STATE OF CONNECTICUT Department of Mental Health & Addiction Services Page 1 of 42 PROCUREMENT NOTICE State of Connecticut Department of Mental Health and Addiction Services REQUEST FOR PROPOSALS (RFP) RFP #DMHAS-EQMI-RBHAO-2017 Legal Notice Regional Behavioral Health Action Organizations The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is seeking proposals from qualified private non-profit applicants capable of providing strategic behavioral health planning across an individual’s lifespan regarding the treatment, prevention, and recovery continuum of care. Respondents will be expected to address substance use, problem gambling, and mental health promotion through training and education on the regional and sub-regional level. This organization is designed to consolidate and replace the primary services currently being offered through the Regional Mental Health Boards (RMHB’s) and the Regional Action Councils (RAC’s) by creating combined behavioral health action organizations which perform the statutory functions of RMHBs and RACs. Regional Behavioral Health Action Organizations (RBHAO’s) are strategic community partners who will work across the behavioral healthcare continuum. Their role is service assessment, development, and coordination and should not be the provision of direct services to clients. Each RBHAO will be responsible for a range of planning, education, and advocacy services within one of DMHAS’ Uniform Regions. Applicants must be capable of providing the primary functions currently provided by the RMHB’s and the RAC’s including local and regional assessment of the behavioral health needs of children and adults, strategic planning, development of an annual action plan, participation on the State Planning Council and the State Advisory Board, awareness and education for the general public regarding substance use prevention, problem gambling prevention, and mental health promotion and wellness. The RBHAO will also be responsible for administering grants that are allocated to Local Prevention Councils (LPC’s). The RBHAO will provide oversight and direction to local communities regarding the implementation of these funds. In addition, each RBHAO will assume oversight of Problem Gambling Awareness funding that is currently allocated to RACs across the state. That funding is focused on building the capacity of local communities to increase awareness to address and reduce the impact of problem gambling on individuals and families. It is expected that the RBHAO will serve as the bridge to local and statewide prevention and advocacy activities. The RBHAO will work closely with DMHAS’ Prevention and Health Promotion Unit and DMHAS’ Problem Gambling Services in order to integrate and coordinate prevention activities within a region and sub-region. The RBHAO will also be responsible for linking to other Connecticut prevention and advocacy organizations like Connecticut Clearinghouse, Governor’s Prevention Partnership, National Alliance on Mental Illness, Advocacy Unlimited, and Connecticut Community for Addiction Recovery. The successful bidder will be required to begin delivering services by January 1, 2018. The Request for Proposals is available in electronic format on the State Contracting Portal at http://das.ct.gov, the Department’s website at http://www.ct.gov/dmhas or from the Department’s Official Contact: Name: Amy Lopez Address: 410 Capitol Avenue / PO Box 341431 / Hartford, CT 06134 Phone: 860 418-6927 Fax: 860 418-6698 E-Mail: [email protected]A printed copy of the RFP can be obtained from the Official Contact upon request. Deadline for submission of proposals is: 3:00 PM, November 29, 2017
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STATE OF CONNECTICUT
Department of Mental Health & Addiction Services Page 1 of 42
PROCUREMENT NOTICE
State of Connecticut
Department of Mental Health and Addiction Services
REQUEST FOR PROPOSALS (RFP)
RFP #DMHAS-EQMI-RBHAO-2017
Legal Notice
Regional Behavioral Health Action Organizations
The State of Connecticut, Department of Mental Health and Addiction Services (DMHAS) is seeking proposals from
qualified private non-profit applicants capable of providing strategic behavioral health planning across an
individual’s lifespan regarding the treatment, prevention, and recovery continuum of care. Respondents will be
expected to address substance use, problem gambling, and mental health promotion through training and
education on the regional and sub-regional level. This organization is designed to consolidate and replace the
primary services currently being offered through the Regional Mental Health Boards (RMHB’s) and the Regional
Action Councils (RAC’s) by creating combined behavioral health action organizations which perform the statutory
functions of RMHBs and RACs. Regional Behavioral Health Action Organizations (RBHAO’s) are strategic community
partners who will work across the behavioral healthcare continuum. Their role is service assessment, development,
and coordination and should not be the provision of direct services to clients. Each RBHAO will be responsible for a
range of planning, education, and advocacy services within one of DMHAS’ Uniform Regions. Applicants must be
capable of providing the primary functions currently provided by the RMHB’s and the RAC’s including local and
regional assessment of the behavioral health needs of children and adults, strategic planning, development of an
annual action plan, participation on the State Planning Council and the State Advisory Board, awareness and
education for the general public regarding substance use prevention, problem gambling prevention, and mental
health promotion and wellness.
The RBHAO will also be responsible for administering grants that are allocated to Local Prevention Councils (LPC’s).
The RBHAO will provide oversight and direction to local communities regarding the implementation of these funds.
In addition, each RBHAO will assume oversight of Problem Gambling Awareness funding that is currently allocated
to RACs across the state. That funding is focused on building the capacity of local communities to increase
awareness to address and reduce the impact of problem gambling on individuals and families. It is expected that
the RBHAO will serve as the bridge to local and statewide prevention and advocacy activities. The RBHAO will work
closely with DMHAS’ Prevention and Health Promotion Unit and DMHAS’ Problem Gambling Services in order to
integrate and coordinate prevention activities within a region and sub-region. The RBHAO will also be responsible
for linking to other Connecticut prevention and advocacy organizations like Connecticut Clearinghouse, Governor’s
Prevention Partnership, National Alliance on Mental Illness, Advocacy Unlimited, and Connecticut Community for
Addiction Recovery.
The successful bidder will be required to begin delivering services by January 1, 2018.
The Request for Proposals is available in electronic format on the State Contracting Portal at http://das.ct.gov, the
Department’s website at http://www.ct.gov/dmhas or from the Department’s Official Contact:
Region 2: serving the communities of Ansonia, Bethany, Branford, Chester, Clinton, Cromwell, Deep River, Derby, Durham, East Haddam, East Hampton, East Haven, Essex, Guilford, Haddam, Hamden, Killingworth, Lyme, Madison, Meriden, Middlefield, Middletown, Milford, New Haven, North Branford, North
SECTION III. PROGRAM INFORMATION
Department of Mental Health & Addiction Services Page 17 of 42
Haven, Old Lyme, Old Saybrook, Orange, Portland, Seymour, Shelton, Wallingford, Westbrook, West Haven, Woodbridge.
Region 3: serving the communities of Ashford, Bozrah, Brooklyn, Canterbury, Chaplin, Colchester, Columbia,
Region 4: serving the communities of Andover, Avon, Berlin, Bloomfield, Bolton, Bristol, Burlington, Canton,
East Granby, East Hartford, East Windsor, Ellington, Enfield, Farmington, Glastonbury, Granby, Hartford, Hebron, Manchester, Marlborough, New Britain, Newington, Plainville, Plymouth, Rocky Hill, Simsbury, Somers, South Windsor, Southington, Stafford, Suffield, Tolland, Vernon, West Hartford, Wethersfield, Windsor, Windsor Locks.
Region 5: serving the communities of Barkhamsted, Beacon Falls, Bethel, Bethlehem, Bridgewater, Brookfield, Canaan, Cheshire, Colebrook, Cornwall, Danbury, Goshen, Hartland, Harwinton, Kent, Litchfield, Middlebury, Morris, Naugatuck, New Fairfield, New Hartford, New Milford, Newtown, Norfolk, North Canaan, Oxford, Prospect, Redding, Ridgefield, Roxbury, Salisbury, Sharon, Sherman, Southbury, Thomaston, Torrington, Warren, Washington, Waterbury, Watertown, Winchester, Wolcott, and Woodbury.
Successful bidders must be capable of providing the full spectrum of services included in this RFP which
includes:
1. Regional and Sub-Regional Strategic Planning and Coordination: providing DMHAS with information regarding the behavioral health needs of children, adolescents, and adults in the region and sub-region. a. The RBHAO will conduct community needs assessments through formal and informal mechanisms on
the local level. The needs assessments will be utilized to identify service gaps and to inform Annual Regional Strategic Plans.
b. The RBHAO will establish and implement an Annual Regional Strategic Plan that will develop and coordinate needed substance abuse prevention and mental health promotion services in the region or sub region. This plan will link priorities to local and regional initiatives and is to be submitted to the Commissioner annually (in July of each year).
c. The RBHAO will coordinate prevention, treatment, and recovery activities in the region and sub region
by networking with regional stakeholders in order to implement activities that are consistent with the Annual Regional Strategic Plan.
2. Performing Advisory Functions: This requires convening and staffing Regional and Sub Regional Behavioral Health Advisory Boards which would meet minimally 4 times per year. As part of these services, RBHAO’s would represent local and regional needs by participation in the State Behavioral Health Advisory Board and the State Behavioral Health Planning Council. The RBHAO may review Block Grant Applications, provide priority setting recommendations to the Commissioner, and would review funding applications and requests for proposal.
3. Administration of Local Prevention Council (LPC) Funding: The RBHAO will be responsible for administering LPC funding that is allocated by DMHAS to communities in order to support local prevention activities. This service includes assisting LPC’s in developing and reviewing funding applications, contracting with LPC’s, distributing of funds allocated to the LPC’s by the Department, and the development of a reporting process to annually ensure that LPC Program activities are met. The Local Prevention Council funding is shown by town and region in Attachment 1.
4. Problem Gambling Awareness Services: The RBHAO will be responsible for continuing problem gambling
awareness and prevention activities that are currently being delivered by RAC’s in each region. These activities include increasing public awareness about gambling and resources available to address problem gambling. The RBHAO will assist in building the capacity of local communities to increase awareness to address and reduce the impact of problem gambling on individuals and families. Certain regions have specialized funding for problem gambling and these are further described in Attachment 2.
5. Awareness and Advocacy: The RBHAO will raise awareness and provide advocacy to the general public
related to substance abuse prevention and mental health promotion. These services would be directed at preventing issues like suicide, problem gambling, underage drinking, tobacco and other drug (ATOD) abuse and misuse and promoting positive mental health. Distinct activities in this area will be shaped by the Annual Regional Strategic Plan and the current community behavioral health needs identified within the Plan.
SECTION III. PROGRAM INFORMATION
Page 18 of 42 Department of Mental Health & Addiction Services
6. Fundraising – The RBHAO will seek to raise additional funds that can be used to promote issues of
importance in prevention, treatment, and recovery within the Region.
It is expected that the RBHAO will serve as a bridge to local and statewide prevention and advocacy
activities. The RBHAO will work closely with DMHAS’ Prevention and Health Promotion Unit and DMHAS’
Problem Gambling Services in order to integrate and coordinate prevention activities. These services
should incorporate a wide variety of local community resources, including family, friends, faith
communities, and many others.
The primary role of the RBHAO is planning, development and coordination. To that end, they will be
prohibited from providing direct client services. This is so as not to compromise services and compete with
existing service providers.
C. MAIN PROPOSAL COMPONENTS
It is expected that proposals will demonstrate the applicant’s thorough knowledge of the needs of the target population to be served as well as the applicant’s related Connecticut experience in providing the services described in this proposal. All proposals must include the following:
1. Executive Summary. All proposals must include an Executive Summary. The Executive Summary should
not exceed 1 page in length and should summarize the program being proposed, to include total annual
cost, proposed service Region and location of proposed services.
2. Organizational Profile.
(a) Purpose / Mission / Philosophy: Briefly describe the purpose, mission and philosophy of the agency
and the proposed program. This section should also describe how your program or agency will adhere
to applicable state and federal laws, regulations and policies governing provision of behavioral health
prevention and advisory services. Describe how the site/sites will be managed and how ancillary
supports like Information Technology and Administrative Support fit into that management structure.
(b) Entity Type / Years of Operation: Provide a brief history of the agency. Applicants must be registered
to do business in the State of Connecticut through the Office of the Secretary of the State and must
also be a registered private, non-profit 501(c)3 and must provide proof of both in Section G of their
proposal. Additionally, the agency organizational structure should be summarized with a Table of
Organization provided in Section G of the proposal. Please submit an organizational chart that depicts
the total organizational structure and where distinct programs would reside within that structure.
(c) Service Locations: Provide the location of the applicant’s administrative offices, and any sub-regional
offices that may be used in order to meet the service requirements of this RFP.
Does your agency currently control the site? If no, provide details of how and when the site will
be available.
Is the site fully compliant with ADA standards? If no, describe the degree to which the site is ADA
compliant.
Does the program site share space with any other program, agency, business, residence, etc.?
Proposers are not required to obtain possession of physical space prior to submission of a proposal,
although preference will be given to proposals indicating possession of space. The Department will
require retention of space for all programs, in accordance with local regulations, prior to contract
execution.
If space is not secured at the time of proposal submission, the proposer must affirm that both will be
obtained by December 1, 2017. The Department reserves the right to terminate any negotiations or
subsequent contracts if the proposer fails to adequate space. Furthermore, the Department reserves
the right to deem a proposed site as unsuitable for the operation of RBHAO.
SECTION III. PROGRAM INFORMATION
Department of Mental Health & Addiction Services Page 19 of 42
(d) Qualifications / Certification / Licensure: Describe your agency’s qualifications and interest in
providing the kinds of services being requested through this RFP. Describe your agency’s experience
providing planning, advisory, prevention, and health promotion services within the state of
Connecticut. Describe your agency’s experience working with a broad range of stakeholders including
consumers, family members, advocates, behavioral health treatment providers, prevention programs
and local government officials.
(e) References: If your organization does not currently or has not in the past 3 years provided contracted
services to the Department, at least two reference letters must be included in Section H of the
proposal to support the description of your experience in providing these services. Letters must
include agency name, contact name, mailing address, phone number and email address of the writer.
Letters must also include the nature of the writer’s relationship with the proposer and the extent of
the proposer’s provision of services to the writer. This is NOT a Letter of Support. The writer must be
able to detail a prior relationship of services provided by the proposing agency.
3. Service Requirements. This section of the proposal must describe in detail how your agency will provide
each of the services described in Section B (Program Overview) above, including how such service
provision will meet the requirements for each discrete service component. The proposal should describe
how you will integrate mental health and substance abuse activities into a singular organization. The
proposal must address mechanisms that will be used to gather local community input regarding the
behavioral health needs of individuals across the lifespan within a given region.
4. Program Requirements. Services implemented through this RFP must build upon and complement the
Department’s focus on development of a comprehensive recovery-oriented system of care that is
responsive to the needs of each person served. This system of care includes prevention, treatment, and
recovery services and draws upon the program requirements listed below as a foundation for service
delivery. All applicants must specify how they will address or incorporate the following system
expectations into the RBHAO’s services. These requirements speak to core values within the DMHAS
system. Where listed, please refer to the websites for guidance regarding implementation of these
expectations:
(a) Cultural Competence. See Commissioner’s Policy Statement #76: Policy on Cultural Competence: http://www.ct.gov/dmhas/lib/dmhas/policies/Chapter6.21.pdf
Research and experience have shown that culture and society play pivotal roles in behavioral health, behavioral disorders, and the utilization and effectiveness of treatment services. Understanding the wide-ranging roles of culture and society enables the behavioral health field to design and deliver services that are more responsive to the needs of diverse racial and cultural groups. Currently, the DMHAS system serves many different populations and recognizes the significance of culture as a factor that affects individual outcomes. In the coming decades, as Connecticut’s demography continues to change, it will become increasingly important that we strengthen the cultural competence of our service system. In order to address this issue in the present RFP, the applicant must demonstrate an understanding of the demographic, racial, ethnic, socioeconomic, and religious
characteristics of the population in its targeted service area. (b) Family and Significant Other Participation. See Commissioner’s Policy Statement #71 on Family
DMHAS believes the recovery process can be promoted by drawing upon an individual’s natural support system which can include an individual’s family members, friends, and others. Family involvement can be a positive recovery support and contributor to improved treatment outcomes, successful employment, continued education, and stable housing.
(c) Recovery-Oriented Service System. See Commissioner’s Policy Statement #83 Promoting a Recovery-
Oriented Service System: http://www.ct.gov/dmhas/lib/dmhas/policies/chapter6.14.pdf
The purpose of this policy is to formally designate the concept of “recovery” as the overarching goal of the service system operated and funded by DMHAS. This action is consistent with the fact that DMHAS is a healthcare service agency. Thus, it is most appropriate that one should hope and expect
Page 20 of 42 Department of Mental Health & Addiction Services
that, as a result of active involvement with this healthcare system, individuals will be better able to manage their illness and improve the quality of their life.
(d) Co-occurring Capability. See Commissioner’s Policy Statement #84:
The single overarching goal of DMHAS, as a healthcare service agency, is promoting and achieving a quality-focused, culturally responsive, and recovery-oriented system of care. The attainment of this goal is possible only if the service system design, delivery, and evaluation are fully responsive to people with co-occurring mental health and substance use disorders. Given the high prevalence of co-occurring disorders, the high number of critical incidents involving individuals with these conditions, and the often poor outcomes associated with co-occurring disorders in the absence of integrated care, it is extremely important that we collectively improve our system in this area.
(e) Employment and Education. See Commissioner’s Policy Statement # 73 on Accessibility to Services:
DMHAS recognizes that gainful employment is essential for most people’s well-being. Employment makes recovery from, and dealing with, psychiatric and/or addiction disorders easier and increases self-esteem and satisfaction with one’s daily life. The DMHAS providers at all levels will communicate this belief that people with behavioral health disorders can, and should be, productive members of society.
(f) Gender Responsive Care. DMHAS’ initiative for Gender Responsive Care is designed to enhance our
current behavioral health service system for women in a way that is trauma-informed, gender-specific, and promotes self-determination. A best practice system of care for women, supported by system-level policies and standards and program-level practices is currently under development. The goal is to improve treatment outcomes and the quality of services for women receiving substance abuse treatment in Connecticut through participation in a recovery-oriented treatment system of care that incorporates current best practices in gender responsive and trauma-informed programming.
(g) Trauma Informed Care. See Commissioner’s Policy Statement on Trauma Informed Care:
The primary goal of DMHAS’ Trauma Informed Care initiative is to deliver behavioral health care that is sensitive and responsive to the needs of men and women who have experienced trauma. Trauma services are being developed based on the guiding principle that treatment must be informed by a sound scientific, clinical, culturally relevant, and humanistic understanding of the impact and impairment caused by traumatic stress.
(h) Person-Centered Care. See CT Implementation of Person-Centered Care:
Commissioner’s Policy Statement #83 formally designates the concept of “recovery” as the overarching goal of the service system operated and funded by DMHAS. DMHAS’ mission to provide recovery-oriented care requires that services be maximally responsive to each individual’s unique needs, values, and preferences. Emphasis on person-centered care is consistent with major advances
that have already occurred throughout the DMHAS system, e.g., greater collaboration with advocacy and recovery groups and increased recognition of, and funding for, peer-based services.
(i) DMHAS’ Recovery Practice Guidelines. See Practice Guidelines for Recovery-Oriented Behavioral Health Care: http://www.ct.gov/dmhas/lib/dmhas/publications/practiceguidelines.pdf
Wherever possible, programs must be guided by innovative, recovery-oriented, community-focused practice principles and guidelines, such as those outlined in the DMHAS’ Practice Guidelines for Recovery-Oriented Behavioral Health Care. DMHAS’ Guidelines emphasize the following principles: Participation, Promoting Access and Engagement, Continuity of Care, Strengths-Based Assessment, Individualized Recovery Planning, Functioning as a Recovery Guide, Community Mapping, Development, and Inclusion, and Identifying and Addressing Barriers to Recovery.
(j) Citizenship. Citizenship builds on DMHAS’ Recovery vision by fostering full citizenship among the
people served. An important component of this vision requires providers to cultivate partnerships with local communities in all spheres of civic life (e.g., housing, employment, education, socialization, recreation, spirituality, etc.). In some cases, this will involve building on and expanding current partnerships; in others it will involve creating new ones. Citizenship assists program participants to: understand and exercise rights, identify ways to fulfill goals and responsibilities, enhance their roles
Department of Mental Health & Addiction Services Page 21 of 42
as valued members of their communities, enhance their knowledge and access of community
resources, and enhance their ability to develop supportive relationships and networks. (k) Integration of Primary Health and Wellness. Persons with serious mental illness have a life expectancy
that is 25 years less than the general population. Integration of and/or linkages between behavioral and primary health and wellness approaches must be addressed to improve health and quality of life and to enhance life expectancy for individuals served throughout the DMHAS service system.
5. Staffing Requirements. Applicants must include a proposed staffing plan that will permit the
organization to perform the services required in this facility. Proposers must describe the staff categories
used to perform these duties including the extent to which they have the appropriate training, experience
and credentialing to perform assigned duties and the extent to which staff will be multi-lingual and multi-
cultural. Brief job descriptions, minimum qualifications, hours per week and hourly wages must be
provided for all staff categories assigned to this project. Please do not include resumés.
(a) Staffing Levels. It is the Department’s expectation that each RBHAO will meet the minimum staffing
levels specified below. Applicants may propose use of multiple persons to comprise an FTE, but the
Department reserves the right to require a 1 person to 1 FTE ratio at its discretion,
i. A full-time Executive Director/Chief Executive Officer who oversees all aspects of the RBHAO
operations. The Executive Director will minimally have prior experience directing, prevention,
treatment, or advocacy services. The Executive Director will also have knowledge of and/or prior
experience with budget management and fundraising, community organizing and epidemiology as
it relates to behavioral health;
ii. Mental Health Advisory Staff: one advisory staff to perform day-to-day functions of the RBHAO
related to mental health promotion. These staff will link to local communities and implement the
mental health activities specified under the RBHAO plan. Staff must have prior experience with
mental health prevention, treatment, and advocacy services;
iii. Substance Use Advisory Staff: one advisory staff to perform day-to-day functions of the RBHAO
related to substance use prevention. These staff will link to local communities and implement the
substance use activities specified under the RBHAO plan. Staff must have prior experience with
substance use prevention, treatment, and advocacy services;
iv. A part-time Program/Administrative Assistant who is responsible for organizing and coordinating
RBHAO meetings, providing receptionist activities, including triaging calls and coordinating
communication within the team and between the team and consumers; and
v. Staff with sufficient qualifications and experience to perform the Problem Gambling activities and
LPC fund administration activities described herein.
(b) Staff Training and Supervision. The RBHAO must have a written policy for supervision of all staff. This
supervision and direction shall consist of:
i. Participation with team members in organizational staff meetings;
ii. Regular meetings with individual staff to review their work, assess performance, and offer
feedback;
iii. Regular reviews, critiques, and feedback regarding staff performance; and
iv. Documentation of staff participation in training events.
6. Data and Technology Requirements. Proposers must demonstrate sufficient capacity to collect and
manage Department-required data. The Department expects the following:
(a) The RBHAO will have processes in place that utilize data to monitor and inform program management
and improvement;
(b) Applicants will have sufficient capacity to collect and manage DMHAS required data related to
community needs assessment and annual strategic plans;
(c) Proposals must describe how your agency has met these reporting requirements in the past. If this
would be a new reporting requirement, please describe how you will meet these reporting
requirements; and
(d) Applicants and the proposed program have the capability to access the internet, send/receive outside
email and view PDF documents.
SECTION III. PROGRAM INFORMATION
Page 22 of 42 Department of Mental Health & Addiction Services
7. Sub-Contractors/Partners. Proposals must disclose the proposed use of subcontractors to accomplish
program services. If the proposal includes the use of subcontractors, the relationship of the subcontractor
to the applicant, a detailed description of the services to be provided by the subcontractor, the staffing to
be allocated by the subcontractor and the costs of utilizing a subcontractor must be delineated in the
proposal.
It is the Department’s expectation that service provision required under this RFP be primarily provided by
the applicant. Applicants would enter into sub-contractor arrangements with Local Prevention Councils
since oversight and administration of LPC funds is a core service of this RFP.
If the applicant has partnered with an existing RMHB or RAC to consolidate services, this section of the
proposal must identify the partnering agencies and describe the relationship of the partnership to include
which agency will be the surviving entity.
8. Work Plan. Proposals must include a detailed implementation process and timeline, including the
identification of all necessary steps to operationalizing the RBHAO, target dates and individuals
responsible. It is the Department’s expectation that applicants will create and include in their proposals,
the following:
(a) A time line describing the start-up process to obtain and remodel (if necessary) the physical
setting/structure for the RBHAO;
(b) A time line describing the startup process to hire, orient, and train staff;
(c) An estimated date by which the transition process from current RAC’s and RMHB’s will begin and
specify start dates for each program service if start-up will be staggered; and
(d) An estimated date by which the LPC contracts will be transitioned;
(e) An estimated date by which the RBHAO will be fully operational.
The ability to start up a viable program in a short time frame will receive higher consideration in the
evaluation process.
D. COST PROPOSAL COMPONENT
1. Financial Requirements
Any applicant agency that does not hold a current contract with the Department, must submit cover
letters from their auditor for the last 3 annual audits of their agency and a copy of their most recent
financial audit, included in Section H of the proposal. If less than 3 audits were conducted, detail must be
provided as to why, and any supporting documentation assuring the financial efficacy of the applicant
agency should be included (i.e. an accountant prepared financial statement, a tax return, etc.).
If the 3 most recent audits are available via the Office of Policy and Management’s EARS system, such
may be noted in the proposal, and a hardcopy of the audit cover letters and/or audit need not be
provided.
2. Budget Requirements
The Department has developed a cost model for the RBHAO using budget information contained in the
Governor’s Executive Order/Budget combined with additional funding that is currently provided to RAC’s
and RMHB’s for federal discretionary grants or for Local Prevention Councils. Based on this analysis, the
Department has determined that a RBHAO cost will vary based on the funding streams described above.
Funding for each RBHAO for SFY 2018 and 2019 is expected to be as follows:
SECTION III. PROGRAM INFORMATION
Department of Mental Health & Addiction Services Page 23 of 42
Total SFY18 Funding Available: Region Base Gambling LPC Total
1 $115,302 $18,500 $0 $133,802
2 $115,302 $35,000 $0 $150,302
3 $115,302 $18,500 $0 $133,802
4 $115,302 $28,500 $0 $143,802
5 $115,302 $18,500 $0 $133,802
Total $576,510 $119,000 $0 $695,510
Total SFY 19 Annualized Funding Available: Region Base Gambling LPC Total
1 $230,603 $37,000 $83,704 $351,308
2 $230,603 $70,000 $160,290 $460,894
3 $230,603 $37,000 $131,355 $398,959
4 $230,603 $57,000 $175,653 $463,256
5 $230,603 $37,000 $151,008 $418,611
Total $1,153,015 $238,000 $702,010 $2,093,028
Startup costs for the first year of operation may be proposed, but the Department reserves the right to
negotiate these costs based on available funding. Any proposed startup costs must be clearly identified in
the Budget and cannot be annualized into future year funding.
Proposals must contain an itemized budget for SFY 2018 (partial year) and SFY 2019 completed in a
Uniform Chart of Accounts Budget Workbook, found on the Department’s website. The Budget should be
clear, realistic and appropriate to the program(s) proposed.
A budget narrative must be included, explaining all costs contained in the budget. LPC funds for FY 19 are
pass-through in nature and should not be included in indirect cost calculations when developing the
RBHAO budget for subsequent years.
E. Appendices
1. Proof of CT Business Licensure
2. Table of Organization
3. Letters of Reference
4. Cover Letters from Previous 3 Audits
SECTION IV. PROPOSAL OUTLINE
Page 24 of 42 Department of Mental Health & Addiction Services
This form must be completed and included in Section I of the proposal .
3. Form #3: Acknowledgment of Contract Compliance . . . . . . .
This form must be completed and included in Section I of the proposal.
4. Form #4: Notification To Bidders . . . . . . . . . . .
This form must be completed and included in Section I of the proposal. For more
information on completion of this report, go to www.ct.gov/chro
5. Form #5: Employer Information Report . . . . . . . . .
This form must be completed and included in Section I of the proposal. For more
information on completion of this report, go to www.eeoc.gov
5. Form #6: Cover Sheet . . . . . . . . . . . . .
This form must be completed if the proposal is being submitted for a program
NOT currently under contract with the Department.
I. Attachments
1. List of Local Prevention Council town funding by Region
2. List of Unique Regional Gambling Awareness Activities
Page 26 of 42 Department of Mental Health & Addiction Services
FORM #1
STATE OF CONNECTICUT GIFT AND CAMPAIGN CONTRIBUTION CERTIFICATION
Written or electronic certification to accompany a State contract with a value of $50,000 or more
in a calendar or fiscal year, pursuant to C.G.S. §§ 4-250 and 4-252(c); Governor M. Jodi Rell’s
Executive Orders No. 1, Para. 8, and No. 7C, Para. 10; and C.G.S. §9-612(g)(2)
INSTRUCTIONS:
Complete all sections of the form. Attach additional pages, if necessary, to provide full disclosure about any
lawful campaign contributions made to campaigns of candidates for statewide public office or the General Assembly, as described herein. Sign and date the form, under oath, in the presence of a Commissioner of the Superior Court or Notary Public. Submit the completed form to the awarding State agency at the time of initial contract execution and if there is a change in the information contained in the most recently filed certification, such person shall submit an updated certification either (i) not later than thirty (30) days after the effective date of such change or (ii) upon the submittal of any new bid or proposal for a contract, whichever is earlier. Such person shall also submit an accurate, updated certification not later than fourteen days after the twelve-month anniversary of the most recently filed certification or updated certification. CHECK ONE: Initial Certification 12 Month Anniversary Update (Multi-year contracts only.)
Updated Certification because of change of information contained in the most recently filed certification or twelve-month anniversary update. GIFT CERTIFICATION: As used in this certification, the following terms have the meaning set forth below:
1) “Contract” means that contract between the State of Connecticut (and/or one or more of it agencies or instrumentalities) and the Contractor, attached hereto, or as otherwise described by the awarding State agency below;
2) If this is an Initial Certification, “Execution Date” means the date the Contract is fully executed by, and becomes effective between, the parties; if this is a twelve-month anniversary update, “Execution Date”
means the date this certification is signed by the Contractor; 3) “Contractor” means the person, firm or corporation named as the contactor below; 4) “Applicable Public Official or State Employee” means any public official or state employee described in
C.G.S. §4-252(c)(1)(i) or (ii); 5) “Gift” has the same meaning given that term in C.G.S. § 4-250(1); 6) “Principals or Key Personnel” means and refers to those principals and key personnel of the Contractor,
and its or their agents, as described in C.G.S. §§ 4-250(5) and 4-252(c)(1)(B) and (C). I, the undersigned, am a Principal or Key Personnel of the person, firm or corporation authorized to execute this certification on behalf of the Contractor. I hereby certify that, no gifts were made by (A) such person, firm, corporation, (B) any principals and key personnel of the person firm or corporation who participate
substantially in preparing bids, proposals or negotiating state contracts or (C) any agent of such, firm, corporation, or principals or key personnel who participates substantially in preparing bids, proposals or negotiating state contracts, to (i) any public official or state employee of the state agency or quasi-public agency soliciting bids or proposals for state contracts who participates substantially in the preparation of bid solicitations or request for proposals for state contracts or the negotiation or award of state contracts or (ii) any public official or state employee of any other state agency, who has supervisory or appointing authority over such state agency or quasi-public agency. I further certify that no Principals or Key Personnel know of any action by the Contractor to circumvent (or which would result in the circumvention of) the above certification regarding Gifts by providing for any other Principals, Key Personnel, officials, or employees of the Contractor, or its or their agents, to make a Gift to
any Applicable Public Official or State Employee. I further certify that the Contractor made the bid or proposal for the Contract without fraud or collusion with any person. CAMPAIGN CONTRIBUTION CERTIFICATION:
SECTION IV. PROPOSAL OUTLINE
Department of Mental Health & Addiction Services Page 27 of 42
I further certify that, on or after December 31, 2006, neither the Contractor nor any of its principals, as defined in C.G.S. § 9-612(g)(1), has made any campaign contributions to, or solicited any contributions on behalf of, any exploratory committee, candidate committee, political committee, or party committee established by, or supporting or authorized to support, any candidate for statewide public office, in violation of C.G.S. § 9-612(g)(2)(A). I further certify that all lawful campaign contributions that have been made on or after December 31, 2006 by the Contractor or any of its principals, as defined in C.G.S. § 9-612(g)(1), to, or solicited on behalf of, any exploratory committee, candidate committee, political committee, or party committee established by, or supporting or authorized to support any candidates for statewide public office or the General Assembly, are listed below:
Lawful Campaign Contributions to Candidates for Statewide Public Office: Contribution Date Name of Contributor Recipient Value Description
Sworn as true to the best of my knowledge and belief, subject to the penalties of false statement. __________________________________ _________________________________________ Printed Contractor Name Printed Name of Authorized Official
___________________________________ Signature of Authorized Official Subscribed and acknowledged before me this ______ day of __________________, 20___.
___________________________________________ Commissioner of the Superior Court (or Notary Public)
Page 28 of 42 Department of Mental Health & Addiction Services
FORM #2
STATE OF CONNECTICUT CONSULTING AGREEMENT AFFIDAVIT
Affidavit to accompany a bid or proposal for the purchase of goods and services with a value of $50,000 or
more in a calendar or fiscal year, pursuant to Connecticut General Statutes §§ 4a-81(a) and 4a-81(b). For
sole source or no bid contracts the form is submitted at time of contract execution. INSTRUCTIONS:
If the bidder or vendor has entered into a consulting agreement, as defined by Connecticut General Statutes § 4a-81(b)(1): Complete all sections of the form. If the bidder or contractor has entered into more than one such consulting agreement, use a separate form for each agreement. Sign and date the form in the presence of a Commissioner of the Superior Court or Notary Public. If the bidder or contractor has not entered into a consulting agreement, as defined by Connecticut General
Statutes § 4a-81(b)(1): Complete only the shaded section of the form. Sign and date the form in the presence of a Commissioner of the Superior Court or Notary Public. Submit completed form to the awarding State agency with bid or proposal. For a sole source award, submit completed form to the awarding State agency at the time of contract execution. This affidavit must be amended if there is any change in the information contained in the most recently filed affidavit not later than (i) thirty days after the effective date of any such change or (ii) upon the submittal of any new bid or proposal, whichever is earlier. AFFIDAVIT: [Number of Affidavits Sworn and Subscribed On This Day: _____]
I, the undersigned, hereby swear that I am a principal or key personnel of the bidder or contractor awarded a contract, as described in Connecticut General Statutes § 4a-81(b), or that I am the individual awarded such a contract who is authorized to execute such contract. I further swear that I have not entered into any consulting agreement in connection with such contract, except for the agreement listed below: __________________________________________ _______________________________________ Consultant’s Name and Title Name of Firm (if applicable) __________________ ___________________ ___________________ Start Date End Date Cost
Description of Services Provided: ___________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Is the consultant a former State employee or former public official? YES NO
If YES: ___________________________________ __________________________ Name of Former State Agency Termination Date of Employment Sworn as true to the best of my knowledge and belief, subject to the penalties of false statement.
___________________________ ___________________________________ __________________ Printed Name of Bidder or Contractor Signature of Principal or Key Personnel Date ___________________________________ ___________________ Printed Name (of above) Awarding State Agency
Sworn and subscribed before me on this _______ day of ____________, 20___.
___________________________________ Commissioner of the Superior Court or Notary Public
SECTION IV. PROPOSAL OUTLINE
Department of Mental Health & Addiction Services Page 29 of 42
FORM #3
Acknowledgement of Contract Compliance
Notification to Bidders
The contract to be awarded is subject to contract compliance requirements mandated by Section 4-114a of
the Connecticut General Statutes: and when the guarding agency is the state, Section 46a-71(d) of the
Connecticut General Statutes. There are Contract Compliance Regulations codified at Section 4-11a-1 et
seq. of the regulations of Connecticut State Agencies which establish a procedure for the awarding of all
contracts covered by Sections 4-114a and 46a-71(d) of the Connecticut General Statutes.
According to Section 4-114a-3(9) of the Contract Compliance regulations, every agency awarding a
contract subject to the contract compliance requirements has an obligation to “aggressively solicit the
participation of legitimate minority business enterprises as bidders, contractors, subcontractors and
suppliers of materials.” “Minority business enterprise” is defined in Section 4-114a of the Connecticut
General Statutes as a business wherein fifty-one percent or more of the capital stock, or assets, belong to a
person or persons: “(1) Who are active in the daily affairs of the enterprise; (2) who have the power to
direct the management and policies of the enterprises; and (3) who are members of a minority, as such
term is defined in sub-section (a) of Section 32-9n.” “Minority” groups are defined in Section 32-9n of
the Connecticut General Statutes as “ (1) Black Americans...(2) Hispanic American...(3) Women...(4)
Asian Pacific Americans and Pacific Islanders; or (5) American Indians...” The above definitions apply
to the contract compliance requirement virtue of Section 4-114a-1 (10) of the Contract Compliance
Regulations.
The awarding agency will consider the following factors when reviewing the Proposer’s qualifications
under the contract compliance requirements:
(a) the proposer’s success in implementing an affirmative action plan;
(b) the proposer’s success in developing an apprenticeship program complying with Sections
46a-68-17 of the Connecticut General Statutes, inclusive;
(c) the proposer’s promise to develop and implement a successful affirmative action plan;
(d) the proposer’s submission of EEO-1 data indicating that the composition of its work
force is at or near parity when compared to the racial and sexual composition of the work
force in the relevant labor market area; and
(e) the proposer’s promise to set aside a portion of the contract for legitimate minority
business enterprises. See Section 4-11a-3(10) of the Contract Compliance Regulations.
* INSTRUCTIONS Proposer must sign acknowledgment below, and return acknowledgment to
awarding agency along with signed proposal.
The undersigned acknowledges receiving and reading a copy of the “Notification to Bidders” form.
Signature Date
Page 30 of 42 Department of Mental Health & Addiction Services
FORM #4
BIDDER CONTRACT COMPLIANCE MONITORING REPORT
PART I - Bidder Information
(Page 1)
Company Name Saint Francis Hospital & Medical Center
Street Address 114 Woodland Street
City & State Hartford, CT 06106
Chief Executive John Giamalis, Senior VP and CFO
Bidder Federal Employer
Identification Number_060646813_
Or
Social Security Number
Major Business Activity (brief description)
Bidder Identification
(response optional/definitions on page 1)
-Bidder is a small contractor. Yes No
-Bidder is a minority business enterprise Yes No
(If yes, check ownership category)
Black Hispanic Asian American American Indian/Alaskan
Native Iberian Peninsula Individual(s) with a Physical Disability
Female
- Bidder is certified as above by State of CT Yes No
- DAS Certification Number
Bidder Parent Company (If any)
Other Locations in Ct. (If any)
PART II - Bidder Nondiscrimination Policies and Procedures
1. Does your company have a written Affirmative Action/Equal Employment
Opportunity statement posted on company bulletin boards?
Yes No
7. Do all of your company contracts and purchase orders contain non-discrim-
ination statements as required by Sections 4a-60 & 4a-60a Conn. Gen. Stat.?
Yes No
2. Does your company have the state-mandated sexual harassment prevention in the
workplace policy posted on company bulletin boards?
Yes No
8. Do you, upon request, provide reasonable accommodation to employees, or
applicants for employment, who have physical or mental disability?
Yes No
3. Do you notify all recruitment sources in writing of your company’s Affirmative
9. Does your company have a mandatory retirement age for all employees?
Yes No
4. Do your company advertisements contain a written statement that you are an
Affirmative Action/Equal Opportunity Employer? Yes No
10. If your company has 50 or more employees, have you provided at least two (2)
hours of sexual harassment training to all of your supervisors?
Yes No NA
5. Do you notify the Ct. State Employment Service of all employment
openings with your company? Yes No
11. If your company has apprenticeship programs, do they meet the Affirmative
Action/Equal Employment Opportunity requirements of the apprenticeship standards
of the Ct. Dept. of Labor? Yes No NA
6. Does your company have a collective bargaining agreement with workers?
Yes No
6a. If yes, do the collective bargaining agreements contain non-discrim-
ination clauses covering all workers? Yes No
6b. Have you notified each union in writing of your commitments under the
nondiscrimination requirements of contracts with the state of Ct?
Yes No
12. Does your company have a written affirmative action Plan? Yes No
If no, please explain.
13. Is there a person in your company who is responsible for equal
employment opportunity? Yes No
If yes, give name and phone number.
Part III - Bidder Subcontracting Practices
SECTION IV. PROPOSAL OUTLINE
Department of Mental Health & Addiction Services Page 31 of 42
1. Will the work of this contract include subcontractors or suppliers? Yes No
1a. If yes, please list all subcontractors and suppliers and report if they are a small contractor and/or a minority business enterprise. (defined on page 1 / use
additional sheet if necessary)
1b. Will the work of this contract require additional subcontractors or suppliers other than those identified in 1a. above? Yes No
PART IV - Bidder Employment Information Date:
JOB CATEGORY
OVERALL TOTALS
WHITE (not of Hispanic
origin)
BLACK (not of Hispanic
origin)
HISPANIC
ASIAN or PACIFIC ISLANDER
AMERICAN INDIAN or ALASKAN NATIVE
Male
Female
Male
Female
Male
Female
Male
Female
male
female
Management
Business & Financial Ops
Computer Specialists
Architecture/Engineering
Office & Admin Support
Bldg/ Grounds Cleaning/Maintenance
Construction & Extraction
Installation , Maintenance
& Repair
Material Moving Workers
TOTALS ABOVE
Total One Year Ago
FORMAL ON THE JOB TRAINEES (ENTER FIGURES FOR THE SAME CATEGORIES AS ARE SHOWN ABOVE)
Apprentices
Trainees
PART V - Bidder Hiring and Recruitment Practices
1. Which of the following recruitment sources are used by you? (Check yes or no, and report percent used)
2. Check (X) any of the below listed requirements that you use as a hiring qualification
(X)
3. Describe below any other practices or actions that you take which
show that you hire, train, and promote employees without discrimination
SOURCE
YES
NO
% of applicants provided by source
State Employment Service
Work Experience
Private Employment
Agencies
Ability to Speak or
Write English
Schools and Colleges
Written Tests
Newspaper Advertisement
High School Diploma
Page 32 of 42 Department of Mental Health & Addiction Services
Walk Ins
College Degree
Present Employees
Union Membership
Labor Organizations
Personal
Recommendation
Minority/Community
Organizations
Height or Weight
Others (please identify)
Car Ownership
Arrest Record
Wage Garnishments
Certification (Read this form and check your statements on it CAREFULLY before signing). I certify that the statements made by me on this BIDDER CONTRACT COMPLIANCE MONITORING REPORT are complete and true to the best of my knowledge and belief, and are made in good faith. I understand that if I knowingly make any misstatements of facts, I am subject to be declared in non- compliance with Section 4a-60, 4a-60a, and related sections of the CONN. GEN. STAT.
(Signature)
(Title)
(Date Signed)
(Telephone)
SECTION IV. PROPOSAL OUTLINE
Department of Mental Health & Addiction Services Page 33 of 42
FORM #5
Page 34 of 42 Department of Mental Health & Addiction Services
SECTION IV. PROPOSAL OUTLINE
Department of Mental Health & Addiction Services Page 35 of 42
REQUEST FOR PROPOSAL RFP # DMHAS-EQMI-RBHAO-2017
Department of Mental Health & Addiction Services September 2017
FORM #6: Proposal Cover Sheet Applicant Agency FEIN
Address
City/Town State Zip Code Agency Contact: Title: Telephone Number Fax Number E-Mail Address Total Annual Program Cost Total Annual Cost to DMHAS (not including startup) (not including startup)
Requested Startup Costs Proposed Program Address:
Applicant Agency Fiscal Year: to (month) (month)
Is your agency a non-profit? Yes No Is your agency incorporated? Yes No Is your agency registered as a: Minority Business Enterprise? Yes No Women Business Enterprise? Yes No Small Business Enterprise? Yes No I certify that to the best of my knowledge and belief, the information contained in this application is true and correct. The application has been duly authorized by the governing body of the applicant, the applicant has the legal authority to apply for this funding, the applicant will comply with applicable state and federal laws and regulations, and that I am a duly authorized signatory for the applicant. Signature of Authorizing Official Date Typed Name and Title
SECTION V. ATTACHMENTS
Page 36 of 42 Department of Mental Health & Addiction Services
Attachment #1 (LPC Funding by Region)
Town Region
FY19 New Award
Amount
Bridgeport 1 $10,414.79
Darien 1 $4,176.04
Easton 1 $2,891.59
Fairfield 1 $7,181.52
Greenwich 1 $7,181.52
Monroe 1 $4,176.04
New Canaan 1 $4,176.04
Norwalk 1 $9,022.77
Stamford 1 $9,022.77
Stratford 1 $7,181.52
Trumbull 1 $5,694.60
Weston 1 $3,037.12
Westport 1 $5,371.90
Wilton 1 $4,176.04
Subtotal:
$83,704.26
Ansonia 2 $4,176.04
Bethany 2 $2,891.59
Branford 2 $5,371.90
Chester 2 $2,277.84
Clinton 2 $3,929.27
Cromwell 2 $3,929.27
Deep River 2 $2,891.59
Derby 2 $3,929.27
Durham 2 $2,891.59
East Haddam 2 $3,037.12
East Hampton 2 $3,929.27
East Haven 2 $5,371.90
Essex 2 $2,891.59
Guilford 2 $5,371.90
Haddam 2 $3,037.12
Lyme 2 $2,277.84
Hamden 2 $7,181.52
Killingworth 2 $2,891.59
Madison 2 $4,176.04
Meriden 2 $7,181.52
Middlefield 2 $2,277.84
Middletown 2 $7,181.52
SECTION V. ATTACHMENTS
Department of Mental Health & Addiction Services Page 37 of 42
Milford 2 $7,181.52
New Haven 2 $10,414.79
North Branford 2 $3,929.27
Old Lyme 2 $2,891.59
North Haven 2 $5,371.90
Old Saybrook 2 $3,037.12
Orange 2 $3,929.27
Portland 2 $3,037.12
Seymour 2 $3,929.27
Shelton 2 $7,181.52
Wallingford 2 $7,181.52
West Haven 2 $7,181.52
Westbrook 2 $2,891.59
Woodbridge 2 $3,037.12
Subtotal:
$160,290.25
Ashford 3 $2,277.84
Bozrah 3 $2,277.84
Brooklyn 3 $3,037.12
Canterbury 3 $2,891.59
Chaplin 3 $2,277.84
Colchester 3 $3,929.27
Columbia 3 $2,891.59
Coventry 3 $3,929.27
East Lyme 3 $4,176.04
Eastford 3 $2,277.84
Franklin 3 $2,277.84
Griswold 3 $3,037.12
Groton 3 $7,181.52
Hampton 3 $2,277.84
Killingly 3 $4,176.04
Lebanon 3 $2,891.59
Ledyard 3 $3,929.27
Lisbon 3 $2,277.84
Mansfield 3 $5,371.90
Montville 3 $4,176.04
New London 3 $5,371.90
North Stonington 3 $2,891.59
Norwich 3 $7,181.52
Plainfield 3 $3,929.27
Pomfret 3 $2,277.84
Preston 3 $2,891.59
Putnam 3 $3,037.12
Salem 3 $2,277.84
SECTION V. ATTACHMENTS
Page 38 of 42 Department of Mental Health & Addiction Services
Scotland 3 $2,277.84
Sprague 3 $2,277.84
Sterling 3 $2,277.84
Stonington 3 $4,176.04
Thompson 3 $3,037.12
Union 3 $2,277.84
Voluntown 3 $2,277.84
Waterford 3 $4,176.04
Willington 3 $2,891.59
Windham 3 $5,371.90
Woodstock 3 $2,891.59
Subtotal:
$131,355.39
Andover 4 $2,277.84
Avon 4 $4,176.04
Berlin 4 $4,176.04
Bloomfield 4 $4,176.04
Bolton 4 $2,891.59
Bristol 4 $7,181.52
Burlington 4 $3,037.12
Canton 4 $3,037.12
East Granby 4 $2,891.59
East Hartford 4 $7,181.52
East Windsor 4 $3,037.12
Ellington 4 $3,929.27
Enfield 4 $7,181.52
Farmington 4 $5,371.90
Glastonbury 4 $5,694.60
Granby 4 $3,037.12
Hartford 4 $9,022.77
Hebron 4 $3,037.12
Manchester 4 $7,181.52
Marlborough 4 $2,891.59
New Britain 4 $7,181.52
Newington 4 $5,694.60
Plainville 4 $4,176.04
Plymouth 4 $3,929.27
Rocky Hill 4 $4,176.04
Simsbury 4 $5,371.90
Somers 4 $3,037.12
South Windsor 4 $5,371.90
Southington 4 $7,181.52
Stafford 4 $3,037.12
Suffield 4 $3,929.27
SECTION V. ATTACHMENTS
Department of Mental Health & Addiction Services Page 39 of 42
Tolland 4 $3,929.27
Vernon 4 $5,371.90
West Hartford 4 $7,181.52
Wethersfield 4 $5,371.90
Windsor 4 $5,371.90
Windsor Locks 4 $3,929.27
Subtotal:
$175,653.01
Barkhamsted 5 $2,277.84
Beacon Falls 5 $2,891.59
Bethel 5 $4,176.04
Bethlehem 5 $2,277.84
Bridgewater 5 $2,277.84
Brookfield 5 $3,929.27
Canaan 5 $2,277.84
Cheshire 5 $5,371.90
Colebrook 5 $2,277.84
Cornwall 5 $2,277.84
Danbury 5 $9,022.77
Goshen 5 $2,277.84
Hartland 5 $2,277.84
Harwinton 5 $2,891.59
Kent 5 $2,277.84
Litchfield 5 $3,037.12
Middlebury 5 $2,891.59
Morris 5 $2,277.84
Naugatuck 5 $5,694.60
New Fairfield 5 $3,929.27
New Hartford 5 $2,891.59
New Milford 5 $5,371.90
Newtown 5 $5,371.90
Norfolk 5 $2,277.84
North Canaan 5 $2,277.84
Oxford 5 $3,929.27
Prospect 5 $3,037.12
Redding 5 $3,037.12
Ridgefield 5 $5,371.90
Roxbury 5 $2,277.84
Salisbury 5 $2,277.84
Sharon 5 $2,277.84
Sherman 5 $2,277.84
Southbury 5 $4,176.04
Thomaston 5 $2,891.59
Torrington 5 $5,694.60
SECTION V. ATTACHMENTS
Page 40 of 42 Department of Mental Health & Addiction Services
Warren 5 $2,277.84
Washington 5 $2,277.84
Waterbury 5 $9,022.77
Watertown 5 $5,371.90
Winchester 5 $3,037.12
Wolcott 5 $3,929.27
Woodbury 5 $3,037.12
Subtotal:
$151,008.07
Grand Totals $702,010.98
SECTION V. ATTACHMENTS
Department of Mental Health & Addiction Services Page 41 of 42
Attachment #2 (Gambling Awareness Activities by Region)
All Regions Regional Gambling Awareness and Capacity Building
$15,000 Per Region, annually (all 5 regions)
To (1) build and strengthen a gambling awareness infrastructure in order to inform region-
specific planning and gambling awareness integration into existing and new ATOD prevention
programs; (2) strategically gather community awareness and readiness data; (3) provide select
capacity building training; and (4) review and assess the efficacy of select current programs.
Outcomes Measures
Gambling Awareness Team Team structured as designed in
collaboration with PGS and meetings held
quarterly
Gambling Awareness Training Ten Regional Team members attend
statewide problem gambling conference
annually
Leadership Learning Community Team Leader provides one
training/showcase or roundtable session for
all Regional Teams as planned with PGS
Work Force Capacity Building Ten Regional Team members meet
requirements to earn problem gambling
certificate of competency as provided by the
Ct Certification Board
Focus Groups Four focus groups (minimum of six
participants each) completed in compliance
with PGS template and protocol
Youth Peer Leadership Development
$20,000 per Region, annually (all 5 regions)
The long range plan of this inaugural year is to increase capacity of identified middle and/high
school peer leaders to implement peer-to-peer education addressing gambling awareness by (1)
using quantitative and qualitative data on problem gambling and related risk behaviors to
establish a data driven problem gambling prevention awareness effort that will align with ATOD
evidence-based programs; and (2) to adapt to Regional needs by creating a pilot curriculum that
is either gambling-specific or a gambling infusion into ATOD prevention program in preparation
for evaluation to compare to evidence-based models.
Outcomes Measures
Youth Peer Leadership 10 identified youth will (1) receive gambling
awareness and leadership training; (2)
collect and review state and Regional youth-
related ATOD, gambling and other risk
behavior data; (3) attend statewide youth
peer leadership conference; (4) establish
goals/objectives specific to their own
project; (5) with PGS partnership, create
peer presentation to select group(s).
Congregational/Community Assistance Program (CAP) (Statewide Program)
$35,000 annually (specific to Region 2)
(This statewide program has been administered, implemented and monitored through South
Central Ct Regional Action Council since 2002)
SECTION V. ATTACHMENTS
Page 42 of 42 Department of Mental Health & Addiction Services
To raise awareness and provide support and assistance to faith community congregants and
community members on issues of dependence and addiction, including mental health, substance
use, gambling and suicide prevention.
Outcomes Measures
CAP Training 15 faith-based and/or community groups
receive the eight hour curriculum as
developed by PGS. Minimum 200 people
complete training annually
CAP Annual Conference A minimum of 100 faith-based and
community representatives attend day-long
annual conference
Website(s) Update and maintain CAP and Gambling
Awareness Leadership Team websites
CAP Regional Initiative
$2,000 per Region annually (Region 1,3,4,5)
Each Region recruits four faith-based and/or community based groups to receive a CAP training.
Outcomes Measures
Regional CAP training Each Region recruits four faith-based and/or
community based groups to receive CAP
Program and work with Cap leadership to
maintain fidelity
Statewide Youth Peer Leadership Conference
$20,000 annually (specific to Region 4)
(ERASE has been planning and implementing a regional youth peer leadership conference for
over 20 years. Known as the PAWS (Peers are Wonderful Supports) Conference, PGS has
partnered with this conference to infuse gambling awareness into the program and expand
inclusion to all Regions in the state.)
PAWS Conference
Planning and implementation of multi-region conference for identified middle and high school
youth peer leaders. Focus on gambling awareness and development of gambling awareness
media messaging, and scheduled to take place during March, Problem Gambling Awareness
Month (PGAM).
Outcomes Measures
PAWS Conference Minimum of 250 middle and high school