HomeMy WebLinkAboutAgreement A-16-359 with CBANS Service Providers.pdf1 MASTER AGREEMENT
2 Thjs Agreement is made and entered into this day of > 2016, by and
3 between the COUNTY OF FRESNO, a Political Subdivision of the State of California, hereinafter
4 referred to as "COUNTY", and each CONTRACTOR listed in Exhibit A "LIST OF
5 CONTRACTORS", attached hereto and by this reference incorporated herein, and collectively
6 hereinafter referred to as "CONTRACTORS", and such additional CONTRACTOR(S) as may, from
7 time to time dming the term of this Agreement, be added by COUNTY, with the Department of
8 Behavioral Health (DBH) Director or designee approval. Reference in this Agreement to "parties"
9 shall be understood to refer to COUNTY and each individua l CONTRACTOR, unless otherwise
10 specified.
11 W IT N E S S E T H:
12 WHEREAS, COUNTY, through its DBH, Mental Health Services Act (MHSA), Prevention and
13 Early Intervention (PEl) component, and through input from the community stakeholder process,
14 recognizes the need to provide PTevention and Early Intervention Cultural Based Access Navigation
15 and Peer Support (CBANS) services> as specified in this Agreement and as part ofFTesno County's
16 a p proved State PEl Plan, to help reduce stigma and discrimination against mental illness and provide
17 services related to mental well being; and
18 WHEREAS, CONTRACT OR(S) are qualified and willing to provide said services pursuant to
19 the terms and conditions of this Agreement
20 NOW, THEREFORE, in consideration oftheir mutual covenants and conditions> the parties
21 hereto agree as follows:
22 1. COVERED SE RVICES
23 A. CONTRACTOR(S) shall perform all services and fulfill all responsibilities
24 identified in COUNTY's Request fo r Proposal (RFP) No. 952-5412, dated January 12, 2016, and
25 Addendum No. One (1) to COUNTY's RFP No. 952-54 12, dated February 12,2016, hereinafter
26 collectively referred to as COUNTY's Revised RFP No. 952-5412.
27 B . CONTRACTOR(S) shall pe1form all seTvices and fulfill all respo nsibilities as set
28 forth in Exhibit B "Progr am Overview" attached hereto and by this reference incorporated he rein and
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1 made part of this Agreement. CONTRACTOR(S) shall also perform all services and fulfill all
2 responsibilities as set forth in their individual "Scope of Work" documents approved by the
3 COUNTY's DBHDirector or designee, and attached hereto as Exhibits B-1 et seq. and incorporated
4 herein by this reference. In the event of any inconsistency among these documents, the inconsistency
5 shall be resolved by giving precedence in the following order: 1) to this Agreement, including all
6 Ex hibits, 2) to the Revised RFP No. 952-5412, and 3) to the Response to the Revised RFP No. 952-
7 5412. A copy of COUNTY's Revised RFP No. 952-5412, and CONTRACTOR(S)'s response, shall
8 be retained and made available during the term of this Agreement by COUNTY's DBH MHSA
9 Contract Section.
10 2. TERM
11 The term of this Agreement shall be for a period of three (3) years, commencing on the
12 1st day of July, 2016 through and including the 30th day of June, 2019. This Agreement may be
13 extended for two (2) additional consecutive twelve (12) month peliods subject to satisfactory
14 performance outcomes as identified in ExhibitB-1 et seq ., and subject to State :fuuding each year,
15 upon the same tenns and conditions herein set forth, unless written notice of non-renewal is given by
16 COUNTY, CONTRACTOR(S), or COUNTY's DBH Director or designee, not later than. sixty (60)
17 days prior to the close of the then current Agreement tenn.
3. TERMINATION 18
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A. Non-Allocation of Funds -The terms of this Agreement, and the services to be
provided theretmder, are contingent on the approval of funds by the appropriating government agency.
Should sufficient funds not be allocated, the services provided may be modified, or this Agreement
terminated at any time by giving the CONTRACTOR(S) thirty (30) days advance written notice.
B. Breach of Contract -The COUNTY may immedi ately suspend or terminate this
24 Agreement in whole or in part, where in the determination of the COUNTY there is:
25 l) An illegal or improper us.e of funds;
26 2) A failme to comply with any term of this Agreement;
27 3) A substantially incorrect or incomplete report submitted to the COUNTY;
28 4) Improperly performed service.
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1 In no event shall any payment by the COUNTY constitute a wa iver by the COUNTY of any breach of
2 this Agreement or any default which may then exist on the part of the CONTRACTOR(S). Neither
3 shall such payment impair or prejudice any remedy available to the COUNTY with respect to the
4 breach or default. The COUNTY shall have the right to demand of the CONTRACTOR(S) the
5 repayment to the COUNTY of any funds disbursed to CONTRACTOR(S) under this Agreement,
6 which in the judgment of the COUNTY were not expended in accordance with the terms of this
7 Agreement. CONTRACTOR(S) shall promptly refund any such funds upon demand or, at
8 COUNTY's option~ such repayment sball be deducted from future payments owing to
9 CONTRACTOR(S) under this Agreement.
10 C. Without Cause -Under circumstances other than those set forth above , this
11 Agreement may be terminated by CONTRACTOR(S) or COUNTY or COUNTY's DBH Director·, or
12 designee, upon the giving of sixty (60) days advance written notice of an intention to terminate.
13 4. COMPENSATION AND PAYMENTS
14 A. Maximum Contract Amount
15 The maximum compensation amount under this Agreement for each Fiscal Year
16 (FY ) of: July l, 2016 through June 30, 2017~ July 1, 2017 through June 30, 2018 ~ July 1, 2018 through
17 June 30 , 2019 ; July 1, 2019 through June 30, 2020 ; and July 1, 2020 through June 30 , 2021 ; shall not
18 exceed Five Hundred Fifty-O ne Thousand Six Hundred Thirty-Three and No/1 00 Dollars
19 ($551,633.00) for all CONTRACTORS combined.
20 The maximum amounts paid to each CONTRACTOR(S) identified in this
21 Agreement shall be as stated in the individual CONTRACTOR(S)'s "Budget" documents approved by
2·2 the COUNTY 's DBH Director or designee, and attached hereto as Exhibits C-1 , eL seq. and
23 incorporated herein by this reference.
24-In no event shall the maximum compensation amount under this Agreement for
25 FY 2016-17 through FY 2020-21 exceed Two Million Seven Hundred Fifty-Eight Thousand One
26 Hundred Sixty-Five and No/100 Dollars ($2,758,165.00) or proration thereof f or all
27 CONTRACTOR(S) combined.
28 B. It is understood that all expenses incidental to CONTRACTOR(S) performance
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of services under this Agreement shalJ be borne by CONTRACTOR(S). If CONTRACTOR(S) fails to
comply with any provision of this Agreement, COUNTY sha11 be relieved of its obligation for further
compensation.
C. Payments shall be made by COUNTY to CONTRACTOR(S) in arrears, for
services provided during the preceding month, within forty-five (45) days after the date of receipt and
approval by COUNTY of the monthly invoicing as described in Section Five (5) herein. Payments
shall be made after receipt and verification of actual expenditure incurred by CONTRACTOR(S) for
monthly program costs, as identified in Exhibit C-1, et seq ., in the perfonnance ofthis Agreement in
accordance with Exhibit B ·and Exhibits B-1, e/ seq. and shall be documented to COUNTY on a
monthly basis by the tenth (101h) ofthe m<;mth following the month of said expendinu·es.
CONTRACTOR(S) shall submit to COUNTY by the tenth (1 0111) of each month
a detailed general ledger (GL) itemizing costs incurred in the previous month. Failure to submit GL
reports and supporting documentation shall be deemed sufficient cause for COUNTY to withhold
payments until there is compliance, as further described in Section Five (5) herein.
D. COUNTY shall not be obligated to make any payments under this Agreement I
the request for payment is received by COUNTY more than sixty (60) days after this Agreement has
terminated or expired.
E. All final invoices and/or any final budget modification reques ts shall be
submitted by CONTRACTOR(S) within sixty (60) days following the final month of service for which
payment is claimed. No action shall be taken by COUNTY on invoices submitted beyond the sixty
(60) day closeout period. Any compensation which is not expended by CONTRACTOR(S) pursuant
to the terms and conditions of this Agreement sha ll automatic a lly revert to COUNTY.
F. The service provided by CONTRACTOR(S) under this Agreement are funded in
whole or in part by the State of California. In the event that funding fo r these services is delayed by
the State Controller, COUNTY may defer payments to CONTRACTOR(S). The amount of the
deferred payment shall not exceed the amount of funding delayed by the State Controller to the
COUNTY. The period of time of the defenal by COUNTY shall not exceed the period of time of the
State Controller's delay of payment to COUNTY plus forty-five (45) days.
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5. INVOICING
A. CONTRACTOR(S) shall provide invoices as described below to COUNTY by
the tenth (1 01h) day of each month for the prior month's expenditures, to
DBHlnvo'ices@co.fresno.ca.us. Invoices and reports shall be in such detail as acceptable to
COUNTY's DBH, as described in Section Five (5) and in Section Twelve (12) of this Agreement.
Additionally, invoices and supporting documentation may be mailed to 3133 N. Millbrook, Fresno,
CA 93703, Attention: CBANS Contract Analyst. No reimbursement for services shall be made until
the invoice and report is received, verified and approved by COUNTY's DBI-l.
B. At the discretion of COUNTY's DBH Director, or designee, if an invoice is
incorrect or is otherwise not in proper form or substance, COUNTY's DBH Director, or designee,
shall have the right to withhold payment as to only that portion of the invoice that is incorrect or
improper after five (5) days prior notice to CONTRACTOR(S). CONTRACTOR(S) agrees to
continue to provide services for a period of ninety (90) days after notification of an incorrect or
improper invoice. If after the ninety (90) day period, the invoice(s) is still not conected to COUNTY
DBH's satisfaction, COUNTY's DBH Director, or designee, may elect to te1minate this Agreement,
pursuant to the tennination provisions stated in Section Three (3) of this Agreement. In addition, for
invoices received ninety (90) days after the expiration of each term of tllis Agreement or termination
of this Agreement, at the discretion of COUNTY's DBH Director, or designee, COUNTY's DBH shall
have the right to deny payment of any additional invoices received.
C. CONTRACTOR(S) shall provide a monthly activity report with each invoice,
further described in Section Twelve (12). In addition each monthly invoice will be in the fonnat as
identified in Exhibits C-1 et seq., showing each budget Une item, expenses incurred, and the balance
remaining for each budget line item for all services and items as identified in Exhibit C-1 et seq.
D. CONTRACTOR(S) shall subnlit monthly staffing reports that identify all direct
service and support staff, applicable licensure/certifications, and full time hou.rs worked to be used as a
tracking tool to determine if CONTRACTOR(S)'s program is staffed according to the services
provided under this Agreement.
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1 E. CONTRACTOR(S) must attend COUNTY DBH's Business Office training on
2 equipment reporting for assets, intangible and sensitive minor assets.
3 6. INDEPENDENT CONTRACTOR
4 In performance of the work, duties, and obligations assumed by CONTRACTOR(S)
5 under this Agreement, it is mutually understood and agreed that CONTRACTOR(S), including any
6 and all of CONTRACTOR(S)'s officers, agents, and employees will at all times be acting and
7 performing as independent CONTRACTOR(S), and shall act in an independent capacity and not as an
8 officer, agent, servant, employee, joint venture, partner, or associate of COUNTY. Furthermore,
9 COUNTY shall have no right to control or supervise or direct the manner or method by which
10 CONTRACTOR(S) shall perform its work and function. However, COUNTY shall retain the right to
11 administer this Agreement so as to verify that CONTRACTOR(S) is performing their obligations in
12 accordance with the terms and conditions thereof. CONTRACTOR(S) and COUNTY shall comply
13 with all applicable provisions of law and the rules and regulations, if any, of govemmental authorities
14 having jurisdiction over matters which are directly or indirectly the subject of this Agreement.
15 Because of its status as an independent contractor, CONTRACTOR(S) shall have
16 absolutely no right to employment rights and benefits available to COUNTY employees.
17 CONTRACTOR(S) shall be solely liable and responsible fQr providing to, or on behalf of, its
18 employees all legally-required employee benefits. In addition, CONTRACTOR(S) shall be solely
19 responsible and save COUNTY hannless from aLL matters relating to payment ofCONTRACTOR(S')
20 s employees, including compliance with Social Security, withholding, and all other regulations
21 governing such matters. It is acknowledged that during 'the term of this Agreement,
22 CONTRACTOR(S) may be providing services to others unrelated to COUNTY or to this Agreement.
23 7. MODIFICATION
24 Any matters of this Agreement may be modifi.ed from time to time by the written
25 consent of all the parties without, in any way, affecting the remainder.
26 Notwithstanding the above, changes to services as needed to accommodate changes in
27 the Jaw relating to mental health and substance use disorder treatment, as set forth in Exhibjt Band
28 Exhibits B-1 et seq ., may be made with the signed wdtten approval of COUNTY's DBH Director or
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1 designee and CONTRACTOR(S) through an amendment approved by County counsel and Auditor.
2 Changes to line items in the budgets, attached hereto as Exhibit C-1, et seq ., as appropriate, that do not
3 exceed 10% of the indi vidual CONTRACTOR(S)'s program total maximum compensation payable to
4 CONTRACTOR(S), may be made with the written approval of COUNTY's DBH Director or designee
5 and CONTRACTOR(S). Changes to the line items in the budget that exceed 10% of the maximum
6 compensation payable to the CONTRACTOR(S) may be made with the signed written approval of
7 COUNTY's DBH Director, or his or her designee through an amendment approved by County
8 Counsel and Auditor. Said budget line item changes shall not result in any change to the individual
9 CONTRACTOR(S)'s program maximum compensation amount payable to CONTRACTOR(S), as
10 stated herein .
11 Additions to Exhibit A "List of Contractors" may be made with written approval of
12 COUNTY's DBH Director or designee, upon COUNT Y 's DBH Director or designee having received
13 and approved submitted proposals for additional CONTRACTOR(S). Proposals for the inclusion of
14 CONTRACTOR(S) must be prepared and submitted in accordance with Revised RFP No. 952-5412
15 to: County of Fresno , Department of Behavioral Health , Mental Health Services Act , 3133 N.
1 6 Millbrook Avenue, Fresno, CA 93703 , Attention: MHSA CBANS Contract Analyst.
17 8. NON-ASSIGNMENT
1 8 Neither pru1y shall assign , transfer or subcontract tlus Agreement nor their rights or
19 duties under this Agreement without the prior written consent of the other pruty.
20 9. HOLD-HARIVILESS
21 CONTRACTOR(S) agrees to indemnify , save, hold harmless, and at COUNTY's
22 request, defend the COUNTY, its officers, agents and employees from any and all costs and expenses,
23 including attorney fees and court costs , damages, liabilities, claims and losses occuning or resulting to
24 COUNTY in connection with the performance, or failure to perform, by CONTRACTOR(S), its
25 officers, agents or employees under this Agreement, and fi:om any and all costs and expenses,
26 including attorney fees ahd court costs, damages, liabilities, claims and losses occurring or resulting to
27 any person, firm or corporation who may be injured or damaged by the performance, or failm·e to
28 perfmm, of CONTRACTOR(S), its officers, agents or employees under this Agreement.
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1 CONTRACTOR(S) agrees to indemnify COUNTY tor Federal, State of Califomia andloi:
2 local audit exceptions resulting from noncompliance herein on the part of the CONTRACTOR(S).
3 10. INSURANCE
4 Without limiting COUNTY's right to obtain indemnification fi·om CONTRACTOR(S)
5 or any third parties, CONTRACTOR(S), at its sole expense, shall maintain in full force and effect the
6 following insurance pol icies throughout the term ofthis Agreement:
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A.
B.
C .
D.
Commercial General Liability
Commercial General Liability Insurance with limits of not less than One Million
Dollars ($1,000,000) per occunence and an annual aggregate ofTwo Million
Dollars ($2,000,000). This policy shall be issued on a per occurrence basis.
COUNTY may require specific coverage including completed operations,
product liability, contractual liability, Explosion, Collapse, and Underground
(XCU), fire legal liability or any other liability insurance deemed necessary
because of the nature of the Agreement.
Automobile Liability
Comprehensive Automobile Liability Insurance with limits for bodily injury of
not less than Two HLmdred Fifty Thousand Dollars ($250,000) per person, Five
Hundred Thousand Dollars ($500,000) pel' accident and for propetty damages of
not less than Fifty Thousand Dollars ($50,000), or such coverage with a
combined single limit ofFive Hundred Thousand Dollars ($500,000). Coverage
should include owned and non-owned vehicles 1.1sed in connection with this
Agreement.
Professional Liability
IfCONTRACTOR(S) employs licensed professional staff(e.g. Ph.D., R.N .,
L.C.S.W., L.M.F.T.) in providing services, Professional Liability Insurance with
limits of not less than One Million Dollars ($1 ,000,000) per occunence, Three
Million Dollars ($3,000,000) annual aggregate.
Real and Property Insurance
CONTRACTOR(S) shall maintain a policy of insurance for all risk personal
property coverage which shall be endorsed naming the County of Fresno -as an
additional loss payee . The personal propetty coverage shall be in an amount that
will cover the total of the COUNTY purchase and owned property, at a
mininmm, as discussed in Section Nineteen (19) of this Agreement.
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E.
F.
All Risk Prope1ty Insurance
CONTRACTOR(S) will provide property coverage for the full replacement
value ofthe COUNTY'S personal property in possession ofCONTRACTOR(S)
and/or used in the execution of this Agreement. COUNTY will be identified on
an appropriate certificate of insurance as the cettificate holder and will be named
as an Additional Loss Payee on the Property Insurance Policy.
Worker's Compensation
A policy of Worker's Compensation Insurance as may be req uired by the
California Labor Code.
Child Abuse/Mo lestation and Social Serv ices Coverage
The CONTRA CTOR(S) shall have either separate poli cies or umbrel la policy with
endorsements covering Child Abuse/Molestation and Social Services Liability coverage
or have a specific endorsement on their Genera l Commercial liability policy cover ing
Child Abuse/Molestation and Socia l Services Liability. The po li cy limits for these
polic ies shall be $1,000,000 per occurrence w ith a $2,000,000 annual aggregate. Th e
policies are to be on a per occurrence basis.
CONTRACTOR(S) shall obtain endorsements to the Commercial General Liability
insw·ance naming the Cotmty of Fresno, its officers, agents, and employees, individually and
collectively, as additional insured, but only insofar as the operations under this Agreement are
concerned. Such coverage for additional insured shall apply as primar y insurance and any other
insurance, or self-insurance, maintained by COUNTY, its officers, agents and employees shall be
excess only and not contributing with insurance provided under CONTRACTORS's policies herein.
This insurance shall not be cancell ed or changed without a minimum of thirty (30) days advance
written notice given to COUNTY.
Within thirty (3 0) days from the date CONTRACTOR signs this Agreement,
CONTRACTOR(S) shall provide certificates of insurance and endorsements as stated above for all of
the foregoing policies, as required herein, to the County of Fresno, Department of Behav ioral Health,
3133 N . Millbrook Ave, Fresno, California, 93703, Attention: CBANS ContractAnalyst, stating that
such insurance coverages have been obtained and are in full force; that the County of Fresno, its
officers, agents and employees will not be responsibl e for any premiums on the policies; that such
Commercial Gener al Liability insurance names the County of Fresno, its officers, agents and
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1 employees, individually and collectively, as additional insured, but only insofar as the operations
2 under this Agreement are concerned; that such coverage for additional insmed shall apply as primary
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4 insurance and any other insurance, or self-insurance, maintained by COUNTY, its officers, agents and
5 employees, shall be excess only and not contributing with insmance provided under
6 CONTRACTOR(S)'s policies herein; and that this insurance shall not be cancelled or changed without
7 a minimum of thirty (30) days advance, written notice given to COUNTY.
8 ln the event CONTRACTOR(S) fails to keep in effect at all times insurance coverage as
9 herein provided , COUNTY may, in addition to other remedies it may have, suspend or terminate this
10 Agreement upon the occurrence of such event.
11 All policies shall be w ith admitted insurers licensed to do business in the State of
12 Califomi a. Insurance purchased shall be from companies possessing a current A.M. Best, Inc. rating
13 of A FSC VIT or better.
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11. LICENSES/CERTIFICATES
Throughout each tenn of this Agreement, CONTRACTOR(S) and CONTRACTOR(S)'s
staff shall maintain aU necessary licenses, permits, approvals, cettificates, waivers and exemptions
necessary for the provision of the services hereunder and required by the laws and regulations of the
United States of America, State of California, the County ofFresno, and any other applicable
governmental agencies. CONTRACTOR(S) sha ll notify COUNTY immediately in writing of its
inability to obtain or maintain such licenses, permits, approvals, certificates, waivers and exemptions
irrespective of the pendency of any appeal re lated thereto. Additionally, CONTRACTOR(S) and
CONTRACTOR(S)'s staff shall comply with all app li cable laws, rules or regulat ions, as may now
exist or be hereafter changed.
12. REPORTS
A. Activity Rep01ts
CONTRACTOR(S) shall submit to COUNTY's DBH by the 101h of each month
all monthly activity and budget reports for the preceding month.
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1 B. Additional Repolts
2 In addition, CONTRACTOR(S) shall also furnish to COUNTY such statements,
3 records, reports , data, and other information as COUNTY may request pertaining to matters covered
4 by this Agreement. In the event that CONTRACTOR(S) fails to provide such reports or other
5 infmmation required hereunder, it shalll:>e deemed sufficient cause for COUNTY to withhold monthly
6 payments until there is compliance. In addition, CONTRACTOR(S) shall provide written notification
7 and explanation to COUNTY within five (5) days of any funds received from another source to
8 conduct the same services covered by this Agreement.
9 13. MONITORING
10 CONTRACTOR(S) agrees to extend to COUNTY's staff, COUNTY's DBH Director
11 and the State Department of Mental Health, or their designees, the right to review and monitor records ,
12 program or procedures, at any time, in regard to clients, as well as the overall operation of
13 CONTRACTOR(S)'s program, in order to ensure compliance with the terms and conditions of this
14 Agreement.
15 14. REFERENCES TO LAWS AND RULES
16 In the event any law, regulation, or policy referred to in this Agreement is amended
17 during the term thereof, the parties hereto agree to comply with the amended provision as of the
18 effective date of such amendment.
19 15. COMPLIANCE WITH STATE REQUIREMENTS
20 CONTRACTOR(S) recognizes that COUNTY operates its mental health programs
21 under an agreement with the State of California Department ofMental Health, and that und er said
22 agreement the State impo ses certain requirements on COUNTY and its subcontractors.
23 CONTRACTOR(S) shall adhere to all State Requirements, including those identified in Exhibit D
24 "State Mental Health Requirements", attached hereto and by this reference incorporated herein.
25 16. CONFIDENTIALITY
26 All services performed by CONTRACTOR(S) under tllis Agreement shall be in strict
27 confmmance 'Nith all applicable Federal, State of California and/or local laws and regulations relating
28 to confidentiality, including all Health Insurance Portability Accounting Act (HIP AA) regulations.
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17. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT 1
2 COUNTY and CONTRACTOR(S) each consider and represent themselves as covered
3 entities as defined by the U.S. Health Insurance Portability and Accountability Act of 1996, Public
4 Law l 04-191 (HIP AA) and agree to use and disclose Protected Health Information (PHI) as required
5 by law. COUNTY and CONTRACTOR(S) acknowledge that the exchange of PHI between them is
6 only for treatment, payment, and health care operations.
7 COUNTY and CONTRACTOR(S) intend to protect the privacy and provide for the
8 security of PHI pursuant to the Agreement in compliance with HIPAA, the Health Information
9 Technology for Economic and Clinical Health Act, Public Law 111-005 (HITECH), and regulations
10 promulgated thereunder by the U.S. Department of Health and Human Services (HIP AA Regulations)
11 and other applicable Jaws.
12 As part of the HIP AA Regulations, the Privacy Rule and the Security Rule require
13 CONTRACTOR(S) to enter into a contract containing specific requirements prior to the disc losure of
14 PHI, as set forth in, but not limited to , Title 45, Sections 164.314(a), 164.502(e) and 164.504(e) of the
15 Code of Federal Regulations.
16 18. DATA SECURITY
17 For tl1e purpose of preventing the potential loss, misappropriation or inadve1ient access,
18 viewing, use or disclosure of COUNTY data including sensitive or personal client information; abuse.
19 of COUNTY resources; anclJor disruption to COUNTY operations, individua ls and/or agencies that
20 enter into a contractual relationship with the COUNTY for the purpose of providing services under
21 this Agreement must employ adequate data security measures to protect the confidential information
22 provided to CONTRACTOR(S) by the COUNTY, including but not Limited to the following:
23 A. CONTRACTOR(S)-Owned Mobile, Wireless. or Handheld Devices
24 CONTRACTOR(S) may not connect to COUNTY networks via personally-
25 owned mobile, wireless or handheld devices, unless the following conditions are met:
26 1) CONTRACTOR(S) has received authorization by CO UNTY faT
2 7 telecommuting purposes;
28 2) Current virus protection software is in place;
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3) Mobile device has the remote wipe feature enabled/ and
4) A secure connection is used.
B. CONTRACTOR(S)-Owned Computers or Computer Peripherals
CONTRACTOR(S) may not bring CONTRACTOR(S)-owned computers or
computer peripherals into the COUNTY for use without prior authorization from the COUNTY's
Chief Information OffLcer, and/or designee(s), including but not limited to mobile storage devjces. If
data is approved to be transferred~ data must be stored on a secure server approved by the COUNTY
and transfetTed by means of a Virtual Private Network (VPN) connection, or another type of secure
connection. Said data must be encrypted.
C. COUNTY -Owned Computer Equipment
CONTRACTOR(S) may not use COUNTY computers or computer peripherals
on non-COUNTY premises without prior authorization from the COUNTY's Chief fnfmmation
Officer, and/or designee(s).
D. CONTRACTOR(S) may not store COUNTY's private, confidential or sensitive
data on any hard-disk drive, portable storage device, or remote storage installation unless encrypted.
E . CONTRACTOR(S) shall be responsib le to employ strict controls to ensure the
integrity and security of COUNTY's confidential information and to prevent unauthorized access,
viewing, use or disclosure of data maintained in computer files, program documentation, data
processing systems, data files and data processing equipment which stores or processes COUNTY
data intemally and externally.
F. Confidential client information transmitted to one party by the other by means
of electronic transmissions must be encrypted according to Advanced Encryption Standards (AES) of
128 BIT or higher. Additionally, a password or pass phrase must be utilized.
G. CONTRACTOR(S) is responsible to immediately notify COUNTY of any
violations, breaches or potential breaches of security related to COUNTY's confidential info1Tllation,
data maintained in computer files, program documentation, data processing systems, data files and
data processing equipment which stores or processes COUNTY data internally or extemally.
H. COUNTY shall provide oversight to CONTRACTOR(S)'s response to all
-13 -COUN'IY OF FRESNO
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1 incidents arising from a possible breach of security related to COUNTY's confidential client
2 information provided to CONTRACTOR(S). CONTRACTOR(S) will be responsible to issue any
3 notification to affected individuals as required by law or as deemed necessary by COUNTY in its sole
4 discretion. CONTRACTOR(S) will be responsible for all costs incurred as a result ofproviding the
5 required notification.
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19. PROPERTY OF COUNTY
A . COUNTY and CONTRACTOR recognize that fixed assets are tangible and
8 intangible property obtained or controlled under COUNTY's Mental Health Plan for use in operational
9 capacity and will benefit COUNTY for a period more than one year. Depreciation of the qualified
10 items will be on a straight-line basis.
11 For COUNTY purposes, fixed assets must fulfill tlm~e qualitications:
Asset must have life span of over one year.
The asset is not a repair part
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1)
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3) The asset must be valued at or greater than the capitalization thresholds
fm the asset type
Asset type
• land
• buildings and improvements
• infrastructure
• be tangible
o equipment
o vehicles
• or intangible asset
o Internally generated software
o Purchased software
o Easements
o Patents
• capital lease equipment
Threshold
$0
$100,000
$100,000
$5,000
$100,000
$5,000
25 Qualified fixed asset equipment is to be reported and approved by COUNTY. If it is approved
26 and identified as an asset it will be tagged with a COUNTY program number. A "Fixed Asset Log'',
27 attached hereto as Exhibit E and by this reference incorporated herein, will be maintained by
28 COUNTY's Asset Management System and inventoried annually until the asset is fully depreciated.
-14 -COUNTY OF FRESNO
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During the terms of this Agreement , CONTRACTOR's fixed assets may be inventoried in comparison
to COUNTY's DBH Asset Inventory System.
B. Certain purchases l.ess than Five Thousand and Noll 00 Dollars ($5,000.00) with
over one year life span, and are mobile and high risk of theft or loss a1·e sensitive assets. Such sensitive
items are not limited to computers, copiers , televisions, cameras and other sensitive items as
detennined by COUNTY's DBH Director or designee. CONTRACTOR(S) maintains a tracking
system on the items that are not required to be capitalized or depreciated. The items are subject to
annual inventory for compliance.
C. Assets shall be retained by COUNTY, as COUNTY property, in the event tllis
Agreement is terminated or upon expiration oftlus Agreement. CONTRACTOR agrees to participate
in an ammal inventory of all COUNTY fixed and inventoried assets. Upon termination or expiration
o f this Agreement CONTRACTOR shall be physically present when fixed and inventoried assets are
returned to COUNTY possession. CONTRACTOR is responsible for returning to COUNTY all
COUNTY owned undepreciated fiXed and inventoried assets, or the monetary value of said assets if
unable to produce the assets at the expiration or termination oftlus Agreement.
CONTRACTOR further agrees to the following:
I) To maintain all items of equipment in good working order and condition,
normal wear and tear is expected;
2) To label all items of equipment with COUNTY assigned program
number, to perform periodic inventories as required by COUNTY and to
maintain an inventory list showing where and how the equipment is being
used, in accordance with procedures developed by COUNTY. All such
lists shall be subnlitted to COUNT Y within ten (1 0) days of any request
3)
therefore; and
To report in writing to COUNTY immediately after discovery, the lost or
theft of any items of equipment. For stolen items, the local law
enforcement agency must be contacted and a copy of the police report
submitted to COUNTY.
-15 -CO UNlY O Fl-RESNO
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D. The pw-chase of any equ ipment by CONTRACTO R with ftmds provided
hereunder sha ll require the prior wri tten approval of COUNTY's DBH, shall fu lfill the provisions of
this Agreement as appropriate, and must b e directly related to CONTRACTOR's services or activity
under the terms of this Agreement. COUNTY's DBH may refuse reimbursement for any costs
resulting from equipment purchased, which are incurred by CONTRACTOR, if prior written approval
has not been obtained from COUNTY.
E. CONTRACTOR must obtain prior written approval from COUNTY's DBH
whenever there is any modification or change in the use of any property acquired or improved, in
whole or in part, using funds under this Agreement. If any real or personal property acquired or
improved with said ftmds identified herein is sold and/or is utilized by CONTRACTOR for a use
which does not qualify under this Agreement, CONTRACTOR shall reimburse COUNT Y in an
amount equal to the current fair market value of the property, less any pmtion thereof attributable to
expenditures of funds not provided under this Agreement. These requirements shall continue in effect
for the life of the property. In the event this Agreement expires, or terminates, the requirements for
this Section shall remain in effect for activities or property funded with said funds, unless action is
taken by the State government to relieve COUNTY of these obligations
20. NON-DIS CRIMINATION
During the performance ofthis Agreement CONTRACTOR(S) shall not un lawfully
discrinunate against any employee or applicant for employment, or recipient of services, because of
race, religious creed , color, national origin, ancestry, physical disability, mental disability, medical
condition, genetic information, marital status, sex, gende1·, gender identity, gender expression, age,
sexual orientation, o r military or veteran status, pursuant to all applicable State of Cal ifornia and
Federal statutes and regulations.
21. CULTURAL COMPETENCY
As related to Cultural and Linguistic Competence, CONTRACTOR(S) shall comply with:
A. Title 6 of the Civil Rights Act of 1964 (42 U.S.C. Section 2000d, and 45 C.F.R.
Part 80) and Executive 0Jder 12250 of 1979 which prohibits recipients of federal financial assistance
from discriminating against persons based on race, color, national origin, sex, disability or religion. This
-16 -COUNlY O F FRESNO
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is interpreted to mean that a limited English proficient (LEP) individual is entitled to equal access and
participation in fede rally funded programs tlu·ough the provision of comprehensive and quality bilingual
serv ices .
B. Policies and procedures for ensuring access and appropriate use oftrained
interpreters and material translation services for all LEP consumers, including, but not limited to,
assessing the cultural and linguistic needs of its consumers, training of staff on the policies and
procedures, and monitoring its language assistance program. Tbe CONTRACTOR(S)'s procedures must
include ensuring compliance of any sub-contracted providers with these requirements.
C. CONTRACTOR(S) shall not use minors as interpreters.
D. CONTRACTOR(S) shall provide and pay for interpreting and translation services
11 to persons pa11icipating in CONTRACTOR(S)'s services who have limited or no English language
12 proficiency, including services to persons who are deaf or blind. Interpreter and translation services shall
13 be provided as necessary to allow such participants meaningful access to the programs, services and
14 benefits provided by CONTRACTOR(S). Interpreter and translation services, including translation of
15 CONTRACTOR(S)'s "vital documents" (those documents that contain infmmation that is critical for
16 accessing CONTRACTOR(S)'s services or a~·e required by law) sha ll be provided to participants at no
17 cost to the pa~ticipant. CONTRACTOR(S) shall ensure that any employees, agents, subcontractors, or
18 partners who interpret or transJate for a program participant, or who directly communicate with a program
19 participant in a language other than English, demonstrate proficiency in the participant's language and can
20 effectively communicate any specialized terms and concepts peculiar to CONTRACTOR(S)'s services.
21 E. In compliance with the State mandated Culturally and Linguistically Appropriate
22 Services standards as published by the Office of Minority Health, CONTRACTOR(S) must submit to
23 COUNTY for approval, within 60 days from date of contract execution, CONTRACTOR(S)'s plan to
24 address all fifteen national cultural competency standards as set forth in the "National Standards on
25 Culturally and Linguistica lly Appropriate Services (CLAS)"
26 (http://minorityhealth.hhs.gov/assets/pdf/checked/finalreport.pdf). COUNTY's annual on-site review
27 of CONTRACTOR(S) sha ll include collection of documentation to ensure all national standards are
28 Ill
-17 -COUNTY Of'T-IlESNO
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1 imp lemented . As the nat ional competency standards are updated, CONTRACTOR(S)'s plan must be
2 updated accordingly.
3 22. TA X EQUITY AND F ISCAL RE SPON SIBILITY A CT
4 To the extent necessary to prevent disallowance of reimbursement under section 186l(v)
5 (1) (I) of the Social Security Act, (42 U.S.C. § 1395x, subd. (v)(l)[I]), until the expiration of fm.rr (4)
6 years aft er the furni shing of services under this Agreement, CONTRACTOR(S) shall make available,
7 upon written request to the Secretary of the United States Department of Health and Human Serv ices,
8 or upon request to the Comptroller General of the United States General Accounting Office, or any of
9 their duly authorized representatives, a copy of this Agreement and such. books , documents, and
10 record s as are necessary to certify the nature and extent of the costs of these services provided by
11 CONT RACTOR(S) under this Agreement. CONTRACTOR(S) further agrees that in the event
12 CONTRACTOR(S) carries out any of its duties under this Agreement through a subcontract, with a
13 value or co st ofTen Thousand and No/100 Dollars ($10 ,000.00) or more over a twelve. (12) month
14 period, with a re lated organ ization, such Agreement shall contain a cla1.1se to the effect that until the
15 ex piration of four (4) years after the furni s hing of such services pursuant to such subcontract, the
16 related organizations shall make available, upon written request to the Secretary ofthe United States
17 Department of Health and Human Services, or upon request to the Comptroller General of the United
18 States General Account ing Office, or any of their duly authorized representatives, a copy of such
19 subcontract and .such books, documents, and reco rds of such organization as are necessary to ve rify
20 the nature and extent of such costs.
23. SINGLE AU DIT CLAUSE 21
22 A. If CONTRACTOR(S ) expends Seven Hundred Fifty Thousand Dollars
23 ($750,000.00) or more in Federal and Federal flow-through monies, CONTRACTOR(S) agrees to
24 conduct an annual audit in accordance with the requirements of the Single Audit Standards as set forth
25 in Office of Management and Budget (OMB) Circ ular A-L33 . CONTRACTOR(S) shall submi t said
26 audit and management letter to C OUNTY. The audit must include a statement of findings or a
27 statement that there were no find ings. I f there were negative findings, CONTRACT OR(S) must
28 include a corrective action plan signed by an authorized individua l. CONTRACTOR(S) agre es to take
-18 -C O UNTY OF F RESNO
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1 action to conect any material non-complian.ce or weakness found as a result of such audit. Such audit
2 shall be delivered to COUNTY's DBH Business Office for review within nine (9) months of the end
3 of any fiscal year in which funds were expended and/or received for the program. Failure to perform
4 the requisite audit-functions as required by this Agreement may result in COUNTY performing the
5 necessary audit tasks, or at COUNTY's option, contracting with a public accountant to perform said
6 audit, or, may result in the inability of COUNTY to enter into future agreements with
7 CONTRACTOR(S). All audit costs related to this Agreement are the sole responsibility of
8 CONTRACTOR(S).
9 B. A single audit report is not applicable if CONTRACTOR(S)'s Federal contracts
10 do not exceed the Seven Hundred Fifty Thousand Dollars ($750,000.00) requiTement or
11 CONTRACTOR(S)'s only funding is through Drug related Medi-Cal. If a single audit is not
12 app.licable, a program audit must be performed and a program audit report with management letter
13 shall be submitted by CONTRACTOR(S) to COUNTY as a minimum requirement t o attest to
14 CONTRACTOR's solvency. Said audit report shall be delivered to COUNTY's DBH Business Office
15 for review, no later than nine (9) months after the close of the fiscal year in which the funds supplied
16 through this Agreement are expended. Failnre to comply with this Act may result in COUNTY
17 perfmming the necessary audit tasks or contracting with a qualified accountant to perform said audit.
18 AU audit costs related to this Agreement are the sole responsibility ofCONTRACTOR(S) who agrees
19 to take conective action to eliminate any material noncompliance or weakness found as a result of
20 such audit. Audit work performed by COUNTY under this section shall be billed to the
21 CONTRACTOR(s) at COUNTY's cost, as determined by COUNTY's Auditor-ControlleriTreasurer-
22 Tax Collector.
23 C. CONTRACTOR(S) shall make available all records and accounts for inspection
24 by COUNTY, the State of California, if applicable, the Comptroller General ofthe United States, the
25 Federal Grantor Agency, or any of thei:r duly authorized representatives, at all reasonable times for a
26 period of at least tlu·ee (3) years following final payment under this Agreement or the closure of all
27 other pending matters, whichever is later.
2.8 Ill
• 19 -CO UNW Of FRESNO
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24 . COMPLIANCE
CONTRACTOR(S) agrees to comply with the COUNTY's Contractor Code of Conduct
and Ethics and the COUNTY's Compliance Program in accordance with Exhibit F, attached hereto
and incorporated herein by reference . Within thirty (30) days of entering into this Agreement with the
COUNTY, CONTRACTOR(S) shall have all of CONTRACTOR(S)'s employees, agents and
subcontractors providing services under this Agreement certify in writing, that he or she has received,
read, understood , and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S)
shall ensure that within thirty (30) days of hire, all new employees, agents and subcontractors
providing services under this Agreement shall certify in writing that he or she has received, read,
understood, and shall abide by the Contractor Code of Conduct and Ethics. CONTRACTOR(S)
understands that the promotion of and adherence to the Code of Conduct is an element in evaluating
the performance of CONTRACTOR(S) and its employees, agents and subcontractors.
Within thirty (30) days of entering into this Agreement, and annually thereafter, all
employees, agents and s ubcontractors providing services under this Agreement shall complete general
compliance t raining and appropriate employees, agents and subcontractors shall complete
doctunentation and billing or billing/reimbursement training. All new employees, agents and
subcontractors shaiJ attend the appropriate training within 30 days of hire. Each individual who is
required to attend training shall certify in writing that he or she has received the required training. The
ce1tification shall specify the type oftraining1·eceived and the date received. The certification shall be
provided to the COUNTY's Compliance Of ficer at 3133 N. Millbrook Ave, Fresno, California 93703.
CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any penalty imposed upon
COUNTY by the Federal Government as a result ofCONTRACTOR(S)'s violation of the terms of
this Agreement.
25. ASSURANCES
In entering into this Agreement, CONTRACTOR(S) certifies that it is not currently
excluded, suspended , debarred , or otherwise ineligible to participate in the FederaJ Health Care
Programs: that it has not been convicted of a criminal offense related to the provision of health care
items or services; nor l1as it been reinstated to participation in the Federal Health Care Programs after
-20 -CO UNTY Of' FRESNO
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1 a period of exclusion, suspension, debrument, or ineligibility. If COUNTY learns, subsequent to
2 entering into a contract, that CONTRACTOR(S) is ineligible on these grounds, COUNTY will remove
3 CONTRACTOR(S) from responsibility for, or involvement with, COUNTY 's business operations
4 related to the Federal Health Care Programs and shall remove such CONTRACTOR(S) from any
5 position in which CONTRACTOR(S)'s compensation, or the items or services rendered, ordered or
6 prescribed by CONTRACTOR(S) may be paid in whole or part, directly or indirectly, by Federal
7 Health Care Programs or otherwise with Federal Funds at least until such time as CONTRACTOR(S)
8 is reinstated into pruticipation in the Federal Health Care Programs.
9 A. If COUNTY has notice that CONTRACTOR(S) has been charged with a
10 criminal offense related to any Federal Health Cru·e Program, or is proposed for exclusion during the
11 term of any contract, CONTRACTOR(S) and COUNTY shall take all appropriate actions to ensure the
12 accuracy of any claims submitted to any Federal Health Care Program. At its discretion given such
13 circumstances, COUNTY may request that CONTRACTOR(S) cease providing services until
14 resolution ofthe charges or the proposed exclusion .
15 B. CONTRACTOR(S) agrees that all potential new employees of
16 CONTRACTOR(S) or subcontractors ofCONTRACTOR(S) who, in each case, ru·e expected to
17 perform professional services w1der this Agreement, will be queried as to whether (1) they are now or
18 ever have been excluded, suspended, debarred, or otherwise ineligible to participate in the Federal
19 Health Care Programs; (2) they have been convicted of a criminal offense related to the provision of
20 health care items or services~ and or (3) they have been reinstated to participation in the Federal Health
21 Care Programs after a period of exclusion, suspension, debarment, or ineligibility.
22 1) In the event the potential employee or subcontractor informs
23 CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligiBle, or has
24 been convicted of a criminal offense relating to the provision of health care services, and
25 CONTRACTOR(S) hires or engages such potential employee or subcontractor, CONTRACTOR(S)
26 will ensure that said employee or subcontractor does no work, either directly or indirectly relating to
27 services provided to COUNTY.
28 2) Notwithstanding the above, COUNTY at its discretion may terminate this
-21 -COUNTY OF FRJ~SNO
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1 Agreement in accordance with Section Three (3) of this Agreement, or require adequate assurance (as
2 defined by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor
3 of CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
4 COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
5 determined by COUNTY to protect the interests of COUNTY consumers.
6 C . CONTRACTOR(S) shall verify (by asking the applicable employees and
7 subcontractors) that all cun·ent employees and existing subcontractors who, in each case, are expected
8 to petform professional services under this Agreement ( 1) are not currently excluded, suspended,
9 debaned, or otherwise ineligible to· participate in the Federal Health Care Programs; (2) have not been
10 convicted of a criminal offense related to the provision ofhealth care items or s~rvices; and (3) have
11 not been reinstated to participation in the Federal Health Care Program after a period of exclusion,
12 suspension, debarment, or ineligibility. In the event any existing employee or subcontractor informs
13 CONTRACTOR(S) that he or she is excluded, suspended, debarred or otherwise ineligible to
14 pruticipate in the Federal Health Care Programs, or has been convicted of a criminal offense relating to
15 the provision of health care services, CONTRACTOR(S) will ensure that said employee or
16 subcontractor does no work, either direct or indirect, relating to services provided to COUNTY.
17 1) CONTRACTOR(S) agrees to notify COUNTY immediately during the
18 term of this Agreement whenever CONTRACTOR(S) learns that an employee or subcontractor who,
19 in each case, is providing professional services under this Agreement is excluded, suspended, debarred
20 or otherwise ineligible to participate in the Federal Health Care Programs, or is convicted of a criminal
21 offense relating to the provision of health care services.
22 2) Notwithstanding the above, COUNTY at its discretion may terminate this
23 Agreement in accordance with Section 3 of this Agreement, or require adequate assurance (as defined
24 by COUNTY) that no excluded, suspended or otherwise ineligible employee or subcontractor of
25 CONTRACTOR(S) will perform work, either directly or indirectly, relating to services provided to
26 COUNTY. Such demand for adequate assurance shall be effective upon a time frame to be
27 determined by COUNTY to protect the interests of COUNTY consumers.
28 D. CONTRACTOR(S) agrees to cooperate fully with any reasonable requests for
-22 -COUNTY 01' FRESNO
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1 information from COUNTY which may be necessary to complete any internal or external audits
2 relating to CONTRACTOR(S)'s compliance with the provisions of this Section.
3 E. CONTRACTOR(S) agrees to reimburse COUNTY for the entire cost of any
4 pena lty imposed upon COUNTY by the Federal Government as a result of CONTRACTOR(S)'s
5 violation of CONTRACTOR(S)'s obligations as described in this Section .
6 26. PUBLICITY PROHIBITION
7 None of the funds, materials, property or services provided directly or indirectly under
8 this Agreement shall be used for CONTRACTOR(S)'s advertising, fundraising, or publicity (i.e.,
9 purchasing of tickets/tables, silent auction donations, etc.) for the purpose of self-promotion.
10 Not withstanding the above, publicity of the services described in Section One (1) of this Agreement
11 shall be allowed as necessary to raise public awareness about the availability of such specific services
12 when approved in advance by COUNTY's DBH Director or designee and at a cost to be provided in
13 Exhibit C-1 et seq. for such items as written/printed materials , the use of media (i.e., radio, television,
14 newspapers) and any other related expense(s).
15 27. COMP-LAINTS
16 CONTRACTOR(S) shall log complaints and the disposition of all complaints from a
17 client or a client's family. CONTRACTOR(S) shall provide a copy of the detailed complaint log
18 entries concerning COUNTY -sponsored clients to COUNTY at monthly intervals by the tenth (10 111
)
19 day of the following month, in a fmmat that is mutually agreed upon. In addition, CONTRACTOR(S)
20 shall provide details and attach documentation of each complaint with the log. CONTRACTOR(S)
21 shall post signs infonning clients of their right to file a complaint or grievance. CONTRACTOR(S)
22 shall notify COUNTY of all incidents reportable to State licensing bodies that affect COUNTY clients
23 within twenty-four (24) hours of receipt of a complaint.
24 Within ten (1 0) days after each incident or complaint affecting COUNTY-
25 sponsored clients, CONTRACTOR(S) shall provide COUNTY with information relevant to the
26 complaint, investigative details of the complaint, the complaint and CONTRACTOR(S)'s disposition
27 of, or corrective action taken to resolve the complaint. In addition, CONTRACTOR(S) shall inform
28 Ill
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1 every c lient of their tights as set forth in Exhibit G "MHSA Guidelines-Grievance and Incident
2 Reporting", attached hereto and by this reference incorporated herein.
3 28. DISCLOSURE OF OWNERSHIP AND/OR CONTROL INTEREST
4 INFORMATION
5 This provision is only applicable if CONTRACTOR is a disclosing entity. fiscal agent,
6 or managed care entity as defined in Code of Federal Regulations (C .F .R), T itle 42 § 455.101
7 455 .1 04 , and 455.106(a)(1),(2).
8 rn accordance with C.P.R., Title 42 §§ 455.101, 455.104, 455.105 and 455.106(a)(l),(2),
9 the following inf ormation must be disclosed by CONT RACTOR(S) by completing Exhibit H,
10 "Disclosure of Ownership and Control Interest Statement", attached hereto and by this reference
11 incorporat ed herein and made part of this Agreement. CONTRACTOR(S) shall submit this form to
12 the Department of Behavioral Health within thirty (30) days of the effective date of this Agreement.
13 Additionally, CONTRACTOR(S) shall report any changes to this information within thirty five (35)
1 4 days of occun-ence by completing Exhibit H. Submissions shall be scanned pdf copies and are to be
15 sent via email to DBHAdministration@co.fresno.ca.us attention: Contracts Administration.
16 29. DISCLOSURE-CRIMINAL IDSTORY AND CIVIL ACTIONS
17 CONTRACTOR(S) is required to disc lose if any of the following conditions apply to
1 8 them, their owners, officers, corporate managers and partners (hereinafter collectively referred to as
19 "CONTRACTOR(S)"):
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A. Within the three-year period preceding the Agreement award, they have been
convicted of, or had a civil judgment rendered against them for:
1) Fraud or a criminal offense in connection with obtaining, attempting to
obtain, or performing a public (federal , state, or local) transaction or
contract under a public transaction;
2)
3)
Violation of a federal or st ate antitrust statute;
Embezzlement, theft, forgery, bribery , falsification, or destruction of
records; or
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1 4) False statements or receipt of stolen property.
2 B.
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Within a three-year period preceding their Agreement award, they have had a public
transaction (federal, state, or local) terminated for cause or default.
4 Disclosure of the above information will not automatically eliminate
5 CONTRACTOR(S) from further business consideration. The information will be considered as part
6 ofthe detennination ofwhether to continue and/or renew the Contract and any additional
7 information or explanation that a CONTRACTOR(S) elects to submit with the disclosed information
8 will be considered. If it is later determined that the CONTRACTOR(S) failed to disclose required
9 information, any contract awarded to such CONTRACTOR(S) may be immediately voided and
10 terminated for material failure to comply with the terms and conditions of the award.
11 CONTRACTOR(S) must sign a "Certification Regarding Debarment, Suspension, and
12 Other Responsibility Matters-Primary Covered Transactions" in the fonn set forth in Exhibit L
13 attached hereto and by this reference incorporated herein and made part of this Agreement.
14 Additionally, CONTRACTOR(S) must immediately advise the COUNTY in writing if, during the
15 term oftbis Agreement: (1) CONTRACTOR(S) becomes suspended, debarred, excluded or ineligible
16 for participation in federal or state funded programs or fiom receiving Federal ftmds as listed in the
17 excluded parties ' li st system (http://'www.epls.gov); or (2) any of the above listed conditions become
18 appli cable to CONTRACTOR(S). CONTRACTOR(S) shall indemnify, defend and bold the
19 COUNTY harmless for any loss or damage resulting from a conviction, debarment, exclusion,
20 ineligibility or other matter listed in the signed Certification Regarding Debarment, Suspension, and
21 Other Responsibility Matters .
22 30 . DISCLOSURE OF SELF-DEALING TRANSACTIONS
23 This provision ·is only applicable if the CONTRACTOR is operating as a corporation (a
24 for-profit or non -protit corporation) or if during the tenn of this Agreement, the CONTRACTOR(S)
25 changes its status to operate as a corporation.
26 Members ofthe CONTRACTOR(S)'s Board of Directors shall disclose any self-dealing
27 transactions that they are a pru1y to while CONTRACTOR(S) is providing goods or performing
28 services under this Agreement. A self-dealing transaction shall mean a transaction to which the
• 25 -COUN"IY OF FRESNO
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1 CONTRACTOR(S) is a party and in which one or more of its directors has a material financial
2 interest. Members of the Board of Directors shall disclose any self-dealing transactions that they are a
3 party to by completing and signing a Self-Dealing Transaction Disclosure Form, attached hereto as
4 Exhibit J and incorporated herein by reference and made part of this Agreement, and submitting it to
5 the COUNTY prior to commencing with the self-dealing transaction or immediately thereafter.
6 3 1. AUDITS AND INSPECTIONS
7 The CONTRACTOR shall at any time during business hours, and as often as the
8 COUNTY may deem necessary, make availab le to the COUNTY fo r examination all of its records and
9 data with respect to the matte rs covered by this Agreement. The CONTRACTOR(S) shall, upon
10 request by the COUNTY, permit the COUNTY to audit and inspect all such records and data
11 necessary to ensure CONTRACTOR(S)'s compliance with the terms of this Agreement.
12 If this Agreement exceeds Ten Thousand and NollOO Dollars ($10,000.00),
13 CONTRACTOR(S) shall be subject to the examination and audit of the State Auditor General for a
14 period of three (3) years after final payment under contract (California Government Code section
15 8546.7).
16 32. NOTI CES
17 The persons having authority to give and receive notices under this Agreement and their
18 addresses include the following :
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COUNTY
Director, Fresno Cotmty
Department of Behavioral Health
3133 N. Millbrook Ave.
Fresno, CA 93703
CONTRACTOR(S)
(Please Refer to Exhibit A)
23 Any and all notices between COUNTY and CONTRACTOR(S) provided for or
24 permitted under this Agreement or by law shall be in writing and shall be deemed duly served when
25 personally delivered to one of the parties, or in lieu of such persona l service, when deposited in the
26 United States Mail, postage prepaid, addressed to such party.
27 Ill
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-26 -COUN1Y OF FIWSNO
Fresno, CA
1 33. GOVERNIN G LAW
2 The parties agree that for the purpose of venue, performance under this Agreement is in
3 Fresno County, California.
4 The rights and obligations of the parties and a ll interpretation and performance ofthis
5 Agreement sha ll be governed in all respects by the laws of the State of California.
6 34 . ENTIRE A GRE EMENT
7 This Agreement, including all Exhibits, COUNTY's Revised RFP No. 962-5377 and
8 C ONTRACTOR(S)'s Response and Letter of Clarification const itutes the entire agreement between
9 CONTRACTOR(S) and COUNTY with respect to the subject matter hereof and supersedes all
10 previous agreement negotiations, proposals, commitments, writings, advertisements, publications, and
11 understandings of any nature whatsoever tmless expressly in cluded in this Agreement.
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-27 -COUNTY Or: FRESNO
f-resno, C:A
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IN WITNESS WHEREOF the parties hereto have executed this Agreement as of the day and
year first hereinabove written.
ATTEST:
COUNTY; OF FRESNO
By £ y-.~~
Chairman, BoitdOfSllPNisors
Da:te:
BERNICE E. SEIDEL; Clerk
Board of Supervisors
-28 -
PLEASE SEE ADDITIONAL
SIGNATURE PAGES ATTACHED
COUNTV OF FRESNO
Prc::cn<),w\
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APPROVED AS TO LEGAL F ORM:
IQAHH BRJGOS, C O UNTY COUNSEL
Dcu1 r'e ( C..C -e._ d.._ .I!. r bo-rg-
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APPROVED AS TO ACCOUNTING FORM:
VICKI CROW, C.P.A., AUDITOR-CONTROLLER/
TREASURER-TAX COLLECTOR
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REVIEWED AND RECOMMENDED
FOR APPROVAL:
~ lh14-{LtedJ By~~~~-------------------
Dawan Utecht, Director
Department o f Behavioral Health
Fund/Subclas s: 000111 0000
Organization: 56304764
Accoun t/Program: 7294/0
-29 -
PLEAS E SEE ADDITIONAL
~GNATUREPAGESATTACHED
COLJNTY OF I~RESNO
Fresno, Cr\
1 FRESNO AMERICAN INDIAN HEALTH PROJECT (FAIHP)
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{L ~;c:L By-------~~------------
PrintName: /'E ''"''iv.< rz~~
Title: C[,C/-:WI'V1ct'J
Chairman of the Board, or
President or any Vice President
Mailing Address:
1551 E. Shaw Avenue, Suite 139
Fresno, CA 93710
Phone No.: (559) 320-0490
Contact: Jennifer Ruiz, Executive Director
-3 0 -
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRESNO
Frcsoo, CA
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CENTRO LA FAMILIA ADVOCACY SERVICES, Inc. (CLFAS)
B ~
Title: lltce -C~+A•e.
Chaitman of the Board, or
President or any Vice President
Title: k..Z..:, fL..:_-k-
Executive Director
Mailing Address:
302 Fresno Street, Suite 102
Fresno, CA 93706
Phone No.: (559) 237-2961
Contact: Margarita Rocha , Executive Director
-31 -
PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUNTY OF FRE SNO
r rc.~no, CA
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Title: @ /U p
Chairman of the Board, or
President or any Vice President
By ~~ &
Print Name: Z UIA7'2>t J:). v~
Title: bX t;:c.-l)-l'WG ~~-~
Executive Director
Mailing Address:
1940 N. Fresno Street
Fresno, CA 93703
Phone No.: (559) 487-1509
Contact: Zachary Darrah, Executive Director
-32 -
PLEASE SEE ADDITIONAL
SIGNATURE PAGE
COU NTY OF FRESNO
Fresno, CA
1 WEST FRESNO FAMILY RESOURCE CENTER (WFFRC)
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Chairman of the Board, or
President or any Vice President
PrintName:tp{a.ac&. ~A
Title: t:xu~l:iv~ 1Jittu{o/L
Executive Director
Mailing Address:
1802 E. California
Fresno, CA 93706
Phone No.: (559) 621-2967
Contact: Yolanda Randles, Executive Director
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PLEASE SEE ADDITIONAL
SIGNATURE PAGE ATTACHED
COUl'.rrY OF PR.ESNO
Frc~-no,G\
1 SARBA T BHALA, Inc. (SBI)
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Mailing Address:
7 460 E. Floral Ave
Selm~ CA 93662
Phone No.: (559) 3 60-1398
Contact: A:mandip Gill, Director
-34 -COUNlY OF f1RESNO
f1rcsno, CA
CULTURAL BASED ACCE SS NAVIGATION S P ECIALISTS
LIST OF CONTRACTORS
Exhibit A
1. Fresno American Indian Health Project -{American Indian/Alaska
Native)
1551 E. Shaw Avenue, Suite 139
Fresno, CA, 937 10
(559) 320-0490
Con tact: Jenn if er R uiz, Exec utive D irector
II. Centro La Familia Advocacy Services, Inc.-(Latino!Hispanic)
302 Fresno Street, Sui te 102
Fresno, CA, 93706
(559) 237-2961
Contact : Margarita Rocha, Executive Director
III. Fresno Interdenominational Refugee Ministries -(South East Asian
Hmong, Laotian , and Cambodian)
1 940 N. Fresno Street
Fresno, CA 93703
(559) 487-1509
Contact: Zachary Darrah, Executive Director
IV. West Fresno Family Resource Center -{African American)
1802 E. Califo rnia
Fresno, CA, 93706
(559) 621-2967
Contact: Yolanda Rand les, Executive Director
V. Sarbat Bbala-(Punjabi)
4250 E. Lincoln A venue
Fresno, CA 93725
(559) 360-1398
Contact: Amandip Gi ll , Director
MENTAL HEALTH SERVICES ACT
PREVENTION AND EARLY INTERVENTION
EXHIBIT 8
Page 1 of 7
CULTURAL BASED ACCESS NAV IGATION AND P E ER SUPPORT (CBANS )
CBA NS Program Overview
CONTRACT SERVICES: Cultural Based Access Navigation & Peer Support
CONTRACT TERM : July 1, 2016-June 30 , 2019 ; and
Two (2) Twelve-Month Renewal Options
CONTRACTORS: See Exhibit A
CONTRACT MAXIMUM : $551 ,633 per Fiscal Year
CONTRACTOR AWARDS: $466,006 per Fiscal Year-all Providers combined
See Exhibits B-1 et seq. for individual Provider Awards
SERVICE POPULATIONS: American Ind ian/Alaska Native , Hispanic/Latina, Hmong, Laotian ,
Cambodian , African American , & Punjabi ; each serv ice population
includes LGBTQ, Veterans and homeless as needed.
CBANS PROGRAM OVERVIEW
County of Fresno on behalf of the Department of Behavioral Health (DBH), Mental Health Se rvices
Act (MHSA) has developed a Master Agreement for the provision of Cultural-Based Access-
Nav igation and Peer/Family Support (CBANS) services to underserved and un -served culturally
diverse populations i n Fresno County.
PEl Program Intent and Goals -The intent of the PEl program is to provide funds for a CBANS
service program to be delivered in communit y settings to all age groups in a culturally , linguistica ll y
and age-appropriate manner. The goals of the PEl component of the MHSA shall be integrated into
the CBANS program and shall be promoted through community collaboration , cu ltural and linguistic
competency , individual/family driven, wellness/recovery focused , integrated services , and
performance outcomes based .
CBANS Program Intent and Goals -The CBANS Program is an inst rumental component of providing
wrap-around service intervention utilizing a hol istic and culturally relevant approach , and delivered in
a natura l community setting . The purpose ahd goals of this Program are to build on the skills or
interests of the client in order to maximize: emotional and physical independence , self-care and daily
EXHIBIT 8
Page 2 of 7
living abilities, positive stress and symptom coping skills, and social and interpersonal interactions. By
developing these skills, the client shall learn to depend less on more costly crisis services, and shall
minimize or avoid more severe outcomes such as substance abuse, hospitalization or incarceration .
Funding Use-Prevention and Early Intervention (PEl) funding guidelines stipulated by California
Health Care Services specifically limit how PEl funds may be used . The funding for PEl services is
to provide for salaries and stipends for Community Health Workers (CHW) and Peer Support
staffing (PSS), training , consumer incentives, outreach planning and operational costs . CBANS
Program Providers individual funding allocations are identified and detailed in Exhibits C-1 et seq.
Prevention in mental health involves reducing risk factors or stressors , building protective factors
and skills and increasing support. Prevention promotes positive cognitive , social and emotional
development and encourages a state of well being that allows the individual to function well in
challenging circumstances.
Early intervention is directed toward individuals and families for whom a short-duration (up to one
year}, relatively low-intensity intervention is appropriate to measurably improve a mental health
problem or concern very early in its manifestation, thereby avoiding the need for more extensive
mental health treatment or services; or prevent a mental health problem from getting worse.
Services and Performance Measures -Under the provision of the MHSA, PEl component the
County's Department of Behavioral Health receives funding to expand, develop and create
successful PEl programs for children, transitional aged youth, adults, and older adults in a cultura ll y ,
ethica ll y , and linguistically competen t approach for underserved and un-served population . CBANS
Program Providers' culturally specific approaches to these services , and their performance
measures and outcome goals are identified and detailed in Exhibits B-1 et seq. Performance
Measures are further addressed in this document on Page six (6).
Service Populations -CBANS Program service populations include , but are not limited to: American
Indian/Alaska Native, Hispanic/Latina, Hmong , Laotian , Cambodian, African American, and Punjabi.
In addition , each service population includes lesbi an /gay/bi-sexualltransgender/ questioning (LGBTQ},
Veterans and homeless as needed . CBANS services , while targeting specific cultural groups, sha ll not
deny services based on culture. Service populations are identified for each CBANS Provider in
Exhibit A and Exhibits B-1 et seq.
Collaborations -CBANS Providers shall work in collaboration w ith other CBANS partners , including
but not limited to : Fresno American Indian Health Project (FAIHP), Centro La Familia Advocacy
EXHIBIT B
Page 3 of7
Services , Fresno Interdenominational Refugee Ministries (FIRM), West Fresno Family Resource
Center (WFFRC), and Sarbat Bhala, Inc. In addition, collaborations and partnerships shall be
encouraged with all other community stakeholders and service providers, including but not limited to :
private , profit/non-profit, government, faith-based , cultural-specific community resource/service
providers , and advisory boards and commissions.
Master Agreement Addltion$ -Organizations seeking to be included in this Master Agreement, or
seeking to provide additional cultural services to underserved and un-served target/service
populations , funded through MHSA , must submit a written proposal to Fresno County Department of
Behavioral Health , Attention : CBANS Contract Analyst, 3133 N. Millbrook Avenue, Fresno , CA 93703.
The proposal must be prepared and submitted for review and approval in accordance to, and in
proper response to , the Request For Proposal (RFP) #952-5412 issued by Fresno County Purchasing
Division on January 14, 2016 . Proposals received must be approved by DBH Director and/or
designee for addition to Master Agreement.
CBANS SERVICES
The CBANS Program shall help reduce the stigma that groups and/or individuals have about mental
illness and its services, and thus improve individuals' knowledge of mental health and availability of
servi ces designed to meet their psychological and emotional needs . The CBANS's staff shall
provide peer/family and educational services to the community in order to provide a personal
contact or liaison t.o mental health resources and programs within the community so that in dividuals
shall not have to visit a traditional mental health treatment site. Th e CBANS program shall also
ass ist in developing peer and family support groups to help indiv iduals with mental health concerns
receive short term services early in the manifestation of a mental health concern in natural
community settings that are culturally sensitive and linguistically appropriate . The CBANS 's program
shall actively pursue the feedback of community and consumers through surveys distributed at all
activities, monitor the number of servi ce contacts through sign-in procedures, and evaluate the
effectiveness of contacts/presentations through pre-and post-feedback worksheets .
The CBANS program is modeled significantly on evidence-based community-based health models ,
utilizing community healthcare peer support outreach workers employed by community
organizations. The CBANS 's model is used because CHW and PSS are effective disseminators of
information , and act as the bridge or liaison between governmental and non-governmental systems
and the communities they serve . Community health workers also act as change agents within their
naturally occurring social networks. Direct, local involvement can generate creative and dynamic
efforts to address disparities to mental health services in these areas and for these groups ..
EXHIBIT B
Page 4 of 7
The program shall feature a peer/family support component which is culture-specific and tailored to
help bridge cultural and language divides through advocacy, education , and short term peer-support
for non-SM I/SED intervention for individuals and famil ies dealing w ith economic and other related
challenges in a de-stigmat izing and culturally appropriate manner. The Promotores model of CHWs
serving the Latino communities is a good example of how the CBANS program shall serve each
underserved cultural , ethnic , and racial community . The County envis ions that i nd ividuals of
relatively high importance for a given cultural community may act as the CHW (includ ing Hmong
Shaman and Native American Spir itual Leaders). CHW services are delivered , for the most part ,
through community settings (where people congregate), home visits and group presentations, and
also specifically include mental health promotion strategies that impact knowledge , attitudes , and
pract ices on a community leve l. Community settings can include but are not limited to events such
as : health fa irs, church and ne ighborhood meetings, factories , laundromats , gas stat ions, and
grocery stores , among other locations. Trusted experts from within each of the underserved and
un-served communities of Fresno County shall provide information about resources and lihkages for
those communities through advocacy , engagement , educat ion , and knowledge about mental health
services , including the array of prevention and early intervention act iviti es in the community .
In the provision of CBANS serv ices , CONTRACTORS shall include, but are not limited to:
1. Culturally and Lingu istically Appropriate Staffing
a) One (1) identified CHW from each identified service population
• Community Health Workers shall act as change agents with i n the ir naturally
occurring social network to address di sparities to mental health for specific
groups.
b) Up to three (3) PSSs as needed from each identified service population
• Peer Support Specialist shall ass ist in bridging the cultural and linguistic
divides through advocacy, education , and short term peer support for non-
SMI/SED Intervention for individuals and families dealing with econom ic and
immigration-related challenges in a de-stigmatizing and cultural appropriate
manner.
CHW and Peer Support persons must be ca refully recruited for cultural and linguistic
competency in order to parti cipate in the program . Staff should be from within the various
cultural , linguistic , ethnic, and/or racial communities, and should be linguistically and
EX HIBIT 8
Page 5 of7
culturally competent of those cultures , ethnicities , values and the language of the
community. Both the CHW and PSS shall be knowledgeable of mental illness, symptoms ,
medication, cultural sensit ivity , community resources and Prevention and Early Intervention
services . CHW and PSS staff shall clearly understand their roles and utilize the ir skills as
lia isons between the unserved/underserved cultural communities they serve and the
Department of Behavioral Health , as well as other resources and service providers in the
County. Liaisons serve as trusted community leaders who help unserved/underserved
individuals and families navigate the systems of care and resources available within Fresno
County, up to and including warm hand-off referrals and linkages .
2. Ongoing Training/Education for CHW & PSS Staff
Each CHW shall receive extensive training directed towards increased knowledge of
relevant mental health/illness topics . Staff shall be trained to identify and recognize early
signs and symptoms of substance abuse and mental illness disorders, deliver PEl psycho-
soci al educational programs , development of culturally relevant materials, and assist in
ensuring services are delivered in a culturally sensitive manner. Staff shall also be trained in
ways they can participate in mental health coalition building to strengthen their communities'
capacity to increase resilience and wellness . Training shall be provided by each respective
organization either through the County , or other available mental health community
resources .
3 . Community Outreach
Outreach shall be conducted at community events or via culturally specific media outlets
{e .g .: Span ish TV Univisi6n Channel 21 , Hmong Radio KBIF 900 AM , etc.) f requented by
service populations, such as: fairs , cultural celebrations , places of worship, block parties ,
and mental health awareness events (e.g .: NAMI Walk, SOSL Run, etc.). Outreach serves
to introduce and educate the community on mental health and related services available
within the community , and in Fresno County in general. Connections made shall help to
build a trusted presence within the community and thereby encourage future contacts,
follow-ups , and linkages to service information and/or delivery.
4 . Peer/Family Support & Education
a) Peer and family support services shall be appropriately tailored to the culture and
community served . Peer and family support shall be inclusive of group and
EX HIB IT 8
Pag e 6 of 7
educational sessions/presentations regarding mental illness , symptoms, medication,
cultural sensitivity, and awareness based on community needs. Providers shall , at
minimum , facilitate Y2 hour sessions to assist families to improve their quality of life
within the community. Services shall include linkage to other community resources ,
transportation , problem solving , and education in areas of life skills, such as money
management, hygiene , independent livi ng , cooking , cleaning , and other support
services identified as needed through contacts with consumers and family members.
b) Educational sessions shall be provided in natural environmental cultural settings
with in the service community . In collaboration with County mental health , and as
appropriate, CHW's and PSS shall provide training in mental illness , signs and
symptoms , features of medication, sensitivity , suicide prevention , mental
health/suicide stigma , County mental health resources, community and faith-based
organizations , and private providers/agencies.
Educational services shall be provided to help solidify relationship building,
community networking , and personal problem-solving , which shal l allow for an
atmosphere of hope and cooperation. Educational services, informational sessions ,
and peer support shall include, but not be limited to : recognizing signs and symptoms
of mental illness, mental illness management, ways to reduce tension and stress
within the family ; how to find and provide social support and encouragement to
dthers, and other topics to assist families and consumers In developing resiliency and
maintaining recovery.
5. Community Collaboration
Through the CBANS program, Providers shall collaborate with existing partners, such as
local schools and district offices , faith-based organizations, primary care centers, various
health offices , natural gathering sites , social services offices and local law enforcement
offices. Additional efforts shall be made to reach and partner with community based
organizations in underserved/un-served populations to include community/family resource
centers , private and public employment offices, collaboration with local media outlets
throughout Fresno County . The Providers ' organizational model shall leverage community
volunteers who can be trained to work with professionals and para-professionals in the
delivery of services. The Providers shall develop new partnerships and deliver services i n
EXHIBIT 8
Page 7 of 7
faith-based centers, in homes and other natural settings that are culturally sensitive,
linguistically appropriate and non-threatening/non-stigmatizing locations for participants
6. Client and Community Feedback
Providers shall actively pursue the feedback of clients and community through surveys
distributed at all activities; monitor the number and types of service contacts through sign-in
procedures and other available data collection tools; and evaluate the effectiveness of
contacts/presentations through pre-and post-feedback worksheets and other available
tools .
PERFORMANCE OUTCOME MEASURES
All Providers shall comply with all project monitoring and compliance protocols, procedures , data
collection methods, and reporting requirements requested by the County. Providers shall use
performance outcome measures for evaluating program and system effectiveness to ensure
services and service delivery strategies are positively impacting the service population . In addition ,
these measures shall be used to ensure CBANS services are in alignment with MHSA guiding
principles which are inclusive of: an integrated service experience ; community collaboration; cultural
competence ; client/family driven service ; and wellness , resilience, and recovery focused services .
Performance outcome measures shall be tracked on an ongoing basis and used to update the
County monthly (by the 1oth of the month following the report period) regarding CBANS services . In
addition, performance outcome measures are reported to the County annually in accumulat ive
reports for overall program and contract evaluation .
CBANS Partners utilize standardized forms and tools so that data shall be collected in the same
way for each cultural group. The CBANS "Wellness Survey", "Needs/Stressors Form", and the
"Coping Strategies & Protective Factors Form" are examples of tools used to gather and report data
reflecting services provided , populations served, and impact of those services .
CBANS Program Providers ' specific performance measures and outcome goals are identified and
detailed in Exhibits B-1 et seq . Measurable outcomes may be reviewed for input and approval by a
designated Department of Behavioral Health work group upon contract execution. The purpose of
this review process is to ensure a comprehensive system wide approach to the evaluation of
programs through an effective outcome reporting process.
EXHIBIT B-1
Page 1 ofS
FRESNO AMERICAN INDIAN HEALTH PROJECT
CULTURAL-BASED ACCESS NAVIGATION AND PEERIF ANIIL Y SUPPORT
SCOPE OF WORK
CONTRACT SERVICES : Cultural Based Access Navigation and Peer/Fam ily Support Serv ices
CONTRACT TERM : July 1, 2016 -June 30, 2019 , and Two (2) Twelve-Month Renewal Options
SERVICE POPULATIONS : American Indian/Alaska Native , including : LGBTQ, Veterans and Homeless
CONTRACT MAXIMUM : $75 ,206 Per Fiscal Year (See Exhibit C-1 for line item budget details)
NOTE : The informat ion , expectations and requ i rements contained in this Exh ibit B-1 are specific to
Fresno American Indian Hea lth Proj ect (FAIHP ) and shall be considered i n addition to Exh i bit B
and the FAIHP proposa l submitted in response to Request For Proposa l 952-4512.
FAIHP PROGRAM OVERVIEW
The Fresno American Ind ian Health Project (FAIHP) Cultural-Based Access Na vigation and Peer/Family
Support SeNic es (CBANS) Program shall be administered as part of a comprehensive wellness program
serving the underserved and un-served Fresno Native Indian/Alaska Native (AI/AN) community, inclusive of
Lesb ian/Gay/Bi -Sexual/ Transgender/Questioning (LGBTQ), veterans , and homeless members within the
service community. The FAIHP CBANS program shall provide mental health prevention and early
intervention services to help reduce stigma about mental health and improve individuals' knowledge of,
availability of, and access to mental health services in the community . FAIHP shall utilize the evidence-
based Promotores(as) Model , adapted for the American Indian Alaska Native (AI/AN) community , for
implementing the CBANS Program and shall ensure clients receive high-qual ity , cu lturally competent
services . Th is prevention program provides early intervention and promotes positive cognitive , social , and
e mot ional deve lop ment and encourages a state of well-be ing that allows the ind ividua l to function we ll daily
and in cha ll eng ing c ircumstances .
The imp lementation, locat ion of contacts , and strateg ies discussed with cl ients are the primary
mechan isms for infusing cultural traditions , activities , and beliefs into the case management plans that
shall be ut ilized by Community Health Workers and Peer Support Specialists . As an example , FAIHP 's
Community Health Worker uses a curriculum within the CBAN's program for a support group entitled
"Shawl Making for Mental Wellness". This activity reflects the importance of dance and cultural regalia
that exist within AI/AN communities and the support group infuses discussions about mental wellness
EXHffiiTB-1
Page 2 ofS
and positive healthy behaviors . In another support group for recovering substance abuse addicts , the
Peer Support Spec ial ist shall i nfuse the AI/AN cultural practice of drumming i nto the group dynamic. A
published artic le in Ind ian Country Today ent itled , "Drumming Proves Beneficial for Overcoming
Substance Abuse Disorders", discusses the effectiveness that th is practice is proving to have within the
AllAN community . This is an example of what the California Reducing Disparities Project (CROP) report
for Native Americans describes as "community-defined evidence ".
STAFFING
At a minimum , FAIHP shall maintain 1.10 Full Time Employees (FTE) as follow:
.25 FTE Community Health Worker
.70 FTE Peer Support Specialist
.15 FTE Peer Support Specialist
1.10 FTE Total
TRAINING AND EDUCATION
Staff-Training for staff members sha ll include , but is not limited to : weekly mini-teaches on relevant mental
health topics during weekly department meetings; weekly in-service train ing during staff meetings ; and
miscellaneous required and desired relevant annual trainings . In addition , the monthly PEl Staff Meeting
includes cultural and/or service related training . Staff shall also participate in Train-The-Trainer as
appropriate.
Community -Training for community members shall be conducted during monthly Community Advisory
Board Meetings , as well as during the various scheduled monthly support groups (The WISE Elders Group,
the Stress Management Group , the Native Men 's Wellness Group , parenting classes, bi-weekly Stress
Management, etc .). Educational messages and materials shall also be prov ided during various outreach
events that FAIHP staff participate in monthly.
Facilitators -FAIHP shall use variety of resources for tra ining , such as : knowledgeable/professional staff
and community partner resources. Examples include , but are not limited to : Centro La Familia staff provide
Mental Health First Aid training for FAIHP staff annually ; Fresno Survivors of Suicide Loss provide Question
Persuade , Refer (QPR) Tra ining for FAIHP as needed/requested ; local Native American Spiritual Leaders
are contracted to present about Native American spirituality as a personal strength to support resiliency ;
and FAIHP partners with the local Tribal Temporary Assistance for Needy Families (TANF) program to
facilitate Parenting classes.
EXHIBJTB-1
Page 3 ofS
Community Engagement-Trainings and educational health-related messages shall be published/posted as
appropriate in : FAIHP 's monthly newsletter (mailed via USPS to over 600 Native American community
members, and emailed to more than 200 individuals); social media sites (Facebook, Twitter, lnstagram, and
Pinterest); DBH Weekly Community Event Calendar; to PEl provider partners; and at community events ,
such as pow-wows and other social gatherings. In add ition , the community shall be encouraged to attend
tra ini ngs via cu lturally trad itiona l wor d of mouth.
Fe edba ck-Short posHraining satisfaction surveys are used to determine whether the trainings are relevant
and successful. Other data collected may include demographics and #s in attendance.
FUNDING
FAIHP shall util ize fund ing provided by Fresno County Department of Behaviora l Health Department to
operate the CBANS program with in the established gu idelines set for PEl programs in the State of
California . Th is would include salaries of the CHW and PSS , employee benefits, train ing , consumer
incentives and transportation , and operational costs . FAIHP shall produce and maintain a budget and
budget narrative filed with and approved by the County. FAIHP's detailed budget allocations may be found
in Exhibit B-1 .
FAIHP PERFORMANCE GOALS
FAIHP shall adhere to the below set of annual performance outcome measures to demonstrate the on -going
effect iveness of the CBANS program and the positive impact that the services have for the target
population.
#
Pre/Post CBANS
Increase knowledge of risk and Reduce the number of self-reported Needs/Stressors Form
1 resilience/p rotective factors . stressors for 60% of clients within a six Pre/Post CBANS
month time frame . Wellness Survey
Pre/Post CBANS
Increase overa ll mental health At least 75 % of cl ients shall report an Wellness Survey
2 aware ness in the co mmu ni ty. increased sense of hope with in a six mont h
time frame .
Pre /Post CBANS
Overcome ind ividual cu lture -based Increase client's comfort level with ask ing Wellness Survey
3 st igma against mental illness and for help for at least 60% of active clients
mental health concerns . within a six month time frame .
Develop coping skills and build
4 resiliency for historical trauma .
To facilitate identification of early
signs of mental illness for linkages
5 to timely interventions and
treatment.
Increasing the number of culturally
6 competent prevention and early
intervention activities for the Native
American community.
Increase the number of
individuals/families who receive
7 prevention , early intervention , and
linkages to community resources.
Increase early onset interventions
and referrals to prevent problems
8 from getting worse and thereby
requiring more extensive services
from the system.
Increase cultural competency and
understanding that there is no one-
9 size-fits-a ll model for delivery of
prevention and early intervention
strategies for mental illness.
10 Reduce mental health stigma.
Reduce discrimination aga inst
11 those with mental illness within and
across diverse cultural populations.
Increase access to mental health
treatment and services for
12 underserved and un-served
cultural , ethnic , racial , and linguistic
communities .
13 Reduce duration of untreated
mental illness.
Increase the number of healthy coping
skills that clients utilize on a regular basis
for 60% of active clients within a six month
time frame .
100% of clients shall be screened for
depression during their intake (new clients)
or within six months (established clients)
and positive results shall be immediately
referred to licensed mental health provider.
Hold at least 12 educational presentations
for Native American clients/community
members with the goal of 25 attendees per
presentation.
Engage and establish services for at least
80 Native American individuals/ families on
an annual basis. Document approximately
150 unique contacts in the first year, with
10% increase each year thereafter.
Immediately refer clients to licensed mental
health professionals and other community
services as the client presents the need or
based off of screenings.
Participate in at least 9 Fresno community
events (like health fairs parades, etc.) to
provide information about mental health
and the Native American community .
See Goal #6
See Goal #6 and #9
See Goal #8
See Goal #8
EXHIBIT B-1
Page 4 ofS
CBANS Coping
Strategies & Protective
Factors Form
PHQ-9 Assessment Tool
Dated sign-in sheets for
presentations
Agency
Registration/Intake Form
Referral tracking system
Calendar of Events &
monthly Staff Reports
PERFORMANCE TRACKING AND REPORTING
EXHIBIT B-1
P age 5 ofS
FAIHP shall utilize a variety of tools for performance tracking and reporting as identified below.
• FAIHP maintains two agency-wide inter-disciplinary Quality Improvement Committees (one for
adults and one for youth) whose task it is to monitor the effectiveness of agency services and
process .
• Warm hand-offs and client follow-up shall be standard practices to allow staff to identify if service
referrals and linkages resulted in appropriate service delivery and positive outcomes.
• Referral Tracking System: Costs associated with FA IH P paying another provider shall be tracked in
an electronic database which allows for collection and reporting of data , such as: number of
referrals , the referral/receiving provider , and the associated costs .
• Consumer feedback shall be obtained from a variety of sources, including but not limited to : an
annual consumer satisfaction survey; and Native American Community Advisory Board which
enables ongoing feedback regarding services, community needs , and overall service system .
• Calendar of events, monthly staffing reports and event sign-in sheets shall assist with event tracking
and staffing patterns .
• Pre/Post Wellness Surveys shall be used every 6 months to indicate a client's level of im provement.
• CBANS shall use the following to determine client needs and services , as well as outcomes of those
services : Intake/Registration Forms , Coping Skills and & Protective Factors Assessment, CBANS
Wellness Survey, Stress Assessment, PHQ-9, and other report tools/forms as requested by DBH
(e .g.: Outcomes Tracking Spreadsheet, Narrative Activity Report, Event Log , and monthly Staff
Reports).
EXHIBIT B-2
Page 1 of6
CENTRO LA FAMILIA ADVOCACY SERVICES
CULTURAL-BASED ACCESS NAVIGATION AND PEERIFAMIL Y SUPPORT
SCOPE OF WORK
CONTRACT SERVICES: Cultural Based Access Navigation and Peer/Fam ily Support Services
CONTRACT TERM : July 1, 2016-June 30, 2019 , and Two (2) Twelve-Month Renewal Options
SERVICE POPULATIONS: Latino/Hispanic, including : LGBTQ, Veterans and Homeless
CONTRACT MAXIMUM : $115,921 Per Fiscal Year (See Exhibit C-2 for line item budget details)
NOTE: The information , expectations and requirements contained in this Exhibit B-2 are specific to
Centro La Familia Advocacy Services, Inc. (CLFA) and shall be considered in addit ion to
Exh i bit B and the Centro La Familia Advocacy Services proposal submitted in response to
Request For Proposal 952-4512 .
CENTRO PROGRAM OVERVIEW
The Centro La Familia Advocacy Services (CLFA) Cultural-Based Access Navigation and Peer/Family
Support Services (CBANS) Program shall be administered as part of a comprehensive wellness program
serving the underserved and un-served urban and rural Fresno County Latino/Hispanic community,
particularly the immigrant and first generation communities, and inclusive of Lesbian/Gay/Bi-Sexual/
Transgender/Questioning (LGBTQ), veterans, and homeless members within the service community . The
CLFA CBANS program shall provide mental health prevention and early intervention services to help reduce
stigma about mental health and improve individuals ' knowledge of, availability of, and access to mental
health services in the community .
CLFAS shall utilize the evidence-based Promotora model and implement the use of platicas ; a cultural
approach to support groups engaging participants in conversations about mental health issues . This softer
approach all ows staff to slowly create re lationsh ips so that eventually more serious "hidden" issues can be
addressed . CLFA shall ut il ize a family centered , wellness approach , emphasizing the strengths of the
individual and fam ily to he lp cope with the stressors and areas of need . This corresponds to the strong
cultural identification with "whatever an individual does reflects on the entire family ".
EXHIDITB-2
Page 2 of6
CLFA provides prevention activities, with intervention services for mental health treatment provided through
other sources. These include the Integral Solutions Community Institute for sliding fee scale, bilingual
treatment and the Fresno Family Counseling Center also with a sliding fee scale and bilingual therapists.
Centro La Familia Advocacy Services shall be available to all Fresno County, with an emphasis on outreach
to areas within the County where the Latina/Hispanic population heavily reside. Services shall include, but
are not limited to, the Fresno area postal zip codes of 9370€?, 93702, and 93727 , as well as Sanger, Orange
Cove , and Firebaugh. Services will focus on : one-on-one support, advocacy and intake assessments;
support groups (Piaticas); referrals; outreach, and community trainihg/presentations .
This table b elow provides an overview of CLF A CBANS services.
Prevention
• Drop in hours at CLFA
o lnformation & referral
o Screening & referral
• Community Outreach
o Distribution of printed information
o Peer consultations
o General education presentations
o Targeted community presentations
• PlaticasjWellness Conversations in
conjunction with communjty healers (i.e.
curanderos, when appr opriate)
• Media presentations and Public Service
Announ cements
o Univisi6n CIL 21
o Radio Bilingue
o Radio call in therapist show on La
Misionera/1550 AM
Early Intervention
• Screening/assessments-Family
Development Matrix, Wellness Survey,
Patient Health Questionnaire-9,
Needs/Stressors survey
• Referral for more intensive services when
appropriate
• Peer education and support (us e of Mental
Health First Aid, etc.)
o On site at CLFA
o Hom e visits/community sites
• Family and Peer StJpport Groups
o Rural-Orange Cove and Firebaugh
o Urban-west and central Fresno
(93706 and 93702 areas)
Linkage
• Referrals made to existing community
based providers (e .g. substance abuse
prevention and treatment, sexual abuse
prevention and treatment)
• Referrals made to community
resources
• Referrals made to Fresno County
Behavioral Health services
• Provision of consumer advocacy as
individuals/families enter and navigate
the Public Health or Behavioral Health
system
Linkage
• Referrals made for mental health and
substance abuse treatment
• Linkages made to crisis intervention
services
• Provision of consumer advocacy as
individuals enter and navigate the
Behavioral Health system
STAFFING
At a minimum, CLFA shall maintain 2.40 Full Time Employees (FTE) as follow :
.40 FTE Community Health Worker
1.0 FTE Peer Support Specialist
1.0 FTE Peer Support Specialist
2.40 FTE Total
TRAIN ING AND EDUCATION
EXHIBIT B-2
Page3 of6
Staff-Training for staff members shall include, but is not limited to : monthly cultura l awareness trainings on
such topics as holistic approaches to mental health service delivery, Mindfulness (Centering Prayer),
Johari 's Window (Self Awareness; personal and group), Facilitation of Support Groups using Cultural
Competency approaches , and other trainings as available . CLFA staff will also participate in required and
volunteer trainings facilitated by DBH as needed and relevant. In addition , the monthly PEl Staff Meeting
includes cultural and/or service related training . Staff shall also participate in Tra in-The-Tra in er, Wellness
Recovery Action Plan (WRAP), and Mental Health First Aid as appropriate.
Community -There shall be 36 trainings per year for the service community and shall include topics such
as (not all inclusive): Bienestar (Wei/ness), anxiety , depression or stress (culturally different), What to Do in
a Mental Health Crisis, communication , children and mental health, family involvement, cultural healing,
healthy eating/living ; suicide prevention/Question, Persuade, Refer (QPR), and Mental Health First Aid.
Educational messages and materials shall also be provided during various outreach events that CLFA staff
participate in monthly. Training is presented out in the community (e.g.: Kerman , Mendota, Firebaugh, etc.)
in places such as schools , churches , senior centers , etc.
Facilitators-CLFA shall use variety of resources for training , such as : knowledgeable/professional staff and
community partner resources , such as : Department of Behavioral Health; Ca li fornia State University
Fresno ; Fresno County Superior Court; Department of Social Services ; First 5 of Fresno County ; Kings
V iew; Fresno Council on Ch il d Abuse Prevention ; Except io na l Parents Unli mited ; Fresno Center for New
Americans ; and others . Examples of tra ining topics include , but are not limited to: court-mandated
reporting , confident iality , and case management.
Community Engagement-T ra inings and educational health-related messages shall be published/posted as
appropriate in: social media sites (Facebook , Twitter, lnstagram, and Pinte rest); DBH Weekly Community
Event Calendar; to PEl provider partners ; and at community events, such as health fairs , cultural
EXHIBIT B-2
Page 4 of6
celebrations, and other social gatherings. In addition, CLFA will use Latina/Hispanic media to promote
health related trainings, messages and events .
Feedback -Short post-training satisfaction surveys are used to determine whether the trainings are relevant
and successful. Other data collected shall include demographics and #sin attendance.
FUNDING
CLFA shall utilize funding provided by Fresno County Department of Behavioral Health Department to
operate the CBANS program within the estab lished guidelines set for PEl programs in the State of
California . This would include salaries of the CHW and PSS , employee benefits, training, consumer
incentives and transportation, and operational costs . CLFA shall produce and maintain a budget and budget
narrative filed with and approved by the County. CLFA's detailed budget allocations may be found in
Exhibit 8-2.
PERFORMANCE GOALS
CLFA shall adhere to the below set of annual performance outcome measures to demonstrate the on-going
effectiveness of the CBANS program and the positive im pact that the services have for the target
population . The following table shows CLFA's goals for client wellbeing improvement.
• Increase knowledge of risk and resilience/protective
factors;
• Increase overall mental health awareness in the
community;
• Overcome individual culture-based stigma against
men tal illness and mental health concerns
• Develop coping skills and build resiliency for
historica l trauma.
• Facilitate identification of early signs of mental
illness for linkages to timely interventions and
treatment.
• Increase follow-up on service referrals for early
onset interventions to determine use and
effectiveness of referrals .
Yr. 1 = 40%
Yr. 2 =50%
Yr. 3-60%
• Pre/Post Needs/Stressors
Form;
• Pre/Post Wellness Survey;
Patient Health Questionnaire
(PHQ-9)
• Coping Strategies &
Protective Factors Form;
• Family Developme·nt Matrix
(FDM), Event Log&, Periodic
Outcome Reports
EXHIDITB-2
Page 5 of6
T he chart below represents activity and process goals designed to improve the service community in the
following ways:
• Reduce mental health stigma;
• Reduce discrimination against those with mental illness;
• Increase access to mental health treatment and services ;
• Increase cultural competency and understanding within communities ;
• Increase the number of culturally competent prevention and early intervention activities;
• Increase the number of individuals/families who receive prevention, early intervention, and linkages
to community resources; and
• Reduce duration of untreated mental illness .
r--
1 D ' t ' es c np1on
Outreach Events (Number
Events/Number Reached)
Latino Community Educational and
-=-L _Y r. 1 l Ql l .Qi 1· Q3 _LQ4 I YR2_
1
Yr. 3 -l
Baseline 1 Annual 1 # or I # or # or # or Annual Annual
Go al % % % % , Goal , Goa l I 8/1500
65/800
I 24/1800 r 450
1
450 450 1 450
1
24/1800 F '1800
36/540 135 I 135 135 135 36/540 36/540
Targeted Training (Number
train ings/Attendance)
Calls into CLFA for information a-bo_u_t ~0-0--1 1,000 -250 '250 l25o 250 I 1,000
1 mental health and/or as a result of i I
media outreach ____ . _ 1~
Internal referrals for info about mental ~ 49 5S -12 13 12 13 60
health I ~n~~~i~~~~~ts/assessments - - -J --1-00-1 100 I 25 I 2~ 25 l 25 -!--1-0_,.0 -~---
Follow-up contact made for critical/at-17% 40% 25% 30% 35% 40% ; 50%
risk FDM or moderate PHQ-9 E1 I Follow-up contact made for all ot"hefl 17% 40% 25% l 30% 1 35% 40% 50%
I cases I L -~~--~-+---::-::-:.-:--1
· Percent of "Warm Handoffs" (includes 1 N/A 40% 25% 30% 35% 40% ! 50%
in person and direct involvement with I 1 1
calling for appointments) • 1
_ 1
Support groups/total served with new
I and duplicated clients (10 bi-weekly
sessions= 1 support group). Baseline
1 support group locations-Orange Cove
and Southwest Fresno (93706). New I
additions-Firebaugh and Central
Fresno (93702) . ...____ -
6/107 8/96 24 24 24 24 8/96
PERFORMANCE TRACKING AND REPORTING
CLFA will utilize a variety of tools for performance tracking and reporting as identified below.
EXHIBIT B-2
Page 6 of6
• Wellness Survey -used to assess client's wellbeing, stress level, knowledge of resources in the
community, confidence level, and overall well ness.
• Needs (Stressors) Survey -used to assess basic daily living needs to determine the best
resources/services to assist them.
• Patient Health Questionnaire (PHQ9) -used by staff to determine a client's level of depression, not
for diagnosing, but to assist staff in determining the urgency of need and appropriate referrals.
• Family Development Matrix (FDM) Assessment is an electronic service/data management system
implemented with each client at initial assessment and used to monitor, manage, and report on
client progress and program effectiveness in measureable outcomes.
• Family Empowerment Plan (Part of the FDM)
• Client Feedback Tool
• Support Group Feedback Tool
• Call Log Tracking
• Event Log and Periodic Outcome Report
• Sign in Sheets
• Calendar of Events
• Outcomes Tracking Spreadsheet
• Staffing Reports
• Pre/post surveys i
• Agency Registration/Intake & Assessment Forms ;
• And other report tools as requested by DBH
• Warm hand-offs and client follow-up shall be standard practice (as client permits) to allow staff to
identify if service referrals and linkages resulted in appropriate service delivery and positive
outcomes .
EXHIBIT B-3
Page 1 of6
FRESNO INTERDENOMINATIONAL REFUGEE MINI STRIES (FIRM)
CULTURAL-BASED ACCESS NAVIGATION AND PEERIF AMIL Y SUPPORT
SCOPE OF WORK
CONTRACT SERVICES : Cultural Based Access Navigation and Peer/Family Support Services
CONTRACT TERM: July 1, 2016-June 30,2019, and Two (2) Twelve-Month Renewal Options
SERVICE POPULATIONS: Southeast Asian (Hmong, Laotian, and Cambodian), including: LGBTQ,
Veterans and Homeless within the serv i ce populat ions.
CONTRACT MAXIMUM: $120,393 Per Fiscal Year (See Exhibit C-3 for line item budget details)
NOTE: The information , expectations and requirements conta ined in th is Exhibit B-3 are specific to
Fresno Interdenom i national Refugee Mi nistries (FIRM ) and sha ll be considered in addition to
Exh ibit B and the Fresno Interdenominational Refugee Mi nistries proposal subm itted in
response to Request For Proposal 952-45 12 .
FIRM PROGRAM OVERVIEW
The Fresno Interdenominational Refugee Ministries (FIRM) Cultural-Based Access Navigation and
Peer/Family Support Services (CBANS) Program shall be administered as part of a comprehensive wellness
program serving the underserved and un-served Fresno County Hmong, Laotian , and Cambodian
communities , and inclusive of Lesbian/Gay/Bi -Sexualrrransgender/Questioning (LGBTQ), veterans , and
homeless members with in the service populations . The FIRM CBANS program shall provide mental health
prevention and early intervention services to help reduce stigma about mental health and improve
i nd ividua ls' knowledge of, availability of, and access to mental health serv ices in the commun ity .
Promotores Mo de l : FIRM shall use the Promotores model of Community Hea lth Workers (CHW), adapting
the mode l to fit their target populations. Utiliz ing CHWs and Peer Support Speciali sts (PSS ) supports an
evidence -based , commun ity based hea lth model with FIRM staff acting as effective dissemi nators of
information to the ir services populations. In addition , where there is great mistrust with th is service
population of government entities , staff shall bridge the gap between the service commun ity and service
providers . Due to language barriers, staff shall assist clients w ith life skills and service navigation on a daily
basis . FI RM shall utilize a family centered , well ness approach , emphasizing the strengths of the individual
and family to help cope with the stressors and areas of need .
EXHIBITB-3
Page 2 of6
SBIRT: FIRM shall continue the practice of Screening , Brief Intervention and Refe r ral to Treatment (SBIRT)
for each client/family served in order to ensure a streamlined approach to accessing appropriate services.
As each client is case managed , it is the responsibility of the CBANS staff to refer clients/families to
additional resources as needed . A client or family's needs are determined based on results of a variety of
tools used as identified on Page five (5) within this Exhibit 8-2.
Service Provider Componen t: FIRM shall implement a Service Provider Component that includes staff
working w ith community members and service providers to develop a list of trusted community service
providers who are best equipped to work with the Southeast Asian populations. This shall include working
with, and educating service providers to develop practi ces and methods of improving cultural and linguistic
relevance.
Pathways to Wei/ness : This component to FIRM's CBANS case management program will track a designed
and developed pathway for clients in the pursuit of well ness. This shall be utilized for case managed clients
and will allow for better tracking of what CBANS clients are actually doing to secure and manage their
wellness/mental health. "Wellness" is the best word culturally to describe mental health and shall be used in
this tool.
FIRM Program Overview:
PREVENTION
1. Drop ln Hours at CSO
a. Info/Materials
b. Screening
c.?eerSupport
II. Community Outreach
IlL Ethnic Media
Outreach
lV. Workshops!
Education Sessions
v. Cultural Communi~
Events
E AR LY INTERVENTI ON
Vi. Formctiized SBIRT
Vtl. Complete Initial
Wellness SuNeys/
PHQ~9
VII I. Client Case
Management
JX. Create "Pathway to
Wellness/MantaJ
Health''
X. Peer Support
Groups
Level I Linkages
A. Aef~rrals made to
CSO/Community
Resources
8. Aererrals made to
CBANS Partners
(
C. Referrals made to
County primary and
oehavioral health
servrces
D. Consumer
~dvocacy as needod
L evel II Linkages
A. LinkC~.ges io mentai
health treatment ·
B. Linkages made to
substance abuse
'treatment c. Unkag~s to crists
intervention services
D. tntensM.~ coJiSllmer
advocacy as Level If
Unkages are navigated
with client
Follow-UP-S
Follow-up wfth
referral provider to
ensure suc<;es$
r. Follow~up with
:ttent to ensure that
~hem is not in need
further serv1ces at that
lime
it Survey client as to
mproved wet!nessl
mental "'eaJth
Follow-UP-S
i. Case ma11agement of
client untfl ·'PathWay fo
Well ness/Mental
Health" completed
li. Follow-up with
linKages to ensur~ that
services were provided
fir. Follow-up with
clients and evaluation
as to progress on a
quarterly baSIS or as
needed
STAFFING
At a minimum , FIRM shall maintain 2.30 Full Time Employees (FTE) as follow:
0 .75 FTE Community Health Worker (Lao)
1.50 FTE Peer Support Specialist (Hmong and Cambodian)
0.05 FTE Supervisor
2.30 FTE Total
TRAINING AND EDUCATION
EXHIBITB-3
P age 3 of6
Staff-Training for staff members shall include , but is not limited to: monthly internal training on mental
health , focusing on items that are specific to the Southeast Asian community; cultural competency; holistic
approaches to mental health service delivery; Facilitation of Support Groups using Cultural Competency
approaches ; suicide prevention/Question, Persuade, Refer (QPR) and other trainings as available . FIRM
staff shall also participate in required and volunteer trainings facilitated by DBH as needed and relevant. In
addition , the monthly PEl Staff Meeting includes cultural and/or service related training. Staff shall also
participate in , and facilitate Know the Signs, Train-The-Trainer, Wei/ness Recovery Action Plan (WRAP),
and Mental Health First Aid as appropriate . Staff shall be provided a regular calendar of trainings
distributed to staff on a quarterly basis.
Community-FIRM provides training on various mental health topics through its monthly workshops specific
for the Hmong and Laotian communities. Topics include: su icide preventio n and education (Know the
Signs & QPR), stress reduction techniques, the benefits of physical activity for overall wellness and much
more . FIRM shall regularly disseminate information about mental health by utilizing ethnic media outlets
such as Hmong television and radio, and Laotian radio. Educational messages and materials shall also be
provided during various outreach events that FIRM staff participate in monthly . In addition, as part of
FIRM 's Service Provider Component as described above , staff shall work with, and provide educational
opportunities with service providers to improve provider's cultural and linguistic appropriateness in their
delivery of services .
Facilitators-FIRM shall use variety of resources for training, such as : knowledgeable/professional staff and
community partner resources and CBANS partner resources . Some of these collaborating agencies
include: Department of Behavioral Health (e.g.: Lunch and Learn Mini-Series); California State University
Fresno ; National Alliance on Mental Illness (NAM I}, Fresno Center For New Americans, Department of
Social Services; and others. Examples of training topics include , but are not limited to : cultural competency,
confidentiality, and case management.
EXHIBIT B-3
Page 4 of6
Community Engagement -FIRM staff shall use the ir PICO Commun ity Organizing Model training and
expertise as commun ity organ izers to implement a four-fo ld approach to engage their service populations .
Th is includes: 1) door-to-door engagements ; ethnic med ia outreach ; 3) walk-in client outreach ; and 4)
commun ity outreach . Train i ngs and educationa l health-related messages shall be published /posted as
appropriate using : social media sites (Facebook, Twitter, lnstagram , and Pinterest); DBH Weekly
Community Event Calendar; PEl provider partners ; ethn ic media outlets , includ ing , but not limited to Hmong
television and radio , and Laotian radio; and at community events , such as health fairs , cultural celebrations ,
and other social gatherings.
Feedback -Short post-training satisfaction surveys are used to determine whether the trainings are relevant
and successful. Other data collected shall i nclude demographics and #s in attendance.
FUNDING
FIRM sh all utili ze fu nd ing provided by Fresno County Department of Behav ioral Health Department to
operate the CBANS program within the establi shed gu idelines set for PEl programs in the State of
Californ ia. Th is wou ld inc lude salaries of the CHW and PSS , employee benefits , train ing , consumer
incentives and transportation , and operationa l costs . FIRM sha ll produce and maintain a budget and budget
narrative filed w ith and approved by the County . FIRM 's deta il ed budget allocations may be found in Exh ibit
8-3 .
PERFORMANCE GOALS
FIRM shall adhere to the below set of annual performance goals and outcome measures to demonstrate the
on-going effectiveness of the CBANS program and the positive impact that the services have for the target
population . FIRM shall facilitate and/or part icipate in the following activities and services resulting in a
min imum of 2 ,712 i ndividuals directly (not counting those potentially reached through ethnic media events
and special cultural events) reached and/or served annually :
• Workshops /Educa tion Sessions : 72 annual workshops (3 per month with one in each : Khmer
(Cambod ian ), Laotian , and Hmong ) serving a minimum of 1,080 individuals
• Ethn ic Outreach/Educat ion Media Events : 5,000 to 10 ,000 viewers/listeners per event; potentially
reach ing a min imu m of 135,000 individuals annually . Th is includes TV, rad io and print.
• One-on -One Walk-In Services : Serving 100 per month; serving a minimum of 1,200 individuals
annually
• Client Cases (Assessment, Linkage, Referrals): 15 new cases per month ; serving a minimum of 180
annua ll y
• Peer Support Groups: 3 per month ; serving a minimum of 252 individuals annually
EXHIBIT B-3
Page 5 of6
• Special Cultu ral Events: A minimum of 6 annually reach ing a m inimum of 2 ,500 individuals annually.
Events id ent ified above shall resu lt in t he following annua l m inimums:
• 120 Linkages for h igher level menta l health services annually to be tracked by numbers and for
effect iveness.
• 300 Referrals annually to community resources to be tracked by numbers and types of referrals .
• 360 Transports to needed community resources to be tracked by numbers and resource providers.
The following table (Page 5) represents FIRM outcomes, goals and some data sources/tools.
c, ~ ,-, {• .. ' "\~ 'I,
{ tl'T:lT:llllt In ~ 0{. :J-.."1 " ·. ·~r ..... ~~·~r.:.,;;_~J'{tl i'IT= ='ttr.mr::J -"~ • . ~ ~ I '1 Lti:l.i£eiD
• Pre/Post CBANS
1 Red uce socia l an d a ) Red uce the number of self-reported stressors f or 75% of Needs/Stresso rs
env ironme nta l cli ents w ith in a s ix mo nth t ime frame . Form
stressors b) A t least 75 % of clie nts will report pos it ive changes in se lf-• Pre/Post CBANS
reported stress leve l withi n a twelve month ti me frame . Wellness S urvey
• Pre/Post HERTH
2 Imp rove attitudes & a ) At least 85 % of clients w ill report an i ncreased sense of hope Hope Index Tool
o utlook w ithin a six month time frame .
• PHQ-9
3 Increase healthy a) 100% of c lients will be screened for depression during their Assessment Tool
behav iors among intake (new clients) or within six months (established clients). • CBANS Coping
service participants b) 75% of clients with minimal or mild depression (score 1-9 Strategies &
according to PHQ-9 scale) will report increased utilization of Protective
coping strategies and protective factors . Factors Form
c) 100% of clients that score a 10 or higher on the PHQ-9
assessment will be referred to appropriate community
behavioral health services.
PERFORMANCE TRACKING AND REPORTING
FIRM shall utili ze a variety of tools for performance tracking and reporting as identified below.
• Wellness Survey -used to assess client's wellbe ing , stress level, knowledge of resources in the
community , confidence level , and overall wellness .
• Needs (Stressors) Survey -used to assess basic daily living needs to determine the best
resources/services to assist them.
• Patient Health Questionnaire (PHQ9) -used by staff to determine a client's level of depression, not
for diagnosing , but to assist staff in determ i ning the urgency of need and appropriate referrals .
• Client Feedback Tool/Satisfaction Survey
• Quarterly Program Audits (internal)
• Referrals and Linkage Forms
• Event Log and Sign in Sheets
• Calendar of Events
• Outcomes Comparison/Tracking Spreadsheet
• Staffing Reports
• And other report tools as requested by DBH
EXHIBIT B-3
Page 6 of6
• Warm hand-offs and client follow-up shall be standard practice to allow staff to identify if service
referrals and linkages result in appropriate service delivery and positive outcomes.
EXHIBITB-4
Page 1 of6
WEST FRESNO FAMILY RESOURCE CENTER (WFFRC)
CULTURAL-BASED ACCESS NAVIGATION AND PEER/FAMILY SUPPORT
SCOPE OF WORK
CONTRACT SERVICES : Cultural Based Access Navigation and Peer/Family Support Services
CONTRACT TERM : July 1, 2016-June 30, 2019 , and Two (2) Twelve-Month Renewa l Options
SERVICE POPULATIONS: African American including: LGBTQ , Veterans and Homeless within the
service populations .
CONTRACT MAXIMUM : $84,566 Per Fiscal Year (See Exhibit C-4 for line item budget details)
NOTE : The information , expectations and requirements contained in this Exhibit 8-4 are specific to West
Fresno Family Resource Center (WFFRC) and shall be considered in addition to Exhibit 8 and the
West Fresno Family Resource Center proposal submitted in response to Request For Proposal
952-4512 .
WFFRC PROGRAM OVERVIEW
The West Fresno Family Resource Center (WFFRC) Cultural-Based Access Navigation and Peer/Family
Support Services (CBANS) Program shall be administered as part of a comprehensive wellness program
serving the underserved and un-served Fresno County African American community, inclusive of
Lesbian/Gay/Bi-Sexuai/Transgender/Questioning (LGBTQ), veterans , and homeless members within the
service populations. The WFFRC CBANS program shall provide mental health prevent ion and early
intervention services to help reduce stigma that African American youth and adults have about mental
health and its services , -and improve individuals' knowledge of, availability of, and access to mental health
services In the community.
WFFRC shall operate the CBANS program to address menta l health stressors such as : access to healthy
nutrition and lifestyles, crime and safety , education and employment growth , .and economic stability. The
positive connections and linkages to culturally appropriate mental health treatment and resources made
through the WFFRC CBANS program shall help youth and families in Southwest Fresno make positive
choices and improvements with regards to community stressors . This access to services in the
neighborhood has the potential to provide the development of life skills , increase economic activity and
EXHIBIT B-4
Page 2 of6
transform disadvantaged neighborhoods into a stable community , all of which shall improve mental health
outcomes .
The WFFRC CBANS program shall be modeled sign ificantly on evidence-based models , util izing the cost-
effective Community Health Worker model. Community Health Workers (CHW) and Peer Support
Speci alists (PSS) shall prov ide famil iar opt ions for the commun ity to learn about otherwise not-discussed
topics relevant to mental health such as, but not limited to : support ; education , suicide prevention ; and life
skills . CHW/PSS staff shall provide culturally competent services and materials to the community to ensure
greater understanding, acceptance and use of mental health resources . Specifically , staff shall provide
mental health education, promotion and advocacy , and community leadership through activities such as :
peer support , basic self-help training, educational presentations, information and referrals/linkages to
additional services , and support for accessing existing resources and navigating systems of care and
support .
The WFFRC CBANS program shall utilize the PERAS Index as identified by the California Reducing
Disparities Project (CROP): African American Population Report . The index provides specific community
defined prom ising practices , with strength-based , culturally competent approaches that support improved
services for people of African heritage living in America, irrespective of nationality. The model has clearly
identified effective traditional and non-traditional , mental health serv ices that contribute to the communities
overall health and wellness, includ ing these pillars: African-centered; faith or spirit based;
ecological/community ; and wellness , res i liency and recovery . Such pillars shall be used in a holistic fashion
to identify support systems , resources and staff opportunities to learn and/or educate .
In addition , for African American adults, WFFRC shall implement the Cal Works Life Skills Support Group
Model. African American youth shall utilize Adolescent Mental Health & Wellness Curriculum . This
cu rric ulum is to help adolescents acqu ire the words and questions they need to make better decisions in the
area of mental health . Program overview includes, but may not be limited to :
• Outreach and Education
• One-on-One intakes
• Support Groups
• Client Assessments
• Referrals/Linkages
• Follow-up
• Cultural Celebrations, and
• Consent from parent/guardian youth to participate in mental health programs .
STAFFING
At a minimum , WFFRC shall maintain 2.10 Full Time Employees (FTE) as follow :
0 .80 FTE Community Health Worker
0.80 FTE Peer Support Specialist
0.50 FTE Peer Support Specialist
2.10 FTE Total
TRAINING AND EDUCATION
EXHIBIT B-4
Page 3 of6
Staff -Training for staff members shall include, but is not limited to: monthly internal train in g on mental
health , focusing on items that are specific to the African American community ; cultural competency; holistic
approaches to mental health service delivery ; facilitation of support groups using culturally competent
approaches ; suicide prevention/Question, Persuade, Refer (QPR) and other trainings as available . WFFRC
staff shall also participate in required and volunteer trainings facilitated by DBH as needed and relevant. In
addition, the monthly PEl Staff Meeting includes cultural and/or service related training . Staff shall also
participate in , and facilitate Know the Signs, Train-The-Trainer, Motivational Interviewing , Wei/ness
Recovery Action Plan (WRAP), and Mental Health First Aid as available and appropriate.
Community -WFFRC shall provide training on various mental health topics through its monthly workshops
specific for the African American community. Topics include, but are not limited to : suicide prevention and
educat ion (Know the Signs & QPR), stress reduction techniques , anti-stigma , the benefits of physical
activity and nutrition for overall wellness , etc. Educational messages and materials shall also be provided
during various outreach events that WFFRC staff participates in monthly .
Facilitators -WFFRC shall use variety of resources for training , such as: knowledgeable/professional staff
and community partner resources and CBANS partner resources. Some of these collaborating agencies
may include : Department of Behavioral Health (e.g .: Lunch and Learn Min i-Series), National Alliance on
Mental Illness (NAMI), Fresno Center For New Americans , Department of Social Services, and others .
Examples of training topics include, but are not limited to: cultural competency, confidentiality, and case
management.
Community Engagement -WFFRC staff shall engage the service community through use of culturally
relevant and entertaining workshops , team-bu il ding activities , monthly commun ity block parties , health fa i rs ,
topic-related movie screenings , play therapy , support groups , and physical activities. Tra inings and
educational health-related messages shall be published/posted as appropriate using: social media sites
EXIITBIT B-4
Page 4 of6
(Facebook, Twitter, lnstagram, and Pinterest); DBH Weekly Community Event Calendar; PEl provider
partners ; and media outlets.
Feedback -Short post-training satisfaction surveys are used to determine whether the trainings are relevant
and successful. Other data collected shall include demographics and #s in attendance .
FUNDING
WFFRC shall utilize funding provided by Fresno County Department of Behavioral Health Department to
operate the CBANS program within the established guidelines set for PEl programs in the State of
California. This would include salaries of the CHW and PSS , employee benefits, training , consumer
incentives and transportation , and operational costs. WFFRC shall produce and maintain a budget and
budget narrative filed with and approved by the County . WFFRC's detailed budget allocations may be
found in Exhibit 8-4.
PERFORMANCE GOALS
WFFRC shall adhere to the below set of annual performance goals and outcome measures to demonstrate
the on-going effectiveness of the CBANS program and the positive impact that the services have for the
target population . WFFRC shall facilitate and/or participate in the following activities and services annually :
• Individual Peer Support: 200 adults and 75 youth participants with referrals for support services ;
• Support Groups: 12 group sessions for adults (1x month w/8-10 participants); and 96 group
sessions for youth (ages 7 to 12; 2x week ; 5-7 participants)
• Community Presentations: 24 group presentations for adults (2x month; average attendance of 25);
and 12 (1 x a month) fellowship gathering ;
• One-on-one contacts (health fairs, block parties, etc.) April through October resulting in 1,200
individual adult contacts and 600 individual youth contacts.
Activities shall include, but are not limited to:
• Youth and adult mentoring
• Individual and family life skills training
• Opportunities and linkage to other relevant services to help the client gain resi liency, cultural
grounding , self-esteem, connections with the ir community, opportunities for education and
employment, and knowledge of mental health issues and access to services.
Minimum Number of Clients Served by WFFRC:
Year 1: 1,800 Adults and 450 Youth
• Year 2: 1,836 Adults and 459 Youth (2% increase)
• Year 3: 1 ,891 Adults and 473 Youth (3% increase)
EXHIBIT B-4
Page 5 of6
Number of Linkages for support services such as, but not limited to: housing, clothing , food , health
insurance , employment, education/tutoring, etc.
• Year 1:
• Year 2:
• Year 3 :
500 Adults and 1 00 Youth
510 Adults and 102 Youth (2% increase)
520 Adults and 105 Youth (2%-3% increase)
C lient Transports: 100 c lients will be assisted with transportation annually to such places/services as:
medical providers, employment opportunities, trainings/education childcare and mental health services.
The following table represents WFFRC outcomes, goals and data sources/tools .
.....,. ..& on ..., -""-......... .~ lo:io1ll'.:.1 :~r(t.l!J[:Itl~i_c:] ·~J l-"il I • ·I t-It !UOo!_'ol~l :~. -t•..rrJ (toft :r..'i 'j ·!, !.' ' .,
1 Provide Individual a) At least 50% shall report increased knowledge of risk and
mental health resilience/protector factor by the end of the second
support quarter. • Pre/Post CBANS
b) 50 % of clients shall increase their knowledge of overall Wellness Survey
menta l health awareness in the community by the end of • Needs/Stressor
the second quarter. Evaluation Tool
c) 50 % of clients shall overcome individual cultural based • PHQ9
stigma against menta l illness and mental health concerns • FDM
by the end of the third quarter.
d) 75% of c li ents will identify early signs of mental illness
and accept linkage to tim ely intervention and treatment
2 Improve programs a) 75% of clients shall increase knowledge of prevention
and systems of programs and early intervention activities that are • Pre/Post Test
care for those directed at unserved cultural , ethnic, racial and lingu istic • Pre/Post CBANS
seek ing mental commun ities includ ing rural areas of Fresno County by Wellness Survey
health support the end of the second quarter. • Needs/Stressor
b) 100% shall increase knowledge of early onset Evaluation Tool
Intervention and treatment to prevent a problem from
getting worse and thereby requiring more cost ly services
by end of 41h quarter.
3 Bu ilding long-term a) 100% of clients shall increase understanding of cultural
commun ity competency and understand there is no one size fits all
involvement model for delivery of prevention and early intervention • Pre/Post Test
strateg ies for mental health/illness by the end of the third • Pre/Post CBANS
quarter. Wellness Survey
b) 100% of clients shall reduce stigmatizing attitudes
towards mental illness by the end of the second quarter.
c) 75% of clients shall reduce discrimination against those
with mental illness within and across diverse cultural
4 Increase overall
coping sk ills for
youth
populations by the end of the t hird quarter.
a) 50% of c lients shall increase their. Knowledge of overall
mental health awareness in the community by the end of
the second quarter.
b) 35% of clients shall overcome individual cultural based
stigma against mental illness and mental health concerns
by the end of the third quarter
c ) 100% of cl ients w ill gain knowledge on how to seek support
by the end of the third quarter
PERFORMANCE TRACKING AND REPORTING
•
EXHIBIT B-4
Page 6 of6
Pre/Post Test
WFFRC shall utilize a variety of tools for performance tracking and reporting as identified below.
• Family Development Matrix (FDM)
• Patient Health Questionnaire (PHQ9) -used by staff to determine a client's level of depression , not
for diagnosing, but to assist staff in determining the urgency of need and appropriate referrals.
• Pre/Post Wellness Survey-used to assess client's wellbeing , stress level, knowledge of resources
in the community, confidence level , and overall wellness.
• Needs/Stressors evaluation tool to determine the clients daily stressors
• Event Log and Sign in Sheets
• Calendar of Events
• Outcomes Comparison/Tracking Spreadsheet
• Staffing Reports
• And other report tools as requested by DBH
• Warm hand-offs and client follow-up shall be standard practice to allow staff to identify if service
referrals and linkages result in appropriate serv ice delivery and positive outcomes.
SARBAT BHALA, INC. (SBI)
EXHIDIT B-5
Page 1 of6
CULTURAL-BASED ACCESS NAVIGATION AND PEER/FAMILY SUPPORT
SCOPE OF WORK
CONTRACT SERVICES: Cultural Based Access Navigation and Peer/Family Support Serv ices
CONTRACT TERM : July 1, 2016 -June 30 , 2019, and Two (2) Twelve-Month Renewal Options
SERVICE POPULATIONS: Punjabi: LGBTQ , Veterans and Homeless within the service populations .
CONTRACT MAXIMUM : $69,920 Per Fiscal Year (See Exhibit C-5 for line item budget details)
NOTE: T he information, expectations and requirements contained in this Exhibit B-5 are specific to
Sarbat Bhala, Inc. (SBI) and shall be considered in addition to Exhibit B and the Sarbat Bhala,
Inc. proposal submitted in response to Request For Proposal 952-4512.
WFFRC PROGRAM OVERVIEW
The Sarbat Bhala, Inc. (SB I) Cultural-Based Access Navigation and Peer/Family Support Services (CBANS)
Program shall be administered as part of a comprehensive wellness program serving the underserved and
un-served Fresno County Punjabi community, inclusive of Lesbian/Gay/Bi-Sexual/Transgender/Questioning
(LGBTQ), veterans, and homeless members within the service populations . The SBI CBANS program is
based on a variation of the Promotora/community health worker model adapted to meet the cultural, gender-
sensitive and age appropriate needs of the underserved Punjabi community. SBH CBANS shall provide
mental health prevention and early intervention services to help reduce stigma that Punjabi youth and adults
have about mental health and its services, and improve individuals' knowledge of, availability of, and access
to men tal health services in the community. SBI shall collaborate with cultural 1 spiritual, and faith-based
agencies regarding culturally appropriate mental health information as well as collaborating on alternative
ways to achieve wellness , recovery and resilience based on the individual/family cultural norms. These
collaborations include other PEl and CBANS providers , places of worship , and other community service
prov iders. CBANS services provided by SBI shall include, but not limited to: peer support, youth education ,
self-esteem development, family support groups, culturally relevant team building activities , linkage to
behavioral and physical supports in the community , senior support grops, physical wellness education, and
social supports in a cultural sensitive manner.
EXIDBITB-5
Page2 of6
SB I shall operate the CBANS program with flex ible staff schedules and service locations to address mental
health stressors relevant to the Punjabi community such as , but not limited to: culturally related bullying and
hate crimes , post -traumatic stress disorder, mental health related st igma, signs and symptoms of mental
health, suicide prevention, employment , and government trust. The prevention and early intervention (PEl)
services provided through this program shall assist the Punjabi community by establishing trusted
relationsh ips that encourage individuals to discuss and learn about mental health and related issues that are
culturally and historically deemed unmentionable.
Through ongoing efforts and positive community connections, the SBI CBANS program shall introduce and
link community members to culturally appropriate mental health treatment and resources and shall help
youth and families of the Punjabi community make positive choices and improvements with regards to
community stressors. Through individual client-based and culturally relevant services, clients and families
shall progress towards wellness and recovery , improve management of mental illness symptoms , improve
coping skills, and maximize ability to lead a healthy balanced life.
STAFFING
At a minimum, SBI shall maintain 3.25 Full T ime Employees (FTE) as follows :
1.00 FTE Community Health Workers (2 part-time)
2.00 FTE Peer Support Specialists (up to 4 part-time)
0.25 FTE Project Director Peer Support Specialist
3 .25 FTE Total
TRAINING AND EDUCATION
Staff-Training for staff members shall include , but is not limited to : monthly internal training on mental
health , focusing on items that are specific to the Punjabi community; cultural competency; anti-stigma ;
depression ; substance abuse ; stress reduction; holistic approaches to mental health service delivery;
suicide prevention/Question, Persuade, Refer (QPR) and other trainings as available . SBI staff shall also
partici pate in required and volunteer train ings facilitated by DBH as needed and relevant. In addition , the
month ly PEl Staff Meeting includes cultural and/or service related training . Staff shall also participate in ,
and facilitate such trainings as: Know the Signs, Train-The-Trainer, WeJ/ness Recovery Action Plan
(WRAP), and Mental Health First Aid as ava i lable and app ropriate.
Community -SBI shall provide education and training on various mental health topics through monthly
workshops , social gatherings, and places of worship. Topics include , but are not limited to : suicide
prevent ion and education (Know the Signs & QPR), stress and anxiety reduction techniques , anti-stigma ,
.EXHIBIT B -5
Page 3 of6
County mental health resources , etc. Educational messages and materials shall also be provided during
various community and spiritual events that SBI staff participates in monthly .
Facilitators -SBI shall use variety of resources for training, such as: knowledgeable/professional staff,
community leaders , community partner resources, and CBANS partners. Some of these collaborating
agencies may include: Department of Behavioral Health (e .g.: Lunch and Learn Mini-Series), Fresno Center
for New Americans, and others. Examples of training topics include, but are not limited to: cultural
competency , anti-stigma, suicide prevention , anti-bullying , etc.
Community Engagement -SBI staff shall engage the community through use of: culturally relevant
workshops ; engagemenUinclusion of community elders, spiritual leaders and places of worship; publicized
community events; fairs , parades , and other celebrations ; support groups, and physical activities and social
gatherings designed for all ages. In addition , outreach, engagement and education about CBANS shall be
conducted with primary care providers in an effort to integrate physical and mental health services.
Trainings and educational health-related messages shall be published/posted as appropriate using: email ,
radio and print; DBH Weekly Community Event Calendar; and PEl provider partners.
Translators/translations , transportation, and stipends shall be used as appropriate.
Feedback-Short post-train i ng satisfaction surveys are used to determine whether the trainings are relevant
and successful. Other data collected shall include demographics and #s in attendance . In addition ,
feedback on services provided and input on services needed will be sought be interacting and
communicating with individuals at community meetings and through community elders/leaders .
FUNDING
SBI shall utilize fund ing provided by Fresno County Department of Behavioral Health Department to operate
the CBANS program within the established guidelines set for PEl programs in the State of California. This
would include salaries of the CHW and PSS, employee benefits, training , consumer incentives and
transportation , and operational costs . Financial stipends shall be used to assist and encourage community
member participation in specific CBANS services and/or events; stipends shall NOT be used for SBl
CBANS staff .. SB I shall produce and maintain a budget and budget narrative filed with and approved by the
County. SBI 's detailed budget allocations may be found in Exhibit B-5.
PERFORMANCE GOALS
EXHIBIT B-5
P age 4 of6
SBI shall adhere to the below set of annual performance goals and outcome measures to demonstrate the
on-going effectiveness of the CBANS program and the positive impact that the services have for the target
population . SB I shall facilitate and/or participate in the following activities and services annually:
• 150 clients/families served annually with 5% increase per year ;
• Access , navigation and linkage to culturally appropriate agencies such as: social services ,
immigration assistance, education, physical/mental health care , etc. (#depends on client need);
• 10 Educational Sessions (average of 25 in attendance) on topics such as : stress management,
literacy, anxiety , etc.;
• 10 Community Meetings to discuss ''well-being" and PEl practices/services , and to develop
community leadership skills to enhance community well-being;
• 500 contact s through outreach events (fairs, presentations , meeti ngs , etc.);
• 2 to 4 Peer Support Groups monthly (24 to 48 annually dependent upon need) with an average of 7
in attendance focusing on : cultura ll y appropriate PEl techniques ; assist individ uals facing behavioral
health and substance abuse issues;
• Family Support Groups monthly (24 to 48 annually dependent upon need) with an average of 7 in
attendance focusing on developing family resiliency and hope and addressing challenges such as
bullying , family/domestic issues;
• 2 to 4 Barrier Reduction Groups monthly (24 to 48 annually dependent upon need) for issues such
as: English classes , job readiness , citizenship , etc.
• 1 to 2 annual Youth Education CampsNVorkshops , with an average attendance of 20 per camp,
focused on literacy, cultural hi story , self-esteem, positive behavior reinforcement, culturally
appropriate physical activities , art ;
• 2 to 4 Punjabi-Sikh Music Education/Groups monthly (24 to 48 annually dependent upon need), with
an average attendance of 7 , focusing on the influence and healing power of music, which is
paramount in the Punjabi-Sikh community .
Minimum Number of Clients Served/linkages for support services (e .g .: housing , clothing , food , health
insurance, employment, education/tutoring , etc .) provided by SB I:
• Year 1:
• Year 2:
• Year 3 :
500 Adults and 1 00 Youth
510 Adults and 102 Youth (2% increase)
520 Adults and 105 Youth (2% increase)
a ) Reduce the number of self-repo rted stressors for 60% of
1 Red uce s oci a l and c lients within a six m onth t ime frame .
e nviron m e n ta l b) At least 60 % of cl ients w ill report positive changes in self-
stressors reported stress level w ithin a twe lve month ti me frame.
a) At least 75% of clients will report an increased sense of
2 Improve attitudes & hope within a six month time frame.
outlook
a) 100% of clients will be screened for depression during
3 Increase healthy t heir intake (new clients) or within six months
behaviors among (established clients).
service participants b) 50% of clients with minimal or mild depression (score 1-9
according to PHQ-9 scale) w ill report increased utilization
of coping strategies and protective factors .
c ) 100% of clients that score a 10 or h igher on the PHQ-9
assessment w ill be referred to appropriate community
behaviora l health services.
The following table represents SBI outcomes, goals and data sources/tools.
,, ..
_ri --~ • t'T:TF.1IJ1 • I : ' c· •. J • ~'1111'!'~·1'!{t]tn·[oHYL::l~
4 Improved well -a) At least 50% shall report increased knowledge of risk and
being and resilience/protector factor by the end of the second quarter.
hopefulness b) 50% of clients shall increase their knowledge of overall
mental health awa reness in the community by the end of the
second quarter.
c) 50% of clients shal l overcome individual cultural based
stigma against mental i llness and mental health concerns by
the end of the third quarter.
d) 75% of clients will identify ea rly signs of mental Illness and
accept linkage to timely i ntervention and treatment
5 I ncreased a ) 7 5 % of cl ients shall increase knowledge of prevention
c o m m u n ity p rograms and early intervention activities that are d irected at
con nected ness u nserved cu lt u ra l , eth n ic , racia l and lin gu istic commun ities
includ ing ru ra l areas o f Fresno County by t he end of the
second quarter.
b ) 100% shall increase knowledge of early onset intervention
and treatment to prevent a problem from getting worse and
thereby requ iring more costly services by end of 41h quarter.
6 Increased social a) 100% of clients shall increase understand ing of cultural
supports and competency and understand there is no one s ize fits all
reduced isolation model for delivery of prevention and ea r ly intervention
strategies for mental health/illness by the end of the third
quarter.
•
•
•
•
•
EXHIBIT B-5
Page 5 of 6
Pre/Post CBANS
Needs /Stressors
Fo rm
Pre/Post CBANS
Wellness Surve
Pre/Post Herth
Hope Index Tool
PHQ-9
Assessment Too l
CBANS Coping
Strategies &
Protective
Factors Form
~JO .....
ll"t il l
• Pre/Post CBANS
Well ness Survey
• PHQ9
• FD M
• Pre/Post Test
• Pre /Post CBANS
We ll ness Survey
• Pre/Post Test
• Pre/Post CBANS
Wellness Survey
7 Improved access to
care and
knowledge of care
options
8 Increased skills in
problem solving
and help-seeking
9 Increase m number
of Prevention
programs and early
mterven ti on
activ it ies i n a
cultural specific
manner
b) 100% of clients shall reduce stigmatizing attitudes towards
mental illness by the end of the second quarter.
c ) 75% of clients shall reduce discrimi nation against those with
mental illness within and across diverse cultural populations
by the end of the third quarter.
a) 75% of clients shall increase knowledge of prevention
programs and early intervention activities that are directed at
unserved cultural, ethnic, racial and linguistic communities
including rural areas of Fresno County by the end of the
second quarter.
b) 100% shall increase knowledge of early onset Intervention
and treatment to prevent a problem from getting worse and
thereby requiring more costly services by end of 41h quarter
50% of clients shall increase skills in problem solving and shall
seek help as needed.
A gradual increase in the number of prevention and early
intervention activities in a cultural and specific manner shall be
provided based on the needs of the commun ity and resources of
SB I.
PERFORMANCE TRACKING AND REPORTING
•
•
•
•
•
•
EXIDBITB-5
Page 6 of6
Pre/Post Test
Pre/Post CBANS
Wellness Survey
Pre/Post Test
Pre/Post CBANS
Wellness Survey
Pre/Post Test
Pre/Post CBANS
Wellness Survey
SB I shall utilize a variety of tools for performance tracking and reporting as identified below.
• Patient Health Questionnaire (PHQ9) -used by staff to determine a client's level of depr ession, not
for diagnosing, but to assist staff in determining the urgency of need and appropriate referrals .
• Pre/Post Wellness Survey-used to assess client's wellbeing , stress level, knowledge of resources
in the community, confidence level, and overall wellness.
• Event Log and Sign in Sheets
• Calendar of Events
• Outcomes Comparison/Tracking Spreadsheet
• Staffing Reports
• And other report tools as requested by DBH
• Warm hand-offs and client follow-up shall be standard practice to allow staff to identify if service
referrals and linkages result in appropriate service delivery and positive outcomes.
Mental Hea lth Se rvices Act-Prevention and Early Interve ntion
Fresno Ameri can Indian H ealth Project
Ex h ibit C-1
Cu ltural-Bas ed Acc ess-Navigation and Peer Support Special ist Program
FY 2016 -17
Budget Categories -12 month
Line Item Description (Must be itemized) FTE% Admin Direct Total
PERSONNEL SALARIES:
0001 Community Health Worker 0.25 $10,400 $10,400
0002 Peer Support Specialist 0 .70 $29,120 $29,120
0003 Peer Support Specialist 0.15 $4,368 $4,368
SALARY TOTAL 1.10 $43,888 $43,888
PAYROLL TAXES:
0031 FICA /Medicare $3,357 $3,357
0032 S .U .I. $478 $478
PAYROLL TAX TOTAL $3,835 $3,835
EMPLOYEE BENEFITS :
0040 Retirement $988 $988
0041 Workers Compensation $439 $439
0042 Health Insurance (medical vision, life, dental)) $6,600 $6,600
EMPLOYEE BENEFITS TOTAL $8,027 $8,027
SALARY & BENEFITS GRAND TOTAL $55,750
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $6,216
1011 Rent/Lease Equipment $400
1013 Building Maintenance/Janitorial $120
FACILITY/EQUIPMENT TOTAL $6,736
OPERATING EXPENSES:
1060 Telephone $600
1061 Postage $120
1062 Printing/Reproduction $200
1063 Office Supplies & Equipment $200
1064 Food $1,200
1066 Staff Mileage/vehicle maintenance $2,400
1068 Incentives for Peer Meetings/Support Groups $1,200
OPERATING EXPENSES TOTAL $5,920
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $600
1083 Other -Administrative Overhead $5,000
1084 Payroll Services $1,200
FINANCIAL SERVICES TOTAL $6,800
FY 2 016-17 TOTAL PROGRAM EX PENSES $75,206
MHSA FUNDS:
5000 PEl Funds $75,206
MHSA FUNDS TOTAL $75,206
FY 2016-17 TOTAL PROGRAM REVENUE $75,206
Page 1 of 3
M e nta l Health Servi ces Act -Prevention and Early Intervention
Fresno Ame rican Indian H ealth Project
Ex hibit C-1
Cultu ra l-Base d A c c e ss-Navi gation a nd Peer Support Spe cialist Program
FY 2017-18
Budget Categories -12 month
Line Item Description (Must be itemized) FTE% Admin Direct Total
PERSONNEL SALARIES :
0001 Community Health Worker 0.25 $10,608 $10,608
0002 Peer Support Specialist 0.70 $2g ,702 $29,702
0003 Peer Support Specialist 0.15 $4,456 $4,456
SALARY TOTAL 1.10 $44,766 $44,766
PAYROLL TAXES :
0031 FICA /Medicare $3,425 $3,425
0032 S.U.I. $477 $477
PAYROLL TAX TOTAL $3,902 $3,902
EMPLOYEE BENEFITS:
0040 Retirement $988 $988
0041 Workers Compensation $448 $448
0042 Health Insurance (medical vision , life, dental)) $6,600 $6,600
EMPLOYEE BENEFITS TOTAL $8,036 $8,036
SALARY & BENEFITS GRAND TOTAL $56,704
FAC I LITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $6,216
1011 Rent/Lease Equipment $400
1013 Building Maintenance/Janitorial $120
FACILITY/EQUIPMENT TOTAL $6,736
OPERATING EXPENSES :
1060 Telephone $600
1061 Postage $120
1062 Printing/Reproduction $200
1063 Office Supplies & Equipment $200
1064 Food $1,200
1066 Staff Mileage/vehicle maintenance $2,400
1068 Incentives for Peer Meetings/Support Groups $1,200
OPERATING EXPENSES TOTAL $5,920
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $600
1083 Other -Administrative Overhead $4,046
1084 Payroll Services $1 ,200
FINANC IAL SERVIC ES TOTAL $5,846
FY 2 017-18 TOTAL PROGRAM EXPENSES $75 ,206
MHSA FUNDS :
5000 PEl Funds $75,206
MHSA FUNDS TOTAL $75,206
FY 2017-18 TOTAL PROGRAM REVENUE $75,206
Page 2 of 3
Mental Health Services Act -Prevention and Early Intervention
Fresno American Indian Health Project
Exhibit C-1
Cultural-Based Access-Navigation and Peer Support Specialist Program
FY 2018-19 , 2019-20 and 2020-21
Budget Categories -12 month
Line Item Description (Must be itemized) FTE% Admin Direct Total
PERSONNEL SALARIES :
0001 Community Health Worker 0.25 $10,820 $10,820
0002 Peer Support Specialist 0.70 $30,297 $30,297
0003 Peer Support Specialist 0.15 $4,545 $4,545
SALARY TOTAL 1.10 $45,662 $45,662
PAYROLL TAXES:
0031 FICA /Medicare $3,494 $3,494
0032 S.U.I. $477 $477
PAYROLL TAX TOTAL $3,971 $3,971
EMPLOYEE BENEFITS:
0040 Retirement $988 $988
0041 Workers Compensation $457 $457
0042 Health Insurance (medical vision , life, dental)) $6,600 $6,600
EMPLOYEE BENEFITS TOTAL $8,045 $8,045
SALARY & BENEFITS GRAND TOTAL $57,678
FAC I LITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building $6,216
1011 RenULease Equipment $400
1013 Building Maintenance/Janitorial $120
FACILITY/EQUIPM EN T TOTAL $6,736
OPERATING EXPENSES:
1060 Telephone $600
1061 Postage $120
1062 Printing/Reproduction $200
1063 Office Supplies & Equipment $200
1064 Food $1,200
1066 Staff Mileage/vehicle maintenance $2,400
1068 Incentives for Peer Meetings/Support Groups $1,200
OPERATING EXPENSES TOTAL $5,920
FINANCIAL SERVICES EXPENSES:
1080 Accounting/Bookkeeping $600
1083 Other -Administrative Overhead $3,072
1084 Payroll Services $1 ,2 00
FINANCIAL SERVICES TOTAL $4,872
FY 2018-19, 2019-20 and 2020-21 TOTAL PROGRAM EXPENSES $75,206
MHSA FUNDS:
5000 PEl Funds $75,206
MHSA FUNDS TOTAL $75,206
FY 2018-19, 2019-20 and 2020-21 TOTAL PROGRAM REVENUE $75,206
Page 3 of 3
Mental Health Se rvices Act -Prevention and Early Interve ntion
CENTRO LA FAMILIA ADVOCACY SERVICES , INC. (CLFA)
Cultu r al-Based Access -Nav igation Speciali st Program
FY 2016-17, 2017-18 , 2018-19 , 2019-20 , 2020 -21
Ex hib it C-2
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin . Direct Total
PERSONNEL SALARIES :
0001 Peer Support Specia li st (PSS) 1.00 28,275 28 ,275
0002 Peer Support Speci alist (PSS) 1.00 26,813 26 ,813
0003 Program Coord inato r/Community Health Worker 0.40 11,700 11 ,700
SALARY TOTAL $0 66,788 66 ,788
PAYROLL TAXES:
0030 OASDI 0 0
0031 FICNMEDICARE 5 ,109 5 ,109
0032 S .U .I. 1,042 1,042
PAYROLL TAX TOTAL $0 6 ,151 6 ,151
EMP LOYEE BENEFITS:
0040 Workers Co m pensation (1.02 interim rate) 848 848
0041 Health Insurance (med ical v ision, life, dental ) (7 .5%) 11 ,520 11 ,520
EMPLOYEE BENEFITS TOTAL $0 12,368 12,368
SALARY & BENEFITS GRAND T OT AL 85,307 85 ,307
FACILITIES/EQU IPMENT EXPENSES:
1010 Rent/Lease Build ing 4 ,896
1011 Rent/Lease Equipment 720
1012 Utilities 684
1013 Bu ildi ng Maintenance/Janitori al 648
FAC ILITY/EQUIPMENT TOTAL 6 ,948
OPERATING EXPENSES :
1060 Telephone 936
1061 Postage 100
1062 Printing/Reproduction 600
1063 Office Suppl ies & Equipment 1,200
1064 Staff Mileage/vehicle ma intenance 3,000
1065 Incentives for Peer Meetings/Support Gro ups 720
OPERATING EXPENSES TOTAL 6,556
FINANCIAL SERVICES EXPENSES:
1080 Accounti ng/Bookkeeping 3 ,000
1081 External Audit 1,000
1082 Liability Insurance 450
1083 Other -Adm inistrative Overhead 12,420
1084 Payroll Services 240
FINANCIAL SERVICES TOTAL 17 ,110
TOTAL PROGRAM E X PENSES 115,921
MHSA FUNDS:
5100 PEl Funds 115,921
MHSA FUNDS TOTAL 115,921
TOTAL PROGRAM REVENUE 115,921
Exhibit C-3
Cultural Based Access Nav igation & Peer Support Services
Fresno Interden o m inational Refugee M inistries (FIRM)
Fisca l Years 2016-17, 2017-18 , 2018 -19, 2019-20 , 2020 -21
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin. Direct
PERSONN EL SALARIES:
0001 Community Health Worker (Lao) 0.75 $23,400
0002 Peer Support Specialist (1 Hmong & .5 Cambodian) 1.50 $4 3,680
0003 Supervisor 0.05 $3,100
SALARY TOTAL 2.30 $3,100 $67,080
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE $237 $5,132
0032 SU I $22 $976
PAYROLL TAX TOTAL $259 $6,108
EMPLOYEE BENEFITS:
0040 Retirement
0041 Workers Compensation
0042 Health Insurance (medical, vision , life , dental)
EMPLOYEE BENEFITS TOTAL $0 $0
SALARY & BENEFITS GRAND T OT AL
FACILITIES/EQUIPMENT EXPENSES:
1010 Rent/Lease Building
101 1 Rent/Lease Equipment
1012 Utilities
1013 Building Maintenance
FACILITY/EQUIPMENT TOTAL
OPER ATING EXPENSES:
1060 Telephone
1061 Printing/Reproduction
1062 Office Supplies & Equipment
1063 Food
1064 Program Supplies -Therapeutic
1065 Transportation of Clients
1066 Staff Mileage/vehicle maintenance
1067 Staff Training/Registration
1068 Incentives for Peer Meetings/Su pport Groups
OPERATING EXPENSES TOTAL
FI N ANCIAL SERVICES EXPE NSES:
1080 Accounting/Bookkeepi ng
1081 External Audit
1082 Liability I nsurance
1083 Administrative Overhead
FINANCIAL SERVICES TOTAL
TOTAL PROGRAM EXPENSES
MHSA FUNDS:
5000 Prevention & Early Intervention Fun ds
MHSA FUNDS TOTAL
TOTAL PROGRAM REVENUE
_Page l0fl
Total
$23,400
$43,680
$3,100
$70,180
$0
$5,369
$998
$6,367
$0
$89 1
$11,04 0
$11,931
$88,478
$150
$400
$600
$400
$1,550
$600
$500
$150
$3,600
$750
$6,500
$1 ,200
$500
$1 ,800
$15,600
$1,260
$1,400
$105
$12,000
$14,765
$120 ,393
$120,393
$120,393
$120 ,393
Cultu ra l B ased A ccess Navig ati o n & Pee r Suppo rt Servic es
W est Fres n o Fam ily Resourc e Center
2016 -17, 201 7 -1 8, 2018 -19, 2019-20, 2020-21
Budget Categories -Total Proposed Budget
Line Item Description (Must be itemized) FTE% Admin . Di rect
PERSONNEL SALARIES:
0001 Program Supervisor 0.50
0002 Community Health Worker (PM) 0.80
0003 Peer Support Specialist (DB) 0.80
0004 Peer Support Specialist (new) 0.50
0012 Title 0 .00
SALARY TOTAL 2 .60 $0 $0
PAYROLL TAXES:
0030 OASDI
0031 F ICA/MEDICARE
0032 SUI
PAYROLL TAX TOTAL $0 $0
EMP LOYEE BENEFITS:
0041 Workers Compensation 1 .000%
0042 Health Insurance (medical, vision, life, dental)
EMP LOYEE BEN EFITS TOTAL $0 $0
SALARY & BENEFITS GRAND TOTAL
OPERATING EXPENSES·
1060 Telephone
1072 Staff Mileage/vehicle maintenance
1076 Support Group meetings and supplies
OPERATI NG EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES ·
1083 Admi nistrative Overhead
FINANCIAL SERVICES TOTAL
TOTAL PROGRAM EXPENSES
MHSA FUNDS:
5000 Prevention & Early Intervention Funds
MHSA FU NDS TOTAL
TOTAL PROGRAM REVENUE
E x hi bit C-4
Total
3,640
26,624
26 ,624
15,600
0
72,488
4,494
1,05 1
1,528
7,073
725
0
725
80,286
0
0
0
0
4,280
4,280
84,566
84,566
84,566
84,566
Cultural Based Access Navigation & Peer Support Services
Sarbat Bhala, Inc.
2016-17, 2017-18, 2018-1 9,2019-20, 2020-21
Budget Categones -Total Proposed Budget
Line Item Descri ption (Must be itemized) FTE% Admin . Direct
PERSONNEL SALARIES:
0001 Project Director (In-Kind) 0 .25
0002 Community Health Worker (2 PT) 1.00 $24,000
0003 Youth & Family Peer Support (4 PT) 2.00 $24,000
0004 Title 0 .00
SALARY TOTAL 3.25 $0 $48,000
PAYROLL TAXES:
0030 OASDI
0031 FICA/MEDICARE $3,672
0032 SUI $2,976
PAYROLL TAX TOTAL $6,648
EMPLOYEE BENEFITS:
0040 Retirement $960
0041 Workers Compensation
0042 Health Insurance (medical, vision, life, dental)
EMPLOYEE BENEFITS TOTAL $0 $960
SALARY & BENEFITS GRAND TOTAL
FACILITIES/EQUIPMENT EXPENSES
1010 Rent/Lease Building
1011 Rent/Lease Equ1pment
1012 Utilities
FACILITY/EQUIPMENT TOTAL
OPERATING EXPENSES·
1060 Telephone
1061 Pnnting/Reproduction
1062 Office Supplies & Equipment
1063 Program Supplies -Therapeutic
1064 Transportation of Clients
1065 Trainers/Educators/Speakers
1066 Stipends/Consultants
1067 Other -(Identify)
OPERATING EXPENSES TOTAL
FINANCIAL SERVICES EXPENSES
1080 Accounting/Bookkeeping
1081 Liability Insurance
1082 Admini strative Overhead
FINANCIAL SERVICES TOTAL
TOTAL PROGRAM E X PENSES
MHSA FUNDS ·
5000 Prevention & Early Intervention Funds
MHSA FUNDS TOTAL
T O TAL PROG RAM REV ENUE
Exhib it C-5
Total
$0
$24,000
$24,000
$0
$48,000
$0
$3,672
$2,976
$6,648
$960
$0
$0
$960
$55,608.00
$720
$360
$720
$1 ,800
$720
$600
$720
$240
$1,000
$3,000
$2,200
$0
$8,480
$500
$500
$3,032
$4,032
69,920
69,920
69,920
69 ,9 20
STATE MENTAL HEALTH REQUIREMENTS
1. CONTROLREQUIREMENTS
Exhibit-D
Page 1 of 2
The COUNTY and its subCONTRACTOR(S)s shan provide services in accordance with aU
appli.cable Federal and State statutes and regulations.
2. PROFESSIONAL LIC ENSURE
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(S)(S) 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 ofinformatio.n requirements at 42, Code of Federal
Regulations sections 2 .1 er seq; Calif ornia 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 51 009; and Division l , Part 2.6, Chapters l-7 of
the Califomia Civil Code.
4. NON-DISCRIMINATION
A. Eligibilitv for Services
CONTRACTOR(S)(S) shall prepare and make available to COUNTY and to the
public all eligibility requirements to participate in the program plan set forth in Exhibit
B . No person shall, because of ethnic group identification, age, sex, color, disability,
medica l c011dition , 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 d iscrimination under any program or activi ty receiving
Federal or State of Califomia assistance.
B . Employment Opportunity
CONTRACTOR(S)(S) 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 f01ms of compensation, use of facilities , and other terms
and conditions o f employment.
C. Suspension o f Compensation
If an allegation of discrimination occurs, COUNTY may withho ld all further funds,
until CONTRACTOR(S)(S) can show clear and convjncing evidence to the
Exhibit-D
Page 2 of 2
satisfaction of COUNTY that funds provided under this Agreement were not used in
com1ection 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(S) who is related by blood
or marriage to, or who is a member of the Board of Directors or an officer of
CONTRACTOR(S).
5. PATIENTS' RIGHTS
CONTRACTOR(S) shall comply with applicable laws and regulations, including but not
lil:ruted to, laws, regulations, and State policies relating to patients' rights.
Vendor: Contract#
Item
0
Make/Brand Model Serial# > 1:) ';j
Q) ~ )( c: u:: 0
f/)
Q) a.
E Copier Ill Canon 27CRT 9YHJY65R X
Jl
Q) a.
E OVO Player Ill Sony DV2230 PXC4356A X
)( w
Date Prepared: -----
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Date Received :
Contact Person
Date Date
Requested Approved (
(If Fixed If Fixed
Asset) Assset)
3/27/2008 4/1/2008
n/a nla
Contact#
Purchase Locat.ion Condition Date
4/10/2008 Heritage New
4/1/2008 Heritage New
Fresno
County
Exhibit E
Page 1 of 2
Inventory Cost
Number
$6,500.00
$450.00
FIXED ASSET AND SENSITIVE I TEM TRACKING
Yield Number Pield ins truc t i on Conunents Descri pti on or
Header Ve ndo r Indicate the legal name of t he agency contracted to
provide services.
Header Prog ram Indicate the r.l t.le of the proj ect: as described i n the
concract with t he Co unty .
Header Con trace » Indicate the assigned county contract number. If not
known, Co uncy sta.ff can p r ovide .
Header: Contact: Person Indica te the first and last name of the pri mary agency
contact for the contr act:.
Header Contacc u Indicate the most appropriate telephone nu mb er ol the
prima r y a gency contact for the contract:.
Header Date Pr epared Ind i cate t he mo st c1,1r r e n t d a te that. the tracking form
was completed by the vendor.
Item Identify t h e i t em by prov i d ing a commonly recognized a des.cripr.lon o f t h e i tem.
b Ma ke/Bran d I d entify the company t hat manufactured the i t em.
0 Mo d el Identify t h e model number for the item, if app1.icable.
d Seri a l II I denti fy the serial number for the item, if
a ppli cabl e .
Mark the box with an 'ux u if the cost pf the item is
e Fixed Asse t. $5,000 or mo r e to i ndicate that the item is .a fix ed
asset.
f Sen siti ve I tem Mark the box with a n "X '' if the i tem meets the
criteria of a sensicive item as de£ined by the Co u nty.
Date Reque s ted Ind i c ate t he da t e that the agency submitted a r equ est
9 t:O the County to p u rchase the item.
h Date Apprmred Indicate the dace tha t t he Co.u nty approved the request
to pu rchase the item.
i l?urchase Da te Indi .c a te t.he da te the age ncy p urchased the i t.em .
j Lo cation Indica te t.he p hy sica l location of tne item
k Con d i tion Indicate the general condition of the item {New, Go od,
Worn, a:adl .
Fresno Cou n ty
1 Inventery Indicate t he FR u provj,ded b y t he Cou m::.y for the i tem.
Numb e r
Co st: Indicace the total p urcha s e p ric e o f the i.tem m including; sales t ax and o ther costs, such a s s hipping .
EX HIBIT -E
Page 2 of 2
Requi re¢! or
Conditional
Requ ired
Reqllired
Requ ire d
Req\ti red
Requ ir~d
Req uired
Required
Requ ired
Co n ditional
Con ditional
Cond i tion.a l
Conditional
Requ.t red
Req\tlred
Re.quir r~d
Ri!q uired
Required
Conditi onal
Req u.i c~d
Exhibit F
Page 1 of3
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 wruch 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. ContractOT 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 a:nd 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 , comteously 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 0r guideline
5. Take precautions to ensure that claims are prepared and submitted accurately, timely and are
consistent with all applicable laws, regu lations , rules or guidelines.
6. Ensure that no false, fraudulent, inaccurate or fictitious claims for payment or reimbursement
of any kind are submitted.
7. BiU only for eligible services actually rendered and fully documented. Use billing codes that
accmately describe the services provided.
Exhibit F
Page 2 of3
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 repmi 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.
I 0. Consult with the Compliance Ofi1cer if you have any questions or are uncertain of any
Compliance Program standard or any other applicable law, regulation, ruJe or guideline .
11. Immediately notify U1e Compliance Officer if they become or may become an Ineligible person
and therefore excluded from patiicipation in the Federal Health Care Programs.
Fresno countv MeDial Health Compliance Program
Contractor Acknowledgment and Agreement
E xhibit F
Page 3 of3
I hereby ack nowledge that I have received, read and understand the Co ntractor Code of Con duct and
Ethics . I herby acknowledge that I have rece ived 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 Prog ram requirements as they apply to my
responsibilities as a mental hea lth 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 Comp liance Program is a violation of
County po licy and may also be a violation of applica ble laws, regulations , rules or guideli nes. I further
understand that violation of the Contract or Code of Conduct and Ethics or the Compl iance Program
may result in te rmination of my agreement wi th Fresno Cou nty. I f urther understand that Fresno
County will report me to the appropriate Federal or State agency .
F or Indiv idual P r ovider s
Name (print): _______________ _
Discipline: D Psychiatrist D Psychologist D LCSW D LMFT
Signature : _______________ ___ Date : _/ __ /_
For Group or Organ ization a l Provid er s
Grou pi Org. Name (p rint): _______________ _
Employe e Name (print): ________________ _
Discipline: D Psychiatrist D Psychologist D LCSW D LMFT
D Other: ________________ _
Job Title (i f different from Discipline): ___________ _
Signature: Date: I I --------------
MHSA GUIDELINES
GRIEVA NCES AND INCIDENT REPORTING
Grievances
Exh i bit G
Page 1 of 4
Fresno County MHSA Guidelines (MHSAG) provides beneficiaries with a grievance and
appeal process and an expedited appeal process to resolve grievances and disputes at the
earliest and the lowest possible level.
Title 9 of the California Code of Regulations requires that the MHSG and its fee-for-service
providers give verbal and written information to Medi-Cal beneficiaries regarding the following:
• How to access specialty mental health services
• How to file a grievance about services
• How to file for a State Fair Hearing
The MHSG has developed a Consumer Guide , a beneficiary rights poster, a gri evance form ,
an appeal form , and Request for Change of Provider Form . All of these beneficiary materials
must be posted in prominent locations where Medi -Cal beneficiaries receive outpatient
specialty mental health services, including the wa iting rooms of providers' offices of serv i ce.
Please note that all fee-for-service providers and contract agencies are required to give their
clients copies of all current beneficiary information annually at the ti me thei r treatment plans
are updated and at intake.
Beneficia.ries have the right to use the grievance and/or appeal process without any penalty ,
change in mental health services , or any form of retaliation. All Medi-Cal beneficiaries can file
an appeal or state hearing.
Grievances and appeals forms and self addressed envelopes must be available for
benefici aries to pick up at all provider sites without having to make a verbal or written request.
Forms can be sent to the following address :
Fresno County Mental Health Plan
P.O. Box 712
Fresno, CA 93712
(800) 654-3937 (for more information)
(559) 488-3055 (TTY)
Provider Problem Resolution and Appeals Process
The MHSG uses a simple , informal procedure in identifying and reso lving provider concerns
and problems regarding payment authorization issues, other complaints and concerns .
Informal provider problem resolution process-the provider may first speak to a Provider
Relations Specialist (PRS) regarding his or her complaint or concern .
The PRS will attempt to settle the comp laint or concern with the provider. If the attempt is
unsuccessfu l and the provider chooses to forego the informal grievance process, the provider
will be advised to f ile a written complaint to the MHSG address (listed above).
Formal provider appeal process -the provider has the right to access the provider appeal
process at any time before, during , or after the provider problem resolut ion process has
Ex hi b it G
Pa ge 2 o f 4
begun , when the complaint concerns a denied or modified request for MHSG payment
authorization , or the process or payment of a provider's claim to the MHSG.
Payment authorization issues-the provider may appeal a denied or modified request for
payment authorization or a dispute with the MHSG regarding the process ing or payment of a
provider's claim to the MHSG . The written appeal must be submitted to the MHSG within 90
calendar days of the date of the receipt of the non-approval of payment.
The MHSG shall have 60 calendar days from its receipt of the appeal to inform the provider in
writing of the decision , including a statement of the reasons for the decision that addresses
each issue raised by the provider, and any action required by the provider to implement the
decision .
If the appeal concerns a denial or modification of payment authorization request, the MHSG
utilizes a Managed Care staff who was not involved in the initial denial or modification decision
to determine the appea l decision .
If the Managed Care staff reverses the appealed decision , the provider will be asked to submit
a revised request for payment within 30 calendar days of receipt of the decision
Other complaints-if there are other issues or complaints, which are not related to payment
authorization issues, providers are encouraged to send a letter of complaint to the MHSG.
The provider will receive a written response from the MHSG within 60 calendar days of receipt
of the complaint. The decision rendered buy the MHSG is final.
PROTOCOL FOR COMPLETION OF INCIDENT REPORT
Ex hibit G
Page 3 of 4
• The Incident Report must be completed for all incidents involving clients. The staff person
who becomes aware of the incident completes this form , and the superv isor co-signs it.
• When more than one client is involved in an incident, a separate form must be completed
for each client.
Where the forms should be sent -within 24 hours from the t ime of the incident
• Incident Report should be sent to :
• DBH Program Supervisor
INCIDENT REPORT WORKSHEET
When did this happen? (date/time) _______ Where did this happen?
Name/DMH #
1. Bac kground inf or mati on of t he incident:
2. Method of investigation: (chart review, face-to-face interview, etc.)
Who was affected? (If other than consumer)
List key people invo lved . (witnesses, visitors, physicians, employees)
Exhibit G
Page 4 of4
3. Prel imina ry findings: How did it happen? Seq uence of events . Be specific . If attachments are needed write
comments on an 8 1/2 sheet of paper and attach to worksheet.
Outcome severi ty : Nonexistent 0 inconsequential 0 consequential 0 death ·o not applicable 0 unknown D
4. Res ponse: a) corrective action , b) Plan of Action , c) other
Completed by (print name) -------------------------
Completed by (signature) _____________ Date completed
Re viewed by Supervisor (print name)
Supervisor Si gnature Date
DISCLOSURE OF OWNERSHIP AND CONTROL INTEREST STATEMENT
I. ld ent if ing In form ation
Name of enlity 0 /BIA
Addless (number, slfeet) City
CUA number Taxpayer 10 number (EIN) T elCphO<l o number
(
ZIP code
Exhibit H
Page 1 of 2
II. Answer the following questions by checking "Yes" or ''No ." If any of the questions are an-swered "Yes," list names and
addresses of individuals or corporations under "Remarks" on page 2. ldentify each item number to be continued .
A Are there any individuals or organizations having a direct or indirect ownership or control interest
of five percent or more in the institution , organizations , or agency that have been convicted of a criminal
offense related to the involvement of such persons or organizations in any of the programs established
by Titles XVIII , XIX , or XX? ........................................................................................................................ .
B. Are there any directors, officers , agents , or managing employees of the institution , agency , or
organization who have ever been convicted of a criminal offense related to the ir involvement in such
programs established by T itles XVIII, XIX, or XX? .................................................................................... ..
C . Are there any individuals currently employed by the institution , agency, or organization In a managerial,
accounting , auditing , or similar capacity who were emp loyed by the institution's, organization's , or
agency's fisca l intermediary or carrier within the previous 12 months? (Title XVIII providers only) .......... .
YES NO
a o
a a
a a
Ill. A List names, addresses for individuals, or the EIN for organizations having direct or indirect ownership or a controlling
interest in the entity. (See instructions for definition of ownership and controlling interest.) List any additional names
and addresses under "Remarks" on page 2 . If more than one individual is reported and any of these persons are
related to each other, this must be reported under "Remarks."
NAME ADDRESS EIN
B. Type of entity: a Sole proprietorship cr Partnership o Corporation
a Unincorporated Associations a Other(specify) ________ _
C . If the disclosing entity is a corporation , list names , addresses of the directors , and EINs for corporations
under "Remarks."
D. Are any owners of the di sclos ing entity also owners of other Med icare!Medicaid facilities?
(Exa.mpie: sole proprietor, partnership, or members of Board of Directors) If yes , list names, addresses
of individuals, and provider numbers .......................................................................................................... . a a
NAME ADDRE SS PRO VIDER NUMBE R
IV. A. Has there been a change rn ownership or control within the last year? ...................................................... .
If yes , give date.
B. Do you anticipate any change of ownership or control within the year? ...................................................... .
lfyes,when? ______________________________________ __
C. Do you anticipate filing for bankruptcy within the year? .............................................................................. ..
If yes, when? -----------------------------------------
V . Is the facility operated by a management company or leased in whole or part by another organ ization? ..........
If yes , give date of change in operations .
VI. Has there been a change in Administrator, Director of Nursing, or Medical Director within the last year? .........
VII. A. Is this facility chain affiliated? ......... -.......................................................................................................... ..
If es, list name , address of cor oration, and EIN .
Name EtN
Addtess (number, n ame ) Cll\1 State
B. If the answer to question VILA. is NO, was the facility ever affiliated with a chain?
(If yes, list name, address of corporation, and EIN .)
Nam e EIN
Address (11\Jmber, nam e) City Slate
ZIP code
ZIP cod e
Exhibit H
Page 2 of 2
YES NO
0 0
0 0
0 0
0 0
0 0
0 0
Whoever knowingly and willfully makes or causes to be made a false statement or representation of this statement, may be
prosecuted under applicable federal or state laws. In addition, knowingly and willfully falling to fully and accurately disclose the
information requested may result in denial of a request to participate or where the ent;ty already participates, a termination of
its agreement or contract with the agency, as appropriate.
Na me of authori zed tepre·sentatlve (lyped ) Tille
SI!)Miure Date
Remarks
Exhibit I
Page 1 of2
CERTIFICATION REGARDING DEBARMENT,
SUSPE N SION , AND OTHER
RESPONSIBILITY MATTERS--PRIMARY COVERED
TRAN SACTI ONS
INSTRUCTIONS FOR CERTIFICATION
1. By signing and submitting this proposal, the prospective primary participant is providing
the certification set out below.
2. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective participant shall
submit an explanation of why it cannot provide the certification set out below. The
certification or expla nation wil l be considered in connection with the department or
agency's determination whether to enter into this transaction. However, failure of the
prospective primary participant to furnish a certification or an explanation shall disqualify
such person from participation in this transaction.
3. The certification in this clause is a material representation of fact upon which reliance was
placed when the department or agency determined to enter into this transaction . If it is
later determined that the prospective primary participant knowingly rendered an erroneous
certification , in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause or default.
4 . The prospective primary participant shall provide immediate written notice to the
department or agency to which this proposal is submitted if at any time the prospective
primary participant learns that its certification was erroneous when submitted or has
become erroneous by reaso n of changed circumstances.
5 . The terms covered transaction , debarred, suspended , ineligible, participant, person ,
primary covered transaction, principal, proposal, and voluntarily excluded, as used in this
clause , have the mean ings set out in the Definitions and Coverage sections of the rules
implementing Executive Order 12549. You may contact the department or agency to which
this proposal is being submitted for assistance in obtaining a copy of those regulations.
6 . Nothing contained in the foregoing shall be construed to require establishment of a system
of records in order to render in good faith the certification required by this clause. The
knowledge and i nformation of a participant is not required to exceed that which is no rmally
possessed by a prudent person in the ordinary course of business dealings .
CERTIFICATION
Exhibit I
Page 2 of2
(1) The prospective primary participant certifies to the best of its knowledge and be lief, that it,
its owners, officers, corporate managers and partners:
(a) Are not presently debarred, suspended , proposed for debarment, declared ineligible,
or voluntarily excluded by any Federal department or agency;
(b) Have not within a three-year period preceding this proposal been convicted of or had a
civil judgment rendered against them for commission of fraud or a criminal offense in
connection with obtaining , attempting to obtain, or performing a public (Federal, State
or local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft , forgery , bribery, falsification or
destruction of records , maki ng false statements, or receiving stolen property ;
(c) Have not within a three-year period preceding this application/proposal had one or
more public transactions (Federal , State or local) terminated for cause or default.
(2) Where the prosp.ective primary participant is unable to certify to any of the statements in
this certification , such prospective participant shall attach an explanation to th is proposa l.
Signature: Date :
(Printed Name & Title) (Name of Agency or Company)"
SELF-DEAUNG TRANSAO"ION DISCLOSURE FORM
Exh ibit J
Page 1 of2
In o rder 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-dea li ng 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 be i ng 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 natu re of the material financial interest in the Corporation's transaction that the
board member has .
(4) Describe i n 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).
(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)
Exhibit J
Page 2 o£2
(4) Explain why this self-dealing transaction i s consistent with t he requirements of Corporations Code 5233 (a)
(5) Authorized Signature
Signature : I I Date:
I