HomeMy WebLinkAbout020419_ca01615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
Consent Agenda
January 22, 2019
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
.
DATE: �. `C, 2D19
1
SUBJECT: Agenda Item — Amendment No. 2 to Washington State Department
of Children, Youth and Families for Home Visiting Services;
December 1, 2018 — July 31, 2019; Additional $132,494.02 for a
total $513,008.22
STATEMENT OF ISSUE:
Jefferson County Public Health is requesting Board approval for Washington State Department of
Children, Youth and Families (DCYF) contract amendment for funding Home Visiting Services;
December 1, 2018 — July 31, 2019; Additional $132,494.02 for a total $513,008.22
ANALYSIS/ STRATEGIC GOALS:
The purpose of this amendment is to add expansion funds to the period of performance through
June 30, 2019 and to revise Exhibit A, Statement of Work; Exhibit B, Budget.
The 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.
FISCAL IMPACT:
Fully funded by Washington State Department of Early Learning with state dollars for a total of
$513,008.22
RECOMMENDATION:
JCPH management requests approval of the Washington State Department of Children, Youth and
Families (DCYF) contract amendment for funding Home Visiting Services; December 1, 2018 —
July 31, 2019; Additional $132,494.02 for a total $513,008.22
REVIEWED ff: ~�
L�fPhlfipJMorley,�ou dmir i�stra Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
WA5t11NCT0H STATE
Department of
Children, Youth, and Families
DCYF Contract Number: 18-1047-02
Contractor Contract Number:
Title: Home Visiting Services Account:
Nurse Family Partnership (NFP)
INTERLOCAL AGREEMENT
AMENDMENT #2 TO CONTRACT #18-1047-02
Contract Number 18-1047-02, by and between the Department of Children, Youth, and Families, (hereinafter
referred to as "DCYF") and Jefferson County, a Municipal Subdivision, (hereinafter referred to as "Contractor'),
is amended effective December 1, 2018 through July 31, 2019 as follows:
CONTRACTOR BUSINESS ADDRESS
Jefferson County
615 Sheridan Street
Port Townend WA 98368
TIN: 91-6001322
UBI: 161-001-169
DCYF ADDRESS
Department of Children, Youth, and
Families
PO Box 40970
Olympia WA 98504-0970
CONTRACTOR CONTRACT MANAGER
Jenny Matter
JMatter@co.jefferson.wa.us
Phone: (360) 385-9421
DCYF PROGRAM CONTRACT
MANAGER
Ivon Urquilla
ivon.urquilla@del.wa.gov
Phone: (360) 725-4695
AMENDMENT PURPOSE
The purpose of this amendment is to add expansion funds to the period of performance through June 30, 2019,
and to revise Exhibit A, Statement of Work; Exhibit B, Budget.
SECTIONS CHANGED
Exhibit A, Statement of Work, has been revised as follows:
Section 4, Staffing, Supervision and Training, Subsection 4.1, Staffing Level, has been updated;
Section 5, Service Area and Recruitment of Priority Populations; Subsection 5.1, Staffing Level, has been
updated;
Subsection 6.3.3. has been added to subsection 6.3., Active Caseload Threshold;
Subsection 12.6.2.2 has been added to Section 12.6, Performance Payment Awards.
Exhibit B, Budget has been modified to add expansion funds for use through June 30, 2019.
Amendment Effective Date: December 1, 2018
Amended Contract Maximum: $513,008.22
Previous Change New Total
State Funds: $380,514.20 $132,494.02 $513,008.22
EXHIBITS AND ATTACHMENTS
Exhibit A, Statement of Work Amendment 1 is hereby revised and replaced with Amended Exhibit A, Statement
of Work, Amendment 2 attached and incorporated herein as though set forth in full.
Exhibit B, Budget Amendment 1 is hereby revised and replaced with Amended Exhibit B, Budget Amendment 2
attached and incorporated herein as though set forth in full.
Contract Number: 18-1047-02
Printed Date: 1/9/2019
Page 1 of 21
ALL OTHER TERMS AND CONDITIONS OF THIS CONTRACT REMAIN IN FULL FORCE AND EFFECT.
SIGNATURES
The parties signing below represent that they have read and understand this Contract, and have the authority to
execute this Contract Amendment. This Contract Amendment shall be binding on the parties only upon
signature by both of them.
SIGNATURE: PRINTED NAME AND TITLE DATE SIGNED:
CONTRACTOR:
DCYF:
DCYF Contract Administrator
ATTEST:
By:
Carolyn Gallaway, Deputy Clerk of the Board
APPROVED ASO FORM ONLY:
By:jsyl
. C /]
Philip Hunsucker, Chief Civil Def uty Prosecuting Atty.
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 2 of 21
WASHINGTON STATE
Department of
5, Children, Youth, and Families
DCYF Contract Number: 18-1047-02
Contractor Contract Number:
Title: Home Visiting Services Account: Nurse
Family Partnership (NFP)
Amended Exhibit A - STATEMENT OF WORK
Amendment #2
1. DEFINITIONS. The following terms, as used throughout this Contract, shall have the
meanings set forth below:
1.1. "Active Enrollment Caseload" means those home visiting program participants who are enrolled in the
home visiting program, have some enrollment time during the reporting period, and have participated in at
least one (1) home visit within 90 days of the end of the reporting period. The home visiting program
participant may have entered or exited services within that reporting period.
1.2. "Administrative Supervision" means supervision provided to staff involving adhering to and implementing
agency policy and procedures, paperwork, data collection, report writing, coordinating, monitoring
productivity, and evaluating performance.
1.3. At -Risk Community means a community for which indicators of risk are present in greater proportion than
in Washington as a whole according to the statewide Home Visiting Needs Assessment.
1.4. "At -Risk Family" means families residing in at -risk communities and determining the priority populations
from which participants are recruited.
1.5. "Benchmarks" means the federally or state required performance measures that will be measured and
reported on through this Contract.
1.6. "Clinical Supervision" means regular supervision of staff involving program methods and models, fidelity,
curriculum, screening tools and procedures, case reviews, goal setting with families, reviewing and
evaluating client progress, teaching, and providing guidance and advice.
1.7 "Confidential Information" means information that is protected from public disclosure by law. There are
many state and federal laws that make different kinds of information confidential. In Washington State, the
two most common are the Public Records Act RCW 42.56, and the Healthcare Information Act, RCW
70.02. This includes 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.
1.8. "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.
1.9. "DCYF" means the Department of Children, Youth and Families.
1.10. "De -identified Data" means health information that does not identify an individual and that there is no
reasonable basis to believe that the information can be used to identify an individual, as specified in 45
C.F.R. § 164.514(e)(1).
1.11. "DEL" means Department of Early Learning.
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 3 of 21
1.12. "Deliverable" means the 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 DEL/DCYF in the form and
manner required by this contract.
1.13. "DOH" means the Department of Health.
1.14. "DSA" means Data Sharing Agreement.
1.15. "Efforts To Outcomes (ETO)" means the data collection system for the national Nurse Family Partnership
Program.
1.16. "Enhancements or Adaptations to home visiting model" means adaptations to programs including
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.
1.17. "Enrollment" means a family is considered to be 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.
1.18. "Evidence -based Home Visiting Models" means home visiting models meeting specific evidence
standards as outlined and approved by the federal Health Resources and Services Administration's
(HRSA) MIECHV program and selected by local implementing agencies for funding through the HVSA.
1.19. "Expansion Service Capacity" means as a result of the 2018 Expansion funds the additional number of
families or households that could potentially be enrolled in the Contractor's home visiting program at any
point in time if the program were operating with a full staff, as described in Section 4.1, and at full
enrollment, as set forth in section 6.3.
1.20. "FERPA" means "Family Educational Rights and Privacy Act" that protects the privacy of student education
records, with regulations found at 34 CFR Part 99.
1.21. "HIPAA Rules" means the "Health Insurance Portability and Accountability Act Rules" and includes the
Privacy, Security, Breach Notification, and Enforcement Rules at 45 C.F.R., Part 160 and Part 164.
1.22. "HRSA" means the United States Department of Health and Human Services: Health Resources and
Services Administration.
1.23. "HV" means home visiting.
1.24. "HVSA" means the Home Visiting Services Account established in RCW 43.215.130.
1.25. "HVSA Aligned Measures" means those performance measures described in Attachment 4 of this
Contract.
1.26. "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. "Implementation Hub" is also known as'The HUB.'
1.27. "Implementation Science" (IS) means, 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.
1.28. "Local Implementing Agency (LIA)" means local agency funded through the HVSA contract that provides
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 practices
home visiting models.
1.29. "Maximum Service Capacity" means the highest number of families or households that could potentially
be enrolled in the Contractor's home visiting program at any point in time if the program were operating
with a full staff, as described in Section 4.1, and at full enrollment, as set forth in section 6.3.
Contract Number: 18-1047-02 Printed Date: 1/9/2019
Page 4 of 21
1.30. "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.
1.31. "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.
1.32. "NFP" means the Nurse -Family Partnership home visiting model. Nurse -Family Partnership (NFP),
considered an evidence -based model for the purposes of this contract. Nurse Family Partnership National
Service Office, www.nursefamilypartnership.org.
1.33. "Penelope" means the data collection system to be used by the national Nurse Family Partnership
program, replacing Efforts to Outcomes in 2018.
1.34. "Priority Populations" means the populations from which clients who receiving home visiting services
through this Contract are recruited, defined in Section 5.2 of this Contract.
1.35. "Promising Practices Home Visiting Models" means home visiting models approved by Washington
State HVSA that have demonstrated impacts through evaluation results and selected by local implementing
agencies for implementation through the HVSA. This definition includes a program or practice model that is
based on statistical analysis or a well-established theory of change, shows potential for meeting the
'evidence -based' or'research-based' criteria, which could include the use of a program that is evidence -
based for outcomes other than the alternative use, but does not meet the evidence -based standards for
Maternal, Infant and Early Childhood Home Visiting program funding.
1.36. "Reflective Supervision (RS)" means 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 the work and how reactions to the
content affect the work.
1.37. "Service Area" means the geographical area defined by geographic boundaries where the priority
populations reside or where a specific group of eligible participants will be served by Contractor.
1.38. "State Model Lead" means the HV program model representative that provides contractors with HV
services, supports and TTA in coordination with the Implementation HUB.
1.39. "TANF" means Temporary Assistance for Needy Families administered through the Department of Social
and Health Services (DSHS).
1.40. "Thrive Washington" means the private partner identified in RCW 43.215.130 that is responsible for
supporting the HVSA account by providing TTA through the Implementation Hub to LIAs.
1.41. "TTA" means Training and Technical Assistance and may include coaching and consultation activities.
1.42. "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
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 5 of 21
2.2. The HVSA prioritizes funding towards meeting the needs of Washington's diverse populations, particularly
those families and communities demonstrating the highest needs.
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 and administered by DEL/DCYF 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.
3. Model Fidelity
3.1. The Contractor shall maintain fidelity to the NFP program model as defined as ongoing adherence to
specified criteria and components described by the NFP Model Developer. For home visiting programs that
are not evidence based, the promising practices Contractor will work with a DCYF-authorized provider of
technical assistance to adhere to model fidelity indicators established in prior contracts 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 organization
for evidenced based programs. The letter shall be delivered to DEL with the Quarter 2
Progress Report.
3.1.2. Contractor must obtain prior written approval by the model developer and DEL/DCYF before
implementing enhancements or adaptations to the home visiting model.
3.2. If Contractor subcontracts for delivery of home visiting services, then the subcontract must receive prior
approval from DEL/DCYF and the subcontractor must comply with all sections of this Scope of Work.
4. Staffing, Supervision and Training
4.1. Staffing Level:
Contractor shall maintain staffing levels sufficient to comply with the home visiting program model to meet
required goals and objectives through adherence to the staffing plan outlined as follows:
4.2. Home Visiting Supervisor and Home Visitor Qualifications:
Contractor shall comply with the NFP home visitor supervisor and staffing qualification requirements
throughout the term of this contract. If there are no model requirements, the Contractor shall work with the
DCYF-authorized provider of technical assistance, Thrive Washington, to establish qualifications. The
definitions shall be included with the model fidelity letter submitted by the Contractor as described in
Section 3.1.1. The Contractor shall adhere to these definitions of home visitor supervisor and staffing
qualifications throughout the entire term of this contract.
4.3. Sub -Contracting: With prior approval from DEL/DCYF, 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
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 6 of 21
b.
General
Staffing Plan by Position Type
i502 State
State
HVSA
Funds
Funds
Total
Home Visitor FTE Total
1.50
50
2.0
HV Supervisors FTE Total -- time delivering
home visiting services, if applicable
.05
.05
Supervisor FTE Total -- time dedicated to
.07
.16
.23
supervision
4.2. Home Visiting Supervisor and Home Visitor Qualifications:
Contractor shall comply with the NFP home visitor supervisor and staffing qualification requirements
throughout the term of this contract. If there are no model requirements, the Contractor shall work with the
DCYF-authorized provider of technical assistance, Thrive Washington, to establish qualifications. The
definitions shall be included with the model fidelity letter submitted by the Contractor as described in
Section 3.1.1. The Contractor shall adhere to these definitions of home visitor supervisor and staffing
qualifications throughout the entire term of this contract.
4.3. Sub -Contracting: With prior approval from DEL/DCYF, 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
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 6 of 21
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.
4.4. Background Checks:
The Contractor shall conduct reference and background checks on home visiting staff prior to allowing
home visiting staff to perform work pursuant to this contract. Reference and background check information
for each employee shall be retained in the employee's personnel files.
4.5. Supervision of Home Visitors:
Contractor shall comply with the supervision requirements of NFP program model as follows:
4.5.1. Supervision Ratios: Contractor shall comply with program model requirements for the ratio of
supervisors to home visitors throughout the term of this contract. If no model requirements
exist, Contractor shall comply with requirements established with the DCYF-authorized
technical assistance provider throughout the term of this contract.
4.5.2. Supervision Schedule Hours: Contractor shall comply with the following supervision
schedule:
4.5.2.1. A minimum of two (2) hours per month of individual reflective supervision for each
home visitor working .5 FTE or more; and
4.5.2.2. A minimum of one (1) hour per month of group supervision, case conferencing, or
staff meetings for all home visitors;
4.5.2.3. A minimum of one (1) hour per month for each home visitor working 0.5 FTE of
administrative and clinical supervision;
4.5.2.4. The parties may agree in writing to an alternative supervision schedule.
4.6. Staff Training and Ongoing Professional Development:
4.6.1. The Contractor shall require that all home visitor and supervisor staff adhere to the training
requirements, professional development, and continuing education requirements established
by the model developer and DCYF. Training requirements for home visitors, supervisors, and
home visiting coordinators shall include, but not be limited to the following:
4.6.1.1. New and ongoing model training,
4.6.1.2. Ongoing professional development and continuing education required by the NFP
model,
4.6.1.3. Training required by the DEL/DCYF on data collection methods, Continuous Quality
Improvement, and other topics, which may include the NEAR@Home Toolkit,
Facilitating Attuned Interactions, and other topics to be determined.
4.6.2. Upon request, the Contractor shall deliver to DEL/DCYF documentation pertaining to all staff
training, professional development, and continuing education described in this Section.
4.7. HVSA Orientations and Meetings:
Contractor shall attend and participate in statewide HVSA All Program Meetings conducted in Washington
State. Required attendance shall include, at a minimum, at least one of the Contractor's lead staff persons
or the home visiting program manager. Attendance at the HVSA Statewide meetings shall include, but not
be limited to, the following:
4.7.1. The DEL/DCYF 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 Semi -Annual Statewide Meetings held in Washington State in the
greater Seattle/Tacoma area on dates to be determined;
4.7.3. At least three (3) NFP Supervisor Meetings in locations and on dates to be determined;
4.8. Staff Retention Practices:
To ensure continuity of high quality service delivery, the Contractor shall develop and implement policies
and practices to recruit and retain qualified staff in the home visitor and supervisor positions.
4.9. Staffing Vacancy Plans:
To avoid service disruption in the event of a short- or long-term staffing vacancy, the Contractor shall
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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 priority populations, defined in Section 5.2, who
reside in the following counties or sub -county areas:
5.1.1. Jefferson, Kitsap and Clallam Counties
5.2. Priority Population:
Contractor shall sustain internal practices to serve, from among the HVSA Priority Populations. Priority
Populations are defined as eligible participants with two or more of the following characteristics:
5.2.1. Families with children, prenatal to age three years
5.2.2. Demographic Characteristics:
5.2.2.1. American Indian/Alaskan Native Non -Hispanic
5.2.2.2. Poverty/Low Income
5.2.2.3. Teen Parents
5.2.2.4. Non-English Speaking or Recent Immigrant
5.2.2.5. Enrolled in WorkFirstITANF=
5.2.3. Adverse Experiences
5.2.3.1. Prior Child Welfare System Involvement
5.2.3.2. Intimate Partner Violence
5.2.3.3. Familial History or current experience with Substance Use, including Tobacco
5.2.3.4. Parent Mental Illness
5.2.3.5. Current and Previously Incarcerated Parents
5.2.3.6. Homeless/Unstable Housing
5.2.4. Other Characteristics
5.2.4.1. Parents with Low Educational Attainment
5.2.4.2. Parents with Disabilities
5.2.4.3. Families currently or formerly in the Military
5.2.4.4. Children with Disabilities, especially those not linked with early intervention services
5.3. Outreach Efforts:
5.3.1. The Contractor shall create and implement an outreach plan to reach families to be served
from among the priority populations.
5.3.2. The Contractor shall document outreach efforts and referral sources for potential and enrolled
participant including those who decline services.
5.3.3. The Contractor shall record outreach and referral sources in the NFP data system -
ETO/Penelope.
5.3.4. Contractor shall assess the degree to which outreach efforts are successful in reaching target
populations.
5.3.5. Contractor shall provide to DEL/DCYF in its quarterly reports description of barriers to
reaching the intended populations. Any proposals to adapt the priority population shall be
supported by community data and approved by DCYF.
Contract Number: 18-1047-02 Printed Date: 1/9/2019
Page 8 of 21
6. Participant Enrollment, Retention, and Caseload Maintenance
6.1. Plan for Recruitment of Participants: Contractor shall document and implement a comprehensive plan for
participant recruitment, engagement, and retention aligned with the NFP program model to ensure ongoing
enrollment of priority populations as described in section 5.
6.2. Voluntary Services: The Contractor shall implement program policies and procedures to ensure home
visiting services are provided to program participants on a voluntary basis. For every participant enrolled,
Contractor must obtain a consent form to participate indicating that expectant parents, parents, or
caregivers agree to voluntarily enroll in Contractor's 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. Sample consent form(s) are available at on
the home visiting page of the DEL/DCYF web site.
6.3. Active Caseload Threshold: Contractor shall build and maintain an active participant caseload in
accordance with NFP model requirements. Throughout the entire term of this contract, Contractor shall aim
to serve 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. 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.
6.3.2. DEL/DCYF will initiate the improvement process outlined in Attachment 3 Contract
Monitoring, Compliance and Non -Compliance if the Contractor's Active Enrollment Caseload
falls below 85% of the Maximum Service Capacity.
6.3.3 For Expansion Services Capacity from December 1, 2018 to June 30, 2018 contractor will
work to expand enrollment by an additional 25 families.
6.4. Policies and Procedures for Participant Enrollment, Disenrollment, Re -Enrollment, and Transfer: Contractor
shall develop, maintain, and implement written policies and procedures that are consistent with and in
alignment with NFP model fidelity. The written policies and procedures shall include, but not be limited to,
the following:
6.4.1. Enrollment and Disenroliment: A description of the 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 the program model allows for an alternative visit schedule, the
Contractor must have documented procedures for how alternative visit schedules are
determined and approved.
6.4.2. Re -enrollment: A description of 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 home visiting 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 the home visiting
program. Programs should allow for re -enrolling families when eligible by model and when
appropriate.
6.4.3. Avoiding Dual Enrollment: A description of the processes to assess a family's prior and
current participation in home visiting services upon application for enrollment. If a family is
currently enrolled in an another HVSA funded program or model, in dialogue with the family,
the Contractor's staff shall determine which program is most appropriate to meet the family's
circumstances and the family will remain in the previous program or be seamlessly
transitioned into the new program. It is the intent of the parties that if the family is meeting
participation expectations in the originally enrolled program, 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
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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 Memorandum 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: The number of home visits delivered to family participants shall be based on the
NFP program model requirements. If there are no model requirements, the Contractor shall develop with
Thrive Washington a definition of "frequency". The Contractor shall provide DEL/DCYF a written definition
of "frequency" after such definition has been developed. The definition shall be included with the materials
submitted as part of the model fidelity letter submitted by the Contractor as described in Section 3.1.
7.1.1. As described in Attachment 4 the Contractor shall work towards adhering to the NFP model
expected dosage; for 60% or more of the total enrolled families in the program, the
Contractor shall complete 80% of the model expected home visits.
7.2. Assessments, Service Content, and Referrals: The Contractor shall administer individualized assessments
of participant families, and offer services in accordance with those assessments, family strengths and
needs, and in compliance with the NFP model requirements.
7.2.1. Screenings: The Contractor shall administer screenings with the frequency consistent with
fidelity to the NFP program model requirements, the HVSA Aligned Measures.
7.2.2. Referrals: The Contractor shall refer participants to services needed as identified by
individual assessments and document referrals and results of referrals in the participants'
files.
8. Systems Connections
8.1. Local Engagement and Collective Impact: The Contractor shall participate in local and early learning
regional coalitions (ELRCs) 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 Community Prevention and Wellness Initiative. DEL/DCYF recommends
Contractor develop Memoranda of Understanding with the Early Supports for Infants and Toddlers (ESIT)
program, 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. The intended purpose of the MOUs is to describe the role of each partner in service coordination,
referrals, information sharing, and family transitions.
9. Data Collection and Evaluation Requirements
9.1. Evaluation Purpose and Overview: The parties understand and agree that the HVSA data collection and
evaluation requirements are designed to (1) inform the various stakeholders of home visiting in Washington
State, (2) provide an understanding for how home visiting programs are working in Washington, and (3)
describe how home visiting programs contribute to an early learning system that ensures all children start
life with a solid foundation for success. The HVSA also reports to federal, state, and private funders the
impacts of their investments.
9.1.1. While DEL/DCYF is the administrator of the HVSA, DEL/DCYF contracts with the Department
of Health (DOH) to lead data collection, management, data sharing, quality assurance,
reporting to support program quality and continuous quality improvement and overall HVSA
evaluation efforts. DOH is the DCYF-specified contractor for data management and reporting.
9.2. Data Collection: The Contractor shall collect data from all families, adults, and children enrolled in the home
visiting program as described in this Section (Section 9). Such data collection shall comply with
requirements set forth by the NFP model, DEL/DCYF and the HVSA as described in Attachment 4 Data
Collection, Reporting and HVSA Aligned Measures and outlined below:
9.2.1. Performance Measures, defined in Attachment 4:
9.2.1.1. System and Program Performance Indicators;
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9.2.1.2. Enrollment and Service Utilization;
9.2.1.3. Demographic Information; and
9.2.1.4. Performance Payment Measures.
9.2.2. Upon notification by DCYF, compliance with any changes in data collection expectations as
required of DEL/DCYF from federal or state funding sources.
9.3. Data Management: The Contractor shall collect and input the home visiting data described in this Section 9
into the NFP — ETO/Penelope data collection system. The data shall be stored, maintained, and protected
as described in Section 7 of Exhibit C General Terms and Conditions of this Contract.
9.4. Data Accuracy: The Contractor shall ensure that data collected represent accurately the experience of the
home visiting participants, including the required screenings and assessments administered as designed.
This includes assigning all clients a funding code as designated by DOH (see Section 9.6 for data sharing
requirements).
9.5. Timely Data Collection: The Contractor shall comply with data collection timelines and the Performance
Measures requirements described in Attachment 4. Data shall be entered into the NFP data collection
system within five (5) business days of data collection.
9.6. Data Sharing: The Contractor, and all subcontractors delivering direct home visiting services, must share
with DCYF's contractor of record, DOH, the data necessary to meet data collection requirements specified
in Section 9.2.
9.6.1. Data Sharing Agreement (DSA):
The Contractor, and all subcontractors delivering direct home visiting services, shall maintain
an executed data sharing agreement with DOH to share confidential information, outreach,
referral, enrollment, service utilization, program performance and staffing data as described
in Section 9.2 to be effective throughout the term of the contract. The Contractor shall
maintain documentation of execution of the data sharing agreement with DOH and submit
any revisions to DEL/DCYF and written notice to the NFP NSO within 30 days.
9.6.2. Parental Consent: With consultation and support from DEL/DCYF and DOH, the Contractor
will make every effort to seek Parental Consent to share Confidential Information with DOH
throughout the entire term of the Contract; the Contractor shall seek this consent from all
newly enrolled participants within the first three home visits. Sample consent form(s) are
available on the Home Visiting page at DCYF.wa.gov.
9.6.2.1. Participants who do not provide consent to share confidential information remain
eligible to receive home visiting services.
9.6.2.2. The Contractor shall share with DOH the consent status according to the process
outlined in Attachment 4 no less than quarterly via Secure File Transfer (SFT).
9.7. Quality Assurance: The Contractor shall ensure that data provided to DOH is complete and accurate by
using DOH Quality Assurance Reports of the Contractor's data completion to make corrections to data.
9.7.1. The Contractor shall respond within 10 business days of any request from DOH to resolve
any errors or missing information for all data required in section 9.2.
9.7.2. The Contractor shall strive for less than five percent missing data of all data required in
Section 9.2.
9.7.3. The Contractor shall review data reports prepared by DOH to facilitate reflection, quality
assurance and program improvement efforts.
9.8. Evaluation: The Contractor shall participate in and cooperate with HVSA, DEL/DCYF and DCYF-specified
evaluations. This shall include responding to emerging and non -routine data and evaluation requests from
HVSA funders and working with DEL/DCYF specified contractors. Evaluation activities shall include, but
are not limited to, the following:
9.8.1. Interviews, focus groups, observations and surveys.
9.8.2. The Maternal, Infant Home Visiting Program Evaluation (MIHOPE), the Home Visiting
Workforce Study and the evaluation required by the MIECHV Innovation Grant, which
focuses on recruiting and retaining a high quality home visiting workforce and includes
Contract Number: 18-1047-02 Printed Date: 1/9/2019
Page 11 of 21
working with DEL/DCYF specified contractors, including but not limited to Portland State
University and other vendors.
9.8.3. Completion of all documentation required by the research projects within the timeframes
presented.
9.9. Training and Technical Assistance on Data Collection and Evaluation: The Contractor shall participate in
and cooperate with training and technical assistance related to the topics listed below. Such participation
shall include in-person and remote meetings, staff training, technical assistance opportunities, and reviews
of data, reports and organizational policies and procedures. DOH may support the Contractor in working
towards and achieving contract milestones on topics including, but not limited to, the following:
9.9.1. Data collection;
9.9.2.
Data sharing;
9.9.3.
Reporting process;
9.9.4.
Analysis and interpretation of data;
9.9.5.
Quality assurance.
10. Continuous Quality Improvement (CQI)
10.1. Purpose: The purpose of Continuous Quality Improvement (CQI) is to strengthen practice and 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 encourages testing new strategies that may not always produce desired
results. Building CQI into regular practice may require the Contractor to assess overall organizational
culture for quality. DEL/DCYF will not monitor the Contractor for CQI outcomes but rather for progress on
implementing the CQI Team and Projects as outlined in this Section 10.
10.2. Training and Technical Assistance: The Contractor shall participate in ongoing training and technical
assistance associated with CQI including quarterly phone calls and topic specific group calls during each
project period. DCYF-specified contractors providing this training and technical assistance include Thrive
and DOH who will also support the 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: The Contractor shall develop and implement at least two (2) CQI Projects during this contract
term. The CQI Project periods are (1) July 1, 2018 through December 31, 2018 and (2) January 1, 2019
through June 30, 2019. Each CQI Project shall include the following:
10.3.1. CQI Team—The Contractor shall 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.
10.3.2. CQI Charter and Plan—At a minimum, the Contractor shall define and implement the project
SMART Aim, CQI Team Members, and the initial project plan, as defined in Attachment 5 and
available on the Home Visiting page at DCYF.wa.gov.
10.3.2.1. The Contractor shall submit CQI Charter and Project Plan for Project #1 no later
than August 20, 2018 and for Project #2 no later than February 20, 2019 using the
template described in Attachment 5 Continuous Quality Improvement and available
on the Home Visiting page at DCYF.wa.gov.
10.3.3. Improvement Cycles— The Contractor shall implement at least two (2) Plan, Do, Study, Act
(PDSA) cycles each project period.
10.3.4. CQI Topics—The Contractor shall utilize one of the following four topics for each CQI Project,
unless otherwise approved by DCYF:
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 appropriate services;
10.3.4.3. Family Engagement—increasing length of participation or frequency of completed
visits;
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Page 12 of 21
10.3.4.4. Child Developmental Screening—completion of screening using a validated tool,
referral and connection to appropriate services;
10.3.4.5. Other Topic—To be approved by DCYF.
10.3.5. CQI Project Summary and Reflection— The Contractor shall report on project completion,
changes tested, and reflect on lessons learned, as described in Attachment 5 and available
on the Home Visiting page at DCYF.wa.gov. The reports shall be submitted to DEL/DCYF as
an attachment to the Quarterly Progress Reports due on or before the dates described below
in Section 14; DEL/DCYF will share these reports with DOH and Thrive for review and
feedback during the quarterly CQI calls.
10.3.5.1. The Contractor shall submit the CQI Project 1 PDSA Report no later than October
20, 2018 with the Quarter 1 Progress Report.
10.3.5.2. The Contractor shall submit the CQI Project 1 Summary and Reflection no later than
January 20, 2019 with the Quarter 2 Progress Report.
10.3.5.3. The Contractor shall submit the CQI Project 2 PDSA Report no later than April 20,
2019 with the Quarter 3 Progress Report.
10.3.5.4. The Contractor shall submit the CQI Project 2 Summary and Reflection no later than
July 20, 2019 with the Quarter 4 Progress Report.
11. Technical Assistance
11.1. Technical Assistance (TA) is available to the Contractor to assist in maintaining model fidelity,
implementing best practices, and assuring improving quality of home visiting service delivery. DEL/DCYF
contracts with Thrive Washington (Thrive) to provide technical assistance for the HVSA. The Contractor
shall work with DCYF's designated technical assistance provider for support in achieving contract
milestones including, but not limited to, the following areas:
11.1.1. Program model fidelity as described by the NFP model developer and Section 3 of this
Statement of Work;
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, recruitment, enrollment and retention;
11.1.6. Model specific service delivery and case planning;
11.1.7. Leadership development and organizational support for home visiting model; and
11.1.8. CQI planning, implementation and analysis.
11.2. Technical Assistance Plan: The Contractor shall work with the DCYF-specified contractor for technical
assistance to complete a Self -Reflection Tool and develop a Technical Assistance Plan within the first three
months of this Contract.
11.2.1. Technical Assistance and Coaching: The Contractor shall work with the DCYF-specified
contractor for technical assistance to implement the Technical Assistance Plan throughout
the duration of this Contract.
11.2.2. The Contractor shall participate in at least monthly one-hour Technical Assistance/Coaching
calls and up to three (3) technical assistance site visits led by the DCYF-specified contractor
for technical assistance.
12. Budget and Financial
12.1. Program -Funding Specific Budget: The Contractor understands and agrees that funds provided under this
Contract, with the exception of Performance Payment Awards described in Section 12.6 below, shall be
expended by June 30, 2019 as specifically itemized line by line in Exhibit B Budget. Any requests for shifts
between categories (pay points of the budget) must receive prior written approval from DEL/DCYF, and
transfers across expense categories (pay points of the budget) in excess of 10% of the total for each
Contract Number: 18-1047-02 Printed Date: 1/9/2019
Page 13 of 21
funding source will not be made without prior written approval from DEL/DCYF and require a contract
amendment.
12.2. Financial Management: The Contractor must maintain a financial management system with written policies
and procedures ensuring strong internal controls. Written policies and procedures include, but are not
limited to: accounts payable, payroll, procurements, subrecipients/subcontractors, and equipment inventory
processes. The Contractor shall make such policies and procedures available to DEL/DCYF upon request.
12.3. Supplantation: The 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.
12.4. Travel: The 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:
hrtp://www.ofm.wWhen the lowest available lodging rate exceeds the current
state travel reimbursement rates, an exception may be made 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 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.
12.5. Indirect Costs: The 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.
12.5.1. If claiming the federally negotiated rate, the Contractor must supply, preferably via email, the
documentation verifying the federally approved rate. The Contractor's indirect rate plan and
procedure are subject to review during ongoing or in-depth fiscal monitoring.
12.5.2. The 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: Electronk Code of Federal Regulations.
12.6. Performance Payment Awards: During the term of this contract, the Contractor will receive an additional
monetary award in accordance with the table in Section 12.6.6 for achievement of the Performance
Milestones described in this Section.
12.,6.1. DEL/DCYF will review data provided by the Contractor and DOH to confirm achievement of
the milestones described in this Section prior to issuance of any Performance Payment
Award.
12.6.2. Quarterly Home Visiting Enrollment Performance Milestone:
DEL/DCYF will award the Contractor a Performance Payment Award upon the fulfillment of
the following milestone:
12.6.2.1. The Contractor maintains an average Active Enrollment Caseload of 85% or
greater of their Maximum Service Capacity during the quarter, as measured by the
average of 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 as defined in Section 6.3).
12.6.2.2 For Expansion Services Capacity from December 1, 2018 to June 30, 2018, 25
families will not be counted against.
12.6.3. Quarterly Home Visiting Dosage Performance Milestone:
DEL/DCYF will award the Contractor a Performance Payment Award upon the fulfillment of
the following milestone:
12.6.3.1. Among at least 60% of the total enrolled families, the Contractor completes at least
80% of the expected number of home visits, using the HVSA Model Expected
Dosage defined in Attachment 4.
12.6.4. Annual Depression Screening and Follow-up Performance Milestones:
DEL/DCYF will award the Contractor a Performance Payment Award upon the fulfillment of
either one or both of the following milestones:
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Printed Date: 1/9/2019 Page 14 of 21
12.6.4.1. Depression Screening Annual Performance Milestone:
The Contractor's performance on HVSA Performance Measure 2 Depression
Screening defined in Attachment 4: Contractor completion of a depression
screening for a participating primary caregiver using an approved, validated tool
within 90 calendar days postpartum (if enrolled prenatally) or 90 calendar days after
enrollment (if enrolled postnatally).
12.6.4.1.1 DEL/DCYF will award $20 for each screening using the above criteria,
up to a maximum of $1,240 annually for this Performance Milestone,
or the equivalent of $20 multiplied by 100% of the Contractor's
Maximum Service Capacity (as described in Section 6.3).
12.6.4.2. Follow -Up to Positive Depression Screening Annual Performance Milestone:
The Contractor's performance on appropriate follow-up to Depression Screening:
Contractor follow- up with a referral to or connection with appropriate services for a
participating primary caregiver who screened positive for depression using the
criteria in Section 12.6.4.1 above.
12.6.4.2.1 DEL/DCYF will award the Contractor $20 for each participant who
received follow-up as defined above, up to a maximum of $434
annually for this Performance Milestone, or the equivalent of $20
multiplied by 35% of the Maximum Service Capacity of this Contract.
12.6.5. After assessment and approval from DCYF, the Contractor may invoice for payment
biannually for the enrollment and dosage performance milestones, defined in 12.6.2 and
12.6.3, respectively: performance in Quarters 1 and 2 to be invoiced following Quarter 2, and
performance in Quarters 3 and 4 to be invoiced following Quarter 4. After assessment and
approval from DCYF, the Contractor may invoice for payment annually for the caregiver
depression screening and follow-up performance milestones, defined in 12.6.4; performance
in Quarters 1 through 4 to be invoiced following Quarter 4.
12.6.6. DEL/DCYF will allocate the performance awards according to tiers in the following table:
Enrollment and Dosage Performance Awards will be based on performance level and the
Contractor's Maximum Enrollment Capacity, as defined in Section 6.3 of this Contract; the
Caregiver Depression Screening and Follow -Up Performance Awards will be based on the
number of caregivers receiving the screening and/or follow-up.
Maximum
Total Quarterly Award
Total Quarterly Award
Award Per Caregiver
Enrollment
Enrollment Performance
Dosage Performance
Maternal Depression
Screening/Follow-Up
Capacity of
(12.6.2):
(12.6.3):
Performance (12.6.4):
Contractor
(6.3)
85 to 89%
90% or
60 to 69%
70% or
Screening
Follow -Up
more
more
49 or fewer
$250
$500
$250
$500
$20
$20
Between 50 and 99
$350
$650
$350
$650
$20
$20
100 or more
$450
$800
$450
$800
$20
$20
12.6.7. Contractor must use the funds received from these Performance Payment Awards towards
advancing the goals of the home visiting program in this Contract.
12.7. Financial Reporting and Documentation:
12.7.1. The Contractor shall submit at least monthly, but 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:
12.7.1.1. Monthly or Semi-monthly Expense Summary by fund source (e.g. State General
Fund, State 1502) as produced by Contractor's accounting system and clearly
detailing expenses incurred for each Pay Point in that period's A-19 Voucher;
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Printed Date: 1/9/2019
Page 15 of 21
12.7.1.2. Contractor's Monthly or Semi-monthly Payroll Summary by fund source (e.g. State
General Fund, State i502) describing reimbursed hours for each staff person paid
under the contract for that period; and
12.7.1.3. Documentation supporting all single expenses exceeding $5,000 by fund source
(e.g. State General Fund, State i502).
12.7.2. Payment shall be 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.
12.7.3. In -Depth Financial Review: DEL/DCYF will conduct an annual in-depth financial review of the
Contractor's expenditures charged to the Contract. In preparation for the Annual Site Visit,
the Contractor shall provide to DEL/DCYF upon request the financial documents listed below,
Based upon this review, if questions arise, DEL/DCYF may request additional data and
documentation.
12.7.3.1. Contractor's most recent Annual Financial Audit, Single or Program -Specific Audit,
as applicable
12.7.3.2. Contractor's most recently submitted IRS Form 990;
12.7.3.3. General Ledger activity detail of all expenditures allocated to this Contract incurred
within the dates to be determined and in agreement with A-19 invoices submitted to
DCYF. Detail will be defined by DEL/DCYF and will include indirect costs, accounts
payable transactions, and time and effort transactions;
12.7.3.4. Contractor's Indirect Cost Allocation Plan or Indirect Cost Proposal, or Indirect Rate
Agreement, whichever is applicable;
12.7.3.5. Chart of Accounts;
12.7.3.6. Other detailed supporting financial documentation upon request -such as employee
time sheets, travel and major expense documentation -to be further defined by
DCYF.
13. Publicity, Publication and Acknowledgements
13.1. DEL/DCYF 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/DCYF must comply with Washington State public disclosure law (Chapter 42.56 RCW) and with
regulations set forth in HIPAA and FERPA.
13.1.1. If the Contractor wishes to issue a press release or public report announcing this Contract, or
otherwise use DCYF's name or logo for purposes related to this Contract, the Contractor
shall contact the DEL/DCYF Contract Manager, identified on page 1 of this Contract at least
five (5) business days before the desired announcement or publication date to obtain prior
approval.
13.1.2. For all press releases or public reports approved by DCYF, the Contractor shall include the
name and logo of DEL/DCYF and that the project is funded by the State of Washington,
Washington Department of Children Youth and Families and Home Visiting Services
Account.
14. Contract Reporting, Monitoring, and Deliverables
14.1. Any mention of quarters one through four referenced in this document are defined as
14.1.1. Quarter 1 — July 1, 2018 to September 30, 2018
14.1.2. Quarter 2 — October 1, 2018 to December 31, 2018
14.1.3. Quarter 3 — January 1, 2019 to March 31, 2019
14.1.4. Quarter 4 — April 1, 2019 to June 30, 2019
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14.2. Reporting: The Contractor shall 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 table 14.5 below. Due
dates may be adjusted atthe discretion and approval of the DEL/DCYF Contract Manager to accommodate
the variable reporting structures associated with federal funding requirements. DEL/DCYF 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/DCYF with respect to the Contract.
14.2.1. While funding for this Contract ends June 30, 2019, deliverables describing services
rendered in the months of the Contract term will be due no later than July 31, 2019 and will
be submitted at no additional cost to DCYF.
14.3. Monitoring: As described in Attachment 3 of this Contract, DEL/DCYF will monitor compliance with contract
requirements, model standing, progress toward completion of deliverables, enrollment performance, and
financial activity through review of submitted reports, meetings, phone calls and other communication with
the Contractor.
14.3.1. The Contractor shall provide a right of access to its facilities to DCYF, personnel authorized
by DCYF, 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. DEL/DCYF will work with
Contractor to determine a mutually acceptable date.
14.3.2. Monitoring activities may include, but not be limited to: site visits to review records, observe
implementation of services, or follow up on compliance issues.
14.3.3. If DEL/DCYF (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/DCYF will 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. Any program with prior compliance or improvement
issues, including Implementation Improvement Status and Implementation Improvement
Plans, shall continue until resolved and approved by DCYF.
14.4. Summary of Deliverables and Timelines
14.4.1. Monthly Enrollment Reports: The Contractor shall submit Monthly Enrollment Data Reports
no later than the 20th day following the month of service using the template provided by
DEL/DCYF as described in Attachment 6 Monthly Enrollment Report;
14.4.2. Invoices: As described in Section 12.8, the Contractor shall submit A-19 invoices for
expenditures accompanied by the financial documentation.
14.4.3. Quarterly Progress Reports: The Contractor shall submit four (4) Quarterly Progress Reports
using the template to be provided by DEL/DCYF and described in Attachment 7, to include
the CQI Reports described in Attachment 5. The Contractor shall submit this report each
quarter no later than the 20th day following the quarter of service.
14.4.4. Self -Reflection Tool: The Contractor shall submit the Self -Reflection Tool no later than
September 20, 2018 using the template provided by Thrive.
14.4.5. Annual Pre -Contract Questionnaire: The Contractor shall complete and submit the FY20
HVSA Pre -Contract Questionnaire and FY20 Proposed Budget by March 30, 2019 using the
template to be provided by DCYF.
14.5. Timeline of Reports and Submissions: The table below outlines the reporting and submissions timeline for
deliverables presented in this Statement of Work according to the month of submission.
14.5.1. Some expectations associated with this Contract, including attendance at 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.
14.5.2. If due dates occur on a weekend or holiday, the Contractor shall submit the report before
8am of the following business day.
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Page 17 of 21
Table 14.5 Report Time Table
July 2018
Anly 10 fto DOH);
FY18 Q4 Consenting Clients to DOH
July 20:
June 2018 Monthly Enrollment Report
FY18 Q4 Quarterly Progress Report (April to June)
including:
CQI Q4 Report
Current Insurance Certificate Renewal*
Confidentiality and Non- Disclosure Agreement for new
employees*
July 30:
June 2018 Monthly Invoice
Executed DSA with DOH, if amended
Documented approval of DSA with DOH submitted to NFP
National Service Office
October 2018
October 8 to DON.:
September Consenting Clients to DOH
October 20:
September 2018 Monthly Enrollment Report
Q1 Quarterly Progress Report (July to September)
including
CQI Project 1 PDSA Report
October 30:
September 2018 Monthly Invoice
January 2019
January 0 to FJOH)'
December Consenting Clients to DOH
Contract Number: 18-1047-02
August 2018
August 8:
July Consenting Clients to DOH
August 20,
July 2018 Monthly Enrollment Report
CQI Charter and Project 1 Plan
August 30:
July 2018 Monthly Invoice
September 2018
September 1.1:
August Consenting Clients to DOH
September 20:
August 2018 Monthly Enrollment Report
Self -Reflection Tool (submitted to Thrive)
September 30:
August 2018 Monthly Invoice
November 2018
November 8:
October Consenting Clients to DOH
November 20:
October 2018 Monthly Enrollment Report
November 30:
October 2018 Monthly Invoice
December 2018
December 10:
November Consenting Clients to DOH
December 20:
November 2018 Monthly Enrollment Report
December 30:
November 2018 Monthly Invoice
February 2019
February 8:
January Consenting Clients to DOH
Printed Date: 1/9/2019
Page 18 of 21
Januar20.•
December 2018 Monthly Enrollment Report
Q2 Quarterly Progress Report (October to December)
including
Model Fidelity Letter
CQI Project 1 Summary and Reflection
January 30.
December 2018 Monthly Invoice
April 2019
April 8 fto DQHL,
March Consenting Clients to DOH
April 20:
March 2019 Monthly Enrollment Report
Q3 Quarterly Progress Report (January to March)
including
CQI Project 2 PDSA Report
April 3C7:
March 2019 Monthly Invoice
July 2019
July 10 Ito DOW:
June Consenting Clients to DOH
July 20:
June 2019 Monthly Enrollment Report
Q4 Quarterly Progress Report (April to June) including
CQI Project 2 Summary and Reflection
July 30:
June 2019 Monthly Invoice
Certification of Data Disposition for programs ending""
February20:
January 2019 Monthly Enrollment Report
CQI Charter and Project 2 Plan
Februai y28:
January 2019 Monthly Invoice
March 2019
March 8:
February Consenting Clients to DOH
March 20:
February 2019 Monthly Enrollment Report
March 30:
February 2019 Monthly Invoice
FY20 Pre Contract Questionnaire and Budget
May 2019
May 8:
April Consenting Clients to
May 20:
April 2019 Monthly Enrolln
May 30:
April 2019 Monthly Invoice
June 2019
June 10:
May Consenting Clients to
June 20:
May 2019 Monthly Enrollrr
lune It) -
2019
2
2019 Monthly Invoice
"Updated Insurance Certificate must be submitted when the insurance policy is renewed.
"Updated Statement of Confidentiality and Non -Disclosure must be submitted for any new employees,
agents, or subcontractors with access to confidential or personal information relating to this contract.
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 19 of 21
***Data Disposition to be submitted with closure
Contract Number: 18-1047-02 Printed Date: 1/9/2019 Page 20 of 21
° WASHINGTON STATE DCYF Contract Number: 18-1047-02
r `iDepartmentof Contractor Contract Number:
Children, Youth, and Families Title: Home Visiting Services Account:
Nurse Family Partnership (NFP)
Amended Exhibit B - BUDGET
Amendment #2
Budget for State Fiscal Year 2018 (July 1 2017 - June 30 2018):
See original contract package for budget detail. Total: $180,912.00
Budget for State Fiscal Year 2019 (July 1 2018 - June 30 2019):
Payment Point Budget Limit Note
1. 502State- Personnel $77,484.94
2. 502State - Goods
$0.00
and Services
3. 502State - Travel
$200.00
4. 502State -
$83,144.15
Contracted/
Professional Services
5. 502State -
$16,082.91
Administrative/ Indirect
Charges
6. GenFundState-
$39,885.10
Personnel
7. GenFundState -
$11,805.00
Goods and Services
8. GenFundState -
$1,603.00
Travel
9. GenFundState -
$82,619.83
Contracted/
Professional Services
10. GenFundState -
$13,591.29
Administrative/ Indirect
Charges
11. HVSA -
$5,680.00
Performance Pay
Total: $332,096.22
Contract Number: 18-1047-02
Contract Maximum: $513,008.22
Contract Funding Source(s)
State Funds $513,008.22
Printed Date: 1/9/2019
Page 21 of 21
kvA%H INC, I oN S3.4Tr A19 -1A INVOICE VOUCHER Contractor Contract #:
iJe{�illPifelT[ ❑f
Chliclren, Youth, and Families Agency Number: Contract #: 18-1047-02
Attn: Ivon Urquilla I PO Box 40970 1 Olympia WA 98504-0970 Contract Service Period: July 1 2017 - July 31 2019
t Title: Home Visiting Services Account: Nurse Family Partnershi
DCYF Contact: Ivon Urquilla
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
(sign in ink)
(Title) (Date)
TO BE COMPLETED BY DCYF
TO BE COMPLETED BY VENDOR
Date Reviewed Agency Approval
Invoice Service Period for Budget FY 2018:
Doc Date
Invoice Number:
This is a Final Billing:
Yes n No
Payment Points (Note)
Invoice Date
Contract Billed
Budget Amount
Al
1. STATE- Personnel
2. STATE- Goods and Services
Sub
Obj
$70,594.66
$996.34
OI
3. STATE -Travel
GL
$1,738.09
Invoice #
4. STATE- Contracted/ Professional Services
411
$87,500.00
CZ
5. STATE- Administrative/ Indirect Charges
$16,082.91
6. STATE- Performance Pay
$4,000.00
Total
$180,912.001 $0.001
Total Payment Request $0.00
TO BE COMPLETED BY DCYF
Program Review
Date Reviewed Agency Approval
Date Approved
Doc Date
Current Doc No.
Ref Doc No.
Vendor Number Vendor Message
SWV0002430-02
Invoice Date
Trn
Cd Fnd
Al
PI
Sub
Obj
SSO
OI
Sub
Alloc Proj Proj Ph
GL
Subsidiary
Debit Credit Note Amount
Invoice #
17B
411
36300
CZ
9999 1502
Accounting Approval for Payment
Date Approved
Warrant Total:
1/22/2019 Page 1 of 1
` WASHINGTON STATE A19 -1A INVOICE VOUCHER Contractor Contract #:
I Department of
Children, Youth, and Families Agency Number: Contract #: 18-1047-02
Attn: Ivon Urquilla I PO Box 40970 1 Olympia WA 98504-0970 Contract Service Period: July 1 2017 - July 31 2019
t Title: Home Visiting Services Account: Nurse Family Partnershi
DCYF Contact: Ivon Urquilla
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: 1 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
Jefferson County
615 Sheridan Street
Port Townend WA 98368
(sign in ink)
(Title) (Date)
TO BE COMPLETED BY VENDOR
Invoice Service Period for Bridget FY 2019: Invoice Number: This Is a Final Billing:
Yes No
Contract Billed
Doc Date Current Doc No. Ref Doc No
Payment Points (Note) Budget Amount
Vendor Message
1. 502State- Personnel $77,484-94
2. 502State - Goods and Services $0.00
3. 502State - Travel $200-00
Trn Sub Sub
4. 502State - Contracted/ Prcfessional Services $83,144.15
5. 502State - Administrative/ Indirect Charges $16,082.91
Cd Fnd Al PI Obj SSO OI Alloc Proj Proj Ph GL
6. GenFundState- Personnel $39,885.10
Invoice #
7. GenFundState - Goods and Services $11,805.00
17B 412 36300 NB 574B 0410
8 GenFundState - Travel $1,603.00
9. GenFundState - Contracted/ Professional Services $82,619.83
17B 412 36300 NB 574B 0411
10. GenFundState - Administrative/ Indirect Charges $13,591.29
11. HVSA - Performance Pay $5,680.00
Accounting Approval for Payment Date Approved
Total $332,096.22 .190-001 Total Payment Request
$0.00
TO BE COMPLETED BY DCYF
Program Review
Date Reviewed
Agency Approval
Date Approved
Doc Date Current Doc No. Ref Doc No
Vendor Number
Vendor Message
Invoice Date
SWV0002430-02
Trn Sub Sub
Subsidiary
Cd Fnd Al PI Obj SSO OI Alloc Proj Proj Ph GL
Note Amount
Invoice #
Debit Credit
17B 412 36300 NB 574B 0410
17B 412 36300 NB 574B 0411
Accounting Approval for Payment Date Approved
Warrant Total:
1/22/2019 Page 1 of 1