HomeMy WebLinkAbout081417_ca04615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPubiicl-iealth.rg
Consent Agen a
Public Heap Duly is, Zoic
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Yuko Umeda, Public Health Nurse III
DATE: 311412Dj --71-
SUBJECT: Agenda Item — Washington State Department of Early Learning for
Home Visiting Services; July 1, 2017 — July 31, 2018; $180,912
STATEMENT OF ISSUE:
Jefferson Count, Public Health is requesting Board approval for Washington State Department of
Early Learning for funding Home Visiting Services; July 1, 2017 — July 31, 2018; $180,912
ANALYSIS/ STRATEGIC COALS:
This agreement funds the visiting nurse services Jefferson County Public Health has provided,
based on efficacy studies conducted by Nurse Family Partnership (NFP), and in keeping with NFP
model requirements, to support families in an effort to alleviate the effects of poverty, single
parenthood, parental unemployment or underemployment, parental disability, education
attainment, and family engagement in child welfare on child development. This is the sixth year
JCPH has received the Home Visiting Services grant. The grant allows JCPH community nursing
staff to make home visits, and supports Kitsap County, via subcontracting.
FISCAL IMPACT:
Fully funded by Washington State Department of Early Learning with state dollars for a total of
$180,912 of which $87,500 of these funds is available for Jefferson County to continue its partnership
with Kitsap County Health District, allowing them to continue their services in the NFP program on the
Kitsap Peninsula. $4000 is designated for performance and will be shared with the Kitsap County
Health District.
RECOMMENDATION:
JCPH management requests approval of the Washington State Department of Early Learning for
funding Home Visiting Services; July 1, 2017 — July 31, 2018; $180,912.
E' IE ED Y:
ilip Mo le ou Date
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
Washington State Department of DEL Contract Number: 18-1047
M'
Earl Learning n i n Contractor Contract Number:
rm Y g Title: Home Visiting Services Account:
Nurse Family Partnership (NFP)
INTERLOCAL AGREEMENT
BETWEEN
STATE OF WASHINGTON
DEPARTMENT OF EARLY LEARNING
AND
JEFFERSON COUNTY
THIS CONTRACT, pursuant to Chapter 39.34 RCW, is made and entered into by and between the State of
Washington, acting by and through the Department of Early Learning, a department of Washington State
government (hereinafter referred to as "DEL") located at PO Box 40970, Olympia WA 98504-0970 and
Jefferson County, a Municipal Subdivision, (hereinafter referred to as "Contractor"), located at 615 Sheridan
Street, Port Townend WA 98368.
IT IS THE PURPOSE OF THIS CONTRACT To provide high quality home visiting services to high risk
families using the Nurse Family Partnership (NFP) program model for purposes of improving outcomes for
participants and strengthening coordination of services.
THIS CONTRACT CONTRIBUTES TO THE FOLLOWING AGENCY GOALS:
Provide voluntary, high-quality early learning opportunities for children and families in Washington
THEREFORE, IT IS MUTUALLY AGREED THAT:
1. CONTRACT MANAGEMENT
1.1 The Contract Manager for each of the parties shall be the contact person for all communications and
billings regarding the performance of this Contract.
1.2 Any notice or demand or other communication required or permitted to be given under this Contract or
applicable law shall be effective only if it is in writing, properly addressed, and either emailed, delivered in
person, or by a recognized courier service, or deposited within the United States Postal Service as first-class
certified mail, postage prepaid, and return receipt requested, to the parties at the following addresses:
CONTRACTOR BUSINESS ADDRESS
CONTRACTOR CONTRACT MANAGER
Jefferson County
Jenny Matter
615 Sheridan Street
JMatter@co.jefferson.wa.us
Port Townend WA 98368
Phone: (360) 385-9421
TIN: 91-6001322
U BI: 161-001-169
DEL ADDRESS
DEL PROGRAM CONTRACT MANAGER
Department of Early Learning
Rene Toolson
PO Box 40970
Olympia WA 98504-0970
rene.toolson@del.wa.gov
Phone: (360) 725-4398
1.3 Each party shall notify the other party in writing within ten days of any changes of the name and contact
information regarding either party's designated Contract Manager.
1.4 Notwithstanding RCW 1.12.070, such communications shall be effective upon the earlier of receipt or four
calendar days after mailing or emailing. The notice address as provided herein may be changed by written
notice given as provided above.
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 1 of 32
2. EXHIBITS AND ATTACHMENTS
Attached hereto and incorporated herein as though set forth in full are the following exhibits and attachments:
• Exhibit A - STATEMENT OF WORK
• Exhibit B - BUDGET
• Exhibit C - GENERAL TERMS AND CONDITIONS
• Exhibit D - Deliverables Schedule
• Attachment 1 - Certification of Data Disposition
• Attachment 2 - Statement Confidentiality and Nondisclosure
Attachment 3 - Contract Monitoring, Compliance and Non -Compliance
• Attachment 4 - Jefferson Co PHD Attachment 4 Data Collection Reporting Align Meas
• Attachment 5 - Continuous Quality Improvement
• Attachment 6 - Monthly Enrollment Data Report
® Attachment 7 - Quarterly Progress Report
The parties agree that the exhibits and attachments listed in this paragraph shall be enforceable against the
parties and are a part of this Contract.
3. STATEMENT OF WORK
The parties agree that the Contractor shall perform the activities and obligations as set forth and described in
Exhibit A, STATEMENT OF WORK, attached hereto and incorporated herein as though set forth in full. The
Contractor shall also furnish the necessary personnel, equipment, material and/or service(s) and otherwise do
all things necessary for or incidental to the performance of the work as set forth and described in Exhibit A,
STATEMENT OF WORK. The Contractor agrees to provide the services, products and activities at the costs
set forth in this Contract.
4. PERIOD OF PERFORMANCE
Subject to Department of Enterprise Services (DES) approval requirements and the requirements of this
Contract, the period of performance of this Contract shall commence on July 1, 2017 and be completed on or
before July 31, 2018, unless terminated sooner as provided herein.
5. COMPENSATION
The parties have determined that the cost of accomplishing the work herein shall not exceed $180,912.00. Any
additional authorized expenditures, for which reimbursement is sought, must be submitted as written
documentation to the DEL Contract Manager for pre -approval by the DEL Director or the Director's delegate as
described in this Contract, and established by a written Contract Amendment. Exhibit B, BUDGET, attached
and incorporated herein as though set forth in full is an actual budget of the costs associated with this Contract.
If the Contractor reduces its prices for any of its services during the term of this Contract, DEL will have the
immediate benefit of such lower prices for services following the price reduction. Compensation for services will
be paid upon the timely completion of services as described in Exhibit A, STATEMENT OF WORK, and is
contingent upon acceptance of relevant work products and approval of vouchers by DEL as described in this
Contract.
6. BILLING PROCEDURE
6.1 The Contractor will submit, not more than semi-monthly, properly completed A-19 vouchers (the "voucher"),
to one of the following:
The Department of Early Learning
Attn: Financial Office
P.O. Box 40970
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 2 of 32
Olympia, WA 98504-0970
Or email a scan of an original, signed A-19 voucher directly to the DEL Financial Office
at del.fiscal@del.wa.gov.
6.2 Payment to the Contractor for approved and completed work shall be made by warrant or Electronic Funds
Transfer by DEL and considered timely if made within 30 days of receipt of a properly completed voucher.
Payment shall be sent to the address designated by the Contractor and set forth in this Contract. No payments
in advance or in anticipation of goods or services to be provided under this Contract shall be made by the DEL.
6.3 Each voucher must clearly reference the DEL Contract Number and the Contractor's Statewide Payee
Registration number assigned by the Department of Enterprise Services (DES).
6.4 Properly completed vouchers and attachments completed by the Contractor must contain the information
described in Exhibit A, STATEMENT OF WORK under section titled "Voucher Verification".
6.5 For Statewide Payee Registration: DES maintains a central contractor registration file for Washington State
agencies to use for processing contractor payments. This allows many contractors to receive payments by
direct deposit. The Contractor must be registered in the Statewide Payee Registration system,
http://des.wa.gov/services/ContractingPurchasing/BusinessNendorPay/PaQes/statewideVendors.aspx, prior to
submitting a request for payment under this Contract. No payment shall be made until the Statewide Payee
Registration is complete.
6.6 Upon the expiration of this Contract, any claim or payment not already made shall be submitted to DEL no
later than forty-five (45) days following the expiration date of this Contract. The final voucher shall certify that
the Contractor has completed all requirements of this Contract.
7. SIGNATURES
THIS CONTRACT, including the exhibits and attachments described in Paragraph 2, is executed by the persons
signing below who warrant they have read and understand this Contract and the exhibits and attachments. The
persons signing below further represent that they have the authority to execute this Contract.
CONTRACTOR:
DEL:
SIGNATURE: PRINTED NAME AND TITLE: DATE SIGNED:
DEL Contract Administrator
Anwoved a4 tp form:
Q.--� Date: �_
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 3 of 32
Washington State Department of
Early Learning
DEL Contract Number: 18-1047
Contractor Contract Number:
Title: Home Visiting Services Account: Nurse
Family Partnership (NFP)
Exhibit A - STATEMENT OF WORK
1. DEFINITIONS. The following terms shall have the meanings set forth below:
1.1. At -Risk Community means a community for which indicators of risk are present in greater
proportion than in Washington as a whole.
1.2. At -Risk Family means families residing in at -risk communities and the population receiving home
visiting services provided through this contract.
1.3. Benchmarks means the federally or state required performance measures that will be implemented
through this contract.
1.4. Continuous Quality Improvement (CQI) means a systematic approach to specifying the
processes and outcomes of a program or set of practices through regular data collection and the
application of changes that may lead to improvements in outcomes, process, and performance.
1.5. DEL means the Department of Early Learning.
1.6. Direct Identifiable Information means data or records that include names; postal address
information ( other than town or city, state and zip code); telephone numbers, fax numbers, e-mail
addresses; social security numbers; medical record numbers; health plan beneficiary numbers;
account numbers; certificate /license numbers; vehicle identifiers and serial numbers, including
license plate numbers; device identifiers and serial numbers; web universal resource locators
URLs); internet protocol (IP) address numbers; biometric identifiers, including finger and voice
prints; and full face photographic images and any comparable images.
1.7. Deliverable means the daily delivery of home visiting services and/or a tangible work product
resulting from this contract which is to be documented, described, reported and/or provided to the
Contract Manager in the form and manner requested by this contract.
1.8. DOH means the Department of Health.
1.9. DSA means Data Sharing Agreement.
1.10. DSHS means the Temporary Assistance for Needy Families administered by the Department of
Social and Health Services.
1.11. ELRC means Early Learning Regional Coalitions.
1.12, Enhancements or Adaptations to home visiting model means adaptations to programs include
changes to the model that have not been tested with rigorous impact research but are determined
by the Model Developer not to alter the core components related to program impacts.
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 4 of 32
1.13. Enrollment means a family is to be considered enrolled in a home visiting program as of the date
of the first home visit during which the participant voluntarily consents to participate and signs a
written participant agreement. All services must be voluntary. Active enrollment includes families
who have received at least one home visit in the prior 90 day period.
1.14. Evidence -based Home Visiting Models means models having specific evidence standards and
include Home visiting models approved by the federal Health Resources and Services
Administration's (HRSA) MIECHV program and selected by local implementing agencies for
implementation through the HVSA.
1.15. FERPA means "Family Educational Rights and Privacy Act" that protects the privacy of student
education records, with regulations found at 34 CFR Part 99.
1.16. HIPAA Rules means "Health Insurance Portability and Accountability Act Rules" shall mean the
Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R., Part 160 and Part 164.
1.17. HRSA means the United States Department of Health and Human Services: Health Resources and
Services Administration.
1.18. HV means home visiting.
1.19. HVSA means the Home Visiting Services Account established in RCW 43.215.130.
1.20. Implementation HUB means the central administration of Implementation Science -informed
supports, training, coaching, and technical assistance for home visiting services in Washington
State as provided by Thrive Washington. Can also be referred to as'The HUB.'
1.21. IS means Implementation Science, a framework to promote the full and effective use of evidence -
based programs and evidence -informed innovations so that outcomes shown in research are
achieved and sustained.
1.22. LIA means local implementing agencies funded through the HVSA contracts that provide direct
home visiting services and tasked with establishing the local infrastructure necessary for successful
implementation and provision of the selected evidence -based HV research based or promising
programs.
1.23. Memorandum of Understanding (MOU) means an agreement, between Contractor and partners,
organizations, individuals, agencies and/or other entities in the local service area to provide
wraparound services, additional resources, in-kind services, and/or use of facilities to Contractor in
order to best meet the goals of the Local HVSA Program. MOUs will serve to leverage community
resources and address the existing service gaps and needs of participants and promote successful
implementation and operation of the Local HVSA Program.
1.24, MIECHV Program means the Maternal, Infant and Early Childhood Home Visiting Program
authorized through the federal government via HRSA.
1.25. Model Developer means an entity or its designee responsible for the development of an identified
evidence -based HV model for defining and monitoring fidelity to the model.
1.26. NFP means the Nurse -Family Partnership home visiting model. Nurse -Family Partnership (NFP),
definition can be found at the Nurse Family Partnership National Service Office,
www.nursefamilypartnership.org.
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 5 of 32
1.27. Potentially identifiable information means information that includes indirect identifiers which may
permit linking an individual to that person's health care information. Examples of potentially
identifiable information include:
1.27.1. birth dates;
1.27.2. admission, treatment or diagnosis dates;
1.27.3. healthcare facility codes;
1.27.4. other data elements that may identify an individual. These vary depending on factors such
as the geographical location and the rarity of a person's health condition, age, or other
characteristic.
1.28. Reflective Supervision —Reflective supervision is a distinctive form of competency -based
professional development provided to multidisciplinary early childhood home visitors that
emphasizes relationship development between home visitor and supervisor, between home visitor
and parent, and between parent and infant/toddler. Reflective supervision attends to the emotional
content of their work and how reactions to the content affect the work.
1.29. Service Area means the geographical area defined by geographic boundaries where the at -risk
community is located and where at -risk families reside or a specific people group who will be
served by Contractor.
1.30. State Model Lead means the HV program model representative that provides contractors with HV
services, supports and TTA in coordination with the Implementation HUB.
1.31. SOW means statement of work.
1.32. TANF means Temporary Assistance for Needy Families.
1.33. Thrive Washington means the private partner identified in RCW 43.215.130 the Washington Early
Learning Fund doing business as Thrive Washington that is responsible for supporting the HVSA
account by providing TTA through the Implementation Hub to LIAs.
1.34. TTA means Training and Technical Assistance and may include coaching and consultation
activities.
1.35. WorkFirst means the program for TANF families who are required to participate in certain work-
related activities.
2. Background
2.1. The Home Visiting Service Account (HVSA) is a legislatively mandated private- public partnership
(RCW 43.215.130) that funds high quality home visiting programs so that:
2.1.1. Children are healthier and better prepared for school
2.1.2. Parent-child bonds are stronger
2.1.3. Abuse and neglect are less likely
2.2. The account prioritizes funding towards meeting the needs of Washington's diverse populations,
particularly those families and communities demonstrating the highest needs.
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 6 of 32
3.
4
2.3. Ultimately, the HVSA is working to ensure that home visiting services are embedded in and
contribute towards comprehensive, high quality early childhood systems so that families have
access to high quality information, services and supports prenatally through Kindergarten entry.
2.4. Programs funded through the HVSA administered by DEL aim to improve the health and well-being
of at -risk families understanding there are windows of opportunity to influence family and child
development that occur in the context of community and society. Contractor shall implement the
HVSA-approved home visiting model with the intent of improving outcomes for participants and
strengthening coordination of services.
Model Fidelity
3.1. The intent of this contract is for Contractor to maintain fidelity to the Nurse Family Partnership
(NFP) program model. Model fidelity is defined as a program's adherence to specified criteria and
components on an on-going basis as described by the NFP Model Developer. For home visiting
programs that are not evidence based, the promising practices Contractor will work with a DEL -
authorized provider of technical assistance to establish model fidelity indicators in the first quarter of
this contract and adhere to these requirements throughout the term of this contract.
3.1.1. National Model Standing: Contractor will ensure adherence to NFP program model
standards for the duration of this contract, as indicated through a written letter with
certification of good standing status and/or active, ready to implement status from the NFP
National Service Office.
3.1.2. Enhancements or adaptations to home visiting model: Adaptations or enhancements are
not allowed with this contract unless with prior written approval by the model developer and
DEL.
Staffing, Supervision and Training
4.1. Staffing Plan: Contractor agrees to maintain staffing sufficient to fulfill project goals and objectives
through adherence to the staffing plan outlined as follows:
Staffing Plan by Position Type
Home Visitor FTE Total
HV Supervisors FTE Total -- dedicated to
delivering home visiting services
Supervisor FTE Total -- supervision time
Admin Support Staff FTE Total
a. HVSA-
b. HVSA-
c. HVSA-
e. HVSA
MIECHV
TANF
Other State
Total
Funded
Funded
Funded
1.45
1.45
0.05 10.05
0.1010.20
0.10
0.20 0
4.2. Home Visiting Supervisor and Home Visitor Qualifications: Contractor agrees to minimally adhere to
the NFP program model home visitor supervisor and staffing qualification requirements; if no model
requirements exist, Contractor will work with the DEL -authorized provider of technical assistance to
establish qualifications in the first quarter of this contract, specify them in the model fidelity letter
referenced in Section 3.1.1, and adhere to these requirements throughout the term of this contract.
For a definition of DEL -authorized technical assistance, see Section 11.
4.3. Sub -Contracting: With prior approval from DEL, Contractor may hire directly or subcontract with
clinical staff, other support staff, or consultants to provide topic -specific expertise or clinical support
to home visiting staff. If Contractor hires clinical staff or contracts out for other support services,
Contractor will be required to adhere to model requirements and provide periodic updates on the
activities carried out by the clinical staff, consultant, and/or subcontract.
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 7 of 32
4.4. Background Checks: Due to the confidential nature of the client information that will be accessible
to Contractor, Contractor shall conduct background checks on home visiting staff prior to
performing work and maintain in employee files.
4.5. Supervision: Contractor agrees to adhere to NFP program model supervision requirements as
follows:
4.5.1. Supervision Ratios: Contractor agrees to meet or exceed the NFP program model
requirements for the ratio of supervisors to home visitors; if no model requirements exist,
Contractor will work with a DEL -authorized provider of technical assistance to establish
qualifications in the first quarter of this contract and adhere to these requirements
throughout the term of this contract.
4.5.2. Supervision Schedule Hours: Contractor agrees to maintain or exceed the following
supervision schedule:
4.5.2.1. Two (2) hours per month of individual reflective supervision for each home visitor
working .5 FTE or more; and
4.5.2.2. One (1) hour per month of group supervision, case conferencing, or staff meetings
for all home visitors;
4.5.2.3. Adequate monthly one-on-one administrative and clinical supervision; DEL
recommends a minimum of one (1) hour per month to each home visitor working
0.5 FTE;
4.5.2.4. Contractor may come to mutual agreement with DEL for alternative supervision
schedules, subject to written notification.
4.6. Staff Training and Ongoing Professional Development: Contractor will ensure that all home visitor
and supervisor staff adhere to the training requirements established by the model developer and
the HVSA. Upon request, Contractor will deliver documentation of the following:
4.6.1. All newly hired home visitors, supervisors, and coordinators completion of required model
training before working independently with HVSA enrolled families.
4.6.2. All home visitors, supervisors and coordinators remain up-to-date in the professional
development and continuing education required by the NFP model, and the HVSA—to
include, but not limited to, data collection, Continuous Quality Improvement, the
NEAR@Home Toolkit, and Facilitating Attuned Interactions (FAN).
4.7. HVSA Orientations and Meetings: Contractor agrees that, at a minimum, one lead staff person or
the home visiting program manager will participate in all HVSA statewide meetings conducted in
Washington State to include:
4.7.1. The DEL HVSA Orientation Webinar to occur in the first quarter of the contract period on a
date to be determined.
4.7.2. At least two (2) full-day HVSA Semi -Annual Statewide Meetings held in Washington State
in the greater Seattle/Tacoma area on dates to be determined;
4.7.3. Up to three (3) NFP Supervisor Meetings in locations and on dates to be determined;
4.8. Staff Retention Practices: To assure continuity of high quality service delivery, Contractor will
develop and implement policies and practices to recruit and retain qualified staff in the home visitor
and supervisor positions.
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 8 of 32
4.9. Staffing Vacancy Plans: In the event of short- and long-term vacancies, Contractor agrees to
establish and implement vacancy plans to fill vacant home visitor and supervisor positions to
ensure continuity of home visiting services, minimal client turnover, and adequate supervision
5. Service Area and Recruitment of Priority Populations
5.1. Service Area: Contractor agrees to deliver home visiting services to at risk families, as defined in
Section 5.2. below, who reside in the following counties or sub -county areas:
5.1.1. Jefferson and Kitsap Counties
5.2. Priority Population: Contractor agrees to sustain internal practices to serve participants from among
the HVSA Priority Populations. Priority Populations are defined as eligible participants with multiple
of the following characteristics:
5.2.1. Demographic Characteristics:
5.2.1.1. American Indian/Alaskan Native Non -Hispanic
5.2.1.2. Poverty/Low Income
5.2.1.3. Teen Parents
5.2.1.4. Non-English Speaking or Recent Immigrant
5.2.1.5. Enrolled in WorkFirst/TANF
5.2.2. Adverse Experiences
5.2.2.1. Prior Child Welfare System Involvement
5.2.2.2. Intimate Partner Violence
5.2.2.3. Familial History or current experience with Substance Use, including Tobacco
5.2.2.4. Parent Mental Illness
5.2.2.5. Current and Previously Incarcerated Parents
5.2.2.6. Homeless/Unstable Housing
5.2.3. Other Characteristics
5.2.3.1. Parents with Low Educational Attainment
5.2.3.2. Parents with Disabilities
5.2.3.3. Families currently or formerly in the Military
5.2.3.4. Children with Disabilities, especially those not linked with early intervention
services
5.3. In alignment with model fidelity, Contractor agrees to create and implement an outreach plan to
reach families to be served from among the priority populations. Contractor agrees to document
outreach efforts and referral sources for potential and enrolled participant including those who
decline services; outreach and referral sources will be recorded in the NFP model data system,
currently Efforts to Outcomes (ETO). Contractor agrees to analyze whether outreach efforts are
successfully reaching target populations and communicate via quarterly reports when barriers occur
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 9 of 32
reaching the target population. Any proposals to adapt the priority population would need to be
supported by community data and approved by DEL.
6. Participant Enrollment, Retention, and Caseload Maintenance
6.1. Plan for Recruitment of Participants: Contractor agrees to establish and implement a
comprehensive plan aligned with the NFP program model for participant recruitment, engagement,
and retention to ensure ongoing enrollment of priority populations specified in section 5.
6.2. Voluntary Services: Through program policies and procedures, Contractor will assure that home
visiting services are provided on a voluntary basis. For every participant enrolled, Contractor must
document via a consent form or participant agreement that expectant parents, parents or caregivers
agree to voluntarily enroll in home visiting services. Consent forms or participant agreements must
explicitly state that home visiting services are voluntary, and the consent must be signed and dated
by the participant upon enrollment. Consent forms must be maintained in the participant file in
paper or electronic form. Consent forms should be written in plain language and be available in
multiple languages. When potential participants have barriers with literacy, the consent should be
explained in the participant's primary language, which may require interpretation. When
interpretation is utilized, signatures should be obtained on the consent form from the interpreter,
whenever possible. Sample consent form(s) for voluntary services and data sharing (9.4.2) are
available at www.del.wa.gov\homevisiting.
6.3. Active Caseload Threshold: Contractor will build and maintain an active participant caseload in
accordance with NFP model requirements. Throughout the duration of this contract, Contractor
agrees to target an active Maximum Service Capacity of 37 -families and -maintain a minimum Active
Enrollment Caseload of 85% of those families, or 31 families.
6.3.1. Maximum Service Capacity is defined as the highest number of families or households that
could potentially be enrolled at any point in time if the program were operating with a full
staff, as described in Section 4.1.
6.3.2. Active Enrollment Caseload is defined as including those enrolled with some enrollment
time during the report period and have completed a home visit within 90 days of the end of
the report period. Client may have entered or exited services within that report period.
6.3.3. Contractor's Minimum Active Enrollment Caseload will be calculated each quarter using the
number of families actively enrolled during the quarter divided by the total number of
Maximum Service Capacity.
6.3.4. If Contractor's Active Enrollment Caseload falls below 85% of the Maximum Service
Capacity DEL will initiate the improvement process outlined in Attachment 3.
6.4. Policies and Procedures for Participant Enrollment, Disenrollment, Re -Enrollment, and Transfer:
Contractor agrees to develop and maintain written policies and procedures in alignment with model
fidelity for the following:
6.4.1. Enrollment and Disenrollment: Describing timeline and process for dis-enrolling families
upon graduation as well as what measures are taken and the timeline when contact with a
family is lost. If a model allows an alternative visit schedule, Contractor must have
documented procedures for how alternative visit schedules are determined and approved.
6.4.2. Re -enrollment: Describing the process for responding to families who reapply for program
participation to allow for re -enrollment in the program. Procedures should include an
assessment of prior program participation, and upon re -enrolling, programs will have a
system for determining if/how re -enrollment impacts timelines for program curriculum,
assessment, and services as well as how families are re -oriented to program. Programs
should allow for re -enrolling families when eligible by model and when appropriate.
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 10 of 32
6.4.3. Avoiding Dual Enrollment: Describing the processes to assess prior and current
participation in home visiting services of families upon application for enrollment. If a family
is currently enrolled in an another HVSA funded program or model, in dialogue with the
family, Contractor's staff will determine which program is most appropriate to meet the
families circumstances and the family will remain in the previous program or seamlessly be
transitioned into the new program. In general, if the family is meeting participation
expectations in the original enrollment, enrollment should be maintained in the original
program. When there is a clinical need or planned service transition for dual enrollment,
Contractor will document this need in the client file and the plan for coordination of
services. Contractor will develop and implement policies and procedures to seamlessly
transfer enrolled families to alternate home visiting models if it best meets the interests and
needs of the family and considers risks to disrupting an existing positive relationship
between home visitor and family. When there are multiple HVSA funded contracted
programs or models in the same service area, it is recommended that the Contractor
develop a formal agreement with each program, such as a Memoranda of Understanding,
to describe how the organizations will coordinate recruitment and enrollment of home
visiting services.
7. Home Visits Frequency and Content
7.1. Frequency of Home Visits: Contractor agrees to deliver the number of home visits to families based
on the NFP program model requirements. If there are no model requirements, Contractor will
develop a definition of frequency with Thrive Washington and describe this in the model fidelity
letter cited in Section 3.1.
7.1.1. As outlined in Attachment 4 Contractor agrees to work towards adhering to model expected
dosage and administer at a minimum an average of 65% or higher of expected home visits
per month for enrolled families,
7.2. Assessments, Service Content, and Referrals: Contractor will administer individualized
assessments of participant families, and services will be provided in accordance with those
individual assessments, families' strengths and needs, and ensuring compliance with the NFP
model requirements.
7.2.1. Screenings: Contractor agrees to administer screenings with the frequency in fidelity to the
NFP program model requirements and HVSA aligned measures.
7.2.2. Referrals: Contractor agrees to refer participants to services needed as identified by
individual assessments and to document referrals and results of referrals in participant's
file.
8. Systems Connections
8.1. Local Engagement and Collective Impact: Contractor agrees to participate in local and regional
early learning coalitions and other initiatives to support, coordinate and build connections among
local early childhood partners, early intervention, Early Supports for Infants and Toddlers, child
welfare, economic support services, and the Community Wellness and Prevention Initiative. DEL
recommends Contractor develop Memoranda of Understanding with the Early Supports for Infants
and Toddlers (ESIT), early intervention service providers, Early Childhood Education and
Assistance Program, child welfare services, other non-HVSA home visiting programs and early
learning providers within the service area to describe the role of each partner in service
coordination, referrals, information sharing, and family transitions.
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 11 of 32
9. Data Collection and Evaluation Requirements
9.1. Evaluation Purpose and Overview: The HVSA data collection and evaluation are designed to tell
the story of home visiting in Washington State, understand how home visiting is working, and how it
contributes to an early learning system that ensures all children start life with a solid foundation for
success. The HVSA also accounts to federal, state, and private funders for the impacts of these
investments.
While DEL is the administrator of the HVSA, DEL contracts with the Department of Health to lead data
collection, management, data sharing, quality assurance, reporting and supports for continuous quality
improvement and overall HVSA evaluation efforts. DOH is the DEL -specified contractor for data
management and reporting.
9.2. Data Collection: Contractor will ensure data collection that meets model requirements and the
HVSA, as outlined in Attachment 4, for all families, adults and children enrolled in home visiting
services, which include the measures summarized below and defined in Attachment 4:
9.2.1. Performance Measures:
9.2.1.1. System and Program Performance Indicators;
9.2.1.2. Enrollment and Service Utilization;
9.2.1.3. Demographic Information; and
9.2.1.4. Performance Payment Awards Performance Payment Measures.
9.3. Data Management: Contractor agrees that data will be collected and entered in NFP data system
accurately, timely and stored with appropriate safeguards to ensure protection of client information
according to the following standards:
9.3.1. Data Accuracy: Data should accurately represent the experience of the client; required
screenings and assessments should be administered as designed. This includes assigning
all clients a funding code as designated by DOH (see Section 9.4 for data share
requirements).
9.3.2. Timely Data Collection: Data will be collected adhering to the Performance Measures
requirements outlined in Attachment 4 and entered into NFP data system within five
business days of data collection.
9.3.3. Data Security: Electronic and paper data should be maintained in secure locations and
available only to those with a business need for the data; Contractor must maintain
procedures that do not place individuals at risk of harm and comply with applicable
confidentiality provisions, such as HIPAA and FERPA.
9.4. Data Sharing: Contractor agrees to share data necessary to meet data collection requirements
specified in section 9.2 with DEL's contractor of record, DOH.
9.4.1. Data Sharing Agreement (DSA):
Contractor agrees to execute a data sharing agreement with DOH to share direct
identifiable demographic information, enrollment, service utilization, program performance
and staffing data on or before July 30, 2017. Additionally, Contractor will provide
documentation of execution of data sharing with DOH to the NFP National Service Office
by July 30, 2017.
9.4.1.1. The Contractor shall maintain a data -sharing agreement with DSHS for all staff to
access the eJas.
Contract Number: 18-1047
Printed Date: 7/18/2017 Page 12 of 32
9.4.2. Parental Consent: With consultation and support from DEL and DOH, Contractor will make
every effort to seek Parental Consent to share direct identifiable data with DOH during the
contract period; Contractor agrees to seek this consent from all currently enrolled families
within the first six (6) weeks of the contract period and from all newly enrolled families
within the first three home visits. Sample consent form(s) for voluntary services (Section
6.2) and data sharing (Section 9.4) are available at www. del. wa.gov\homevisiting.
9.4.2.1. Parental Consents for voluntary services and data sharing maybe combined.
9.4.2.2. Families who do not provide consent to share identifiable data remain eligible to
receive home visiting services.
9.4.2.3. For those participants who do not consent to share identifiable data, Contractor
agrees to deliver to DOH a list of client IDs and required de -identified data.
9.5. Quality Assurance: the Contractor will make every effort to assure that data provided to DOH is
complete and accurate. The Contractor will use DOH reports of Contractor's data completion to
make corrections to data.
9.5.1. Contractor will respond to any requests from DOH to resolve any errors or missing data
needed for performance measures within 15 business days.
9.5.2. Contractor will strive for less than five percent missing data of all data required in Section
9.2.
9.5.3. Contractor agrees to review data reports prepared by DOH to facilitate reflection and
quality assurance and improvement efforts.
9.6, Evaluation: Contractor is required to participate in and cooperate with HVSA, DEL and DEL -
specified evaluations. This will include responding to emerging and non -routinize data and
evaluation requests from funders of the HVSA and working with DEL specified contractors.
Evaluation activities include but are not limited to interviews, focus groups, observations and
surveys and may involve:
9.6.1 The Home Visiting Workforce Study and its evaluation required by the MIECHV Innovation
Grant, which focuses on recruiting and retaining a high quality home visiting workforce and
includes working with DEL specified contractors, including but not limited to Portland State
University and other vendors.
9.6.2. Completing all documentation required by the research projects within the timeframes
provided; DEL will provide advanced notice to Contractor of additional requirements
whenever possible.
9.7. Training and Technical Assistance on Data Collection and Evaluation: Contractor agrees to
participate in and cooperate with training and technical assistance related to the topics listed below.
Participation may include in-person and remote meetings, staff training, technical assistance
opportunities, and reviews of data, reports and organizational policies/procedures. DOH is available
to support Contractor in working towards and achieving contract milestones on numerous topics
including, but not limited to the following:
9.7.1. Data sharing
9.7.2. Data collection
9.7.3. Reporting process
9.7.4. Analysis and interpretation of data
9.7.5. CQI planning and processes
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 13 of 32
9.7.6. Quality assurance
10. Continuous Quality Improvement (CQI)
10.1. Purpose: The purpose of Continuous Quality Improvement (CQI) is to improve outcomes for
families engaged in home visiting services. CQI activities will be designed around home visiting
teams' practices, utilize program data, and improve the program's quality and outcomes over time.
CQI is prospective and inherently testing new strategies that may not always result in improved
services. Building CQI into regular practice may require Contractor to assess overall organizational
culture for quality, and DEL recognizes this may be new to Contractor; therefore, DEL will not
monitor Contractor for CQI outcomes but rather for progress on implementing the CQI Team and
Plan as outlined in this Statement of Work.
10.2. Training and Technical Assistance: Contractor agrees to participate in ongoing training and
technical assistance associated with CQI including quarterly phone calls lasting at least one hour
and topic specific group bi-monthly calls lasting at least one hour. DEL -specified contractors
providing this training and technical assistance include Thrive and DOH who will also support
Contractor on development measures, quarterly data reports for the selected CQI measures, and
CQI Toolkit for use in implementing the CQI Projects.
10.3. CQI Projects: Contractor agrees to develop and implement at least two (2) CQI Projects during this
contract term. The CQI Project periods are July 1, 2017 through December 31, 2017 and January ,
2018 through June 30, 2018. Each CQI Project will include the following:
10.3.1. CQI Team—establish an internal CQI staff team established by the Contractor to oversee,
support, and implement CQI activities to assess program processes and outcomes; the
CQI Team membership may change depending upon the focus of the CQI Project.
10.3.2. CQI Charter and Plan—implement, at minimum, the project SMART Aim, CQI Team
Members, and the initial project plan, as defined in Attachment 5 and available at
www.del.wa.govlhomevisiting. CQI Charter and Project 1 Plan are due to DEL on or before
August 25, 2017, and CQI Charter and Project 2 Plan are due to DEL on or before
February 25, 2018.
10.3.3. Improvement Cycles—implement at least two (2) Plan, Do, Study, Act (PDSA) cycles each
project period.
10.3.4. CQI Topics—utilize one of the following four topics for each CQI Project, unless otherwise
approved by DEL:
10.3.4.1. Maternal Depression Screening—completion of screening, referral and connection
to appropriate services;
10.3.4.2. Intimate Partner Violence Screening—completion of screening, referral and/or
connection to services;
10.3.4.3. Family Engagement—increasing length of participation or frequency of completed
visits;
10.3.4.4. Parent Child Interaction—completion of assessment of positive parenting
behaviors using a validated Parent -Child Interaction tool;
10.3.4.5. Other Topic—to be approved by DEL.
10.3.5. Reporting and Deliverable—report on the CQI Project progress and results using the CQI
Quarterly Report Templates described in Attachment 5 and available at
www.del.wa.gov\homevisiting; submit the reports to DEL with the Quarterly Progress
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 14 of 32
Reports and share with DOH and Thrive for review and feedback during the quarterly CQI
calls.
11. Technical Assistance
11.1. Technical Assistance (TA) is available to Contractor to assist in maintaining model fidelity,
implementing best practices, and assuring and improving quality of home visiting service delivery.
DEL contracts with Thrive Washington (Thrive) to provide of technical assistance for the HVSA. The
Contractor agrees to work with DEL's designated provider of technical assistance for support in
achieving contract milestones including, but not limited to, the following areas:
11.1.1. Program model fidelity
11.1.2. Staff qualifications, and selection and onboarding of home visitors and supervisors
11.1.3. Reflective supervision process
11.1.4. Staff retention and vacancy planning
11.1.5. Participant outreach and recruitment
11.1.6. Model specific service delivery and case planning
11.1.7. Leadership development and organizational support for home visiting model
11.1.8. CQI planning, implementation and analysis
11.2. Technical Assistance Plan: Contractor agrees to collaborate with the DEL -specified contractor for
technical assistance during the contract term to including development of a Technical Assistance
Plan during quarter 1.
11.3. Technical Assistance and Coaching: Contractor agrees to participate at minimum in monthly one-
hour Technical Assistance/Coaching calls and up to three (3) technical assistance site visits with
the DEL -specified Technical Assistance provider.
12. Budget and Financial
12.1. Program -Funding Specific Budget: Contractor agrees that funds provided under this contract will be
expended by June 30, 2018 as specifically itemized line by line in Exhibit B, and that transfers
within expense categories of the budget in excess of 10% of the contract amount for each funding
source (column) will not be made without prior written approval from DEL and may require a
contract amendment.
12.2. Supplantation: Contractor shall ensure that HVSA funds received under this contract will be used to
supplement and not supplant the amount of federal, state, and local funds otherwise expended for
work performed under this Contract.
12.3. Travel: Contractor shall receive compensation only for lodging, per diem, and meal expenses at
current state travel reimbursement rates and in accordance with the State of Washington Office of
Financial Management Travel Regulations. Current rates for travel may be accessed at:
.ZZWww.ofm.wo.acvlresaurcesltraveLnsn. When the lowest available lodging rate exceeds the
current state travel reimbursement rates, an exception may be made and when pre -approved in
writing by Contractor's fiscal authority, documented, and available for review. Travelers must be
prudent when planning and conducting essential business travel, ensuring they select travel
alternatives that are the most economical. Appropriate planning must take place to avoid
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 15 of 32
unnecessary travel in the performance of work assignments, seeking alternatives such as
teleconference calls, video and web collaboration and conferencing. Contractor's travel policy is
subject to review during ongoing or in-depth fiscal monitoring.
12.4. Indirect Costs: Contractor may either claim the indirect rate negotiated with its cognizant federal
agency (also known as the federally approved cost allocation plan) or an indirect rate that does not
exceed 10% of modified total direct costs.
12.4.1. If claiming the federally negotiated rate, Contractor must supply the documentation
verifying the federally approved rate. Contractor's indirect rate plan and procedure are
subject to review during ongoing or in-depth fiscal monitoring.
12.4.2. Contractor's indirect cost plan must comply with the CFR part 200.56.57 and 200.414
Certification of cost allocation plan or indirect (facilities & administrative (F&A)) cost rate
proposal. The CFR can be found at the following link: http.IAvww.ecfr.gov/cgi-bin/text-
idx?SID=89e31 f63d8c85ba9e4f7a6a7fd6fdea5&mc=true&node=se2.1.200 156&rgn=div8
and http.lAvww.ecfr.gov/cgi-bin/text-
idx?SID=89e31 f63d8c85ba9e4f7a6a 7fd6fdea5&mc=true &node =se2.1.200 1414&rgn=div8
12.5. Performance Payment Awards: During the term of this contract, Contractor will receive an
additional $500 per quarter for achievement of each of the following Performance Milestones
described in 12.5.4 below within that quarter.
12.5.1. DEL will review data provided by Contractor and DOH to confirm achievement of both
milestone with Contractor prior to issuance of any Performance Payment Award.
12.5.2. Contractor may receive up to a total of $4,000 in Performance Payment Awards within the
contract term as detailed in the Budget Exhibit B and distributed with reimbursements for
invoices submitted for months 3, 6, 9, and 12.
12.5.3. Funds received for Performance Payment Awards must be used to advance the goals of
the home visiting program in this contract.
12.5.4. Performance Milestone- Quarterly Enrollment: $500 per quarter, up to a total of $2,000
during the contract term, will be provided as a Performance Payment Award upon the
fulfillment of the following performance measure
12.5.4.1. Contractor maintains an average Active Enrollment Caseload of 90% or higher, of
their Maximum Service Capacity during the quarter, as measured by the number
of families actively enrolled on the 15th of Month 1, Month 2 and Month 3 of the
quarter divided by the Maximum Service Capacity (total number of possible
families), or 33.3 families.
12.5.5. Performance Milestone: Home Visiting Dosage: $500 per quarter, up to a total of $2,000
during the contract term, will be provided as a Performance Payment Award upon the
fulfillment of the following performance measure:
12.5.5.1. Contractor maintains NFP dosage requirements for home visits for 70% of all
clients as measured by the proportion of enrolled clients that met the model
defined dosage expectation during the time the client was enrolled during report
period. See Attachment 4 for model defined dosage expectation.
12.6. Financial Reporting and Documentation:
12.6.1. Contractor agrees to submit, at least monthly and not more often than semi-monthly, a
properly completed A-19 Voucher accompanied by the following documentation of the
actual expenses incurred during that period, as described below:
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 16 of 32
12.6.1.1. Monthly or Semi-monthly Expense Summary by fund source (e.g. State) as
produced by Contractor's accounting system and clearly detailing expenses
incurred for each Pay Point in that period's A-19 Voucher;
12.6.1.2. Contractor's Monthly or Semi-monthly Payroll Summary by fund source (e.g.
State) describing reimbursed hours for each staff person paid under the contract
for that period; and
12.6.1.3. Documentation supporting all single expenses exceeding $5,000 by fund source
(e.g. State).
12.6.2. Payment is based upon approval of financial expenditures using the billing submission
procedure outlined in this contract, with the total payment not to exceed what is set forth in
Exhibit B Budget.
12.6.3. In -Depth Financial Review: DEL will conduct an in-depth financial review annually of
Contractor's expenditures charged to the contract. In preparation for the Annual Site Visit,
Contractor agrees to provide, upon request, the financial documents listed below. Based
upon this review, if questions arise, DEL may request additional data and documentation.
12.6.3.1. Contractor's most recent Annual Financial Audit/A-133 Audit;
12.6.3.2. Contractor's most recently submitted IRS Form 990;
12.6.3.3. At least one month, with the month specified by DEL, General Ledger detail for
Substantiation Testing;
12.6.3.4. Detailed financial documentation including specified payroll/timesheets, travel,
and major expense documentation upon request;
12.6.3.5. Other financial documentation and information, to be determined
13. Publicity, Publication and Acknowledgements
13.1. DEL may include information on this Contract in their periodic public reports and may make
information about this Contract public at any time in their web pages and as part of press releases,
public reports, speeches, newsletters, and other public documents related to the Contract or the
HVSA. DEL is obligated to Washington State public disclosure law (RCW 42.56) and to comply with
regulations set forth in HIPAA and FERPA.
13.1.1. If Contractor wishes to issue a press release or public report announcing this contract, or
otherwise use DEL's name or logo for purposes related to this Contract, Contractor agrees
to contact the DEL Contract Manager, identified on page 1 of this Contract at least five (5)
business days before the desired announcement or publication date to obtain advanced
approval.
13.1.2. Contractor also agrees to include the name and logo of DEL and that the project is funded
through the State of Washington, Washington Department of Early Learning Home Visiting
Services Account in such media related to the project.
14. Contract Reporting, Monitoring, and Deliverables
14.1. The most current version of the following implementation elements and contractor requirements are
further detailed in the HVSA Implementation Policies and Procedures Manual online at
www.del.wa.gov\homevisiting. DEL will advise Contractor when updates to this manual are made at
least 10 (ten) business days prior to their taking effect. Any mention of quarters one through four
referenced in this document are defined as:
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 17 of 32
14.1.1. Quarter 1 — July 1, 2017 to September 30, 2017
14.1.2. Quarter 2 — October 1, 2017 to December 31, 2017
14.1.3. Quarter 3 — January 1, 2018 to March 31, 2018
14.1.4. Quarter 4 — April 1, 2018 to June 30, 2018
14.2. Reporting: Contractor agrees to submit program and expense reports, as well as perform all other
requirements outlined in this Statement of Work, on or before the dates indicated in Exhibit D. Due
dates may be adjusted atthe discretion and approval of the DEL Contract Manager to
accommodate the variable reporting structures associated with federal funding requirements. DEL
reserves the right to aggregate, disaggregate, analyze, reproduce, and/or disseminate the data
provided in Program Reports, Financial Activity Reports, or any other reports submitted to DEL with
respect to the Contract.
14.2.1. While this contract funding ends June 30, 2018, deliverables describing services rendered
in the months of the contract term will be due no later than July 31, 2018 and will be
submitted at no additional cost to DEL.
14.3. Monitoring: As described in Attachment 3, throughout the term of this contract, DEL will monitor
compliance with contract requirements, model standing, progress toward completion of
deliverables, enrollment performance, and financial activity through review of submitted reports,
monthly phone calls, and meetings with Contractor.
14.3.1. Contractor agrees to participate in at least one monitoring site visit on a mutually agreed
upon date.
14.3.2. If DEL (a) encounters non-compliance with the terms outlined in this contract on the part of
Contractor, or (b) is not satisfied, in its sole discretion, with the quality of Contractor's work,
DEL will follow to make a reasonable attempt to assist Contractor with technical assistance
to resolve issues that impede quality and compliance. In the event that compliance and/or
quality issues are not resolved through standard technical assistance, Contractor will be
engaged in corrective action through Implementation Improvement processes, as outlined
in Attachment 3.
14.4. Summary Deliverables and Timelines
14.4.1. Monthly Reports: Contractor will submit Monthly Enrollment Data Reports no later than the
25th day following the month of service outlined in Attachment 6 and available at
www. del.wa.gov\homevisitin.
14.4.2. At least monthly A-19 Invoice, accompanied by financial documentation detailed in Section
12.
14.4.3. Quarterly Reports: Contractor will submit four (4) Quarterly Progress Reports no later than
30 days following the end of each quarter outlined in Attachment 7 and available at
www.del.wa.gov\homevisiting.
14.4.4. Annual Pre -Contract Questionnaire. Contractor agrees to complete and submit the HVSA
Pre -Contract Questionnaire with the Q3 Report, detailing organizational summary, a
program implementation plan and a budget for the subsequent contract year. The Pre -
Contract Questionnaire Template will be available at www.del.wa.gov\homevisiting.
14.4.5. Table of Deliverables and Timelines. Exhibit D outlines the reporting timeline and
deliverables presented in this statement of work according to their timeline. Some
deliverables associated with this contract, including the HVSA Semi -Annual Statewide
Meetings and Supervisor Meetings are not included in this table as the dates of these
events will be determined after contract execution.
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 18 of 32
9"& Washington State Department of
n Early Learning
Exhibit B - BUDGET
State Fiscal Year 2018 (July 12017 - June 30 2018):
Payment Point
1. STATE- Personnel
2. STATE- Goods and
Services
3. STATE- Travel
4. STATE- Contracted/
Professional Services
5. STATE -
Administrative/ Indirect
Charges
6. STATE- Performance
Pay
DEL Contract Number: 18-1047
Contractor Contract Number:
Title: Home Visiting Services Account:
Nurse Family Partnership (NFP)
Budget Limit Note
$70,594.66
$996.34
$1,738.09
$87,500.00
$16,082.91
$4,000.00
Total: $180,912.00
Contract Maximum: $180,912.00
Contract Funding Source(s)
State Funds $180,912.00
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 19 of 32
M'& Washington State Department of
a Early Learning
1. AMENDMENTS
DEL Contract Number: 18-1047
Contractor Contract Number:
Title: Home Visiting Services Account: Nurse
Family Partnership (NFP)
Exhibit C - GENERAL TERMS AND CONDITIONS
This Contract may be amended by mutual agreement of the parties. Such amendments shall not be binding
unless they are in writing and signed by personnel authorized to bind each of the parties.
2. ASSIGNMENT
Neither this Contract, nor any claim arising under this Contract, shall be transferred, delegated, or assigned
by the Contractor without prior written consent of DEL.
3. ATTORNEY'S FEES
In the event of litigation or other action brought to enforce this Contract, each party agrees to bear its own
attorney fees and costs.
4. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND INELIGIBILITY
If federal funds are the basis for this Agreement, the Contractor certifies that neither it nor its principals are
debarred, suspended, proposed for debarment, or voluntarily excluded from participation in transactions by
any federal department or agency. The Contractor further certifies that they will ensure that potential
subcontractors or subrecipients or any of their principals are not debarred, suspended, proposed for
debarment, or voluntarily excluded from participation in "covered transactions" by any federal department or
agency. "Covered transactions" include procurement contracts for goods or services awarded under a non -
procurement transaction (e.g. grant or cooperative agreement) that are expected to equal or exceed $25,000,
and sub -awards to subrecipients for any amount. The Contractor may do so by obtaining a certification
statement from the potential subcontractor or subrecipient or by checking the "List of Parties Excluded from
Federal Procurement and Non -Procurement Programs" provided on-line by the General Services
Administration.
5. CHOICE OF LAW AND VENUE
This Contract shall be construed and interpreted in accordance with the laws of the State of Washington. The
venue of any action brought under this Contract shall be in the Superior Court for Thurston County.
6. COMPLIANCE WITH LAWS, RULES, AND REGULATIONS
6.1. Assurances
The Contractor agrees that all activity pursuant to this Contract will be in accordance with all applicable
current federal, state and local laws, rules, and regulations, including but not limited to the Public Records
Act (chapter 42.56 RCW), the Freedom of Information Act (5 U.S.C. 522) and the Records Retention Act
(chapter 40.14 RCW).
6.2. Child Health, Safety, And Well Being And Child Abuse Or Neglect
In the delivery of services under this Contract, children's health, safety, and well-being shall always be
the primary concern of the Contractor. Contractors shall fully comply with the mandatory reporting
requirements of RCW 26.44.030 pertaining to child abuse or neglect. In addition, pursuant this Contract,
when the Contractor has reasonable cause to believe that a child has suffered abuse or neglect at the
Contract Number: 18-1047
Printed Date: 7/18/2017
Page 20 of 32
hands of any person, the Contractor shall immediately report such incident to Child Protective Services
(CPS) Intake at 1-866-ENDHARM.
6.3. Civil Rights Laws
6.3.1.During the performance of this Contract the parties shall comply with all federal and state
nondiscrimination laws including, but not limited to chapter 49.60 RCW, Washington's Law Against
Discrimination, and 42 U.S.C. § 12101 et seq., the Americans with Disabilities Act (ADA).
6.3.2.In the event of the Contractor's or its subcontractors' noncompliance or refusal to comply with any
nondiscrimination law, regulation or policy, this Contract may be rescinded, canceled or terminated
in whole or in part, and the Contractor may be declared ineligible for further contracts with the DEL.
The Contractor shall, however, be given a reasonable time in which to remedy this noncompliance.
Any dispute may be resolved in accordance with the "Disputes" procedure set forth herein.
6.4. Conflict of Interest
6.4.1. Notwithstanding any determination by the Executive Ethics Board or other tribunal, the DEL may, in
its sole discretion, by written notice to the Contractor terminate this Contract if it is found after due
notice and examination by the DEL that there is a violation of the Ethics in Public Service Act,
Chapter 42.52 RCW, or any similar statute involving the Contractor in the procurement of, or
performance under, this Contract.
6.4.2.In the event this Contract is terminated as provided above, the DEL shall be entitled to pursue the
same remedies against the Contractor as it could pursue in the event of a breach of the contract by
the Contractor. The rights and remedies of the DEL provided for in this clause shall not be exclusive
and are in addition to any other rights and remedies provided by law. The existence of facts upon
which the DEL makes any determination under this clause shall be an issue and may be reviewed
as provided in the "Disputes" clause of this Contract.
6.5. Licensing, Accreditation and Registration
The Contractor and its subcontractors shall comply with all applicable local, state, and federal licensing,
accreditation and registration requirements/standards necessary for the performance of this Contract.
7. DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION
7.1. Scope of Protection
This Section (Section 7) applies to data, information, or materials related to the subject matter of this
Contract which is received, created, developed, revised, modified, or amended by the DEL, the
Contractor, or subcontractors. Such data, information, and materials shall include but is not limited to all
confidential information.
7.2. Use of Confidential Information
7.2.1.For data and confidential information collected, used, or acquired in connection with this Contract
the parties shall comply with the following:
7.2.1.1. All federal and state laws and regulations, as currently enacted or revised, regarding
data and confidential information protection, security; and
7.2.1.2. All federal and state laws and regulations, as currently enacted or revised, regarding the
use, disclosure, modification or loss of data and confidential information.
7.2.2.The DEL does not warrant or guarantee the accuracy of the data or confidential information
provided pursuant to this Contract. The Contractor understands all the risks and liabilities of the
use and misuse of the information provided pursuant to this Contract.
7.3. Confidentiality Protection
7.3.1.To safeguard the confidentiality of all confidential information and in addition to the requirements
contained in this Section (Section 7) the Contractor must:
7.3.1.1. Ensure that the Contractor, the Contractor's staff, subcontractors, and the
subcontractors' staff use confidential information solely for the purposes of accomplishing
the services set forth in this Contract.
7.3.1.2. Limit access to confidential information to the Contractor's staff and subcontractors' staff
requiring access for performance of their assigned duties.
Contract Number: 18-1047 Printed Date: 7/18/2017
Page 21 of 32
7.3.2. Require all Contractor's staff and subcontractors' staff with access to confidential information to sign
a Statement of Confidentiality and Non -Disclosure Agreement consistent with Attachment 2
Statement of Confidentiality and Non -Disclosure agreement.
7.3.3.Require the Contractor will maintain records of the statement of confidentiality and non -disclosure
agreements with signatures from all applicable staff. These records will be made available to DEL
upon request.
7.3.4.Notify its staff person(s) and ensure its subcontractors notify the subcontractors' staff person(s) of
the requirements of Section 6.1 (Assurances), and this Section (Section 7).
7.3.5.Ensure that personal information is not released, disclosed, published, modified, transferred, sold,
or otherwise made known to unauthorized persons without the prior written consent of the
individual named or as otherwise authorized by law.
7.3.6.Ensure that confidential information is protected from loss and from unauthorized physical or
electronic access.
7.3.7.Destroy all confidential information so that it cannot be accessed by unauthorized individuals and
cannot be recovered when the confidential information is no longer used for providing services
under this Contract, and retention is no longer required by the Records Retention Act (chapter 40.14
RCW) or Section 26 (Records Maintenance), whichever is longer. Unless the Washington State
Office of the Chief Information Officer IT Standards require a different method for the destruction of
confidential information, confidential information required to be destroyed under this section must be
destroyed as follows:
7.3.7.1. For paper documents containing data, but not confidential information, a contract with a
paper shredding firm is acceptable, provided the contract ensures that the confidentiality of the
data will be protected. Such documents may also be destroyed by on-site shredding, pulping,
or incineration.
7.3.7.2. For paper documents containing Confidential Information requiring special handling (e.g.
Protected Client Information) the documents must be destroyed by on-site shredding, pulping,
or incineration.
7.3.7.3. If data or confidential information has been contained on optical discs (e.g. CDs or
DVDs), the Contractor shall either destroy by incineration the disc(s), shredding the discs, or
completely deface the readable surface with a coarse abrasive.
7.3.7.4. If data or confidential information has been stored on magnetic tape(s), the Contractor
shall destroy the data or confidential information by degaussing, incinerating or crosscut
shredding.
7.3.7.5. If data or confidential information has been stored on server or workstation data hard
drives or similar media, the Contractor shall destroy the data or confidential information by
using a "wipe" utility which will overwrite the data or confidential information at least three (3)
times using either random or single character data, degaussing sufficiently to ensure that the
data or confidential information cannot be reconstructed, or physically destroying disk(s).
7.3.7.6. If data or confidential information has been stored on removable media (e.g. floppies,
USB flash drives, portable hard disks, or similar disks), the data recipient shall destroy the
data or confidential information by using a "wipe" utility which will overwrite the data or
confidential information at least three (3) times using either random or single character data,
degaussing sufficiently to ensure that the data or confidential information cannot be
reconstructed, or physically destroying disk(s).
7.3.8.Within fifteen calendar days after the completion of the requirements contained in Section 7.3.6 the
Contractor shall complete and deliver to the DEL a signed Certification of Data Disposition
(Attachment 1).
7.3.9.Paper records must be protected by storing the records in a secure 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.
7.3.10. Shall immediately notify the DEL after becoming aware of any potential, suspected, attempted
or actual breaches of security including, but not limited to, unauthorized access, use or
disclosure. The Contractor shall take all necessary steps to mitigate the harmful effects of such
breach of security. The Contractor agrees to defend, protect and hold harmless the DEL for any
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damages related to a breach of security by their officers, directors, employees, subcontractors or
agents.
7.4. Confidentiality Breach
In the event of a breach by the Contractor of this Section (Section 7 and in addition to all other
rights and remedies available to the DEL, the DEL may elect to do any of the following:
7.4.1.Terminate the Contract;
7.4.2. Require that the Contractor return all confidential information to the DEL that was previously
provided to the Contractor by the DEL;
7.4.3.Require that the Contractor destroy all confidential information so it cannot be accessed by
unauthorized individuals and cannot be recovered; or
7.4.4.Suspend the Contractor's on-line access to accounts and other information.
7.5. Public Disclosure
7.5.1.Either party to this Contract may designate certain Confidential Information as Confidential
Information/Notice Requested." This designation shall be made by clearly stamping, watermarking,
or otherwise marking each page of the Confidential Information. The p a r t y who owns the data
is responsible for informing the other p a r t y what it considers confidential.
7.5.2.If a third party requestor seeks information that has been marked "Confidential Information/Notice
Requested," notice shall be given to the marking party prior to release of the information. Such
notice shall be provided to the program contact no less than five business days prior to the date of
the disclosure, to allow the party objecting to disclosure to seek a protective order from the proper
tribunal.
7.6. Access to Data
7.6.1.In compliance with RCW 39.26.180, the Contractor shall provide access to data generated under
this Contract to DEL, the Joint Legislative Audit and Review Committee, and the State Auditor at no
additional cost. This includes, but is not limited to, access to all information that supports the
findings, conclusions and recommendations of the Contractor's reports, including computer models
and methodology for those models.
7.7. Definitions
As used throughout this Contract, the following terms shall have the meanings set forth below:
7.7.1."Confidential Information" means information that may be exempt from disclosure under either
chapter 42.56 RCW or other state or federal statutes. Confidential Information includes, but is not
limited to, personal information, agency source code or object code, and agency security data.
7.7.2."Converted Data" means the data which has been successfully converted by the Contractor for
processing by the DEL's computer system.
7.7.3."Data" means the DEL's records, files, forms, data, information and other documents in electronic or
hard copy form, including but not limited to Converted Data.
7.7.4."Personal Information" means information identifiable to any person, including, but not limited to,
information that relates to a person's name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, social security numbers,
driver license numbers, e-mail addresses, credit card information, law enforcement records or other
identifying numbers or Protected Health Information, any financial identifiers, and other information
that may be exempt from disclosure under either chapter 42.56 RCW or other state and federal
statutes.
7.8. Licensing, Accreditation and Registration
The Contractor and its subcontractors shall comply with all applicable local, state, and federal licensing,
accreditation and registration requirements/standards necessary for the performance of this Contract.
7.9. Noncompliance with Laws, Regulations, or Policies
The Contractor shall be responsible for and shall pay any fines, penalties, or disallowances imposed on
the State or Contractor arising from any noncompliance with the laws, regulations, policies, guidelines
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Printed Date: 7/18/2017
Page 23 of 32
and Collective Bargaining Agreements that affect the Services or Deliverables that are to be provided or
that have been provided by Contractor, its Subcontractors or agents.
7.10. Registration with Department of Revenue and Payment of Taxes
The Contractor must pay all taxes including, but not limited to, sales and use taxes, Business &
Occupation taxes, other taxes based on the Contractor's income or gross receipts, or personal property
taxes levied or assessed on the Contractor's personal property. The Contractor shall complete
registration with the Washington State Department of Revenue and be responsible for payment of all
taxes due on payments made under this Contract.
8. CONTINUED PERFORMANCE
If the DEL, in good faith, has reason to believe that Contractor does not intend to, or is unable to perform or
has refused to perform or continue performing all material obligations under this Contract, the DEL may
demand in writing that Contractor give a written assurance of intent to perform. Failure by Contractor to
provide written assurance within the number of days specified in the demand (in no event less than five
business days) may, at the DEL's option, be the basis for terminating this Contract under the terms and
conditions or other rights and remedies available by law or provided by this Contract.
9. COPYRIGHT
9.1 Unless otherwise provided, all Materials produced under this Contract shall be considered "works for hire"
as defined by the U.S. Copyright Act and shall be owned by the DEL. The DEL shall be considered the
author of such Materials. In the event the Materials are not considered "works for hire," under the U.S.
Copyright Laws, the Contractor hereby irrevocably assigns all right, title, and interest in Materials,
including all intellectual property rights, to the DEL effective from the moment of creation of such
Materials.
9.2 "Materials" means all items in any format and includes, but is not limited to, data, reports, documents,
pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or
sound reproductions. Ownership includes the right to copyright, patent, register and the ability to transfer
these rights.
10. DISALLOWED COSTS
The Contractor is responsible for any audit exceptions or disallowed costs incurred by its own organization or that
of its Subcontractors.
11. DISPUTES
In the event that a dispute arises under this Contract, it shall be determined by a Dispute Board in the
following manner: Each party to this Contract shall appoint one member to the Dispute Board. The members
so appointed shall jointly appoint an additional member to the Dispute Board. The Dispute Board shall
evaluate the facts, Contract terms, applicable statutes and rules, and make a determination of the dispute.
The decision shall not be admissible in any succeeding judicial or quasi-judicial proceeding concerning the
Contract. The Dispute Board shall precede any action in judicial or quasi-judicial tribunal. The cost of
resolution will be borne as allocated by the Dispute Board.
12. DUPLICATE PAYMENT
DEL shall not pay the Contractor if the Contractor has charged or will charge the State of Washington, or any
other party under any other contract or agreement, for the same services or expenses.
13. ENTIRE CONTRACT
This Contract, including referenced exhibits, represents all the terms and conditions agreed upon by the
parties. No other statements or representations, written or oral, shall be deemed a part hereof or to bind any
of the parties to this Contract.
14. EXPENSES
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All expenses not provided for specifically in this Contract shall be the responsibility of the Contractor unless
otherwise mutually agreed upon by the parties.
15. FEDERAL FUNDING REQUIREMENTS
15.1. Covenant Against Contingent Fees. If this Contract is funded, in whole or in part, with federal
funds, the Contractor warrants that no person or selling agent has been employed or retained to solicit or
secure this Contract upon an agreement or understanding for a commission, percentage, brokerage or
contingent fee, excepting bona fide employees or bona fide established agents maintained by the
Contractor for securing business. DEL shall have the right, in the event of breach of this clause by the
Contractor, to annul this Contract without liability or, in its discretion, to deduct from the Contract price or
consideration or recover by other means the full amount of such commission, percentage, brokerage or
contingent fee.
15.2. Single Audit Requirements. If the Contractor is a subrecipient of federal awards as defined by
Office of Management and Budget (OMB) 2 Code of Federal Regulations C.F.R. §200, the Contractor
shall maintain records that identify all federal funds received and expended. Such funds shall be
identified by the appropriate OMB Catalog of Federal Domestic Assistance (CFDA) Numbers. The
Contractor shall make the Contractor's records available for review or audit by officials of the federal
awarding agency, the General Accounting Office, DEL, and the Washington State Auditor's Office. The
Contractor shall incorporate OMB 2 C.F.R. §200 audit requirements into all contracts between the
Contractor and its Subcontractors who are subrecipients. The Contractor shall comply with any future
amendments to OMB 2 C.F.R. §200 and any successor or replacement Circular or regulation.
15.3. If the Contractor expends $750,000 or more in federal awards from any and/or all sources in any
fiscal year ending after December 26, 2014, the Contractor shall procure and pay for a single or
program -specific audit for that year. Upon completion of each audit, the Contractor shall submit to DEL's
Contract Manager the data collection form and reporting package specified in OMB 2 C.F.R. §200, and
any reports required by the program -specific audit guide (if applicable).
15.4. Certification of cost allocation plan or indirect (facilities & administrative (F&A)) cost rate proposal.
Each cost allocation plan or indirect (F&A) cost rate proposal must comply with the following:
15.4.1. A proposal to establish a cost allocation plan or an indirect (F&A) cost rate, whether submitted to
a Federal cognizant agency for indirect costs or maintained on file by the non -Federal entity, must
be certified by the non -Federal entity using the Certificate of Cost Allocation Plan or Certificate of
Indirect Costs as set forth in Appendices III through VII, and Appendix IX. The certificate must be
signed on behalf of the non -Federal entity by an individual at a level no lower than vice president or
chief financial officer of the non -Federal entity that submits the proposal.
15.4.2. Unless the non -Federal entity has elected the option under OMB 2 C.F.R. §200.414 Indirect
(F&A) costs, paragraph (f), the Federal Government may either disallow all indirect (F&A) costs or
unilaterally establish such a plan or rate when the non -Federal entity fails to submit a certified
proposal for establishing such a plan or rate in accordance with the requirements. Such a plan or
rate may be based upon audited historical data or such other data that have been furnished to the
cognizant agency for indirect costs and for which it can be demonstrated that all unallowable costs
have been excluded. When a cost allocation plan or indirect cost rate is unilaterally established by
the Federal Government because the non -Federal entity failed to submit a certified proposal, the
plan or rate established will be set to ensure that potentially unallowable costs will not be
reimbursed.
15.5. Certifications by non-profit organizations as appropriate that they did not meet the definition of a
major nonprofit organization as defined in OMB 2 C.F.R. §200.414 Indirect (F&A) costs, paragraph (a).
15.6. See also OMB 2 C.F.R. §200.450 Lobbying for another required certification.
16. FUNDING CONTINGENCY
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16.1. In the event funding from state, federal, or other sources is withdrawn, reduced, or limited in any
way after the effective date of this Contract and prior to completion of the work in this Contract, the DEL
may:
16.1.1. Terminate this Contract with ten (10) days advance notice. If this Contract is terminated, the
parties shall be liable only for performance rendered or costs incurred in accordance with the
terms of this Contract prior to the effective date of termination;
16.1.2. Renegotiate the terms of the Contract under the new funding limitations and conditions;
16.1.3. After a review of project expenditures and deliverable status, extend the end date of this Contract
and postpone deliverables or portions of deliverables; or
16.1.4. Pursue such other alternatives as the parties mutually agree to in writing
17. HEADINGS
The headings throughout this Contract are for reference purposes only, and the words contained therein shall
in no way be held to explain, modify, amplify or aid in the interpretation, construction or meaning of the
provisions of this Contract.
18. INDEMNIFICATION
18.1. To the fullest extent permitted by law, Contractor shall indemnify, defend and hold harmless
State, agencies of State and all officials, agents and employees of State, from and against all claims for
injuries or death arising out of or resulting from the performance of the Contract. Contractor's obligation
to indemnify, defend, and hold harmless includes any claim by Contractors' agents, employees,
representatives, or any subcontractor or its employees.
18.2. The Contractor expressly agrees to indemnify, defend, and hold harmless the State for any claim
arising out of or incident to Contractor's or any subcontractor's performance or failure to perform under
the Contract. The Contractor shall be required to indemnify, defend, and hold harmless the State only to
the extent claim is caused in whole or in part by negligent acts or omissions of Contractor.
18.3. The Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify,
defend and hold harmless State and its agencies, officials, agents or employees.
19. INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the performance of this Contract shall continue to
be employees or agents of that party and shall not be considered for any purpose to be employees or agents
of the other party
20. INSURANCE
20.1 Insurance Required
If the Contractor is currently covered under an insurance risk pool. Sections 20.5, 20.6, and 20.7 shall
only apply if the Contractor terminates coverage under the insurance risk pool and obtains a different form
of insurance consistent with this section (Section 20). The Contractor shall provide insurance coverage as
set out in this section. The intent of the required insurance is to protect DEL should there be any
claims, suits, actions, costs, damages or expenses arising from any negligent or intentional act or
omission of the Contractor or Subcontractors, or agents of either, while performing under the terms of this
Contract.
20.2 Eligible Insurance Companies
The insurance required by this Contract shall be issued by an insurance companyhes authorized to
do business within the state of Washington and have a rating of A-, Class VII or better in the most
recently published edition of Best's Reports. Any exception shall be reviewed and approved by the DEL
Risk Manager, or the Risk Manager for the State of Washington, before the contract is accepted
20.3 Cancellation
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The Contractor shall instruct the insurers to give DEL thirty (30) calendar days advance written notice
of any insurance cancellation or non -renewal.
20.4 Certificate of Insurance
The Contractor shall submit to the DEL within fifteen (15) calendar days of the Contract effective
date, a certificate of insurance that outlines the coverage and limits defined in the Insurance section,
herein. The Contractor shall submit renewal certificates as appropriate during the term of the
Contract.
20.5 Subcontractors
Subject to Section 20.1, the Contractor shall include all subcontractors as insureds under all
required insurance policies, or shall furnish separate certificates of insurance and endorsements for
each subcontractor. Subcontractor(s) must comply fully with all insurance requirements stated
herein. Failure of subcontractor(s) to comply with insurance requirements does not limit the
Contractor's liability or responsibility.
20.6 Additional Insured
Subject to Section 20.1, the State of Washington, DEL, its elected and appointed officials, agents
and employees shall be named as an additional insured on all general liability, excess, umbrella
and property insurance policies.
20.7 Primary Insurance
Subject to Section 20.1, all insurance provided in compliance with this Contract shall be primary to
any other valid and collectable insurance or self-insurance programs afforded to or maintained by the
State of Washington.
20.8 Insurance Coverage Limits
By requiring insurance herein, DEL does not represent that coverage and limits will be adequate
to protect the Contractor, and such coverage and limits shall not limit the Contractor's liability
under the indemnities and reimbursements granted to DEL in this Contract.
20.9 The Contractor shall provide insurance coverage, which shall be maintained in full force and effect during
the term of this Contract, as follows:
20.9.1 Commercial General Liability Insurance Policy. The Contractor shall maintain Commercial General
Liability ("CGL") Insurance, including contractual liability, and, if necessary, commercial umbrella insurance
with a limit of not less than $2,000,000 per each occurrence. If such CGL Insurance contains aggregate
limits, the general aggregate limit shall be at least twice the "each occurrence" limit.
20.9.2 Automobile Liability Policy. In the event that services delivered pursuant to this Contract involve
the use of vehicles, either owned or unowned by the Contractor, automobile liability insurance shall be
required. The minimum limit for automobile liability is $1,000,000 per accident, using a Combined Single
Limit for bodily injury and property damage.
20.9.3 Professional Liability Policy_. If services delivered pursuant to this Contract, either directly or
indirectly, involve or require providing professional services, than professional liability insurance shall be
required. Such coverage shall cover injury or loss resulting from the Contractor's rendering of or failing to
render professional services and shall be no less than $1,000,000 per incident, loss, or person, as
applicable. If defense costs are paid within the limit of liability, the Contractor shall maintain limits of
$2,000,000 per incident, loss, or person, as applicable. If the policy contains a general aggregate or policy
limit, it shall be at least two times the incident, loss or per person limit. If professional liability insurance is
written on a "claims made" basis, the policy shall provide full coverage for prior acts or include a
retroactive date that precedes the effective date of this Contract. The Contractor is required to buy
professional liability insurance for a period of 24 months after completion of this Contract. This requirement
may be satisfied by the continuous purchase of commercial insurance or an extended reporting period.
20.9.4 Industrial Insurance Policy. The Contractor shall comply with the provisions of Title 51 RCW
(Industrial Insurance). If the Contractor fails to provide industrial insurance coverage to statutory limits or
fails to pay premiums or penalties on behalf of its employees as may be required by law, DEL may
collect from the Contractor the full amount payable to the Industrial Insurance accident fund. DEL may
deduct the amount owed by the Contractor to the accident fund from the amount payable to the
Contractor by DEL under this Contract, and transmit the deducted amount to the Department of Labor and
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Industries (L&I) Division of Insurance Services. This provision does not waive any of L&I's right to collect
from the Contractor.
20.9.5 Employers Liability ("Stop Gap") Insurance. The Contractor shall buy employers liability
insurance with limits of not less than $1,000,000 each accident for bodily injury by accident or
$1,000,000 each employee for bodily injury caused by disease.
21. MONITORING
21.1. DEL has the right to monitor and evaluate performance, compliance, and quality assurance under
this Contract. The Contractor shall provide a right of access to its facilities to DEL, personnel authorized
by DEL, or to any other authorized agent or official of the State of Washington or the federal government
at all reasonable times in order to monitor and evaluate performance, compliance, and/or quality
assurance under this Contract.
21.2. Monitoring activities may include, but are not limited to:
21.2.1. Review of deliverables listed in Exhibit A Statement of Work.
21.2.2. Intensive on-site program reviews to monitor Contract compliance, scheduled in advance with the
Contractor.
21.2.3. Site visits to review records, observe implementation of services or follow up on compliance
issues. These visits may be unannounced.
21.2.4. Review of the Contractor's compliance with Section 11 Confidentiality of Personal Information.
22. NEUTRAL AUTHORSHIP
Each of the provisions of this Contract has been reviewed and negotiated, and represents the combined work
product of both parties hereto. No presumption or other rules of construction which would interpret the
provisions of this Contract in favor of or against the party preparing the same shall be applicable in connection
with the construction or interpretation of any of the provisions of this Contract.
23. ORDER OF PRECEDENCE
23.1. In the event of an inconsistency in the terms of this Contract, or between its terms and any
applicable statute or rule, the inconsistency shall be resolved by giving precedence in the following order:
23.1.1. Applicable Federal statutes, regulations, and policies;
23.1.2. Applicable State of Washington statutes and regulations;
23.1.3. Terms and Conditions as contained in this basic Contract instrument but not contained in exhibit
A, exhibit B, or exhibit C, of this Contract;
23.1.4. Exhibit C: General Terms And Conditions;
23.1.5. Exhibit B: Budget;
23.1.6. Exhibit A: Statement of Work; and
23.1.7. Any other exhibit or attachment, provision, term or material incorporated herein by reference or
otherwise.
24. PUBLICITY
24.1. The award of this Contract to Contractor is not in any way an endorsement of Contractor or
Contractor's Services by DEL and shall not be so construed by Contractor in any advertising or publicity
materials.
24.2. All publications funded, in whole or in part, under this Contract will use the DEL logo and will
acknowledge credit as either providing "funding in partnership with" or "funded by" the DEL. The full-color
or black -and -white DEL logo, provided by the DEL Contract Manager, shall appear in its entirety, without
modification.
25. RECAPTURE
25.1. In the event that the Contractor fails to expend funds under this contract in accordance with state
laws and/or the provisions of this contract, the DEL reserves the right to recapture state funds in an
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amount equivalent to the extent of the noncompliance in addition to any other remedies available at law
or in equity.
25.2. Such right of recapture shall exist for a period not to exceed six years following contract
termination. Repayment by the Contractor of funds under this recapture provision shall occur within 30
days of demand. In the event that the DEL is required to institute legal proceedings to enforce the
recapture provision, the DEL shall be entitled to its costs thereof.
26. RECORDS MAINTENANCE
1.1. The Contractor shall maintain all books, records, documents, data and other evidence relating to this
Contract and performance of the services described herein, including but not limited to accounting
procedures and practices which sufficiently and properly reflect all direct and indirect costs of any nature
expended in the performance of this Contract. Contractor shall retain such records for a period of six
years following the date of final payment. At no additional cost, these records, including materials
generated under the contract, shall be subject at all reasonable times to inspection, review or audit by
the DEL, personnel duly authorized by the DEL, the Office of the State Auditor, and federal and state
officials so authorized by law, regulation or agreement.
1.2. If any litigation, claim or audit is started before the expiration of the six (6) year period, the records shall
be retained until all litigation, claims, or audit findings involving the records have been resolved.
27. REMEDIES
Except for remedies designated specifically as exclusive, no remedy conferred by any of the specific
provisions of this Contract is intended to be exclusive of any other remedy, and each and every remedy shall
be cumulative and shall be in addition to every other remedy given hereunder, now or hereafter existing at law
or in equity or by statute or otherwise. The election of any one or more remedies by either party shall not
constitute a waiver of the right to pursue other available remedies.
28. SEVERABILITY
If any provision of this Contract or any provision of any document incorporated by reference shall be held
invalid, such invalidity shall not affect the other provisions of this Contract which can be given effect without
the invalid provision, and to this end the provisions of this Contract are declared to be severable.
29. SITE SECURITY
While on the DEL's premises, the Contractor, its agents, employees, or subcontractors shall conform in all
respects with physical, fire or other security policies or regulations.
30. SUBCONTRACTING
30.1. As used throughout this Contract, the following terms shall have the meanings set forth below:
30.1.1. "Subcontractor" means one not in the employment of a party to this Contract, who is performing
all or part of those services under this Contract under a separate contract with a party to this
Contract. The terms "subcontractor" and "subcontractors" mean subcontractor(s) in any tier, and the
subcontractors' directors, officers, employees, and agents.
30.1.2. "Staff' or "staff person" means the Contractor's subcontractors, directors, officers, employees,
and agents who provide goods or services on behalf of the Contractor. The term "staff' or "staff
person" also means the subcontractors' directors, officers, employees, and agents who provide
goods or services on behalf of the subcontractor and Contractor.
30.2. Neither the Contractor nor any Subcontractor shall enter into subcontracts for any of the work
contemplated under this Contract without obtaining prior written approval of DEL. All subcontracts must
be in writing and in effect before Subcontractor services begin. "Subcontractor" shall mean one who is
not employed by the Contractor, but who is performing all or part of those services under this Contract
under a separate contract with the Contractor. The terms "Subcontractor" and "Subcontractors" mean
Subcontractors in any tier. In no event shall the existence of the subcontract operate to release or
reduce the liability of the Contractor to DEL for any breach in the performance of the Contractor's duties.
The Contractor is responsible to DEL for the performance and monitoring of the Subcontractor to ensure
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compliance with the terms, conditions, assurances, and certifications of this Contract. This clause does
not include contracts of employment between the Contractor and personnel assigned to work under this
Contract.
30.3. Additionally, the Contractor is responsible for ensuring that all terms, conditions, assurances, and
certifications set forth in this Contract are carried forward to any subcontracts.
31. TERMINATION FOR CAUSE
31.1. In the event DEL determines the Contractor is in default, DEL has the right to immediately
suspend or terminate this Contract. Before suspending or terminating the Contract, the DEL may, in
DEL's sole discretion, elect to notify the Contractor in writing of the need to take corrective action and
offer the Contractor the opportunity to take corrective action before the Contract is suspended or
terminated.
31.2. In the event of termination or suspension, the Contractor shall be liable for damages as
authorized by law including, but not limited to, any cost difference between the original Contract and the
replacement or cover contract and all administrative costs directly related to the replacement contract
(e.g., cost of the competitive bidding, mailing, advertising and staff time). DEL may also declare the
Contractor ineligible for further contracts with DEL.
31.3. DEL reserves the right to suspend all or part of the Contract, withhold further payments, or
prohibit the Contractor from incurring additional obligations of funds during investigation of any alleged
breach, or during any pending corrective action by the Contractor or pending a decision by DEL to
terminate the Contract.
31.4. If it is later determined that: (1) the Contractor was not in default, or (2) Contractor's failure to
perform was outside the Contractor's control, fault, or negligence, the termination shall be considered a
Termination for Convenience.
31.5 The rights and remedies of DEL provided in this Contract are not exclusive and are in addition to
any other rights and remedies provided by law.
32. TERMINATION FOR CONVENIENCE
Except as otherwise provided in this Contract, DEL may terminate this Contract, in whole or in part, by giving
the Contractor ten (10) calendar days written notice. Termination becomes effective ten (10) calendar days
from the second day after mailing the notice. If this Contract is so terminated, DEL shall be liable only for
payment required under the terms of this Contract for services rendered or goods delivered prior to the
effective date of termination.
33. TERMINATION PROCEDURE
33.1. Upon termination of this Contract, DEL, in addition to any other rights provided in this Contract, may
require the Contractor to deliver to DEL any property specifically produced or acquired for the performance
of such part of this Contract as has been terminated. The provisions of Section 34, the "Treatment of
Assets" clause, shall apply in such property transfer.
33.2. DEL shall pay to the Contractor the agreed upon price, if separately stated, for completed work
and services accepted by DEL, and the amount agreed upon by the Contractor and DEL for (i)
completed work and services for which no separate price is stated, (ii) partially completed work and
services, (iii) other property or services that are accepted by DEL, and (iv) the protection and
preservation of property, unless the termination is for default, in which case DEL shall determine the
extent of the liability of DEL.
33.3. DEL may withhold from any amounts due the Contractor such sum as DEL determines to be
necessary to protect DEL against potential loss or liability arising from the Contractor's performance of
the Contract. The rights and remedies of DEL provided in this Section shall not be exclusive and are in
addition to any other rights and remedies provided by law or under this Contract.
33.4. After receipt of a notice of termination, and except as otherwise directed by DEL, the Contractor
shall:
Contract Number: 18-1047
Printed Date: 7/18/2017 Page 30 of 32
33.4.1. Stop work under the Contract on the date, and to the extent specified, in the notice;
33.4.2. Place no further orders or subcontracts for materials, services, or facilities except as may be
necessary for completion of such portion of the work under the Contract that is not terminated;
33.4.3. Assign to DEL, in the manner, at the times, and to the extent directed by DEL, all of the rights,
title, and interest of the Contractor under the orders and subcontracts so terminated, in which case
DEL has the right, at its discretion, to settle or pay any or all claims arising out of the termination of
such orders and subcontracts;
33.4.4. Settle all outstanding liabilities and all claims arising out of such termination of orders and
subcontracts, with the approval or ratification of DEL to the extent DEL may require, which approval
or ratification shall be final for all the purposes of this clause;
33.4.5. Transfer title to DEL and deliver in the manner, at the times, and to the extent directed by DEL
any property which, if the Contract had been completed, would have been required to be furnished
to DEL;
33.4.6. Complete performance of such part of the work as shall not have been terminated by DEL; and
33.4.7. Take such action as may be necessary, or as DEL may direct, for the protection and preservation
of the property related to this Contract, which is in the possession of the Contractor and in which
DEL has or may acquire an interest.
34. TREATMENT OF ASSETS
34.1. Title to all property furnished by DEL shall remain in DEL. Title to all property furnished by the
Contractor, for the cost of which the Contractor is entitled to be reimbursed as a direct item of cost under
this Contract, shall pass to and vest in DEL upon delivery of such property by the Contractor. Title to
other property, the cost of which is reimbursable to the Contractor under this Contract, shall pass to and
vest in DEL upon (i) issuance for use of such property in the performance of this Contract, or (ii)
commencement of use of such property in the performance of this contract, or (iii) reimbursement of the
cost thereof by DEL in whole or in part, whichever first occurs.
34.2. Any property of DEL furnished to the Contractor shall, unless otherwise provided herein or
approved by DEL, be used only for the performance of this Contract.
34.3. The Contractor shall be responsible for any loss or damage to property of DEL that results from
the negligence of the Contractor or that results from the failure on the part of the Contractor to maintain
and administer that property in accordance with sound management practices.
34.4. If any DEL property is lost, destroyed, or damaged, the Contractor shall immediately notify DEL
and shall take all reasonable steps to protect the property from further damage.
34.5. The Contractor shall surrender to DEL all property of DEL prior to settlement upon completion,
termination, or cancellation of this Contract.
34.6. All reference to the Contractor under this clause shall also include the Contractor's employees,
agents, or Subcontractors.
35. WAIVER
Waiver of any default or breach shall not be deemed a waiver of any subsequent default or breach. Any
waiver shall not be construed to be a modification of the terms of this Contract unless stated to be such in
writing and signed by an authorized representative of DEL.
36. WARRANTY
36.1. The CONTRACTOR warrants that all services performed pursuant to this Contract shall be
generally suitable for the use to which the DEL intends to use said services and deliveries as expressed
in Exhibit A.
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 31 of 32
36.2. In the performance of services under this Contract, the Contractor and its employees agree to
exercise the degree of skill and care required by customarily accepted good practices and procedures
followed by professionals/consultants rendering the same or similar type of service. All obligations and
services of the Contractor hereunder shall be performed diligently and completely according to such
professional standards.
36.3. If the Contractor intends to rely on information or data supplied by the DEL, other DEL contractors
or other generally reputable sources without independent verification, such intent shall be brought to the
attention of the DEL.
37. WITHHOLDING PAYMENTS
The DEL may withhold payment to the Contractor for any services/deliverables not performed as required
hereunder until such time as the Contractor modifies or delivers services/deliverables to the satisfaction of the
DEL.
Contract Number: 18-1047 Printed Date: 7/18/2017 Page 32 of 32
Exhibit D Deliverables
The following Deliverables Table outlines the reporting timeline and deliverables presented in Exhibit A
Statement of Work according to their timeline. Some deliverables associated with this contract,
including the HVSA Semi -Annual Statewide Meetings and Supervisor Meetings are not included in this
table as the dates of these events will be determined after contract execution.
July 2017
July 15:
Current Insurance Certificate*
July 30:
Executed DSA with DOH
Documented approval of DSA
with DOH submitted to Program
National Service Office
October 2017
nrtnhpr 9S -
August 2017
August 2_5:
July's Monthly Enrollment Data
Report
CQI Charter
August -3.1.:
Most recent independent
Financial Audit**
August 30:
July's Monthly Invoice and
Financial Report
November 2017
Alnvpmhpr 21; -
September's Monthly Enrollment October's Monthly Enrollment
Data Report Data Report
October 30: November 30:
September's Monthly Invoice and October's Monthly Invoice and
Financial Report Financial Report
October 30:
July - September's Quarterly
Progress Report
CQI Quarter 1 Report
September 2017
Se ternber 25:
August's Monthly Enrollment Data
Report
September 30_
August's Monthly Invoice and
Financial Report
Schedule Annual Monitoring Site
Visit
Client data for nonconsenting
participants shared with DOH
December 2017
Decet rl bei- 2 7:
November's Monthly Enrollment
Data Report
December 30:
November's Monthly Invoice and
Financial Report
Client data for nonconsenting
participants shared with DOH
Exhibit D Deliverables
January 2018
January25:
December's Monthly Enrollment
Data Report
January30:
December's Monthly Invoice and
Financial Report
October - December's Quarterly
Progress Report including
Model Fidelity Letter and
CQI Quarter 2 Report
April 2018
April 25:
March's Monthly Enrollment Data
Report
April 30:
March's Monthly Invoice and
Financial Report
January - March's Quarterly
Progress Report and
CQI Quarter 3 Report
FY19 Pre Contract Questionnaire
and Proposed FY19 Budget
July 2018
July 25:
June's Monthly Enrollment Data
Report
July 30:
June's Monthly Invoice and
Financial Report
April - June's Quarterly
Progress/Year-End Report and
CQI Quarter 4 Report
February 2018
February25:
January's Monthly Enrollment
Data Report
CQI Charter
February28:
January's Monthly Invoice and
Financial Report
May 2018
May 25:
April's Monthly Enrollment Data
Report
May 30:
April's Monthly Invoice and
Financial Report
Evidence Based Programs
March 2018
March 25:
February's Monthly Enrollment
Data Report
March 30:
February's Monthly Invoice and
Financial Report
Client data for nonconsenting
participants shared with DOH
June 2018
June 25:
May's Monthly Enrollment Data
Report
June 30:
May's Monthly Invoice and
Financial Report
Annual Site Visit Completed
(sometime in prior 6 months)
Client data for nonconsenting
participants shared with DOH
*An updated Insurance Certificate will need to be submitted when the insurance policy is renewed.
**A more current Independent Financial Audit, if one exists, will need to be submitted as part of the in-
depth financial monitoring.
2
ATTACHMENT 1: CERTIFICATION OF DATA DISPOSITION
Date of Data Disposition
I. Data Disposition Requirements
Unless the Washington State Office of the Chief Information Officer IT Standards require a different
method for the destruction of data or confidential information, data or confidential information required
to be destroyed under DEL Contract No. 18-1047 must be destroyed as follows:
(A) For data or confidential information that is contained on optical discs (e.g. CDs or DVDs), the
Contractor shall either destroy by incineration the disc(s), shredding the discs, or completely
deface the readable surface with a coarse abrasive.
(B) For data or confidential information that is contained on magnetic tape(s), the Contractor shall
destroy the data or confidential information by degaussing, incinerating or crosscut shredding.
(C) For data or confidential information that is contained on a server or workstation data hard drive or
similar media, the data or confidential information shall be destroyed by either
(1) Physically destroying the disk(s); or
(2) Using a„ wipe utility which will overwrite the data or confidential information at least three
times using either random or single character data, degaussing sufficiently to ensure that the
data or confidential information cannot be reconstructed.
(D) For data or confidential information that is contained on removable media (e.g. floppies, USB
flash drives, portable hard disks, or similar disks), the data or confidential information shall be
destroyed by either:
(1) Physically destroying the disk(s); or
(2) Using a "wipe” utility which will overwrite the data or confidential information at least three
times using either random or single character data, degaussing sufficiently to ensure that the
data or confidential information cannot be reconstructed.
Certification
All copies of any data sets related to DEL Contract No. 18-1047 have been wiped from data
storage systems.
All materials and non -wiped computer media containing any data sets related to DEL Contract
No. 18-1047 have been destroyed.
All copies of any data sets related to DEL Contract No. 18-1047 that have not been disposed of
in a manner described above, have been returned to the Contractor's Contract Manager listed
in this Contract.
The Contractor hereby certifies by the signature below that the data disposition requirements as
described in this Certification of Data Disposition and DEL Contract No. _18-1047, have been complied
with as indicated above.
Signature of Contract Manager:
Print Name:
Date.
Return original to DEL Contract Manager indicated on page 1 of this Contract. Retain a copy for
your records.
Aoved s o f m:
pP. C'. ,._.- pate: Prosecuting C. Hunsucker, Chief Civil Deputy Prosecuting A Corney
Jefferson County Prosecuting Attorney's Office
Page 1 of 1
Attachment 2
STATEMENT OF CONFIDENTIALITY AND NON -DISCLOSURE AGREEMENT
Between
The Department of Early Learning
And
Jefferson County
I. Recitals
1.1 Pursuant to Department of Early Learning (the "DEL") Contract Number 18-1047, attached hereto
Jefferson County (the "Contractor") has agreed to provide high quality home visiting services to high
risk families using the Nurse Family Partnership (NFP) program model for purposes of improving
outcomes for participants and strengthening coordination of services.
1.2 During the course of providing such services the Contractor and its employees, agents, and
subcontractors will have access to confidential or personal information owned by the DEL relating to
DEL 18-1047 which may be protected from disclosure under the Public Records Act (chapter 42.56
RCW), the Freedom of Information Act (5 U.S.C. 522), or other state or federal statutes.
ll. Definition of Confidential or Personal Information
2.1 "Confidential Information" or "Data" means information that may be exempt from disclosure
under either chapter 42.56 RCW or other state or federal statutes. Confidential Information
includes, but is not limited to, personal information, agency source code or object code, and agency
security data.
2.2 "Personal Information" means information identifiable to any person, including, but not limited to,
information that relates to a person's name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, social security numbers,
driver license numbers, e-mail addresses, credit card information, law enforcement records or other
identifying numbers or Protected Health Information, any financial identifiers, and other information
that may be exempt from disclosure under either chapter 42.56 RCW or other state and federal
statutes.
III. Terms of Agreement
3.1 As an employee, agent, or subcontractor of the Contractor I have access to information or data
described and contained in Department of Early Learning (the "DEL") Contract Number 18-1047.
This information may be confidential information or data, and I understand that I am responsible for
maintaining this confidentiality. I understand that the information may only be used for the purposes
of the work described in DEL Contract Number 18-1047.
3.2 1 understand that before I am allowed access to information and data that is described and/or
contained in DEL Contract Number 18-1047, 1 must sign and agree to the following:
(A) I have been informed and understand that information provided under DEL Contract Number
18-1047 may be confidential information or data and may not be disclosed to unauthorized
persons. I agree not to divulge, transfer, sell, or otherwise make known to unauthorized
persons any information described or contained in DEL Contract Number 18-1047.
(B) I also understand that I am not to access or use the information that is provided under DEL
Contract Number 18-1047 for my own personal information, but only to the extent necessary
and for the purpose of performing my assigned duties as an employee of the Contractor under
Attachment 2
this Agreement. I understand that a breach of this confidentiality will be grounds for disciplinary
action which may also include termination of my employment and other legal action.
(C) I agree to abide by all Federal and state laws and regulations regarding confidentiality and
disclosure of the information in DEL Contract Number 18-1047.
By signing this Agreement, the undersigned agree to this Agreement being effective as of the last signing
date noted below.
Contractor Name: Employee/Sub-Contractor/Agent Name:
Signature., _
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Ap roved as
Date:
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
Signature:
Print Full Narne:
Job Title:
-
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Attachment 2
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature: Signature:
Print Full Name: Print Full Name:
Job Title: Job Title:
Date: Date:
Signature: Signature:—
Print Full Nance: Print Full Name:
Job Title: Job Title:
Date: Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name.-
Job
ame:Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Signature:
Print Full Name:
Job Title:
Date:
Attachment 3: Contract Monitoring, Compliance and Non -
Compliance
1. Program Reporting and Documentation
1.1. Reporting. Contractor agrees to submit reports outlined in Exhibit A Scope of Work using the
templates available at www.del.wa.govhomevisitin y according to the timeline described in Exhibit A
and Exhibit D of this contract.
1.2 Additional Documentation: Contractor agrees to maintain the following information and
documentation, keeping it current on a monthly basis. At a minimum, this information will be requested
for review at the annual DEL Site Visit; DEL may request to review it at other times.
1.2.1. Staff Training Records
1.2.2. TA Self Reflection and TA Plan
1.2.3. CQI Charter, Project Plans for Projects 1 and 2 and CQI Quarter Reports for Quarters 1
through 4 using templates in Attachment 5
1.2.4. Memoranda of Understanding with community providers related to referrals or
coordination of Home Visiting Services
1.3. Site Visits: Contractor agrees to cooperate with up to eight (8) scheduled site visits conducted for
monitoring program and fiscal compliance, organizational due diligence, HVSA evaluation and data
collection, quality implementation technical assistance, and continuous quality improvement.
1.3.1. Document Preparation: Contractor agrees to assemble documents listed above, financial
information detailed in Section 12 of Exhibit A Statement of Work, and any additional information
requested by DEL in advance of the scheduled site visit.
1.3.2. During the Site Visits, Contractor agrees to allow access to DEL, if requested, documentation
demonstrating accomplishments of this Agreement. Such documentation may include, but is not
limited to:
1.3.2.1. Services Provided, Service Dates, and Number of Service Hours, including Case
Files of Participants;
1.3.2.2. Attendance Sheets and Service Logs;
L.3.2.3. Data Collection and Assessments by Participants;
1.3.2.4. Demographic Information of Participants;
1.3.2.5. Personnel records of those staff employed through funds under this contract; and
1.3.2.6. Policy and procedures documents as related to implementation of this contract
including, but not limited to, agency, human resources, and financial policies and
procedures.
Attachment 3: Contract Monitoring, Compliance and Non -Compliance NFP
2. Contract Monitoring
2.1. Contract Monitoring. The Contractor agrees to ensure all Contractor Requirements, as outlined in
Exhibit A Statement of Work of this Contract. Failure to comply with or submit timely and complete
materials related to Contract requirements may result in withheld or delayed payments. DEL will
monitor Contractor compliance with Contract requirements, model standing, implementation progress,
enrollment performance and financial activity through review of the following:
2.1.1. Submitted reports, invoices and documents.
2.1.2. Model Fidelity: Affiliate status from the Nurse Family Partnership National Service Office
demonstrating Contractor's good standing and/or active ready to implement status.
2.1.2.1. If fidelity is not sustained throughout the Contract Term, DEL will conduct a joint
due diligence review in coordination with its designated contractor for technical
assistance of the of the Contractor's model fidelity status; and then DEL may, upon
written notification to the Contractor, terminate this Contract.
2.1.2.2. Achieving Model Standing. If Contractor does not have affiliate in good standing
and/or active ready to implement status as of the Start Date of this Contract, the
Contractor must obtain such status within 90 days of the Start Date. If the Contractor does
not timely obtain such status, then DEL may, at its discretion and upon written notice to
`he Contractor, terminate this Contract.
2.1.3. Implementation Progress. The DEL Contract Monitor will review monthly budget/financial
documentation and quarterly Contractor activities and progress toward completion of the
Required Program Elements described in Exhibit A Statement of Work:
2.1.3.1. Staffing, Supervision, and Training,
2.1.3.2. Service Area and Recruitment of Priority Populations
2.1.3.3. Participant Enrollment, Retention and Caseload Maintenance
2.1.3.4. Home Visit Frequency and Content, and financial activity related to the Budget.
2.1.3.5. Systems Connections
2.1.3.6. Data Collection and Evaluation Requirements
2.1.3.7. Continuous Quality Improvement Activities
2.1.3.8. Quality Improvement Technical Assistance
2.1.3.9. Financial documentation aligned with Contract budget
?.1.3.10. Delay in meeting one or more of the category areas above and/or non-
compliance related to financial activity during a quarter, will result in Contractor's
transition to Implementation Improvement Status.
2.1.5. Enrollment Performance: On a quarterly basis, DEL will review Contractor's enrollment
performance for the following measure: Minimum Active Enrollment Caseload, as defined in
Section 6.3 of Exhibit A Statement of Work of this Contract: Throughout the duration of this
Contract Monitoring, Compliance and Non -Compliance
Attachment 3: Contract Monitoring, Compliance and Non -Compliance NFP
contract, Contractor agrees to maintain a Minimum Active Enrollment Caseload equivalent to or
greater than 85% of its Maximum Service Capacity.
2.1.5.1. Start -Up Programs. Contractors receiving first year HVSA funding are considered
to be Start -Up Programs. Exhibit A Statement of Work of this Contract specifies
enrollment rates over the term of the contract to reach full enrollment caseload. Progress
°n meeting enrollment rates toward building full caseload will be reviewed on a monthly
basis. If the Contractor does not meet enrollment rates specified in accordance with the
timeline as specified in Exhibit A Statement of Work, DEL will transition Contractor to
Implementation Improvement Status for additional contract monitoring focused on
supporting improvement in Contractor's enrollment.
2.1.5.2. Continuing Programs: Contractors receiving second year or beyond of HVSA
funding are considered to be Continuing Programs. If a Continuing Program Contractor's
Minimum Active Enrollment Caseload is between 75% and 84% for one quarter, DEL will
inform Contractor with written notification of the low enrollment status and Contractor
agrees to participate in a follow-up call with DEL to discuss barriers and strategies for
increasing enrollment. If Contractor maintains an enrollment of less than 84% of Proposed
Families Served for an additional quarter after receiving written notification of low
enrollment status and the follow-up call, DEL will transition Contractor to Implementation
Improvement Status for additional contract monitoring focused on supporting
improvement in Contractor's enrollment.
2.1.5.3. If a Continuing Program Contractor's Minimum Active Enrollment Caseload is
below 75% for one quarter, DEL will transition Contractor to Implementation
improvement Status for additional contract monitoring focused on supporting
improvement in Contractor's enrollment.
3. Implementation Improvement Status, Non -Compliant Status and Non -Compliant
Courses Of Action
3.1. Implementation Improvement Status: If transitioned to Implementation Improvement Status by
DEL, Contractor agrees to participate in the steps outlined below within 30 days of written notification
by DEL, or within an extended, alternate timeline with written approved by DEL:
3.1.1. Completion of Self -Assessment provided by DEL which may address, but is not limited to,
the following: compliance with contract requirements, model fidelity, implementation progress,
financial activity, and/or enrollment performance in need of improvement.
3.1.2. Participation in Implementation Improvement Meeting(s) with DEL staff to discuss the Self -
Assessment; gather information and feedback from Contractor; share and review DOH program
data and other available program data; and other information related to areas in need of
improvement which may be used to inform the development of an Implementation Improvement
Plan.
3.1.3. Collaborate with DEL in development of a written Implementation Improvement Plan to be
issued by DEL within 30 days of the last Implementation Improvement Meeting. The Plan shall:
Contract Monitoring, Compliance and Non -Compliance
Attachment 3: Contract Monitoring, Compliance and Non -Compliance NFP
3.1.3.1. Cite and describe Contractor's specific area(s) in need of improvement, including,
but not limited to: compliance with contract requirements, model fidelity, implementation
progress, financial activity, and/or enrollment performance in need of improvement. For
the specified area(s) in need of improvement, the Plan shall provide metrics or
benchmarks to serve as indicators of satisfactory improvement.
3.1.3.2. Identify corrective action items and/or steps Contractor shall comply with to
address cited areas in need of improvement. The plan shall also identify technical
assistance and/or other supports designated to be made available to Contractor by DEL to
assist Contractor in achieving satisfactory improvement.
3.1.3.3. Outline a timeline for the completion of the Implementation Improvement Plan by
Contractor.
3.1.4. If satisfactory improvement in the specific area(s) indicated in Plan is met by Contractor,
within the timeline for completion of the Plan, DEL shall transitioned Contractor out of
Implementation Improvement Status. DEL will provide Contractor written notice of this transition
once it has determined satisfactory improvement has been met following the timeline for
completion of the Plan.
3.1.5. If satisfactory improvement in the specific area(s) indicated in the Plan within the timeline
for completion of the Plan is not met by Contractor, DEL shall transitioned Contractor out of
Implementation Improvement Status into Non -Compliant Status. DEL will provide Contractor
written notice of this transition once it has determined satisfactory improvement has not been
met within the timeline for completion of the Implementation Improvement Plan.
3.2. Non -Compliant Status: If DEL transitions Contractor to Non -Compliant Status, Contractor agrees to
participate in the steps outlined below, within 14 days of written notification from DEL, or within an
extended, alternate timeline with written approved by DEL:
3.2.1. P2rticipate in Non -Compliant Status meeting(s) with DEL staff to:
3.2.1.1. Review Contractor's Implementation Improvement Plan and discuss progress
made and barriers encountered during the Plan's implementation, including technical
assistance and/or other supports designated to be made available to Contractor by DEL.
3.2.1.2. Identify and review Contractor's contractual requirements and areas of
contractual non-compliance.
3.2.1.3. Discuss Non -Compliant Courses of Action.
3.3. Non -Compliant Course(s) of Action. After completing the Non -Compliant Status meeting and any
additional Non -Compliant Status follow-up meetings with Contractor to gather information or feedback,
DEL will issue Contractor a written Non -Compliant Course(s) of Action within 14 days of the last Non -
Compliant Status meeting date. The written Non -Compliant Course(s) of Action shall include one or
more of the four Non -Compliant Course(s) of action listed below:
Contract Monitor%ng, Compliance and Non -Compliance
Attachment 3: Contract Monitoring, Compliance and Non -Compliance NFP
3.3.1. Continuation of Implementation Improvement Plan: DEL may propose to modify and/or
extend the Contractor's Implementation Improvement Plan for up to an additional 3 month period
to meet specific area(s) cited in need of improvement.
3.3.2. Suspension of Payment: DEL may suspend payment of all or part of Contract funds until
satisfactory contract compliance is met.
3.3.3. Reduction in Maximum Contract Total: DEL may amend this contract to reduce the
Contractor's maximum contract total:
3.3.3.1. To reflect the amended Implementation Plan scope negotiated between DEL and
the Contractor based on Contractor's cost per family served and other related factors,
and,
3.3.3.2. If feasible and in compliance with HVSA and DEL funding requirements,
;:ontractual requirements, and approval processes, including Home Visiting Model
Developer program requirements.
3.3.4. Ez.,-ly Contract Termination: DEL may terminate this contract prior to the end of the Term if
satisfactory contract compliance is not met by Contractor in the implementation of Contractor's
Implementation Improvement Plan, and/or if Contractor is not able to, or is not cooperative in
development and implementation of the Implementation Improvement Plan.
3.3.5. Notice: The written Non -Compliant Course(s) of Action shall become effective a minimum of
30 days after the delivery of the written Non -Compliant Course(s) of Action to Contractor.
Contract Monitoring, Compliance and Non -Compliance
Attachment 4: Data Collection, Reporting and HVSA Aligned Measures, Evidence Based
Attachment 4: Data Collection, Reporting and HVSA Aligned
Measures
1. Data 5liiii- ag
1.1 Required elements of the DSA with DOH: The contractor will work with DOH to establish data
sharing agreements according to the timelines set forth within the statement of work. The data sharing
agreement outlines specifications of the data use and data sharing to implement required reporting,
evaluation and quality assurance or improvement activities. The data sharing agreement will minimally:
1.2.1 Allow DOH access to identifiable client and program data as outlined below in section 4.0
1.2.2 When parental consent is provided, allow DOH to share identifiable data with DEL
1.2.3 When parental consent is provided, allow DOH to share home visiting data with child welfare
to conduct administrative match from families in both programs.
1.2. National Service Office Permissions for data sharing:
1.2.1 DEL will work with NFP National Service Office to secure an approved template for NFP
programs to authorize the national service office to share data with DOH. Contractors will send
authorization using the approved template to the NFP National Service Office by July 30, 2017.
2,0 Data Collection Process and Schedule
2.1. The Contactor will collect all of the data outlined in section 4 of this attachment for all eligible
families. Data should be recorded in model specific database within five (5) business days of data
collection. The Contractor will provide data as outlined in the Data Sharing Agreement executed with
the Departmeot of Health. Data will be provided to the Department of Health directly from National
Service Office on a monthly basis. Alternative data schedules may be approved by the Department of
Health.
3.0 Parental Consent
3.1. The Contractor will make every effort to seek Parental Consent to share direct identifiable data with
DOH during the contract period; Contractor agrees to seek this consent from all currently enrolled
families within the first six (6) weeks of the contract period and from all newly enrolled families within
the first three home visits. Sample consent form(s) are available at www.del.wa.gov\homevisiting.
3.2. Parental Consents for voluntary services and data sharing may be combined.
3.3. Families who do not provide consent to share identifiable data remain eligible to receive home
visiting services.
3.4. For those participants who do not consent to share direct identifiers such as name and address,
Contractor agrees to deliver to DOH all client level data to meet the reporting requirements listed below
along with a unique client ID for each client served
Attachment 4: Data Collection, Reporting and HVSA Aligned Measures, Evidence Based
3.5. Contractor will maintain consent forms on file for all caregivers enrolled in home visiting services in
both physical files and electronically, if applicable in model data system.
4.0 HVSA Ali iced Pes•formance Measures
4.1 HVSA Aligned Measures: As outlined in statement of work, the Contractor will ensure data
collection for all enrolled HVSA families that meets model requirements and the HVSA Aligned Measures
definitions outlined in Table 4.1.1-4.1.6. Department of Health will work with the Contractor to review
data collection and reporting to support Contractor quality assurance. Of note, primary caregivers,
caregiver and .Iients are used interchangeably with the same intent.
4.1.1. HVSA Aligned Measures: System and Program Performance Indicators: The Contractor will
ensure data collection of all measures outlined for caregivers and children that meet the
eligibility requirement as outlined in table 4.1.
4.1.2. Enrollment and Service Utilization: The Contractor will ensure data collection for all
enrollment and service utilization measures outlined for caregivers and children that meet the
eligibility requirement.
4.1.3 Demographic Information: The Contractor will ensure data collection for all demographic
information outlined for caregivers and children that meet the eligibility requirement.
4.1.4. Performance Payment Awards Performance Payment Measures: The Contractor will
review data reports from DOH to substantiate Performance Payment Measures.
4.1.5. HVSA Dosage and Home Visiting Definitions: Model -specific dosage requirements, HVSA
defined dosage, and home visit definitions.
41
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Attachment 5: Continuous Quality Improvement
The purpose of CQI activities is to improve outcomes for families engaged in home visiting services.
CQI Team Guidelines: CQI Team: Contractor agrees to establish an internal CQI staff team to oversee,
support, and implement CQI activities to assess program processes and outcomes. The CQI Team
membership may change depending upon the focus of the CQI Project
CQI Projects: Contractor agrees to develop and implement at least two CQI Projects using the CQI Plan
and Charter Template in this attachment.
• CQI Charter and Project Plan #1: Due August 25, 2017
• CQI Charter and Project Plan #2: Due February 25, 2018
CQI Project Summary and Reflection: Contractor agrees to report on CQI Projects using the Quarterly
Report templates in this attachment.
• Quarterly 1 Report and PDSA Template : Due October 30, 2017
• Quarter 2 Report/Project Summary and Reflection: Due January 30, 2018
• Quarterly 3 Report and PDSA Template : Due April 30, 2018
• Quarter 4 Report/Project Summary and Reflection: Due July 30, 2018
Continuous Quality Improvement 1
CQI Charter and Project Plan - Due 8/25/17, 2/25/18
Program Name, Model
Project Period ❑ Period 1(July — December)
❑ Period 2 (January—June)
❑ Caregiver Depression Screening/Referral
❑ Parent Child Interaction
CQI Project Topic
❑ Intimate Partner Violence Screening/Referral
❑ Family Engagement
Problem Statement/Opportunity for Change: _
CQI Team
CQI SMART Aim
_SMART Aim Statement (Specific, Measurable, Achievable, Relevant, Time -bound,
When:
Achieve What:
For Whom:
How will you measure success? (Indicators/Measures
What will you measure?
How will you measure it?
Considerations (Assumptions/Predictions, Potential Barriers/Obstacles
Assumptions/
Predictions?
Potential Barrier/Obstacles?
Continuous Quality Improvement 1
CQI Quarter 1/Quarter 3 Report _
Program Name, Model I
Project Period
CQI Project Topic
AIM Statement
Aim Update: Were any changes made to
the SMARTAim statement or project plan
since submitting the Team Charter & Plan?
If so, please describe:
❑ Period 1 (July —December)
❑ Period 2 (January—June)
❑ Caregiver Depression Screening/Referral
❑ Parent Child Interaction
❑ Intimate Partner Violence Screening/Referral
❑ Family Engagement
PDSA Cycle 1
PDSA - Provide a brief, but detailed update on change tests implemented
Change test:
What question (s) do you want to answer?
What changes do you predict as a result of this test?
Plan Who is responsible?
Tasks/Tools Needed to Complete Test
How was the test carried out?
Do i
Continuous Quality Improvement 2
Continuous Quality Improvement
PDSA Cycle 2 (if more than one PDSA completed)
PDSA - Provide a brief, but detailed update on change tests implemented
Change test:
What question (s) do you want to answer?
What changes do you predict as a result of this test?
Plan I Who is responsible?
Tasks/Tools Needed to Complete Test
How was the test carried out?
Do What did you observe that wasn't part of the plan?
Study
What did the data tell you?
What I-esults did you see?
What did you learn?
Continuous Quality Improvement
Continuous Quality Improvement
CQI Quarter 2/Quarter 4 Report
Project Summary and Reflection
Program Name, Model
Project Period
CQI Project Topic
AIM Statement
Aim Update: Were any changes made to
the SMART Aim statement or project plan
since submitting the Team Charter & Plan?
If so, please describe:
❑ Period 1 (July —December)
❑ Period 2 (January—June)
❑ Caregiver Depression Screening/Referral
❑ Parent Child Interaction
❑ Intimate Partner Violence Screening/Referral
❑ Family Engagement
Continuous Quality Improvement 1
Attachment 6: Monthly Enrollment Data Report
This attachment outlines the components of the Monthly Enrollment Data Report; the actual electronic
template to be submitted by Contractor is available at www.del,wa. ov homevisitin .
1. Organization Information
1.1. Organization Name
<prepopulate>
1.2. Home Visiting Model
<pre,populate>
1.3. Contract # 1.4. Month
<prepopulate>
hoices: Q1: July 2017 ... June 2018>
2. Active Caseload
Please provide the following information for children and families served by HVSA funds during the reporting month.
funded by funded by I funded by
MIECHV General State NF
Funds
2.1. Number of families/clients actively enrolled: All clients
with some enroll. nent time during the month and have completed a
home visit within 90 days of the end of the month. Client may have
entered or exited services within the month.
2.2. Number of children enrolled:
Received a home visit or other model -approved contact in last 90 days
2.3. Number of families that received home visits
during report month:
2.4. Number of home visits during report month:
3. Caseload Changes
Please provide the following information about new enrollments, exits, and program completion during the reporting
month.
funded by funded by
funded
E HVy General State TANF
Funds
3.1. Number of new families enrolled:
3.2. Number of exits before reaching HVSA retention goal:
Clients that exited the program during the month before receiving
24 months of services.
3.3. Number of clients exiting after reaching the HVSA
retention goau Clients that have exited the program during the
month after receiving at least 24 months of services :
Attachment 6: Monthly Report
4. Enrollment to Capacity
Please calculate your enrollment -to -capacity percentage by dividing the number of families in actively enrolled on
the 15`h of the report month by the number of funded families described in your contract. If the percentage of family
enrollment to capacity for your program is below 85%, please provide a brief explanation in the space provided.
4.1. Total Number of Actively
Enrolled Families/Clients this 4.2
Month (2.1)
Maximum Service Capacity
(# slots in Contract)
4.3. Active Enrollment Caseload
(Percent of Families Currently Enrolled
to Funded Families
(2.1/4.2)
I
4.4. If Active Enrollment Caseload (#4.3) is less than 85%, please explain:
Monthly Enrollmeat Data Report
Attachment 7: Quarterly Progress Report
This attachment outlines the components of the Quarterly Progress Reports. Most questions will be asked each
quarter, with indicators to those questions unique to specific quarters. Quarter's actual electronic template to be
submitted by Contractor is available at www.del.wa.aovthgT!t isiting. 1. Organization Information
1.1. Organization Name
<prepopulate=
1.2. Home Visiting Model
j<prepopulate.
1.3. Contract # 1.4. Quarter
<prepopulate>
2. Fidelity to Program Model
Choices: Q1: July 1— Sept 30; Q2, Q3, Q4...> I
2.1.a. Q2 If your program is an evidence -based program (e.g. EHS, Family Spirit, NFP, PAT, EHS) or a
promising practice with a National Model Office (PCHP), please submit your letter from your national
model indicating your program's standing with relationship to model fidelity.
<upload: >
2.1.b. Q2 If your program does not have a national model office (e.g. CPP, Outreach Doula, STEEP),
please submit a letter from Thrive Washington detailing the model fidelity indicators of your program
and your program's standing with relationship to those indicators of model fidelity.
<upload: > J
2.2.a. Q2-3-4 If the letter from your National Model Office/Thrive indicates areas where your program
does not meet model fidelity, please list those indicators and a your program's progress towards
meeting model fidelity for each those indicators.
Indicator Area Program Progress Towards Fidelity
Attachment 7: Quarterly Progress Report
3. Staffing Deliverables
3.1. Please report any changes in FTE/staffing positions funded by this contract for Home Visitors,
Program Supervisors, or other staff:
❑ no changes in staff funded through this Contract from prior quarter
1
3.2. Please describe any other changes in program staff that your program experienced in the quarter.
❑ n/a
3.3. If you have experienced staffing challenges to keeping or recruiting staff, please describe these
experiences. What is your plan and timeline to address these challenges and/or recruit new staff.
❑ n/a
Challenges with staff retention
Challenges with staff recruitment
4. Supervision Deliverables
4.1. Supervision Hours: Please report on the # of hours of supervision that Supervisors provided for all
Horne Visitors this quarter.
Type of Supervision Average # hours provided to each Home Visitor per month
Comments/Notes:
4.2. If during this last quarter, you encountered barriers to fulfilling supervision hours or group/case
conferences as outlined in your contract (or as expected for model fidelity), please explain why and
describe the steps you are taking to ensure fidelity.
4.3. Q4 Describe any changes your organization has implemented to staffing policy and/or practice in
the past year to support high-quality program implementation and reduce turnover in the program or
organization.
I _ -
Quarterly Progress Report 2
Attachment 7, Quarterly Progress Report
5. Service Delive
5.1. Please tell us how many unduplicated caregivers received services this quarter (received at least
one home visi+ during this quarter). Please include all caregivers that are participating in the program.
# Female Caregivers #Male Caregivers J
5.2.a. Number Of Home Visits Completed and Attempted but not Completed
L# Completed # Attempted, but NOT
completed
5.2.b. Please describe the successes and challenges you have faced in completing home visits this
quarter. Were there circumstances that impacted your program's ability to deliver home visits this
quarter? If so, please describe.
5.3. Q2/Q4 Outgoing Referral Networks
Based on a review of your program data from July-December/January to June please list the top 5 sources to which
your program referred home visiting participants for additional resources, and indicate the primary services this
organization delivers.
0 Type of Service Organization Name
<categories> -
<categories>
<categories> —
<categories>
<categories>
< categories>
Family support/parent education Child welfare Domestic violence prevention Other
Early childhood development Employment Education
Food Support Health Legal
Mental Health Substance Abuse WIC
5.4. Referrals: Of the referrals made, please describe any barriers encountered to connecting families
to services. What, if any major trends are you seeing that are different from prior referral patterns?
5.5. TANF: Please summarize what has been working well and what has been difficult in recruiting,
enrolling and providing services with TANF referred families.
Quarterly Progress Report
Attachment 7: Quarterly Progress Report
6. Technical Assistance
6.1. Q2/Q4 In reviewing your TA Plan, please describe one key outcome or success that your program
achieved utilizing TA during July -December and January -June.
6.1/2. Please describe any Training or TA needs you have for NEXT quarter (this may include work
with Thrive, DEL, DOH or others).
7. Oreanizational and Communitv Updates
7.1. Please describe any notable changes within your program or organization that have impacted
implementation of your program.
7.2. Describe r,ny notable activities that occurred this quarter to create or improve connections with
other service delivery systems: early learning, child welfare, early intervention, DSHS, including local
early learning coalitions?
7.3. Q2/4 So far this year, which two to three community partners did you cultivate a stronger
working relationship for recruitment, wrap around services, training or other resources?
- 1
7.4. Q2/4 Describe your relationship with/level of participation in the local Early Learning Regional
Coalition so far this year.
7.5. Q4 TANF How has your home visiting program strengthened its engagement with families and
children in the DSHS system throughout the course of the HVSA TANF expansion work?
F_
7.5/6a. Q4 De.,cribe any notable demographic changes in your community in the past year.
7.5/6b. Q4 Describe any steps your program is taking to address changes in community need.
Quarterly Progress Report 4
Attachment'7: Quarterly Progress Report
8. Continuous Quality Improvement
8.1. Please submit your CQI Quarterly Report for this quarter.
8.2. Please idE ratify the measure you focused on last quarter in CQI (choose from the following
measures, or describe your own):
❑ Maternal Depression Screening — completion of screen, referral and connection to services
❑ jintimate Partner Violence Screening — completion of screen, referral and/or connection to services
❑ JlFamily Engagement— length or frequency
❑ Parent Child Interaction Program selected
❑ Other (please describe)
9. 01/Q3 Parent or Familv Feedback:
9.1. Success Story
Describe the impact of your home visiting program on a program participant (parent/child/family) through a
detailed story. (Please be sure to change the names of individuals and any identifying information in your story to
preserve their confidentiality).
9.2. Client Satisfaction
Please provide any information, data, and findings you have gathered over the past several months on
client satisfaction. This may include ongoing client satisfaction surveys or information retrieved as
families leave services about what did or didn't work for them.
Quarterly Progress Report
Attachment 1: Quarterly Progress Report
Quarterly Data Dashboard Reflection
10. Please review your Quarterly Data Dashboard from DOH.
10.1. Comments on the dashboard as a whole. What surprised you, what concerns you?
10.2. Reflections on progress made in the following areas:
Data Element Verified Reflection
�# children served '—
# Families Served ❑
# Home Visits ❑ { 1
# Families Referred into program ❑
10.3. Reflecting on your enrollment, what successes and challenges have you faced in meeting your
contract recruitment deliverables?
10.4. Please describe any successes or challenges from last quarter in data management or data use.
Indicate how these affect staff and/or program practice.
— - I
Quarterly Progress Report 6
MI& Weshlagton State Department of A19-1A INVOICE VOUCHER I Contractor Contract #:
®w Early Learning Agency Number: 3570 1Contract #: 18-1047
Attn: Fiscal Office I PO Box 40970 1 Olympia WA 98504-0970 Contract Service Period: July 1 2017 - July 31 2018
ct Title: Home Visiting Services Account: Nurse Family Partnershi
DEL Contact: Rene Toolson
Instruction to Vendor or Claimant: Submit this form to claim payment for materials, merchandise, or services. Show complete detail for each item.
VENDOR'S CERTIFICATE: I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise, or
services furnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination on the grounds of
race, creed, color, national origin, sex, or age.
Vendor or Claimant
BY
Jefferson County
615 Sheridan Street
Port Townend WA 98368
(Title)
(sign in ink)
(Date)
TO BE COMPLETED BY VENDOR
Invoice Service Period for Budget FY 2018: Invoice Number:
This is a Final Billing:
Yes n No n
Contract Billed
Payment Points (Note) Budget Amount
Date Approved
Doc Date
Current Doc No.
1. STATE- Personnel $70,594.66
Vendor Number
SWV0002430-02
Vendor Message
Invoice Date
2. STATE- Goods and Services $996.34
Program
Index
Sub
Obj
SSO
3. STATE -Travel $1,738.09
Proj
Sub
Proj
Ph
4. STATE- Contracted/ Professional Services $87,500.00
Subsidiary
Note
Amount
5. STATE- Administrative/ Indirect Charges $16,082.91
Debit Credit
17B 411
36300
6. STATE- Performance Pay $4,000.00
9999
1502
Total $180,912.00 $0.00
Total Request for Payment
$0.00
TO BE COMPLETED BY DEL
Program Review
Date Reviewed
Agency Approval
Date Approved
Doc Date
Current Doc No.
Ref Doc No.
18-1047
Vendor Number
SWV0002430-02
Vendor Message
Invoice Date
Trn
Cd Fnd Al
Program
Index
Sub
Obj
SSO
Alloc
Proj
Sub
Proj
Ph
GL
Subsidiary
Note
Amount
Invoice #
Debit Credit
17B 411
36300
CZ
9999
1502
Accounting Approval for Payment
Date Approved
Warrant Total:
7/18/2017 Page 1 of 1