Attachment_2a_SAMPLE_PWS_Direct_Care.pdf

SAMPLE Performance Work Statement for Direct Care and Supervision Services

1. GENERAL INFORMATION

1.1 Background

The Administration for Children and Families (ACF), Office of Refugee Resettlement (ORR) is responsible for the care and placement of unaccompanied children (UC) transferred from the Department of Homeland Security. In accordance with the Homeland Security Act of 2002 and the Trafficking Victim Protection Reauthorization Act (TVPRA) of 2008, ORR is responsible for providing care and custody of all UC who have been referred by the U.S. Department of Homeland Security (DHS) within 72 hours of apprehension. ORR has worked to increase permanent bed capacity in state licensed care facilities to align with increased referrals year over year since passage of the TVPRA. Unfortunately, due to shifting and unpredictable migration patterns, ORR has experienced several periods when UC referrals far exceeded available bedspace capacity leading to significant and lengthy backups along the Southwest Border. This includes a historic increase in FY 2021 when ORR received over 100,000 UC referrals in less than six months posing significant child safety. To better prepare for future surges, ORR has an urgent need for Influx Care Facility (ICF) sites across the country to augment its permanent bed capacity. These ICF sites will allow ORR to accept referrals from U.S. Border Patrol more expeditiously and limit the time UC spend in Border Patrol facility.

1.2 Purpose

The purpose of this Performance Work Statement (PWS) is to specify ORR’s requirements for the provision and operation of ICFs and related services throughout the continental US. Under this PWS, the Contractor(s) shall provide Direct Care of UC including all personnel, services, and resources necessary to provide for the care and supervision of UC housed at the ICF.

Prime contractor capabilities, experience, subcontractor base, community-network, and expertise related to the provision of safe and appropriate care and support of UC, and/or similarly situated at-risk minor populations, are critical to the success of this effort.

1.3 Policy and Reference Documents

ICF operations shall be in accordance with the following:

• ORR Policy Guide, Children Entering the United States Unaccompanied:

https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied

• Policy for Influx Care Facilities (See Section 7 of ORR Policy Guide referenced in Section 1.3.1.1 above): https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-7#7.1

• ORR Field Guidance containing updates to ICF standards: https://www.acf.hhs.gov/orr/policy-guidance/uc-program-field-guidance https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-7#7.1 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-7#7.1 https://www.acf.hhs.gov/orr/policy-guidance/uc-program-field-guidance https://www.acf.hhs.gov/orr/policy-guidance/uc-program-field-guidance

• ORR Key Documents: https://www.acf.hhs.gov/orr/policy-guidance/unaccompanied-children-program

• The Contractor shall comply with ORR Policy related to preventing, detecting, and responding to sexual abuse and harassment in accordance with ORR’s Zero Tolerance Policy(See Section 4.5.3 of ORR Policy Guide referenced in Section 1.3.1.1 above)::

https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-4).

• UC Manual and Procedures (UC MAP) provides procedures that operationalize ORR policy. The UC MAP is accessed through ORR’s online case management system which will become available for Contractor access after award.

Performance requirements are based upon policy, regulations, and guidelines. The Contractor is responsible for staying up to date with policy and regulatory changes and should adapt to the evolving nature of the working environment. The Contractor shall notify the Contracting Officer’s Representative (COR) in the event of any significant discrepancies.

1.4 Type of Contract

The Government intends to award a Firm Fixed Price type contract.

1.5 Period of Performance

The Period of Performance (POP) will be a 6-month base with 2 3-month option periods.

1.6 Place of Performance

Contractors will be expected to primarily work on site at the ICF. The ICF location of the site will be Southwestern United States.

The place of performance for the staffing/planning phase will be at the Contractor’s site.

The population size (also referred to as census) will be determined by the capacity of the site provided by the Contractor. Total capacity for the site shall accommodate between approximately 500 and 2000 UC. Capacity will be determined by the site and facilities provided by the Contractor.

The population may vary due to changes in the overall UC population across the program. The Contractor must have the capability to adapt to changing conditions. When the census is increasing, the Contractor must accommodate by increasing staff and support services. When the census is decreasing, the Contractor must have the ability to scale back staffing and services down to 500 population.

https://www.acf.hhs.gov/orr/policy-guidance/unaccompanied-children-program https://www.acf.hhs.gov/orr/policy-guidance/unaccompanied-children-program https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-4

1.7 Overview of Required Services (Flores and Adherence to ORR Policy) The Contractor shall provide all services, resources, equipment, and staff necessary for Direct Care and Supervision of UC. The scope of services under this effort includes providing for the care, housing, and supervision of UC ages 13 - 17 in ORR custody until such time as: the UC can be released to an ORR-approved/vetted sponsor, the UC is transferred to another ORR facility, or the UC is transferred as directed by the Government. Note: the population of ICF’s will generally be limited to UC aged 13 and above; however, the Contractor may be required to house minors under the age of 13 who are part of a sibling or family group at the direction of ORR. All services provided to UC must be tailored to the unique needs of UC and commensurate with their age, gender, level of development, and other demographics such as country of origin, language-spoken, etc.

Factors other than age are considered when assigning UC to an ICF. These factors are provided in ORR Policy Guide Section 7.2.1.

ICF shall comply with all applicable State child welfare laws and regulations and all state and local building, fire, health, and safety codes. ICF must deliver services in a manner that is sensitive to the age, culture, native language, and needs of each unaccompanied child. Under the terms of the Flores Settlement Agreement, ICF must provide the following minimum services for each UC in their care:

Proper physical care and maintenance, including suitable living accommodations, food, appropriate clothing, and personal grooming items.

Appropriate routine medical and dental care, family planning services, including pregnancy tests and comprehensive information about and access to medical reproductive health services and emergency contraception, and emergency health care services; a complete medical examination (including screenings for infectious diseases) within 48 hours of admission, excluding weekends and holidays, unless the UC was recently examined at another ORR care provider facility;

appropriate immunizations as recommended by the Advisory Committee on Immunization Practices’ Child and Adolescent Immunization Schedule and approved by HHS’ Centers for Disease Control and Prevention; administration of prescribed medication and special diets;

appropriate mental health interventions when necessary.

An individualized needs assessment, which includes the various initial intake forms, collection of essential data relating to the identification and history of the child and his or her family, identification of the UC’s special needs including any specific problems which appear to require immediate intervention, an educational assessment and plan, and an assessment of family relationships and interaction with adults, peers and authority figures; a statement of religious preference and practice; an assessment of the UCʼs personal goals, strengths and weaknesses;

identifying information regarding immediate family members, other relatives, godparents or friends who may be residing in the United States and may be able to assist in connecting the child with family members.

Educational services appropriate to the UCʼs level of development and communication skills in a structured classroom setting Monday through Friday, which concentrates primarily on the development of basic academic competencies, and secondarily on English Language Training. The educational program shall include instruction and educational and other reading materials in such languages as needed. Basic academic areas should include Science, Social Studies, Math, Reading, Writing and Physical Education. The program must provide UC with appropriate reading materials in languages other than English for use during leisure time.

Activities according to a recreation and leisure time plan that include daily outdoor activity – weather permitting – with at least one hour per day of large muscle activity and one hour per day of structured leisure time activities (that should not include time spent watching television).

Activities should be increased to a total of three hours on days when school is not in session.

At least one individual counseling session per week conducted by trained social work staff with the specific objective of reviewing the child’s progress, establishing new short- term objectives, and addressing both the developmental and crisis-related needs of each child.

Group counseling sessions at least twice a week. Sessions are usually informal and take place with all UC present. The sessions give new children the opportunity to get acquainted with staff, other children, and the rules of the program. It is an open forum where everyone gets a chance to speak.

Daily program management is discussed, and decisions are made about recreational and other activities. The sessions allow staff and unaccompanied alien children to discuss whatever is on their minds and to resolve problems.

Acculturation and adaptation services, which include information regarding the development of social and interpersonal skills which contribute to those abilities necessary to live independently and responsibly.

A comprehensive orientation regarding program intent, services, rules (written and verbal), expectations, and the availability of legal assistance.

Whenever possible, access to religious services of the child’s choice.

Visitation and contact with family members (regardless of their immigration status), which is structured to encourage such visitation. The staff must respect the child’s privacy while reasonably preventing the unauthorized release of the UC.

A reasonable right to privacy, which includes the right to wear his or her own clothes when available, retain a private space in the residential facility, group or foster home for the storage of personal belongings, talk privately on the phone and visit privately with guests, as permitted by the house rules and regulations, receive and send uncensored mail unless there is a reasonable belief that the mail contains contraband.

Services designed to identify relatives in the United States as well as in foreign countries and assistance in obtaining legal guardianship when necessary for the release of the unaccompanied alien child.

Legal services information, including the availability of free legal assistance, the right to be represented by counsel at no expense to the government, the right to a removal hearing before an immigration judge, the right to apply for asylum or to request voluntary departure in lieu of deportation. This information is included in the Legal Resource Guide for Unaccompanied Alien Children.

The defined and priced requirements under this contract shall be measured in terms of facility capacity for UC general population beds, facility capacity for UC medical isolation/quarantine beds, staffing support for UC general population beds, staffing support for UC medical isolation/quarantine beds, and one-time Demobilization/Site Reclamation/Restoration.

The Contractor will maintain sufficient personnel necessary to accommodate the minimum staffed capacity at all times as determined by ORR. This will be between 500 and 2000 children depending upon the site, facilities and infrastructure at the site

The Contractor shall use staffing plans (including the use of standing posts and deploying staff beyond minimum ratios) when the facility design/layout may make direct line of sight supervision challenging. The Contractor shall make recommendations for housing UC in a manner that achieves these goals for approval by ORR. In addition, the Contractor is encouraged to conduct outreach and partner with local non-governmental and community-based organizations to the greatest extent possible.

The Contractor shall provide all staffing necessary to accommodate the ORR-stated capacity of the ICF site, taking into consideration demographics of the UC, as well as medical status of the UC. At all times, the Contractor shall maintain and operate in a manner that promotes child safety and that adheres to child welfare practices, as mandated in ORR policy. The Contractor shall provide sufficient staffing, in accordance with ORR mandated ratios, all times to provide line of sight supervision of UC both during waking and sleeping hours.

The Contractor shall use creative solutions to maintain line of sight supervision while physically segmenting children into smaller groups, including but not limited to temporary partitions and other devices approved by the COR. The Contractor shall use staffing plans (including the use of standing posts and deploying staff beyond minimum ratios) when the facility design/layout may make line of sight supervision challenging and as needed to maintain line of sight supervision.

make recommendations for bed placement and housing UC in a manner that achieves these goals, subject to approval by the COR. The Contractor is encouraged to conduct outreach and partner with local non-governmental and community-based organizations to the greatest extent possible.

As part of the services provided by the Contractor under the terms of the contract, and with the approval of the COR, the Contractor is encouraged to bring in services from the community to support UC program, such as visits from local organizations, cultural activities, and sports/recreation organizations. Costs for these services may not be passed on to the Government without the explicit pre-approval of the CO, in writing.

1.8 Staffing

Staffing shall be provided based on staff to child ratios established for ICFs identified in Children Entering the United States Unaccompanied Section 7.7.

The Contractor’s staffing model shall be flexible and able to accommodate both expansion and contraction of staff commensurate with the capacity limits directed by ORR. The Contractor shall develop staff recruitment and retention strategies and models that limit cost expenditures and minimize the time necessary to meet the capacity levels directed by ORR including meeting mandatory ORR staffing ratios and adhering to ORR background check requirements. The Contractor is encouraged to recruit and maintain a labor pool of individuals who have a current Public Trust Background Check completed by a Federal agency. The use of teaming arrangements and partnerships with non-profit organizations, local organizations and businesses, social service organizations, and other entities with broad experience serving unaccompanied children, migrant populations, and other similarly situated populations is strongly encouraged.

Background Investigation

Only Contractor staff (and volunteers) who have been cleared through a fingerprint-based, federal background check, are permitted to supervise direct care staff. Staff and volunteers who provide direct care must pass public record criminal background checks for deployment at ICF.

Additionally, all medical providers must maintain current state licensure, possess clean background checks, and clean child abuse and neglect checks in the staff's state(s) of U.S.

residence for the last 5 years. Staff who will have unsupervised direct access (e.g., physically present) to UC must have an FBI based background check, and child abuse and neglect checks in the staff's state(s) of U.S. residence for the last 5 years (if not waived or modified by ORR). Staff who do not have direct access to children must have a public records criminal background check and be under the direct supervision and control at all times of staff who have completed FBI based background and child abuse and neglect checks. Background checks will be conducted by the Contractor. ORR will ensure receipt of background checks for ICF staff. Staff and volunteers who provide direct care may not have unsupervised contact with UC until all background checks have been completed.

In accordance with OMB Memorandum M-05-24, federal agencies must have verified and/or completed background investigations for contractors who require access to HHS information, IT systems, other than occasional or intermittent access to HHS-controlled facilities, or any combination of these three. To gain the required access and successful award, the Contractor shall comply with Homeland Security Presidential Directive 12, Policy for a Common Identification Standard for Federal Employees and Contractors, and with the personal identity verification and investigation procedures contained in:

• HHS Information Security Program Policy https://www.hhs.gov/about/agencies/asa/ocio/cybersecurity/information-security-privacy-program/index.html

• HHS Continued Implementation for the HSPD-12 Program, dated January 13, 2017

• OPM Final Credentialing Standard, dated June 2008

• OMB M-05-24, dated August 5, 2005, Implementation of Homeland Security

Presidential Directive (HSPD) 12 --Policy for a Common Identification Standard for Federal Employees and Contractors

• Executive Order 13467 https://www.opm.gov/forms/pdf_fill/sf85p.pdf https://www.hhs.gov/about/agencies/asa/ocio/cybersecurity/information-security-privacy-program/index.html https://www.hhs.gov/about/agencies/asa/ocio/cybersecurity/information-security-privacy-program/index.html

The minimum Government investigation is a HSPD-12 PIV Credential Tier 1 (National Agency Check and Inquiries--NACI), which consists of searches of records covering specific areas of a person’s background during the past five years. However, Contactors supporting ORR shelter operations including licensed facilities, Influx Care Facilities, including those Contractors providing operations support to these facilities (i.e. all Contractor staff who have access to children) must achieve a HSPD-12 PIV Credential Tier 2 (Minimum Background Investigation— MBI) Moderate Risk Public Trust. HHS will process HSPD-12 PIV background investigations for all Contractor staff and the ORR COR shall provide instructions for completing this process. All costs shall be borne by HHS; however, Contractor’s staff shall be required to submit fingerprints, complete various forms, and participate in interviews with investigators, as applicable. Contractors shall ensure the employees whose names they submit have a reasonable chance for access approval. In some cases, employees with existing background investigations commensurate with sensitivity designations will expedite performance.

This requirement applies to all subcontractors supporting ORR programs. The Contractor is responsible for the custody and control of all forms of HSPD-12 Credentials issued by HHS to Contractor employees, including all subcontractor employees. The Contractor shall immediately notify the Program Manager when a Contractor or subcontractor employee no longer requires agency access due to transfer, completion of a project, retirement, removal from work on the contract, or termination of employment. The Contractor shall also ensure that Contractor or subcontractor employees comply with HHS requirements concerning the renewal, loss, theft, or damage of an ID card. Failure to comply with the requirements for custody and control of HHS issued ID cards may result in a delay in withholding final payment or contract termination, based on the potential for serious harm caused by inappropriate access to HHS facilities, sensitive information, information systems or other HHS resources.

2 DIRECT CARE SERVICES REQUIREMENTS

2.1 General

The Contractor shall provide all personnel and services necessary to care for UC housed at the ICF. Program rules and discipline standards shall be formulated with consideration for the range of ages and maturity in the program and shall be culturally sensitive to the needs of minors. Employ strength-based behavior management and trauma-informed care approaches and never hit, harass, humiliate, or degrade an unaccompanied child or staff member. Use strength-based behavior management and trauma-informed care approaches, such as using conflict resolution, problem solving skills, using rewards and consequences and de-escalation techniques, and helping children and youth learn accountability and self-control.

The Contractor shall establish a Code of Conduct in accordance with ORR Policy 4.5.3 that will include the following:

• Staff will not engage in any form of sexual abuse or sexual harassment, as defined at Section 4.1 of ORR’s UC Policy Guide.

• Staff will not verbally or physically abuse any unaccompanied alien child.

• Staff will not engage in sexual contact with anyone while on duty or while acting in the official capacity of their position.

• Staff will not exchange letters, gifts, pictures, phone numbers, e-mail addresses, or social media information with any UC in ORR care or within three years of the child’s discharge.

Requests for exceptions must be submitted in writing to and approved by care provider management.

• Staff may not have contact with any unaccompanied alien children outside of the care provider facility beyond that necessary to carry out job duties while the child is in ORR care or within three years of the child’s discharge. Requests for exceptions must be submitted in writing to and approved by care provider management.

• Staff must confine their relationships with UC families and sponsors to those activities which fall within the scope of the staff’s job duties. Requests for exceptions must be submitted in writing to and approved by care provider management.

• Staff may not engage in a romantic or sexual relationship with a UC while the child is in ORR care or within three years of the child’s discharge.

• Staff may not live with a UC within three years of the child’s discharge.

• Staff must report knowledge, suspicion, or information about sexual abuse, sexual harassment, or inappropriate sexual behavior according to mandatory reporting laws, Federal laws and regulations, and ORR policies and procedures.

• Staff with knowledge or information of a staff violating this Code of Conduct must report this knowledge or information to their supervisor.

• Staff have a continuing affirmative duty to disclose any misconduct that occurs on or off duty.

Minors shall not be subjected to corporal punishment, humiliation, mental abuse, or punitive interference with the daily functions of living, such as eating or sleeping. Any sanctions employed shall not: (1) adversely affect either a minor's health, or physical or psychological well-being; or

(2) deny minors regular meals, sufficient sleep, exercise, medical care, correspondence privileges, or legal assistance. Care provider facilities must immediately terminate any staff member who violates this Code of Conduct. Care provider facilities must suspend any staff member suspected of violating this Code of Conduct pending investigation

Regardless of whether staff is counted in the child/caregiver ratio, each employee must, in the absence of a more specific rule requirement, demonstrate competency, prudent judgment, and self-control in the presence of children and when performing assigned responsibilities.

2.2 UC Orientation

Upon admission, the Contractor shall provide UC with a comprehensive orientation regarding program intent, services, rules (written and verbal), expectations and the availability of legal assistance.

ORR Policy 2.2.2 Orientation

2.2.1.1 Care providers must have a standardized orientation that is provided to all admitted UC.

The orientation must be provided within 48 hours of admission and must be presented in a fashion that is appropriate for the age, culture, and language of the child or youth. The orientation must be provided in formats that are accessible to UC who are limited English proficient, deaf, visually impaired, or otherwise disabled, as well as those who have limited reading skills.

2.2.1.2 If the UC is not literate, the care provider must verbally explain all the documents in the UC’s native or preferred language. If forms are not translated into a language that the UC can read, the care provider staff must verbally translate the document for the child or youth.

Care providers lacking staff who speak a UC’s native or preferred language must make every attempt to utilize a professional translation service for the UC’s orientation. In cases where no such service exists, or is unavailable, then care providers must consult with the ORR FFS, the Care Coordinator, and other relevant stakeholders to create and implement a strategy for communicating with the child as effectively as possible.

2.2.1.3 The orientation shall also address ORR Policy 4.7.1 Educating Children and Youth on Sexual Abuse and Sexual Harassment.

2.2.1.4 As part of the orientation, the care provider must also provide UC a tour of the facility and note emergency evacuation routes and exits. The orientation must include the following information: an explanation of the nature of the UC’s custody in ORR; the care provider’s rules, responsibilities, and procedures; the UC’s rights and responsibilities, including general legal-related information; the care provider’s behavior management policies; the care provider’s grievance policies and procedures; emergency and evacuation procedures;

and other policies and procedures to help the child or youth adjust to the new setting. The tour shall also include distribution of PSA pamphlets and presentation of PSA Posters with UC Sexual Abuse hotline and other reporting numbers, as well as the pre-programmed phones for kids to report sexual abuse and harassment.

2.3 Case Management Services

The contractor shall provide on-site case management services to meet the unique needs of the UC population. For the purposes of this statement of work, case management includes both services related to supporting UC behavioral health including referral and access to services include counseling and other supportive services, as well as all activities related to the unification of UC with an ORR-approved, vetted sponsor. A combination of in-person and distance/virtual-based assistance is appropriate as determined by the COR.

• The contractor shall contact and engage potential sponsors to initiate sponsor assessments, including performing background checks, child abuse and neglect checks, and sex offender registry checks in accordance with ORR policies, procedures, and field guidance-https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-4 .

• The contractor and its personnel shall comply with all applicable State child welfare laws and regulations, and all State and local health and safety codes. The contractor and its care providers shall deliver services in a manner that is sensitive to the age, culture, native language, and needs of each unaccompanied child. The contractor shall develop an Individual Service Plan for the care of each child (per ORR Policy Guide Section 3.3).

• The contractor shall make determinations on sponsor suitability by thoroughly vetting the sponsor identity and confirming the validity of government-issued identity documents as required by the field guidance issued for each applicable UC category. The contactor shall provide Sponsor Related Updates for the UC Reviews as needed for each UC.

• The contractor shall coordinate with ORR care providers, consulates, international bodies, child advocates, third-party coordinators, and U.S. Federal agencies.

• The Contractor shall support family unification services designed to identify relatives in the United States as well as in foreign countries and assistance in obtaining legal guardianship when necessary for the release of the unaccompanied child. The Contractor must be familiar with ORR Policy Guide Section 2, UC MAP Section 2, and relevant Field Guidance. The Contractor shall adhere to timelines and requirements outlined by ORR Policy related to unification. ORR Policy Guide Section 2: Safe and Timely Release from ORR Care outlines the family unification process in detail, including the roles and responsibilities and required services. Some of the required assessments are outlined below:

o ORR Policy 2.4 Sponsor Assessment Criteria and Home Studies states that: As noted in the Section 2.2 Application for Safe and Timely Release of an Unaccompanied Child from ORR Care, the application process for release of an unaccompanied child involves a number of steps, including background checks (see Section 2.5 ORR Policies on Requesting Background Checks) and submission of the application by the sponsor. This section describes the criteria ORR uses to assess each potential sponsor’s ability to provide for the physical and mental well-being of the unaccompanied child, and the role of home studies in the process.

o The sponsor assessment reviews a sponsor’s strengths, resources, risk factors and special concerns within the context of the UC needs, strengths, risk factors, and relationship to the sponsor. ORR also determines whether to conduct a home study, as required by the law or as necessary to ensure the welfare of the child.

• The contractor shall coordinate with ORR stakeholders to unify UC with the respective sponsors.

• The staffing model must include shift work from 8 am – 8 pm, 7 days a week, including holidays to maximize availability for sponsor access.

• The qualifications for case management staff roles are as follows:

o Lead Clinician: Master’s degree in social work, 2 years of postgraduate direct service delivery experience or a Master’s degree or Ph.D. in psychology, sociology, or other relevant behavioral science in which clinical experience is a program requirement, plus 2 years of postgraduate direct service delivery experience/or bachelor’s degree plus 5 years clinical employment experience in the behavioral sciences. Must have supervisory experience and be licensed to provide clinical services in the State where the care provider is located.

o Clinician: Master’s degree in social work with clinical experience in the program, or Master’s degree in psychology, sociology, or other relevant behavioral science in which direct clinical experience is a program requirement, or a bachelor’s degree plus 5 years clinical employment experience. Must be licensed or eligible for licensure.

o Lead Case Manager: Master’s degree in the behavioral sciences, human services or social services fields or bachelor’s degree and at least 3 years progressive employment experience that demonstrates supervisory and case management experience.

o Case Manager: Bachelor’s degree in behavioral sciences, human services, or social service fields. Must have at least one year of experience working with child welfare standards, best practices, or quality assurance or compliance.

o Teacher: Bachelor’s degree; certification by the relevant governing authority, Teaching English as a Second Language/Teaching English to Speakers of Other Languages certification or other appropriate accrediting body and additional training to meet the special needs of unaccompanied children.

o Youth Care Worker: High school diploma or equivalent degree and a minimum of 1 year of employment experience in the child welfare field working with children and/or adolescents in a social service setting.

2.4 Case Management Services – Performance Requirements Summary

Table 1 - Case Management Services Performance Requirements Summary

Required Service PWS Section

Performance Standard Summary

Maximum Allowable Deviation/Definition of Success

Method of Surveillance

Case Management Fundamentals The Contractor shall provide case management services to meet the unique needs of the UC population.

2.3 - A process for case management services is proposed and maintained, with a focus on family reunification.

- Culturally sensitive and age-appropriate case management services is provided.

- An initial intake assessment and an individual service plan for the care of each child is completed.

- A ratio of 50% on-site to 50% virtual case management services is maintained. Ratio of unification staff may vary.

- Language/ Translation services per individual service plan is provided for all UCs within 48 hours of admission

- Initial assessments are completed for all UCs within 24 hours of admission to program

- Individual Service Plans are completed for all of UCs within 7 days of admission to program

COR will monitor contractor provided data.

- Periodic inspection of Portal timestamps

Sponsor Assessment The Contractor shall contact and engage potential sponsors to initiate sponsor assessments, including performing background checks and vetting the sponsor identity to make

2.3 - A process for case management services to identify potential sponsors and complete the initial sponsor assessment is proposed and maintained.

- All contract requirements connected with assessing the

- Sponsor application packets are completed for all of UCs within 7 days of admission to program

- Sponsor background checks, abuse and neglect checks, and sex offender registry checks are completed for all of UCs

COR will monitor contractor provided data.

- Periodic inspection

Required Service PWS Section

Performance Standard Summary

Maximum Allowable Deviation/Definition of Success

Method of Surveillance recommendations for timely reunifications.

suitability of potential sponsors are carried out.

- All contract requirements connected with confirming the identity of potential sponsors are carried out.

within 10 days of admission to program

- Sponsor background identification authentication is completed for all of UCs within 10 days of admission to program

- Family unification process or transfer to a traditional licensed facility is completed for all UCs within 30 days of admission to program

Staff Compliance The Contractor and its personnel shall comply with all applicable State child welfare laws and regulations, meet ORR minimum standards for deployment to an Influx Care Facility (ICF) facility including necessary background checks, and shall follow procedures consistent with relevant provisions in the ACF ORR Policies and UC Manual of Procedures (UC

MAP).

2.3 - A process for internal compliance audits is proposed and maintained.

- A process for ensuring staff meet required background checks is proposed and maintained.

- Quarterly internal compliance audits are completed

- At least 75% of personnel and volunteer records for staff with unsupervised direct access to UCs contain documentation of FBI-based background check, within 1 days of deployment

- At least 75% of personnel and volunteer records for staff who do not have direct access to UCs contain documentation of a public records criminal background check, within 3 days of deployment

COR will monitor contractor provided data.

- Compliance Audit results

- Periodic inspection of Portal timestamps

- Periodic inspection of personnel records

Staff Capabilities The Contractor shall provide the required capabilities to maintain a cadre of qualified staff to provide case management services and shall provide a staffing and supervision plan.

2.3 - A competent core management group is provided and maintained, along with an up-to-date list of this group, their skills and competencies.

- A staffing and supervision plan is provided that meets minimum staffing ratios.

- Updated key personnel matrix is provided no later than 2 days after changes occur.

- Key personnel turnover rate <25%.

COR will monitor contractor provided data.

- Key personnel turnover statistics

Required Service PWS Section

Performance Standard Summary

Maximum Allowable Deviation/Definition of Success

Method of Surveillance

Staff Training The Contractor shall train staff on ORR policies and procedures, cultural competence training, and child-welfare best practices.

2.3 - All staff receive required training.

- Training materials are reviewed and approved by COR and ORR, before staff trainings occur.

- Completion of training certificates are maintained in personnel records

COR will monitor contractor provided data.

- Periodic inspection of personnel records

Staff Coordination/Updates to Stakeholders The Contractor shall coordinate with ORR stakeholders, consulates, international bodies, child advocates, third-party coordinators, and U.S.

Federal agencies, and provide updates to ensure the UC’s safe and timely release to the sponsor.

2.3 - A process for coordination with appropriate stakeholders is proposed and carried out.

- A process for providing weekly case updates to appropriate ORR stakeholders is proposed and carried out.

75% of complex cases are resolved with stakeholder assistance within 10 days of case elevation

COR will monitor contractor provided data.

- Periodic inspection

2.5 Medical Services

The Contractor shall provide appropriate routine medical and dental care, family planning services.

These services shall include pregnancy tests and comprehensive information about and access to medical reproductive health services and emergency contraception, and emergency health care services, including a complete medical examination (including screenings for infectious disease).

Notwithstanding the intake health screening, a medical exam must be completed within 48 hours of admission, excluding weekends and holidays, unless the unaccompanied child was recently examined at another ORR ICF facility. Medical services include appropriate immunizations in accordance with recommendations of the U.S. Department of Health and Human Services /U.S.

Public Health Service (PHS), Centers for Disease Control and Prevention (CDC); administration of prescribed medication and special diets; and appropriate mental health interventions when necessary.

2.5.1 Intake Health Screening

The Contractor shall set up and operate a screening location where medical personnel will perform COVID-19 and other infectious disease screening and testing, obtain a medical history (including dietary restrictions or allergies), and screen to determine acute or chronic issues that require immediate or continuing medical attention when children first arrive at the site. This Initial Medical Exam (IME) will be conducted based on the following table:

Table 2 – Intake Initial Medical Exam

IME Components Requirements Comprehensive History and Physical Exam All children Communicable disease testing COVID -19 testing All children, per CDC and ORR requirements

Influenza testing Symptomatic children, per CDC and ORR requirements

Rapid Strep testing Symptomatic children, per CDC & ORR requirements

Vision/Hearing Vision Screening (Snellen test ) All children >3 years of age Hearing Screening (Whisper test) All children Psychosocial Psychosocial assessment /Risk factor screening

All children

Risk factor based testing:

Point-of-care urine pregnancy test All girls 10 years of age and older, or under 10 with reported menarche or sexual abuse/activity

Hep B Surface Antigen Children reporting sexual abuse/activity or injection drug use

Chlamydia (urine NAAT) Children reporting sexual abuse or activity Gonorrhea (urine NAAT) Children reporting sexual abuse or activity Syphilis RPR Children reporting sexual abuse or activity

HIV screening

Children 13 years of age and older or children under 13 years who report sexual abuse or activity

Hepatitis C antibody Children reporting injection drug use Lead testing Children 6 months up to 6 years Vaccines All Advisory Committee on Immunization Practices (ACIP) recommend vaccinations, based on age and eligibility https://www.cdc.gov/vaccines/schedules/hcp/imz /catchup.html

Influenza (Seasonal) All eligible children COVID-19 All eligible children TB Screening TST/PPD skin test Children <2 years

IGRA Children 2-17 years

CXR

Children 2-14 years with +IGRA All children ≥ 15 years of age https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html

2.5.2 Ongoing Medical Services

The Contractor shall provide ongoing health services that continue past the initial health screening and IME, and these services shall include, but not be limited to, the following: medical history interviews and physical examinations, point-of-care urine pregnancy, medication prescriptions and administration, vaccinations, COVID-19 and other infectious disease testing and other medical treatment consistent with the ORR Medical Services Policy Section 3.4.

Depending on site-specific conditions, the Contractor must arrange phlebotomy, mobile imaging and other point-of-care diagnostic testing (e.g., strep, pregnancy testing) services directly with a company that is contracted via Point Comfort Underwriters, ORR’s 3rd party insurance underwriter. See below regarding CLIA Certificate requirements.

ORR Policy Guide 3.4 Health Care Services ORR Policy Guide 3.4.2 Initial Medical Examination, ORR Policy Guide 3.4.4 Medication Administration and Management, ORR Policy Guide 3.4.5 Responding to Medical Emergencies ORR Policy Guide 3.4.6 Management of Communicable Diseases ORR Policy Guide 3.4.7 Maintaining Health Care Records and Confidentiality ORR Policy Guide 3.4.8 Medical Clearance Prior to Release or Transfer

2.5.3 Sick Call

The Contractor shall provide sick call twenty-four (24) hours per day, seven (7) days/week.

The site shall operate at the level of a Pediatric Urgent Care to mitigate reliance on local healthcare facilities which are facing higher hospitalization rates due to the COVID-19 pandemic. It is ill-advisable to bring children in COVID-19 isolation to medical facilities (except for extreme emergencies) for minor medical issues.

The Contractor shall procure supplies and durable medical equipment to manage musculoskeletal injuries (X-rays, splinting/casting) and laceration repairs among other minor injuries. The Contractor shall procure point-of-care testing for common communicable diseases (influenza, strep) as well as other conditions (glucose, pregnancy testing).

2.5.4 Emergency Medical Services

Emergency medical services shall be in accordance with ORR Policy Guide Section 3.4.5.

• Care provider staff must follow these steps in the event of a medical emergency:

• Contact 9-1-1 and arrange the child’s transportation to the nearest emergency room (ER) for evaluation.

• Render first aid as necessary until 9-1-1 responders arrive on the scene. Staff providing

CPR must use a mouthpiece or do hand-only CPR.

• Employ Standard Precautions (use of protection barriers, such as gloves, gowns, aprons, masks or protective eyewear) to reduce the risk of exposure to potentially infectious materials.

https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4.2 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4.5 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4.6 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4.7 https://www.acf.hhs.gov/orr/policy-guidance/children-entering-united-states-unaccompanied-section-3#3.4.8

• Notify immediately the care provider’s Program Director of the medical emergency and the actions employed.

• Submit an Emergency SIR to ORR within 4 hours of ER visit.

• Notify the following stakeholders of the medical emergency within 48 hours of the emergency incident, per guidelines in Table 5.5 SIR Notifications in UC MAP Section 5.8 Reporting Emergencies, Significant Incidents, and Program-Level Events.

• If hospitalization is recommended by the ER physician, contact the child on a daily basis by telephone and visitation.

• Provide ORR and DHUC with regular updates on the child’s health status and progress.

• If hospitalization is not required, obtain medical records or other documentation verifying that the child is stable enough for release to the care provider (for example, written doctor authorization or order, discharge instructions recommending release to the program with follow-up care).

• Discuss the case with the care provider’s case management and clinical staff. Evaluate whether the care provider can meet the child’s medical needs. Review the ER or hospital discharge plan and implement treatment recommendations.

• Request medical records related to the emergency treatment and any inpatient treatment from the medical services provider.

• Maintain records in the child’s health files.

The Contractor shall provide all personnel, products, and materials to perform emergency medical assessment and treatment 24 hours a day 7 days a week to stabilize a child prior to ER transfer.

Due to variable response times and capabilities of local jurisdictional EMS systems, the Contractor shall have two (2) ambulances onsite and appropriate emergency staff.

The Contractor shall provide sufficient operable AEDs located throughout the facility in areas of larger gatherings that are routinely tested as per American Heart Association guidelines. There shall be trauma bags and staff with basic life support training situated in strategic locations around the facility to ensure a timely emergency response.

The Contractor shall have an ORR approved written emergency response/evacuation plan developed in coordination with the Facilities Management Contractor and shall conduct drills to ensure appropriate, timely, emergency response. The plan shall be required to be in place prior to UC occupancy.

The Contractor shall establish relationships with local EMS and tertiary facilities to ensure continuity of medical care and streamline communication.

The Contractor shall provide vehicles for non-urgent/emergent transfers of UC to and from healthcare facilities or outpatient clinics. The Contractor shall not use EMS vehicles for non-urgent/emergent transport.

2.5.5 Pregnancy Testing and Family Planning Services

The Contractor shall administer urine pregnancy tests to all females who are 10 years of age and older, or females under 10 years of age who have reached menarche for pregnancy or have reported sexual activity in accordance with UC MAP 3.4.2.

The Contractor shall ensure pregnancy screening is conducted before vaccine administration so that vaccines not appropriate for pregnant women are withheld. In accordance with UC MAP 3.4.2, live virus vaccines (MMR and varicella), human papillomavirus (HPV), and polio (IPV) vaccines should be deferred for pregnant girls, but pregnant girls must receive all other indicated vaccinations: https://www.cdc.gov/vaccines/pregnancy/hcp-toolkit/guidelines.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fpre gnancy%2Fhcp%2Fguidelines.html unless otherwise advised by a medical professional.

The Contractor shall provide pregnancy test supplies and equipment.

The Contractor shall provide family planning services to include comprehensive information about, and access to, medical reproductive health services and emergency contraception as per ORR guidelines.

The Contractor shall follow policy requirements found in the Policy Memorandum on Medical Services Requiring Heightened ORR Involvement and related procedures found in UC MAP Section 3.

ORR’s policy and responsibility with regard to UC seeking an abortion, is addressed in Medical Services Requiring Heightened ORR Involvement (Sept. 29, 2020):

https://www.acf.hhs.gov/sites/default/files/documents/orr/garza_policy_memorandum.pdf

Congress made the Secretary of HHS responsible for the care and custody of all UC. 8 U.S.C. § 1232(b)(1). Given the authority that Congress vested in HHS, the legal position of HHS is that state courts cannot lawfully compel the ORR federal staff or ORR care providers to: consent to the provision of abortions to UC; bring UC to state court; facilitate access to UC by state-appointed guardians or attorneys ad litem; or provide a state court, or a state-appointed guardian or attorney ad litem, with access to federal records. HHS has determined as a matter of policy that HHS and ORR federal staff will exercise their delegated federal custodial authority in a manner informed by child welfare principles and in alignment with state law governing the conduct of medical providers who provide abortions to minors.

ORR care providers must notify the ORR federal staff of any UC who is pregnant or requesting an abortion using the Significant Incident Reporting mechanism in section 5.8 of the ORR Policy Guide. ORR federal staff and ORR care providers shall not take actions to obstruct or interfere with UC access to state judicial bypass proceedings (however ORR is not required to fund representation in those hearings), non-directive options counseling, abortion counseling, or an abortion.