Supervised Visitation Services

Procurement 530-13-0102

Contracting with DFPS

The Road to a Successful Contract

Meets Client Needs

Meets DFPS DFPS Needs Needs Meets

Fulfills Contract Terms

DFPS Mission Program Purpose Service Authorization Processes for Supervised Visitation Documentation & Record Keeping Contractor Performance Measures

The Mission of DFPS is to protect children, the elderly and people with disabilities from abuse, neglect, and exploitation by working with clients, families and communities.

DFPS Mission
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To obtain the expertise of a Contractor that will:

Effectively monitor and adequately document the observations of behaviors and interactions between participants in a sibling visit or visits between children and their parents or caregivers. Provide appropriate documentation that is of the quality and within the timeframes to enable CPS to make the best permanency decision for the child. Offer flexible hours to accommodate participant schedules. Offer Emergency/Expedited supervised visits as legally directed

Offer services in locations convenient to the participants.

Offer services in sites appropriately equipped for different participant needs.

Contract Purpose
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Requirements

Broadband Internet Connection Internet Explorer 6.0 or Higher Microsoft Word Email Address Anti-Virus Program (Active and Up-to-Date)

DFPS Internet Site

DFPS Internet Homepage

Purchased Client Services (PCS) Homepage

Regional CPS Contracts Homepage Regional CPS Contracting Forms Client Services Contractor Reference Guide ABCS Registration ABCS User Login
Select Contracting with DFPS from the DFPS Internet Homepage

http://www.dfps.state.tx.us/

Technology
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http://www.dfps.state.tx.us/PCS/About_ PCS/

Select to Access the Regional CPS Contracts Homepage

Quick Links: Select Contracting and Procurement Forms to Obtain the 2970C and 2971C

DFPS Internet Site

Scroll down to Log-in to ABCS

Purchased Client Services (PCS) Homepage

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http://www.dfps.state.tx.us/PCS/Regional_Contr acts/

Select to Access Forms

DFPS Internet Site

Regional CPS Contracts Homepage

DFPS Internet Site

Regional CPS Contracting Forms

Forms Grouped by Category Click on Category to AutoScroll to Applicabl e Forms

Supervised Visitation Services

Authorization to Provide Supervised Visitation

Form 2054 (Service Authorization)

Participants Referral Information

Form 3101 Referral for Supervised Visit Services DFPS Caseworker may indicate Emergency/Expedited for services

Court Related Services

Authorization to Provide Court Related Services

Form 2054 (Service Authorization)

Note: A current Form 2054 must be received prior to services being rendered and must be maintained in each clients record.

Referrals

Valid Referral Packet Contents (Minimum)

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Supervised Visitation Services

Within three (3) business days from the receipt of the complete referral (Form 2054 and Referral Packet) Make initial contact with Household and notify participants of:

The date and time the initial visit will occur Who may visit The location where the visit will be held Preliminary visitation rules or general information

Hold the first (1st) visitation within ten (10) business days of receipt of the authorization to provide services. Emergency situations may occur requiring a need for expedited services. Work closely with DFPS Caseworker to expedite service delivery as requested.

Contractor Contact Information

Contractor must provide the participants with at least two (2) of the following methods to contact the Contractor in the event participant needs to cancel an appointment. Phone number Email address Number to send a text message

Initial Contact Timeframe

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Preparation for Supervised Visit

Includes all activities necessary to prepare to oversee for each supervised visit.

Pre-Visitation Activities
Includes preparing the participating adults prior to the supervised visit in order to lay the ground work for a productive visit.
Initial Visit (Each 2054 must include all Initial Visit activities) Standard Visit (All visits except the Initial Visit)

Visit Monitoring & Supervision

Includes observing the entire visit and the interactions of the participants.

Visit Documentation
Includes documentation of the observations between all participants.

Court Related Services

Includes preparing for, testifying and documenting the court related event.

Service Expectations
Major Service Deliverables
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Emergency/Expedited Supervised Visitation

Within 24 hours from the receipt of the complete referral (Form 2054 and form 3101-Referral Packet) 1. Make initial contact with Household and notify participants of: 2. The date and time the initial visit will occur 3. Who may visit 4. The location where the visit will be held 5. Preliminary visitation rules or general information Hold the Emergency/Expedited visitation within ten (3)days of receipt of the authorization (form 2054 & form 3103) to provide services.

Contractor Contact Information Contractor must provide the participants with at least two (2) of the following methods to contact the Contractor in the event participant needs to cancel an appointment. Phone number Email address Number to send a text message

Emergency/Expedited Contact
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Secure an appropriate visitation site based on CPS Caseworker recommendations visitation venues;
A= Private-Secure visitation settings; CPS Office, Contractor Office, Contractor Satellite Office B= Semi-Private, Secure visitation settings;

Extended family home, private dining area in public restaurants, etc. C= Public-Secure visitation settings; Restaurants, Parks, etc.
Contractor must receive approval directly on the Service Authorization (Form 2054)
Contractor must obtain written approval from the CPS Program Liaison

Confirm the visitation schedule

Confirm who may participate in the visitation Ensure all preparation activities have been completed

Service Expectations
Preparation for Supervised Visit
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Prepare and equip visitation site

Meet with Adult Participants prior to children being present
Read the Visitation Rules on Form 3103A with the Adult Participants
Supervised Visitation Rules for Adult Participants (Form 3103A)

Finalize Visitation Plan

Visitation Plan is located in the Certification section of Form 3103A.

Ensure each Adult Participant signs and dates Form 3103A

Provide each Adult Participant a completed & signed copy of Form 3103A Adult participant refuses to sign Form 3103A
Notify CPS Caseworker by 5:00 p.m. on the business day following the refusal Record the following information in the box at the bottom of Form 3103A Reason for refusal Date and manner CPS Caseworker notified on the refusal Instructions provided by the CPS Caseworker

Service Expectations

Pre-Visitation Activities: Initial Visit

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Prepare and equip visitation site

Meet with Adult Participants prior to children being present
Review the Visitation Rules on Form 3103A with the Adult Participants
Supervised Visitation Rules for Adult Participants (Form 3103A)

Review Visitation Plan

Visitation Plan is located in the Certification section of Form 3103A.

LAST VISIT
Observer Agency Date

OF

AUTHORIZED 2054

Prepare Supervised Visitation Satisfaction Survey Questionnaire for each Adult Participant with the Observer name, Contractor name and date distributed.

Service Expectations

Pre-Visitation Activities: Standard Visit & Emergency/Expedited Visits

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Observation
Observer must be present for the entire visit. Observer must be attentive to the interactions of all the participants. Observer must only observe one (1) visitation at a time. Observer must observe and document observations of the parents or caregivers interactions with the child/children during the visit. Document observations on the Parent/Caretaker Visitation Record and Observation Checklist (Form 3102A). Provide to CPS Caseworker within five (5) business days of the visitation date. Observer must observe and document observations of interactions between siblings during sibling visits. Document observations on the Sibling Relationship Checklist (Form 3113). Provide to CPS Caseworker within five (5) business days of the visitation date.

Prior Approval to Participate

All attendees must be approved by DFPS to participate in the visit prior to the visit. All Adult Participants must sign the Sign-In Log (Form 3104A) in order to participate.

Service Expectations
Visit Monitoring & Documentation
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Video Recording the Visit

Contractor must record the visit upon written request of DFPS. Format: standard DVD Provide the recorded DVD to the CPS Caseworker within five (5) business days of the visitation date.

Safety
Visit must end at any time the child/children express or exhibit fear of continuing the visit. Visit must end at any time there are safety concerns. Only persons authorized by DFPS are allowed to remove the child/children from the visit. All adult attendees must comply with the Visitation Rules.

Communication
Participants must be allowed to converse in the language of their choice. Observer must be able to understand and effectively communicate with the participants.

Supervised Visitation Satisfaction Survey Questionnaire

Provide to each Adult Participant at the end of the last scheduled visit authorized by an individual 2054. Completion of the questionnaire is anonymous and voluntary.

Service Expectations
Visit Monitoring & Documentation
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Court Related Services allowed under this Contract:

ONLY when DFPS requests the service via a valid Form 2054 (Service Authorization).

Contractor must:
Receive a 2054 (Service Authorization) Print and Complete Form 2057 (Court Related Services Case Note)
Take to the Deposition or Court Hearing Complete and Sign Obtain DFPS Authorized Signature

Submit Form 2057 with the Invoice

File Copy of Form 2057 as Case Note in the Assessment file.

Service Expectations
Court Related Services
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FORM #
2054 3101 3102A

FORM NAME
Service Authorization Referral for Supervised Visit Services Parent/Caretaker Visitation Record and Observation Checklist Supervised Visitation Rules for Adult Participant(s) Sign-In Log No No

PROVIDE

TO

DFPS

CLIENT FILE
Yes Yes Yes

FILE

IN

Provide to Caseworker within 5 BD* of Visit Date Provide Copy to Adult Participant(s) Missed Appointment Provide to DFPS Caseworker by 5:00 p.m. on next BD* Provide to DFPS Caseworker within 5 BD* of Visit Date Submit to DFPS with Invoice

3103A

Yes

3104A

Yes

3113 2057

Sibling Relationship Checklist Court Related Services Case Note

Yes Yes

*Business Day 1Refer to Client Record Documentation Requirements Section 2.20 (Table 3) in the Statement of Work

Deliverables

Documentation1 & Timeframes

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Missed Appointments (by Client)

A missed appointment is when a Client fails to notify the Contractor within twenty-four (24) hours of the scheduled appointment AND fails to present themselves for the scheduled visitation. After each missed appointment Document the time and date of any missed appointment and obtain the signatures of those present on the Sign-In Log (Form 3104A). Send Form 3104A to the CPS Caseworker by 5:00 p.m. on the business day following the missed appointment. After two (2) consecutive missed appointments Obtain instructions on how to proceed from the DFPS Caseworker. The DFPS instructions must be documented on Form 3104A that clearly identify the scheduled appointment time and date for the visitation appointment that was missed. Missed appointments without this authorization will not be billable to DFPS as visitation or missed appointments. Do not schedule further appointments unless instructed by DFPS.

Cancellations (by Contractor)

The Contractor must notify participants and DFPS Caseworker twenty-four (24) hours prior to Contractor cancelling a visitation appointment. The Contractor must maintain documentation and contacts in each Client file regarding cancellation.

Cancelled or Missed Appointments

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Maintain sufficient funds to support the contracted services.

Have an operational system for managing referrals, assignments, and distributing reports. Ensure Supervisory Staff and Monitors meet minimum qualifications and required pre-service orientation. Meet all submission and documentation requirements. Maintain accurate and complete claims and supporting documentation. Develop, manage and maintain a continuous quality improvement process to satisfy the requirements of the contract.

Complete all contracting actions.

Administrative Functions
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Background Check
Applies to All Contractors Employees, Volunteers & Subcontractors
Involved in Direct Delivery of Services to Clients Who Will Have Access to Personal Client Information

Contractor Must Submit Requests Electronically through the DFPS Automated Background Check System (ABCS) Required Every 2 Years Forms 2970c and 2971c
Employee/volunteer/subcontractor information requested on these forms is collected in order to run the background check. Contractor must file the completed 2970c and 2971c with cleared disposition in the employee/volunteer/subcontractor personnel record.

List of Staff, Subcontractors and Volunteers

Applies to All Persons Providing Services or Having Access to Client Information
Submit Form PCS-102 within three (3) months of Contract execution Submit Form PCS-102 annually thereafter on the first business day of each July during the Contract Period of Performance

Report All New Persons Associated with this Contract Using PCS-102

Staff/Subcontractors
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Staff
Staff Record Must Be Maintained

Subcontractors
All subcontractors providing services under this Contract must meet the same requirements as specified in this Contract. Prior to the commencement of any services by any subcontractor:
Contractor must receive written acceptance of its subcontract document, subcontracting policies and procedures, and background check procedures within 90 days from the contract effective date. Contractor must receive written DFPS approval on the PCS-102 of the use of the subcontractor.

Staff/Subcontractors
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All Required Records

Must be made accessible to DFPS staff upon request. Must support all Contractor Minimum Qualification requirements for Employees, Subcontractors, and Volunteers.

Required Personnel Records

Performance Measure Records

Must maintain documentation to support validity of performance measure results.
All dated Supervised Visitation Satisfaction Survey Questionnaires A copy of the calculation of the final tally reported to DFPS Contract Performance A copy of the results reported to DFPS Contract Performance

Required Contractor Case Records*

Must include Complaint Investigation and Outcome Reports. Individual Client files and documents must support all services provided. Documentation must exist to adequately support all claims. Case records must be housed or maintained in a central location.

*Note: DFPS reserves the right to require additional records from the Contractor as needed.

Required Record Keeping

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Process DFPS Receives a Complaint DFPS Notifies the Contractor DFPS Determines Who Investigates
DFPS Investigates
Contractor Investigates Report Preliminary Information to DFPS within 5 Business Days of Receiving the Complaint Investigation Completed Determination Reached Complaint Not Validated Complaint Validated

DFPS Notifies Contractor of Determination and Findings

Complaints
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Monitoring
On-Site Monitoring Planned

Notice of Monitoring Activity Inform of Goals and Objectives

Conducted with Least Disruption to Day-to-Day Operations as Possible Results Communicated During Exit Conference Contractor Satisfaction Survey Distributed Desk Review Billing Review Formal Monitoring Report Provided to Contractor

Performance Measures
Pursuant to Texas Human Resources Code 40.058(b) all Contracts for client services must include clearly defined goals and outcomes that can be measured to determine whether the objectives of the program are being achieved. Performance Measure results will be provided to the Contractor in order to assist the Contractors compliance with the terms of the contract, DFPS policies, and applicable state and federal regulations.

Contract Evaluation
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Performance Measures
Outcome #1
Authorized services provided by the Contractor meet Caseworker expectations.

Target
Percent of aggregated favorable responses made to items on the Caseworker Satisfaction Survey Questionnaire: 90%

Quarterly Performance Periods

September 1 November 30 December 1 February 28/29

March 1 May 31 June 1 August 31

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Performance Measures
Methodology
How Will Performance Be Calculated?
Performance will be calculated for each performance period, wholly or partially, depending on the contract start and end dates.
The aggregated number of favorable responses to the Caseworker Satisfaction Survey Questionnaires obtained from Caseworkers for the outcome performance period. The aggregated number of all responses, excluding N/A responses, to the Caseworker Satisfaction Survey Questionnaires obtained from Caseworkers for the outcome performance period.

= % of aggregated favorable responses made to items on the Caseworker Satisfaction Survey Questionnaire

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Performance Measures
Outcome #2
Authorized services provided by the Contractor meet Participant expectations.

Target
Percent of aggregated favorable responses made to items on the Supervised Visitation Satisfaction Survey Questionnaires: 50%

Quarterly Performance Periods

September 1 November 30 December 1 February 28/29

March 1 May 31 June 1 August 31

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Contractor will bill for appropriate unit of service based on the type of service, the site of service delivery and the applicable number of units provided. Fees for all service delivery areas specified below:
Ector (Gardendale, Goldsmith, Odessa and West Odessa), Midland (Midland), Andrews (Andrews and McKinney Acres), Ward (Barstow, Monahans, Thorntonville, Wickett, Grandfalls, and Pyote), and Howard (Coahoma, Forsan, Sand Springs and Webb Village) Counties.

Unit Rate
Service Service Code Unit of Service In CPS Office Location Other than CPS Office Add On for Video Recording Visit

Rules Discussion & Visitation Planning Visitation Missed Appointments Court Related Services

92L

One Time

$7.50

$10.00

92L 92L 86H

*Hourly One Time *Hourly

$30.00 $15.00

$40.00 $20.00 $40.00

$5.00

Compensation
*Contractor will bill for appropriate unit of service based on the type of service, the site of service
delivery and the applicable number of units provided.
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Pre-Visitation Rules Review Compensation

Contractor must bill a one-time fee per family unit for time spent presenting and discussing the Supervised Visitation Rules for Adult Participants and the Visitation Plan.

Visitation Compensation
The Unit of Service is per hour of face-to-face time spent observing, videotaping and documenting the visit.

Missed Appointments Compensation

Compensated at 50% of the applicable Unit of Service.

Court Related Services Compensation

The Unit of Service is per hour for time spent waiting to testify and for the provision of Court Related Services.

All Billing
Billed under the name of the oldest family member in attendance. Time spent waiting to begin the Visitation Services when participant is late is billable from the moment the visit is scheduled to begin until the time the visit is completed. Beginning and ending time supporting the Unit of Service billed must be documented in each Client file on the applicable observation checklists and sign-in logs.

Compensation
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Invoicing
DFPS
Create 2054 Send Send Pre-Bill Pre-Bill

Receive 2054

Provide Service

Review Pre-Bill

Contractor
Send Billing Invoice Complete Billing Invoice Determine Billable Amount

Send Billing Invoice & Forms to DFPS

Billing Invoice (Pre-Bill), signed Form 2016, if applicable

Form 4116-Xe, signed Form 2057 for Each Court Ordered Service Billed, signed

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Invoicing
In CPS Office

Determine Billable Amount

Yes

$7.50
No

Rules Discussion & Visitation Planning

Completed & Signed 3102A

$0

Receive Pre-Bill

What is the Service?

Visitation

Completed & Signed 3102A or 3113?

Yes

$30/hr
Video Recording

$5.00

No

Court Related Services

Completed 3104A For Missed Appointment?

Yes

$15.00

No Have DFPS-Signed 2057? No

$0
For visits conducted in the following service delivery areas: Ector (Gardendale, Goldsmith, Odessa and West Odessa), Midland (Midland), Andrews (Andrews and McKinney Acres), Ward (Barstow, Monahans, Thorntonville, Wickett, Grandfalls, and Pyote), and Howard (Coahoma, Forsan, Sand Springs and Webb Village) Counties 33

Yes

$40/hr

Invoicing
Location Other than CPS Office
Receive Pre-Bill What is the Service?

Determine Billable Amount

Yes

$10.00
No

Rules Discussion & Visitation Planning

Completed & Signed 3102A

$0

Visitation

Completed & Signed 3102A or 3113?

Yes

$40/hr
Video Recording

$5.00

No

Court Related Services

Completed 3104A For Missed Appointment?

Yes

$20.00

No Have DFPS-Signed 2057? No

$0
For visits conducted in the following service delivery areas: Ector (Gardendale, Goldsmith, Odessa and West Odessa), Midland (Midland), Andrews (Andrews and McKinney Acres), Ward (Barstow, Monahans, Thorntonville, Wickett, Grandfalls, and Pyote), and Howard (Coahoma, Forsan, Sand Springs and Webb Village) Counties 34

Yes

$40/hr

DFPS and Contractor may make modifications to this Contract according to the requirements in Section 8 of the Uniform Terms and Conditions (2282UTC).

8.1.1 Bilateral Amendment 8.1.2 Unilateral Amendment 8.1.3 Contract Renewal

Contract Changes
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Initial Contact (Regular Visit)

Within 3 Business Days of Complete Referral Packet
Make initial contact with Client

Missed Appointment (by Client)

Form 3104A to Caseworker by 5:00 p.m. on Business Day Following Missed Appointment After 2 Missed Appointments: Do Not Schedule Unless Instructed to by DFPS

Initial Contact (Emergency Visit)

Within 24 hours initial contact of Complete Referral Packet

Cancel by Contractor
24-Hour Notice to Client Required

1st Visitation (Regular Visit)

Within 10 Business Days of Complete Referral Packet

Pre-Visitation Explain Visitation Rules Obtain Signed Form 3103A Visitation Obtain Signatures on Sign-In Log Form 3104A

Complaints
Within 5 Business Days from Notification
Submit preliminary report

Invoice
15th Day of the Month
Submit Invoice Court Related Services Include 2057 with Invoice

1st

Visitation (Emergency) within 72 hours

Visit Documentation

Due to Caseworker within 5 Business Days of the Visit Date

Form 3102A or 3113 Associated DVD (if applicable)

Timeframes Recap

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Form 2054 Service Authorization

Form 3101 Referral for Supervised Visit Services Form 3102A Parent/Caretaker Visitation Record and Observation Checklist Form 3103A Supervised Visitation Rules for Adult Participant(s) Form 3104A Sign-In Log Form 3113 Sibling Relationship Checklist Form 2057 Court Related Services Case Note

2016 Delivered Services Input Supplement to the Pre-Bill

Form 4116-Xe State of Texas Purchase Voucher

Handouts
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DFPS CPS/PCS Regional Contracts Region 08 Contacts

Contract Managers
Shelly Grunewald; Tel. 210-337-3573 Email: shelly.grunewald@dfps.state.tx.us

Contract Technicians
Linda Bernal. Tel. 210- 337-3597 Email: linda.bernal@dfps.state.tx.us

Victoria Navarette; Tel. 210-337-3132 Email: victoria.navarette@dfps.state.tx.us

Sandra Levrie. Tel. 210-304-3887 Email: sandra.levrie@dfps.state.tx.us

Samuel Garcia; Tel. 210-337-3400 Email: samuel.garcia@dfps.state.tx.us

Contract Director Linda Tavel

Phone (210) 337-3362

Email Linda.Tavel@dfps.state.tx.us

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