Substance Abuse Residential Level II Program for Girls
3. Substance Abuse Residential Level II Program for Girls (12-17 year old): The
proposed item would allow SFBHN to contract with a Network provider to open a
Substance Abuse Residential Level II program (that meets the definition in Rule
65D-30, F.A.C. and in Rule 65E-14, F.A.C.) in Miami-Dade County. It should be
noted that Atlantic Shores was providing this service for our community, but closed
their unit. At this time, the nearest SA Residential program for girls is Sandy Pines
in Tequesta, FL. The community is need of a local residential program that can meet
the treatment needs of the community.
Total annualized projected funding for this project: $401,150.00
3.1: Page limitation clause as referenced in Section II, paragraph 9, Format
Please be as thorough as possible in your response and limit your narrative response
ten (10) pages.
The page limitation exclude budgets, timelines, copies of
licenses/certifications, and any other supporting documentation you may submit as part
of the application as referenced in the narrative.
Budgets, timelines, copies of licenses/certifications, and any other supporting
documentation referenced in the narrative responses must be labeled and numbered
accordingly.
3.2: NARRATVE
Organizations Legal Name: ______________________________________________
I.
II.
Total Funding Requested for this service: ___________________________
Briefly describe your organization and its current infrastructure, addressing your
readiness and capability to acquire an additional program/service.
III.
History and experience treating the target population and providing services in
this milieu.
IV.
Identify the service site address.
V.
VI.
If your agency is currently providing residential services to a different target
population explain the how your agency will ensure the safety of the girls,
specifically physical separation.
Identify the client-to-counselor ratio
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VII.
Minimum staffing qualifications
Staff Name
Covered service name
Supervisory
Direct
Service
SA Residential Level II
VIII.
Identification and Engagement Strategies:
1. Identify the major referral sources for persons receiving services and describe
your agencies history and relationship with the referral source(s).
2. Describe the organization’s specific individual identification and engagement
strategies applicable to the Program.
3. Identify the evidence-based approaches for the target population served as
recognized by SAMHSA’s National Registry of Evidence-based Programs (EBP)
and Practices (NREPP).
Target Population
Children/Adolescents (Girls) with Substance
Abuse Problems
Evidence-based Practice
1.
2.
3.
4. Explain how you will ensure adherence to each of the EBP models
5. List each evidence-based practice utilized and the fidelity tool used for each.
Evidence-based Practice
Identify the Fidelity Tool used. If no
fidelity tool is available, describe how
fidelity will be ensured
1.
2.
3.
4.
6. Describe why your agency selected the EBP(s) identified above to serve the target
population.
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7. Please provide the name and title of the staff that are certified in the evidence-based
practice.
Name
Title
EBP
1
.
2
.
3
.
4
.
IX.
Service Delivery Strategies:
Describe the organization’s specific service delivery strategies for providing individual
services/care under the Program. This description should address the service delivery
strategies as applied to the program that will be used, the services made available,
individual and family assessment of needs and re-evaluation of those needs, and the
processes used to match individuals and families to services and ensure that services
are consistent with the their recovery and resiliency needs.
1. Describe the specific services that will be made available.
2. Admission criteria.
3. Discharge criteria.
4. Average length of participation for persons served.
5. Describe the means and the frequency by which individual and family needs will be
evaluated and re-evaluated throughout the episode of care.
6. Describe the processes employed to match individuals and families to services and
ensure that services are consistent with the individuals’ and families’ individual
recovery and resiliency needs.
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7. Specify the nature and role of Incidental Expense funding and any categorical
funding, if applicable and allocated, used in support consumer participation in
services.
X.
Continuing Care Strategies:
Identify the major continuing strategies for individuals completing services through this
program. Continuing care strategy descriptions should address placement and referral
activities specific to processes by which individuals and families are prepared for and
transitioned to continuing care services; the major continuing care strategies, best
practice models, community housing/living options, primary health care needs, natural
supports, and/or other alternatives for individuals and families completing services in
this Activity (within the organization and within the community system of care).
1. Describe the processes by which individuals are prepared for and transitioned to
continuing care services.
2. Describe the major continuing care strategies, best practice models, and community
housing/living options, primary health care needs, natural supports, and/or other
alternatives for
individuals completing services in this program (within the
organization and within the community system of care).
3. Provide a description of any activity funded covered service and related services
utilized to affect the transition.
4. Describe how Incidental Expense funds are used to support individual transitions.
XI.
XII.
XIII.
Please indicate why your agency and proposed program should be selected to
receive the funding for this program.
Provide a timeline for the implementation of the service identifying key activities,
milestones, deliverables and responsible staff – This attachment will not counted
toward the suggested page limitation. The attachment must be labeled and
numbered accordingly.
Budget:
All costs associated with services proposed in this bid must be reasonable,
necessary and allowable, and relate to the program/coalition in compliance with
both the Cost Principles for Nonprofit Organizations: OMB 2 CFR Chapter I,
Chapter 2, Part et.al. Uniform Administrative Requirements, Cost Principles and
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Audit Requirements for Federal Awards, and The Community Substance Abuse
and Mental Health Services Financial Rules specified in Chapter 65E-14021(5)(e),
Florida Administrative Code. Applicants will submit a one (1) year, 12 month
budget for related expenditures as outlined in this bid, consistent with the start
times reflected in the timelines for implementation of the activities.
All proposed costs must be in accordance with the Department of Financial
Services Reference Guide for State Expenditures, February 2011, which may be
located at: http://www.flrules.org/Gateway/reference.asp?No=Ref-04201
The budget forms (“Fiscal Forms 15-16v.5”), which are incorporated herein by
reference, have been posted on the SFBHN website as a separate document to this
bid. The budget must be submitted along with your application.
A detailed (using complete sentences) budget justification narrative is required.
Indicate what current resource will be allocated to support the software provided
through this application. It must clearly link all budget items to program activities
and justify the proposed costs.
The page limitation does not apply to the budget(s).
XIV.
Licensing, Programmatic, and Administrative Requirements:
Applicant agrees to follow, including but not limited to, all statutes and rules
contained in Chapter 397 of the Florida Statutes, Rule 65D-30.007, F.A.C.,
Licensing Standards for Residential Level 2 Treatment, and Rule 65E-14., F.A.C.,
Community Substance Abuse and Mental Health Services Financial Rules
requirements.
Attach a copy of the Department of Children and Families License(s) for SA
Residential Level 2 for Adolescents or a copy of the application submitted to DCF if
not yet licensed as a SA Residential Level 2 treatment facilities for Adolescents.
If an applicant does not currently have the required license and/or certification
required for the program/service applied for, a plan and timeline for obtaining the
required license and/or certification must be submitted with the application(s).
Failure to do so will be deemed non-responsive with a critical flaw and the
application for that service will not be considered for funding. The plan will be
reviewed by SFBHN’s staff who in their sole discussion will determine if the
timeframe to obtain the license and implement the program is reasonable and
therefore allow the application to be considered for funding.
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