Department of Children and Families Tier Classification System User Guide. December 2015

Transcription

1 Department of Children and Families Tier Classification System User Guide December 2015

2 The Department of Children and Families Tier Classification System User Guide TABLE OF CONTENTS Introduction Page 3 Acknowledgements Page 4 Key Terms Page 5-6 Tier Classification Levels Page 7 Tier Classification hodology and Tier Level Comparison Page 8 Program Performance Development: Service Development Plans and Corrective Action Plans Page 9-10 Tier Level Comparison Table Page 11 Foundational Elements Domain Page 12 Utilization and Timeliness Domain Page 13 Program Performance Domain Page 14 Cultural Competence Domain Page 15 Client/Family Feedback Domain Page 16 Staffing Domain Page 17 Administrative Performance Domain Page 18 Service Development Plan Form Template Page Corrective Action Plan Form Template Page Provider Request Form for Tier Classification Early Review Page 24 2 P a g e

3 The Department of Children and Families Tier Classification System User Guide Strong Programs Help Build Strong Families. The Department of Children & Families (DCF) is committed to obtaining the best outcomes for all programs funded by DCF. The Tier Classification System will align several areas of work within the Department and formalize existing practices used to assess program performance. The classification of programs will enhance the Department's ability to support decision-making toward the improvement of client outcomes, strengthen internal and external partnerships, create opportunities to recognize excellent performance, and identify opportunities for improvement at a program and system level. The Tier System measures general contractual requirements defined by the Department, in collaboration with provider partners. The requirements are grouped into three Tier Classifications and an additional Provisional Tier. All Tier Classification protocols for rating contractual requirements are defined in the Tier Classification User Guide co-developed by DCF and provider partners. 3 P a g e

4 Acknowledgements We would like to thank the following group of dedicated professionals for working collaboratively on the design of this DCF Tier Classification System: Ana Flamengo, Connecticut Junior Republic Anne McIntyre-Lahner, DCF Bethany Zorba, DCF Brunilda Ferraj, CCPA Cheryl Burack, Family Centered Services of CT Colleen Kearney, CT Association of Non-Profits Dan Panchura, DCF Diane Rosell, DCF Elisabeth Cannata, Wheeler Clinic Ellen Ross, United Community & Family Services Gary Steck, Wellmore Ines Eaton, DCF Isabel Turmeque, DCF Jennifer Sisk, DCF Jim McPherson, DCF Jonathan Jacaruso, DCF Judi Jordan, DCF Marty DiTuccio, DCF Mary Cummins, DCF Melanie Rossacci, DCF Michael Russo, Wheeler Clinic Pamela Burney, DCF Paul Shanley, DCF Sarah Gibson, DCF Sarah Lockery, Children s Center of Hamden Tere Foley, DCF Ted Sanford, DCF 4 P a g e

5 Key Terms Tier Classifications will be based on a review of a number of different data sources both from inside and outside the Department. The Tier Classification review may include an on-site visit when necessary. The data sources utilized in the review process are designed to assist the Department and the provider in gaining a holistic view of the program s functioning. The following are definitions of key terms and DCF data sources. Contract Management (CM): Provides support, guidance, and leadership in issues related to the Department s contracted services. Functions include purchasing services, contract clarity, Personal Service Agreement and scope of service writing, fiscal administration, and helping to facilitate communication between area office staff, program leads and the providers related to the procurement of services. Fiscal Leads are DCF fiscal staff assigned to oversee the contracted provider budget. Corrective Action Plan (CAP): A formal document required to be submitted by a DCF contracted program due to failure to effectively implement or achieve the goals of an SDP. A CAP may be required without an SDP first being submitted if the issues identified represent a significant impact on the health and safety of children. Licensing Division: Responsible for the licensing of four categories of services delivered to children and their families throughout the state of Connecticut. Child Caring Facilities (Residential Treatment, Residential Education, Temporary Shelters, Group Homes, and S-FIT); Child Placing Agencies; Extended Day Treatment; Outpatient Psychiatric Clinics for Children. Office of Performance Management (PM): Manages the Commissioner s annual Performance Expectations; provides technical assistance, coaching, and coordination to the regions, divisions, and facilities in the development and management of their Operational Strategies; and works with PDOCs, contracting staff, and provider partners in the development of contract performance measures, Results Based Accountability(RBA) Report Cards, and performance management. Private Non-Medical Institution (PNMI): Federal and state standards of any out of home rehabilitating program that has less than 16 beds and funded, at least in part, by the state s Medicaid system. The state standards include review of any congregate program that is a clinical placement. The PNMI Standards are the structural components for achieving effective child specific rehabilitative service outcomes in support of restoring the child to the highest possible level of functioning and achieving the child specific discharge plan. Program: DCF funded program delivering services to the children and families of Connecticut. Program Development & Oversight Coordinator (PDOC): Supports and coordinates the development and oversight of DCF contracted programs to ensure the delivery of high quality, accountable services. Ensures effective communication and positive relationships with the DCF Regions, providers and other divisions within Central Office. 5 P a g e

6 Results Based Accountability (RBA) Report Card: The report card is designed to measure program performance on key contracted performance measures developed to determine the quantity, quality, and effectiveness of programs. RBA report cards help to identify whether consumers are better off as a result of the service, and to identify proposed efforts to improve performance. Risk Management (RM): Is the conduit for the receipt of information on quality of care and programmatic/system issues and the dissemination of said information to internal DCF staff and external stakeholders. Another major function of Risk Management is data collection, analysis and reporting regarding incidents related to Significant Events, Medication Errors, Critical Incidents, and other programmatic/system issues. Service Array Review and Assessment Team (SARA): A team of DCF administrators and staff that meet on a regular basis to discuss resources, service needs, and program outcomes, all in an effort to help ensure a comprehensive and effective service system for the children and families of Connecticut. Service Development Plan (SDP): A collaboratively developed document submitted by a DCF contracted program in response to quality of service concerns jointly identified by the provider and relevant DCF staff; DCF staff may include, Licensing staff, a PDOC, Regional Systems Program Director, Area Office Social Worker, Evidence-Based Quality Assurance Program Director, or other DCF staff who may come into contact with the provider. Special Investigations Unit: (SIU) This unit is part of the Careline Division and is charged with investigating reports of suspected abuse and neglect that involve licensed caregivers (foster homes), licensed state agencies (child care), facilities (residential) and DCF employees. Please e: The DCF Careline is the centralized unit that receives all telephone calls or written information alleging that a child is suspected of being abused or neglected and initiates appropriate action. The Careline also responds to other types of calls related to services for children and families. The Office for Research and Evaluation (ORE): ORE contributes to the development and use of knowledge at DCF by shaping, supporting and conducting research, evaluation and analytic inquiry. This includes improving the analytic data environment; initiating, facilitating and conducting data analysis, & research and evaluation. ORE oversees the Provider Information Exchange (PIE); Private Non-Medical Institution (PNMI) and Risk Management. The Provider Information Exchange (PIE) (formerly PSDCRS): The PIE is DCF's web-based system for collecting and analyzing client-level data on services by contracted providers. It includes both Behavioral Health and Child Welfare programs. For many programs, it reports on clients who are not involved with DCF as well as those who are involved with the Department. DCF uses the system to collect data used to monitor services and outcomes, and to manage program contracts. Tier Classification System Foundational Elements: Five basic elements/contractual requirements that all programs are expected to have in order for a program to maintain acceptable standing with the Department. Tier Classification System Elements of Performance: 20 elements, found within 6 domains,that are used to measure compliance with contractual requirements. 6 P a g e

7 Tier Classification Levels Tier I: A program is classified as Tier I when the program meets all applicable foundational requirements and is meeting all but two or less of the elements of performance in the six domains. See chart below. Tier II: A program is classified as Tier II when the program meets all applicable foundational requirements and is meeting all but three or four of the elements of performance in the six domains. See chart below. Tier III: A program is classified as Tier III if any one of the applicable foundational requirements is not met and/or five or more of the elements of performance in the six domains are not met. See chart below. Provisional Tier: A program is classified as Provisional Tier when the program is newly contracted. New programs will have up to one year to meet Foundational elements and Elements of Performance before being classified, and may be classified sooner at the program s request. When particular elements of performance are found to be non-applicable for a particular program model, scores will be adjusted based on the number of applicable elements. Please see table below for examples: Tier I Meets all Foundational Requirements and all but 2 or less Elements of Performance Scoring Table Tier II Meets all Foundational Requirements and all but 3 or 4 Elements of Performance Tier III NOT : 1 or more Foundational Requirements and/or 5 or more Elements of Performance of of or less of of of or less of of of or less of of of or less of of of or less of 16 7 P a g e

8 Tier Classification hodology The Division of Contract Management will coordinate the Tier System Classification in partnership with several units throughout DCF. The time period for review is the previous twelve (12) months from the date of review. Tier classification will be determined after review of all elements of performance set forth by the Department. The review process is designed to assist the Department and the provider in gaining a holistic view of the program functioning. A written report will be submitted to the provider by the DCF Contract Management Unit following a Tier review. The provider will have ten (10) calendar days to review their Tier Classification report and get back to DCF with their feedback. DCF will review the feedback, seek/review additional information if needed, and submit a final report to the provider. At that time the classification becomes final for one calendar year. Tier Classification determination is final for the year of review and is not subject to appeal; however, an agency s senior administrator may request the program be re-classified earlier if significant improvements have been made that would advance the program to a higher Tier. Requests for earlier reclassification shall be made through a formal process established by the Department. This process is explained later within this document. (Form p.24) TIER LEVEL COMPARISON: Tier I classification: a. The program is in excellent standing and will receive The Commissioner s Award for Excellence in Service Delivery b. If any elements of performance are not met, the program in conjunction with DCF staff will develop an SDP c. The program may be re-classified to a lower tier at any time due to an identified issue of health or safety. A CAP may also be required. d. The program may have reduced DCF Tier oversight Tier II classification: a. The program has met basic contract expectations b. The program in conjunction with the DCF staff will develop an SDP for elements of performance and/or foundational requirements not met c. The program may request a re-classification if it would advance the program to a higher tier d. The program may be re-classified to a lower tier at any time due to an issue of health or safety. A CAP may also be required. Tier III classification: a. The program falls below basic contract expectations due to not meeting all of the applicable foundational requirements and/or five or more of the elements of performance within the six domains. b. The program in conjunction with the DCF staff will develop an SDP for elements of performance not met c. A CAP will be required if the program does not meet at least 50% of the applicable elements of performance or if a serious health or safety concern is identified d. The program may request a re-classification if it would advance the program to a higher Tier Excellent or Satisfactory performance will result in Tier I or Tier II ranking respectively; however, it is important to note that a program s viability may still be impacted as a result of budget cuts when DCF is required to make such cuts. In addition, poor performance, and/or failure to successfully address issues identified on a Corrective Action Plan (CAP), may eventually lead to termination of a contract based on performance. 8 P a g e

9 PROGRAM PERFORMANCE DEVELOPMENT Service Development Plan (SDP) for Tier II and III A SDP is a collaboratively developed document submitted by a DCF provider to address unmet elements of performance jointly identified by the provider and relevant DCF staff and/or an evidence based quality assurance representative. The improvement goals of the SDP should be jointly developed between the provider and relevant DCF staff. The SDP must include the specific steps that will be taken to remedy the issues, along with timeframe for completion and a plan to sustain improved performance. It is critical that the specific steps be clearly time-bounded and measurable. Once the SDP is reviewed and accepted by the PDOC and DCF regional staff, the PDOC will send written notice via to the provider that the SDP has been accepted. Service Development Plan process steps: 1. The Department in conjunction with the provider will develop a SDP with specific goals and timeframes. 2. The provider must submit a written SDP to the program PDOC within 30 business days from receipt of the final tier classification determination. DCF staff will have 10 business days to review and accept the SDP. 3. The program and the PDOC will establish a schedule to provide progress updates prior to the 90-day mark. 4. DCF staff shall follow-up with the program within 90 days from acceptance of the SDP in order to verify implementation. A site visit may occurred at this time. 5. There will be an official SDP progress review visit within 180 days from the acceptance of the SDP If at the six month review: i. All goals have been attained; the program may be considered for re-classification if requested by the agency. Sustained improvement must be maintained for at least 90 days. ii. SOME progress has been made; a follow up review will be made in three (3) months to ensure program is ongoing iii. NO progress towards goal attainment has occurred; in some cases the program may be placed on a CAP. 6. Visits and other follow up activity may be more frequent depending on the issues identified, such as data reports, meetings, etc. CORRECTIVE ACTION PLANS (CAP) A CAP is a formal document required to be submitted by a DCF provider if the goals of the SDP have not been effectively implemented or achieved. A CAP may also be required without a SDP first being submitted if the issues identified represent a significant impact on health and safety of children. The CAP is required to identify specific actions that will be taken by the program to bring itself into compliance, along with timeframes for completion and a plan to sustain improved performance. Failure to successfully implement a CAP may lead to licensing or contract action up to and including revocation of a license or termination of the contract. 9 P a g e

10 Corrective Action Plan process steps: 1. The provider will develop a CAP for the program with specific goals and deadlines. The provider will consult any relevant DCF staff during the CAP development process for guidance, if necessary. 2. The provider will submit the final written CAP to the program PDOC within 30 business days from the receipt of the tier classification determination. DCF staff will then have 10 business days to review and accept the final written CAP. The DCF Deputy Commissioner of Operations has final approval authority over all Corrective Action Plans. 3. The provider will minimally submit monthly updates to the PDOC in order to keep DCF regularly informed of progress. 4. DCF staff shall follow-up with the program within 45 days from acceptance of the CAP in order to verify implementation. A site visit may occur at this time. 5. There will be an official CAP progress review visit 90 days from the acceptance of the CAP. If at the 90 day review: i. All goals as defined in the CAP have been attained. If progress is maintained for an additional of 90 days the program may be considered for re-classification if requested by the agency. ii. SOME progress has been made, a follow up review will be made in three (3) months to ensure improvements are sustained. iii. NO progress towards goal attainment has occurred; it may lead to a licensing or contract action. 6. Visits and other follow up activity may be more frequent depending on the issues identified, such as data reports, meetings, etc. 7. Failure to successfully implement a CAP may lead to licensing or contract action up to and including revocation of a license and/or the termination of a contract. Please note that the PDOC is responsible for monitoring progress in Service Development Plans and Corrective Action Plans Service Development Plans and Corrective Action Plans Timeframes Comparison SDP CAP Written submission within 30 days 30 days Provider Updates As requested Every 30 days DCF review of Progress 90 days 45 days 2 nd Review date 180 days 90 days Site visit within 90 days required Required 10 P a g e

11 TIER LEVEL COMPARISON Level Criteria Incentives Tier Classification Review Timeframe Tier I Tier II The program: Meets all applicable Foundational Requirements, and Meets all but two or less of the elements of performance in the six domains. The program: Meets all applicable Foundational Requirements, and Meets all but four or less of the elements of performance in the six domains. Commissioner s Award of Excellence in Service Delivery Reduced Tier oversight None At least one year The program may be re-classified to a lower tier if an issue of health or safety is identified in the interim. No longer than one year. The program may request a reclassification sooner if it would advance the program to a higher tier The program may be re-classified to a lower tier if an issue of health or safety is identified in the interim. Required SDP or CAP SDP for elements not met (if applicable) review annually SDP- review minimally 90 days Tier III The program: Meets less than all applicable Foundational Requirements, and/or Is not meeting five or more of the elements of performance in the six domains None Re-review will occur at least every 90 days. The program may request a reclassification sooner if it would advance the program to a higher tier. SDP review minimally 90 days or a CAP w/review at 45 days 11 P a g e

12 DCF Tier Classification System Scoring Tool: Foundational Elements: Score Source 1. A review of applicable measures of health and safety indicates that clients are safe. 2. The Program has a written Continuous Quality Improvement Plan/Policy 3. Program data is submitted as contractually specified. 4. The Program's agency has a written plan that promotes development towards Cultural Competence in service delivery 5. The Program has monitored and documented subcontractor performance to ensure contractual requirements are being met (if applicable) Element Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 1. Based on program model, applicable measures can include, review of documented Careline activity, Significant events, and Licensing Actions (For example, involuntary action against the program, such as reducing bed capacity, closing of admissions, or suspension of a license or license activity.) (In consultation with SIU, ORE and Licensing.) 2. The written plan or policy utilizes data to assess program performance and identify areas and strategies for improvement. Provider gives copy of CQI plan. (In consultation with the contracted provider.) 3. This includes submission to PIE and/or any other required data submission documents. (In consultation with the PDOC.) 4. The written plan may be in the form of an agency policy or documented process. The policy, plan, or process that is in place serves as framework for the work that the organization is doing in the area of Cultural Competency. The Department and the Provider will work together to further develop the plan as it evolves. (In consultation the contracted provider.) 5. As evidence by the existence of written performance measures within the subcontractor. (In consultation with the contracted provider.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 12 P a g e

13 Utilization and Timeliness Domain Elements of Performance Score Source 1. Program meets contract capacity 2. Program meets contract response time 3. Program's average length of service is within the required contractual time frames Element Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 1. The program has demonstrated that it actively receives referrals, admits clients, and maintains an active caseload as specified in the scope of services, and has been actively engaged with the DCF area office or CO to address utilization issues if necessary. (In consultation with the region, contracted provider and PDOC.) 2. As defined in the scope of service if applicable. (In consultation with the region and the PDOC.) 3. Defined as: based on scope of service requirements and DCF allowed exceptions, if applicable. (In consultation with the region and the PDOC, and the contracted provider.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 13 P a g e

14 Program Performance Domain Elements of Performance Score Source 4. The program adheres to the contracted service model. 5. The Program is utilizing a Results Based Accountability (RBA) framework to oversee program performance. 6. Contractually required data is submitted accurately and within timelines. 7. The Program submits case specific progress reports to referral source within contractually required timeframes and maintains documentation of such. (if applicable). Element definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 4. Minimally defined as evidence that service delivery matches the service description in the scope of service. (In consultation with the region and the PDOC.) 5. Contractual performance measures will be as assessed by the DCF Service Array Review and Assessment (SARA) Team and RBA report cards reviewed. (In consultation with the Provider-CQI plan.) 6. As defined in the Scope of Service. (In consultation with the PDOC and the region.) 7. As defined in the Scope of Service. (In consultation with the region and the contracted provider.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 14 P a g e

15 Cultural Competence Domain Elements of Performance Score Source 8. The Program utilizes a plan for assessing its cultural competence and addresses areas for improvement 9. The Program has the staff and resources to provide culturally and linguistically appropriate services, as negotiated with DCF. Element Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 8. As evidence by documentation and implementation of a plan. Documentation may include culture competence meeting minutes, documentation of trainings, or cultural events, etc. (In consultation with contracted provider and the PDOC.) 9. Documented efforts of recruitment and retention of culturally and linguistically diverse staff and that the staff has exhibited the ability to work with a diverse population, including all protected classes. Services are trauma informed and gender responsive. Please note resources may include the availability of program pamphlets and forms in other languages, access to a language line, etc. Please also note that as negotiated with DCF means mutually agreed upon terms. (In consultation with the contracted provider and the region.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 15 P a g e

16 Client/Family Feedback Domain Elements of Performance Score Source 10. Referral agent satisfaction data is regularly and systemically sought and collected 11. Client/Family satisfaction data is regularly and systematically sought and collected Elements Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 10. Source of information regional referral agent sharepoint satisfaction survey. If program model is not included in the sharepoint survey the expectation will be that the contracted provider will provide documentation that they have a mechanism to seek and collect referral agent satisfaction data. (In consultation with region, contracted provider.) 11. The program must provide documentation that are seeking and collecting client/satisfaction data. The YSS-F is one example of this. (In consultation with the contracted provider.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 16 P a g e

17 Staffing Domain Elements of Performance Score Source 12. The Program follows required hiring policies and practices that comply with DCF requirements 13. The Program maintains contractually required staffing levels (The Program has a system in place for ensuring staff coverage). 14. The Program notifies DCF of any changes in key personnel. 15. Program staff receives contractually required trainings and maintains documentation of such. Elements Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 12. As defined in the contract. This would include background checks, child welfare checks of its employees. Hiring policies must be provided. Current list of staff in the program and their credentials. (In consultation with the contracted provider.) 13. Priority access and waiting list processes will be reviewed. What percentages of program staff is able to see clients. Agency staff coverage policy will be reviewed. (In consultation with contracted provider, region and PDOC.) 14. Key personel: Provider shall immediately notify the DCF Director of the Contract Management in writing whenever the Provider intends to make or undergo changes in key personnel, i.e., Chief Executive Officer, Chief Fiscal Officer, Medical Director, and program directors of Department funded programs. (In consultation with the PDOC and fiscal lead.) 15. As evidence by written training plan and documented attendance. (In consultation with contracted provider.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 17 P a g e

18 Administrative Performance Domain Elements of Performance Score Source 16. The Program has submitted accurate and complete Budgets/Amendments within the required timeframes 17. The Program has submitted accurate and complete 8th Month and Year End Financial Reports within the required timeframes. 18. The Program has submitted contractually required Annual Fiscal Audits within the required timeframe. 19. The Program has vetted and documented that all subcontractors are meeting all DCF contractual requirements. 20. The Program has informed DCF of all changes of subcontractors. Elements Definitions: Elements will be scored based on evidence of the program s ongoing monitoring and documentation to ensure contractual requirements 16. As evidence by meeting timeframes established by the Department. (In consultation with contract management/fiscal leads) 17. As evidence by meeting timeframes established by the Department. (In consultation with contract management/fiscal leads) 18. As evidence by meeting timeframes established by the Department. (In consultation with contract management and auditing unit) 19. As evidence by a signed subcontract in a written process for overseeing subcontractor activities. (In consultation with contracted provider and contract management.) 20. As evidence by written updates as necessary. (In consultation with contract management/fiscal leads and PDOC.) Key: CM: Contract Management; LIC: Licensing, LINK: DCF Electronic Case Specific Database; ORE: office for Research and Evaluation; PDOC: Program Development & Oversight Coordinator: PIE: Provider Information Exchange; PM: Performance Management; REG: Region; SIU: Special Investigation Unit 18 P a g e

19 Agency: DCF Service Development Plan (SDP) PDOC: Program Name: Date of Tier Classification Determination : Date Program Submitted SDP: Date PDOC Informed Program of SDP Acceptance: The purpose of this Service Development Plan (SDP) is to define areas for improvement based on DCF s contractual requirements, and allow (program) the opportunity to demonstrate improvement. A SDP is a collaboratively developed document submitted by a DCF provider in response to quality of service concerns jointly identified by the provider and relevant DCF staff and/or an evidence based quality assurance representative. Data and Observations: Areas Identified for Improvement: Improvement Goals: 1. Date Signatures PDOC - DCF Regional Systems PD Program Manager, Provider Provider Administrator 19 P a g e

20 DCF Service Development Plan (SDP) UPDATE Provider Program Date of Plan Date of this update SECTION I. Providers who are working on plans with the Department will submit monthly updates. To do so, the Provider may copy and paste as many GOAL update sections as needed. 3 are listed but if not all are needed, please delete. Below each GOAL are lines for the provider to describe the steps taken to reach the goal. Providers can list activities they plan to do all upfront or add activities as they are thought of. Additional lines to list activities can be added as needed. When a GOAL is achieved, enter the date. GOAL # 1 Activity (describe all steps to accomplish the goal) DATE ACHIEVED: START DATE: GOAL # 2 Activity (describe all steps to accomplish the goal) DATE ACHIEVED: START DATE: GOAL # 3 Activity (describe all steps to accomplish the goal) DATE ACHIEVED: START DATE: SECTION II Once a GOAL has been achieved the Provider will use the space below to describe how it will be sustained Signatures PDOC - DCF Regional Systems PD Program Manager, Provider Provider Administrator 20 P a g e

21 Agency: Program Name: DCF Corrective Action Plan (CAP) A Corrective Action Plan (CAP) is a formal document required to be submitted by a DCF provider due to failure to effectively implement or achieve the goals of a SDP. A CAP may also be required without a SDP first being submitted if the issues identified represent a significant impact on a health and safety of children. The (CAP) is to define areas for improvement and to allow the program the opportunity to demonstrate improvement required to continue to deliver services. Sections A, B, and C must be jointly developed between the Provider and relevant DCF staff. A. Data and Observations: (Date of DCF review and review activities) PDOC: Date: B. Areas Identified for Improvement: (Identify the specific regulation, standard, contract provision) C. Improvement Goals: Goal # Targeted Completion Date Signatures PDOC - DCF Regional Systems PD Program Manager, Provider Provider Administrator Deputy Commissioner of Operations - DCF 21 P a g e

22 DCF Corrective Action Plan (CAP) UPDATE Provider Program Date of Plan Date of this update SECTION I. Providers who are working on CAPS with the Department will submit monthly updates. To do so, the Provider may copy and paste as many GOAL update sections as needed. 3 are listed but if not all are needed, please delete. Below each GOAL are lines for the provider to describe the steps taken to reach the goal. Providers can list activities they plan to do all upfront or add activities as they are thought of. Additional lines to list activities can be added as needed. When a GOAL is achieved, enter the date. GOAL # 1 Activity (describe all steps to accomplish the goal) PROJECTED COMPLETION DATE DATE ACHIEVED Start Date GOAL # 2 Activity (describe all steps to accomplish the goal) PROJECTED COMPLETION DATE DATE ACHIEVED Start Date GOAL # 13 Activity (describe all steps to accomplish the goal) PROJECTED COMPLETION DATE DATE ACHIEVED Start Date SECTION II Once a GOAL has been achieved the Provider will use the space below to describe how it will be sustained Signatures PDOC - DCF Regional Designee (OD, SPD, CPD) Program Manager, Provider Provider Administrator 22 P a g e

23 Progress Reviews: The following schedule will be used to evaluate progress To Be Completed by Authorized DCF Staff: Goal # Activity Review Date DCF Reviewer Status es In Progress Resolved Addressed) In Progress Resolved Addressed) In Progress Resolved Addressed) In Progress Resolved Addressed) In Progress Resolved Addressed) In Progress Resolved Addressed) In Progress Resolved Addressed) 23 P a g e

24 Provider Request For Tier Classification Early Review A provider classified as Tier II or Tier III has the option of requesting their next review be completed at an earlier date if the provider is able to demonstrate that the review will reclassify the program. An early review may be requested after six months of the most recent Tier classification. The provider must complete this form and send to DCF Contract Management, with a copy to their DCF PDOC Provider Program Program Type Contact person and contact information Date of Prior Tier Classification Determination Date of this request A. Foundational Elements: Please check one: All were met during prior review All were not met during prior review (complete the below) The following Foundational Elements were not met during the prior review (add rows as necessary) The program now meets the Foundational Elements as evidenced by: X here to confirm the program has sustained compliance for a minimum of 3 months B. Domains: Please check one: All Elements of Performance were met during the review All were not met during the review (check the number below that corresponds to the Element of Performance that was not met)** Complete the below: ** # The following Elements of Performance were not met during prior review (add rows as necessary) The program now meets the Element of Performance as evidenced by: X here to confirm the program has sustained compliance for a minimum of 3 months Authorized Provider Signature Date Date received // Request granted // Request denied // Date Provider Informed 24 P a g e