Request for Application Newborn Home Visiting Initiative 3 Year Funding: FY 06-07 to FY 08-09 Applications must be received by: 5:00pm Thursday February 23rd, 2005 First 5 Santa Barbara County 1 East Anapamu, Suite 200 218 Carmen Lane, Suite 111 Santa Barbara, CA 93101 Santa Maria, CA 93458 (805) 884-8085 (805) 739-8740 ABLE OF CONTENTS Part 1: Background A. What is First 5 Santa Barbara County? B. Vision and Mission C. Strategic Plan Focus Areas and Goals D. Funding Strategy Part 2: Initiative Description A. Vision of the Initiative B. Eligible Strategies for Investment C. Initiative Program Model D. Expected Initiative Outcomes E. Types of Eligible Applications F. Available Funding Part 3: Eligibility and Requirements A. Eligibility B. Requirements Part 4: Application Narrative A. Abstract B. Agency and Staff Qualifications C. Proposed Program Implementation D. Supervision and Accountability E. Description of Collaborative Planning Process F. Evaluation and Program Improvement G. Fiscal Management and Controls H. Budget and Cost Effectiveness I. Sustainability J. Required Attachments Part 5: Timeline and Submission Guidelines A. Timeline B. Submission Guidelines Part 6: Award Process Part 7: Grant Conditions Part 8: Attachments 2 Part 1: Background A. What is First 5 Santa Barbara County Research shows that a child’s brain develops more during the first 5 years of life than at any other time of their lives. What parents and caregivers do during these first years of a child’s life can make a profound difference on their brain development and can impact the rest of their life. Based on this research, California voters passed Proposition 10, the California Children and Families Act, in 1998. Proposition 10 added a 50 cent tax on all tobacco products to fund early childhood development, health care, parent education and programs that improve services for children five and under and their families. Funds from Proposition 10 are distributed to local counties based on the number of babies born in the county. Santa Barbara County receives approximately $5 million per year. Funds are distributed by local county commissions. First 5 Santa Barbara County is responsible for developing a strategic plan to guide local funding decisions that are consistent with the intent of the California Children and Families Act. First 5 Santa Barbara County is led by a Commission appointed by the County Board of Supervisors. An Advisory Board with community representatives is actively involved in First 5 programs and projects including strategic planning, the funding process and evaluation. B. Vision First 5 Santa Barbara County envisions a future where all children in Santa Barbara County will live and thrive in safe, supportive, nurturing, and loving environments; enter school as healthy, active learners; develop resilience; and achieve their potential. Mission First 5 Santa Barbara County is committed to working with families, partners, and communities to improve the lives of children through the support of countywide, integrated, culturally relevant and sustainable systems of services that promotes optimal child development. C. Strategic Plan Focus Areas and Goals First 5 Santa Barbara County is focused on making progress in four focus areas with four overarching results that they would like to see for children birth through age five and their families in Santa Barbara County. Child Health: Healthy Children Early Development & Education: From Birth to Kindergarten, Children Learning & Ready for School Family Strengthening: Strong Families Systems Improvement: Accessible Community-Based Services and Support for Children and Their Families 3 Goals First 5 believes that in order to accomplish our mission for children and families we must commit to a set of goals and outcomes that will be the foundation for First 5’s investment and work over the next 6 years. For each of the four focus areas a set of corresponding goals and outcomes has been developed. These are based on input from the community on priority needs, community-wide data, research and First 5’s experience over the past 6 years of investing in local programs and initiatives. Goal 1: Child Health Improve children’s health by increasing access and utilization of comprehensive, preventative and primary health care Goal 2: Early Development & Education Support each child’s innate ability to grow and develop cognitively, emotionally, socially and physically by increasing and enhancing early learning opportunities Goal 3: Family Strengthening Increase support for families so that they are able to provide safe, stable and nurturing environments for their children Goal 4: Systems Improvement Improve the systems of programs and services for children and families so that they are easily accessible for all families D. Funding Strategy First 5 Santa Barbara County funds programs based on structured initiatives with a prescribed menu of research based strategies. This application process will provide 3- year funding (FY 06-07 – FY 08-09) for 1 of the following 5 initiatives: Early Childhood Oral Health: A countywide partnership to provide oral health education, screenings and treatment for children 0-5 and their families. Early Care and Education: A partnership to increase the availability of high quality early care and education services in the county and to raise awareness of the importance of early care and education. Family Support: A network of community-based family support programs that will provide services and links to services for families. (i.e. parent education, family support, counseling, eligibility assistance) Early Childhood Mental Health and Other Special Needs: A partnership of organizations to provide services for children and families that focus on early identification, assessment and comprehensive services. Newborn Home Visiting: Home visiting services for all infants in Santa Barbara County from birth through nine months. Services to include information, support, health and developmental screenings and referrals for infants and their families. Each initiative has a separate application process. Please make sure that you are using the correct initiative application for your program. 4 Part 2: Newborn Home Visiting Initiative Description A. VISION: Every family in Santa Barbara County creates a nurturing and healthy environment in which their babies will thrive. This includes continuing to visit families of all newborns in Santa Barbara County that consent to visits. B. NEWBORN HOME VISITING INITIATIVE STRATEGIES FOR INVESTMENT: ONLY THE STRATEGIES LISTED BELOW ARE ELIGIBLE FOR FUNDING. PLEASE DO NOT REQUEST FUNDING FOR STRATEGIES NOT LISTED. Newborn Home Visiting: Postpartum assessments, developmental screenings, RN and child development specialist visits, linkages to community health resources and follow-up for newborns and their parents. Parental Support For Children’s Early Learning: Programs and services that help parents, as their child’s first teacher, to foster their child’s early learning and support their emotional and social development from birth onwards. Information & Referral: Support for outreach to connect families to available services through information and referral, family resource centers, home visiting, community- based programs and community and media outreach. Coordinated Service Delivery: Require cross-agency coordination in all funded initiatives and cross-initiative communication and coordination. Encourage co-location of services, coordinated case management and integrated data collection systems where appropriate. Support the development of integrated services within communities that provide a continuum of services from birth through Kindergarten entry. C. INITIATIVE PROGRAM MODEL: First 5 Santa Barbara County will select only one Application to fund in this initiative. Therefore, only Lead Agency Applications may be submitted. All potential linked services, such as transportation or nursing must be included as subcontracts under the lead agency. Program Components: A successful application will: a. Offer professional-level (RN/BA) newborn home visitation services to all families residing in Santa Barbara County with a baby aged birth through 9 months b. Base all service delivery on a research based newborn home visitation model that has shown to be effective when used universally (non-targeted population) c. Provide or link to other agencies to provide additional family supports as needed d. Coordinate services with hospitals and birthing centers e. Demonstrate effective communication with OBGYN’s and Pediatricians 5 f. Establish/strengthen relationships with Family Resource Centers throughout the county to provide parent and family support, especially after home visitation program services have ended g. Coordinate the distribution of the Kits for New Parents h. Educate families about the multitude of services for families with young children by serving as a platform to distribute information for First 5 Santa Barbara County and its funded agencies D. WHAT ARE THE EXPECTED OUTCOMES FOR THE NEWBORN HOME VISITING INITIATIVE: ALL APPLICANTS MUST DEMONSTRATE HOW THEY WILL POSITIVELY IMPACT THE OUTCOMES LISTED BELOW. IN ADDITION, APPLICANTS MUST LIST AND DESCRIBE EACH OF THE INDICATORS THAT WILL TRACK THE PROGRAM PROGRESS. 1. Parents understand their children’s development and participate in their children’s care and early learning beginning at birth 2. Children’s health and developmental needs are identified and addressed early 3. Children live in safe, stable and nurturing family environments Newborn Home Visiting Indicators: Children 0-5 who received a well child check-up in the past year Children 0-5 who receive regular well-child visits according to the schedule recommended by the American Academy of Pediatrics Children 0-5 with a comprehensive developmental screening in the past year Children who received services addressing needs identified in the developmental screening Children 0-5 exposed to tobacco smoke Age of referral for health and other special needs intervention and/or treatment services Children who are receiving breast milk until they are 6 months old Mothers screened for and referred for treatment, if necessary, for post-partum depression or other mental health problems Parents have confidence in their ability to parent Parents identified and referred for treatment for substance abuse problems Parents provide, safe, stable, nurturing homes for their children Parents have formed secure attachments to their children in the first 5 years of their children’s lives Systems Improvement Indicators: Programs are leveraging funding Programs provide transportation services Programs have expanded service hours or make scheduling flexible Providers have the training, knowledge and capacity to work with children with disabilities and other special needs Programs are providing services to traditionally underserved and underrepresented populations Services are culturally and linguistically reflective of the children and family members served 6 Parents are involved in joint planning at the service level Programs that participate in coordination and collaboration across agencies including client consultation/case management and data integration E. TYPES OF ELIGIBLE APPLICATIONS: One type of Application may be submitted: Lead Agency Application Description: An application in which one applicant agency agrees to act as Lead Agency/Fiscal Agent for the project. The lead agency must submit one set of attachments with the project totals (Lead Agency and all subcontractors combined) and separate attachments A-3, A-4, A-5, A-6, A-7, and A-8 for each contributing agency, including subcontractors. Each subcontracting agency must sign the application cover sheet (A-1). First 5 Santa Barbara County reserves the right to contract directly with each Partner or Subcontracting Agency or to exclude funding one or more of the partners within the application. All applications, including subcontractors, must show how they will support the overall vision of the initiative and work in active cross-agency collaboration to meet and sustain the outcomes outlined in the evaluation plan. Please read the following materials which were adopted by the First 5 Santa Barbara County Commission in 2005 and can be downloaded from the First 5 website: Newborn Home Visiting Sustainability Plan, Newborn Home Visiting Evaluation Plan, 2006-2011 First 5 Strategic Plan. F. AVAILABLE FUNDING: The maximum amount of funding that will be awarded to the successful Lead Agency per year is $1,018,000 per year for a 3-year maximum of $3,054,000. First 5 Santa Barbara County may reserve a portion of the dollars allocated for this initiative to solicit additional applications for areas not met in this application process. 7 Part 3: Eligibility and Requirements for all Applicants A. ELIGIBILITY Through this competitive process, the Commission will award grants to applicants that have the expertise and qualifications to successfully facilitate and manage the described program model for children aged 0-5 and their families. An organization is eligible to apply if they: • Are a nonprofit organization that is tax-exempt of the Internal Revenue Code, including faith-based organizations (please request Faith-Based policy if clarification is needed) or a Public Agency • Have at least three (3) years of demonstrated expertise in serving the under 5 age year population • Have a demonstrated track record, or capacity to provide services, to families within the geographic region that they are proposing to serve; • Have the capacity to facilitate and manage the delivery of services as an active member of a community based collaborative; • Have adequate financial resources and accounting standards; • Have no record of unsatisfactory performance or poor business practices; and • Have the capacity to conform to all requirements set forth in this RFA B. REQUIREMENTS Fingerprinting and Criminal Clearances Grantees must guarantee that all employees, volunteers and contractors who will provide direct services to children have a criminal clearance that states that they do not have a criminal history which would compromise the safety of children. Child Abuse Prevention and Adherence to Mandatory Reporting Requirements Grantees and all collaborative partners must ensure that all known or suspected instances of child abuse or neglect are reported to the either a local law enforcement agency or Child Welfare Services. Thus, each employee, volunteer or contractor who have direct contact with children when providing First 5 funded services must receive annual training and sign a statement that he or she knows of the child abuse reporting laws and will comply with all requirements. Technical Assistance and Training Grantee will be required to participate in all mandatory orientation and training sessions offered by First 5 Santa Barbara and its approved contractors. All grantees will be required to participate in a contractors’ orientation. Bi-monthly Initiative Meetings Grantees (lead and subcontractors) must attend 6 initiative meetings per year in order to enhance collaboration, program planning, service quality, sustainability and evaluation. 8 First 5 Initiative Collaboration To maximize resources and provide a wider array of services and supports to families, it is imperative that organizations work together. To facilitate joint efforts at the community level, First 5 Santa Barbara County expects that programs providing services within an initiative will collaborate with providers from other First 5 initiatives. Principles on Equity and Diversity First 5 Santa Barbara County, in fulfilling its mission, will “take proactive steps to ensure that children and their families from diverse populations, including children with disabilities and other special needs, are an integral part of the planning and implementation of Proposition 10.” 1 The Principles on Equity developed by the State Committee on Equity will serve as a guide throughout the work of the Commission: 1. Inclusive Governance and Participation: to obtain meaningful participation and input of the families and other caregivers of children from diverse backgrounds with diverse abilities 2. Access to Services: to assure that children from diverse backgrounds, with diverse abilities and that have been traditionally underserved, have access to high quality early care and education/development opportunities 3. Legislative and Regulatory Mandates: to ensure that funded programs adhere to all legislative, regulatory and accreditation mandates pertinent to the provision of services to children from diverse backgrounds and with diverse abilities 4. Results-Based Accountability: to ensure that First 5 programs have meaningful outcomes that benefit children from diverse backgrounds and with diverse abilities Record-Keeping and Reports Grantees, including subcontractors, must institute sound programmatic and fiscal record-keeping practices. Grantees must keep written and/or electronic records of all services and activities that are/were provided to families by the lead agency and subcontractors (if applicable) for which payment will be rendered under the Initiative for 4 years from the date of delivery. In-Kind and Matching Funds Grantees and collaborative partners are strongly encouraged to allocate a portion of their existing revenue and resources to support the activities in this RFA. In-kind and matching contributions may include staffing, facilities, supplies and services. Cash-match contributions may include new or restricted funds to support the Initiative program requirements and model. Tri-Annual Reporting Requirements Grantees will be required to submit a status report three times per year. Any 1 Adapted from the Advisory Committee on Diversity, California Children and Families Commission 9 reports that are submitted late may be subject to a fiscal penalty. First 5 Policies Several commission policies provide information about grantee expectations. Some of these include: tobacco policy, funding faith-based organizations, confidentiality, logo and attribution standards, leveraging, supplantation, and service age. Insurance Requirements Successful applicants must maintain and submit annually proof of insurance with an endorsement naming First 5 Santa Barbara County Children and Families Commission as additional insured. Please see section 7 in this application for details. Lead Agency Responsibilities When Monitoring a Subcontract The Lead Agency must supervise and monitor all work performed by any and all sub-contractors including units of service performed, insurance coverage, invoice amounts and fiscal records. Lead Agency is responsible for reporting units of service for the subcontractor in each tri-annual report. Fiscal Reporting Grantees will be required to submit monthly or tri-annual contractor’s payment applications in order to be reimbursed for actual expenses. Leveraging Public Dollars with First 5 Santa Barbara award: If, during the term of this Agreement, Contractor obtains funding or other income from a source other than the Commission and such funding or other income is in excess of that shown as part of the Project Budget and such funding or other income relates directly to the program or activity funded pursuant to this Agreement, then Contractor shall so notify the Commission in writing at the next request for reimbursement. Please note that the Commission strictly prohibits supplantation of funds (see below.) In addition, it is the expectation that all state or federal dollars (Title IVE, MAA, TCM, etc.) that are leveraged from commission dollars are reinvested in services for children aged 0-5 and their families within two years of receipt. Supplanting First 5 Santa Barbara County funds may not be used to replace other federal, state, private, or local funds that currently, or within the last 12 months, have been committed for program activities. Grantees that receive State or Federal funds should only request funds for activities or components not currently supported by other sources. Funds that are requested by the applicant must be used exclusively for the operation and administration of the proposed activities outlined in the applicant’s performance scope of work. Participation in First 5 Santa Barbara County-sponsored Initiative Evaluation 10 In addition to their own evaluation efforts, Grantees will be required to actively participate in the initiative evaluation activities sponsored and funded by First 5 Santa Barbara County. The Commission has partnered with researchers at the Center for School-Based Youth Development (C4YBSD) in the Givertz Graduate School of Education at the University of California, Santa Barbara (UCSB) to provide evaluation consultation and support to help the Commission and its funded partners document outcomes for children and families. Grantees participation in the initiative evaluation includes (but may not be limited to) the collection of data on project implementation, participant characteristics, and participant outcomes to inform the Commission’s Initiative Evaluation and promote program learning and improvement. As described in the data collection section below, data will be entered and reported using the GEMS database. All grantees will be required to use this data system. Data Collection Grantees will be required to collect client-level data on family members and providers receiving services through First 5 Santa Barbara County funded programs. Required data collection may include the following: attendance and case management logs, family demographic information; outcomes and performance measures; etc. The Commission will provide training on the use of any data collection instruments as well as the GEMS data collection reporting and management system. Grantees are expected to have a dedicated staff person who is responsible for data collection and management (Data Clerk). This staff person is required to attend all training sessions on usage of the evaluation and data reporting systems. 11 Technology To facilitate use of the data reporting system, the grantee (including subcontractors) must already have, or include in their budget, a computer system or upgrades with the following specifications: GEMS System Requirements Area Minimum STRONGLY Preferred PC with Intel Pentium/Celeron, Processor Type AMD K6/Athlon/Duron family, or PC with Intel Pentium 4 or above compatible processor. 600 megahertz (MHz) or above Processor Speed (300-MHz minimum required; 2 gigahertz (GHz) or above may limit performance) 256 megabytes (MB) or higher Ram (128 MB minimum supported; 512 MB or higher may limit performance) 350 megabyte (MB) of available 350 megabyte (MB) of available free Disk Space free hard disk space hard disk space Operating Windows 98/ME/2000/NT/XP Windows XP System 128 Kbps (Kilobits Per Second) or higher-speed modem, or a 1 Mbps (Megabits Per Second) or network connection (56 Kbps Internet Speed higher-speed Cable, DSL or T1 minimum supported; may limit equivalent network utility of data transfer to and from the server) 12 Part 4: Application Narrative Use exact headings and subheadings in the narrative. The narrative must not exceed fifteen (15) pages total, not including appendices and required documents. In completing the narrative, applicant must pay special attention to the Initiative Description and applicant eligibility and requirements section. It is the responsibility of the applicant to address all issues listed in the Initiative Description and eligibility and requirements section. A. Project Abstract – ½ page maximum Provide a brief, concise abstract of the proposal that is no longer than ½ page. This summary should highlight clearly what you hope to accomplish, and the proposed plan of action to undertake the activities described in the RFA. Please note that the Abstract will be used in the Executive Summary of each application. B. Agency and Staff Qualifications - 1 page maximum (5 points) 1. Please provide a brief description of your agency/organization, including any subcontractors. 2. State your agency’s mission and overall philosophy. 3. Highlight all relevant experience in providing early childhood services. 4. List the qualifications, relevant experience, education, and training of each person that will work in the program. Include subcontractors and administrators who will have significant involvement in the project. 5. Specifically describe the ethnic, cultural and linguistic composition of direct service staff for this project. C. Proposed Program Implementation – 7 pages maximum (50 points) 6. Utilizing the Program Components outlined in “Part 2 – Section C – Initiative Program Model,” detail how each Program Component is fulfilled in this application. Please reference each Program Component by number and letter. Under each Program Component identify what strategies the applicant will use to fulfill that component, and how the strategies utilize best practices. Please include expertise the applicant has in the provision of these services. 7. How will services from various entities such as Santa Barbara County Public Health Department, Public Health Teenage Parenting Program, Cottage and Marian Hospitals, and others be triaged with proposed services in this application so that newborn home visiting services are not duplicated anywhere in the county? Please explain any regional differences in program services. 8. Describe how families who are utilizing the newborn visitation program will be connected with family support and other programs offered in the community. In particular, how will families who have completed the program be connected with other support services in the community? Please list which community programs, including family 13 resource centers, for which you already have established referral protocols and/or MOU’s. 9. What process will be used to connect with families who are difficult to reach in order to insure that client cases are not closed prematurely? 10. In the proposed program, what will be the formal process for clients to offer feedback and program suggestions? 11. In the proposed program, what will be the formal process for nurses, physicians, and key partners to offer feedback and program suggestions? 12. What role will the applicant take in advocating for regional unmet needs which are identified during the home visits? 13. Describe your familiarity with serving parents of newborns. Include your expertise in working with culturally, linguistically, geographic and socio-economically diverse groups. 14. Describe how you will build on your agency strengths and resources and those of other community or collaborative partners to implement the model in this application. 15. Discuss how plans for implementation will ensure that services are sensitive and relevant to diverse populations. 16. Discuss the specific role that collaborative partners and key staff will play in implementation and day-to-day activities. 17. If this application includes a subcontractor/s, please explain how you will monitor the completion of subcontractor duties including: program, fiscal, and evaluation. Specify which staff person will be responsible monitoring subcontractors. D. Supervision and Accountability – ½ page maximum (5 points) 18. Please describe how project services and activities will be supervised. 19. Describe the protocols that you will follow to verify that clients receive needed/requested services and monitor participant outcomes. 20. Explain how collaborative governance will occur amongst participating organizations, groups and families. E. Description of Collaborative Planning Process – ½ page maximum (5 points) 21. Please describe the process utilized to develop this application including the involvement and collaboration of agencies and partners. F. Evaluation – 2 pages maximum (15 points) 22. Utilizing the First 5 Initiative Evaluation Plan, provide an overview of how you will assess and evaluate the effectiveness of the program and your efforts. Please explain how the proposed program meets some/all of the priority outcomes listed in Part 2 Section D of this application. 23. Please list all tools that will track and evaluate program services. This should match tools listed in Attachment 6. Explain the rationale for choosing each tool selected. 24. How will program participants be included in program evaluation? 25. Explain how you will ensure the security of client related data. How is 14 data collected and where is it stored? G. Fiscal Management and Controls – 1 page maximum (5 points) 26. Describe the fiscal management experience of your agency and discuss the fiscal controls that will be used for this project. 27. Provide a brief description of agency accounting systems including payroll and ledger systems for receivables, payables, expenses and disbursements. 28. If this application includes a subcontractor/s, please explain how you will monitor expenditures and verify subcontractor invoices. H. Budget and Cost Effectiveness – 1 page maximum, not including attachments (5 points) 29. Provide the most recent Independent Audit for the Lead Agency. Label as Attachment 12. If the lead agency does not have an independent audit, please explain why and provide your most recent agency fiscal report. 30. Complete a detailed budget for each year that you are requesting funds in this application using Attachment # 7. If this application includes a subcontract, complete attachment # 7 for each subcontracting agency. 31. Provide an explanation of how your agency and any subcontracting agencies determine indirect cost rate and describe what costs are specifically included in this rate using Attachment #8 . Please note that indirect cost cannot exceed 15% of total grant amount awarded excluding equipment and capital expenditures. 32. Provide a narrative for your proposed budget. The information included in this section should correspond to the figures in Attachment 7. If the budget includes consultant costs, describe scope and purpose of consultant. I. Sustainability Plan – 1 ½ pages maximum (10 points) 33. If this application is awarded, specifically describe how you plan to sustain the proposed program and program results beyond this 3-year term. 34. Describe your experience in sustaining grant-funded programs for children in the last 5 years. Please include: how many grant-funded programs your agency has sustained and to what extent the original program services still exist. 35. What strategies will the applicant agency utilize in maximizing opportunities for federal, state and private forms of leveraging dollars for long-term sustainability and program enhancement? 36. If applicable, please list all staff positions in this application whose work will qualify to leverage additional resources such as Medi-Cal Administrative Activities (MAA), Targeted Case Management, etc. Please explain how these dollars, once secured, will be utilized to expand or enhance project services. 15 J. Required Attachments – Attachments must be clearly labeled. 1. Application Cover Sheet (Attachment 1) 2. Application Checklist (Attachment 2) 3. Geographic Location of Clients Served (Attachment 3) 4. Units of Service (Attachment 4) 5. Client Type Details (Attachment 5) 6. Evaluation Tool Matrix (Attachment 6) 7. Program Budget (Attachment 7) 8. Indirect Cost Rate Description (Attachment 8) 9. Agency Involvement in Litigation (Attachment 9) 10. Agency Organizational Chart (Label as Attachment 10) 11. Proof of nonprofit status, if applicable (Label as Attachment 11a) 12. Clinic/Agency license, if applicable (Label as Attachment 11b) 13. Independent Audit (Label as Attachment 12) If your agency has not had a recent independent audit, please explain. 16 Part 5: Timeline and Submission Guidelines A. Timeline Date Activity January 9, 2006 RFA Release Date January 13, 2006 Bidders Conference Applicant Workshop and Informational Meeting 9am-12pm at Royal Scandinavian, Solvang January 27, 2006 In-person technical assistance regarding forms and requirements 9:30am-1:30pm in the Santa Maria and Santa Barbara First 5 Office. Questions regarding content will not be answered. February 23rd, 2006 Applications are due received by 5:00 p.m. at either First 5 Santa Barbara County office (Santa Barbara or Santa Maria) Applications are Reviewed by Funding Panels March 27 – April 6, 2006 Funding recommendations posted to the First 5 Santa Barbara April 12, 2006 County website April 17, 2006 Recommendations are heard by the Commissioners April 17 – 21st , 2006 Protest Period April 27th, 2006 Protest Hearing Funding Approved by Commission May 15, 2006 17 B. Submission Guidelines Applicant must submit the original (signed in blue ink), ten (10) photocopies that are 3-hole punched of the application, and a CD that includes a copy of the application and all required attachments (not including agency audit). These materials must be addressed to: Pat Wheatley, Executive Director Pat Wheatley, Executive Director First 5 Santa Barbara County First 5 Santa Barbara County OR 1 East Anapamu, Suite 200 218 Carmen Lane, Suite 111 Santa Barbara, CA 93101 Santa Maria, CA 93458 Applications can also be delivered by the U.S. Postal Service or Private Mail Courier but must be received (not post-marked) by 5:00 p.m. on February 23rd, 2006. First 5 Santa Barbara County takes no responsibility for the handling of any application that is mailed and not delivered in person. Applications received after 5:00 p.m. on February 23rd, 2006, or sent via fax or via email to the First 5 Santa Barbara County office will not be accepted. NOTE: First 5 Santa Barbara County is not responsible for delays due to traffic, parking, or other issues that may prevent the timely submission of the application. Any application that does not meet these submission guidelines will not be reviewed. Please allow for additional time to account for unexpected delays. Applications must adhere to the following guidelines to be considered: • Use only 8 ½” by 11”, white paper • Times New Roman font, no less than 12-point • Single sided only • No less than 1-inch margins • 1.0 line spacing • Clip all copies of the application-no bound copies accepted • Provide page numbers • The narrative must not exceed 15 pages total, not including attachments and required documents A complete proposal package will consist of a complete narrative and all required attachments. Submission Order: 1. Application Cover Sheet (Attachment 1) 2. Application Checklist (Attachment 2) 3. Application Narrative 4. Geographic Location of Clients Served (Attachment 3) 5. Units of Service (Attachment 4) 6. Client Type Details (Attachment 5) 7. Evaluation Tool Matrix (Attachment 6) 18 8. Program Budget (Attachment 7) 9. Indirect Cost Rate Description (Attachment 8) 10. Agency Involvement in Litigation (Attachment 9) 11. Agency Organizational Chart (Label as Attachment 10) 12. Proof of nonprofit status or applicable business license, if applicable (Label as Attachment 11a) 13. Clinic/Agency license, if applicable (Label as Attachment 11b) 14. Independent Audit (Label as Attachment 12) If your agency has not had a recent independent audit, please explain. Withdrawal of Application by Applicant An application may be withdrawn in its entirety by submission of a written request signed by a representative of the organization. Submit and label a withdrawal request as follows: WITHDRAWAL OF RFA 06-09 First 5 Santa Barbara County 1 East Anapamu Street, Suite 200 Santa Barbara, CA 93101 19 Part 6: Award Process First 5 Santa Barbara County will award grants to applicants that have the expertise and qualifications to successfully provide high quality programming matching the prescribed strategies listed in part 2: Initiative Description . Review of Applications will occur in two phases: Phase I Applications must first pass the “Application Requirements Checklist” review (Attachment 2) in order to be eligible for further review. This is a pass/fail evaluation. To pass the Checklist, the applicant must have responded “yes” to each of the questions. If “N/A” is checked a documented reason must be given for this response. Applications that do not pass the Checklist review will be considered unresponsive and will not be eligible for further consideration. Phase II A panel will be assembled to review proposals. Applications and all required documentation will be reviewed and scored according to the applicant’s experience and demonstrated capacity to implement and manage the requirements of the initiative and program model as listed in this Request for Application. A one-hour question and answer session will be scheduled on the day that initiative applications will be reviewed in order to clarify any items for which panel members would like additional information from applicants. This session will be done in a group format, by initiative. Agencies will receive two weeks advance notice regarding the date, time and location that this question and answer session will be held. Scoring Guidelines Agency and Staff Qualifications 5 points Proposed Program Implementation 50 points Supervision and Accountability 5 points Description of Collaborative Planning Process 5 points Evaluation and Program Improvement 15 points Fiscal Management and Controls 5 points Budget and Cost Effectiveness 5 points Sustainability 10 points Based on these reviews, qualified applicants will be recommended by the funding review panel for funding to the First 5 Santa Barbara County Commission. An applicant must receive a minimum of 75 points in order to be considered for funding. Notification of Intent to Award 20 On April 17th, 2006, written notification of the Commission’s recommendations will be e-mailed to all applicants and posted to the First 5 Santa Barbara County website. A public hearing will be held by the Commission on final funding recommendations on May 15, 2006. Written notification of the Commission’s final recommendations for funding will be e-mailed, and a hard copy mailed, to all applicants notifying them of the identity of the selected applicants and the contract amounts. Contract Award Protest Process 1. An applicant that has submitted a application may file a Protest Letter within five (5) working days after the “Notice of Intent to Award” has been posted on April 17th, 2006. Protests will only be considered if received in the Commission office by 5:00 p.m. on April 21st 2006. 2. Protest Letters must state the reasons, law, rule, regulation or practice on which the protest is based. 3. Protest Letters are to be labeled and addressed as follows: PROTEST TO RFA 06-09 First 5 Santa Barbara County 1 East Anapamu Street, Suite 200 Santa Barbara, CA 93101 4. The Commission shall conduct a public hearing on April 27th, 2006 in Solvang to resolve all timely protests. The Commission’s decision on each protest will be final and cannot be appealed. The Commission will give written notice to each protester, setting forth the final outcome of their protest. 21 Part 7: Grant Conditions Specific grant conditions, including but not limited to the following, apply to proposal submission and implementation and to any agreements that result from the submission and implementation of the application. This is not an exhaustive list of conditions. A. Rights of the Commission The Commission may, at its sole discretion, reject any or all applications submitted in response to this document. The Commission also reserves the right to cancel this offer at its sole discretion at any time before execution of a Grant Agreement. The Commission shall not be liable for any costs incurred in connection with the preparation of any application submitted in response to this document. Any applications, including attached materials, submitted in response to this document shall become property of the Commission. B. Disclaimer The Commission is not responsible for the representations made by any of its officers or employees before the execution of a Grant Agreement by the Commission unless such understanding or representation is included in this document and/or in subsequent addenda. The Commission is responsible only for that which is expressly stated in this solicitation document and any authorized addenda thereto. C. Applicant’s Financial Status The Commission reserves the right to request additional financial status information at any time to verify an applicant’s past and/or current financial status. D. Disclosures of Contents of Proposals All applications, statements of qualification, corporate or organizational documents, financial statements and/or any other information submitted in response to this RFA shall be become the excusive property of First 5 Santa Barbara County. To the extent required by applicable law, all applications shall be regarded as public records, with the exception of those parts of each proposal defined by the Applicant as business or trade secrets and plainly marked as “TRADE SECRET,” “CONFIDENTIAL,” or “PROPRIETARY.” Such information should not appear on the same page as non-proprietary or non- confidential information. All determinations regarding the confidentiality of any information shall be made in the sole and absolute discretion of the Commission in consultation with legal counsel. The Commission shall not in any way be liable or responsible for the disclosure of any such records or any part therefore, if disclosure is required or permitted under the California Public Records Act or other applicable law or order of a court. E. Contact with First 5 Santa Barbara County Employees, Commissioners, and/or 22 Advisory Board Members As of the issue date of this Funding Request and continuing through the public notification of the award, all First 5 Santa Barbara County personnel and Commissioners (except for the below designated First 5 Santa Barbara County personnel) are specifically directed not to hold meetings, conferences, or technical discussions regarding this Funding Request with prospective grantees. “Off the record” contacts can potentially taint the Commission’s decision- making process. Please do not attempt to initiate this type of communication. Any questions or comments regarding this Funding Request must be addressed in writing to: Sara Soto, Administrative Secretary First 5 Santa Barbara County Via fax (805) 564-8586 or email firstname.lastname@example.org In addition to your specific question, indicate which Initiative RFA you are inquiring about and your contact information (in case we do not understand your question.) All questions received by January 17th at 5pm will be compiled and answered in a comprehensive document on our website by 5pm on January 20th. Questions received between January 18th and February 1st will be answered as above by 5pm February 3rd. ALL QUESTIONS RECEIVED AFTER 5PM FEBRUARY 1ST WILL NOT BE ANSWERED. F. Conflict of Interest Condition It is the applicants’ sole responsibility to be aware or and comply with all applicable laws and regulations including, without limitation, California’s strict conflict of interest laws. FIRST 5 SANTA BARBARA COUNTY RESERVES THE RIGHT TO REJECT ANY PROPOSAL THAT DOES NOT COMPLY WITH THIS REQUIREMENT. Applicants who have any question about this or any other restriction are advised to consult with the designated First 5 Santa Barbara staff member BEFORE expending time and/or money on developing an application. G. Conflict of Interest (Grant Agreement Term) It shall be the responsibility of the Grantee to abide by applicable conflict of interest laws and regulations pursuant to California law. During the term of this Agreement, Grantee shall not recruit, hire, employ or compensate any current Commission employee or consultant for services in connection with this or any other Commission – funded project without the advance written consent of Commission. H. Grantee’s Project Requirements The Grantee shall be responsible for providing competent, qualified staff to fulfill the Grant Agreement. The Grantee will provide sufficient personnel to perform all work in accordance with the specifications set in the Grant Agreement’s Scope of Work. The Grantee shall fully comply with Federal statutes and regulations regarding employment of aliens and certify to the Commission that the Grantee and its 23 employees assigned to the resultant agreement fully meet the standards imposed by Federal statutes and regulations. The Grantee will indemnify, defend and hold the Commission harmless from any sanctions that may be assessed against the Grantee for violation of Federal statutes and regulations pertaining to employment of undocumented workers. The Grantee shall provide a “Project Director” who shall be responsible for the performance of the work under this Grant Agreement. The name and telephone number of this person and an alternate who can act for the Grantee when the director is absent shall be designated in writing to the Commission. I. Licenses, Permits, Registrations, Accreditations, and Certificates The Commission reserves the right to request at any time, any or all appropriate licenses, permits, registrations, accreditations, and/or certificates required by Federal, State, and local laws, regulations, guidelines, and/or directives for the operation of applicant’s facility(ies) and for the provision of services hereunder as well as its officers, employees, and/or agents performing the services hereunder. J. Responsibility for Employee Wages and Benefits The Grantee shall be solely responsible for providing to its employees all legally required employee benefits. The Commission shall not be called upon to assume any liability for the direct payment of any salaries, wages, or other compensation to any employees of the contractor or its collaborative partners. K. Public Statement/Materials Grantee shall indicate in any and all press release(s), statement to the public, or printed materials (including brochures, newsletters, reports, etc.) related to the program that it is “Funded by First 5 Santa Barbara County” and include the First 5 logo as possible. Please see the Logo and Attribution Policy for details. L. Confidentiality The Grantee shall maintain the confidentiality of all records, including but not limited to Grantee records and client records in accordance with all applicable federal, state and local laws, regulations, ordinances and directives regarding confidentiality to the extent permitted by law. Grantee shall inform all of its employees and agents providing services hereunder of the confidentiality provisions of the Grant Agreement. Grantee shall employ reasonable procedures to assure that the details of the advertising campaigns adhere to laws on confidentiality. M. Program and Evaluation Review The selected Grantee shall be required to submit status reports three times per year (“Tri-annual Reports”) that outline the progress on the activities defined in the application and relevant attachments. First 5 Santa Barbara County will conduct programmatic and fiscal compliance visits during the grant term. N. Tangible Property and Capital Expenditures 24 Any Items purchased and capital improvements made with First 5 funds must be used for their intended purposes as set forth in the grant. If a grant recipient ceases operation of their business or the program for which the expenditure was made is discontinued, then at the discretion of the Commission, assets purchased must be returned to the Commission and expenditures made on capital improvements must be reimbursed to the Commission. O. Scope of Work Revisions In order to make applications within and across initiatives consist and to address funding panel recommendations, items within an application may need revisions in order to be funded. Revisions to the scope of work, budget, or evaluation plan, must be finalized and approved by commission staff no later than June 2, 2006. Any change in this date will be made in writing by the Commission staff. P. Contract Signing Deadline The selected Grantee will be required to sign the Contract no later than June 9th 2006. If the Contract is not signed and returned to the commission by this date, the Commission may withdraw or decrease the grant award. Any change in that date must be submitted in a written document that is signed and approved by both parties. Q. Required Documentation The following documents will be required before the Contract can be executed: • Insurance Coverage (see below section) Grantee shall provide and maintain in effect throughout the duration of this contract at least the following policies of insurance, issued by insurers admitted to do business in the State of California with a current A.M. Best’s Guide Rating of A: VII or better. Each such policy of insurance shall apply on a primary and non-contributing basis as to Commission and be endorsed to include as additional insured, First 5 Santa Barbara County Children and Families Commission AND Santa Barbara County, its officials, employees and agents, using standard ISO endorsement No. CG 2010 with an edition prior to 1992. Grantee shall provide certificates and endorsements evidencing such insurance to Commission by June 9, 2006. Each such certificate shall state explicitly that the policy of insurance shall not be cancelled, withdrawn or allowed to lapse for any reason unless the insurer has first given thirty (30) days written notice to the Commission. Failure to maintain such insurance and/or to provide the required certificates shall constitute a material breach of this Contract. Grantee and subcontractors shall provide policies of liability insurance of at least the following coverage and limits: Commercial General Liability Insurance Such insurance shall be written on an ISO commercial general liability form with minimum limits of not less than one million dollars ($1,000,000) 25 per occurrence and two million dollars ($2,000,000) in the aggregate for any personal injury, death, loss or damage. Workers’ Compensation Insurance Such insurance shall be in an amount and form to meet all applicable requirements of the Labor Code of the State of California, including Employer’s Liability with limits not less than one million dollars ($1,000,000) per accident or disease, covering all persons who provide services for Grantee. Professional Liability Insurance Such insurance shall cover liability arising from any error, omission, or negligent or wrongful act of Grantee or its employees, with a limit of liability of not less than one million dollars ($1,000,000) per medical incident for medical malpractice liability, or of not less than one million dollars ($1,000,000) per occurrence for all other types of professional liability. Business Auto Liability Primary coverage shall be provided on ISO Business Auto Coverage forms for all owned, non-owned, and hired vehicles with a combined single limit of not less than $1,000,000 per accident and $2,000,000 aggregate. Evidence of Self Insurance Legally adequate evidence of self- insurance meeting the approval of the Commission’s Legal Counsel may be substituted for any coverage required above. Grantee must submit a copy of the self-insured certificate issued by the State of California. R. Submission of Annual Audit Grantee shall submit an annual independently audited financial statement to First 5 within 120 days of fiscal year-end unless an annual waiver of this requirement is received and approved by the County of Santa Barbara Auditor- Controller’s office prior to the end of the fiscal year in question. S. Indemnification (Grant Agreement Term) To the maximum extent permitted by law, GRANTEE shall defend, indemnify and hold harmless COMMISSION, its officers, officials, employees, agents and volunteers, from any losses, injuries, damages, claims, lawsuits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses or costs of any kind, actual attorneys fees, court costs, interest, defense costs including expert witness fees and any other costs or expenses of any kind whatsoever incurred in relation to, as a consequence of, or arising out of or in any way attributable in whole or in part to GRANTEE’S performance of this Agreement including, without limitation, matters of active or passive negligence on the part of COMMISSION. Without affecting the rights of COMMISSION under any provision of this Agreement or this Section, GRANTEE shall not be required to indemnify or hold harmless COMMISSION for liability attributable to the sole fault of COMMISSION, provided such sole fault is determined by agreement between the Parties or the 26 findings of a court of competent jurisdiction. This exception shall apply only in those instances where COMMISSION is shown to have been solely at fault and not in instances where GRANTEE is solely or partially at fault or in instances where COMMISSION’S fault accounts for only a percentage of the total liability. In such cases, the obligation of GRANTEE to indemnify and defend shall be all-inclusive. GRANTEE SPECIFICALLY ACKNOWLEDGES THAT ITS OBLIGATION TO INDEMNIFY AND DEFEND EXTENDS TO LIABILITY ATTRIBUTABLE TO COMMISSION, IF THAT LIABILITY IS LESS THAN THE SOLE FAULT OF COMMISSION. 27 Part 8: Attachments Directions: All of the required attachments to be included in your application are listed below with specific instructions. Please DO NOT print and use this application copy as you must complete attachments 1-9 on the template provided on the First 5 Santa Barbara County website www.First5SantaBarbaraCounty.org . 15. Application Cover Sheet (Attachment 1) When this attachment is downloaded from the website, notice that there are two fields needing to be completed through a dropdown menu that will 1) identify the initiative for which you are applying and 2) indicate if the application is from a Single Agency or from a Lead Agency with subcontractors. Because this is a generic cover sheet across all 5 Initiative applications, please make sure that you check Part 2E of your particular initiative application to see which types of Applications (Lead or Single Agency) are acceptable. Once you have completed all of the text and numeric fields via computer, print the attachment, and have the agency director, board president, and any subcontractors sign the form in blue ink. 16. Application Checklist (Attachment 2) Download the attachment from the website and utilize the checkmark option to the right of each question to complete the form. Please type the Applicant Agency name in the text field located at the top of the form. Once the above steps are competed, print the attachment and sign the second page in blue ink. 17. Geographic Location of Clients Served (Attachment 3) This form is required for each agency included in the application, including subcontractors. If the application contains subcontractors, complete one form that comprises the project total (Lead Agency + all Subcontractors) and one form for EACH contributing agency (Lead Agency + all Subcontractors). Complete all columns and rows of the attachment, which correspond with the each fiscal year of the grant 06- 07, 07-08, 08-09. Download the attachment from the website and utilize the checkmark and numeric fields to compete the tables. Please type the Applicant Agency name and the Subcontractor Name (if applicable) located at the top of the form. There are two tables included in this attachment, one to indicate the number of individual/unduplicated clients projected to be served by this project and another table that indicates how many group/duplicated clients projected to be served by this project. Please complete the table 28 that best matches your project. Depending on your project, you may complete one table or both. 18. Units of Service (Attachment 4) This form is required for each agency included in the application, including subcontractors. If the application contains subcontractors, complete one form that comprises the project total (Lead Agency + all Subcontractors) and one form for EACH contributing agency. Complete all columns and rows of the attachment, which correspond with the each fiscal year of the grant 06-07, 07-08, 08-09. Download the attachment from the website and utilize the dropdown, text, and numeric fields to compete the tables. Please type the Applicant Agency name, Subcontractor Name (if applicable), and the Program Name located at the top of the form. If the applicant has more than 6 units of service, please complete additional pages of the template as needed. There are 6 types of dropdown menus located on this form: Service Code, Client Type, Client Type Details, Focus Area, Service Modality, and Measurement Type. Each is described below. Based on what best matches the descriptions below with proposed applicant activities, select options from the dropdown menus provided. Service Codes are designated names for program strategies. For each unit of service, select the service code that best matches your program strategy. Each of the available service codes and their descriptions are located in Table A of these instructions. Please note that there are two dropdown menus that provide available codes based on alpha sequence A-He and Hf-Z. Select ONLY 1 code per unit of service. Client Types include 3 main categories under which all First 5 clients are tracked for evaluation purposes. The types are: Family Member, Provider (for example child care provider or health care provider), and Group. Client Type Details provide further information about who programs are serving. Details by the 3 client types are below. Family member: Child 0-5, Biological parent, Foster Parent, Adopted Parent, Expecting Parent, Grandparent, Other Relatives, Domestic Partner, Sibling 6-18 Provider: Center based ECE, Education Community, Family Support Providers, Family Based ECE, Health Care Providers, Informal Care Providers, Internal Program Staff, Kindergarten Teachers, Other Group: Business Community, Center Based ECE, Children 29 0-5, Community At Large, Education Community, Expectant Parents, Family Support Providers, Family Based ECE Providers, Health Care Providers, Infant Care Providers, Internal Program Staff, Kindergarten Providers, Parents/Guardians, Siblings 6-18 The Focus Area dropdown menu links the applicant proposed services to the First 5 Strategic Plan. As described in the application, the 4 Strategic Plan focus areas are: Child Health, Family Strengthening, Systems Improvement, and Early Development and Education. While the proposed strategy may fit under more than one category, choose the one category that BEST describes it. Service Modality describes how the applicant will be providing the service. The available modalities for selection in the drop down menu are: case management, class/workshop, home visit, in-person consultation, mailing/distribution of materials, mobile service, phone consultation, public community event, and support group session. Measurement Type is how the applicant and First 5 Santa Barbara County staff will measure the applicants’ progress in achieving the proposed units of service under the column “Units Funded By First 5.” For example, 1 unit = 1 hour of service. Units Funded By First 5 is where the applicant will type the number of measurable units the project will complete per fiscal year with the award. Total Units for Project (including leveraged dollars) is where the applicant will type the number of measurable units that will be completed by the applicant for the project as a whole (First 5 award + additional matched and leveraged dollars). If your proposed program will be funded 100% by the request in this application, then the numbers in this column would be the same as “Units Funded by First 5.” EXAMPLE: Program Healthy Teeth is applying to treat 100 children aged 1-5 who have severe dental problems. Service Code = dental treatment; Client Type = Family Member; Client Type Details = Child 0-5; Focus Area = Child Health; Service Modality = In-person consultation; Units of Measurement = Client Contacts; Units Funded by First 5 = 200 (assumption is that each of the 100 children needed to have 2 contacts/visits to the dentist to complete treatment.) 19. Client Type Details (Attachment 5) This form is required for each agency included in the application, including subcontractors. If the application contains subcontractors, complete one form that comprises the project total (Lead Agency + all 30 Subcontractors) and one form for EACH contributing agency. Complete all columns and rows of the attachment, which correspond with the each fiscal year of the grant 06-07, 07-08, 08-09. Download the attachment from the website and utilize the numeric fields to compete the tables. Please type the Applicant Agency name and Subcontractor Name (if applicable) at the top of the form. This attachment is comprised of three tables that the applicant will complete in order to illustrate how many clients the proposed program will serve over the duration of the grant with First 5 funds and as a whole (including leveraged funds.) If your proposed program will be funded 100% by the request in this application, then the numbers in the column “Clients Funded by First 5” would be the same as “Total Clients in the Project.” Depending on what type of program the applicant is proposing, there may be projected client counts in one, two, or all three of the tables. Please enter “0” in each field where there are no clients projected to be served. The three tables are: projected unduplicated family members, projected unduplicated providers, and projected duplicated/group clients and are described below. Each table is mutually exclusive. In other words, family member numbers included in table 1 should not count that be included in table 3. Table 1: Projected individual/unduplicated family members to be served Based on the Family Member Type Details that are listed on the left side of the table and which correspond to the description in Attachment 4, project how many individual/unduplicated family members will be served for each fiscal year of the program. An individual and unduplicated count means that regardless of how many times a program serves a family member “Anna” she is still counted as 1 person. Table 2: Projected individual/unduplicated providers to be served Based on the Provider Type Details that are listed on the left side of the table and that correspond to the description in Attachment 4, project how many individual/unduplicated providers will be served for each fiscal year of the program. An individual and unduplicated count means that regardless of how many times a program serves a provider named “Maria” she is still counted as 1 person. Table 3: Projected group/duplicated clients to be served Based on the Group Type Details that are listed on the left side of the table and which correspond to the description in Attachment 4, project how many clients served in these categories for each fiscal year of the program. These counts may contain duplicated counts. This table should be used to estimate counts of group types for programs that are, as part of the funded application scope of work, serving audiences in a format 31 where it would not be feasible to obtain specific and individual client information (for example, hosting a conference or large workshops.) 20. Evaluation Tool Matrix (Attachment 6) This form is required for each agency included in the application, including subcontractors. Use the text fields at the top of the form to type the applicant name, subcontractor name (if applicable) and the program name. In the “Name of Tool” column, please type the name of each tool (assessment, screening or other measurement instrument) that the applicant is proposing to use in order to evaluate program success and client progress. In the narrative section, applicants must explain why they have chosen each of the tools listed in this attachment. In the second column, please select one of the predesignated client types from the drop down menu (family member, provider/professional, or group) to indicate the audience for which this tool will be administered. In the third column, briefly describe how often the tool will be administered to the client. For example: 2 times per year, every 8 weeks, etc. In the forth column, indicate how many individual clients will be assessed with the tool within each fiscal year. If the client type for the tool is a group, indicate how many different groups will be assessed within each fiscal year. In the last column, type each of the indicators in part 2 of this application that the selected tool will measure. Please use the exact language in the application. If it will measure more than one indicator, please number each indicator starting with “1” for each tool. 21. Program Budget (Attachment 7) This form is required for each agency included in the application, including subcontractors. If the application contains subcontractors, complete one form that comprises the project total (Lead Agency + all Subcontractors) and one form for EACH contributing agency. For Lead Agencies and Subcontractors, complete one attachment for each of the fiscal years corresponding to the application (06-07, 07-08, 08-09.) Please make sure that the budget adds correctly and corresponds to the application request on Attachment 1- Cover Sheet. The maximum allowable indirect cost rate is 15% of the program total minus the cost of any equipment and/or capital expenses. 22. Indirect Cost Rate Description (Attachment 8) 32 This form is required for each agency included in the application, including subcontractors. Complete each of the two questions in the text fields provided. Items that listed as part of the indirect cost may not also be included as line items in the budget (Attachment 7). 23. Agency Involvement in Litigation (Attachment 9) Complete one form per application utilizing the text fields and the check- mark enabled boxes to the right of each question. 24. Agency Organizational Chart (Label as Attachment 10) Submit the Lead Agency organizational chart and label as Attachment 10 centered at the top of the page. 25. Proof of nonprofit status, if applicable (Label as Attachment 11a) Submit the Lead Agency nonprofit status and label as Attachment 11a centered at the top of the page. 26. Clinic/Agency license, if applicable (Label as Attachment 11b) Submit the Lead Agency License and label as Attachment 11b centered at the top of the page. 27. Independent Audit (Label as Attachment 12) Submit the Lead Agency Audit and label as Attachment 12 centered at the top of the page. If your agency has not had a recent independent audit, please explain. 33 Table A Service Code Service Definition Educational and consulting activities to help providers obtain and maintain state-regulated licenses and accreditation for operating child Accreditation Facilitation care and preschool facilities Administrative/collaborative coordination Activities to help agencies deliver high-quality services/activities for children and families Includes assessing needs, coordinating the delivery of needed services, creating a service plan with family goals, ensuring that services Case Management are obtained in accordance with the case plan, and/or following up and monitoring progress to ensure that services are having an impact Dental Screening Providing brief dental screenings to identify need to additional treatment Dental Treatment Providing check-ups, cleanings, and treatment for identified problems Developmental Services Providing behavioral and developmental services not covered by more specific codes in this table; please provide specifics in Attach # 4 Developmental assessments Assessment used to determine if a client has a developmental delay Developmental Screening Screening to determine if a client appears to have typical development or will need further assessment to identify a developmental delay Classes (not for training or education) that give providers a chance to assemble, discuss common issues, and develop a professional ECE Classes network ECE outreach & information Outreach to the Early Childhood Provider Community Providing educational activities and experiences for children 0-5 that are intended to foster social, emotional, and intellectual growth and ECE provided during other service provision prepare them for further formal learning at the same time their parent or caregivers are receiving other services (ex. Parent workshop) ECE provider grants Mini-grants to improve quality of care ECE provider site visits Site visits to early childhood providers ECE provider technical assistance Workshops, classes, or consulting with providers to build their knowledge and skills for working with children and families Family assessments/ screening Tracks when a family member or client has received an assessment or screening (for example mental health screening) Family literacy services Providing classes, workshops or other supports that focus on the importance of literacy of the family as a whole Family school readiness services Providing classes, workshops or home visits with parents together with their children to promote school readiness Family support services/linkages Linking families with support programs such as counseling or food assistance and following up to see if the client accessed services Family Support/Advocacy Working with families to access needed supports and services Father support services Programming designed to specifically support and engage fathers in the health and development of their 0-5 aged child Health advocacy services Working with families to connect them with health related services or insurance programs Health Screening Brief screenings to identify if further assessment is needed to treat health related problems such as vision, hearing, asthma, etc. Health Treatment Provision of health services previously identified during screenings Health/Safety Presentation Providing education regarding health and safety of families with young children Home play kits Giving or lending educational materials to families to use with children 0-5 Home Visit - Developmental Screening Screening a client in his/her home to identify if they appear to have typical development or indicate they should have further assessment Home Visit - Health and Safety Focus Serving a client in his/her home with a focus on client and family health and safety Table A Home Visit - Parent Education Focus Providing individualized parent education in his or her home Home Visit - Birth/Infant Focus Providing home visits in a client’s home with a focus on the health, development and well being of his/her infant Providing individual and family counseling of children or adults (and their families), including play therapy, parent-child interaction Individual/Family Counseling therapy, and family therapy Providing referrals or service information about various community resources, such as medical facilities, counseling programs, family Information & referral resource centers, and other supports for families. This is intended to capture quick I&R - NOT related to ongoing case management Kindergarten Preparatory Education Providing classes, home visits, camps, tours, or other activities designed to help children transition smoothly into kindergarten Providing activities that promote adult literacy skills, such as reading, writing, speaking, listening, and learning English as a second Language/Literacy Education language. Mental Health Assessment A formal assessment to identify if a client has mental illness and/or to create a mental health treatment plan Mentoring Mentoring of Early Care Providers Offering classes, groups, or other educational opportunities for parents or expectant parents to increase knowledge and skills related to Parenting Education parenting young children Service provider training/TA Workshops, classes, mentoring, or consulting with providers to build their knowledge and skills for working with children and families Site Visit - ECE Licensing Site Visits with a focus on licensing Salary augmentation, honorariums, or tuition scholarships to encourage early care and education providers to participate in further Staff/Provider Stipends training and remain in the field Offering classes and other educational opportunities for providers to increase knowledge and skills related to children 0-5 and their Staff/Provider Training families Transportation Providing free or low cost transportation for individuals whose points of origin and destination are within the county W.E.B. 1. Hospital liaison visits Hospital visit to explain and offer the Welcome Every Baby program to new parents W.E.B. 2. Postpartum home visits Home visit completed to new parents with newborns under 2 weeks old W.E.B. 3. Postpartum follow-up telephone call Phone call completed to new parents with newborns under 2 weeks old W.E.B. 4. 4-month home visit Home visit completed to new parents with babies who are approximately 4 months old W.E.B. 5. 6-month follow-up telephone call Phone call to parents with babies who are approximately 6 months old W.E.B. 6. 9-month home visit Home visit completed to new parents with babies who are approximately 9 months old W.E.B. 7. 9-month follow-up telephone call Phone call to parents with babies who are approximately 9 months old Attachment 1 First 5 Santa Barbara County Application Cover Sheet What Initiative: Select Type of Application Select Name of Applicant Agency/Organization: Program Contact/Title Telephone # Email address: Agency Address: FAX # (Street/City/Zip) FY 06-07 FY 07-08 FY 08-09 Total Amount of Grant Application Request $ $ $ $ Name of Agency Director Signature of Agency Director Name of the President of the Board of Directors Signature of President of the Board of Directors Tax-exempt Status: Granted 170 Status with State of CA Applied for Tax Exempt Qualified with 509 exemption Other Tax ID Number: Subcontractor Signatures All subcontractors included in the requested budget must sign below. By signing, the subcontractor is assuring First 5 Santa Barbara County that they have seen and approved the corresponding subcontractor budget, scope of work, and related attachments submitted by the applicant on their behalf. For reference, these attachments are: 3, 4, 5, 6, 7 and 8. NAME OF AGENCY NAME OF AGENCY DIRECTOR DIRECTOR SIGNATURE Attachment 2 Application Requirements Checklist Agency Name: Yes No N/A 1. My organization is a non profit organization or a public agency 2. My organization has the relevant experience and capability to perform the work described in this proposal, and certifies that adequate internal controls are in place to manage and meet all terms and conditions of the contract 3. My organization has submitted proof of its financial solvency as evidenced by the most recent CPA audit (unless exempt), or year end financial statement and fully explained any exceptions 4. My organization agrees to comply with all requirements and grant conditions .conditions set forth in this Request for Application 5. My organization has completed and included the following items in this proposal package: a) Proposal Content: i) Abstract ii) Agency and Staff Qualifications iii) Proposed Program Implementation Supervision and Accountability Description of Collaborative Planning Process iv) Evaluation and Program Improvement v) Fiscal Management and Controls vi) Budget and Cost Effectiveness vii) Sustainability b) Required Attachments: i) Application Cover Sheet (Attachment 1) ii) Application Checklist (Attachment 2) i) Geographic Location of Clients Served (Attachment 3) ii) Units of Service (Attachment 4) iii) Client Type Details (Attachment 5) iv) Evaluation Tool Matrix (Attachment 6) v) Program Budget (Attachment 7) vi) Indirect Cost Rate Description (Attachment 8) vii) Agency Involvement in Litigation (Attachment 9) viii) Agency Organizational Chart (Label as Attachment 10) ix) Proof of nonprofit status, if applicable (Label as Attachment 11a) x) Clinic/Agency license, if applicable (Label as Attachment 11b) Attachment 2 Application Requirements Checklist xi) Independent Audit (Label as Attachment 12) If your agency has not had a recent independent audit, please explain. 6. Each subcontractor included in this application has: i) Signed the Application Cover Sheet ii) A separate attachment 3, 4, 5, 6, 7, and 8 included in this Application 7. Lead Agency Applications include one set of Attachments 3, 4, 5, 6, 7, 8 that comprise a complete project total (all subcontractors + lead agency) 8. Applicant Agency and subcontractors have not had any contact with First 5 Commissioners and First 5 Commission Staff regarding the content of this Application starting January 9th 2006 and will continue not to have contact regarding these matters until May 16th, 2006 9. Applicant has signed the original application in blue ink and made 10 copies of the application on 3-hole punched paper. Applicant will submit a CD copy of the application narrative and all attachments (excluding agency audit). _______________________________________________________________________________ Name of agency/organization _____ _____________________________________ Name of authorized agency official Title _____________________________________ Authorized signature Date Attachment 3 Location of Clients Served Required for Lead Agency & all Subcontractors. Lead Agency Name: Subcontractor Name: Directions: Please identify how many clients will be served with First 5 funding Table 1: Geographic Location of Clients to be Served Individually Check Community Area 2006-2007 2007-2008 2008-2009 all that Projected Projected Projected apply Santa Barbara Carpinteria Cuyama/New Cuyama Los Alamos Santa Maria Lompoc Valley Goleta Guadalupe Orcutt Isla Vista Santa Ynez Valley Other in SB County Table 2: Geographic Location of Clients to be Served in Groups Check Community Area 2006-2007 2007-2008 2008-2009 all that Projected Projected Projected apply Santa Barbara Carpinteria Cuyama/New Cuyama Los Alamos Santa Maria Lompoc Valley Goleta Guadalupe Orcutt Isla Vista Santa Ynez Valley Other in SB County Required for Lead Agency Attachment 4 & all Subcontractors. Projected Units of Service Agency Name: Program Name: Subcontractor: Units Funded by First 5 Total Units for Project including leveraged dollars Units of Service FY: 06-07 FY: 07-08 FY: 08-09 FY: 06-07 FY: 07-08 FY: 08-09 Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 1. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 2. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 3. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Required for Lead Agency Attachment 4 & all Subcontractors. Projected Units of Service Agency Name: Program Name: Subcontractor: Units Funded by First 5 Total Units for Project including leveraged dollars Units of Service FY: 06-07 FY: 07-08 FY: 08-09 FY: 06-07 FY: 07-08 FY: 08-09 Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 4. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 5. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Service Code: (A - He) OR (Hf - Z) Client Type: Select Client Type Details: Select 6. Focus Area: Select Service Modality: Select Measurement Type: Select Additional details: Attachment 5 Client Type Details Required for Lead Agency & all Subcontractors. Lead Agency Name: Subcontractor Name: Table 1: Enter total # individual/unduplicated family members expected to be served by this program. (Enter “0” if none) Number of Family Member Type Total Clients Total Clients Total Clients Clients Funded by Clients in Funded by Clients Funded by in Project First 5 Project First 5 in Project First 5 FY: 06-07 FY: 06-07 FY: 07-08 FY: 07-08 FY: 08-09 FY: 08-09 Child 0-5 Biological Parent Foster Parent Adopted Parent Expecting Parent Grandparent Other Relatives Domestic Partner Sibling 6-18 Table 2: Enter total # individual/unduplicated providers expected to be served by this program. (Enter “0” if none) Number of Provider Type Total Clients Clients Total Clients Total Clients Funded in Project Funded by Clients in Funded by Clients by First 5 FY: 06-07 First 5 Project First 5 in Project FY: 08-09 FY: 06-07 FY: 07-08 FY: 07-08 FY: 08-09 Center based ECE Education Community Family Support Providers Family Based ECE Health Care Providers Informal Care Providers Internal Program Staff Kindergarten Teachers Other Attachment 5 Client Type Details Lead Agency Name: Subcontractor Name: Table 3: Enter total # clients expected to be served by this program in groups-duplicated counts. (Enter “0” if none) Number of Group Client Type Total Clients Clients Funded Total Clients Clients Total Clients Clients in Project by First 5 in Project Funded by in Project Funded by FY: 06-07 FY: 06-07 FY: 07-08 First 5 FY: 08-09 First 5 FY: 07-08 FY: 08-09 Business Community Center Based ECE Children 0-5 Community at Large Education Community Expectant Parents Family Support Providers Family Based ECE Providers Health Care Providers Infant Care Providers Internal Program Staff Kindergarten Teachers Parents/Guardians Siblings 6-18 Attachment 6 Evaluation Tool Matrix Lead Agency Name: Program Name: Subcontractor Name: Name of Tool To whom will this tool How often will it be How many List the indicator(s) this tool will measure (RFA Section 2) be administered? clients will be administered to the client? (client type) screened/ assessed by this tool per year? Select Select Select Select Select Select Attachment 7 Program Budget Required for Lead Agency & all Subcontractors for each fiscal year Complete this form for the entire project. If there are subcontractors budgets involved, please submit an additional form for each. Identify the subcontractor, and the line items involved in each subcontract. Agency Name: (Please check the appropriate box) Prime Contractor’s budget Subcontractor’s budget (Subcontractor’s Name) Program Name: Budget Period (Please check the appropriate box) July 1, 2006 – June 30, 2007 July 1, 2007 – June 30, 2008 July 1, 2008 – June 30, 2009 I. PERSONNEL Amount Matching Total Salary Requested Amount ** Project Position Title Range FTE from First 5 Available Source Budget Code A. B. C. D. E. F. Benefits@ % Benefits@ various % Sub Total-Personnel II. OPERATING EXPENSES A. Rent and Utilities B. Office Supplies and Materials C. Telephone/Communications D. Postage/Mailing E. Reproduction/Copying F. Printing G. Equipment Lease/Equipment H. Travel I. Insurance J. Audit K. Training Conferences L. Evaluation M. Subcontractors N. Other Subtotal –Operating Expenses Capital Expenditures over $5,000 (if required for this project) (Itemize and identify items requested.) Competitive bids may be requested by the Commission prior to contract. Total Capital Expenditures *INDIRECT COSTS Total Program Costs **Using the code list below, indicate the In-Kind: Please identify any in-kind support that is source of the marching amount available to available to this project (i.e.: Volunteer hours, support this program. identify role(s) of volunteers, donated office space or equipment, etc.) Source Code Description 1 Agency General Fund 2 Foundation Grant 3 Government Grant 4 Other 5 State/Federal Leveraging And Attachment 8 Indirect Cost Rate Description Required for Lead Agency Lead Agency Name: & all Subcontractors. Subcontractor Name: 1. How is the rate for which indirect costs are charged calculated? 2. List all items that are included in your indirect costs: Please note that indirect cost cannot exceed 15% of total grant amount awarded, excluding equipment and/or capital expenses. Attachment 9 Agency Involvement in Litigation Form and/or Compliance Difficulties Agency Name: Program Name: Check YES or NO on the following questions. If a YES answer is checked, please explain fully the circumstances and include discussion of the potential impact on the program, if funded. As part of the grant agreement process, the COMMISSION, as its own discretion, may implement procedures to validate the responses made below. The COMMISSION reserves the right to reject all or part of the grant agreement if false or incorrect information is submitted by the grantee. YES NO 1. Is the organization (or a collaborative partner) currently, or within the past two (2) years, involved in litigation? 2. Is the lead agency director currently, or within the past two (2) years, involved in litigation related to the administration and operation of a program or organization? 3. Have there been unfavorable rulings by a funding source against the agency (or collaborative partners) for improper management or contract compliance deficiencies? 4. Has the agency or agency director (for the lead agency or subcontractors) ever had public or foundation funds withheld? 5. Has the agency (or subcontractors) ever had its non-profit status revoked or withheld? 6. Has the agency or agency director (for the lead agency or subcontractors) refused to participate in any fiscal audit requested by a government agency or funding source? Explanation (Use additional pages, if necessary): Signature: ___________________________________________ Date: _________________ (Must be signed by authorized sign signatory).