Exhibit “A” |
RTS Agreement – Phases II and III (CSAT grant funded) |
In consideration of the payments set forth in Exhibit “B”, Contractor shall provide the following services: |
Rape Trauma Services (RTS) will provide direct trauma focused services to girls with significant trauma history at the RTS facility. Services will be offered to Girls Program participants for 49 weeks annually, over a three-year period, from October 1, 2005 through September 30, 2008.
RTS will provide the following services:
1) Up to 32 hours per year associated with researching, developing and presenting a training curriculum for the entire GIRLS program staff as well as Institutions Division staff. The training will emphasize a trauma-focused theoretical framework for all aspects of the program. The hours of training provided will depend upon team needs (specialized focus based on varying professional roles, optimal size of groups, time constraints of specific groups).
2) Girls with significant trauma history elect to avail themselves of RTS services. Girls who wish to receive RTS services will be introduced into group discussions and activities. Typically this would involve ongoing group counseling at RTS for 2-8 girls, facilitated by two counselors. Group sessions are “open” in format allowing new members to enter. Initial and closing individual counseling-assessments will be conducted for each girl. The goals of the sessions are to facilitate healing and to teach the girls about violence prevention.
3) When it is deemed appropriate by Probation staff and RTS girls will participate in individual trauma-focused counseling at RTS. Counselors will seek to illuminate how emotional responses and behaviors are connected to the hurts or trauma they have suffered. RTS will accommodate between 5 and 15 girls at any time.
4) For the parents/guardians of girls with significant trauma RTS will conduct individual and/or group trauma-focused counseling sessions at RTS as needed, in English and Spanish for 3 to 10 parents. The goals of these sessions are to educate parents about how trauma impacts the family system, about the connection between trauma and anti-social behaviors, to discuss appropriate responses to girls’ acting out and in, and to see how trauma focus can promote the re-integration and restoration of self, family community and society. Additionally RTS will offer a one-day trauma-focused workshop for family members to strengthen understanding for ending cycles of trauma and supporting individual and family healing.
An RTS representative will attend the 2-hour weekly GIRLS program team meeting every Thursday from 12:30-2:30 pm as well as monthly Implementation meetings and periodic Steering Committee meetings.
See Attachment I “Description of Phases II and III Program Components” for more information about the objectives of RTS Phases II & III services.
Exhibit “B” |
In consideration of the services provided by Contractor in Exhibit “A”, County shall pay Contractor based on the following fee schedule: |
Amount, Method and Rate of Payment
The total amount of this contract is not to exceed $112,251. Invoices are to be submitted quarterly, and will indicate the total number of clients served and total number of hours of service provided during the quarterly billing period.
Quarterly invoices submitted during the service period term, from October 1, 2005 through September 30, 2008, are not to exceed $9,354.25, for a total contract amount of $112,251.
October-December 2005 $9,354.25
January-March 2006 $9,354.25
April-June 2006 $9,354.25
July-September 2006 $9,354.25
October-December 2006 $9,354.25
January-March 2007 $9,354.25
April-June 2007 $9,354.25
July-September 2007 $9,354.25
October-December 2007 $9,354.25
January-March 2008 $9,354.25
April-June 2008 $9,354.25
July-September 2008 $9,354.25
Total $112,251.00
1. Invoices shall be in the format specified by the Probation Department. All claims shall clearly reflect and, in reasonable detail, give information regarding the services for which claim is made.
2. Contractor shall bill on or before 30 days after quarter end for prior quarter’s services.
3. June invoices must be received by the San Mateo County Probation Department no later than the immediate following July 15.
4. All invoices must include an invoice number and reference the Agreement number on them before submitting for payment. Invoices are to be sent to the San Mateo County Probation Department, 222 Paul Scannell Drive, San Mateo, CA 94402, Attention: Karen Morrill.
5. The County shall not be obligated to pay Contractor for services covered by any invoice received more than 120 days after the date Contractor renders the services, or more than 90 days after this Agreement terminate, whichever is earlier.
6. In the event Contractor claims or receives payment from County for a service, reimbursement for which is later disallowed by County or the State of California, or the United States Government, than Contractor shall promptly refund the disallowed amount to County upon request, or at its option, County may offset the amount disallowed from any payment due or become due to Contractor under this Agreement or any other agreement.
7. Payments for services provided are contingent upon the availability of County, State or Federal funds. In the event the State or the Federal government does not appropriate the necessary funds as part of either or both of their budgets, the County shall not be liable for any payment whatsoever; including but not limited to, payments that are based on County funds. The County may terminate this Agreement for unavailability of Federal, State or County funds.
Exhibit C
Description of Phases II and III Program Components
About the agency: Rape Trauma Services: A Center for Healing and Violence Prevention (RTS) is a nonprofit volunteer-based organization, the only agency in San Mateo County offering comprehensive direct services to survivors of sexual and other trauma and to their significant others. Informed by our understanding of traumatic experiences as they effect cycles of violence, we facilitate healing and the prevention of violence through the provision of individual and group trauma counseling, accompaniment and advocacy in such venues as school settings, the county juvenile facility, medical-legal exams, and many others. We also work to eliminate all forms of violence, abuse and oppression through education in a variety of settings. As an agency, we promote and adopt policies, practices, and social values rooted in fairness, equity, and inclusiveness.
Phase II GIRLS Group: Our objective with our Phase II and III group work with the GIRLS program young women is to provide a safe space to begin or continue the healing process regarding the trauma they have experienced. Through discussions and group activities, they will have the opportunity to share hurtful experience and together learn how healing happens, both by tapping into their own wisdom and by listening and supportively responding to the experience of others. A primary goal is for the girls to see how their acting out and acting in behaviors connect to the hurts or trauma they have suffered as well as how trauma cycles through families and over generations.
Recognizing that doing trauma work in a probation setting presents special challenges, we are alert to the here-and-now issues the young women will bring to the group setting. Our task is to help them understand their present issues in the larger context of their healing, particularly focusing on the role of present emotions as they may connect to past experience. While we do not expect all the young women to be ready to do deep healing work in this context, our goal is to plant seeds of understanding which they may carry with them to retrieve and use when ready. Although we will be attending to other issues such as exploring their identity as teens, the most critical learning will be about the healing process as it consists of telling or in some way depicting hurtful or traumatic experience, understanding the emotions or feelings connecting to that experience and making sense of the trauma in personally meaningful ways. It is this powerful process which frees them to focus their energy on building positive futures.
Individual Trauma-focused Counseling: The ideas (above) underlying group counseling inhere similarly in the work between a trauma counselor or therapist and an individual girl/young woman. We seek to develop a collaborative relationship for helping girls restore or retrieve the aspects of self rendered silent, seemingly inaccessible, shattered or lost to the traumas they have suffered during the tender early years of their lives. Each girl will have the opportunity to share hurtful experience, to be heard and seen in meaningful ways, to develop healing skills to carry with them into their lives outside the counseling relationship. Accompanying the development of these skills is an increasing ability to respond to life's challenges, little and big, an increased feeling of well-being and internal power as they learn to take responsibility for their choices, behaviors and actions.
A special challenge in this probation context arises from the fact that a person cannot be forced to heal. Pressure to face the trauma before she is ready is likely to summon feelings of having meaningful control taken away, mimicking the core wounding of the original trauma. Yet many of these girls are acting out from their trauma in ways that put them at great risk for suffering additional trauma. The individual work is intended to be useful to illuminate how their acting out and acting in behaviors connect to the hurts or trauma they have suffered as well as how trauma cycles through families and over generations. Trauma is never presented as an excuse for acting out behavior but only an explanation. Understanding their acting out behavior as information they provide themselves (as often mirroring the hurts they have experienced) can motivate and ready them to do the trauma work. It is this work which has the powerful and long-lasting effect of quieting the very impulse to act out.
Since identifying, understanding and having the feelings connected to trauma are core aspects of individual work, we encourage girls to identify their assumptions about healthy emotional life. They explore who were their primary models for the expression or non-expression of emotions (e.g., parents and other family members). How did they develop their own emotional habits and styles? The purpose here is to support them in developing the emotional competence fundamental to healing, to forging positive relationships and to creating positive future lives.
Workshop for Adult Family Members: Trauma does not happen in a vacuum. The event of trauma may occur outside the family context or within it. Either way, families vary in their abilities to support the healing of their children. While good intentions are common if not universal, many factors get in the way of providing what a child urgently needs after experiencing trauma. So often it is the unhealed trauma of a family member preventing her or him from being able to hear the child and respond in ways that promote recovery. Families who carry trauma across generations (most of ours) are likely to develop emotional cultures tending to silence suffering. What we hear from trauma survivors is: "I don’t feel safe to tell my story. It's not okay in my family to express the feelings coming up for me when I talk or think about what happened? They don't want to hear the meaning of this experience for my life?" Silencing patterns don't change overnight. In addition, family members themselves are often traumatized by their child's experience, making it all the more difficult to summon existing internal resources for supporting themselves or their child.
This workshop is designed as a beginning step to help family members explore ways they may achieve their good intentions to support their traumatized child and themselves. We particularly want parents to understand the event of their child's trauma as an opportunity for healing their own trauma and strengthening the integrity of their family system. We will provide an overview of how trauma impacts the developing self, the family system and the larger contexts within which the family is imbedded (e.g., community, culture, state, country). Since their children are now wards of the justice system, we will explore how a trauma focus provides the opportunity for re-integration and restoration of self, family, community and thus society. A trauma lens offers an alternative to retribution or punishment, an institutional focus tending toward disintegration and destruction of the self and of the family system. We will present practical ideas for pursuing individual and family healing and for supporting their child's recovery as well as promoting ongoing safety within the family and community contexts.
Individual or Group Counseling for Parents: Most parents have some history of emotional, verbal, physical or sexual abuse, or a combination thereof. Many have not defined their experience as such. Our work with parents whose children have been hurt starts with developing a relationship of safety and trust in a non-shaming, non-blaming context. We invite parents to consider the meaning of violence as violation of any kind, to explore the impact experienced violations have had on their own lives as well as their children's lives. Some primary goals of collaborative work with parents are: 1) helping them strengthen and develop emotional skills, 2) addressing the developmental issues of their adolescents, 3) exploring the impact of trauma on their adolescent's development, 4) supporting them to strengthen and develop their parenting skills. Groups provide the opportunity for parents to feel less alone, to support each other, and to understand and mediate common shame. Working together, they are less likely to express judgment and more readily develop the capacity to express accurate empathy. This will serve them well in future social interactions. Individual counseling provides a more private context for parents to focus on their own unhealed trauma and its relationship to their child's experience and ability to heal.
Parents will be invited to go within themselves to identify their own pain, to make sense of their own childhood experience and identify the profound effect it has on how they parent their children. They will be encouraged to see how the present is impacted by events from their past. Where there is no reflection on the past, history is likely to repeat itself, with parents passing unhealthy patterns handed down over generations as a consequence of traumas or hurts unhealed at their origins. When parents can construct a coherent narrative of their past, they may connect to their children in more empathic ways and model the recovery or healing work their hurt children must do to be able to transcend their trauma and live productive lives. Parents will be supported to develop skills to communicate in reciprocal, sensitive ways tending to nurture a sense of safety and trust in the parent-child relationship. Such communication allows their children to be able to enter or continue the healing process. We work to combat myths carrying a message that people are permanently damaged by trauma, particularly the trauma of sexual abuse. Healing can happen from any trauma. There is no more powerful context for this healing than in a child's own family.
Practice-based Trauma Training for Staff: The Margaret J. Kemp GIRLS Camp mission states: "We believe our girls are valuable and worthy of our community support. We provide sustainable resources that promote the process of healing, educating and empowering each girl to achieve her greatest potential." Within the context of a gender-responsive theoretical framework, the GIRLS Program has taken the courageous step of opening to a particular way of understanding behaviors girls do that bring them under the auspices of the juvenile justice system. To focus on trauma theory as part of the gender-responsive theoretical framework is to acknowledge that these girls have suffered hurtful events in their lives. These events tend to provoke acting out or risk-taking behaviors when girls do not have the individual skills or family support to heal from those events. To provide the "sustainable resources that (will) promote the process of healing, educating and empowering each girl…," an understanding of trauma is fundamental to all aspects of program development. A general understanding of trauma-in-practice can also help all of us define our roles more clearly and how we connect to the group goal of promoting girls' healing.
A primary challenge to the program's worthy mission lies in the fact that trauma inevitably causes fragmentation or disintegration of the self, the family system and the larger contexts within which the girl and her family are imbedded (e.g., communities, institutional systems, cultures, state, country). To be successful, the GIRLS Program, as the primary community and institutional system supporting the girls "to achieve (their) greatest potential," must address this issue of fragmentation. While it is wise to assume some level of fragmentation in any community or system, understanding where it exists and working toward integration has inherent value and power to bring healing to any context. For example, it is common to promote a "teamwork" approach to working with the GIRLS population. But where there has been trauma, defined as a violation of private space and a profound loss of control over experience, teamwork must and can be carefully configured to avoid repeating aspects of the traumatic experience. An objective of training will be to gain competence as individuals and as a collaboration to identify and close the "fragmentation gaps" that exist and that will inevitably arise and threaten to undermine the program mission, goals and objectives.
Practice-based trauma training will begin to address such complex issues as benign teamwork in conversation with all the people who make up the system. It will be important for each person who will have an impact on the girls to have a basic, practical, exploratory and evolving understanding of trauma as it may affect the girl and as it may be affecting her or his own behavior in relationship to the girl or girls and their families. A primary training objective is to gain an understanding of trauma as it impacts the different practice contexts of the GIRLS Program.
An understanding of trauma helps us better understand ourselves and our families. As we better understand ourselves and our own experience, we increase our ability to see how each individual girl's trauma "plays out" within the family, group or institutional setting. We can learn to respond to acting out in ways that are restorative, that promote healing rather than invoke shame or punishment, behaviors that hinder healing. A common misunderstanding of the trauma approach is to think that a focus on events that have hurt people will allow "excuse-making" by the person who is acting out from those hurts. Trauma never excuses acting out behaviors. It only explains them. We are all responsible for our behaviors, for choices we make. A core objective of training will be to teach what we believe to be context-crucial concepts of trauma theory, particularly its inherent ideas about emotional competence. Our assumption is that these concepts offer a framework of thought to encourage creative and context-appropriate ideas from all program staff regarding acting out behaviors. Ideas for mediating the inevitable tension between a custodial environment and the program goal of promoting healing through creating at least a benign and at most a kind and caring treatment environment best come from the people doing this challenging work.
Attachment H |
Health Insurance Portability and Accountability Act (HIPAA) |
Business Associate Requirements |
Definitions |
Terms used, but not otherwise defined, in this Schedule shall have the same meaning as those terms are defined in 45 Code of Federal Regulations section 160.103 164.304 and 164.501. (All regulatory references in this Schedule are to Title 45 of the Code of Federal Regulations unless otherwise specified.) |
a. Designated Record Set. “Designated Record Set” shall have the same meaning as the term “designated record set” in Section 164.501. b. Electronic Protected Health Information. “Electronic Protected Health Information” (“EPHI”) means individually identifiable health information that is transmitted or maintained in electronic media, limited to the information created, received, maintained or transmitted by Business Associate from or on behalf of Covered Entity. |
c. Individual. “Individual” shall have the same meaning as the term “individual” in Section 164.501 and shall include a person who qualifies as a personal representative in accordance with Section 164.502(g). |
d. Privacy Rule. “Privacy Rule” shall mean the Standards for Privacy of Individually Identifiable Health Information at 45 Code of Federal Regulations Part 160 and Part 164, Subparts A and E. |
e. Protected Health Information. “Protected Health Information” shall have the same meaning as the term “protected health information” in Section 164.501 and is limited to the information created or received by Contractor from or on behalf of County. |
f. Required By Law. “Required by law” shall have the same meaning as the term “required by law” in Section 164.501. |
g. Secretary. “Secretary” shall mean the Secretary of the United States Department of Health and Human Services or his or her designee. h. Security Incident. “Security Incident” shall mean the attempted or successful unauthorized access, use, disclosure, modification, or destruction of information or interference with systems operations in an information system, but does not include minor incidents that occur on a daily basis, such as scans, “pings”, or unsuccessful random attempts to penetrate computer networks or servers maintained by Business Associate i. Security Rule. “Security Rule” shall mean the Standards for the Protection of Electronic Protected Health Information at 45 CFR Part 160 and Part 164, Subparts A and C. |
Obligations and Activities of Contractor |
a. Contractor agrees to not use or further disclose Protected Health Information other than as permitted or required by the Agreement or as required by law. |
b. Contractor agrees to use appropriate safeguards to prevent the use or disclosure of the Protected Health Information other than as provided for by this Agreement. |
c. Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to Contractor of a use or disclosure of Protected Health Information by Contractor in violation of the requirements of this Agreement. |
d. Contractor agrees to report to County any use or disclosure of the Protected Health Information not provided for by this Agreement. |
e. Contractor agrees to ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by Contractor on behalf of County, agrees to the same restrictions and conditions that apply through this Agreement to Contractor with respect to such information. |
f. If Contractor has protected health information in a designated record set, Contractor agrees to provide access, at the request of County, and in the time and manner designated by County, to Protected Health Information in a Designated Record Set, to County or, as directed by County, to an Individual in order to meet the requirements under Section 164.524. |
g. If Contractor has protected health information in a designated record set, Contractor agrees to make any amendment(s) to Protected Health Information in a Designated Record Set that the County directs or agrees to make pursuant to Section 164.526 at the request of County or an Individual, and in the time and manner designed by County. |
h. Contractor agrees to make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by Contractor on behalf of, County available to the County, or at the request of the County to the Secretary, in a time and manner designated by the County or the Secretary, for purposes of the Secretary determining County’s compliance with the Privacy Rule. |
i. Contractor agrees to document such disclosures of Protected Health Information and information related to such disclosures as would be required for County to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with Section 164.528. |
j. Contractor agrees to provide to County or an Individual in the time and manner designated by County, information collected in accordance with Section (i) of this Schedule, to permit County to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with Section 164.528. k. Contractor shall implement administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of EPHI that Contractor creates, receives, maintains, or transmits on behalf of County. l. Contractor shall conform to generally accepted system security principles and the requirements of the final HIPAA rule pertaining to the security of health information. m. Contractor shall ensure that any agent to whom it provides EPHI, including a subcontractor, agrees to implement reasonable and appropriate safeguards to protect such EPHI. n. Contractor shall report to County any Security Incident within 5 business days of becoming aware of such incident. o. Contractor shall makes its policies, procedures, and documentation relating to the security and privacy of protected health information, including EPHI, available to the Secretary of the U.S. Department of Health and Human Services and, at County’s request, to the County for purposes of the Secretary determining County’s compliance with the HIPAA privacy and security regulations. |
Permitted Uses and Disclosures by Contractor |
Except as otherwise limited in this Schedule, Contractor may use or disclose Protected Health Information to perform functions, activities, or services for, or on behalf of, County as specified in the Agreement; provided that such use or disclosure would not violate the Privacy Rule if done by County. |
Obligations of County |
a. County shall provide Contractor with the notice of privacy practices that County produces in accordance with Section 164.520, as well as any changes to such notice. |
b. County shall provide Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, if such changes affect Contractor’s permitted or required uses and disclosures. |
c. County shall notify Contractor of any restriction to the use or disclosure of Protected Health Information that County has agreed to in accordance with Section 164.522. |
Permissible Requests by County |
County shall not request Contractor to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by County, unless the Contractor will use or disclose Protected Health Information for, and if the Agreement provides for, data aggregation or management and administrative activities of Contractor. |
Duties Upon Termination of Agreement |
a. Upon termination of the Agreement, for any reason, Contractor shall return or destroy all Protected Health Information received from County, or created or received by Contractor on behalf of County. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Contractor. Contractor shall retain no copies of the Protected Health Information. |
b. In the event that Contractor determines that returning or destroying Protected Health Information is infeasible, Contractor shall provide to County notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Parties that return or destruction of Protected Health Information is infeasible, Contractor shall extend the protections of the Agreement to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Contractor maintains such Protection Health Information. |
Miscellaneous |
a. Regulatory References. A reference in this Schedule to a section in the Privacy Rule means the section as in effect or as amended, and for which compliance is required. |
b. Amendment. The Parties agree to take such action as is necessary to amend this Schedule from time to time as is necessary for County to comply with the requirements of the Privacy Rule and the Health Insurance Portability and Accountability Act, Public Law 104-191. |
c. Survival. The respective rights and obligations of Contractor under this Schedule shall survive the termination of the Agreement. |
d. Interpretation. Any ambiguity in this Schedule shall be resolved in favor of a meaning that permits County to comply with the Privacy Rule. e. Reservation of Right to Monitor Activities. County reserves the right to monitor the security policies and procedures of Contractor |
ATTACHMENT I
The undersigned (hereinafter called the "Contractor(s)") hereby agrees that it will comply with Section 504 of the Rehabilitation Act of 1973, as amended, all requirements imposed by the applicable DHHS regulation, and all guidelines and interpretations issued pursuant thereto.
The Contractor(s) gives/give this assurance in consideration of for the purpose of obtaining contracts after the date of this assurance. The Contractor(s) recognizes/recognize and agrees/agree that contracts will be extended in reliance on the representations and agreements made in this assurance. This assurance is binding on the Contractor(s), its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Contractor(s).
The Contractor(s): (Check a or b)
a. Employs fewer than 15 persons.
b. Employs 15 or more persons and, pursuant to section 84.7 (a) of the regulation (45 C.F.R. 84.7 (a), has designated the following person(s) to coordinate its efforts to comply with the DHHS regulation.
_____________________________________________________
Name of 504 Person - Type or Print
_Rape Trauma Services__________________________________
Name of Contractor(s) - Type or Print
__1860 El Camino Real, Suite 301_____________________
Street Address or P.O. Box
__Burlingame, CA 94010______________________________
City, State, Zip Code
I certify that the above information is complete and correct to the best of my knowledge.
_____________________________________________________
Signature
_____________________________________________________
Title of Authorized Official
_____________________________________________________
Date
*Exception: DHHS regulations state that:
"If a recipient with fewer than 15 employees finds that, after consultation with a disabled person seeking its services, there is no method of complying with (the facility accessibility regulations) other than making a significant alteration in its existing facilities, the recipient may, as an alternative, refer the handicapped person to other providers of those services that are accessible."