HomeMy WebLinkAbout072213_ca09~osm ~oG
Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
'T~. 615 Sheridan Street o Port Townsend o Washington :0 98368
www.jeffersoncou ntypublichealth. org
July 2, 2013
.7EFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: .J 'j ~ ~ ~ ~ , ~ l
SUBJECT: Agenda Item -Agency Agreement -Early Family Support Services
(EFSS) #1363-79229 with the Department of Social and Health
Services; July 1, 2013 -June 30, 2014; 36,203
STATEMENT OF ISSUE:
Jefferson County Public Health is requesting Board approval of the Agency Agreement -Early Family
Support Services (EFSS) #1363-79229 with the Department of Social and Health Services; July 1, 2013 -
June 30, 2014; 36,203
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This is a continuation of services provided by JCPH. JCPH will 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 and will include conducting family
assessments, developing family service plans and providing family management services. JCPH will utilize
the Promoting First Relationships program for families with children birth-3 years, dedicated to promoting
children's social/emotional development through responsive, nurturing caregiver-child relationships and the
Positive Parenting Program, which targets the treatment/prevention of emotional/behavioral disorders in
children as well as child maltreatment and juvenile delinquency with the intended outcome of reducing risk
of abuse or neglect of children in the home, enhancing parenting skills, family and personal self-sufficiency,
family functioning and reduction of stress on the family, reduce the likelihood of additional referrals to CPS
and to enhance the health status of families and linkages to health services.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The funding from Department of Social and Health Services covers all program costs. There is no general
fund support in this program.
COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH
DEVELOPMENTAL DISABILITIES WATER QUALITY
MAIN: (360) 385-9400 ALWAYS WDRRIND FOR A SAFER AND MAIN: (360) 385-9444
FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487
Consent Agenda
RECOMMENDATION:
JCPH management request approval of the Agency Agreement -Early Family Support Services (EFSS)
#1363-79229 with the Department of Social and Health Services; July 1, 2013 -June 30, 2014; 36,203
~~
Date
(Routed to all Public Health Managers)
DSHS Agreement Number
C'~u NTY
(~ ,¢
~i DEPI
RTMENT OF 1363-79229
~
,\ eOC1ALbHEALTH
SERVICES PROGRAM AGREEMENT
Early Family Support Services
This Program Agreement is by and between the State of Washington Administration or Division
Department of Social and Health Services (DSHS) and the County identified Agreement Number
below, and is issued in conjunction with a County and DSHS Agreement On 0614-
County Agreement Number
General Terms and Conditions, which is incorporated by reference.
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE
Childrens Administration Division of Children and Family 1223 2046CS-63
Services
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Dianne Thompson 1949 So. State St., MS: N27-33
Re Tonal Contracts Mana er Tacoma, WA 98405-
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL
253 983-6266 253 983-6433 thdi300 dshs.wa. ov
COUNTY NAME COUNTY ADDRESS
Jefferson County 615 Sheridan St
Port Townsend, WA 98368-
COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME
NUMBER
Julia Danskin
COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL
360 385-9420 360 385-9401 danskin co.'efferson.wa.us
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS
AGREEMENT?
No
PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
07!01/2013 06/30/2014 $36,203.00
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:
® Exhibits (specify): Exhibit A -Data Security Requirements; Exhibit B -Statement of Work; Exhibit C -Program
Re uirements; Exhibit D -Exit Code Definitions; and ®Exhibit E -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 families in the focus to reduce safety threats
• Work to increase safe parenting skills; and
• Re uire immediate communication with the Children's Administration about safet threats to the child
By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all
documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject
matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify that they
are authorized to si n this Pro ram A reement.
COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Dianne E. Thompson, Contracts Manager
~~7~'~~~~~ ~s T~ ~~r~ o~+~y
DSHS Central Contract Services U~ ~ ~~~~?S
2046CS Early Family Support Services - EFSS (5-29-13)
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~.(.f. ~1 jzl~~
Special Terms and Conditions
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. "Authorized User(s)" means an individual or individuals with an authorized business requirement to
access DSHS Confidential Information.
e. "Case" means a family for which a risk of abuse or neglect has been determined to be low (1) or
moderately low (2) either at CPS Intake or after the completion of a CPS investigation.
f. "CA" means Children's Administration, which is an Administration within DSHS.
g. "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.
h. "CFWS" means Child and Family Welfare Services, administered by CA.
i. "Client" means any child or adult who is authorized services by DSHS.
j. "Community Resources" means community supports and concrete services.
k. "Community Resource Directory" means a list of local resource agencies or individuals that provide
supports for families.
I. "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.
m. "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.
n. "Contract" means the entire written County Program Agreement between DSHS and the
Contractor, including any Exhibits, documents, and materials incorporated by reference.
o. "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.
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p. "Corporal Punishment" means any act that willfully inflicts or causes the infliction of physical pain on
a child.
q. "Corrective Action Plan" means a written plan approved by DSHS which identifies deficiencies in
Contractor's performance, describes the steps Contractor must take to correct the deficiencies, and
sets forth timeframes within which such steps must be taken to return Contactor to compliance with
the terms of the Contract.
r. "CPS" means Child Protection Services, a program under CA.
s. "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.
t. "CA EFSS Liaison" means the CA staff person who is responsible for making referrals and
maintaining contact with the Contractor.
u. "EFSS" means Early Family Support Services.
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. "Hardened Password" means a string of at least eight characters containing at least one alphabetic
character, at least one number and at least one special character such as an asterisk, ampersand
or exclamation point.
y. "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.
z. "KBS Scores" means the Knowledge, Behavior, and Status scores from the Omaha System
assessment.
aa. "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.
bb. "LEP" means Limited English Proficiency, and indicates an individual's need for additional support
and assistance in comprehending the English language.
cc. "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 C -Program Requirements, Section 1 -
Qualification Requirements. Paraprofessional workers are supervised by Professional staff. The
paraprofessional worker is not intended to replace the role and responsibilities of professional staff.
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dd. "Participation" means family participation in one or more of the services outlined in the Family
Service Plan.
ee. "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 C -
Program Requirements, Section 1. Professional staff shall supervise paraprofessional staff.
ff. "Omaha System" means the assessment model used in this contract for the In Home Services
intervention.
gg. "Regulation" means any federal, state, or local regulation, rule, or ordinance.
hh. "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.
ii. "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.
jj. "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 and/or other provider, consultants, parents or others, for the purpose of reviewing or
discussing, or for making decisions concerning, a client or case.
kk. "Structured Decision Making" means the Structured Decision Making Assessment tool (SDM) is a
risk assessment that is completed during a Child Protective Services Investigation.
II. "Unique User ID" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase or other mechanism, authenticates a user to an
information system.
2. Data Security Requirements -Exhibit A. The Contractor shall protect, segregate, and dispose of
data from Children's Administration as described in Exhibit A, as required in the Section below entitled
Secure Management of Confidential Information.
3. Statement of Work -Exhibit B. The Contractor shall provide services and staff as described in the
Statement of Work attached as Exhibit B.
4. Program Requirements -Exhibit C. The Contractor shall comply with all program and other
requirements for providing services under this Contract, as stated in the Program Requirements
attached as Exhibit C.
5. Exit Code Definitions -Exhibit D. The Contractor shall utilize the Exit Code Definitions when
documenting case closure with a family, attached as Exhibit D.
6. Budget -Exhibit E. If Exhibit E -Budget is checked on page 1 of this Agreement, and the
Consideration Section indicates payment for services either based on actual costs or in monthly
payments, then the Contractor's Budget for providing services under this Contract is attached as
Exhibit E. Funds may be transferred between budget line items of the Contractor's Budget subject to
the following conditions:
a. Transfer of funds up to 10% of the budget line item must be requested in writing by the Contractor
and may be made without amending this Contract.
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b. Transfer of funds that exceeds 10% of the budget line item shall require a written amendment to
this Contract UflOr to the transfer of funds between budget line items.
Secure Management of Confidential Information
The Contractor shall ensure that all Confidential Information (also referred to as Personal
Information) as defined in the General Terms and Conditions Section 1, acquired under this contract
is used only for the provision of services under this contract and is handled with the utmost
confidentiality as described in the General Terms and Conditions, Section 6, Confidentiality. Inaddition:
Contractors have permission to use mobile devices under this contract and shall ensure that mobile
devices and data are accessed and protected as described in Exhibit A- Data Security
Requirements.
b. Failure to comply with applicable requirements may result in termination of this contract.
8. 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. Allocated Funds. Allocated funds not expended during the period ending June 30, 2014 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.
If 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.
e. Rate of Payment. DSHS will pay Contractor as follows:
(1) DSHS will pay Contractor for actual costs related to services provided to CA referred families
during the period of this Contract.
9. Billing. The Contractor shall submit the following documents, prepared in the manner prescribed by
DSHS, to invoice services performed under this Contract:
DSHS may choose to pay the Contractor for services under this Contract through FamLink as an
alternative method to the invoice billing process, described below. The Contractor shall be notified in
writing of any change in the billing process.
a. A-19 Invoice. The Contractor shall submit a monthly invoice for services performed under this
Contract on State of Washington Invoice Voucher forms (Form A-19), prepared in the manner
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prescribed by DSHS.
Special Terms and Conditions
(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. 1363-
79229 FOR THE MONTH OF , 20 "
(4) The A-19 invoice shall be submitted to:
Kui Hug, Program Administrator
Children's Administration
Region 3
P.O. Box 45714
Olympia, WA 98504-5714
(5) The Contractor shall contact Kui Hug at (360) 725-6798 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.
10. 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.
11. Payment Only for Authorized Services
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.
12. Funding Stipulations
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Special Terms and Conditions
a. Information for Federal Fundino. 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 Billinca. 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 far 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. Suoalanting. 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.
13. 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.
14. 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.
15. 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.
16. Investigations of Contractor or Related Personnel
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 employee or
volunteer of the Contractor or a subcontractor, is investigated by DSHS or 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
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.
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Special Terms and Conditions
DSHS may also take other lesser action, including, but not limited to, disallowing the subject of the
investigation, whether an employee, volunteer 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.
17. Removal of Individuals from Performing Services
a. In the event that any of Contractor's employees, subcontractors, or volunteers who provide services
under this Contract do not meet qualifications required by this Contractor do not perform the
services as required in this Contract, DSHS may require that Contractor assure DSHS that such
individual will not provide services to DSHS clients under this Contract.
b. DSHS shall notify the Contractor of this decision verbally and in writing and the Contractor shall,
within 24 hours, disallow that person from providing direct services to DSHS clients. Failure to do
so may result in a Corrective Action Plan and possible suspension or termination of this Contract.
18. Compliance with Corrective Action Plan
In the event that DSHS identifies deficiencies in Contractor's performance under this Contract, DSHS
may , at its option, establish a Corrective Action Plan. When presented with a Corrective Action Plan,
Contractor agrees to undertake the actions specified in the plan within the timeframes given to correct
the deficiencies. Contractor's failure to do so shall be grounds for termination of this Contract.
19. 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 Liabilitv 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 Liabilitv 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,
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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.
20. Resolution of Differences
In 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.
If the parties are unable to resolve their difference as stated above, then either party may submit a
request for dispute resolution as provided below, in the sections titled "Disputes".
A copy of the regional conflict resolution process is available from the DSHS Contact person listed on
Page 1 of this Contract.
21. 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
22. 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;
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Special Terms and Conditions
• 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://www1.dshs.wa.gov/pdf/publications/22-1108.pdf
23. 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.
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Exhibit A -Data Security Requirements
Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following
definitions:
a. "Authorized User(s)" means an individual or individuals with an authorized business requirement to
access DSHS Confidential Information.
b. "Hardened Password" means a string of at least eight characters containing at least one alphabetic
character, at least one number and at least one special character such as an asterisk, ampersand
or exclamation point.
c. "Unique User ID" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase or other mechanism, authenticates a user to an
information system.
2. Data Transport. When transporting DSHS Confidential Information electronically, including via email,
the Data will be protected by:
a. Transporting the Data within the (State Governmental Network) SGN or Contractor's internal
network, or;
b. Encrypting any Data that will be in transit outside the SGN or Contractor's internal network. This
includes transit over the public Internet.
3. Protection of Data. The Contractor agrees to store Data on one or more of the following media and
protect the Data as described:
a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID
and Hardened Password or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards.
b. Network server disks. Data stored on hard disks mounted on network servers and made
available through shared folders. Access to the Data will be restricted to Authorized Users through
the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on disks mounted to such servers must be located in an area which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as
long as the disks remain in a Secured Area and otherwise meet the requirements listed in the
above paragraph. Destruction of the Data as outlined in Section 5. Data Disposition may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area.
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c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS
on optical discs which will be used in local workstation optical disc drives and which will not be
transported out of a Secured Area. When not in use for the contracted purpose, such discs must
be locked in a drawer, cabinet or other container to which only Authorized Users have the key,
combination or mechanism required to access the contents of the container. Workstations which
access DSHS Data on optical discs must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by
DSHS on optical discs which will be attached to network servers and which will not be transported
out of a Secured Area. Access to Data on these discs will be restricted to Authorized Users
through the use of access control lists which will grant access only after the Authorized User has
authenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on discs attached to such servers must be located in an area which is accessible only
to authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
e. Paper documents. Any paper records must be protected by storing the records in a Secured Area
which is only accessible to authorized personnel. When not in use, such records must be stored in
a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons
have access.
Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or
Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. If so authorized, the Data shall be given the fallowing protections:
(a) Encrypt the Data with a key length of at least 128 bits
(b) Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical token or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum period of
inactivity is 20 minutes.
Physically Secure the portable device(s) and/or media by
(d) Keeping them in locked storage when not in use
(e) Using check-in/check-out procedures when they are shared, and
(f) Taking frequent inventories
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(2) When being transported outside of a Secured Area, portable devices and media with DSHS
Confidential Information must be under the physical control of Contractor staff with
authorization to access the Data.
(3) Portable devices include, but are not limited to; smart phones, tablets, flash memory devices
(e.g. USB flash drives, personal media players), portable hard disks, and
laptop/notebook/netbook computers if those computers may be transported outside of a
Secured Area.
(4) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic media
(e.g. floppy disks, tape), or flash media (e.g. CompactFlash, SD, MMC).
h. Data stored for backup purposes.
(1) DSHS data may be stored on portable media as part of a Contractor's existing, documented
backup process for business continuity or disaster recovery purposes. Such storage is
authorized until such time as that media would be reused during the course of normal backup
operations. If backup media is retired while DSHS Confidential Information still exists upon it,
such media will be destroyed at that time in accordance with the disposition requirements in
Section 5. Data Disposition
(2) DSHS Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual
media, etc.) as part of a Contractor's existing, documented backup process for business
continuity or disaster recovery purposes. If so, such media will be protected as otherwise
described in this exhibit. If this media is retired while DSHS Confidential Information still exists
upon it, the data will be destroyed at that time in accordance with the disposition requirements
in Section 5. Data Disposition.
4. Data Segregation.
a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to
ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or
destruction. It also aids in determining whether DSHS Data has or may have been compromised in
the event of a security breach. As such, one or more of the following methods will be used for data
segregation.
b. DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no non-
DSHS Data. And/or,
c. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data. And/or,
d. DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
e. DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the
value of a specific field or fields within database records.
f. When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container.
g. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
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5. Data Disposition. When the contracted work has been completed or when no longer needed, except
as noted in 4.b above, Data shall be returned to DSHS or destroyed. Media on which Data may be
stored and associated acceptable methods of destruction are as follows:
Data stored on: Will be destro ed b
Server or workstation hard disks, or Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
Removable media (e.g. floppies, USB flash drives, character data, or
portable hard disks) excluding optical discs
Degaussing sufficiently to ensure that the Data
cannot be reconstructed, or
Ph sicall destro in the disk
Paper documents with sensitive or Confidential Recycling through a contracted firm provided the
Information contract with the recycler assures that the
confidentialit of Data will be rotected.
Paper documents containing Confidential Information On-site shredding, pulping, or incineration
requiring special handling (e.g. protected health
information
Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Ma netic to a De aussin , incineratin or crosscut shreddin
6. Notification of Compromise or Potential Compromise. The compromise or potential compromise
of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1)
business day of discovery. If no DSHS Contact is designated in the Contract, then the notification
must be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must
also take actions to mitigate the risk of loss and comply with any notification or other requirements
imposed by law or DSHS.
7. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a
subcontractor, the Contract with the subcontractor must include all of the data security provisions within
this Contract and within any amendments, attachments, or exhibits within this Contract. If the
Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub-
Contractormust be submitted to the DSHS Contact specified for this contract for review and approval.
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EXHIBIT B
STATEMENT OF WORK
Early Family Support Services (EFSS)
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. Dual 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
The Contractor shall ensure that services provided under this Contract at all times meet the specifications
described in this Statement of Work Exhibit.
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:
a. Reduce risk of abuse or neglect of children in the home;
b. Enhance parenting skills, family and personal self-sufficiency, and family functioning;
c. Reduce stress on the family;
d. Reduce the likelihood of additional referrals to CPS; and
e. Enhance the health status of families and linkages to health services.
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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 or 5
has occurred.
(1) Abuse or neglect allegations have been reported to CPS;
(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, the risk on the closing Structured Decision
Making (SDM) risk assessment is low to moderate, and is appropriate for EFSS services, and
the family has agreed to EFSS services. The family is referred to an EFSS Contractor using
the agency protocol for transferring a case from CPS to EFSS.
OR
(5) The family has completed a CPS investigation, the family has agreed to EFSS services and the
risk on closing of the Structured Decision Making (SDM) risk assessment is moderately high to
high, is appropriate for EFSS services and has approval from the Regional CPS Program
Manager or designee. 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 will submit the EFSS referral form to the Contractor which will authorize services.
c. The Contractor shall adhere to the referral procedures set forth in the CA regionalllocal 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.
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6. Service Episodes
a. A family may only have two service episodes of EFSS within a 3-year period unless the Contractor
receives approval from the CA local liaison.
b. Per Special Terms and Conditions, 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. Anew 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.
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:
a. Family Enoaaement Services shall not exceed 9 months from acceptance of the referral; or
b. 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
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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.
11. Family Centered Practice Model
The Contractor shall provide services consistent with Solution Based Casework, the family-centered
practice model used by the Children's Administration. It shall be the Contractor's responsibility to
obtain information on Solution Based Casework from CA. Information about Solution Based Casework
is available at htto://www.dshs.wa.gov/ca/about/sbc.asp
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.
(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?
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(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.
(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 may 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.
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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
(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
Contractors are encouraged to utilize the following Promising and Evidenced Based
Practices when appropriate:
(1) Promotino 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.
(2) 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 oflnterventions. 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.
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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
(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 Plan
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 9 "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 one face to face meeting 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:
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(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; and
iii. Help during a crisis.
(e) A referral for the parent to necessary services; and
(f) A referral to other resources that may be of support.
(3) The Contractor shall follow the same reporting requirements found in Section 13. Reports
below.
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. Written reports must be submitted by secure email to the DSHS contacts identified in the section
titled "Reporting Procedures". The DSHS Secure E-mail User Guide is available at
http://www. ds hs.wa. gov/ca/partners/intro.asp
b. 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 complete the monthly service report on all families
served under this EFSS Contract, on a form provided by CA and obtained from the CA
EFSS Regional Liaison.
(b) Exit Summary. The Contractor shall complete the EFSS Exit Summary on all families
referred to EFSS upon completion of services. The Exit Summary form is #10-478 and may
be accessed at: http://www.dshs.wa.gov/forms/eforms.shtml. 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;
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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 complete the monthly service report on all families
served under this EFSS Contract, on a form provided by CA and obtained from the CA
EFSS Regional Liaison.
(b) 90-Day Review. The Contractor shall complete the EFSS 90 Day Review on all families
served by the Contractor up to and beyond 90 days. The 90 Day Review form is #10-476
and may be accessed at: htto://www.dshs.wa.gov/forms/eforms.shtml 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 EFSS Exit Summary on all families
referred to EFSS upon completion of services. The Exit Summary form is #10-478 and may
be accessed at: htto://www.dshs.wa.cov/formsleforms.shtml. 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 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 electronic copy to the EFSS By the 15 of the
CA regional liaison month for services
Name: Kui Hug provided in the
Email:kui.hug@dshs.wa.gov previous month
1 electronic copy to the EFSS
CA headquarters liaison
Lori VanClifford
Lori.vanclifford dshs.wa. ov
• 90 Day Review 1 electronic copy to the EFSS By the 15 of the
• Exit Summary CA regional liaison (as above) month for services
provided in the
revious month
• Annual 1 electronic copy to the EFSS B the 15 of the
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report to
CA regional liaison (as above)
month of July each
year of the contract
include:
o # of referrals
o # of unduplicated children served
o # of unduplicated families (cases)
served
o # of families (cases) exited from
EFSS for:
• # of families- Provider unable to
make contact
• # of families -Family refused
services
• # of families -Family was
referred to another program
within CA
• # of families -Services were
completed
• # of families -Provider referred
EFSS case back to CPS as
higher risk
• # of families - re-referral and
accepted for investigation
o # of cases with another CPS
referral received while family was
participating in EFSS
o # of families enrolled in community
resource and referral services
o # of families enrolled in Family
Engagement Services
• Of total # of families, what
improved KBS scores in caretaking
and parenting over time
1 electronic copy to the EFSS
CA headquarters
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.
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EXHIBIT C
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 ensure that all qualifications, performance expectations and program requirements for
services provided under this Contract at all times meet the specifications described in this Program Requirement
Exhibit.
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 Suoervisorv 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
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(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 a minimum
qualification of an Associate's degree in a social service related field.
c. Exceptions for Required 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 or Statutory Requirements
a. The Contractor shall meet or exceed all minimum licensing or certification requirements or other
requirements as required by statute.
b. When licensing or certification 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. If the Contractor or any of the Contractor's staff are required to be licensed or certified to provide any
of the services under this Contract, the required license or certification must be in good standing at all
times during the term of the Contract.
b. In the event that a required license or certification 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:
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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.orp.
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 shall be grounds for termination of this
Contract.
5. Staff and Subcontractor Training
a. The Contractor will ensure that all direct service staff have completed the Omaha Training. The
Omaha Training can be obtained through the King County Health Department or the Tacoma-Pierce
County Health Department. Training is to be paid by the Contractor through the allotted Contract
dollars.
b. Any training offered or supported by CA in relation to this Contract should assist EFSS workers in
areas such as Assessment, Screening, and Training Principals. 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' ;
(3) Training on Triple P, Positive Parenting Program;
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(4) Motivational Interviewing; and
(5) Other training as recommended by CA.
c. Mandated Reporter Training
(1) The Contractor shall ensure that all current employees and volunteers, who are mandated
reporters or who have access to children, read and/or view the materials in CA's Mandated
Reporter Toolkit within 30 days of the effective date of a first time CA Contract and annually
thereafter; and that all newly hired employees and volunteers who are mandated reporters or who
have access to children read and/or view the materials in the Mandated Reporter Toolkit within two
(2) weeks of initial employment. After reading and reviewing the materials, each employee and
volunteer shall sign and date a statement acknowledging his or her duty to report child
maltreatment and affirming that he or she understands when and how to report suspected child
abuse or neglect. The Contractor shall retain the signed statement in each individual's personnel
file.
(2) The Contractor shall either obtain a copy of the Mandated Reporter Toolkit from DSHS, or access
the Mandated Reporter Toolkit online at the following address:
http://www. dshs.wa. gov/ca/safety/a bu se Report. asp?2
6. Annual EFSS Provider Meetings
It is expected under this Contract that, at a minimum, one Contractor representative shall attend any
scheduled annual EFSS provider meetings.
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 all 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.
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.
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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
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. Corporal 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.
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12. Transportation
The Contractor shall only provide transportation that is safe, reliable, and in conformance with state and
federal safety laws. Specifically, that:
a. Drivers shall be age 21 or older, have a current valid driver's license for the classification of motor
vehicle operated, have proof of liability insurance, and successfully pass aDSHS/CA background
check.
b. 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 served under this Contract. Current
child passenger restraint requirements may be accessed at htto:/lwww.8t70bucklup.org/.
c. Driver and/or other staff accompanying clients in the motor vehicle shall have current first aid and
cardiopulmonary resuscitation (CPR) training.
d. Motor vehicle is maintained in safe operating condition.
e. Number of passengers does not exceed the seating capacity of the motor vehicle.
f. Motor vehicle is equipped with appropriate safety devices and individual seat belts which shall be used
when the vehicle is in motion.
g. The Contractor shall ensure that no transportation of DSHS clients occurs unless an auto
insurance policy that covers the transportation of DSHS clients is in effect.
h. DSHS shall have discretion to disallow any employee, subcontractor, or volunteer of the Contractor
from providing transportation to DSHS client.
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. All 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.
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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
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.gov/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;
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(6) 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 11;
(8) A copy of any subcontract or other agreement for subcontracted services and the provider's
qualifications;
(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 shall inform staff and clients that (f) 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 shall 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) 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) Hours worked and payment records;
(11) Proof of driver's license and automobile liability insurance, if staff or subcontractor provides
transportation to DSHS clients;
(12) Staff training log;
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(13) Signed statements to adhere to confidentiality of client information;
(14) Signed statements acknowledging duty to report child maltreatment; and
(15) 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 pertormed, the Contractor shall forward a
copy of the audit report to the DSHS Contact listed on Page 1 of this Contract.
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
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a. 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.
b. The Contractor shall notify the CA headquarters Program Manager when the OFCO makes a request
for records.
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EXHIBIT D
page 1 of 2
Exit Code Definitions
Early Family Support and Early Intervention
Exit Summary Code Definitions
Code Definition
1a. Family Engagement The family has engaged in onpoinp services with a provider and has identified
and Assessment Services goals and priorities for services. The family has engaged in interventions or
Completed services outlined in the service plan to address risk factors for child abuse and
ne lect and su ort famil stren the and rotective factors.
1 b. Community Resource The family has initiated community services.
and Referral Com leted
2. Initial Screening Visit The family engaged in the initial screening visit with the provider and declined
Only further services either directly or by agreeing to services and then failing to
show fora ointments.
3. Participated in Services
but did not complete
service plan due to:
a. Change in
Circumstance 3a. The family engages in services to a level the provider believes will benefit
the family to some degree, but further services are discontinued due to change
in circumstances.
b. Refused
3b. The family engages in services to a level that the provider believes the
children will benefit to some degree from the changes that will occur, but the
family refuses to further en4ape in services prior to addressing all
risk protective factors for child abuse and neglect. (The provider MUST write
the activities the famil artici ated in on the exit summa
Family has reached the The family continues to participate in services and is no longer eligible for
service limit and is not EFSS services.
longer eligible for services.
4a. Family has transferred
to other community 4a. The Family has transferred to other community services.
services.
4b.No other community
services are available. 4b. The communi does not have a ro riate services for the famil .
5.All services declined Provider contacts family by phone, or in person and the family declines to
artici ate in services.
6.Unable to locate family The provider is not able to physically locate the address or the family at the
address rovided.
7.Unable to contact Family does live at the identified address but the provider is not able to contact
the family through at least 2 attempted home visits; and phone calls and/or
letters.
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EXHIBIT D
page 2 of 2
8.Services not needed Family was contacted in person and is already engaged in community services
that address the allegations, thus services would be duplicative and would not
be necessary.
8a. Self Report 8a. Client self reported, unable to verify
8b. Verification received 8b. Provider verified other service involvement
9.Returned to CPS due to Prior to contact with the family CPS receives additional information accepts the
high level of risk case for investigation or after further discussion with CA results in accepted
investigation.
EFSS Onl
10. New CPS referral. Anytime after the first face-to-face visit, an additional referral is made to CPS
Assigned for investigation and the case is accepted for investigation.
EFSS Onl
11. Participated in Family no longer in EFSS service area and cannot receive services.
Services then family
moved.
12. Child Placed in out of Child has been placed in out of home care through a dependency or court
home care intervention
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EXHIBIT E
BUDGET
Early Family Support Services (EFSS)
July 1, 2013 -June 30, 2014
ACTIVITY (not limited to the items below)
Please add footnotes to the budget section as FTEs -
needed. Percent Budget Request forFY14
PERSONNEL
Names:
38% $ 32,176.01
°/a $
Fringe $
TRAVEL (itemize) $ 200.00
LODGING (itemize) $ 286.00
PER DIEM (itemize) $ 150.00
OTHER DIRECT COSTS
Equipment $
Supplies (includes curricula) $ 100.00
Professional services $
Other (use as many lines as needed) $
TOTAL DIRECT CHARGES $32,912
INDIRECT CHARGES
(see attachment & use as many lines as needed)
$3,291.2
TOTAL INDIRECT CHARGES
$3,291
GRAND TOTAL 36,203
*Travel/Training/Per Diem: Training Costs
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