3(u) SOW Licensed Clinical Social Worker.docx

Note: The terms Contractor, Contract Provider and Social Worker shall mean the provider or providers of care throughout this document.

1. Scope of Work. The Contractor shall provide personal medical services to all eligible beneficiaries within the capabilities normally granted to a Psychiatric Social Worker.

A. The Licensed Clinical Social Worker shall perform in accordance with established principles, practices and ethics the standards of performance for all employees provided by the contractor shall reflect the degree and care, skill and learning expected of a reasonably prudent healthcare provider in the Psychiatric Social Worker profession in the state of their practice.

B. The Licensed Clinical Social Worker will provide professional diagnostic assessments and evidenced based therapy U.S. Coast Guard members at Locations specified in the Performance Work Statement (PWS) (Attachment 3).

2. Qualifications. The Licensed Clinical Social Work services shall possess and maintain current licensure for the duration of this agreement:

A. A and a Masters or Doctorate Degree in Social Work from an ASWB (Association of Social Work Boards) accredited social work program B. An current unrestricted license for the practice of Clinical Social Work in one of the 50 United States C. A minimum of two (2) years direct clinical diagnostic practice ( within the last five years while holding the highest level of licensure in your state as a clinical social worker

D. A current certification in Basic Cardiac Life Support (BLS) for the Health Care Provider by the American Heart Association (AHA), American Red Cross (ARC), American Safety & Health Institute (ASHI) or the American College of Emergency Physicians (ACEP);

E. “No adverse action/ information on file” with the state board or National Practitioners Data Bank (NPDB).

3. Credentials Review. The contractor shall submit the following credentials with the proposal in order to be evaluated for technical acceptability.

A. A current curriculum vitae including the following information:

(1) Social security number;

(2) Current clinical social work license number;

(3) Date of birth (to be used only for the purposes of independent query of the NPDB);

(4) Tax identification number;

(5) Degrees earned;

(6) Career history;

(7) Professional Training/Courses and number of continuing education credits attained in the past two years; Professional organization affiliations and memberships;

(8) Three professional references within the last five years including name of organization, number of years services rendered, address and name of reference with telephone number and email;

(9) Evidence that Clinical Social Work has been practiced during 2 of the last 5 years immediately preceding performance under this contract;

(10) Awards and certifications received.

ATTACHMENT 3(u)

LICENSED CLINICAL SOCIAL WORKER SERVICES

B. Copies of:

(1) A degree from an accredited school with a Master's Degree in Clinical Social Work (a “Polaroid” picture is acceptable as a copy); school must be accredited by the ASWB (American Social Work Board)

(2) A current unrestricted license to practice as a Licensed Clinical Social Worker;

(3) Evidence of immunity to Hepatitis “A” and “B” and evidence of freedom from active communicable disease(s) i.e. TB

(4) Proof of insurability against malpractice in the amount of one million ($1,000,000) dollars per occurrence;

(5) Social Security Card;

(6) A current certification in Basic Cardiac Life Support (BLS) for the Health Care Provider by the American Heart Association (AHA), American Red Cross (ARC), American Safety and Health Institute (ASHI), or the American College of Emergency Physicians (ACEP).

(7) At least three (3) letters of recommendation from recent employers.

4. Professional Services. The Contractor shall perform a full range of a Licensed Clinical Social Worker, using government furnished facilities, equipment and supplies to a variety of patients. All aspects of Clinical Social Work services shall be commensurate with the capabilities of the provider and the Medical Department including but not limited to the items listed below and in the PWS.

A. Conduct diagnostic biopsychosocial assessments utilizing clinical interview techniques, mental status examination, collection of history from collaborative sources, psychometric screening tools, in collaboration with other clinic staff and TRICARE referrals, as needed for the purpose of determining of a Mental Health diagnosis and plan of treatment;

B. Develop, review and implement Treatment Plans for care of behavioral health conditions, providing follow-up care, discharge plans, and appropriate transfers to other health care facilities (psychiatric units, residential care, nursing homes, rehabilitation hospitals, MTFs, VA and civilian facilities) as indicated;

C. Provide outpatient care in individual, group, couples, and family modalities , exercising professional judgment and using a range of clinical skills to include evidenced based psychotherapy , psychoeducation and recommendations for lifestyle / behavioral change as appropriate D. Provide a health record entry for every patient utilizing prescribed behavioral health templates from the HSWL Service Center – Entries are made in the Electronic Health Record in accordance with the Coast Guard Medical Manual;

E. Evaluate fitness for unrestricted worldwide duty and document any mental health conditions or diagnosis that might adversely affect a member’s ability to safely and effectively carry out a mission;

F. Within HIPAA confidentiality guidelines, maintain professional communications with other Clinic Healthcare staff and Commands and provide consultation services regarding mental health issues including diagnosis, , treatment plans, prognosis and fitness for duty status;

G. Provide appropriate and timely evaluation, intervention and management for urgent and emergent problems as they occur in addition to providing regularly scheduled appointments. follow clinic guidance for crisis intervention protocol to ensure safety H. Provide immediate notification to the Medical Department should a medical emergency occur and report the nature of the emergency to the Commanding Officer or their authorized representative. Inform the Senior Coast Guard Medical Officer of any patient exhibiting significant non- compliance with the prescribed treatment program;

I. Make appropriate and timely mandated reports of abuse or neglect in accordance with Social Work licensure standards as well as Coast Guard Regulations and Medical Manual J. Plan, develop and maintain referral and care coordination services with other mental health resources and social service agencies to provide optimal patient care. Act as liaison with Work-Life personnel, Substance Abuse Program Specialists, Chaplains, EAP providers, civilian TRICARE

Mental health providers, Department of Defense mental health providers and psychiatric hospitals to coordinate care as needed;

K. Make appropriate referrals to specialists utilizing appropriate resources as directed by the clinic administrator. TRICARE Network resources will be used when availability exists within the TRICARE access standards. Use of other military treatment facilities is encouraged when/where available;

L. ;already covered above M. Participate in the Health Services Quality Improvement Program;

N. Collaborate with other behavioral health stakeholders in implementing psycho-educational programs, training and referral resources which might improve the level of behavioral health and awareness within a defined community or area of responsibility;

O. As requested by the Chief of Health Services or the Clinic Administrator, provide in-service training on Mental Health related issues to clinic personnel and (at Petaluma only) to students in the Health Services School;

P. Monitor rates of mental health related behavior and resource utilization, such as psychiatric admissions, suicide or suicide related behavior, domestic violence cases, substance abuse treatment, alcohol related incidents Q. In all aspects of care, follow applicable Coast Guard regulations, policies and directives.

5. Hours of Performance. The contractor shall provide all aspects of personal Psychiatric Social Work services at locations in the PWS (Attachment 3) and hours specified by the Clinic Administrator.