DEPARTMENT OF FAMILY AND SUPPORT SERVICES - HOMELESS SERVICES

Scope of Services

Agency Information

Agency:

Program Name:

Administrative Office Site Address & Ward:

Site # / Address / Zip / Ward / Comment

Please refer to your award notice to complete the information below:

Term of contract: ______through ______

Total Program Amount: $______

P.O. Number / Budget Allocation / Contract Type/Funding Source
1.
2.
3.
4.
5.
6.

Agency contact person for this contract:

Executive Director

Name:

Phone Number:

Fax Number:

E-Mail:

Program Director

Name:

Phone Number:

Fax number:

E-Mail:

Fiscal Contact

Name:

Phone Number:

Fax Number:

E-Mail:

Reporting Contact

Name:

Phone Number:

Fax Number:

E-Mail:

Program Models – please select model that applies to this program

Permanent Housing

£  permanent supportive housing

£  Permanent Housing with short-term supports

£  Rapid Rehousing

£  safe havens

Homeless Prevention

£  Homeless prevention

interim housing

£  interim housing

specialized supportive system of services

£  clinical services

engagement services

£  Basic street outreach

£  Specialized outreach and engagement services

£  emergency shelter

£  Community Hospitality Center (drop-in centers)

Youth Intentional Permanent Supportive Housing

£  Youth-Intentional Permanent Supportive Housing

Youth transitional housing

£  Scattered site transitional housing - Youth

£  project based transitional housing – Youth

£  Interim housing - Youth

low-threshold youth continuum

£  Youth drop-in centers

£  Youth outreach program

£  low threshold youth overnight shelter

Special Programs

£  Outreach Coordinator

£  System Coordinator

£  Plan to End Homelessness

£  FUSE

Other______

Sub-contracted partner agencies - Agency shall provide a copy of the subcontract agreement(s) including budget between agency & subcontractor. Indicate “Not applicable” if none.

Agency Name / Major Function/Role / Number of Positions Supported by DFSS

Number of staff positions supported by DFSS funding (Total at both grantee agency and at any other sub-contracted partner agencies):

Full-time
Part-time

Listing of positions supported by DFSS funding- indicate % of time spent on program.

Title / % of time spent on program

Basic Program Operation Per site address

Please list all sites with corresponding site #

Site address & Ward:

Days of Operations

SUN / MON / TUES / WED / THU / FRI / SAT
FROM (Time)
TO
(Time)
□ 24 HOURS 7 DAYS A WEEK

Intake Hours:

Intake phone number: ( )

SUN / MON / TUES / WED / THU / FRI / SAT
FROM
(time)
TO
(time)
□ 24 HOURS 7 DAYS A WEEK

(**PLEASE NOTE: Shelters MUST accept clients referred by DFSS and Catholic Charities (24/7) regardless of intake hours**)

INDICATE WHICH meals will be provided to clients
(check all that apply) / Breakfast
Lunch
Dinner
Number of meals to be provided
(Average daily attendance X number of meals served X operating days)
For example, a 30 bed program that provides breakfast, lunch, and dinner, and operates 365 days a year would have 32,850 Meals (30 x 3 x 365)

Will your agency be using DFSS funding to purchase meals for clients?

£  Yes

£  No

Providers are required to promote family preservation by accepting families of all sizes and ages. Families must be kept together regardless of the children’s age/gender.

TARGET POPULATION:
Single Adult Females Only
Single Adult Males Only
Single Females and Males
Families
Unaccompanied Youth - Aged 18-24 / □ Males Only
□ Females Only
□ Males and Females
PROGAM CAPACITY:
Number of Beds
Number of Apartments
Number of Rooms
Number of Cribs
N/A
PROGAM CAPACITY (BED Breakdown) # of beds by subpopulation :
Families
Single Female
Single Male
Unaccompanied Youth - Aged 18-24
N/A
Program configuration:
Congregate Living: client does not have private room for sleeping
Individual bedrooms: client has private room for sleeping; shared bathroom
Individual Apartments: clients reside in their own unit
Other (explain)
N/A
INDICATE THE PROGRAMS CASE MANAGEMENT RATIO:
(All programs)
INDICATE THE FREQUENCY CLIENTS WILL BE SEEN BY A CASE MANAGER:
( Must select one)
Daily
Weekly
Monthly
Other (explain)

Description of program and target population – All Programs

The project description should address the entire scope of the project, including a clear picture of the target population(s) to be served, the plan for addressing the identified needs/issues of the target population(s), and coordination with other source(s)/partner(s). The narrative is expected to describe the project at full operational capacity.

Number of clients and households to be served - All Programs

Carryover from Dec / Jan –Mar
(new) / Apr-Jun
(new) / Jul-Sept
(new) / Oct-Dec
(new) / Total
(new plus carryover)
Number of unduplicated clients to be served
Number of unduplicated households to be served

Outcomes and Performance Measures – Refer to programs models chart

Agency must list out the performance MEASURES ASSOCIATED with this contract:

Describe the activities that will be performed to achieve these outcomes:

Core Elements

Eligibility/Intake/Discharge:

-  Programs ensure services and access into the program regardless of substance use or history, mental health barriers, physical or developmental challenges, domestic violence, involvement with the criminal legal system, rental/eviction history, financial resources, non-violent rule infractions with agency’s own program, protective class, gender or gender non-conforming identity, and sexual identity.

-  Permanent housing programs receive all housing referrals from Chicago’s Coordinated Access System (CAS), in accordance with CAS policy and procedures.

-  Discharge policy is explained and easily accessible to Person with Lived Experience(PLEs)

-  Programs proactively intervene when behavioral or tenancy issues arise with PLEs before they reach a level warranting discharge; likewise, agencies proactively equip staff with training and support to prevent and intervene when a discharge is imminent

-  Discharge policies include an internal due process hearing or investigation prior to discharging the PLE; assistance with locating other housing and service options if needed; and a statement that the agency will make and document all reasonable attempts to avoid discharging PLEs from housing programs and/or without needed services

-  Programs preserve families as required by the HEARTH Act,

Policies, Procedures, and Practices:

-  Program staff and PLEs have public access to PLE rights, responsibilities, and grievance policies and procedures

-  Programs seek to strengthen and align policies and procedures with the values of harm reduction and stages of change—to promote PLE’s success in various homeless services programs

-  Agencies have policies and procedures that ensure the safety and security of staff, volunteers and PLEs, etc.

-  Programs have policies and procedures to address and resolve issues related to violence, conflict, mediation, and other crises

Training and Staff Development/Supervision:

-  Program staff are supervised and trained on issues related to core values (i.e. trauma-informed care, crisis intervention, engaging diverse communities, etc.)

-  Staff are trained and experienced in working with vulnerable youth, families, and individuals experiencing homelessness; staff demonstrate cultural competency to engage PLEs from diverse cultures and backgrounds

-  PLEs and staff are trained in conflict mediation, crisis intervention, violence prevention and intervention, and community accountability approaches to preventing, interrupting, and transforming violence to promote long-term engagement

-  Programs have ongoing supervision policies, procedures, and practices for staff and volunteers that allows for ongoing support and monitors performance

-  Programs ensure appropriate staff is trained in using the Homeless Management Information System (HMIS) for coordinated access activities.

Systems:

-  Programs provide Coordinated Access System information and/or assistance to PLEs; Coordinated Access best practices will be used (i.e. programs follow the designated Central Referral System and/or Coordinated Access process for program referrals)

-  Programs identify a point of contact for CAS communications (i.e. a staff person who can help connect a PLE to an outreach worker attempting to make contact with the PLE)

-  Programs support and advocate alongside families and individuals with issues related to tenancy (coordinate between property management, landlord and PLE, provide education on benefits and tenant rights) and other systems (i.e. benefits, education)

-  Programs participate in Coordinated Access as required by HEARTH ACT

-  Programs collaborate and build relationships with landlords (as a part of providing continued support to PLEs)

-  Programs engage in efforts to improve systems integration and continuity of care for their PLEs

-  Programs, with the exception of Domestic Violence (DV) programs, participate in the Homeless Management Information System (HMIS) in alignment with the CoC-approved Standard Operating Procedures and Data Quality Plan. DV must use a compatible database.

Model of Care:

-  Programs are equipped to meet the complex needs of families

-  Programs use the stages of change model with PLEs to ensure services are appropriate and responsive to needs

-  Programs provide a variety of services that are flexible and appropriate for PLEs in various stages of change

-  Programs use motivational interviewing strategies and/or additional evidence-based tools to engage PLEs in various stages of change

-  Provision of or linkage to ongoing supportive services beyond provision of basic needs including educational/ vocational support, case management and systems advocacy, housing assistance, legal assistance, life skills programming, mental health and substance use services, medical, self-care and children’s services

-  Programs abide by non-discriminations policies

-  Programs provide provision of or linkage to child-focused assessments and appropriate services for families

-  Programs enroll PLEs in cash and non-cash public benefits that increase and/or maintain income and improve health outcomes for individuals who qualify for medical benefits

-  Programs proactively address violence to promote issues related to safety

Programs are accessible and uphold federal accessibility standards (i.e. translated forms, bilingual/multilingual staff, and physical space)

Mandatory Activities:

·  Enter data into HMIS (program entry, services provided, program exit) within 2 days of client interaction.

·  Enter additional Coordinated Access System HMIS data points as required by DFSS, Coordinated Access System Lead Agency, or HMIS Lead Agency.

Indicate name of program in HMIS and unique Service Point HMIS I.D. for this program

for all programs

·  All agencies that work with children shall be in compliance with the Illinois Child Abuse and Reporting Act; employees shall complete the Mandated Status Form & it must be kept filed at agency.

·  Provide reports as required including but not limited to quarterly, yearly and as requested by the Chicago Department of Family and Support Services.

·  Participate and be compliant in the HMIS Quarterly Data Assessment clean-up process.

·  Assist DFSS in responding to extreme weather emergencies.

·  Develop individualized case plan for each household when applicable to your program model.

·  Maintain and secure all client files.

·  Participate in the Annual Homeless Point in Time Count and other special initiatives as required by DFSS.

·  Perform benefits screening and linkage to mainstream resources

·  Provision or/or linkage to physical health assessment, psycho-social assessment, and linkage to mental health and/or substance abuse services as appropriate for all household members including children.

·  All agencies that handle food must have appropriate staff with food handler certificate.

·  Must voucher monthly. Below illustrates what percentage of the grant should be expended quarterly.

o  First quarter – 25%

o  Second Quarter – 50%

o  Third Quarter – 75%

o  Fourth Quarter – 100%

·  Programmatic Changes: Please note if there are any changes to your staff, facility, facility location or Scope you must notify in writing to your DFSS Program Liaison and Director of Homeless Services Division.

·  Program will adhere to the essential elements of the program model as identified in the CoC Program Models Chart.

for shelter programs

·  Provide daily data for the DFSS – Catholic Charities Shelter Bed Clearinghouse.

·  Submit bed census reports upon request.

·  Cannot maintain a waiting list.

·  Must accept clients over the week-ends.

·  There is no pre-intake interview prior to a family’s arrival in shelter.

·  Submit the Quarterly Bed bug certification

·  Conduct Yearly Public Health and Fire certifications in collaboration with DFSS and other appropriate entities.

·  Program must complete coordinated access assessments in HMIS for households in need of permanent housing within seven days of program enrollment

·  Ensure that all children ages 0 to 5 receive development screenings (either direct or through Child Find)

·  Ensure that all children ages 5 and up are enrolled and are attending school regularly.

·  Follow-up with clients at 3-month intervals for a period of 6- months after permanent housing placement. Follow up must be documented in households file.

·  Interim Housing programs will not discharge households solely based on their length of time in program. Performance targets for housing clients within 120, 180 and 270 days are not time limits.

·  Program will adhere to the essential elements of the program model as identified in the CoC Program Models Chart.

FOR BASIC STREET OUTREACH, SPECIALIZED OUTREACH & ENGAGEMENT PROGRAMS

·  Accept and work with referrals of individuals matched to housing from the Coordinated Access System and assist in obtaining documentation necessary for housing eligibility determination (i.e. disability documentation, chronic homelessness documentation, identification).

SERVICES:

(Check all that apply):

·  How will follow up be done?

Phone Call Home Visit

Letter Other – indicate below:

·  This program will offer the following (check all that apply):

Life Skills Effective Communication

Coping Skills Tenant Rights and Responsibilities

Financial Literacy/Budgeting Create Savings Plan/Account

Housing Location/Make Application Housing Retention Skills

CTA Card Client ID

Employment/Training Linkage Education/GED Linkage

Client documents (e.g. birth certificate, marriage license, school grades, etc.)

Individual/Group/Family Therapy Other-indicate below:

Include other services provided by grantee that are not listed above:

Ø  agency must submit the following documents with scope:

£  Client responsibility agreement

£  Client termination policy

£  Plan for fire drills/safety

£  Grievance Procedures

£  A list of Board Members

£  List of staff persons/titles trained to complete coordinated access assessments

£  Name and contact information of CAS central point of contact