TAB 10 PWS April 2021.pdf

Pinon Health Center Counseling Services (PHCCS) Performance Work Statement (PWS) for Domestic Violence Prevention Initiative (DVPI) Grant Program Contractual Services

Table of Contents

Section Page

1.0 General 1-2

2.0 Definitions 3-4

3.0 Government Furnished Information, Property, & Services 5

4.0 Contractor Furnished Property 6

5.0 Performance-Based Requirements 7-8

6.0 Contractor Qualification Requirements 9-10

7.0 Challenges to Conflicts 11

8.0 52.212-4 Contract Terms and Conditions-Commercial Items (MAY 2015) (m) 12

9.0 Performance-Based Matrix 13-14

10.0 List of Attachments and Exhibits 1

Pinon Health Center Counseling Services (PHCCS) Performance Work Statement (PWS) for Domestic Violence Prevention Initiative (DVPI) Grant Program Contractual Services

Comprehensive PHCCS, DVPI

1.0 General: This performance work statement describes the requirements for contractual services for Domestic Violence Initiative Program to support the Pinon Health Center Counseling Services mission of the Indian Health Service (IHS) by raising the physical, mental, social, and spiritual health of American Indians and Alaska Natives to the highest level.

1.1 Background: IHS is an agency within the U.S. Department of Health and Human Services and is responsible for providing federal health services to American Indians and Alaska Natives. 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.

The IHS is the principal federal health care provider and health advocate for the Indian people.

The goal is to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indians and Alaska Natives. The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 557 federally recognized tribes in 34 states.

1.1.1 Navajo Area Indian Health Service (NAIHS) administers health centers and hospitals providing health care to approximately 201,583 members of the Navajo Nation. The Navajo Nation is the largest Indian tribe in the United States and has the largest reservation, which encompasses more than 25,516 square miles in northern Arizona, western New Mexico, and southern Utah, with three satellite communities in central New Mexico. The NAIHS is the primary provider of inpatient, ambulatory care, preventive and community health, and environmental health services for members of the Navajo Nation and the San Juan Southern Paiute Tribe.

1.1.2 Chinle Comprehensive Health Care Facility (CCHCF) provides medical care for approximately 35,000 Navajo. Serving a rural area, many of our patients travel 100 miles round trip to receive care and do not have electricity or running water in their homes. In addition, most of our elderly patients speak only Navajo, and live according to traditional Navajo cultural practices. The CCHCF and Ambulatory Care Center is a 60-bed inpatient hospital and outpatient facility. Services offered are:

• Adult Inpatient • Mental Health • Physical Therapy

• Adult Intensive Care • Native Medicine • Podiatry

• Anesthesiology • Nurse Phone Triage Services* • Public Health

• Audiology • OB/GYN & Midwifery • Radiology

• Dental • Occupational Therapy • Respiratory Therapy

• Emergency Medicine • Optometry • School Health

• General Surgery • Outpatient Primary Care • Speech Pathology

• Lab • Pediatric Inpatient • Women’s Health

• Labor & Delivery • Pharmacy *Available after hours.

1.1.3 Urgent Care Department – ER Department care for approximately 30,000 patients per year. The ER Department consists of nine (9) beds and emergency care services are provided on a 24-hour basis for adults, adolescent children and infants. The Urgent Care Department operates from 8 am - 8 pm, Monday through Sunday including Holidays. The Urgent Care Department consists of six (6) beds and is staffed by mid-level providers (Physician Assistants or Nurse Practitioners) who see patients that present for acute care and who have been triaged as lower acuity.

1.2 Scope: The contractor shall provide an outreach mental wellness community programs as stated in the Pinon Health Center Counseling Services Domestic Violence Initiative grant proposal.

1.2.1 Duties and responsibilities shall encompass the communities within the Pinon Services area with wellness programs at schools, at chapter houses and at community-based sites.

Contractor shall administer and implement appropriate educational program for the various group in the community. Contractor shall partner with other service providers for sustainability of the programs. Contractor is responsible for solicitation of activities and increase program participation. Contractor is responsible for evaluation of all DVPI activities.

1.2.2 Place of Performance: Services are to be performed with the schools and community on field trips and capacity building venture locations, and at contractor’s office. Contractor shall have a personal on site at program function.

1.2.3 Period of Performance: The program shall perform the wellness activities from May 1, 2021 to September 30, 2021.

Definitions

2.1 Acceptance: Constitutes acknowledgement that the supplies or services conform to the applicable contract quality and quantity requirements, except as provided in FAR subpart 46.5 and subject to other terms and conditions of the contract.

2.2 Approval: Acknowledgment by the designated Government official that submittals, deliverables, or administrative documents (e.g., insurance certificates, installation schedules, planned utility interruptions, etc.) conform to the contractual requirements. Government approval does not relieve the Contractor from responsibility for compliance with contract requirements.

2.3 Area: A defined geographical region for Indian Health Service administrative purposes. Each Area Office may administer several Service Units.

2.4 Code of Ethics: The Code of Ethics for service provider contractors is to provide honest, trauma informed care and have positive behavior during the contractual work.

2.5 Contracting Officer (CO): A Government employee with the authority to enter into, administer, and/or terminate contracts and make related determinations and findings.

2.6 Contractor: The organization awarded a legal binding contract to provide supplies and/or services; includes the organization’s employees.

2.7 Contracting Officer’s Representative (COR): A federal employee who assists the ordering/issuing activity contracting officer in the administration of task orders issued under this contract. The COR is primarily responsible for the technical assistance and day-to-day program management of the ordering activity’s task orders. Ordering activities may have different designators for this employee (e.g. GTR – Government Technical Representative, COTR–Contracting Officer’s Technical Representative, or PO - Project Officer).

2.8 Cultural Awareness: Realization and respect for American Indian and Alaska Native practices.

2.9 Customer: Patients, staff and visitors of an IHS service unit and health center.

2.10 Customer Evaluation/Input: Every program shall be evaluated and comments made about the educational activity must be made available the evaluator for grant’s semi-annual report and annual report.

2.11 Dependability: Qualities of being trusted and being able to repeat the same task to yield the same result.

2.12 Federal Acquisition Regulation (FAR): The FAR is the primary regulation for use by all Federal Executive agencies in their acquisition of supplies and services with appropriated funds.

2.14 Government Vehicle: Contractor shall use their owned private motor vehicle.

2.15 Health Center: A facility physically separated from a hospital, with a full range of ambulatory services including at least primary care providers, nursing, laboratory, and x-ray which are available at least 40 hours a week for outpatient care.

2.16 Non-Personal Services Contract: A contract under which the personnel rendering the services are not subject, either by the contact’s terms or by the manner of its administration, to the supervision and control usually prevailing in relationships between the Government and its employees, as defined in FAR 37.401.

2.17 Ordering Activity: An authorized user of IHS that may issue a task order to obtain required services under this contract.

2.24 Service Unit: The local administrative unit of IHS.

2.25 Standards of Practice and Standards of Care: Authoritative statements by which the medical profession describes the responsibilities for which its practitioners are accountable. The standards provide direction for professional medical practice and a framework for the evaluation of practice. The standards of professional medical practice may pertain to general or specialty practice.

2.26 Supervisor. Government employee authorized to provide verbal and written performance direction to the Contractor that the Contractor must follow without exception.

2.29 Valid Patient Complaint: Justifiable accusation made by a patient and supported by investigation.

3.0 Government Furnished Information, Property and Services

3.1 Information: Government unique information related to this requirement, which is necessary for Contractor performance, will be made available to the Contractor. The Contracting Officer or designee will be the point of contact for identification of any required information to be supplied by the Government.

3.2 Joint Use by the Government and the Contractor: Except for the property and service listed in

3.3 and 4.0, the Government will provide, for joint use by the Government and the Contractor, all necessary equipment, supplies, and clinic space to perform the services under this contract.

3.2.1 Government Vehicle: Contractor shall not be use Government Vehicle under this contract.

3.3 Contractor Exclusive Use:

3.3.1 Personal Protective Equipment (PPE). The Government will furnish the Contractor with appropriate PPE other than specified in paragraph 4 of the contract. The Government will be responsible for any repair, cleaning, and inventory required for the PPE. This does not include any type of uniform or laboratory coat.

3.3.2 The Government will provide facility specific contractor identification badges for each contractor. A minimum fee of $10.00 will be charged for lost or destroyed badges.

3.5.1 Contracting Officer Representative (COR): COR is primarily responsible for monitoring the technical progress including surveillance and assessment of performance for this order.

4.0 Contractor Furnished Property

4.1 Use of copying machine shall be furnished by PHCCS: Pinon Counseling Services will provide copying supplies for contractor to produce material used in program function, program evaluation material, education and reports.

5.0 Performance-Based Requirements. The Contractor shall provide mental health wellness activities as stated in DVPI grant proposal:

5.1 Contractor shall carry-out the PHCCS Comprehensive DVPI Program:

5.2 Contractor shall support and collaborate with agencies on family education projects.

5.3 Contractor shall carry-on an all-inclusive with sufficient supplies for each of the project.

5.4 Contractor is responsible for promoting project to increase participates.

5.5 Contractor shall arrange logistic such as lodging, incentives, award, transportation, field trips and venue of an activities.

5.6 Contractor shall ensure that all activities are evaluated.

5.7 Contractor shall ensure that all projects are meeting the PHCC DVPI’s goals.

5.8 Contractor shall use strength based and positive attitude to support the wellness of the community members.

5.9 The Contractor shall conduct only such business as covered by this contract during the periods of award

5.10.1 The Contracting Officer has the authority to remove any employee that is deemed unacceptable or is identifies as a potential threat to the health, safety, general well-being or operational mission of the facility and its population.

5.10.2 Contractor shall comply with all applicable Federal and Indian Health Service regulations and policies.

5.10.3 The contractor shall be responsible for all reporting of federal, state and local taxes including applicable employment taxes for all days that services were provided.

5.1.7 The contractor shall submit an invoice with a copy of advertisement of activity in a flyer format that was used to promote activity, and certification statement of service rendered will be included with a signature from the designated COR for this contract.

5.2 Work Schedule: The contractor shall work to accomplish set number of activities with the Family Programs, Youth Leaderships and chess program and Scout & Cultural Activities and be responsible for evaluation of all the programs. Twelve (12) hours per shift, seven (7) days per week, Monday to Sunday including Holidays. The work shifts will be scheduled by the Urgent Care Supervisor. The total work shifts hours will range from 80 hours – 84 hours biweekly.

5.3 Fee and Schedule: The contractor shall be compensated at an All-inclusive rate for each event.

The “All-inclusive rate” means the contractor is responsible for all costs associated with providing said services, i.e. travel, per diem, lodging, staff support, supplies, materials, equipment, transportation, supervision, administration and all other necessary items not listed herein to complete services:

Line #1: Family Programs: We R Family @ 12 sessions, ABNDN/ADAD @ 5 sessions, Parent Summit @ 4 sessions, Dzil Yijiin Health Council, Women’s Empowerment, Community Wellness, Arts $ Craft, Administration for Family Programs 200 hrs.

Line #2: Leadership/Chess: Youth Membership fees, Youth conferences (Unity, etc), Afterschool program/Chess Club, tournament/competition.

Line #3: Scouts & Cultural Activities. Scout membership fees, Girls & Boys afterschool programs. Girls & Boys afterschool programs.

Line #4: Evaluation service for all DVPI activities.

6.0 Contractor Qualification Requirements: The contractor shall meet the qualifications and credentialing standards and retain the following qualifications and certification throughout the term of this contract.

6.1 Experience/Training. Contractor shall provide at least one employee with at least a Master’s Degree level of education or with a minimum of 4 years’ experience in working on the Navajo Reservation.

6.4 Language Requirements and Cultural Awareness. The contractor shall read, understand, speak, and write English to effectively communicate to carry-out monthly, semi-annual and annual report, and shall be respectful of the local, American Indian culture.

6.6 Background Checks: The contractor shall be provide background check for all staff working with the schools and community.

6.7 General Requirements:

6.8.1 The contractor shall provide a current letter of reference from agency familiar with the contractor's community work with Native community specifically one with the Navajo Reservation.

7.0 Challenges to Conflicts: For any inconsistency between supervisor directions, this Performance Work Statement, attachments and exhibits, the following order of precedence will apply:

(a) First Priority: DVPI Supervisor’s directions

(b) Second Priority: IHS DVPI regional Supervisor

8.0 52.212-4 Contract Terms and Conditions-Commercial Items (MAY 2015) (m): Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the contractor, or if the contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the contractor for any amount for supplies or services not accepted, and the contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience.

8.1 Any contractor employee demonstrating impaired judgment shall not be allowed to continue working on the contract. The Government reserves the right to remove from the facility any contractor employee who in the judgment of a licensed healthcare practitioner is impaired.

9.0 Performance – Based Matrix

Performance-Based Task Indicator Standard Quality Assurance Incentives

State the end results or outputs that you, the customer will formally accept or reject.

For the requirement, state the feature(s) of end result that will be surveilled.

For each “indicator,” state a performance level that, when met, means the task has been performed satisfactorily.

This Standard describes “What Success Looks Like.”

For each “Standard”, state the method used to check performance (i.e. random sampling, 100% inspection, periodic inspection, customer complaints).

List Positive and Negative Incentives. Address method of linking payment to quality of service.

Contractor shall provide community mental wellness activities for the PHCCS DVPI grant programs.

a. Prevention education

b. Hand-on wellness activities

c. Culturally Sensitivity

d. Documentation

e. Professionalism

Contractors provided fully successful or excellent community mental health wellness programs shall be tha portions of the population took part in the project.

Contractors were compassionate and culturally sensitive.

Contractors completed require documentation in clear and legible form in a timely manner. Evaluation and sign-in by all participants was taken at the program site.

Contractors presented in professional appearance, demonstrated exceptional ethical conduct with effective communication, and exhibited exemplary attitude by being flexible and being adaptable.

Majority of the participants signed in and completed an evaluation.

Payment of contract price for satisfactory service.

No payment for incomplete work.

Contractor performance will be evaluated by completion of each project in the 5 line items.

9.1 Peer Review CSU Provider Exit Profile. The Peer Review Exit Profile will be completed for each contractor. The completed Peer Review CSU Provider Exit Profile Form is a peer review document and is confidential as afforded under Arizona Revised Statutes 36.445 and 36.445-01.