EP_CSC_MSA_Response_Cover_Sheet.docx
DOCX document 18 KB Posted
- Attached to
- Early Psychosis Coordinated Specialty Care Program Staff Enhancement and Evidence Based MA RFA
- Solicitation number
- BD-23-1022-DMH08-8210C-87233
- Issued by
- Massachusetts
About this file
The document is a Department of Mental Health (DMH) Request for Applications (RFA) for an Early Psychosis Coordinated Specialty Care (EP CSC) Program Staff Enhancement and Evidence Based Practice Implementation Master Agreement. The RFA seeks to establish a pool of existing or planned EP CSC Programs to which DMH can award grants to enhance staffing or assist with the implementation of Evidence Based Practices. The RFA includes details on the EP CSC Program, such as the stage of development, whether the applicant currently has a DMH grant, and requires information from the applicant including the program name, parent agency, clinic address, and primary contact details.
The RFA does not provide details on pricing, set asides, incumbents, funding requirements and sources, or other financial information. It focuses on the application process and details required from the applicant to be considered for the grant opportunity.
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Text version
DEPARTMENT OF MENTAL HEALTH
RFA RESPONSE COVER SHEET
Please use this as the first page of your response materials and the label on your submission package. Indicate the grant for which you are submitting an application.
| RFA Number: |
| 2023-DMH-3045-01 |
| RFA Title: |
| EARLY PSYCHOSIS COORDINATED SPECIALTY CARE PROGRAM STAFF ENHANCEMENT AND EVIDENCE BASED PRACTICE IMPLEMENTATION – MASTER AGREEMENT REQUEST FOR APPLICATIONS |
Name of EP Program:
Parent Agency/Hospital:
EP Clinic Address & Zip Code:
Name (Primary Contact):
Position (Primary Contact):
Email (Primary Contact):
Phone (Primary Contact):
Stage of development that best describes your EP CSC program:
☐ Operational for more than 2 years with all or nearly all staff trained in EP CSC EBPs ☐ Operational for less than 2 years with most staff enrolled in ongoing training and consultation ☐ Preparing to launch a new program ☐ Other: ______________
Does the Applicant currently have a grant with DMH for an EP CSC Program? ☐ YES ☐ NO If YES, is it for the Program specified above? ☐ YES ☐ NO If NO, please indicate the current EC CSC Program funded by DMH:
Signature (must be an individual authorized to negotiate for and execute the contract on behalf of the Bidder):
(Signature) ____________________________
| (Print Name) | ____________________________ | |
| (Title) | ____________________________ | |
| (Email and Phone) | ____________________________ | |
| (Date) | ____________________________ |
FOR DMH USE ONLY
| Date Response Received: | Time: | |
| Received by: | Title/Department: |
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