PWS - CHR 9-13-21.pdf

Performance Work Statement (PWS) Community Health Representatives (CHR) Home Visiting Program

1.1 Mission

1.2 Background

1.3 Scope

2 General Requirements

2.1 Non-Personal Services

2.2 Business Relations

2.3 Contract Administration and Management ..................................... Error! Bookmark not defined.

2.4 Contract Management

2.5 Contract Administration

2.6 Personnel Administration ................................................................ Error! Bookmark not defined.

2.7 Subcontract Management

2.8 Contractor Personnel, Disciplines, and Specialties .......................... Error! Bookmark not defined.

2.9 Location and Hours of Work

2.10 Travel ............................................................................................. Error! Bookmark not defined.

3 Performance Requirements .......................................................................................................... 5-11

4 Government-furnished Property/Services and Expectations

5 Records

6 Storage and Disposition of Materials

7 Contractor Payment .......................................................................... Error! Bookmark not defined.2

8 Period of Performance………………………………………………………………………………………………………………..12

9 Deliverables…………………………………………………………………………………………………………………………. 12-13

10 Quality Assurance Survallance Plan………………………………………………………………………………………13-15

Community Health Representatives (CHR) Home Visiting Program

1.1 Mission

The mission of the Indian Health Service (IHS) is to raise the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.2 Background

The IHS, an agency within the Department of Health and Human Services (HHS), is responsible for providing Federal health services to American Indians and Alaska Natives (AI/AN). The provision of health services to members of Federally-recognized tribes grew out of the special Government-to- Government relationship between the Federal Government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is the principal Federal health care provider and health advocate for AI/AN people and its goal is to raise their health status to the highest possible level. The IHS provides a comprehensive health service delivery system for AI/ANs people who are members of 574 Federally recognized Tribes across the U.S. In general, the health services provided to AI/AN people by the IHS include in-patient hospital care, out-patient clinic services, and home-visiting services which are provided by Community Health Representatives (CHRs). This contract will focus on continuing to provide training to CHRs as home visiting educators to optimize use of available workforce for a proven prevention intervention currently named as Family Spirit.

Under the IHS, the Office of Clinical and Preventive Services (OCPS) provides oversight and guidance for policy development, budget development and allocation for clinical, preventive and public health programs throughout the IHS. The Division of Clinical and Community Services (DCCS), under OCPS has authority and the responsibility to establish a national quality CHR program to meet the needs of the AI/ANs people.

The CHR program provides community-based services through health paraprofessionals. CHRs visit clients in their homes and other community settings. CHR refer clients in need of care to the proper facility; interpret; promote wellness; educate community members on a variety of health topics and behaviors related to alcohol use, cigarette smoking, poor eating habits and poor hygiene; collect patient specific data such as vital signs, blood glucose monitoring and provide transportation or arrange for police/ambulance transport in accident or emergency situations among other services.

Currently, the CHR program has provided a structured home-visiting intervention program called Family Spirit for pregnancy to 36 months postpartum implemented by CHR health paraprofessionals. Family Spirit created by Johns Hopkins University (JHU), Center of American Indian Health (CAIH) is a defined clear curriculum for CHRs benefiting AI/AN families by improving the mother’s parenting knowledge and skills thereby improving health outcomes of her infant or child. Since 2013 a total of 51 Tribal, Federal and Urban health program sites have been reached representative of 194 CHRs trained.

1.3 Scope

There is a need to continue this structured IHS CHR family-centered (maternal child health focused) home visiting program. The curriculum is evidence-based and culturally appropriate for American Indian and Alaska Native communities, focusing on the physical, cognitive, and social/emotional development of preschool-aged children. The scope of this contract will be used to train CHRs and strengthen knowledge and skills through peer sharing and learning. Therefore, the purpose of the procurement is to purchase an evidence-based home-visiting program as described above that includes training virtual, technical assistance on the implementation of the Community of Practice Learning Collaborative, and evaluation of the program.

2. General Requirements The following sub-sections provide details of various considerations on this effort. IHS will support 15 virtual training slots from active Family Spirit affiliate sites per year. IHS will support 25 virtual slots per community of practice learning collaborative for a total of 2 collaboratives. The Contractor shall provide all training materials and technical assistance services necessary for participants specific to the Community of Practice Learning Collaborative. The Contractor shall provide all logistics for training, including location, registration, trainers, and evaluation of all training sessions, and overall program effectiveness. The contractors shall have an evidence-based and culturally tailored home-visiting intervention program appropriate for American Indian and Alaska Native communities, focusing on the physical, cognitive, and social/emotional development of preschool-aged children delivered by paraprofessionals.

2.1 Non-Personal Services

The Government shall neither supervise Contractor employees nor control the method by which the Contractor performs the required tasks. Under no circumstances shall the Government assign tasks to, or prepare work schedules for, individual Contractor employees. It shall be the responsibility of the Contractor to manage its employees and to guard against any actions that are of the nature of personal services, or give the perception of personal services. If the Contractor believes that any actions constitute, or are perceived to constitute personal services, it shall be the Contractor's responsibility to notify the Contracting Officer (CO) immediately.

2.2 Business Relations

The Contractor shall successfully integrate and coordinate all activity needed to execute the requirement. The Contractor shall manage the timeliness, completeness, and quality of problem identification. The Contractor shall provide corrective action plans, proposal submittals, timely identification of issues, and effective management of subcontractors. The Contractor shall seek to ensure customer satisfaction and professional and ethical behavior of all Contractor personnel.

2.3 Contract Management

The Contractor shall establish clear organizational lines of authority and responsibility to ensure effective management of the resources assigned to the requirement. The Contractor must maintain continuity between the support operations between the Contractor's corporate offices and Indian Health Service Division of Clinical and Community Services.

2.4 Contract Administration

The Contractor shall establish processes and assign appropriate resources to effectively administer the requirement. The Contractor shall respond to Government requests for contractual actions in a timely fashion. The Contractor shall designate a single point of contact between the Government and Contractor personnel assigned to support this contract. The Contractor shall assign work effort and maintaining proper and accurate timekeeping records of personnel assigned to work on the requirement.

2.5 Subcontract Management

The Contractor shall be responsible for any subcontract management necessary to integrate work performed on this requirement and shall be responsible and accountable for subcontractor performance on this requirement. The prime Contractor shall manage work distribution to ensure there are no Organizational Conflict of Interest (OCI) considerations. Contractors may add subcontractors to their team after notification to the CO or COR.

2.6 Location and Hours of Work

Accomplishment of the results contained in this PWS requires work at various Contractor, Subcontractor facilities. Normal workdays are Monday through Friday except US Federal Holidays. Workers typically work eight (8) hours per day, 40 hours per week. Flextime workers start not earlier than 6:00am and not later than 9:00pm. Core hours of work are from 9:00am to 4:00pm EST daily. All employees are expected to be available during core hours. Contractor may telework as approved by the COR. If the IHS building is closed staff will be required to telework per HHS guidelines.

3. Performance Requirements The Contractor will be responsible for training, technical assistance, and program training evaluations for the active affiliate sites of the CHR home-visiting program.

Contractor will provide an evidence-based curriculum with documented program outcomes for a culturally tailored home-visiting intervention appropriate for American Indian and Alaska Native communities, focusing on the physical, cognitive, and social/emotional development of preschool-aged children delivered by paraprofessionals.

Contractors will support 15 training slots from active Family Spirit affiliate sites per year.

Contractor shall provide one virtual training per year from Family Spirit affiliate sites.

Contractor will be responsible for training and materials, technical assistance, and program training evaluations for the Community of Practice (total of 2) Learning Collaboratives. (A total of two virtual Learning Collaboratives with a cohort of up to 25 CHRs in each cohort will be conducted throughout the contract duration).

Contractor will provide an “alumni” group that will allow for continued peer sharing and learning upon completion of the Learning Collaborative each cohort.

The Contractor shall be responsible to implement a process using a Community of Practice Learning Collaborative (Learning Collaborative) approach that will provide a robust and innovative training for CHRs that is framed in Social Determinants of Health, which will confer important knowledge and skill set around community health. A Learning Collaborative is a systematic approach to process improvement based on the Institute for Healthcare Improvement Breakthrough Series Collaborative model.

For the base year, there will be a planning phase that consists of developing the Learning Collaborative program, creating the application materials, selecting the CHR participants and developing the evaluation. Each Learning Collaborative will bring together a cohort of CHRs and supervisors who have been trained in the current Family Spirit model to participate in a series of “learning sessions” to learn from each other. During the Collaborative, training topics will be developed according to needs determined by participating organizations. Participating CHR sites will test and implement system changes and measure their impact. The CHRs will share their experiences to accelerate learning and broader implementation of their work. Upon completion of the Learning Collaborative each cohort will join an “alumni” group that will allow for continued peer sharing and learning. By the end, program alumni from both cohorts will have had the opportunity to engage and learn from each other creating a strong network and resource for participants that will last beyond completion.

For each Learning Collaborative, teams from participating organizations will attend three learning sessions, each followed by an action period. Participants will gain additional instruction in core components relevant to their work, and practice for testing and implementing changes that will lead to achieving the team’s aim. At each session, teams will report on activities, methods, and results surrounding improvement efforts. During the action periods, participants will work diligently to make their changes a reality. Action periods will be supplemented with site-specific coaching sessions, e-mail communications, monthly progress reports, and web conferences.

The Contractor shall provide monthly learning sessions workshops for each cohort. The Contractor shall provide individual technical support to up to approximately 5 IHS CHR sites with up to 5 people per CHR site per cohort. The Contractor shall supply all learning materials, provide content expertise and develop group and individual coaching modules to address the technical assistance. Topics may include the following, but it should be noted that they may be prioritized, added, or eliminated in consultation with

IHS project officers.

1. Development and enhancement of supervisory skills and assistance with team goal-setting, referral tracking, and documentation

2. Program promotion, outreach methods and guidance

3. Understanding community needs and how to tailor the work to those needs (e.g. substance use, mental health issues, connecting families to resources, etc.)

4. Review of service delivery techniques

5. How and when to screen clients and for what

6. Development of reflective practice skills

7. Technical assistance with quarterly reporting and understanding implications of data

8. Developing a comprehensive referral system of resources

9. Connect virtually with other IHS sites around the nation to facilitate peer support

10. Utilizing a ‘culture as prevention and healing’ approach

11. Boundary setting with a culturally humility lens

12. Self-care for CHRs

13. Building resiliency with a trauma-informed approach

14. CHRs reintegration into homes post COVID-19

Task # Time Point Virtual Learning Collaborative

Phase

Quantity

001 Base Year Planning phase including application and selection of participants

002 Option

Period One

Learning Collaborative Cohort

I (Maximum of 25 participants); launch alumni group

1 (with 3 virtual sessions with an action project)

003 Option

Period Two

Lessons learned from Learning

Collaborative Cohort I, continue worked with Alumni from Cohort I, prepare for

Cohort II, application and selection of participants for

Cohort II

004 Option

Period

Three

Learning Collaborative Cohort

II (Maximum of 25 participants), continue alumni activities with cohort I

1 (with 3 virtual sessions with an action project)

005 Base and All option periods

Conduct one virtual CHR family-centered home visiting program training with 15 participants maximum

1 per period

3.1 Training Plan and Sessions

The Contractor shall provide training sessions consisting of 15 training slots per year. The Contractor shall provide a total of two Learning Collaboratives with a cohort of up to 25 CHRs in each cohort. Upon completion of the Learning Collaborative, each cohort will join an “alumni” group that will allow for continued peer sharing and learning.

Tasks

A001 Training plan (4-year), schedules and logistics for active affiliate sites, and Learning Collaboratives

A002 Training materials A003 Training announcements and communication materials A004 Registration and communications materials A005 Roster of instructors A006 Program evaluation of affiliate sites, and Learning Collaboratives A007 Community of Practice Learning Collaborative/Community Health Training

Series

3.2 Technical Assistance

The Contractor shall provide technical assistance through virtual learning communities, webinars, and/or national conference calls.

Tasks

B001 Agendas, meeting meetings, and quarterly and annual reports

3.3 Virtual Visits

The Contractor shall provide tailored virtual technical assistance to resolve implementation challenges and assist with local evaluation.

Quarterly Reports shall include but not limited to:

Topic Outcome Measures Data Source

Development and enhancement of supervisory skills and assistance with team goal-setting, referral tracking, and documentation

Track CHR participant retention through Quarterly Affiliate Report

Quarterly Affiliate Report

Program promotion, outreach methods and guidance

# of new enrollments by category

# of clients dropped/ withdrawn

# of clients graduated

# of new referrals

Quarterly Affiliate Report

Understanding community needs and how to tailor the work to those needs (e.g.

substance use, mental health issues, connecting families to resources, etc.)

Development of site-specific resource guide

Quarterly Affiliate Report

Review of service delivery techniques

Assess service delivery techniques Quarterly Affiliate Report

Quality Assurance Form

How and when to screen clients and for what

# of screenings completed

Development of reflective practice skills

Assess supervisor reflective practice skills

Quality Assurance form

Technical assistance with quarterly reporting and understanding implications of data

# of quarterly reports completed

Tracking applications of data collected

Quarterly Affiliate Report

Pre/ Post assessment

Developing a comprehensive referral system to resources

# of referrals made

# of referrals successful

# of services

Quarterly Affiliate Report

Pre/ Post assessment

Connect virtually with other

IHS sites around the nation to facilitate peer support

Tracking Log of COP Activities Tracking Log

Pre/ Post assessment

Utilizing a ‘culture as prevention and healing’ approach

Assess program challenges through a cultural lens

Quality Assurance form

Pre/ Post assessment

Boundary setting with a culturally humility lens

Assess how participants incorporate boundary setting techniques into their work

Quality Assurance form

Self-care for CHRs

Job satisfaction level

CHR retention (attrition rate)

Quarterly Affiliate Report

Pre/ Post assessment

Building resiliency with a trauma-informed approach

Assess resiliency of participants Quarterly Affiliate Report

CHRs reintegration into homes post COVID-19

# of in-person visits conducted

A thorough planning phase is required in the first year to refine the specific topic areas and variables to measure.

C001 Virtual quarterly visit schedule C002 Virtual quarterly visit reports with outcomes and next steps

3.4 Training Evaluation and Reporting

The Contractor shall provide summaries and reports for training sessions, learning collaboratives, alumni groups, action projects, virtual quarterly check-in support, technical assistance areas, and annual and overall program improvement and effectiveness.

The Contractor shall follow the reporting plan, which shall be submitted as part of the proposal and incorporated into the contract and keep the Government fully informed of the status throughout the contract period of performance. The Contractor shall provide critical attention to the reporting plan to minimize interruptions or delays to work in progress that would impact the mission.

The Contractor shall provide status reports to the COR to include but not be limited to expense variance to budget, logistical updates, attendee metrics, attendee training evaluations, project plan tracking, evaluation data, and other items as determined by the COR. The Contractor shall deliver status reports by email or postal service no less than every month but may be adjusted as determined necessary by the COR throughout the course of the project. Electronic reports shall be presented in Microsoft Office format and approved by the COR. The monthly status reports shall be discussed at the Kick-off meeting.

The Contractor shall provide to the COR, annual performance reports that include but are not limited to project plan status and accomplishments, fiscal accountability, evaluation data, sub-Contractor performance reports (if applicable) and a Contractor self-evaluation report. The Contractor shall provide a written outline of the annual report to the COR for approval according to the deliverable schedule. The annual reports shall be delivered by e-mail and postal service according to the deliverable schedule before the end of the contract period. The annual report shall be discussed at the kick-off meeting.

Write and provide at the conclusion of the project a Comprehensive Final Report of the CHR Home- Visiting Program that includes but is not limited to an introduction; accomplishments of the project including numbers of CHRs and other staff trained; a description of the trainings completed; budget summary; emerging challenges and mitigation strategies and actions; lessons learned, recommendations; instructor biographies, etc..

Evaluation

An evaluation will be conducted to assess how the Community of Practice (COP) Learning Collaborative improves lives for American Indian people by tracking specific outcomes of CHR participants. The evaluation will assess how the COP impacts participating CHRs, client outcomes, and the community at large. Process and outcome measures will be tracked on the topic areas as outlined in table 2 below.

In addition to tracking the outcomes on the content taught through the COP, a survey will be administered at 3 time points (Pre-, Mid – (at end of COP), and Post (6-months post completion of the program) to assess the impact of the COP on the impact of service delivery of the program, on the program delivery by looking at client recruitment and retention rates, adherence to fidelity measures for

CHRs administering the home visiting program and overall program success.

QASP

Create a Quality Assurance Surveillance Plan (QASP) and Quality Control Plan (QCP). The COR will use the QASP and QCP to monitor quality and evaluate the Contractor’s performance to ensure the objectives of the contract are met. The primary method of surveillance shall be 100% inspection.

Develop, implement and maintain a QCP. The QCP shall outline all steps in the quality control process to ensure high quality deliverables developed by the Contractor and its subcontractors. The QASP shall be directly aligned with the specific objectives and activities outlined in the SOW and the Contractor’s approach. The QASP shall include the following:

Required tasks Performance indicators Performance standards Acceptable Quality Levels (AQLs) A focus on customer satisfaction (PO and awardees), quality, timeliness, quantity, accuracy A summary of the outputs/inputs to be surveilled, including the identification of each specific task

Methods of surveillance

D001 Evaluation report for each training D002 Evaluation report of successes, challenges, action projects, and needs related to technical assistance learning collaborative D003 Evaluation report of base year, each option year, and overall comprehensive program D004 Provide a QASP and QCP as outlined within 45 days of award of contract.

4. Records Contractor shall specifically destroy or return to IHS all data utilized in the evaluation of the project. The Contractor shall not use, retain, publish, or add the data to any other data it has collected at any time for any other purpose. The Contractor shall use only non-personally identifiable information in the evaluation of the project.

5. Storage and Disposition of Materials Disposition of any national training and marketing materials will be determined in the kick-off meeting.

Storage should be available as soon as national materials are generated. A disposition schedule will be discussed with the COR during the kick-off meeting.

6. Contractor Payment If the Contractor fails to perform required services at the acceptable quality level, payment may be withheld until Contractor makes corrections. If performance is below the performance standard, Government oversight or contractor reporting will be increased. The COR is responsible for documenting and communicating performance deviations, corrective actions, and performance improvements to the CHR PO, the Contracting Office, and the Contractor This will be documented in the Contractor Performance Assessment Reporting System (CPARS).

7. Period of Performance The period of performance is a base period of 12 months with four (4) 12 month optional periods. The

Government may exercise options to extend the period of performance in accordance with 52.217-9 –

Option to Extend the Term of the Contract; upon written notification by the Contracting Officer within

30 days of contract expiration.

Base Period: September 29, 2021 through September 28, 2022 Option Period One: September 29, 2022 through September 28, 2023 Option Period Two: September 29, 2023 through September 28, 2024 Option Period Three: September 29, 2024 through September 28, 2025

8. Deliverables

Timeline Deliverable Schedule Who to Report To

Within 10 days of contract award

Kick-off meeting with the CO, COR, Program Official

COR,CO, PO

30 days after award Task 3.1 Training Plan

A001 Training plan (4-year), schedules and logistics for active affiliate sites, and Learning Collaboratives A002 Training materials A003 Training announcements and communication materials

COR

2 months after award

Task 3.1 Training Sessions

A004 Registration and communications materials A005 Roster of instructors A006 Program evaluation of affiliate sites, and Learning Collaboratives A007 Community of Practice Learning Collaborative/Community Health Training Series

3 months after award Task 3.2 Technical Assistance

B001 Agendas, meeting meetings, and quarterly and annual reports

COR

5 months after award Task 3.3 Virtual Check-in Visits

C001 Virtual quarterly visit schedule C002 Virtual quarterly visit reports with outcomes and next steps

15 days after completed training

Task 3.4 Training Evaluation and Reports

D001 Evaluation report for each training

12 months after Award Task 3.4 Training Evaluation and Reports

D003 Evaluation report of base year, each option year, and overall comprehensive program