HomeMy WebLinkAboutAgreement A-22-227 with Alliant Clinical.pdf Agreement No. 22-227
1 AGREEMENT
2 THIS AGREEMENT is made and entered into this 7t" day of June 2022, by
3 and between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and ALLIANT INTERNATIONAL UNIVERSITY, INC., a California
5 Corporation, whose address is 5130 E. Clinton Way, Fresno, CA 93727, hereinafter referred to as
6 "UNIVERSITY" (collectively the "parties").
7 WITNESS ETH:
8 WHEREAS, UNIVERSITY has an approved graduate program in clinical counseling that
9 require facilities to provide clinical and field experience for required learning experiences for its
10 students; and
11 WHEREAS, UNIVERSITY has approved doctorate programs in clinical psychology that require
12 facilities to provide clinical and field experience for required learning experiences for its students; and
13 WHEREAS, COUNTY, through its Department of Behavioral Health (DBH), maintains and
14 operates facilities for furnishing such clinical and field experience; and
15 WHEREAS, it is to the mutual benefit of the parties hereto that personnel and students of
16 UNIVERSITY'S graduate program in clinical counseling and doctoral programs in clinical psychology
17 use COUNTY's facilities for their clinical and field experience.
18 NOW, THEREFORE, in consideration of their mutual covenants and conditions, the parties
19 hereto agree as follows:
20 1. RIGHTS AND RESPONSIBILITIES OF UNIVERSITY
21 A. UNIVERSITY will designate students enrolled in the clinical counseling and
22 clinical psychology programs of the UNIVERSITY to be assigned for clinical and field experience at
23 the COUNTY, and schedule the clinical and field experience of the students in conformity with the
24 calendar of the UNIVERSITY's academic year and with the curriculum of the educational programs of
25 the UNIVERSITY. The students selected shall have at the minimum, the following qualifications:
26 1) Graduate Students— Each graduate level student will be currently
27 enrolled in academic coursework at UNIVERSITY in clinical counseling and have spent at least one
28 (1) year of supervised professional experience (fifteen (15) to twenty (20) hours per week). Students
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I will have completed pre-practicum coursework in assessment and clinical interviewing, intervention,
2 ethical and legal knowledge, and individual and cultural differences. Practicum readiness shall be
3 determined via the Practicum Readiness Evaluations, identified in Exhibit A, attached hereto and by
4 this reference incorporated herein.
5 2) Doctoral Students — Each doctoral level student will have earned a
6 Master's Degree (or equivalent), have spent at least one (1) year of supervised professional
7 experience (fifteen (15) to twenty (20) hours per week). Students will have completed pre-practicum
8 coursework in assessment and clinical interviewing, intervention, ethical and legal knowledge, and
9 individual and cultural differences. Practicum readiness shall be determined via the Evaluation of
10 Core Competencies and Clinical Competency Exam as identified in Exhibit A.
11 B. UNIVERSITY recognizes that the clinical and field education programs
12 conducted pursuant to the terms and conditions of this Agreement is an education program of
13 UNIVERSITY and not of COUNTY, and that students participating in UNIVERSITY's program shall at
14 all times be under the exclusive jurisdiction of UNIVERSITY.
15 C. UNIVERSITY shall designate students enrolled in the counseling and
16 psychology programs of UNIVERSITY to be assigned for clinical and field experience at COUNTY
17 facilities, in such numbers as can be supported and to be mutually agreed upon by both COUNTY's
18 DBH Director or designee, and UNIVERSITY.
19 D. UNIVERSITY shall establish a rotational plan for the clinical and field
20 experience available at COUNTY facilities and shall schedule the students in conformity with the
21 calendar of UNIVERSITY's academic year and with the curriculum of the counseling and psychology
22 programs of UNIVERSITY; provided, however, that the specific COUNTY client care areas to be
23 utilized by UNIVERSITY are identified and available, as subsequently agreed upon by mutual
24 agreement between COUNTY's DBH Director, or designee and UNIVERSITY's chairpersons, or duly
25 authorized representatives, of the psychology program.
26 E. UNIVERSITY shall supervise all instruction of the clinical and field experience
27 provided at COUNTY facilities to assigned students and shall provide the necessary instructors for
28 the educational training program provided for under this Agreement.
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1 F. UNIVERSITY shall keep all attendance and academic records of students
2 participating in the clinical and field experience provided for under this Agreement.
3 G. UNIVERSITY shall certify to COUNTY at the time each student first reports to
4 COUNTY's facilities to participate in the clinical and field education program, that the student shall be
5 enrolled with UNIVERSITY's available health plan for students.
6 H. UNIVERSITY shall ensure students act professionally and appropriately while at
7 COUNTY facilities and/or participating in projects with/for the COUNTY.
8 I. UNIVERSITY shall require every student to conform to all applicable COUNTY
9 policies, procedures, regulations, and all requirements and restrictions specified jointly by
10 representatives of UNIVERSITY and COUNTY.
11 J. UNIVERSITY shall require its instructors to notify COUNTY's DBH Director, or
12 designee, as appropriate in advance of student placement regarding:
13 1) Locations, dates, times and the number of hours or changes thereof,
14 regarding student availability for clinical and field assignment(s); and
15 2) Any change in the placement of students in clinical and field
16 assignments.
17 K. UNIVERSITY shall, in consultation and coordination with COUNTY'S DBH
18 Director, or designee, arrange for periodic conferences between appropriate representatives of
19 UNIVERSITY and COUNTY to evaluate the clinical and field experience programs provided under
20 this Agreement.
21 L. UNIVERSITY shall provide and be responsible for the use and control of its
22 educational supplies, materials and equipment used for instruction during the clinical and field
23 experience program.
24 M. UNIVERSITY shall distribute to each student a statement which explains the
25 hazards of substance use in their profession.
26 N. UNIVERSITY shall provide for an introductory orientation to students assigned
27 to COUNTY facilities, which shall provide an overview of the clinical and field assignment(s) and the
28 terms and conditions of student placement at COUNTY facilities.
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1 O. UNIVERSITY shall agree that initiating work, reviews, or studies related to the
2 production of special reports, projects, theses, and/or publications based on studies and research
3 arising out of the cooperative education experience permitted by this Agreement may require
4 advance approval from COUNTY's DBH. In some cases, approval may include the Institutional
5 Review Board process, as determined to be appropriate by COUNTY staff.
6 P. UNIVERSITY shall agree that special reports, projects, thesis, and/or
7 publications based upon studies and research arising out of the cooperative education experience
8 permitted by this Agreement, shall be reviewed and approved prior to release through the committee
9 responsible for planning the course and then with the COUNTY's DBH Director or designee, as
10 appropriate, for approval by means of such procedures as COUNTY's DBH shall designate. Approval
11 of reports by UNIVERSITY's planning committee and COUNTY's DBH shall not be unreasonably
12 withheld.
13 Q. UNIVERSITY shall agree to complete an evaluation of each student at least
14 once during a specific program period.
15 R. UNIVERSITY shall allow COUNTY program managers and other designated
16 personnel to attend meetings of UNIVERSITY's faculty, or any committee thereof, to coordinate the
17 clinical and field experience programs provided under this Agreement and to designate lines of
18 authority and communication for coordination of relations between COUNTY personnel and
19 UNIVERSITY instructors.
20 S. UNIVERSITY's employees, agents, and students shall abide by the provisions
21 of State of California law relating to confidentiality of medical records, further described in Paragraph
22 Fifteen (15) of this Agreement, and any person knowingly and intentionally violating provisions of
23 State of California law may be guilty of a misdemeanor.
24 T. UNIVERSITY's employees, agents, and students shall be issued COUNTY
25 identification badges which must be worn only at COUNTY facilities while participating in the clinical
26 and field experience program, pursuant to the terms and conditions of this Agreement.
27 U. UNIVERSITY will ensure that each participating student understands that
28 students are not employees of COUNTY, and students shall have absolutely no right to employment
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1 right and benefits available to COUNTY employees.
2 2. RIGHTS AND RESPONSIBILITIES OF COUNTY
3 A. COUNTY's DBH Director, or designee, at their sole discretion, shall have the
4 right to approve and accept, or reject, each student selected by UNIVERSITY for clinical and field
5 experience placement at COUNTY's facilities. For each student selected and designated by
6 UNIVERSITY, COUNTY shall permit each student to receive clinical and field experience pursuant to
7 Paragraph One (1) of this Agreement, at an agreed (between COUNTY and UNIVERSITY) location
8 and number of hours, and shall furnish and permit students and/or instructors access to appropriate
9 COUNTY facilities for such clinical and field experience, subject to the terms and conditions of this
10 Agreement.
11 B. COUNTY shall furnish the appropriate facilities, as applicable, in such a manner
12 that there will be no conflict in the use thereof between UNIVERSITY's students and those from other
13 educational institutions, if any.
14 C. COUNTY shall, subject to budgetary and operational concerns, maintain clinical
15 and field facilities used for the learning experience in a manner that shall at all times conform to the
16 requirements of UNIVERSITY's clinical programs listed in the "Witnesseth" section of this
17 Agreement.
18 D. COUNTY shall provide staff adequate in number and quality to provide safe and
19 continuous health care to clients involved in clinical and field experience programs.
20 E. COUNTY shall provide to students and instructors appropriate space to conduct
21 clinical and field experience work, as applicable.
22 F. COUNTY shall permit its clinical staff to participate in the instructional phase of
23 UNIVERSITY's clinical and field experience programs.
24 G. COUNTY shall permit its various program directors and other designated
25 personnel to attend meetings of the UNIVERSITY's faculty, or any committee thereof, to coordinate
26 the clinical and field experience programs provided for under this Agreement, and to designate lines
27 of authority and communication for coordination of relations between UNIVERSITY instructors and
28 COUNTY personnel.
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I H. COUNTY shall provide an introductory orientation for UNIVERSITY instructors
2 and faculty staff which shall provide an overview of COUNTY facilities, clinical and field experience
3 opportunities, and the terms and conditions of student placement within a clinical and field
4 experience, as applicable.
5 I. COUNTY shall notify UNIVERSITY's instructors, in advance, of any change in
6 its Director(s) or designee(s) appointments.
7 J. COUNTY shall, within the limits of its resources, provide whatever equipment,
8 supplies, and assistance necessary for the care of COUNTY clients in the course of UNIVERSITY's
9 students clinical and field experience and consistent with COUNTY's plan of care.
10 K. COUNTY shall reserve the absolute right to review, authorize, and at its sole
11 discretion, deny access or admission by any student, instructor and/or UNIVERSITY representative
12 into COUNTY facilities.
13 L. COUNTY shall provide input into the evaluation conducted by UNIVERSITY, of
14 students' skills and progress.
15 M. COUNTY shall agree to allow access to existing break room space for students'
16 break and meal periods. UNIVERSITY's students shall purchase food in the regular system or bring
17 food with them; no special arrangements for food will be made.
18 3. JOINT RESPONSIBILITIES OF THE COUNTY AND THE UNIVERSITY
19 Each student nominated by the UNIVERSITY and accepted by the COUNTY for
20 placement in this program shall enter into a signed agreement. UNIVERSITY shall forward to
21 COUNTY a copy of the signed student Agreements and COUNTY will append each one to this
22 Agreement and they shall become addendums to this Agreement. Addendums shall include at least
23 the following:
24 A) Certification of the student's prior educational experience.
25 B) Objectives required to be accomplished by the student, by the UNIVERSITY and
26 the individual's designed research and/or grant writing curriculum.
27 C) Administrative responsibilities of the student while engaged in research and/or
28 grant-writing opportunities at COUNTY including.
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I D) A schedule of hours that include consultation as well as training.
2 E) Each addendum shall be signed by at least the following individuals:
3 1) UNIVERSITY's Placement Coordinator, or equivalent.
4 2) COUNTY's Placement Coordinator, or equivalent.
5 3) Student.
6 4. TERM
7 This Agreement shall become effective on the first day of July, 2022 and shall terminate
8 on the 30th day of June, 2025.
9 This Agreement, subject to satisfactory completion of the terms and conditions of this
10 Agreement, may be extended for two (2) additional twelve (12) month periods upon the written
11 approval of COUNTY and UNIVERSITY not later than thirty (30) days prior to the first day of the next
12 twelve (12) month extension period. COUNTY's DBH Director, or designee, is authorized to execute
13 such written approval on behalf of COUNTY based on UNIVERSITY's satisfactory completion of the
14 terms and conditions of this Agreement.
15 5. TERMINATION
16 A. Non-Allocation of Funds - The terms of this Agreement, and the services to be
17 provided thereunder, are contingent on the approval of funds by the appropriating government
18 agency. Should sufficient funds not be allocated, the services provided may be modified, or this
19 Agreement terminated at any time by giving the UNIVERSITY thirty (30) days advance written notice.
20 B. Breach of Contract - COUNTY may immediately suspend or terminate this
21 Agreement in whole or in part, where in the determination of COUNTY there is:
22 1) An illegal or improper use of funds;
23 2) A failure to comply with any term of this Agreement;
24 3) A substantially incorrect or incomplete report submitted to the
25 COUNTY;
26 4) Improperly performed service.
27 In no event shall any payment by the COUNTY constitute a waiver by the COUNTY of any breach
28 of this Agreement or any default which may then exist on the part of the CONTRACTOR. Neither shall
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I such payment impair or prejudice any remedy available to the COUNTY with respect to the breach or
2 default. The COUNTY shall have the right to demand of the CONTRACTOR the repayment to the
3 COUNTY of any funds disbursed to the CONTRACTOR under this Agreement, which in the judgment of
4 the COUNTY were not expended in accordance with the terms of this Agreement. The CONTRACTOR
5 shall promptly refund any such funds upon demand.
6 C. Without Cause - Under circumstances other than those set forth above, this
7 Agreement may be terminated by UNIVERSITY or COUNTY or COUNTY's DBH Director, or
8 designee, upon the giving of thirty (30) days advance written notice of an intention to terminate.
9 6. COMPENSATION
10 The clinical experience program conducted pursuant to the terms and conditions of this
11 Agreement shall be performed without the payment of any monetary consideration by UNIVERSITY
12 or COUNTY, one to the other, or by or to any STUDENT participating in said clinical experience
13 program.
14 7. INDEPENDENT CONTRACTOR
15 In performance of the work, duties, and obligations assumed by UNIVERSITY under
16 this Agreement, it is mutually understood and agreed that UNIVERSITY, including any and all of
17 UNIVERSITY's officers, agents, employees, students and residents will at all times be acting and
18 performing as an independent contractor, and shall act in an independent capacity and not as an
19 officer, agent, servant, employee, joint venturer, partner, or associate of COUNTY. Furthermore,
20 COUNTY shall have no right to control or supervise or direct the manner or method by which
21 UNIVERSITY shall perform its work and function. However, COUNTY shall retain the right to
22 administer this Agreement so as to verify that UNIVERSITY is performing its obligations in
23 accordance with the terms and conditions thereof. UNIVERSITY and COUNTY shall comply with all
24 applicable provisions of law and the rules and regulations, if any, of governmental authorities having
25 jurisdiction over matters which are directly or indirectly the subject of this Agreement.
26 Because of its status as an independent contractor, UNIVERSITY, shall
27 have absolutely no right to employment rights and benefits available to COUNTY employees.
28 UNIVERSITY shall be solely liable and responsible for providing to, or on behalf of, its employees all
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1 legally-required employee benefits. In addition, UNIVERSITY shall be solely responsible and save
2 COUNTY harmless from all matters relating to payment of UNIVERSITY's employees, including
3 compliance with Social Security, withholding, and all other regulations governing such matters. As
4 between COUNTY and UNIVERSITY, should the students be deemed employees, by any
5 governmental or regulatory body, the students shall be the employees of UNIVERSITY. It is
6 acknowledged that during the term of this Agreement, UNIVERSITY may be providing services to
7 others unrelated to COUNTY or to this Agreement.
8 8. MODIFICATION
9 Any matters of this Agreement may be modified from time to time by the written consent
10 of all the parties without, in any way, affecting the remainder.
11 9. NON-ASSIGNMENT
12 Neither party shall assign, transfer or subcontract this Agreement nor their rights or
13 duties under this Agreement without the prior written consent of the other party.
14 10. HOLD-HARMLESS
15 A. UNIVERSITY agrees to indemnify, save, hold harmless, and at COUNTY'S
16 request, defend the COUNTY, its officers, agents, and employees from any and all costs and
17 expenses, damages, liabilities, claims, and losses occurring or resulting to COUNTY in connection
18 with the performance, or failure to perform, by UNIVERSITY, its officers, agents, residents, students,
19 or employees under this Agreement, and from any and all costs and expenses, damages, liabilities,
20 claims, and losses occurring or resulting to any person, firm, or corporation who may be injured or
21 damaged by the performance, or failure to perform, of UNIVERSITY, its officers, agents, residents,
22 students, or employees under this Agreement. The provisions of this Section 12 shall survive
23 termination of this Agreement.
24 11. INSURANCE
25 For the purposes of this Agreement, students/interns will be explicitly considered
26 employees of the UNIVERSITY. Without limiting COUNTY's right to obtain indemnification from
27 UNIVERSITY or any third parties, UNIVERSITY, at its sole expense, shall maintain in full force and
28 effect the following insurance policies or a program of self-insurance, including but not limited to, an
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I insurance arrangement or Joint Powers Agreement (JPA) throughout the term of this Agreement:
2 A. Commercial General Liability
3 Commercial General Liability Insurance with limits of not less than Two Million Dollars
4 ($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars ($4,000,000.00). This
5 policy shall be issued on a per occurrence basis. COUNTY may require specific coverages including
6 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
7 liability or any other liability insurance deemed necessary because of the nature of this contract.
8 B. Automobile Liabilitv
9 Comprehensive Automobile Liability Insurance with limits of not less than One Million
10 Dollars ($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
11 include any auto used in connection with this Agreement.
12 C. Professional Liability
13 If UNIVERSITY employs licensed professional staff(e.g. Ph.D., R.N., L.C.S.W.,
14 L.M.F.T.) in providing services, Professional Liability Insurance with limits of not less than One Million
15 Dollars ($1,000,000) per occurrence, Three Million Dollars ($3,000,000) annual aggregate.
16 UNIVERSITY shall ensure that each student who participates in COUNTY's "covered functions" (as
17 defined by the HIPAA regulations at 45 C.F.R. §164.501) procures and maintains in force
18 during the term of this Agreement, at the student's sole cost and expense, Professional Liability
19 Insurance in amounts reasonably necessary to protect the student against liability arising from any
20 and all negligent acts or incidents caused by the student. Coverage under such professional liability
21 insurance shall not be less than One Million Dollars ($1,000,000) per occurrence, Three Million
22 Dollars ($3,000,000) annual aggregate. This policy shall include Limited General Liability coverage
23 for sexual harassment and abuse, standards of care, property damage, bodily injury, and personal
24 injury within the stated limits. Professional Liability Insurance shall be maintained for three (3) years
25 past termination of this agreement.
26 D. Worker's Compensation
27 A policy of Worker's Compensation Insurance as may be required by the
28 California Labor Code. UNIVERSITY shall be responsible for Worker's Compensation coverage for
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I students who participate in the program.
2 E. Sexual Abuse/Molestation Liability
3 Sexual Abuse/Molestation Liability Insurance with limits of not less than One Million
4 Dollars ($1,000,000) per occurrence with a Two Million Dollars ($2,000,000) annual aggregate. This
5 policy shall be issued on a per occurrence basis.
6 F. Cyber Liability
7 Cyber Liability Insurance, with limits not less than $2,000,000 per occurrence or
8 claim, $2,000,000 aggregate. Coverage shall be sufficiently broad to respond to duties and
9 obligations undertaken by both parties in this agreement and shall include, but not be limited to,
10 claims involving infringement of intellectual property, including but not limited to infringement of
11 copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or
12 destruction of electronic information, release of private information, alteration of electronic
13 information, extortion and network security. The policy shall provide coverage for breach response
14 costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits
15 sufficient to respond to these obligations.
16 Definition of Cyber Risks. "Cyber Risks" include but are not limited to (i) Security
17 Breaches, which may include Disclosure of Personal Information to an Unauthorized Third Party; (ii)
18 breach of any of the Contractor's obligations under Section # of this Agreement; (iii) infringement of
19 intellectual property, including but not limited to infringement of copyright, trademark, and trade dress;
20 (iv) invasion of privacy, including release of private information; (v) information theft; (vi) damage to or
21 destruction or alteration of electronic information; (vii) extortion related to the Contractor's obligations
22 under this Agreement regarding electronic information, including Personal Information; (viii) network
23 security; (ix) data breach response costs, including Security Breach response costs; (x) regulatory
24 fines and penalties related to the Contractor's obligations under this Agreement regarding electronic
25 information, including Personal Information; and (xi) credit monitoring expenses.
26 Additional Requirements Relating to Insurance
27 UNIVERSITY shall obtain endorsements to the Commercial General Liability
28 insurance naming the County of Fresno, its officers, agents, and employees, individually and
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I collectively, as additional insured, but only insofar as the operations under this Agreement are
2 concerned. Such coverage for additional insured shall apply as primary insurance and any other
3 insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
4 excess only and not contributing with insurance provided under UNIVERSITY's policies herein. This
5 insurance shall not be cancelled or changed without a minimum of thirty (30) days advance written
6 notice given to COUNTY.
7 UNIVERSITY hereby waives its right to recover from COUNTY, its officers, agents,
8 and employees any amounts paid by the policy of worker's compensation insurance required by this
9 Agreement. UNIVERSITY is solely responsible to obtain any endorsement to such policy that may be
10 necessary to accomplish such waiver of subrogation, but UNIVERSITY's waiver of subrogation under
11 this paragraph is effective whether or not UNIVERSITY obtains such an endorsement.
12 Within Thirty (30) days from the date UNIVERSITY signs and executes this
13 Agreement, UNIVERSITY shall provide certificates of insurance and endorsement as stated above
14 for all of the foregoing policies, as required herein, to the County of Fresno, Department of Behavioral
15 Health, 3133 N. Millbrook Ave., Fresno, California 93703), Attention: Contracted Services Division or
16 electronically to dbhcontractedservicesdivision(a fresnocountyca.gov with a copy to the assigned
17 COUNTY's DBH Staff Analyst, stating that such insurance coverage have been obtained and are in
18 full force; that the County of Fresno, its officers, agents and employees will not be responsible for any
19 premiums on the policies; that such Commercial General Liability insurance names the County of
20 Fresno, its officers, agents and employees, individually and collectively, as additional insured, but
21 only insofar as the operations under this Agreement are concerned; that such coverage for additional
22 insured shall apply as primary insurance and any other insurance, or self-insurance, maintained by
23 COUNTY, its officers, agents and employees, shall be excess only and not contributing with
24 insurance provided under UNIVERSITY's policies herein; and that this insurance shall not be
25 cancelled or changed without a minimum of thirty (30) days advance, written notice given to
26 COUNTY.
27 In the event either party fails to keep in effect at all times insurance coverage as
28 herein provided, the other party may, in addition to other remedies it may have, suspend or terminate
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I this Agreement upon the occurrence of such event.
2 All policies shall be issued by admitted insurers licensed to do business in the State
3 of California, and such insurance shall be purchased from companies possessing a current A.M.
4 Best, Inc. rating of A FSC VII or better.
5 12. LICENSES/CERTIFICATES
6 Throughout each term of this Agreement, UNIVERSITY and UNIVERSITY's staff shall
7 maintain all necessary licenses, permits, approvals, certificates, waivers and exemptions necessary
8 for the provision of the services hereunder and required by the laws and regulations of the United
9 States of America, State of California, the County of Fresno, and any other applicable governmental
10 agencies. UNIVERSITY shall notify COUNTY immediately in writing of its inability to obtain or
11 maintain such licenses, permits, approvals, certificates, waivers and exemptions irrespective of the
12 pendency of any appeal related thereto. Additionally, UNIVERSITY and UNIVERSITY's staff shall
13 comply with all applicable laws, rules or regulations, as may now exist or be hereafter changed.
14 13. MONITORING
15 UNIVERSITY agrees to extend to COUNTY's staff, COUNTY's DBH Director and
16 DHCS, or their designees, the right to review and monitor records, programs or procedures, at any
17 time, in regard to clients, as well as the overall operation of UNIVERSITY's programs, in order to
18 ensure compliance with the terms and conditions of this Agreement.
19 14. REFERENCES TO LAWS AND RULES
20 In the event any law, regulation, or policy referred to in this Agreement is amended
21 during the term thereof, the parties hereto agree to comply with the amended provision as of the
22 effective date of such amendment.
23 15. CONFIDENTIALITY
24 All services performed by UNIVERSITY under this Agreement shall be in strict
25 conformance with all applicable Federal and State laws and regulations relating to confidentiality.
26 16. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
27 COUNTY and UNIVERSITY each consider and represent themselves as covered
28 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public Law
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1 104-191 (HIPAA) and agree that any use and disclosure of Protected Health Information (PHI) shall
2 be in compliance with applicable law.
3 COUNTY and UNIVERSITY acknowledge that the exchange of PHI between them is
4 only for treatment, payment, and health care operations.
5 COUNTY and UNIVERSITY intend to protect the privacy and provide for the security of
6 PHI shared pursuant to the Agreement in compliance with HIPAA, the Health Information Technology
7 for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations promulgated
8 thereunder by the U.S. Department of Health and Human Services (HIPAA Regulations) and other
9 applicable laws.
10 To the extent applicable, UNIVERSITY and COUNTY agree to comply with the HIPAA
11 Regulations, including those set forth in as set forth in, but not limited to, Title 45, Sections
12 164.314(a), 164.502(e) and 164.504(e) of the Code of Federal Regulations.
13 17. DATA SECURITY
14 For the purpose of preventing the potential loss, misappropriation or inadvertent
15 disclosure of COUNTY data including sensitive or personal client information; abuse of COUNTY
16 resources; and/or disruption to COUNTY operations, individuals and/or agencies that enter into a
17 contractual relationship with the COUNTY for the purpose of providing services under this Agreement
18 must employ adequate data security measures to protect the confidential information provided to the
19 UNIVERSITY by the COUNTY, including but not limited to the following:
20 A. UNIVERSITY-Owned Mobile, Wireless, or Handheld Devices
21 UNIVERSITY will advise STUDENTS that STUDENTS may not connect to
22 COUNTY networks via personally-owned mobile, wireless or handheld devices except: 1) University
23 has received authorization by County for telecommuting purposes; 2) current virus protection
24 software is in place; 3) Mobile device has the remote wipe feature enable; and 4) a secure connection
25 is used.
26 B. UNIVERSITY-Owned Computers or Computer Peripherals
27 UNIVERSITY will advise STUDENTS that STUDENTS may not bring
28 UNIVERSITY-owned computers or computer peripherals into the COUNTY for use without prior
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1 authorization from the COUNTY's Chief Information Officer, or designee(s), including but not limited
2 to mobile storage devices. If data is approved to be transferred, data must be stored on a secure
3 server approved by the COUNTY and transferred by means of a virtual private network (VPN)
4 connection or another type of secure connection. Said data must be encrypted.
5 C. COUNTY-Owned Computer Equipment
6 UNIVERSITY may not use COUNTY computers or computer peripherals on
7 non-COUNTY premises without prior authorization from COUNTY's Chief Information Officer, or
8 designee(s).
9 D. UNIVERSITY may not store COUNTY's private, confidential or sensitive data on
10 any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
11 E. UNIVERSITY shall be responsible to employ strict controls to ensure the
12 integrity and security of the COUNTY's confidential information and to prevent unauthorized access to
13 data maintained in computer files, program documentation, data processing systems, data files and
14 data processing equipment which stores or processes COUNTY data internally and externally.
15 F. Confidential client information transmitted to one party by the other by means of
16 electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
17 128 BIT or higher. Additionally, a password or pass phrase must be utilized.
18 G. UNIVERSITY shall be responsible to immediately notify COUNTY of any
19 breaches or potential breaches of security related to COUNTY's confidential information, data
20 maintained in computer files, program documentation, data processing systems, data files and data
21 processing equipment which stores or processes COUNTY data internally or externally.
22 H. COUNTY shall provide oversight to UNIVERSITY's response to all incidents
23 arising from a possible breach of security related to COUNTY's confidential client information
24 provided to UNIVERSITY. UNIVERSITY will be responsible to issue any notification to affected
25 individuals to the extent required by law. UNIVERSITY will be responsible for all costs incurred as a
26 result of providing the required notification.
27 18. NON-DISCRIMINATION
28 During the performance of this Agreement, UNIVERSITY shall not unlawfully
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I discriminate against any employee or applicant for employment, or recipient of services, because of
2 race, religion, color, national origin, ancestry, physical handicap, mental disability, medical condition,
3 genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual
4 orientation, or military and veteran status, pursuant to all applicable State and Federal statutes and
5 regulations. This non-discrimination policy covers admission and access to and treatment and
6 employment in the UNIVERSITY's programs and activities, including occupational education.
7 19. CONFLICT OF INTEREST
8 No officer, agent, or employee of the COUNTY who exercises any function or
9 responsibility for planning and carrying out the services provided under this Agreement shall have
10 any direct or indirect personal financial interest in this Agreement. The UNIVERSITY shall comply
11 with all Federal, State of California, and local conflict of interest laws, statutes, and regulations, which
12 shall be applicable to all parties and beneficiaries under this Agreement and any officer, agent, or
13 employee of the COUNTY.
14 20. COMPLIANCE
15 UNIVERSITY agrees to comply with the COUNTY's Contractor Code of Conduct and
16 Ethics and the COUNTY's Compliance Program in accordance with Exhibit B. Within thirty (30) days
17 of entering into the agreement with the COUNTY, UNIVERSITY shall have all of UNIVERSITY's
18 students, employees, agents and subcontractors providing services under this Agreement certify in
19 writing, that he or she has received, read, understood, and shall abide by the Contractor Code of
20 Conduct and Ethics. UNIVERSITY shall ensure that within thirty (30) days of hire, all new students,
21 employees, agents and subcontractors providing services under this Agreement shall certify in writing
22 that he or she has received, read, understood, and shall abide by the Contractor Code of Conduct
23 and Ethics. UNIVERSITY understands that the promotion of and adherence to the Code of Conduct
24 is an element in evaluating the performance of UNIVERSITY and its students, employees, agents
25 and subcontractors.
26 Within thirty (30) days of entering into this Agreement, and annually thereafter, all
27 students, employees, agents and subcontractors providing services under this Agreement shall
28 complete general compliance training. All new students, employees, agents and subcontractors shall
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I attend the appropriate training within thirty (30) days of hire. Each individual who is required to attend
2 training shall certify in writing that he or she has received the required training. The certification shall
3 specify the type of training received and the date received. The certification shall be provided to the
4 COUNTY's Compliance Officer at 3133 N. Millbrook Avenue, Fresno, CA 93703. UNIVERSITY
5 agrees to reimburse COUNTY for the entire cost of any penalty imposed upon COUNTY by the
6 Federal Government as a result of UNIVERSITY's violation of the terms of this Agreement.
7 21. COMPLIANCE WITH STATE REQUIREMENTS
8 UNIVERSITY recognizes that COUNTY operates its mental health system under an
9 agreement with the State of California Department of Mental Health, and that under said agreement
10 the State of California imposes certain requirements on the COUNTY and its subcontractors.
11 UNIVERSITY shall adhere to all State of California requirements, including those identified in Exhibit
12 C "State Mental Health Requirements", attached hereto and by this reference incorporated herein and
13 made part of this Agreement.
14 22. DISCLOSURE OF SELF-DEALING TRANSACTIONS
15 This provision is only applicable if the UNIVERSITY is operating as a corporation (a
16 for-profit or non-profit corporation) or if during the term of this agreement, the UNIVERSITY changes
17 its status to operate as a corporation.
18 Members of the UNIVERSITY's Board of Directors shall disclose any self-dealing
19 transactions that they are a party to while UNIVERSITY is providing goods or performing services
20 under this agreement. A self-dealing transaction shall mean a transaction to which the UNIVERSITY
21 is a party and in which one or more of its directors has a material financial interest. Members of the
22 Board of Directors shall disclose any self-dealing transactions that they are a party to by completing
23 and signing a Self-Dealing Transaction Disclosure Form (Exhibit D) attached hereto and by this
24 reference incorporated herein and made part of this Agreement and submitting it to the COUNTY
25 prior to commencing with the self-dealing transaction or immediately thereafter.
26 23. AUDITS AND INSPECTIONS
27 UNIVERSITY shall at any time during business hours, and as often as COUNTY may
28 deem necessary, make available to COUNTY for examination all of its records and data with respect
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1 to the matters covered by this Agreement. UNIVERSITY shall, upon request by COUNTY, permit
2 COUNTY to audit and inspect all such records and data necessary to ensure UNIVERSITY
3 compliance with the terms of this Agreement. The above notwithstanding, COUNTY shall not be
4 permitted to examine, audit, or inspect STUDENTS' academic or other education records.
5 24. NOTICES
6 The persons having authority to give and receive notices under this Agreement and
7 their addresses include the following:
8 COUNTY UNIVERSITY
9 Director, County of Fresno Provost
Department of Behavioral Health Alliant International University, Inc.
10 1925 E. Dakota Avenue 5130 E. Clinton Way
11 Fresno, CA 93726 Fresno, CA 93727
12 All notices between the COUNTY and UNIVERSITY provided for or permitted under this
13 Agreement must be in writing and delivered either by personal service, by first-class United States
14 mail, by an overnight commercial courier service, or by telephonic facsimile transmission. A notice
15 delivered by personal service is effective upon service to the recipient. A notice delivered by first-
16 class United States mail is effective three (3) COUNTY business days after deposit in the United
17 States mail, postage prepaid, addressed to the recipient. A notice delivered by an overnight
18 commercial courier service is effective one (1) COUNTY business day after deposit with the overnight
19 commercial courier service, delivery fees prepaid, with delivery instructions given for next day
20 delivery, addressed to the recipient. A notice delivered by telephonic facsimile is effective when
21 transmission to the recipient is completed (but, if such transmission is completed outside of COUNTY
22 business hours, then such delivery shall be deemed to be effective at the next beginning of a
23 COUNTY business day), provided that the sender maintains a machine record of the completed
24 transmission. For all claims arising out of or related to this Agreement, nothing in this Section
25 establishes, waives, or modifies any applicable claims presentation requirements or procedures
26 provided by law, including but not limited to the Government Claims Act (Division 3.6 of Title 1 of the
27 Government Code, beginning with Section 810).
28
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1 25. GOVERNING LAW
2 The parties agree, that for the purposes of venue, performance under this Agreement is
3 to be in Fresno County, California.
4 The rights and obligations of the parties and all interpretation and performance of this
5 Agreement shall be governed in all respects by the laws of the State of California.
6 27. SEVERABILITY
7 The provisions of this Agreement are severable. The invalidity or unenforceability of
8 any one provision in the Agreement shall not affect the other provisions.
9 28. ELECTRONIC SIGNATURE
10 The parties agree that this Agreement may be executed by electronic signature as provided in
11 this section. An "electronic signature" means any symbol or process intended by an individual signing
12 this Agreement to represent their signature, including but not limited to (1) a digital signature; (2) a
13 faxed version of an original handwritten signature; or(3)an electronically scanned and transmitted (for
14 example by PDF document) of a handwritten signature. Each electronic signature affixed or attached to
15 this Agreement (1) is deemed equivalent to a valid original handwritten signature of the person signing
16 this Agreement for all purposes, including but not limited to evidentiary proof in any administrative or
17 judicial proceeding, and (2) has the same force and effect as the valid original handwritten signature of
18 that person. The provisions of this section satisfy the requirements of Civil Code section 1633.5,
19 subdivision (b), in the Uniform Electronic Transaction Act (Civil Code, Division 3, Part 2, Title 2.5,
20 beginning with section 1633.1). Each party using a digital signature represents that it has undertaken
21 and satisfied the requirements of Government Code section 16.5, subdivision (a), paragraphs (1)
22 through (5), and agrees that each other party may rely upon that representation. This Agreement is not
23 conditioned upon the parties conducting the transactions under it by electronic means and either party
24 may sign this Agreement with an original handwritten signature.
25 29. ENTIRE AGREEMENT
26 This Agreement, including all Exhibits, constitutes the entire agreement between
27 UNIVERSITY and COUNTY with respect to the subject matter hereof and supersedes all previous
28 agreement negotiations, proposals, commitments, writings, advertisements, publications, and
- 19 -
1 understandings of any nature whatsoever unless expressly included in this Agreement.
2 1H
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I IN WITNESS WHEREOF, the parties hereto have executed this Agreement as of the day and
2 year first hereinabove written.
3
4 UNIVERSITY: COUNTY OF FRESNO
ALLIANT INTERNATIONAL
5 UNIVERSITY, INC.
7 By By
Brian Pacheco,
8 Chairman of the Board of
9 Supervisors of the County of Fresno
Print Name: Tracy L. Heller, PhD
10 Title:Provost & Executive VP, Academic Affairs Date: ZP
11
12 Date: 5/23/2022 ATTEST:
Bernice E. Seidel
13 Clerk of the Board of Supervisors
14 County of Fresno, State of California
15 By
16 Date: t0/7 22
17
18
19 Mailing Address:
5130 E. Clinton Way
20 Fresno, CA 93727
21
22
23 FOR ACCOUNTING PURPOSES ONLY:
Fund/Subclass: 0001/10000
24 Organization: 56302007
25 Account#: 7295
26
27
28 E.G.
- 21
Exhibit A
Page 1 of 8
Practicum Readiness Evaluation
PSY 6728 Mid-Term/Final Assessment Form
Student Name:
Evaluation Date:
Purposes:
1. To provide trainee with an opportunity to review levels of competency in the
performance skill areas of basic helping skills and procedural skills.
2. To provide the trainee with a basis for identifying areas of emphasis within
supervision.
Basic Helping Skills Not evident Learning Recognize Basic Mastery
1. Ability to demonstrate active attending behavior. 1 2 3 4 5 N/0*
2. Ability to listen to and understand nonverbal behavior. 1 2 3 4 5 N/O
3. Ability to listen to what client says verbally, noticing 1 2 3 4 5 N/O
mix of experiences, behaviors and feelings.
4. Ability to understand the client's point of view. 1 2 3 4 5 N/O
5. Ability to identify themes in client's story. 1 2 3 4 5 N/O
6. Ability to respond with accurate empathy. 1 2 3 4 5 N/O
7. Ability to ask open-ended questions. 1 2 3 4 5 N/O
8. Ability to help clients clarify and focus. 1 2 3 4 5 N/O
9. Ability to balance empathic response,clarification,and 1 2 3 4 5 N/O
probing.
10. Ability to assess accurately severity of client's problems. 1 2 3 4 5 N/O
11. Ability to establish a collaborative working relationship 1 2 3 4 5 N/O
with client.
12. Ability to paraphrase client's statements. 1 2 3 4 5 N/O
13. Ability to summarize client's statements. 1 2 3 4 5 N/O
14. Ability to reflect on client's feelings. 1 2 3 4 5 N/O
15. Ability to explore the counselor-client relationship. 1 2 3 4 5 N/O
Exhibit A
Page 2 of 8
16. Ability to identify inconsistencies between client's story 1 2 3 4 5 N/O
and reality and then use confrontation effectively.
Basic Helping Skills Not evident Learning Recognize Basic Mastery
17. Ability to identify and challenge unhealthy or distorted 1 2 3 4 5 N/O
thinking or behavior.
18. Ability to provide nonjudgmental feedback to peers. 1 2 3 4 5 N/O
19. Ability to share information appropriately 1 2 3 4 5 N/O
(psych oeducation).
20. Ability to share constructively some of own experiences, 1 2 3 4 5 N/O
behaviors,and feelings through self-disclosure with clients.
21. Ability to assess client's strengths and 1 2 3 4 5 N/O
resources,and encourage client's to use these assets in problem solving.
22. Ability to help clients set goals and move toward action in 1 2 3 4 5 N/O
problem solving.
23. Ability to understand and facilitate decision making. 1 2 3 4 5 N/O
24. Ability to recognize and manage client reluctance and 1 2 3 4 5 N/O
resistance.
25. Ability to help clients explore consequences of the goals 1 2 3 4 5 N/O
they set.
26. Ability to help clients sustain action in direction of goals. 1 2 3 4 5 N/O
27. Ability to help clients review and revise, or recommit to, 1 2 3 4 5 N/O
goals based on new experiences.
Diversity and Social Justice Advocacy integration
28.Ability to broach issues of race, ethnicity,gender, 1 2 3 4 5 N/O
social class,ability, sexual orientation, religion, national origin.
29.Ability to identify and articulate social justice advocacy 1 2 3 4 5 N/O
issues in client's situation.
Procedural Skills
30. Ability to open session smoothly, 1 2 3 4 5 N/O
including providing informed consent.
31. Ability to work with client to identify important 1 2 3 4 5 N/O
concerns for the session.
Exhibit A
Page 3 of 8
32. Ability to work with a client who is in crisis or a situation 1 2 3 4 5 N/0
in which confidentiality needs to be broken.
33. Ability to close session smoothly, 1 2 3 4 5 N/O
including providing summary statement of the session.
Metacognitive Competencies (Ridley et al.,2011)
Not evident Learning Recognize Basic Mastery
34.Ability to demonstrate purposefulness in guiding sessions
and intentionality in selection of interventions. 1 2 3 4 5 N/0
35.Ability to demonstrate energy and motivation towards
attaining appropriate therapeutic outcomes. 1 2 3 4 5 N/0
36.Ability to use discernment in the selection of
appropriate techniques and strategies. 1 2 3 4 5 N/0
37.Ability to appropriately sequence the microskills
to attain desired therapeutic outcomes. 1 2 3 4 5 N/0
38.Ability to use appropriate timing in the
therapeutic encounter. 1 2 3 4 5 N/0
Overall Counseling Skills 1 2 3 4 5
Comments:
Students must score at least a "2" on all of the items and average at or above a "3" overall.
Students who do not meet these expectations will develop, in conjunction with the SERC, a
remediation plan that includes a timeline and specific goals relevant to areas of deficit,
including repeating the O & I course as needed. Permission to enroll in Practicum will not be
granted until that plan is completed to the satisfaction of the involved faculty, SERC and
Program Director.
Exhibit A
Page 4 of 8
Alliant International University—CSPP-Fresno Doctor of Psychology Program in Clinical Psychology
Novice Practicum Competencies Form
Evaluation of core competencies prior to students beginning Gl/first supervised practicum
Note: This document is adapted from the 2004 Report on Practicum Competencies developed by The Association of Directors of Psychology
Training Clinics (ADPTC)Practicum Competencies Workgroup (Hatcher&Lassiter).
Student's Name: Date:
Process:During student evaluation meetings("Globals")held each January,the clinical program faculty discuss the interpersonal,academic and professional competencies
demonstrated across students' first semester in the program. This checklist is used to both inform faculty judgment as to whether the student is ready to begin functioning as a
clinician under supervision and to also identify areas that students must work on during the initial practicum placement. If concerns are raised in this meeting,the student is not
allowed to begin the PSY6570 First Year Practicum and readiness must be re-assessed in the May Globals meeting on the basis of student performance in spring G-1 classes.
The required level of competency will be referred to as novice(N),and is defined as follows:Novices have limited knowledge and understanding of(a)how to analyze
problems and of(b)intervention skills and the processes and techniques of implementing them.They learn general principles or specific techniques to use,but the student's
beginning level of experience limits the flexible use of these skills.Novices do not yet recognize patterns,and do not differentiate well between important and unimportant details;
they do not have filled-in cognitive maps of how,for example,a given patient may move from where he/she is to a place of better functioning. (Benner,1984). Students must score
at least a"2"on all of the items and average at or above a"Y'overall. Students who do not meet these expectations will be referred to SERC to develop a remediation plan.
Permission to enroll in the G-1 Practicum will be granted when that plan is completed to the satisfaction of the involved faculty, SERC and Program Director.
A. Baseline Competencies: Skills.Attitudes and Knowledge that students should possess at the Novice level prior to their practicum training: Scale: 1 =Not evident
Before beginning practicum,the Novice student should possess and demonstrate a set of basic personal and intellectual skills,attitudes and values,and a 2=Aware 3 =Emerging
core of professional knowledge.This core knowledge and these skills,attitudes and values are baseline competencies of the professional psychologist.
The work of subsequent clinical training is to shape and refine these baseline skills into professional skills. 4=Basic 5 =Mastery
1.Personal Characteristics and Skills
a) Interpersonal skills:ability to listen and be empathic with others;respect for/interest in others'cultures,experiences,values,points of view,goals
and desires, fears, strengths and limitations, etc. Trainee is able to establish and maintain appropriate boundaries with others. Skills in this domain
include verbal as well as non-verbal domains.
b) Cognitive skills:problem-solving ability,critical thinking,organized reasoning,intellectual curiosity and flexibility.
c) Affective skills: affect tolerance;tolerance/understanding of interpersonal conflict;tolerance of ambiguity,uncertainty,and ambivalence.
d) Attitudes:Demonstrates a desire to help others;openness to new ideas;honesty/integrity/valuing of ethical behavior;personal courage.
e) Expressive skills: ability to communicate one's ideas,feelings and information in verbal,non-verbal and written forms.
f) Reflective skills: ability to examine and consider one's own motives,attitudes,behaviors,one's effect onothers and especially the ability to be
open to feedback.
g) Personal skills:personal organization,personal hygiene,and appropriate dress. /Average=
1
Exhibit A
Page 5 of 8
2.Knowledge from Classroom Experience:
The practicum experience will engage and develop skills and knowledge that have been the focus of pre-practicumcoursework. Grades of B-or better(CR for PSY6123)must
be achieved in the following courses:Intellectual Assessment,PSY6501,Basic Foundations of Clinical Practice,PSY6507,Introduction to Ethical Practice and Law,
PSY6530A,and Cultural Diversity Training I,PSY6123.
PSY6123 Grade= PSY6501 Grade= PSY6507 Grade= PSY6530A Grade=
a) Assessment&Clinical Interviewing competencies from Intellectual Assessment PSY6501 and Basic Foundations of Clinical Practice I
i) Knowledge of scientific,theoretical,empirical and contextual bases of psychological assessment.
ii) Knowledge of test construction,validity, score reliability and related assessment psychometrics.
iii) Training in principles and practice of systematic administration,data-gathering and interpretation forassessment,including identifying problems,
formulating diagnoses,goals and case conceptualizations;understanding the relationship between assessment and intervention,assessment of treatment
progress and outcome.
iv) Training in the models and techniques of clinical interviewing.
b) Intervention competencies from Basic Foundations of Clinical Practice I PSY650
i) Basic knowledge of scientific,theoretical,empirical and contextual bases ofintervention.
ii) Training in basic clinical skills, such as empathic listening, framing problems,etc.
iii) Training in assessment of treatment progress and outcome.
iv) Training in emergency assessment and management of risk for harm to self or others
c) Ethical&Legal knowledge from Introduction to Ethical Practice and Law PSY6530A and other first semester coursework
i) Principles of ethical practice and decision making(APA,2010)
ii) Legal knowledge related to the practice of psychology[Federal(e.g.,HIPAA),State law]
iii) Specific knowledge and understanding of CA statutes on mandated child and elder abusereporting
d) Individual and Cultural Differences(ICD)from Cultural Diversity Training I,PSY6123 and other first semester coursework
i) Knowledge and understanding of the principles and findings related to ICD as they apply to professionalpsychology.
ii) Understanding of one's own situation(e.g.,one's ethnic/racial,socioeconomic,gender,sexual orientation;one'sattitudes towards diverse others)relative to the
dimensions of ICD(e.g.,class,race,physical disability etc.).
iii) Understanding of the need to consider ICD issues in all aspects of professional psychology work(e.g.,assessment,treatment,research,relationships with
colleagues,etc.).
Concerns identified by faculty and recommendations:
2
Exhibit A
Page 6 of 8
Clinical Competency Exam - EVALUATION FORM
Fresno Clinical PhD Program
Student: Interviewer 1::
Date: Interviewer 2:
RATING KEY
Please rate using a six point scale—2 points within each category.
• Outstanding Progress"Excel in performance beyond normal expectations
• "Competent Progress"Performance demonstrates high standard of clinical competence expected of students at the ` eady
for internship"level,in accordance with developmental criteria(see CSPP,APAandNCSPP).
• 'Insufficient Progress,Remediation Indicated"
1 2 3 4 5 6
SIGNIFICANTLY BELOW GENERALLY CLEARLY EXCEEDS GREATLY
BELOW EXPECTATIONS MEETS MEETS EXPECTATIONS EXCEEDS
EXPECTATIONS EXPECTATIONS EXPECTATIONS EXPECTATION
INSUFFICIENT PROGRESS COMPETENT PROGRESS OUTSTANDING PROGRESS
1. ASSESSMENT CIRCLE ONE
Appropriate assessment methods and/or tools are selected taking into account client's 1 2 3 4 5 6
presentation or presenting problem.
Student appropriately uses, interprets, and integrates assessment data skillfully 1 2 3 4 5 6
(includinq Mental Status
Assessment findings are used appropriately in the generation of a treatment plan for 1 2 3 4 5 6
the client.
Appropriate DSM diagnostic impressions, including justification and differential 1 2 3 4 5 6
diagnoses
Use of ongoing assessment data to monitor treatment 1 2 3 4 5 6
Selection of assessment methods and/or tools takes into account ethnic, cultural and 1 2 3 4 5 6
class variables.
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
Areas for Improvement:
2. FORMULATION CIRCLE ONE
Formulation is appropriately grounded in clinical data. 1 2 3 4 5 6
Student is aware of alternative formulations and limits of own formulations. 1 2 3 4 5 6
Formulation of the problem takes into account the influences of ethnic, cultural, and 1 2 3 4 5 6
class variables.
Formulation of the problem demonstrates an understanding of the client's level of 1 2 3 4 5 6
acculturation or stage of adaptation to the dominant culture.
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
Exhibit A
Page 7 of 8
Areas for Improvement:
3. Intervention Strategy: CIRCLE ONE
Clarity and thoroughness of treatment program. 1 2 3 4 5 6
Ability to integrate patient expectations into interventions when appropriates. 1 2 3 4 5 6
Appropriate consideration of time limitations, resource constraints, and community 1 2 3 4 5 6
resources in the choice of interventions.
Shows evidence of ability to modify therapeutic approach when necessary 1 2 3 4 5 6
Intervention strategies are consistent with the client's level of acculturation, language, 1 2 3 4 5 6
cultural values, and interpersonal styles.
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
Areas for Improvement:
4. Relationship: CIRCLE ONE
Ability to establish atmosphere that facilitates effective communication. 1 2 3 4 5 6
Demonstrates concern and respect in an empathic manner. 1 2 3 4 5 6
Able to establish and maintain professional objectivity. 1 2 3 4 5 6
Assesses and when appropriate discusses the influence of the client's ethnicity, 1 2 3 4 5 6
culture, and class on the development of the therapeutic relationship.
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
Areas for Improvement:
5. Self Examination: CIRCLE ONE
Understands own personality and biases. 1 2 3 4 5 6
Able to question and reflect on own feelings, attitudes, and behavior during treatment 1 2 3 4 5 6
process.
Able to recognize limits of competence. 1 2 3 4 5 6
Examines the impact on treatment of own attitudes about ethnicity, culture, and class. 1 2 3 4 5 6
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
11 Areas for Improvement:
Exhibit A
Page 8 of 8
6. Professional Communication Skills: CIRCLE ONE
Able to communicate orally. 1 2 3 4 5 6
Responsive to questions and feedback. 1 2 3 4 5 6
Manages stress appropriately. 1 2 3 4 5 6
Quality of written work. (weighted equally with above three oral categories) 1 2 3 4 1 5 1 6
CATEGORY SCORE 1 2 3 4 5 6
Strengths:
Areas for Improvement:
OVERALL RATING:
Notes and Comments:
"Competent Progress, Clearly Meets Expectations." [or whatever outcome is]
Exhibit B
Page 1 of 3
FRESNO COUNTY MENTAL HEALTH COMPLIANCE PROGRAM
CONTRACTOR CODE OF CONDUCT AND ETHICS
Fresno County is firmly committed to full compliance with all applicable laws,
regulations, rules and guidelines that apply to the provision and payment of mental health services.
Mental health contractors and the manner in which they conduct themselves are a vital part of this
commitment.
Fresno County has established this Contractor Code of Conduct and Ethics with which
contractor and its employees and subcontractors shall comply. Contractor shall require its employees
and subcontractors to attend a compliance training that will be provided by Fresno County. After
completion of this training, each contractor, contractor's employee and subcontractor must sign the
Contractor Acknowledgment and Agreement form and return this form to the Compliance officer or
designee.
Contractor and its employees and subcontractor shall:
1. Comply with all applicable laws, regulations, rules or guidelines when providing and billing
for mental health services.
2. Conduct themselves honestly, fairly, courteously and with a high degree of integrity in their
professional dealing related to their contract with the County and avoid any conduct that could
reasonably be expected to reflect adversely upon the integrity of the County.
3. Treat County employees, consumers, and other mental health contractors fairly and with
respect.
4. NOT engage in any activity in violation of the County's Compliance Program, nor engage in
any other conduct which violates any applicable law, regulation, rule or guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regulations, rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. Bill only for eligible services actually rendered and fully documented. Use billing codes that
accurately describe the services provided.
Exhibit B
Page 2 of 3
8. Act promptly to investigate and correct problems if errors in claims or billing are discovered.
9. Promptly report to the Compliance Officer any suspected violation(s) of this Code of Conduct
and Ethics by County employees or other mental health contractors, or report any activity that
they believe may violate the standards of the Compliance Program, or any other applicable
law, regulation, rule or guideline. Fresno County prohibits retaliation against any person
making a report. Any person engaging in any form of retaliation will be subject to disciplinary
or other appropriate action by the County. Contractor may report anonymously.
10. Consult with the Compliance Officer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, rule or guideline.
11. Immediately notify the Compliance Officer if they become or may become an Ineligible person
and therefore excluded from participation in the Federal Health Care Programs.
Exhibit B
Page 3 of 3
Fresno County Mental Health Compliance Program
Contractor Acknowledgment and Agreement
I hereby acknowledge that I have received, read and understand the Contractor Code of Conduct and
Ethics. I herby acknowledge that I have received training and information on the Fresno County Mental
Health Compliance Program and understand the contents thereof. I further agree to abide by the
Contractor Code of Conduct and Ethics, and all Compliance Program requirements as they apply to my
responsibilities as a mental health contractor for Fresno County.
I understand and accept my responsibilities under this Agreement. I further understand that any
violation of the Contractor Code of Conduct and Ethics or the Compliance Program is a violation of
County policy and may also be a violation of applicable laws, regulations, rules or guidelines. I further
understand that violation of the Contractor Code of Conduct and Ethics or the Compliance Program
may result in termination of my agreement with Fresno County. I further understand that Fresno
County will report me to the appropriate Federal or State agency.
For Individual Providers
Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
Signature : Date
For Group or Organizational Providers
Group/Org. Name (print):
Employee Name (print):
Discipline: ❑ Psychiatrist ❑ Psychologist ❑ LCSW ❑ LMFT
❑ Other:
Job Title (if different from Discipline):
Signature: Date: / /
Exhibit C
Page 1 of 6
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROL REQUIREMENTS
The COUNTY and its subcontractors shall provide services in accordance with all
applicable Federal and State statutes and regulations.
2. PROFESSIONAL LICENSURE
All (professional level) persons employed by the COUNTY Mental Health
Program (directly or through contract) providing Short-Doyle/Medi-Cal services
have met applicable professional licensure requirements pursuant to Business
and Professions and Welfare and Institutions Codes.
3. CONFIDENTIALITY
CONTRACTOR shall conform to and COUNTY shall monitor compliance with all
State of California and Federal statutes and regulations regarding confidentiality,
including but not limited to confidentiality of information requirements at 42, Code
of Federal Regulations sections 2.1 of seq; California Welfare and Institutions
Code, sections 14100.2, 11977, 11812, 5328; Division 10.5 and 10.6 of the
California Health and Safety Code; Title 22, California Code of Regulations,
section 51009; and Division 1, Part 2.6, Chapters 1-7 of the California Civil Code.
4. NON-DISCRIMINATION
A. Eligibility for Services
CONTRACTOR shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set
forth in the Agreement. No person shall, because of ethnic group
identification, age, gender, color, disability, medical condition, national
origin, race, ancestry, marital status, religion, religious creed, political
belief or sexual preference be excluded from participation, be denied
benefits of, or be subject to discrimination under any program or activity
receiving Federal or State of California assistance.
B. Employment Opportunity
CONTRACTOR shall comply with COUNTY policy, and the Equal
Employment Opportunity Commission guidelines, which forbids
discrimination against any person on the grounds of race, color, national
origin, sex, religion, age, disability status, or sexual preference in
employment practices. Such practices include retirement, recruitment
advertising, hiring, layoff, termination, upgrading, demotion, transfer, rates
of pay or other forms of compensation, use of facilities, and other terms
and conditions of employment.
Exhibit C
Page 2 of 6
C. Suspension of Compensation
If an allegation of discrimination occurs, COUNTY may withhold all further
funds, until CONTRACTOR can show clear and convincing evidence to
the satisfaction of COUNTY that funds provided under this Agreement
were not used in connection with the alleged discrimination.
D. Nepotism
Except by consent of COUNTY's Department of Behavioral Health
Director, or designee, no person shall be employed by CONTRACTOR
who is related by blood or marriage to, or who is a member of the Board
of Directors or an officer of CONTRACTOR.
5. PATIENTS' RIGHTS
CONTRACTOR shall comply with applicable laws and regulations, including but
not limited to, laws, regulations, and State policies relating to patients' rights.
STATE CONTRACTOR CERTIFICATION CLAUSES
1. STATEMENT OF COMPLIANCE: CONTRACTOR has, unless exempted,
complied with the non-discrimination program requirements. (Gov. Code§ 12990
(a-f) and CCR, Title 2, Section 111 02) (Not applicable to public entities.)
2. DRUG-FREE WORKPLACE REQUIREMENTS: CONTRACTOR will comply
with the requirements of the Drug-Free Workplace Act of 1990 and will provide a
drug-free workplace by taking the following actions:
a. Publish a statement notifying employees that unlawful manufacture,
distribution, dispensation, possession or use of a controlled substance is
prohibited and specifying actions to be taken against employees for
violations.
b. Establish a Drug-Free Awareness Program to inform employees about:
1) the dangers of drug abuse in the workplace;
2) the person's or organization's policy of maintaining a drug-free
workplace;
3) any available counseling, rehabilitation and employee assistance
programs; and,
4) penalties that may be imposed upon employees for drug abuse
violations.
C. Every employee who works on this Agreement will:
1) receive a copy of the company's drug-free workplace policy
statement; and,
2) agree to abide by the terms of the company's statement as a
condition of employment on this Agreement.
Failure to comply with these requirements may result in suspension of payments
under this Agreement or termination of this Agreement or both and
Exhibit C
Page 3 of 6
CONTRACTOR may be ineligible for award of any future State agreements if the
department determines that any of the following has occurred: the
CONTRACTOR has made false certification, or violated the certification by failing
to carry out the requirements as noted above. (Gov. Code §8350 et seq.)
3. NATIONAL LABOR RELATIONS BOARD CERTIFICATION: CONTRACTOR
certifies that no more than one (1) final unappealable finding of contempt of court
by a Federal court has been issued against CONTRACTOR within the
immediately preceding two (2) year period because of CONTRACTOR's failure to
comply with an order of a Federal court, which orders CONTRACTOR to comply
with an order of the National Labor Relations Board. (Pub. Contract Code
§10296) (Not applicable to public entities.)
4. CONTRACTS FOR LEGAL SERVICES $50,000 OR MORE- PRO BONO
REQUIREMENT: CONTRACTOR hereby certifies that CONTRACTOR will
comply with the requirements of Section 6072 of the Business and Professions
Code, effective January 1, 2003.
CONTRACTOR agrees to make a good faith effort to provide a minimum number
of hours of pro bono legal services during each year of the contract equal to the
lessor of 30 multiplied by the number of full time attorneys in the firm's offices in
the State, with the number of hours prorated on an actual day basis for any
contract period of less than a full year or 10% of its contract with the State.
Failure to make a good faith effort may be cause for non-renewal of a state
contract for legal services, and may be taken into account when determining the
award of future contracts with the State for legal services.
5. EXPATRIATE CORPORATIONS: CONTRACTOR hereby declares that it is not
an expatriate corporation or subsidiary of an expatriate corporation within the
meaning of Public Contract Code Section 10286 and 10286.1, and is eligible to
contract with the State of California.
6. SWEATFREE CODE OF CONDUCT:
a. All CONTRACTORS contracting for the procurement or laundering of
apparel, garments or corresponding accessories, or the procurement of
equipment, materials, or supplies, other than procurement related to a
public works contract, declare under penalty of perjury that no apparel,
garments or corresponding accessories, equipment, materials, or
supplies furnished to the state pursuant to the contract have been
laundered or produced in whole or in part by sweatshop labor, forced
labor, convict labor, indentured labor under penal sanction, abusive forms
of child labor or exploitation of children in sweatshop labor, or with the
benefit of sweatshop labor, forced labor, convict labor, indentured labor
under penal sanction, abusive forms of child labor or exploitation of
children in sweatshop labor. CONTRACTOR further declares under
penalty of perjury that they adhere to the Sweatfree Code of Conduct as
set forth on the California Department of Industrial Relations website
located at www.dir.ca.gov, and Public Contract Code Section 6108.
Exhibit C
Page 4 of 6
b. CONTRACTOR agrees to cooperate fully in providing reasonable access
to the CONTRACTOR's records, documents, agents or employees, or
premises if reasonably required by authorized officials of the contracting
agency, the Department of Industrial Relations, or the Department of
Justice to determine the contractor's compliance with the requirements
under paragraph (a).
7. DOMESTIC PARTNERS: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.3.
8. GENDER IDENTITY: For contracts of$100,000 or more, CONTRACTOR
certifies that CONTRACTOR is in compliance with Public Contract Code Section
10295.35.
DOING BUSINESS WITH THE STATE OF CALIFORNIA
The following laws apply to persons or entities doing business with the State of
California.
1. CONFLICT OF INTEREST: CONTRACTOR needs to be aware of the following
provisions regarding current or former state employees. If CONTRACTOR has
any questions on the status of any person rendering services or involved with this
Agreement, the awarding agency must be contacted immediately for clarification.
Current State Employees (Pub. Contract Code §10410):
a). No officer or employee shall engage in any employment, activity or
enterprise from which the officer or employee receives compensation or
has a financial interest and which is sponsored or funded by any state
agency, unless the employment, activity or enterprise is required as a
condition of regular state employment.
b). No officer or employee shall contract on his or her own behalf as an
independent contractor with any state agency to provide goods or
services.
Former State Employees (Pub. Contract Code §10411):
a). For the two (2) year period from the date he or she left state employment,
no former state officer or employee may enter into a contract in which he
or she engaged in any of the negotiations, transactions, planning,
arrangements or any part of the decision-making process relevant to the
contract while employed in any capacity by any state agency.
b). For the twelve (12) month period from the date he or she left state
employment, no former state officer or employee may enter into a
contract with any state agency if he or she was employed by that state
agency in a policy-making position in the same general subject area as
Exhibit C
Page 5 of 6
the proposed contract within the twelve (12) month period prior to his or
her leaving state service.
If CONTRACTOR violates any provisions of above paragraphs, such action by
CONTRACTOR shall render this Agreement void. (Pub. Contract Code §10420)
Members of boards and commissions are exempt from this section if they do not
receive payment other than payment of each meeting of the board or
commission, payment for preparatory time and payment for per diem. (Pub.
Contract Code §10430 (e))
2. LABOR CODE/WORKERS' COMPENSATION: CONTRACTOR needs to be
aware of the provisions which require every employer to be insured against
liability for Worker's Compensation or to undertake self-insurance in accordance
with the provisions, and CONTRACTOR affirms to comply with such provisions
before commencing the performance of the work of this Agreement. (Labor Code
Section 3700)
3. AMERICANS WITH DISABILITIES ACT: CONTRACTOR assures the State that
it complies with the Americans with Disabilities Act (ADA) of 1990, which
prohibits discrimination on the basis of disability, as well as all applicable
regulations and guidelines issued pursuant to the ADA. (42 U.S.C. 12101 et seq.)
4. CONTRACTOR NAME CHANGE: An amendment is required to change the
CONTRACTOR's name as listed on this Agreement. Upon receipt of legal
documentation of the name change the State will process the amendment.
Payment of invoices presented with a new name cannot be paid prior to approval
of said amendment.
5. CORPORATE QUALIFICATIONS TO DO BUSINESS IN CALIFORNIA:
a. When agreements are to be performed in the state by corporations, the
contracting agencies will be verifying that the CONTRACTOR is currently
qualified to do business in California in order to ensure that all obligations
due to the state are fulfilled.
b. "Doing business" is defined in R&TC Section 23101 as actively engaging
in any transaction for the purpose of financial or pecuniary gain or profit.
Although there are some statutory exceptions to taxation, rarely will a
corporate contractor performing within the state not be subject to the
franchise tax.
C. Both domestic and foreign corporations (those incorporated outside of
California) must be in good standing in order to be qualified to do
business in California. Agencies will determine whether a corporation is
in good standing by calling the Office of the Secretary of State.
6. RESOLUTION: A county, city, district, or other local public body must provide
the State with a copy of a resolution, order, motion, or ordinance of the local
governing body, which by law has authority to enter into an agreement,
authorizing execution of the agreement.
Exhibit C
Page 6 of 6
7. AIR OR WATER POLLUTION VIOLATION: Under the State laws, the
CONTRACTOR shall not be: (1) in violation of any order or resolution not
subject to review promulgated by the State Air Resources Board or an air
pollution control district; (2) subject to cease and desist order not subject to
review issued pursuant to Section 13301 of the Water Code for violation of waste
discharge requirements or discharge prohibitions; or (3) finally determined to be
in violation of provisions of federal law relating to air or water pollution.
8. PAYEE DATA RECORD FORM STD. 204: This form must be completed by all
contractors that are not another state agency or other governmental entity.
9. INSPECTION and Audit of Records and access to Facilities.
The State, CMS, the Office of the Inspector General, the Comptroller General,
and their designees may, at any time, inspect and audit any records or
documents of CONTRACTOR or its subcontractors, and may, at any time,
inspect the premises, physical facilities, and equipment where Medicaid-related
activities or work is conducted. The right to audit under this section exists for ten
(10) years from the final date of the contract period or from the date of
completion of any audit, whichever is later.
Federal database checks.
Consistent with the requirements at § 455.436 of this chapter, the State must
confirm the identity and determine the exclusion status of CONTRACTOR, any
subcontractor, as well as any person with an ownership or control interest, or
who is an agent or managing employee of CONTRACTOR through routine
checks of Federal databases. This includes the Social Security Administration's
Death Master File, the National Plan and Provider Enumeration System
(NPPES), the List of Excluded Individuals/Entities (LEIE), the System for Award
Management (SAM), and any other databases as the State or Secretary may
prescribe. These databases must be consulted upon contracting and no less
frequently than monthly thereafter. If the State finds a party that is excluded, it
must promptly notify the CONTRACTOR and take action consistent with §
438.610(c).
The State must ensure that CONTRACTOR with which the State contracts under
this part is not located outside of the United States and that no claims paid by a
CONTRACTOR to a network provider, out-of-network provider, subcontractor or
financial institution located outside of the U.S. are considered in the development
of actuarially sound capitation rates.
Exhibit D
Page 1 of 2
SELF-DEALING TRANSACTION DISCLOSURE FORM
In order to conduct business with the County of Fresno (hereinafter referred to as "County'),
members of a contractor's board of directors (hereinafter referred to as "County Contractor"), must
disclose any self-dealing transactions that they are a party to while providing goods, performing
services, or both for the County. A self-dealing transaction is defined below:
"A self-dealing transaction means a transaction to which the corporation is a party and in which one
or more of its directors has a material financial interest"
The definition above will be utilized for purposes of completing this disclosure form.
INSTRUCTIONS
(1) Enter board member's name,job title (if applicable), and date this disclosure is being made.
(2) Enter the board member's company/agency name and address.
(3) Describe in detail the nature of the self-dealing transaction that is being disclosed to the
County. At a minimum, include a description of the following:
a. The name of the agency/company with which the corporation has the transaction; and
b. The nature of the material financial interest in the Corporation's transaction that the
board member has.
(4) Describe in detail why the self-dealing transaction is appropriate based on applicable
provisions of the Corporations Code.
(5) Form must be signed by the board member that is involved in the self-dealing transaction
described in Sections (3) and (4).
Exhibit D
Page 2 of 2
(1)Company Board Member Information:
Name: Date:
Job Title:
(2)Company/Agency Name and Address:
(3) Disclosure(Please describe the nature of the self-dealing transaction you are a party to)
(4)Explain why this self-dealing transaction is consistent with the requirements of Corporations Code 5233(a)
(5)Authorized Signature
Signature: Date: