1. DCF Congregate Care Network RFR Restatement 9.2.21.docx

Request for Response (RFR)

RFR Title: Congregate Care Network

RFR Number: DCF CCNET22

Restatement:

September 2, 2021

Brief Description:

Through this Request for Responses (RFR), the Massachusetts Department of Children and Families (DCF) seeks to drive innovation in congregate care programming that will yield a congregate care network with capacity to meet the diverse and complex needs of children, adolescents, and young adults who require the 24/7 therapeutic milieu available in congregate care programs. DCF seeks Bidders motivated to: 1) collaborate with DCF in meeting children’s, adolescents’, and young adults’ needs through both the direct provision of treatments and service and the coordination of behavioral health treatments across providers and systems, and 2) implement Continuous Quality Improvement to achieve safety, permanency, and well-being outcomes for children, adolescents, and young adults served in the congregate care network.

CONGREGATE CARE NETWORK

APPENDICES

PROGRAM MODEL SPECIFICATION APPENDICES

Appendix A Community Treatment Residence Appendix B Specialty Treatment Residence Appendix C Specialty Treatment Residence CSEC Appendix D Intensive Treatment Residence Appendix E Emergency Residence Appendix F Intensive Emergency Residence Appendix G Medically Complex Residence Appendix H Medically Complex and Behavioral Residence Appendix I Youth and Young Adult Group Residence Appendix J Youth and Young Adult Supported Living Community Appendix K Young Adult Supported Living Appendix L Young Parent Living Program Appendix M Residential School

ADD-ON APPENDICES

Appendix N Programmatic Add-On Appendix O Enhanced Residential Treatment Program Appendix P Regional Service Resolution Group Appendix Q Shared Space

ADDITIONAL RESOURCES APPENDICES

Appendix R Youths’ and Siblings’ Rights Appendix S Historic Utilization of Former Program Models and Crosswalk to New Program Models Appendix T Projected Need for Emergency Residences and Intensive Emergency Residences Appendix U Projected Need for Young Parent Living Programs Appendix V Massachusetts Cities and Towns by DCF Area Office and Regions Appendix W Applicable Statutes Regulations Policies Procedures

RESPONSE SHEET 1 APPENDICES

Appendix 1A Community Treatment Residence Appendix 1B Specialty Treatment Residence Appendix 1C Specialty Treatment Residence CSEC Appendix 1D Intensive Treatment Residence Appendix 1E Emergency Residence Appendix 1F Intensive Emergency Residence Appendix 1G Medically Complex Residence Appendix 1H Medically Complex and Behavioral Residence Appendix 1I Youth and Young Adult Group Residence Appendix 1J Youth and Young Adult Supported Living Community Appendix 1K Young Adult Supported Living Appendix 1L Young Parent Living Program Appendix 1M Residential School

RESPONSE SHEET 2 APPENDICES

Appendix 2A-L Proposed Staffing Structure Appendix 2M Residential School Staffing Structure

RESPONSE SHEET 3 APPENDICES

Appendix 3A Community Treatment Residence Appendix 3B Specialty Treatment Residence Appendix 3C Specialty Treatment Residence CSEC Appendix 3D Intensive Treatment Residence Appendix 3E Emergency Residence Appendix 3F Intensive Emergency Residence Appendix 3G Medically Complex Residence Appendix 3H Medically Complex and Behavioral Residence Appendix 3I Youth and Young Adult Group Residence Appendix 3J Youth and Young Adult Supported Living Community Appendix 3K Young Adult Supported Living Appendix 3L Young Parent Living Program

ADD-ON RESPONSE SHEETS

Appendix 4N Programmatic Add-On Response Sheet Appendix 4O Enhanced Residential Treatment Program Response Sheet Appendix 4P Regional Service Resolution Group Response Sheet Appendix 4Q Shared Space Response Sheet Appendix 3Q Shared Space Proposed Staffing Structure

Introduction Through this Request for Responses (RFR), the Massachusetts Department of Children and Families (“the Department” or “DCF”) seeks to drive innovation in congregate care programming to meet the diverse and complex needs of children, adolescents, and young adults who require congregate care. The opportunity for innovation is offered through options for flexibility that Bidders may use when proposing program models in response to this RFR.

As more children and adolescents are served in their families of origin, with kin, and in family-based foster settings, there is a shared perception that the behavioral health profiles of children and adolescents referred to congregate care are becoming increasingly more complex. Children and adolescents referred to congregate care programs are those whose complex trauma histories and significant behavioral health challenges require treatment and 24/7 supervision that cannot be delivered in a family setting.

Children and adolescents with no, mild, or even some moderate behavioral health challenges will be served in their family homes or in other family-based settings. Youth with moderate and severe behavioral health challenges will be served in congregate care. Therefore, Bidders are expected to propose programs for the congregate care network that are prepared not only to identify and manage youths’ challenges but also to:

· Build on children’s and adolescents’ strengths to build self-regulation skills;

· Provide trauma-informed therapeutic milieus;

· Respond to the daily care and treatment needs of all children and adolescents in a manner that is respectful of and responsive to diversity across all human characteristics, including age, race, color, religious creed, national origin, ancestry, disability, genetic information, sex, gender identity, and sexual orientation; and

· Deliver behavioral health treatments directly and, when needed, coordinate behavioral health treatments across providers and systems.

Young adults (i.e., consumers age 18 and older) may be referred to congregate care settings by the Department. Young adults who are no longer in the Department’s custody live in congregate care settings on a voluntary basis. Therefore, Bidders are expected to propose programs that will engage young adults to continue both the skill development to prepare for adulthood that started when they were younger as well as the establishment of supportive relationships and family membership that will last well into adulthood.

The federal Administration for Children and Families established metrics for all public child welfare agencies to assess the safety, permanency, and well-being of youth involved with the agency. The Department seeks Bidders motivated to partner with the Department in using Continuous Quality Improvement (CQI) to achieve safety, permanency, and well-being outcomes for children, adolescents, and young adults served in the congregate care network. Should findings from CQI yield insights that could improve the quality of services and achievement of outcomes, the Department reserves the right to amend contract requirements and to work with Contractors on implementing improvements.

In sum, the Department seeks Bidders committed to ongoing partnership with the Department to ensure:

· A competent and diverse congregate care network capable of meeting the needs of all the children, adolescents, and young adults who are served by the Department and who require congregate care.

· Achievement of safety, permanency, and well-being outcomes for children, adolescents, and young adults in congregate care.

Framework for Congregate Care Network The framework for the Department’s network of congregate care programs has five program categories:

1. Treatment Residences

2. Emergency Residences

3. Medically Complex Residences

4. Youth and Young Adult Programs

5. Residential Schools The program models within each program category are shown in the table below.

A. Community Treatment Residence B. Specialty Treatment Residence C. Specialty Treatment Residence CSEC D. Intensive Treatment Residence E. Emergency Residence F. Intensive Emergency Residence G. Medically Complex Residence H. Medically Complex and Behavioral Residence I. Youth and Young Adult Group Residence J. Youth and Young Adult Supported Living Community K. Young Adult Supported Living L. Young Parent Living Program M. Residential School

Section 2.01 Flexibility to Meet Diverse Needs Within the framework, Bidders have flexibility to propose Specialty Treatment Residences to meet the diverse needs of youth requiring congregate care services. Respecting the knowledge and experience of Bidders, the Specialty Treatment Residence may be used as an omnibus program model for Bidders to propose a program to meet the needs of youth with a clinical profile for which the Bidder has expertise.

The availability of Specialty Treatment Residences creates the opportunity to rely on both a specialty approach and a universal approach for meeting youths’ needs. A robust congregate care network includes both approaches to meet the diverse needs of the population of youth who need congregate care, which includes subgroups of youth. A few examples of subgroups include:

· Youth who are lesbian, gay, bisexual, transgender, gender diverse, or questioning;

· Youth who have specialized medical needs;

· Youth who have experienced commercial sexual exploitation (CSEC);

· Youth who have an Autism Spectrum Disorder.

When staff receive training that builds competencies for meeting special needs, youth in these different subgroups can be served in non-specialized settings. These youths’ needs may also be met in specialized settings that serve a homogeneous group of youth, such as all CSEC or all youth on the Autism Spectrum.

In a congregate care network designed to serve approximately 2,000 youths, a reliance on both the universal and the specialized approach is needed rather than exclusive use of either approach. Examples that illustrate the need for both approaches include:

· Knowledge that a youth has experienced sexual trafficking may not be available when there is a need for placement, making a universal approach necessary. In contrast, some youth who have experienced sexual trafficking may not engage in individual treatment, requiring instead the group treatment available in a specialized setting.

· A transgender youth with a plan for rapid reunification with family would benefit from placement in a non-specialized program closest to home, rather than in a specialized program located further away. In contrast, a transgender youth, whose primary need is validation from peers with transgender experiences, would benefit from a specialized program.

The Department seeks a congregate care network that is strengthened by inclusion of both specialty and universal approaches for meeting specialized needs.

Specifications for the Specialty Treatment Residence are in Appendix B. Specifications for the Specialty Treatment Residence CSEC are in Appendix C.

There is flexibility for Bidders to propose a staffing model that differs from the staffing model underlying the program model rate (101 CMR 413). Except for certain licensed professional requirements, Bidders may propose their own staffing configurations that will fulfill the program’s responsibility to achieve safety, permanency, and treatment outcomes for youth. The proposed alternative staffing model must be possible within the program model rate and must be approved by the Department.

Instructions for proposing alternative staffing models, and for all response requirements, are in SECTION 10.

Should a Bidder have an idea for a program that would require additional funding for staff that could not be accommodated in the program model rate, Bidders may propose a programmatic add-on, which is subject to the Department’s review and approval, and will be negotiated and contracted individually with each Bidder.

The specifications for a programmatic add-on are in Appendix N Programmatic Add-On. The response sheet for proposing a programmatic add-on is in Appendix 4N Programmatic Add-On Response Sheet. Instructions for proposing a programmatic add-on are in SECTION 10.

After approval, and while operating a program, Contractors may propose a consumer-specific add-on, subject to review and approval by the Department, for temporary, specialized services to meet the needs of an individual youth. This option will offer Contractors additional flexibility and support to meet the diverse needs of youth, but Bidders will not propose consumer-specific add-on services in response to this RFR.

Enhanced Residential Treatment Program In addition to meeting requirements for being trauma-informed and for engaging families, which are required of all congregate care families, Enhanced Residential Treatment Programs (ERTP) must meet standards for accreditation, 24/7 staffing by nursing and behavioral health staff, and aftercare. It is the intent of the Department that providers may opt-in or opt-out to apply for ERTP status. The result will be a hybrid congregate care network consisting of both ERTP and non-ERTP programs.

The specifications for ERTP programs are in Appendix O Enhanced Residential Treatment Program. The response sheet for proposing an Enhanced Residential Treatment Program is Appendix 4O Enhanced Residential Treatment Program Response Sheet.

Size of the Congregate Care Network The size of the congregate care network will be based on the number of youths with profiles better served in a 24/7 congregate environment than in a home-based setting and will be subject to appropriations.

To provide Bidders with projections of the size of the to-be-procured congregate care network, Appendices S – U show:

· Appendix S Historic Utilization of Former Program Models with a Crosswalk to New Program Models;

· Appendix T Projected Utilization of Emergency Residences and Intensive Emergency Residences; and

· Appendix U Projected Utilization of Young Parent Living Programs.

Shared Space Section 1.01(A) There may be circumstances that motivate a Bidder to propose a shared space arrangement, where DCF youth referred to different program models are served within a single facility.

The description and eligibility requirements for shared space are in Appendix Q Shared Space.

Bidders interested in proposing a shared space arrangement shall submit, for the Department’s review and approval, a Shared Space Response Package, as described in SECTION 10.

Key Terms and Definitions Adolescents. Youths ages 13-17.

Adolescent Community Reinforcement Approach (A-CRA). A developmentally appropriate behavioral health treatment for youth and young adults ages 12 to 24 years old with substance use disorders.

Area Office Service Resolution Meeting. A collaborative process facilitated by a DCF Area Director or designee in response to unresolved concerns regarding issues for a youth in congregate care, such as appropriateness of a treatment plan, behavioral health progress, or a program’s capacity to continue serving a youth. This meeting may be requested by a youth, family, Contractor, or DCF staff member.

Best Interest Determination. The collaborative process, based on the individual student’s unique best interests and involving input from multiple parties, used for making decisions about whether a student placed in foster care should continue to attend the school of origin.

Bidder. An organization that submits a proposal to the Department to provide human or social services in response to this RFR.

Child/Children. Refers to youths ages 0-12. However, when used in connection with a parent, or other adult serving the role of a parent, the term “child” applies regardless of the age of the offspring. That is, in the phrases “the mother’s child” or “increasing capacity to care for their child,” the term “child” may refer to youth of any age. Also, in the phrase “Commercially Sexually Exploited Child,” the term “child” may refer to youth of any age.

Contractor. An organization that enters into a Contract with the Department to provide human or social services in conjunction with the operation of programs as delineated in this RFR.

Educational Decision-Maker. Person or persons empowered to make educational decisions on behalf of a child in Department care or custody. Examples may include a Special Education Surrogate Parent or Guardian Ad Litem appointed to address educational matters.

Emergency Service Program/Mobile Crisis Intervention (ESP/MCI). A Massachusetts program that delivers community-based behavioral health crisis assessment, intervention, and stabilization services funded by MassHealth, but available regardless of insurance coverage.

Enhanced Residential Treatment Programs. Congregate care programs that, in addition to meeting the trauma-informed and family engagement standards for all congregate care programs, also meet standards for accreditation, 24/7 staffing by nursing and behavioral health staff, and aftercare.

Family. A term used inclusively in this RFR to describe not only biological or adoptive parents and siblings, but other individuals who are important to a youth, who can serve as lifelong connections for a youth, and who may care for a youth in their home. These individuals may be kin, foster, pre-adoptive family members, or other caring adults in a youth’s life.

Family Time. Encompasses not only parent-youth in-person visitation, but also virtual visitation, phone calls, email and letter exchanges, and any other activities designed to maintain and strengthen connections between a youth and family members.

Guardian Ad Litem. An individual appointed by the court to participate in court proceedings on behalf of a minor party. Types of Guardian Ad Litem appointments include extraordinary medical treatment and education surrogate.

Intake. Initiation of services by the Contractor which coincides with the first day of admission to a congregate care program.

Kin. Used inclusively to refer to relatives by blood or marriage and people who, though not related by blood or marriage, have a close emotional relationship with the youth. Neighbors, family friends, teachers, coaches, and other community members are included.

Licensed Practitioner of the Healing Arts (LPHA). A professional who provides care within the scope of practice as defined by the specific provisions of the General Laws at Chapter 112 and is licensed per the individual regulatory citations* set forth below:

· Physicians, pursuant to 243 CMR 2.00;

· Registered Nurse, pursuant to 244 CMR 3.00;

· Advanced Practice Registered Nurse, pursuant to 244 CMR 4.00;

· Psychologist, pursuant to 251 CMR 3.00;

· Educational Psychologist, pursuant to 262 CMR 5.00;

· Licensed Independent Clinical Social Workers or Licensed Certified Social Workers, pursuant to 258 CMR 12.00;

· Occupational Therapist, pursuant to 259 CMR 3.00;

· Licensed Alcohol and Drug Counselors, pursuant to 105 CMR 168.00;

· Rehabilitation Counselors, pursuant to 262 CMR 4.00;

· Mental Health Counselors, pursuant to 262 CMR 2.00;

· Applied Behavior Analyst, pursuant to 262 CMR 10.00;

· Marriage and Family Therapist, pursuant to 262 CMR 3.00;

· Speech / Language Pathologist, Audiologist, pursuant to 260 CMR 2.00;

· Physical Therapist, pursuant to 259 CMR 5.00.

*For nursing or clinical staff working in a congregate care program operating outside of Massachusetts and licensed or registered by the state / jurisdiction in which the congregate care program is operating, these individuals shall be considered registered or licensed in accordance with this provision provided that the individual’s license and/or registration remains active and in good standing in accordance with the state laws and/or regulations that issued the individual’s license and/or registration.

Local Education Agency (LEA). A Massachusetts municipal school department or regional school district acting through its school committee or superintendent of schools that has programmatic and administrative responsibility for educational services within a geographic area.

Medication Administration Program (MAP). A process, authorized by the Massachusetts Department of Public Health regulation (105 CMR 700.000), which allows administration of medications by unlicensed direct care staff in residential programs. MAP operates under state-wide standards, functioning as part of an extensive system of clinical, program, and system supports. This includes training using an approved, standardized curricula and testing by an independent third party.

Medicaid Rehabilitation Services Option (Rehab Option). A federal program through which the Commonwealth may receive reimbursement for rehabilitation services delivered in congregate care programs.

Preparing Adolescents for Young Adulthood (PAYA). A program developed by the Department to prepare adolescents for the transition to young adulthood. The PAYA program components, which are used with youth in placement, ages 14 or over for whom it is developmentally appropriate, include five Independent Living Skills Modules.

Regional Service Resolution Group. A group facilitated by a DCF Regional Director or designee at the request of an Area Office or Contractor to serve as problem-solving forum for 1) intake challenges, 2) concerns that remain unresolved after an Area Office Service Resolution Meeting, or 3) other issues regarding congregate care. See Appendix P.

Special Education Surrogate Parent (SESP). An individual appointed by the SESP Program to be a youth’s special education decision-maker when: (1) the youth has an IEP or is being referred for a Team Evaluation due to a suspected disability that prevents progress in regular education; (2) the youth’s parent is not the designated educational decision-maker; and (3) the youth is placed with a foster/pre-adoptive family that has not become the educational decision-maker or the youth is placed in a congregate care program.

Staff-secure facility. A residential setting in which staff supervision is the deterrent to exit rather than physical barriers to exit, such as locked doors or fences.

Strength-based. An approach based on identifying and building on an individual’s or family’s assets or abilities rather than focusing on deficits. The approach is based on the fundamental principle that all youth and families have strengths.

Transitional Aid to Families with Dependent Children (TAFDC). TAFDC is a state and federally-funded program that provides cash assistance and employment supports to families with children, and pregnant women, with little or no income or assets. The goal of TAFDC is to support families as they transition from economic crisis to stability.

Trauma-Informed. Refers to environments, services, and treatments based on knowledge of the impacts of trauma, effective responses to trauma, and commitments to promote healing from trauma and avoidance of re-traumatization.

Virtual Gateway. An Internet portal operated by the Executive Office of Health and Human Services that allows the general public, medical providers, community-based organizations and state employees a centralized technology platform to find information and access health and human services including the Department’s iFamilyNet Statewide Automated Child Welfare Information System.

Young Adults. Youth ages 18 – 23.

Youth. Used to refer collectively to children, adolescents, and young adults, who span a wide range of ages and developmental abilities. When text refers only to “children,” “adolescents,” or “young adults,” the specific terms will be used.

General Service Specifications The General Service Specifications apply to all program models being procured. Any exceptions or additions to the General Service Specifications appear in the Program Model Specifications for each program model in Appendices A – M.

Compliance with the General and Program Model Specifications in this RFR does not constitute any certification or accreditation of residential treatment services.

The General and Program Model Specifications describe Contractors’ responsibilities in caring for youth and meeting safety, permanency, and well-being outcomes.

Community Connections and Relationships Congregate Care programs are in communities, where they are subject to local laws and regulations and receive local governmental services. Building and maintaining relationships with local governmental officials is a Contractor’s responsibility, which can contribute to achievement of safety, permanency, and well-being of the youth in the program.

Knowing the array of medical and behavioral health, human services, and cultural organizations within a community, and building relationships with leadership in those organizations, will enhance and expand the services delivered within a congregate care program.

Local Government and Governmental Services Engage in relationship building with local governmental officials, including:

Elected and appointed officials;

Leadership of local law enforcement, fire and emergency medical services; and Leadership of LEA, including a school district’s designated Foster Care Point of Contact, per the federal Every Student Succeeds Act of 2015, and each youth’s individual teacher.

Local Medical and Behavioral Health Resources Congregate care programs will both deliver medical and behavioral health services directly to youth and, when needed, coordinate with external providers to arrange services to meet youths’ needs that cannot be met within the program. Contractors shall:

Identify local resources and build relationships with individuals working in those organizations to ensure availability of services and treatments when needed, including:

Health Clinics and Medical Offices:

Local ESP/MCI teams;

Urgent Care locations;

Hospitals;

Community Mental and Behavioral Health Centers, Clinics, and Offices;

LEAs offering behavioral health programs and treatments.

Community-based Organizations Connect with local human services organizations that provide either direct service options for youth or offer volunteer opportunities in which youth can participate.

Identify arts and cultural organizations in the community so participation in arts and cultural events can be incorporated into youths’ life experiences.

Cultural Humility, Racial Equity, and Rights Consistent with the Department’s principles and responsibility (110 CMR 1.05) for fair, just, and equitable provision of services, including special provisions for meeting diverse cultural needs, Contractors will join the Department in commitments to:

· Understand and provide interventions that are responsive to diversity across human characteristics – including age, race, color, religious creed, national origin, ancestry, disability, genetic information, sex, gender identity, sexual orientation, which shall not include persons whose sexual orientation includes minor children as the sex object, status as a veteran, and pregnancy or a condition related to said pregnancy, including but not limited to, lactation or the need to express breast milk for a nursing child; and

· Promote equity through delivering services with humility that respects the broad range of human diversity and experiences.

Cultural Humility 1.01(A)(i) Use decorations, print materials, play accessories, and media resources that reflect the diverse identities of youth and staff, 1.01(A)(ii) Hire staff who reflect the cultural and ethnic diversity of the youth served and train staff on applying cultural humility in their interactions with youth, families, and with other staff members;

1.01(A)(iii) Serve food that is a representation of cultural and religious identity including foods familiar to a youth, which can contribute to a sense of well-being and belonging - 1.01(A)(iii)(1) Include family in identifying important foods and favorite recipes rather than assuming which foods a family eats based on their culture;

1.01(A)(iii)(2) Expand all youths’ experiences of foods by delivering varied menus influenced by different cultures;

Screen media resources for negative cultural, ethnic, gender or racial stereotypes and use discussions of media images to deepen youths’ understanding of diversity and how it is represented in the media.

Train staff in effective strategies for addressing instances of youth expressing negative stereotypes and biases for any human characteristic, including culture, ethnicity, gender, race, disability, sexual orientation, and religion so that youth gain skills to interact in positive ways with peers and adults regardless of race, gender, ethnicity, culture, disability or other human characteristic;

Seek information from youth and families about their diverse cultural, ethnic, racial and other background characteristics that will enhance staff members’ capacities to work with them;

Include cultural considerations in decisions of what assessments to use and what treatments to provide - 1.01(A)(iii)(3) Include youth, as developmentally appropriate, and family, as protective concerns allow, in these decisions;

1.01(A)(iii)(4) Acknowledge and accommodate the stigma surrounding behavioral health conditions and treatments in some cultures;

Include youths’ demographic characteristics, such as race and language, in CQI reviews of safety, permanency, and well-being to promote equitable outcomes for all youth.

Linguistic Competency 1.01(A)(iv) Communicate with youth and families, whether orally, in writing, or through American Sign Language (ASL) or Communication Access Realtime Translation Service (CART), in a language and manner that they understand;

1.01(A)(v) Provide youth who use English as an additional language with opportunities to speak and read in their primary language;

1.01(A)(vi) Provide professional interpreting services, whether in-person, virtually, or telephonically, in the absence of a staff person who is fluent in the preferred language of the youth or family;

1.01(A)(vii) Avoid having youth serve as interpreters between their family and program staff, especially during assessments, treatment planning and review sessions, and other treatment-focused discussions;

1.01(A)(viii) Exercise caution, and provide training, if non-clinical staff members, who may be fluent in a youth’s or family’s preferred language, but lack professional insights into the responsibilities of an interpreter, serve as interpreters during assessments, treatment planning and review sessions, and other treatment-focused discussions; and Coordinate with the DCF Social Worker in securing interpreter services for a low prevalence language or dialect (i.e., used by less than .05% of the Massachusetts population) or for communication services that are difficult to secure.

Religious, Spiritual, and Faith Practices Respect the role that religious, spiritual, and faith practices play in cultural and ethnic identities and in providing a youth with a sense of normalcy and support;

Connect youth, through virtual or in-person sessions, with their preferred religious, spiritual, or faith community, which may be in in their home community or a different location;

Coordinate with family members in supporting a youth’s ability to observe religious holidays and celebrations, whether in the family’s home or in the program;

Allow youth to opt-out from participation in any religious, spiritual, or faith practice that is not consistent with their own practices and beliefs; and Encourage youth and families to connect with their religious, spiritual, or faith community for support and assistance.

Nondiscrimination in Service Delivery, Hiring, and Employment Contractors shall not discriminate in the delivery of services against any youth who otherwise meets the eligibility criteria for services. When delivering services to family members who have a physical or mental impairment that substantially limits a major life activity, Contractors shall make reasonable accommodations to meet the family members’ needs and collaborate with the DCF Clinical Team to arrange additional services for family members with disabilities.

Contractors shall not discriminate in the hiring of any applicant for employment nor shall any qualified employee be demoted, discharged or otherwise subject to discrimination in the tenure, position, promotional opportunities, wages, benefits or terms and conditions of their employment because of race, color, national origin, ancestry, age, sex, religion, disability, status as a Vietnam Era Veteran, sexual orientation or for exercising any rights or benefits afforded by law.

Youths’ and Siblings’ Rights In recognition of the human dignity of all youth and of the value of sibling relationships, Contractors shall incorporate fundamental rights, as described in Appendix R Youths’ and Siblings’ Rights, into congregate care programming and shall support sibling relationships through Family Time activities.

Contractors shall demonstrate respect for youths’ rights by including youth, as developmentally appropriate, in decision making and by providing youth with leadership opportunities, such as youth advisory committees.

Referrals and Intakes The Department expects Contractors to be responsive to the fast-paced, and often crisis-driven, speed of child welfare work as well as to youths’ needs for stability.

Crises in families’ lives necessitate that Contractors have the capacity to accept emergency placements. And, even in non-emergency situations when youth need residential placement, there is urgency to this work, including the need for expeditious step down from in-patient psychiatric hospitalizations and from other acute behavioral health settings. Uncertainty about where they will be living and who will care for them undermines youths’ sense of stability. Therefore, it is essential that congregate services, from intake to discharge, reflect the youth’s sense of time.

As partners with the Department in achieving safety, permanency, and well-being for youth, Contractors will prioritize management of the receipt and review of referrals to ensure prompt communication with the Department about referrals and intake planning. DCF reserves the right to review and approve a Contractor's intake process and all forms used in the intake process of DCF-referred youth.

Contractors will be prepared to serve youth referred from any of the Department’s Area Offices.

To maintain family and community connections, referrals will most often be for youth whose family home is in the same geographic region as the congregate care program.

Circumstances in which a youth will be placed in geographic areas outside their home region may include the need for specialty services available only in a different region or the need to distance a youth from negative peer influences in the home community.

For emergency placements in Emergency Residences and Intensive Emergency Residences, the Department will strive to place youth close to their family homes to promote reunification whenever possible.

Emergency Residences and Intensive Emergency Residences shall be prepared to work with DCF Area Offices throughout the Commonwealth. In contrast to past practice, beds in Emergency Residences and Intensive Emergency Residences will not belong to a single DCF Area Office. DCF Regional and Area Offices will work closely with the Emergency Residences and Intensive Emergency Residences to identify beds appropriate for youth.

1.01(A)(viii)(1) The projected need for Emergency Residences and Intensive Emergency Residences is in Appendix T.

The timeframes for responding to referrals and arranging intakes for each program model are included in the Program Model Specifications, Appendices A–M.

Two program models, Emergency Residence and Intensive Emergency Residence, are designed to accept emergency intakes at all times.

Bidders proposing an Intensive Treatment Residence have the option of proposing an emergency intake add-on service – a description of which, including the timeframe for the emergency intake, is included on Appendix 1D.

1.01(A)(viii)(2) The emergency intake add-on service will require expedited processing of a referral and an expedited intake timeframe when requested by the Department. Referrals submitted without a request for emergency intake will be handled on a non-emergency basis, following the timeframe in Appendix D.

1.01(A)(viii)(3) Bidders interested in proposing an emergency intake add-on service to an Intensive Treatment Residence shall complete the emergency intake add-on section of Appendix 1D Intensive Treatment Residence.

Contractors shall collaborate with The Department in problem-solving intake challenges for youth and in maximizing programs’ capacities to serve referred youth.

1.01(A)(ix) One measure of the congregate care network’s capacity to serve referred youth will be the percentage of referrals that are accepted for intake. Contractors shall contribute to this measure of capacity by:

Developing and implementing a process for tracking the number of referrals received from DCF and the number of referrals accepted for intake, which is influenced by the number of available beds and by the appropriateness of referrals received.

Calculating the acceptance rate (i.e., number of DCF intakes divided by number of DCF referrals received) on a quarterly basis, discussing the acceptance rate trend as part of Continuous Quality Improvement, and submitting the quarterly acceptance rate to the DCF Network Specialist.

Discussing, during the program’s annual performance review, strategies the program will implement to improve the program’s acceptance rate. If a program is unwilling to implement strategies to improve the program’s acceptance rate, the Department reserves the right to terminate the contract with the program.

Including a description of what progress a youth must make to be considered a candidate for the program whenever a Contractor declines to offer an intake for a referred youth. And, reviewing the descriptions on a quarterly basis to inform efforts to improve acceptance rates.

1.01(A)(x) The Department will rely on Regional Service Resolution Groups – one in each of the Department’s five Regions – as one venue for collaborative problem-solving of intake challenges and other issues affecting the congregate care network.

A description of Regional Service Resolution Groups is in Appendix P Regional Service Resolution Group.

Bidders interested in serving on a Regional Service Resolution Group shall submit, for the Department’s review and approval, a Regional Service Resolution Response Package as described in SECTION 10.

The size of the Regional Service Resolution Group will vary by Region, with sizes expected to range from five to ten Contractors on each Regional Service Resolution Group.

Assessment Assessment and treatment planning are complimentary, on-going processes, with assessment preceding and informing treatment planning. Re-assessments track progress, which necessitates updates in the treatment plan. This dynamic process of re-assessing and planning continues throughout a youth’s tenure in the program.

Specific timeframes for the completion of comprehensive assessments and treatment plans in each model are included in the Program Model Specifications in Appendices A – M.

Assessment 1.01(A)(xi) To be considered “comprehensive,” the assessment process must use multiple methods to obtain information about a youth and family that will inform effective treatment planning, including:

Observations of the youth in the program;

Interviews with youth, family, family supports, and professionals familiar with the youth and family;

Review of previous assessments;

Use of standardized screenings and assessments, whenever standardized tools are possible and appropriate. The Department reserves the right to review and approve all of a Contractor’s screening and assessment tools to ensure use of standardized tools that best match the population of youth served in congregate care programs. The following screenings and assessment tools are required for each youth:

Screenings

i. Conduct, immediately at intake, a screening for any emergency medical or behavioral health needs and secure services for any identified needs;

ii. Conduct a safety and risk screening for:

Self-harm, including suicide;

Substance use;

Running;

Quality of peer relations;

Aggression;

Sexual reactivity; and Coping skills.

Assessments using Contractor-selected tools

iii. Conduct trauma assessments, including the impact of discrimination and inequities, family history of domestic violence, youth’s personal experience with intimate partner violence, sexual exploitation, and human trafficking:

Notify the DCF Social Worker should assessment reveal active domestic violence in the family and/or previously unknown sexual abuse or sexual exploitation; and Collaborate with the DCF Social Worker in linking family with domestic violence resources and supports and ensuring supports for sexually exploited youth.

iv. Conduct substance use assessments, including history and current use of alcohol, tobacco, and other drugs, age of onset, previous interventions or treatment, and any co-occurring behavioral health disorders.

v. Conduct assessments for other addictive behaviors, such as food, technology, and gambling.

Assessments using Department-selected tools

vi. CANS (The Massachusetts Child and Adolescent Needs and Strengths, ages 5-20). Completed by a CANS certified assessor. The most recent version of CANS, as established by the MassHealth Office of Behavioral Health, shall be used; and

vii. For youth ages 14 and older – the YRAT (Youth Readiness Assessment Tool) or, for youth ages 14 and older with Intellectual Disabilities, a Contractor-selected life skills assessment tool.

Specialized Assessments Specialized assessments are not required, but are selected in collaboration with the DCF Clinical Team depending on a youth’s needs;

Connect with a representative from the youth’s school and the youth’s educational decision maker to discuss options for specialized educational assessments to evaluate a youth’s learning and educational needs;

Examples of specialized assessments for youth may include:

Psychological/Neuropsychological testing;

Psychiatric and Medication Evaluation;

Sensory assessments, e.g., hearing, vision;

Occupational and Physical therapy assessments;

Bonding and Attachment; and Eating Disorders.

viii. Determine the payer for a specialized assessment by determining what is provided through:

a youth’s school;

a youth’s medical and behavioral health insurance;

the Contractor’s service array; and the DCF Area Office.

1.01(A)(xii) Assessment Report Synthesize information obtained through the assessment process described above into an individualized, comprehensive assessment report that covers:

a. Youth’s history, strengths and needs in the areas of:

i. Behavioral health;

ii. Rehabilitative needs for achieving life skills, emotional and symptom management, and social skills;

iii. Education and career planning; and

iv. Medical health.

b. Family history and caregivers’ strengths and needs regarding parenting capacity; and

c. The reason a youth requires congregate care.

Treatment Plans Engage family, youths, as developmentally appropriate, and the DCF Team with the Contractor’s internal treatment team for the youth to develop a strengths-based, individualized treatment plan focused on ameliorating the reasons a youth requires congregate care.

For a youth with a history of serious behavioral health challenges, invite partners such as a youth’s external behavioral health clinician, a representative from the local ESP/MCI team, a youth’s teacher or other school representative to assist with treatment planning, which will enhance the program’s ability to partner with external entities in preventing behavioral health crises.

Components of Treatment Planning 1.01(A)(xiii) Cultural Perspective. Successful treatment planning incorporates a youth’s and family’s cultural perspective into each section of the treatment plan and into the treatment planning process itself. Strategies may include:

Avoid professional jargon and acronyms. Instead use terms that are familiar to a youth and family members;

Provide an overview of what happens in a congregate care setting, which may not be understood or may be misinterpreted in some cultures;

Ask…