ASSESSMENT SERVICES

Procurement 530-13-0013A
CONTRACT PURPOSE
To obtain the expertise of a Contractor that will:
Provide a work product that is of the quality and within the
timeframes to enable CPS to make the best permanency
decision for the child.
Provide thorough FAD Screenings, HSEGH Reports and
Kinship Home Assessments.
Offer flexible hours to accommodate the applicants
schedules
Be available to receive referrals.
Adequately screen, select, develop, supervise and
manage qualified, trained service providers (if using
subcontractors).
2
TECHNOLOGY
Requirements
Broadband Internet Connection
Internet Explorer 6.0 or Higher
Microsoft Word
Email Address
Anti-Virus Program (Active and Up-to-Date)
DFPS Internet Site
DFPS Internet Homepage
http://www.dfps.state.tx.us/
Purchased Client Services (PCS) Homepage
Regional CPS Contracts Homepage
Regional CPS Contracting Forms
Client Services Contractor Reference Guide
ABCS Registration
ABCS User Login 3
Select Contracting with DFPS
from the DFPS Internet
Homepage

DFPS INTERNET SITE
PURCHASED CLIENT SERVICES (PCS) HOMEPAGE
http://www.dfps.state.tx.us/PCS/About_PCS/
4
Quick Links: Select
Contracting and
Procurement Forms to
Obtain the 2970C and
2971C

Select to Access
the Regional CPS
Contracts
Homepage
Scroll
down to
Log-in to
ABCS
DFPS INTERNET SITE
REGIONAL CPS CONTRACTS HOMEPAGE
http://www.dfps.state.tx.us/PCS/Regional_Contracts/
5
Select to Access
Forms
6
Forms
Grouped by
Category

Click on
Category to
Auto-Scroll
to
Applicable
Forms
DFPS INTERNET SITE
REGIONAL CPS CONTRACTING FORMS
REFERRALS
VALID REFERRAL PACKET CONTENTS (MINIMUM)
Foster/Adopt (FAD) Home Screening
Form 2054 (Service Authorization)
Form 2700FAD (Routing and Approval)
Form 2178FAD (Home Screening Referral)
Foster/Adopt (FAD) Home Screening with Kinship
Form 2054 (Service Authorization)
Form 2700FAD (Routing and Approval)
Form 2178FAD (Home Screening Referral)
Most Recent Kinship Caregiver Assessment
Health, Social, Educational and Genetic History (HSEGH) Report
Form 2054 (Service Authorization)
Form 2700HSEGH (Routing and Approval)
Form 2644 (Referral for HSEGH Report)
Kinship Caregiver Home Assessment (KCHA)
Form 2054 (Service Authorization)
Form 2700KIN (Routing and Approval)
Form 6581 (Kinship Request for Assessment) or ICPC Referral (ICPC Regulation 2 Case Manager
Statement)
Court Related Services
Form 2054 (Service Authorization) 7
REFERRALS
INITIAL CONTACT - TIMEFRAME
Within Two (2) Business Days from the Receipt of the Complete
Referral (Form 2054 and Referral Packet)
Acknowledge Receipt of Referral
Make Initial Contact with Client
Validate Household Composition

8
WITHDRAWALS
9
Acceptable Withdrawals of a Referral*
The household desires to be removed from consideration for placement of a Child
DFPS notifies the Contractor that the Assessment is no longer needed
The Contractor notifies DFPS of information that may result in the immediate rejection of
the Client for placement of a Child
The household is uncooperative
The Contractor must:
Notify DFPS person making the referral via email within 1 business day of Contractors
knowledge of the households withdrawal
Complete and submit Form 5520 (Withdrawal Report) within 5 calendar days of the
withdrawal

*All Withdrawals subject to DFPS approval
Face-to-Face Contact
(Refer to Fee Schedule)
No Face-to-Face Contact
(Refer to Fee Schedule)
ADMINISTRATIVE FUNCTIONS
Maintain sufficient funds to support the contracted services.
Have an operational system for managing referrals, assignments,
and obtaining work product approval that is complimentary with
DFPS internal processes.
Ensure CPM Staff and Service Providers meet minimum
qualifications for License, Education and Experience. (Submit to
Contract Manager-PCS-102 & Form 551 & resume attached *
form must be approved by Contract Specialist before staff can
work with DFPS clients)
Develop, manage, and maintain a Quality Assurance process and
satisfy the requirements of the contract.
Successfully administer a performance-based contract.
Secure translation and interpreter assistance as needed.
Meet all submission and documentation requirements.
Complete all contracting actions.



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SERVICE EXPECTATIONS
FOSTER/ADOPT (FAD) HOME SCREENING
Collect Case Information
Read All Referral Packet Information
Examine & Understand All Other Information Provided by CPS Staff
Conduct Interview
Conduct face-to-face interviews with all household members at least 3 years of age or older according to
Section 2.17 of the Statement of Work.
Conduct interviews in an effective and appropriate manner.
Obtain signed Form 2163 (Agreement to Give Information) from all adult household members.
Compile Assessment
Consider all information provided by DFPS and disclosed during the interview when developing the final
product.
Use prescribed format.
Adoptive Only: Form 2190 (Adoptive Home Screening) and Form 2190ins (Instructions)
Foster /Adoptive: Form 2191 (Foster/Adoptive Home Screening ) and Form 2191ins (Instructions)
Foster Only: Form 2192 (Foster Care Home Screening) and Form 2192ins (Instructions)
Microsoft Word (Font: Arial 10 point)
Compose and submit completed assessments according to the requirements in Sections 2.17, 2.18 and
2.19 of the Statement of Work.
Timeframes
Standard: 20 Calendar Days*
Expedited: 15 Calendar Days*
* The day count begins the calendar day following the date of the email acknowledging the referral or two (2) business days after the receipt of the
referral and the Form 2054 whichever is earlier.
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SERVICE EXPECTATIONS
FOSTER/ADOPT (FAD) HOME SCREENING W/KINSHIP
Collect Case Information
Read All Referral Packet Information
Use the previously completed (within the past 2 years) Kinship Caregiver Home Assessment
Examine & Understand All Other Information Provided by CPS Staff
Conduct Interview
Conduct all interviews and other contacts as required in the Minimum Standards and Section 2.17 of the Statement of
Work.
Conduct interviews in an effective and appropriate manner.
Obtain signed Form 2163 (Agreement to Give Information) from all applicable adult household members.
Compile Assessment
Consider all information using the information provided by DFPS, included in the previously completed Kinship
Caregiver Home Assessment and disclosed during the interview when developing the final product.
Use prescribed format.
Foster/Adoptive with Kinship: Form 2193 (Foster and Adoptive Home Screening with Kinship Guide)
Foster /Adoptive: Form 2191 (Foster/Adoptive Home Screening ) and Form 2191ins (Instructions)
Microsoft Word (Font: Arial 10 point)
Compose and submit completed assessments according to the requirements in Sections 2.17, 2.18 and 2.19 of the
Statement of Work.
Timeframes
Standard: 20 Calendar Days*
Expedited: 15 Calendar Days*
* The day count begins the calendar day following the date of the email acknowledging the referral or two (2) business days after the receipt of the referral and the Form 2054
whichever is earlier.
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SERVICE EXPECTATIONS
HEALTH, SOCIAL, EDUCATIONAL & GENETIC HISTORY (HSEGH) REPORT
Collect Case Information
Read All Referral Packet Information
Examine All Other Data Provided by CPS Staff including the DFPS Official Case Records according to
requirements in Form 2649ins (HSEGH Report Instructions for Contractors)
Contact individuals identified in Form 2644 (HSEGH Referral Form) as applicable
Conduct Interview
Only at DFPS request
With Child or Biological Family
Compile Report
Consider all information provided by DFPS when developing the final product.
Use prescribed format.
Health, Social, Educational and Genetic History (Form 2649)
HSEGH Report Instructions for Contractors (Form 2649ins)
Microsoft Word (Font: Arial 10 point)
Compose and submit completed assessments according to the requirements in Sections 2.17, 2.18 and
2.19 of the Statement of Work.
Timeframes
Standard: 20 Calendar Days*
Expedited: 15 Calendar Days*
* The day count begins the calendar day following the date of the email acknowledging the referral or two (2) business days after the receipt of the
referral and the Form 2054 whichever is earlier.

13
SERVICE EXPECTATIONS
KINSHIP CAREGIVER HOME ASSESSMENT (KCHA)
Collect Case Information
Read All Referral Packet Information
Examine & Understand All Other Information Provided by CPS Staff
Conduct Interview
Hold at least one (1) face-to-face interview with all household members.
Conduct interviews in an effective and appropriate manner.
Provide a Kinship Manual and Kinship Profile Questionnaire to the family.
Obtain All Applicable Forms 0399 (Kinship Release of Information and Acknowledgement).
Compile Assessment
Consider all information provided by DFPS and disclosed during the interview when developing the final
product.
Use prescribed format.
Kinship Caregiver Home Assessment Template (Form 6588)
Kinship Caregiver Home Assessment Instruction Guide (Form 6588ins)
Microsoft Word (Font: Arial 10 point)
Compose and submit completed assessments according to the requirements in Sections 2.17, 2.18 and
2.19 of the Statement of Work.
Timeframes
Standard: 15 Calendar Days*
Expedited: 5 or 10 Calendar Days*
* The day count begins the calendar day following the date of the email acknowledging the referral or two (2) business days after the receipt of the
referral and the Form 2054 whichever is earlier.
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SERVICE EXPECTATIONS
COURT RELATED SERVICES
Court Related Services allowed under this Contract:
ONLY when DFPS requests the service via a valid Form 2054 (Service
Authorization).
Contractor must:
Receive a 2054 (Service Authorization)
Print and Complete Form 2057 (Court Related Services Case Note)
Take to the Deposition or Court Hearing
Complete and Sign
Obtain DFPS Authorized Signature
Submit Form 2057 with the Invoice
File Copy of Form 2057 as Case Note in the Assessment file.

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DELIVERABLES
TIMEFRAMES
16
STANDARD EXPEDITED
Kinship 15 Calendar Days
5 Calendar Days
or
10 Calendar Days
FAD
FAD with Kinship
20 Calendar Days 15 Calendar Days
HSEGH 20 Calendar Days 15 Calendar Days
Timeframe Begins the Earlier of:
o One (1) Calendar Day after Acknowledgement OR
o Two (2) Business Days after Receipt of 2054
Timeframe Ends:
o DFPS Receipt of Complete Assessment AND
o Hard Copy of Signed Signature Page
MINIMUM INSURANCE REQUIREMENTS
Commercial General Liability Insurance or
equivalent insurance coverage including, but not
limited to, liability with a minimum combines bodily
injury (including death) and property damage limits
of $300,000 per occurrence , and $600,000
aggregate.
Commercial Crime Insurance or equivalent
insurance coverage to cover losses from fraudulent
and dishonest acts with a minimum limit of $25,000.
The Commercial Crime Insurance or equivalent
insurance coverage must include a third party
endorsement and an employee dishonesty
endorsement or equivalent endorsements.
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STAFF/SUBCONTRACTORS
Background Check
Applies to All Contractors Employees, Volunteers & Subcontractors
Involved in Direct Delivery of Services to Clients
Who Will Have Access to Personal Client Information
Contractor Must Submit Requests Electronically through the DFPS Automated
Background Check System (ABCS)
Required Every 2 Years
Forms 2970c and 2971c
Employee/volunteer/subcontractor information requested on these forms is collected in order to run the
background check.
Contractor must file the completed 2970c and 2971c with cleared disposition in the
employee/volunteer/subcontractor personnel record.
List of Staff, Subcontractors and Volunteers
Applies to All Persons Providing Services or Having Access to Client Information
Submit Form PCS-102 within three (3) months of Contract execution
Submit Form PCS-102 annually thereafter on the first business day of each July during the Contract
Period of Performance
Report All New Persons Associated with this Contract Using PCS-102
Submit Form 5519 for new persons identified as CPM Staff or Key Personnel


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STAFF/SUBCONTRACTORS
Staff
Supervisory Staff Must Be Employees
Staff Record Must Be Maintained
Subcontractors
All subcontractors providing services under this Contract must meet the same
requirements as specified in the contract.
Prior to the commencement of any services by any
subcontractor:
Contractor must provide DFPS with a copy of the
subcontract
Contractor must have received written DFPS approval on
the PCS-102 of the use of the subcontractor
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REQUIRED RECORD KEEPING
All Required Records
Must be made accessible to DFPS staff upon request.
Required Personnel Records
Must support all Contractor Minimum Qualification requirements for Employees, Subcontractors,
and Volunteers.
Performance Compliance Review Meeting (PCR) Records
Must maintain records of each PCR meeting
Refer to Section 2.25.B of the Statement of Work for a List of PCR Record Requirements
Performance Measure Records
Must maintain documentation to support validity of performance measure results
Required Contractor Case Records*
Must include Complaint Investigation and Outcome Reports
Must contain the individual (hard copy) of the individual Assessment documents.
Case records must be housed or maintained in a central location.
Refer to Section 2.25.D of the Statement of Work for a List of the Minimum Assessment Client
Record Requirements

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

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COMPLAINTS
Process
DFPS Receives a Complaint
DFPS Notifies the Contractor
DFPS Determines Who Investigates
DFPS Investigates
Contractor Investigates
Report Preliminary Information to DFPS within 5 Business Days of
Receiving the Complaint
Investigation Completed
Determination Reached
Complaint Not Validated
Complaint Validated
DFPS Notifies Contractor of Determination and Findings
21
CONTRACT EVALUATION
Monitoring
On-Site Monitoring
Planned
Notice of Monitoring Activity
Inform of Goals and Objectives
Conducted with Least Disruption to Day-to-Day Operations as Possible
Results Communicated During Exit Conference
Contractor Satisfaction Survey Distributed
Desk Review
Billing Review
Formal Monitoring Report Provided to Contractor
Performance Measures
Pursuant to Texas Human Resources Code 40.058(b) all Contracts for client services must
include clearly defined goals and outcomes that can be measured to determine whether the
objectives of the program are being achieved.
Performance Measure results will be provided to the Contractor in order to assist the Contractors
compliance with the terms of the contract, DFPS policies, and applicable state and federal
regulations.

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PERFORMANCE MEASURES
Output #1
Contractors submissions of completed Assessments occur
within the required timeframes.
Target
Percent of Assessments that were completed within required
timeframes: 85%
Quarterly Performance Periods
September 1 November 30
December 1 February 28/29
March 1 May 31
June 1 August 31
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PERFORMANCE MEASURES
Methodology
How Will Performance Be Calculated?
Performance will be calculated for each performance period, wholly or
partially, depending on the contract start and end dates.
The total number of Assessments
completed within the required timeframe
during the performance period

= % of Assessments
completed within
required timeframes

The total number of completed
Assessments that were due during the
performance period
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PERFORMANCE MEASURES
Outcome #1
Applicants perceive Contractor delivery of authorized services
as professional and respectful.
Target
Percent of aggregated favorable responses made to items on
the Applicant Satisfaction Survey Questionnaires: 86%
Quarterly Performance Periods
September 1 November 30
December 1 February 28/29
March 1 May 31
June 1 August 31
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PERFORMANCE MEASURES
Methodology
How Will Performance Be Calculated?
Performance will be calculated for each performance period, wholly or
partially, depending on the contract start and end dates.
The aggregate number of favorable
responses from Applicant Satisfaction
Survey Questionnaire returned during the
performance period

= % of aggregated
favorable responses
made to items on the
Applicant Satisfaction
Survey Questionnaires
The aggregate number of all responses
from Applicant Satisfaction Survey
Questionnaires returned during the
performance period
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PERFORMANCE MEASURES
Output/Outcome #2
Contractors assessment contain all required documentation
in a clear, concise narrative format.
Target
Percent of Assessments that contain all required
documentation: 85%
Quarterly Performance Periods
September 1 November 30
December 1 February 28/29
March 1 May 31
June 1 August 31
27
PERFORMANCE MEASURES
Methodology
Performance will be calculated for each performance period,
wholly or partially, depending on the contract start and end
dates as Contractor reviews completed Assessments
The aggregate number of Assessment
categories with completed required
categories from Assessments during the
performance period

= % of aggregated
completed reviewed
items completed
Assessments

The aggregate number of all responses
from Assessment categories reviewed
during the performance period

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COMPENSATION

Paid per Unit of Service
Financial Remedies
Timeframes not met
Product submitted is not acceptable
Acceptable product received after it
is no longer useful
Unit of Service Includes
Contractor Costs for:
Travel
Translators
Interpreters
Reports
Long Distance Calls
Time spent preparing for or
documenting Court Related
Services
Foster/Adoptive
(FAD) Home
Screening
Assessment
Foster/Adoptive
(FAD) Home
Screening
Assessment with
Kinship
Kinship
Caregiver
Home
Assessment
HSEGH
Report
Service Codes 88B, 88C, 88E, 88Y
or 88Z
88B 68A or 81D 88A
STANDARD
One (1) Unit = One (1) Complete
Assessment
$525.00 $262.50 $525.00 $525.00
ADDITIONAL CHILD
Additional Payment for a Completed
Report per child in a sibling group
$50.00
EXPEDITED - 5-Day
Received Timely and Complete
Additional 20% of STANDARD Unit Rate
$630.00
EXPEDITED - 10-Day
Received Timely and Complete
Additional 6% of STANDARD Unit Rate
$556.50
EXPEDITED - 15-Day
Received Timely and Complete
Additional 6% of STANDARD Unit Rate
$556.50 $278.25 $556.50
WITHDRAWN
NO Face to Face conducted
15% of STANDARD Unit Rate
$78.75 $39.38 $78.75
WITHDRAWN
Face to Face
25% of STANDARD Unit Rate
$131.25 $65.63 $131.25
LATE
Still Useful
80% of STANDARD Unit Rate
$420.00 $210.00 $420.00 $420.00
NO LONGER USEFUL
Assessment Services
Fee Schedule
SERVICE
$0.00
Disposition
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INVOICING
DFPS
Contractor
Create
2054
Send
Pre-Bill
Provide
Service
Receive
2054
Review
Pre-Bill
Send
Billing
Invoice
Determine
Billable
Amount
Complete
Billing
Invoice
Create
2054
Send
Pre-Bill
Billing Invoice (Pre-Bill), signed
Form 2016, if applicable
Form 4116-Xe, signed
Form 2700 for Each Assessment Billed
Form 2057 for Each Court Ordered Service
Billed, signed
Form 5520 for each Withdrawn Assessment

Send Billing Invoice & Forms to DFPS
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CONTRACT CHANGES
DFPS and Contractor may make modifications to
this Contract according to the requirements in
Section 8 of the Uniform Terms and Conditions
(2282UTC).
8.1.1 Bilateral Amendment
8.1.2 Unilateral Amendment
8.1.3 Contract Renewal
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TIMEFRAMES RECAP
Acknowledgement
Within 2 Business Days of Complete
Referral
Email DFPS of receipt of 2054 and Referral
Packet
Make initial contact with Client
Verify household composition
Deliverables*
FAD Home Screening
Standard: 20 Calendar Days
Expedited: 15 Calendar Days
FAD Home Screening with Kinship
Standard: 20 Calendar Days
Expedited: 15 Calendar Days
HSEGH Report
Standard: 20 Calendar Days
Expedited: 15 Calendar Days
Kinship Assessment
Standard: 15 Calendar Days
Expedited: 5 or 10 Calendar Days
Withdrawals
Within 1 Business Day
Submit written notification of household
withdrawal
Within 5 Calendar Days
Submit Withdrawal Report (Form 5520)
Complaints
Within 5 Business Days from
Notification
Submit preliminary report
Invoice
15
th
Day of the Month
Submit Invoice
Court Related Services
Include 2057 with Invoice
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*Timeframe Begins the Earlier of:
o One (1) Calendar Day after Acknowledgement OR Two (2) Business Days after Receipt of 2054
*Timeframe Ends Upon DFPS Receipt of:
o Complete Assessment AND Hard Copy of signed Assessment Signature Page

DFPS CONTACTS
ASSESSMENT SERVICES
33
Contract Director
Linda Tavel
Phone
(210) 337-3362
Email
Linda.Tavel@dfps.state.tx.us
DFPS CPS/PCS Regional Contracts
Region 08 Contacts
Contract Manager
Shelly Grunewald
Tel# 210-337-3573
Email: Shelly.Grunewald@dfps.state.tx.us
Victoria Navarette
Tel# 210-337-3132
Email: Victoria.Navarette@dfps.state.tx.us
Samuel Garcia
Tel# 210-337-3400
Email: Samuel.Garcia@dfps.state.tx.us
Contract Technician
Linda Bernal
Tel# 210-337-3597
Email: Linda.Bernal@dfps.state.tx.us
Sandra Levrie
Tel# 210-304-3887
Email: Sandra.Levrie@dfps.state.tx.us