PWS Safe Haven.docx

B.PERFORMANCE WORK STATEMENT

Health Care for Homeless Veterans (HCHV) Contract Residential Care Safe Haven Model Demonstration Program

BACKGROUND AND OVERVIEW:

The VA has been providing direct and specialized services for Veterans experiencing homelessness for nearly 30 years. The Secretary of the VA has set a zero-tolerance policy for homelessness within the Veteran population. As part of the Plan to End Homelessness among Veterans announced in late 2009, the Veterans Health Administration (VHA) has been increasing both capacity of existing programs and services offered to program participants. The plan calls for utilizing new models of care not previously offered by VA.

The Department of Veterans Affairs’ (VA) Plan to End Homelessness Among Veterans calls for enhancing current homeless service capacity as well as developing new programs and initiatives in concert with community and federal partners. The intent of this contract is for the VAMC in Boston, Massachusetts to engage a community provider to offer Veterans experiencing homelessness services through a “Safe Haven” model of residential care. Under the contract authority of VA’s Healthcare for Homeless Veterans (HCHV) Contract Residential Care programs, the VAMC in Boston, Massachusetts will solicit community organizations to provide “Safe Haven” services as a ‘specialty model.’

Entities that are interested in providing Veterans these services should be aware that although this contract seeks services for the Boston, Massachusetts VAMC, HCHV is a national program serving Veterans throughout the country. This program continues to expand and has become one of the largest VA interventions to assist homeless Veterans. It is also the first specialized homeless program developed by the VA. It represents one of VA’s most significant efforts to achieve the President’s goal of ending homelessness among Veterans. The Safe Haven model demonstration is being conducted in twenty sites and is highly monitored.

The Boston, Massachusetts VA Medical Center is seeking a Contractor to assist with the provision of emergency residential placement and supportive services through the Health Care for Homeless Veterans (HCHV) program Safe Haven model demonstration. This contract will serve 10 Veterans who are chronically street homeless in need of immediate placement in a safe environment with onsite supportive services. Many of these Veterans have co-morbid conditions that include serious mental illnesses, substance abuse disorders, and other serious medical conditions. The goal of the HCHV Contract Residential Care Program is to rapidly stabilize Veterans’ medical, mental health, substance abuse, and other psychosocial problems in order to place Veterans in other appropriate transitional or permanent housing within 60 to 90 days, but no more than 180 days. VA intends to engage a Contractor to provide rapid placement of VA-referred Veterans in a safe, supportive, residential setting while addressing Veterans’ complex needs through on-site intensive supportive case management services using a Safe Haven model. This housing must meet the criteria established both by HCHV clinical staff and VA fire and safety officials. Contractors are urged in the strongest terms to carefully review the requirements outlined in the Statement of Work to ensure that all facilities fire and safety and supportive services criteria can be met in a timely way.

This contract is intended for a community-based contractor currently operating a Safe Haven emergency housing program with on-site supportive services and demonstrated experience serving chronically street homeless Veterans in conjunction with the VA medical center whereby this contract provides supplemental funding for Veterans to receive immediate placement and enhanced on-site services designed to address Veterans’ unique and population specific needs. The selected contractor must have at least three (3) years of direct experience as a provider of a Safe Haven program. The selected contractor must also have more than five (5) years of direct experience working with homeless Veterans in partnership with the Department of Veterans Affairs through one or more VA homeless housing programs such as HCHV Contract Residential Care or VA’s Homeless Providers Grant and Per Diem Program. VA places a great deal of emphasis on the responsibility and accountability of contractors receiving VA funds through the HCHV Contract Residential Care program. VA has procedures in place to monitor facilities and services provided to homeless veterans as well as outcomes associated with the services provided in HCHV Contract Residential Care programs and the Safe Haven model demonstration programs.

The target population for HCHV Contract Residential Care Safe Haven is chronically homeless, chronically mentally ill Veterans, Veterans with chronic substance abuse disorders, and/or serious medical problems and complex needs. To be eligible for the HCHV Contract Residential Care Safe Haven program, Veterans must:

· Be eligible for VA health care as determined by the local VA medical center

· Be determined to be chronically street homeless based on McKinney-Vento Act definitions [see Reference section for additional information] by the local VA medical center HCHV program

· Be assessed by the HCHV program at the VA medical center to have serious medical, mental health, substance abuse, or other serious psychosocial conditions or stressors that makes the Veteran highly vulnerable with a high likelihood of death due to homelessness, and have been unable or unwilling to participate in more traditional supportive services.

This contract will only be awarded to one contractor with a facility in the inner Boston area. A VA Liaison to the contractor will be identified by the homeless program leadership at the Boston Massachusetts, VAMC. She/he will act as the clinical liaison for all client related issues between the Contractor and the Boston, Massachusetts VA homeless team. She/he will provide clinical oversight. She/he will not provide direct clinical supervision.

IMPLEMENTATION TIMELINE

The contract facility and associated onsite services are expected to pass inspection and become fully operational within 30 days from the date of contract award. Failure to meet the 30-day milestone may result in the contract being terminated.

A. The contractor providing Safe Haven housing and supportive services must accommodate male, female, and transgendered Veterans, as well as disabled Veterans and Veterans with a sex offense status. Contractor is required to ensure the safety and privacy of these Veterans. Men and women must have separate bathroom facilities. The facility must have female residential rooms or sections that are securely segregated or restricted from men to ensure safety and privacy. If the facility cannot accommodate these Veterans at one location, the provider must make available equivalent facilities and services for the opposite gender that meet the terms of the contract for facilities and services.

B. Contractor must provide a safe and secure environment for all residents that are consistent with the Safe Haven model of housing and services. The contractor will offer a low-demand environment with a minimum set of rules designed to re-establish trust in the chronically homeless Veteran and engage the Veteran in needed treatment services.

C. The contractor must provide designated onsite office space to a VA Liaison from the Boston, Massachusetts VA. The office space must afford the VA Liaison and Veterans privacy and confidentiality when meeting. The VA Liaison is expected to be onsite at the Contractor facility two to five days per week in keeping with VA model development program expectations.

D. Contractor will allow VA staff to inspect that facility and/or review Veteran participant treatment protocols at any time determined necessary by VA.

E. Safe Haven location will be located in the inner city of Boston in order to maximize access to chronically homeless Veterans.

F. The location will be in walking distance (under 1 mile) to public transportation.

STAFFING AND SUPPORTIVE SERVICES

A. The contractor shall employ sufficient professional health care personnel to carry out the policies, responsibilities, and programs of the facility. In contract housing, there must be, at a minimum:

a. A full-time administrative staff member on duty and available for emergencies 24 hours a day, 7 days a week. A Director/Manager of the program and/or facility on call and available for emergencies 24 hours a day, 7 days a week.

b. A professionally credentialed clinical Manager available to provide ongoing supervision of cases to case management personnel, as well as ongoing management of the program. The clinical supervisor must be on call and available for emergencies 24 hours a day, 7 days a week.

c. Sufficient, trained case management personnel to provide the necessary therapeutic interventions and activities and to ensure a meaningful integration of these efforts with those provided in the residential setting on a 1:5 ratio.

d. Security staff onsite 24 hours a day, 7 days a week. Security staff must be sufficient to ensure a safe and secure environment for all residents. Security staff must also be cognizant of and sensitive to the Safe Haven model and populations served.

e. At least one staff or security member with Cardio-Pulmonary Resuscitation (CPR) certification on site and available in an emergency during each shift, 24 hours per day.

f. Program entrance is appropriately separated and secured for privacy and security given the populations served.

B. Outreach will be conducted by the Safe Haven provider and VA homeless outreach staff to optimally engage the target population. Outreach by the provider should be conducted collaboratively with HCHV staff and target chronically homeless Veterans who have difficulty accepting housing and services from traditional programs.

C. The contractor shall provide, at minimum, the following intensive case management services to Veterans in the program:

a. Engagement of the Veteran in the service planning process. Contractor will carry responsibility for interviewing, counseling, and case management of identified Veterans by conducting biopsychosocial assessments to identify treatment needs which affect the Veterans’ adjustment to their environment and establish treatment goals.

b. Develop a highly individualized Service Plan with the Veteran consistent with low demand program goals; the plan must specifically include provisions for Veteran placement into an appropriate transitional or permanent housing placement within 60-90 days of admission to the HCHV Contract Residential Care facility, but no more than 180 days. Acceptance of the services offered should not be a condition of continued stay in Safe Haven. However, engagement and service delivery should retain the expectation that the resident will advance to permanent housing with support, recognizing that it will often be at his or her own pace.

D. The contractor will provide the following onsite therapeutic and rehabilitative services including:

a. A variety of daily structured groups and activities to promote social skills building and healthy lifestyle (i.e., resident participation in psychosocial group sessions, topics based upon resident preference and recommendations by the residential treatment setting staff and VA Liaison; physical activities; facilitated outings or social activities in the local community). Daily activity schedules must be printed and posted in facility common areas to ensure Veteran awareness and promote participation.

b. Three (3) meals daily, including weekends.

c. Facility will provide all linen including sheets, towels, pillows, and blankets during LOS.

d. VA will pay up to two (2) nights for any unscheduled/unauthorized absences for a Veteran under the following conditions:

i. Provider must have evidence of and document active outreach to locate and reengage Veteran;

ii. Provider must not place anyone else in the room/bed;

iii. Veteran be discharged from the program if not located within 48 hours.

e. Veterans are able to receive up to four (4) overnight passes, as clinically indicated. The bed will be included in the monthly census and reason for overnight pass be documented and consistent with and support the Veteran’s service/treatment plan. Provider must not place anyone else in the bed.

f. The per diem payment may be made to the Contractor/provider for a period of up to 7 days for a Veteran if Veteran requires inpatient medical or psychiatric treatment.

g. Health and personal hygiene maintenance;

h. Monitoring of medications, if necessary;

i. Supportive social services, in collaboration with the case managers, VA or other community resources;

j. Professional counseling as required, including emphasis on self-care skills, adaptive coping skills, vocational counseling, in collaboration with the VA Liaison or community resources as appropriate;

k. Opportunities for immediate learning and/or development of responsible living with a goal of achieving a more adaptive level of psychosocial functioning;

l. Support for an alcohol and/or drug-free lifestyle;

m. Opportunities for learning, and internalizing knowledge of the illness and/or recovery process, improving social skills, and improving personal relationships.

n. Opportunities for client participation in community activities, volunteer opportunities, local consumer services, etc.

o. Contractor will work in partnership with VA Liaison to provide and maintain data on performance measures related to discharges to permanent housing, negative discharges, and 3-month post discharge follow-up.

p. Contractor will maintain regular communication with VA Liaison regarding Veteran’s progress in the program.

ADMISSIONS AND LENGTH OF STAY

The goals of the HCHV Contract Residential Care Safe Haven Program are to:

· Rapidly stabilize Veterans’ medical, mental health, substance abuse, and other psychosocial problems by expediting placement of these Veterans into safe, supportive emergency housing.

· Place Veterans in other appropriate transitional or permanent housing within 60 to 90 days, but no more than 180 days from the date of admission.

a. Veterans will be screened and referred to the contractor by the VA Liaison. Excepting lack of available beds, the contractor will be expected to provide immediate admission to housing and services to these Veterans 24 hours per day, 7 days per week. The date of admission must be approved by the VA Liaison for billing purposes. If a Veteran presents at the facility during weekends, at night, or a holiday day, the Safe Haven provider may accept the Veterans. However, VA staff has the right of approval or disapproval for payment. Engagement of homeless Veterans in the provision of housing placement, treatment, and supportive services is a key element of the HCHV Contract Residential Care program. Therefore management of program dropout will be an element of the quality assurance review of this program.

b. Although demands are kept minimal in the Low-Demand/Safe Haven setting, expectations should be kept high regarding the resident utilizing the time to access other residential treatment, transitional, or permanent housing settings offered by VA and the community. Continuous engagement should be directed at helping the resident achieve goals of securing a more permanent setting. Maintaining housing stability should always be the primary goal.

c. Veterans will ideally be placed in other transitional or permanent housing suitable for the Veteran within 60 to 90 days from the date of admission, but not more than 180 days from the date of admission. However, option to extend based on clinical need is available and will be discussed with VA Liaison.

d. In the event that a Veteran’s length of stay exceeds 180 days from the date of admission and there is not approval from the VA Liaison for continued per diem, the contractor will retain the responsibility for finding suitable transitional or permanent housing in the community at its own expense.

QUALITY ASSURANCE SURVEILLANCE PLAN

Safe Haven

1. PURPOSE.

This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate Contractor performance related to a specific contract. This QASP explains the following:

· What performance measures will be monitored?

· How will the monitoring take place?

· Who will monitor the performance?

· How will monitoring efforts and results be documented?

This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. In addition, the QASP should recognize that unforeseen and uncontrollable situations may occur.

This QASP is a “living document” and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Updates shall ensure that the QASP remains a valid, useful, and enforceable document. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.

2. GOVERNMENT ROLES AND RESPONSIBILITIES.

The following personnel shall oversee and coordinate surveillance activities:

· Contracting Officer (CO) - The site Contracting Officer shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.

· Contracting Officer’s Representative (COR) - The COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractor’s performance. The COR shall keep a quality assurance file. At the conclusion of the contract or when requested by the CO, the COR shall provide documentation to the CO.

· Safe Haven VA Coordinator will provide clinical and administrative supervision. Any concerns will be shared immediately with the contracting agency. The contractor will be expected to be a participant of the Safe Haven team.

3. PERFORMANCE STANDARDS.

Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards. The Performance Requirements Summary Matrix includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).

Access

· The Contractor shall be responsible for: admitting veterans, assessing veterans (including initial and ongoing assessments), care planning (including the care-planning process and the evaluation of the care and services provided), clinical case management, crisis intervention, and discharge planning. There must be a full-time case manager or their designee available 24 hours a day, 7 days per week.

Therapeutic and Rehabilitative Services

· The Contractor shall meet the therapeutic and rehabilitative needs of each veteran in accordance with a plan of care which addresses the specific needs of each veteran.

· The plan shall be written by a licensed professional with input from the veteran, other community resources, and the VA, as needed.

· The plan should provide motivation and education geared toward achieving independence in ADL’s and self-care.

· The Contractor will establish and maintain an intensive therapeutic relationship with the Veteran, program staff, significant others, and other State, Federal, and community providers.

Record & Reports

· The veteran’s record will include all essential identifying data relevant to the veteran (including all relevant assessments), data relating to the veterans admission, reports of contact with each veteran, reports of ‘staffing’ by the treatment team, documentation of the veteran’s progress within the program, and discharge summaries.

· Individual case records must be kept in a secure, locked environment and be maintained in confidence as required by the Privacy Act of 1974, and all other applicable laws and regulations, and VA statutes and policies.

· Records will be available for inspection and evaluation at all times.

· Discharges will be reported to the VA within 24 hours of discharge and Discharge Summaries will be provided to the VA Safe Haven Coordinator within 5 working days.

4. SURVEILLANCE METHODS

Various methods exist to monitor performance. The CO will use the surveillance methods listed below in the administration of this QASP.

Regardless of the surveillance method, the CO shall always contact the contractor or on-site representative when a problem is identified, and inform the manager of the specifics of the problem. The CO, with assistance from the COR, shall be responsible for monitoring the contractor’s performance in meeting a specific performance standard/AQL.

· DIRECT OBSERVATION.

· MANAGEMENT INFORMATION SYSTEMS (MIS).

· PROGRESS OR STATUS MEETINGS

· PERIODIC INSPECTION.

· USER SURVEY

5. RATINGS

· Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. Compliance with the Statement of Work is evaluated on an ongoing basis using various surveillance methods. The following ratings shall be used to indicate the extent to which the Contractor meets performance standards:

6. DOCUMENTING PERFORMANCE.

· ACCEPTABLE PERFORMANCE.

The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action.

· UNACCEPTABLE PERFORMANCE.

When unacceptable performance occurs, the COR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COR shall document the discussion and place it in the COR file.

When the COR determines formal written communication is required, the COR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's task manager or on-site representative. Any CDRs may become a part of the supporting documentation for contractual action. The Contractor will have 30 days from the receipt of the CDR to address actions that will be taken to address the concerns.

The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COR. The Government shall review the contractor's corrective action plan to determine acceptability.

· FREQUENCY OF MEASURMENT

During contract performance, the COR shall periodically assess whether the negotiated frequency of measurement is appropriate for the work being performed.

The COR or designee shall meet with the contractor quarterly to assess performance and shall provide a written assessment.

Contract Program Manager Date

Contract Officer’s Representative (COR) Date

PERFORMANCE REPORT

1. CONTRACT NUMBER:

2. Prepared by: (Name of COR)

3. Date and time of observation: Quarterly Reviews

4. Observation:

Prepared by: Shara Katsos

QUALITY ASSURANCE SURVILLANCE PLAN (QASP)

Task

Quality Level

immediately

Does not currently have duties under current HCHV contracts that exist. (no double staffing of staff)