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615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator Consent Agenda August 7, 2019 FROM: Vicki Kirkpatrick, Director Yuko Umeda, Public Health Nurse III DATE: Q�b 2%� , 1 /a SUBJECT: Agenda Item — Washington State Department of Children, Youth and Families; July 1, 2019 — July 31, 2020; $406,530• -,1-Z STATEMENT OF ISSUE: Jefferson County Public Health is requesting Board approval for Washington State Department of Children, Youth and Families for funding Home Visiting Services; July 1, 2019 — July 31, 2020; $406,530.72 ANALYSIS/STRATEGIC GOALS: 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 eighth 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 Children, Youth and Families with state dollars for a total of $406,530.72 of which $194,718.64 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. RECOMMENDATION: JCPH management requests approval of the Washington State Department of Children, Youth and Families for funding Home Visiting Services; July 1, 2019 — July 31, 2020; $406,530.72. REVIEWED BY: Philip Morley, County Administrator 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 WASHINGTON STATE Department of DCYF Contract Number: 20-1171 Children, Youth, and Families Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 INTERLOCAL AGREEMENT Home Visiting Services Account: Nurse Family Partnership THIS CONTRACT is made and entered into by and between the State of Washington, acting by and through the Department of Children, Youth, and Families, a department of Washington State government (hereinafter referred to as "DCFY") and Jefferson County, a Municipality, (hereinafter referred to as "Contractor'), located at 615 Sheridan Street, Port Townend WA 98368. 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 Prevention Services Program Specialist ivon.urquilla@dcyf.wa.gov Phone: (360) 725-4695 THIS CONTRACT is managed in the following categories: AGENCY DIVISION: Family Support CONTRACT SERVICE CATEGORY: Home Visiting CONTRACT SERVICE TYPE(S): Nurse -Family Partnership THIS CONTRACT CONTRIBUTES TO THE FOLLOWING AGENCY GOALS: • Health - Heathy Birthweight. • Resilience - Children/youth are supported by healthy relationships with adults. • Resilience - Parents/caregivers are supported to meet the needs of their children/youth. THE PURPOSE OF THIS CONTRACT is to provide high quality home visiting services to vulnerable families for the purpose of improving outcomes for participants and strengthening coordination of services. THEREFORE, IT IS MUTUALLY AGREED THAT: 1. CONTRACT MANAGEMENT a. Contract Managers (1) The Contract Manager as shown on page 1 for each of the parties shall be the contact person for all communications and billings regarding the performance of this Contract. (2) Each party shall provide the other party with written notice of any changes of the name and contact information regarding either party's designated Contract Manager. The written notice shall not be effective until fourteen business days from the date of mailing. The requirements contained in the Section titled Contractor Staff of exhibit D shall apply to this Section (Section 1.a). b. Notices Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 3 (1) 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 with the United States Postal Service as first-class certified mail, postage prepaid and return receipt requested, to the parties at the addresses listed in Section 1.a. (2) 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 on page 1. 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 Report • Exhibit C - Deliverables Report • Exhibit D - General Terms and Conditions • Attachment 1 - Confidentiality and Non -Disclosure Agreement • Attachment 2 - Certification of Data Disposition • Attachment 3 - Contract Monitoring, Compliance and Non -Compliance • Attachment 4 - Continuous Quality Improvement • Attachment 5 - Monthly Enrollment Data Report Components • Attachment 6 - HVSA Quarterly Progress Report Components • Attachment 7 - Data Collection Reporting Aligned Measurers 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 Contractor shall perform the activities and obligations as set forth and described in Exhibit A. 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. The Contractor shall provide the services, goods, products and activities at the costs set forth in this Contract. 4. PERIOD OF PERFORMANCE The effective date of this contract, shall commence on July 1, 2019 and must be completed on or before July 31, 2020. Performance on this Contract shall not begin before the effective date. 5. COMPENSATION The cost of accomplishing the work described in this Contract shall not exceed $406,530.72. Any additional authorized expenditures, for which reimbursement is sought, must be submitted as written documentation to the DCYF Contract Manager for pre -approval by the DCYF Secretary or the Secretary's delegate as described in this Contract, and established by a written Contract Amendment. Exhibit B 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, DCYF shall receive 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 and is contingent upon acceptance of relevant work products and approval of vouchers by DCYF as described in this Contract. 6. BILLING PROCEDURE a. The Contractor shall submit, not more than semi-monthly, properly completed A-19 vouchers (the "voucher") to one of the following: Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 3 The Department of Children, Youth, and Families Attn: Ivon Urquilla PO Box 40970 Olympia WA 98504-0970 Or, email a scan of an original, signed A-19 voucher directly to the DCYF Contract Manager at home.visiting@dcyf.wa.gov b. Payment to the Contractor for approved and completed work shall be made by warrant or Electronic Funds Transfer by DCYF 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. c. Each voucher must clearly reference the DCYF Contract Number and the Contractor's Statewide Payee Registration number assigned by the Office of Financial Management (OFM). d. Properly completed vouchers and attachments completed by the Contractor must contain the information described in Exhibit A under the Section titled "Compensation and Voucher Payment". e. For Statewide Payee Registration: OFM 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, https://ofm.wa.gov/it-systems/statewide-vendorpayee-services, prior to submitting a request for payment under this Contract. No payment shall be made until the Statewide Payee Registration is complete. f. Upon the expiration of this Contract, any claim for payment or voucher not already made shall be submitted to DCYF no later than forty-five (45) days following the expiration date of this Contract. In the event the Contractor does not provide to DCYF a claim for payment or voucher within forty-five (45) days following the expiration date of the Contract, DCYF shall have no obligation to pay such claim for payment or voucher even if the service or product has been delivered and/or accepted. 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 Section 2, is executed by the persons signing below who warrant they have read and understand this Contract, including the exhibits and attachments. The persons signing below further represent they have the authority to execute this Contract. SIGNATURE: PRINTED NAME AND TITLE: DATE SIGNED: Jefferson County CONTRACTOR DEPARTMENT OF CHILDREN, YOUTH, AND FAMILIES DCYF: Ap ro a t orm only:�� Date: PhiJip-C,-fir, 6#rief Civil Deputy Prosecuting Atto ney Jefferson CountyPr secuting Attorney's Office �n�6 A Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 3 WASHINGTON STATE DCYF Contract Number: 20-1171 Department of Contract Maximum: $406,530.72 Children, Youth, and Families From-To:07/01 /2019-07/31 /2020 Exhibit A - Statement of Work Table of Contents 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. DEFINITIONS........................................................................... Background............................................................................... ModelFidelity............................................................................ Staffing, Supervision and Training ............................................ Service Area and Recruitment of Priority Populations .............. Participant Enrollment, Retention, and Caseload Maintenance Home Visits Frequency and Content ........................................ Systems Connections............................................................... Data Collection and Evaluation Requirements ......................... Continuous Quality Improvement(CQI).................................... Technical Assistance................................................................ Budget and Financial................................................................ Publicity, Publication and Acknowledgements .......................... Contract Reporting, Monitoring, and Deliverables ..................... .,.4 ................4 ................5 ................8 ................7 ................8 ................9 ................9 .........., ...11 ..............12 ..............13 ..............17 47 1. DEFINITIONS. The following terms, as used throughout this Contract, shall have the meanings set forth below: a. "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. b. "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. C. "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. d "At -Risk Family" means families residing in at -risk communities and determining the priority populations from which participants are recruited. e. "Benchmarks" means the federally or state required performance measures that will be measured and reported on through this Contract. f. "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. g. "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 Contract Number: 20-1171 Printed Date: 8/7/2019 rays 1 vi 10 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. h "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. i. "DCYF" means the Department of Children, Youth and Families. j. "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). k. "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 DCYF in the form and manner required by this contract. I. "DOH" means the Department of Health. M. "DSA" means Data Sharing Agreement. n. "Efforts To Outcomes (ETO)" means the data collection system for the national Nurse Family Partnership Program. o. "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. p. "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. q, "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. r. "FERPA" means "Family Educational Rights and Privacy Act" that protects the privacy of student education records, with regulations found at 34 CFR Part 99. S. "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. t. "HRSA" means the United States Department of Health and Human Services: Health Resources and Services Administration. U. "HV" means home visiting. V. "HVSA" means the Home Visiting Services Account established in RCW 43.215.130. W. "HVSA Aligned Measures" means those performance measures described in Attachment 7 of this Contract. X. "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/Ounce of Prevention. "Implementation Hub" is also known as 'The HUB.' Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 18 Y. "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. "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. aa. "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.a., and at full enrollment, as set forth in Section 6.c. bb. "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. CC. "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. dd. "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. ee. "Ounce of Prevention" means the private partner to be responsible for supporting the HVSA account by providing TTA through the implementation Hub to LIAs. During State Fiscal Year 2020, Thrive Washington's role as the private -public partner to DCYF will transfer to the Ounce of Prevention Fund to support the work of the Implementation HUB as described in RCW 43.216.130. ff. "Penelope" means the data collection system to be used by the national Nurse Family Partnership program, replacing Efforts to Outcomes in 2019. gg. "Portfolio Programs" means the array of home visiting models funded by the HVSA, including Child Parent Psychotherapy, Early Head Start, Family Spirit, Outreach Doula, ParentChild+, and Steps to Effective Enjoyable Parenting. hh. "PSRS" means the Prevention Services Reporting System, an online electronic reporting system managed by the Department of Children, Youth, and Families for contractor submission of deliverables. "Priority Populations" means the populations from which clients who receiving home visiting services through this Contract are recruited, defined in Section 5.c of this Contract. jj. "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. kk. "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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 18 "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. mm. "State Model Lead" means the HV program model representative that provides contractors with HV services, supports and TTA in coordination with the Implementation HUB. nn. "TANF" means Temporary Assistance for Needy Families administered through the Department of Social and Health Services (DSHS). oo. "Thrive Washington" means the private partner identified in RCW 43.216.130 that is responsible for supporting the HVSA account by providing TTA through the Implementation Hub to LIAs. pp. "TTA" means Training and Technical Assistance and may include coaching and consultation activities. qq. "WorkFirst" means the program for TANF families who are required to participate in certain work- related activities. 2. Background The Home Visiting Service Account (HVSA) is a legislatively mandated private- public partnership (RCW 43.216.130) that funds high quality home visiting programs so that: (1) Children are healthier and better prepared for school (2) Parent-child bonds are stronger (3) Abuse and neglect are less likely b. The HVSA prioritizes funding towards meeting the needs of Washington's diverse populations, particularly those families and communities demonstrating the highest needs. C. 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. d. Programs funded through the HVSA and administered by 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 The Contractor shall maintain fidelity to the Nurse -Family Partnership program model as defined as ongoing adherence to specified criteria and components described by the Nurse -Family Partnership 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. (1) National Model Standing: Contractor will ensure adherence to Nurse -Family Partnership 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 Nurse -Family Partnership national organization for evidenced based programs. The letter shall be delivered to DCYF with the Quarter 2 Progress Report. (2) Contractor must obtain prior written approval by the model developer and DCYF before implementing enhancements or adaptations to the home visiting model. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 18 4. b. If Contractor subcontracts for delivery of home visiting services, then the subcontract must receive prior approval from DCYF, and the subcontractor must comply with all sections of this Scope of Work. Staffing, Supervision and Training 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: Staffing Plan by Position Type Home Visitor FTE Total Supervisors FTE Total -- time delivering 7e visiting services, if applicable ervisor FTE Total -- time dedicated to iin Support Staff FTE Total a Support Staff FTE Total iagement Staff FTE Total itional Direct Service Staff FTE Total Home Visiting Supervisor and Home Visitor Qualifications: Contractor shall comply with the Nurse -Family Partnership 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/Ounce of Prevention, to establish qualifications. The definitions shall be included with the model fidelity letter submitted by the Contractor as described in Section 3.a. The Contractor shall adhere to these definitions of home visitor supervisor and staffing qualifications throughout the entire term of this contract. C. Sub -Contracting: With prior approval from 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 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. d. 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. e. Supervision of Home Visitors: Contractor shall comply with the supervision requirements of Nurse -Family Partnership program model as follows: (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. (2) Supervision Schedule Hours: Contractor shall comply with the following supervision schedule: Contract Number: 20-1171 (a) A minimum of two (2) hours per month of individual reflective supervision for each home visitor working .5 FTE or more; and (b) A minimum of one (1) hour per month of group supervision, case conferencing, or staff meetings for all home visitors; Printed Date: 8/7/2019 Page 5 of 18 d. a. b. C. General e. MIECHV TANF i502 State State HVSA Funds Funds Funds 1.42 Funds Total 1.10 2.52 0.00 Home Visiting Supervisor and Home Visitor Qualifications: Contractor shall comply with the Nurse -Family Partnership 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/Ounce of Prevention, to establish qualifications. The definitions shall be included with the model fidelity letter submitted by the Contractor as described in Section 3.a. The Contractor shall adhere to these definitions of home visitor supervisor and staffing qualifications throughout the entire term of this contract. C. Sub -Contracting: With prior approval from 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 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. d. 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. e. Supervision of Home Visitors: Contractor shall comply with the supervision requirements of Nurse -Family Partnership program model as follows: (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. (2) Supervision Schedule Hours: Contractor shall comply with the following supervision schedule: Contract Number: 20-1171 (a) A minimum of two (2) hours per month of individual reflective supervision for each home visitor working .5 FTE or more; and (b) A minimum of one (1) hour per month of group supervision, case conferencing, or staff meetings for all home visitors; Printed Date: 8/7/2019 Page 5 of 18 (c) A minimum of one (1) hour per month for each home visitor working 0.5 FTE of administrative and clinical supervision; (d) The parties may agree in writing to an alternative supervision schedule. Staff Training and Ongoing Professional Development: (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: (a) New and ongoing model training, (b) Ongoing professional development and continuing education required by the Nurse -Family Partnership model, (c) Training required by the DCYF on data collection methods, Continuous Quality Improvement, and other topics, which may include the NEAR@Home Toolkit, Facilitating Attuned Interactions, Intimate Partner Violence, and other topics to be determined. (2) Upon request, the Contractor shall deliver to DCYF documentation pertaining to all staff training, professional development, and continuing education described in this Section. HVSA Orientations, Webinars and Meetings: Contractor shall attend and participate in statewide HVSA All Program Meetings conducted in Washington State. Required attendance shall include, at a minimum, 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: (1) The bi-monthly DCYF Webinars to occur on dates to be determined. (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; (3) At least three (3) Nurse -Family Partnership Supervisor Meetings in locations and on dates to be determined; h. 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. Staffing Vacancy Plans: To avoid service disruption in the event of a short- or long-term staffing vacancy, the Contractor shall 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 a. Service Area: Contractor agrees to deliver home visiting services to priority populations, defined in Section 5.d who reside in the following counties or sub -county areas: (1) Jefferson, Kitsap and Clallam Counties b. Age of Service Findings in brain science research confirms the importance of supporting families and caregivers during the first years in a child's life. The Contractor shall prioritize enrollment for prenatal families, and families with infants and toddlers, up to 36 months. Priority Populations: Contractor shall sustain internal practices to serve, from among the HVSA Priority Populations. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 6 of 18 6. Priority Populations are defined as eligible participants with two or more of the following characteristics: (1) Demographic Characteristics: (a) American Indian/Alaskan Native Non -Hispanic (b) Poverty/Low Income (c) Teen Parents (d) Non-English Speaking or Recent Immigrant (e) Enrolled in WorkFirst/TANF (2) Adverse Experiences (a) Prior Child Welfare System Involvement (b) Intimate Partner Violence (c) Familial History or current experience with Substance Use, including Tobacco (d) Parent Mental Illness (e) Current and Previously Incarcerated Parents (f) Homeless/Unstable Housing (3) Other Characteristics (a) Parents with Low Educational Attainment (b) Parents with Disabilities (c) Families currently or formerly in the Military (d) Children with Disabilities, especially those not linked with early intervention services Outreach Efforts: (1) The Contractor shall create and implement an outreach plan to reach families to be served from among the priority populations. (2) The Contractor shall document outreach efforts and referral sources for potential and enrolled participant including those who decline services. (3) The Contractor shall record outreach and referral sources in the NFP data system - ETO/Penelope. (4) Contractor shall assess the degree to which outreach efforts are successful in reaching target populations. (5) Contractor shall provide to 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. Participant Enrollment, Retention, and Caseload Maintenance Plan for Recruitment of Participants: Contractor shall document and implement a comprehensive plan for participant recruitment, engagement, and retention aligned with the Nurse -Family Partnership program model to ensure ongoing enrollment of priority populations as described in Section 5. b. 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 Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 18 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 DCYF web site. C. Active Caseload Threshold: Contractor shall build and maintain an active participant caseload in accordance with Nurse -Family Partnership model requirements. Throughout the entire term of this contract, Contractor shall aim to serve an active Maximum Service Capacity of 62 families and maintain a minimum Active Enrollment Caseload of 85% of those families, or 52 families. (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. (2) 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. 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 Nurse -Family Partnership model fidelity. The written policies and procedures shall include, but not be limited to, the following: (1) Enrollment and Disenrollment: 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. (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. (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 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 a. Frequency of Home Visits: The number of home visits delivered to family participants shall be based on the Nurse -Family Partnership program model requirements. If there are no model requirements, the Contractor shall develop with Thrive Washington/Ounce of Prevention a definition of "frequency". The Contractor shall provide DCYF a written definition of "frequency" after such definition has been developed. The definition shall be included with the materials Contract Number: 20-1171 Printed Date: 8/7/2019 Page 8 of 18 submitted as part of the model fidelity letter submitted by the Contractor as described in Section 3.a. (1) The Contractor shall adhere to the Nurse -Family Partnership model expected dosage, as described in Attachment 7. b. 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 Nurse -Family Partnership model requirements. (1) Screenings: The Contractor shall administer screenings with the frequency consistent with fidelity to the Nurse -Family Partnership program model requirements, the HVSA Aligned Measures. (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 a. 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. 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. Data Collection and Evaluation Requirements a. 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. (1) While DCYF is the administrator of the HVSA, 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. b. 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 Nurse -Family Partnership model, DCYF and the HVSA as described in Attachment 7 Data Collection, Reporting and HVSA Aligned Measures and outlined below: (1) Performance Measures, defined in Attachment 7: (a) System and Program Performance Indicators; (b) Enrollment and Service Utilization; (c) Demographic Information; and (d) Performance Payment Measures. (2) Upon notification by DCYF, compliance with any changes in data collection expectations as required of DCYF from federal or state funding sources. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 9 of 18 C. Data Management: The Contractor shall collect and input the home visiting data described in this Section 9 into the ETO/Penelope data collection system. The data shall be stored, maintained, and protected as described in Exhibit C General Terms and Conditions of this Contract. d. 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.f for data sharing requirements). e. Timely Data Collection: The Contractor shall comply with data collection timelines and the Performance Measures requirements described in Attachment 7. Data shall be entered into the ETO/Penelope data collection system within five (5) business days of data collection. f. 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.b. and described in Attachment 7. (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.b. 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 written notice to the NFP NSO authorizing the release of data to DOH in coordination with the NSO; the Contractor shall submit a copy of the notice to DCYF. (2) Parental Consent: With consultation and support from 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. Required language to be used in consent form(s) are available on the Home Visiting page at DCYF.wa.gov. (a) Participants who do not provide consent to share confidential information remain eligible to receive home visiting services. (b) The Contractor shall share with DOH the consent status according to the process outlined in Attachment 7 no less than monthly via Secure File Transfer (SFT). g. Quality Assurance: The Contractor shall ensure that data provided to DOH is complete and accurate. (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.b. (2) The Contractor shall strive for less than five percent missing data of all data required in Section 9.b. (3) The Contractor shall review Dashboards, Quality Assurance Reports, and other data reports prepared by DOH to facilitate reflection, quality assurance and program improvement efforts. h. Evaluation: The Contractor shall participate in and cooperate with HVSA, DCYF and DCYF- specified evaluations. This shall include responding to emerging and non -routine data and evaluation requests from HVSA funders and working with DCYF specified contractors. Evaluation activities shall include, but are not limited to, the following: (1) Interviews, focus groups, observations and surveys; (2) Planning for Performance Based Contracting; (3) Other DCYF or funded evaluation efforts. (4) Completion of all documentation required by the research projects within the timeframes presented. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 10 of 18 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 expectations on topics including, but not limited to, the following: (1) Data collection; (2) Data sharing; (3) Reporting process; (4) Analysis and interpretation of data; (5) Quality assurance. 10. Continuous Quality Improvement (CQI) a. Purpose and Framework: 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. 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. (1) Breakthrough Series (BTS) Learning Collaborative: CQI Projects will follow a model called the Breakthrough Series (BTS) Learning Collaborative that offers Contractors a 12 - month structured opportunities collaborative and group learning and opportunities. (2) The Contractor shall participate in all aspects of the BTS Collaborative to include Pre - Work, Learning Sessions, and Action Periods, and described in detail in Attachment 7. b. Training and Technical Assistance: The Contractor shall participate in ongoing training and technical assistance associated with CQI including two (2) Learning Sessions and monthly Action Period webinars, occurring from December through June. DCYF-specified contractors providing this training and technical assistance include Thrive/Ounce of Prevention and DOH who will also support the Contractor with data collection and measurement, quality improvement methodologies, implementing PDSA (Plan Do Study Act) cycles, and with Learning Collaborative Project materials as described in Attachment 7, and the CQI Toolkit. C. BTS Learning Collaborative Project: The CQI Learning Collaborative project will take place during the entire contract term, July 1, 2019 through June 30, 2020. The Contractor shall participate in one CQI project focusing on one topic during this contract term, completing all of the following components: (1) CQI Topics—The Contractor shall engage in one of the following two topic tracks as part of the BTS Learning Collaborative: (a) Caregiver Depression Screening, Referral, and Follow-up —completion of screening, referral and connection to appropriate services; appropriate follow-up; (b) Family Retention – Increased length of active participation and retention of clients, in alignment with model recommendations (2) 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 members are expected to participate in regular CQI team meetings, CQI Action Period webinars, and CQI project activities. CQI Learning Collaborative Pre -work the Contractor shall complete the pre -work assignments, as described below and in Attachment 7, and submit to DCYF no later than October 21, 2019. At a minimum, the Pre -Work will include the following activities: (1) Complete a root cause analysis tool, such as a process map; Contract Number: 20-1171 Printed Date: 8/7/2019 Page 11 of 18 11. (2) Review key topic documents to prepare for Learning Session 1; (3) Review baseline data; (4) Prepare a storyboard to introduce the Contractor's team and share lessons learned from the pre -work. e. CQI Learning Collaborative Action Periods: The Contractor shall participate in two Action Periods during the contract term. (1) Action Period 1 will occur from December 1, 2019 through March 31, 2020 and Action Period 2 taking place from April 1, 2020 through June 30, 2020. (2) During each Action Period, the Contractor shall complete the following activities: (a) Participate in monthly Action Period webinars; (b) Conduct rapid cycle PDSA Ramps, including at least one PDSA Improvement Cycle each month; (c) Track PDSA and Project Data; and (d) Submit Monthly Reports using the template provided by DCYF. CQI Plan -Do -Study -Act (PDSA) Reports — The Contractor shall submit reports to DCYF summarizing and reflecting on implementation of Plan -Do -Study -Act cycles, using the template provided by DCYF and available on the Home Visiting web page at www.dcyf.wa.Qov; a sample template is described in Attachment 7. DCYF will share these reports with Thrive/Ounce and DOH for review and written feedback to the Contractor. (1) From January through June, 2020, the Contractor shall submit monthly CQI PDSA Reports monthly to DCYF with the Quarterly Progress Reports using the deliverables schedule described below in Section 14. (2) The Contractor shall submit a Final Learning Collaborative Storyboard to reflect on project learnings, data, and team experiences to DCYF no later than July 20, 2020 using a template to be provided by DCYF and to be available on the DCYF Home Visiting web page at DCYF.wa.gov. Technical Assistance a. 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. DCYF contracts with Thrive Washington/Ounce of Prevention 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: (1) Program model fidelity as described by the Nurse -Family Partnership model developer and Section 3 of this Statement of Work; (2) Staff qualifications, and selection and onboarding of home visitors and supervisors; (3) Reflective supervision process; (4) Staff retention and vacancy planning; (5) Participant outreach, recruitment, enrollment and retention; (6) Model specific service delivery and case planning; (7) Leadership development and organizational support for home visiting model; and (8) CQI planning, implementation and analysis. b. 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. Contract Number: 20-1171 Printed Date: 8/7/2019 rage 11 OT Id (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. (2) The Contractor shall participate in at least monthly one-hour Technical Assistance/Coaching calls and a minimum of one (1) technical assistance site visits led by the DCYF-specified contractor for technical assistance, with more upon request from the Contractor. 12. Budget and Financial a. 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.f. below, shall be expended by June 30, 2020 as specifically itemized line by line in Exhibit B Budget. (1) Any requests for shifts between categories (pay points of the budget) within a funding source must receive prior written approval from DCYF; transfers across expense categories (pay points of the budget) in excess of 10% of the total for each funding source will not be made without prior written approval from DCYF and may require a contract amendment. (2) No shifts may occur across funding sources. b. 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, sub- recipients/subcontractors, travel, and equipment inventory processes. The Contractor shall make such policies and procedures available to DCYF upon request. C. 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. d. 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: http.Ilwww.ofm.wa.cou/resourcesltravel.agg. When the lowest available lodging rate exceeds the current state travel reimbursement rates or the lodging provider requires a government -issued identification card in order to receive the state per diem rate and the Contractor is not a government -based entity, an exception may be made only when pre -approved in writing by the Contractor's director or authorized designee (i.e. finance director), 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. (1) Additional training or other professional development opportunities may be presented throughout the term of this contract. DCYF at its sole discretion may pay for these costs directly. e. Indirect Costs: The Contractor may claim the indirect rate based on one of three options: the rate negotiated with its cognizant federal agency, also known as the federally approved cost allocation plan; the rate negotiated with DCYF, not to exceed the federally approved cost allocation plan; or the rate calculated at 10% of modified total direct costs. (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. (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)) Contract Number: 20-1171 Printed Date: 8/7/2019 Page 13 of 18 cost rate proposal. The CFR can be found at the following link: Electronic Code of Federal Be ulations. Performance Payment Awards: During the term of this contract, the Contractor will be eligible to receive an additional monetary award not to exceed $9,593.43, based on available funding and achievement of any combination of the following the Performance Milestones described in this Section. (1) 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. (2) Quarterly Home Visiting Enrollment Performance Milestone: DCYF will award the Contractor a Performance Payment Award upon the fulfillment of the following milestone: (a) The Contractor maintains an average Active Enrollment Caseload of 90% or greater of their Maximum Service Capacity during the quarter, as measured by the average of the number of families actively enrolled on the last day of each 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.c.). The calculation of Active Enrollment Caseload for this performance award will be limited to the number of prenatal families, and families with enrolled children up to 60 months of age. DCYF may award $479.67 for each quarter where the contractor meets or exceeds the 90% milestone. (3) Annual Family Retention Performance Milestone: DCYF will award the Contractor a Performance Payment Award upon the fulfillment of the following one or both milestones: (a) Twelve-month Family Retention Performance Milestone: The Contractor's 12 -month participant engagement performance, as defined by the number of participants engaged in the program for 12 months after enrollment. i. DCYF may award $40 for each participant who has not exited and remains engaged in the program for 12 months after enrollment, as indicated by receiving a home visit, on a date between 30 days before and 30 days after the 12 -month anniversary of their enrollment date, as defined in Attachment 7. ii. DCYF may award an additional $20 for each participant who meets the 12 -month retention milestone above and possesses at least two of the demographic characteristics related to early exit as described in Attachment 7. (b) Eighteen -month Family Retention Performance Milestone: The Contractor's 18 -month participant engagement performance, as defined by the number of participant engaged in the program for 18 months after enrollment. DCYF may award $20 for each participant who has not exited and remains engaged in the program for 18 months after enrollment, as indicated by receiving a home visit on a date between 30 days before and 30 days after the 18 -month anniversary date of their enrollment date, as defined in Attachment 7. DCYF may award an additional $10 for each participant who meets the 18 -month retention milestone above and with at least two of the demographic characteristics related to early exit as described in Attachment 7. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 14 of 18 (c) For either the 12 -month or 18 -month retention milestones, if data is missing on the family retention criteria for additional support, the participant is ineligible for the additional award payment. (d) For either the 12 -month or 18 -month retention milestones, if the anniversary home visit occurs after June 30, the milestone will be calculated and awarded in the subsequent fiscal year. (4) Annual Depression Screening and Follow-up Performance Milestones: DCYF will award the Contractor a Performance Payment Award upon the fulfillment of either one or both of the following milestones: (a) Depression Screening Annual Performance Milestone: The Contractor's performance on HVSA Performance Measure 2 Depression Screening defined in Attachment 7: 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). i. DCYF may award $30 for each screening using the above criteria, capped at a maximum of $1,860.00 for the contract year. (b) Follow -Up to Positive Depression Screening Annual Performance Milestone: The Contractor's performance on follow-up to Caregiver Depression Screening: Contractor follow-up with a referral to or connection with appropriate services for a participating primary caregiver who screened positive for depression. DCYF may award the Contractor $50 for each participant who received follow-up as defined above, capped at a maximum of $1,100.00 for the contract year. (5) Annual Healthy Birthweight Outcomes Performance Milestones: DCYF will award the Contractor a Performance Payment Award upon the fulfillment of one or both of the following outcomes milestones: (a) Participant Healthy Birthweight Milestone: 1 The Contractor's performance on healthy birthweight outcomes during the contract year, as indicated by the number of participants who give birth to an infant of healthy birthweight during the contract year as defined in Attachment 7. i. DCYF may award $60 for each participant who gives birth to an infant of healthy birthweight using the definition in Attachment 7. A. The award will not be paid for participants if the following data are not available or incomplete: date of birth of the child, or child's birthweight. ii. DCYF may award an additional $40 for each participant who gives birth to an infant of healthy birthweight during the contract year and with at least one HBW Criteria for Additional Support using the definition in Attachment 7. A. If a participant's data is missing for these HBW Criteria for Additional Support, the birthweight will be ineligible for the additional $50 payment. (b) Cohort Health Birthweight Milestone: 2 The statewide HVSA NFP Cohort's performance and the Contractor's performance on healthy birthweight outcomes during the contract year, as defined below and in Attachment 7; DCYF may award the Contractor $750 for the following healthy birthweight outcome performance by the statewide HVSA NFP Cohort and the performance of the Contractor: Contract Number: 20-1171 Printed Date: 8/7/2019 Page 15 of 18 A. The statewide HVSA NFP Cohort achieves a target of 91 % of healthy birthweight outcomes for all births to program participants during the contract year. B. At least 85% of the births to active participants in the Contractor's program are healthy birthweight outcomes. C. DCYF may tier and/or risk -adjust the Contractor's and the statewide HVSA NFP Cohort calculations and payments to account for variations in the caseload mix of women who need additional support to achieve healthy birthweights. (6) Invoicing for Performance Awards: (a) After assessment and approval from DCYF, the Contractor may invoice for payment biannually for the enrollment performance milestone, defined in Section 12.f.(2): 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. (b) After assessment and approval from DCYF, the Contractor may invoice for payment annually for the family retention, caregiver depression screening and follow-up, and healthy birthweight outcomes performance milestones, defined in Sections 12.f.(3), and 12.f.(4), and 12.f.(5); performance in Quarters 1 through 4 to be invoiced following Quarter 4. (c) The total reimbursement for the contract year of all the Performance Payment Award invoices will not exceed $9,593.43. (7) Contractor must use the funds received from these Performance Payment Awards towards advancing the goals of the home visiting program in this Contract. Financial Reporting and Documentation: (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: (a) Monthly or Semi-monthly Expense Summary by fund source (e.g. State Gen 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; (b) Contractor's Monthly or Semi-monthly Payroll Summary by fund source (e.g. State Gen Fund, State 1502) describing reimbursed hours for each staff person paid under the contract for that period; and (c) Documentation supporting all single expenses exceeding $5,000 by fund source (e.g. State Gen Fund, State 1502). (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. (3) In -Depth Financial Review: 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 DCYF upon request the financial documents listed below. Based upon this review, if questions arise, DCYF may request additional data and documentation. (a) Contractor's most recent Annual Financial Audit, Single or Program -Specific Audit, as applicable (b) 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 DCYF and will include indirect costs, accounts payable transactions, and time and effort transactions; (c) Contractor's Indirect Cost Allocation Plan or Indirect Cost Proposal, or Indirect Rate Agreement, whichever is applicable; Contract Number: 20-1171 (d) Chart of Accounts; Printed Date: 8/7/2019 Page 16 of 18 (e) Written policies and procedures to include, but not limited to: accounts payable, payroll, procurements, sub-recipients/subcontractors, travel, and equipment inventory processes; (f) 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 a. 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. DCYF must comply with Washington State public disclosure law (Chapter 42.56 RCW) and with regulations set forth in HIPAA and FERPA. (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 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. (2) For all press releases or public reports approved by DCYF, the Contractor shall include the name and logo of 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 a. Any mention of quarters one through four referenced in this document are defined as: (1) Quarter 1 — July 1, 2019 to September 30, 2019 (2) Quarter 2 — October 1, 2019 to December 31, 2019 (3) Quarter 3 — January 1, 2020 to March 31, 2020 (4) Quarter 4 — April 1, 2020 to June 30, 2020 b. 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 Section 14.d. and Table 14.e. below. Due dates may be adjusted atthe discretion and approval of the DCYF Contract Manager to accommodate the variable reporting structures associated with federal funding requirements. 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 DCYF with respect to the Contract. (1) Contractor must create and maintain at least one active user account in the Prevention Services Reporting System (PSRS) and use that system to submit monthly enrollment reports and other deliverables when available. (2) While funding for this Contract encompasses expenditures from July 1, 2019 through June 30, 2020, deliverables describing services rendered in the months of the Contract term will be due no later than July 31, 2020 and will be submitted at no additional cost to DCYF. C. Monitoring: As described in Attachment 3 of this Contract, 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. (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 Contract Number: 20-1171 Printed Date: 8/7/2019 Page 17 of 18 evaluate performance, compliance, and/or quality assurance under this Contract. DCYF will work with Contractor to determine a mutually acceptable date. (2) Monitoring activities may include, but not be limited to: monthly monitoring calls and site visits to review records, observe implementation of services, or follow up on compliance issues. (3) If 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, 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. d. Summary of Deliverables and Timelines (1) Monthly Enrollment Reports: The Contractor shall submit Monthly Enrollment Data Reports no later than the 201h day following the month of service submitted using the template in the PSRS and described in Attachment 5 Monthly Enrollment Report. (2) Invoices: As described in Section 12.h., the Contractor shall submit A-19 invoices for expenditures accompanied by the financial documentation. (3) Quarterly Progress Reports: The Contractor shall submit four (4) Quarterly Progress Reports using the template in the PSRS, if available, or provided by DCYF and described in Attachment 6, to include the CQI Reports described in Attachment 4. The Contractor shall submit this report each quarter into the PSRS no later than the 20"' day following the quarter of service. (4) Self -Reflection Tool: The Contractor shall submit the Self -Reflection Tool described in Section 11 no later than August 16, 2019 using the template provided by Thrive/Ounce of Prevention. (5) CQI Pre -Work and Monthly Reports, as described in Section 10. (6) Annual Pre -Contract Questionnaire: The Contractor shall complete and submit the FY21 HVSA Pre -Contract Questionnaire and FY21 Proposed Budget by March 30, 2020 using the template to be provided by DCYF. e. Timeline of Reports and Submissions: Exhibit C, Deliverables and the attached reference document titled Timeline for Reporting and Submission of Deliverables outlines the reporting and submissions timeline for deliverables presented in this Statement of Work according to the month of submission. (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. (2) If due dates occur on a weekend or holiday, the Contractor shall submit the report before 8am of the following business day. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 18 of 18 WASHINGTON STATE DCYF Contract Number: 20-1171 Department of Contract Maximum: $406,530.72 ` Children, Youth, and Families From-To:07/01 /2019-07/31 /2020 Exhibit B - Budget Report Any variances to the Payment Points allocated within this Budget must be pre -approved by the DCYF Contract Manager in writing. Failure to obtain pre -approval may result in non-payment of the unapproved expense. State Fiscal Year 2020 (July 1 2019 - June 30 2020): Payment Point Budget Limit Note 1. 502 State — Personnel $67,355.60 2. 502 State — Goods $9,829.34 and Services 3. 502 State — Travel $500.00 4. 502 State — $83,144.15 Contracted/Professional Services 5. 502 State — $16,082.91 Administrative/indirect Charges 6. General Fund State — $58,387.67 Personnel 7. General Fund State — $25,060.83 Goods and Services 8. General Fund State — $5,000.00 Travel 9. General Fund State— $111,574.49 Contracted/Professional Services 10. General Fund State $20,002.30 — Administrative/Indirect Charges 11. HVSA Performance $9,593.43 Pay Total: $406,530.72 Contract Number: 20-1171 Contract Maximum: $406,530.72 Contract Funding Source(s) State Funds $406,530.72 Printed Date: 8/7/2019 Page 1 of 1 WASHINGTON STATE DCYF Contract Number: 20-1171 Department of Contract Maximum: $406,530.72 !� Children, Youth, and Families From-To:07/01 /2019-07/31 /2020 Exhibit C - Deliverables Report State Fiscal Year 2020 (July 1 2019 - June 30 2020): # Deliverable Title, Due Note, Description Due Date 1.00 Documented approval of DSA No Date Due by July 30, 2019. The Contractor must submit documented approval of DSA with DOH submitted to NFP National Service Office. 2.00 Consenting Clients to DOH No Date Due by the sixth (6th) business day of the month immediately following services. The Contractor shall share with DOH the consent status according to the process outlined in Attachment titled Contract Monitoring, Compliance and Non -Compliance. 3.00 Monthly Enrollment Reports No Date By the 20th of the following month of service. The Contractor shall submit Monthly Enrollment Data Reports using the template in the PSRS and described in Attachment titled Monthly Enrollment Data Report Components. 4.01 Quarterly Progress Reports Oct 21, 2019 By the 20th day following the quarter of service. The Contractor shall submit Quarterly Progess Reports using the template in the PSRS as described in the Attachment titled HVSA Quarterly Progress Report Components. 4.02 Quarterly Progress Reports Jan 20, 2020 4.03 Quarterly Progress Reports Apr 20, 2020 4.04 Quarterly Progress Reports Jul 20, 2020 5.00 Self -Reflection Tool No Date Due to Thrive/Ounce of Prevention by 8/16/2019. The Contractor shall submit the Self -Reflection Tool descripted in the Statement of Work, Section 11 using the template provided by Thrive/Ounce of Prevention. 6.00 CQI Pre -Work No Date Due to Thrive/Ounce of Prevention by 10/21/19 The Contractor shall complete the CQI pre -work assignments, as described below and in the Attachment titled Continuous Quality Improvement 7.00 CQI Monthly Report No Date Due by the 20th of the month immediately following the month of service starting on 7/20/2019 and then each month starting on 1/20/2020. The Contractor shall submit monthly CQI PDSA Reports, as described below and in the Attachment titled Continuous Quality Improvement. 8.00 Final Learning Collaborative Storyboard No Date Due by 7/20/2020. The Contractor shall submit a Final Learning Collaborative Storyboard to reflect on project learnings, data, and team experiences using the template to be provided by DCYF. 9.00 Annual Pre -Contract Questionnaire No Date Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 2 Due by 4/30/2019 for contractors planning to continue services in the following fiscal year. The Contractor shall complete and submit the FY21 HVSA Pre -Contract Questionnaire and FY21 Proposed Budget using the template provided by DCYF. 10.00 Updated Insurance Certificate No Date Due to DCYF when certificate is renewed. Updated Insurance Certificate must be submitted when the insurance policy is renewed. 11.00 Updated Statement of Confidentiality and Non -Disclosure No Date Due by 7/30/2019. 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. 12.00 Data Disposition No Date Due by 7/20/2020 or upon closure of contract. Data Disposition must be submitted with the closure of the contract. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 2 WASHINGTON STATE Department of Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Exhibit D - General Terms and Conditions Table of Contents 1. DEFINITIONS...................................................................................................................................................1 2. ADVANCE PAYMENTS PROHIBITED.............................................................................................................3 3. AMENDMENT...................................................................................................................................................3 4. ASSIGNMENT..................................................................................................................................................3 5. ATTORNEY FEES............................................................................................................................................3 6. CHOICE OF LAW AND VENUE.......................................................................................................................3 7. COMPLIANCE WITH LAWS, RULES, AND REGULATIONS..........................................................................4 8. CONTRACTOR STAFF....................................................................................................................................5 9. CONTINUED PERFORMANCE........................................................................................................................5 10. COPYRIGHT.....................................................................................................................................................5 11. DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION.................................................................................................................................................5 12. DISALLOWED COSTS..................................................................................................... .9 13. DISPUTES......................................................................................................................................................10 14. DUPLICATE PAYMENT .................... .................................................... .......................................... .............. .10 15. .... ................... ENTIRE CONTRACT................................................................................. ............................ ..10 16. EXPENSES.....................................................................................................................................................10 17. FUNDING CONTINGENCY.................................................................................................................... ....10 18. .........11 HEADINGS........................................................................................................................... ................. 19. INDEMNIFICATION........................................................................................................................................11 20. INDEPENDENT CONTRACTOR....................................................................................................................11 21. INDUSTRIAL INSURANCE COVERAGE......................................................................................................11 22. LIMITATION OF AUTHORITY.......................................................................................................................11 23. MONITORING.................................................................................................................................................11 24. NEUTRAL AUTHORSHIP ....................... ......................................................................................................... 12 25. ORDER OF PRECEDENCE............................................................................................... ........................... .12 26. OVERPAYMENT............................................................................................................................................12 27. PUBLICITY.....................................................................................................................................................13 28. RECAPTURE..................................................................................................................................................13 29. ............ RECORDS MAINTENANCE...................................................................................................... .........13 30. REMEDIES ..................................................... .............................................................. - ..... .... ....... -- ........13 31. SEVERABILITY...............................................................................13 32. SITE SECURITY .............................................. .......................................................................................... ..... 14 33. ................... SUBCONTRACTING........................................................................................................... .......14 34. TERMINATION FOR CAUSE.........................................................................................................................14 35. TERMINATION FOR CONVENIENCE...........................................................................................................15 36. TERMINATION PROCEDURE.......................................................................................................................15 37. TREATMENT OF ASSETS............................................................................................................................16 38. WAIVER..........................................................................................................................................................16 39. CONTRACTOR REPRESENTATIONS AND WARRANTIES.........................................................................16 40. WITHHOLDING PAYMENTS..........................................................................................................................17 1. DEFINITIONS The following terms as used throughout this Contract shall have the meanings as set forth below. Contract Number: 20-1171 Printed Date: 8/7 Page 1 of 17 a. "Confidential Information" means information that may be exempt from disclosure to the public or other unauthorized persons under either chapter 42.56 RCW or other state or federal laws. Confidential Information includes, but is not limited to, Personal Information, agency source code or object code, and agency security data. b. "Contract" or "Agreement" means the entire written agreement between DCYF and the Contractor, including any Exhibit, attachments, documents, program agreement, materials incorporated by reference, and all amendments hereto. The parties may execute this contract in multiple counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail or Facsimile transmission of a signed copy of this Contract shall be the same as delivery of an original. c. "Contractor" means one not employed by the department that is the individual or entity performing services pursuant to this Contract and includes the Contractor's owners, members, officers, directors, partners, employees, and/or agents, unless otherwise state in this Contract. For purposes of any permitted Subcontract, "Contractor' includes any Subcontractor and its owners, members, officers, director, partners, employees, and/or agents. d. "Converted Data" means the data which has been successfully converted by the Contractor for processing by DCYF's computer system. e. "Data" means DCYF's records, files, forms, data, information and other documents in electronic or hard copy form, including but not limited to Converted Data. f. "Debarment" means an action taken by a State or Federal agency to exclude a person or business entity from participating in transactions involving certain federal or state funds. g. "DCYF" or "Department" means the Washington State Department of Children, Youth, and Families, including any division, section, office, unit or other entity thereof, or any of the officers or other officials lawfully representing DCYF. h. "In-home Caregiver" means an in-home child care provider that (1) provides regularly scheduled care for a child; (2) receives child care subsidies; and (3) is either licensed by the state or is exempt from licensing. L "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. j. "Overpayment" means any payment or benefit to a recipient or to a vendor in excess of that to which is entitled by law, rule, or contract, including the amounts in dispute. k. "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, email 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. I. "RCW" means the Revised Code of Washington. All references in this Contract to RCW chapters or sections shall include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at http://apps.leg.wa.gov/rcw/. m. "Regulation" means any federal, state, or local rule, rule, or ordinance. n. "Sensitive Personal Information" means personally identifying information of In-home Caregivers including, but not limited to: names, addresses, GPS [global positioning system] coordinates, telephone numbers, email addresses, social security numbers, driver's license numbers, or other personally identifying information. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 17 o. "Staff" means the Contractor's directors, officers, employees, and agents who provide goods or services pursuant to this Contract. "Staff' also means Subcontractors' directors, officers, employees, and agents who provide goods or services on behalf of the Contractor. The term "Staff' also means the Subcontractors' directors, officers, employees, and agents who provide goods or services on behalf of the Subcontractor and Contractor. p. "Subcontract" means a contract or contractual action entered into by the Contractor or Subcontractor for the purpose of obtaining supplies, materials, equipment, or services of any kind under this Contract. The terms "subcontract" and "subcontracts" means subcontract(s) in any tier. q. "Subcontractor" means a person, partnership, company, or other entity that is not in the employment of or owned by Contractor and that is performing services under this Contract under a separate contract with or on behalf of the Contractor. The terms "subcontractor" and "subcontractors" mean subcontractor(s) in any tier. r. "WAC" means the Washington Administrative Code. All references in this Contract to WAC chapters or sections shall include any successor, amended, or replacement regulation. Pertinent WAC chapters or sections can be accessed at http://apps.leg.wa.gov/wac/. 2. ADVANCE PAYMENTS PROHIBITED No payments in advance or in anticipation of goods or services to be provided under this Contract shall be made by DCYF. 3. AMENDMENT 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. 4. ASSIGNMENT a. Assignment by Contractor. With the prior written consent of DCYF's Contract Administrator, which consent shall not be unreasonably withheld, the Contractor may assign this Contract including the proceeds hereof, provided that such assignment shall not operate to relieve the Contractor of any of its duties and obligations hereunder, nor shall such assignment affect any remedies available to DCYF that may arise from any breach of the sections of this Contract, or warranties made herein including but not limited to, rights of setoff. b. Assignment by DCYF. DCYF may assign this Contract to any public agency, commission, board, or the like, within the political boundaries of the state of Washington, provided that such assignment shall not operate to relieve DCYF of any of its duties and obligations hereunder. 5. ATTORNEY 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. 6. CHOICE OF LAW AND VENUE a. This Contract shall be governed by the laws of the State of Washington without regard to the conflict of law rules of any jurisdiction. Every dispute concerning the interpretation or effect of this Contract and/or the use of the goods or services described in this Contract must be resolved in the federal or state courts located in Washington. The Contractor agrees to the exclusive personal jurisdiction, and subject matter jurisdiction of these courts. Thurston County shall be the venue of any litigation arising out of this Contract. b. The Contractor agrees that the United States Bankruptcy Court, Western District of Washington in Seattle, shall be the venue of any and all bankruptcy proceedings that may involve the Contractor. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 17 7. COMPLIANCE WITH LAWS, RULES, AND REGULATIONS a. 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). b. 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 hands of any person, the Contractor shall immediately report such incident to Child Protective Services (CPS) Intake at 1-866- ENDHARM. c. Civil Rights Laws (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). (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 DCYF. 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. d. Conflict of Interest (1) Notwithstanding any determination by the Executive Ethics Board or other tribunal, DCYF may, in its sole discretion, by written notice to the Contractor terminate this Contract if it is found after due notice and examination by DCYF 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. (2) In the event this Contract is terminated as provided above, DCYF 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 DCYF 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 DCYF makes any determination under this clause shall be an issue and may be reviewed as provided in the "Disputes" clause of this Contract. e. 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. f. 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 and Collective Bargaining Agreements that affect the Services, goods, or Deliverables that are to be provided or that have been provided by Contractor, its Subcontractors or agents. g. 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 and 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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 17 8. CONTRACTOR STAFF a. Contractor staff list and job description. Prior to the effective date of this Contract, the Contractor shall have provided to DCYF a list of Contractor Staff that will be performing services pursuant to this Contract. The list shall also include Staff member's job title and his or her job description. b. All Staff proposed by Contractor as replacements for other Staff shall have comparable or greater skills for performing the activities as performed by the Staff being replaced. The Contractor shall provide DCYF with written notice of any Staff changes that the Contractor proposes. The written notice shall not be effective until fourteen (14) business days from the date of the mailing. 9. CONTINUED PERFORMANCE If DCYF, 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, DCYF 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 (5) business days) may, at DCYF'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. 10. COPYRIGHT a. 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 DCYF. DCYF 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, Contractor hereby irrevocably assigns all right, title, and interest in Materials, including all intellectual property rights, to DCYF effective from the moment of creation of such Materials. b. For Materials that are delivered under the Contract, but that incorporate preexisting materials not produced under the Contract, Contractor hereby grants to DCYF a nonexclusive, royalty -free, irrevocable license (with rights to sublicense others) in such Materials to translate, reproduce, distribute, prepare derivative works, publicly perform, and publicly display. The Contractor warrants and represents that Contractor has all rights and permissions, including intellectual property rights, moral rights and rights of publicity, necessary to grant such a license to DCYF. c. The Contractor shall exert all reasonable effort to advise DCYF, at the time of delivery of Data furnished under this Contract, of all known or potential invasions of privacy contained therein and of any portion of such document which was not produced in the performance of this Contract. DCYF shall receive prompt written notice of each notice or claim of infringement received by the Contractor with respect to any Data delivered under this Contract. DCYF shall have the right to modify or remove any restrictive markings placed upon the Data by the Contractor. 11. DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION a. Scope of Protection. This Section (DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION) applies to Data, information, or Materials related to the subject matter of this Contract which is received, created, developed, revised, modified, or amended by DCYF, the Contractor, or Subcontractors. Such Data, information, and Materials shall include but is not limited to all Confidential Information and Sensitive Personal Information of In-home Caregivers. b. Use of Confidential Information and Sensitive Personal Information (1) For Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information that is collected, used, or acquired in connection with this Contract the parties shall comply with the following: (a) All federal and state laws and regulations, as currently enacted or revised, regarding the protection, security, and electronic interchange of Sensitive Personal Information of In- home Caregivers, data, and Confidential Information; and Contract Number: 20-1171 Printed Date: 8/7/2019 Page 5 of 17 (b) All federal and state laws and regulations, as currently enacted or revised, regarding the use, disclosure, modification or loss of Sensitive Personal Information of In-home Caregivers, data, and Confidential Information. (2) DCYF does not warrant or guarantee the accuracy of the Sensitive Personal Information of In- home Caregivers, 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. c. Protection of Sensitive Personal Information (1) The Contractor agrees to protect the confidentiality of Sensitive Personal Information of In-home Caregivers. (2) The Contractor further understands and agrees that Sensitive Personal Information of In-home Caregivers may only be released or disclosed if required by this Contract, or a lawfully issued court order. The Contractor further understands and agrees that before the Contractor can release the Sensitive Personal Information of In-home Caregivers pursuant to a third party request, or for any other reason, the Contractor must comply with all the requirements, including notice requirements, contained in this Section (Protection of Sensitive Personal Information). (3) Notice of Third Party Request and Intended Disclosure (a) Written Notice Required. If a third party requestor seeks from the Contractor the Sensitive Personal Information of an In-home Caregiver, or the Contractor intends to release or disclose the Sensitive Personal Information of an In-home Caregiver for any other reason not related to a third party request, the Contractor shall give notice to DCYF of such request and/or the Contractor's intent to release or disclose such information. (b) Notice Deadline: Third Party Request. The notice required under this Section (Notice of Third Party Request and Intended Disclosure) shall be provided to DCYF's program contact within five (5) calendar days from the date of the request, to allow DCYF to seek a protective order from the proper tribunal. (c) Notice Deadline: Disclosure for any Other Reason. If the Contractor intends to release or disclose the Sensitive Personal Information of an In-home Caregiver for a reason that is unrelated to a particular third party request, the Contractor shall provide written notice to DCYF no less than twenty-one (21) calendar days prior to the intended release date. (d) Basis for Disclosure. The Contractor understands and agrees that it will not release the Sensitive Personal Information of an In-home Caregiver without the express written consent from DCYF, or a lawfully issued court order in which DCYF has been given an opportunity to oppose prior to entry of the order. (4) If the Contractor is required by this Contract to release or disclose the Sensitive Personal Information of an In-home Caregiver(s), prior to such release or disclosure the Contractor must obtain from the recipient of such Sensitive Personal Information a signed Statement of Confidentiality and Non -Disclosure Agreement consistent with Attachment 1 to this Contract. (5) The Contractor understands and agrees that before the Contractor releases or discloses, pursuant to the terms of this Contract, the Sensitive Personal Information of In-home Caregivers to a subcontractor, the Contractor must obtain prior written approval from DCYF agreeing to such disclosure. d. Information Technology Security Standards (1) The Contractor and its Staff and the Subcontractors and their Staff shall comply with the following: (a) All security standards, practices, and procedures which are equal to or exceed those of the DCYF (which security standards, practices, and procedures of DCYF shall have been provided to Contractor in writing); and Contract Number: 20-1171 Printed Date: 8/7/2019 Page 6 of 17 (b) The Washington State Office of the Chief Information Officer IT Standards. (2) The parties agree to implement physical, electronic, and managerial policies, procedures, and safeguards to prevent the unauthorized access, use, or disclosure of Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information. The Contractor shall make the Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information available to amend as directed by DCYF and incorporate any amendments into all the copies maintained by the Contractor or their Subcontractors. e. Confidentiality Protection To safeguard the confidentiality of all Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information, and in addition to the requirements contained in this Section (DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION) the Contractor must: (1) Ensure that the Contractor's Staff, Subcontractors, and the Subcontractors' Staff use Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information solely for the purposes of accomplishing the services set forth in this Contract. The term "Staff' shall have the same meaning as set forth in Section (DEFINITIONS). (2) Limit access to Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information to the Contractor's Staff and Subcontractors' Staff requiring access for performance of their assigned duties. (3) Require that the Contractor's Staff and Subcontractors' Staff having access to Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information sign a Statement of Confidentiality and Non -Disclosure Agreement consistent with Attachment 1. Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information shall not be released to the Contractor's Staff person(s) or Subcontractors' Staff person(s) until the following conditions have been met: (a) DCYF approves the Contractor's Staff person, or Subcontractor's Staff person, to work on this Contract; and (b) DCYF must receive the signed original Statement of Confidentiality and Non -Disclosure Agreement, signed by the Staff person, from the Contractor or Subcontractor. (4) Notify its Staff person(s) and ensure its Subcontractors notify the Subcontractors' Staff person(s) of the requirements of Section (COMPLIANCE WITH LAWS, RULES AND REGULATIONS), and this Section (DATA SHARE AND PROTECTION OF CINFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION). (5) Ensure that Sensitive Personal Information of In-home Caregivers, Data, and Confidential 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. (6) Ensure that Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information is protected from loss and from unauthorized physical or electronic access. (7) Ensure that the input of user identifications and passwords are necessary and required before the Contractor, the Contractor's Staff, or Subcontractor's Staff can access electronically stored Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 17 (8) Destroy all Sensitive Personal Information of In-home Caregivers, Data, and Confidential Information so that it cannot be accessed by unauthorized individuals and cannot be recovered when the information is no longer required or used for providing services under this Contract, and retention is no longer required by the Records Retention Act (chapter 40.14 RCW) or Section (RECORD MAINTENANCE), whichever is longer. Unless the Washington State Office of the Chief Information Officer IT Standards require a different method for the destruction of Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information, the information required to be destroyed under this Section (DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION) must be destroyed as follows: (a) For paper documents containing Data, but not Sensitive Personal Information of In-home Caregivers or 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. (b) For paper documents containing Sensitive Personal Information of In-home Caregivers, or Confidential Information, requiring special handling (e.g. Protected Client Information) the documents must be destroyed by on-site shredding, pulping, or incineration. (c) If Sensitive Personal Information of In-home Caregivers, 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. (d) If Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information has been stored on magnetic tape(s), the Contractor shall destroy the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information by degaussing, incinerating or crosscut shredding. (e) If Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information has been stored on server or workstation data hard drives or similar media, the Contractor shall destroy the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information by using a "wipe" utility which will overwrite the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information at least three (3) times using either random or single character data, degaussing sufficiently to ensure that the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information, cannot be reconstructed, or physically destroying disk(s). (f) If Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information has been stored on removable media (e.g. floppies, USB flash drives, portable hard disks, or similar disks), the recipient shall destroy the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information by using a "wipe" utility which will overwrite the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information at least three (3) times using either random or single character data, degaussing sufficiently to ensure that the Sensitive Personal Information of In-home Caregivers, Data, or Confidential Information cannot be reconstructed, or physically destroying disk(s). (9) Ensure that within fifteen (15) calendar days after the completion of the requirements contained in Section (Confidentiality Protection) the Contractor shall complete and deliver to DCYF a signed Certification of Data Disposition (Attachment 2). (10) Ensure that paper records are 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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 8 of 17 (11) Shall immediately notify DCYF after becoming aware of any potential, suspected, attempted or actual breaches of security including, but not limited to, unauthorized access, use or disclosure, and compromised Data, or compromised login IDs or passwords. 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 DCYF for any damages related to a breach of security by their officers, directors, employees, Subcontractors or agents. Immediately after becoming aware of a suspected, attempted, or actual breach the Contractor must contact the DCYF Contract Manager and DCYF's Help Desk at (360) 407-1960 or dcyf.servicedesk@dcyf.wa.gov. f. Confidentiality Breach (1) In the event of a breach by the Contractor of this Section (DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION) and in addition to all other rights and remedies available to DCYF, DCYF may elect to do any of the following: (a) Terminate the Contract; (b) Require that the Contractor return all Sensitive Personal Information of In-home Caregivers and Confidential Information to DCYF that was previously provided to the Contractor by DCYF; (c) Require that the Contractor destroy all Sensitive Personal Information of In-home Caregivers and Confidential Information so it cannot be accessed by unauthorized individuals and cannot be recovered; or (d) Suspend the Contractor's on-line access to accounts and other information. g. Method of Transfer All Data transfers to or from the Contractor shall only be made by using the secure data.wa.gov portal provided by the State Of Washington with login and hardened password security. h. Public Disclosure (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 party who owns the Data is responsible for informing the other party what it considers Confidential Information. (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 (5) 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. i. Access to Data (1) In compliance with RCW 39.26.180, the Contractor shall provide access to Data generated under this Contract to DCYF, 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. 12. DISALLOWED COSTS The Contractor is responsible for any audit exceptions or disallowed costs incurred by the Contractor or that of its Subcontractors. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 9 of 17 13. DISPUTES a. Except as otherwise provided in this contract, when a dispute arises between the parties and it cannot be resolved through discussion and negotiation, either party may request a Dispute Resolution Board ("DRB"). b. A request for a DRB must: (1) Be in writing; (2) State the disputed issues; (3) State the relative positions of the parties; (4) State the Contractor's name, address, and contact telephone number; and (5) Be mailed to the other party's (respondent's) Contract Manager after the parties agree that they cannot resolve the dispute. c. The respondent shall mail a written answer to the requester's Contract Manager within ten (10) business days of the receipt of the request for a DRB. d. Once a party requests a DRB, each party shall designate a representative. The representatives shall mutually select a third member. The DRB shall evaluate the facts, Contract terms and applicable statutes and rules and make a determination by majority vote. The decision shall not be admissible in any succeeding judicial or quasi-judicial proceeding concerning the Contract. The parties agree that the DRB shall precede any action in a judicial or quasi-judicial tribunal. 14. DUPLICATE PAYMENT DCYF 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. 15. ENTIRE CONTRACT This Contract, including all referenced exhibits and attachments, contains all the terms and conditions agreed upon by the parties. No other understanding, written, oral, or otherwise regarding the subject matter of this Contract shall be deemed to exist or to bind any of the parties hereto. 16. EXPENSES All expenses not provided for specifically in this Contract shall be the responsibility of the Contractor unless otherwise mutually agreed upon by the parties. 17. FUNDING CONTINGENCY a. 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, DCYF may: (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; (2) Renegotiate the terms of the Contract under the new funding limitations and conditions; (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 (4) Pursue such other alternatives as the parties mutually agree to in writing. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 10 of 17 b. Any termination under this Section (FUNDING CONTINGENCY) shall be considered a Termination for Convenience. 18. 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. 19. INDEMNIFICATION a. 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. b. 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. Contractor's obligation to indemnify, defend, and hold harmless the State shall not be eliminated or reduced by any actual or alleged concurrent negligence of State or its agents, agencies, employees and officials. c. 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. 20. INDEPENDENT CONTRACTOR The parties intend that an independent contractor relationship will be created by this Contract. The Contractor and his or her employees or agents performing under this Contract are not employees or agents of DCYF. The Contractor will not hold himself/herself out as nor claim to be an officer or employee of DCYF or of the State of Washington by reason hereof, nor will the Contractor make any claim of right, privilege or benefit which would accrue to such employee under law. Conduct and control of the work will be solely with the Contractor. 21. INDUSTRIAL INSURANCE COVERAGE The Contractor shall comply with the provisions of Title 51 RCW (Industrial Insurance). If the Contractor fails to provide industrial insurance coverage or fails to pay premiums or penalties on behalf of its employees, as may be required by law, DCYF may collect from the Contractor the full amount payable to the Industrial Insurance accident fund. DCYF may deduct the amount owed by the Contractor to the accident fund from the amount payable to the Contractor by DCYF under this Contract, and DCYF may also transmit the deducted amount to the Department of Labor and Industries (L&I), Division of Insurance Services. This provision does not waive any of L&I's right to collect from the Contractor. 22. LIMITATION OF AUTHORITY Only the Contractor's agent or agent's delegate by writing (delegation to be made prior to action) and DCYF's agent or agent's delegate by writing (delegation to be made prior to action) shall have the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this Contract. Furthermore, any alteration, amendment, modification, or waiver of any clause or condition of this Contract is not effective or binding unless made in writing and signed by the agents for both parties. 23. MONITORING a. DCYF 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 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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 11 of 17 b. Monitoring activities may include, but not be limited to: (1) Review of the deliverables and other requirements listed in Exhibit A. (2) Site visits to review records, observe implementation of services or follow up on compliance issues. These visits may be unannounced. (3) Intensive program reviews, including intensive on-site program reviews. The off-site and on-site program reviews may include, but not be limited to, review of the following: (a) Contractor's compliance with Section (COMPLIANCE WITH LAWS, RULES AND REGULATIONS); (b) Contractor's compliance with Section (DATA SHARE AND PROTECTION OF CONFIDENTIAL INFORMATION AND SENSITIVE PERSONAL INFORMATION); (4) On-site program reviews and site visit records reviews must be scheduled in advance with the Contractor. 24. 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. 25. ORDER OF PRECEDENCE In the event of an inconsistency in the terms of this Contract, or between the terms and any applicable statute or rule, the inconsistency shall be resolved by giving precedence in the following order: a. Applicable State of Washington statutes, regulations, and policies b. The Contract terms and conditions (pages 1 thru 4) c. Exhibit D (General Terms and Conditions) d. Exhibit A (Statement of Work) e. Exhibit C (Deliverables) f. Exhibit B (Budget) g. Attachment 1 (Statement of Confidentiality and Non -Disclosure Agreement) h. Attachment 2 (Certification of Data Disposition) 26. OVERPAYMENT a. Contractor shall promptly, but in all cases within thirty (30) Days, pay to DCYF the full amount of any erroneous payment or overpayment (a) upon Notice of an erroneous payment or overpayment to which Contractor is not entitled with supporting documentation to substantiate such erroneous payment or overpayment and the grounds for DCYF's determination of such erroneous payment or overpayment or (b) when any such erroneous payment or overpayment is otherwise discovered by Contractor. b. In addition to the requirements contained in this Section (OVERPAYMENT), the Contractor agrees that DCYF may also recover overpayments made to the Contractor by deducting amounts owed to the Contractor. DCYF must provide written notice to the Contractor if it elects to recover overpayments by deducting amounts owed to the Contractor. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 12 of 17 27. PUBLICITY a. The award of this Contract to Contractor is not in any way an endorsement of Contractor or Contractor's Services by DCYF and shall not be so construed by Contractor in any advertising or publicity materials. b. The Contractor agrees to submit to DCYF all advertising and publicity matters relating to this Contract in which the State of Washington or DCYF's name, state seal or logo is mentioned or used or language is used from which a connection with the State of Washington or DCYF may, in DCYF's judgment, be inferred or implied. The Contractor agrees not to publish or use such advertising and publicity matters without the prior written consent of DCYF. c. All publications funded, in whole or in part, under this Contract will use DCYF logo and will acknowledge credit as either providing "funding in partnership with" or "funded by" DCYF. The full-color or black -and - white DCYF logo, provided by DCYF Contract Manager, shall appear in its entirety, without modification. 28. RECAPTURE a. 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, DCYF reserves the right to recapture state funds in an amount equivalent to the extent of the noncompliance in addition to any other remedies available at law or in equity. b. Such right of recapture shall exist for a period not to exceed six (6) years following Contract termination. Repayment by the Contractor of funds under this recapture provision shall occur within thirty (30) days of demand. In the event that DCYF is required to institute legal proceedings to enforce the recapture provision, DCYF shall be entitled to its costs thereof. 29. RECORDS MAINTENANCE a. 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 (6) 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 DCYF, personnel duly authorized by DCYF, the Office of the State Auditor, and federal and state officials so authorized by law, regulation or agreement. b. 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. 30. 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. 31. 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. If any term or condition of this Contract is held invalid by any court, the remainder of the Contract remains valid and in full force and effect. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 13 of 17 32. SITE SECURITY While on DCYF's premises, the Contractor, its agents, employees, or Subcontractors shall conform in all respects with physical, fire or other security policies or regulations. 33. SUBCONTRACTING a. Subcontractor Approval by DCYF. Neither the Contractor nor any Subcontractor shall enter into subcontracts for any of the work contemplated under this Contract without obtaining prior written approval from DCYF. b. Subcontract Terms and Conditions. The Contractor must ensure that all terms, conditions, assurances and certifications set forth in this Contract are included in any and all Subcontracts. The Contractor shall forward to DCYF upon request, copies of all subcontracts and other materials pertaining to any and all subcontracts. c. Performance. Contractor is responsible and liable for the proper performance of and the quality of any work performed by any and all Subcontractors. In no event shall the existence of a subcontract operate to release or reduce the liability of Contractor to DCYF for any breach in the performance of Contractor's duties. In addition, Contractor's use of any Subcontractor shall not cause the loss of any warranty from Contractor. All subcontracts shall be made in writing. Any failure of the Contractor or its Subcontractors to perform the obligations of this Contract shall not discharge the Contractor from its obligations under this Contract. d. Direct Agreements. Upon expiration or termination of this Contract for any reason, DCYF and/or the State will have the right to enter into direct contracts with any of the Subcontractors. Contractor agrees that its arrangements with Subcontractors will not prohibit or restrict such Subcontractors from entering into direct contracts with DCYF. 34. TERMINATION FOR CAUSE a. In the event DCYF determines the Contractor has failed to comply with the conditions of this Contract in a timely manner, DCYF has the right to suspend or terminate this Contract. DCYF shall notify the Contractor in writing of the need to take corrective action. If appropriate corrective action is not taken within thirty (30) days, the Contract may be terminated. b. DCYF 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 the alleged compliance breach and pending corrective action by the Contractor or a decision by DCYF to terminate the Contract. In the event of termination, 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. The termination shall be deemed to be a "Termination for Convenience" if it is determined that: (1) the Contractor was not in default; or (2) failure to perform was outside of Contractor's control, fault or negligence. The rights and remedies of DCYF provided in this Section (TERMINATION FOR CAUSE) shall not be exclusive and are in addition to any other rights and remedies provided by law or under this Contract. d. A filing for bankruptcy by Contractor will be deemed a material breach and may result in immediate termination of this Contract. e. Section titled TERMINATION FOR CAUSE, sub -section a. shall not apply to conduct in the performance of this Contract by the Contractor or sub-contractor(s) that involves child abuse or neglect. In the event DCYF has reason to believe that in the performance of this Contract the Contractor or its sub -contractors cause a child to be abused or neglected as defined in chapter 26.44 RCW, DCYF may immediately suspend or terminate this Contract. DCYF may elect to notify the Contractor in writing of the need to take corrective action before the Contract is suspended or terminated by DCYF. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 14 of 17 35. TERMINATION FOR CONVENIENCE DCYF may terminate this Contract in whole or in part when it is in the best interest of DCYF by giving the Contractor at least thirty (30) calendar days' written notice. If this Contract is so terminated, DCYF shall be liable only for payment required under the terms of this Contract for services received and accepted, or goods delivered and accepted, prior to the effective date of termination. 36. TERMINATION PROCEDURE a. Upon termination of this Contract the DCYF, in addition to any other rights provided in this Contract, may require the Contractor to deliver to DCYF any property specifically produced or acquired for the performance of such part of this Contract as has been terminated. The provisions of Section (TREATMENT OF ASSETS) shall apply in such property transfer. DCYF shall pay to the Contractor the agreed upon price, if separately stated, for completed work and service(s) accepted by DCYF, and the amount agreed upon by the Contractor and DCYF for (i) completed work and service(s) for which no separate price is stated, (ii) partially completed work and service(s), (iii) other property or services which are accepted by DCYF, and (iv) the protection and preservation of property, unless the termination is for default, in which case DCYF and Contractor may agree to the extent of the liability of DCYF. Failure to agree to the extent of the liability shall be a dispute within the meaning of Section (DISPUTES) of this Contract. DCYF may withhold from any amounts due the Contractor such sum as DCYF determines to be necessary to protect DCYF against potential loss or liability. c. The rights and remedies of DCYF provided in this Section (TERMINATION PROCEDURE) shall not be exclusive and are in addition to any other rights and remedies provided by law or under this Contract. d. After receipt of a notice of termination, and except as otherwise directed by DCYF, the Contractor shall: (1) Stop work under the contract on the date, and to the extent specified, in the notice; (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 as is not terminated; (3) Assign to DCYF, in the manner, at the times, and to the extent directed by DCYF, all of the rights, title, and interest of the Contractor under the orders and subcontracts so terminated, in which case DCYF has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and subcontracts; (4) Settle all outstanding liabilities and all claims arising out of such termination of orders and subcontracts, with the approval or ratification of DCYF to the extent DCYF may require, which approval or ratification shall be final for all the purposes of this clause; (5) Transfer title to DCYF and deliver in the manner, at the times, and to the extent directed by this Contract or by DCYF any property which, if the contract had been completed, would have been required to be furnished to DCYF; (6) Complete performance of such part of the work as shall not have been terminated by DCYF; and (7) Take such action as may be necessary, or as DCYF 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 DCYF has or may acquire an interest. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 15 of 17 37. TREATMENT OF ASSETS Title to all property furnished by DCYF shall remain in DCYF. 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 DCYF 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 DCYF 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 DCYF in whole or in part, whichever first occurs. b. Any property of DCYF furnished to the Contractor shall, unless otherwise provided herein or approved by DCYF, be used only for the performance of this Contract. c. The Contractor shall be responsible for any loss or damage to property of DCYF which results from the negligence of the Contractor or which results from the failure on the part of the Contractor to maintain and administer that property in accordance with sound management practices. d. If any property of DCYF is lost, destroyed or damaged, the Contractor shall immediately notify DCYF and shall take all reasonable steps to protect the property from further damage. e. The Contractor shall surrender to DCYF all property of DCYF prior to settlement upon completion, termination or cancellation of this contract. f. All reference to the Contractor under this clause shall also include Contractor's employees, agents or Subcontractors. 38. WAIVER A failure by either party to exercise its rights under this Contract shall not preclude that party from subsequent exercise of such rights and shall not constitute a waiver of any other rights under this Contract. Waiver of any default or breach shall not be deemed to be 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 signed by personnel authorized to bind each of the parties. 39. CONTRACTOR REPRESENTATIONS AND WARRANTIES Contractor makes each of the following representations and warranties as of the effective date of this Contract: a. Qualified to do Business. Contractor represents and warrants that it is in good standing and qualified to do business in the State of Washington, that it possesses and shall keep current all required licenses and/or approvals, and that it is current, in full compliance, and has paid all applicable taxes owed to the State of Washington. b. Suspension & Debarment. Contractor represents and warrants that neither it nor its principals or affiliates presently are debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in any governmental contract by any governmental department or agency within the United States. Quality of Goods or Services. Contractor represents and warrants that any goods and/or services sold pursuant to this Contract shall be merchantable, shall conform to this Contract, shall be fit and safe for the intended purposes, shall be free from defects in materials and workmanship, and shall be produced and delivered in full compliance with applicable law. Contractor further represents and warrants it has clear title to the goods and that the same shall be delivered free of liens and encumbrances and that the same do not infringe any third party patent. Upon breach of warranty, Contractor will repair or replace (at no charge to DCYF) any goods and/or services whose nonconformance is discovered and made known to the Contractor. If, in DCYF's judgment, repair or replacement is inadequate, or fails of its essential purpose, Contractor will refund the full amount of any payments that have been made. The rights and remedies of the parties under this warranty are in addition to any other rights and remedies of the parties provided by law or equity, including, without limitation, actual damages, and, as applicable and awarded under the law, to a prevailing party, reasonable attorneys' fees and costs. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 16 of 17 Wage Violations. Contractor represents and warrants that, during the term of this Contract and the three (3) year period immediately preceding the effective date of this Contract, it is not determined, by a final and binding citation and notice of assessment issued by the Washington Department of Labor and Industries or through a civil judgment entered by a court of limited or general jurisdiction, to be in willful violation of any provision of Washington state wage laws set forth in RCW chapters 49.46, 49.48, or 49.52. For purposes of this Subsection (Wage Violations) and pursuant to RCW 49.48.082, "willful" shall mean a knowing and intentional action that is neither accidental nor the result of a bona fide dispute, as evaluated under the standards applicable to wage payment violations under RCW 49.52.050(2). e. Pay Equality. Contractor represents and warrants that, as required by Washington state law (Laws of 2019, Chap. 415, §225(4)(f)), during the term of this Contract the Contractor agrees to equality among its workers by ensuring similarly employed individuals are compensated as equals. (1) For purposes of this Subsection (Pay Equality), employees are similarly employed if the individuals work for the same employer, the performance of the job requires comparable skill, effort, and responsibility, and the jobs are performed under similar working conditions. Job titles alone are not determinative of whether employees are similarly employed. (2) For purposes of this Subsection (Pay Equality), the Contractor may allow differentials in compensation for its workers based in good faith on any of the following: a seniority system; a merit system; a system that measures earnings by quantity or quality of production; a bona fide job-related factor or factors; or a bona fide regional difference in compensation levels. (a) A bona fide job-related factor or factors may include, but not be limited to, education, training, or experience, that is: consistent with business necessity; not based on or derived from a gender-based differential; and accounts for the entire differential. (b) A bona fide regional difference in compensation level must be consistent with business necessity; not based on or derived from a gender-based differential; and account for the entire differential. (3) Notwithstanding any provision to the contrary, upon breach of this pay equality warranty (Subsection Pay Equality) and Contractor's failure to provide satisfactory evidence of compliance within thirty (30) days, DCYF may suspend or terminate this Contract. f. Procurement Ethics & Prohibition on Gifts. Contractor represents and warrants that it complies fully with all applicable procurement ethics restrictions including, but not limited to, restrictions against Contractor providing gifts or anything of economic value, directly or indirectly, to Purchasers' employees. q. Sensitive Personal Information of In-home Caregivers. Contractor represents and warrants that, as required by state law (RCW 42.56.640, RCW 42.56.645, and RCW 43.17.410), it agrees to fully comply will all applicable non -disclosure requirements that pertain to the Sensitive Personal Information of In- home Caregivers. 40. WITHHOLDING PAYMENTS DCYF 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 DCYF. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 17 of 17 WASHINGTON STATE Department of Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Attachment 1 - Confidentiality and Non -Disclosure Agreement STATEMENT OF CONFIDENTIALITY AND NON -DISCLOSURE AGREEMENT Between The Department of Children, Youth, and Families And Jefferson County I. Recitals 1.1 Pursuant to Department of Children, Youth, and Families (the "DCYF") Contract Number 20-1171, attached hereto Jefferson County (the "Contractor") has agreed to provide high quality home visiting services to vulnerable families for the purpose 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 DCYF relating to DCYF Contact Number 20-1171 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. II. 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 DCYF Contract Number 20-1171. 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 DCYF Contract Number 20-1171. 3.2 1 understand that before I am allowed access to information and data that is described and/or contained in DCYF Contract Number 20-1171, 1 must sign and agree to the following: (A) I have been informed and understand that information provided under DCYF Contract Number 20-1171 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 DCYF Contract Number 20-1171. (B) I also understand that I am not to access or use the information that is provided under DCYF Contract Number 20-1171 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 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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 3 (C) I agree to abide by all Federal and state laws and regulations regarding confidentiality and disclosure of the information in DCYF Contract Number 20-1171. 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: arson �o u(14, , Signature: Print Full Name:�Li��' Job Title:' Date: Signature: Print Full Narne: Job Title: Date: Signature: Print Full Name: Job Title: Date.— Signature:- Print ate:Signature:Print Full Name: Job Title: Date, Apo d fnrm nly: � �/ / Date: `� Phir, Elf -Civil Deputy Prosecuting Attorney J gonCounty Prosecuting Attorney's Office 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: Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 3 Signature: Print Full I 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: Signature:._ Print Full N 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: (The number of signature lines can be deleted and copied to meet your needs). Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 3 WASHINGTON STATE DCYF Contract Number: 20-1171 Department of Contract Maximum: $406,530.72 Children, Youth, and Families From-To:07/01 /2019-07/31 /2020 Attachment 2 - 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 DCYF Contract No. 20-1171 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 DCYF Contract No. 20-1171 have been wiped from data storage systems. _ All materials and non -wiped computer media containing any data sets related to DCYF Contract No. 20- 1171 have been destroyed. All copies of any data sets related to DCYF Contract No. 20-1171 that have not been disposed of in a manner described above, have been returned to tate DCYF'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 DCYF Contract No. 20-1171, have been complied with as indicated above. Signature of Contract Manager: Date: Print Name: Return original to DCYF Public Records at dcyf.publicrecords@dcyf.wa.gov Ap ed a=orm:onl�y: � g _ Date: CUief Civil Deputy Prosecuting Attorney Jefferson C unty Prosecuting Attorney's Office Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 1 WASHINGTON STATE Department of Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Attachment 3 - Contract Monitoring, Compliance and Non - Compliance Program Reporting and Documentation a. Reporting: The Contractor shall submit reports using the templates in the Prevention Services Reporting System, if available, or provided by DCYF and according to the schedule outlined in Section 14 of Exhibit A Statement of Work of this contract. b. Additional Documentation: The Contractor shall maintain the following information and documentation, keeping it current on a monthly basis. At a minimum, DCYF may request this information for review at the annual DCYF Site Visit, including: (1) Staff Training Records demonstrating compliance with HVSA and model requirements; (2) TA Self Reflection and TA Plan; (3) CQI Charter, Project Plans for Projects 1 and 2 and CQI Quarter Reports for Quarters 1 through 4 using template attached as reference document titled Continuous Quality Improvements; (4) Memoranda of Understanding with community providers related to referrals or coordination of Home Visiting Services; (5) Copies of signed participant consent forms for participation in the program; (6) If funded with DSHS/TANF dollars, information on TANF families served by homeless service providers, PE Pathways and Other including number of families served; name of family members receiving services (primary caregiver and target child); individual client identifiers, such as date of birth; and dates of service (by month including enrollment and exit dates). C. Site Visits: The Contractor shall cooperate with up to eight (8) scheduled site visits conducted for monitoring program and fiscal compliance, contractual and reporting requirements, organizational due diligence, HVSA evaluation and data collection, quality implementation technical assistance, and continuous quality improvement. (1) Document Preparation: The Contractor shall assemble documents listed above, financial information detailed in Section 12 of Exhibit A Statement of Work, and any additional information requested by DCYF in advance of the scheduled site visit. (2) During the Site Visits, the Contractor shall allow access to DCYF, upon request, documentation demonstrating accomplishments of this Agreement. Such documentation may include, but is not limited to: Contract Number: 20-1171 (a) Services Provided, Service Dates, and Number of Service Hours, including Case Files of Participants and signed consent forms; (b) Attendance Sheets and Service Logs; (c) Data Collection and Assessments by Participants; (d) Demographic Information of Participants; (e) Personnel records of those staff employed through funds under this contract; and (f) Policy and procedures documents as related to implementation of this contract including, but not limited to, agency, human resources, and financial policies and procedures. Printed Date: 8/7/2019 Page 1 of 4 2. Contract Monitoring: The Contractor shall ensure all compliance with all Contract requirements described in Exhibit A Statement of Work of this Contract. Failure to comply with or submit timely and complete materials related to the Contract requirements may result in withheld or delayed payments. DCYF will monitor Contractor compliance with Contract requirements, model standing, implementation progress, enrollment performance and financial activity through review of the following: a. Submitted reports, invoices and documents, as detailed above and in Section 14 of Exhibit A Statement of Work Compliance with Contract requirements. b. Model Fidelity: Affiliate status from the National Service Office/Indicators of model fidelity established by the DCYF-authorized provider of technical assistance demonstrating Contractor's good standing and/or active ready to implement status. (1) If the Contractor does not sustain fidelity throughout the Contract Term, DCYF will conduct a joint due diligence review of the of the Contractor's model fidelity status in coordination with its designated contractor for technical assistance; and then DCYF may, upon written notification to the Contractor, terminate this Contract. (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 obtain such status within 90 days of the Start Date of this Contract, then DCYF may, at its discretion and upon written notice to the Contractor, terminate this Contract. 3, Implementation Progress: The DCYF Contract Manager 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: a. Staffing, Supervision, and Training, b. Service Area and Service to Priority Populations C. Participant Enrollment, Retention and Caseload Maintenance d. Home Visit Frequency and Content e. Systems Connections; if funded with DSHS/TANF dollars, this includes Contractor relationships with local DSHS Community Service Offices and reporting participants' program enrollment and exit in eJas Data Collection and Evaluation Requirements g Continuous Quality Improvement Activities h. Quality Improvement Technical Assistance i. Financial activity and documentation aligned with Contract budget Delay in meeting two or more of the category areas above and/or non-compliance related to financial activity during a quarter, may result in Contractor's transition to Implementation Improvement Status. 4. Enrollment Performance: On a quarterly basis, DCYF will review the Contractor's enrollment performance for the following measure: Throughout the duration of this contract, Contractor shall maintain a minimum Active Enrollment Caseload (as defined in Section 6 of Exhibit A Statement of Work) equivalent to or greater than 85% of the Contractor's Maximum Service Capacity. a. Start -Up Programs: DCYF identifies Contractors receiving first year HVSA funding are considered as 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 in meeting enrollment toward building full caseload will be reviewed on a monthly basis. If the Start -Up Program does not meet enrollment in accordance with the timeline specified in Exhibit A Statement of Work, DCYF will Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 4 inform Contractor of enrollment status and may transition Contractor to Implementation Improvement Status for additional contract monitoring and technical assistance focused on supporting improvement in Contractor's enrollment. b. Continuing Programs: DCYF identifies Contractors receiving second year or beyond of HVSA funding as Continuing Programs. (1) If a Continuing Program's minimum Active Enrollment Caseload is between 75% and 84% of the Contractor's Maximum Service Capacity for one quarter DCYF will inform Contractor with written notification of the low enrollment status and Contractor shall participate in a follow-up call with DCYF to discuss barriers and strategies for increasing enrollment. If during the subsequent quarter the Contractor does not demonstrate continuous positive improvement of active enrollment and at least the final month of the quarter with enrollment at or above 85% of the Contractor's Maximum Service Capacity, DCYF may transition Contractor to Implementation Improvement Status for additional contract monitoring and technical assistance focused on supporting improvement in Contractor's enrollment. (2) If a Continuing Program Minimum Active Enrollment Caseload is below 75% of the Contractor's Maximum Service Capacity for one quarter, DCYF will transition Contractor to Implementation Improvement Status for additional contract monitoring and technical assistance focused on supporting improvement in Contractor's enrollment. 5. Implementation Improvement Status, Non -Compliant Status and Non -Compliant Courses of Action a. Implementation Improvement Status: If transitioned to Implementation Improvement Status by DCYF, the Contractor shall participate in the steps outlined below: (1) Within 30 days of written notification by DCYF, the Contractor shall complete the Self - Assessment provided by DCYF which may address, but is not limited to the following: model fidelity, implementation progress, financial activity, and/or enrollment performance in need of improvement, and other issues of compliance with contract requirements. (2) Within 45 days of written notification by DCYF, the Contractor shall participate in Implementation Improvement Meeting(s) with DCYF staff to discuss the Self - Assessment; gather information and feedback from Contractor; share and review DOH program data and other available program data; and review other information related to areas in need of improvement which may be used to inform the development of an Implementation Improvement Plan. This meeting may include other DCYF contractors of technical assistance (Thrive) and data management and reporting (DOH). (3) Within 30 days of the Implementation Improvement Meeting, the Contractor shall prepare a written Implementation Improvement Plan approved by DCYF. The Plan shall: (a) Cite and describe the Contractor's specific area(s) in need of improvement including, but not limited to: 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. (b) Identify corrective action items and/or steps the 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 DCYF to assist Contractor in achieving satisfactory improvement. (c) Outline a timeline for the completion of the Implementation Improvement Plan by the Contractor. (4) If satisfactory improvement in the specific area(s) indicated in Plan is met by the Contractor within the timeline for completion of the Plan, DCYF will transition the Contractor off Implementation Improvement Status. DCYF will provide the Contractor written notice of this transition once it has determined satisfactory improvement has been met following the timeline for completion of the Implementation Improvement Plan. (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 the Contractor, DCYF may transition the Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 4 Contractor out of Implementation Improvement Status into Non -Compliant Status. DCYF will provide the 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. b. Non -Compliant Status: If DCYF transitions the Contractor to Non -Compliant Status, the Contractor shall participate in the steps outlined below, within 14 days of written notification from DCYF, or within an extended, alternate timeline with written approved by DCYF: (1) Participate in Non -Compliant Status meeting(s) with DCYF staff to: (a) Review the 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 the Contractor by DCYF. (b) Identify and review the Contractor's contractual requirements and areas of contractual non-compliance. (c) Discuss Non -Compliant Courses of Action. C. Non -Compliant Course(s) of Action. Within 14 days of the last Non -Compliant Status meeting DCYF will issue the Contractor a written Non -Compliant Course(s) of Action. The written Non - Compliant Course(s) of Action shall include one or more of the four Non -Compliant Course(s) of action listed below: (1) Continuation of Implementation Improvement Plan: DCYF 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. (2) Suspension of Payment: DCYF may suspend payment of all or part of Contract funds until satisfactory contract compliance is met. (3) Reduction in Maximum Contract Total: DCYF may amend this contract to reduce the Contractor's maximum contract total: (a) To reflect the amended Implementation Plan scope negotiated between DCYF and the Contractor based on Contractor's cost per family served and other related factors and, (b) If feasible and in compliance with HVSA and DCYF funding requirements, contractual requirements, and approval processes, including Home Visiting Model Developer program requirements. (4) Early Contract Termination: DCYF may terminate this contract prior to the end of the Term if satisfactory contract compliance is not met by the Contractor in the implementation of Contractor's Implementation Improvement Plan, and/or if the Contractor is not able to or is not cooperative in development and implementation of the Implementation Improvement Plan. (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 Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 4 'Gti- WASHINGTON STATE Department of Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Attachment 4 - Continuous Quality Improvement Overview of CQI Learning Collaborative Approach and Timeline Breakthrough Series Learning Collaborative (BTS) - 7. Purpose a. The purpose of CQI activities is to improve outcomes for families engaged in home visiting services. b. Breakthrough Series (BTS) Learning Collaborative: CQI Projects will follow a model called the Breakthrough Series (BTS) developed by the Institute for Healthcare Improvement. The Breakthrough Series Learning Collaborative facilitates collaborative learning so that teams can easily learn from peers and from recognized subject matter experts in the topic area for improvement. This 12 month BTS Learning Collaborative will provide a structure for learning and action by engaging teams in achieving real, programmatic and system -level changes to support improvement. C. The BTS Learning Collaborative will include three components: (1) Pre -work -- July to October 2019; (2) Learning Sessions -- November 2019 and April 2020; (3) Action Periods -- December 2019 to March 2020 and April to June 2020. 2. BTS Pre -work a. Pre -work is an important aspect of learning collaboratives and should be completed as a team. Pre -work helps ensure our work is targeted and in alignment with the aim. (1) Pre -work activities will allow teams to: (a) Establish a common understanding of the current process/systems (related to specific CQI topic) (b) Prepare for Learning Session 1 (c) Create opportunities to connect and network with other teams (2) The Contractor shall complete the pre -work assignments, as described below and in Attachment 5, and submit to DCYF no later than October 21, 2019 (3) Pre -work activities, at a minimum, will include: (a) Completing a process map or other root cause analysis (b) Reviewing key documents in preparation for Learning Session 1 (c) Reviewing baseline data (4) Prepare a storyboard to introduce your team and share lessons learned from the pre - work 3. Learning Sessions a. Learning Sessions are face-to-face meeting opportunities during the course of the learning collaborative. (1) Contractors shall participate in three (3) learning sessions during the contract year. (a) Learning Session 1 will occur in the fall of 2019 Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 4 4. (b) Learning Session 2 will occur in the Spring of 2020 (c) Learning Session 3 will occur in the Summer of 2020. (2) During each Learning Session the Contractor's CQI team will learn from Subject Matter Experts, deepen knowledge of improvement strategies, and dialogue with other teams about successes, barriers and lessons learned. Learning Session 3 will be focused on reviewing results and celebrating teams' work. Action Periods a. The Contractor shall participate in Action Periods to occur between the Learning Sessions. During each Action Period, the Contractor shall: (1) Participate in monthly topic -based calls/webinars to share information and learn from peers. The aim is to sustain collaboration and peer support throughout the learning collaborative. (2) Conduct rapid cycle PDSAs where they shall test and implement changes in their local settings; (3) Collect data relevant to their PDSA cycles; (4) Submit monthly PDSA progress reports; Breakthrough Series Model Topic Two Topic �Selecfion Tracks July - October 1 YL 1t i Action Period Action Pero( 1 (PDSAs) 2 (PDSAs) Dec. - Mar. May - June July 2019 - June 2020 Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 4 WASHINGTON STATE Department of ;4b Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 HVSA PLAN -DO -STUDY -ACT (PDSA) Planning Form Agency: Learning Collaborative CQI Topic: Primary Driver: PDSA Cycle # Model: Date: ❑ Caregiver Depression Screening/Referral ❑ Family Retention ❑ 1- ❑ 2- ❑ 3- ❑ 4_ ❑ 5 - NOTE: The following portion of the form can be completed in a few sentences or bullet points, please be as clear and specific as possible - What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement? Plan -Do -Study -Act (PDSA) Prediction If we... Plan Contract Number: 20-1171 It will result in... Plan for this test: Start Date End Date Who/What/Where? Who is responsible? Tasks/Tools Needed to Complete Test: Printed Date: 8/7/2019 Page 3 of 4 M Study Act ❑ Adapt 0 Adopt ❑ Abandon Was the test carried out as planned? What did you observe that wasn't part of the plan? What did the data tell you? (include here any data that answers the question or prediction you sought to answer with this PDSA) What did you observe? What surprised you? What changes are to be made to the process (decisions made/action to take)? Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 4 WASHINGTON STATE DCYF Contract Number: 20-1171 Department of Contract Maximum: $406,530.72 Children, Youth, and Families From-To:07/01 /2019-07/31 /2020 Attachment 5 - Monthly Enrollment Data Report Components Sample Monthly Enrollment Data Report. Template and submission method subject to change. Current electronic template to be submitted by Contractor is available on Home Visiting webpage at www.dc f.wa. ov services child-dev-su ort- roviders home-visitin . Using the Prevention Services Reporting System https://apPs.dcYf wa.4ov/PSRS, please complete the questions below in reference to activities for the reporting month. This report is due to Department of Children, Youth, and Families on the 201h of each month following the reporting month. 1. Organization Information a. Home Visiting Model (select) b. Contract # 1.4. Month (select) c Name of Person Completing 1.6 Phone # Renort 1.7 Email address 2. Active Caseload Please provide the following information for children and families served by HVSA funds during the reporting month. 3. Caseload Changes Please provide the following information about new enrollments, exits, and program completion during the reporting month. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 2 funded by funded by funded by State General State funded by TAN MIECHV i502 Funds Funds a. Number of families/clients actively enrolled: All clients with some enrollment 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. b. Number of children enrolled: Received a home visit or other model - approved contact in last 90 days c. Number of families that received home visits during report month: d. 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. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 2 4. Enrollment to Capacity Please calculate your enrollment -to -capacity percentage by dividing the number of families in actively enrolled in the report month by the number of funded families described in your contract. If the percentage of family pnrn►lmpnt to rnnnritu fpr limir nrnnrom is hPlnw R5%. please provide a briefexolanotion in the space provided. funded by funded by State funded by General State funded byTAN F Caseload MIECHV i502 Funds Funds Month (2.1) a. Number of new families Enrolled to Funded Families) (4.1/4.2) enrolled: #DIV/0! b. Number of exits before reaching HVSA retention goal: Clients that exited the program during the month before receiving 24 months of services. c. Number of clients exiting after reaching the HVSA retention goal: Clients that have exited the program during the month after receiving at least 24 months of services : 4. Enrollment to Capacity Please calculate your enrollment -to -capacity percentage by dividing the number of families in actively enrolled in the report month by the number of funded families described in your contract. If the percentage of family pnrn►lmpnt to rnnnritu fpr limir nrnnrom is hPlnw R5%. please provide a briefexolanotion in the space provided. 4.4. If Active Enrollment Caseload (#4.3) is less than 85%, please explain: Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 2 4.3. Active Enrollment a Total Number of Actively 4.2. Maximum Service Capacity Caseload Enrolled Families/Clients this (# slots in your Contract) (Percent of Families Currently Month (2.1) Enrolled to Funded Families) (4.1/4.2) 0 #DIV/0! 4.4. If Active Enrollment Caseload (#4.3) is less than 85%, please explain: Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 2 WASHINGTON STATE J. Department of Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Attachment 6 - HVSA Quarterly Progress Report Components 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.dc .wo. ov services child-dev-su ort- roviders home-visitin . Using the Prevention Services Reporting System, haps://apps.dty ..wo.cov/PSRS, please complete the questions below in reference to activities from Month 1 to Month 3 of the reporting quarter. This report is due to Department of Children, Youth, and Families on the 201h of each month following the reporting quarter. 1. Organization Information 1.1. Organization Name 1.2. Home Visiting Model - --- 1.3. Contract # 1.4. Quarter _ TI J<Choices: Q1: July 1 — Sept 30; Q2, Q3, Q4...> 2. Fidelity to Program Model 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. plo d: > .1 2.1.b. If your program does not have a national model office (e.g. ,_.-._gip_ ^ - ,T" ), 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: > 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 fidelitv for each those indicators. 11ndicator Area lProgram Progress Towards Fidelity Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 7 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. To build our understanding of staffing, caseload, and transition we need detailed and accurate completion of the two tables below: Staffing Status Table as of Last Day of the Quarter Please list the total FTE funded by each source Please list the total FTE funded by below. Please respond with a number (t1J. each source below Staff Role/Positions funded by your DCYF d' Home Contract (HVSA) and other funds in your c. HVSA- a. HVSA- b. HVSA- HVSA- e. Non a. b. C. d. Program State Funds Funds Gen Funds HVSA- HVSA- HVSA- Total e. Total Funds # of Home Visitors — Currently filled positions 0.00 # of Vacant Home Visitor Positions Home Home Visitor Home Vtea,; a Visiting Select Role — Type in Full Name or Start Date Visitor End LL C N tea, > d Program include vacant "vacant" if position is HV ID# if known, Date > # of Vacant Supervisor Positions positions not currently f lied Month and if left home u Z LL LL Year visitor role L H z° 0.00 # of Vacant Other Staff Positions 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.2. Please describe any changes in program staff that occurred during the reporting quarter (e.g. vacancies, extended leave, etc.). Leave blank if not applicable. 3.2a. If you are experiencing staffing transitions, please describe how your program plans for/addresses those transitions in order to maintain enrollment numbers and continuity of services to families. Leave blank if not applicable. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 7 Please list the total FTE funded by each source below. Please respond with a number (t1J. f. Total Staff Role/Positions funded by your DCYF d' Home Contract (HVSA) and other funds in your c. HVSA- a. HVSA- b. HVSA- HVSA- e. Non Visiting home visiting program i502 MIECHV TANF State HVSA Program State Funds Funds Gen Funds Funds Funds # of Home Visitors — Currently filled positions 0.00 # of Vacant Home Visitor Positions 0.00 # of Supervisors— Currentlyfflled positions l 0.00 # of Vacant Supervisor Positions 0.00 # of Other Staff— Currently filled positions 0.00 # of Vacant Other Staff Positions 0.00 3.2. Please describe any changes in program staff that occurred during the reporting quarter (e.g. vacancies, extended leave, etc.). Leave blank if not applicable. 3.2a. If you are experiencing staffing transitions, please describe how your program plans for/addresses those transitions in order to maintain enrollment numbers and continuity of services to families. Leave blank if not applicable. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 7 3.3. Please describe, if applicable, any ongoing challenges with recruiting or retaining staff and how your program is currently addressing these challenges. Leave blank if not applicable. 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 Home this quarter. of Supervision nistrative/Clinical Supervision (one -on - Reflective Supervision (one-on-one) Group (staff meetings, trainings, etc.) # hours provided to each Home Visitor per month 4.2. Please add any comments related to supervision below. Include any barriers encountered to fulfilling supervision hours in the above categories as expected for model fidelity or outlined in your contract. 1 4.3. Q4 What is your organization doing (at the policy, procedural or practice levels) to support your program in hiring and retaining high-quality program staff (and reducing turnover)? 1 5. Service Delivery 5.1. Please tell us how many unduplicated caregivers received services this quarter (received at least one home visit during this quarter). Please include all caregivers that are participating in the program. # Female Caregivers # Male Caregivers 5.1. b. Please tell us how many unduplicated caregivers received services this year (received at least one home visit from July 12018 through June 30, 2019). Please include all caregivers that are participating in the program. # Female Caregivers # Male Caregivers l 5.2.a. Number Of Home Visits Completed and Attempted but not Completed during this Quarter # Completed # Attempted, but NOT completed This is reported in the monthly already 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. 5.3a. Do you have a waiting list for your home visiting program? I Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 7 5.3.b. If yes, how many people are currently on your waiting list? C 5.3.c Please tell us the estimated number of days it takes for people to wait on the waiting list before you are able to enroll them in your program? 5.3.d. Please provide comments regarding service delivery for enrolled families. 5.4. Q2/Q4 Outgoing Referral Networks Based on a review of your program data during the last 6 months, 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. # Type of Service 1 <categories> 2 <categories> 3 <categories> 4 <categories> 5 <categories> < categories> Family support/parent education Early childhood development Food Support Mental Health Child welfare Employment Health Substance Abuse Domestic violence prevention Education Legal WIC Name Other 5.5. Describe any gaps in services needed by your home visiting participants that are not available in your community (In your response, if relevant, please align with the service categories above) 5.6. Referrals: Of the referrals made, please describe any challenges or barriers connecting families to services. What, if any major trends are you seeing that are different from prior referral patterns? 5.7.a. TANF: Please summarize what has been working well and what has been difficult in recruiting, enrolling and serving TANF referred families. 5.7.b. Please describe how you have been connecting and communicating with your CSO(s). Examples may include weekly phone calls, monthly case conferencing, or quarterly meetings. 6. Technical Assistance 6.1.. In reviewing your TA Plan, please describe one key outcome or success that your program achieved utilizing TA during the last 6 months. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 7 6. Please describe any Training or TA needs you have for NEXT quarter (this may include work with Thrive, DEL, DOH or others). 7. Organizational and Community Updates 7.1. Please describe any notable changes within your program or organization that have impacted implementation of your program. 7.2. a. Describe any notable activities that occurred this quarter to create or improve connections with other service delivery systems: early learning, child welfare, early intervention. 7.2. b. Please describe any activities or efforts you participated in during this quarter to specifically strengthen referral pathways from TANF families into your program including connections with DSHS and your local Community Services Office. 7.2. c. Describe your relationship with/level of participation in the local Early Learning Regional Coalition. 7.3. During the past 6 months, which two to three community partners did you cultivate a stronger working relationship for recruitment, wrap around services, training or other resources? 7.4/5a. Q4 Describe any notable demographic changes in your community in the past year. - —1 7.4/5b. Q4 Describe any steps your program is taking to address changes in community need noted above. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 5 of 7 8. Continuous Quality Improvement 8.1. Q1111 Please submit your CQI Charter and Project Plan for this quarter. 8.2. �"V; z, Please submit your CQI Quarterly Report for this quarter. 9. Q1/Q3 Parent or Family 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). J 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 Reflection 10.1. Reflecting on your enrollment, what successes and challenges have you faced in meeting your contract recruitment deliverables? Please include thoughts on recruitment, retention, early exits, etc. 10.2. In reviewing your program's Data Dashboard and a data quality report prepared by DOH for the prior quarter, please reflect on the data presented in both reports. What stood out to you? What surprised you, or what concerned you? How did the data inform any program adjustments, if at all? 10.3. Please describe any successes or challenges in data management or data use during the last quarter. Indicate how these affected staff and/or program practice. 11. General Comments 11. Comments: Please include anything you would like to add that was not addressed elsewhere in this progress report. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 6 of 7 12. FOR TANF: TANF Referrals Worksheet 12.1. Please complete the following table for the reporting quarter Cumulative Families Served for I Current Enrollees as of the last day the Reportine Quarter I of the Reporting Quarter Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 7 # Total # Total Referrals # Total Referrals to Date # Total Referrals from # Total Referrals from Resulting in Enrollment (from July 1 to Current CSO for the Reporting Other Source for the the Reporting Quarter)for quarter Reporting Quarter Quarter contact for all referrals Who left Program than graduation Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 7 # Total # Total Average number of days Participants Participants from referral to first who left Summary of client exit reasons other contact for all referrals Who left Program than graduation for the Reporting Quarter Program by Without Graduating Completion Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 7 WASHINGTON STATE Department of w, Children, Youth, and Families DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 Attachment 7 - Data Collection Reporting Aligned Measurers 1. Data Sharing a. Required elements of the Data Sharing Agreement (DSA) with Department of Health (DOH): The Contractor will work with DOH to establish data sharing agreements according to the timelines set forth within Exhibit A, Statement of Work. The data sharing agreement shall outline specifications of the data use and data sharing to implement required reporting, evaluation and quality assurance or improvement activities. The data sharing agreement shall minimally: (1) Allow DOH access to client and program data as outlined below in section 4.0. (2) When parental consent is provided, (a) Share with and allow DOH access to confidential information listed in Table 4.a.(3) below; (b) Allow DOH to share confidential information with DCYF; and (c) Allow DOH to share confidential information with other Washington State agencies, including, but not limited to, the Office of Research and Data Analysis (RDA) housed within DSHS to conduct administrative match from families in Home Visiting and Child Protective Services (CPS) programs. b. National Service Office Permissions for data sharing: (1) DCYF 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. The Contractor shall send authorization using the approved template to the NFP National Service Office in coordination with the NSO. 2,Q ]Data Collection n Schedule a. The Contractor shall collect all of the data outlined in section 4 of this attachment for all enrolled participants according to the guidelines and requirements outlined in the HVSA Data Manual. The Contractor shall record data in the model specific database within five (5) business days of data collection. The Contractor shall provide data as outlined in the Data Sharing Agreement executed with DOH. Data will be provided to the Department of Health directly from National Service Office on a monthly basis. 3.0 Parental Consent a. The Contractor will make every effort to seek Parental Consent to share confidential information with DOH during the contract period; the Contractor shall seek this consent from all newly enrolled participants within the first three home visits. Consent form(s) are available on the Home Visiting page at DCYF.wa.gov. b. Parental Consents for voluntary services and data sharing may be combined. c. Participants who do not provide consent to share confidential information remain eligible to receive home visiting services. Non -confidential program data reporting is still required for these participants. d. For those participants who consent to share confidential information, the Contractor shall send to DOH the list of participants by client ID and their consent status (e.g., Yes or No) on at least a monthly basis and no later than 6 business days after the close of the prior month. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 7 e. The Contractor will maintain consent forms on file for all participants enrolled in home visiting services in both physical files and electronically in model data system, if applicable. Upon request, the Contractor will provide to DCYF a copy of the consent form used. 1.0 HVSA Aligned Perfo mance Measures a. HVSA Aligned Measures: As outlined in statement of work, the Contractor will collect data for all enrolled HVSA families that meets model requirements and the DCYF definitions outlined in Table 4.a.(1) -4.a.(5), using the guidance and processes outlined in the HVSA Data Manual. DOH will work with the Contractor to review data collection and reporting to support Contractor quality assurance. Of note, primary caregivers, caregiver and clients are used interchangeably with the same intent. (1) HVSA Aligned Measures - System and Program Performance Indicators: The Contractor shall collect and share data for all measures for participating caregivers and children as outlined in Table 4.a.(1). (2) Enrollment and Service Utilization: The Contractor shall collect and share data on all enrollment and service utilization measures outlined for participating caregivers and children. (3) Demographic Information: The Contractor shall collect and share data for all demographic information outlined for participating caregivers and children. (4) Performance Payment Awards Performance Payment Measures: The Contractor shall review data reports from DOH to substantiate Performance Payment Measures as described in Table 4.a.(4). (5). HVSA Definitions: Table 4.a.(5) presents definitions of measures related to Performance Payment Awards as well as the model -expected dosage and home visit. Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 7 . . Table 4.a Measure WASHINGTON STATE Department of Children, Youth, and Families HVSA: S DCYF Contract Number: 20-1171 Contract Maximum: $406,530.72 From-To:07/01 /2019-07/31 /2020 ystem and Program Performance Indicators Timeline for Data Share with H Definition Numerator/Denominator Collection LIAs All Me HVSA Aligned Measures: All Contractors shall Percent of infants (among mothers who enrolled 1. Breastfeeding prenatally) who were breastfed any amount at 6 months of age 2. Depression Screening 3. Well Child Visit 4. Child Maltreatment S. Parent -Child Interaction 6. Early Language and Literacy Activities Percent of enrolled primary caregivers who are screened for depression using a validated tool within 3 months of enrollment if enrolled post -delivery or within 3 months after of delivery if enrolled prenatally Percent of enrolled children who received the last recommended well child) visit based on the American Academy of Pediatrics (AAP) schedule Percent of enrolled children with at least one investigated case of maltreatment following enrollment within the reporting period Percent of enrolled primary caregivers who receive an observation of caregiver -child interaction using a validated tool and demonstrate positive parenting behaviors including behaviors that promote attachment and child development Percent of enrolled children with a family member who reported that during a typical week s/he read, told stories, and/or sang songs with their child ort on the following eight Number of enrolled children breastfed any amount at 6 months / Number of enrolled children age 6-12 months Number of clients with at least one PHQ-9 screening completed within 90 days of delivery if enrolled prenatally or within 90 days of enrollment if enrolled with a child / Number of primary caregivers enrolled for at least three months if enrolled post -delivery, or number of primary caregivers enrolled at least 90 days after delivery if enrolled prenatally Number of children enrolled who received the last recommend well child visit based on AAP schedule / Number of children enrolled in home visiting Number of children with at least one investigated case of maltreatment since enrollment / Number of children enrolled Number of children with an assessment completed using validated tool for the age range / Number of children who have reached an age appropriate for assessment Number of enrolled children with a family member who reported that during a typical week s/he read/told stories/sang songs with child every day / Number of enrolled children Percent of enrolled Number of enrolled children 7. Developmental children with at least one with at least one ASQ-3 Screening screening for screening within the AAP Contract Number: 20-1171 with defined age/ Number of Printed Date: 8/7/2019 measures Collect after 6 Quarterly months of age and QA reports, before 12 months of Annual age reports Collect within 90 Quarterly Dashboards, days of enrollment QA reports, or 90 days Performanc postnatally (for a Payments, those enrolled while Annual pregnant) reports Collect well child Quarterly visit data at QA reports, minimum once per Annual month reports Report participant Annual consent within first reports 3 home visits Collect at least Quarterly once during the Dashboards, reporting year, QA reports, ideally spaced Annual every 12 months reports QA reports, Collect data at least once during each Annual reporting period for reports each enrolled child Collect for children QA reports, at 10, 18, and 24 Annual months of age reports Page 3 of 7 Table 4.a.(1 ) HVSA: Measure 8. IPV Screening ,ystem and Program Performance Indicators Definition a validated tool according to the AAP -defined age „groups Percent of enrolled primary caregivers who are screened for intimate partner violence (IPV) within 6 months of enrollment using a validated tool Numerator/Denominator children enrolled who are eligible for an ASQ-3 screening Number of caregivers with an IPV screen within 6 months of enrollment / number of clients enrolled for at least 6 months Timeline for Data Share with H Collection LIAs Ali Me 4.a.(2) HVSA AIF ned Measures: Enrollment and Service Utilization Measure Definition Collect screening Quarterly _ 1. New Clients data for all primary Dashboards, Collect enrollmei caregivers within 6 QA reports, report period months of Annual home visit during the report period enrollment Reports 2. Enrolled Clients 4.a.(2) HVSA AIF ned Measures: Enrollment and Service Utilization Measure Definition Eligibility Timinq_of I _ 1. New Clients All clients who enrolled during the All clients who enrolled during the Collect enrollmei 2. Primary Guardian Age report period and completed one report period enrollment home visit during the report period 2. Enrolled Clients All clients with an enrollment date All clients with an enrollment date Collect enrollmei and at least one completed home and at least one completed home enrollment and d visit. Clients may have entered or visit and is still enrolled at the end of visits exited services within that report the report period or exited at or after period. the start of the report period. 3. Client Exits All clients who exited the program All clients who exited the program Collect exit date during the report period. during the report period program 4. Exit Reasons Reasons a client exited program: All clients who exit during the report Record exit date Completion —specific to each model period time of exit Withdrawn —Client requests to leave program before graduation Transfer —Client transferred to another site or model Lost to Follow-up- Unable to contact client and complete a home visit for more than 90 days Began/Returned to Work Began/Returned to School Clients that exited the program All clients who exited the program Collect exit date S. Exits after 24 months of during the report period and received during the report period program service* at least 24 months of service (or 2 program cycles for PCHP). _ 6. Exits before 24 All clients who exited home visiting All clients who exited the program Collect exit date months of service program before 24 months of service. before 24 months of service. from the progran * 7. Total Home visits All home visits completed during the All home visits completed during the Record dates of report period report period immediately afte visit 8. Total number of _ All alternative visits of at least 30 _ Record date and All alternative visits of at least 30 alternative visits minutes in length completed during minutes completed during the report alternative visits the report period period completing the v Table 4.a.(3). Demographic Information Measure Definition Eligibility Timing o- 1. Primary Guardian Gender Male or Female All primary guardians Collect at em 2. Primary Guardian Age Age of primary guardian All primary guardians Collect DOB Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 7 Table 4.a. 3 . Demographic Information Measure Definition Eligibility All enrolled children Timing o 3. Enrolled Child DOB Age of child Collect child'; 4. Primary Guardian Ethnicity Hispanic, Non -Hispanic, Not All primary guardians Collect at em reported/ref used S. Primary Guardian Race White, Black, Asian, American All primary guardians Collect at eni Indian/Alaska Native, Pacific Islander, Multiple Races, Not reported/refused -Married (legal or common law) All primary guardians Collect enroll 6. Primary Guardian Marital Status -Single-never married thereafter -Widowed -Divorced -Separated -Not married — living with partner 7. Primary Guardian Education -Enrolled in middle school All primary guardians Collect at eni -Enrolled in high school annually ther -High school diploma -GED -Less than high school diploma not enrolled -Training certificate program -Associates degree -Some college -Bachelor degree or higher -Other -Unknown/not reported 8. Primary Guardian -Employed >=30 hours a week All primary guardians Collect at eni Employment -Employed <30 hours a week annually ther -Unem to ed 9. Housing Status -Not homeless: Owns or shares own All primary guardians Collect at eni home, condominium or apartment annually ther -Not homeless: Rents or shares own home or apartment -Not homeless: Lives in public housing -Not homeless: Lives with parent or family member -Not homeless: Some other arrangement -Homeless: Sharing housing -Homeless: Living in an emergency or transitional shelter -Homeless: Some other arrangement All primary guardians Collect at eni 10. Primary language in -English household -Spanish -Other 11. Household Income Total income from all household members All primary guardians Collect at eni from all sources annually ther (Collected as actual dollar amount or in income ranges if family does not want to share) Primary guardian is pregnant during the Collect due d 12. Pregnant All primary guardians report period Yes/No All primary guardians children 13. Primary Guardian Health -Title XIX (Medicaid) Collect at eni Insurance Status -Title XXI (State insurance program) six months & -Private or Other -Tri-care -No insurance coverage -Unknown/Not reported f Contract Number: 20-1171 Printed Date: 8/7/2019 Page 5 of 7 Measure 14. Enrolled Child Health Insurance Status 15. Child's Usual Source of Medical Care 16. Child's Usual Source of Dental Care 17. Additional Confidential Demographics required for consenting participants Measure Home Visiting Enrollment (Active Enrollment) Family Retention —12 months Family Retention —18 months Depression Screening ....... ........ .. Depression Referral Table 4.a.(3)-: Demo -q Definition -Title XIX (Medicaid) -Title XXI (State insurance program) -Private or Other -Tri-care -No insurance coverage -Unknown/Not reported -Doctor's/Nurse Practitioner's Office -Hospital Emergency Room -Hospital Outpatient -Federally Qualified Health Center -Retail Store or Minute Clinic -Other -None Unknown/ Did not Report -Yes: Has a usual source of dental care -No: Does not have a usual source of dental care -Unknown Parent Full Name Parent Date of Birth Parent Address Child Full Name Child Provider One Number is Information Eligibility Timil,,La All enrolled children Collect at eni six months & All enrolled children Collect at eni annually ther All enrolled childrenI Collect at eni annually ther All enrolled children I Collect at eni 4.a.(4): Performance Payment Awards Performance Payment Measures Definition Percent of Maximum Service Capacity filled during the quarter, as measured by the average of the number of participants actively enrolled on the last day of each of Month 1, Month 2 and Month 3 of the quarter divided by the Maximum Service Capacity total number of possible families) Number of participants who are engaged in the program for 12 months after enrollment Number of participants who are engaged in the program for 18 months after enrollment Number of participating primary caregivers who are screened for depression using an approved, validated tool within 90 calendar days postpartum (if enrolled prenatally) or 90 calendar days after enrollment (if enrolled postnatally) . ................ ............ Number of participating primary caregivers who screened positive for depression and were referred to or connected with appropriate services. A Contractor can receive this award only once per participant over the years. Award Criteria Performance Milestone: Active Enrollmei Maximum Service Capacity for the repori calculation limited to prenatal families am children up to and including 60 months o - Per Client Award: Number of participants engaged in the program for 12 months al indicated by receiving a home visit on a c days before and 30 days after the 12 -mo their enrollment date and not exited prior Per Client Award is increased for each p, the retention criteria and reporting demos related to earlyexits described in Table 4 Per Client Award: Number of participants engaged in the program for 18 months ai indicated by receiving a home visit on a c days before and 30 days after the 18 -mo of their enrollment date and not exited pr Per Client Award is increased for each p, the retention criteria and reporting demos related to early exits described in Table 4 Per Client Award: Number of eligible car( a depression screening during the contra this definition ........................................................... . ............... Per Client Award: Number of primary car positive for depression who were referrer appropriate services during the contract i Contract Number: 20-1171 Printed Date: 8/7/2019 Page 6 of 7 4.a.(4): Performance Pa t Awards Performance Payment Measu Measure _ Definition _ Healthy Birthweight - Number of participants who give birth to an infant of Participant Outcomes healthy birthweight during the contract year using the definition below in Table 4.1.5. ... Healthy Birthweight - Cohort Outcome ... _ .. _.._... • Cohort Measure: Number of all NFP participants who give birth to an infant of healthy birthweight during the contract year as a percent of all births to NFP participants ■ LIA Measure: Number of the Contractor's participants who give birth to an infant of healthy birthweight during the contract year as a risk-adjusted percent of the Contractor's total births during the year Award Criteria Per Client Award: Number of participants infant of healthy birthweight during the cc the definition below in Table 4.1.5. An ac be given for each participant with at least factor or risk marker also detailed in Tabl birth to an infant ofheap.birthweight dt Cohort Award: Each Contractor receives • Among births to the entire cohort of pari Contractors, the risk-adjusted rate during participants gave birth to an infant of he • The Contractor achieves a risk-adjusted r participants give birth to an infant of hea 4.a. S HVSA Definitions Impacting Performance Payment. AWai s Model Model Expected Dosage Home Visit Definition Demographic Factors Related to NFP • 1x week for the first four Any home visit or any The characteristics listed below have been identifiec weeks alternative visit >30 minutes among the FY18 HVSA participants. This list is not all • 2x month until baby is born and incorporates model change during the contract year. • 1x week 6 weeks postpartum content • Teenage (<20) • 2x month until the child is 21 • Less than high school education (among non -teen months • Homelessness • 1x month until 24 months or • Participating on TANF graduation. • Other factors as determined through analysis of p community engagement NFP Healthy Birthweight Infant birthweight is: * greater than or equal 2500g and * less than or equal 4500g Identified Risk Factors or Risk Markers of Mother* • Black/African American • American Indian or Alaskan Native • 35 years or older at enrollment • Used alcohol while pregnant • Used drugs while pregnant (marijuana, cocaine, or other drugs) • Smoked while pregnant • Homeless (on the street or living in a group home or shelter) *The characteristics listed above were identified as correlated with birthweights below based on analysis of birthweights of infants born to HVSA participants in 2017 and 201E Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 7 Timeline for Reporting and Submission of Deliverables July 2019 August 2019 July 9 (to DOH): August 8: FY19 Q4 Consenting Clients to DOH July Consenting Clients to DOH July 20: June 2019 Monthly Enrollment Report FYI Q4 Quarterly Progress Report (April to June) For TANF: including: TANF Q4 Referral Report Current Insurance Certificate Renewal* Confidentiality and Non- Disclosure Agreement for new employees'" July 30: June 2019 Monthly Invoice <Except Lummi & Suquamish>Executed DSA with DOH Documented approval of DSA with DOH submitted to NFP National Service Office October 2019 October 8 (to DOH]: September Consenting Clients to DOH October 21: September 2019 Monthly Enrollment Report CQI Pre -Work Q1 Quarterly Progress Report (July to September) For TANF: including TANF Q1 Referral Report October 30: September 2019 Monthly Invoice A ugust 16: Self -Reflection Tool (submitted to Thrive/Ounce) August 20: July 2019 Monthly Enrollment Report August 30: July 2019 Monthly Invoice For TANF: Executed DSA with DSHS to access the eJas, if amended September 2019 5eotember 10.- August D;August Consenting Clients to DOH September 20: August 2019 Monthly Enrollment Report September 30: August 2019 Monthly Invoice November 2019 November 8: October Consenting Clients to DOH November 20: October 2019 Monthly Enrollment Report November 30: October 2019 Monthly Invoice December 2019 December 9: November Consenting Clients to DOH December 20: November 2019 Monthly Enrollment Report December 30: November 2019 Monthly Invoice Timeline for Reporting and Submission of Deliverables January 2020 February 2020 January 9 (to DOW February 10: December Consenting Clients to DOH January Consenting Clients to DOH January 20. December 2019 Monthly Enrollment Report December CQI PDSA Report Q2 Quarterly Progress Report (October to December) including Model Fidelity Letter For TANF: TANF Q2 Referral Report January 30: December 2019 Monthly Invoice April 2020 April 8 fto ©OH)_ March Consenting Clients to DOH April 2D: March 2020 Monthly Enrollment Report March CQI PDSA Report Q3 Quarterly Progress Report (January to March) For TANF: including TANF Q3 Referral Report April 30: March 2020 Monthly Invoice Fehruary20: January 2020 Monthly Enrollment Report January CQI PDSA Report E-ehruary28: January 2020 Monthly Invoice March 2020 March 9: February Consenting Clients to DOH March 20: February 2020 Monthly Enrollment Report February CQI PDSA Report March 30: February 2020 Monthly Invoice FY21 Pre Contract Questionnaire and Buc May 2020 May 8: April Consenting Clients to DOH May 20: April 2020 Monthly Enrollment Report April CQI PDSA Report May 30: April 2020 Monthly Invoice June 2020 June 8: May Consenting Clients to DOH June 20: May 2020 Monthly Enrollment Report May CQI PDSA Report June 30: May 2020 Monthly Invoice 2 Timeline for Reporting and Submission of Deliverables July 2020 July 9 (to DOHS June Consenting Clients to DOH July 20: June 2020 Monthly Enrollment Report June CQI PDSA Report and Year -End Storyboard Q4 Quarterly Progress Report (April to June) For TANF: including TANF Q4 Referral Report July 30: June 2020 Monthly Invoice Certification of Data Disposition for programs a. *Updated Insurance Certificate must be submitted when the insurance policy is renewed. b. **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. C. ***Data Disposition to be submitted with closure of contract. 1. Data Sharing a. Required elements of the Data Sharing Agreement (DSA) with Department of Health (DOH): The Contractor will work with DOH to establish data sharing agreements according to the timelines set forth within Exhibit A, Statement of Work. The data sharing agreement shall outline specifications of the data use and data sharing to implement required reporting, evaluation and quality assurance or improvement activities. The data sharing agreement shall minimally: (1) Allow DOH access to client and program data as outlined below in section 4.0. (2) When parental consent is provided, (a) Share with and allow DOH access to confidential information listed in Table 4.a.(3) below; (b) Allow DOH to share confidential information with DCYF; and (c) Allow DOH to share confidential information with other Washington State agencies, including, but not limited to, the Office of Research and Data Analysis (RDA) housed within DSHS to conduct administrative match from families in Home Visiting and Child Protective Services (CPS) programs. b. National Service Office Permissions for data sharing: (1) DCYF 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. The Contractor shall send authorization using the approved template to the NFP National Service Office in coordination with the NSO. 2.0 Data Collection Process and Schedule a. The Contractor shall collect all of the data outlined in section 4 of this attachment for all enrolled participants according to the guidelines and requirements outlined in the HVSA Data Manual. The Contractor shall record data in the model specific database within five (5) business days of data collection. The Contractor shall provide data as outlined in the Data Sharing Agreement executed with DOH. Data will be provided to the Department of Health directly from National Service Office on a monthly basis. 3.0 Pai•erital Coiisetit a. The Contractor will make every effort to seek Parental Consent to share confidential information with DOH during the contract period; the Contractor shall seek this consent from all newly enrolled participants within the first three home visits. Consent form(s) are available on the Home Visiting page at DCYF.wa.gov. b. Parental Consents for voluntary services and data sharing may be combined. c. Participants who do not provide consent to share confidential information remain eligible to receive home visiting services. Non -confidential program data reporting is still required for these participants. HVSA 20 Att7 Data Collection, Reporting and Aligned Measures, Evidence Based Programs d. For those participants who consent to share confidential information, the Contractor shall send to DOH the list of participants by client ID and their consent status (e.g., Yes or No) on at least a monthly basis and no later than 6 business days after the close of the prior month. e. The Contractor will maintain consent forms on file for all participants enrolled in home visiting services in both physical files and electronically in model data system, if applicable. Upon request, the Contractor will provide to DCYF a copy of the consent form used. 4.0 HVSA Aligned Performance Measures a. HVSA Aligned Measures: As outlined in statement of work, the Contractor will collect data for all enrolled HVSA families that meets model requirements and the DCYF definitions outlined in Table 4.a.(1) -4.a.(5), using the guidance and processes outlined in the HVSA Data Manual. DOH will work with the Contractor to review data collection and reporting to support Contractor quality assurance. Of note, primary caregivers, caregiver and clients are used interchangeably with the same intent. (1) HVSA Aligned Measures - System and Program Performance Indicators: The Contractor shall collect and share data for all measures for participating caregivers and children as outlined in Table 4.a.(1). (2) Enrollment and Service Utilization: The Contractor shall collect and share data on all enrollment and service utilization measures outlined for participating caregivers and children. (3) Demographic Information: The Contractor shall collect and share data for all demographic information outlined for participating caregivers and children. (4) Performance Payment Awards Performance Payment Measures: The Contractor shall review data reports from DOH to substantiate Performance Payment Measures as described in Table 4.a.(4). (5). HVSA Definitions: Table 4.a.(5) presents definitions of measures related to Performance Payment Awards as well as the model -expected dosage and home visit. 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A19 -1A INVOICE VOUCHER Contractor Contract #: c pepartnent of Children. Youth, and Families Agency Number: Contract #: 20-1171 Attn: Ivon Urquilla I PO Box 40970 1 Olympia WA 98504-0970 Contract Service Period: July 1 2019 - July 20 2020 Tact Title: Home Visiting Services Account: Nurse Family Partne DCYF Contact: Ivan Urtluilla 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 VENDOR Invoice Service Period for Budget FY 2020: Invoice Number: This is a Final Billing: Yes No El Contract Billed Payment Points (Note) Budget Amount Date Approved Doc Date 1. 502 State — Personnel $67,355.60 Ref Doc No. Vendor Number SWV0002430-02 Vendor Message 2. 502 State — Goods and Services $9,829.34 Trn Cd Fnd Al Sub PI Obj SSO 01 3. 502 State — Travel $500.00 Sub Subsidiary Proj Ph GL Debit Credit Note 4. 502 State — Contracted/Professional Services $83,144.15 Invoice # 17B 411 5. 502 State — Administrative/Indirect Charges $16,082.91 0410 6. General Fund State — Personnel $58,387.67 7. General Fund State — Goods and Services $25,060.83 17B 411 36300 NB 574B 8. General Fund State — Travel $5,000.00 9. General Fund State — Contracted/Professional Services $111,574.49 10. General Fund State — Administrative/Indirect Charges $20,002.30 11. HVSA Performance Pay $9,593.43 Total $406,530.72 $O.00J 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 SWV0002430-02 Vendor Message Invoice Date Trn Cd Fnd Al Sub PI Obj SSO 01 Alloc Proj Sub Subsidiary Proj Ph GL Debit Credit Note Amount Invoice # 17B 411 36300 NB 574B 0410 17B 411 36300 NB 574B 0411 Accounting Approval for Payment Date Approved Warrant Total: 8/7/2019 Page 1 of 1