1. SS25 Cover Sheet-Checklist~1.docx
DOCX document 69 KB Posted
- Attached to
- Support & Stabilization RFR
- Solicitation number
- BD-24-1034-0009-DSS09-102793
- Issued by
- Suffolk County, Massachusetts
About this file
This document is the DCF S&S25 RFR Cover Sheet and Checklist for the Massachusetts Department of Children and Families' Support & Stabilization (S & S) services contract opportunity. The RFR seeks providers to deliver a variety of S & S services tailored to the individual strengths and needs of children and families served by the Department, designed to achieve safety, permanency, and well-being for children. The initial proposals are due on July 12, 2024. The contract covers services across five regions - Western, Central, Northern, Southern, and Boston. Bidders can propose to provide services statewide or in selected regional areas. The contract will include multiple service models such as Safe & Stable Family Services, Comprehensive Services for Child Welfare, Substance Use Interventions, Therapeutic Family/Child Support, Evidence-Based Practices, and more.
The document provides instructions for completing the required response materials, including a Cover Sheet, Part A: General Response, Part B: Service Model Responses, Supplier Diversity Form, and Financial Qualification Package (if not already qualified). The contract award and negotiations will require additional documents such as the Commonwealth Standard Contract Form, Program Model Summary Sheet, and other administrative forms.
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DCF S&S25
COMMONWEALTH OF MASSACHUSETTS
DEPARTMENT OF CHILDREN AND FAMILIES
DCF RFR: DCF S&S25
RFR COVER SHEET and CHECKLIST
Please use this cover sheet and checklist as the first page of your response materials
BIDDER INFORMATION
Bidder Type: Click on the appropriate box to indicate whether Bidder is a Provider Organization or an Individual Provider.
☐ Provider Organization (including but not limited to for- and non-profit organizations and sole proprietorships) ☐ Individual Provider
Provider Organization or Individual Provider Name:
Provider Organization or Individual Provider Mailing Address:
Provider Organization Main Phone Number (if applicable):
Vendor Code # (if applicable): FEIN:
Contact Name and Title:
Contact Phone Number: Contact Email Address:
RFR DOCUMENTS; Select All (Click on appropriate box to indicate completion of document.)
| Document |
| Provider Organization |
| Individual Provider |
| Cover Sheet – one per Provider Organization or Individual Provider |
| ☐ |
| ☐ |
| Part A: General Response – one per Provider Organization or Individual Provider (Appendix E.1 or F.1) |
| ☐ |
| ☐ |
| Part B: Service Model Response(s) – one per service model proposal (Appendix E.2-18 or F.2-3) (indicate completion in chart below) |
| ☐ |
| ☐ |
| Supplier Diversity Form for Purchase of Services (POS) – one per Provider Organization or Individual Provider |
| ☐ |
| ☐ |
| Provider Financial Qualification Package (if not already qualified) – one per Provider Organization (not required for Individual Providers) |
| ☐ |
OR if already qualified, check here: ☐ N/A
PROVIDER ORGANIZATIONS – check the Service Models and appropriate catchment areas included in your proposal.
| Part B Completed |
| Service Model |
| Statewide |
| If not Statewide, check the Region where services are proposed (whole Region or selected Area Offices) |
| Western |
| Central |
| Northern |
| Southern |
| Boston |
E.2 Safe & Stable Family Services
| ☐ | Safe & Stable | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Safe & Stable – Peer Support Specialist | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Safe & Stable – Social Connections and Permanency Support | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.3 Comprehensive Services for Child Welfare |
| ☐ | Comprehensive Services – Family | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Comprehensive Services – Intensive Family | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Comprehensive Services – Therapeutic | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Comprehensive Services – Family Member with a Disability | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.4 Substance Use Interventions for Child Welfare – Parent/Caregiver |
| ☐ | Substance Use Interventions – Parent/Caregiver Substance Use | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Substance Use Interventions – Peer Support Specialist Substance Use | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.5 Substance Use Interventions for Child Welfare – Youth |
| ☐ | Substance Use Interventions – Youth Substance Use | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.6 Therapeutic Family/Child Support for Child Welfare – Family |
| ☐ | Therapeutic – Family | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.7 Therapeutic Family/Child Support for Child Welfare – Youth |
| ☐ | Therapeutic – Youth | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.8 Evidence-Based Practices for Child Welfare – Brief Strategic Family Therapy® |
| ☐ | Evidence-Based – Brief Strategic Family Therapy® | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.9 Evidence-Based Practices for Child Welfare – Multisystemic Therapy® |
| ☐ | Evidence-Based – Multisystemic Therapy® | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.10 Evidence-Based Practices for Child Welfare – Intercept® |
| ☐ | Evidence-Based – Intercept® | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.11 Family Crisis/Trauma Intervention |
| ☐ | Family Crisis/Trauma Intervention | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.12 Respite for Child Welfare |
| ☐ | Caregiver Respite | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.13 Preparation Support for Child Welfare |
| ☐ | Preparation Support | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Preparation Support – Peer Support Specialist | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Preparation Support – Supervised Family Time | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.14 Youth Support and Stabilization |
| ☐ | Youth Support – Enrichment | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Youth Support – Educational & Vocational | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Youth Support – Non School Hours for Children with Disabilities | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Youth Support – Transition-Aged Youth | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.15 Mediation for Child Welfare |
| ☐ | Mediation for Child Welfare | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.16 Assessment Services for Child Welfare |
| ☐ | Assessment for Child Welfare | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.17 Other Services for Child Welfare |
| ☐ | Other, as proposed by Bidder | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| E.18 Groups for Child Welfare |
| ☐ | Safe & Stable – Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Substance Use Interventions – Parent/Caregiver Substance Use Specialty Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Substance Use Interventions – Youth Substance Use Specialty Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Therapeutic – Parent/Caregiver Specialty Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Therapeutic – Youth Specialty Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Preparation Support – Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| ☐ | Youth Support – Group | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
INDIVIDUAL PROVIDERS – check the Service Models and appropriate catchment areas included in your proposal.
| Part B Completed |
| Service Model |
| Statewide |
| If not Statewide, check the Region where services are proposed (whole Region or selected Area Offices) |
| Western |
| Central |
| Northern |
| Southern |
| Boston |
F.2 Assessment Services for Child Welfare
| ☐ | Assessment for Child Welfare | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
| F.3 Other Services for Child Welfare |
| ☐ | Other, as proposed by Bidder | ||||
| ☐ | ☐ | ☐ | ☐ | ☐ | ☐ |
The following documents are NOT Submitted with the Initial Proposal Bid, but must be completed upon contract award and negotiations:
· Commonwealth Standard Contract Form & incorporated Commonwealth Standard Terms and Conditions for Health and Human Services
· Program Model Summary Sheet
· POS Attachment 1
· Subcontract Information Form (when applicable)
· Request for Taxpayer Identification Number and Certification Form (W-9)
· Authorization for Electronic Funds Payment Form (mandatory if not already on EFT)
· Contract Authorized Signatory Listing Form
· Clarification/Negotiated Adjustment Form (when applicable)
Name Title
Authorized Signature Date image1.png
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