Attachment A Sample Contract~4.pdf

RFA 5651/Attachment A SAMPLE CONTRACT Page 1 of 62

S#10000-00006578

Contract Number 000000

STATE OF OREGON

PERSONAL/PROFESSIONAL SERVICES CONTRACT

In compliance with the Americans with Disabilities Act, this document is available in alternate formats such as Braille, large print, audio recordings, Web-based communications, and other electronic formats. To request an alternate format, please send an e-mail to dhs-oha.publicationrequest@state.or.us or call 503-378-3486 (voice) or 503-378-3523 (TTY) to arrange for the alternative format.

This Contract is between the State of Oregon, acting by and through its Department of Human

Services, hereinafter referred to as “ODHS,” and

Contractor d.b.a. Facility or Assumed Name

Address

Address

Telephone: (required)

Fax: (optional)

E-mail address: (required)

Contractor's home page URL, if applicable (optional) hereinafter referred to as “Contractor.”

Work to be performed under this Contract relates principally to ODHS’

ODHS, Youth Transitions Program

500 Summer Street NE

Salem, OR, 97301

Contract Administrator: Rosemary Iavenditti or delegate

Telephone: (503) 884-8821

E-mail address: Rosemary.IAVENDITTI@dhsoha.state.or.us

1. Effective Date and Duration.

This Contract shall become effective on the date this Contract has been fully executed by every party and, when required, approved by Department of Administrative Services and

Department of Justice, or on [insert start date], whichever date is later. Unless extended or terminated earlier in accordance with its terms, this Contract shall expire on [insert mailto:dhs-oha.publicationrequest@state.or.us mailto:dhs-oha.publicationrequest@state.or.us

RFA 5651/Attachment A SAMPLE CONTRACT Page 2 of 62 end date]. Contract termination shall not extinguish or prejudice ODHS' right to enforce this Contract with respect to any default by Contractor that has not been cured.

2. Contract Documents.

a. This Contract consists of this document and includes the following listed exhibits which are incorporated into this Contract:

(1) Exhibit A, Part 1: Statement of Work

(2) Exhibit A, Part 2: Payment and Financial Reporting

(3) Exhibit A, Part 3: Special Provisions

(4) Exhibit B: Standard Terms and Conditions

(5) Exhibit C: Insurance Requirements

(6) Exhibit D: Federal Terms and Conditions

There are no other contract documents unless specifically referenced and incorporated in this Contract.

b. This Contract and the documents listed in Section 2., “Contract Documents”, Subsection a. above, shall be in the following descending order of precedence:

this Contract less all exhibits, Exhibits D, B, A, and C.

3. Consideration.

a. The maximum, not-to-exceed compensation payable to Contractor under this

Contract, which includes any allowable expenses, is [insert amount]. ODHS will not pay Contractor any amount in excess of the not-to-exceed compensation of this Contract for completing the Work and will not pay for Work performed before the date this Contract becomes effective or after the termination or expiration of this Contract. If the maximum compensation is increased by amendment of this Contract, the amendment must be fully effective before

Contractor performs Work subject to the amendment.

b. Interim payments to Contractor shall be subject to ORS 293.462 and shall be made in accordance with the payment schedule and requirements in Exhibit A, Part 2., “Payment and Financial Reporting.”

c. ODHS will only pay for completed Work under this Contract. For purposes of this

Contract, “Work” means the tasks or services and deliverables accepted by ODHS as described in Exhibit A, Part 1, “Statement of Work.”

4. Contractor or Subrecipient Determination. In accordance with the State Controller’s

Oregon Accounting Manual, policy 30.40.00.102, ODHS’ determination is that:

Contractor is a subrecipient Contractor is a contractor Not applicable

Catalog of Federal Domestic Assistance (CFDA) #(s) of federal funds to be paid through this Contract: ______

RFA 5651/Attachment A SAMPLE CONTRACT Page 3 of 62

5. Contractor Data and Certification.

a. Contractor Information. This information is requested pursuant to ORS

305.385 and OAR 125-246-0330(1).

PLEASE PRINT OR TYPE THE FOLLOWING INFORMATION

Contractor Name (exactly as filed with the IRS):

Street address:

City, state, zip code:

Email address:

Telephone: ( ) Fax: ( )

Is Contractor a nonresident alien, as defined in 26 U.S.C. § 7701(b)(1)?

(Check one box): YES NO

Business Designation: (Check one box):

Professional Corporation Nonprofit Corporation Limited Partnership

Limited Liability Company Limited Liability Partnership Sole Proprietorship

Corporation Partnership Other

Contractor Proof of Insurance. Contractor shall provide the following information upon submission of the signed Contract. All insurance listed herein and required by Exhibit C must be in effect prior to Contract execution.

If Contractor is self-insured for any of the Insurance Requirements specified in Exhibit C of this

Contract, Contractor may so indicate by: (i) writing “Self-Insured” on the appropriate line(s); and

(ii) submitting a certificate of insurance as required in Exhibit C.

Professional Liability Insurance Company: ___________________________________________

Policy #: ______________________________________ Expiration Date: ________________

Commercial General Liability Insurance Company: ____________________________________

Policy #: ______________________________________ Expiration Date: ________________

Automobile Liability Insurance Company: ___________________________________________

Policy #: ______________________________________ Expiration Date: ________________

Workers’ Compensation: Does Contractor have any subject workers, as defined in ORS

656.027? (Check one box): YES NO If YES, provide the following information:

Workers’ Compensation Insurance Company: ________________________________________

Policy #: ______________________________________ Expiration Date: ________________

b. Certification. Without limiting the generality of the foregoing, by signature on this Contract, the undersigned hereby certifies under penalty of perjury that:

RFA 5651/Attachment A SAMPLE CONTRACT Page 4 of 62

1. Contractor is in compliance with all insurance requirements in Exhibit C of this Contract, and notwithstanding any provision to the contrary, Contractor shall deliver to the DHS Contract Administrator (see page 1 of this Contract) the required Certificate(s) of Insurance within 30 days of execution of this Contract. By certifying compliance with all insurance as required by this Contract, Contractor acknowledges it may be found in breach of the Contract for failure to obtain required insurance. Contractor may also be in breach of the Contract for failure to provide Certificate(s) of Insurance as required and to maintain required coverage for the duration of the Contract.

2. Contractor acknowledges that the Oregon False Claims Act, ORS 180.750 to 180.785, applies to any “claim” (as defined by ORS 180.750) that is made by (or caused by) the Contractor and that pertains to this Contract or to the project for which the Contract work is being performed. Contractor certifies that no claim described in the previous sentence is or will be a

“false claim” (as defined by ORS 180.750) or an act prohibited by ORS

180.755. Contractor further acknowledges that in addition to the remedies under this Contract, if it makes (or causes to be made) a false claim or performs (or causes to be performed) an act prohibited under the Oregon

False Claims Act, the Oregon Attorney General may enforce the liabilities and penalties provided by the Oregon False Claims Act against the

Contractor;

3. The undersigned is authorized to act on behalf of Contractor and represents and warrants that Contractor has complied with the tax laws of the State of Oregon and the applicable tax laws of any political subdivision of Oregon. Contractor shall, throughout the duration of this

Contract and any extensions, comply with all tax laws of this state and all applicable tax laws of any political subdivision of Oregon. For the purposes of this Section, “tax laws” includes: (i) All tax laws of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and

318; (ii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, to Contractor’s property, operations, receipts, or income, or to Contractor’s performance of or compensation for any work performed by Contractor; (iii) Any tax provisions imposed by a political subdivision of Oregon that applied to Contractor, or to goods, services, or property, whether tangible or intangible, provided by

Contractor; and (iv) Any rules, regulations, charter provisions, or ordinances that implemented or enforced any of the foregoing tax laws or provisions.

Contractor acknowledges that the Oregon Department of Administrative

Services will report this Contract to the Oregon Department of Revenue

(DOR). The DOR may take any and all actions permitted by law relative to the collection of taxes due to the State of Oregon or a political subdivision, including: (i) garnishing the Contractor’s compensation under this Contract; or (ii) exercising a right of setoff against Contractor’s

RFA 5651/Attachment A SAMPLE CONTRACT Page 5 of 62 compensation under this Contract for any amounts that may be due and unpaid to the State of Oregon or its political subdivisions for which the

DOR collects debts;

4. The information shown in Section 5.a., “Contractor Information” above is

Contractor’s true, accurate and correct information;

5. To the best of the undersigned’s knowledge, Contractor has not discriminated against and will not discriminate against minority, women or emerging small business enterprises certified under ORS 200.055 in obtaining any required subcontracts;

6. Contractor and Contractor’s employees and agents are not included on the list titled “Specially Designated Nationals” maintained by the Office of

Foreign Assets Control of the United States Department of the Treasury and currently found at: https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx;

7. Contractor is not listed on the non-procurement portion of the General

Service Administration’s “List of Parties Excluded from Federal procurement or Non-procurement Programs” currently found at:

https://www.sam.gov/portal/public/SAM/;

8. Contractor is not subject to backup withholding because:

(a) Contractor is exempt from backup withholding;

(b) Contractor has not been notified by the IRS that Contractor is subject to backup withholding as a result of a failure to report all interest or dividends; or

(c) The IRS has notified Contractor that Contractor is no longer subject to backup withholding; and

(9) Contractor Federal Identification Number (FEIN) or Social Security

Number (SSN) provided is true and accurate. If this information changes, Contractor shall provide ODHS with the new FEIN or SSN within 10 days.

https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://www.treasury.gov/resource-center/sanctions/SDN-List/Pages/default.aspx https://www.sam.gov/portal/public/SAM/

RFA 5651/Attachment A SAMPLE CONTRACT Page 6 of 62

CONTRACTOR, BY EXECUTION OF THIS CONTRACT, HEREBY

ACKNOWLEDGES THAT CONTRACTOR HAS READ THIS CONTRACT,

UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND

CONDITIONS.

CONTRACTOR: YOU WILL NOT BE PAID FOR SERVICES RENDERED PRIOR TO

NECESSARY STATE APPROVALS.

6. Signatures. This Contract and any subsequent amendments may be executed in several counterparts, all of which when taken together shall constitute one agreement binding on all parties, notwithstanding that all parties are not signatories to the same counterpart.

Each copy of the Contract and any amendments so executed shall constitute an original.

Contractor Name

By:

Authorized Signature Printed Name

Title Date

State of Oregon, acting by and through its Department of Human Services

By:

Authorized Signature Printed Name

Title Date

Approved by the Department of Administrative Services:

Exempt per OAR 125-246-0170(2)

Authorized Signature Title Date

Approved for Legal Sufficiency:

With Protect Form on, click here With Protect Form on, click here

Department of Justice Date

RFA 5651/Attachment A SAMPLE CONTRACT Page 7 of 62

EXHIBIT A

Part 1

Statement of Work

1. Definitions

For the purposes of this Contract, capitalized words are defined in OAR 125-246-0110 or as defined below.

Aftercare Client – Young Adult who has submitted a self-referral and has been accepted and enrolled in an ILP.

Basic Funding – the funds paid monthly to the Contractor for 60 minutes of ILP Services per client as outlined in Attachment G.

Community Volunteer Mentors or Mentor(s)-community members who volunteer to participate in group sessions with participants or whom the Contractor has screened and trained to serve as a Mentor to children and Young Adults outside of group sessions.

Completion of Services – A Young Person’s ILP services will be considered completed when a young person has:

i. achieved self-sufficiency to the extent that there is no longer a need for services; or

ii. made the voluntary and informed decision to no longer participate in services; or

iii. reached age 24.

Comprehensive Transition Plan (CTP) – The Transition Plan crafted with input from the Young Person, ILP Provider, and other supportive adults the young person wants to be involved and must include the ODHS or Tribal Nation’s caseworker, unless the young person is an Aftercare Client. The CTP should drive ILP life skills service delivery.

Contract-the Contract awarded as a result of an RFA in accordance with the requirements set forth in Section 6.

Contractor -the Applicant selected through an RFA to enter into a Contract with ODHS Child Welfare to perform the Work.

Experiential Learning Activities – The process where knowledge is created through the transformation of experience (i.e., Kolb’s Experiential Learning Cycle).

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Fee For Service – A model in which the Contractor is paid a specific rate for the type of service provided or efforts to engage young people in services. Rates are outlined in Attachment G.

Federally Recognized Tribal Nations in Oregon or Tribe– Burns Paiute Tribe;

Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians; Confederated Tribes of Grand Ronde Community of Oregon; Confederated Tribes of Siletz Indians; Coquille Indian Tribe; Confederated Tribes of the Umatilla Indian Reservation; Confederated Tribes of Warm Springs; Cow Creek Band of Upper Umpqua Tribe of Indians; and Klamath Tribe.

Flex Funds – Funding to motivate or encourage youth engagement, or to stimulate a young person’s investment in services. Use of Flex Funds may include food at group sessions or one-on-one meetings, payment for participation in meetings/activities (gift cards, coffee, lunch, raffles, etc.) and program item(s) to assist young people during skill building activities (sensory items, music) that will remain at the program. Does not cover gifts for special occasions (birthdays, graduation, etc.), tips, staff meals or other costs for staff.

Foster Care – 24-hour substitute care for children and Young Adults placed away from their parents or guardians for whom the state agency or Tribe has placement and care responsibility, which may include custody. This includes but is not limited to placements in resource family homes, relative care, group homes, emergency shelters, residential facilities, childcare institutions, supervised independent living, self-selected placements, and pre-adoptive homes. It further covers ILP enrolled Young People placed in the State’s Independent Living Subsidy Program. A Young Person is in Foster Care in accordance with this definition regardless of whether the Foster Care setting is receiving payment from ODHS or a Tribal Nation.

Funds Available – All funds provided under this Contract are to be used for ILP related activities, services, leadership opportunities, or Group Workshops for eligible Young People who have been referred to the program or those within a service area that are ILP eligible that would like to attend Group Workshops. Expenditures may include administrative costs and direct program costs.

Governmental Application-an Application submitted to ODHS by a Governmental Applicant.

Governmental Applicant-a governmental entity that submits an Application and is recognized as a governmental entity in accordance with Oregon Revised Statue (ORS) 190.

Group Workshops – Skill building activities or classes for three or more Young People.

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ILP Central – The central and administrative center, housed at Central Office, for administering the Youth Transitions Programs which include Independent Living Skill Building, Discretionary Funds, the Independent Living Subsidy Program (ILSP), the Chafee Housing Program (ILP-CH), Driver’s Education, Credit Reports, the Education and Training Voucher Program (ETV), and the Foster Youth Tuition and Fee Waiver.

ILP Services – Services include, but are not limited to, skill building classes, Group Workshops, conferences, experiential learning outings/field trips, leadership opportunities/support and one-on-one meetings that are geared toward assisting a Young Person to gain the knowledge, skills, and ability to make a successful transition to self-sufficiency and adulthood. Services may be provided directly by the Contractor, or the Contractor may facilitate the young person’s services from another entity.

Facilitated services may include, but are not limited to, educational supports, vocational training, job placement, health education, supportive relationships (mentors) and community connections.

ODHS Sponsored Teen Events – ODHS sponsored events intend to bring children and Young Adults that are in or have experienced foster care together from across the state to provide a unique learning experience and fun activities they would otherwise not get to experience. Conference locations may vary each year. The events vary between 1 to 4 days, including overnight stays.

Independent Living Program or ILP – Program to assist ODHS and Federally Recognized Tribal Nations in Oregon, by providing Young People that experienced the Foster Care system or are expected to age out of the foster care system, with the knowledge, skills, and ability to make a successful transition to self-sufficiency and adulthood.

Intangible skills - Skills needed for building interpersonal relationships, self-determination, and maintaining employment, e.g., decision-making, problem solving, planning, communication, and social skills.

Key Personnel or Key Persons-the person or persons on Contractor’s staff to be assigned to perform the Work under the Contract. For Key Persons not identified prior to Application submission, a position description must be submitted.

Leadership Opportunity – Activities which allow a young person to develop their skills, work closely with others, share ideas and influence change. Requires Contractor to assist young person to prepare for the activity, ensure young person is supported during the activity, and debriefing the experience with the young person to determine whether support efforts were adequate, identify opportunities for growth and provide mutual feedback.

Life Skills – Skills a Young Person needs to function and succeed in everyday life including, but not limited to cooking, comparison shopping, money management, education, employment, housing options & maintenance, transportation, decision

RFA 5651/Attachment A SAMPLE CONTRACT Page 10 of 62 making, legal issues, personal hygiene, community resources, interpersonal skills, pregnancy prevention/parenting awareness, substance abuse prevention, emergency, and safety skills.

Transition Readiness Discussion Guide – is a worksheet to guide initial discussion with the child or Young Adult to aid in assessing skills and developing the Transition Plan.

The purpose is to prompt discussion to assess the child or Young Adult and prioritize skill-building activities.

One-On-One Meeting: may have a dual meaning as follows: 1) Contractor is to meet with a child or Young Adult individually, face-to-face for a minimum of 60 minutes to provide ILP Skill Building Services, or 2) a meeting where all parties in attendance are focused solely on a specific, individual child or Young Adult and their needs.

Peer Specialist-a near-peer mentor usually aged 18-23 with experience living in foster care. This individual or individuals will facilitate the curriculum, serve as inspirational role models to participants, and provide technical assistance to community Mentor(s).

Application-a written response submitted to ODHS in response to this RFP.

Applicant-the person or entity that submits an Application.

Referring Agency – Either an ODHS child welfare agency or a Federally Recognized Tribal child welfare agency.

RFA-Request for Application.

Service Area – The area defined in Attachment G in the table of specific geographic areas where ILP Services shall be provided.

Social Capital – the social relationships and networks that support healthy development.

Self-Determination –the ability to set personal goals; take action; advocate for self;

and believe in one’s own capacity to succeed.

Self-Referral – Young Adults may refer themselves to their local ILP Contractor. This is reserved for those Young Adults who no longer have an open ODHS Child Welfare case.

Staff- the individual(s) employed by the Contractor and assigned the task of managing recruitment, training, support and retention of children and Young Adults, Peer Specialist(s) and Mentor(s).

State Meeting– is an activity the Contractor will be invited to participate in or a training the Contractor has obtained permission from the Contract Administrator to attend. State Meeting activities and trainings aid the Agency in carrying out the

RFA 5651/Attachment A SAMPLE CONTRACT Page 11 of 62 purpose of the Independent Living Program. Allowable costs include registration fees, state travel per diem (vehicle rental, mileage, lodging, meals, etc.), however, do not include the costs of staff wages.

Tangible Skills – Skills needed for daily living, self-maintenance, maintaining healthy relationships and obtaining employment (e.g., money management, household management, and vocational aptitudes).

Transition Plan – The plan that is to be crafted, with the child or Young Adult’s involvement, that outlines the child’s or Young Adult’s seven areas (Personal Growth & Social Development, Family Support & Healthy Relationships, Health Education & Risk Prevention, Education, Employment/Career Preparation, Housing & Home Management. Money Management, Transportation, and Other Life Skills), and the steps and services necessary to help the children and Young Adults achieve their goals.

Work-the required activities, tasks, deliverables, reporting and invoicing requirements, as described in Section 3. Scope of Work of this RFP also referred to as Services or ILP Services.

Young Adult – A person who is between the ages of 18 through 23 (ending on 24th birthday), who exited foster care on or after their 14th birthday and had at least 180 days of, State or Tribal, child welfare substitute care services after the age of 13.

Youth Advisory Committee – Referred Young Person who, with the help of Contractor, have created a committee to discuss various topics related to the ILP and services to be provided by the Contractor.

Youth Assessment Summary – A summary assessment that identifies a Young Person’s level of awareness, knowledge, and skill on a variety of topic areas, to be completed following assessment using the Transition Readiness Discussion Guide.

Client Participation - A process in which children and Young Adults are allowed to share their opinions, wants, and needs in a manner of their choosing. This includes goals for their transition plan, services they wish to receive, and methods for learning Life Skills.

Youth Transition Plan – The Transition Plan crafted with input from the young person and other supportive adults, but the ODHS or Tribal child welfare caseworker is absent, or young person is an Aftercare client.

Youth Served per Month or YSM – The number of Young People served by Contractor during a calendar month.

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ILP Groups

(Ages 14 – 23)

1. Independent Living Program (ILP) Groups.

a. Groups are available for all ILP Eligible young people. Contractor must confirm eligibility with Youth Transitions by emailing ILP.Central@odhsoha.Oregon.gov prior to providing services.

b. Group-based skills workshops and experiential learning events (at least 90 minutes in duration) shall be provided monthly to allow for peer exposure and community building. Group events will rotate target populations throughout the year, four (4) months of curriculum devoted to the younger population (based on chronological age or developmental stage), four (4) months of curriculum devoted to the older population (based on chronological age or developmental stage), and (4) months devoted to group outings/experiential learning in the community (volunteering, holiday activities, excursions, field trips, etc.).

c. Group events do not replace one-on-one, face-to-face skill building meetings with an assigned ILP provider.

d. A young person may attend one monthly group. Contractor may bill for ILP Group meetings, regardless of if young person participates in any other ILP activities.

2. Contractor shall complete the following within 30 days of the effective date of this

Contract:

a. Make all arrangement for appropriate meeting space including being compliant with the American Disabilities Act.

b. Determine precise dates and times for group meetings in collaboration with young people.

(1) Provide a group schedule no less than three (3) months in advance for planning and engagement purposes.

(2) Distribute the group schedule to young people, ODHS and Tribal Nation’s child welfare staff, and Youth Transitions (ILP.Central@odhsoha.Oregon.gov).

(3) Coordinate with other ILP Contractors for regional group events, when possible.

(4) For Group Experiential Learning Excursions, Contractor will submit an email

Application to the ODHS Contract Administrator requesting pre-approval for expenditures.

1) Provide date, time, location, and duration of the proposed event, including the plan for legal guardian consent, transportation, supervision, emergency plan, food, activity costs, equipment costs, etc.

2) Provide supportive narrative about how the event will meet the definition of an experiential learning activity.

3) Once written approval is provided, Contractor can execute plan.

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c. Obtain background checks on any adult community Mentor(s) and on Contractor staff that do not have a current background check on file. Including any Peer Specialists who are no longer in the care or custody of a State or Tribal child welfare agency.

(1) To request a Background Check the Subject Individual (SI) submits an email which includes the contract number and Contractor’s email address to:

childwelfare.contractbackgroundchecks@odhsoha.oregon.gov

(2) The SI receives a secure email to collect the necessary information which is then entered into ORCHARDS to initiate the background check.

(3) SI receives an email from bcu.orchards@odhsoha.oregon.gov with instructions and a link to complete the Authorization and Disclosure in ORCHARDS. Note: The background check is closed if the Contractor does not complete within 21 days.

(4) The Final Determination is emailed to the SI, contractor, and the contract administrator. Contractor and contract administrator should keep in file.

3. Contractor shall provide the following services to build Intangible Skills, Tangible Skills and provide Experiential Learning experiences:

a. Provide instruction and assistance to young people about personal growth, social development, and Self-Determination, including serving others, rather than solely being a recipient of services. Include assistance in learning how to share life experiences to help and support others and how to advocate for themselves.

b. Assist young person in identifying how past trauma influences current behavior and responses to situations. Build skills to help young person self-regulate and learn how to maintain relationships after a conflict or stressful situation has occurred.

c. Assist young person to build skills to establish healthy relationships and build Social

Capitol that helps the young person to achieve their life goals. Assist young person to understand and gain skills for internal motivation, goal setting, planning and problem-solving.

d. Provide activities which follow Kolb’s Experiential Learning Cycle. Provide a process where knowledge is created through the transformation of experience. Contractor may access the Experiential Learning Activities Funds to support the Experiential Learning activities executed each quarter.

4. Reports

a. Monthly Reports The Contractor shall communicate with Youth Transitions monthly to provide a list of services delivered and engagement level achieved by the child or Young Adult, using the

Monthly Services & Progress Report (“MSPR”), attached hereto as Attachment 6 (Step

5) and incorporated herein by this reference. The MSPR is to be completed and submitted by the 15th calendar day of the month following the month in which services were mailto:childwelfare.contractbackgroundchecks@odhsoha.oregon.gov mailto:bcu.orchards@odhsoha.oregon.gov

RFA 5651/Attachment A SAMPLE CONTRACT Page 14 of 62 provided. MSPRs will be used to validate invoices. Contractor shall include the following information on the MSPR that includes:

(1) The date of Group session.

(2) The duration of the Group session.

(3) The appropriate federal categories and subcategories for the group activities.

(4) A description of the skill building delivered.

(5) A summary of the group discussion.

(6) When applicable, a description of how the Peer Specialist(s), Mentor(s), and young person are interacting and whether the group is building connections and young people are expanding their Social Capitol.

Independent Living Program Skill Building Services (ILP)

(Ages 14 - 23)

1. Work to be performed

a. Contractor shall provide ILP services for an average of ___ young people per month, residing in ______, within ODHS Service District __ referred by ODHS staff or one of the nine federally recognized Tribes in Oregon (referring agent) or

Young Adult (if a Self-Referral) based on the child or Young Adult’s needs and interests.

b. Contract Services shall be provided to each young person in accord with developmental readiness and stages of independence (not chronological age).

Services shall be individualized, trauma informed and culturally appropriate.

Contractor shall be required to accept all referrals made by ODHS or Tribe, unless: a)

Young person poses a danger to self or others, b) young person poses as a health risk, c) young person declines to participate in program services, or d) based on YSM maximum limits established for the service area.

When deemed appropriate, ODHS shall authorize Contractor’s request to serve young people who reside outside of the Contractor’s service area. This will be approved by the

ODHS Contract Administrator (Youth Transitions Program Coordinator) on a case-by-case basis. The young person must be able to attend or get to regularly scheduled

Contractor activities and skill building classes. The ODHS or Tribal Nation’s caseworker is responsible for submitting the appropriate documentation for approval.

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2. Contractor shall provide the following Services within the timelines listed:

a. Response to Referral

Respond in writing to the referring agent or Young Adult within five working days of referral regarding the child or Young Adult’s acceptance or non-acceptance (i.e., young person declines or placed on a wait list) into the

Contractor's ILP Skill Building Services. Referring agency includes ODHS and

Oregon Tribes that ODHS partners with. When the Contractor must implement a wait list, the process for removing a child or Young Adult from the wait list and enrolling in the Contractor’s ILP services will be crafted in collaboration with the local ODHS branch staff. Waitlist management will be communicated directly to

Youth Transitions (ILP.Central@odhsoha.Oregon.gov) every month to determine if workplans need to be implemented or contracts amended to support Youth

Transitions programming.

b. Assessment, Engagement, and Skill Building

(1) Youth Engagement and Skill Building Services

(a) The Contractor shall deliver skill building services to the young person for a minimum of 60 minutes, One-On-One.

i. Permission from the ODHS Contract Administrator is required when the Provider plans to use technology to meet or supplement the face-to-face requirement.

ii. The option to use technology to meet the face-to-face requirement is to be requested when there are significant barriers to an in-person meeting with a young person (e.g.: extreme weather conditions, illness, etc.) or to supplement a previous One-On-One Meeting during the same month which was less than 60 minutes.

(b) ILP Skill Building Services are to facilitate access to individualized services and supports across all independent living domains guided by the young person’s transition plan goals or immediate needs. Contractor will include the young person in determining the services to be provided.

(c) The Contractor shall engage with young people and their support team to promote the young person’s goal attainment and engagement in services.

(d) The Contractor may access Flex Funds to provide the young person an incentive/stipend as a means to promote engagement in service provision and participation in the assessment and transition planning process.

(2) Transition Readiness Discussion Guide (life skills assessment)

Contractor is to use the Transition Readiness Discussion Guide form attached hereto as Attachment 2 and incorporated herein by this reference, to build rapport and gain a global sense of the young person’s knowledge, skills, and abilities, as well as a sense of the young person’s self-determination, readiness, and priorities for adulthood. The Transition Readiness Discussion Guide (“Discussion Guide”), mailto:ILP.Central@odhsoha.Oregon.gov

RFA 5651/Attachment A SAMPLE CONTRACT Page 16 of 62 also referred to as the “life skills assessment,” will inform the Contractor’s placement of which Stage the young person appears to be functioning.

(3) Youth Assessment Summary

Contractor completes the Youth Assessment Summary (YAS) based on information gathered from the child or Young Adult and their support team based on conversation resulting from the Transition Readiness Discussion Guide. The

Contractor shall identify which stage the young person is in using the Youth

Assessment Summary (“YAS”) form, attached hereto as Attachment 3 and incorporated herein by this reference. The assessment provides vital information about a young person’s function that is critical when planning service delivery.

The YAS also determines a knowledge and skills baseline that allows a

Contractor to track progress over time. Use the following scale to determine a young person’s stage:

Stage I, Awareness Stage II, Learning Stage III, Doing

First circle

Has minimal information about this topic area

Has started gaining knowledge and developing new skills in this area

Has started applying some skills in real-life settings or activities, with support

Second circle

Has basic information about this topic area and some understanding of why it is important

Has basic knowledge and skills in this area, needs further opportunities to practice and strengthen most skills

Is regularly applying some skills in real-life settings and or activities, with limited support

Third circle

Has solid information about this topic and understands why it is important, but has not started developing knowledge or skills

Has solid knowledge and skills in this area, but has not started applying these in real-life settings or activities

Is consistently applying many skills in real-life settings and activities, with limited support (May stay in this stage for as long as provider monitors application of skills)

c. Reports

(1) Youth Transition Plan (YTP)

ILS services require collaboration with ODHS in the development of a written

Youth Transition Plan for each child or Young Adult in Child Welfare custody within ninety (90) days of acceptance to the Contractor’s program. To create

RFA 5651/Attachment A SAMPLE CONTRACT Page 17 of 62 the Transition Plan, the ODHS Caseworker and or ILP provider must arrange for a youth decision-making meeting (YDM) between the child or Young

Adult, Contractor, caseworker, resource parent, attorney, CASA, family members, and other significant adults the child or Young Adult has invited (the child or Young Adult must have the opportunity to invite up to two additional participants). The purpose of the decision-making meeting is to determine the child or Young Adult’s goals, identify what steps and services are needed to assist the child or Young Adult to achieve the identified goals, determine which ILP Skill Building Services can be provided directly, and which services are best obtained within the community by means of other resources. The

Transition Plan will outline the steps the Contractor and Agency will take to facilitate referral for those services that are to be obtained in the community.

The Transition Plan will outline the services that will be offered, the needs the services intend to address, the anticipated time frame for when services will begin and end, and what responsibility each member of the decision-making team will assume. The Transition Plan is attached hereto as Attachment 3 and incorporated herein by this reference.

(2) IL Service Planning Checklist

The IL Service Planning Checklist is a list of skills a young person should possess in order to transition to adulthood successfully. The checklist is the framework for Oregon’s Independent Living Program and intended to be used as a tool to guide service planning and service provision. Contractors will employ the IL Service Planning Checklist as a tool during the following activities:

a) When training new staff.

b) When assessing a young person’s knowledge, skills and abilities.

c) During supervision to ensure staff are working within Oregon’s ILP framework.

d) During transition planning sessions to aid in the creation of meaningful goals and short-term steps/actions.

e) When planning group classes, workshops, or experiential activities to ensure appropriate skills are being discussed and taught.

The IL Services Planning Checklist is attached hereto as Attachment 3 and incorporated herein by this reference.

(3) Annual Update

The Youth Assessment Summary (YAS) and the Youth Transition Plan

(YTP) will be updated at least yearly (365 days) following the initial YTP plan. The purpose of the Youth Assessment Summary update is to assess the young person's progress in gaining knowledge, skills, and movement between stages in preparation for a successful transition to adulthood. The purpose of the YTP update is to reflect on the young person’s progress in achieving the goals set forth in the YTP, update transition goals as needed based on young person’s input to ensure appropriate services are being

RFA 5651/Attachment A SAMPLE CONTRACT Page 18 of 62 provided with and for the young person, and that the young person is actively engaged in the planning process and the services identified in the YTP.

(4) On-going Progress Monitoring & Service Report

Contractor will submit a monthly report outlining the child or Young Adult’s progress in relation to the established services being provided (including

Groups/Experiential Learning excursions and leadership activities), or to document the three (3) Engagement Efforts Only provided. Communicate with the child or Young Adult on a regular basis as outlined “Basic Services” in

Section 1.e. below. Discuss accomplishments, needs, and progress toward goals. The Contractor shall communicate with the referring agent and Youth

Transitions monthly to provide documentation regarding the following:

a) Date(s) of face-to-face, one-on-one skill building,

b) Location of service provision,

c) The minutes spent during face-to-face skill building,

d) The appropriate federal categories and subcategories for the skill building activities, and

e) Description of the skill building services delivered.

The Contractor shall use the Monthly Services & Progress Report (“MSPR”), attached hereto as Attachment 6 and incorporated herein by this reference. The

Monthly Services & Progress Report is to be submitted by the 15th of the month following the month in which services were provided. Late submissions will result in a delay of payment for services provided.

It is ODHS’ plan to transition all MSPR documentation to be entered by the

Contractor into a provider portal. Development of the provider portal is currently underway. The Contractor will be assigned security clearance and will receive training to utilize the provider portal once available.

(5) Final Progress & Service Report

Prepare the final Monthly Services and Progress Report when client is discharged from the Contractor’s program or Completion of Services. Provide the referring agent and Youth Transitions a termination summary of each young person within fifteen (15) calendar days of discharge from the program or completion of services. The discharge summary must include updates on the young person’s demographics, educational status, living arrangements, stage(s) and outcomes achieved, and the reason for service ending.

(6) Filing of Reports

Unless defined differently, each of the above reports must be submitted to the

Referring Agent and Youth Transitions (ILP.Central@odhsoha.Oregon.gov) within five (5) business days of completion in order to be filed in the young person’s case records.

RFA 5651/Attachment A SAMPLE CONTRACT Page 19 of 62

Independent Living Program Plus (ILP+)

Ages 16 - 23

1. Work to be performed

a. Contractor may provide ILP+ services for an average of 20 percent of the young people served per month (YSM).

b. If ILP+ services are provided, services shall be implemented in accord with each young person’s developmental readiness and stages of independence (not chronological age). Services shall be individualized, trauma informed and culturally appropriate.

c. ILP+ additional skill building activities are intended to support a young person during a time of higher need or transition (planned housing transition, housing instability, substance use issues, tragedies, transitioning to college, parenting struggles, educational challenges, employment barriers, mental/behavioral health symptoms, etc.). Appropriate ILP+ children and Young Adults are those who will benefit from more intensive skills training focused on developing internal assets and external resources (housing, treatment services, medical care, planning/modeling support, community-based resources, etc.).

(1) Contractor will focus on stabilization, successful transition, and building self-determination skills, such as youth-driven goal identification, problem-solving, and stress management.

(2) Contractor shall oversee ILP+ hours to ensure equity in service delivery.

This will be demonstrated by the Contractor serving the ILP+ population in a way that mirrors the demographic makeup of their overall population.

(3) ILP+ Services allows the Contractor to serve young people aged 16+ in additional increments of 30-minutes (Basic 60-minute service plus 30 minutes, 60 minutes, or 90 minutes; not to exceed a total of 150 minutes per young person, per month).

(4) The Contractor shall oversee ILP+ hours to ensure they are not serving more than 20% of their population served each month at the maximum rate of 150 minutes.

(5) This service is not meant for compliant young people that might appreciate more time. It is designed to support young people experiencing circumstances that warrant additional skill-building activities to meet stabilization or transition goals.

d. On-going Progress Monitoring & Service Report

In addition to the information provided in the MSPR for basic ILP Skill Building

Services, the Contractor must include the following details on the MSPR when providing ILP+ services:

RFA 5651/Attachment A SAMPLE CONTRACT Page 20 of 62

(1) Additional minutes (beyond the basic 60 minutes) spent during One-On-One

Meeting.

(2) Summary of why the additional service minutes were necessary.

The Contractor shall use the Monthly Services & Progress Report (“MSPR”), attached hereto as Attachment 6 and incorporated herein by this reference; The

Monthly Services & Progress Report is to be submitted by the 15th of the month following the month in which services were provided. Late submissions may result in a delay of payment for services provided.

Leadership Opportunities

Ages 14 - 23

Contractor shall support young people to access leadership activities which allow a young person to develop their skills, work closely with others, share ideas and influence change.

1. Contractor shall:

a. Assist young person to prepare for the leadership opportunity activity by:

(1) Collaborate with ODHS staff (local office as well as Central office), and other entities who include young people’s voice in their policies and programming.

(2) Ensuring young person is supported during the activity.

(3) Debriefing the experience with the young person to determine whether support efforts were adequate.

(4) Identify opportunities for growth and provide mutual feedback.

(5) Follow-up with any feedback for improvement for the entity who hosted the leadership opportunity.

b. Identify and recruit Peer Specialists to participate in the ILP Group meetings and be interactive with the young people.

(1) Ensure Peer Specialist is prepared to engage as a co-creator, co-facilitator, and mentor to their peers

(2) Peer Specialists should be supported prior to and during the ILP Group or activity.

(3) Provide a debrief following the activity to allow the young person to reflect on their experience and provide feedback.

c. The time spent preparing, supporting and debriefing with a young person is skill building (organization/planning, public speaking, advocating for needed supports, and communication skills/brainstorming solutions), as such the Contractor may bill

RFA 5651/Attachment A SAMPLE CONTRACT Page 21 of 62 for time spent supporting a young person engaged in a Leadership Opportunity, using the ILP Skill Building Service, and if necessary, the ILP Plus service (not to exceed a total of 150 minutes of skill building per month).

Engagement Efforts Only

Ages 14 - 23

1. Engagement Efforts Only is a service type to support the Contractor’s unsuccessful attempts to engage a young person in group or skill building activities within a given month.

2. Contractor will document, using the MSPR, at least three (3) attempts to contact and engage the young person and the various means used: phone, text, email, family, resource parent, caseworker, home visit, etc. Contractor must include the following details on the MSPR:

a) Date(s) of engagement attempts,

b) Means of engagement attempts (see above), and

c) Description of contact efforts and results.

3. Engagement Efforts Only can be invoiced for two (2) consecutive months. If a young person has not re-engaged after two months of Engagement Efforts Only, no additional payments will be provided until the young person has either attended a Group Session or been provided an ILP Skill Building Service.

Additional Resources

Additional financial resources are being made available to the Contractor to assist with a successful implementation of service provision. Following are the various funding resources and when they are to be accessed:

1. Leadership Opportunities for 14 – 23-year-olds:

a. The Contractor shall provide a stipend or other form of compensation to a young person when participating in a Leadership Opportunity offered by ODHS

(meeting/training), by a community partner, or taking a leadership role within the

Contractor’s ILP.

b. Types of Leadership Opportunities young people may participate in include:

(1) Peer Specialist work during ILP Groups, mentoring peers during Transition

Planning activities, assisting Contractor with co-crafting curriculum or planning ILP skill building activities,

(2) Participating in a focus group,

(3) Participating on the Contractor’s Advisory Committee or other Advisory

Committees,

(4) Participating in ODHS workgroups, Policy Advisory Committee, staff and resource parent trainings, etc.,

(5) Teen panel (e.g.: ASPIRE Conference)

RFA 5651/Attachment A SAMPLE CONTRACT Page 22 of 62

1. State Meeting Funds:

ODHS shall make funding available to reimburse expenses for Contractor when:

a. At the specific request of Youth Transitions, the Contractor participates in special ILP activities, meetings, trainings, or other functions. The Contractor may also identify activities, meetings or trainings that relate to and support ILP work, including supporting Contractor’s staff attendance at the ODHS Sponsored Teen

Events. Contractor will submit an email Application to ODHS Contract

Administrator requesting preapproval for the expenditure. The Application shall include:

(1) Employee’s name

(2) Date, time, location, itinerary and title of the event and any available supporting documentation

(3) Registration fees

(4) Anticipated lodging, transportation, and food expenses (travel per diem expenses calculated using the State reimbursement rates, total costs)

(5) Summary of how the training/conference/event will benefit the Contractor’s ILP service provision.

b. Once written approval is provided by the ODHS Contract Administrator, Contractor can execute planning.

c. State Meeting Funds will not cover the costs of Contractor’s staff wages.

2. Flex Funds

ODHS shall make Flex funding available to reimburse expenses for…