Q--CLINICAL PSYCHOLOGIST

ITEM NUMBER DESCRIPTION OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT 0001 1.00 LT $00.00 $00.00 A licensed clinical psychologist expert in Motivational Interviewing (MI), MI-informed Assessment (MIA), and the training of clinicians in MI. GRAND TOTAL $00.00 This Sources Sought Notice is for informational and planning purposes only and shall not be construed as a solicitation or as an obligation or commitment by the Government. This notice is intended strictly for market research. The purpose of this Sources Sought notice is to determine interest and capability of businesses including (but not limited to) 8(a), HUBZone, Service Disabled Veteran-Owned Small Business, and Veteran-Owned Small Business firms relative to the North American Industry Classification Code (NAICS) 339113. The Department of Veterans Affairs is seeking both manufacturers and/or distributors of the exact match or functionally equivalent equipment/ services to the following: PERFORMANCE BASED WORK STATEMENT Licensed Clinical Psychologist, certified by the motivational interviewing (MI) network of trainers and trained in motivational interviewing assessment (MIA) to train and certify staff members in motivational interviewing assessment. BACKGROUND The VISN 17 Center of Excellence (COE) for Research on Returning War Veterans in Waco, Texas, was designated in 2006. Congress instructed the Department of Veterans Affairs (VA) to designate the Waco campus as a Center of Excellence to focus on mental health/post-traumatic stress disorder (PTSD) needs. The COE will allow the VA to consolidate personnel, training, and specialized resources in an efficient manner to improve knowledge related to treatment, prevention, rehabilitation, and clinical services to our nation s veterans, with focus on those veterans returning from Operations Iraqi Freedom and Enduring Freedom (OIF/OEF). The primary mission of the VISN 17 Center of Excellence (COE) is to (1) develop, implement, and disseminate research into the causes of PTSD and its effects on combat veterans and their significant others; and (2) provide education for health care specialists and administrators around improved methods of diagnosing and treating individuals with mental health problems, especially veterans. The COE serves as a major source of expertise on the mental health consequences of war to legislative bodies such as Congress, and it serves as an internationally visible focus of research activity on the psychological problems of combat veterans. Administratively, the COE consortium is under the direct control of the Office of Mental Health Services at VA Central Office. BASIC SERVICES OBJECTIVE: In support of our primary mission, a VA research protocol entitled Adaptation, Refinement, and Open Trial of Parent Training for Veterans with PTSD has been initiated and requires a licensed clinical psychologist who is certified by the Motivational Interviewing (MI) network of trainers and who is trained in Motivational Interviewing Assessment (MIA) to train and certify staff members in motivational interviewing assessment. AVALIBILITY: The training outlined in this statement is required on or about 15 January 2019. That date is approximate and subject to change pending the actual award date of any contract associated with this requirement. GENERAL SCOPE: A licensed psychologist is needed for 3 years to complete the tasks listed below. Training/Tasks should take approximately 4 hours a week excluding the two-day workshop. The psychologist will conduct a two-day workshop that will combine formal didactic material on MI consistent assessment with in-vivo MI practice session role-plays with real-time feedback. After the two-day training, trainees will submit audio-recorded mock MIA sessions for fidelity coding. Tapes will be coded using the Interview Rating Guide that accompanies the MIA and one-on-one telephone coaching will be provided after each submitted tape is code. It is expected that the MI psychologist will spend four hours per week over the course of three years training and coaching staff in MI/MIA, coding sessions for fidelity, and creating a structured assessment manual. The MI psychologist will provide ongoing MIA coaching and consultation throughout all years of the project. The MI psychologist will attend weekly team meetings. QUALIFICATIONS: 1) Is a licensed clinical psychologist who is certified by the motivational interviewing (MI) network of trainers. 2) Is trained in motivational interviewing assessment (MIA). 3) Has 5 or more years of experience coding, training and providing supervision in motivational interviewing. 4) The psychologist must have clinical experience with veterans and parents. 5) Have an active role in research to apply MI to the research study. TRAINING TASKs: Task 1 Two-day MI workshop o Psychologist travels to Waco, TX and conducts 2-day (16 hour) training at Center of Excellence for training staff in MIA assessment to include workshop prep time and feedback and report writing afterwards. Travel to be reimbursed separately. Task 2 Fidelity coding of training recordings for study staff The psychologist will code at least 6 mock 1.5 hour MIA sessions conducted by study staff (2 staff members) using the Interview Rating Guide that accompanies the MIA and one-on-one telephone coaching will be provided after each submitted recording is coded. Estimated to take 10 hours per recording to include telephone coaching, feedback and attendance at team meetings. Task 3 Assist the project team in creating a project specific MIA protocol and manual o Psychologist assists project team in creating standardized MIA assessment protocol and manual, estimated to take approximately 175-250 hours to include attendance at team meetings. Task 4 Fidelity coding of recordings for study staff The psychologist will code study MIA sessions (10 sessions x 1.5 hours each) conducted by study staff using the Interview Rating Guide that accompanies the MIA. This includes coding, analysis, feedback, report writing and attendance at team meetings. SPECIFIC REQUIREMENTS: EDUCATION: The Psychologist shall have a Doctor of Philosophy (Ph.D.) degree in clinical or counseling psychology from an APA accredited psychology program or a program acceptable to the Secretary, Department of Veterans Affairs. -Contractor shall have completed an APA accredited internship/residency in professional psychology or an internship/residency acceptable to the Office of the Secretary, Department of Veterans Affairs. LICENSE/CERTIFICATION: Shall have and maintain a current license to practice psychology in any one of the 50 states, the District of Columbia, Puerto Rico, or the U.S. Virgin Islands. License cannot be under investigation nor have any adverse action pending from a national licensing/certification agency. The psychologist must demonstrate a record of continuing education since becoming licensed. -Periodic CME may be conducted at the VISN 17 CoE and will be available, at no cost, if the provider desires to attend. If training is received within the CoE, the time spent out of the duty section not performing contracted services (to obtain the CME), will not be billable to the Government. HIPAA COMPLIANCE: The psychologist agrees to abide by all the requirements of the Health Insurance Portability and Accountability Act (HIPAA) as codified at 45 CFR Part 160 and Part 164, subparts A and E, regarding the privacy and confidentiality of health records and information being provided and shared under the resulting contract. RESEARCH COMPLIANCE: The psychologist will adhere to all research protocol parameters and immediately report any protocol deviations to the Primary Investigator. PERSONNEL QUALIFICATION STATEMENT: The psychologist will completely fill out and answer all questions on the Personnel Qualification sheet, which is part of this requirement. PERSONNEL QUALIFICATIONS SHEET (PQS): Licensed Clinical Psychologist, certified by the motivational interviewing (MI) network of trainers and trained in motivational interviewing assessment (MIA) to train and certify staff members in motivational interviewing assessment 1. Every item on the Personal Qualifications Sheet must be addressed. Please sign and date where indicated. Any additional information required may be provided on a separate sheet of paper (indicate by number and section the question(s) to be addressed). 2. The information provided will be used to determine personnel ranking. 3. After contract award, the information provided may be verified during the credentialing process. If you submit false information, the following actions may occur: Your contract may be terminated and you may lose your clinical privileges. If that occurs, an adverse credentialing action report will be forwarded to your State licensing bureau and the National Practitioners Databank. 4. Personal and Practice Information: Yes No 1. Have you ever been the subject of a malpractice claim? ___ ___ (indicate final disposition of case in comments) 2. Have you ever been a defendant in a felony or misdemeanor case? ___ ___ (indicate final disposition of case in comments) 3. Has your license to practice or DEA certification ever been revoked ___ ___ or restricted in any state? 4. Have you ever been arrested for or charged with a crime involving a child? ___ ___ 5. a. Are you a U.S. Citizen? ___ ___ b. If yes, do you hold dual citizenship or a passport from a foreign country? ___ ___ If answered yes to any questions under Personal and Practice Information Section above, you will need to attach a detailed explanation. Specifically address the disposition of the claim or charges for numbers 1 through 4, and the State of the revocation for number 3 above. If you hold a dual citizenship or have a passport issued from a foreign country, address which country the dual citizenship is held and/or which foreign country has issued you a passport. PRIVACY ACT STATEMENT Under 5 U.S.C. 552a and Executive Order 9397, the information provided on this page and the Personal Qualifications Sheet is requested for use in the consideration of a contract; disclosure of the information is voluntary; failure to provide information will result in the denial of the opportunity to enter into a contract. _________________________ _____________(mm/dd/yy) (Employee Signature) (Date) I. General Information Name: _________________________________________ SSN: ______________ Last First Middle Date of Birth: ___________ Address: ___________________________________ ___________________________________________ _______________________________________ ___ Phone: (_____) ________________ Email: ________________________ Medical Information YES NO 1. Do you have any physical or mental impairment that could limit your clinical practice? ___ ___ 2. Have you been hospitalized for any reason during the past 5 years? ___ ___ 3. Are you currently receiving or have you ever received formal mental health therapy or treatment? ___ ___ 4. Are you currently receiving, or have you in the past ever received, treatment or therapy for any alcohol or drug-related condition? ___ ___ 5. Have you ever been unlawfully involved in the use of controlled substances? ___ ___ If answered yes to any questions under Medical Information, you will need to attach a detailed explanation. II. State Professional Licensure (License must be current, valid, and unrestricted): ________ (State) Date of Expiration: _____________ (mm/dd/yy) ________ (State) Date of Expiration: _____________ (mm/dd/yy) ________ (State) Date of Expiration: _____________ (mm/dd/yy) III. Board Certification(s): ___________________________ ____________________ Title of Certification Date of Certification (mm/dd/yy) ___________________________ ____________________ Title of Certification Date of Certification (mm/dd/yy) 674-19-1-1908-0004 - PQS IV. Professional Employment: List your current and preceding employers. Provide dates as month/year. Name and Address of Present Employer From To (1) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ From To (2) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ From To (3 _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ From To (4) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ From To (5) _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Are you are currently employed on a contract (public or private)? If so where is your current contract and what is the position? ___________________________________________ When does the contract expire? _____________________________________ V. Professional Recommendations/Clinical Competency: Provide two letters of recommendation from supervisors attesting to your personal clinical experience and professional skills as a practitioner in your discipline. These letters must be dated and shall include the name, title, phone number, address and signature of the individual providing the recommendation. The letters must have been written within the 2 years preceding submission of your proposal. VI. Continuing Education Hours within the preceding 3 years: Title of Course From To CE Hours ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ VII. Additional Information: Provide any additional information you feel may enhance your ranking. Factors to be used in a Contract Award Decision, such as your resume, curriculum vitae, commendations or documentation of any awards you may have received, etc. I hereby certify the above information to be true and accurate: _________________________________ ____________________(mm/dd/yy) (Employee Signature) (Date) Enclosures: Copy of Professional Education Degree(s) Copy of certificate of completion of pre-doctoral clinical internship or residency Copy of all medical licenses held within the preceding 10 years Copy of relevant continuing education certificates (see VIII above) Copy of two (2) Professional Recommendations ____________________________________________ Employee Name (Printed)