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Master Contract Template for School Health CentersExhibit ADefinition of ServicesContractor: [Agency Name].Contract Term: [July 1, 2014 through June 30, 2015]Type Of Contract: Master Contract AmendmentAmount:I. Program Name

Center for Healthy Schools and Communities – School Health Centers

II. Services [Agency Name]“Contractor,” shall ensure that funds are used to increase access to health and wellness services for low-income and uninsured children and their families in Alameda County. “Contractor” shall ensure that the funds are used to support the coordinated and integrated delivery of core services, including medical, dental (as indicated below), behavioral health, health education, health promotion, and youth development, to all students, regardless of insurance status, seeking health services and attending the following schools:

Name of School Health Center(s)

Name of School(s) Served & Student Enrollment*

* To determine current enrollment: use the most current available total school enrollment data from the California Department of Education DataQuest website (http://dq.cde.ca.gov/dataquest/). 1. Select “School” for Level2. Select “Student Demographics/Enrollment” for Subject

Produced by The Center of Healthy Schools and Communities | School Health Works 1

About this ToolSchool health centers (SHC) in Alameda County are collaborative efforts. The county provides an annual base allocation to a lead agency to manage each SHC. The base allocation helps sustain SHC operations, maintain high quality services, and ensure that the services are provided free of charge. This contract, re-negotiated annually, lays out the specific services to be provided, coordination strategies, and quality improvement goals.

http://dq.cde.ca.gov/dataquest/

3. Click “Submit”4. Ensure the year selected is the most recent available5. Enter one word in the name of the school6. Select the correct name of the school from the drop down menu under “Select an

Agency”

2 Master Contract Template for School Health Centers | School Health Works

III. Contract Term The term of the contract is one year: July 1, 2014 – June 30, 2015. The terms of the contract are based upon satisfactory performance and reporting.

IV. Program Information and RequirementsA. Program Definitions“Contractor” shall provide the Center for Healthy Schools and Communities, Alameda County Health Care Services Agency health and wellness services for [Name of SHC].A School Health Center (“SHC”) is a school-based/linked center that provides age-appropriate, comprehensive and confidential medical, behavioral health, health education, health promotion, and youth development services to youth and adolescents during and after school hours. A SHC can be located on school property or near a school. A SHC serves students attending the school(s) and possibly other youth from nearby schools and the local neighborhood.A School Health Center (SHC) Lead Agency is an organization contracted by the Alameda County Center for Healthy Schools and Communities to operate one or more school health centers, which are designed to diminish cultural, financial, and physical barriers to accessing health care. SHC Lead Agencies are responsible for overseeing the overall operations of the school health center to deliver a continuum of health and wellness services to students and other community members as appropriate.B. Program Goals, Results Framework, Priority Actions, and Evaluation

1. The Center for Healthy Schools and Communities (CHSC) Goal The overall goal of the CHSC is for all youth in Alameda County to graduate from

high school healthy and ready for college and career.2. The Center for Healthy Schools and Communities Results Framework

a. Children are physically, socially, and emotionally healthyb. Children succeed academicallyc. Environments are safe, supportive, and stabled. Families are supported and supportivee. Systems are integrated and care is coordinated and equitable

3. School Health Center Priority Actions The priority of school health centers is to provide medical, dental, and behavioral

health services in order to achieve the goals of the Center for Healthy Schools and Communities.

C. Target Population

1. Service Groups: Contractor shall provide services to the following populations: enrolled students at the schools listed, former students (as appropriate), students of other (district) schools, and families of students (as appropriate and agreed upon with school partners). Contractor shall provide services to all students that seek health services, with an emphasis on at-risk students.

2. Referral Process to Program: Students are self-referred, referred by peers, teachers, administrators, support staff (e.g., through coordination of the Service Team), and cross-referred within the SHC (e.g., medical providers refer to behavioral health clinicians through an integrated service delivery model).


3. Program Eligibility:Services will be provided to all enrolled students regardless of their ability to pay or their health insurance status.


D. Program Description and Requirements 1. Hours of Operation

Contractor shall provide SHC services during the hours that the school and/or facilities are open and be based on a schedule that is accessible to youth and based on demand. Open hours are Monday through Friday, from 8:00 am to 6:00 pm, during the school year. Prior to any change in hours, in accordance with need, notice will be given of the change in hours of operation and must be preapproved by the Center for Healthy Schools and Communities. Summer hours are to be determined based on summer school schedules and demand.

2. Service Delivery Sites Contractor shall provide services at the following locations:SHC Address

3. Minimum Staffing Qualifications:SHCs are staffed by a multidisciplinary team with varying degrees and licensure requirements. Contractor shall have, and maintain, current job descriptions on file with the Human Resources (HR) Department for all personnel whose salaries, wages, and benefits are reimbursable in whole or in part under this agreement. Job descriptions shall specify the minimum qualifications for the services to be performed. Contractor shall submit revised job descriptions prior to implementing any changes or employing persons who do not meet the minimum qualifications on file with the Contractor’s HR Department.

V. Contract Deliverables and Requirements Contractor shall provide the following: An on-site coordinator supported by the necessary infrastructure Mechanism for obtaining youth, school, and community input At least a one-to-one match to county core funding through other funding sources,

including school, city, state, federal, private, and third-party reimbursement revenue Participation in county-wide planning, coordination, and evaluation to strengthen

school health centers as a model for increasing universal access to health and wellness services for children and youth

For all the following Process Measures, Contractor shall provide services as set forth in the Strategy column and provide reports as set forth in the Measurement column.


A. Process Measures Contractor shall provide the following services/deliverables: 1) Medical Services

Process Outcome 1ABy June 2015, Contractor should have provided services so that 30%–50% of the student body, should have received medical-related services from the SHC Lead Agency. Strategy Measurement1. Provide between 16 and 40 hours

of medical services per week, as permitted under the licensing regulations, to the student body throughout the school year and possibly during summer school. Medical services include, but are not limited to, health assessments, diagnosis and treatment of acute conditions, immunizations, first aid, family planning services and STD screening, anticipatory guidance related to healthy growth and development, identified health issues and management of health conditions, age-appropriate health screenings (e.g., sexually-exploited minors), and medical case management.

Report staff and medical provider full-time equivalency (FTE) in budget.

Report staff and provider names, contact info, and Efforts to Outcomes (ETO) codes in Quarterly Report (QR).

Report number of service hours in QR.

Post signage of service hours at the school.

Report the number of students served and the services provided in the ETO evaluation database or another data collection method as indicated.

2) Dental Health ServicesProcess Outcome 2AStrategy Measurement1. Provide oral health screenings that

reach more than 80% of the students at [Name of SHC]. Pilot oral health screening for at least one additional school campus served by an SHC.

Track numbers and referrals from each screening in ETO or another data collection method as indicated.

2. Provide dental case management (follow-up) and referrals for urgent care at the [Name of SHC] or home clinic.

Track referrals in ETO or another data collection method as indicated.

3. Provide a minimum of 16 hours of oral health services per week, as permitted under licensing regulations to the student body throughout the year and possibly during summer school at [name of SHC]. Oral health services include

Report staff and provider full-time equivalency (FTE) in budget.

Report staff and provider names, contact info, and ETO codes in QR.


screening, exams, preventative services, and dental treatment as appropriate.


Report number of students served and services provided in the ETO evaluation database or another data collection method as indicated.


3) Behavioral Health ServicesProcess Outcome 3AContractor shall provide behavioral health related services to students and youth at all campuses served by SHCs. Contractor shall provide behavioral health related services to students and youth who seek services, and accept referrals from youth who self-refer, or are referred by COST, medical providers, school staff, or administrators. Contractor shall provide services or referral linkages as appropriate to meet the unique needs of each student or youth. Strategies listed below will be provided through June 2015.

Strategy Measurement1. Provide 20 to 40 hours of

behavioral health services per week at each SHC, as permitted under the licensing regulations, to the student body throughout the school year and possibly during summer school.

Report provider personnel names, full-time equivalency (FTE) and duty statements in budget.


Report number of students served and services provided in the evaluation database or another data collection method as indicated.

4) Health Education, Health Promotion, and Youth Development ServicesProcess Outcome 4ABy June 2015 Contractor shall provide, at minimum, an average of 16 to 35 hours per week of clinical health education, health promotion, and youth development services. Health education topics may include, but are not limited to, conflict resolution, unintentional injury prevention (the leading cause of death among young adolescents), drug and alcohol prevention, sexual health, teen pregnancy prevention, STD/HIV prevention, violence and dating violence prevention, nutrition and fitness, dental health education, management of chronic illness such as asthma, and communication, decision-making, goal-setting, and other personal/social skills contributing to overall health and wellness.Service will include the site-specific strategies listed in each category below:


Strategy Measurement1. Clinical Health Education Strategy:

Clinical health education services include but are not limited to: Individual (one-on-one)

encounters with a trained Health Educator that includes information about one or more of the topics detailed above.

Group encounters with a trained Health Educator that include information about one or more of the topics above.

Report activities and progress in QR and/or ETO or other data collection method as indicated.

2. Health promotion on school campus: Classroom presentations lead by a

trained Health Educator that include information about one or more of the topics above.

Other group based presentations (to afterschool groups or specific populations) that include information about one or more of the topics above.

Report number of activities, students served, and services provided in QR.

3. Youth Development:Youth development programs use a health education framework to promote youth leadership and build concrete skills. Examples: Peer Health Education programs

where students learn about a health topic and conduct outreach to their peers.

On campus programs where students learn about individual, community and environmental health.

Peer Leadership or advocacy programs where youth can gain critical thinking skills and enhance self-efficacy through research and advocacy among adults or peers.

Mentorship and internship programs.

Report number of activities, students served, and services provided in QR.

5) Family Engagement ServicesProcess Outcome 5ABy June 2015, Contractor will have coordinated and/or participated in at least one (1) family or community health-related event and/or activity each


year to increase awareness of and support for SHC programs and services (three total). Strategy Measurement1. Seek input from the school

community and other collaborators (including youth, families, teachers, staff, and principals) in the development and implementation of family or community health-related events and/or activities.

Report activities and progress in QR.


6) Collaboration, Referral, and Follow-Up Contractor will report quarterly on collaboration, referral, and follow-up activities

for medical services and behavioral health services.Strategy Measurement1. Participate in broader school

initiatives that create a positive climate and promote the positive social-emotional development of students.


2. Develop and implement a process to screen and enroll eligible, uninsured clients for appropriate health coverage (e.g., Full-Scope Medi-Cal, Healthy Families, HealthPAC, and other health and social programs) in partnership with Alameda County Social Services Agency, schools, school districts, and/or other community agencies.

Report number of families screened and enrolled in QR.

Develop protocol for health coverage screening and enrollment.

3. Provide follow-up and referrals to primary care providers and/or home clinic as appropriate.

Report number of referrals made in ETO or other evaluation system.

4. Assess academic performance indicators (e.g., discipline, attendance, grades), as available, to inform the provision of health and wellness services to SHC clients.

Protocol for assessing academic performance indicators for clients.

5. Participate in school service coordination meetings (e.g., SST or COST), if available, with all on-site service providers (e.g., health, mental health, afterschool, family engagement) to support the development of a service delivery system that goes beyond the co-location of services to a fully integrated system of care.


6. Participate in an assessment exercise with collaborative partners including CHSC to examine expanded community access and set site-specific goals in preparation for the Affordable Care Act.



7) Quality Improvement Site-Specific Outcome 7A: By June 2015, contractor will conduct activities listed below. These activities contribute to the expanded reach of services, pilot new services, or improve clinical services for the youth served. FOR EXAMPLE:SCHOOL HEALTH CENTER

Activity Timeline Measurable Outcomes Conduct targeted

outreach to boys athletics and gender-specific clubs and use peer-to-peer engagement to increase the number of male students who utilize clinic services.

August 2014 through May 2015.

By June 2015, show an increase of 10% of male clients compared to the 2012–2014 school year.

Enhance collaboration and continuity of care for students with positive pregnancy tests through the establishment of a weekly multi-disciplinary Pregnant Student Huddle within the clinic, and clear protocol for ensuring timely and teen-specific support around pregnancy.

Fall 2014, pilot Huddle for students with positive pregnancy tests. Monitor referrals and documentation.

Spring 2015, conduct chart review of patients with positive pregnancy tests and evaluate progress toward objectives.

Spring 2015, review data from the chart review and the lessons learned (from participating staff) to identify and address challenges in connecting students to referral services or new goals for the Huddle.

By January 2015, 100% of all identified pregnant students will be included and discussed within the Pregnant Student Huddle interdisciplinary team and documented in a log.

By June 2015, 90% will have a documented referral for follow-up services (i.e., prenatal care, pregnancy termination, adoption services, and teen parent case management) and 80% will have documented keeping a referral. 80% will have birth control method follow-up within a two-month time period.

Increase the percentage of students who utilize the clinic for

Fall 2014, conduct outreach to parents during

By November 2014, 90% of all parents of students identified as


primary care services through outreach to families during the registration process and through targeted outreach to newcomers.

school registration about the range of primary care services offered.

Spring 2014, conduct a newcomer registration drive.

being without a primary provider at registration will be contacted and offered primary care services.

By April 2015, a registration drive targeting new students will be conducted.


8) Administrative ServicesProcess Outcome 8A Between July 1, 2014 and June 30, 2015, Contractor will participate in county-wide planning and coordination to strengthen our SHC model as a means to create universal health access.

Strategy Measurement1. Attend at least 80% of Health Care

Services Agency meetings to support the development, design, sustainability, and efficacy of SHCs and respond to any follow-up requests in a timely manner.

2. Monthly SHC Coordinator meetings are regularly scheduled for the third Tuesday of each month from 9:30 am to 11:30 am. If you are unable to attend the meeting or send a representative, please notify CHSC.

Meeting sign-in sheets.

3. Participate in the annual CHSC conference and other events as requested.

Event sign-in sheet.

4. Develop formal agreements (e.g., memorandum of understanding, professional services contracts, letters of agreements) with the school and the school district with regard to the SHC and its services.

Executed formal agreement with Contractor, school(s), and/or school district(s).

5. Provide information regarding service delivery models, financing, revenue generation (e.g., third-party medical and mental health reimbursement), and other data as requested by the Center for Healthy Schools and Communities.

Data request reports.

Contractor shall not seek the same grants from corporations or foundations as the Center for Healthy School and Communities (CHSC) without the prior knowledge of CHSC staff. In the event that the SHC, its sponsor, or its provider partners seek the same grants/funding, the SHC will notify the CHSC staff in writing as per the Fund Development Protocol.

Contractor shall provide additional agreed upon services as other funding emerges.

Contractor shall conform to all federal and state laws relating to the confidentiality of patient medical information, including but not limited to the Health Insurance Portability and Accountability Act (HIPAA).

Communication is vital in our collective work with schools. In matters related to SHC(s), Contractor, and the Center for Healthy Schools and Communities, staff


shall notify and inform each other about communication with the school board, district, and school site staff.


VI. Reporting and Evaluation Requirements A. Reporting Requirements 1) Between July 1, 2014 and June 30, 2015, Contractor will fully cooperate with the

Center for Healthy Schools and Communities evaluators and participate in the process and outcomes evaluation.

Contractor shall enter data into ETO and/or provide other evaluation data as requested by the 15th of every month.

Contractor will use the provided client service form to track services provided until another data collection method is identified.

Contractor will cooperate with planning efforts for and adoption of a revised method of data collection from EHR.

2) Contractor shall provide the Center for Healthy Schools and Communities with electronic copies of the quarterly reports for the preceding three months utilizing the Quarterly Report template according to the following schedule:

October 15, 2014 (for the period covering July 1, 2014 through September 30, 2014) January 15, 2015 (for the period covering October 1, 2014 through December 31, 2014) April 15, 2015 (for the period covering January 1, 2015 through March 31, 2015) July 15, 2015 (for the period covering April 1, 2015 through June 30, 2015)

If the reporting requirements cannot be met by the above deadlines, Contractor shall immediately contact the Center for Healthy Schools and Communities and its evaluators with the reason for the delay and the estimated date for the report completion. It is within the discretion of CHSC to extend any due dates. Lack of notification or failure to meet a deadline will result in fund reduction. Contractor shall include hardcopies of the Quarterly Report and data reports with each invoice in order to receive payment.Alameda County reserves the rights to request additional information from the contractor.

B. Quality Assurance and Monitoring Requirements1) Alameda County representatives may perform site visits to directly observe the

operations of any contractor with a 48-hour notification. In the performance of site visits, county representatives shall conduct inspections and manage information in a manner consistent with applicable laws relating to confidentiality of records, and in a manner that will minimize the disruption of Contractor’s work and will not interfere with patient care.

2) The scope of the review may include, but is not limited to, availability and accessibility of care, waiting time for appointments and services, review of third-party billing and reimbursement, and utilization review.

3) All medical records related to services rendered under this Exhibit A, shall be accessible to the county for inspection and audit as required for public health related conditions and as provided under HIPAA exclusion.

4) All business records related to services rendered under this Exhibit A shall be accessible to the county for inspection and audit as a part of the administrative monitoring and evaluation.

5) County representatives will maintain the confidentiality of any patient records or protected health information made available to them pursuant to this Exhibit A in


accordance with all applicable Federal and state statutes and regulations relating to confidentiality.

VII. Additional RequirementsA. Certification/Licensure/ Confidentiality/Communication

1) Contractor will maintain all required licenses and special permits issued by federal, state, and local agencies related to the services it provides. All SHC staff are subject to school district staffing regulations regarding fingerprinting and background checks. This may require Contractor to provide current evidence of California Department of Justice, FBI, or Activity Supervisor Certificate (ASCC) security clearances for all volunteers/employees that have contact with children.

2) Contractor shall notify The Center for Healthy Schools and Communities staff immediately by telephone and in writing within five days when there is a change in the license and/or certification of any program, service, department, or facility providing services under this Exhibit A.

3) Contractor shall conform to all federal and state laws relating to confidentiality of patient medical information, including but not limited to, the Health Insurance Portability and Accountability Act when applicable.

4) Communication and coordination are key to successful fund development. In the event that the SHC and its sponsor or provider partners seek the same grants/funding as the Center for Healthy Schools and Communities (CHSC), the SHC will notify the CHSC staff in writing.

5) Communication is vital in our collective work with schools. In matters related to schools, Contractor and the Center for Healthy Schools and Community staff shall notify and inform each other about communication with the school board, district, and school site staff.

6) Contractor shall provide additional agreed upon services as other funding emerges.7) Contractor shall not seek the same grants from corporations or foundations as the SHC

Fund without the prior knowledge of CHSC staff. In the event that the SHC, its sponsor, or provider partners seek the same grants/funding, the SHC will notify CHSC staff in writing as per the Fund Development Protocol.

VIII. Entirety of AgreementContractor shall abide by all requirements contained in the Master Contract General Terms and Conditions, all Exhibits and all Attachments that are associated with and included in this contract.


Exhibit BTerms of Payment___ contractIn addition to all terms of payment described in the Master Contract Terms and Conditions and any relevant exhibits and attachments, the parties to this Agreement shall abide by the following terms of payment:I. Budget (7/1/2014–6/30/2015)

Contractor shall use all payments solely in support of the program budget. The term of the contract is one year: July 1, 2014–June 30, 2015. Contractor shall submit a budget that includes other funding sources that are leveraged

to implement the program.II. Terms and Conditions of Payment

Reimbursement:1. The total amount of reimbursement under the terms of this Agreement shall not

exceed $________. Funds shall be used solely in support of the School Health Center operational budget. Funds may not be used for any purpose other than those specified in Exhibit A of this Agreement without prior written approval from the Center for Healthy Schools and Communities staff.

2. Contractor shall invoice the county for actual expenses incurred, not exceeding $_________ per quarter, without approval from the Center for Healthy Schools and Communities staff. The fourth quarter invoice for each fiscal year shall reflect actual expenses incurred, not exceeding the remaining balance of the contract. After review, the Center for Healthy Schools and Communities staff must sign off on the invoice for payment.

3. County shall process the invoice submitted for reimbursement by Contractor within forty-five (45) days of receipt of invoice, submission of acceptable quarterly report status, and evaluation reports as defined in Exhibit A of this Agreement and any other back-up documentation as requested.

4. Contractor shall claim no more than 11.4% of charges for administrative overhead costs.

III. Invoicing Procedures Contractor shall invoice county quarterly. Invoice, with an original signature, must be accompanied by required quarterly report. Invoice should be sent to:

Attn: Marta Lutsky/Connie YaleCenter for Healthy Schools and Communities/Alameda County Health Care Services Agency 1000 San Leandro Blvd., Suite 300San Leandro, CA 94577


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