[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
Enter Bidder’s Name in the header area above.
This form is broken into the following twelve (12) sections:
Section D-1. ADMINISTRATIVE RESPONSES (PASS/FAIL)
Section D-2 Services Priorities for Funding Response;
Section D-3. Statewide Model Response;
Section D-4. Diversity and Inclusion Response;
Section D-5 Agency Background Response;
Section D-6. Staff Qualifications Response;
Section D-7. Service Delivery Response;
Section D-8. Client Records Response;
Section D-9 Document Management Response;
Section D-10 Program Evaluation Response;
Section D-11 Budget and Fund Projection
Section D-11Financial Statement; and
Section D-12. Bidders References.
Bidders must respond to all questionsin all sections of this Attachment in the expandable space provided or as directed. If a question requires Bidder to submit additional documents, please attach them (do not imbed the document) to this document or email and label them clearly as part of your response to this AttachmentC. If an attachment is provided, please include the name of the attachment in the Response field.
Please follow instructions for each section. Failure to respond to instructions specific to any section may result in Bidder’s disqualification.
SECTION D-1 – ADMINISTRATIVE RESPONSES (PASS/FAIL)
Instructions: Bidders Response to the questions in this Section D-1, combined with the information provided in referenced required Attachments, demonstrates compliance with the Administrative Requirements of this Solicitation. While the Administrative Response is not given a numbered score, information provided as part of Bidder’s Administrative Response may cause the Bidder Response to be disqualified and may be considered in evaluating Bidder’s qualifications and experience.
# / Response Requirements Checklist: / Included: YES/NO1 / Bidder’s Letter of Submittalis attached, containing required elementsand responses perSection D.1.- a“Letter of Submittal”
2 / AttachmentB - Bidder’s Certification and Assurances form is signed and attached.
This AttachmentC – Bidder Response Form:
3 / Section D-2 – Services Priorities for Funding Responsecompleted or attached.
4 / Section D-3 – Statewide Model Responsecompleted.
5 / Section D-4 – Diversity and Inclusion Responsecompleted.
6 / Section D-5 –Agency Background Responsecompleted or attached.
7 / Section D-6 –Staff Qualification and Recruitment Response completed.
8 / Section D-7–Service Delivery Responsecompleted.
9 / Section D-8 – Client Records Responsecompleted.
10 / Section D-9 – Document Management Response completed.
11 / Section D-10–Program Evaluation Response completed.
12 / Section D-11 Budget and Fund Projection Response completed.
13 / Section D-12 – Financial Statement/Information Response completed.
14 / Section D-13 Bidders Referencescompleted or attached.
SECTION D-2 – Service Priorities for Funding (Maximum 25 Points)
Instructions: Bidder’s response to the questions in this Section D-2 documents how Bidder meets the Minimum Qualifications. All Minimum Qualifications must be responded to and are evaluated as Pass/Fail. Failure to respond or demonstrate how the requirements are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please describe the experiences, skills and qualifications your organization and proposed staff possesses that are relevant to an evaluation of your ability to meet the Minimum Qualifications in this Solicitation. Please ensure that your answer to this question includes all information that you wish DSHS to consider in determining whether you meet the Minimum Qualifications set forth in the Solicitation Document.
# / Minimum Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYThe Bidder must provide a brief synopsis, one page maximum, of the Bidder understands of Family Mentoring Services needs and how the Bidder will meet those needs. This should provide a broad understanding of the Bidder’s program or services model, which includes the program vision, goals, activities and projected outcomes.
The following service priorities are identified for funding. Bidders must address all of the priorities in their proposals. / 25
1 /
Culturally sensitive home visits and family activity events.
Bidder’s demonstration of experience in providing culturally sensitive home visits, and family activity events. Services should target the unique language, cultural, education, linguistic, religious, ethnic and regional needs of families disproportionately represented in the early intervention services as described in the target population below, but not limited to:
- POC
- Seniors who raise the child or are engaged in the child’s life
- LGBTQ
- Tribal affiliation
- Hard of hearing parents or family members
- Late-deafened parents or family members
- Parents or family members with other disabilities
RESPONSE:
2 / Family Services
Programs for children 0 to 6 years of age who are Deaf, DeafBlind, Hard of Hearing and Deaf plus, including addressing family interaction and involvement, early language acquisition and development, preschool education, kindergarten preparedness and other services offered to the population.
Bidder’s demonstration of experience in providing family services of the following children, including but not limited to management, service coordination, home visits and related service delivery activities:
- Deaf
- DeafBlind
- Hard of Hearing
- DeafPlus
- Children who have unilateral hearing
- D, DB, HH or DP children with behavior challenges
- Children with Auditory neuropathy
- Any of above with other syndrome(s)
RESPONSE:
3 / Media Outreach
Demonstrate your experience in providing outreach services. Give examples on how it can provide an increase in public awareness of your programs and services focusing on Family Mentoring Program offered to the target population.
Attachment C – Bidder Response FormPage 1 of 27
[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D-3 – Statewide Model (Maximum 45 Points)
Instructions: Bidder’s response to the questions in this Section D-3 documents how Bidder meetsthe requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. All questionsmust be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualificationsare met may cause Bidder to be deemed unresponsive and may be disqualified.
Please describe the experiences, skills and qualifications your organization and proposed staff possesses that are relevant to an evaluation of your ability to perform the Contract that is the subject of this Solicitation. Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document. Please include any relevant experience that distinguishes your organization or makes it uniquely qualified for the Contract.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYBidders must submit a proposal, which addresses the service priorities identified for funding in this RFQ. / 45
1 /
Describe how your program plans to utilizes Family Mentoring Program, which is family centered and strength based, individualized and developed in partnership with the family. A “family unit” can be defined broadly to include birth, blended, kinship, and foster and adoptive families. Describe your method of family engagement and the role of parents has in planning, implementing and evaluating services provided by your agency.
RESPONSE:2 /
Provide a brief synopsis of each component for the program you are proposing including staffing of Family Mentors, family visits, number of potential participants and future initial and refreshers training.
RESPONSE:3 /
Describe your plan to acquire families with Deaf, DeafBlind Hard of Hearing and Deaf Plus children, determine when a family or individual is eligible for services, what type of services they will receive, and how those services will be provided. Identify and describe these programs and services and required fees, if any.
RESPONSE:4 / Describe your model for statewide service delivery within the State of Washington.
RESPONSE:
SECTION D-4 –Diveristy and INLCUSION (MAXIMUM 25 points)
Instructions:Bidder’s response to the questions in this Section D-4 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYA successful response will demonstrate cultural sensitivity for the perspectives and attitudes regarding the worth and importance of cultural differences for the target population to be served by the proposed program. Culturally sensitive services are defined as services and staff that are responsive to languages and culture of Deaf, DeafBlind, Hard of Hearing and Deaf Plus adults who will serve families of Deaf, DB HH DP infants and toddlers age 0 - 6. / 25
1 / Include in the Bidder’s response submission, attach your agency’s policy or a draft of the policy to ensure the all staff are proficient in American Sign Language (ASL), proficiency in using other communication modalities and provide services to families using languages other than English or ASL.
RESPONSE:
2 /
Describe your experience in providing family services in diverse groups, rural areas and Tribal communities.
RESPONSE:3 /
Describe your experience in providing and participating in outreach and community engagement activities; include a description of current formal and informal alliances established within the State’s diverse, rural areas and Tribal communities.
RESPONSE:4 /
Please attach a copy of Bidder’s policies and values for providing culturally sensitive services. Include examples of your agency’s existing policies and activities that illustrate commitment to serving the diverse community.
RESPONSE:5 / Attach your agency’s procedures for making requests for interpreters and translator services for family meetings. Identify reporting methods to identify language usage, family culture and communication modalities
RESPONSE:
Attachment C – Bidder Response FormPage 1 of 27
[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D- 5 Organizational Capability(MAXIMUM 45 Points)
Instructions:Bidder’s response to the questions in this Section D-5 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYBidders must submit a proposal, which addresses the program priorities identified for funding in this RFQ. Program description must respond to the following questions. / 45
1 /
Describe your agency’s philosophy supporting DeafBlind Hard of Hearing and Deaf Plus adult role models in providing services to families of Deaf, DeafBlind Hard of Hearing and Deaf Plus children. Describe research and evidences supporting mentoring services offered to Deaf, DeafBlind Hard of Hearing and Deaf Plus children.
RESPONSE:2 / Describe your agency’s’ infrastructure and how the services funded by this RFQ will be supported by that infrastructure.
RESPONSE:
3 /
Describe your agency’s formal and informal relationships with children and families service delivery system and community-based organizations that would support the program model (include type, duration and depth of relationships and/or collaboration).
RESPONSE:4 /
Please attach your agency’s Code of professional conduct designated for professionals working with families of Deaf, DeafBlind Hard of Hearing and Deaf Plus children.
RESPONSE:5 / Describe your agency’s capacity to provide secure network and virtual services, including the use of encrypted emails between your staff and video technology such as Skype and Face Time to make home visits.
RESPONSE:
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[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D-6 STAFF QUALIFICATIONS (MAXIMUM 20 Points)
Instructions:Bidder’s response to the questions in this Section D-6 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYBidder must submit a proposal, which addresses qualifications and recruitment of staff identified for funding in this RFQ. Bidder must respond to the following questions.
* ODHH must approve each Family Mentor prior to providing Family Mentor Program services.
/ 201 /
Based upon your experience with effectively providing program activities to reflect the divers cultural and linguistic characteristics of the client population served. Provide a detailed listing of the Key Personnel or team you propose for this engagement, including the titles of staff, staff roles and responsibilities, and current resume of Program Director or the expected minimum qualification of a Program Director. Resumes must detail experience with the required skills applicable to each position.
RESPONSE:2 /
Please include a resume that must include work experience, education, any special license or certification, volunteer work, and any publications or project worked related to the Family Mentoring Program.
.RESPONSE:
3 /
Provide personnel and staffing information, including job description for each position, which includes a list of duties and minimum qualifications for filling the position, for all employees who will be involved in delivering services under the proposed contract.
.RESPONSE:
Attachment C – Bidder Response FormPage 1 of 27
[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D-7–Service delivery (MAXIMUM 25 points)
Instructions:Bidder’s response to the questions in this Section D-7 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYBidders must submit a proposal, which addresses service delivery that identifies different services identified for funding in this RFQ, including explaining the content, framework and processes of services.
Bidders are required to respond to the following requests
/ 251 /
Describe your guidelines for conducting first family visit, including intake interview and assessment.
RESPONSE:2 /
Describe factors and steps for matching Family Mentors with families. Any mapping and visual aids regarding coordination of family mentors will be helpful.
RESPONSE:3 /
Describe home visits and various service activities provided by Family Mentors to families.
RESPONSE:4 /
Explain the procedures for conducting an annual review conducted by Family Mentor with each family in one (1) year following the date of the first family visit and every year thereafter.
RESPONSE:5 /
Describe your experience in working with different family dynamics and structures, including ever-changing issues and needs of some families.
RESPONSE:6 / Attach safety policies and procedures of Family Mentors making home visits
RESPONSE:
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[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D-8–Client Record MAXIMUM 25 points)
Instructions:Bidder’s response to the questions in this Section D-8 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.
Please ensure that your answers to these questions include all information that you wish DSHS to consider in determining whether you meet the requirements and qualifications set forth in the Solicitation Document.
# / Requirements/ Qualifications: / MAXIMUM TOTAL POINTS / FOR EVALUATION PURPOSES ONLYBidder must submit a proposal, which addresses maintenance of Client records of services identified for funding in this RFQ.
By using Family Mentoring curriculum forms, bidders must explain best practices in maintaining the following Client records:
/ 251 /
Initial intake and assessment.
RESPONSE:2 /
Home Visit Service Delivery Plan.
RESPONSE:3 /
Progress notes of home visits, including the format and when applicable, checklist(s).
RESPONSE:4 /
Review of language and literacy benchmarks achieved by the child.
RESPONSE:5 /
Miscellaneous records related to child’s skill development including but not limited to language development, interactive communication, daily routines spent with the child, concept development, active listening, turn taking, eye gazing, behavior management, special needs, use of hearing aids or cochlear implant and storytelling. Bidder may attach a copy of checklists and handouts used for Family Mentoring Program.
RESPONSE:6 /
Ongoing assessment such as assessment of child’s language and literacy development.
RESPONSE:7 / Annual Service Review
RESPONSE:
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[BIDDER’S NAME]DSHS RFQ #1713-649
AttachmentC - Bidder Response Form
SECTION D-9–Document Management (MAXIMUM 10 points)
Instructions:Bidder’s response to the questions in this Section D-9 documents how Bidder meets the requirements and qualifications to provide the services set forth in Attachment A – Sample Contract. All questions must be responded to and will be scored. Failure to respond or demonstrate how the requirements/qualifications are met may cause Bidder to be deemed unresponsive and may be disqualified.