amendment.
All contract references to the Budget Exhibit are hereby amended to refer to the revised Budget
4. Section 6. Consideration, subsection a. "Maximum Contract Amount" is amended as follows:
a. Maximum Contract Amount. The maximum amount of total consideration payable to the Contractor
for satisfactory performance of work under this Contract is reduced by the amount shown on page 1
of this Amendment under "Amount of Increase or Decrease" for the new "Total Maximum Contract
Amount" shown on page 1 of this Amendment.
5. Section 6. Consideration, subsection e. "Rate of Payment" is amended as follows, depending
on the Contractor's payment type as identified in the original Contract as actual costs, equal
monthly payments or hourly rate:
Actual Costs. DSHS will pay the Contractor a reduced amount, according to the Contractor's revised
budget for actual costs related to services provided during the period of this Amendment.
.Equal Monthly Payment. DSHS will pay the Contractor a revised equal monthly payment, calculated by
subtracting the total dollar amount of the equal monthly payments paid and/or scheduled through
November 30, 2010 from the new Total Maximum Contract Amount and dividing that subtotal by the
number of months remaining in the contract period.
• The number of families to be served under this contract is
Hourlv. DSHS will pay the Contractor at the rate stated in the original Contract within the reduced
maximum consideration stated on page 1 of this Amendment.
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services Page 2
2046CS Early Family Support Services - EFSS Amendment (11-18-10)
DSHS Agreement Number
C~U~TY
('~
DEPAltT~~ENT tJF
~~
`''~" _ 1463-83~8~{
j
~~ PROGRAM. AGREEMENT
Early Family Support Services
This Program Agreement. is by and between the State of Washing#on Administration or Division
Department of Social and Health Services {DSHS) and the County identified os ~ement Number
below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number
General Terms and Conditions, which is incor rated b reference. FamLink#
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE
Childress Adm+nistration Division of Children and Family 1223 2046CS-63
Services
DSWS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Ann Polanco 6840 Capital Blvd Bldg 3
Contracts Manager PA. Box 45714
OI m ia, WA 98504-
DSHS GONTACTTELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL
360 725.6760 Ext: 360 725-6769 ann300 dshs.wa. ov
COUNTY NAME COUNTY ADDRESS
Jefferson County 615 Sheridan St
Port Townsend, wA 98368-
COUNTY fEDERAL EMPLOYER 1DENTIt=ICATION COUNTY Ct7NTACT NAME
NUMBER
916001322 Julia Danskin
COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL
360 385-9x20 Ext: 360 385.940f 'danskin ce. efferson,wa.us
IS THE COUNTY A SUBRECtP1ENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS
AGREEMENT?
No
PROt'aRAM AOaREEN1EN7 START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
07101!2010 06134/201t ~ $38.632.00
EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this
County Program Agreement by reference:
ram Requirements; and ~ Exhibit C -
hibit B -Pro
f W
k
E
t
S
g
or
;
x
o
tatemen
~ Exhibits (specify): Exhibit A -
Bud et
Contract Purpose: The purpose of these services is to control threats to child safety so children can remain safely in their
own homes, while continuing to support families. These services at a minimum will:
• Place the child and their safety as the center of focus for service delivery
• Assess the child's safety to remain in the home on an ongoing basis
Engage #amilies in the focus to reduce safety threats
• Work to increase safe parenting skills; and
+ Re airs immediate communication with the Children's Administration about safe threats to the child
t3y their signatures below, the pertiea agree to the terms and conditions of this County Program Agreement and aA
documents incorporated by reference: No other understandings or representations, oral or otherwise,, regarding the
subject matter c;f,this Program Agreement shall be deemedto exist :or bind the parties. The parties signing below certify
that the are authorized to si n this Pro ram ;4 reelnent:
COUNTY SIGNATURE PRINTED NAME(S) AND TITLES} DATE(S) SIGNED
' - t U~l~i ~ 'Q.J(1 ~ ' t.Y ~ t ~ i ~
DSHS S1 ATU PRINTED NAME AND TITLE DATE SIG ED
Ann Polanco, Contracts ManangerlMonitor
DSHS Children's Administration Re ion 6 ~
~,~
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10)
~~
- Page 1
•~"er~on ia. f'TOSer(.ULOr'S w..
Special Terms and Conditions
1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the
following definitions:
a. "Abuse of Client" means the injury, sexual abuse or exploitation, negligent treatment or
maltreatment of a client by any person under circumstances which indicate that the client's health,
welfare or safety is harmed thereby.
b. "Agency" means a public or private agency or other organization providing services to DSHS
clients.
c. "Authorized" means approved by a CA social worker as evidenced by receipt of an SSPS Social
Services notice or other written notice.
d. "Case" means a family for which a risk of abuse or negiect has been determined to be low (1) or
moderately low (2) either at GPS Intake or after the completion of a CPS investigation.
e. "CA" means Children's Administration, which is an Administration within DSHS.
f. "Child Abuse or Neglect" means the injury, sexual abuse, sexual exploitation, negligent treatment,
or maltreatment of a child under circumstances, which indicate that the child's health, welfare, and
safety is harmed. An abused child is a child who has been subjected to child abuse or neglect.
g. "CFWS" means Child and Family Welfare Services, administered by CA.
h. "Client" means any child or adult who is authorized services by DSHS.
i. "Community Resources" means community supports and concrete services.
j. "Community Resource Directory" means a list of local resource agencies or individuals that provide
supports for families.
k. "Community Supports" means services that are offered to families by community providers that may
include but are not limited to: housing assistance, mental health services, public health services,
alcohol and drug treatment, family and social support connections, financial assistance, domestic
violence counseling and treatment, educational and employment assistance, parent education,
legal services and cultural and language assistance.
I. "Concrete Services" means concrete goods or services that are available in the community to
reduce risk of abuse and neglect of children in the home, such as food, shelter or clothes.
Community agencies that may provide concrete goods or services may include but are not limited
to: charities, food banks, thrift stores, counselors or churches.
m. "Contract" means the entire written County Program Agreement between DSHS and the Contractor,
including any Exhibits, documents, and materials incorporated by reference.
n. "Contractor" means the individual or entity performing services pursuant to this Contract and
includes the Contractor's owners, members, officers, directors, partners, employees, and/or agents,
unless otherwise stated in this Contract. For purposes of any permitted Subcontract, "Contractor"
includes any Subcontractor and its owners, members, officers, directors, partners, employees,
and/or agents.
o. "Corporal Punishment" means any act that willfully inflicts or causes the infliction of physical pain on
a child.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 2
p. "CPS" means Child Protection Services, a program under CA.
q. "CPS Intake" is the process designated to record all referral reports concerning instances of
suspected child abuse and neglect, determine if the referral meets referral screening criteria and
make a disposition concerning the referral.
r. "DCFS" means the Division of Children and Family Services, which is a division of CA.
s. "CA EFSS Liaison" means the CA staff person who is responsible for making referrals and
maintaining contact with the Contractor.
t. "DLR" means the Division of Licensed Resources, which is a division of CA.
u. "EIP" means Early Intervention Program. ACA program provided by contracted County Public.
Health Departments.
v. "Face to Face Contact" means an in home visit or visit at an alternative location with the referred
family which is visual contact within the same room not to include any form of electronic contact,
e.g., telephone or computer, with the exception of the use of such equipment as reasonable
accommodation for a client with a disability. Per Exhibit A, Statement of Work, section no. 12, the
Contractor shall make a face to face visit with the referred family within 10 working days of receiving
the referral from CA to discuss the ARS program.
w. "FTEs" means full-time equivalent staff.
x. "Inappropriate Referral" means a referral which is considered inappropriate because the case is
deemed a higher risk than low or moderately low risk, or the referral lacks adequate identifying
information to enable the Contractor to make contact with the family.
y. "KBS Scores" means the Knowledge, Behavior, and Status scores from the Omaha System
assessment.
z. "Low to Moderately Low Risk Cases" means cases where the primary concerns are issues of
neglectful social, environmental, parenting practices that have not yet resulted in serious injury,
developmental delays or other significant problems for the at-risk child.
aa. "LEP" means Limited English Proficiency, and indicates an individual's need for additional support
and assistance in comprehending the English language.
bb. "Paraprofessional Worker" means any staff. of the contractor who is trained and qualified to provide
assistance and community support systems development for families, and who meet or exceed the
staffing qualifications, which are set forth in Exhibit B, Qualification Requirements, section no. 1.
Paraprofessional workers are supervised by Professional staff. The paraprofessional worker is not
intended to replace the role and responsibilities of professional staff.
cc. "Participation" means family participation in one or more of the services outlined in the Family
Service Plan.
dd. "Professional Staff' means staff of Contractor who provide direct services for clients under this
Contract and who meet or exceed the staffing qualifications, which are set forth in Exhibit B,
Qualification Requirements, Section 1. Professional staff shall supervise paraprofessional staff.
ee. "Omaha System" means the assessment model used in this contract for the In Home Services
intervention.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 3
ff. "Regulation" means any federal, state, or local regulation, rule, or ordinance.
gg. "Service Episode" means the period of time from when the Contractor receives the initial referral for
a case to the time the Contractor closes the case.
hh. "Service Plan" means an initial family plan written with input from the provider and family to:
address CPS allegations, family goals, risk of future child abuse and neglect, specific interventions
and community referrals. The service plan is reviewed and revised, at a minimum, 90 day intervals.
ii. "Staffing" means a formal or informal meeting, conducted by a CA social worker or CA staff member
with one or more of the following persons: other CA staff, professional staff of the Contractor andlor
other provider, consultants, parents or others, for the purpose of reviewing or discussing, or for
making decisions concerning, a client or case.
jj. "Structured Decision Making" means the Structured Decision Making Assessment tool (SDM) is a
risk assessment that is completed during a Child Protective Services Investigation.
2. Previous Contract Superseded. In the event any previous contract between the Contractor and CA
for these services should be in effect upon execution of this Contract, this Contract shall terminate and
supersede that previous contract.
3. Statement of Work -Exhibit A. The Contractor shall provide services and staff as described in the
Statement of Work attached as Exhibit A.
4. Program Requirements -Exhibit B. The Contractor shall comply with afl program and other
requirements for providing services under this Contract, as stated in the Program Requirements
attached as Exhibit B.
5. Budget -Exhibit C. If Exhibit C -Budget is checked on page 1 of this Contract, and the
Consideration Section indicates payment for service either based on actual costs or in monthly
payments, then the Contractor's budget for providing services under this Contract is attached as
Exhibit C.
6. Consideration.
a. Maximum Contract Amount. The maximum amount of total consideration payable to the Contractor
for satisfactory performance of the work under this Contract is the amount stated on page 1 of this
Contract under "Maximum Program Agreement Amount."
b. Allotted Funds. Allotted funds not expended during the period ending June 30, 2011 shall not be
carried forward into the following fiscal year.
c. Vendor Rate Increase or Decrease. In the event of a legislatively mandated vendor rate increase or
decrease for the services under this Contract, the rates under this Contract shall be adjusted
accordingly and incorporated into this Contract as of the date the new rate becomes effective.
d. Concrete Goods and Services. The Contractor shall assist the family in obtaining concrete goods
and support services outlined in the family's service plan. The Contractor shall first seek
community resources to provide concrete goods and services that are available at no cost to the
client or the Contractor before EFSS funds are expended for concrete goods and support services.
ff community resources for concrete goods and services are not available, the Contractor shall
request written authorization from the referring social worker to purchase concrete goods and/or
services. CA is not able to pre-pay for any services. Thus, swipe cards, gift cards, or any prepaid,
preloaded purchase card, etc. are not reimbursable with funds for concrete goods.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 4
e. Rate of Payment. DSHS will pay Contractor for actual costs related to services provided to CA
referred families during the period of this Contract.
Billing. The Contractor shall submit the following documents, prepared in the manner prescribed by
DSHS, to invoice services performed under this Contract:
a. A-19 Invoice. The Contractor shall submit a monthly invoice for services performed under this
Contract on State of Washington invoice Voucher forms (Farm A-19), prepared in the manner
prescribed by DSHS.
(1) The A-19 invoice shall state the amount of each cost or expense incurred by Contractor in the
preceding calendar month that is based on the items listed in the Budget Exhibit. Costs or
expenses listed in the A-19 invoice must match the corresponding- items listed in the Budget
Exhibit for costs or expenses that will be incurred by the Contractor..
(2) The cost or expense billed for each such item shall be charged against the total amount listed
for that item in the Budget Exhibit. The cumulative dollar amount for each such item, for all
invoices submitted by Contractor, shall not exceed the total dollar amount stated for that item in
the Budget Exhibit.
(3) The A-19 invoice shall clearly indicate that it is:
"FOR SERVICES RENDERED IN PERFORMANCE UNDER DSHS CONTRACT NO. 1063-
93584 FOR THE MONTH OF , 20 "
(4) The A-19 invoice shall be submitted to:
Ann Polanco, Contracts Manager/Monitor
Children's Administration
Region 6 -Contracts
P.O. Box 45714
Olympia, WA 98504-5714
(5) The Contractor shall contact Pamela Mahan at (360) 725-6811 concerning billing questions.
(6) The Contractor shall bill for each month of service on a separate A-19 invoice. The A-19 invoice
shall state the month services were provided.
8. Payment.
a. Claims for payment must be received by DSHS no later than sixty (60) days from the date services
were rendered.
b. DSHS will make payment within thirty (30) days of receipt of a properly completed invoice for
services.
c. DSHS may stop payment to the Contractor if reports required under this Contract are delinquent,
i.e., not submitted within 10 days of the due date, or incomplete.
d. DSHS may, at its sole discretion, withhold or deny payment claimed by the Contractor for services
rendered if Contractor fails to satisfactorily comply with any term or condition of the Contract.
9. Payment Only for Authorized Services.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 5
DSHS shall pay the Contractor only for authorized services provided in accordance with this Contract.
If this Contract is terminated for any reason, DSHS shall pay only for services authorized and provided
through the date of termination.
10. Funding Stipulations.
a. Information for Federal Funding. The Contractor shall cooperate in supplying any information to
DSHS that may be needed to determine DSHS or the client's eligibility for federal funding.
b. Duplicate Billing. The Contractor must not bill other funding sources for services rendered under
this Contract which would result in duplicate billing to different funding sources for the same service.
Furthermore, the Contractor shall ensure that no subcontractor bills any other funding sources for
services rendered under this Contract, which would result in duplicate billing to different funding
sources for the same service.
c. No Federal Match. The Contractor shall not use funds payable under this Contract as match toward
federal funds without the prior written permission of DSHS.
d. Supplanting. The Contractor shall use these funds to supplement, not supplant the amount of
federal, state and local funds otherwise expended for services provided under this Contract.
11. Recovery of Fees for Noncompliance.
In the event the Contractor bills for services provided and is paid fees for services that DSHS later finds
were either (a} not delivered or (b) not delivered in accordance with applicable standards or the
requirements. of this Contract, DSHS shall have the right to recover the fees for those services from the
Contractor, and the Contractor shall fully cooperate during the recovery process.
12. Overpayments.
In the event that DSHS establishes overpayments or erroneous payments made to the Contractor
under this Contract, DSHS may secure repayment, plus interest, if any, by requiring the posting of a
bond, assignment of deposit, or some other form of security acceptable to DSHS.
13. Prohibition of Use of Funds for Lobbying Activities.
The Contractor shall not use funds payable under the Contract for lobbying activities of any nature. The
Contractor certifies that no state or federal funds payable under this Contract shall be paid to any
person or organization to influence, or attempt to influence, either directly or indirectly, an officer or
employee of any state or federal agency, or an officer or member of any state or federal legislative body
or committee, regarding the award, amendment, modification, extension, or renewal of a state or
federal contract or grant.
Any act by the Contractor in violation of this prohibition shall be grounds for termination of this Contract,
at the sole discretion of DSHS, and shall subject Contractor to such monetary and other penalties as
may be provided by law.
14. Contract Suspension.
DSHS may, without prior notice, suspend the Contractor's performance of the Contract if the
Contractor, or any partner, officer or director of the Contractor or a subcontractor, or any staff or
employee of the Contractor or a subcontractor, is investigated by a local, county,. state or federal
agency regarding any matter that, if ultimately established, could either:
a. Result in a conviction for violating a local, state or federal law, or
DSHS Central Contract Services
2046GS Early Family Support Services - EFSS (6-8-10) Page 6
b. In the sole judgment of DSHS, adversely affect the delivery of services under this Contract or the
health, safety or welfare of DSHS clients.
DSHS may also take other lesser action, including, but not limited to, disallowing a staff member,
employee, or other person associated with the Contractor or a subcontractor, from providing services,
or from having contact with DSHS clients, until the investigation is concluded and a final determination
made by the investigating agency.
15. Insurance. For purposes of this Contract:
a. DSHS certifies that it is self-insured under the State's self-insurance liability program, as provided
by RCW 4.92.130, and shall pay for losses for which it is found liable.
b. The Contractor certifies, by checking the appropriate box below, initialing to the left of the box
selected, and signing this Contract, that:
® The Contractor is self-insured or insured through a risk pool and shall pay for losses
for which it is found liable; or
^ The Contractor maintains the types and amounts of insurance identified below and
shall, prior to the execution of this Contract by DSHS, provide certificates of insurance to
that effect to the DSHS Contact on Page 1 of this Contract.
(1) Commercial General Liability Insurance
The Contractor shall maintain Commercial General Liability Insurance, or Business Liability
Insurance, including coverage for bodily injury, property damage, and contractual liability, with
the following minimum limits: Each Occurrence - $1,000,000; General Aggregate - $2,000,000.
The policy shall include liability arising out of premises, operations, independent contractors,
products-completed operations, personal injury, advertising injury, and liability assumed under
an insured contract. The State of Washington, Department of Social & Health Services (DSHS},
and elected and appointed officials, agents, and employees of the state, shall be named; as
additional insured.
(2} Business Automobile Liability Insurance
The Contractor shall maintain a Business Automobile Policy on all vehicles used to transport
clients, including vehicles hired by the Contractor or owned by the Contractor's employees,
volunteers or others, with the following minimum limits: $1,000,000 per accident combined
single limit. The Contractor's carrier shall provide DSHS with a waiver of subrogation or name
DSHS as an additional insured.
(3) Professional Liability Insurance
The Contractor shall maintain Professional Liability Insurance or Errors & Omissions insurance,
including coverage for losses caused by errors and omissions, with the following minimum
limits: Each Occurrence - $1,000,000; Aggregate - $2,000,000..
16. Resolution of Differences.
to the event of any differences between the parties on matters related to the interpretation and
implementation of this Contract, the parties shall first attempt to resolve the difference informally
between themselves at the local or regional level, by following the regional conflict resolution process.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 7
If the parties are unable to resolve their difference as stated above, then either party may submit a
request for dispute resolution as .provided in Section 20. Disputes.
A copy of the regions{ conflict resolution process is available from the DSHS Contact person listed on
Page 1 of this contract.
17. Disputes.
a. Either party who has a dispute concerning this Contract may submit a written request for dispute
resolution. The amount of any rate set by law, regulation, or DSHS policy is not disputable. A
party's written request for dispute resolution must include:
(1) A statement identifying the issue(s) in dispute; and
(2) Contractor's name, address and contract number.
b. The request must be mailed to the following address within thirty (30) calendar days after the party
could reasonably be expected to have knowledge of the issue, which is disputed.
c. A copy of the current CA dispute resolution process is available at any time by written request.
d. Requests for dispute resolution or for a copy of the current CA's dispute resolution process should
be sent to:
DSHS/Children's Administration
Attention Contracts Management Unit
P.O. Box 45710
Olympia, WA 98504-5710
This dispute resolution process is the sole administrative remedy available under this Contract
18. Addressing Diversity.
In providing services to DSHS clients under this Contract, the Contractor shall adhere to the principles
of the CA Diversity Charter, which principles include but are not limited to the following:
• Non-discrimination;
• Exceptional customer service;
• Diversified, individualized, responsive and inclusive services;
• Services that meet the cultural and ethnic needs of clients;
• Equal opportunity for the workforce.
To ensure compliance with the above requirement, the Contractor shall be familiar with the CA Diversity
Charter, which can be accessed at http:l/www1.dshs.wa.gov/pdf/publications/22-1108.pdf
19. Braam Considerations.
In the event that CA should need to include additional requirements relating to the services provided
under this Contract, as part of CA's obligation to meet the requirements of Braam v. State of
Washington, the parties agree to negotiate in good faith the incorporation of such additional
requirements in this Contract, either by an amendment to this Contract or by a revised contract that
would replace this Contract.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 8
EXHIBIT A
STATEMENT OF WORK
Early Family Support Services (EFSS)
The Contractor shall provide services under the Contract as described in this Statement of Work.
ORGANIZATION OF STATEMENT OF WORK
1. Intent of Services
2. Family Eligibility and Priority for Services
3. Referral Procedures
4. Re-assessment of Case -Higher Risk
5. Re-referrals to Child Protective Services
6. Service Episodes
7. Duaf Case Management with Another Agency
8. Length of Services
9. Exit from the EFSS Program
10. Service Requirements
11. Family Centered Practice Model
12. Provision of Services
a. Face to Face Contact
', b. Initial Screening
c. Family Engagement and Assessment Services
d. Community Resource and Referral
e. Promising and Evidenced Based Practices
f. Toolbox
g. Implementation of Service Plan
h. Intensity of Services
i. Prenatal and Substance Abuse Referrals
j . 90-Day Reviews
13. Reports
14. Reporting Procedures
Intent of Services.
The Contractor shall provide Early Family Support Services (EFSS) through direct services to families
and/or by linking families to community resources to accomplish the following goals for families:
• Reduce risk of abuse or neglect of children in the home;
• Enhance parenting skills, family and personal self-sufficiency, and family functioning;
• Reduce stress on the family;
• Reduce the likelihood of additional referrals to CPS; and
• Enhance the health status of families and linkages to health services.
2. Family Eligibility and Priority for Services
a. Families are eligible for EFSS if item numbers 1 through 3 have occurred or item number 4 has
occurred.
(1) Abuse or neglect allegations have been reported to CPS;
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 9
(2) CPS has designated the case to be appropriate for alternate intervention; and
(3) CA refers the case to the Contractor;
OR
(4) The family has completed a CPS investigation and the risk on the closing Structured Decision
Making (SDM) risk assessment is low to moderate, and is appropriate for EFSS services. The
family is referred to an EFSS contractor using the agency protocol for transferring a case from
CPS to EFSS.
3. Referral Procedures.
a. CA shall have sole responsibility for referring clients to the Contractor under this Contract. All
referrals must be initiated in writing by CA. CA will not pay for any families served under this
Contract which were not referred by CA.
b. CA shall submit a written "Intake Referral Summary Report" to the Contractor which will authorize
services.
c. The Contractor shall adhere to the referral procedures set forth in the CA regional/local protocol.
4. Re-Assessment of Case -Higher Risk.
The EFSS Contractor shall contact their CA EFSS Liaison if the Contractor assesses a referred case to
be at a higher risk level than low or moderately low risk. If the Contractor and CA mutually determine
the case is a higher risk level, the Contractor shall submit an Exit Summary to the CA EFSS Liaison
indicating the reason for termination.
5. Re-referrals to Child Protective Services.
CA will contact the Contractor if another CPS referral is received for a family who is participating in the
Contractor's EFSS program. The following determinations and actions will be made. by CA based on
risk-level of re-referrals:
a. The family continues to be eligible for EFSS.
b. The case is accepted for investigation and assigned to a CPS social worker. Contractor closes
EFSS within 30 days.
6. Service Episodes.
a. A family may only have two service episodes of EFSS within a 3-yeas period unless the Contractor
receives approval from the CA local liaison.
b. Per Section 1. "Definitions", a service episode refers to the period of time from when the initial
referral was received by the Contractor for a case to the time the Contractor closes the case. A
new referral sent to the Contractor while the family's case is still open does not count as a new
episode. Anew referral sent to the Contractor after the family's case has been closed begins the
second and final service episode for that family within a 3-year period.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 10
7. Dual Case Management with Another Agency.
a. If the Contractor and another agency are performing case management services for the same
family, the Contractor shall facilitate a staffing with the other agency to assure that the family's
needs are met in a coordinated approach.
b. The Contractor shall ensure services being provided under this Contract are not being charged to
another funding source which would result in duplicate payment.
8. Length of Services.
In consultation with the Contractor, CA shall consider information from the 90-day case review to
determine continued EFSS eligibility for the family.
EFSS families' maximum length of service shall not exceed nine (9) months depending on the service
delivery path:
• Family Engagement Services shall not exceed 9 months from acceptance of the referral;
• Community Resource and Referral Services shall not exceed 45 days from initial screening.
9. Exit from the EFSS Program.
The Contractor shall close an EFSS case if one or more of the following occurs:
a. Contractor was unable to make contact with the family;
b. Contractor determined that the family does not require EFSS;
c. Family refused service;
d. Family was referred to another program within CA;
e. Services were completed;
f. Contractor referred an EFSS case back to CPS as higher risk; or
g. CPS receives a re-referral on an EFSS case and is accepted for investigation.
10. Service Requirements.
The Contractor shall ensure that:
a. Services are scheduled at the family's convenience and are tailored to accommodate a family's
work schedule whenever possible;
b. Consistency of services for the family. is provided by assigning a single service worker to each
family with an identified backup service worker to provide assistance as necessary;
c. Service workers are available to testify at court hearings and attend CA meetings, staffings and
child fatality reviews, when requested by CA staff. If service workers are not able to attend in
person, the contractor shall provide a written summary of the family's progress.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 11
11. Family Centered Practice Model.
The Contractor shall provide services consistent with the "Washington State Division of Children and
Family Services Family Centered Practice Model" ft shall be the Contractor's responsibility to obtain
information on the Family Centered Practice Model from CA. The Family Centered Practice Model may
be accessed at: http:!lwww1.dshs.wa.govlpdf/ca/FCPModel.pdf
12. Provision of Services. The Contractor shall deliver the following services for CA referred families:
a. Face to Face Contact.
(1) Attempt initial contact with the family via a telephone call, face-to-face contact or written letter to
the family within 72 business hours of acceptance of the referral. Preference under this contract
is to contact the family via a telephone call or a face-to-face contact.
(2) The Contractor must attempt to make face to face contact with the family within 10 working days
after accepting the referral from CA. Make face-to-face contact with the family through an
announced or unannounced home visit, except when an alternative location is requested by the
family or CA. Preference under this contract is to provide an unannounced home visit.
(3) Notify the CA EFSS Liaison in writing within 10 working days if the family is unavailable or
unwilling to meet with the Contractor for an initial face-to-face home visit.
(4) Make, at a minimum, three attempts to contact the family of which two shall be home visit
attempts, before closing a case. If a second home visit attempt is not completed, the Contractor
shall document on the Exit Summary the reason a second attempt for a home visit was not
completed.
b. Initial Screening.
(1) The Contractor shall facilitate an initial screening to determine the service delivery path. The
initial screening must include at least one (1) contact with the family and includes at a minimum
the consideration of the following questions:
(a) What is the family's perception of the CPS referral?
(b) What is the family's perception of services needed?
(c} Are the family's needs clearly identifiable?
(d) Has the family already engaged in services that respond to the allegations of concerns?
(e) Would referral to a community resource or resources meet the family's needs?
(f) Is the family receptive to services and willing to engage in ongoing services?
(2} After the initial screen, the Contractor shall consider if the family is in need of and amenable to
family engagement ongoing services. The initial screen is intended to assist the Contractor in
determining the path of service delivery, either 1) Family Engagement and Assessment
Services or 2) Community Resource and Referral. The Contractor shall also use the guide
below in determining the path:
(a) If Family is amenable to ongoing services: Move to Family Engagement and Assessment
Services, subsection c. below.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 12
(b) If family is unsure of committing to ongoing services: continue to work with family in an
.effort to engage. The Contractor has 30 days to determine the path for families who are
unsure about participating.
(c) If Family is unwilling to participate in ongoing services: Contractor shall proceed as follows:
i. Community Referral: Further services can be met from Community Resources or
Referral.
ii. Not Needed: Family does not want additional services. Case Closed.
iii. Refusal Family refuses services. Case Closed.
iv. Unable to contact beyond first contact: Case Closed.
c. Family Engagement and Assessment Services.
(1) The Contractor shall assess the alleged child abuse and neglect allegations and concerns in the
home by utilizing their current assessment tool until completing the Omaha System and the
Omaha Pathways Training Program developed for EFSS. At such time, The Contractor shall
utilize the Omaha System for assessing and documenting family needs and outcomes. The
Contractor shall develop a written service plan in collaboration with the family that addresses
the identified priorities in the family assessment.
(2) The Contractor shall use Motivational Interviewing as one engagement strategy when working
with the family to establish goals. Goals shall prioritize child safety, but also respect the issues
identified by the parents and children, as well as those identified in the assessment. The goals
shall be a part of the Service Plan as described below.
(3) The Service Plan shall be behavior-oriented and goal-directed and shall:
(a) Identify family concerns;
(b) Identify family strengths;
(c) Identify family goals and timelines which address CPS allegations;
(d) Outline safeguards for reducing potential risk to children in the home;
(e) Describe direct service interventions; and
(f) Refer family to community resources and supports.
d. Community Resource and Referral.
The Contractor shall follow the Community and Resource and Referral pathway for short-term
interventions:
(1) Resource and Referral: Contractor shall direct or provide the client with one or more of the
following:
(a) Community Resources
(b} Community Information
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10} Page 13
(c) Community Services
(d} Concrete Services
(2) Follow-up: The Contractor shall follow-up with the client after referring or providing services to
the family to see how the family has engaged in the services and if they need further assistance.
e. Promising and Evidenced Based Practices.
CA will provide training to Contractors in the following promising and evidenced based
practices. Contractors are not expected to utilize these methods until they have completed
the CA approved training. Once trained in the methods and in the program criteria,
Contractors are expected to utilize these methods, as appropriate:
(1) Promoting First Relationships. The Contractor shall utilize Promoting First Relationships for
families with children birth to three years of age AND who are interested and willing to
participate in the family assessment and engagement path of service delivery.
Promoting First Relationships is a prevention program dedicated to promoting children's social-
emotional development through responsive, nurturing caregiver-child relationships. Service
providers receive training in the use of practical, effective strategies for promoting secure and
healthy relationships between caregivers and young children (birth to 3 years). By supporting
parents and caregivers to be loving, responsive and tuned in to their children's feelings and
needs, the desired goals can be achieved: happy children who engage in trusting and caring
relationships with others and are free to explore and learn about the world around them.
This 10-13 week intervention can be done in the home or during individual sessions with
parents and children at a family support center or other appropriate setting. This intervention
can include videotaping the parent-child interaction and giving positive feedback to the parents.
(Z) Triple-P -Positive Parenting Program. The Contractor shall utilize Triple-P as appropriate with
the families who engage in the family assessment and engagement path of service delivery and
according to the guidelines set forth by CA.
Triple P is amulti-level set of parenting interventions that primarily targets the
treatment/prevention of emotional/behavioral disorders in children, but also focuses on the
prevention of other negative outcomes such as child maltreatment and juvenile delinquency.
Range of Interventions. Level One provides brief information resources such as tip sheets and
videos. Levels Two and Three include brief targeted interventions (for specific behavior
problems) offered by primary care practitioners. Levels Four and Five are more intense,
targeting broader family issues such as relationship conflict and parental depression and stress.
Triple P targets five developmental periods from infancy through adolescence and aims to help
parents create a safe, engaging, and positive learning environment for their children, use
assertive discipline, have realistic expectations, and take care of oneself as a parent.
f. Toolbox.
The Contractor may also utilize any of the following assessment and/or screening tools below on an
as needed basis as appropriate.
(1) Nursing Child Assessment Satellite Training (NCAST)
(a) Feeding and Teaching Assessments
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10)
Page 14
(b} Community Life Skills Scale (GCBs}
(c) Difficult Life Circumstances (DLC)
(d) Network Survey
(2) Ages & Stages Questionnaires (ASQ)
(3} The Injury Prevention Program (TIPP) -Framingham Safety Survey
(4) Denver Developmental Screening Tool II - DDST II
(5) Edinburough Depression Scale
g. Implementation of Service Ptan.
The Contractor shall provide direct intervention services for the family, refer the family to other
community service providers., or assist the family in obtaining concrete services to reduce risk of
abuse and neglect of children in the home and to address goals in the family's service plan. Per
Special Terms and Conditions, section 6 "Consideration", the EFSS Contractor shall first seek
community resources to provide concrete services that are available at no cost to the client before
EFSS funds are expended.
h. Intensity of Services.
The intensity of family contacts is dependent upon the service plan of the family. Contact with the
family is expected to be at least monthly.
i. Prenatal and Substance Abuse Referrals.
(1) The Contractor may receive referrals based on the Children's Administration prenatal and
substance abuse policy. In order to qualify for a referral to the Contractor under this policy, the
following must occur:
(a) The newborn has been identified as AFFECTED by substance(s) or has withdrawal
symptoms resulting from prenatal substance exposure AND
(b) Known risk factors indicate a low risk or moderately low risk of imminent harm.
(2) In the cases referred under this policy the Contractor shall attempt to engage the family in the
in-home services pathway. At a minimum, the Contractor shall conduct a Plan. of Safe Care that
includes at a minimum the following:
(a) Medical care for the newborn
(b) Safe housing
(c) A plan of child care if the parent(s) is employed or in school
(d) A list of phone numbers and contacts for the parent(s) to call, including
i. Emergency care for the newborn
ii. Help with parenting issues
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 15
iii. Help during a crisis
(e) A referral for the parent to necessary services
(f) A referra{ to other resources that may be of support.
(3) The Contractor shall follow the same reporting requirements found in Section 13. Reports.
j. 90-Day Reviews.
The Contractor shall meet with the family and complete a case review every 90 days to determine:
(1) Case progress; and
(2) Continuation of EFSS services
13. Reports.
a. The Contractor shall submit the following reports for the following service interventions on the
form(s) provided by CA:
(1} Short Term and Service Referral Intervention
(a) Monthly Report. The Contractor shall include information regarding the families served in
the Monthly Report as provided by CA.
(b) Exit Summary. The Contractor shall complete the Exit Summary as provided by CA upon
case closure or when returning a case to CPS. The Contractor shall include at a minimum
the following information in the Case Summary section of the Exit Summary:
i. Services family was offered, referred to or given;
ii. Services family participated in;
iii. Concrete services offered or received;
iv. Length of time family participated; and
v. Family's willingness to work with provider.
(2) In Home Services
(a) Monthly Report. The Contractor shall include information regarding the families served in
the Monthly Report as provided by CA.
(b) 90-Day Review. The Contractor shall complete a 90-Day review as provided by CA every
90 days as long as the family is served by the Contractor. The Contractor shall include a
justification for continuation of services and shall obtain approval from the local or regional
gatekeeper for continuation of services.
(c) Exit Summary. The Contractor shall complete the Exit Summary as provided by CA upon
case closure or returning a case to CPS. The Contractor shall include at a minimum the
following information in the Case Summary section of the exit summary.
i. Services family was offered, referred to or given;
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 16
ii. Services the family participated in;
iii. Concrete Services offered or received;
iv. Length of time family participated;
v. Omaha System Knowledge, Behavior and Status entry and exit scores for the EFSS
Pathways or other areas identified in the Omaha System and issues in the family's case
plan, also known as the family's Outcomes; and
vi. Ongoing recommendations for the family.
14. Reporting Procedure.
a. The Contractor shall submit the following monthly reports, in a format prescribed by CA:
EFSS Contractor
Re orts Submit to: Due Date
• EFSS Monthly Report 1 copy to EFSS regional liaison By the 15th of the month for
[Attention: Peggy Lopez (regional services provided in the
liaison) previous month
Children's Administration
P.O. Box 45714
Olympia, WA 98504-5714]
1 copy to the local liaison
[Attention: EFSS (local liaison)
Children's Administration
915 Sheridan, Suite 201
Port Townsend, WA 98368]
1 copy to regional billing person
[mail with A-19 to address under Billing
section
• 90 Day Review 1 copy to the local liaison By the 15th of the month for
• Exit Summary [at address above] services provided in the
revious month
b: Additional Data
DSHS may request additional measurable service and outcome data for services provided. In the
event DSHS so requests, DSHS commits to work with the Contractor to develop data elements. If
so requested, the Contractor agrees to provide data collection in a manner prescribed by DSHS.
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 17
EXHIBIT B
PROGRAM REQUIREMENTS
Early Family Support Services (EFSS}
ORGANIZATION OF PROGRAM REQUIREMENTS
1. Qualification Requirements
a. Professionals and Supervisory Staff
b. Paraprofessionals
c. Exceptions for Required Staff Qualifications
2. Licensing or Statutory Requirements
3. Required License in Good Standing
4. Degree Requirements
5. Staff and Subcontractor Training
6. Annual EFSS Provider Meetings
7. Evaluation of Contractor
8. Background Checks
9. Health and Safety of DSHS Clients
10. Corporate Punishment Prohibited
11. Smoking Prohibited in Presence of Client Children and Foster Youth
12. Transportation
13. Culturally Relevant Services
14. Interpretation and Translation
15. Confidentiality -Additional Requirements
16. Records
a. Client Records
b. Administrative Records
c. Personnel and Subcontractor Records
17. Auditing and Monitoring
18. Operating Procedures
19. Office of the Family and Children's Ombudsman
The Contractor shall comply with alf program and other requirements for providing services under this Contract,
as set forth below.
Qualification Requirements.
The Contractor shall ensure that employees, subcontractors, and/or volunteers providing services to
DSHS clients under this Contract have the following minimum qualifications:
a. Professionals and Supervisory Staff
(1) Professional and supervisory staff shall have the following minimum qualifications:
(a) Masters degree in Social Work or a Master's degree in social or behavioral science or closely
allied field, which qualifies them to provide counseling services to individuals, families or
groups; OR
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 18
(b) A Bachelor's degree in social work or behavioral science or closely allied field, AND 2 years of
direct. casework experience working with children and families, OR
(c) Licensed by the State of Washington as a Registered Nurse.
(2) Contractors are encouraged under this Contract to use professional staff-time to complete
assessments, service plans, exit summaries and supervise paraprofessional staff.
b. Paraprofessionals
Paraprofessionals shall be closely supervised by professional staff and shall have the following
minimum qualifications:
• Associates degree in a social service related field.
c. Exceptions for Reauired Staff Qualifications
The Contractor shall obtain written approval from the CA Headquarters EFSS Program Manager for all
exceptions to the professional staffing qualifications required under this Contract by submitting the
following information to the address listed below;
• Documentation of the individual's credentials
• Position description for which the exception is being requested.
DSHS/Children's Administration
Attention: EFSS Program Manager
PO Box 45710
Olympia, WA 98504-5710
2. Licensing ar Statutory Requirements
a. The Contractor shall meet or exceed all minimum licensing, certification or registration requirements or
other requirements as required by statute.
b. When licensing, certification, registration or other statutory requirements differ from contract
requirements, the Contractor shall meet whichever requirement imposes the higher standard. Any
variance from such requirements shall require a licensing waiver from the issuing agency
3. Required License in Good Standing.
a. ff the Contractor or any of the Contractor's staff are required to be licensed, certified, or registered to
provide any of the services under this Contract, the required license, certification or registration must
be in good standing at all times during the term of the Contract.
b. In the event that a required license, certification, or registration is suspended, or has any limitations or
restrictions are placed on it, the Contractor shall immediately notify the DSHS contact person listed on
page 1 of this contract.
4. Degree Requirements.
The Contractor shall ensure that any degrees required of the Contractor or the Contractor's staff under this
Contract, or by statute, shall meet the following requirements before the Contractor shall provide services
under this Contract:
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 19
a. The degree must be awarded following successful completion of a required course of instruction
undertaken by the recipient of the degree;
b. The degree must be awarded by a public or private 4-year or 2-year college, university, community
college, trade or vocational school, or other institution of higher education in the United States that is
accredited by the Council for Higher Education Accreditation (CHEA) or an accreditation organization
recognized by the Council for Higher Education Accreditation, or by one of the following regional
accreditation boards for the United States:
(1) MSA - Middle States Association
(2) NWCCU -Northwest Commission on Colleges and Universities
(3) NCA - North Central Association of Colleges and Schools
(4) NEASC -New England Association of Schools and Colleges
(5) SACS -Southern Association of Colleges and Schools
(6} WASC -Western Association of Schools and Colleges
c. If the degree has been awarded by a tribal college, university, community college, trade or vocational
school, it must be accredited by one of the above regional accreditation boards or other accreditation
organization recognized by the American Indian Higher Education Consortium, which may be
accessed at: www.aihec.orq.
d. If the degree has been awarded by a foreign educational institution outside of the United States, it
must be qualified in the country in which it is located to provide the course of instruction leading to that
degree, and must be accredited by an accreditation organization recognized as such in the country in
which it is located or recognized by the Council for Higher Education Accreditation.
The Council for Higher Education Accreditation (CHEA) is located at One Dupont Circle NW, Suite
510, Washington,. DC 20036-1135 and may be accessed at: www.chea.org.
e. Failure to comply with the degree requirements of this section shalt be grounds for termination of this
Contract.
5. Staff and Subcontractor Training.
a. HUB Training. The Contractor shall meet with locally designated training teams on at least a quarterly
basis. HUB Training is designed to assist EFSS workers in areas such as Assessment, Screening, and
Training Principals. Training teams will work together and with the HUB Leader to prioritize training
needs.
HUB Leaders will report to the CA program manager listed in Section 1.c. above with the names of
individuals participating and the topics covered. HUB Leaders will be selected based on their
qualifications, skills, and leadership abilities.
The HUB Training may include a combination of the following:
(1) Case Review and Scoring using the Omaha System to work on inter-rater reliability
(2) Training on screening tools, such as those listed in the Statement of Work Section 12 under
"Toolbox".
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 20
(3) Training on Triple P, Positive Parenting Program
(4) Motivational Interviewing
(5) Other training as determined by HUB Leaders
(6) Other training as recommended by CA
Mandated Reporter Training. The Contractor shall ensure that all current staff view the video "Making
a CPS Referral: A Guide for Mandated Reporters" within 30 days of the effective date of this Contract
and that all future employees view the video within two (2) weeks of initial employment. After viewing,
each employee shalt sign and date a statement acknowledging his or her duty to report child
maltreatment, and the Contractor shall retain the signed statement in the employee's personnel file. If
staff have viewed the video within the last three (3) years, they shall be considered as having satisfied
this requirement provided the Contractor has the employee's signed statement on file. The Contractor
shall either obtain a copy of the video from DSHS, or access the video online at the following address:
http~//www1 dshs.wa.gov/ca/pubs/pubcats.asp?cat=Multi-Media.
6. Annual EFSS Provider Meetings.
It is expected under this Contract that, at a minimum, one Contractor representative shall attend annual
EFSS provider meetings.
7. Evaluation of Contractor.
a. DSHS may evaluate the Contractor's performance during the term of the Contract. Areas of review
may include, but are not limited to, the following:
(1) Face to face contacts are completed on 85% of ail families referred by CA, less those cases that
were returned to CPS due to inappropriate referrals;
(2) 60% of referred families participate in one or more services outlined in the family service plan;
(3} Family Outcomes as documented in the Omaha System;
(4} Reports required under this contract are complete and submitted in a timely manner;
(5) Families are referred to appropriate community resources; and
(6) EFSS direct service staff participation in CA training and training HUBS.
b. If the Contractor fails to meet any of the performance measures, DSHS may terminate this Contract.
8. Background Checks.
a. This requirement applies to any employees, volunteers and subcontractors who may have
unsupervised access to children served under this Contract.
b. This requirement does not apply to currently licensed foster parents who are affiliated with the
Contractor. Licensed foster parents are subject to the criminal history background provisions
associated with obtaining and maintaining a current foster license.
c. The Contractor shall ensure a criminal history background check pursuant to RCW 43.43.832,
43.43.834, RCW 43.20A.710 and WAC 388-06 has been completed through DSHS for all current
employees, volunteers, and subcontractors, and that a criminal history background check shall be
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 21
initiated for all prospective employees, volunteers and subcontractors who may have unsupervised
access to children served under this contract.
d. The Contractor shall assist in obtaining additional state or national criminal history and/or child
abuse/neglect history, if requested by DSHS.
e. The Contractor shall ensure that no employee, volunteer or subcontractor, including those
provisionally hired pursuant to RCW 43.43.832(7), has unsupervised access to children served under
this contract, until a full and satisfactory background check is completed and documentation, qualifying
the individual for unsupervised access, is returned to the Contractor.
9. Health and Safety of DSHS Clients.
In the delivery of services under this Contract, children's health, safety and well-being shall always be the
first concern of the Contractor.
a. If the Contractor determines that there are additional health and safety concerns, suspected substance
abuse, or other presenting problems which were not stated in the CA referral, the Contractor shall
immediately report this information to the referring CA social worker and, if appropriate to CPS Intake.
The Contractor shall follow such verbal notification by written notification within 24 hours to the CA
social worker and to CPS Intake.
b. Contractors are mandated reporters under Chapter 26.44.030 RCW. The Contractor shall immediately
report all instances of suspected child abuse and neglect to (1) Child Protective Services (CPS) Intake
and (2) the referring CA social worker. The Contractor shall follow verbal notification by written
notification within 24 hours to the CA social worker and to CPS Intake.
c. CPS Intake shall make the determination of whether the referral constitutes an allegation of child
abuse or neglect that shall be accepted for investigation, as a possible licensing compliance issue, or
as a matter of "information only".
d. Written notification required by the Contractor shall include notification by fax or by secure a-mail.
10. Corporal Punishment Prohibited.
Corporal punishment of children in the Department's care or custody is prohibited. Gorporal punishment is
any act which willfully inflicts or causes the infliction of physical pain on a child. The Contractor, and the
Contractor's agents and employees, shall not administer corporal punishment to children served under this
Contract.
11. Smoking Prohibited in Presence of Client Children and Foster Youth.
Smoking in the presence of client children is prohibited including, but not limited to, the following
circumstances:
a. When transporting client children under age 18 and foster youth 18 to 21 years of age;
b. When there is direct contact with client children under age 18 and foster youth 18 to 21 years of age,
such as talking with a child or accompanying a child, even when in a public place where smoking may
otherwise be permitted.
12. Transportation.
a. The Contractor shall only provide transportation that is safe, reliable, and in conformance with state
and federal safety laws. Specifically, that:
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 22
b. Drivers shall be age 21 or older, have a current valid driver's license for the classification of motor
vehicle operated, have no history of DWI violations, and have proof of liability insurance.
c. Drivers shall at all times comply with the child passenger restraint requirements of RCW 46.61.687
when transporting children or providing transportation to children sensed under this Contract. Current
child passenger restraint requirements may be accessed at http://www.800bucklup.orq/.
d. Driver and/or other staff accompanying clients in the motor vehicle shall have current first aid and
cardiopulmonary resuscitation (CPR) training.
e. Motor vehicle is maintained in safe operating condition.
f. Number of passengers does not exceed the seating capacity of the motor vehicle.
g. Motor vehicle is equipped with appropriate safety devices and individual seat belts which shall be used
when the vehicle is in motion.
h. The Contractor shall not transport DSHS clients under this contract unless the Contractor has
Business Auto Policy insurance coverage.
13. Culturally Relevant Services.
The Contractor shall provide appropriate, accessible, and culturally relevant services to clients and their
families. Service delivery shall be culturally competent and responsive to each client's cultural beliefs and
values, ethnic norms, language needs, and individual differences. Contractors are encouraged to employ
a diverse workforce that reflects the diversity of their clientele and the community. The Contractor shall
have a written recruitment policy which demonstrates that the Contractor is an equal opportunity employer.
14. Interpretation and Translation.
a. The Contractor shall provide Limited English Proficient (LEP) clients with certified or otherwise
qualified interpreters and translated documents.
b. The Contractor shall provide deaf, deaf-blind, or hard of hearing clients with the services of a certified
sign language interpreter.
c. Interpreter and translation services shall be provided at no cost to the client. Alf interpreter and
translation costs shall be the financial responsibility of the Contractor. These costs are included in the
contracted rate.
d. Extraordinary costs, which create an undue hardship for the Contractor in providing interpretation
and/or translation services to an individual client, may be reviewed and addressed for supplemental
reimbursement by the CA Regional Administrator or designee on a case by case basis.
15. Confidentiality -Additional Requirements.
This Contract imposes the following additional requirements to the section titled Confidentiality, set forth as
one of the General Terms and Conditions of this Contract:
a. Consent by Minor. The Contractor shall not use, publish, transfer, sell or otherwise disclose any
Confidential Information of a minor except as provided by law or with the prior written consent of the
minor's parent, legal representative or guardian. If a child is a dependent of Washington State, then
prior written consent must be obtained from DSHS.
b. Encrypted Email Account. The Contractor shall use an encrypted email account for electronic
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 23
submissions which contain Confidential, and Personal Information, as defined in the General Terms
and Conditions. Information regarding encrypted email accounts can be obtained at CA's website,
located at: http://www.dshs.wa.c~ov/ca/partners/intro.asp.
16. Records.
a. Client Records
The Contractor shall maintain individual client records and shall promptly submit to DSHS a copy of
such records upon request. At a minimum, individual client records must include:
(1) CA Intake Referral Summary Report;
(2) Additional referral information, if applicable;
(3) Assessment and Family Service Plan;
(4) Omaha System Knowledge, Behavior and Status (KBS) Scores;
(5) 90 Day Reviews;
(6) Exit Summary;
(7) Clinical consultation log;
(8) Concrete Service expenditures; and
(9) Contacts with the family to include: date of contact, name(s) of member(s) present, and charting
notes.
b. Administrative Records
The Contractor shall retain the following administrative records:
(1) Community Resource Directory that lists: name of agency, address, telephone number, description
of available resources and supports for families;
(2} Monthly Reports;
(3) Fiscal records that shall substantiate costs charged to DSHS under this contract;
(4) Audits, license review, contract monitoring and corrective actions required and action taken;
(5) Documentation of all audits, license reviews, contract monitoring reports, and corrective action
reports and actions taken. Documentation of all costs associated with service provided under this
Contract;
(6) Recruitment policy which demonstrates that Contractor is an equal opportunity employer;
(7) Personnel policy reflecting CA policy requirements re "Smoking Prohibited in Presence of Client
Children and Foster Youth", as stated above in Section 9;
(8) A copy of any subcontract or other agreement for subcontracted services and the provider's
qualifications;
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 24
(9} Copy of the Certificate of Insurance for each subcontractor; and
(10} Protected group data:
(a} A list of current staff by position that addresses date of birth, sex, and identified protected
group status, including race, Vietnam Era Veteran, Disabled Veteran, and person of disability.
(b) A list of all clients served that addresses date of birth, sex, and race.
When collecting protected groups data, the Contractor shat! inform staff and clients that (?) the
furnishing of the information is entirely voluntary,' (2) the refusal to furnish the data shall not
have adverse effects:
c. Personnel and Subcontractor Records
The Contractor shalt retain the following records on (1 }all of Contractor's staff and employees,
whether full-time or part-time, (2) volunteers, and (3} any subcontractor's staff and employees who
may have contact with DSHS clients in performing duties or providing services under this Contract:
(1) DSHS criminal history background check approval;
(2} Any other criminal history background checks;
(3) Current license(s), registration(s), or certification(s) to practice in the state of Washington and/or in
the state in which services are provided, as applicable;
(4) Proof of degree(s), if required, and transcripts from college or other school awarding any degree(s)
required under this Contract for service provision;
(5) Documentation of academic history and credentials, as applicable;
(6) Employment and experience history;
(7) Job description;
(8) Annual performance evaluations;
(9) Training records, as applicable;
(10) HUB Training Participation;
(11) Hours worked and payment records;
(12) Proof of driver's license and automobile liability insurance, if staff or subcontractor provides
transportation to DSHS clients.
(13) Staff training log;
(14) Signed statements to adhere to confidentiality of client information.;
(15) Signed statements acknowledging duty to report child maltreatment; and
(16) Copy of each signed subcontract or other agreement for any subcontractors.
17. Auditing and Monitoring.
a. If the Contractor is required to have an audit or if an audit is performed, the Contractor shall forward a
copy of the audit report to the DSHS Contact listed on Page 1 of this Contract.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-&10) Page 25
b. If federal or state audit exceptions are made relating to this Contract, the Contractor must reimburse
the amount of the audit exception, and any other costs including, but not limited to, audit fees, court
costs, and penalty assessments.
c. The Contractor shall be financially responsible for any overpayments by DSHS/CA to the Contractor.
The Contractor shall be financially responsible for any audit disallowances resulting from a federal or
state audit which resulted from an action, omission or failure to act on the part of the Contractor.
d. DSHS may schedule monitoring visits with the Contractor to evaluate performance of the program.
The Contractor shall provide at no further cost to DSHS reasonable access to all program-related
records and materials, including financial records in support of billings, and records of staff and/or
subcontractor time.
18. Operating Procedures.
a. In collaboration with CA, the Contractor shall develop written operating procedures, which set forth
procedures for the day-to-day operation and conduct of activities under this Contract. Such
procedures must be in accord and consistent with, and shall not conflict with, the provisions of this
Contract. The written operating procedures shall address:
(1) Referral process steps;
(2) Communication links (contact persons);
(3) Case updating requirements;
(4) Case termination and extension procedures;
(5} Scheduling process;
(6) Training collaboration, if any;
(7) Report and feedback process;
(8) Emergency procedures.
b. The Contractor shall submit a copy of the written operating procedures to the DSHS Contact identified
on Page 1 of this Contract.
c. The Contractor and CA shall each retain a copy of the written operating procedures.
19. Office of the Family and Children's Ombudsman.
a. The Office of the Family and Children's Ombudsman (OFCO) shall have the same right of access to
clients as DSHS.
b. The Contractor shall release records relating to services provided to youth that are dependent under
Chapter 13.34 RCW to the OFCO. The Contractor can release records without the consent of a
dependent youth's parent or guardian or the youth if the youth is under the age of 13 years, unless law
otherwise specifically prohibits such release.
c. The Contractor shall notify the CA headquarters Program Manager when the OFCO makes a request
for records.
DSHS Central Contract Services
2046CS Early Family Support Services - EFSS (6-8-10) Page 26
EXNtBIT C
BUDGET
Early Family Support Services (EFSS)
AGENCY: Jefferson County Public Health
PROGRAM: EFSS
PERIOD OF PERFORMANCE: July 1, 2010 -June 30, 2011
ACTIVITY (not limited to the items below) Please add FTEs - Budget Request
footnotes to the budget section as needed. Percent for FY11
PERSONNEL (Direct Admin Costs)
Names:
Quen Zorrah $13,129
Denis Langlois $13,572
Fringe $6,966
TRAVEL (registration, ferry) $440
LODGING (hotel) $283
PER DIEM (food) $150
OTHER DIRECT COSTS MUST BE PROGRAM SPECIFIC
Equipment
Supplies (includes curricula) $100
Professional services $480
Other (use as many lines as needed)
TOTAL DIRECT. CHARGES $35,120
INDIRECT CHARGES (NOT TO EXCEED 10%) $3,512
(see attachment & use as many lines as needed)
TOTAL INDIRECT CHARGES $3,512
GRAND TOTAL $38,632
DSHS Central Contract Services
2046CS Early Family Support Services -EFSS (6-8-10) Page 27