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CPA New Provider Self-Assessment Instrument

 
 100% of survey complete.
New Child Placing Agency (CPA) Provider applicants are required to complete this online agency self-assessment prior to submitting the New Provider Application to the Office of Provider Management. The assessment is intended to provide applicants with a framework of elements that are critically important in the provision of out-of-home care to children in the custody of DFCS. Completing the assessment should give your agency a sense of its current capacity to appropriately serve children and families at various Room Board and Watchful Oversight (RBWO) program designations. Additionally, the assessment should guide your agency's future development and service planning needs.

While affirmative answers to the items in the assessment does not guarantee approval as an RBWO provider, these items represent a portion of the prerequisite conditions for approval as a new provider. To determine all applicable provider requirements, please refer to the RBWO Minimum Standards document, located on the home page of www.gascore.com.

Please answer each question on the assessment, and click the "Done" button at the bottom of the document when you have completed the assessment. Once you click "Done, the assessment will be automatically submitted to the DFCS Office of Provider Management. Your agency is eligible to submit the remaining portions of the New Provider Application Package, once the assessment has been submitted. A representative from the Office of Provider Management will contact you once the completed application package is received.

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* 1. Please provide the following information:

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* 2. Choose the option from the following Current RBWO Provider Services Needs List that matches with the program designation and location of your agency's proposed new site and program:

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* 3. Describe the type(s) of child(ren) for which the agency targets its services?

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* 4. If seeking a specialty designation, describe the prior experience, if any, the agency has with children needing the type of care required for the respective designation?

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* 5. If the agency is seeking a specialty program designation, describe how the agency will ensure that it has foster parents prepared to care for children with the respective designation?

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* 6. If the agency is seeking an MWO program designation, how will the agency be adequately prepared to accept (Psychiatric Residential Treatment Facility) PRTF step-downs?

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* 7. Describe the agency's initial foster parent recruitment plan as it relates to the Division targeted needs. Must include one of the following: (recruitment for large sibling groups, African American children, Hispanic population, Teens, LGBTQIA, Medically Fragile and children with high level needs).

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* 8. Does the agency have a current license, from the Residential Child Care Licensing (RCCL), to operate a Child Placing Agency for the agency's proposed site location?

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* 9. Please indicate what type of RCCL license your agency have along with the issue date.

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* 10. Please upload a copy of your agency RCCL License

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* 11. Does your agency have a minimum of two staff members that have completed IMPACT or NTDC Train-the-Trainer Certification?

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* 12. Please upload staff IMPACT or NTDC Train-the-Training Certificates

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* 13. Does your agency have a minimum of two staff members certified in the S.A.F.E Model?

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* 14. Please upload your staff S.A.F.E Training Certificates

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* 15. Does your agency have staff with S.A.F.E Model Supervisor certification?

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* 16. Please upload S.A.F.E Supervisor Training Certificate(s)

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* 17. Does the agency have a minimum of 50% of your agency’s starting operating capital to cover fixed expenses for at least six months? (Funds will be verified prior to contracting)

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* 18. Is the Owner and/or Program Director of your agency prior/existing DFCS Staff?  If so, what county/counties of employment and dates of employment.

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* 19. Is the Owner and/or Program Director of your agency prior/existing RBWO Staff? If so, what agency/agencies and dates of employment.

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* 20. Is the owner of your agency prior/existing foster parent? If so, what agency and/or county along with dates of approval.

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* 21. Is the Owner and/or Program Director of your agency prior/existing Sub Contractor with the Division? If so, what agency and program areas.

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* 22. Does the agency have a complete policy manual which includes all written agency policies and procedures based on the current RBWO Minimum Standards?

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* 23. Does your agency have a process in place to complete the following screenings on staff and prospective foster parents? (ie., Criminal Background checks, Safety Screening Checks, Pardons and Paroles, Sex Offender Registry and Department of Corrections.)

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* 24. Have all staff within your agency received all of the above-mentioned screenings?

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* 25. Does your agency have a policy addressing procedures to ensure that a CPS screening is completed on each staff member and foster parent.

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* 26. Does the agency's behavior management policy reinforce the strict ban on the use of corporal punishment and have staff been trained on prohibited discipline and punishment?

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* 27. Does the agency ensure that its foster parents and staff have the necessary skills to carry out the agency's behavior management policies?

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* 28. Does the agency ensure that its foster parents are prohibited from using or authorizing the use of corporal punishment?

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* 29. Will the agency ensure that the principles of trauma-informed practice are incorporated into foster parent on-going training?

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* 30. Does the agency's staff meet the minimum educational and work experience requirements according to the RBWO Minimum Standards?

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* 31. Does the agency have a policy and written procedure for accepting evening and weekend placements?

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* 32. Does the agency have a plan in place which provides for planned and crisis respite care for foster parents?

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* 33. Do all of the agency's staff have current Office of Investigative Services (OIG)Fitness Determination Letters on file?

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* 34. Does the agency have a process in place to ensure that CPS Screenings are conducted prior to new foster home approval to ensure that children will not be placed in foster homes where there has been a finding by DFCS that a foster parent is the perpetrator of substantiated abuse or neglect or has violated a policy of DFCS which has threatened the safety of a child?

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* 35. Will the agency ensure that the principles of trauma-informed practice are incorporated into foster parent on-going training?

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* 36. Does the agency ensure that annual continuing education training requirements for staff and foster parents are met?

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* 37. If the agency plans to accept children ages 14 and older, is the agency prepared to incorporate required independent living skills into agency services (see RBWO Minimum Standards, Independent Living and Transitional Living Program Standards Section) for such children?

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* 38. If the answer to the previous question was yes, indicate the agency's initial plan for ensuring independent living skills are incorporated into services:

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* 39. Does the agency have a foster parent recruitment plan which supports the type of children the agency serves?

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* 40. Does the agency have telephones and computers with internet access to assure that DFCS is able to communicate with the provider as needed, and by telephone, 24 hours per day, seven days per week?

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* 41. In an effort to move toward permanency, is the agency prepared to have at least monthly contact with the birth parents, guardian or other permanency person of each child in care?

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* 42. Does your agency have a policy on Reasonable and Prudent Parenting Standards (RPPS) to include training of staff and foster parents?

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* 43. Is the agency prepared to participate in Family Team Meetings, Multi-Disciplinary Team Meetings and discharge planning meetings as requested if an RBWO contract is granted?

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