G -- Clinical Supervision

Fill in Blanks: TIN (tax ID): ________________ CAGE: ________________ DUNS: __________________ Vendor Point of Contact: ______________________Phone: ____________________ Vendor email: ______________________ Naval Medical Center Portsmouth POC: Pastoral Care Vendors quoted price shall be inclusive of all cost including labor and travel. Selected vendor must be able to start work within 14 days upon award of resulting contract. Payment Monthly, in Arrears Note: vendor will be required to provide billing electronically via the WAWF Electronic Invoicing method. For additional information, a review of the following web sites may be required: https://wawf.eb.mil http://wawftraining (email) contact@example.gov Vendor to reference N00183-07-T-0152 on all inquires. Government reserves the right to: (1) award based on an "All or Nothing Evaluation". (2) award a ?Best Value? requirement. Vendors with superior past performance histories may be given 1st consideration. PROMPT PAYMENT For Prompt Payment Act Purposes, this contract is: Subject to the 7-calender day constructive acceptance period. Section B - Supplies or Services and Prices ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 52 Week Small group sessions FFP For the period 01 Jul 07 - 30 June 08. See Section C for details of requirement FOB: Destination MILSTRIP: N0018307RQHCS02 PURCHASE REQUEST NUMBER: N0018307RQHCS02 NET AMT ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0002 22 Week Additional small groups as needed FFP For the period 01 Jul 07 - 30 June 08. See Section C for details of requirement FOB: Destination MILSTRIP: N0018307RQHCS02 PURCHASE REQUEST NUMBER: N0018307RQHCS02 NET AMT Section C - Descriptions and Specifications CLAUSES INCORPORATED BY FULL TEXT STATEMENT OF WORK CLINICAL PASTORAL (CPE) SUPERVISION 1. INTRODUCTION/SCOPE Background. Clinical Pastoral Education (CPE) Clinical Supervision is the industry standard and one that is examined by JCAHO. CPE Clinical Supervision is an ongoing process, regardless of the years that a Chaplain has in experience. It is similar in structure to that Supervision used by other mental health providers. This type of Supervision was initiated at NMCSD in 2001 and continues today. CPE Clinical Supervision is an industry standard within healthcare. It provides the Staff Chaplains with the opportunity to process significant patient cases that otherwise attribute to their vulnerability to the effects of secondary trauma. The intent of this requirement shall be to contract for the non-personal services of a Clinical Pastoral (CPE) Supervisor to provide for small group supervisions with the Staff Chaplains at NMCP. 2. CONTRACTOR REQUIREMENTS. A. The Clinical Pastoral (CPE) Supervisor shall be an independent contractor of Pastoral Care Services. The contractor shall: ? Provide weekly small group supervision/training every Wednesday from 1100 ? 1230. This time can be adjusted when mutually agreed upon by the Command Chaplain and the contractor. Note that additional Small Group sessions may be ordered on an as needed basis. There are no minimum guarantees. The Government will provide a minimum of 3 days notice of additional Small Group sessions. ? Construct, in concert with the Command Chaplain and the small group members, a written covenant of learning to cover CPE learning goals, pastoral reflection/formation, and clinical ministry competence. ? Validate, in writing and by signature, the supervisory hours of Staff Chaplains when they are pursuing certification with professional chaplaincy organizations. During the small group supervision/training the contractor shall facilitate the process and cover the learning goals. During the small group supervision/training the contractor shall facilitate the process and cover the learning goals. B. The contractor shall be paid per weekday service (1? hour Small Group Supervision / Training) occurrence. 1. Services shall not be required on federal holidays. 2. Unexplained absences due to illness or other incapacitation will be allowed up to 4 days per contract year. The contractor shall advise the COR of such absences. 3. The contractor shall provide competent Clinical Pastoral (CPE) Supervisor substitute with equal credentials who will cover during period of contractor absences (not to exceed 4 days / year). Note that the vendor shall be responsible for actions of substitute CPE and shall make any and all required payments for service to substitute CPE. 4. The contractor shall perform, within the parameters of his ordination and the dictates of his faith group. C. Staff orientation is required and the independent contractor will attend the one (1) day orientation within the first month of service and up to one (1) day departmental orientation at the discretion of the Command Chaplain. Note that this requirement may not apply to vendors who have previously attended orientation. D. Term of this contract, the contractor (Clinical Pastoral (CPE) Supervisor) agrees to perform on behalf of the U.S. Government duties of a Clinical Supervisor for Staff Chaplains serving aboard NMCP. E. Place of Performance. Work shall be performed onboard NMCP. Meetings between the contractor and the Command Chaplain, or his/her representative, shall be performed on-site. F. Communication. The contractor will pursue all administrative matters through the Command Chaplain. G. Personal Qualifications. The contractor shall be: ? Validly ordained clergy in good standing with his faith group. ? Have ecclesiastical endorsement, in writing. ? Qualified CPE Supervisor or Supervisor in-training with ACPE. ? Diplomat or fellow with AAPC or Licensed Mental Health Professional (LPC, MFT, LCSW). ? The contractor shall maintain certification for the entire contract period. The Government reserves the right to request proof of qualification at any time during contract period. Documentation of these qualifications will be presented to the Command Chaplain. H. The Clinical Pastoral (CPE) Supervisor shall demonstrate reliability, good relational skills and the ability to serve on an ecumenical ministry team. The Clinical Pastoral (CPE) Supervisor will comply with government policies and regulations in regard to identification badges, parking, and professional decorum. ? A physical examination certification which states the date on which the physical examination was conducted, the name of the doctor who performed the examination, and a statement concerning physical health of the contractor. The certification must contain the following statement: ?(Name of Contractor) is suffering from no physical disability/medical condition which would restrict or preclude him from providing services as a Clinical Pastoral Education (CPE) Supervisor. (Name of Contractor) is suffering from no contagious diseases to include but not limited to AIDS, tuberculosis, hepatitis, and venereal diseases, and is not positive for HIV anti-bodies?. ? The contractor shall be able to read, write, speak and understand English fluently. I. Guidance. The Command Chaplain will provide direct guidance for the contracted Clinical Pastoral Education (CPE) Supervisor. J. INS verification. No alien shall be allowed to perform under this contract without an Alien Registration Card (?green card?) and/or in violation of the Immigration Laws of the United States. K. Personal Appearance. The contractor shall be neat, clean, well-groomed, and in appropriate clergy clothing when in patient care and public areas. The contractor shall display the identification badge provided by security any time while at work. The contractor shall provide all clothing which is deemed personal. L. Government Regulations. The contractor shall become acquainted with and obey all pertinent Command, Navy, and DOD regulations, shall perform in a manner which precludes any waste of utilities and shall not use government equipment for personal business. All motor vehicles operated on this installation by the contractor shall be registered with base security and operated according to applicable directives. Eating and smoking by the contractor are prohibited in patient care areas and are restricted to designated areas. M. Absences. The contractor shall advise the Command Chaplain, or his acting substitute, of any planned or unplanned absences. The contractor shall provide a competent Clinical Pastoral (CPE) Supervisor substitute with equivalent credentials who will provide coverage during periods of contractor absences. N. The contractor, although in fact not a Government employee, shall comply with Executive Order 11222 of May 8, 1965, ?Prescribing Standards of Ethical Conduct for Government Officers and Employees,? and shall also comply with Department of Defense (DOD) and Department of Navy (DON) regulations implementing this Executive Order. In addition, the contractor shall adhere to all DOD, Navy, and Command policies and regulations during the performance of their duties. Contractor shall not accept tips and donations for services rendered. In the event that donations are offered all such donations shall be referred to the general offerings of the NMCP Pastoral Care Department. O. As an independent contractor, all medical, dental and professional liability insurance is the responsibility of the contractor. 3. PROPERTY. A. Government-Furnished Property. The government will make a best effort to provide shared office space, office furniture, telephone/fax service, pager, charting stamp, and the use of a copier and computer hardware and software necessary for use by the contractor. The government will allow unlimited telephone usage, both local and long distance, in support of the Pastoral Care Services programs. The government will provide utility services for the contractor?s use while on site. The government will provide the referenced information (reference material, religious literature, study guides etc.) as required. The Pastoral Care Services staff will coordinate the retrieval of information needed by the contractor and serve as the interface. The government will provide resources for the administration and celebration of sacraments and other professional resources deemed necessary by the Command Chaplain of Pastoral Care Services. B. Contractor-Furnished Property. The contractor shall furnish any items which are for personal use/ownership, or which are resources the government may be restricted in appropriating. 4. GENERAL INFORMATION. The following documents and data sources shall be provided to the contractor in the performance of duty upon request. This information will be provided by the NMCP Pastoral Care Services staff: A. Demographic information on the Staff Chaplains being served. Current data on patient preferences as determined by survey, correspondence, and patient relations statistics. B. Information regarding non-medical issues such as facilities, parking, support services, staffing, watch bills, and other amenities. C. Results of inspections/surveys by internal and external agencies. D. An explanation of the Pastoral Care concept being used and how it is implemented. E. Charting of the pastoral visit.