HomeMy WebLinkAbout021621_ca07615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
Public Health Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Apple Martine, Community Health Director
DATE:
SUBJECT: Agenda Item — Amendment 1 to Washington State Department of Children,
Youth and Families (DCYF); July 1, 2019 — July 31, 2021; Additional
$399,480.72 for a total of $806,011.44
STATEMENT OF ISSUE:
Jefferson County Public Health (JCPH) is requesting Board approval for Washington State DCYF contract
amendment for funding Home Visiting Services contract; July 1, 2019 — July 31, 2021; Additional
$399,480.72 for a total of $806,011.44
ANALYSIS/STRATEGIC GOALS:
The purpose of this amendment is to add funds to the period of performance through July 31, 2021 and to
revise Exhibit A, Statement of Work; Exhibit B, Budget and Exhibit C, Deliverables.
This agreement funds the visiting nurse services JCPH 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. The
grant allows JCPH community nursing staff to make home visits, and supports Kitsap County, via
subcontracting.
FISCAL IMPACT:
Fully funded by Washington State DCYF with state dollars for a total of $806,011.44.
RECOMMENDATION:
JCPH management requests approval of the Washington State DCYF contract amendment for funding
Home Visiting Services; July 1, 2019 — July 31, 2021; Additional $399,480.72 for a total of $806,011.44.
REVIEWED BY:
Philip Morley,uhty Admini trator.._::>
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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
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
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Department of DCYF Contract Number. 20-1171-01
Children, Youth, and Families Contract Maximum: $806,011.44
From-To:07/01 /2019-07/31 /2021
INTERLOCAL AGREEMENT
Home Visiting Services Account: Nurse Family Partnership
AMENDMENT #20-1171-01 TO CONTRACT #20-1171
THIS CONTRACT 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
"DCYF") and Jefferson County, a Municipality , (hereinafter referred to as "Contractor"), located at 615 Sheridan
Street, Port Townend WA 98368, is amended effective July 1, 2020 through July 31, 2021 as follows:
CONTRACTOR BUSINESS ADDRESS
Jefferson County
615 Sheridan Street
Port Townend WA 98368
TIN:91-6001322
UBI: 161-001-169
DCYF ADDRESS
Department of Children, Youth, and Families
PO Box 40970
Olympia WA 98504-0970
CONTRACTOR CONTRACT MANAGER
Appalachia (Apple) Martine
AMartine@co.jefferson.wa.us
Phone: (360) 385-9400 x443
DCYF PROGRAM CONTRACT MANAGER
Ivon Urquilla
Prevention Services Program Specialist
ivon.urquilia@dcyf.wa.gov
Phone: (360) 725-4695
AMENDMENT PURPOSE
The purpose of this Contract Amendment is to extend the Contract through June 30, 2021.
SECTIONS CHANGED
Section 4, Period of Performance; Contract end date extend to June 30, 2021.
Exhibit A, Statement of Work; Revised and replaced
Exhibit B, Budget; Added funding for FY21
Exhibit C, Deliverables; Added Deliverables for FY21
Attachments titled Contract Monitoring, Monthly Enrollment Data Report Components, HVSA Quarterly Progress
Report Components and Data Collection Reporting Aligned Measurers are revised and replaced with Attachments
titled: Monthly Enrollment Data Report, Quarterly Progress Report, and Data Collection Reporting and Aligned
Measures.
Attachment titled Continuous Quality Improvement has been deleted from the Contract.
Amendment Effective Date: July 1, 2020
Amended Contract Maximum: $806,011.44
Previous Change New Total
State Funds: $406,530.72 $399,480.72 $806,011.44
Amended Contract Dates:
Contract Start Date: July 1, 2019
Previous End Date: July 31, 2020
Amended End Date: July 31, 2021
EXHIBITS AND ATTACHMENTS
Exhibit A — Statement of Work is hereby revised and replaced with Amended Exhibit A — Statement of Work
Amendment 1 attached and incorporated herein as though set forth in full.
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 1 of 2
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Exhibit B — Budget is hereby revised and replaced with Amended Exhibit B — Budget Amendment 1 attached and
incorporated herein as though set forth in full.
Exhibit C — Deliverables is hereby revised and replaced with Amended Exhibit C — Deliverables Amendment 1
attached and incorporated herein as though set forth in full.
Attachment 4 - Continuous Quality Improvement is hereby deleted in its entirety and is of no further force or
effect.
Attachment 5 — Monthly Enrollment Data Report Components is hereby revised and replaced with Amended
Attachment 5 — Monthly Enrollment Data Report Amendment 1 attached and incorporated herein as though set
forth in full.
Attachment 6 — HVSA Quarterly Progress Report Components is hereby revised and replaced with Amended
Attachment 6 — Quarterly Progress Report Amendment 1 attached and incorporated herein as though set forth in
full.
Attachment 7 — HVSA20 Data Collection Reporting is hereby revised and replaced with Amended Attachment 7 —
Data Collection, Reporting and HVSA Aligned Measures Amendment 1 attached and incorporated herein as
though set forth in full.
ALL OTHER TERMS AND CONDITIONS OF THIS CONTRACT REMAIN IN FULL FORCE AND EFFECT.
SIGNATURES
The parties signing below represent that they have read and understand this Contract, and have the authority to
execute this Contract Amendment. This Contract Amendment shall be binding on the parties only upon signature
by both of them.
Jefferson County DEPARTMENT OF CHILDREN,
Board of Commissioners YOUTH, AND FAMILIES
Signature
Kate Dean
Name
Chair
Title
Date
ved as t for on
(-• Date: 1 J7 Ti10'L�
Philip C. Hunsucker, Chief Civil Deputy Prosektint Attorney
Jefferson County Prosecuting Attorney's Office
Signature
Name
Title
Date
Contract Number 20-1171-01 Printed Date: 12/18/2020 Page 2 of 2
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Department of
Children, Youth, and Families
Table of Contents
DCYF Contract Number: 20-1171-01
Contract Maximum: $806,011.44
Exhibit A - Statement of Work
From-To:07/01 /2019-07/31 /2021
1.
DEFINITIONS. The following terms, as used throughout this Contract, shall have the meanings set forth
below:.......
1
2.
Background.......................................................................................................................................................4
3.
Model Fidelity....................................................................................................................................................4
4.
Staffing, Supervision and Training....................................................................................................................5
5.
Service Area and Recruitment of Priority Populations......................................................................................6
6.
Participant Enrollment, Retention, and Caseload Maintenance........................................................................7
7.
Home Visits Frequency and Content................................................................................................................8
8.
Systems Connections.......................................................................................................................................9
9.
Data Collection and Evaluation Requirements.................................................................................................9
10.
Continuous Quality Improvement(CQI)........................................ .............. .....................................................
11
11.
Technical Assistance......................................................................................................................................11
12.
Budget and Financial.....................................................................................................................................:12
13.
Publicity, Publication and Acknowledgements................................................................................................16
14.
Contract Reporting, Monitoring, and Deliverables...........................................................................................16
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 security numbers; medical
record numbers; health plan beneficiary numbers; account numbers-, certificate/license numbers;
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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. "Encounter" means two-way interactions with families via email, text or phone call with minimal or no
model content.
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. TERPA" 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. "Home Visit" means an in -person, virtual, or telephone visit with an enrolled participant meeting model
expectations for content and duration.
u. "HRSA" means the United States Department of Health and Human Services: Health Resources and
Services Administration.
v. "HV" means home visiting.
w. "HVSA" means the Home Visiting Services Account established in RCW 43.215.130.
x. "HVSA Aligned Measures" means those performance measures described in the Attachment entitled
Data Collection, Reporting and HVSA Aligned Measures of this Contract.
y. "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 Ounce WA. "Implementation Hub" is also known as 'The HUB.'
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z. "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.
aa. "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.
bb. "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.
cc."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.
dd. "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.
ee. "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.
ff. "Ounce WA" means the private partner to be responsible for supporting the HVSA account by providing
TTA through the implementation Hub to LIAs as described in RCW 43.216.130.
gg. "Penelope" means the data collection system to be used by the national Nurse Family Partnership
program.
hh. "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.
ii. "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.
jj. "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.
kk."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.
Il. "Reflective Supervision (IRS)" 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.
mm. "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.
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nn. "State Model Lead" means the HV program model representative that provides contractors with HV
services, supports and TTA in coordination with the Implementation HUB.
oo. "TANF" means Temporary Assistance for Needy Families administered through the Department of
Social and Health Services (DSHS).
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
a. 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.
e. Washington's home visiting programming is impacted by a wide range of contextual factors and
circumstances. During state FY 2020, exceptional circumstances created by the COVID 19
pandemic resulted in modification of service components and delay of others. In light of these
circumstances that will continue indefinitely into the SFY 2021 contract term, this contract allows for
minor shifts in contract terms that are aligned with program model expectations and the goals set
forth in section 2.a. Such shifts must be approved in writing by DCYF.
3. Model Fidelity
a. The Contractor shall maintain fidelity to the NFP program model as defined as ongoing adherence to
specified criteria and components described by the NFP Model Developer. For home visiting
programs that are not evidence based, the promising practices Contractor will work with a DCYF-
authorized provider of technical assistance to adhere to model fidelity indicators established in prior
contracts throughout the term of this contract.
(1) National Model Standing: Contractor will ensure adherence to NFP program model standards for
the duration of this contract, as indicated through a written letter with certification of good
standing status and/or active, ready to implement status from the NFP national organization
for evidenced based programs. The letter shall be delivered to 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.
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.
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4. 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 taffing plan outlined as follows:
b.
Staffing Plan by Position Type
a.
i502 State
General
C.
HVSA
Funds
State
Total
Funds
Home Visitor FTE Total
1.27
1.22
2.49
HV Supervisors FTE Total -- time delivering
home visiting services, if applicable
.05
.12
.17''
Supervisor FTE Total -- time dedicated to
15
supervision
.15
Admin Support Staff FTE Total
Data Support Staff FTE Total
Management Staff FTE Total
.02
_02
Additional Direct Service Staff FTE Total
b. Home Visiting Supervisor and Home Visitor Qualifications:
Contractor shall comply with the NFP home visitor supervisor and staffing qualification requirements
throughout the term of this contract. If there are no model requirements, the Contractor shall work
with the DCYF-authorized provider of technical assistance, Ounce WA, 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 NFP 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:
(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;
(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.
f. 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
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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 NFP 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, Healthy Families
Parenting Inventory, Parenting Interactions with Children: Checklist of Observations
Linked to Outcomes (PICCOLO), 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.
g. 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) NFP 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.
i. 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, 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.
c. Priority Populations:
Contractor shall sustain internal practices to serve, from among the HVSA Priority Populations.
Priority Populations are defined as eligible participants with two or more of the following
characteristics:
(1) Demographic Characteristics:
(a) American Indian/Alaskan Native
(b) Poverty/Low Income
(c) Teen Parents
(d) Non -English Speaking or Recent Immigrant
(e) Enrolled in WorkFirst/TANF
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(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 Developmental Delays or Disabilities
(c) Families currently or formerly in the Military
(d) Children with Developmental Delays for Disabilities, especially those not linked with early
intervention services
d. 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 �enelope.
(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.
6. Participant Enrollment, Retention, and Caseload Maintenance
a. Plan for Recruitment of Participants: Contractor shall document and implement a comprehensive plan for
participant recruitment, engagement, and retention aligned with the NFP program model to ensure
ongoing enrollment of priority populations as described in Section 5.
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 consent 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 agreed upon with electronic or paper format including the date by the participant upon
enrollment. Consent must be maintained in the participant file in paper or electronic form. Consent
agreement should be written in plain language and be available in multiple languages. When potential
participants have barriers with literacy, the consent should be explained in the participant's primary
language, which may require interpretation. When interpretation is utilized, signatures should be
obtained on the consent form from the interpreter. Sample consent form(s) are available at on the
home visiting page of the DCYF web site.
c. Active Caseload Threshold: Contractor shall build and maintain an active participant caseload in
accordance with NFP model requirements. Throughout the entire term of this contract, Contractor
shall aim to serve an active Maximum Service Capacity of 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.
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(2) DCYF will initiate the improvement process outlined in the Attachment entitled Contract
Monitoring, Compliance and Non -Compliance if the Contractor's Active Enrollment Caseload
falls below 85% of the Maximum Service Capacity.
d. Policies and Procedures for Participant Enrollment, Disenrollment, Re -Enrollment, and Transfer:
Contractor shall develop, maintain, and implement written policies and procedures that are consistent
with and in alignment with NFP model fidelity. The written policies and procedures shall include, but
not be limited to, the following.-
(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 NFP program model requirements. If there are no model requirements, the Contractor shall
develop with Ounce WA 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 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 NFP model expected dosage, as described in the Attachment
entitled Data Collection, Reporting and HVSA Aligned Measures.
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 NFP model requirements.
(1) Screenings: The Contractor shall administer screenings with the frequency consistent with fidelity
to the NFP 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.
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c. During extenuating circumstances (e.g. the COVID-19 pandemic), specific frequency, content,
assessment, and other model -required components of home visits may be modified per guidance
from the program model developer and DCYF.
8. Systems Connections
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.
9. 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 NFP model, DCYF and the HVSA as described in the Attachment
entitled Data Collection, Reporting and HVSA Aligned Measures and outlined below:
(1) Performance Measures, defined in the Attachment entitled Data Collection, Reporting and HVSA
Aligned Measures:
(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.
c. Data Management: The Contractor shall collect and input the home visiting data described in this Section
9 into the NFP 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 the Attachment entitled Data Collection, Reporting and HVSA
Aligned Measures. Data shall be entered into the Penelope data collection system within five (5)
business days of data collection.
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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 the Attachment entitled Data Collection, Reporting and
HVSA Aligned Measures.
(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/DataKeepers authorizing the release of data to DOH in
coordination with the NSO; the Contractor shall submit a copy of the notice to DCYF.
(a) Throughout the term of this Contract, the Contractor and all subcontractors delivering
direct home visiting services shall share data at least quarterly with DOH, in a format
determined by DOH, submitting quarterly data no later than 6 business days
following the end of each quarter.
(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
agreement(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 the Attachment entitled Data Collection, Reporting and HVSA Aligned
Measures no less than monthly via Secure File Transfer (SIFT).
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.
i. 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;
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(4) Analysis and interpretation of data;
(5) Quality assurance.
10. Continuous Quality Improvement (CQI)
Purpose and Framework: The purpose of Continuous Quality Improvement (CQI) is to promote learning,
creativity and innovation in order 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. Integrating
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 Activities as outlined in this Section 10.
(1) CQI Learning Collaborative: CQI activities will be implemented using a model called the Learning
Collaborative (adapted from the Breakthrough Series (BTS) model developed by the Institute
for Healthcare Improvement. The Learning Collaborative model facilitates collaborative
exploration and provides structured opportunities for learning so that teams can learn from
peers and subject matter experts in topics relevant to CQI. .
(2) The Contractor shall participate in CQI activities throughout the contract period as directed by
DCYF to include rapid -cycle Plan -Do -Study -Act (PDSA) tests, progress reports, and CQI
webinars.
b. Training and Technical Assistance: The Contractor shall participate in ongoing training and technical
assistance associated with CQI. DCYF-specified contractors providing this training and technical
assistance include Ounce WA and DOH who will also support the Contractor with data collection and
measurement, quality improvement methodologies, implementing PDSA (Plan Do Study Act) cycles,
topic specific CQI tools and resources, and the CQI Toolkit.
c. CQI Learning Collaborative Components: the Contractor shall implement the following CQI Learning
Collaborative components during the entire contract term, July 1, 2020 through June 30, 2021:
(1) Focus on one of the HVSA priority topics:
(a) Caregiver Mental Health;
(b) Family Engagement and Retention; or
(c) Or other topic areas approved by DCYF
(2) 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 webinars, and CQI project activities.
d. CQI Activities:
(1) Participate in monthly CQI calls/webinars to share information and learn from peers. The aim is to
sustain collaboration and peer support related to improving practice and program
implementation;
(2) Conduct rapid cycle PDSA tests and ramps, at least one each month where they shall test, adapt,
and implement changes in their local settings;
(3) Track data relevant to PDSA tests and CQI activities and reflect on that data;
(4) Submit Monthly CQI Progress Reports using templates provided by DCYF and available on the
Home Visiting web page at www.dcyf.wa.gov; DCYF will share these reports with Ounce WA
and DOH for review and feedback to the Contractor; and
(5) Create a plan for sustaining gains made through CQI activities.
11. 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
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contracts with Ounce WA 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 NFP 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.
(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, 2021 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.
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://www.ofm.wa.gov/resources/travel. asp. 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
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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)) cost rate
proposal. The CFR can be found at the following link: Electronic Code of Federal
Regulations.
f. Performance Payment Awards: During the term of this contract, the Contractor will be eligible to receive
an additional monetary award, 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.).
i. 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.
ii. DCYF may award the greater of $250 or 0.125% of the contractor's budget,
excluding performance payments, for each quarter where the contractor
meets or exceeds the 90% milestone.
(3) 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 the
Attachment entitled Data Collection, Reporting and HVSA Aligned
Measures.
ii. DCYF may award an additional $30 for each participant who meets the 12-month
retention milestone above and reports at least two the Attachment
entitled Data Collection, Reporting and HVSA Aligned Measures.
(b) Eighteen -month Family Retention Performance Milestone:
The Contractor's 18-month participant engagement performance, as defined by the
number of participants engaged in the program for 18 months after enrollment.
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i. DCYF may award $30 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
the Attachment entitled Data Collection, Reporting and HVSA Aligned
Measures.
ii. DCYF may award an additional $20 for each participant who meets the 18-month
retention milestone above and reports at least two of the demographic
characteristics related to early exits as described in the Attachment
entitled Data Collection, Reporting and HVSA Aligned Measures.
(c) For either the 12-month or 18-month retention milestones, if participant data is missing
for the demographic characteristics related to early exits, the performance payment
will be calculated assuming the participant has no characteristics related to early
exits.
(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) 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 Performance Milestone:
The Contractor's performance on HVSA Performance Measure 2 Depression
Screening defined in the Attachment entitled Data Collection, Reporting and HVSA
Aligned Measures. Contractor completion of a depression screening for a
participating primary caregiver using an approved, validated tool within 92 calendar
days postpartum (if enrolled prenatally) or 92 calendar days after enrollment (if
enrolled postnatally).
i. DCYF may award $30 for each screening using the above criteria, capped at
100% of the contractors' Maximum Service Capacity multiplied by $30
for the contract year.
(b) Follow -Up to Positive Depression Screening 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.
i. DCYF may award the Contractor $50 for each participant who received follow-up
as defined above, capped at 35% of the contractors' Maximum Service
Capacity multiplied by $50 for the contract year.
(5) Healthy Birthweight Outcome Performance Milestones:
DCYF will award the Contractor a Performance Payment Award upon the fulfillment of one or
both of the following outcomes milestones:
(a) 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 the Attachment entitled Data
Collection, Reporting and HVSA Aligned Measures.
i. DCYF may award $50 for each participant who gives birth to an infant of healthy
birthweight using the definition in the Attachment entitled Data Collection,
Reporting and HVSA Aligned Measures.
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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 $50 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 the
Attachment entitled Data Collection, Reporting and HVSA Aligned
Measures.
A. If a participant's data is missing for the HBW Criteria for
Additional Support, the birthweight will be recorded as
having no HBW Criteria for Additional Support when
calculating the award payment.
(b) 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 the
Attachment entitled Data Collection, Reporting and HVSA Aligned Measures.
i. 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:
A. The statewide HVSA NFP Cohort achieves a target percentage
to be determined by DCYF 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
semi-annually for all performance milestones, defined in Section 12.f.(2), 12.f.(3),
and 12.f.(4), and 12.f.(5): 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
(7) Contractor must use the funds received from these Performance Payment Awards towards
advancing the goals of the home visiting program in this Contract.
g. 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
602) 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 602) 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 602).
(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.
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(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;
(d) Chart of Accounts;
(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, 2020 to September 30, 2020
(2) Quarter 2 — October 1, 2020 to December 31,2020
(3) Quarter 3 — January 1, 2021 to March 31, 2021
(4) Quarter 4 — April 1, 2021 to June 30, 2021
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 data reports
and other deliverables when available.
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(2) While funding for this Contract encompasses expenditures from July 1, 2020 through June 30,
2021, deliverables describing services rendered in the months of the Contract term will be
due no later than July 31, 2021 and will be submitted at no additional cost to DCYF.
c. Monitoring: As described in the Attachment of this Contract entitled Contract Monitoring, Compliance and
Non -Compliance, 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 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
the Attachment entitled Contract Monitoring, Compliance and Non -Compliance. 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 Data 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 the Attachment entitled Monthly Enrollment Data 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 the
Attachment entitled HVSA Quarterly Progress Report. The Contractor shall submit this report
each quarter into the PSRS no later than the 20th 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 July 20, 2020 using the template provided by Ounce WA.
(5) CQI Monthly Reports, as described in Section 10 shall be submitted no later than the 201h day
following the month of service into the PSRS using the template provided by DCYF.
(6) Annual Pre -Contract Questionnaire: The Contractor shall complete and submit the FY22 HVSA
Pre -Contract Questionnaire and FY22 Proposed Budget by April 30, 2021 using the template
to be provided by DCYF.
e. Timeline of Reports and Submissions: The table below outlines the reporting and submissions timeline for
deliverables presented in this Statement of Work according to the month of submission.
(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.
Table 14.e Report Time Table
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 17 of 20
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
July 2020
August 2020
July 9 (to DOH):
August 9:
FY20 04 Consenting Clients to DOH
July Consenting Clients to DOH
July 20:
August 20:
Self -Reflection Tool (submitted to Ounce WA)
July 2020 Monthly Enrollment Data Report
June 2020 Monthly Enrollment Data Report
July CQI PDSA Report
FY20 04 Quarterly Progress Report (April to June)
August 30:
July 2020 Monthly Invoice
June 2020 CQI PDSA Report
Current Insurance Certificate Renewal*
September 2020
Confidentiality and Non- Disclosure Agreement for new
September 9:
employees'
August Consenting Clients to DOH
July 30:
September 20.-
June 2020 Monthly Invoice
August 2020 Monthly Enrollment Data Report
Documented approval of DSA with DOH submitted to
August CQI PDSA Report
NFP National Service Office
September 30:
August 2020 Monthly Invoice
October 2020
November 2020
October 8 (to DOH):
November 9:
September Consenting Clients to DOH
October Consenting Clients to DOH
October 21:
November 20:
September 2020 Monthly Enrollment Data Report
October 2020 Monthly Enrollment Data Report
September CQI PDSA Report
October CQI PDSA Report
Q1 Quarterly Progress Report (July to September)
November 30:
October 2020 Monthly Invoice
December 2020
October 30:
September 2020 Monthly Invoice
December 8:
November Consenting Clients to DOH
December 20:
November 2020 Monthly Enrollment Data Report
November CQI PDSA Report
December 30:
November 2020 Monthly Invoice
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DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F1 7
January 2021 February 2021
January 11 (to DOH): February 8:
December Consenting Clients to DOH January Consenting Clients to DOH
January 20: Febr
December 2020 Monthly Enrollment Data Report January 2021 Monthly Enrollment Data Report
December CQI PDSA Report January CQI PDSA Report
Q2 Quarterly Progress Report (October to December)
including
Model Fidelity Letter
January 30:
December 2020 Monthly Invoice
April 2021
April 8 (to DOH):
March Consenting Clients to DOH
April 20:
March 2021 Monthly Enrollment Data Report
March CQI PDSA Report
Q3 Quarterly Progress Report (January to March)
April 30:
March 2021 Monthly Invoice
FY21 Pre Contract Questionnaire and Budget
July 2021
July 9 (to DOH):
June Consenting Clients to DOH
July 20:
June 2021 Monthly Enrollment Data Report
June CQI PDSA Report
04 Quarterly Progress Report (April to June)
JuIV 30:
June 2021 Monthly Invoice and Performance Payment
Invoice
Certification of Data Disposition for programs endi
February28:
January 2021 Monthlv Invoice
March 2021
March 8:
February Consenting Clients to DOH
March 20:
February 2021 Monthly Enrollment Data Report
February CQI PDSA Report
March 30:
February 2021 Monthly Invoice
May 2021
MaV 10:
April Consenting Clients to DOH
MaV 20:
April 2021 Monthly Enrollment Data Report
April CQI PDSA Report
May 30:
Aoril 2021 Monthly Invoice
June 2021
June 8:
May Consenting Clients to DOH
June 20:
May 2021 Monthly Enrollment Data Report
May CQI PDSA Report
June 30:
Mav 2021 Monthly Invoice
*Updated Insurance Certificate must be submitted when the insurance policy is renewed.
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 19 of Zu
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F1 7
**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.
***Data Disposition to be submitted with closure of contract.
Contract Number: 20-1171-01 Printed Date: 12/18/2020 rage zu or Zu
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
" ' "'" "'"' DCYF Contract Number: 20-1171-01
'+ Department of Contract Maximum: $806,011.44
Children, Youth, and Families
From-To:07/01 /2019-07/31 /2021
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.
'Budget for State Fiscal Year 2020 (July 1 2019 - June 30 2020):
See original contract package for budget detail. Total: $406,530.72
Budget for State Fiscal Year 2021 (July 12020 - June 30 2021):
Payment Point Budget Limit Note
1. 502 State -
$70,801.18
Personnel
2. 502 State - Goods
$6,533.76
and Services
3. 502 State - Travel
$350.00
4. 502 State -
$83,144.15
Contracted/Professions
I Services
5. 502 State -
$16,082.91
Administrative/Indirect
Charges
6. General Fund State -
$73,656.06
Personnel
7. General Fund State -
$3,307.48
Goods and Services
8. General Fund State -
$4,940.00
Travel
9. General Fund State -
$111,574.00
Contracted/Professiona
I Services
10. General Fund State
$19,347.75
- Administrative/Indirect
Charges
11. HVSA -
$9,743.43
Performance Pay
Total: $399,480.72
Contract Maximum: $806,011.44
Contract Funding Source(s)
State Funds $806,011.44
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 1 of 1
DocuSign Envelope ID. BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
DCYF Contract Number:
20-1171-01
Department of Contract Maximum:
$806,011.44
Children, Youth, and Families
From-To:07/01 /2019-07/31
/2021
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 811612019.
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 10121119
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
712012019 and then each month starting on 112012020.
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 712012020.
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.
Contract
Number: 20-1171-01 Printed Date: 12/18/2020
Page 1 of 3
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9.00 Annual Pre -Contract Questionnaire No Date
Due by 413012019 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 713012019,
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 712012020 or upon closure of contract.
Data Disposition must be submitted with the closure of the contract.
State Fiscal Year'2021 (July 12020 -June 30 2021)
#
Deliverable Title, Due Note, Description
Due Date
1.00
Documented approval of DSA
No Date
Due by July 30, 2020.
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, 2020
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, 2021
4.03
Quarterly Progress Reports
Apr 20, 2021
4.04
Quarterly Progress Reports
Jul 20, 2021
5.00
Self -Reflection Tool
No Date
Due to Start Early/Ounce of Prevention by 7/20/20.
The Contractor shall submit the Self -Reflection Tool descripted in the Statement of Work,
Section 11 using the template provided by Start Early/Ounce of Prevention.
7.00
CQI Monthly Report
No Date
Due by the 20th of the month immediately following the month of service starting on
Contract
Number: 20-1171-01 Printed Date: 12/18/2020
Page 2 of 3
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
• 11
10.00
11.00
12.00
712012019 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.
Annual Pre -Contract Questionnaire
Due by 4130121 for contractors planning to continue services in the following fiscal year.
The Contractor shall complete and submit the FY22 HVSA Pre -Contract Questionnaire
and FY22 Proposed Budget using the template provided by DCYF.
Updated Insurance Certificate
Due to DCYF when certificate is renewed.
Updated Insurance Certificate must be submitted when the insurance policy is renewed.
Updated Statement of Confidentiality and Non -Disclosure
Due by 713012020.
Updated Statement of Confidentiality and Non -Disclosure most be submitted for any new
employees, agents, or subcontractors with access to confidential or personal information
relating to this contract.
Data Disposition
Due by 712012021 or upon closure of contract.
Data Disposition must be submitted with the closure of the contract.
No Date
No Date
No Date
No Date
Contract Number: 20-1171-01 Printed Date: 12/18/2020 rayu ') ui 0
DocuSign Envelope ID.- BC07D424-4BFDAFF7-85C4-CABA4ED51 F1 7
Department of
Children, Youth, and Families
DCYF Contract Number: 20-1171-01
Contract Maximum: $806,011.44
From-To:07/01/2019-07/31/2021
Attachment 5 - Monthly Enrollment Data Report
Monthly Enrollment Data Report
Smmpf- 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.dcyf wo.gov.
U '3ir'q ihe P!even, !,'On e, vic�-.,,5 Repoti Y-- pleose We questions below in
r0'"rence "o 47'Ct:'vi-1-' S ;-',or..he reporting morth. 711.15 rep orf is due to Denartmenf of Chifu'ren, o""C t M-Mffls on the 20",
of coch, the rePoning imoi-th
1. Organization Information
a. Organization Name b. Organization ID
c. Home Visiting Model d. Funding Source
I I
e. Name of Person Completing Report f. Contact Phone g. Contact Email
I I I
2. Active Caseload
Please provide the following information for children and families served by HVSA funds during the reporting
month.
funded by
funded by State
funded by General
funded by
MIECHV
i502 Funds
State Funds
TANF
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 lost 90 days
c. Number of families that received
visits during report month:
d. Number of visits during report
month:
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 1 of 2
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F1 7
3. Caseload Changes
Please provide the following information about new enrollments, exits, and program completion during the
rpnnrtinn month_
funded by
funded by State
funded by General
funded
MIECHV
i502 Funds
State Funds --
by TANF
a. Number of new families enrolled:
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
anrnllmvnt to rnnnrity fnr vnnr nrnnrnm is hnlnur RS% nlancP nrnvirlP n hriPf PXnlnnntinn in the snace Drovided.
c. Active Enrollment Caseload
a. Total Number of Actively Enrolled
b. Maximum Service Capacity
(Percent of Families Currently Enrolled
Families/Clients this Month (2a)
(# slots in your Contract)
to Funded Families)
{4a/4b)
0
#DIV/0?
4.d. If Active Enrollment Caseload (#4.3) is less than 85%, please explain:
4.e. Please describe the successes and challenges you have faced in completing home visits this quarter and
any circumstances that impacted your program's ability to deliver home visits this quarter.
S. Please submit your monthly Continuous Quality Improvement PDSA Report
<upload: >
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 2 of 2
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F17
l Department of
Children, Youth, and Families
DCYF Contract Number: 20-1171-01
Contract Maximum: $806,011.44
From-To:07/01 /2019-07/31 /2021
Attachment 6 - Quarterly Progress Report
HVSA Quarterly Progress Report
This attachment outlines the components of the Quarterly Progress Reports. Most questions will be asked each quarter,
with indicators to those questions unique to specific quarters. Quarter's actual electronic template to be submitted by
Contractor is available at dcyf. wa.gov/services/child-dev-support-providers/home-visiting.
Using the Prevention Services Reporting System, Ihttps.Ilapps,dcyf.wa.gavIPSRS, please complete the questions below in
reference to activities from r4onth 1 to Month 3 of the reporting quarter. This report is due to Department of Child, en;
Youth, and Families on the 20rr' of each month following the reporting quarter.
1. Organization Information
1.1, Organization Name
1.2. Home Visiting Model
1.3. Organization ID
2. Contact Information
2.1. Name of Person Completing Report:
2.2. Contact Phone
2.3. Contact Email
3. Fidelity to Program Model
3.1.a. Q2 If your program is an evidence -based program (e.g. EliS, Family Spirt, NFP, PAT, Ei-IS) or a promising practice
(PCHP) with a National Model Office, please submit your letter from your national model indicating your program's standing
with relationship to model fidelity.
<upload: >
3.1.b. Q2 If your program does not have a national model office (e.g. CPP, Outreach Doula, STEEP), please submit a letter
from Ounce WA detailing the model fidelity indicators of your program and your program's standing with relationship to
those indicators of model fidelity.
<upload: >
3.2.a. Q2-3-4 If the letter from your National Model Office/Thrive indicates areas where your program does not meet model
idelity, please list those indicators and your program's progress towards meeting model fidelity for each those indi4
Indicator Area Program Progress Towards Fidelity
ators.
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 1 of 5
DocuSign Envelope ID: BC07D424ABFD-4FF7-85C4-CABA4ED5lF17
4. Staffing Deliverables
4.1. Please report all FTE/staffing positions funded by this contract for Home Visitors, Program Supervisors, and other staff.
This includes any vacant positions. To build our understanding of staffing, caseload and transition we need detailed and
accurate completion of the tables below.
Staffing Status Table as of Last Day of the Quarter
Please
list the total
FTE funded
by
each source
below
a.
b.
C.
d.
HVSA-
HVSA-
HVSA-
Total
e. Total
Home
Home Visitor Home
a
tea,
;;
¢
Visiting
Select Role — Type in Full Name or Start Date Visitor End
LL
m
>
Program
include vacant "vacant" if position is HV ID# if known, Date
>
11
c
positions not currently filled Month and if left home
Q
o LL
Z LL
Year visitor role
w
0.00
0.00
0.00
0.00
0,00
0.00
0.00
Please list the total FTE funded by each source
below. Please respond with a number (#J.
., Total
Staff Role/Positions funded by your DCYF
d,
Home
Contract HVSA and other funds in our
(HVSA) Y
C. HVSA-
a. HVSA- b. HVSA- e. Non
:Visiting
home visiting program
i50HVSA-
MIECHV TANF State HVSA
,
Program
tat e
State
Funds Funds Gen Funds
Funds
Funds
# of Home Visitors — Currently filled positions
0.00 ' ,
# of Vacant Home Visitor Positions
0.60
# of Supervisors— Currently filled positions
0.00
# of Vacant Supervisor Positions
0:06
# of Other Staff— Currently filled positions
0.00
# of Vacant Other Staff Positions
0.00"""
4.2. Please describe any changes in program staff that occurred during the reporting quarter (e.g. vacancies, extended
leave, etc.). Leave blank if not applicable.
4.2a. 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.
4.3. 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
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 2 of b
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5. Supervision Deliverables
5.1. Please report on the number of hours of supervision that Supervisors provided for all Home Visitors -this quarter.
Type of Supervision
Average # hours provided to each Home Visitor per month
Month 1
Month 2
Month 3
Administrative/Clinical Supervision (one-on-one)
Reflective Supervision (one-on-one)
Group (staff meetings, trainings, etc.)
5.2. Please add any comments on your supervision activity this past quarter below, including any barriers encountered to
fulfilling supervision hours in.the above categories (as expected for model fidelity or outline in your contract.)
5.3. 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)?
6. Service Delivery
6.1. 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.
Number of Female
Number of Male Caregivers
Caregivers
6.1. b. Q4 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
6.2. a. Do you have a waiting list for your home visiting program?
6.3.b. If yes, how many people are currently on your waiting list?
6.3.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?
6.3.d. Comments.
6.4. 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
Organization Name
1
<categories>
2
<categories>
3
<categorl s>
4
<categories>
5
<categories>
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 3 of 5
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6.5. 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)
6.6. 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?
6.7.a. TANF: Please summarize what has been working well and what has been difficult in recruiting, enrolling and serving
TANF referred families.
6.7.b. TANF: 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.
7. Technical Assistance
7.1. Q2/Q3/Q4 In reviewing your TA Plan, please describe one key outcome or success that your program achieved utilizing
TA during the last 6 months.
7.1/2/3. Please describe any Training or TA needs you have for NEXT quarter (this may include work with Ounce WA, DCYF,
DOH or others).
8. organizational and Community Updates
8.1. Please describe anv notable changes in your program or organization that impacted implementation of your
8.2. 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.
8.2. b. Please describe any activities or efforts you participated in during this quarter to specifically strengthen referral
oathways from TANF families into your program including connections with DSHS and your local Community Services Office.
8.2. c. Describe your relationship with/level of participation in the local Early Learning Regional Coalition.
8.3. Q2/4 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?
8.4/5a. Q4 Describe any notable demographic changes in your community in the past
8.4/5b. Q4 Describe any steps your program is taking to address changes in community need noted above.
9. QI/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).
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DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F1 7
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.
10. Quarterly Data 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
12. FOR TANF: TANF Referrals Worksheet
12.1. Please complete the following table for the reporting quarter
a CumUlatrve Families served #or tlae
_Reporting Quarter `:
Current Enrollees as v#tt a last Id r�#
" ` .. =the, Repojt arter
Contract Number: 20-1171-01 Printed Date: 12/18/2020 Page 5 of 5
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
Attachment 7 - Data Collection, Reporting and l VSA Aligned
Measures, Evidence Based Programs
1. Data Shariin�
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 (S) 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.
DocuSign Envelope ID: BC07D424-4BFD-4FF7-85C4-CABA4ED51 F1 7
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.
3. 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
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)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.
4.a.(1) HVSA Aligned Measures Performance 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).
4.a.(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.
4.a.(3) Demographic Information: The Contractor shall collect and share data for all
demographic information outlined for participating caregivers and children.
4.a.(4). Performance Payment Award Measures: The Contractor shall review data reports from
DOH to substantiate Performance Payment Measures as described in Table 4.a.(4).
4.a.(5). HVSA Definitions: Table 4.a.(5) presents definitions of measures related to
Performance Payment Awards.
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f WASHINGTON STAT[
Department of
Children, Youth, and Families
DCYF Contract, Number: 20-1171
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, hftps://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 CHIL REN, YOUTH, AND FAMILIES KriS Gorgag
~ ;st Specialist
DCYF:
Ap qr=rm only:
Date:
un r, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
}-h h W( 4-V�(.�-,f
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 3
WASHINGTON STATI:
Department of
Children, Youth, and Families
D.,, F Contract Number: 20-1171
Contract Maximum: $406,530.72
Table of Contents
Exhibit A - Statement of Work
From-To:07/01 /2019-07/31/2020
1.
DEFINITIONS.
1
2.
Background.......................................................................................................................................................4
3.
Model Fidelity....................................................................................................................................................4
4.
Staffing, Supervision and Training....................................................................................................................5
5.
Service Area and Recruitment of Priority Populations......................................................................................6
6.
Participant Enrollment, Retention, and Caseload Maintenance........................................................................7
7.
Home Visits Frequency and Content................................................................................................................8
8.
Systems Connections.......................................................................................................................................9
9.
Data Collection and Evaluation Requirements.................................................................................................9
10.
Continuous Quality Improvement(CQI)..........................................................................................................11
11.
Technical Assistance......................................................................................................................................12
12.
Budget and Financial......................................................................................................................................13
13.
Publicity, Publication and Acknowledgements................................................................................................17
14.
Contract Reporting, Monitoring, and Deliverables...........................................................................................17
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 Page 1 of 18
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
"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.
Z. "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.
Background
a. 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.
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.
Model Fidelity
a. 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
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.
4. Staffing, Supervision and Training
a. 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:
a.
b.
C.
d.
General
e.
Staffing Plan by Position Type
MIECHV
TANF
i502 State
State
HVSA
Funds
Funds
Funds
Funds
Total
Home Visitor FTE Total
1.42
1.10
2.52
HV Supervisors FTE Total -- time delivering
0.00
home visiting services, if applicable
Supervisor FTE Total -- time dedicated to
0.15
0.15
supervision
Admin Support Staff FTE Total
0.00
Data Support Staff FTE Total
0.00
Management Staff FTE Total
0.00
Additional Direct Service Staff FTE Total
0.00
b. 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:
(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;
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(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;
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.
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
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.
C. 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
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
a. 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.
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.
9. 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.
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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)
(2)
(3)
(4)
Interviews, focus groups, observations and surveys;
Planning for Performance Based Contracting;
Other DCYF or funded evaluation efforts.
Completion of all documentation required by the research projects within the timeframes
presented.
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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)
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.
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.
d. 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
(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.
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.dcvf.wa.gov; 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.
11. Technical Assistance
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 Page 12 of 18
(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.
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://www.ofm.wa.gov/resources/traveLasp. 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 113
cost rate proposal. The CFR can be found at the following link: Electronic Code of
Federal Regulations.
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.
ii. 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.
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.
ii. 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.
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.
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 602) 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 602) 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 602).
(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;
(d) Chart of Accounts;
Contract Number: 20-1171 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
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 20th 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 20th 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
Dv i F Contract Number: 20-1171
t 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 Maximum: $406,530.72
Contract Funding Source(s)
State Funds $406,530.72
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 1 of 1
l ">.N WASHINGTON STATE.
I v j Department of
Children, Youth, and Families
Du t F Contract Number: 20-1171
Contract Maximum: $406,530.72
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 811612019.
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 10121119
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 112012020.
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 712012020.
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 413012019 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 713012019.
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 712012020 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 STATL
t `i Department of
Children, Youth, and Families
fJ,-, rF 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.
HEADINGS.....................................................................................................................................................11
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: 8/7/2019 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.
i. "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 hftp://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.
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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.
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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.
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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
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(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 warrantor 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
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(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.
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(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.
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(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.
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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.
c. 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: 8R/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.
b. 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 maybe
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.
c. 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
d. 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.
g. 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
f WASHINGTON STATE
Department of
Children, Youth, and Families
D(, , r 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:
Signature:
Print Full Name:I i
Job Title: P o
Date:
Signature:
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Date:
Signature:
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Date:
Signature:
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Date:
Appr vtad t fo� ( // / � Date: 9 (`7
Pb4r, Gh e€-Civil Deputy Prosecuting Attorney
J fferson County Prosecuting Attorney's Office
U&W(AA)
Employee/Sub-Contractor//A (ent Name:
Signature:
Print Full Name: ix, %fii�-
Job Title:
Date:
Signature:
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Date:
Signature:
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Signature:
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ntract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 3
Signature:
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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
D Contract Number: 20-1171
Contract Maximum: $406,530.72
WASHINGTON STATE
�i Department of
,. 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.
II. 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 the 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 ontract No. 20-1171, have been complied with as indicated above.
Signature of Contract Manager: Date: � Z, f
Print Name: a - f )m r,�-'
Return original to DCYF Public Records at dcyf.publicrecords@dcyf.wa.gov
Date:
as o rm only:
Ap ed /
, Chief 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
L,. (F 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
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).
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:
(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.
Contract Number: 20-1171 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
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
<< WASHINGTON STAI,
Department of
Children, Youth, and Families
L_ fF 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) -
1. Purpose
a. The purpose of CQI activities is to improve outcomes for families engaged in home visiting
services.
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
(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.
4. 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
s Topic Two Topic
Selection = Tracks
Prework: I A F A P
July -
� October I
I S D S D
Dec. - Mar. ` ` May - June
July 2019 - June 2020
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 4
WASHINGTON STATE
a i Department of
Children, Youth, and Families
HVSA PLAN -DO -STUDY
Agency: I
Learning Collaborative [
CQI Topic: [
Primary Driver: [
PDSA Cycle #
NOTE: The following portion of the fo,
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...
It will resu,
Plan
Plan for d
Start Date
Who/Whal
Who is res
Tasks/Toc
Contract Number: 20-1171
Dl.. r Contract Number: 20-1171
Contract Maximum: $406,530.72
From-To:07/01 /2019-07/31 /2020
Do Was the test carried out as planned? What did you observe that wasn't part
of the plan?
Study 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?
Act What changes are to be made to the process (decisions made/action to
❑ Adapt take)?
❑ Adopt
❑Abandon
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 4
` . WASHINGTON STATL
C, . -'1 Department of
�? Children, Youth, and Families
[j- r F Contract Number: 20-1171
Contract Maximum: $406,530.72
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.dcyf.wa.gov/services/child-dev-support-providers/home-visiting.
Using the Prevention Services Reporting System https://apps.dcyf.wa.gov/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
20t" 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 #
1.7 Email address
2. Active Caseload
Please provide the following information for children and families served by HVSA funds during the reporting
month.
funded by
funded by State
funded by
General State
funded by TANF
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
funded by
funded by State
funded by
MIECHV
i502 Funds
General State
funded byTANF
Funds
a. Number of new families
enrolled:
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
enrollment to capacity for your program is below 85°0, please provide a brief explanation in the space provided.
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:
umber: 20-1171 Printed Date: 8/7/2019 Page 2 of 2
WASHINGTON STATI=
i Department of
Children, Youth, and Families
D.,. F 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 dcYf wa oov/services/child-dev-support-providers/home-visiting.
Using the Prevention Services Reporting System, https.Ijapps.dcyf wa.gov/PSRS, please complete the questions below in
reference to activities from Month 2 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
<Choice . 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.
<upload: >
2.1.b. Q2 If your program does not have a national model office (e.g. CPP, Outreach Doula, STEEP), please
submit a letter from Thrive Washington detailing the model fidelity indicators of your program and your
program's standing with relationship to those indicators of model fidelity.
<upload: >
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
riaenty for eacn tnose inaicators.
Indicator Area jProgram Progress Towards Fidelity
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
below
a.
b.
C.
d.
HVSA-
HVSA-
HVSA-
Total
e. Total
Home
Home Visitor Home
a
a,
Visiting
Select Role — Type in Full Name or Start Date Visitor End
- a
> a
Program
include vacant "vacant" if position is HV ID# if known, Date
>
�+-
►- c
= c
positions not currently filled Month and if left home
v
U.
r U.
c LL
Year visitor role
2
O
Z
0.00
0.00
0.00
0.00
- 0.00
0.00
0.00 -
0.00
Please list the total FTE funded by each source
below. Please respond with a number (#J.
Staff Role/Positions funded by your DCYF
d'
f. Total
Contract (HVSA) and other funds in your
c. HVSA-
a. HVSA- b. HVSA- HVSA- e. Non
Home
Visiting
home visiting program
i502
MIECHV TANF State HVSA
:Program
State
tate
Funds Funds Gen Funds
Funds
Funds
# of Home Visitors — Currently filled positions
0.00
# of Vacant Home Visitor Positions
0.00
# of Supervisors— Currently filled positions
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
Visitors this quarter.
Type of Supervision Average # hours provided to each Home Visitor per month
Administrative/Clinical Supervision (one-on-
one)
Reflective Supervision (one-on-one)
Group (staff meetings, trainings, etc.)
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.
4.3. Q4 What is your organization doing (at the policy, procedural or practice levels) to support your program
in hirine and retainine high -quality grogram staff (and reducina turnover)?
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. Q4 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
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?
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?
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
5.4. Q2/Q4 Outgoing Referral Networks
service delivery for enrolled families.
Based on a review of your program data during the last 6 months, please list the top S sources to which your program
referred home visiting participants for additional resources, and indicate the primary services this organization delivers.
#
Type of Service
Organization Name
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
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. TANF: 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. Q2/Q3/Q4 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
6.1/2/3. 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. Q2/4 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.
7.4/5b. Q4 Describe any steps your program is taking to addre
Contract Number: 20-1171 Printed Date: 8/7/21
8. Continuous Quality Improvement
8.1. Q1/3 Please submit your CQI Charter and Project Plan for this quarter.
8.2. Q2/4 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).
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. Q2/3/4 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 ICurrent Enrollees as of the last day
the Reporting Quarter of the Reporting Quarter
# Total Referrals to Date # Total Referrals from # Total Referrals from enrollment
#Total Referrals
(furrent CSO for the Reporting Other Source for the Resulting in
romJuly.i to C
Quarter) for the Reporting'
Quarter Reporting Quarter quarter
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 7 of 7
WASHINGTON STATI-
C j Department of
Children, Youth, and Families
U_ F 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 ShariLig
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 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.
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.
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.
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 2 of 7
WASHINGTON STATL
Department of
Children, Youth, and Families
Table 4,a.(1) HVSA: Svstem and Program Performance Indicators
D,, . F Contract Number: 20-1171
Contract Maximum: $406,530.72
From-To:07/01 /2019-07/31 /2020
Measure
Definition
Numerator/Denominator
Timeline for Data
Share with
H
Ali
Collection
LIAs
Me
HVSA Aligned Measures: All Contractors shall `re ort on the following, eiht 8 measures
Percent of infants (among
Number of enrolled children
Collect after 6
Quarterly
1. Breastfeeding
mothers who enrolled
prenatally) who were
breastfed any amount at 6
months of age and
QA reports,
breastfed any amount at 6
months /Number of enrolled
before 12 months of
Annual
months of age
children age 6-12 months
age
reports
Number of clients with at
least one PHQ-9 screening
Percent of enrolled
completed within 90 days of
primary caregivers who
delivery if enrolled prenatally
Quarterly
are screened for
or within 90 days of
Collect within 90
Dashboards,
depression using a
enrollment if enrolled with a
days of enrollment
QA reports,
2. Depression
validated tool within 3
child / Number of primary
or 90 days
Performanc
,
Screening
months of enrollment if
caregivers enrolled for at
postnatally (for
a Payments,
a Pay
enrolled post -delivery or
least three months if
those enrolled while
Annual
within 3 months after of
enrolled post -delivery, or
pregnant)
reports
delivery if enrolled
number of primary
prenatally
caregivers enrolled at least
90 days after delivery if
enrolled prenatally
Percent of enrolled
Number of children enrolled
children who received the
who received the last
Collect well child
Quarterly
3. Well Child visit
last recommended well
recommend well child visit
visit data at
QA reports,
,
child) visit based on the
based on AAP schedule /
minimum once per
Annual
American Academy of
Number of children enrolled
month
reports
Pediatrics AAP schedule
in home visiting
Percent of enrolled
Number of children with at
a
4. Child
children with at least one
investigated case of
least one investigated case
Report participant
Annual
'
Maltreatment
maltreatment following
of maltreatment since
consent within first
reports
enrollment / Number of
3 home visits
enrollment within the
children enrolled
re ortin eriod
Percent of enrolled
primary caregivers who
Number of children with an
receive an observation of
assessment completed
Collect at least
Quarterly
5. Parent -Child
caregiver -child interaction
using a validated tool and
using validated tool for the
once during the
Dashboards,
age range /Number of
reporting year,
QA reports,
Interaction
demonstrate positive
children who have reached
ideally spaced
Annual
parenting behaviors
an age appropriate for
every 12 months
reports
including behaviors that
assessment
promote attachment and
child development
Percent of enrolled
Number of enrolled children
children with a family
with a family member who
Collect data at least
6. Early Language
member who reported that
reported that during a typical
once during each
, QA reports
,
and Literacy
during a typical week s/he
week s/he read/told
reporting period for
Annual
Activities
read, told stories, and/or
stories/sang songs with child
each enrolled child
reports
sang songs with their child
every day / Number of
every day
enrolled children
Percent of enrolled
Number of enrolled children
Collect for children
QA reports,
7. Developmental
children with at least one
with at least one ASQ-3
at and 24
Annual
Screening
screening for
screening within the AAP
o
months of age
reports
developmental delays with
defined age/ Number of
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 3 of 7
Table 4.a.(1) HVSA; System and Program Performance Indicators
Measure
Definition
Numerator/Denominator
Timeline for Data
Collection
Share with
LIAs
H
Ali
Me
a validated tool according
children enrolled who are
to the AAP-defined age
eligible for an ASQ-3
groups
screening
Percent of enrolled
primary caregivers who
Number of caregivers with
Collect screening
Quarterly
are screened for intimate
an IPV screen within 6
data for all primary
Dashboards,
S. IPV Screening
partner violence (IPV)
months of enrollment /
caregivers within 6
QA reports,
within 6 months of
number of clients enrolled
months of
Annual
enrollment using a
for at least 6 months
enrollment
Reports
validated tool
HYSAAIi ned:Aeasures'Enrollment°nd
Service:tlttluatiort
.
Measure
Definition
Eligibility
Timingof [
1. New Clients
All clients who enrolled during the
All clients who enrolled during the
Collect enrollmei
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
5. Exits after 24
Clients that exited the program
All clients who exited the program
Collect exit date
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
All alternative visits of at least 30
Record date and
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 Derry' ra `tic in#orma#ion..
,
Measure
Definition
Eligibility
Timing o
1. Primary Guardian Gender
Male or Female
All primary guardians
Collect at em
Age of primary guardian
All primary guardians
Collect DOB
2. Primary Guardian Age
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 4 of 7
7abie.�;a: 3 : Delnora' I�Ic�t�formatibn
Measure
Definition
Eligibility
Timin o-
3. Enrolled Child DOB
Age of child
All enrolled children
Collect child':
4. Primary Guardian Ethnicity
Hispanic, Non -Hispanic, Not
All primary guardians
Collect at eni
reported/refused
S. Primary Guardian Race
White, Black, Asian, American
All primary guardians
Collect at eni
Indian/Alaska Native, Pacific Islander,
Multiple Races, Not reported/refused
6. Primary Guardian Marital
-Married (legal or common law)
All primary guardians
Collect enroll
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 em
-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
-Unemployed
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
10. Primary language in
-English
All primary guardians
Collect at em
household
-Spanish
-Other
11. Household Income
Total income from all household members
All primary guardians
Collect at em
from all sources
annually ther
(Collected as actual dollar amount or in
income ranges if family does not want to
share
12. Pregnant
Primary guardian is pregnant during the
All primary guardians
Collect due d
report period Yes/No
children
13. Primary Guardian Health
-Title XIX (Medicaid)
All primary guardians
Collect at eni
Insurance Status
-Title XXI (State insurance program)
six months &
-Private or Other
-Tri-care
-No insurance coverage
-Unknown/Not reported
Number: 20-1171 Printed Date: 8/7/2019 Page 5 of 7
Taljle 4.a. 3 : l3em ra lic Information,,
Measure
Definition
Eligibility
Timing o'
14. Enrolled Child Health
-Title XIX (Medicaid)
All enrolled children
Collect at em
Insurance Status
-Title XXI (State insurance program)
six months tl-
-Private or Other
-Tri-care
-No insurance coverage
-Unknown/Not reported
15. Child's Usual Source of
-Doctor's/Nurse Practitioner's Office
All enrolled children
Collect at eni
Medical Care
-Hospital Emergency Room
annually ther
-Hospital Outpatient
-Federally Qualified Health Center
-Retail Store or Minute Clinic
-Other
-None Unknown/ Did not Report
16. Child's Usual Source of
-Yes: Has a usual source of dental care
All enrolled children
Collect at em
Dental Care
-No: Does not have a usual source of
annually ther
dental care
-Unknown
17. Additional Confidential
Parent Full Name
All enrolled children
Collect at eni
Demographics required for
Parent Date of Birth
consenting participants
Parent Address
Child Full Name
Child Provider One Number
�. :a� 4 : 'eOf tMan�ce '�,' riienf �iwaids.P if, n
lnce �� ent`�Ileastiltes
Measure
Definition
Award Criteria
Home Visiting
Percent of Maximum Service Capacity filled during
Performance Milestone: Active Enrollmer
Enrollment
the quarter, as measured by the average of the
Maximum Service Capacity for the report
(Active Enrollment)
number of participants actively enrolled on the last
calculation limited to prenatal families an,
day of each of Month 1, Month 2 and Month 3 of the
children up to and including 60 months o-
quarter divided by the Maximum Service Capacity
total number of possible families
Family Retention —12
Number of participants who are engaged in the program
Per Client Award: Number of participants
months
for 12 months after enrollment
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 early exits described in Table 4
....... ................ _..._....... ...... _............ __........ ................. .......... ........... _...-......
Family Retention —18
.... _._._._......... ----.......................... _..... ............
Number of participants who are engaged in the program
Per Client Award: Number of participants
months
for 18 months after enrollment
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 demo(
related to early exits described in Table 4
Depression Screening
Number of participating primary caregivers who are
Per Client Award: Number of eligible care
screened for depression using an approved, validated tool
a depression screening during the contra
within 90 calendar days postpartum (if enrolled
this definition
prenatally) or 90 calendar days after enrollment (if
enrolledpostnatally)...._...__...._......._._................._....._............._...................... _....... -............. _................. _..............
... .......... __.................. _.... _..._...... __............ _... ... _............ _..... .._.............. -._...............-_.......... .... -..........
... ................... _.-..... _........ ............. __..................... _....................... -..............
Depression Referral
._....... -.._..... -.__...... _._
Number of participating primary caregivers who screened
Per Client Award: Number of primary car
positive for depression and were referred to or connected
positive for depression who were referrer
with appropriate services. A Contractor can receive this
appropriate services during the contract
award only once per participant over the years.
Contract Number: 20-1171 Printed Date: 8/7/2019 Page 6 of 7
measure
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 Measure: Number of all NFP participants who
Cohort Outcome give birth to an infant of healthy birthweight during
the contract year as a percent of all births to NFP
participants
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 of healthy birthweight dt
.........._........._..................__...._............
_.....
Cohort Award: Each Contractor receives
• Among births to the entire cohort of part
Contractors, the risk -adjusted rate during
participants gave birth to an infant of he;
• LIA Measure: Number of the Contractor's participants • The Contractor achieves a risk -adjusted r
who give birth to an infant of healthy birthweight participants give birth to an infant of hea
during the contract year as a risk -adjusted percent of
the Contractor's total births during the year
5 IVSA DefiOitions""gin ctin Performance Pa men , waM$
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 TAN
graduation.
• Other factors as determined through analysis of p
community engagement
Healthy Birthweight
Identified Risk Factors or Risk Markers of Mother*
NFP
Infant birthweight is:
• Black/African American
• greater than or equal 2500g
• American Indian or Alaskan Native
and
. 35 years or older at enrollment
• less than or equal 4500g
• 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
July 9 (to DOH):
FY19 Q4 Consenting Clients to DOH
July 20:
June 2019 Monthly Enrollment Report
FY19 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
August 2019
Auqust 8:
July Consenting Clients to DOH
August 16:
Self -Reflection Tool (submitted to Thrive/Ounce)
Auqust 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
September 10:
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
January 9 (to DOH):
December 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
An it 8 (to DOH):
March Consenting Clients to DOH
April it 20:
March 2020 Monthly Enrollment Report
March CQI PDSA Report
Q3 Quarterly Progress Report (January to March) For
TANF: including TANF Q3 Referral Report
A rp it 30:
March 2020 Monthly Invoice
February 2020
February 10:
January Consenting Clients to DOH
February20:
January 2020 Monthly Enrollment Report
January CQI PDSA Report
Februa 28:
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 Budget
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 DOM:
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 endin *'
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.
3
1. Data Shariin�
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 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.
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.
HVSA 20 Att7 Data Collection, Reporting and Aligned Measures, Evidence Based Programs
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WASHINGTON STATE
"t Department of
Children, Youth, and Families
Attn: [von Urquilla I PO Box 40970 1 Olympia WA 98504-0970
A19-IA ✓OICE VOUCHER
Contractor Contract #:
Agency Number:
Contract #: 20-1171
Contract Service Period: July 1 2019 - July 20 2020
ract Title: Home Visiting Services Account: Nurse Family Partne
DCYF Contact: Ivon Urquilla
nstruction to Vendor or Claimant: Submit this form to claim payment for materials, merchandise, or services. Show complete detail for each item.
✓ENDC R'S CERTIFICATE: I hereby certify under penalty of perjury that the items and totals listed herein are proper charges for materials, merchandise, or services
iirnished to the State of Washington, and that all goods furnished and/or services rendered have been provided without discrimination on the grounds of race,
-reed, color, national origin, sex, or age.
Vendor or Claimant
BY
Jefferson County
515 Sheridan Street
Port Townend WA 98368
(Title)
(sign in ink)
(Date)
TO BE COMPLETED BY VENDOR
nvoice Service Period for Budget FY 2020:
Invoice Number:
This is a Final Billing:
Yes No
Payment Points (Note)
Contract
Budget
Billed
Amount
I. 502 State — Personnel
$67,355.60
2. 502 State — Goods and Services
$9,829.34
3. 502 State — Travel
$500.00
1. 502 State — Contracted/Professional Services
$83,144.15
>. 502 State — Administrative/Indirect Charges
$16,082.91
3. General Fund State — Personnel
$58,387.67
F. General Fund State — Goods and Services
$25,060.83
3. General Fund State — Travel
$5,000.00
3. 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
$0.001
Total Payment Request
$0.00
TO BE COMPLETED BY DCYF
Drogram Review
Date Reviewed
Agency Approval
Date Approved
hoc Date
Current Doc No.
Ref Doc No.
Vendor Number
SWV0002430-02
Vendor Message
Invoice Date
fm
'.d
Fnd
All
PI
Sub
Obj
SSO
OI
Alloc
Proj
Sub
Proj
Ph
GL
Subsidiary
Note
Amount
Invoice #
Debit
Credit
17B
411
36300
NB
574B
0410
17B
411
36300
NB
574E
0411
>ccounting Approval for Payment
Date Approved
Warrant Total:
J7/2019 Page 1 of 1