Special_Provisions_-_240403.pdf

Appendix A: Family Navigation Services RFP 24-034 i

Table of Contents

APPENDIX A – SPECIAL PROVISIONS (d. 04/XX/2024)

1.0 SPECIAL PROVISIONS

APPENDIX A - SPECIAL PROVISIONS (d. 04/##/2024)

1.0 SPECIAL PROVISIONS

GENERAL DESCRIPTION

The Contractor will provide family navigator services for Charles County.

PROGRAM STRUCTURE AND STRATEGIES

Family Navigation services provides resource coordination and support for families seeking services for their children. The services provided should be based on a peer support model and include training to ensure staff are aware of the local resources as well as best practices when working with families. While Family Navigation is not case management, there is a level of follow-up and direct coordination that is needed to complete the services.

FAMILY NAVIGATOR SERVICES

The Family Navigator will provide services to families with more intensive needs or those who are involved with multiple agencies. A staff person will be provided for all Local Care Team meetings and be directly involved with Local Care Team

(LCT) families.

POPULATION TO BE SERVED

Charles County families seeking services for their child with a mental health, behavioral health, or developmental need. This will include but not be limited to families who are working with the Local Care Team.

SCOPE OF WORK

1.5.1 Program Structure and Strategies

Family Navigation provides access to services and improved coordination and utilization of existing services through Family

Navigators

A. The goals are:

1. To provide assessment and care coordination to families with children with intensive needs.

2. To ensure ongoing development of prioritized resources to support a comprehensive system of care.

3. Attend Charles County Local Care Team meetings and coordinate with all Local Care Team families prior to, and during LCT meetings.

B. The Center will be staffed with two (2) Family Navigators.

1.5.2 Family/Family Navigator Qualifications

A. Parents of children with special needs who have experience with various systems.

B. Bachelor’s degree preferred (other commensurate experience or training may be substituted).

C. Excellent communication/listening skills.

D. Knowledge of community resources.

E. Proficient organizational skills.

F. Insurance and the extent to which various types of coverage impact the ability to get services.

G. Behavioral/Mental Health:

1. Developmental Disabilities.

2. Education and academic development.

3. Medical and physical health.

4. ‘Real Life Needs’ (e.g., finding a dentist, a place to get child’s haircut).

5. Family Navigators will NOT provide therapy or diagnostic assessments.

The Center will be housed in a comfortable, neutral, and stigma-free location, such as a storefront, medical office building, library, or community center. The center must be located in Charles County. The space will have private offices, to offer confidentiality, a general meeting room and a resource room/library with a space for children to play. Parents will be able to browse through and borrow materials from the resource room/library. There they would also have access to a database of local resources.

The Center will be required to operate regular business and non-business hours (evenings and weekends) to accommodate working caregivers. Possible hours could include 12:00 PM – 8:00 PM or splitting the day – 9:00 AM to 1:00 PM and 5:00 PM to 8:00 PM, and some weekend hours.

The Family Navigator work will include but not be limited to the following:

A. Assist families in identifying their strengths and needs.

B. Support the development of their Family / Service plan.

C. Identify specific programs/organizations that will provide key resources for families.

D. Document, accurately, all services being provided to the individual families.

E. Assist the families in obtaining necessary services; and

F. Ensure agencies and families follow through with contacting each other.

The Family Navigator position must be filled by an individual who is considered to be a ‘Legacy Parent’. This is a parent that has provided direct care for youth with intensive needs, has hands-on experience in seeking resources for their child(ren), and is familiar with navigating the resource system. The Family Navigator will link families to services and available resources, conduct outreach for the program, organize events that will assist families in the community along with completing the

Information and Referral gathering process.

Services will be flexible and culturally competent to meet the individual needs of the family. A broad range of services will be offered. The family will participate as a partner and must be involved in planning, developing, and implementing the Family

Plan.

PAYMENT TO THE CONTRACTOR

CCACCFY anticipates the following payment schedule, but reserves the right to make changes:

A. 25% upon fully executed contract

B. 25% upon receipt of 1st quarter report

C. 25% upon receipt of 2nd quarter report

D. 15% upon receipt of 3rd quarter report

E. 10% upon receipt of 4th quarter report

Payments shall not be issued earlier than 7/15 of the fiscal year. Payments shall not exceed the maximum percentages above of the program budget and shall reflect actual expenditures, whichever is less. Payment is contingent upon the Contractor’s timely and complete submission of the required program and fiscal reports on CCACCYF approved forms for all payment requests made after the initial payment of the fiscal year. Supporting documentation of actual expenditures such as general ledger or actual expenditure report is required when submitting fiscal reporting.

The CCACCYF will be permitted thirty (30) consecutive calendar days from date of receipt of reports (fiscal, narrative, etc.)

to review all received documents prior to releasing payment. For any purchased equipment during the fiscal year, a copy of the invoice/receipt for that equipment shall be submitted along with the financial report/form 432 requesting reimbursement for the expenditure.

PROGRAM ACTIVITIES

1.7.1 Outreach and Referral

The Center will provide outreach and referral services primarily through its dedicated phone line. The dedicated phone line will serve as an umbrella number for all Charles County families, including those with high intensive need children. A highly trained Family Navigator will field the calls and will provide parents with immediate information and referrals. Family

Navigator will be trained to ask targeted questions and to actively listen so that they can quickly determine caller needs (e.g., referral information or more intensive FN services). The Center will maintain a detailed and updated resource directory.

The Center will market its services to a variety of audiences such as community members, school personnel, pediatricians, clergy, law enforcement, and mental health workers using the following mechanisms:

A. Public Forums

B. Schools

C. Libraries

D. Support Groups

E. Family Support

F. Communications through the media (newsletters, newspapers, billboards, radio, local TV)

G. Faith-Based Centers and Organizations

H. Electronic Bulletin Boards and/or Website (optional, not a requirement)

I. Mental Health Providers

J. Health Community

K. Local Child-Serving Agencies

L. Existing Fairs

SYSTEM ENTRY/ACCESS & SCREENING ASSESSMENT

1.8.1 Access & Screening

In addition to referral services, the Center will also be the point of access for families needing more intensive services. FN/SN taking calls will use a carefully developed screening tool to assess caller need during the initial call. It is important to note however that families experiencing a crisis or emergency situation will immediately be referred to 911 and will not participate in the screening process. The screening tool will aid the Family Navigator in determining which level of service the family may need.

• Level I – information and referral only.

• Level II – targeted intervention/care coordination.

• Level III – most intensive/care coordination.

1.8.2 Level I (Referral Only)

Level I (referral only):

It is anticipated that about 80% of the calls received will only require a referral phone number to another service. These callers will be encouraged to contact the Center again if they are not helped by the referring agency. Referrals will also include peer support networks (e.g., support groups and mentors).

1.8.3 Level II (Targeted Intervention)

Level II (targeted intervention):

It is anticipated that about 15% of the callers will fit into this category, which will include families who are in the midst of a serious, although not a crisis, situation. It is anticipated that if these serious situations are not addressed that they may become crisis situations in the near future. These children may not fit into the system’s criteria for services and, thus, they may “fall through the cracks” of existing services. These children include those who have complex problems and possible family issues, and who do not qualify or meet thresholds for existing services. These children may have a multitude of problems such as:

• Learning/developmental disabilities

• Social/emotional difficulties

• Behavioral concerns

• Attention Deficit/Hyperactivity Disorder

1.8.4 Level III (Most Intensive)

Level III (most intensive):

It is anticipated that about 5% of the calls will be in this category. Children and families who fall into this category will generally be children who:

• Were briefly treated for mental health issues (2-3 days in a hospital) or untreated for mental health issues and are a:

o Suicide danger.

o Danger to other family members.

o Sexually acting out.

o Serious substance abusers (such as heroin).

• Are not having their needs met by the public mental health system.

• Have been arrested, are involved with Juvenile Services, and have mental health, substance abuse or other serious issues.

• Have developmental disabilities with additional diagnoses and/or physical, mental health, or behavioral issues.

• Have multiple diagnoses and are receiving services from a system that is designed to treat one disability: or

• Those families that have a lead agency (e.g., Department of Juvenile Services (DJS), Department of Social Services

(DSS), or School System Special Education) may be referred to the Local Care Team for technical assistance.

The families who call may also be experiencing crisis situations such as:

• Economic stress.

• Parental mental health/substance abuse issues.

• Parents experiencing a high stress level.

• Families who have very few supports.

• Family violence issues.

• Divorce/separation issues.

1.8.5 Assessment

Following the initial call and screening, a more detailed assessment will be offered to families by the Family Navigator. This assessment will assist families in identifying their strengths and areas of need. For example, Family Navigator may consider use of the CANS comprehensive tool. Families that are determined to have children with "intensive needs" will be eligible for

FN services including the development of a Family Care Plan and care coordination. Families that opt for FN services will be scheduled for a subsequent meeting with their assigned FN to develop a Family Care Plan. The ultimate goal of Family

Navigator will be to aide parents in developing the skills that empower them to access and navigate their children’s care independently.

The Family Navigator will participate in training that furthers their knowledge in the areas of Racial and Ethnic Diversity as well as Adverse Childhood Experiences (ACEs). In addition, through regular staff meetings, Family Navigator will continually provide cross-training and support one another.

1.8.6 Care Coordination

Care coordination will be available for families of children who fall into the level II and level III categories. Care coordination will include the development of a Family Care Plan using a family-centered, strengths-based approach, along with the coordination of services and support. Family Navigators and parents will also note gaps and barriers in obtaining services.

Family Navigation services are considered to be short-term with an average case lasting 30 days or less, with a maximum of

120 days. Once cases are successfully linked and actively receiving services from the receiving agencies, the case will be terminated from the Family Navigator services.

1.8.7 Information Management

The program will be required to utilize an electronic case management system which will be used for collecting information on case management, measuring outcomes, and tracking the family. The system should provide easy access, unduplicated counts, a database to collect and store client information, identify gaps in services, track trends regarding risk factors and an excellent case management tool. The system must be HIPAA compliant.

RESULTS TO BE ACHIEVED

Family Navigator: Performance measures will be updated annually based on funding requirements.