Appendix J - Service Capacity Worksheet and Model Implementation Approval.pdf

This is an Appendix J Service Capacity Worksheet and Model Implementation Approval form for the Family Support Programs (25-RFA-13800) administered by Pennsylvania's Department of Early Childhood, specifically the Office of Child Development and Early Learning (OCDEL), Bureau of Early Intervention Services and Family Supports. The document serves as a planning tool for applicants seeking to provide Evidence Based Home Visiting (EBHV) services, which are designed to improve family health, increase school readiness, prevent child abuse and neglect, and promote positive parenting. Applicants must complete the worksheet for the first year of the agreement term (July 1, 2027 to June 30, 2028) and, if selected, the chart will be duplicated for Year 2. The form requires applicants to identify service locations (or indicate a single primary location per county), specify the EBHV model(s) to be implemented, identify the county or counties to be served, list direct service staff full-time equivalents (FTEs), document service capacity (the maximum number of families that can be served when fully staffed), and provide the amount requested and cost per family for each EBHV service.

Applicants must also submit the recommended caseload size for each selected EBHV model, expressed as the number of families per direct service staff FTE, and must ensure that staffing levels reported on this chart align with information provided in the cost submittal. Additionally, applicants are required to provide model developer implementation approval documentation for each model listed on the chart. The Department's priority is to maintain the presence of at least one Family Support Program in each of Pennsylvania's 67 counties. Applicants should not include enhancement details or requests on this capacity worksheet; such information is to be submitted separately.