HomeMy WebLinkAboutInterlocal Agreement Washington State Department of Children, Youth and Families (DCYF) Amendment 1 - 021621 cal Artfrtf 30,A71
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Department of DCYF Contract Number. 20-1171-01
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From-To:0 7/01/2019-07/31/2021
INTERLOCAL AGREEMENT
Home Visiting Services Account: Nurse Family Partnership —C
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 CONTRACTOR CONTRACT MANAGER
Jefferson County Appalachia(Apple)Martine
615 Sheridan Street AMartine@co.jefferson.wa.us
Port Townend WA 98368 Phone: (360)385-9400 x443
TIN:91-6001322
UBI: 161-001-169
DCYF ADDRESS DCYF PROGRAM CONTRACT MANAGER
Department of Children,Youth,and Families !von Urquilla
PO Box 40970 Prevention Services Program Specialist
Olympia WA 98504-0970 ivon.urquilla@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 C mmissioners YOUTH,AND FAMILIES
q4.144
Sidnatu e Signature
Kate Dean Kris Gorgas
Name Name
Chair Contract Specialist
Title Title
2 // / 2 3/11/2021
Date Date
vele t orr on :
Date: 1 Z44N
Philip C.Hunsucker, Chief Civil Deputy Prose ti Attorney
Jefferson County Prosecuting Attomey's Office
Contract Number:20-1171-01 Printed Date: 12/18/2020 Page 2 of 2
Do i Sign Envelope It1 F( .'4 4F'1 D lFF7 t1 CA CAGA4EIN,1FVt/ 1.
•`""'""""""""`_ )C;Y! Contract Number 20-11 71.-01
Department u;
- Contract Maximum $b06,011.44
Children Youth.and Families
From 10.0/M1/2019 07/31:2021
Exhibit A - Statement of Work
Table of Contents
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,goat 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(IJRLs); internet protocol (iP)address numbers; brometric
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. "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. "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.
as "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.
II. "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.
min. "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.
0o "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 1 ANF families who arc 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 2.020,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
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:
- b. -
Staffing Plan by Position Type i502 State General HVSA
Funds State Total
Funds
Home Visitor FTE Total 1.27 1.22 2.49
HV Supervisors FTE Total--time deliveries. 05 .12 .17
home visiting services, if applicable
Supervisor FTE Total--time dedicated to 15 .15
supervision
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,andtor 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 NIP 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 he 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) i lomeless!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.
b. Voluntary Services:The Contractor shall implement program policies and procedures to ensure home
visiting services are provided to program participants on a voluntary basis. For every participant
enrolled, Contractor must obtain 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
fails below 8 %of the Maximum Service Capacity.
d. Policies and Procedures for Participant Enrollment, Disenroliment, 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. It 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
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
(D011)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(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 ail 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)
a 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. COI activities will be designed around home visiting teams' practices, utilize
program data, and improve the program's quality and outcomes over time.COI is prospective and
inherently encourages testing new strategies that maynot 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) COI 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.
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.o(m.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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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
i502)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 i502)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 i502).
(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
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 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 200'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 20"'day following the quarter of service.
(4) Self-Reflection Tool:The Contractor shall submit the Self-Reflection Tool described in Section 11
no later than 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 20'h 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.
1 Table 14.e Report Time Table
Contract Number 20 1171-01 Printed Date: 12/18/2020 Page 17 of 20
DocuSign Envelope ID-BCO7D424-4BFD-4FF7-85C4-CABA4ED51F17
July 2020 August 2020
July 9.(to UUH1: August 9:
FY20 Q4 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 Q4 Quarterly Progress Report(April to June) August 30:
July 2020 Monthly Invoice
June 2020 COI 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
October 30: December 2020
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
-Contract Number:20-1171-01 Printed Date: 12/18/2020 Page 18 of 20
DocuS'ign Envelope ID E3C071)424--4131=D-41 Fi-85C4-CAt3A4ED51 1117
January 2021 February 2021
January 11 (to DOH)_ February 8:
December Consenting Clients to DOH January Consenting Clients to DOH
Janua 20: February20:
December 2020 Monthly Enrollment Data Report January 2021 Monthly Enrollment Data Report
December CQI PDSA Report January CQI PDSA Report
02 Quarterly Progress Report(October to December) February28:
including January 2021 Monthly Invoice
Model Fidelity Letter
I March 2021
January 30: March 3
December 2020 Monthly Invoice February Consenting Clients to DOH
March 20:
February 2021 Monthly Enrollment Data Report
February CQI PDSA Report
March 30:
February 2021 Monthly Invoice
April 2021 May 2021
April 8(do DOH): May_10:
March Consenting Clients to DOH April Consenting Clients to DOH
April 20: May 20;
March 2021 Monthly Enrollment Data Report April 2021 Monthly Enrollment Data Report
March CQI PDSA Report April CQI PDSA Report
Q3 Quarterly Progress Report(January to March) May 30:
A ril 2021 Monthly Invoice
April 30: June 2021
March 2021 Monthly Invoice (
June 8:
4
FY21 Pre Contract Questionnaire and Budget I May Consenting Clients to DOH
June 20:
May 2021 Monthly Enrollment Data Report
May CQI PDSA Report
June 30:
May 2021 Monthly Invoice
July 2021
July 9 I(fo,
June Consenting Clients to DOH
July 20:
June 2021 Monthly Enrollment Data Report
June CQI PDSA Report
Q4 Quarterly Progress Report(April to June)
July 30:
June 2021 Monthly Invoice and Performance Payment
Invoice
Certification of Data Dis•osition for •ro•rams endin•'
*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 20
DocuSign Envelope ID:BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
"'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 Page 20 of 20
Uocusign Env.:-Inv:II) 130)7 IN?r1-413P D-4I'f7-l3bC7-A13/4;Eritl,11'17
Yrr..r n r.o,.nv. OCYr Contract Number. 20-1171-01
Department of contract Maximum: +806.011..14
Children,Youth.and Families
From-To'07101/2019-07/31/20'21
Exhibit B - Budget Report
Any variances to the Payment Points allocated within this Budget roust 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 1 2020 -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/Profession a
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/Professions
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 Printrd bate: 12/18/2020 Page 1 of 1
D oco8gn Envelope ID:BC070424 4BI D 4FFI b"C4-CA8A4EO tF11
"""'I
"""„ ' C)CYFContract Number 20-11Jt-01
Department of Contract Maximum. $806,011.44
Children,Youth,and Families
From-To:07 01/2010 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 2.1, 2019
By the 20th day following the quarter of service.
The Contractor shall submit Quarterly Progess Reports using the template in the PSRS
as described in the Attachment titled HVSA Quarterly Progress Report Components.
4.02 Quarterly Progress Reports Jan 20, 2020
4.03 Quarterly Progress Reports Apr 20, 2020
4.04 Quarterly Progress Reports Jul 20, 2020
5.00 Self-Reflection Tool No Date
Due to Thrive/Ounce of Prevention by 8/16/2019.
The Contractor shall submit the Self-Reflection Tool descripted in the Statement of Work,
Section 11 using the template provided by Thrive/Ounce of Prevention.
6.00 COI Pre-Work No Date
Due to Thrive/Ounce of Prevention by 10/21/19
The Contractor shalt complete the CQI pre-work assignments, as described below and in
the Attachment titled Continuous Quality Improvement
7.00 CQI Monthly Report No Date
Due by the 20th of the month immediately following the month of service starting on
7/20/2019 and then each month starting on 1/20/202.0.
The Contractor shall submit monthly CQI PDSA Reports, as described below and in the
Attachment titled Continuous Quality Improvement.
8.00 Final Learning Collaborative Storyboard No Date
Due by 7/20/2020.
The Contractor shall submit a Final Learning Collaborative Storyboard to reflect on
project learnings, data, and team experiences using the template to be provided by
DCYF.
Contract Number:20-1171-01 Printed Date_ 12/18/2020 Page 1 of 3
DociSign Envelope ID:6CO?D424 4F31 D-41F7-85C4-CABA4ED51117
9.00 Annual Pre-Contract Questionnaire No Date
Due by 4/30/2019 for contractors planning to continue services in the following fiscal
year.
The Contractor shall complete and submit the FY21 HVSA Pre-Contract Questionnaire
and FY21 Proposed Budget using the template provided by DCYE.
10.00 Updated Insurance Certificate No Dale
Due to DCYF when certificate is renewed.
Updated Insurance Certificate must be submitted when the insurance policy is renewed.
11.00 Updated Statement of Confidentiality and Non-Disclosure No Date
Due by 7/30/2019.
Updated Statement of Confidentiality and Non-Disclosure must be submitted for any new
employees, agents, or subcontractors with access to confidential or personal information
relating to this contract.
12.00 Data Disposition No Date
Due by 7/20/2020 or upon closure of contract.
Data Disposition must be submitted with the closure of the contract.
State Fiscal Year 2021 (July 1 2020 -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:BCO7D424-4BFDAFF7-85C4-CABA4ED51F17
7/20/2019 and then each month starting on 1/20/2020.
The Contractor shall submit monthly CQI PDSA Reports, as described below and in the
Attachment titled Continuous Quality improvement.
9.00 Annual Pre-Contract Questionnaire No Date
Due by 4/30/21 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.
10.00 Updated Insurance Certificate No Date
Due to DCYF when certificate is renewed.
Updated insurance Certificate must be submitted when the insurance policy is renewed.
11.00 Updated Statement of Confidentiality and Non-Disclosure No Date
Due by 7/30/2020.
Updated Statement of Confidentiality and Non-Disclosure must be submitted for any new
employees, agents, or subcontractors with access to confidential or personal information
relating to this contract.
12.00 Data Disposition No Date
Due by 7/20/2021 or upon closure of contract.
Data Disposition must be submitted with the closure of the contract.
Contract Number:20-1171-01 Printed Date: 12/18/2020 Page 3 of 3
F1x l Iu'.Envelope II) B(t)711v24-0BI a 4FF7 bh( 1 CAtiA4E Df.,1EI I
""^`""""'"'"""" DCYF Contract Number: 20-1171-01
Department of Contract Maximum: $806,01144
Children,Youth,and Families
From-To:07101i2019-07/31/2021
Attachment 5 - Monthly Enrollment Data Report
Monthly Enrollment Data Report
sumpi_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.dcy .wa.gov.
• _ ,:iPr£.,...., ..1 5..91"', :r_O ..t .< i,3.5: n;;r)'dCyf wo gOti/PS . ietzse:,_,t p etr thF. q ue!,,: io;;s below to
rofTrenr.e to ac,tivitios'a he reporting rt:og month. This,eper!is due to Department of Children, Youth, end ramifies on the 2O°
month fn!;o "the re.p.ortmp mci%t'
1. Organization Information
a.Organization Name b.Organization ID
c.Home Visiting Model d.Funding Source
E I I I
a.Name of Person Completing Report f.Contact Phone g.Contact Email
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
MIECI-IV 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 last 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 BCO7D424-4BFD-4FF7-85C4-CABA4ED51F17
3.Caseload Changes
Please provide the following information about new enrollments,exits,and program completion during the
reporting month.
funded by funded by State funded by General funded
MIECHV 1502 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
enrollment to capacity for your program is below 85%,please provide a brief explanation in the space provided.
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/o!
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.
5. 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:BCo7D424-48FD-4FF7-85C4-CADA4ED51F17
• """"'"'""'\""'"`"` DCYF Contract Number: 20-1171-01
Department of Contract Maximum: $806,011.44
< ; Children,Youth,and Families
From-To:07/01/2019-07/3112021
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/servicesichild-dev-support-providers/home-visiting.
€isir€a the Prevention Services Reporting System,https://apns.dcyf.t mgorf/PSF S.please complete the questions below in
reference to octivities from Month 1 to Month 3 of the reporting qucdi"ter. This report is due to Department of Children,
Youth,and Families on The 20:i;of each month following tl?e 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
EE2.3.Contact Email
L
3.Fidelity to Program Model
3.1.a.Q2 If your program is an evidence-based program(e.g.ENS,Family Spirit,NEP,PAT, Ft-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.CPn,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
fidelity,please list those indicators and your program's progress towards meeting model fidelity for each those indicators.
Indicator Area Program Progress Towards Fidelity
Contract Number:20-1171-01 Printed Date:12/18/2020 Page 1 of 5
DocuSign Envelope ID:BC07D424-48FD-4FF7-85C4-CABA4ED51F17
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
v Home
Home Visitor Home - w a) a Visiting
Select Role- Type in Full Name or ! Start Date Visitor End a c fa w > w Program
include vacant "vacant"if position is HV ID# if known, Date = Li- s VI c c
positions not currently filled Month and if left home u Z .., u_ 0 u.
Year visitor role Fa-
0.00
0.00
M— — - - -
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(PJ.
Staff Role/Positions funded by your DCYF d f.Total
Contract(HVSA)and other funds inyourc.HVSA- Home
a.HVSA- b.HVSA- HVSA e.Non Visiting
home visiting program MIECHV TANF r�02 State HVSA
State Program
Funds Funds Gen Funds
Funds
Funds
#of Home Visitors--Currently filled positions® _W _ 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
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.
I
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 5
DocuSign Envelope ID BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
5. Supervision Deliverables
5.1.Please report on the number of hours of supervision that Supervisors provided for all Home Visitors-this quarter.
ype 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)?
1
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
Caregivers Number of Male Caregivers
6.1.b.Q4 Please tell us how many unduplicated caregivers received services this year(received at least one home visit from
July 1 2018 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 <categories>
4 <categories>
5 <categories>
Contract Number:20-1171-01 Printed Date:12/18/2020 Page 3 of 5
DocuSign Envelope ID.BC07D424-4BFD-4FF7-85C4-CABA4ED51F17
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.TAW: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 any notable changes in your program or organization that impacted implementation of your program.
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
pathways 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?
C.
8.4,1, Q4 Describe any notable demographic changes in your community in the past year.
8.4/5b.Q4 Describe any steps your program is taking to address changes in community need noted above.
9.Q1fQ3 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).
Contract Number:20-1171-01 Printed Date: 12/18/2020 Page 4 of 5
DocuSi nn Envelope ID:1.3C07D.12.t-.1131D-.1 F1-7-85G,CABA i E051 F 17
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?!low
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.
• . _1
11. General Comments
11.Comments:Please include anything you would like to add that was not addressed elsewhere in this progress report.
12. FOR TANF:TANF Referrals Worksheet
12.1.Please complete the following table for the reporting quarter
Cumulative Families Served for the Current Enrollees as of the last day of
Reporting Quarter the Reporting Quarter
#Total Referrals to Date #Total Referrals from #Total Referrals from It Total Referrals
(from July 1 to Current CSO for the Reporting Other Source for the Resulting in Enrollment
Quarter) Quarter Reporting Quarter for the Reporting Quarter
Average number of days
from referral to first #Total Participants #Total Participants Summary of client exit reasons
contact for all referrals for who Left Program who Left Program other than graduation
the Reporting Quarter by Graduating Without Completion
Contract Number:20-1171-01 Printed Date: 12/18/2020 Page 5 of 5
DoeuSigri Envelope iD BCC7D124-41-1FD 4FF785C4-CABA4ED5IF17
Attachment 7 - Data Collection, Reporting and HVSA Aligned
Measures, Evidence Based Programs
1. Data Sharing
a. Required elements of the Data Sharing Agreement(DSA)with Department of Health(DOH):The
Contractor will work with DOH to establish data sharing agreements according to the timelines set forth
within Exhibit A,Statement of Work. The data sharing agreement shall outline specifications of the data
use and data sharing to implement required reporting,evaluation and quality assurance or
improvement activities.The data sharing agreement shall minimally:
(1)Allow DOH access to client and program data as outlined below in section 4.0.
(2)When parental consent is provided,
(a) Share with and allow DOH access to confidential information listed in 1 able 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.
DocuSign Envelope ID:BCO7D424-4BFD-4FF7-85C4-CABA4ED51F17
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
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)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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.9e/thson www.JeffersonCountyPublicHealth.org
Public He`alll 1 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:
/„. /c7(
/---6/7-/D/ e 2_7 /
Philip Morley;C16ul ty Administrator`a 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
CMS
Public Healt�i
CONTRACT REVIEW FORM
CONTRACT WITH: Dept.of Children,Youth and Families(DCYF) TRACKING NO.: N-19-123 Al
(Contractor/Consultant)
CONTRACT FOR: Nurse Family Partnership TERM: 7/1/2019-7/31/2021
IMJ 07 2021
COUNTY DEPARTMENT: Jefferson County Public Health
For More Information Contact: Apple
Contact Phone #: x443
RETURN TO: Karen Abbott RETURN BY: ASAP
(Person in Department) (Date)
AMOUNT: $399,480.72 additional PROCESS: ❑ Exempt from Bid Process
❑ Consultant Selection Process
Revenue ❑ Cooperative Purchase
Expenditure ❑ Competitive Sealed Bid
Matching funds Required ❑ Small Works Roster
Source(s) of Matching Funds ❑ Vendor List Bid
❑ RFP or RFQ
O Other-State Funded
Step 1: REVIEW BY-R:1*C.MANAGE NF /
ReyieN b
Date Reviewed:
APPROVED FORM ❑ Returned for revision(See Comments)
Comments
Step 2: REVIEW BY OS t ING ATTORNEY
Review by: (,11.,C Philip C. Hunsucker
Date Reviewed: 102/ Chief Civil Deputy Prosecuting Attorney
h,d' APPROVED AS TO FORM sk eturned for revi ion(See Comments)
Comments
Step 3: (If required)DEPARTMENT MAKES REVISIONS&RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY
Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF ORIGINALS
Step 5: SUBMIT TO BOCC FOR APPROVAL
Submit original Contract(s),Agenda Request,and Contract Review form. Also,please send 2 copies of just the Contract(s)
(with the originals)to the BOCC Office. Place"Sign Here"markers on all places the BOCC needs to sign. MUST be in
BOCC Office by 4:30 p.m.TUESDAY for the following Monday's agenda.
(This form to stay with contract throughout the contract review process.)