2-CFSS-Attachment 2-B Offer's Experience and Capacity.docx

Offer Forms Request for Proposal Solicitation No. BPM006769 Parenting Time Services State of Arizona Department of Child Safety Office of Procurement & Contracts 3003 N. Central Avenue, 20th Floor Phoenix, AZ 85012

Attachment 2-B Offeror’s Experience and Capacity The Offeror is cautioned that it is the Offeror's sole responsibility to submit information related to the evaluation categories and that the State of Arizona is under no obligation to solicit such information if it is not included with the Offeror's proposal. Failure of the Offeror to submit such information may cause an adverse impact on the evaluation of the Offeror's proposal. It is strongly discouraged for you to copy the Scope of Work in lieu of providing unique responses below.

OFFER MAY BE DETERMINED AS NON-RESPONSIVE IF ALL QUESTIONS ARE NOT ANSWERED FULLY.

Question 1: Describe the Entity’s experience providing parenting time services, including the number of years of experience, history and capability.

Offeror Response:

Child and Family Support Services (CFSS) has been contracted with the Department of Child Safety since 2012, the past thirteen (13) years, for the provision of Supervised Visitation Only (SVO) services. In addition to the Supervised Visitation contract, CFSS has been contracted to provide Parent Aide Services, In-Home Family Preservation / Placement Stabilization, and In-Home Family Reunification services. These former contracts are now incorporated in the current Nurturing Parenting and Family Connections contracts. While CFSS currently only provides Supervised Visitation services in Maricopa, Pima and Yavapai counties, we previously also served Coconino and Mohave counties. As a result of our long history of partnership with the Department in providing the continuum of reunification services, CFSS has significant understanding and historical perspective of the Scope of Work outlined in the new Parenting Time contract.

As we have been contracted for Supervised Visitation services under the existing contract, now in its seventh (7th) year, the CFSS leadership and supervisory teams have been through extensive yearly program compliance reviews. The CFSS Statewide Director of DCS programs has been in her role for the past eight (8) years. Without exception, a review of our site visits summaries will show that our scores and documented feedback are always exemplary. In fact, CFSS tracking tools, protocols and feedback were frequently provided to Daya Foster (DCS Statewide Service Coordinator for Supervised Visitation Only Services), at her request, to share with other agencies and within the Department. In addition to our historical participation in program reviews and service delivery, CFSS Case Aide Supervisors are well trained in the Scope of Work and are the leaders of their program service delivery and compliance. CFSS Case Aide Supervisors meet weekly for supervision with their teams. Weekly supervision addresses service delivery compliance with all timelines and engagement efforts; training and skills development around issues of child development, enhancement of parental protective factors, understanding trauma and addressing behavior challenges. Team meetings, designed to enhance camaraderie and communication, typically will focus on refreshers from CORE training; and brainstorming with teammates on how to work with families presenting with complex needs or various barriers. Daily communication occurs within the teams related to schedule changes, transportation, and practice guidance for resolution of barriers and issues.

CFSS was one of a handful of select agencies that participated in the workgroup coordinated between the Arizona Council of Human Services Provider and the Department of Child Safety to help redefine Parenting Time. This workgroup consulted and advised the Department on various aspects of the proposal including cost drivers, productivity assumptions, barriers to care, caseload sizes, appropriateness of referrals and “fit” with the existing Nurturing Parenting and Family Connections contracts. In addition to the select workgroup, CFSS has served on a variety of organizing meetings and committees over the past seven (7) years of the existing Supervised Visitation contract. These include:

· CFSS participates in the Child Welfare subcommittee of the Arizona Council of Human Services Providers. This subcommittee frequently meets with the executive leadership of the Department of Child Safety to consult and troubleshoot a variety of issues from addressing the waitlist issues to revision of the proposed Scope of Work for the new contract.

· CFSS participated in the 2023 DCS provider rate study conducted by Public Consulting Group.

· CFSS leadership attended all scheduled Supervised Visitation provider meetings, providing feedback and exploring performance measurements and quality improvement opportunities.

· CFSS staff have attended the training offered through the ADCS Child Welfare Training Institute.

· CFSS staff have been trained in the use of Guardian.

Child and Family Support Services has been providing behavioral health and child welfare services and supports since our inception in 2003. Our initial behavioral health work was heavily focused on prioritizing children in the foster care system and/or children at-risk of entering the foster care system and their parents. One of the hallmarks of our work has always been the effort to maintain children with their family in their communities of origin. Whenever children have been removed from their family, we remain committed to the concept of “forever” families ensuring that children are reunited with their parents whenever possible and safe.

CFSS provides a myriad of additional services across the state of Arizona. These services include different service mixes in different communities:

· DCS Supervised Visitation

· Direct Support Children’s intensive in-home behavioral health services

· Direct Support Young Adult wrap-around services

· Comprehensive Outpatient Behavioral Health Services (includes medication management, Child and Family Team facilitation, counseling, birth-to-five services, services to members with ASD and case management)

· Family and Community Teams (FACT) intensive services to transition youth home from acute care settings

This wide array of services allows CFSS to support children and families with a comprehensive approach in many communities. In communities where we do not have the comprehensive array of services (and in communities where we do) we collaborate with multiple child-serving agencies to develop the best possible plan for children and families.

With our history and background, CFSS was uniquely qualified to begin providing Parent Aide/Case Aide services when we were awarded the contract in 2012. CFSS embraced the statewide initiatives regarding the Protective Factors and the movement to trauma informed care. CFSS has provided all staff with extensive training in the trauma work of Doctor Bruce Perry and the Visitation work of Marty Byer Ph.D..

CFSS has a longstanding history for supporting children and families with complex and unique needs. CFSS utilizes our knowledge and resources to support parents to understand “big” behaviors in children. We work with families utilizing a trauma “lens” to help them interpret behaviors and respond with Positive Parenting approaches as they practice and improve their individual parenting skills.

CFSS understands the importance of foster families and offers encouragement to families and foster families to work together to support each child. When lines of communication between foster families and biological families need improving, CFSS staff work with DCS staff at all levels to reduce the strains and build positive relationships. CFSS understands and appreciates the complex role and significant work and commitment of the Department. We are committed to always being responsive and providing the DCS Specialist with timely communication and coordination as part of our service delivery. We are committed to attending Team Decision Making and Child and Family Team meetings and being active participants when requested.

Question 2: Provide a detailed plan of how your agency will be ready to serve cases on the go-live date, after award. The response shall at a minimum describe and provide a response for each of the following bullet points listed below:

· Provide the anticipated number of referrals your agency expects to have the capacity to serve on the first day of contract implementation.

· Does your agency anticipate an increase in capacity throughout the contract term? If yes, describe your plan for scaling up, including timelines, staffing, and resource allocation.

· Describe how your agency tracks and manages service capacity and the progression of referrals (cases) in real-time. What tools, systems, or processes do you use to ensure timely scheduling and service delivery?

Offeror Response:

As explained above, Child and Family Support has been providing Supervised Visitation services with the Department of Child Safety for the past thirteen (13) years. While the new Parenting Time Scope of Work has some modest changes, the key service provisions, timelines and compliance activities remain largely unchanged. In fact, with modest adjustments to our existing forms and documentation, CFSS will easily be ready for full implementation on the first day of a contract award. With this said, CFSS is also acutely aware of the planned overlap with referrals for legacy providers within the existing Supervised Visitation contract and the planned timelines for referral transition and full implementation utilizing only the Parenting Time Scope of Work.

With respect to agency capacity, Leadership and Case Aide supervisors review caseloads and capacity assumptions on a daily basis. CFSS teams project how many referrals are closing, probable service extensions, and any staff additions or planned turnover. This information is then compared to several internal weekly trend reports to assist with the number and timing of referral to be requested. On the Go-Live date of this solicitation, Child and Family Support Services is proposing the following capacity assumptions, by county (this includes any total combination of former Supervised Visitation or new Parenting Time referrals through the transition period):

· Maricopa County-total capacity of forty (40) families

· Pima County-total capacity of forty (40) families

· Yavapai County-total capacity of twenty (20) families

CFSS is proposing the minimum capacity assumptions we believe are sustainable and sound based on current staffing, recruitment trends, and historic Department referral volume in the respective Counties we are proposing to serve. If post-implementation trends support the assumption that CFSS can hire and sustain the referral volume to add more staff capacity, in collaboration with the on-going needs of the Department, we would be willing to increase our capacity and grow. CFSS has a dedicated Talent Acquisition department consisting of three (3) full-time recruiters. CFSS consistently interviews multiple times per week in each region we are proposing to serve.

CFSS Supervisors and leadership meet weekly to discuss progress for each family, no-shows and canceled visits or the need for make-up visits, barriers to visits, and the status of the service authorization or anticipated service extensions. This also includes any DCS Specialist requests to increase or decrease services, or any requested change in the location of the visits-which also may include home visit approval or allowance of unsupervised visitation time.

Question 3: Provide examples of challenges your agency has encountered in parenting time services and how you addressed them. Include challenges with maintaining contract capacity, if applicable.

Offeror Response:

Within the past year, Child and Family Support Services, an existing provider under the previous contract, met or exceeded the contracted capacity in Yavapai County but had struggles securing the staffing necessary to maintain the contracted capacity in Maricopa and Pima County. This was not an issue as the waitlist in both locations was eliminated and the contract had been unilaterally extended by the Department multiple times.

As was the case with all contracted Supervised Visitation (SVO) providers, in the early years of the current SVO contract implementation, CFSS did partner with the Department in weekly Capacity Reporting activities. CFSS worked to report on caseload sizes, recruiting and hiring activities, as well as projected referral needs. In the initial years after the contract award, providers had to coordinate a variety of factors to determine team sizing, caseload needs and the availability of referrals. Prior to the current service waitlist, there was more system capacity than demand. Providers were able to obtain new referrals based on DCS volume in a given county and that provider’s relative placement on the referral grid determined by their cost. Essentially, the higher an agency’s proposed pricing, the lower they were on the referral grid. This created a dynamic whereby more “expensive” agencies had less access to new referrals as lower costs agencies ahead of them on the grid order were able to fill their capacity first. As a result, through attrition or business demands, available referrals quickly determined provider capacity as agencies lower on the grid order were forced to “rightsize” their teams. Over time the lower cost agencies were not able to sustain their practice and maintain sufficient employees, which arguably played a significant role in the capacity shortfall leading to the current waitlist. Throughout this process, in collaboration and full transparency with the Department, CFSS made the decision to discontinue Supervised Visitation services in Mohave and Coconino counties based on a lack of available referrals and sufficient network capacity at the time of the agreement.

At no point did CFSS request a reassignment of referrals nor has CFSS failed to provide visitations at the frequency and amount of time requested for assigned referrals. CFSS also was not issued a Corrective Action Plan (CAP) or any Demand Assurance notification. As outlined in question 2 of this attachment, there were unforeseen challenges as a result of the initial lack of available referrals as a function of the referral grid methodology. In many instances, this drove down reimbursement rates. As agencies were no longer able to sustain staffing levels and operations over time, when referrals became more abundant, the systemic capacity was no longer at the same levels as the initial contract award. Simultaneously, based on global economic conditions, workforce wage demands and work from home expectations surged. As a result, the contracted agencies, including CFSS and ADCS, were unable to rapidly hire or even effectively maintain existing workforce levels to match the pre-pandemic contract awards.

In the current environment, post pandemic with a sustained service waitlist, CFSS has been extremely proactive in a variety of programmatic and talent-development efforts. Programmatically, families that are inconsistent or difficult to engage are assigned to supervisors in order to free up more caseload capacity for our Case Aide staff. Additionally, CFSS has implemented Cancellation Teams within our Pima and Maricopa County programs. These teams allow our supervisors to strategically over schedule visits which serves to increase caseload sizes. Over-scheduling allows for staff that have cancellations or no-shows to still hit their target hours without having to work to reschedule on their assumed days off. This aids with morale (staff retention) and productivity while the Cancellation Team coordinates any make-up visits or overflow. Finally, in the face of unprecedented workforce shortages and explosive salary demands, CFSS has increased base hourly pay by 30% since the original contract award.

While CFSS has experienced the same level and degree of staff turnover and workforce shortages as other social services agencies, the previously referenced strategies to mitigate these impacts has had significant positive qualitative results. Despite the strategies implemented, including significant hourly wage increases, CFSS continues to struggle to maintain staffing levels given the current DCS reimbursement rates and workforce competition from the general community. Wage expectations, flexible work hours, and cost of housing are significant challenges for employers and the workforce we are attempting to hire. When these factors are coupled with the lack of any service waitlist and dwindling SVO referrals, maintaining efficient and productive team size and structure has been challenging.

Question 4: Describe your agency's experience in partnering with Child Welfare entities and/or other related fields, including examples that required collaboration and coordination.

Offeror Response:

As mentioned previously, Child and Family Support Services has been contracted with the Department of Child Safety for the provision of Supervised Visitation services for the past thirteen (13) years. Since the original contract in 2012, we have also been contracted to provide In-Home Family Preservation / Placement Stabilization services, In-Home Family Reunification services and Parent Aide services with the Department. As a result of this long-standing partnership, we have built strong relationships, credibility and trust with many DCS Specialists, Unit Supervisors, Program Managers and even the Executive Leadership teams. We have always enjoyed very close, collaborative and professional working relations with the Fidelity and Compliance teams at ADCS. We have made it a purposeful focus to understand the mission and vision of ADCS so that we can operate as effective partners to meet the goals and objectives of each family’s case plan.

In addition to strong working relationships within the Department, CFSS also has worked extensively with countless Court Appointed Special Advocates (CASA), Guardian Ad Litem (GAL), foster and adoptive parents, Health Plans as well as a host of other child welfare and behavioral health service providers. Child and Family Support Services, as a licensed behavioral health outpatient clinic, is contracted with AHCCCS and all six (6) current AHCCCS Complete Care (ACC) health plans state-wide serving more than 2800 enrolled youth and families presenting with complex behavioral health needs. As such, the CFSS Case Aide teams have unprecedented access to tremendous resources and support related to training on trauma, autism and a variety of mental health disorders and treatments; care management and coordination; Child and Family Team facilitation; and administrative support much greater than would typically be afforded by smaller programs within an agency.

Perhaps the best example of how we partner with the Department can be summarized from a recent incident where a parent was not picked up by MTM, the DCS contracted transportation vendor. This situation speaks to the character of the agency and the commitment of our teams. It’s likely a situation that will never come to the full attention of DCS leadership, but unfortunately it occurs far too often.

On Friday, February 21, 2025, the CFSS Tucson team coordinated a visit for Tam Leo and her daughter. The services occur at the Recreation Center on the Tohono O’odham reservation 35 minutes outside the town of Sells. When the scheduled visit ended at 2:00 PM the scheduled MTM (formerly MTBA) driver was not present so the DCS Supervisor that was covering the visit contacted MTM for the parent. MTM assured that a driver had been dispatched and should arrive within 45-minute. The parent suggested she was fine to wait so the CFSS Supervisor left.

Knowing the relative issues with transportation reliability, particularly on the reservation, the CFSS Supervisor continued to check in with the parent. Two hours after the estimated 2;45 pick up time (6;45PM) the transportation company still did not pick up the mother. The CFSS Supervisor again contacted MTM who suggested they arrived at the Rec Center and the parent was unable to be located. The parent suggested she was outside charging her cell phone and despite letting others know she was awaiting transportation, nobody ever came. MTM suggested they would again re-route a driver to pick-up the waiting mother.

The CFSS Supervisor grew concerned when the waiting mother stopped responding to text and phone calls and contacted the Sells police department to request a welfare check. The Sells police were unable to dispatch an offer at that time. Concerned about the safety and welfare of the waiting mother, the CFSS supervisor contacted the Program Manager who contacted the Chief Business Officer for further guidance. Uber and Lyft were not options on the Reservation due to lack of a pickup address (only GPS coordinates and mile markers are accessible on the Reservation). At this point the decision was made to contact the ICWA Case Manager who again contacted the Sells police department and requested another welfare check and transport. This time the Sells PD were able to dispatch an officer who picked up the waiting mother and transported her to Arizona City where she was met by the CFSS Program Manager. By this time it was after 11:00 PM and the mother was cold, tired and had not eaten.

The CFSS Program Manager stopped to make sure the mother had a meal then transported her to her home (in Phoenix) arriving at approximately 1:00 AM. The CFSS Program Manager then drove herself back to Tucson arriving at her home at approximately 3:00 AM.

End of Attachment 2-B Solicitation Instructions Part 2 A v a i l a b l e SECTION 2-D: Offer Forms, Attachment 5-B o n l i n e a t :

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